Acknowledging that the Veterans Affairs Department's private health care referral system is "too complicated" and "saddled with a confusing array of authorizations and mechanisms," VA officials pressed lawmakers Wednesday to consider streamlining several programs into a single initiative designed to improve veterans access to medical services.
The ambitious plan would combine seven VA community health care programs, including the newest and largest, VA Choice, into a New Veterans Choice Program, with clearer eligibility rules, improved access to care and faster payments to participating providers.
Deputy VA Secretary Sloan Gibson told members of the House Veterans' Affairs Committee that the move is necessary to create the "Choice program of tomorrow."
"Consolidation will improve access and make the process easier for veterans to use," Gibson said. "Veterans will have better access to the best care outside VA, providers will be encouraged to participate and to provide higher-quality care, and VA employees will be able to serve both better, while also being good stewards of taxpayer funds."
VA was required to submit a proposal for merging its community care programs under the Surface Transportation and Veterans Health Care Improvement Act, passed by Congress in July.
The requirement is aimed at eliminating duplication in programs and gaps in the referral system for private care through VA.
The VA Choice program was rolled out earlier this year to solve problems with veterans waiting weeks or months for appointments and or living at least 40 miles from a VA hospital or clinic.
But the department already had a number of smaller private-care agreements and contracts, creating confusion for patients, VA employees and private doctors.
The $16 billion VA Choice program also has been beset with problems, ranging from a lack of awareness of the program among VA employees to payment delays to providers to misunderstandings of the benefit among veterans.
And since VA Choice was launched, the number of veterans waiting more than 30 days for an appointment actually has grown — to 550,000 from 300,000.
Gibson said the longer wait lists are largely the result of "more veterans coming to us for more care."
"Having said that, we complete mental health appointments within three days, primary care, four days, specialty care about six days ... that's the average," he said. "We are providing a lot of timely access to good care care, but we fail to do that consistently in every instance."
Roughly 10 percent of all medical appointments made through the VA are for private care.
Under the New VCP program, VA would establish a single set of eligibility criteria for private care; expand access to emergency treatment and urgent care; simplify the referral and authorization system; and improve the claims, billing and reimbursement processes.
The health care network under New VCP would be larger as well. The plan calls for VA and other government health care networks to serve as the core for providing health care services and a large external network of commercial and preferred providers to provide both primary care specialty services.
VA estimates the cost of the redesign alone would run between $1.2 billion and $2.4 billion over the first three years.
VA spent roughly $7 billion per year on commercial health care services before implementing the Choice program, and officials say Choice is likely to cost $6.5 billion per year if allowed to continue as is.
The cost estimates do not include the price tag for improved medical records management, which VA officials say will be necessary to support effective care coordination.
To implement the plan, VA needs congressional approval of at least 10 legislative bills, including amendments to existing law and some proposals already in the works.
Committee members on both sides of the political aisle seemed receptive to the plan, but it may face opposition in the sharply divided House, where conservatives have spoken in favor of increased privatization of VA care, while liberals have voiced support for increasing the size of the VA.
Rep. Jeff Miller, R-Fla., House Veterans Affairs Committee chairman, said allowing veterans to get care from private physicians at government expense is an "increasingly viable component of the health care system at VA."
"As the veterans population grows in age and number, and as the healthcare landscape shifts, the need for non-VA providers to supplement — note, I said supplement, not supplant — the care VA provides in-house will only continue to grow," Miller said.
Second-term Rep. Beto O'Rourke, a Texas Democrat who has floated his own plan to VA for fixing the department's health care system in his district — ranked second-worst for access to mental health care among the VA's 157 medical centers across the country — called the new consolidation plan a "high-water mark for collaboration with VA" in his legislative career.
"How grateful I am for this initiative for the veterans in my district," he said. "It's restoring VA to its rightful place as a leader in American health care, which should be setting the standard and known for excellence and figuring out problems."
Veterans groups, including Disabled American Veterans, Paralyzed Veterans of America, and the Veterans of Foreign Wars, called the plan "an important step in the right direction to provide veterans with high quality, comprehensive, accessible, veterans-centric care."
The groups noted their opposition to two specific proposals in the plan: $100 copayments for emergency care and $50 copayments for urgent care services, and requirements for veterans to report whether they have other health insurance.
Still, they praised the plan for seeking "to move beyond arbitrary federal standards regulating when and where individual veterans can access medical care."
"[This] keeps those clinical decisions between a veteran and his or her doctor, without bureaucrats, regulations or legislation getting in the way," they wrote.
Pete Hegseth, CEO of the conservative group Concerned Veterans for America called the proposal a "cosmetic solution" for the systemic problems at VA.
"This program is nothing new but was mandated by a measure passed by Congress in July that, ironically, granted the VA's request to raid the current Choice Card program to the tune of $3.3 billion to pay for its mismanagement of other programs," Hegseth said. "Worse, it does nothing to remove the VA as the final authority on veterans' health care decisions and empower veterans to make those choices."
Patricia Kime is a senior writer covering military and veterans health care, medicine and personnel issues.