f. II 10-76-21 (3) In cases requiring admission to outpatient treatment by scheduling of an appointment in the future, i.e., within 90 days, the reception activity will contact centralized scheduling for an appropriate appointment. In some instances, notice of the date and time of the future appointment may have to be mailed to the veteran at a later date. This scheduling will also be done in the sequence of priority listed in paragraph 17.51 above. (4) Veterans not requiring VA hospitalization or outpatient treatment will be referred to Social Work Service or dismissed as recommended by the evaluation team. Requests for C&P examinations, after classifications as to professional elements to conduct the examination have been entered on VA Form 21-2507, will be forwarded directly to the centralized scheduling activity for scheduling of an appointment in keeping with Group I priority assigned to these type of examinations. g. Bed services discharging patients to NBC or OPT will contact centralized scheduling for an appointment as described in section I, this chapter. Appointments for these veterans will also be made in the sequence of priority shown in paragraph 17.51. h. Veterans who are in a treatment category, such as ambulatory care, and are subsequently placed in another treatment category, such as PBC, will be reclassified to the appropriate group, i. e., from Group VI to Group V. 558438 Dr. CHASE. I would like to say one further thing, Mr. Hammerschmidt. The military retiree with very few exceptions has dual eligibility so that such a situation as you have identified in its actual application would really come down only to the military retiree who had no wartime service and therefore from a technical standpoint was not a veteran. Otherwise he would be viewed as a veteran with whatever veteran rights he would have. Mr. HAMMERSCHMIDT. Thank you. Mr. SATTERFIELD. Mr. Edwards. Mr. EDWARDS. Does the VA provide psychiatric assistance to veterans who seek assistance in psychiatric treatment? Dr. CHASE. Yes, sir, we do. Mr. EDWARDS. Must it be defined as service connected? Dr. CHASE. No, sir. Within the capability of the system to admit non-service-connected patients, and this is true of all disease processes, we have the authority to provide those services to them. We have the highest percentage of service-connected veterans in those disease states under the care of psychiatrists, of any of the groups that we care for. Mr. EDWARDS. This would include outpatient care? Dr. CHASE. Yes, sir. Mr. EDWARDS. Thank you. Mr. SATTERFIELD. The next bill, H.R. 8484. Mr. Hammerschmidt. Mr. HAMMERSCHMIDT. Dr. Chase, the American Legion opposes H.R. 8484, which would provide hospital care and medical services in VA facilities to Commonwealth Army (Philippines) veterans while they are in the United States. The American Legion says that the veterans are already covered by section 109 of title 38 of the United States Code, which grants benefits to the discharged members of the allied forces. What is your reaction to the American Legion's position? Dr. CHASE. I Would defer to Mr. Coy of the General Counsel's Office on that. Mr. Cor. I think there is probably some disagreement on that. You are talking about the provision that relates to reciprocal agreements between the United States and nations allied with the United States during World War II. That provision requires reimbursement whereas the present proposal does not. Furthermore, section 109 indicates that hospitalization of people covered by the reciprocal agreements should generally not be afforded in VA facilities, except in emergencies, unless there are surplus beds available. While it might be possible to draw up an agreement which would cover these service-connected Commonwealth Army veterans while they are in the United States, we believe the authority which would be provided by H.R. 8484 is more desirable. We would be happy to take another look at it, however, if you so desire. Mr. HAMMERSCHMIDT. If you would. I am sure the Legion's testimony is more succinct than my question to you. I think what the Legion is really saying is that under the VA block grant-in-aid program such veterans had the opportunity to be covered. If you would expand on your comments on that question it would be appreciated. [The following statement was supplied for the record:] We believe Mr. Coy's statement is responsive to the question raised by the American Legion. We still favor H.R. 8484. Mr. SATTERFIELD. The next bill discussed is H.R. 6087. Mr. Hammerschmidt. Mr. HAMMERSCHMIDT. I have no questions, Mr. Chairman. Mr. Edwards. Mr. EDWARDS. No questions. Mr. SATTERFIELD. Mr. Hammerschmidt. Mr. HAMMERSCHMIDT. No questions. Mr. SATTERFIELD. I have one question, Dr. Chase, with respect to the exact measure of cost. As I understand it, it would increase the cost not to exceed 40 percent to 45 percent. I don't know whether your full statement deals with the dollar amounts or not, but I wondered if you could state the dollar amounts of 40 percent vis-a-vis what it would be at 45 percent. Dr. CHASE. We can provide that for the record, Mr. Chairman. [The following information was supplied for the record:] The total cost of Community Nursing Home Care for FY 75 was $47,272,000. Of that amount $46,279,000 was paid directly to the nursing homes, the remainder being cost of administration. Increasing the maximum nursing home per diem rate from 40 to 45% of the per diem cost of a VA general hospital would affect payments only in those parts of the country with a very high cost of living, especially Alaska, Hawaii and New York. In most of the remainder of the country, rates have not yet approached the 40% maximum. We are unable to estimate an exact dollar amount because of the many variable factors involved. However, based on FY 1975 data we estimate that the increased cost of this provision will not exceed $100,000 per year. Dr. CHASE. If I may, sir, based on 1976 at a national level the current figure per diem rate is $89.12. It would therefore be $35.64 at 40 percent and at 45 percent would be $40. Mr. SATTERFIELD. Thank you, sir. The next measure which was discussed is H.R. 3349. We did discuss H.R. 14469. H.R. 3349. Mr. Edwards. Mr. EDWARDS. No questions. Mr. SATTERFIELD. Mr. Hammerschmidt. Mr. HAMMERSCHMIDT. Thank you, Mr. Chairman. Dr. Chase, the National Association of Retail Druggists, in a submitted statement on H.R. 3349, states: We have had reports that some [VA] facilities are so taxed that volunteer assistance is required to maintain the drug mailing schedules at any reasonably adequate level. Is this true? ... Dr. CHASE. There have been from time to time some delays in mailout of prescriptions received by the veteran. However, there has been marked improvement in this in the past 6 months, Mr. Hammerschmidt, and I am not aware of any serious delay at the present time which has denied patient receipt of medication. Mr. HAMMERSCHMIDT. The National Association of Retail Druggists, in submitted testimony on H.R. 3349, points to various dangers in mailing prescriptions: delays of a week or more, thefts, and waste due to incorrect or obsolete addressing. What is your reaction to these dangers? Dr. CHASE. I think they are very minimal dangers. We are certainly aware of what the implication is of mailing medications. We have very tight regulations which prohibit the mailing of medications which are in the narcotics class. I must tell you, Mr. Hammerschmidt, that I have no personal concern about this in the sense of difficulty of delivering the appropriate medication to the appropriate patient at a reasonable time. Mr. HAMMERSCHMIDT. In your testimony on H.R. 3349, you state that: There is no advantage in permitting a veteran to determine the source from which he may obtain drugs or medicines at the expense of the VA. Isn't convenience to the veteran an advantage? Dr. CHASE. It is an advantage and of course we do have a fee basis prescription program for hometown pharmacies. At the present time we are providing half a million such prescriptions a year. Mr. HAMMERSCHMIDT. The National Association of Retail Druggists further in a submitted statement on H.R. 3349, states: *** neither the VA nor any other group can provide adequate pharmaceutical service by mail. Would you like to make a comment on that statement for the record? Dr. CHASE. As I earlier indicated, I believe we are providing an appropriate and good service to veterans using the mail route with prescriptions being filled from our own premises. [The following letter was subsequently submitted for the record:] Hon. DAVID E. SATTERFIELD III, VETERANS ADMINISTRATION, DEPARTMENT OF MEDICINE AND SURGERY, Washington, D.C., September 1, 1976. Chairman, Subcommittee on Hospitals, Committee on Veterans' Affairs, House of Representatives, Washington, D.C. DEAR MR. CHAIRMAN: Thank you for your inquiry regarding comments made by Mr. William E. Woods, Washington Representative and Associate General Counsel of the National Association of Retail Druggists, concerning the Veterans Administration position on H.R. 3349. As I have said, our goal is to assure that eligible veterans are treated with the most effective therapeutic agents, at the most favorable cost. Veterans who are receiving outpatient treatment at VA medical facilities are provided their prescription service at these facilities satisfactorily. Veterans who receive medical care from non-VA sources at VA expense are also provided their drugs and medicine from VA pharmacies or, when this is not practical, from participating local pharmacies which are reimbursed by the VA. In fiscal year 1976, these participating pharmacies filled 1,074,238 prescriptions at a cost of $8,971,565. Although we often hear from retail pharmacists, our patients seldom ask to receive their prescription medications from sources other than the VA. We believe this constitutes an expression of satisfaction by the veteran. VA pharmacies are staffed with dedicated, competent pharmacists who implement the drug policies established by the Therapeutic Agents and Pharmacy Review Committee at each VA facility. This committee is charged with the responsibility of assuring proper selection of drugs for rational use. Prescriptions filled by VA pharmacies cover the full range of medications for treatment of acute and chronic conditions, both high-cost and low-cost drugs. We have questioned several of our facilities in regard to their routine reviews of prescriptions filled by participating retail pharmacies. They tell us that the range of medications provided by these private pharmacists is quite comparable. The VA average cost for filling a prescription in fiscal year 1975, cited in my testimony, includes the cost of drugs and containers, and the salaries of pharmacists and technicians. The costs of space, overhead and mailing are not included. We have no basis upon which to project what increase there would be in the number of veterans who might choose to obtain their pharmaceutical services from other than VA sources. If there were an increase, any resulting decrease in VA pharmacy staffing would be more than offset by the increase in employees required to process the increased number of invoices that would be submitted for payment. I appreciate the opportunity to provide you this information. Sincerely yours, LAURANCE V. FOYE, Jr., M.D. For and in the absence of John D. Chase, M.D., Chief Medical Director. Mr. SATTERFIELD. I have one question. In testimony received on this measure last week some discussion was had about the possibility of building into the legislation a limit on the amount of profit that an independent pharmacist might charge with the idea the VA would reimburse the wholesale cost of the drug or replace the drug or medication itself. If we could devise such a device would this in any way change your view with respect to this legislation? One of the figures mentioned was a maximum of $1.50 service charge or profit. Dr. CHASE. I think I would have to leave to others any comment relative to profit because that is simply not an area of my expertise at all. I think in terms of a proposal which would make it possible for us to place stocks in the private pharmacy from federally procured stocks, that would be a legal question and such a question has been addressed to the General Counsel and I am quoting their opinion. I think the bottom line, Mr. Chairman, in this entire area is the relative cost to the taxpayer of providing medication to patients, tempered of course by such issues as convenience, appropriateness, timeliness. As we have looked at this program it is my judgment that the cost saving to the taxpayer, as significant as it is and which I mentioned in my opening statement-outweighs these other considerations and therefore I would wish to stand on my current position. Mr. SATTERFIELD. I note with interest you point out in your basic statement that the average cost of a prescription still from a VA is $3.98 compared to the average cost by participating pharmacists of $7.68, which is almost double. Dr. CHASE. Yes, sir. Mr. SATTERFIELD. Thank you. The next bill is H.R. 12980, dealing with canteens. Mr. Edwards. Mr. EDWARDS. No questions. Mr. SATTERFIELD. Mr. Hammerschmidt. Mr. HAMMERSCHMIDT. Dr. Chase, the Veterans of Foreign Wars, in testimony on this bill, H.R. 12980, the bill on canteen services, recommends that the present wording of the law be retained. I quote that for you: Service at such canteens may also be furnished to personnel of the VA and recognized veterans organizations employed at such hospitals and homes. If H.R. 12980 is enacted, is there any chance that personnel of veterans organizations would be denied canteen services? |