Healthcare Business News

Lawmakers ask why VA didn't rely more on private care

By Virgil Dickson
Posted: June 18, 2014 - 7:15 pm ET

As Congress considers legislation that would steer veterans to civilian healthcare providers, lawmakers are questioning why the Veterans Affairs Department didn't take greater advantage of existing authority to pay for private care as thousands of veterans waited months for appointments.

“By allowing 121,000 veterans to languish on VA waiting lists, the VA has made it disturbingly clear that it is unwilling to utilize existing non-VA care authority when, where and to the extent that it should to ensure access to care for veteran patients,” Rep. Jeff Miller (R-Fla.), said during a Wednesday hearing, which he chairs. “Unfortunately, thousands of veterans have paid the price, some with their lives, for that unwillingness.”

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Acting VA Secretary Sloan Gibson said Wednesday that about 10% of veterans have to wait 30 days or more for an appointment, more than twice the rate the department announced last week, according to the Associated Press. A recent audit found that more than 57,000 veterans had to wait at least three months for initial appointments. Another 64,000 veterans who asked for appointments over the past decade never got them.

A separate investigation by the VA's inspector general's office confirmed that at least 35 veterans died while waiting for treatment at the Phoenix VA facility, though investigators did not determine whether the delays contributed to their deaths.

The House and Senate have both passed bills that would lower the barriers for veterans enrolled in the VA system to get care from private providers.

In fiscal 2013, the VA spent about $4.8 billion on non-VA medical care for more than 1 million veterans, which accounted for about 11.6% of the department's total medical services budget for that year, according to the U.S. Government Accountability Office. Half that amount was for emergency care, though, and doesn't reflect the discretion to refer patients outside the system.

“Did the VA not want to spend the money?” asked Rep. Ann McLane Kuster (D-N.H.). “If this was an option, why didn't you use it more?”

A VA official testifying at the hearing responded that the reluctance stems from earlier criticism that the department relied too much on civilian providers. “Maybe, inappropriately, we overcorrected,” said Philip Matkovsky, assistant deputy undersecretary for health for administrative operations at the Veterans Health Administration. Asked if directors of VA facilities were rewarded with bonuses if the didn't send patients outside the system, Matkovsky said they were not.

The use of civilian care is likely to increase as the VA gets better data about where veterans are experiencing long waits and what their care needs are, Matkovsky said.

He also expressed concern, however, about the department's ability to handle the administrative burden under House and Senate bills that would allow any veteran more than 40 miles from a VA facility to seek care from a non-VA provider. “Some of the legislation may really restructure the consumer health benefit in the marketplace,” Matkovsky said.

The GAO has criticized the VA's ability to process claims and found that VA facilities often wrongly denied payment. Randall Williamson, director of healthcare at the GAO, testified that VA officials told the watchdog agency this month that they are working to address the issues.

Follow Virgil Dickson on Twitter: @MHvdickson

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