Hospitals around the country expect a big influx of armed forces veterans, starting May 30 and continuing indefinitely.  And many of them have mixed feelings.  On the one hand, most hospitals have at least some empty beds and welcome patients to fill them.  After all, that’s their mission.

On the other hand, the Veterans Administration has developed a reputation for being low-pay and slow-pay and for erecting bureaucratic mazes that are daunting even by federal government standards.

The cause of the influx is the VA’s new Accelerating Care Initiative, requiring VA facilities to refer veterans to non-VA facilities if they’re on a waiting list or have an appointment more than 30 days out.  The program was expected to refer its first patients at the end of last week.

Many hospitals already have experience with the VA.  In 2011 it launched its Access Received Closer to Home initiative, allowing veterans in rural areas to access participating non-VA facilities when there’s no VA facility nearby.  It’s estimated that 40% of veterans live in rural areas.

The problem for hospitals is that payment is generally at Medicare rates, and hospitals report that the care of veterans costs more than Medicare pays.  In addition, the VA has developed a reputation among many hospitals for being very slow to pay its bills.

And for many hospitals, as well as physicians, the bureaucratic burden of working with the VA is too heavy.   Some smaller hospitals have simply turned down the chance to work with the VA, or they’ve signed up and then dropped out.  Unfortunately, many of these smaller hospitals are located in rural areas—precisely the kinds of areas where so many veterans are concentrated.