The Veterans Choice Program for private health care is in such bad shape that the bill backed by President Donald Trump to fix it will be difficult to implement even if done right, according to the nonpartisan Government Accountability Office.
The Choice program was aimed at reducing wait times through increased access to private health care, but the GAO's performance audit conducted from April 2016 through May 2018 found that, in many cases, veterans would have been better off making appointments at VA facilities.
"Timeliness of appointments is an essential component of quality health care," the report released Monday said, but poor management and bookkeeping under the Choice program can result in veterans waiting up to 70 days to see a private doctor.
In 2016, the average wait for a private appointment was 51 days, the GAO said, although the VA eligibility rules made private care an option when the veteran had to wait 30 days to see a VA doctor.
"Delays in care have been shown to negatively affect patients' morbidity, mortality, and quality of life," the report said, and the "VA lacks assurance that veterans are receiving care from community providers in a timely manner."
At a White House ceremony Wednesday, Trump is expected to sign the VA Mission Act, which provides $4.2 billion to overhaul and expand the Choice program for private care while consolidating its seven existing care options into one.
The GAO report warned that staff shortages, bureaucratic roadblocks and poor communication between the VA and private doctors under the existing Choice program make a quick fix unlikely.
"To the extent that these factors persist under the consolidated community care program that VA plans to establish, they will continue to adversely affect veterans' access to care," the GAO said.
Citing the problems with Choice detailed in the report, the GAO said, "Ignoring these lessons learned and the challenges that have arisen under the Choice Program as [VA officials] design the future consolidated program would only increase VA's risk for not being able to ensure that all veterans will receive timely access to care in the community."
VA Pledges Action to Correct Problems
The blizzard of acronyms used by the GAO in its report, and by the VA in its response, illustrates the difficulty the individual veteran has in navigating the system.
The GAO called for better coordination among the VA's Veterans Health Administration (VHA), the VA medical centers (VACMs), the VHA's Office of Community Care (OCC), third-party administrators (TPAs), the Computerized Patient Record Systems (CPRS), the Community Care Network (CCN) and private doctors themselves, who often complain of late payments.
In its response to the GAO report, the VA concurred with four of the five recommendations for improving the transition from the Choice program to the VA Mission Act but disagreed with the GAO on urgent care.
The GAO found that "VAMCs and TPAs do not always categorize Choice Program referrals and authorizations in accordance with the contractual definition for urgent care."
The GAO said that a referral to private care is to be marked "urgent" when a VHA doctor determined that it was essential and "if delayed would likely result in unacceptable morbidity or pain." However, the GAO found that some referrals originally marked as routine were changed to urgent to speed up the slow appointment process.
Even that conclusion was difficult to reach because of the VA's lack of reliable records and data, the GAO said. "Without complete, reliable data, VHA cannot determine whether the Choice Program has helped to achieve the goal of alleviating veterans' wait times for care," the GAO said.
In its response to the report, the VA said that the GAO's recommendation on urgent care "is no longer needed because VHA has resolved the issue with the new CCN (Community Care Network) contract."
Under the new contract, VHA staff will have responsibility for scheduling community care appointments with providers, as opposed to the old system in which administrators routed referrals to the TPAs (third-party administrators), the VA said.
In the transition from Choice to the VA Mission Act, the VA will also set up a new referral and authorizations system that will be called "Health Share Referral Manager (HSRM)."
The VA said that HSRM will "measure the time it takes to review and accept consults, prepare referrals and schedule veterans community appointments."
The VA in Flux
The VA Mission Act has been estimated to cost as much as $55 billion over five years. Sen. Johnny Isakson, R-Georgia, chairman of the Senate Veterans Affairs Committee, has said that funding sources have yet to be identified, but he was confident they would be found.
When Trump signs the bill Wednesday as one of the major achievements of his administration, he will not have a VA secretary looking over his shoulder.
Robert Wilkie, who had been the Pentagon's undersecretary for personnel and readiness, was named acting secretary after Trump ousted former VA Secretary Dr. David Shulkin in March.
However, Wilkie stepped down as acting secretary last week to get around a law that made it questionable whether an acting secretary could succeed to the permanent post.
Trump has said that he intends to nominate Wilkie to the permanent job, but the Senate has yet to set a date for his confirmation hearing. In the meantime, Peter O'Rourke, who had been the VA chief of staff, has become acting secretary temporarily.
Its major proponents have acknowledged that the VA Mission Act and the overhaul of Choice will be difficult to implement.
At a panel discussion last month sponsored by the Concerned Veterans for America, which lobbied hard for the expansion of private care, Rep. Phil Roe, R-Tennessee, chairman of the House Veterans Affairs Committee, said that putting the VA Mission Act into effect will sorely test the VA.
"Let me tell you, it is a painful thing to do," Roe said. "This is a massive undertaking. It could be very disruptive to the VA. It's humongous."
-- Richard Sisk can be reached at Richard.Sisk@Military.com.