Document mmo4J2ZnjoRREDv7BX20zV58B

DR. ARMSTRONG MEMORANDUM May 31, 1946 Z hurt road Mr* Klvlin's memoranda on payments to rialting nurse asaoeiatlona and I aa very ouch inclined to agree on tbs payment baaed^unanaunity rates. I taka it for granted that the VXA *111 establish its community rate on a cost per visit basis*. In any event, analyses of posts must be continued, and I agree with the last sentenoe in the fourtiTparagrapa of Dr. Wheatley^a'eonmenta that we should stipulate that we have the right to request a review of poets aa say be Indicated froa tlae to tine. Then the ocaamnity ooat rate appaariToat of line, It would be aubjaet to analysis by KLZ. It way be advisable to add a swell fee to the eowwonity rate to cover the cost of collect7T> ffT" MT-T - Tbs atatemant by Mr. Kivlln on page 9 of bis report on Cannuity Rate vs. Cost Per Visit, appears to be well thought out and aoeurate. Considering all the experience that the VXl's have had in recent years on cost analysis, it would sees that there is sufficient lafonation available both to then and to ourselves so as to prove an effeotive cheok against the thought out lined In paragraph four of Mr. ipfal' s contents. Certainly we can rely on the good faith of VNA'a and if irregularitiea ooeur, they can be checked. If we arc to try basing our payaents to VHA'a ontteconaunlty rate, i I mold be Inclined to *]* tin. wiHeehia rather than to experlsent t with any selected portion of the whole. If ws adopt the community rate payaant 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 and could than, if neeessary, revert io the present plan, but I think it would be sore advantageous if we are going to try the community rate plan, p,t. n 1 * 00 the sane basis, taking it for granted that the VNA's themselves are agreeable. If soma of then object, we sight then try it on a partial baeis. One other thought occurs to me as a result of reading the various memoranda on this general subject and that is, do any of the VHA' s render service to the community other then vleltlng nursing. If so, should ths costs of such other services be, kapt ap^rt from ths cost of visiting nursing so that the viaitlng uuree service does not become burdened by costs for which it is not responsible. Aa J Mm Dm Associate Medical Director