On Wednesday June 18th, 2014, the House Committee on Veterans’ Affairs held an oversight hearing entitled “Non-VA Care: An Integrated Solution for Veteran Access.” The Department of Veterans’ Affairs recently released an internal access audit, which revealed that more than 57,000 Veterans have been waiting 90 days or more for their first VA medical appointment and 64,000, over the last decade, never received the appointment they requested. The Department of Veterans’ Affairs has the authority to use non-VA care to ensure access to care for Veteran patients, but Veterans have still been put on long electronic waitlists.
The committee heard testimony from two panels and five witnesses. The first panel included Mr. David J. McIntyre Jr., President and Chief Executive Officer, TriWest Healthcare Alliance; RADM Thomas Carrato USPHA (Ret.), President, Health Net Federal Services; and Ms. Kris Doody RN, Chief Executive Officer, Cary Medical Center. The second panel included Mr. Randy Williamson, Director, Health Care, U.S. Government Accountability Office and Mr. Phillip Matkovsky, Assistant Deputy Under Secretary for Health for Administrative Operations, Veterans Health Administration, U.S. Department of Veterans’ Affairs.
Mr. McIntyre and RADM Carrato spoke to their organizations’ experiences with the Patient-Centered Community Care (PC3) program, the VA’s new non-VA care initiative designed to augment the VA’s ability to provide specialty care and behavioral health care for Veterans when the local VA Medical Center cannot. Ms. Doody spoke to Project Access to Care Received Closer to Home (Project ARCH), a 2011 pilot program that allows Veterans to use health care services closer to home. Each witness spoke positively about the program they had experience with.
Members of the House Committee on Veterans’ Affairs were most concerned with the lack of non-VA providers who wanted to partner with the VA, the VA’s slow reimbursement process, and the lack of data showing the costs and benefits of non-VA programs. Mr. McIntyre maintained that it is possible to form a strong network of providers by asking many providers to take on a small number of veterans and that TriWest does not have an issue with reimbursement turnaround. RADM Carrato made similar statements about Health Net, but Ms. Doody agreed with the committee that reimbursements from the VA take longer than other federal reimbursements.
Rep. Beto O’Rourke (D-TX) asked which specialized services the panel thought could be best provided by non-VA care. He thought the VA might “be better at handling PTSD and the after effects of traumatic brain injury” and wanted to know what kind of services should be moved over to the private sector. McIntyre replied that at this point that question is unanswerable, but that in 6 to 9 months, with more data and a category by category analysis of the services, it could be answered.
During the second panel, Mr. Williamson said that the VA needs to correct the ineffective claims process, have more focused oversight over non-VA providers, should communicated better with Veterans about their eligibility for reimbursements. He also said that the VA inappropriately denied 20% of the claims made by Veterans and did not always notify the Veterans that their claims were denied. Additionally, the VA does not have data from non-VA care providers about their wait times. Mr. Matkovsky explained that the VA cannot always reimburse emergency department visits, because the Veteran must meet certain requirements, but agreed that the VA needs to communicate those criteria better.
Rep. O’Rourke (D-TX) expressed disappointment over the lack of data about wait times. He said that one month ago he was told by the VHA that the wait time for new patient mental health care appointments in El Paso was zero days, but then a week ago the VHA’s audit revealed that it was actually 60 days and “if there were people being referred out into the community and that’s not being tracked we may still not have the correct [information].”
Rep. O’Rourke (D-TX) also asked about how the VA doles out money, because El Paso received $1.9 million, while Fayettville, NC received $7.4 millon. He wanted to know why El Paso received less funding when El Paso performs at the worst of all VHAs in the country in certain categories like existing patient access to mental health care, while Fayetteville does not. Mr. Matkovsky explained that one factor was because El Paso uses more non-VA care than Fayettville, but there could be other discrepancies in the two budgets that contribute to the difference.
To conclude the hearing, Rep. O’Rourke (D-TX) explained that in El Paso, “36% of veterans seeking to make a mental health care appointment were unable to obtain one at all… They call the VA, the VA says we can’t schedule you right now call back in a year.” He then asked, “How are you going to reach those veterans who attempted to make an appointment and were never in the system at all? Will you publicize a 1800 number? Can we have it and advertise it? How do we reach these folks who haven’t been able to make an appointment?”
Mr. Matkovsky replied, “Any veteran who is trying to get a hold of our system today: 1-877-222-VETS. That is our contact center in Topeka, Kansas and Waco, Texas. I urge them to call us. We will find it, we will figure out where you are, and we will get you your appointment.”