Document NGKeeROEd62M9ZwVO8d04ve78

DR. ARMSTRONG MEMORANDUM May 31, 1946 _ Z hurt read Mr* Klrlin1 a memoranda on payments to rialting nurse association* sad I am very ouch inclined to agree on the payment faased^u~camaunty rates. ' I take it for granted that the VXA will establish its co-unity rate on a cost per visit basis.. In any event, analyses of posts Most be continued, and I agree with the last ssatenee In the foortiTparagrapa of Dr. Wh--tie^s'comments that we should stipulate that we have the right to request a review of posts as say be indicated from tine to tine. Then the op-unity post rate appear~oat of line, it would be subjeet to analysis by KLX. It nay be advisable to add a snail fee to the eo--unity rate to cover the oort of edllso'fcVffl fW *T-T - The etate--at by Mr. Kivlln on page 9 of hie report on Co-unity Rate vs. Cost Per Visit, appears to be sell thought out end aoourate. Considering all the experience that tbs VXA* a have had in recent years on cost analysis, it would sees that there is sufficient infomstioa available both to then and to ourselves so as to prove an affaetive ebook against tbs thought out lined in paragraph four of Mr. ipfel' a eoanants. Certainly ee oan rely on the good faith of VNA'a and if irregularitiaa ooeur, they ean be obeoked. If we are to try baaing our payments to TOi< on dm oo--unity rate, i I mold be inclined to *]* tin. wiHwhia rather than to experiment with any selected portion of the whole. If we adopt the eo--unity rate payment plan for all the VHA's concerned, we would, at the end of two or three years, know whether or not the change was a wise one end eould than, if neeesaary, revert io the present plan, but I think it would be sore advantageous if we are going to try the eo--unity rate plan, p,t. n 1 * 00 the >M> basis, taking it for grantsd that the VNA's themselves are agreeable. If so-- of them object, we sight then try it on a partial basis. Ons othar thought occurs to as ss a result of reading the various memoranda on this general subjeet and that la, do any of tho VH1' a rendar service to the oo--inlty other then visiting mining. If so, should the costs of such other services be, kaptsgfrt from ths cost of visiting nursing so that the visiting nurse service does not beeo-- burdened by costs for which it is not responsible. A J# Ms D* Associate Medical Director