A Senate hearing and GAO report called into question VA preparedness for its community care programs, as well as potential VA privatization.
The Department of Veterans Affairs is under scrutiny about the preparedness of its Veterans Community Care Program, a consolidated community access program set to improve patient care access.
Earlier this week, VA staffers faced questioning from the Senate Committee on Veterans Affairs about whether the VCCP is ready for its June 6 launch and whether its community care protocol will actually lead to privatization of the VA.
The VCCP is the consolidated community care program that came out of the VA MISSION Act, signed into law in June of last year. The MISSION Act, among other things, combines the VA’s various community care programs, including the Veterans Choice program. These programs aim to connect veterans facing extraordinary circumstances with care from non-VA, community care providers.
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The new community care programs are set to launch on June 6, 2019. However, some lawmakers have expressed concerns that VA may be unprepared to successfully carry out that launch while still preserving the integrity of care delivered at VA facilities.
At the Senate hearing, VA representatives heard from ranking member Jon Tester about concerns for VA privatization.
“Since the Mission Act was signed into law, my concern is that VA’s primary focus is supplanting in-house care, as opposed to supplementing that care when it makes the most sense for veterans,” Tester said in his opening remarks. “In its rush to open the door to the private sector, my concern is that VA is outsourcing its responsibility to ensure veterans receive timely and high-quality care.”
Tester acknowledged VA’s limited knowledge about the timeliness of veteran community care access as well as the quality of care delivered, despite VA promises to allocate funds to community providers who deliver top-notch care.
“So on one hand, VA doesn’t have a clear understanding of how much this Program will cost. And on the other, VA openly states that it would make funding decisions based on whether its facilities are meeting the standards it fails to enforce on the private sector,” Tester said. “What I see is behavior that smacks of a deliberate effort – not to implement the best policy but to carry out a political agenda.”
For its part, VA worked to assuage some of those concerns. Richard A. Stone, MD, VA’s executive in charge, said VA indeed prioritizes its own responsibilities to veteran care and that the VCCP program will be ready to launch on June 6.
“It is important to note that the proposed Veterans Community Care Program does not supplant VA’s mission to provide care in VA facilities to Veterans who have earned it,” Stone said during the hearing. “VA’s proposed access standards will complement existing VA care by providing Veterans with greater choice to receive care in the community based on their individual needs and preferences.”
But recent reports confirm Tester’s fears, at least insofar as launch preparedness goes. A recent Government Accountability Office report indicated that VA has insufficient systems to successfully carry out VCCP. The report also suggested that VA has not actively heeded advice to improve its VCCP systems.
For example, VA still struggles with timely patient access to community care. Convoluted referral and appointment scheduling processes, poor communication between VA and its facilities, and inadequate numbers of providers in community care networks serve as obstacles.
These issues are not new, GAO reported, and while there are some systems intended to address issues, VA has not fully carried them out.
For example, previous GAO recommendations called for improved care coordination and better patient data exchange between TPAs, VA, and community care providers. While VA agreed with each of those recommendations, they have not actually addressed them, GAO stated.
Additionally, VA has fallen short addressing problems with insufficient data. Specifically, VA lacks the data to monitor timely care access.
Again, this area is one that GAO has previously addressed. In a June 2018 report, GAO suggested VA implement systems to monitor the amount of time taken for referrals, schedule appointments, and complete appointments. VA agreed with those recommendations but has not yet put those systems in place.
Finally, VA is unable to make timely payments to community care providers. VA is untimely in its payments to third-party administrators, which handle the referral and scheduling process for veterans. In turn, TPAs are unable to make timely provider claim payments.
Additionally, Veterans Choice has unintuitive reimbursement requirements and inadequate provider education that have led to claims denials.
VA has taken some steps to address these issues. For example, the agency has changed some reimbursement requirements.
But VA is lagging in making improvements in two other areas. GAO previously recommended VA collect data on and monitor customer service within community care clinics, but the agency has not yet addressed those suggestions.
In total, GAO issued twelve recommendations targeting each of the three above mentioned areas. These recommendations also echoed previous ones GAO made to VA. Although VA did object to one of GAO’s recommendations, GAO maintained that all are essential to launch VCCP and serve veterans in VA facilities.
Date: April 18, 2019
Source: PatientEngagementHIT