Going Beyond Fee Basis Care

While Daigh noted that VA needs to tap expertise outside of its system, he dismissed fee-basis care as an acceptable solution. Fee-basis arrangements are when VA agrees to reimburse a veteran for going to a private provider. Not only is the process of getting approval for such an arrangement long and work-intensive, it often creates more gaps in care than it fills, Daigh said.

“VA ought to consider establishing arrangements with providers that are beyond fee-basis arrangements,” he said,  making use of “prearranged partnerships with universities and private practices where you can easily call on them, rather than fee-basis care where you tell a veteran, ‘We can’t meet your demand. Here’s a check. Go get care.’ With these partnerships, they expect to see patients.”

Also, VA would better be able to share medical records and track patients, unlike with fee-basis care in which patients receive care that is never tracked or evaluated by VA.

In areas where VA does not have a mental-health care presence — communities that might be so small that there is not enough demand for mental-health providers — VA needs to sit down with local community leaders to talk about the issue, Daigh said. “They should see if they can’t pool patients to create a demand, and pull resources to provide funding to take care of those individuals where they live.”

Responding to the IG report and Daigh’s testimony, William Schoenhard, VA deputy under secretary for health, said, “We concur with the IG, and I’ve talked with [the director] there. We were not as quick as we should have been, and we’re going to learn from this. We’re taking this report, not just for Atlanta, but for other facilities, particularly in high-growth areas.”

While he and other VA officials at the hearing apologized for the problems veterans have faced getting care, they also assured legislators that VA was actively working to fill these gaps.

The committee members expressed a high level of anger and frustration and were skeptical of VA’s response. Sen. Murray told Schoenhard that assurances from VA Central Office were no longer sufficient.

 “I’d like you to go back to each one of the VISNs and survey the clinicians on the ground about these wait times we’ve been hearing about,” she said. “I think it’s really imperative that we hear directly from VA’s mental-health care providers who are on the front lines treating veterans. We need to know if the providers, not the administrators, have sufficient resources.”

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