Session number: 1098
Abstract title: VA Healthcare Delivery Systems for Women Veterans: The Role of Fee Basis Care
Author(s):
SM Frayne - VA Boston Healthcare System; CHQOER
MR Seaver - VA Boston Healthcare System
S Loveland - CHQOER
V Parker - CHQOER
C Christiansen - CHQOER
KM Skinner - CHQOER
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Objectives: Congressional legislation a decade ago sought to increase access to and coordination of gender-specific care for women veterans. For low-volume services, including women’s health care, one strategy VA has used is to pay for their provision in non-VA settings (“fee basis” care). We examined the extent to which VA facilities currently rely on fee basis approaches to providing gender-specific women’s health care.
Methods: In 2001, we surveyed the Women Veterans Coordinator (WVC) designated by each facility in the VA healthcare system (response rate 84%, N=122). Included on this mailed survey were questions about clinical services provided to women veterans at the respondent’s facility.
Results: Only 2% of VA facilities used a fee basis approach to providing military sexual trauma counseling. However, facilities often contract out a number of other women’s health services including obstetric care (75% contract out care), infertility (60%), mammography (57%), gynecologic oncology (48%), urology (37%), and breast surgery (19%). Among WVCs, 8% say it is “frequently” and 45% say it is “occasionally” a problem to get gender-specific fee-based care when needed for women patients. Although 75% of VA facilities have a separate women’s clinic, 86% of WVCs cited VA staff’s lack of awareness of services available to women as a barrier for women seeking care.
Conclusions: In VA, a substantial amount of gender-specific care is provided off-site on a contract basis. WVCs identify problems with getting fee-basis care and with staff awareness of the availability of gender-specific services as barriers to women’s health care delivery.
Impact statement: Almost all facilities provide military sexual trauma counseling on-site, reflecting VA’s commitment to and expertise in this domain of women's health care. For other care, VA has approached the challenge of providing low-volume women’s health services in part by turning to fee-basis care, even for a common but technology-dependent procedure like mammography. Facilities relying on fee basis care for women must assure that clinicians are attuned to the availability of specialized women’s health services, and that these services can be attained expeditiously when they are needed.