Non-VA Care: An Integrated Solution for Veteran Access






Non-VA Care: An Integrated Solution for Veteran Access   

WASHINGTON, D.C.                                                                                        June 18, 2014   


On behalf of the men and women of the Veterans of Foreign Wars of the United States (VFW) and our Auxiliaries, I would like to thank you for the opportunity to submit for the record regarding non-VA health care.   

The recent events at the Phoenix VA Medical Center and the subsequent national audit of all VA facilities have shed light on the fact that many facilities lack the capacity to meet demand for care.  This means that access is insufficient, leading to a diminished level of care, which in some cases could be life threatening for veterans in need of essential services and procedures.  The VFW finds this absolutely unacceptable and appreciates the urgency with which Congress is acting to address this problem. 

VA must use all available tools to provide timely access to care, including non-VA care when necessary.  Ideally, VA would have the capacity to provide timely, quality direct care to all those who need it.  We know, however, that they currently do not.  Although the VFW supports expanding VA infrastructure and hiring enough health care professionals to meet demand at Department facilities, we recognize that these improvements will not happen overnight.  Veterans cannot be allowed to suffer in the meantime, and non-VA care must be used as a bridge between full access to direct care and where we are now.

It is vitally important that VA remains the guarantor of care, wherever that care is provided.  This means that VA facilities must refer veterans to community providers using a system that requires full coordination and guarantees access and quality.  Under the old fee basis system, VA would issue veterans in need of non-VA care authorization letters.  It would then be up to the veteran to shop this letter around, searching for a community provider who was willing to accept the authorization and could schedule an appointment in a timely manner.  Following the appointment, the veteran would be responsible for returning any records to VA, in order to have them included in the veteran’s VA medical record.  This system was entirely uncoordinated, failed to guarantee access or quality, and was highly susceptible to improper billing.

The dangers of uncoordinated care are well documented.  An April 2013 OIG report revealed the mismanagement of non-VA care at the Atlanta VAMC in which approximately 4,000 veterans were referred to non-VA mental health providers without an adequate tracking system.  OIG found that this led to an average wait time of 92 days, with 21 percent of veterans receiving no care at all, and never receiving any follow up from the VAMC.  Even VA staff admitted to OIG that, due to the large number of referrals, many veterans had “fallen through the cracks.”  The lesson from Atlanta is clear: VA must not be allowed to push large numbers of veterans to outside providers without proper coordination simply to create the appearance that access is being provided.

In order to address the problems of non-VA care, VA developed a new contract care model, Patient-Centered Community Care (PC3).  Under this program, networks of specialty care providers were created across the country to provide care at pre-negotiated rates in a well-coordinated manner.  According to VA, veterans will be referred to PC3 providers if direct care cannot be readily provided due to lack of available specialists, long wait times, or geographic inaccessibility. 

In theory, this program should help solve the access problems that have been plaguing many VA facilities.  The program cannot succeed, however, if individual facilities are not open and honest about access to care issues and appointment wait time data continue to be unreliable.  We believe that VA must develop and implement wait time standards that would trigger PC3 referrals, and enforce those standards at each facility.  Rather than an arbitrary number of days, these wait time standards should be developed based on the type of care being provided and the immediacy of the individual veteran’s need for that care, based on a physician’s medical opinion. 

Although the VFW supports PC3, we will be watching its progress closely, and ask Congress to conduct robust oversight to ensure it is being utilized to its full potential.  Specifically, we will want to know which facilities are using PC3 properly to reduce actual wait times, and which are not.  If it appears that certain facilities are not making proper referrals due to improper training, lack of standards, or institutional resistance, VA must move swiftly to correct those problems.  If PC3 is not being used effectively due to insufficient funding at the local level, we will call on VA and Congress to work together to get them the resources they need.

The PC3 program is new, and we recognize that the capacity of its networks may not immediately be sufficient to provide timely access for all specialties.  In addition, PC3 is not currently set up to provide primary care.  Consequently, it may be necessary for some facilities to enter into local contracts for specific services.  Under no circumstances should veterans be expected to coordinate their own care or be held responsible for record sharing when receiving care outside of VA.  The VFW believes that all contracts should include provisions that ensure the same level of coordination, access, and quality as the PC3 contracts.  Anything less would not only fail to address the access problems many VA facilities are facing, but would also represent a huge step backwards in the evolution of non-VA care.

Mr. Chairman, this concludes my testimony and if you or the Committee has any questions, I would be happy to respond to them for the record.