More non-VA care could backfire

Tom Philpott

Tom Philpott

By Tom Philpott

Military Update

A report by the Department of Veterans Affairs’ inspector general and a separate “access audit” of appointment scheduling practices across VA healthcare facilities confirm system-wide abuses to distort wait times for care. It shows patients have been put at risk and shaken confidence in how VA hospitals and clinics are staffed, managed and resourced.

Yet even as the acting IG and another senior VA official confirmed the depth of the patient wait-time scandal at a recent hearing of the House veterans affairs committee, as well as possible criminal activity by some administrators, they cautioned irate lawmakers against sending thousands more VA patients into the private sector for healthcare needs.

The caution flags haven’t slowed Congress. Last week, the House unanimously passed the Veterans Access to Care Act (HR 4810) from Rep. Jeff Miller, R-Florida, VA committee chairman. It would require VA to offer non-VA care to enrolled veterans who cannot get an appointment within VA wait time goals or who live more than 40 miles from a VA medical facility.

Then the Senate voted 93 to 3 for similar language as part of a more comprehensive bill, the Veterans’ Access to Care through Choice, Accountability and Transparency Act of 2014 (S 2450), from Sens. Bernie Sanders, I-Vermont, VA committee chairman, and John McCain, R-Arizona.

VA already spends 10 percent of its healthcare budget, about $5 billion a year, on private sector care. In 2013, VA authorized and reimbursed for 15.3 million non-VA outpatient visits, a 72 percent increase since 2008. Eligibility for such care is complex, however, and varies by veteran status and circumstance. Pre-authorization usually is required.

In response to the appointments scandal, Congress wants VA to experiment for two years with giving many more veterans easier access to non-VA care. Veteran service organizations long have feared such moves as a step toward dismantling their prized, fully integrated VA health system. Big government critics say it will improve access to care but save tax dollars.

At last week’s hearing, VA officials, including the acting inspector general, and a health expert from the Government Accountability Office, warned against a rush of veterans into private sector care, saying it could backfire if not carefully coordinated and properly resourced.

Tom Philpott can be contacted at Military Update, P.O. Box 231111, Centreville, Va. 20120-1111, or by e-mail at:
milupdate@aol.com