On January 28th, Democratic Senator Jon Tester, Minority Leader of the Senate Committee on Veteran Affairs and 28 other Democrats sent a letter to VA Secretary Wilkie stating their disappointment with his lack of consultation with Congress.
It questioned his lack of transparency in creating the recently proposed rules for veterans to access for-profit Non-VA health care, and whether the rules will be truly compatible with the intent of the new Veterans Community Care program passed by Congress. The letter also stated: “Given that the administration opposes increasing overall federal spending [including for the VA… emphasis added], these increased costs for community care will likely come at the expense of VA’s direct system of care. And that is something we cannot support.”
Then, on January 30th, VA Secretary Wilkie announced the proposed rules, that will determine how veterans gain access to this private-providers network. His plan is to base access on both “wait times” for appointments and on “drive times” to VA facilities. According to Suzanne Gordon of the Veterans Health Policy Institute (VHPI): “… According to internal VA estimates, the rule change could channel up to 63 percent of [VA] patients into the private sector. What’s worse, every dollar spent on outsourcing would come out of the [VA] medical care budget. This could quickly drain resources from [VA] facilities and programs, which are already understaffed and over-stretched.”
In my opinion, the 2018 MISSION Act was sold to the public, and most veterans groups, as a better way to give greater health care access to veterans who don’t live close to VA hospitals or clinics …but at the expense of VA-based care. Theoretically, greater access should be good for veterans! But access to “for-profit” health care networks does not automatically mean veterans will receive the same high quality care that the VA provides. Multiple studies (e.g. William B. Weeks, Dec. 2018, Annals of Internal Medicine) show that “for-profit” care is at best only equal to VA care, but often of lesser quality.
Even Secretary Wilkie, citing several academic studies, has stated that: “Since 2014, the number of annual appointments for VA care is up by 3.4 million, with over 58 million appointments in fiscal year 2018. Simply put, more veterans are choosing to receive their health care at VA. Patients’ trust in VA care has skyrocketed – currently at 87.7 percent– and VA wait times are shorter than those in the private sector in primary care and two of three specialty care areas.”
Now, given this stellar characterization of VA health care, you would think Secretary Wilkie would call for expanding the VA and for greater funding and staffing of the VA nationally to resolve issues of both veteran travel and wait times. But, in contradiction to his cited studies, he calls for more private-sector health care for veterans.
I have many concerns about these rules, including: Will the VA establish standards of credentials, training and competence for private-sector Veteran Community Health Care equal to that required of VA doctors, nurses and staff?
I call for amending the 2018 MISSION Act as follows:
• Fund the VA MISSION Act so that Veteran Community Health Care – provider funding does not come from the VA budget, VA facilities, or its programs. Many veterans with service-connected conditions and low income veterans rely on the VA for their complete care. They should not experience additional costs in the form of copays nor a decrease in service to primary and specialty care at VA facilities.
• Ensure that the proposed rules require these private sector providers deliver the same high level of care and staff credentialing as the VA.
• Require that these private sector providers must use evidence-based care for treating PTSD, traumatic brain injury (TBI), and are knowledgeable about how to care for veterans who have experienced military sexual trauma (MST).
• Require that these private sector providers always submit thorough documentation (not just invoices) to the appropriate VA facility / VA medical staff regarding the care delivered to the veterans. And, if these providers fails to meet this obligation, the VA must withhold payment from them.
• That if these private sector providers cannot provide comparable or better care than the VA, they should not be offered as an option to veterans, regardless of the drive time or distance from a VA facility.
• That VA and Medicare websites must include options to search for healthcare providers based on their proficiency in treating specific medical conditions like PTSD and TBI. Private sector providers would only be added to this website if they are qualified to care for patients with PTSD, TBI, and other veteran-related medical conditions.
Jeff Roy, Vietnam Combat Veteran
St. Louis Park, Minnesota
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