Pentagon & Congress

VA’s community care programs lack wait-time standards and proof of success, critics charge

Programs granting veterans broader access to doctors outside the Veterans Affairs health care system were supposed to speed up times for medical care. Now House Democrats are charging it may be slowing down appointments instead.

On Wednesday, members of the House Veterans' Affairs Committee blasted administration officials for failing to set clearer guidelines for VA’s community care programs despite repeated warnings from watchdogs that such limits were needed to ensure the best care for veterans.

President Donald Trump has repeatedly touted changes to the Veterans Affairs community care program as a signature achievement of his term in office, claiming that veterans can now get faster and better care because of more available choices outside the federal health care system.

However, in a report released earlier this week, Government Accountability Office researchers said VA leaders for the last seven years have not established any wait-time performance measures for the outside medical appointments, even though VA’s in-house wait times face heavy scrutiny.

“Without a wait-time performance measure, VA cannot determine whether the (community care program) has helped the department achieve its goal of reducing veterans' wait times for receiving care,” said Sharon Silas, director of the GAO health care team.

Critics said that undermines Trump’s promises that shifting funding and resources to outside health care programs would ultimately benefit veterans.

“When the president signed the Mission Act into law in June 2018, he promised that the expansion of VA’s community care program would end the problem of veterans standing in line for weeks and weeks and weeks to see a doctor,’” said Rep. Julia Brownley, D-Calif., chairwoman of the committee’s panel on health care.

“For the first time we have data that clearly shows this program is not great, and it is not delivering on President Trump’s promise to veterans of more timely care. It should come as no surprise that veterans are still standing in line for weeks and weeks and weeks to see community providers.”

Steven Lieberman, acting Principal Deputy Under Secretary for Health at the Veterans Health Administration, said on urgent referrals to outside physicians, VA has made sure that veterans are seen within two days.

But he noted that wait time standards for the outside care are not mandated under the law, and said they may not be practical in some cases.

“If I want to have cataract surgery, and I want to go to the community because I’m eligible, and I want the best cataract surgeon in the state,” he said. “I may have to wait longer if we were to put on a requirement for a timeframe. We may lose a lot of providers who are unwilling to move a veteran ahead.”

The issue of expanding community care programs has been contentious within the veterans community, with critics saying it amounts to partial privatization of VA responsibilities. Committee Chairman Mark Takano, D-Calif., said the latest GAO findings again raise concerns about the role of the program.

“In the wake of the wait time scandal of 2014, access to care in the community was touted as the cure all,” he said. “Yet this latest report suggests veterans are potentially waiting longer to access care in the community than if they opted to remain at VA because of an overly bureaucratic, administratively burdensome appointment scheduling process.”

GAO officials earlier this week recommended new legislation to force VA officials into wait-time standards for the outside care programs. Brownley did that on Tuesday, including in the measure requirements that VA publish wait times for community care in the same way they do for VA services.

The measure is unlikely to become law this year, given the short time frame left in Congress' legislative schedule due to the upcoming November elections.

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