The Dangers of ‘Choice’

BY PETE PETERSON, CHAIR,
AND GOVERNMENT AFFAIRS STAFF

In announcing the awarding in December of contracts to Optum Public Sector Solutions to manage the first three regions in the VA’s new Veterans Community Care Program, Secretary Robert Wilkie offered a rosy prognosis.

“These contract awards reflect our ongoing commitment to increasing veterans’ access to care. As part of VA’s modernization efforts, we designed the new network based on feedback from veterans and other stakeholders, along with lessons learned from the Veterans Choice Program. We are confident,” he said, “this new network will greatly improve customer service for veterans and timeliness of payments to community providers.” 

The release notes that these providers will follow “industry-standard approaches and guidelines.” It neglects to mention, however, that the “industry-standard” is less stringent than the guidelines in the VA’s own medical centers and outpatient clinics.

The Choice Program “outsourced more veterans’ care to private providers but never monitored the quality of those services,” a blog headlined “Veterans Deserve Accountability from Private Healthcare Providers” pointed out. To rectify this oversight, the newly enacted MISSION Act directed the VA “to set rigorous quality standards on par with the Veterans Health Administration.”

This, however, doesn’t seem to have gone over particularly well with private providers. “Joanne Frederick, VP of WellPoint Military Care, a division of Anthem, stated at a VA meeting in September that use of their network to increase access would come with an expected ‘tradeoff’ in quality.”

If the VHA “introduces extra quality criteria, ‘the people that don’t want to meet those standards won’t deliver the service,’ ” she said.

Similar sentiments were echoed by the CEO of URAC, Kylene Greene, who noted that any new reporting requirements “may result in providers declining to participate in the Community Care Network.” She recommended the VHA go easy on private providers and allow invoice claims to count as substitutes for performance data.

The blog notes that “without comprehensive information on private sector care, veterans will be blindly sent to private sector doctors and hospitals without knowing whether the quality of care they deliver is inferior to the VHA.”

The danger, of course, should be as obvious as it is troubling. We echo the blogger’s conclusion that “because payment for private sector providers comes directly from the budget for existing VHA facilities, services will steadily erode, staffing will be cut, and veterans will be unable to get care at the VHA. Most veterans insist they want the VHA to be strengthened, but that’s not what will happen if more veterans are channeled to private sector providers whose quality has not been proven.”

VVA intends to vigorously monitor the implementation of the Veterans Community Care Program. Our fear is that it will jeopardize the quality health care VA medical centers and community-based outpatient clinics provide at a cost Congress sooner or later will find unsustainable.

And we will always fight to save and improve VA health care.

At the December 19 joint hearing on the MISSION Act, newly re-elected Sen. Jon Tester (D-Mont.), Ranking Member of the Senate Veterans’ Affairs Committee, told Secy. Wilke what many of us in the audience were thinking.

“Six months ago,” he said, “we discussed designating the excess standards for services like routine lab work and x-rays. But we agreed to give the VA the authority to decide exactly which services or categories of care should make veterans automatically eligible to receive care within the community.

“Now VA has decided to head in what I believe is a completely different direction. VA now indicates it plans to designate access standards that apply to each and every type of care a veteran might need. This would essentially outsource all segments of VA health care to the community based on arbitrary wait times or geographic standards which we’re supposed to be moving away from by ending the Choice Program.

“And that’s despite the fact that several studies have indicated the quality of care at the VA is good or better than the private sector. To make matters worse, VA officials have offered only vague verbal descriptions of the various sets of potential access standards under consideration by you, Mr. Wilkie. It also concerns me that each time we have discussed this issue in the last two months VA officials have given us wildly different estimates of budgetary resources needed to implement these sets of access standards that you are considering.

“So we need to know how much it’s going to cost. No conflicting or vague answers, no fuzzy math, no games because the stakes are simply too high, Mr. Secretary.

“If you move further down this path gutting the VA health care system for those veterans who want and need to use it, you will end up bringing down the whole boat and you’re going to spend a whole lot of time and money sending veterans into community for care that is less timely and not as high in quality.

“That’s a bad deal for our taxpayers. It’s a bad deal for our veterans who would ultimately bear the brunt of cuts to other services or benefits to cover the increased cost of community care. And that will lead to a bad deal for veterans because at some point you will burn through the funds quicker than expected and come to us because VHA is running out of money again. Veterans will be in limbo when seeking community care as Congress sorts out the VA’s fiscal issues.”

Some seventy-five years ago, Gen. Smedley Butler penned an essay, “War Is a Racket.” The two-time Medal of Honor recipient railed against the greed of companies and the individuals who ran them who were more interested in profiteering from the carnage of World War I than in caring for the troops who served, fought, and came home shells of the men they once were. It’s as relevant in many respectstoday as it was in the depths of the Depression.

The same individual and corporate greed was evidenced in the Vietnam War. A corrupt sergeant major schemed millions of dollars out of the PX system in South Vietnam; he was assassinated in 1970 aboard his yacht in Hong Kong Harbor. Several chemical corporations made and marketed herbicides that have been associated with such life-threatening illnesses as prostate cancer, diabetes mellitus, Hodgkin’s disease, and non-Hodgkin’s lymphoma.

Troops were told that Agent Orange was not harmful to humans, onlyto foliage. Yet the dioxin in these defoliants has left a lingering legacy of life-threatening maladies among those who served in Southeast Asia, not to mention a litany of birth defects, suffering, and death among the people of Vietnam.

And what of our children and grandchildren? Too many anecdotal reports about birth defects, learning disabilities, and childhood cancers prompted VVA to launch the “Faces of Agent Orange” project. It’s why VVA President John Rowan led a grassroots effort that pushed hard for enactment of the Toxic Exposure Research Act.

Most recently, we have been working with other VSOs and MSOs to finally enact the Blue Water Navy bill. After sailing through the House, 382-0, it was stymied in the Senate by a handful of Senators who continue to buy into the VA’s specious reasoning for opposing H.R. 299.

The Blue Water Navy Vietnam Veterans Act was recently reintroduced in the 116th Congress by Rep. Phil Roe (R-Tenn.), Ranking Minority Member of the House Veterans’ Affairs Committee. VVA will work with Sen. Johnny Isakson (R-Ga.), Chair of the Senate Veterans’ Affairs Committee, on introducing companion legislation to the House bill.

Again, VVA and our allies are all hands on deck to pass this much-needed and long-delayed legislation. Passing the Blue Water Navy bill is our Number 1 legislative priority.

Preventing veteran suicide is the VA’s top clinical priority. The current VA Secretary acknowledges this. So did his predecessor. So do just about any member of Congress you might ask.

But it doesn’t appear to be so in practice. Seems that, to quote the new chair of the House Veterans’ Affairs Committee, Mark Takano (D-Calif.), “It is simply wrong that only $57,000 in funds Congress prioritized to address preventing veteran suicide has been spent and $6.2 million has been left on the table.”

It is poor performance like this that erodes public and congressional confidence in the ability of the VA to comply with its responsibilities.