WASHINGTON, DC—In 2008, Congress authorized VA to implement a pilot program enhancing contract care for rural veterans. The law required that the program be well on its way within 120 days following the law’s authorization in October 2008. However, a series of unexpected challenges delayed VA, which expects to roll the program out by the beginning of next year. Legislators are anxious to see the pilot begin, since 40% of the 3 million veterans using the VA healthcare system live in rural areas, even though some are concerned that the pilot, in its current form, is limited in its scope.

Calculating Rural

When VA officials started planning for the pilot in October 2008, they found that the disconnect between law’s language and VA’s current practices presented challenges which prevented them from implementing the program by the February 2009 deadline.

“The first challenge was the statute’s definition of ‘highly rural’,” explained Patricia Vandenberg, VA deputy under secretary for policy and planning, at a House VA Committee hearing last month. “The statue used driving distance to determine a highly rural veteran. VA uses census bureau data.” Using census data, VA defines “highly rural” as those veterans living in a county with fewer than seven
civilians per square mile.

“We knew we’d have to reconfigure our data systems to calculate travel distances for each enrolled veteran for multiple VA facilities, conduct analysis to identify eligibility according to the statute’s definition, and develop enrollment projections for the pilot program,” Vandenberg explained.

That analysis was not completed until October 2009.

Another delay was caused by the word “hardship,” and how to determine which veterans were worse off in terms of access to care than others—a process that Vandenberg testified could take up to two years for VA to nail down. However, with the passage of recent legislation amending the law, that language—and the bureaucratic roadblock it represented—has been removed.

“While progress has been slower than expected and what we would have liked, our goal is to have the pilot program operational in latter part of 2010 or early 2011,” Vandenberg declared.

A Tentative Timetable

Currently, the pilot program is being set for roll-out in VISNs 1, 6, 15, 18, and 19. Those VISNs have been provided with enrollment distribution maps and asked to submit proposals for where the program might be of the most use. VA expects the proposals to be reviewed, and viable proposals accepted by the end of the summer. However, Vandenberg noted that the final roll-out date is unknown since the program will depend on the willing cooperation of private healthcare contractors.

“Because this process depends somewhat on the willingness of non-VA providers to participate, we’re not able to stipulate exactly when the pilot can commence. However, we are using all of the resources and insights gained from Project HERO (Health Care Effectiveness Through Resource Optimization Pilot) and contracting specialists to expedite the process.”

She also noted that the project will depend on the willing cooperation of veterans, some of whom might prefer VA care over closer private care. “In an instance where there are options, rather than instructing the veteran that they absolutely have to go one place or the other place, we are working with them to understand what best suits their healthcare needs and their preferences.”

While legislators accepted that the program would be delayed, some expressed disappointment and concern that the pilot will only be rolled out in certain areas within each VISN, rather than be available for any veteran in that VISN that meets the criteria. They noted that the Congressional Budget Office evaluation for the legislation was for the entire VISN.

“I think we will make a terrible mistake if we implement this pilot program and only target the easy areas within a VISN,” declared Rep Jerry Moran, R-KS. “I think we should only [go through with it] if we can demonstrate it can be done VISN-wide.”

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