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Healthcare professionals coalition raises concerns about the impact of new VA access standards on veterans
Read the press release at VeteransPolicy.org:
The Veterans Healthcare Policy Institute has joined eight VA professional associations along with the American Psychological Association to raise serious concerns about VA’s proposed rules governing the implementation of the VA MISSION Act’s Veterans Community Care Program (VCCP).
In a joint Public Comment submission posted to the Federal Register, these organizations, representing thousands of doctors, nurses and other professionals who care for America’s veterans, support the need for a community care network but assert VA’s proposed regulations will compromise the integrity of the Veterans Health Administration (VHA) model of health care by:
- Requiring VHA to meet new drive time and wait time standards while VCCP providers are not required to meet any access to care standard;
- Proposing quality standards for VCCP providers that do not equal standards for VHA providers, especially for mental health care;
- Incentivizing VCCP “over-treatment” often found with fee for service models;
- Diverting VHA staff who perform clinical services to positions that administrate VCCP care; and
- Failing to address that additional expenses for VCCP will likely be drawn from VHA’s budget.
The organizations observe that with more than half of covered veterans becoming eligible for VCCP vouchers, the rules will hasten the conversion of VHA into becoming an insurance company more than a provider of care.
The organizations state that veterans would be better served if standards were immediately amended to require that:
- The drive/wait time standards (access standards) that apply to VHA also apply to VCCP care;
- The same credentials, training, competence and quality that are established for VHA providers (quality standards) are required for VCCP providers before adding them to the network; and
- The additional expense of VCCP care (costs) be appropriated separately and not drawn from VHA funding.
“Unfortunately, the good within these rules – identifying underperforming VA clinics and limiting what non-VA providers can do outside VA authority – are overshadowed by the harm caused sending veterans to the community with no assurance of better timeliness, convenience or quality of care,” said Brett Copeland, VHPI’s executive director. “It’s doubtful that these issues can be resolved by the time the VCCP is planned to be rolled out nationwide in June 2019.”
VHPI submitted the joint comment with:
- American Psychological Association
- Association of VA Anesthesiologists
- Association of VA Psychologist Leaders
- Association of VA Social Workers
- Association of VA Surgeons
- Association of Veterans Affairs Nurse Anesthetists
- National Association of Veterans Affairs Optometrists
- Nurses Organization of Veterans Affairs
- Veterans Healthcare Policy Institute
- Veterans Affairs Physician Assistants Association
Read the Joint Public Comment at Regulations.gov or download a PDF copy at VeteransPolicy.org.
21,543
The number of public comments that have been posted as of 1 p.m. ET. There's still time to comment on Regulations.gov. The submission period ends at 11:59 p.m. ET.
VA prepares ‘massive shift’ to private care providers
From Lisa Rein at The Washington Post:
Within two years, as many as half the 7 million veterans now seen at VA could receive their care elsewhere, advocates of the change say.
Trump’s proposed budget, released last week, includes up to $3.2 billion in new spending next year for private-sector visits, including to walk-in clinics.
VA, with 1,200 hospitals and clinics, is the country’s largest health-care system. For conservatives who failed to repeal the Affordable Care Act, rerouting veterans’ care to the private sector is the next front in the battle over U.S. health policy. For President Trump, giving veterans more choices will probably be a reelection theme next year as he seeks shorter waits and potentially better care for veterans, a crucial constituency.
Democrats now in charge in the House are resisting. They say proposed rules on when veterans could go outside VA are too lenient and would damage the government system — a long-held fear of Democrats who worry that union jobs will be siphoned off and the government system dismantled.\
While not directly opposing a veteran’s right to see a private doctor, opponents are undermining the new policy in hearings, statements and letters and preparing for aggressive oversight as VA rolls out rules to put in place legislation Congress passed last year.
Democrats and some veterans groups have accused Wilkie of leaving them out of planning. “They profess to be against privatization,” said Rep. Mark Takano (D-Calif.), who ascended to chairman of the House Veterans’ Affairs Committee in January, “but by default, we will see privatization happen under our very noses.” House Speaker Nancy Pelosi (D-Calif.) has raised alarms for months that the policy lacks a “sustainable funding source.”
VA Mission Act’s bipartisan passage was a victory for the president, who vowed to revamp veterans’ access to a health-care system beset by poor access after a 2014 scandal.
The law boosted a group backed by billionaire industrialist Charles Koch that has shaped Trump’s veterans policy. Concerned Veterans for America has quickly mobilized against the law’s critics, launching a paid lobbying campaign this month to defend it.
The system is down
Issac Arnsdorf reports on the disarray of the tech that will determine eligibility under the VA MISSION Act. Read it at ProPublica:
As the Trump administration prepares to launch a controversial program to expand private medical care for veterans, the Department of Veterans Affairs is developing a software tool to determine who's eligible.
But the tool is so flawed, according to an independent review obtained by ProPublica, that it threatens to disrupt the health care of about 75,000 veterans every day.
“This degradation goes against the spirit of the Mission Act to improve the veterans experience and quality of care," the review said, referring to the 2018 law that authorized the program to expand private care. The program is supposed to start in less than three months.
The review was conducted by the U.S. Digital Service, an elite group of software developers and designers employed by the White House to help federal agencies improve their technology. The USDS team said the VA should scrap the eligibility tool and start over.
The VA needs authorization from Congress to cover the $5.6 million cost of completing work on the eligibility tool, the department said in a March 4 letter to a House appropriations subcommittee. The panel has not yet acted on the request.
VA spokesman Curt Cashour declined to comment on the USDS review, saying it “remains a work in progress." The USDS didn't respond to requests for comment.
The USDS report raised concerns that the eligibility tool was designed in a way that wouldn't work for VA doctors. The report predicted that the tool would generate errors or run slowly or crash. These glitches would lengthen each appointment by five to 10 minutes, the USDS team estimated, which equates to being able to treat 75,000 fewer veterans every day systemwide.
…
Wilkie has said the Mission Act will “revolutionize VA health care as we know it.” But the USDS review said the agency is making only “piecemeal updates” to existing policies and procedures, and has conducted little research to understand how veterans, doctors and staff actually use private care.
The report recommended starting over on a simpler tool that wouldn’t be a drain on doctors’ time because it could be used by nurses or clerks, or even by veterans themselves. The USDS said the simpler tool could be done in time for the private care program’s launch in June.
AbleVets’ CEO, Wyatt Smith, declined to comment.
If the VA doesn’t provide a tool for veterans to check their own eligibility, patients may get into arguments with staff about whether they’re entitled to private care, the report warned, leading “to the public perception that the criteria are arbitrary, inconsistent, or unfair.”
VA clinic closes, MISSION Act cited as a factor
An Indiana VA outpatient clinic closes after one year, allegedly without informing elected officials. Read it at the Kokomo Tribune:
The part-time Veterans Affairs clinic in Kokomo has closed less than a year after opening, and local officials say they were blindsided by the decision by VA administrators. ‘
The VA outpatient facility opened in February 2018 inside the current city-county clinic at 620 N. Bell St. and was open two days a week to see area veterans.
But in January, the clinic stopped seeing patients and moved out of the city-county facility, according to Howard County Veterans Service Officer Ross Waltemath.
Tom Blackburn, public affairs officer for the VA Northern Indiana Healthcare System, which oversaw the clinic, confirmed Friday the facility has closed.
Reasons for the closure included the need to relocate a provider back to the Marion VA clinic and improved access at other clinics, Blackburn said.
He also cited new treatment options that will be coming with the Mission Act, which was signed into law in June by President Donald Trump and aims to offer more treatment options to veterans and introduce long-care fixes to the VA system.
Changes to disability system could save time and money
From Leo Shane III at Military Times:
Those reforms amount to “establishing a more reasonable policy in determining when a VA examination is warranted in connection with a claim for compensation,” according to the budget documents.
Administration officials argue that court rulings on the veterans disability process have shown that current VA medical standards for benefits are excessive compared to the legal evidence needed to establish eligibility.
Many check-ups, reexaminations and VA appointments duplicating private-sector medical evaluations could be cut, saving veterans time and the federal government money. VA estimates that more than 180,000 unnecessary medical appointments were conducted in 2016 and more than 210,000 in 2017, a small but significant portion of the department’s workload.
The reforms package also includes changing disability compensation benefits to remove annual income from the eligibility calculation, a move that could increase the number of eligible beneficiaries but also save time and staff in calculating those payouts.
“This helps VA standardize the calculation and potentially automate payments, allowing veterans to get payments faster,” the budget document stated.
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