VA watchdog: multibillion-dollar program 'cumbersome' for veterans


By NIKKI WENTLING | STARS AND STRIPES Published: February 2, 2017

WASHINGTON — An internal watchdog at the Department of Veterans Affairs released findings this week confirming what many veterans and lawmakers already knew: the $10 billion Vpdf shoteterans Choice Program created to give veterans access to private health care has been “cumbersome” and “confusing” to use.

PDF: Review of the implementation of the Veterans Choice Program

The program was established by Congress in 2014, following discoveries veterans were suffering with long waits for care at VA facilities. The nominee for VA Secretary, David Shulkin, who worked as the VA’s undersecretary of health, was responsible for implementing it. Because of his involvement, the report – and the program’s deficiencies, in general – was questioned Wednesday during Shulkin’s Senate confirmation hearing.

Shulkin reiterated to senators that the VA inspector general reviewed only the start of the program, from November 2014 through September 2015, and it has since improved. Inspectors noted Congress gave the VA only 90 days to establish the program – a timeline that “posed many challenges.”

“[I]t described, I think accurately, a program that was in disarray,” Shulkin said of the report. “We’ve made this a much, much different program than it was then, and you can see the results.”

The VA used nearly $165 million to implement the program during its first year, while spending only $16 million on medical care during the same time, the report states. In many cases, veterans were sent back to the VA after waiting 48 days, on average, to get an appointment with a doctor in the private sector. About 98,200 veterans who were still holding out for an appointment in the private sector as of September 2015 were waiting an average of 72 days to be scheduled.

Through the Veterans Choice Program, a third-party administrator was responsible for scheduling appointments for veterans for private-sector care.

“[T]he procedures used to authorize and schedule appointments under Choice… were cumbersome and required veterans to schedule their treatment without assistance from [the VA],” inspectors wrote. “These procedures placed a greater burden on veterans than seeking treatment at [VA] facilities.”

Inspectors gave a few examples of how the system led to errors. In one case, the third party scheduled a primary care appointment in New York for a veteran living in Idaho. One veteran in Florida was given an appointment with a specialist in California. Another veteran in south Texas was scheduled with a specialist who couldn’t perform the surgery that he needed.

Spending on medical care has improved since then, the report states. Shulkin testified Wednesday that administrative costs are down to about 10 percent of overall costs associated with the program, which he said is “not bad.”

“When the Choice program got stood up, when we were just enrolling patients, the administrative costs were astronomical because we were building a brand new administrative infrastructure,” Shulkin said.

Latest data from the VA shows 32 percent of appointments made by veterans were sent to outside providers in fiscal 2016, up from 23 percent that were sent to the private sector in fiscal 2015.

The Veterans Choice Program is likely to face more examination this congressional session. The program, meant to be only temporary, is set to expire in August, and lawmakers are trying to devise a system to replace it.

There have been several proposals for how the VA should manage private-sector care.

President Barack Obama established the Commission on Care to draft a proposal, and former VA Secretary Bob McDonald released his own plan. Conservative-leaning veterans group Concerned Veterans for America recently released a proposal for radical change for how private-sector care is managed, and President Donald Trump has said he wants all veterans to have access to the private market.

Shulkin described a plan Wednesday to allow veterans to access private-sector doctors for urgent care. Eligibility is now based on veterans’ distance from a VA facility and how long they’ve been waiting for appointments with the VA.

Rep. Phil Roe, R-Tenn., chairman of the House Committee on Veterans’ Affairs, said his committee will discuss the Veterans Choice Program during a hearing Feb. 15.

Twitter: @nikkiwentling


Secretary of Veterans Affairs nominee Dr. David Shulkin, right, shakes hands with Senate Committee on Veterans' Affairs Ranking Member Sen. Jon Tester, D-Mont, before Shulkin's confirmation hearing on Capitol Hill, Feb. 1, 2017.