VA community care program to launch June 6, despite IT, doctor concerns

Abbie Bennett
April 10, 2019 - 7:24 pm

ID 76967936 © Sherry Young |

The U.S. Department of Veterans Affairs will meet a June 6 deadline to launch a program offering veterans greater access to private healthcare, despite widespread concerns among senators and veteran service organizations that the launch is premature.

Senate Veterans Affairs Committee chairman Johnny Isakson, R-Ga., said the VA will meet the June 6 deadline to roll out the MISSION Act’s community care program during a committee hearing Wednesday.

“We’re going to technically be ready by June 6 but practically we all know that because of incumbent systems that are inherited because of changes in technology that have to be made … we’re going to have to stumble before we walk,” Isakson said. “But our goal is to walk and then run and do so successfully.”  

That pronouncement followed two hours of senator questions, VA and VSO testimony. Many of the senators raised questions of how prepared the VA was for the launch, what standards the private doctors about to care for an unknown number of veterans will be held to, and wait times for care. VSO representatives raised issues of lack of VA transparency in the policy-shaping process and lack of confidence in the VA’s ability to launch the program without disrupting or even “endangering” veteran health.

“I’ve had concerns that the VA’s primary focus would be supplanting care … instead of supplementing,” Sen. Jon Tester, D-Mont., said during the hearing. The community care option represents the VA “outsourcing its responsibility,” Tester added.

Tester told VA officials at the hearing that their work on the community care program “smacks of an attempt to carry out a political agenda,” and added that costs of the program are as yet unclear and standards for private care were not the same as standards set for care in VA facilities.

“I don’t know what the hurry is. I don’t know why we’re pushing this,” Sen. Joe Manchin, D-W.Va., said, referring to the June 6 deadline, adding that veterans and VSOs are “scared to death” that the community care program is “the door opening to” veteran healthcare privatization.  

“The private sector is going to prey on our veterans like you’ve never seen,” Manchin said. “That’s a whole other cash cow for them.”

Isakson asked Veterans Health Administration acting head Dr. Richard Stone if the VA would be ready for the June 6 community care expansion deadline.

“Are you going to be ready June 6 to deliver what the MISSION Act asks for? Are you going to have all the tasks you’ve been given done? From the answers you’ve given … the answers to that question already is ‘no.’”

Stone said the MISSION Act “is as complex a piece of legislation as you can have,” and said the community care system requires at least 11 different software programs that are still being tested.

“Are we going to get it all right? No,” Stone said. “Are we going to deliver care on June 6? Yes."

“We are confident that we are doing everything we possibly can to hit June 6 running … We will get this right. I’m not going to sit before you and say we’ll have everything right on June 6.”

Stone said the VA anticipates ⅓ of a million contacts with veterans the day the program launches.

Sen. Patty Murray, D-Wash., said community care expansion “must be done in tandem with investment in the VA health system,” echoing concerns of other senators that investment in private care could mean less investment in the VA, which has about 40,000 job vacancies.

Murray also asked if the VA had “fully implemented all of the U.S. Digital Service recommendations” and whether the promised online tool for veterans to make community care decisions would meet those recommendations in time for the June 6 launch.

“Time is running out,” Murray said.

Dr. Kameron Matthews, VA deputy undersecretary for health for community care said the VA was still developing the tool and when pressed, said the VA did not implement all the USDS recommendations.

“We have learned and grown from the (USDS) report to make sure the tool we deliver on June 6 is excellent,” added Dr. Jennifer MacDonald, VA MISSION Act lead.

That USDS report caused concern among VSOs. Disabled American Veterans spokesman Adrian Atizado also spoke at the hearing, asking that the VA delay its launch of the community care standards until the system could be further tested to avoid disrupting veteran health.

“The Department seems unlikely to meet the June 6 deadline set by law without sacrificing quality and endangering veterans’ health outcomes,” Atizado said.

Sen. Richard Blumenthal, D-Conn., and other members of the committee said they were concerned that private physicians would not be held to the same standards or have the same specialized training in treating veterans as VA doctors.

“What standards will be imposed to assure that those doctors are trained to recognize signs of potential suicide, depression, post-traumatic stress?” Blumenthal asked.

“This is not something that we can simply give a course to a private physician,” Stone said, adding that it will be the role of the VA to work alongside the veteran and private providers to ensure veterans receive the care they need in the proper context.

Isakson said veterans could not get the best care without private participation alongside the VA.

“We’re not going to privatize the VA. I can’t see any way you could privatize it. Nor do I see any way you could treat our veterans by taking away the option of having a private choice. We just got to make sure the private choice options they make is the best option … and we’re demanding the best out of both (the VA and private providers) without prejudice. I think we can do that,” Isakson said. “I hear loud and clear the fear that people have.”

Veterans are eligible for community care if they meet any of five standards:

Service is not available at the veteran’s CAMC or clinic;

The veteran lives in a state or territory without a full-service VA medical facility;

The veteran was eligible under the CHOICE 40-mile rule in North Dakota, South Dakota, Montana, Alaska or Wyoming;

It’s in the veteran’s “best medical interest” after a consultation between the veteran and their VA provider;

The VA’s care for the veteran’s need is not in compliance with VA quality standards.

Veterans could be eligible with a sixth standard still in development by the secretary of the VA -- if the veteran meets specific access standards of wait times and drive times to nearest VA facilities.

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