Extension of veterans health care program urged despite woeful record

The House Veterans Affairs Committee this week unanimously approved an extension of the troubled Veterans Choice program – the hastily assembled solution to veterans’ massive wait times for VA medical care that came to light three years ago.

If approved by Congress, the vote would extend the controversial program until what’s left of the $10 billion set aside in 2014 runs out. It came despite mounting evidence that the program is failing at its most basic goals, with some veterans still waiting more than eight months to receive outside medical care. Congress must still act on the measure.

Newly confirmed VA Secretary David Shulkin had urged Congress to continue the program, saying during a committee hearing on the eve of the vote that sunsetting the program on Aug. 7 would jeopardize care for more than a million veterans and leave $1 billion in unspent funds.

“If we don’t do this,” he said, “this is going to be a disaster for American veterans.”

That committee got a grim peek at the Government Accountability Office’s ongoing probe of Veterans Choice, including potential waits of up to 81 days for veterans to receive routine private care if the VA and private program administrators take the maximum time allowed under their own policies. That’s far short of the program’s goal of 30 days or less.

While the GAO investigation is not yet complete, health care team director Randall Williamson released a 32-page document of “preliminary observations” of delays at six VA facilities across the country. One was Alaska’s, the focus of an investigation last year by Reveal from The Center for Investigative Reporting, which found that access to private care worsened under the Choice program.

The GAO’s document and a report released last week by the VA’s Office of Inspector General both found that delays were hidden by poor record keeping. For example, the VA does not track the time it takes to pass appointment referrals on to the private contractors, who then authorize care and schedule appointments.

The Choice program was a rush job crafted by Congress after news broke of falsified waitlists at VA facilities that hid true delays so extensive that veterans became gravely ill and in some cases died before getting care. While the VA always had the authority to send veterans to private doctors, the Choice program made it an entitlement.

Rolled out in November 2014 and administered by two private companies, the program quickly became plagued by its own delays – in care and payments to health care providers. At the root were built-in bureaucratic complexities, the VA’s antiquated IT system and a dearth of available providers in rural areas. As undersecretary of health, Shulkin – a medical doctor appointed the following spring – was charged with trying to fix the fix.

Four legislative adjustments and 70 amendments to contracts with TriWest Healthcare Alliance and Health Net Federal Services led to improvements but failed to address many core flaws.

Shulkin has pledged to roll out an improved “Choice 2.0” program to ensure more streamlined access to private care. To do so, he needs congressional buy-in to his plan, as well as the extension beyond August.

Shulkin stressed at Tuesday’s hearing that he has no plans to privatize all veterans’ medical care. He pledged to enhance VA care specific to veteran issues such as PTSD and traumatic brain injury. But he has said that he wants to expand eligibility for outside care in the next iteration of Choice, eliminating restrictions that limit access largely to those who can’t get a VA appointment within 30 days or live more than 40 miles from a VA health facility.

The GAO’s preliminary findings noted workaround efforts by the VA to improve the Choice program, among them pilot programs in Alaska and Fargo, North Dakota, that stripped the private administrators of scheduling duties, returning them to the VA.

Shulkin won praise from many on the committee for those improvements and for pledging to acquire an “off-the-shelf” electronic medical scheduling and claims processing system rather than attempt to upgrade its own.

The GAO’s Williamson called the new system a top priority but warned that it, along with expanded eligibility and staff for in-house scheduling, would be costly. Colorado Republican Mike Coffman was more scathing. Noting that VA employees had falsified wait times leading to the 2014 scandal, the congressman asked how it made sense to return scheduling duties for private care “back to them.”

“VA couldn’t manage its own employees,” Coffman said at the Tuesday hearing. “It doesn’t surprise me that VA couldn’t manage the contract with the appointment process. So I’m not sure we’re really making progress here.”