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June 7, 2018

New law will overhaul how VA coordinates with private providers

Daily Briefing

    President Trump on Wednesday signed into law a bill (S 2372) to revamp the Veterans Choice Program (VCP), just days after a report showed veterans seeking private care under the program were experiencing long wait times.

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    About VCP

    VCP aims to increase veterans' access to health care by providing them with federally subsidized care at non-Veterans Affairs (VA) facilities. Veterans are eligible to use the program if they have been waiting more than 30 days for a VA health care appointment, if they live 40 miles or farther from a VA facility, or if they face undue burdens accessing care at VA medical centers.

    However, the program has faced funding issues, and veterans advocates have criticized the program, saying its eligibility requirements are cumbersome and citing delays in reimbursements for care provided by private providers.

    Report finds veterans using VCP experienced long wait times

    In addition, a Government Accountability Office (GAO) report released Monday found instances in which veterans seeking care through VCP in 2016 had to wait longer than 30 days for an appointment, which GAO said raises questions about whether the program has improved veterans' access to timely care.

    GAO reviewed samples of VCP care authorizations in 2016, and found that:

    • Out of 55 routine care authorizations created between January 2016 and April 2016, it took an average of at least 64 days for veterans to receive care; and
    • Out of 5,000 authorizations created between July 2016 and September 2016, it took an average of 51 days for veterans to receive care.

    GAO wrote that those timelines are "not consistent with the statutory requirement that veterans receive [VCP] care within 30 days of their clinically indicated date (when available)."

    GAO said the Veterans Health Administration (VHA) does not have the ability to "systematically monitor the timeliness of veterans' access to [VCP] care because it lacks complete, reliable data to do so." GAO also said VCP's short implementation timeline, which had lasted about three months, had not been adequate to properly create and administer the program.

    Trump signs bill to replace VCP, expand veterans' access to private care

    But Trump on Tuesday signed legislation that will replace VCP with a new program that aims to further expand veterans' access to private care.

    The legislation, called "The VA MISSION Act of 2018," allocates $5.2 billion to fund VCP until it can be replaced with the new program, called the Veterans Community Care Program. According to a summary of the bill, VA providers under the new program will be required to:

    • Coordinate coverage for veterans who use health care services outside of the region in which they live;
    • Ensure continuity of health care services and care;
    • Ensure that veterans can schedule medical appointments "in a timely manner"; and
    • Ensure veterans do not experience lapses in health care.

    Under the new program, veterans will be able to access "community care" if they live 40 miles or farther from a VA facility "and mee[t] certain other criteria," or if a veteran and his or her "referring clinician agree" that receiving community care "would be in the best medical interest of the veteran," after considering certain criteria. In addition, veterans under the new program will be able to access "community care" if VA:

    • Cannot provide the services a veteran needs at the same level of quality "when compared with two or more distinct and appropriate quality measures at non-VA medical service lines";
    • Cannot provide the services a veteran needs within a timeframe comparable "with the same medical service line at different VA facilities";
    • Does not operate a full-service medical facility in the state in which a veteran lives;
    • Does not provide the services a veteran needs; or
    • Is not able to provide care "within the designated access standards established by VA."

    Veterans under the new program also will be permitted to access "walk-in care" at community providers that have contracted with VA if the veterans have "used VA health care services in the 24-month period before seeking walk-in services."

    According to the summary, VA under the new law also will create "a prompt payment process" under which VA will pay or deny payment to community health providers within 30 days of receiving an electronic claim for rendered services or within 45 days of receiving a paper claim for rendered services.

    The new law also requires VA to create and implement an educational program intended to inform veterans about their health care options, as well as a program to train VA staff on how to implement the new program. The law also calls for VA to create certain policies to govern how community care providers should interact with VA, including policies on opioid prescribing, medical record sharing, and certain "competency standards" for "treating veterans for injuries and illnesses that VA has a special expertise in, such as post-traumatic stress disorder, traumatic brain injury, and military sexual trauma."

    White House aides reportedly oppose funding legislation

    However, the law does not include funding for the new program, and White House aides reportedly have been lobbying Republican lawmakers to vote against separate legislation that would allocate $50 billion to fund the new program, the Washington Post reports.

    According to the Post, White House officials in a memo privately distributed this week to Republican senators portrayed the legislation as "anathema to responsible spending" that could lead to "virtually unlimited increases" in spending on private care for veterans. The memo, which was obtained by the Post, stated, "Without subjecting the program to any budgetary constraint, there is no incentive to continue to serve veterans with innovative, streamlined, and efficient quality of care."

    According to Axios' "Vitals," the aides are encouraging lawmakers to shift money from other initiatives to fund the new program. The White House in a statement said Trump's fiscal year 2019 budget proposal "supports a new, consolidated community care program for veterans and all of VA health care within the discretionary caps already in place."

    However, some observers and policymakers have raised concerns that shifting funds from other VA programs could harm VA's ability to provide care to veterans, "Vitals" reports. For instance, Rep. Tim Walz (D-Minn.), the ranking member on the House Veterans' Affairs Committee, during debate on the bill said the lack of funding could force VA "to cannibalize itself in order to pay for private care" but potentially cutting VA funds for infrastructure, job training, medical research, and more (Davidson, "PowerPost," Washington Post, 6/5; GAO release, 6/4; GAO report, 6/4; AP/Modern Healthcare, 6/5; Slack, USA Today, 6/6; Yen, AP/ABC News, 6/6; Baker, "Vitals," Axios, 6/7; Werner/Rein, Washington Post, 6/6; Bowden, The Hill, 6/6).

    See how your patient access performance stacks up


    Patients' choice about where and from whom they receive care is in their hands now more than ever before. To solve for access, health system and medical group leaders must look both internally at operations and externally at the market to ensure the care their organizations provide is convenient, coordinated, and seamless—or risk losing patients to local competitors.

    To see how yours stacks up, compare your metrics to our 15 patient access benchmarks.

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