Monday’s Government Accountability Office (GAO) report hit the Choice Program on multiple fronts. Choice allows Department of Veterans Affairs health-care patients to receive services from private providers in certain circumstances. The program, created in 2014, was a response to the scandalous coverup of long wait times for service at VA health-care facilities.
But Choice was plagued with long waits, too.
While the Choice Program required that its veterans receive health care within 30 days, the GAO found that patients could wait 70 days for care, more than twice as long as mandated.
“For example, when GAO analyzed 55 routine care authorizations that were created between January and April of 2016, it found that the process took at least 64 calendar days, on average,” the report says. “When VHA [the Veterans Health Administration] analyzed about 5,000 authorizations created between July and September of 2016, it took an average of 51 calendar days for veterans to receive care.”
Timing was a problem for Choice from its creation. In a hasty reaction to the wait-time scandal, Congress gave VA only 90 days to put the program in place, a “compressed implementation time frame,” in the GAO’s words. That contributed to “programmatic weaknesses, such as insufficient provider networks, significant delays in scheduling appointments, and a lack of timely payments to network providers.”
A VA statement said the department “appreciates GAO’s review, which focuses mostly on Choice Program authorizations and analysis of the program from nearly two years ago. VA worked closely with Congress and Veterans Service Organizations on the MISSION Act, which will streamline and make many improvements to VA’s community care efforts. We look forward to implementing the important changes included in this legislation once President Trump signs it into law this week.”
The GAO report cites three reasons for the poor service: the burdens of complex referral and appointment scheduling, poor communication between VA and its hospitals, and problems with the networks of private health-care professionals, “including an insufficient number, mix, or geographic distribution of community providers.”
Having learned lessons from the Choice Program, strong bipartisan congressional majorities approved the Mission Act, which Trump is set to sign during a midday White House ceremony. It allows for a one-year transition from Choice — a more realistic start-up period — before scrapping it and consolidating the department’s seven private-provider care programs into one.
Among other things, the legislation also will help the department with personnel recruitment and expand the caregiver program to vets of any era. Currently, it supports only those who care for veterans injured on duty on or after the 9/11 terrorist attacks.
Garry Augustine, the Washington executive director of Disabled American Veterans (DAV), plans to attend the signing. The integrated network, Augustine said, is “the hallmark of the Mission Act.”
DAV and other veterans service organizations strongly resist privatization of VA health care, but they support the Mission Act and community care that supplements services coordinated by VA. About one-third of VA outpatient appointments now take place outside VA facilities. The Congressional Budget Office “estimates that in the early years of the [Mission] program, roughly 640,000 additional veteran patients would be referred out to community care each year at an average cost of $8,600 per patient.”
Fearing privatization of VA health care, the American Federation of Government Employees, which represents VA workers, and other unions oppose the Mission Act.
“We made a promise to veterans when they signed up to serve that they would be taken care of when they got home — not forced to wait in longer lines at private, walk-in clinics,” said AFGE National VA Council President Alma Lee. “These brave men and women didn’t risk life and limb to receive inferior care outside of the only health-care system tailored to their unique needs.”
But the DAV and nearly 40 veterans’ organizations don’t share those fears. They endorsed the Mission Act in a letter to Congress, saying that “the legislation would consolidate VA’s community care programs and develop integrated networks of VA and community providers to supplement, not supplant VA health care, so that all enrolled veterans have timely access to quality medical care.”
Plus, they are happy to get rid of Choice. “The Choice Program,” said Augustine, “has been problematic from Day One.”