THE HOMEWORK IS ATTACHED —— Disc-WK 6(A) 

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 Discuss an interesting or difficult case you encountered this past week. How did you use evidence to support your actions?

 this one is for me ri

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Department of Veterans Affairs (VAMC) is a federal government agency organization that provides healthcare services to its service members. The way the VA charges for service is based on service connection and means test to determine financial eligibility for a copay. A veteran is eligible to seek care within the VA organization if he/she enrolls within the VA, and received in the past twenty-four months. With the passage of the Mission Act 2019, VA is partnered with the community to allow veterans more accessible access to care within their community. For whatever the care the individual is seeking in the community, if it is service-connected, the VA will cover the entire bill. If it is not service-connected, the VA will submit a claim to the individual insurance in an attempt to collect the payment. Again, the way the organization obtains its reimbursement is: based on an individual’s disability acquired during federal service (Service-connected) fees would be determined based on the percentage of coverage. If the care is related to service connection, no copayment is required. Inpatient services no additional charges. If the individuals need to have service that is not related to service connection, the VA will file a claim to the insurance in an attempt to collect payment. Primary care services – individual with service connection- no copay. Non-service-connected for primary care $ 15.00 copay and specialty care (eyes, heart, hearing etc.) $50.00 copay and particular test like MRI/CT scan $50.00 copay.

           If the individuals are not able to pay their bills, the treatment will be provided regardless. The VA is required by law to collect all copay dept for VA health care services 30 days to pay the bill in full, dispute the charge, or request a financial hardship for assistance such as a payment plan or debt relief before the 30 days otherwise, late fees and interest will accrue. As of January 1, 2020, some veterans do not have copay due to their disability rating, income level, or special eligibility. 

Urgent Care Copay rates are in group priority based on military service has eight priority group when the individual enrolled in VA Health care. Priority group 1-5 no copay for the first three visits in each calendar year, and additional visits within the same year will be $30. Group 6 if the condition is related, no copay for the 3 visits, and if not related $ 30 each visit. Group 7-8 $30 copay. 

NR533: Touchpoint Reflections Experience Table

Your Name’s Healthcare Organization: VA Medical Center

Healthcare Delivery System (Type)

 Federal government agency

Payer Mix

Percentage

Medicare

% of service connected

Medicaid

 % service connected

Managed Care

n/a

HMO

 n/a

PPO

 n/a

IPA

 n/a

Self-pay

 welcome

Uninsured

 welcome

Reflection:  

In completing this assignment, I have learned a lot about the organization.  I did not know before to answer patients’ questions about their eligibility for care, details about copay, and what was required for their service or not. Recently with the passage of the Mission Act in June of 2019, everyone was required to complete the modules to learn about the process. The modules completed to fulfill administration requests for their deadlines; however, minimum information retained about the outpatient urgent care services.   Base on this data, the assumptions that could be made about the veterans’ population that the VA health care is not really free. What I have noticed that the individuals are on a fixed income, and they are accruing additional copay, which they cannot afford.  I believe if the frontline staff is empowered with the knowledge of how the institutions can assist the veterans with financial difficulties, this will alleviate some of their burdens. I know each veteran assigns to a social worker. Still, at the time the conversation is taking place, the provider can inform the patient to apply for financial hardship or place a consult with the social worker to address the situation. The variables in coverage do not affect the services provided to the individuals. No one will be turned away for not having the means to pay for care. The organization will do anything to give care to the individuals to fulfill President Lincoln’s promise. “To care for him who shall have borne the battle, and for his widow, and his orphan” by serving and honoring the men and women who are America’s Veterans (VA Mission statement). The other implication I noticed that might happen that VA is funded based on the federal budget; it does not have sufficient funds then, that will affect care.

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Healthcare Delivery System Nonprofit 130 Bed Community Hospital

Payer Mix

Percentage

Medicare

 50.2

Medicaid/Managed Care

 10.5

HMO

 0

PPO

 34.4

IPA

 0

Self-pay/ Uninsured

 4.5

Dr. Strong and Class,

I work in a small community hospital in south-central Nebraska. We are in the Midwest farm belt.  The breakdown of our payor source for our organization. I do believe this is an accurate reflection of the community.  The city itself is an aging sleepy community that caters to the Medicare type clientele. There are very few fast food joints, and new and upcoming businesses do not happen in this city.  The town is a large commuter town in which there are many that travel 20-30 mins away to work but “doctor” in their hometown. Many of the Medicaid/managed care people are here due to family support or the decreased cost of living that this community provides. The PPO is primarily the families of those that work in the city and or hospital. 

As a future nurse leader, one of the predications that I foresee with the aging population that the Medicare percentage will continue to grow, at least until Medicare itself is exhausted.  The PPO percentage will decrease due to the aging of the people. Like many farm communities, the “kids” leave the area after graduating from high school. Without local businesses growing and investing in the future of the community as a whole, they will not come back.

One of the recent concerns for our organization that within 20 miles, there is a brand new hospital that will be opening up to the community. They have the potential to entice staff to leave our facility. This adds additional burdens to the system.  Our organization needs to be more competitive pay and staff benefits with neighboring community hospitals. These benefits would entice staff into staying.  Early estimations from the hospital include expected loss if ten percent of the team to this new place.  The employees that will leave initially are the ones that drive past it every day.  That is a lot of people in an already struggling healthcare environment of the 1200 employees that our facility employees that would 120 people.

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