THE VIRGINIAN-PILOT
Copyright (c) 1996, Landmark Communications, Inc.
DATE: Monday, January 29, 1996 TAG: 9601250041
SECTION: FRONT PAGE: A6 EDITION: FINAL
TYPE: Editorial
LENGTH: Medium: 70 lines
Community hospitals lay off employees, reduce capacity and scramble to meet managed-care demands for cost efficiency. Meanwhile, Congress and President Clinton propose increasing the Veterans Health Administration's budget.
The president would give the agency, which oversees 173 VA hospitals, including one in Hampton, another $700 million; Congress, another $400 million. Most of the funding is earmarked for construction. Yet, the number of veterans is shrinking. So why is the VA's budget growing?
William G. Wright, who runs the VA hospital in Hampton, says that while the number of vets his hospital serves may be shrinking, their age is increasing. And it costs considerably more to treat an older person - who may be afflicted with several chronic diseases.
His hospital last year treated 22,000 veterans but is expecting a small decrease in its $74 million annual operating budget. It did receive an extra allocation last year to build a $25 million outpatient clinic.
Which begs the question: Why build a new clinic if your patient population is shrinking?
The answer is in the clinics themselves. A series of 90-year-old brick buildings joined by jury-rigged hallways, they sport exam rooms offering little privacy. If patients need lab work and X-rays, they have to go back to the main building. Doctors can work on only one patient at a time because there aren't enough exam rooms.
The new, state-of-the-art facility will improve efficiency, Wright claims, thus reducing costs. Hampton is finding other ways to bring its old-fashioned system into the 21st century.
The hospital now imposes a managed-care template to its outpatient services, assigning veterans to primary-care physicians instead of the current ``see who's available'' system.
In the past two years, the hospital has moved half of all surgical procedures to an outpatient setting.
Hampton - and other VA hospitals - is ignoring regulations that seem inefficient, such as requiring that patients needing crutches be admitted to the hospital. ``We're much more driven by cost effectiveness than by the regulations because there just isn't the money to go around,'' Wright says.
The hospital cut 66 full-time positions in the past year, all through attrition.
Hampton has entered into joint ventures with regional military hospitals to win deeper discounts from drug companies and other vendors. ``It's amazing how much companies are willing to deal when there's eight hospitals instead of just one,'' Wright says.
VA critics note that nearly a quarter of the nation's VA beds are empty. For Hampton, the occupancy rate is 70 percent. But that competes favorably with community hospitals in Hampton Roads. According to the Virginia Cost Review Council, the average occupancy rate here is 59 percent.
The VA hospital could improve its average length of stay. Hampton's was 11 days last year, compared with the regional average of 5.2 days.
Part of the problem is the population Hampton serves - largely indigent, single men. Such patients can't be sent home hours after a procedure because no one is there to provide care. An expensive hospital stay is the result. Possible solutions include home-health services or the hiring of minimum-wage aides to travel home with these patients.
Even Wright acknowledges the VA system is 10 years behind the private sector in reducing costs and improving efficiency. But with the number of veterans in Congress now below 25 percent and deficit reduction a top priority, powerful political forces are pushing the VA to catch up. It had better do so. by CNB