Program to help vets get health care outside VA nearly bankrupt

This program is a total fraud against the veterans who try to use the card. It was not honored at all by the VA, in fact when I fractured my ankle I wanted to go to a outside doctor and the VA turned me down. It seems there were too many catch-all’s in this program and vets were  turned away.

New Hampshire Union Leader – by Gretchen M. Grosky

John O’Leary of Manchester is a Vietnam veteran who wants the Veterans Administration to pay for his health care — he just doesn’t want the agency to provide it.

“You keep hearing these stories about the VA and it’s scary. There are a lot of good regular docs in Manchester, so that’s who I try and see,” he said.  

O’Leary’s concerns about the VA health care system have been a common theme in recent years, with the VA coming under fire for long wait times to see doctors, ineffective leadership and reports of substandard patient care. Similar allegations were made against the Manchester VA Medical Center last week by some of its own doctors, resulting in the removal of two top officials.

A program aimed to fix some of these problems by allowing veterans to choose care from community providers is now coming under fire itself for many of the same issues. It’s called the Veterans Choice Program, and providers say it takes too long for veterans to be approved and it takes too long to get paid.

“It’s a bunch of bureaucratic brain damage. It’s very bureaucratic and very cumbersome, and it’s very difficult to just get approval for care,” said Catholic Medical Center Chief Operating Officer Alex Walker, a Marine veteran. “Once you have been through that bureaucratic brain damage, the second prize is you don’t get paid.”

It’s also nearly bankrupt. If Congress does not come up with a plan to address a $1 billion shortfall by Aug. 7, the program will shutter, said Dan Caldwell, policy director for Concerned Veterans of America.

Both Walker and Caldwell said the program is of critical importance in New Hampshire, the only state in the contiguous United States without a full-service VA hospital. A shutdown could force veterans to wait longer for certain services or have to travel to Boston or beyond for care.

“New Hampshire is a prime example of why you need a Veterans Choice plan, and it’s unfortunate it’s not operating as intended,” Caldwell said.

Walker agreed.

“I think there is a huge, missed opportunity in New Hampshire,” Walker said. “In light of recent allegations, it makes the availability of that choice that much more important for veterans that lost that confidence in the VA to make sure they get the care they deserve.”

Still waiting

Congress passed Veterans Choice in 2014 in response to long patient wait times at VA centers resulting in delayed treatment — and in some cases death — for veterans in need.

“The Choice program should be a terrific way for veterans to get world-class care and get it in a timely way, to get it locally, and to give them a choice,” Walker said. “They should have the right to it, and there should be very little impediment. But that’s not the way the program is working.”

To get an appointment or have a procedure done, it must be approved and booked by the third-party vendor hired by the VA called Health Net Federal Services. Walker said that’s where the bureaucracy begins and the delays in care delivery occur.

“If a veteran lives on the West Side of Manchester and they need to see a cardiologist, why should they have to wait for months on end to get an appointment locally or jump on a shuttle bus to go to Jamaica Plain (in Boston) when you can get a stress test around the corner at a world-class facility?” Walker said.

A Health Net Federal Service spokesman did not respond for comment, and the Manchester VA did not provide information on average wait times for approvals.

Part of the 2014 VA reforms was the addition of a website showing average wait times at each VA facility. A new patient can wait as few as eight days to see a primary care doctor at the Keene VA clinic or as long as 42 days at the Somersworth clinic, according to the site. The Manchester VA averages a 32-day wait time for a new primary care patient.

Delayed payments

Currently, the VA owes CMC $3.2 million — $1.2 million of which is more than 90 days overdue, Walker said. He said it’s difficult for a large facility to carry that type of burden, but said the impact is really being felt by smaller practices.

“That’s a significant amount of money for any organization, and it’s kind of reflective of the VA not fully embracing Veterans Choice,” Walker said. “For smaller providers in private practices, that’s a game-changer.”

Caldwell said the VA has a long history of late payments to providers, dating back before the Veterans Choice Program. He said in some cases providers dumped those unpaid bills back on veterans and that it seems to be happening again under Veterans Choice.

On July 10, 40 congressmen sent a letter to VA Secretary David Shulkin saying over 57,000 veterans sought help with negative credit reports after being saddled with Veterans Choice bills the VA should have paid. One of those signing the letter was New Hampshire Congresswoman Carol Shea-Porter.

“For months, I have been deeply concerned by failures in the administration of the Veterans Choice Program by the VA and its contractor HealthNet,” Shea-Porter said in a statement. “These failures include delayed or missing payments to providers, which, in some cases, have negatively impacted veterans’ credit scores after their provider reported them for nonpayment. No veteran should ever receive an unexpected bill for the care they were promised, much less suffer lifelong credit damage.”

Failure to market

CMC was a “very earlier adopter of the program and adopted it fully,” said Walker. He said there’s been less excitement from the VA.

“The program, quite honestly, is very challenging,” Walker said.

The first full year of Veterans Choice was 2015. Catholic Medical saw 70 patients, and that number grew to 173 in 2016. Walker said this year the hospital is on track to exceed last year’s numbers, with 129 seen so far. According to U.S. Census numbers, 106,000 veterans live in New Hampshire.

“We’re trending in the right direction, but we could be seeing a lot if the program were better advertised to veterans by the VA,” Walker said.

VA Communications Specialist Maureen Heard provided figures showing the number of Veterans Choice providers in the network in New Hampshire has increased 26 percent in the last year to 3,839. The number of referrals granted to New Hampshire’s veterans has remained steady over the last two years, averaging about 1,100 per month.

The future

Shea-Porter’s office said Congress is expected this week to consider a six-month funding extension of the Choice program. Caldwell said Secretary Shulkin has demanded reforms before Sept. 30, the end of the fiscal year.

Shea-Porter called the current situation “unacceptable” and said she sent a letter in April to House and Senate leaders calling for Congress to act to fix the issues with delays in access to care and payments to providers.

“I have been working to reorganize VA’s Community Care programs, including Choice, into a permanent and sustainable program that meets the needs of New Hampshire veterans,” Shea-Porter said in a statement. “The slow progress Congress has made to date is unacceptable and I will continue pushing to get this done with the urgency the current situation demands.”

Caldwell said his group is urging Congress to provide wider access to community care and providers for veterans through a system more like a private sector approach. He said the current program places too many restrictions on veterans, including geographic requirements on eligibility.

One of those restrictions is a veteran must live more than 40 miles from a VA medical facility. Only veterans from New Hampshire, Alaska and Hawaii are exempt from that restriction. New Hampshire is exempt because it has no full-service VA facility.

Walker said whatever reforms are adopted, the success will be measured by how well VA facilities embrace the Veterans Choice Program.

“It has to be continued with the full backing and support of the VA to make sure they live up to the promise of Veterans Choice Program,” Walker said. “There really needs to be a better way to provide them the care that honors their service.”

One thought on “Program to help vets get health care outside VA nearly bankrupt

  1. This has been a problem for a lot of us I live 65 miles from the VA hospital and have had to go to local ER a couple of times what a joke I get stuck with the bills

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