June 5, 2019
Jennifer Steinhauer | NY Times
WASHINGTON — The Department of Veterans Affairs on Thursday will begin allowing a broad section of its nine million enrollees to seek medical care outside of traditional V.A. hospitals, the biggest shift in the American health care system since the passage of the Affordable Care Act nearly a decade ago.
While department officials say they are ready, veterans groups and lawmakers on Capitol Hill have expressed concerns about the V.A., which has been dogged for years by problems with its computer systems. They worry that the department is not fully prepared to begin its new policy, which Congress adopted last year to streamline and expand the way veterans get care.
Previously, veterans facing a wait of 30 days or more for an appointment at their closest V.A. health care center could seek private care. Under the new policy, that waiting time would be reduced to 20 days, with the goal of 14 days by 2020.
The new measurement is expected to greatly open private-sector medical care to veterans in both rural communities and high-traffic urban areas, a goal conservatives have long pushed, especially after a 2015 scandal over hidden waiting lists for care. Veterans will also be allowed to use a bevy of walk-in clinics.
In the 2018 fiscal year, 1.7 million veterans used some form of private care. That number, based on the department’s eligibility projections, could increase as much as 30 percent under the new Mission Act, adding just over a half-million veterans to the pool seeking private care — although both critics and supporters of the change believe that number is low.
“I think it’s safe to assume that over the next several years you will see more veterans getting their health care in the community,” said Dan Caldwell, a senior adviser to Concerned Veterans for America — an advocacy group with ties to the billionaire industrialist Charles G. Koch — which has pursued expanding the use of private health care for veterans. Democrats on Capitol Hill agree.
Even so, it will take some time to see whether the expanded access to private care results in a gentle migration of veterans who are not being well served by nearby V.A. centers, or in a shift of a significant share of veteran care to an increasingly expensive private health care marketplace, starving the V.A., as critics have warned. The quality of care in the private system, as well as wait times within it, will be closely monitored by both opponents and supporters of private care.
“I don’t expect a flood of veterans coming in tomorrow or next week saying I want to go into the private sector,” Robert Wilkie, the secretary of veterans affairs, said Tuesday in an interview. “I’m confident that we will have a good rollout. I’m looking forward to it.” Mr. Wilkie said he will visit the V.A. in Salem, Va., on Thursday to observe the start there.
Mr. Wilkie has repeatedly said that most veterans would continue to seek care at department health care centers because they largely like the care and the understanding of veterans’ issues. Several studies underscore the V.A.’s popularity.
Some veterans groups and members of Congress have listed their concerns. Will there be enough doctors to take in the potentially large number of new veteran patients around the nation? Will the department’s information systems, particularly a software tool meant to integrate patient data from six information systems, be ready? Will providers and schedulers have adequate training in the new system? Will the V.A., which often has trouble making timely payments to providers, keep up with the expected influx — especially after computer glitches resulted in major problems with G.I. bill payments last year?
A smooth transition to the policy is a major test for Mr. Wilkie, who was brought in to restore both political and policy equilibrium after years of conflict and scandals at the department. The policy went from passage to rollout in just one year, an aggressive time frame for any large-scale change to an enormous health care system.
But even before it went into effect, critics were speaking out.
“After touring both the Atlanta and Boston V.A. facilities this past month, I’m concerned that V.A. has not done its due diligence to adequately prepare veterans, community providers, and V.A. staff for the June 6 implementation of the Mission Act’s new community care guidelines,” said Representative Mark Takano, Democrat of California and the chairman of the House Committee on Veterans’ Affairs. “I’m apprehensive about the transition this week.”
Members of the committee were even asked by the department not to visit, or to send their staff aides to visit, veterans health care centers this week.
Despite that, officials from the House panel plan to visit V.A. facilities around the country that have lower rankings to assess their progress on Thursday. The officials do not know if they will be allowed entry.
President Trump views veterans — a group he has taken pains to court, even though at times he has slighted them — as part of a key component of his political base, and he has long sought to put more veterans in private health care.
“All during the campaign, I’d go out and say, ‘Why can’t they just go see a doctor instead of standing in line for weeks and weeks and weeks?’” Mr. Trump said last year as he signed the Mission Act. “Now they can go see a doctor. It’s going to be great.”
“The V.A. certainly does not have the best track record implementing new I.T. systems,” said Representative Phil Roe of Tennessee, the top Republican on the House veterans committee. “It’s important to remember that while June 6 is a major milestone, many of the other shifts the law requires have either already been implemented or are still to come, and we will continue to provide oversight of all of these changes.”
Officials at the V.A. say they are confident things will go smoothly.
The agency has “conducted extensive user testing and training at sites across the nation,” said Curt Cashour, a department spokesman. He noted that all veterans enrolled in V.A. health care received mailings about the changes, which also are detailed online. He said that Mr. Wilkie and other department officials have done extensive outreach to veterans.
The V.A. is expected to have over 8,000 new urgent care clinics participating in that part of the program, he said. As of last month, the department had over 548,000 health care providers participating in its private care network, up from 474,765 in January 2018.
“We continue to work with our contracting partners to grow that number,” Mr. Cashour said.
Some veterans’ service organizations have complained that the V.A. has left them in the dark. “They can’t give straight answers about who is eligible,” said Rick Weidman, the executive director for policy and government affairs at Vietnam Veterans of America, which is threatening to file a lawsuit to slow the process down. “We should be delaying this until the V.A. gets its act together.”
There is no other analogous public health care system in the United States to the V.A. or this transition with services.
Medicare under Mr. Trump has increasingly shifted consumers into private plans, but that is a public payer system, not a health care system. “The V.A. has a number of characteristics worth studying for valuable lessons on health care in the private sector,” said David Blumenthal, the president of the Commonwealth Fund.