Extension of VA clinic in Carthage likely

Officials from Carthage Area Hospital and the Syracuse Veterans Affairs Medical Center will meet today to try to forge an agreement for the hospital to continue operations at its outpatient VA clinic in Carthage from Dec. 1 through Feb. 14.

Currently, no contract ensures that health care services for veterans will continue in Jefferson County during that period, the gap between when the Carthage hospital's contract for the clinic runs out and the start date of services at a new clinic, slated to open Feb. 15 in Watertown. That clinic will be operated by Valor Healthcare Inc., a national company, at the CANI building, 19472 Route 11.

Though relations have been tense since the Syracuse VA hospital announced last week that it opted for Valor over Carthage in awarding the contract — and Carthage Hospital Administrator Walter S. Becker railed against the decision during a press conference Friday announcing the change — both parties have expressed a willingness to continue working together until the new clinic opens in February.

Mr. Becker charged that the Syracuse VA dragged its feet in ensuring against a gap in services. The Carthage hospital was notified Nov. 16 it was not successful in its bid to continue operating the VA clinic; the VA announced its decision publicly Friday. With seven days to go before the Carthage hospital's contract expires, Mr. Becker said by early Monday he still hadn't heard from the Syracuse VA about working out a deal to continue operations, so he contacted the medical center Monday to set up today's meeting.

"Patients are nervous," he said. "It's a short week this week. If they want to get something done, they better get moving."

"It's not important to know who called the meeting; it's important to know that there is a meeting," Richard G. Kazel, manager of medical and surgical services for the Syracuse VA Medical Center, said Monday. "Both parties are very anxious to ensure that there is no gap in service for our veterans."

He said he expected an agreement to come out of today's talks. No announcements about a deal were made Monday.

The Carthage clinic has been operating on a series of three-month extensions on its original contract since 2006, as the Department of Veterans Affairs has been working to alter the kinds of agreements it uses in contracting for community-based outpatient clinics nationally, Mr. Kazel said. The switch is from a fee-for-service model — often criticized during the current national health care debate because it gives providers a financial incentive to prescribe excessive tests and treatments — to a "capitation" model, which pays providers a set fee per patient per year for all of their health care.

For the Syracuse VA hospital, the lengthy transition period between the two contracting systems has meant a series of short-term contract extensions with providers such as the Carthage clinic, Mr. Kazel said. Those short-term agreements do not provide the same safeguards against gaps in service that typical, longer-term contracts do — namely, a period following the contract end date when a health care provider is required to continue offering services to patients.

That left a very short time frame — just more than two weeks — between when the new long-term contract for the Jefferson County clinic was awarded and when the contract with the Carthage hospital runs out.

Syracuse VA Medical Center administrators failed to address the gap before it arrived. Now the hospital is left in the awkward position of having to negotiate for continued services with a disgruntled vendor just days before patients could lose their doctors for 2 1/2 months.

Officials said that seems unlikely to happen, but in a worst-case scenario Jefferson County veterans might have to head to the medical center in Syracuse for their appointments until Feb. 15.

Asked to comment on whether this was a case of poor planning, Mr. Kazel said, "I wish I could. We're working very diligently on the continuation of services. In an ideal scenario you wouldn't want to be put in this situation."