Category: Veterans Hospital

The revelation that a Veterans Administration Hospital in Phoenix falsified its reporting of waiting times for veterans seeking medical care pushed a festering problem past its breaking point forcing Washington to wake up and take action. General Eric Shinseki, Secretary of Veterans Affairs and probably one of the most honest men in the city, ended up falling on his sword for his commander over the matter. On the theory that it is bad politics to appear soft on supporting our veterans, funding committees for the Veterans Administration that had been languishing in the hyper-polarized and consequently paralyzed Congress, sprang into life. Both the House and Senate have just passed versions of their own bills to address the wait-time issue and some attendant reforms. It is virtually certain some compromise will emerge soon.

The term scandal has been used with regard to the long wait-times. Certainly to the extent that quality and utilization data were falsified in order to look good on paper, scandal is too kind a word. Another kind of scandal is demanding that the VA system perform to a specified standard but withholding the resources required to do so. We see a lot of that in Washington.

Is it better in the private sector?
When it appeared that the VA system itself did not have sufficient capability to provide services to existing veterans, and that the location of clinics and hospitals does not always match up with the locations of the veterans themselves, a groundswell of suggestions arose proposing that if the VA cannot do it alone, let the private sector help! This is not intrinsically an unreasonable suggestion. The private sector is already helping with military retirees and families. There are certainly capabilities that the VA must have that the private sector is ill-suited to deal with, but most care provided in the VA system is nuts-and-bolts medicine that can be provided by the same providers used by nonveterans. Indeed, I have argued in these pages that better coordination or contracting with non-VA facilities can avoid community duplication and help assure that Veterans get at least as good care as the rest of us. It is only a short step to a system in which the government pays non-VA providers directly, at least for specific services or in places where the VA does not have resources available in a timely manner. (Of course, wait-times in the private sector are often very long too, especially for those without commercial insurance!) Continue reading “Congress To Allow Veterans Access to Private Healthcare Providers?”

p.s. It’s not about the neighbors or the disputed $3.1 million!

The Courier-Journal has long advocated for a downtown location for the replacement Mobley Rex VA Medical Center. The newspaper’s leadership and a variety of downtown-boosters are obviously disappointed with the result of a long-studied and reasonable determination not to place the hospital downtown, but rather on a site near the intersection of the Watterson Expressway and Brownsboro Road. A series of articles and an editorial earlier this month focused on the appraisal process used for the Brownsboro parcel purchased by the VA in July, 2012 for $12.9 million. The newspaper seems to insinuate that hanky-panky has occurred and that a cover-up is underway. Rep. Yarmouth has joined the fray asking for a governmental examination of the appraisal and purchase process. That is a fair request, especially since the reputation of some individuals has been questioned in unavoidable service to the interests of others, some of whom also wish to profit from a downtown location. Be well advised, that this controversy is no longer about the interests of the neighbors of the Brownsboro site who would have seen a major new commercial project there in any event.

Possible overpayment does not invalidate site-selection process.
I have been involved with or reporting on the site-selection process for the new VA since its inception. I believe my reports have been the most comprehensive available on the matter. Many of the public documents are available in these pages. I believe I have attended every public hearing and some non-public ones as well. The Courier-Journal and allied downtown-boosters are conflating the site-appraisal process with the site-selection process in a last ditch effort to pressure the federal government to relocate the hospital in downtown Louisville. The two processes are separate and very different things. Any inadvertent overpayment by the Federal Government for the land invalidates in no way the tediously careful process of site selection that went on. Continue reading “Opponents of Brownsboro Location for New VA Hospital Going All-In.”

Did the KMA get rolled?

I was out of the country for most of the past few weeks and missed the Fall annual meeting of the Kentucky Medical Association (KMA). I was surprised to learn that the Association’s House of Delegates passed a resolution opposing the new Brownsboro Road location for Louisville’s Robley Rex Veterans Administration Hospital and furthermore resolved that it supports “a location in close proximity to the University of Louisville Medical Center.” As I investigated what happened, I was not surprised to find a cast of familiar characters affiliated with Grow Smart Louisville, a one-issue advocacy group initially founded by neighbors to oppose building a new VA on the Midlands site at Brownsboro Rd. but which appeared to redirect its focus to advocate specifically for a downtown location.

In truth, I did not expect that the University would give up on its cherished dream of having another captive group of patients on its doorstep. I congratulate the players on the success of this latest tactical maneuver. Of course I had no right to be surprised, because the organizers told me explicitly last spring at a country club reception held for community physicians that this was how they planned to open an avenue for President James Ramsey to renew the University’s opposition to the Brownsboro location. You can read about that event and the operational strategy it launched in an earlier article. Continue reading “Kentucky Medical Association Endorses Downtown Veterans Hospital Location”

Back-channel attempts to change the hospital location persist.

It has been six months since I’ve written anything about the Robley Rex Veterans Hospital being built on Old Brownsboro Road at the Watterson Expressway. Neither have I seen anything in our local media about the matter. When I called the local VA office last winter I was told that plans were going ahead on schedule. The VA was in working regularly with the leadership of the University of Louisville and it was felt that planning with UofL was going forward in good faith. It appears however that opposition to construction at the new site has not faded into the woodwork altogether.

A few weeks ago, I received an invitation to attend a cocktail reception at Big Spring Country Club sponsored by Grow Smart Louisville, an advocacy group formed as much to generate pressure to get the VA to change its mind and build the replacement hospital downtown as to oppose construction at the Brownsboro site. I had to assume I was invited because I am a physician and not because I have been following the issue as a journalist. Only a tiny handful of physicians showed up– fewer than a dozen. An effort was made to stimulate discussion about how wrong the decision not to build downtown has been, but the ball never got rolling. I must say, that we physicians present had pleasant discussions about a variety of things over wine and hors d’oeuvres, however, I heard no substantial opposition from anyone other than the organizers of the session. Continue reading “New Robley Rex VA Hospital Project on Track”