Policy Analysis
Proposals for the Veterans Choice Program Redesign
and their Impact on Veterans’ Health Care

Download copy HERE

 Developed by
Fighting for Veterans Healthcare
Association of VA Psychologist Leaders*
Association of VA Social Workers*
Nurses Organization of Veterans Affairs*
July 7, 2017
* An independent organization, not representing the Department of Veterans Affairs

Background

Over the last decade, as the rising demand for veterans’ healthcare services outpaced the Veterans Health Administration (VA)’s capacity to meet it, excessive delays developed at some VA facilities. In 2014, Congress enacted the temporary Veterans Choice Program whose goal was to reduce delays by offering non-VA options to veterans who had to wait long or travel far for care. To date, over 1.6 million veterans have utilized the program.1

The demand for veterans’ healthcare services is predicted to continue to climb during the next several years.2 There are two basic ways to address VA’s lack of capacity to meet this demand – bolster the VA by augmenting its number of clinicians and support staff, or purchase more services in the private sector. Those two options offset each other, since increases in Choice would be carved out of the VA.

As Congress deliberates Choice program redesign, policy makers should consider not only the plan’s ability to remedy access problems, but also its broad impact. Congress must ensure that the next Choice program does not compromise VA’s overall quality of health care – care that has been demonstrated, with geographic variations, to be at least equal to and often superior to non-VA care. Congress must ensure that the VA’s innovative, integrated care model is preserved. It must assure that the system for clinically training the majority of U.S. healthcare professionals is maintained. It must make sure that the VA is able to sustain its research mission that benefits not only veterans, but also every American. It must ensure that the private sector has the capacity to absorb an influx of veterans in a timely manner, and delivers excellent care. Given that non-VA care is more expensive than VA care, Congress must ensure that Choice is used judiciously so that there is no reduction in the level of services available to veterans. Finally, it must ensure that the VA is improved, not dismantled, because that’s what veterans overwhelmingly prefer, and have been promised by administration and Congressional officials. Our analysis of major policy ideas for the next version of Choice concludes that only one proposal does all this.

Proposals for Veterans Choice Program Renewal

At least four ideas for modifying Choice have been proposed by policy makers and veterans’ stakeholders. One – which we endorse – would fortify VA-delivered care and its management of the network of Choice providers. The other three concepts, although structured differently and still lacking specific details, would eliminate distance and wait time requirements, purchase far more care in the private sector, cut VA services and incrementally privatize veterans’ healthcare.

The following are the four ideas, and their potential impact on veterans’ healthcare if enacted:

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ENDNOTES

 

 

 


Wrong Choice for Veterans Healthcare

Initial Analysis

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