HD15 - Veterans' Mobile Medical Facility


Executive Summary:
Background

The 2001 Virginia General Assembly requested the Virginia Department of Veterans' Affairs (VDVA) through House Joint Resolution Number 783 (HJR 783) to study the need for and operation of a mobile medical facility as a cost-effective way to bring needed services to Virginia's veterans who are unable to travel to United States Department of Veterans Affairs Medical Centers (VAMC's) and to consider the following:

• An assessment of the staffing and operational needs for a mobile medical facility

• An evaluation of methods to fund the purchase of a mobile medical facility

Methodology

To initiate the study three factors had to be considered. First, the population of veterans in Virginia. Second, the eligibility of veterans to be treated at VAMC's. And finally, the location of VAMC's available to veterans in Virginia. An analysis of the Code of Virginia failed to disclose any provisions in §§ 2.2-1900 and 2.2-1901 that authorized the VDVA to purchase, staff and operate a mobile medical facility.

Identifying Groupings of Veterans

It was determined that the total number of veterans living in Virginia is estimated at 713,694 as of September 30, 2000. Eighty percent of those reside in the one of the 4 geographic regions: Northern, Hampton Roads, Central and Southwest Virginia. These locations closely coincide with the population distribution of the general public.

Eligibility

The United States Department of Veterans Affairs (USDVA) is the primary federal agency designated by the U.S. Congress to provide the needed medical care and treatment for veterans of the United States uniformed services. The Veterans Health Administration (VHA), an agency of the USDVA, established the criteria for the care and treatment of veterans. First, those who are combat wounded. Second, those who have a rated service connected disability. Finally, all other veterans with an honorable discharge that have no other private health care plans. An estimated eighteen percent (128,464) of veterans in Virginia are retirees from the five branches of the uniformed services. As such, these retirees are allowed by law to choose between VAMC's or the medical centers of the uniformed services for health care. Another estimated thirty-one percent (220,400) of veterans in Virginia are over the age of 65 and are therefore eligible for care and treatment under Medicare.

Location of VAMC's in Virginia

There are 8 VAMC's available to Virginia's veterans. These medical centers have established 20 Community Based Outreach Clinics (CBOC's) within Virginia and 8 more are planned in the near future. The CBOC's provide wellness and primary medical care to veterans enrolled with them. The CBOC's refer veterans to the VAMC's for secondary and tertiary treatment. It should be noted that each of the 8 VAMC's have different medical specialties, as well as wellness and primary care capabilities. The CBOC's and VAMC's provide either transportation or compensation for expenses incurred by veterans during travel to or between facilities. There are certain state veterans' service organizations (VSO's) that have been equipped with commercial medical vans to transport veterans who are unable to transport themselves between CBOC's and VAMCs.

USDVA position of mobile medical facilities

The VHA has determined that the need for any type of mobile medical facility is inappropriate and counterproductive to sound medical practice for the care and treatment of the combat wounded and disabled veterans. There are specialized protocols and modalities needed that can only be delivered at CBOC's or VAMCs. Secondly, the 4 Veterans Integrated Service Networks (VISN's) of the VHA in the mid-Atlantic region that effect Virginia veterans have determined a mobile medical facility is cost ineffective. This is based on the veteran's population distribution.

Conclusions

The study concludes that the need for and the operation of a mobile medical facility by the VDVA is costly and ineffective as well as a medically inappropriate means of delivering primary and wellness care to combat wounded and eligible disabled veterans. This conclusion is based on 3 findings. First, the analysis of the demographics of the veterans living in Virginia indicates that only a very small number live outside a 50-mile radius from VAMC's or CBOC's. Second, the procurement, staffing and operation of a mobile medical facility is expensive, about $955,000.00 for the first year of operation. Finally, the care and treatment of combat wounded and disabled veterans is best accomplished in a VAMC's facility that is fully equipped and staffed with safe and proven protocols. Veterans deserve only the best medical care and treatment. They earned it.

Recommendation

There are 2 recommendations. It is recommended that the Director, VDVA:

• Be tasked with the responsibility to provide oversight on the matter of transporting veterans to VAMC's and CBOC's

• Coordinate with the USDVA to ensure that the needed medical services are provided to the combat wounded, the disabled and all eligible veterans in the Commonwealth.