PAs in VA :C&P exams to be dumped on primary care?

[gleannfia]

I work in a VA CBOC.  Recently, the local Veterans Service Office in the county has been sending vets to their PCPs with reams of C&P forms to be filled out.  Due to the extensive backlog of disability claims, the VA is looking for other ways to address the claims.  They have been paying contractors to do some of the work, but now the rumor is that they are going to force PCPs to complete the paperwork so that veterans do not have to wait as long for their clams to be processed. They are hoping to save money this way. So far, we have been refusing, and directing the veterans back to their VSO to start the C&P process.

 

Needless to say, we are really pissed about this.  Most of us are stretched to the max just caring for our panels, with all of the required documentation.  I always have to laugh at those who claim government workers have a cushy situation, as I and all of my colleagues routinely work unpaid overtime and also work from home. I think we have it better than the private sector, but still we work very hard (at least those of us who take our duties seriously)

 

Our CBOC director says she has not been informed of this, that this is hearsay from the County VSO.

 

Anyone else here work for the VA and have heard anything about this?  I have no desire to do C&P exams, I find the documentation tedious and cumbersome, and further, have not had this kind of training.  I am sympathetic to the plight of the veterans but this is not the answer.

[GetMeOuttaThisMess]

Isn't your CBOC a contracted operation for the VA and not managed by the VA directly (some are, some aren't)?  If so, shouldn't the management company take this to the VA themselves?  Let me guess, from their perspective it's about the dollars and not the impact on your ability to perform your job in a satisfactory and timely manner.

[myerardi]

Well I just deleted a big diatribe about the VA and its employees. I wrote it and deleted it. I feel better! Let me say however, this is one old Vietnam era veteran who doesn't have to depend on the VA for health care. Thank God!!

[PACProvider]

I had a job interview at the VA two weeks ago. It was a position that did not hold much appeal. Job was just H&Ps for admission, discharges and "as needed" acute care for 28 day domiciliary substance treatment.  The interviewer told me that the job would only take 4 hours a day to complete. I thought to myself "Why would a PA want to spend a full day to do four hours of work?" Thus, I asked what other assignments could be included to expand the responsibilities of the job. He responded "We could let you do C&P exams."  I have no interest in doing C&P exams for the same reason I wouldn't have an interest in doing Medicaid disability exams and associated forms. There is no satisfaction in the work. The bigger problem with the C&P exams being pushed into PCP at the VA is that the job involves considerable stress because sometimes Veterans believe that denials are unfair. Most of your time with C&P is spent protecting yourself from claims of unfair treatment. 

[Guest Paula]

Forgive my ignorance but what does C&P stand for?  The rural tribal clinic I work at is developing a contract with the VA and IHS to offer our services as an outreach clinic for veterans.  It will serve Native American veterans only for the first year or two, then expand.  I sure hope it is not just doing paperwork and C&P exams, whatever they are!!!!!

 

The contract is still caught up in red tape (for the last 2 years) so I won't hold my breath that it will be finalized anytime soon. 

[PACProvider]

If a Veteran of military service has a medical or psychiatric condition that was either caused by or exacerbated by his or her service, the veteran may be entitled to received both a monthly stipend for the duration that the condition exists and medical coverage for the condition and associated conditions that derive from the original condition. The "C&P" is a compensation and pension exam to determine if the veteran's condition is "service connected" and if service connected, at what percentage and how much monthly pension the veteran shall receive. Like civilian claims for disability, some are legitimate and others are not. A very common claim today at the VA is for "Post traumatic stress disorder." Many veterans can and do retire with a good C&P exam finding. 

[gleannfia]

C&P is "compensation and pension."  This applies to service-connected problems, say, tinnitus or a bad shoulder or leukemia.  These are highly specialized exams and the paperwork is very exacting.  And yes, the VA is in the process of contracting with private providers to help with the backlog of claims.  And let me stress that they do indeed need to make this a priority. 

 

My CBOC is  not contracted, though many are.

 

To the Viet Nam veteran:  First, thank you for your service.  Secondly, I take a great deal of pride in the care that I and my fellow clinicians provide at the VA. Many of my fellow clinicians are veterans themselves.  In the private sector, I can't remember a time when the doctor spent more than 10 minutes with me, if I was lucky.  I only wish I was a veteran.  I am sorry that the care you received was not satisfactory.  But frankly, I love working there and having the chance to provide quality care to my patients. I think the VA has come a long way in the past 20 years, but I understand that excellent care has not always been the experience of, in particular, the veterans of your era.

[Guest Paula]

I turn over civilian exams for disability to the physician.  I hate them.  How do you decide who is really disabled?   I am too cynical from the civilian viewpoint.  After all, how do I say my patient is disabled from her arm tendonitis (a reason she tried to get disability) yet she spends her summers training, riding and showing horses?  Somehow it keeps getting in my dictation that she spends her free time at horse shows and cleaning the barn. i can't help myself. 

 

Veterans at least have a better (or worse) reason for disability with the ravages of war. 

[gleannfia]

I agree, Paula. I tend to be cynical with regard to disability determination, although I agree, veterans more often have a valid reason.  I knew a woman (civilian) who claimed a bad back, yet toiled in her garden and went out playing bridge and drinking every night.  Also bragged about her Mensa IQ.  I lost it with her one day and told her that if she really was so freaking brilliant, she could be doing something besides mooch off the taxpayer.

 

I had a patient who was in the National Guard, was way overweight, and wanted me to give her a permanent profile so she wouldn't have to run.  She hoped to ride out another 5 years to get retirement.  I told her no way, and referred her to her Guard doc. Oh, that's another sore subject, the Guard is trying to foist some of this stuff on the VA, pleading overload. Again, I do not feel qualified to make these assessments.  There is a good reason I work in the VA and not a military setting.  Give me diabetes, HTN, and heart problems over ortho stuff any day of the year.

 

Either way, I hate the tediousness of these exams and the paperwork.  I thought that in the civilian sector, only specially-designated physicians could do them anyway.

[Boatswain2PA]

Some thoughts about VA disability and C&P from a retired guy...

I think the C&P exam SHOULD be done by the VA primary care doc.  I realize this would require an organizational change, including requiring MANY more primary care providers, but who better to do the C&P exams than the person who will be following the veteran?  This would give the provider more than a single snap-shot of the veteran while making C&P decisions. 

There are some very good, and some incredibly BAD things about how the VA disability system is set up.

 

Good thing:  You don't have to be DISabiled to receive VA disability because it is structured to compensate the veteran for the partial loss of function of different body parts.  Furthermore, partial loss of function of multiple body parts are not directly cumulative (ie: 30% for back and 10% for ankle does not equal 40% disability, but rather 67% ABLE). 

 

The worst thing about VA disability has been fixed, and that was how those of us who retired from the military were effectively not able to benefit from the VA disability system (our retired pay was reduced by the amount of the disability we received - "concurrent receipt" of both was unlawful).  This, fortunately, has mostly been fixed and is in the process of being totally phased out.

The worst thing, systemically, about the VA disability system is how it is easily abused.  The system is an honorable system designed to care for our veterans who become "broken" while protecting our nation.  While it still does that, there is disgusting abuse.  I have a distant relative who went to Air Force boot-camp in the 1950's.  Two weeks into boot camp he has a mental breakdown in the shower and is tossed out of the AF.  Thirty five years later, after decades of drug abuse, he files for VA disability and receives a 100% rating.  That's a nice little check he gets every month that allows him to continue smoking pot every day and go sailing....