Wrong Choice: How Outsourcing Care Endangers VA Healthcare

Prepared by VHCAC, April 4, 2017

(Download a copy of this document HERE)

Legislative proposals in Congress threaten to drastically change how veterans receive
healthcare. Three years ago, when there were extended wait times at a handful of VA
medical centers, some policy makers wrongly characterized the entire VA as fundamentally
broken. Their critiques ignored well-documented evidence that the VA outperforms the
private sector in delivering high-quality care and that veterans consistently report a high
degree of satisfaction with VA care. The policy makers’ proposed solution, which is now on
the verge of being adopted, is to give veterans the option of private sector care, with the VA
picking up the tab. While giving options to veterans sounds reasonable on the surface, this
misguided proposal alters the existing Veterans Choice Program in two crucial ways that
will cripple and ultimately dismantle the VA healthcare system:

Financing

Money to pay for outsourced care would be siphoned straight from the same
pot that funds VA care. When a veteran uses non-VA care, local VA allocations would be
reduced. Over time, as local VA funds are cut to pay for outsourced care, their providers,
programs and clinics would be eliminated. The VA will become a shell of itself.

Guardianship

The VA would no longer be the guardian of veterans’ healthcare. Under
the proposed solution, veterans could bypass the VA, even if a nearby VA facility were
fully capable of providing comprehensive, specialized care as quickly and at lower cost.

Advocates of outsourcing argue that moving more veterans into private sector health care
will improve access and quality of care to veterans, while maintaining the integrity of the VA.
Similarly, they claim outsourced care will have no negative impact on the VA’s teaching and
research missions. They also also insist that this proposal does not constitute any form of
privatization of the VA. Nothing could be further from the truth.

Here are the myths and facts about what veterans – and the country – stand to lose with outsourced care.

SCROLL THROUGH THE MYTHS AND FACTS

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Recommendations

1. Increase funding to those VA medical centers and clinics where staff/patient ratios are low. 
Support efforts to recruit and retain more VA healthcare professionals.
2. Allocate funding for outsourced Choice Care when the VA is unable to provide timely or geographically convenient care. Sustain the VA as the guardian of decisions whether to offer a veteran outsourced care.
3. Keep the allocations for outsourced Choice Care separate from VA facility budgets.
4. Continue to strengthen and reform the VA healthcare system.

References

  1. http://www.stripes.com/veterans-groups-warn-against-unlimited-choice-for-health-care-1.456560#.WLg7mBCsn-A
  2. Farmer, C. M., Hosek, S. D., & Adamson, D. M. (2016). Balancing Demand and Supply for Veterans’ Health Care [Product Page]. Retrieved February 14, 2017, from http://www.rand.org/pubs/research_reports/RR1165z4.html
  3. O’Hanlon, C., Huang, C., Sloss, E., Price, R. A., Hussey, P., Farmer, C., & Gidengil, C. (2017). Comparing VA and Non-VA Quality of Care: A Systematic Review. Journal of General Internal Medicine, 32(1), 105–121. https://doi.org/10.1007/s11606-016-3775-2
  4. Association of VA Psychologist Leaders. (2016). Comparison of VA to community healthcare: Summary of research 2000 – 2016. Retrieved from: http://bit.ly/1UOlEmF
  5. Tanielian, T., Farris, C., Epley, C., Farmer, C. M., Robinson, E., Engel, C. C., …Jaycox, L. H. (2014). Ready to Serve: Community-Based Provider Capacity to Deliver Culturally Competent, Quality Mental Health Care to Veterans and Their Families. Santa Monica, CA: RAND Corporation. Retrieved from http://www.rand.org/pubs/research_reports/RR806.html
  6. Pomerantz, A. S., Kearney, L. K., Wray, L. O., Post, E. P., & McCarthy, J. F. (2014). Mental health services in the medical home in the Department of Veterans Affairs: factors for successful integration. Psychological Services, 11(3), 243–253. https://doi.org/10.1037/a0036638
  7. Commission on Care. (2016). Commission on Care: Final Report. Retrieved from  https://s3.amazonaws.com/sitesusa/wp-content/uploads/sites/912/2016/07/Commission-on-Care_Final-Report_063016_FOR-WEB.pdf
  8. VA Office of Inspector General. (2017).Review of the Implementation of the Veterans Choice Program. Retrieved from https://www.va.gov/oig/pubs/VAOIG-15-04673-333.pdf
  9. https://s3.amazonaws.com/sitesusa/wp-content/uploads/sites/912/2016/03/Estimating-Costs-for-Veterans-Health-022916.pdf
  10. http://cv4a.org/wp-content/uploads/2016/01/Fixing-Veterans-Healthcare.pdf
  11. http://www.research.va.gov/about/history.cfm
  12. VFW. (2017). Our Care 2017: A report evaluating Veterans health care. Washington D.C.: VFW. Retrieved from https://www.vfw.org/news-and-publications/press-room/archives/2017/3/vfw-survey-veterans-want-va-fixed-not-dismantled