On April 19th, President Trump signed into law (S. 544) extending the Veterans Choice Program which allows some veterans to receive healthcare from local doctors and hospitals. The legislation passed with broad bipartisan support – the bill was approved, by voice vote, in both the House and the Senate.
The Veterans Choice program was enacted in response to the 2014 crisis where the Department of Veterans Affairs (VA) was required to respond to a congressional inquiry related to the allegations that the VA health facilities altered records related to the length of time veterans waited for care. Congress appropriated $10 billion for the Veterans Choice Program which funds private health care in a veteran’s community. To qualify for the Choice Program, a veteran’s wait time was required to be greater than 30 days for an appointment at a VA facility or live more than 40 miles from a VA facility. The Veterans Choice Program was set to expire in August 2017 with more than $1 billion unspent – S. 544 would extend the program until the funding is exhausted.
Despite the Choice Program’s overwhelming bipartisan support, the program is not without its critics who highlight that the Choice Program is too complicated and it is often time-consuming for veterans and providers to participate in the program. Critics point out that the cumbersome administration of the program has caused delays in veteran referrals to community providers as well as delays in payment to providers.
VA leaders have noted that a significant cause for the Veterans Choice Program’s administrative issues are directly linked to the Congressional requirement that the program be operational within 90 days of the law’s enactment. In fact, the VA has released an RFP to improve its administration of the Veterans Choice Program through its privately managed Community Care Network (CCN). The program divides the nation into four regions and successful Community Care Network bidders will be responsible for managing a network of high-quality providers in one or more regions to provide veterans with timely access to care in their community.
The Choice Program’s extension will also bring additional authority to streamline the program’s effectiveness, such as new authorization for the VA to share medical records with non-VA providers.
One of the tenets of the VA’s Community Care Network is the need for bidders to establish and maintain a network of high-quality providers. To ensure the quality of services provided to veterans, the VA requires successful Community Care Network bidders to hold accreditation from a national accrediting organization. The VA requires that the accreditation cover the bidder’s network of providers and its credentialing process. Should a bidder seek to provide case management and disease management services, these areas must also be accredited. The VA’s use of accreditation in its oversight of the Community Care Network is an indication that the VA is committed to ensuring that veterans have access to the highest quality care in the community.
With the Choice Program’s extension and more veterans receiving access to care in the community, some, including President Trump, believe in protecting a veteran’s timely access to care in their community. Some advocate for increased privatization as the key to improving the quality and timeliness of care delivered to veterans. However, VA Secretary Shulkin and key members of Congress have ruled out privatization of the entire VA system. It is undeniable that VA facilities have capacity issues in many areas of the country which has led to unacceptable delays in care for veterans.
Like most challenges in healthcare, there is no single resolution to solving the VA’s access issues. However, whatever solution policymakers craft, private organizations and providers located in a veteran’s community will have an important role to play. Secretary Shulkin has indicated that he will present plans to broaden the VA’s Choice Program later this year. Perhaps this blended public-private delivery model as embodied in the Veterans Choice Program will be the appropriate balance to ensure continued high-quality and timely care is delivered to our veterans.