Regional official says treatment there costs less, but there’s no system to decide who will be referred.

Some local veterans with cancer who would have been treated in Fort Wayne in the past will soon be referred to Indianapolis for care.

Just who will be affected is unclear. But Robert Beller, acting director of the VA Northern Indiana Health Care System, which includes Fort Wayne and Marion, said the decision to have certain patients travel to the Roudebush Veterans Administration Medical Center is the right one “because that is less costly,” and is a better use of the capacity and resources available in Indianapolis.

But a local physicians group, which has provided radiation therapy for area VA patients for 25 years, says sending veterans to have their cancer treated 120 miles away is not in the best interest of the patient and is more costly in the long run.

Fort Wayne Radiation Oncology has a contract with the VA to treat 50 cancer patients a year at the local VA hospital or its outpatient clinic, or at Parkview Radiation Oncology. If the number surpasses 50 - as it has the past three years - the VA pays an additional amount for each patient.

Who goes, who stays

Dr. John Crawford, an oncology group member and a Republican on City Council, said the VA has told the group it will refer those additional patients to Indianapolis.

He is concerned there is no system in place to decide which patients will go to Indianapolis and which will receive treatment here.

Beller said the VA has no intention of ignoring individual needs of veterans.

“We’re not saying, ‘You’re No.51 and you’re off to Indianapolis.’ That’s not going to happen.”

Prostate cancer patients, Beller said, are among those likely to be sent to Indianapolis. Such patients undergo radiation treatments every day, five days a week, for four to six weeks.

“Let’s take 10 prostate cancer patients,” Crawford said. “Let’s make them go to Indy. They could live next door to the place here, but they’d have to go to there. It will come out of the Indianapolis (VA) budget to treat them. It will be more expensive because treatment in Indianapolis is more expensive.”

Beller disagrees. Sending cancer patients to the Indianapolis VA, he said, is less costly because oncologists are on staff there.

The Fort Wayne site, however, has to pay outside oncologists to treat patients.

Generally speaking, patients with few other health problems will be sent to Indianapolis, Beller said.

The oncology group is giving the VA a break, Crawford said, charging it about half what it bills private insurers or managed-care organizations.

The group would be willing to negotiate a different contract to include more than 50 patients.

“I wouldn’t care if this decision was saving a dollar,” Crawford said. “But they’re not. That’s not the problem. Things are changing at the VA. They are consolidating services into regional (areas). We’re getting patients from a much larger area in the past few years.”

Radiation Oncology sees veterans from 20 counties in Indiana, Ohio and Michigan.

“So we’re seeing more patients, and the VA is under such a money crunch all over, that they’re trying to find any way to decrease expenditures here in Fort Wayne,” Crawford said.

Future of local outpatient services

The issue of transferring more patients to Indianapolis concerns U.S. Rep. Mark Souder, R-3rd District. He says such a decision is not a good sign that local outpatient services will be increased, even if the Fort Wayne inpatient hospital on Lake Avenue is closed.

Last May, then-U.S. Secretary of Veterans Affairs Anthony J. Principi accepted a recommendation from the Capital Asset Realignment for Enhanced Services Commission, or CARES, that the VA close the Fort Wayne inpatient hospital.

The commission was formed to overhaul the nation’s VA health-care system, cut expenses and improve space usage. Closing the hospital would save the VA about $2.1 million annually, according to the commission.

Since then Souder has sponsored several meetings to receive input from area veterans on their needs and what hardships they would face if the local hospital closed.

The closest hospital is Indianapolis.

Although Principi accepted the report, which clearly called for increasing outpatient VA services in Fort Wayne, there was no funding approved by Congress to pay for it.

Stretching resources

In November, Souder inserted a provision in H.R. 3936, the Veterans Health Programs Improvement Act for 2004, that called for more review of VA hospitals slated for closing.

“The goal was to buy us some more time,” Souder said.

“CARES said if they would close the inpatient unit, they would increase outpatient services. We haven’t seen that. That’s been my frustration here.”

Beller says the number of outpatient visits continues to grow - up more than 1,000 at four northeast Indiana clinic sites compared with this time last year.

The problem is that budgeted funds haven’t kept pace.

“We get an allocation of money and have to make it go as far as we can,” Beller said. “Our goal is not only to try to make the best use of (facilities), but we look for opportunities every day to save a dollar.”

To not send patients to Indianapolis for treatment is, he continued, a “waste of capacity and use of the VA Health Care System.”

He emphasized he must look at the big picture of a region and realize he has responsibility to veterans from South Bend to Muncie.

Cancer patients won’t be the only ones making the trip to Indianapolis. The Fort Wayne site, for example, provides no orthopedic care.

“I’m trying to do the most I can for the most veterans,” Beller said. “I’m very passionate that veterans get the services they need, but we don’t have unlimited resources.”