Contract lapse between VA and MVH affects Island veterans


Island veterans with a Veterans Administration (VA) health plan must now seek pre-approval through a clinic manager in Hyannis in order to obtain medical treatment and prescriptions on Martha’s Vineyard.

According to VA and Martha’s Vineyard Hospital (MVH) officials, the change in services resulted from a lapsed contract that recently came to light. A new agreement is currently being discussed.

Up until this week, Island veterans were left in the dark and had received no official notification or guidance from the VA. On Monday, the VA took steps to address the lack of communication and confusion.

The Providence VA medical center issued a fact sheet for Island veterans about obtaining health care on Martha’s Vineyard. The two-page fact sheet, summarized below, is available in its entirety at and from Dukes County director of veterans’ services Jo Ann Murphy.

Why no contract?

Ten years ago the VA Medical Center in Providence signed a contract effective December 18, 2000, that allowed MVH to provide a Community-Based Outpatient Clinic (CBOC), under the auspices of the VA. At that time, approximately 1,400 veterans lived on the Island.

A press release from the Department of Veterans Affairs announcing the new VA clinic’s opening noted that U.S. Congressman William Delahunt wrote a letter to the House Appropriations Committee urging congressional approval for the proposal.

The contract allowed Island veterans to receive primary care services and fill prescriptions written by doctors on Martha’s Vineyard. For other required services, veterans received referrals and/or consultations to other resources within the VA’s New England healthcare system.

The contract between MVH and the VA expired about two to three years ago, according to Providence VA Medical Center public affairs officer and veteran Tom Antonaccio, who also is currently the assistant to the medical center’s acting director, William Burney.

“This is a project that came my way, and I look at it as being something we have to address as both a short-term and a long-term solution,” Mr. Antonaccio said. “The short-term solution would be to see how we can take care of the veterans that are there that are eligible for care, while we address the larger issue, which is the contract expiring a couple of years ago.”

When the hospital’s contract with the VA expired, Mr. Antonaccio said the physicians at MVH continued to work in good faith and to provide care for the veterans.

“And then some questions came up in terms of how do we provide care in this particular circumstance, and about reimbursements and what not, and the mention was made, let’s refer back to the contract,” Mr. Antonaccio said. “And then it came to our attention at the VA that the contract had expired. At that point, which I think was only fairly recently within the last year, that’s when things started to spiral and come to the head that they are at right now.”

Mr. Antonaccio said he worked with MVH director of physician services Jay Ferriter to iron out a short-term solution within the VA guidelines to provide care when there is no CBOC or VA facility nearby.

As for a long-term solution, “Mr. Ferriter has expressed interest in working with us to look at if we can do some sort of agreement or contract for the routine services, primary care, maybe some basic blood work, and basic x-rays,” Mr. Antonaacio said. “That’s all fluid right now. There are a lot of unanswered questions at this point.”

“We’re working towards a resolution as soon as it can be done,” Mr. Ferriter confirmed in a phone call last week.

Any new contract or agreement between the VA and MVH would only apply to veterans eligible for VA care. Mr. Antonaccio said he is working with Ms. Murphy to determine exactly how many. Although she estimates there are about 350 veterans on Martha’s Vineyard, not all of them are on a VA health plan. Some use private heath insurance and some MediCare.

“But the bottom line is — and I think everybody here would be on the same sheet of music in talking about this issue — we realize that we have an obligation to all eligible veterans and we want to go ahead and make sure that we take care of them,” Mr. Antonaccio said.

How it works now

Under the new process now in place, although Island veterans may continue to see their Island primary care physicians, they must contact clinic manager Eleanor McLaughlin at the Hyannis CBOC for pre-approval. Consultations and diagnostic tests would require a veteran’s Island medical provider to submit a fee-basis request for approval through the chief of staff’s office at the Providence VA Medical Center, Mr. Antonaccio said.

“We only ‘fee-base’ when we can’t meet the need in our facilities,” he explained. That means Island veterans may be scheduled for consultations, diagnostic, and lab tests, and other medical services at the Hyannis VA clinic or the VA Medical Center in Providence.

The VA bases the delivery of care provided to veterans throughout the country on the “community standard,” Mr. Antonaccio said. The prevalent expectation for medical care among people who live in a big city like Boston would differ from those who live in rural Maine, for example.

Mr. Antonaccio said he understood from Mr. Ferriter, that in addition to a number of primary care doctors on staff, MVH has specialists from off-Island that see patients on a limited number of days a month. If anything happens in-between visits or patients need specialty treatment or care, they are sent to medical facilities on the mainland.

“So that’s got to be factored into the process,” Mr. Antonaccio said. “We can’t just go in there and arbitrarily say we’re going to provide 100 percent of the care over there. One, because I don’t think the capability exists, and two, by virtue of that fact that the veterans live there, they have to accept the fact that there are limitations on what’s going to be provided on that Island.”

Unfortunately, Mr. Antonaccio said, no contract or agreement is likely to please all Island veterans.

“I think maybe some expectations are out there that, ‘It’s easier for me to go to Falmouth,’ for example, and that may very well be the case, but if we provide that service in Boston or in Providence, the expectation is that they’ll come for that specialty service to Boston or Providence,” he said. “I think any hospital would do the same thing. So I think perhaps that’s a frustrating piece, because it may be easier for Island veterans to go to another location. But even if we had the best of circumstances and contracts in place, it’s still going to be pretty much the same.”

He also explained that the VA is looking at the issues of providing health care to veterans on Nantucket and Block Island, as well as Martha’s Vineyard.

“We want to balance individual need with a bigger picture and just make sure we’re providing equitable care as best as we can,” he said.

Island reaction

Ms. Murphy said she only recently learned of the changes in Island VA health care, through calls from Island veterans. Like Island veterans, Ms. Murphy also questioned why the VA had not formally notified anyone and she was a strong advocate for getting the fact sheet out as soon as possible. Her biggest concern is that veterans who do not know about the pre-approval requirement might experience a lag time in getting necessary services such as prescription refills.

“We owe the Island veterans an answer, and I think the time has come that we really focus on doing our best to try to get that message out,” Mr. Antonaccio agreed. “I think what some of the frustration is, is that people are just sitting there feeling that we abandoned them. And I can certainly see where that perception is coming from, but again, we’re just trying to address this in the right way.”

Former U.S. Marine Woodrow (Woody) Williams of Tisbury, raised the issue of the lapsed VA contract with Ms. Murphy and also Congressman Delahunt’s office last May.

The Congressman followed up in response with a letter to Mr. Burney, reiterating that a VA clinic on Martha’s Vineyard is as important now as it was in the 1990’s.

As a Vietnam veteran with a 100 percent service-connected disability, Mr. Williams said the recent changes in his VA health plan have made it extremely frustrating and difficult for him to get the care he needs.

He said he has experienced long delays in getting pre-approvals through Ms. McLaughlin, and did not receive a fee-basis card he was promised for several weeks.

Mr. Antonaccio said this week the Hyannis clinic staff has taken steps to ensure that veterans would receive a timely response.