Over­haul of Vet­er­ans Choice pro­gram get­ting a warm re­cep­tion

Modern Healthcare - - NEWS - By Vir­gil Dick­son

The Trump ad­min­is­tra­tion is push­ing a plan to im­prove co­or­di­na­tion be­tween Vet­er­ans Af­fairs hos­pi­tals and pri­vate-sec­tor providers.

Dur­ing a Se­nate hear­ing last week, Vet­er­ans Af­fairs Sec­re­tary Dr. David Shulkin out­lined his vi­sion of a re­vamped Vet­er­ans Choice pro­gram, which would be re­named the Vet­er­ans Af­fairs Com­mu­nity Care Pro­gram and aim to give VA doc­tors and pa­tients more say on whether pri­vate care is ap­pro­pri­ate.

Cre­ated in Au­gust 2014, Vet­er­ans Choice al­lows vet­er­ans who have waited at least 30 days for an ap­point­ment at a VA fa­cil­ity or who have to travel more than 40 miles for VA care to re­ceive fed­er­ally funded treat­ment from lo­cal, non-VA doc­tors. More than 1 mil­lion vet­er­ans have re­ceived care un­der the ini­tia­tive, ac­cord­ing to VA data.

The new pro­gram would jet­ti­son the time and dis­tance re­quire­ments. In­stead, a VA clin­i­cian would per­form a health risk as­sess­ment on a vet­eran and de­ter­mine if the VA or a pri­vate provider would be the best place for the pa­tient to re­ceive care. Then the pa­tient and VA doc­tor would work to­gether on the next steps for treat­ment.

“This will give vet­er­ans real choice in get­ting the care they need and en­sure it is of the high­est qual­ity,” Shulkin told mem­bers of the Se­nate Vet­er­ans’ Af­fairs Com­mit­tee. “At a min­i­mum, where the VA does not of­fer a ser­vice, vet­er­ans will have the choice to re­ceive care in their com­mu­ni­ties.”

The new ap­proach would en­sure that ser­vice-re­lated ailments that are bet­ter-treated by the VA will con­tinue to be treated there, while more univer­sal mal­adies are treated in a pa­tient’s com­mu­nity.

The VA Choice Pro­gram is set to sun­set later this year and Shulkin is hope­ful that leg­is­la­tion to launch the new pro­gram will be passed by the end of the fis­cal year in Septem­ber.

Ad­vo­cacy groups such as Dis­abled Amer­i­can Vet­er­ans sup­port the new vi­sion. Adrian Ati­zado, deputy na­tional leg­isla­tive di­rec­tor for the group, told law­mak­ers at the hear­ing he be­lieved the changes would make ac­cess­ing ap­pro­pri­ate care, both in and out­side the VA, eas­ier than it is now un­der the Choice pro­gram.

“I’ve been look­ing for­ward to this hear­ing be­cause Choice has been such a train wreck,” said Sen. Jon Tester (D-Mont.), rank­ing mem­ber on the com­mit­tee. “It was sup­posed to in­crease avail­abil­ity of health­care, and it’s done just the op­po­site.” Vet­er­ans in his state and else­where have said it has been hard to get a timely ap­point­ments, and providers say it takes too long to get paid un­der the pro­gram.

In April, Pres­i­dent Don­ald Trump signed leg­is­la­tion meant to ad­dress the provider pay­ment is­sue. The VA had been re­ly­ing on a third-party ven­dor to over­see pay­ments. Start­ing this sum­mer, the VA will pay claims di­rectly.

Other com­mit­tee mem­bers wanted as­sur­ances that the VA would con­tinue work­ing to im­prove its own care ca­pa­bil­i­ties and that the Trump ad­min­is­tra­tion wasn’t at­tempt­ing to to­tally pri­va­tize care for vet­er­ans. The VA sys­tem has at least 45,000 provider va­can­cies.

“If you only give your cus­tomers a choice to get out, you’re go­ing to rob the re­sources from a sys­tem that we need to make sure is work­ing,” Sen. Patty Mur­ray (D-Wash.) said.

Shulkin said he agreed and in­sisted that work is con­tin­u­ing to also en­sure ac­cess to care in the VA sys­tem.

“At a min­i­mum, where the VA does not of­fer a ser­vice, vet­er­ans will have the choice to re­ceive care in their com­mu­ni­ties.”

Dr. David Shulkin Vet­er­ans Af­fairs sec­re­tary

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