Description of impact and Committee's views This reduction equates to 1,612,720 outpatient visits or better than 10 percent of the outpatient workload in the VA health care delivery system. The impact of the cutback in outpatient visits could, in effect, end many of the outpatient services now available to the poor, non-serviceconnected veteran. The Committee has already established that current available resources for outpatient services are not sufficient to take care of all eligible veterans who are in need of these services. The proposed further reduction would have a major adverse impact on both quality and quantity of care for non-service-connected veterans seeking outpatient treatment. Many VA hospital administrators and medical staff have expressed concern to Committee staff investigators about their inability to care for veterans who establish need for care. Under present law and policy, a non-service-connected veteran cannot be cared for under ambulatory arrangements, unless such treatment would otherwise "obviate" the need for admission to hospital bed care. Failure to treat these patients, because they do not satisfy that requirement at a particular moment, can mean that their conditions are not brought under medical management when they could be. Subsequently, these veterans become so ill as to finally warrant the very admissions to a medical-surgical bed that earlier treatment could have avoided. As one staff physician put it, .. although a veteran's condition today does not require care to 'obviate' a hospital admission, 20 cents worth of medicine might now prevent a stroke and hospitalization tomorrow." As a result, the future demand for hospital bed care from particularly the very large nonservice-connected veteran population may be substantially greater than it has been in past years. The administration's proposed cost-saving is unacceptable to the Committee. As some VA physicians have put it, it is not only good medicine, but good economics as well, to treat the chronically ill applicant by placing him into non-service-connected outpatient treatment status. Refusal to treat and follow up such an applicant would only lead to a deterioration in the veteran's condition, so that he ultimately will require the very hospitalization everyone wishes to avoid. The best available research to date reveals that about 20 percent, or between 500,000 and 700,000 veterans of Vietnam, are to this day markedly impaired by the aftereffects of their war experiences. The problems which are most generally acknowledged as stemming from these experiences are lingering memories of death and dying and other mental and emotional problems, drug and drinking problems, and difficulties in interpersonal relationships. The psychological readjustment counseling Outreach Centers are designed to enable Vietnam veterans to emotionally reconcile their war experiences. Between April 1. 1980 and March 20, 1981, 60,455 Vietnam veterans have been treated at 91 of these Outreach Centers. In addition, between 14,000 and 15,000 family members were seen in associated counseling. Total person/visits have numbered 158,311. Three major studies have confirmed the presence of psychological trauma in Vietnam veterans, especially in those who have been in combat. The studies are a 1976 study commissioned by the Disabled American Veterans, "The Forgotten Warrior." by John Wilson, the VA's 1980 report of a Louis Harris Associates survey, "Myths and Realities A Study of Attitudes Toward Vietnam-era Veterans," and the just released Center for Policy Research study, mandated by the Congress, which identifies the problem as larger than previously estimated and recommends the continuation of services such as Operation Outreach. The outreach program is only now becoming well established. With 500,000 to 700,000 affected veterans, the potential for beneficial service to these Vietnam veterans has barely been tapped. The Committee opposes the recommended reductions. Description of impact and Committee's views This proposal would reduce an estimated 2,220 full-time equivalent employees (FTEE) and close an estimated 60 wards averaging 40 beds each, for a total closure of 2,400 hospital beds. As of this date, the VA was unable to tell the Committee where the consolidation of some wards, and the closing of others, will take place. This proposal was directed by the Office of Management and Budget without any input from the Department of Medicine and Surgery. Although the specific wards have not as yet been identified, they are supposed to be wards with occupancy rates of approximately 50 percent. They will be converted to a standby status and patients will be transferred. According to the VA, these ward closures will create a patient mix problem in that it would be necessary to combine wards not normally mixed, such as surgical cases and psychiatric cases. This would also cause serious staffing problems. In the Committee's view, these beds and personnel will be lost forever. Closing wards and reducing personnel will compound the serious staff workload problems confronting most VA hospital directors. The Committee is very much opposed to these proposed cuts. Description of impact and Committee's views (1) The proposed revision in the schedule for facility activation will also delay the activation of new VA facilities, mostly new VA nursing home facilities, by at least one year and would reduce full-time equivalent employment by 203 and funding by $18,548,000 in fiscal year 1982. Medical Centers that will possibly be affected include: Bay Pines, Fla.; Chillicothe, Ohio; Richmond, Va.; Wilkes-Barre, Pa.; Hines, Ill.; South Bend, Ind.; Atlanta, Ga.; Philadelphia, Pa.; Tuskegee, Ala.; Castle Point, N.Y., and Brooklyn, N.Y. (2) The Community Nursing Home proposed workload reduction reduces 1,093 census and 3,581 patients treated, when Congress has expressed its strong intent that community nursing home beds be increased in the report language accompanying the HUD/Independent Agencies Appropriations for fiscal year 1981. Additionally, the reduction would remove flexibility from VA nursing home care efforts. If the proposed reduction is implemented, veterans will be required to seek nursing home care at their own expense or under the auspices of Medicaid or other Federal/State programs, or veterans will not receive the necessary care since most veterans do not have private insurance which would enable them to obtain such care. The latter is the most likely result. The Committee opposes these reductions. Eliminate the hospital based home care program. Under this program veterans with chronic illness are discharged to their own homes, and the family provides the necessary personal care under coordinated supervision of a hospital based multidisciplinary team. The team provides the medical, nursing, social, dietetic, and rehabilitation regimens as well as the training of family members and the patient. Each team of 9.25 FTEE consists of a physician, public health nurse, social worker, dietitian, physical and rehabilitation therapists, four nursing assistants, and a secretary, and provides a total of 350 visits per month to an average of 50 patients. Thirty VA medical centers are providing hospital based home care services. These were initially funded as special medical programs but are now funded within VA hospital operations. No new teams were requested in fiscal year 1982. In fiscal year 1980, 157,064 home visits were made by health professionals providing 616,082 days of care in the home at a cost of $12.78 per patient day. By reducing the need for readmission to a hospital, acute care beds in hospitals were made available, thus enabling the VA to treat more patients. The requested reduction of 240 FTEE and $6.2 million applied to this program will result in eliminating 26 of the 30 teams. Within a year many of the veterans who will no longer receive home care will probably need to be readmitted to a hospital or placed in a nursing home at an increased cost per patient day. Currently a number of studies are underway in the VA to determine the true cost effectiveness of the program. As such it offers a valuable opportunity for OMB and other agencies, as well as the VA, to evaluate alternatives to institutionalization. Reduce the increase allowed for inflation by $42.8 million. This line item reflects the costs associated with inflationary trends. The reductions from President Carter's budget are based on a new projection of the annual rate of inflation for fiscal year 1982. The new rate of inflation is projected at 9.1 percent. The Committee expects the Committee on the Budget to make adjustments in projections of inflation. when accurate projections are available. Eliminate the first increase in over 20 years in payments made to expert physicians who act as consultants and attendings in the treatment of seriously ill veterans. These physicians are contracted to act as consultants and attendings in those medical disciplines which the VA either has not been able to recruit staff to fulfill the requirement or the need for the discipline is such that it can be more cost effective to use consultants rather than full or part-time physicians. Eliminate all of the funds to fully implement the Veterans Health Programs Extension and Improvements Act of 1979, P.L. 96–151. This law provides, among other things, authorization to provide contract health care for non-service-connected conditions for treatment of a medical emergency, a VA conducted study on Agent Orange, and the VA's furnishing of home health services to housebound veterans or veterans in need of aid and attendance. The Committee has carefully reviewed these proposed reductions and considers each to be of importance to the VA's ability to provide medical care and treatment to eligible veterans. It is projected that over 1.3 million inpatients will be treated in the VA direct and contract care delivery system in 1982 and 18.6 million outpatient medical and dental visits will be made. The Committee is greatly concerned that, given the magnitude of the work load imposed on the Department of Medicine and Surgery, severe reductions in funding and personnel resources will result in most of the indigent non-serviceconnected veterans being denied the medical care that they urgently require. Description of impact and Committee's views (1) The Supply Revolving Fund is a revolving fund which is used by the Department of Medicine and Surgery to purchase medical supplies on a centralized purchase point basis to support the 172 Veterans' Administration hospitals. The annual Supply Revolving Fund funding level is $5.2 million with expenditures during the last fiscal year of $4.8 million. The proposed reduction of $800,000 will occur as a result of reduced employee travel and reduced purchasing of equipment. (2) The Veterans Canteen Service (VCS) is a self-sustaining nonappropriated fund activity which is financed by a revolving fund which obtains no revenues from Federal sources. The Committee does not concur with these proposals. Description of impact and Committee's views The rescission of the construction of the new and replacement hospitals at Baltimore and Camden impact on the FY 1982 budget by only $8 million. All of this amount is for Baltimore. A total of $162 million was available for these two projects through appropriations in FY 1981 or earlier. The deferral of nine major construction projects will reduce the FY 1982 budget request as follows: Project: Fiscal year 1982 budget request [In millions of dollars] Brooklyn (St. Albans), N.Y.-laundry. Chillicothe, Ohio-modernization____ Denver, Colo.-clinical addition____ East Orange, N.J.-building environment deficiencies- Gainesville, Fla.-clinical improvements. Long Beach, Calif.-research building.... -10.7 (2) -52.1 -2.0 (1) -.8 New Orleans, La.-clinical addition__ Palo Alto. Calif.-surgical addition___ Washington, D.C.-nursing home care unit and parking lot. Total 1 Funds appropriated prior to FY 1982. -65. 6 The Committee does not take a position on the Baltimore and Camden hospitals, and does not oppose the deferral of the nine projects listed above. |