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Report on VA Calls for Network of Public-Private Care Providers

VA Healthcare

A long-awaited report released Wednesday on the nation's troubled veterans' health care system recommends 18 "bold" changes, including creating a new network of public-private care providers, to address the crippling wait times and other problems at Department of Veterans Affairs.

The Commission on Care called its report a "foundation for far-reaching organizational transformation," yet two members of the task force issued their own scathing dissent, saying the recommendations don't go nearly far enough to fix a failed system that needs a sweeping overhaul.

Debate over reform at the VA has been growing in the two years since the discovery of long appointment wait times revealed a pattern of data manipulation and poor access for veterans at VA medical centers across the country. Since then, promised reform has sparked volatile discussion. Controversial calls to close the VA and offer veterans privatized care, supported by the two dissenting commissioners, prompted unified opposition from major veterans organizations and sparked street protests by unionized VA workers.

The report submitted to VA Secretary Bob McDonald and President Barack Obama did not go that far, but it did identify a troubled system. The 15-member commission, created by Congress in the wake of the wait times scandal, found that despite billions of dollars spent to improve the sprawling health care system, the VA is still failing to provide adequate access to high-quality care. It suffers from flawed leadership, inadequate staffing, procurement problems and an antiquated IT system.

In their recommendations, the majority of commissioners endorsed a public-private network of community-based care that would replace the flawed Choice Program meant to give veterans access to private care when needed. They also called for creating a governing board to oversee reforms and operations at the Veterans Health Administration.

Under the Choice Program, also set up in the wake of the scandal, veterans were supposed to be able to get medical attention outside the VA if their doctor wait was more than 30 days or they had to travel more than 40 miles. But veterans had trouble getting those visits approved and getting reimbursed for out of pocket expenses. Under the proposed plan, those requirements would be scrapped and veterans would have a choice of medical providers from a network in their community that includes VA, federal and private doctors and specialists.

"The commissioners ... agree that America's veterans deserve much better, that many profound deficiencies in VHA require urgent reform and that America's veterans deserve a better organized, high-performing health care system," they wrote. "These recommendations are not small-scale fixes to finite problems. Instead they constitute a bold transformation of a complex system that will take years to fully realize."

Other reforms include cultural and leadership changes from creating an 11-member board of directors -- a move Congress would have to legislate -- to developing a leadership promotion pipeline. One recommendation suggests revising regulations to allow care for veterans with other than honorable discharges who are deemed eligible because of mitigating factors like combat trauma or injuries.

"While the Commission on Care's nearly 300-page report will take time to completely review and digest, the document makes it abundantly clear that the problems plaguing Department of Veterans Affairs medical care are severe," said Congressman Jeff Miller, R-Florida, who chairs the House Committee on Veterans' Affairs.

He said the committee would review the report in detail in September when Congress reconvenes. Many of the recommendations could be implemented directly by Obama, though some reforms, like a governing board, would still require congressional action.

In a six-page dissent, commissioners Stewart Hickey and Darin Selnick charged that the commission had missed an opportunity for true reform of a system suffering from "bureaucratic paralysis."

Selnick is a former VA employee and a senior adviser on veterans affairs for the conservative group Concerned Veterans for America, which has advocated for turning the VA into a non-profit government corporation that would give veterans a wide choice of care. Hickey is a retired Marine major and was executive director of the service organization American Veterans.

They welcomed some of the proposals, including a plan for the VA to repurpose or divest itself of underused facilities, but said other proposals would "only superficially and temporarily move the VHA out of its current state of dysfunction."

Carlos Fuentes, deputy legislative director at the Veterans of Foreign Wars (VFW), said Wednesday the veterans organization agrees with the commission's proposal for integrated care, but cautioned that the VA must remain the coordinator.

"We agree with the model, but how veterans navigate it and what role the VA plays, that is something we have to iron out," he said.

The VFW's National Commander John Biedrzycki shared similar concerns about the integrated care network, saying that the VA must develop a process for veterans to make informed choices.

"What we can't support is veterans being given a list of primary care providers and told to go find someone willing to see them," Biedrzycki said in a statement. "That's not a choice, that's shirking inherent responsibility to care for our nation's wounded ill and injured veterans."

Along with Selnick and Hickey, a third commission member also refused to sign the report. Michael Blecker, executive director of the nonprofit Swords to Plowshares, drafted a letter saying he believed the recommended community care plan was a "dangerous idea" that would "threaten the survival of our nation's veteran-centered health care system as a choice for millions of veterans who rely on it."

Blecker said many sick or elderly veterans rely on VA coordination and want more of it, not less.

McDonald said he will examine the report in the coming weeks, but was pleased to see that many of the recommendations are in line with his own vision for the VA.