The Veterans Community Care Program, a Trump-era initiative designed to help veterans get access to healthcare quickly and efficiently, has been anything but, according to a recent report issued by the Government Accountability Office.
The program was officially launched in 2019 under the MISSION Act, which ended the Veterans Choice Program and replaced with the newly established Veterans Community Care Program, which gives veterans access to more healthcare options outside of the Veterans Affairs system.
Since its rollout, however, Sen. Mike Rounds, R-S.D., said the program has been far from what Congress intended, with veterans being told they must wait weeks before they can be seen by a provider, due to the VA struggling to handle the demand.
"Veterans in the U.S. have earned these benefits," said Rounds. "We have to fix it."
Rounds said he wasn’t surprised that a recent Government Accountability Office report confirmed what some of his veteran constituents had been complaining about for years — long wait times and the inability to secure medical appointments with a non-VA provider, even if they qualify to see a doctor outside of the VA.
The actual surprise: That such a "damning" report went public.
After the GAO heard complaints about how difficult it was for veterans to get the promised care, its healthcare team, led by Sharon Silas, went undercover to investigate the shortcomings, posing as veteran callers.
Silas detailed on the GAO's Watchdog Report podcast how her team conducted the operation, in which 80 community providers were contacted.
Silas said the undercover phone calls provided a "good method" to "help better understand appointment scheduling challenges firsthand and to corroborate with some of our other findings."
She added, "What we found out is that we did indeed have some similar results to what we had been hearing about appointment scheduling."
Using the VA system to identify providers to schedule appointments, Silas said the team called a selection of gastroenterologists and dentists to schedule appointments and found "numerous examples of inaccurate information about these providers, including incorrect addresses, phone numbers, and even some providers who said that they were no longer participating in the Community Care Program."
The GAO also surveyed 127 VA medical centers about their experiences in scheduling specialty care appointments within 30 days for veterans with Community Care providers.
During this investigation, Silas said the GAO learned there are a "variety of specialty medical care services with the least appointment availability," including gastroenterology, neurology, rheumatology, dermatology, and endocrinology.
Though the GAO found that contractors participating in the program were "generally meeting the standards," Silas said when her team "really dug into" the data, they found it was "incomplete," which could have provided a "misleading picture of network adequacy."
The GAO also reported that VA medical centers were facing a "number of challenges," including inaccurate provider information, an insufficient number of providers in the networks, limited appointment availability, and insufficient staff to schedule veteran appointments.
She noted that only 6% of the 127 facilities questioned by the GAO said they had enough staff to schedule veterans' appointments for Community Care.
As veterans age, Rounds fears the VA's current lack of manpower issues will only be exacerbated by an increasing number of patients, which makes the Community Care Program even more important.
One of the issues identified by the GAO is the VA's utilization of two contractors who manage its regional networks of community providers.
The contractors are responsible for maintaining adequate provider networks that meet two key standards: maximum distances veterans may drive to community providers, and maximum wait times for appointments.
Rounds said the VA has essentially created "gatekeepers" in the contractors who are "pushing hard" against veterans, who are calling to schedule appointments outside of the VA.
"The VA has been concerned about the leakage of VA funds going outside of the VA to take care of these patients," said Rounds.
Last year, a USA TODAY investigation found that VA administrators were overruling decisions made between veterans and their medical providers to seek care in the community.
Rounds called any efforts by the VA to try to keep veterans in their understaffed institutional facilities rather than allowing them to see a provider of their own choice a
"terrible thing to do to veterans."
The VA is designed monitor the contractors to make sure the requirement standards are being followed. However, the GAO report found the contractors were not submitting all the necessary data that the VA needs to ensure compliance.
To fix the discrepancies, Silas said the GAO recommended the VA take two steps:
1) Ensure that contractors report complete claims data when calculating performance against the VA's requirements of driving and waiting times.
2) Work to increase the accuracy of information of providers who are participating in the Community Care networks.
"The bottom line of the report is that it is important contractors for the Community Care Program are maintaining a robust network of providers to meet the health care needs of veterans," Silas said. "It could potentially impact veterans' ability to receive timely access to medical care.
"And to do this, VA needs to have complete and accurate information on the providers participating in these networks and be effectively monitoring the contractor's performance," added Silas.
According to the GAO's report, the VA agrees with its findings and has identified steps it will take to implement its recommendations.
Rounds believes that Secretary of Veterans Affairs Denis McDonough is "aware of the challenges" he faces when it comes to navigating a bureaucracy that wants to make sure resources stay inside of the VA institutions and he is "working hard to find a path forward."
Rounds has also attempted to fix gaps in the program, via legislation.
Earlier this year, Rounds co-sponsored an amendment, which was blocked by Democrats, to the PACT Act.
The amendment would have permitted veterans exposed to toxic burn pits to seek care outside of the VA system even if they didn’t meet the criteria for the existing Community Care Program.
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