Taking on Veterans as Patients post-VA Employment

[Hope4Grad]

For those who are familiar with the VA system…are there specific rules against taking on Veterans in my private practice if I was seeing them while employed by the VA?

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[AcronymAllergy]

You can double-check with your local business compliance person, but so long as you aren't referring them to yourself in private practice, then no, I don't think so.

 

[Hope4Grad]

Confused by this answer…so I want to leave the VA, they know I want to leave, and they know I have a private practice. I leave the VA, and they come calling because of the relationship we’ve built over the years and want to see me in private practice and they will pay me. How is that different than referring them to myself? Is it just because I didn’t outright suggest it? That seems like a pretty heavy trail of breadcrumbs, right?

 

[AcronymAllergy]

Confused by this answer…so I want to leave the VA, they know I want to leave, and they know I have a private practice. I leave the VA, and they come calling because of the relationship we’ve built over the years and want to see me in private practice and they will pay me. How is that different than referring them to myself? Is it just because I didn’t outright suggest it? That seems like a pretty heavy trail of breadcrumbs, right?

The issue of self-referral is more a problem if you're concurrently working at VA and also have a PP on the side, and are sending veterans who are eligible for VA care to your PP instead. Or if you haven't yet started the PP, but you're telling all of your patients that they should wait until you leave and then come see you in the community instead of going to VA.

While you're still with VA, I would just refrain from telling any patients to see you in the community after you leave. Again, you can check with your local resource person about the issue (which I did before leaving VA), but if the patients find you of their own volition, there's no problem with that. I'd just be clear with the patients if they say they want to keep seeing you that it's certainly their choice to do so, but VA won't be paying for it, and they also have the option of continuing their care within the VA instead.

And there's no "cool down" period needed between when you leave VA and when you could start seeing patients who find you out in the community. I'd thought I remembered in one of those TMS trainings that there was a waiting period needed before you could begin contracting with VA after leaving (e.g., if you want to be a community care provider), but that may not be the case.

 

[cara susanna]

For what it's worth, I know someone who referred patients to their private practice while still at the VA, AND eventually left the VA for said PP full time, who didn't get into any trouble.

 

[WisNeuro]

For what it's worth, I know someone who referred patients to their private practice while still at the VA, AND eventually left the VA for said PP full time, who didn't get into any trouble.

While this person did not get into any trouble, I am almost certain that a licensing board would have some thoughts about such an arrangement if they were made aware. Although, if this were in your current state, given the unresponsiveness of your board, they may just shrug.

 

[AcronymAllergy]

For what it's worth, I know someone who referred patients to their private practice while still at the VA, AND eventually left the VA for said PP full time, who didn't get into any trouble.

I suppose if the service offered weren't available at VA, the patient knew it wasn't being paid for by VA, and the patient were made aware that there are possibly other options in the community, it may not be an issue. But I agree that regardless, the optics of referring VA patients to your private practice are not good.

 

[ClinicalABA]

Confused by this answer…so I want to leave the VA, they know I want to leave, and they know I have a private practice. I leave the VA, and they come calling because of the relationship we’ve built over the years and want to see me in private practice and they will pay me. How is that different than referring them to myself? Is it just because I didn’t outright suggest it? That seems like a pretty heavy trail of breadcrumbs, right?

In most places, the regulations and "case" laws look pretty favorable on the clients' rights to choose their therapist, and look unfavorable on any practice, rule, etc., (e.g., non-compete clauses) that get in the way of that right.

You are working somewhere else (exclusively- without still having the capacity to see those clients through their VA benefits), and the clients choose to come to you, knowing that there are other providers (including the VA) who they can see, likely- as through the VA- with less cost to themselves? Nothing likely wrong with or unethical about that.

If, however, that client really believes (and would state to a board or hearing officer) that they really didn't have a reasonable option for continued effective care, other than you and your more expensive services? Then you might have an issue. I think people are encouraging you to make it as clean as possible- no active solicitation of current/ex-clients (and notifying them of your leaving the VA an what you will be doing next is NOT active solicitation); clear evidence that they know they didn't need to follow you to continue to receive care; etc. If you're PP is largely made up of ex-VA clients, it might look a bit suspicious.

Now- you may have a non-compete in your VA contract. If so, you should check on the legality of such a clause in your state. They are not legal/unenforceable for psychologists in many places, but not all. If you have one and are planning to act in a way that violates it, it would be well worth a few hundred bucks to have an employment attorney take a peek at it.

That's the legal and ethical stuff. As for the "you don't want to be seen as an untrustworthy jerk by your colleagues/community" stuff, watch out for anything that looks like active solicitation of clients AWAY from a program. People still work there and count on clients to pay the bills. Having an new practice made up of a bunch of your old VA clients may not be looked upon too favorably by your ex-coworkers, and they will talk about it, and that talk can turn into rumors that are only partially based on the realities of the situation. In other words, you're probably going to be ok, but keep it all as clean and transparent as possible and work really hared to make sure that the majority of your new clients aren't ex-VA and the majority of your old VA clients are still VA clients. Those veterans have paid for that benefit and should be using it.

 

[AcronymAllergy]

In most places, the regulations and "case" laws look pretty favorable on the clients' rights to choose their therapist, and look unfavorable on any practice, rule, etc., (e.g., non-compete clauses) that get in the way of that right.

You are working somewhere else (exclusively- without still having the capacity to see those clients through their VA benefits), and the clients choose to come to you, knowing that there are other providers (including the VA) who they can see, likely- as through the VA- with less cost to themselves? Nothing likely wrong with or unethical about that.

If, however, that client really believes (and would state to a board or hearing officer) that they really didn't have a reasonable option for continued effective care, other than you and your more expensive services? Then you might have an issue. I think people are encouraging you to make it as clean as possible- no active solicitation of current/ex-clients (and notifying them of your leaving the VA an what you will be doing next is NOT active solicitation); clear evidence that they know they didn't need to follow you to continue to receive care; etc. If you're PP is largely made up of ex-VA clients, it might look a bit suspicious.

Now- you may have a non-compete in your VA contract. If so, you should check on the legality of such a clause in your state. They are not legal/unenforceable for psychologists in many places, but not all. If you have one and are planning to act in a way that violates it, it would be well worth a few hundred bucks to have an employment attorney take a peek at it.

That's the legal and ethical stuff. As for the "you don't want to be seen as an untrustworthy jerk by your colleagues/community" stuff, watch out for anything that looks like active solicitation of clients AWAY from a program. People still work there and count on clients to pay the bills. Having an new practice made up of a bunch of your old VA clients may not be looked upon too favorably by your ex-coworkers, and they will talk about it, and that talk can turn into rumors that are only partially based on the realities of the situation. In other words, you're probably going to be ok, but keep it all as clean and transparent as possible and work really hared to make sure that the majority of your new clients aren't ex-VA and the majority of your old VA clients are still VA clients. Those veterans have paid for that benefit and should be using it.

Agreed 100%.

I would add that your VA colleagues might actually appreciate the ability to now know of a reputable/solid clinician in the community to whom they could refer VA patients in the future who don't want to be seen at VA for whatever reason. Or, if you want to keep working with a lot of veterans, you could consider getting approved by VA as a community care/MISSION Act/whatever they're calling it nowadays provider. Your VA colleagues, if they're overbooked already, would probably also appreciate being able to refer patients to you in this capacity. VA providers are probably a bit different from providers in other hospital systems and in private practice in this regard. They'll generally get paid regardless of how many patients they see.

The noncompete advice is solid. Fortunately, with VA, I've never yet heard of any VA provider having a noncompete clause in their contract. I've also known a very large number, proportionally speaking, of VA psychologists who have part-time private practices outside VA. Some of their offices were literally right down the street from the VA hospital.