This week the House Veterans Affairs Committee (HVAC) held a hearing on the Choice Program and its implementation since becoming law less than three years ago. Since that time, the Choice Program has allowed some veterans to seek care outside the VA health care system if their wait time is longer than 30 days or they live more than 40 miles away from a VA facility….At least that is how the program works, in theory.
In practice, the Choice Program has caused a copious amount of problems. Veterans have faced large medical bills and damage to their credit due to an ineffective billing system. Additionally, a report from the Office of Inspector General (OIG) just found that facilities in North Carolina and Virginia were continually manipulating wait times and thus keeping veterans off the Veterans Choice List. The Choice Program was intended as a stopgap measure until major VA choice reforms could be put in place, and it’s clear that those reforms are seriously needed.
The general consensus of this hearing among the VA Secretary, representatives from the OIG, Government Accountability Office (GAO) and committee members is that the Choice Program’s infrastructure is inadequate. Secretary Shulkin has stated on multiple occasions that one of his top priorities is a complete redesign of choice, or “Choice 2.0,” as he is calling it. Secretary Shulkin has suggested that the way to make the VA strong is by allowing veterans to choose where they receive care. A plan for this should be forthcoming in this year.
A reoccurring point from this hearing was that IT is a major factor in Choice working and the VA’s success in general. VA Inspector General Michael Missal also pointed out the difficulty in records management – medical records following the veteran when they seek private care and coming back to the VA to ensure continuity of care. Secretary Shulkin would like to see the VA use software that is “off the shelf” rather than software developed on the inside. Modernization is severely needed, however, what is also severely needed are consequences for not using the scheduling software correctly in the first place. “Zeroing out” wait times to decrease the perceived number of days’ veterans are waiting for care is still taking place. Along with new IT software needs to be accountability for not following scheduling policy.
Secretary Shulkin stated that accountability measures are necessary to get the wrong people out of the VA and transform the culture to a transparent one. Randy Williamson from GAO also pointed out that oversight and accountability along with specific timeframes are needed to get the VA office the GAO’s high risk list on which it currently sits regarding IT.
The Choice Program is currently in talks to be extended until it’s budget has run out. At that point there will hopefully be an updated approach to choice and accountability that puts veterans in control of health care and quickly removes employees who stifle that control.