Appropriation Language For expenses necessary for the maintenance and operation of hospitals, nursing homes, and domiciliary facilities; for furnishing, as authorized by law, inpatient and outpatient care and treatment to beneficiaries of the Veterans Administration, including care and treatment in facilities not under the jurisdiction of the Veterans Administration, and furnishing recreational facilities, supplies and equipment; maintenance and operation of burial grounds; repairing, altering, improving or providing facilities in the several hospitals and homes under the jurisdiction of the Veterans Administration, not otherwise provided for, either by contract or by the hire of temporary employees and purchase of materials; uniforms or allowance there for as authorized by law (5_U.S.C. 5901-5902); and aid to State homes as authorized by law (38 U.S.C. 641); /$2,606,153,000/ $2,656,000,000, plus reimbursements: Provided /That the foregoing appropriation shall not be used to provide for less than an average of 98,500 operating beds, nor to furnish inpatient care and treatment to an average daily patient load of less than 85,500 beneficiaries, nor to provide an average staff/patient ratio of less than 1.49 to 1 in all Veterans Administration hospitals during the fiscal year 1973: Provided further ̧/ That allotments and transfers may be made from this appropriation to the Public Health Service of the Department of Health, Education, and Welfare, and the Army, Navy, and Air Force of the Department of Defense, for disbursements by them under the various headings of their applicable appropriations, of such amounts as are necessary for the care and treatment of beneficiaries of the Veterans Administration. 92-005 73 pt. 1 54 GENERAL STATEMENT This appropriation provides for expenses necessary for the maintenance and operation of Veterans Administration hospitals, nursing home care units, domiciliaries and outpatient clinics, and the care and treatment of eligible beneficiaries in contract hospitals, community nursing and State nursing home facilities, State home hospitals, and State home domiciliaries. In addition, training of medical residents and interns and other professional, paramedical, and administrative personnel in the health-science fields is provided to support the Agency's manpower supply in these shortage categories. In fiscal year 1974 the Medical Care appropriation is projected to increase by $114,000,000. Among the more significant changes in Medical Care program operating levels which form the basis for these projections are the following: 1. The continued activation of the new general hospitals at Columbia, Missouri, (406 beds), San Antonio, Texas (760 beds), San Diego, California (781 beds), Tampa, Florida (720 beds), and White River Junction, Vermont (174 beds), and the new general hospital addition at Lexington, Kentucky (370 beds). 2. Workload increases in the Outpatient Care programs are projected in fiscal year 1974. Outpatient medical visits (staff and fee) are estimated to increase by 1,916,079 to 13,549,000. Increased use of outpatient programs is due to (a) continuing growth of the veteran population; (b) continuing demand for treatment from the increased number of Vietnam era veterans being released from active military service; (c) examinations to determine need for hospital care; (d) pre-bed and post-hospital care; and (e) the continued impact of recent legislation which provides increased benefits for eligible veteran beneficiaries. 3. The activation of additional VA nursing home care beds in fiscal year 1974 4. Increase of $1,583,000 to upgrade Drug Dependence Treatment Centers. 5. Increase of $8,467,000 for increased workload in the Home Dialysis program. 6. Increase of $6,000,000 for stipends paid to trainees in the VA Centralized Training program. Activity Classifications Fiscal Year 1974 appropriation requirements are presented in this estimate under the following major activity classifications: Maintenance and Operation of VA Facilities VA Hospital Care Incorporated herein are estimates for workloads, employment and funding requirements necessary to provide care and treatment to eligible veteran beneficiaries consistent with the capability encompassed within these estimates to assure only high quality medical care to each veteran treated. During fiscal year 1974 it is expected that 170 Veterans Administration hospitals will be in operation, counting separate divisions of consolidated hospitals. Within each of these hospitals there will be operated medical, surgical and psychiatric bed sections concurrent with other treatment facilities and supportive functions. The fiscal year 1974 estimates include provision for treating 1,008,000 patients, with an average daily patient census of 80,000, which represents an increase of 28,000 patients treated while the census will decline 2,000 below the 1973 level of 82,000. The operating levels, by bed section, estimated for fiscal year 1974 are as follows: Medical Bed Sections In fiscal year 1974 the operating level is estimated at 37,650 average census which constitutes a decrease in average census of 620. Patients treated of 522,000 in fiscal year 1974 represents an increase of 21,800 above fiscal year 1973. Surgical Bed Sections An average census of 14,500 in fiscal year 1974 is a decrease of 1,129 below fiscal year 1973, while the estimated patient treated level of 315, 200 in fiscal year 1974 is an increase of 3,100 above fiscal year 1973. Psychiatric Bed Section The average census of 27,850 in fiscal year 1974 is 251 less than estimated in fiscal year 1973, while the patients treated reflects an increase of 3,100 in fiscal year 1974. Nursing Home Care As of June 30, 1973 the VA will have an estimated average daily census of 6,361. In fiscal year 1974 it is planned to increase this level by 339 average census to further provide the program needed for nursing care treatment as opposed to a hospital environment in a medical, surgical or psychiatric bed section. The continued aging process of much of the veteran population necessitates added facilities in VA as well as State Home locations to meet the demand. VA Domiciliaries In the Operating levels in fiscal year 1974 project a decrease of 749 average daily census in the VA Domiciliary Program to a 9,750 average census. ten year period from 1983 through 1972 the VA domiciliary census has decreased an average of 505 per year. The 749 census decrease is predicated on this trend along with the increased use of nursing facilities. The currently estimated total demand for domiciliary care will be provided for in the combined VA and non-VA systems. Outpatient Care Outpatient care for medical and dental reasons is provided eligible veteran beneficiaries in each of the Veterans Administration hospitals and independent outpatient clinics. As a supplement to in house capabilities the services of private physicians and dentists are utilized on a fee basis to provide necessary care to all eligible beneficiaries whenever VA facilities are not available. From 1965 through 1974 outpatient medical visits (both staff and fee) will have increased approximately 126%. New legislation, the Vietnam conflict and changing medical treatment techniques and modalities have each contributed to this significant increase. This trend is expected to continue throughout fiscal year 1974 with an increase over 1973 of 1.9 million medical visits. Dental workloads are anticipated to remain at 1973 levels. Miscellaneous Benefits and Services This activity includes those items of expense not directly connected with the medical care and treatment of beneficiaries such as beneficiary travel, care of the dead, operation of housekeeping and non-housekeeping quarters and the costs involved for furnishing supply, engineering, housekeeping and services furnished to other than DM&S activities (DVB, DDM and other agencies) on a non-reimbursable basis. Education and Training The Veterans Administration conducts a program of education and training of health service personnel to assure a continuing elevation in the quality of medical care throughout all VA hospitals and outpatient clinics. Each of the medical facilities in the VA system faces a shortage of qualified medical, paramedical and administrative staff. Each VA hospital that has the facilities and expertise to conduct quality training of health service personnel provides directly and indirectly an asset to the care of veteran beneficiaries as well as contributing to the nation's overall capabilities in providing health care. Although the training program is first and foremost an educational endeavor, most valuable and practical by-product is rendered in the care and treatment of patients in VA facilities. In addition, each trainee is a potential recruit to regular VA employment upon completion of his training program. Contractual Services with Non-VA Facilities Contract Hospitalization The VA supplements its inpatient program through the use of contract hospitals for eligible beneficiaries, mainly where VA hospital beds are not reasonably available or sufficient in number. It is expected that the census level of 1,250 in fiscal year 1973 will drop to a level of 1,200 in fiscal year 1974 because of the activation of VAH San Diego, California. |