A provision in the Senate’s veterans health access bill that would allow some vets to be seen at military hospitals is raising concerns among military advocacy groups.
The bill, passed by the Senate on Thursday, would expand veterans’ access to health care at non-Veterans Affairs Department facilities by requiring VA to contract with hospitals participating in Medicare as well as Defense Department, Indian Health Service or other federal facilities.
The initiative is aimed at helping veterans who live more than 40 miles from a VA facility or face lengthy waits for care.
But military advocates worry about the potential impact on DoD hospitals, which serve more than 4 million military personnel, family members and retirees.
In a legislative update sent June 6 to members, the Military Officers Association of America acknowledged that the bill — the Veterans Access to Care Through Choice, Accountability and Transparency Act — includes many improvements.
But it also raises concerns, MOAA officials said.
“Although MOAA is encouraged by the collaboration of both parties to find a solution to improve access, we remain concerned how this bill could impact access to military treatment facilities for current Tricare beneficiaries,” MOAA officials wrote.
Kathy Moakler, government relations director for the National Military Family Association, said her organization also is concerned about the bill’s impact on Tricare Prime beneficiaries using the DoD’s 421 military treatment facilities.
“We have access concerns, given the Defense Department already is pulling more beneficiaries back into the military treatment facilities,” Moakler said.
Military hospitals and clinics serve active-duty personnel, family members and retirees and their families enrolled in Tricare Prime, the military version of a health maintenance organization.
Depending on availability, these facilities also serve Medicare-eligible retirees and family members on Tricare for Life and some Tricare Standard beneficiaries. A handful also provide care to veterans at joint VA-DoD facilities.
Roughly 16 percent of outpatient military medical appointments go unused, according to data provided to Military Times by the services.
In 2013, an average of 18 percent of outpatient appointments at 62 domestic Air Force medical facilities went unused, while 16.3 percent of Army appointments in the U.S. went unfilled in September.
The Navy did not provide specific outpatient data, but a review of the major medical facilities found that an average of 74 percent of the population eligible for Tricare Prime at the facilities are enrolled, potentially leaving room for more patients.
Sen. John McCain, R-Ariz., co-sponsor of the Senate legislation, said veterans who can’t get care at VA for service-related conditions deserve to have a choice.
“[The bill] would empower veterans to exercise the choice — I emphasize the choice — of getting medical care from any doctor in a Medicare or Tricare program,” McCain said.
Bill author Sen. Bernie Sanders, I-Vt., said the legislation would ensure that veterans have timely access to quality care.
“At a time when 2 million more veterans have come into the VA in the last four years, we must ensure that there are enough doctors, nurses and other health care professionals to meet the needs of veterans in every facility in the country,” Sanders said.
But others are cautioning against the rush to expand use of non-VA providers. In a June 9 hearing before the House Veterans’ Affairs Committee, VA officials and a Government Accountability Office analyst discussed the complexities of sending veterans outside the VA system for care.
GAO analyst Debra Draper detailed the case of a patient who needed surgery to repair two aneurysms but was unable to have the surgery in a VA facility and did not get it scheduled for nearly two months at a private facility. The patient died before getting the needed treatment.
“While non-VA care may expand capacity, there are also some potential pitfalls. For example, non-VA care requires prior approval which may delay care,” Draper said. “More coordination is needed between the VA medical center, the veteran and the non-VA provider.”
“I think we have to watch very carefully. One of the things we’ve also learned ... is that we need to ensure that there is sufficient non-VA care coordination staff and facilities,” said Philip Matkovsky, VA’s assistant deputy under secretary for health for administrative operations.
Increased access also would not come without cost. The Congressional Budget Office said the legislation would encourage more veterans to enroll in VA care and could increase health care use among those already enrolled, since it will be easier for them to get an appointment.
The estimated total cost to the federal government, according to the CBO, is $50 billion a year — roughly the size of DoD’s entire annual health care budget now.
In recent years, the Pentagon has launched an effort to streamline the military health system and encourage beneficiaries to seek care at military hospitals and clinics, which cost the Pentagon less than paying for private-sector care.
VA has moved in the other direction, embarking on initiatives to expand private coverage for veterans who live far from VA health facilities or who cannot get a specialty appointment at the VA.
Last year, VA spent $5 billion on private-sector care. And in September, it awarded contracts worth up to $9.4 billion over five years to two health care companies to provide specialty care and mental health treatment in the private sector.
Former Tricare West Region contractor TriWest Healthcare Alliance and Health Net Federal Services, the company that manages the Tricare North Region, were chosen to run the VA Patient-Centered Community Care program.
The program is designed to make use of established health care networks and contract negotiations to provide cost-effective, efficient care when an appointment is unavailable at a local VA hospital or the facility is too far from a veteran’s home.
But while it focuses on consults and specialty care, the initiative should help release some of the burden on overcrowded VA medical facilities, said TriWest President David McIntyre.
“The first place care should be rendered is in the federal system with federal providers where it can be done. And where it can’t, we are the release valve,” McIntyre said.