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Senators question value of contracted VA care

A Senate committee reviewing the increased use of contracted health care for veterans disability exams and treatment is growing increasingly skeptical that this is a cheaper or higher-quality alternative to using Veterans Affairs Department health care workers.

About one-quarter of the medical exams required for compensation and pension claims are handled by contract doctors as part of an effort launched in 1996 to address delays in getting appointments.

VA also has turned to contractors under a pilot project to provide specialty care not available — or not available without a long wait — at veterans hospitals and clinics, and general and specialty care in rural areas or other locations far from VA facilities.

But the Senate Veterans’ Affairs Committee, which endorses the idea of reducing appointment wait times, is not sure the increased reliance on contract health care is a good thing.

Sen. Jon Tester, D-Mont., said he doubts that an exam to determine a veteran’s disability rating could be done as accurately by a contract doctor as by a VA physician with years of experience.

Sen. Richard Burr, R-N.C., said he has heard from a North Carolina urologist who has decided to stop providing contract care to veterans because VA does not provide enough information about a veteran’s medical condition in advance of an appointment, and does not do a good enough job monitoring patients who had a one-time visit with a contract specialist.

And, Sen. Roland Burris, D-Ill., pressed VA officials — without getting a direct answer — about why the department does not try to hire more doctors in places like the Washington, D.C., area, rather than rely on a contractor to provide disability exams.

A psychiatric clinical nurse testifying before the committee on behalf of the American Federation of Government Employees, an employee union, called contract care “over-utilized and under-scrutinized by many VA facilities in both rural and urban areas” and questioned whether reliance on contracts as a short-term fix for staff shortages and long patient waiting lists was in the best interests of veterans.

“Contract care requires that VA give up a certain degree of control to a for-profit outside entity,” said Mary Curtis, a nurse and clinical care coordinator at the VA medical center in Boise, Idaho.

“In the short term, the effect is that VA may be less able to control costs, quality of care, provider qualifications and medical privacy or ensure that care is delivered timely and is geographically accessible,” Curtis said. “In the long term, excessive use of contract care may deplete the VA health care system of the staff, equipment and other resources it needs to continue to provide veterans with a full range of services. The diversion of large numbers of veterans to contract providers may also weaken VA’s research capacity and academic affiliations.”

VA officials and representatives of the major health care contractors defended the quality and cost of care.

Tim McClain, president and chief executive officer of Humana Veterans Health Services, which provides specialty care, said his company does not undermine VA. He called his company’s work an “effective backstop.”

VA officials said they are restructuring their contract oversight from local authority to more centralized control so they can better monitor services and costs.