Report Shows Veterans Wait Longer to See a Private Doctor Than a VA Provider

Posted in Uncategorized on September 25, 2018

A recent report by the nonpartisan group Government Accountability Office (GAO) confirmed fears that veterans using the Veterans Choice Program – created to reduce VA wait times through increased access to private healthcare – would have actually been seen sooner through a VA provider.Report Shows Veterans Wait Longer to See a Private Doctor Than a VA Provider

The new program allows veterans to elect to see certain private healthcare providers when their wait for a VA appointment exceeds 30 days. However, according to the GAO, the average wait for an appointment with private care was 51 days, with some reports of up to 70 days to see a private doctor.

Veterans Wait Longer to See a Private Doctor Than a VA Provider

According to the GAO, who audited metrics from April 2016-May 2018, poor bookkeeping and management were some of the main causes for the long wait times. Additionally, the entire process involved a large group of separate organizations and a list of acronyms, like:

  • The Community Care Network (CCN) and private doctors themselves
  • The Computerized Patient Record Systems (CPRS)
  • The VHA's Office of Community Care (OCC)
  • Third-Party Administrators (TPAs)
  • The VA Medical Centers (VAMCs)

Oftentimes, the private practices worked with third-party administrators to schedule these appointments, some of whom did not categorize patients consistently. Physicians complained of late payments and, overall, the program lacked hard metrics of success, leaving little oversight for improvements. Especially concerning is the gap between the categorization of and appointments for veterans deemed “urgent,” meaning they needed immediate care to avoid death or serious pain.

As a result of the GAO report, several recommendations were made and agreed to by the VA, including:

  1. A revised plan for the categorization of and next steps for veterans needing urgent care.
  2. VA will also set up a new referral and authorizations system called the "Health Share Referral Manager" to help measure the time it takes to review and accept consults, prepare referrals, and schedule veterans’ community appointments.
  3. VHA staff now has the responsibility of scheduling community care appointments with providers, as opposed to TPAs.

Some of these recommendations fell in line with groundwork already being laid for the new $52 mil VA Mission Act – formal title, “VA Maintaining Systems and Strengthening Integrated Outside Networks Act” – signed into law by President Trump on June 6, 2018. The new act was propelled forward by not only reports like those of the GAO, but by the impending end-of-life of the original Veterans’ Choice program, which was scheduled to end late May 2018. Today, it continues to be funded in the short-term until it can be fully replaced by new procedures in the Mission Act.

A main component of the Mission Act is strikingly similar to the impudence for the Choice program: the VA is required to provide, “access to community care” if the VA does not offer the care or services the veteran requires, the VA does not operate a full-service medical facility in the state a veteran resides, the veteran was eligible for care in the community under the 40-mile rule in the Veterans Choice Program and when the veteran meets certain requirements.

The Mission Act places heavy importance on the VA correcting agreements with local health care providers, including clinics, nursing homes and private practices to help ensure veterans to do not experience a lapse in care.

Other changes coming through the VA Mission Act include walk-in care access for certain veterans under VA care, an expansion of caregivers covered in the VA Veteran Caregiver Program and more stringent adherence to safe prescription practices for opioids. Additionally, the law creates a framework to review all VA facilities and properties by the year 2021 to see what facilities are truly needed.

The VA and other lawmakers with a concern for the nation’s veterans continue to slowly turn the ship in a direction that will benefit servicemen and women who sacrificed so much during their time serving the country. It is hopeful the must urgent need – getting veterans to health care providers when they need it, rather than waiting months – is of paramount importance and can no longer be ignored.

You can access a PDF of the VA Mission Act here.

Written by Megan Hammons

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