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  • VA Choice System Not Working, Say VA Officials, Legislators

    A program meant to fix a broken Veterans Affairs (VA) health system is itself broken, according to lawmakers working to overhaul the Veterans Choice program. Critics say that the program, intended to provide some veterans with the option to see a provider outside the VA system, has done little to help reduce wait times and gaps in care.

    According to reports in Stars and Stripes and the Military Times, legislators on the Senate Veterans Affairs Committee are working on an omnibus bill that would include reforms to Veterans Choice, a $10 billion program quickly assembled in 2014 in response to scandals at the VA involving lengthy waits for care—waits that some associated with the deaths of veterans.

    Veterans Choice was devised as a temporary program to allow veterans to receive medical care outside of the VA system under certain circumstances. Under the program, a veteran can work with a non-VA provider participating in the Choice system if the VA cannot schedule an appointment within 30 days of the veteran's preferred date, if the date has been deemed medically necessary by the veteran's provider, or if the veteran lives more than 40 miles from her or his closest VA medical facility.

    But the fix is in trouble. Stars and Stripes reports that David Shulkin, the undersecretary for health at the VA’s Veterans Health Administration, described the program as one that "has not worked." News outlets have picked up on the problems, first at the local level in places like North Carolina and Colorado, and more recently by way of a report on National Public Radio that recounted the months-long efforts of a veteran to schedule physical therapy and acupuncture treatments, only to have those treatments ended when the providers stopped participating in the Choice program due to slow reimbursements.

    Among the legislation considered at a March 15 Veterans Affairs Committee meeting were the "Improving Veterans Access to Care in the Community Act," introduced by Sen Jon Tester (D-MT), and Sen Richard Burr's (R-NC) "Veterans' Choice Improvement Act." Both bills would eliminate third-party administrators, with the VA coordinating care and providers billing the department directly. They also would require the VA to set reimbursement rates and pay providers within 30 days of electronic claim submission, and within 45 days for paper claims.

    Tester's bill specifically would mandate "the use of value-based reimbursement models" and establishment of a process for monitoring quality of care. Burr's bill would include "stringent requirements on reimbursement rates and a mandate that VA provide compensation to veterans within 90 days of determining that the former service member has a presumptive health condition," according to the Military Times.

    "Bottom line is the Choice program is broken," Tester is quoted as saying in the Stars and Stripes report. "We need to fix it and we need to fix it as soon as possible."

    Comments

    • We are see good results from the VA Choice program, they are allot quicker at getting authorizations back than the VA was. Yes they still take too long but they are better. We now have a 3-4 week wait for the 2nd authorization as where before it was 2 months or more to get the auth back.

      Posted by Luke Klaja -> ?FR_C on 3/24/2016 2:42 PM

    • I know that the Choice Program is a very positive step in the right direction, albeit imperfect. I think the logical next steps to further improve service delivery must include: 1). Authorized visits should reflect the frequency and duration supported in the literature as Gold Standard protocols while also respecting well understood human, physiologic, tissue healing rates. 2) the Vet should hand carry a referral to his preferred PT provider. The therapist should be able to call, or access online an authorization. Best Regards Tim Cousens PT, DPT, MS, Cert SMT, Cert DN Owner

      Posted by Tim Cousens on 3/24/2016 8:49 PM

    • I am thrilled to hear there will be some work on this program. We have waited for reimbursement on one course of care for 11 months, with several calls to the VA in the process. We have been on the verge of stopping our participation. I also have 2 people that required a second authorization to continue care, and it has taken a 6-8 week lag to get that continuation. It is a very broken system in our area, and I am thrilled our Senator is helping to work on the problem.

      Posted by Jacquie McAdam on 4/10/2016 10:14 PM

    • I want to the VA emergency room on July 10th 2016. I had a lump and swollen breast. the doctor scheduled me for an x-ray the next day. I went for a breast Imaging exam the next day. they said the soonest they can schedule me, was about six weeks. they said you can apply for veterans choice since the waiting time is more than 30 days. they made me an appointment with a local provider in about 40 days. I went to the appointment and the local provider said I needed my VA medical records and a letter from my VA doctor. I didn't have either so they said they could have to reset the appointment give me another 5 weeks to get the documentation that I needed. I said that's fine I got a VA appointment in a week and a half I'll make that. I want to my VA appointment on 8/19/2016. they said it had been cancelled by veterans choice. I called Veterans choice and they denied this. so I made another appointment with VA 10/ 5/2016 for the for the breast Imaging exam. after 2 months of cold patch I feel that my lump is benign,I didn't get any help from the VA.do a lot of research before you use veterans choice!

      Posted by David Hall on 8/19/2016 3:52 PM

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