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Cavalier County Memorial Hospital to offer VA Choice

The Cavalier County Memorial Hospital (CCMH) is now giving area veterans the option of having their U.S. Department of Veterans Affairs (VA) appointments in Langdon with the implementation of the Veterans Choice program. 

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Posted on 2/20/16

By Melissa Anderson

Veterans Choice provides primary care, inpatient and outpatient specialty care, and behavioral health care options for eligible veterans that are outside of a 40 mile range of a VA health facility.

The Veterans Choice program was created to allow eligible veterans to seek and receive care from community-based providers such as CCMH when their local VA health care facility cannot provide the services due to either a lack of available specialists, extended wait times for appointments at a VAMC,  or a more than 40 mile distance from the veteran’s home.

Health Net Federal Services, LLC (Health Net) coordinates with Veterans Choice-eligible veterans to obtain authorization for all care within the program. Health Net schedules the appointments and sends the authorization to the participating Veterans Choice provider.

All providers must meet the VA certification standards and must agree with the program requirements prior to rendering services to the veteran. The decision to join the Veterans Choice program was an easy one for CCMH and the program is currently being overseen by veteran and Chief Financial Officer for CCMH Marcus Lewis.

“We felt it was a great program for our community. This is a wonderful opportunity to provide local care to our veterans in Cavalier County,” Lewis said.

One of the qualifying factors,  the minimum of 40 miles to the closest VA facility, was a major contributing factor to the decision by CCMH to join the Veterans Choice program. Langdon and the majority of Cavalier County is one of the most highly rural areas in the state.

“Due to the distance, almost all of our local veterans in the area qualify for the program,” Lewis stated, “We have strived to provide exceptional services to fit the needs of our community, and in our view, this initiative fell along those aspirations.”

Veterans in the area will no longer need to drive to Grafton or Devils Lake for regular outpatient clinic services. Now  they will be able to see the local providers at CCMH for service-connected issues and not worry about the insurance/deductible impact.

For hospital-based services like radiology, lab, and GI procedures, this could save a veteran a six hour round-trip drive to Fargo. The availability and scheduling are also beneficial when a veteran is working with our facility.

Veterans Choice provides coverage for outpatient services. This can be defined as clinic visits, diagnostic services, etc. However, this does not include emergency room, inpatient, or pharmacy services.
“I think it is a great program in giving veterans a choice in their health care needs,” Lewis stated.

Lewis continued by stating that allowing the veteran to choose their provider will undoubtedly improve transparency between health care organizations, quality of care, and reduce burden on facilities around the country.

“Ultimately, it puts the control of health care back into the patient’s hands, right where it should be,” Lewis said.

As with any new federal program, there are challenges. Cavalier County Veterans Services Officer Leon Hiltner knows this all to well.

The program, which has been in place for a little over a year now was put in place by an act of Congress as a way to combat the long waiting time for veterans who needed medical care.

“The concept is wonderful. If  a veteran can go to their local clinic it’s not only good for the veteran it’s good for the local community too.” Hiltner said.

“But it’s got to run smoothly otherwise, people aren’t going to do it if it’s too difficult.”Hiltner continued
Hiltner alludes to the issues and frustrations that have occurred in regards to the scheduling of appointments through the third party administrator Health Net. There is currently no solution in sight for the issues that have occurred as result of Health Net.

The Veterans Choice program requires veterans to call in to Health Net for pre-authorization prior to any visit. Waiting holds can be over an hour at peak call times, and CCMH has been noticing inconsistencies with the appointment scheduling process.

“This is why, during the advertisements, we’ve put my desk phone number, in the ad,” Lewis said, “I am happy to help in the process with the veteran in my office; we can go through each step together.”
Lewis does have one idea on  how to improve the Veterans Choice program. His solution for improvement over the current process would be to have it operate more like Medicare.

“Once the patient is deemed eligible, given an explanation of benefits, and then given a listing of participating facilities, we can then let them decide their needs,” Lewis explained, “This would reduce call volume, streamline a convoluted process, and allow for much faster appointment scheduling.”

The current limitations to outpatient services has also been frustrating for most. Lewis stated that to expand this beneficial program across services under CMS guidelines would be much more beneficial.

Overall, however, area veterans will benefit greatly not only from the newly implemented Veterans Choice program at CCMH but also the Cavalier County Veterans Services van that can take veterans to any other medical appointments. This gives area veterans the necessary means to reach and have the health care that they require.

“I think we are lucky in our area to be able to take advantage of the Veterans Choice program,” Lewis said, “There are many great people working in the VA system, and it sometimes gets muddied by stories like Jordan Buisman, Cheyenne VAMC, and Eric Shinseki.”

It should be noted that the Veterans Choice program does not replace the current VA system, only supplements it with options for those that are burdened by barriers. This is an opportunity for veterans to visit their primary care providers for all ailments, without worrying about travel, availability, or financial impact.

For more information, appointment scheduling, or eligibility verefication, veterans can call 866-606-8198 or visit www.va.gov/opa/choiceact

For questions on the program, Marcus Lewis is available  at 701-256-6177 during business office hours at CCMH in Langdon.