If compensation under the General Schedule is too low to retain police officers and this turnover is, in turn, costly and disruptive to mission accomplishment, the questions of "why" compensation is too low and "how" the situation may be corrected logically result. Section 5 addresses these questions by examining the current GS-083 classification standard, the relative value of police work vis a vis other occupations, and current job evaluation methods and systems. Question 13. Can you tell us how long ago OPM issued the standards which place police officers in grades GS-4 and 5? Don't many modern police forces require college training in a related field, as well as providing intensive training as long as six months? Answer. The OPM Position-Classification Standard for the Police Series, GS-083 which is currently in use has a publication date of August 1974. Although many advanced police departments at the state, municipal and county levels place a high value on college training among applicants and offer premium pay and tuition assistance to on-board police officers who pursue college courses, few police departments actually require college degrees for entry. Basic police recruit training in the majority of governmental jurisdictions is from four to six months in length. We believe that the training of police officers is very important but should be geared to the actual needs of the employing agency. VA police officer minimum entry qualifications require two years prior experience as a police officer with a governmental agency or the completion of a two year college program in law enforcement, criminology, or police administration. In view of these entry level requirements for police knowledge, skills and abilities, it remains our task to provide police officers with the training for a smooth transition to VA's internal policies and procedures. HON. JOHN PAUL HAMMERSCHMIDT TO VETERANS' ADMINISTRATION Question 1. In your statement, you say, "If VA is required to fill privately written prescriptions for all veterans for compensable rated service connected disabilities, it would seem logical to also provide those veterans with other services ordered by private physicians, such as x-rays, laboratory studies and other diagnostic tests." What is your current policy in this area if such services are requested by a fee basis doctor treating a service connected veteran who had a fee basis card? In this connection, I am assuming that the fee basis doctor would not have the capacity to take xrays, do lab work or diagnostic testing. Answer. The authority for fee-basis treatment carries with it the authority for the treating physician to refer veterans to non-VA sources for supportive medical services that he/she prescribes. The costs for these services are included in the monthly maximum amount authorized for the total fee-basis treatment program of the veteran. This policy is based on the same premise that the overall fee treatment program is approved for the veteran, i.e., geographic inaccessibility to care in a VA health care facility. If a fee-basis physician requests the VA to provide laboratory studies, x-rays or other services, the request would be honored. However, it could indicate that geographic inaccessibility may not exist and the fee authority may be rescinded and the veteran instructed to obtain staff treatment at the appropriate VA health care facility. Question 2. In answer to a question, the General Counsel inquired of you if a distinction was made before the legal issue arose as to whether these private prescriptions were for service connected or non-service connected conditions. Your answer was, "There was not." Wouldn't a review take place prior to filling such prescriptions? Would not a typical VA Medical Center handle such reviews in much the same way that they handle bills for private pharmacies prior to paying them or for that matter from fee basis doctors? Answer. No VA policy had been published on this issue, thus, no specific requirements had been mandated. In many cases prescriptions were for veterans entitled to medical services for any condition. There was no useful purpose served by trying to determine what disability the medications were prescribed to treat. In addition, there was no policy mandated that required that the service-connected disability be compensable, so we did not have to check on that item. Question 3. By your testimony do you mean to state that the VA was paying out $7 million a year for these type prescriptions before the legal issue arose or do you mean that a legislated entitlement would create a new cost over and above what was previously spent or is it a combination of the two? Answer. We estimate that the cost of implementing H.R. 3876 would be approximately $6.4 million per year. That dollar estimate is based on an estimate of the number of service-connected veterans for whom we believe prescriptions were being filled prior to issuance of the legal opinion disallowing the provision of such prescriptions. Since those prescriptions are not now being filled by the VA, and have not been for sometime, the $6.4 million will be additional costs to the VA. Question 4. If, for whatever reason, a qualified fee basis doctor had his treatment bill paid by a qualified veteran authorized to receive fee treatment for a service connected veteran instead of the doctor billing the VA, would VA fill the proper prescription of that doctor? Answer. The prescription would be filled if the fee-basis treatment, at VA expense, has been authorized in advance. Question 5. Testimony was received that if a law is passed to erase the legal issue, VA would be required to be certain that prescriptions coming in were for service connected conditions. Several field station Directors have indicated that their Medical Centers made such reviews under the old policy. In view of this, would you still feel that such reviews would be "administered add-on" and add to VA's cost. Answer. Yes, we believe such reviews would add to the cost. As noted previously, reviews were limited in the past in that many prescriptions were filled for veterans who were eligible for medical services for any disability. A review of these cases would have been non-productive. Under H.R. 3876, every prescription would require review to assure that it is for a service-connected disability, and, that in addition, the disability is compensable. Question 6. You infer in your answer to questions that this issue involves "mainstreaming" because the service connected veteran decides to pay his own doctor bill but then asks VA to furnish his prescriptions. Do you make a significant distinction between the veteran deciding and you deciding? Doesn't the fact that VA would make the decision as to whether or not to furnish medicine really mean that VA and not the veteran decides? Answer. A veteran requiring treatment decides how he wishes to obtain his care. If legal eligibility exists and VA facilities are geographically inaccessible, treatment may be authorized at VA expense by an appropriate non-VA physician if the veteran desires this and requests if from the VA. If the veteran decides not to request VA authorization for treatment for one reason or another, or is not eligible for it, he/she may elect to pay for his/her own treatment costs. Except for those included in 38 USC 612(h), medications would not be provided in this latter situation since the VA cannot control treatment and quality of care when providing medication only. The decision on what treatment is best for a veteran should be made by a VA physician or one under contract with the VA. This provides controls, in either case, in assuring that the treatment a veteran receives is that which the VA prescribes and for which responsibility can be accepted. Question 7. Because money actually controls, does not the current policy deny a benefit to service connected veterans to the benefit of the non-service connected? Answer. The current policy provides the same benefit to the service-connected veteran receiving increased compensation by reason of being permanently housebound or in need of regular aid and attendance as it does for the nonservice-connected veteran receiving increased pension for the same reason. Question 8. You testified that one of your main objections to H.R. 3876 is that you have no control and that you have no knowledge of what the prescription is for. Couldn't you establish control by relating the prescription to the service connected condition and by appropriate contact with the private doctor? Answer. Any controls of this nature would not only be costly but excessively time consuming. On the other hand, where fee-basis care is involved, the treating physician accepting the veteran for care at VA expense is performing a contractual-type service for the VA. He/she is aware of the disabilities for which care is authorized by the VA. This provides certain controls necessary for the program that are not available under H.R. 3876, or if established would be costly. Question 9. Did DM&S express concern when the "white paper" legal opinion was first drafted and did DM&S want to continue the furnishing of drugs and medicines to these service connected veterans as it had in the past. Answer. When the "white paper" legal opinion was made available, we recognized the need to publish the information for the guidance of everyone. We were compelled to advise our health care facilities that what had previously been considered by many of them as a medical benefit that should be made available to several categories of veterans, was in fact a benefit to which only a limited number of veterans were entitled. The only policy existing at this time was the specific issue of 38 USC 612(h). We had published nothing on the broader issue of filling prescriptions for any other category of veteran. TESTIMONY OF PAUL W. SCHAFER, M.D., EXECUTIVE DIRECTOR, NATIONAL ASSOCIATION OF VA PHYSICIANS H.R. 4792. A preliminary survey of our membership does not allow me to speak with a clear voice on this substantial proposal to create a Special Veterans Police Force within Title 38. This matter has been placed on the agenda of the next monthly meeting of the National Association of VA Physicians Board of Directors and on the quarterly meeting of NAVAP District Directors which will occur on Friday and Saturday next, respectively on March 9 and March 10. I request the opportunity to furnish the Committee a written report of the actions taken at these two meetings. H.R. 4625. It is my understanding that this Bill provides a needed 15 day grace period for the Comptroller General to file a Report concerning the Director of the Office of Management and Budget's compliance with his requirement to provide the Veterans Administration its funded personnel ceiling. We obviously support the careful monitoring of this Administration Official's actions since he has now publicly targeted the Veterans Medical Program as one of his prime areas for budget cutting during the effort to reduce the staggering federal deficit. H.R. 3876 provides statutory authority for VAMC Pharmacy Services to do what many of them have been doing for years; namely, providing drugs and medicines to service-connected veterans who are not on staff or fee basis treatment. It is my understanding that about six months ago a Central Office directive terminated this practice. At least at the Washington, D.C. VAMC this resulted in a Medical Administrative Service letter of notification to such veterans that only one more prescription would be filled without the veteran being seen by a VA Outpatient physician who would then be required to rewrite the prescription, if indeed it seemed to be indicated. I am advised that no workload or budgetary impact of this change has been noted by the Pharmacy Service but that it has increased Outpatient physician and administrative workload. It is certainly suggested that service connected veterans' needs might be better and more conveniently served by return to prior practice such as is provided by this proposed legislation. H.R. 4694 represents the basis for continuation of the now-expired provisions of the Civil Service Reform Act of 1978 to provide that the Administrator may authorize an exception to existing Title 5 restrictions that require mandatory reductions in military retirement pay of certain retired military officers if necessary to recruit a well qualified doctor of medicine or osteopathy for a DM&S position which otherwise cannot readily be filled. The main thrust of this proposed legislation is such that it guarantees support by the National Association of VA Physicians. The NAVAP Charter defines the organization's purpose to be the preservation and strengthening of the Veterans Medical Program and to insure it being served by physicians of the highest caliber. NAVAP has consistently represented that the Agency has a chronic recruitment and retention problem in respect to first-class physicians. It has been shown repeatedly that VA physicians' income is substantially inferior to that of physicians in the private sector, academic and otherwise. Income disparity is the largest causative factor producing this indolent cancer threatening the Veterans Medical Program. On December 28, 1981 former VA Administrator Robert P. Nimmo, promulgated an infamous order reducing VA physicians' Special Incentive Pay by $4,982 per year. This arbitrary and capricious action was justified by the erroneous representation that the Agency did not have a substantial physician recruitment and retention problem requiring the Special Incentive Pay authorized by PL 96-330. You will recall that this law came into being by override of then-President Carter's veto on August 26, 1980 by a vote of 401 to 5 in the House and by an historic 85 to 0 vote in the Senate, only the fourth time in the history of the Republic such a unanimous Senate override occurred. NAVAP tried unsuccessfully to obtain judicial relief from this irrational position in which the Agency finds itself as a result of the action of an Administrator who left the Washington scene after other much publicized aberrant behavior. The Nimmo Legacy is that VA physicians have to date suffered a $7,293 loss of income which continues to increase at the rate of $2,682 per year. We respectfully represent that the Agency's first-class physician recruitment and retention problem would be more meaningfully addressed by immediate cancellation of the Special Incentive Pay reduction schedule which was published on December 9, 1982. We respectfully request that the Committee advise Administrator, Harry N. Walters to take this meritorious action. For the Veterans Medical Program to provide first quality health care to sick and injured veterans no impediments should be allowed to stand in the way of the Agency's efforts to staff the Program with the most competent health professionals it can obtain. How a Nation honors its contract with the men and women who have served in its Armed Forces is a measure of its destiny. Hon. ROBERT W. EDGAR, NATIONAL ASSOCIATION OF VA PHYSICIANS, Chairman, Committee on Veteran's Affairs, Bethesda, Md., March 12, 1984. Subcommittee on Hospitals and Health Care, Washington, D.C. DEAR MR. CHAIRMAN: As promised in my testimony before your Subcommittee on Wednesday last, H.R. 4792 was discussed at length during the March 10 quarterly meeting of NAVAP National Officers and District Directors. I must inform you that the National Association of VA Physicians does not support this proposed legislation. Very Sincerely Yours, PAUL W. SCHAFER, M.D., Executive Director. STATEMENT OF DAVID W. GORMAN, ASSOCIATE DEPUTY NATIONAL LEGISLATIVE DIRECTOR, DISABLED AMERICAN VETERANS Mr. Chairman and members of the subcommittee, on behalf of the more than 849,000 members of the Disabled American Veterans, I want to thank you and the members of the Subcommittee for allowing us this opportunity to relate our views on various bills pertaining to the Veterans Administration health care system. H.R. 3876 Introduced on September 13, 1983 by a distinguished member of the Subcommittee, Mr. Mica, this measure proposes, through appropriate amendment of Title 38, United States Code, to authorize the Veterans Administration to furnish each veteran with a compensable service-connected disability, such drugs and medicines as may be prescribed by any licensed physician for treatment of the service-connected disability. Mr. Chairman, as you are well aware, a recent VA General Counsel opinion has held that Section 612(h), Title 38, United States Code is the exclusive legal authority for the VA to fill prescriptions written by private, non-VA physicians. This opinion was rendered following a request by the Chief Medical Director that the General Counsel reconsider a position that had previously been taken on the same question. The recently published General Counsel opinion simply affirms the previously held conclusion. According to the General Counsel, only veterans receiving authorized fee-basis care, receiving increased compensation or pension benefits predicated on the VA's findings that they are permanently housebound or in need of regular aid and attendence are eligible to have such prescriptions filled by the VA Pharmacy Service. The General Counsel concluded that there exists no legal authority that would permit the VA to fill such prescriptions for any other category of veterans, including service-connected disabled veterans, who are otherwise entitled to the full array of outpatient medical services. The conclusion reached and its subsequent implementation by all VA medical care facilities has unquestionably produced a major disruption of medical treatment in the lives of countless service-connected disabled veterans. We view this administrative decision as very unfortunate, as it has effectively terminated a long-standing practice and policy at many VA medical facilities. Also, we wish to point out that there are various factors to this issue that produce "ripple effects" for both the veteran and the Administration, such as: cost-effectiveness, increased workload, and significant difficulty for veterans. Mr. Chairman, the issue of cost-effectiveness is very real. Filling prescriptions by mail or through direct veteran contact with a VA pharmacy acids the necessity of occupying the valuable time of various VA medical facility personnel in scheduling appointments, pulling and routing medical records and providing beneficiary travel pay. Similarly, there will be an increased workload placed on already overburdened VA physicians. In a medical care system that will experience a total of nearly 17 million staff outpatient medical visits in Fiscal Year 1985 (79,000 visits over Fiscal Year 1984) and will do so with a meager increase in the number of physicians and support personnel, we find it both ironic and impractical to require actually encourage-a significantly large influx of additional veterans to come into the system. Also, we wish to remind the Subcommittee that a large number of veterans, many with seriously disabling conditions, but who do not have eligibility for fee-basis care, find it difficult or sometimes impossible to receive direct VA care. I refer, of course, to veterans afflicted with such disabilities as amputation, chronic back disorders or severe neurological conditions, to name only a few. We recognize that additional controls may be necessary to insure that various drugs and medicines are not prescribed in an haphazard manner or that such prescriptions are not contraindicated for other drugs prescribed for other diseases or disabilities. Nevertheless, Mr. Chairman, for the reasons previously mentioned, and so long as proper medical and administrative monitoring is initiated to assure that prescriptions are appropriate in terms of the service-connected disability being treated, we conclude that this legislation is reasonable and necessary. Moreover, we believe that the VA can curb the prescription of unneeded or contraindicated drugs and, at the same time, implement the necessary provisions contained in the pending legislation. Accordingly, in concert with the goal of a resolution approved by the delegates to our most recent National Convention, the DAV supports the enactment of H.R. 3876. H.R. 4625 The pending bill, introduced on Janaury 24, 1984 by you, Mr. Chairman, would, by appropriate amendment to Title 38, United States Code, clarify the time frame for submission of the Comptroller General's Report required by Section 5010, United States Code. Currently, the Director of the Office of Management and Budget is required, with respect to each law authorizing appropriations for the Veterans Administration for any fiscal year (or any part of a fiscal year), to (1) provide to the VA such funded personnel ceiling and the funds necessary to achieve such ceiling; and (2) submit to the appropriate Committees of Congress and to the Comptroller General of the United States certification that the Director has provided such ceiling. The Comptroller General then has 45 days after the enactment of each law to submit a report to the appropriate Congressional Committees setting forth an opinion as to whether the Director of the Office of Management and Budget has complied in providing such funded personnel ceilings. The proposed measure simply clarifies that the Comptroller General Report shall be submitted not later than 15 days after the end of the period specified for the Director of the Office of Management and Budget to submit the required certification. Mr. Chairman, the DAV has no official position on this proposed legislation, however, as it appears to place an additional degree of accountability upon the Office of Management and Budget, we favor its enactment into law. H.R. 4694 This measure, introduced by you, Mr. Chairman, on January 31, 1984 would amend Title 38, United States Code, to authorize the Administrator of Veterans Affairs to waive mandatory reductions in military retired pay of certain retired military officers recruited for employment by the Department of Medicine and Surgery. Mr. Chairman, the intended purpose of this bill seems clear-the recruitment of well qualified Doctors of Medicine or Osteopathy, who are military retirees, for positions which otherwise could not readily be filled by such physician without reduction or loss of military retirement or retainer pay. The DAV has no official position on this bill, however, we do not object to its enactment, as employment of such individuals could only serve to enhance the type and quality of medical care provided to disabled veterans. |