GAO: Vet Wait Times in Private Care Not Known

Lawmakers hoping to end long wait times for veterans seeking Department of Veterans Affairs' health care by sending more of them to private or community providers may first want find out what the wait times are for vets already going outside the VA.

Currently, the VA does not track the wait times of these veterans, so it cannot compare how they stack up against those of veterans receiving in-system care, the director of the General Accountability Office's health team told Congress on Wednesday.

"At the national and local levels the VA does not have the oversight system in place to monitor the non-VA program," Randy Williamson said. Because of that, wait times for veterans in non-VA healthcare could be a problem, as well, he said.

"Once a veteran is authorized to use the [non-VA] care, the VA does not track how long the veteran waits to see the provider. So little is known about wait times for [these] veterans," he said.

Last year the VA paid $4.8 billion to non-VA providers for the care of one million veterans, said Williams, one of several witnesses who testified before the House Veterans Affairs Committee on Wednesday.

VA investigations have confirmed April media reports of a secret patient wait list and veterans dying waiting to see a doctor at the VA Medical Center in Phoenix, Arizona.  Investigators also found that manipulation of appointments is a systemic problem across the VA.

In Phoenix, where CNN reported up to 40 veterans died before being seen, VA investigators confirmed that appointment wait times were manipulated and also confirmed 35 deaths.

A VA audit of its hospitals and clinics also found that 57,000 veterans had been waiting 90 days or more for their first VA medical appointments and 63,000 other veterans had never received appointments over the past 10 years after enrolling and requesting them.

Since the audit last month, the VA has moved quickly to contact the veterans and get them in for appointments.

In Washington, the secret wait lists and veteran deaths prompted senators and representatives from both parties to demand veterans have access to private practices and community hospitals in order to access timely heath care.

A Senate bill sponsored by Sens. Bernie Sanders, I-Vt., and John McCain, R-Ariz., would provide a "choice" card to veterans enrolled in VA health care that would allow them to get care at any community hospital or practice.

The legislation, which includes other steps aimed at cutting down patient wait times, as well as provisions dealing with military sexual assault and veterans' education, passed the Senate and a compromise bill is now being worked out House lawmakers.

"My hope is that use of such a card will not be necessary," said David J. McIntyre Jr., president and chief executive officer of TriWest Healthcare Alliance, which contracts with DoD to coordinate and administer Tricare services, and with the VA for its Patient-Centered Community Care program, which gives veterans access to specialty care. 

McIntyre said that TriWest, the VA and Congress should be able to customize the program to better meet veterans' needs. 

Thomas Carrato, president of Health Net Federal Services, which provides regional oversight of Defense Department's Tricare program and the VA's PC3 program, said "a card for unfettered access to providers may sound attractive to some."

"But ... what I think we need is to make sure we built an integrated, coordinated [delivery] system," said Carrato, a retired Navy rear admiral. "Our network and TriWest ... we fully credential the providers. We know who the quality providers are. The key is that we augment the VA's brick and mortar [facilities]."

During his testimony, Williams also told lawmakers that GAO in March reported serious compliance issues with the VA's programs for using outside health care providers and facilities.

Of 128 claims it reviewed for emergency care at non-VA facilities, GAO found the VA inappropriately denied payment in 20 percent of the cases. VA clerks "made mistakes ... and were sloppy in their procedures for processing the claims," he said.

Also, the VA did not always inform the veteran that the claim was denied, he said.

"Some veterans likely were billed for care that the VA should have paid for, and those not notified by VA were denied their appeal rights and were unaware they were liable for pay8ing bills [to] non-VA providers," he said.

-- Bryant Jordan can be reached at bryant.jordan@monster.com.