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VA Choice Program Needs Reworking Ahead of MISSION Act Revamp

A GAO report found that considerable fixes are necessary for the VA Choice Program ahead of changes mandated in the VA MISSION Act.

va choice program mission act

Source: Thinkstock

By Sara Heath

- The process by which the VA refers patients to the Veterans Choice Program is complicated and creates more delays in patient access to care for the VA’s patient population, according to a report from the Government Accountability Office (GAO).

This most recent report builds upon another published by GAO in March 2017. Both reports contend that the referral protocol for the Veterans Choice Program needs reworking.

Currently, VA enlists the expertise of third party administrators (TPAs), or contractors who complete the referral process for VA. TPAs usually take the maximum amount of time allowed for them to schedule community care appointments for patients. This leads to a backlog in scheduling and, in the end, causes patients to wait longer than the allotted 30 days mandated for scheduling a VA appointment.

This negates the purpose of the Choice Program, which was enacted in response to long wait times at the VA. The program aims to connect veterans who face extraordinary travel barriers, long wait times, or other limited care access issues with non-VA providers.

In GAO’s analysis of 55 routine care authorizations in 2016, the average wait time was 64 calendar days. An analysis of 5,000 routine care authorizations in 2016 showed average wait times at 55 days.

READ MORE: President Signs VA Mission Act Into Law, Extends VA Choice Program

Part of VA’s issue is that it does not have any means to track progress on appointment authorizations, GAO pointed out. This is because VA does not have reliable data for doing so. Currently, there is a lack of data on referring timeliness and timeliness of veterans opting into the Choice Program. There is also inaccuracy of clinically indicated dates and unreliable data on timeliness of urgent care.

Additionally, other logistical and programming problems hinder the VA in connecting veterans to third-party, community caregivers.

“GAO found that numerous factors adversely affected veterans’ access to care through the Choice Program,” GAO reported. “These factors include: (1) administrative burden caused by complexities of referral and appointment scheduling processes, (2) poor communication between VHA and its VAMCs, and (3) inadequacies in the networks of community providers established by the TPAs, including an insufficient number, mix, or geographic distribution of community providers.”

Since GAO’s initial findings that VA has too complicated a referral process for the Choice Program, the agency has only halfway complete measures to address its issues. For example, VA has established a system by which TPAs can access veterans’ health records. While this step is essential for TPAs to discern which type of provider the veteran needs, VA still failed to establish a method for it to track authorization progress from TPAs.

In this most recent report, GAO offered ten recommendations for the agency, including efforts to redesign the appointment scheduling process, track how long appointment authorization takes, establish a system to sort urgent and non-urgent Choice Program referrals, create performance metrics, and facilitate information sharing between VA and community health providers.

READ MORE: Veterans Choice Program Extends Third-Party Care Options for Vets

These findings are of note because of the recent legislative action taken around the Veterans Choice Program. Earlier this month, both houses of Congress passed the VA MISSION Act, which allocated $5.2 billion for the VA to revamp the Veterans Choice Program. Last week, the President signed the bill into law.

The law provides funding for VA to keep the Choice Program running until the agency has created a new, consolidated community care program that is slated to replace the Choice Program. Veterans Choice was slated to end in late June, but will not run until VA can replace it with something better, agency officials state.

Creating the fixes to the Veterans Choice Program is still important, however, GAO noted.

“While the Choice Program will soon end, VA anticipates that veterans will continue to receive community care under a similar program that VA plans to implement, which will consolidate the Choice Program and other VA community care programs,” GAO explained. “Incorporating lessons learned from the Choice Program into the implementation and administration of the new program could help VHA avoid similar challenges.”

The VA MISSION Act has implications beyond changes to the Choice Program and community care options. The law also expands veteran access to caregiver services to veterans who served prior to 9/11.

READ MORE: What Providers Should Know to Improve Patient Access to Healthcare

The legislation comes as a part of the Presidents efforts to revamp the VA, something he says is a duty to those who served in the armed forces.

“In every generation there have been heroes like them, patriots who answer the call to serve, who do whatever it takes, wherever and whenever we need them to defend America,” the President said in a statement about the MISSION Act. “They put everything on the line for us. And when they come home, we must do everything that we can possibly do for them. And that's what we're doing.”

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