Push to Let Veterans Use Private Care Gains Traction
The Des Moines Register; Tony Leys, 6/7/2014
Robert Hunter, like many Iowa veterans, has few qualms about the quality of care he receives from the Department of Veterans Affairs.
But the system’s bureaucracy and lack of resources can be aggravating, and he wishes he didn’t have to drive 90 miles from Fort Madison to Iowa City for most of his appointments.
He might soon get his wish, thanks to a boiling national controversy over waiting times at VA hospitals and clinics.
Some members of Congress have long pushed the VA to let more veterans use their benefits for care in private hospitals and clinics. That idea is gaining traction since reports surfaced that VA administrators in Phoenix and elsewhere covered up the fact that veterans had died while waiting months for care.
A bipartisan compromise reached last week in the U.S. Senate would let veterans seek private care if the VA can’t get them an appointment within 30 days or if they live more than 40 miles from the nearest VA facility.
No evidence has surfaced that waiting-list cover-ups happened in Iowa, but VA reports show that its facilities here often fail to meet their goal of getting new patients in for appointments within two weeks of a request.
U.S. Sen. Chuck Grassley, an Iowa Republican who backs the bipartisan compromise, told The Des Moines Register that he believes the proposal will move forward. He also noted that VA leaders already have pledged to let more veterans seek outside care.
Without the controversy about backlogs, “the legislation probably would not have been introduced,” he said. “Also, the VA probably would not voluntarily be letting people go to non-VA facilities except in really emergency situations.”
The upshot could be good news for Hunter. The VA pays for his visits to a Fort Madison chiropractor. But for most other care, he must drive to the Iowa City facility, one of two VA hospitals in the state.
Hunter, 43, a disabled Iowa National Guard veteran of the Iraq War, said he has seen the Iowa City VA hospital become increasingly stretched in recent years. He said he had few problems gaining prompt care when he started going there a decade ago. “But then it seemed like it wasn’t big enough or had enough staff to handle all the guys coming back” from wars in Iraq and Afghanistan, Hunter said.
Grassley: Quality complaints rare
Grassley said that in his frequent meetings with Iowans, he sometimes hears complaints about how long it takes for veterans to get into the VA system, but rarely hears serious complaints about the quality of care.
Grassley said he does not foresee giving veterans insurance cards they could use at private facilities whenever they wanted. “If you just had open enrollment, you’d be running two systems, which would be very inefficient,” he said, noting that the government has spent billions of dollars setting up more than 1,000 VA hospitals and clinics. “You’ve got to ensure that if you have a VA system, it’s going to be used in an economical way.”
VA officials acknowledged last week that a few Iowa veterans wait more than a month for appointments, usually for specialized procedures or surgeries for which the agency has to contract with outside providers.
At the Des Moines VA hospital and its five outlying clinics, which serve 30,000 veterans per year, 52 patients were on a list of people for whom no appointment could be scheduled within 90 days of a request, a report showed. However, such people often don’t have to wait that long because they are seen when openings crop up in the schedule, officials said.
On average, the report said, new patients wait an average of 14 to 34 days to be seen for various types of care in the Des Moines VA system. In the Iowa City system, the averages are 21 to 39 days.
The Des Moines VA’s director, Judith Johnson-Mekota, said national auditors checked her hospital recently and found no signs that waiting-list data had been manipulated to hide how long patients were waiting. She said the auditors recommended improved training for schedulers, which will be implemented.
A spokesman for the Iowa City hospital said auditors also found no wrongdoing surrounding waiting lists at his facility. A national report on the audits is expected to be released soon.
Iowa VA facilities are shorthanded
Johnson-Mekota, who became the Des Moines director last fall, worries that publicity about problems in some VA hospitals will discourage veterans from seeking care even if they could get right in. She’s striving to prevent such misunderstandings and to keep her staff members from becoming discouraged.
“This VA has such a strong work ethic, and they have such a commitment to veterans,” she said.
Dr. Fred Bahls, who is the Des Moines system’s chief of staff, said the system has improved substantially in recent decades. Bahls, a neurologist, returned to the VA in 2002 after being gone for 12 years. “It was a totally different VA than I’d seen,” he said.
Patients’ care is much better coordinated now, he said, and the staff carefully tracks how patients fare. However, he acknowledged that the Iowa hospitals and clinics are shorthanded.
The Des Moines system has 74 physicians and is trying to fill about a dozen other openings, he said. But Bahls noted that private Iowa hospitals and clinics also struggle to recruit enough doctors. If the VA were part of the military, it could order its physicians to move to high-need areas such as Iowa. But the agency relies on civilian employees, who can decline to move.
VA facilities are judged on how well they do at scheduling non-emergency appointments within 14 days for new patients. Bahls believes that’s a good goal, but he speculated many private clinics would have trouble meeting it. “I don’t know if people understand that the 14-day standard is a pretty high bar,” he said.
Anecdotal evidence supports his contention. For example, a recent report found that in the Des Moines VA system, 55 percent of new mental health patients were scheduled for non-emergency appointments within 14 days after they requested one.
At many other mental health agencies in the area, new patients typically wait several weeks or even months for their initial appointments. Broadlawns Medical Center, Polk County’s public hospital, said its typical wait time for such an appointment recently jumped from two weeks to four weeks. Broadlawns has seen a surge in requests for mental health appointments since Mercy Medical Center announced plans to shutter a large outpatient mental health clinic. Mercy leaders said they’re closing the clinic because they can’t recruit enough psychiatrists.
Grassley’s office last week released internal documents about wait times reported by Iowa’s two VA hospitals and 14 outlying clinics. The reports show the percentages of patients in March who were given appointments within two weeks. Grassley’s staff warned that such figures can vary significantly from month to month, but the reports show how varied veterans’ experiences can be.
For example, five clinics reported that at least 90 percent of new mental health patients received prompt appointments. But at the Sioux City and Spirit Lake clinics, the scores were just 2 percent and 7 percent. A spokeswoman said the psychiatrist who serves that clinic was out with a medical emergency, but has since returned to work.
In Des Moines, the VA has already started to see the flow of new patients ease with the end of the Iraq War and the winding down of the Afghanistan War. The system saw 6,800 new patients two fiscal years ago and 5,230 last fiscal year. It is on track to see about 4,000 this fiscal year.
However, Johnson-Mekota said the agency projects that the number of veterans using her system, now around 30,000, won’t peak until 2020.
Vets groups back separate system
National veterans organizations are offering to compromise — at least temporarily — on their longtime opposition to giving veterans insurance vouchers to use at private hospitals.
“Drastic times take drastic measures,” said Ray Kelley, national legislative director for the Veterans of Foreign Wars.
Kelley said the VFW supports easing of rules to let veterans use their VA benefits at private hospitals and clinics if the VA can’t offer them prompt care. However, many veterans probably would find they also face substantial waits at private facilities, he said.
The VFW and other major veterans groups remain committed to keeping a separate health care system for veterans. They argue that the VA helps uncover and treat maladies rooted in military service. Kelley noted that the VA also has developed unparalleled expertise in fitting prosthetic devices to people who have lost limbs and providing mental health treatment to those suffering post-traumatic stress disorder.
A privatized system would not likely do as well at such things, he said. “Our government has the responsibility to make whole the people they’ve sent to war,” he said.