David Zalubowski/AP Photo
A potentially costly and harmful experiment in veterans' health care is scheduled to begin eight weeks from now. The Veterans Community Care Program (VCCP), created under the VA MISSION Act of 2018, will channel millions of the nation's most vulnerable veterans to private-sector doctors and hospitals. VA leadership is determined to launch the program on June 6, in spite of federal reports and Capitol Hill testimony by both friends and foes of privatization that say it is not ready for rollout.
This was made abundantly clear at an April 10 Senate Committee on Veterans' Affairs hearing. Chairman Johnny Isakson (R-GA), a leading proponent of outsourcing veterans’ care from the Veterans Health Administration (VHA) to private doctors and hospitals, predicted, “We’re going to stumble before we walk.” It was a staggering admission: VA leaders and Republicans like Isakson seem willing to send waves of patients into the private sector where the care is likely to cause harm.
Passed last June, with bipartisan support and only 83 congressional dissenters, the VA MISSION Act of 2018 was intended to remedy the problems inherent in the 2014 Veterans Choice Program. Sharon Silas, acting director of Health Care for the Government Accountability Office, catalogued a long list of Choice’s failings at the hearing. The program was hastily implemented, poorly coordinated, and riddled with cost overruns. Meanwhile, third-party administrators who mishandled reimbursement claims and overbilled for their services were greatly enriched as Choice delivered more than $19 billion to private-sector interests. Secretary of Veterans Affairs Robert Wilkie, according to the GAO, has neglected to correct many of these administrative problems.
These and many other stumbles have led some veterans' service organizations, which originally supported the VCCP legislation, to express alarm. The VHA “is not yet prepared, nor likely to be prepared within eight weeks, to implement significantly more complex and expansive access standards without risking serious disruption to veterans' healthcare,” warned Adrian Atizado, deputy national legislative director of the Disabled American Veterans, at the Senate Committee hearing. He questioned whether the VHA can “safely coordinate the clinical care of the increased number of veterans who use the VCCP networks.”
VA leadership, in a report sent to Congress last month, said that “fragmentation of care between VA and non-VA providers creates new risks for harm.” While patients with “straightforward medical conditions and a strong support system” may have “excellent outcomes,” outsourced care could be less successful “if a provider sees a Veteran with complex needs such as homelessness or co-existing mental illness.”
Despite a looming problem with wait times, coordination, and quality of care, the report confirmed that Wilkie is reluctant to hold private-sector doctors and hospitals to the same high-performance standards required of the VHA, because doing so might “have a significant negative impact on their participation.”
During his testimony at the April 10 hearing, Dr. Richard Stone, the executive running the VHA, noted that the agency's overall assessment of private-sector capacity to care for veterans was still incomplete. He also reported that more in-house staff would be needed to manage outside care arrangements. Such a task would leave VHA doctors, nurses, and therapists with less time to provide direct care to veterans. Staff are already dealing with heavier patient loads because of the secretary's unwillingness to fill 40,000 vacant positions.
In one telling exchange, ranking committee member Jon Tester (D-MT) asked Stone about possible harm inflicted by outside providers. Veterans injured as a result of medical error inside the VHA can file a 1151 claim for compensation and lifetime care, using a process like the one that determined their original eligibility for coverage, based on a service-related condition. Stone admitted that patients suffering harm in the private sector would have no such recourse and would, instead, “have to rely on the tort system.” (Studies confirm that patients have a difficult time proving medical harm, with very few victims of malpractice ever receiving any compensation.)
Tester, who co-sponsored the MISSION Act, and fellow Democrats Sherrod Brown (D-OH) and Joe Manchin (D-WV), who voted for it, used the April 10 hearing to express second thoughts about its consequences. Tester worries that veterans will end up with private care that's “lower value, less timely and of lower quality.” In his view, the Trump administration's hurried implementation of the MISSION Act reflects “a political agenda,” rather than “best policy.”“This opens the door to privatization,” noted Manchin. “The private sector is going to prey on veterans like you've never seen. I truly believe that in my heart. That's a whole other cash cow for them.”
Disabled American Veterans is demanding that the expansion of outsourcing scheduled for June be delayed until the “VA can certify to veterans and to Congress” that it has been “properly tested” and will occur with “minimal disruption.” Other veterans' service organizations should join that call and let members of Congress know that, when patients' lives are at stake, “stumbling” is simply unacceptable.
