VA Inspector General Reviews Veterans Choice Program

VA Inspector General Reviews Veterans Choice Program

U.S. Senator Johnny Isakson, Chairman of the Senate Committee on Veterans’ Affairs, had requested The Department of Veterans Affairs (VA) Office of Inspector General (OIG) conduct a review of the Veterans Choice Program based on concerns about the implementation of the program.

The Veterans Choice Program was designed to give veterans the option to receive health care from a private hospital, physician or specialist rather than waiting for an appointment at a VA facility or traveling a driving distance greater than 40 miles from the closest VA facility.

How the Choice Program is designed to work

A veteran is placed on the Veterans Choice List (VCL) and may opt into the Choice Program and pursue health care from a networked provider in the community under certain conditions:

  • VA appointment wait time of more than 30 days
  • Veteran resides more than 40 miles from a VA medical facility
  • Veteran must travel by air, boat, or ferry to reach a VA medical facility
  • Veteran faces an unusual or excessive burden in accessing care at a VA medical facility
  • Veteran resides in a State with no VA medical facilities

The Choice Program covers only pre-authorized medical care, emergency and urgent care needs are generally excluded.

The OIG Review

The VA OIG reviewed data from November 2014 to September 2015 to identify the average wait times for multiple stages of the Choice Program process, including authorization of care, scheduling, and delivery of health care. Program costs are reported through May 2016.

Key Takeaways

Identified Barriers to Success of the Program

  • Cumbersome authorization and scheduling procedures
  • Inadequate provider networks
  • Potential veteran liability for treatment costs

The authorization and processing procedures averaged 32 days – 2 days longer than the VA standard of an appointment within 30 days. After receiving authorization the veteran had an additional average wait of 13 days to actually receive care.

Many veterans who opted into the Choice Program had a less-than-desirable experience:

  • 53 percent of veterans who received care waited an average of 45 days
  • 13 percent of veterans were returned to the VA without having received any care
  • 35 percent of veterans were still waiting for appointment to be scheduled, waiting an average of 72 days

Because of the delays in payments to the providers, veterans were also billed directly for the medical care, and many experienced adverse credit reporting for those unpaid bills.

By the Numbers

  • 13 Days – Average wait time to receive care after being scheduled with a Choice provider
  • 283,500 – Number of eligible veterans who opted into the Choice Program
  • 149,000 – Number of veterans who received an appointment with a Choice provider
  • 13 Percent – Rate of Choice Program utilization by veterans (appointments made)
  • 87 Percent – Rate of Choice Program non-utilization by veterans (eligible, but no appointments made)

VA OIG Recommendations

Based on the findings the VA OIG made the following recommendations to the Under Secretary for Health for the Veterans Choice Program:

  • Streamline processes and procedures for accessing care
  • Develop accurate forecasts of demand for health care purchased in the community
  • Reduce providers’ administrative burdens by simplifying billing requirements
  • Ensure veterans are not financially liable for the full cost of authorized care
  • Make provider payments in a timely manner
  • Determine if provider network growth is limited by below Medicare-rate reimbursements

References:

  • VA Office of Inspector General, Office of Audits and Evaluations, Veterans Health Administration, Review of Implementation of the Veterans Choice Program, Report # 15-04673-333 dated January 30, 2017 available at https://www.va.gov/oig/pubs/VAOIG-15-04673-333.pdf
  • The Veterans Access, Choice, and Accountability Act of 2014 enacted August 7, 2014
  • The VA Budget and Choice Improvement Act enacted July 31, 2015

To report suspected wrongdoing in VA programs and operations, contact the VA OIG Hotline:

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