Hospitals can absorb some VA patients

Local hospital officials say they can take on the VA's medical patients, but there is no inpatient psychiatric care available here.

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A federal commission's proposal to end inpatient care at Walla Walla's veterans hospital offers few recommendations about where to send patients who fill the hospital's 66 beds.

Officials with Walla Walla's two private hospitals say their facilities can take the medically ill patients.

``We don't expect that to be a problem,'' said Kathleen Obenland, director of public affairs for St. Mary Medical Center.

``It won't place an undue burden on us,'' said Duane Meidinger, vice president of finance for Walla Walla General Hospital.

But patients requiring psychiatric and long-term rehabilitation may have a harder time finding services and care. Neither local hospital offers such inpatient programs.

The proposal from the Capital Asset Realignment for Enhanced Services commission recommends converting the Jonathan M. Wainwright Memorial Veterans Affairs Medical Center to an outpatient facility. The proposal would close the 73-year-old hospital, which has five beds for medically ill patients, 31 beds for psychiatry and residential programs, such as substance abuse treatment, and 30 nursing home beds. On an average daily basis, about 47 of the beds are full. About half, or 22, are taken by long-term care patients.

The proposal calls for contracting with local hospitals and long-term care facilities to care for patients.

``When it comes to inpatient medicine and nursing home care, the local community in Walla Walla has options for providing this care,'' the report states.

Meidinger and Obenland agree, saying their hospitals can care for the medically ill patients, who account for 10 percent of the VA hospital's average daily patient census.

Obenland said VA physicians should have no difficulty obtaining hospital privileges at St.

Mary. Meidinger said WWGH already grants such privileges to doctors with surgery and other patients at the hospital.

``The numbers are fairly small,'' Meidinger said. ``I'm sure we'll be able to care for those people.''But neither hospital has psychiatric care services, leaving the fate of an average of 21 patients in limbo. The recommendation reports those patients come from three primary areas: Yakima, the Tri-Cities and Walla Walla.

Yakima and the Tri-Cities have in-patient psychiatric services, but there are none in Walla Walla. Nor do the area's two hospitals anticipate a change in that status.

Meidinger said WWGH had such services in the 1980s, but phased them out because they were expensive.

``Financially, we can't afford to subsidize it,'' he said. ``We can't cross subsidize with acute care. It has to be close to break even.

Psychiatry is a stand-alone area.''Obenland told a similar tale at St. Mary, which closed its psychiatric ward for financial reasons.

According to Randy Revelle, vice president of the Washington State Hospital Association, closure of psychiatry beds in hospitals across the state for economic reasons is becoming a ``a real crisis for us.''In the last two years, Revelle estimates the state overall has lost about 10 percent, roughly 70, of its psychiatric beds because of funding problems. He said Medicare reimbursements are very low, accounting for about 60 percent of the actual costs of care. According to the VA's own early studies, such patients care costs about $2,100 per day.

``One of probably two most critical areas impacting hospitals right now are the financial instability of the inpatient psychiatric units,'' Revelle said.

The recommendation says veterans may find themselves referred to the Spokane veterans hospital, 3 hours north of Walla Walla, if local services remain unavailable. The VA's preliminary study identifies Our Lady of Lourdes Medical Center in Pasco as the closest facility with psychiatric beds.

Lourdes President Jim Dover said his hospital's program has 20 beds, with an average daily census of 14 patients. But Dover said Lourdes officials ``have not seen any information regarding the Veterans Affairs Hospital's psychiatric unit patient population....Only after review of that detailed information could we speak to additional capacity in this area.''Meidinger said local hospitals do offer emergency care for psychiatric patients, but once those patients have been stabilized, they must be transferred to another facility.

The commission recommendation states a combination of solutions may be needed to care for the veterans. But ``...before taking action to alter existing VA services, VA must ensure that there are viable alternatives in the community.''Officials at Walla Walla hospitals said they are interested in exploring possible contracts with the VA, but thus far the recommendation includes no plan for implementation.

``The analysis is ongoing,'' Obenland said. ``It's still a draft at this point. When it's complete, we'll have a better sense of our role.''

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