Another policy being bolstered is one requiring a physician to staff the clinic full-time. Previously, nurses and physician's assistants would treat patients with oversight from one of the few full-time physicians on staff at the hospital.
"Here we've been recruiting a physician's assistant for over a year," said Boula, "and now they want us to have a full-time physician."
Boula said that it was highly unlikely the hospital would be able to find a new physician itself, so Veterans' Affairs would provide someone for the position.
"This clinic was the first clinic in the country," stated Hoffman, "and it's operated beautifully since 1988."
Though Veterans' Affairs has not stated intentions to pull the clinic out of ECH, the current lack of a contract puts the future of the clinic in question. Boula said that it was ultimately up to Veterans' Affairs to decide whether or not to continue operating out of ECH, noting the trend in recent years has been to move away from hospital-based clinics, which VA often finds to be too expensive.
"Our goal is to provide high quality services for our veterans," said Peter Potter, Public Affairs officer for Stratton VA Medical Center, declining to comment further on the on-going negotiations.
"30-minute appointments and a full-time physician meet the standard of care we've set for veterans at all our facilities," Potter added. "We will continue to work with the contractor to determine the best way to resolve these issues and are fully committed to serving our veterans in the Elizabethtown area."
Veterans themselves, both Hoffman and Boula say they too are committed to providing services to veterans. Still, they emphasized that ECH is not allowed to offer its services at a discounted rate to the VA clinic.
"We're not overcharging [Veterans' Affairs] to be here," said Hoffman, noting that medicare would offer a higher reimbursement rate for use of the hospital space were the clinic not operating there.
"This is very important to us," said Boula, "but it's also very important to our hospital to be able to cover our costs."