When news broke in 2014 that the Department of Veterans Affairs (VA) was covering up dangerously long wait times at VA clinics, the administration was quickly buried in an avalanche of bad press.
Congress responded by creating the Choice Card program, which allows veterans facing long wait times to seek care from private doctors.
Now that program, too, has encountered a serious problem. The VA reportedly hasn’t been paying these out-of-network doctors.
Despite the program’s $10 billion budget, the VA is behind on $878 million in payments for emergency services rendered at non-VA hospitals throughout the nation, according to testimony delivered to Congress by Vince Leist on behalf of the American Hospital Association (AHA).
That’s giving these hospitals pause when it comes to working with the VA to treat veterans.
“While we are very dedicated to serving the veterans in our community, and we accept each and every one who walks through our doors, we have decided against contracting with the VA due to slow or no payment for claims and the bureaucracy involved with getting claims through the payment process,” Leist, the chief executive officer of an Arkansas healthcare system, told Congress last June.
Started Too Quickly?
Administrative hiccups also frustrate many veterans.
Part of the problem is the speed with which the program was introduced, according to the private companies contracted by the VA to handle referrals and process payments.
The program began on Nov. 5, 2014, just a few months after President Obama signed the Choice Act into law.
“Within record time, we created the infrastructure, hired and trained hundreds of staff, and mailed Choice Cards to the four million veterans in our area of responsibility,” a public relations team from Triwest, the firm that administers the program in the West and parts of the South, told Healthline in an email.
“We continue to work alongside the VA to refine the program to help improve upon its original structure as the program is matured,” they wrote.
Some Changes Made
Since its inception, the Choice Card program has been adjusted in several ways in response to user complaints.
Originally, veterans were eligible to use the program if they had to wait more than 30 days past the time a doctor recommended they be treated, or if they lived more than 40 miles from the nearest VA clinic as measured by a straight line.
Now, veterans are eligible if they have to wait any amount of time longer than what the doctor recommends, or if they live more than 40 miles away in terms of driving distance.
Most recently, the VA eliminated the requirement that veterans’ medical records must be received in order to process claims. The move was meant to streamline payments, and was applauded by Triwest and Health Net, the other health insurance company contracted by the VA.
But Carlos Fuentes, a policy advisor with the Veterans of Foreign Wars (VFW), is skeptical that decoupling medical records from payments is the right approach.
“We’re actually supportive of tying payment and medical documentation and we don’t completely agree that that was what was causing the delay,” he told Healthline.
One of the benefits of the VA system is that it provides “integrated care,” he said, meaning that doctors can track a patient’s medical history and progress even if different doctors at different places saw that patient. Keeping track of medical records is an important part of such care, he said.
Indeed, of the recommendations that Leist made to Congress last year, removing the medical records requirement was not among them.
He suggested that the VA commit to accepting or denying a claim within seven days and paying approved claims within 30 days. The administration should also be clear about why it denies claims.
Fuentes also cited poor communication as a major roadblock to processing claims, as well as an outdated paperwork system that relies heavily on actual paper rather than electronic records.
VA Says It’s ‘Moving Forward’
In a press release, the VA said it “is moving forward on two paths to further improve timely payment.“
First, VA officials are working toward a single community care program that is easy to understand, simple to administer, and meets the needs of veterans, community providers, and VA staff.
Secondly, VA officials plan to pursue a claims solution that moves to a more automated process for payment.
Marilyn Park, a lobbyist with the American Federation of Government Employees (AFGE), a union that includes VA employees, says the Choice Program took resources away from the already underfunded and understaffed VA hospital network.
“It’s simple physics,” she told Healthline. “Demand’s going up and resources for staff are not meeting it at all.”
Veterans themselves prefer the VA, she said, citing polling commissioned by the Vet Voice Foundation, a nonprofit. That poll found that 64 percent of veterans oppose privatizing their healthcare.
“We want the veterans to get the care they prefer and we want veterans to get the comprehensive and integrated care that they were promised,” she said.
When the Choice Card program expires in 2017, it will likely be folded into a new program consolidating the eight private payer programs administered by the VA. The union supports that plan, Park said.
Payment woes are “another example of why the VA needs to reassert control and do a smart version of contract care,” she said.