Reforms to ‘Choice’ Program Raise Questions about VA’s Future

by U.S. Medicine

July 7, 2017

Opponents Say Pilot Programs Could Lead to Privatization

By Sandra Basu

WASHINGTON—Calling the criteria to access community care “arbitrary” and “unnecessarily cumbersome,” VA Secretary David Shulkin, MD, sought support from lawmakers last month to improve the processes.

“Our goal is to modernize and consolidate community care. We owe veterans a program that is easy to understand and simple to administer and meets their needs,” Shulkin told lawmakers.

Some senators raised strong objections, however, questioning whether the proposals would ultimately lead to privatization of veterans’ care.

Under Shulkin’s proposed Veterans Coordinated Access and Rewarding Experiences Program (CARE), eligibility to access community care would no longer be based on distance from a VA facility or a 30-day or longer wait, as is currently the case with the Choice Program.

Ranking Member Sen. Jon Tester (D-MT) of the Senate Committee on Veterans’ Affairs, shown here talking to a veterans, warned that the proposed FY 2018 budget moves the VA toward privatization. Photo from Senate Committee on Veterans’ Affairs.

Instead, a clinical assessment by a VA clinician would result in a decision about whether a VA specialist is best for the patient or whether community care would better meet a patient’s needs.

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“If community care is the answer, then the veteran chooses the provider from a high-performing network. … Assessment tools help veterans evaluate community providers and make the best choices themselves,” he said. “We may help veterans schedule appointments in the community or in some circumstance veterans may schedule the appointments themselves.”

Shulkin said this was all about “individualized, convenient, well-coordinated modern healthcare and a positive experience for the veteran” And that legislation is needed to make the proposed changes.

“If the VA doesn’t offer the necessary service then the veteran goes to the community. If the VA can’t provide timely services, then the veteran goes to the community. If there are unusual burdens in receiving care, then the veteran goes to the community,” he said.

Still, Shulkin said he was not recommending “unfettered access” to community care

Privatization?

Shulkin made his comments on the Choice Program, one of VA’s community care programs for veterans, at a Senate Committee on Veterans’ Affairs hearing.

“We are at the point where, if we don’t fix it permanently, we are going to have a program that is out of money, out of gas or out of both,” Senate Committee on Veterans’ Affairs Chairman Sen. Johnny Isakson (R-GA) said of the current VA Choice Program.

Several Democrats on the committee agreed that change was needed to VA’s community care program but expressed concern that Shulkin’s proposal might move VA too far in the direction of privatizing VA care.

Ranking Member Sen. Jon Tester (D-MT) said the proposed fiscal year 2018 budget gives a 33% increase for private sector care vs. 1.2% for care provided directly by VA.

“We are privatizing the VA with that budget,” Tester warned.

Shulkin answered, however, that VA is seeking flexibility from Congress to be able to transfer money between the two accounts so they can build capacity in the VA.

“The reason why we are letting people go in the community now is because, if VA doesn’t have it, we have to get them that care,” he said.

“If we don’t make the investment so that they can get that healthcare [inside VA], then they will never get it there,” Tester responded.

Also expressing concern was Sen. Patty Murray (D-WA), who pointed out that VA’s draft proposal for community care included pilot projects for VA regarding governance and an alternate care model that would send veterans directly to the private sector.

Murray noted that those proposals sound similar to concepts put forth by Concerned Veterans for America and in a paper that was known as the “strawman document,” written by seven of the 15 members of the Commission on Care.

 “I just want you to know that I will not support them, and I will fight them with everything I have,” she said.

Shulkin said he would like feedback from lawmakers and that he was not in support of “of a program that would lead to privatization or shutting down the VA programs.”

“What I am in support of is using pilots to testing various ideas about governance, about the way the system should be organized and the way we should evolve,” he emphasized.

Isakson said pilot projects are an “opportunity” and should not be feared.

He also denied that VA’s CARE proposal “is a threat to VA and VA healthcare” and suggested it might have the opposite effect of putting “additional pressure on VA and VA healthcare to provide services to a greater number of veterans.”

“We have no goal whatsoever to reduce the role of the VA healthcare system in the life of a veteran,” Isakson stated.

Advocacy groups also had an opportunity to weigh in on the new community care proposal.

Veterans of Foreign Wars Director of the National Legislative Service Carlos Fuentes said his organization “largely supports” VA’s proposal but that it opposes the pilot projects that VA is seeking as part of the proposal.

American Legion National Legislative Assistant Director Jeff Steele told lawmakers, meanwhile, that the American Legion “adamantly opposes the degradation of organic VA healthcare services and calls on this Congress and administration to reinforce and strengthen VA.”

“The American Legion simply urges the Congress to fund the community care program at appropriate levels, which should be no less than what is currently being allocated without cannibalizing other areas of the VA budget,” he said.


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