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VA’s New Program Helps Vets Seek Care From Outside Doctors

A sign at the San Diego VA is shown in this Nov. 15, 2018, photo.

Photo by Megan Wood / inewsource

Above: A sign at the San Diego VA is shown in this Nov. 15, 2018, photo.

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The new program replaces the sometimes troubled Choice program, passed in the wake of the wait time scandal, where veterans were waited months for basic care at the VA.

Aired: June 6, 2019 | Transcript

The Veterans Health Administration is rolling out a major new program that will allow more veterans to see private doctors outside the system. Some of the services available to veterans are new.

“Under the MISSION Act, there is an urgent-care benefit, where veterans can seek care at an urgent care center, a contracted urgent-care center with no pre-authorization, no referral. They can simply stop by and get care for a bee sting,” VA San Diego director Robert Smith said.

For ailments such as bronchitis or the stomach flu, veterans enrolled in VA care can go into one of the agency’s private partners without a referral from their VA doctors. It’s part of an effort to give vets more choices outside the VA, Smith said.

The MISSION Act is a follow-up to the Choice Act. Congress quickly passed Choice in 2014 in the wake of the wait-time scandal, where vets languished for months on long waiting lists in Phoenix and around the country, Veterans Affairs Secretary Robert Wilkie said.

“Veterans Choice was a very hasty response to the problem in Phoenix,” he said. “This department was given 90 days to change its direction, change its ethos, and that was absolutely impossible to do.”

Doctors dropped out of the program over problems with billing and lost referrals. This time Congress gave the VA a year to work out the details of how to implement the MISSION Act.

Choice also relied heavily on being managed by private contractors. The VA is taking back some of that control.

Tosha Jones, a former Army medic who works as a section chief in customer service, says it takes a lot of effort to make the program work.

“As long as we have the resources and the staff we need, I’m confident the VA can do things like customer service and care coordination better,” he said. “I’m actually excited that it’s coming back.”

VA San Diego hired 60 people to manage the MISSION program, many of them schedulers like Jones who arrange appointments and answer billing questions. The VA is also deploying new software to make it easier for doctors to share patient records with the VA, Smith said.

The VA estimates that nationally, the program roughly doubles the number of veterans who will be eligible to go outside the VA for care.

To use the program for primary care or mental health, veterans only have to show that the wait to see a VA doctor is longer than 20 days or that they live more than a half-hour drive from a VA facility. The VA is banking on most patients sticking with VA care, which tends to be cheaper than paying for outside doctors, Smith said.

“Those are a small number of veterans, though,” he added. “About 95 percent of the veterans would still have their care or the coordination of their care provided by the VA.”

Even with a year to prepare, the process of implementing the MISSION Act is still coming down to the wire. Monday, just days before the change was set to be implemented, the director of the VA San Diego was still waiting for a final list of outside providers who would be part of the new urgent-care benefit.

“There are a lot of negotiations going on in the background and kind of filling in the gaps,” Smith said. “I have a promise of an email later today, but I have not seen a complete list (of outside providers) for the San Diego community. But it will be there June 6.”

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The Veterans Health Administration is implementing a major new program Thursday that will allow more veterans to see private doctors outside the system. KPBS takes a look at how the MISSION program will be rolled out here in San Diego.

Plus, a Scripps Institution of Oceanography study has found microplastics far below the ocean’s surface; a cross-border sewage fix may be coming; and the San Diego International Fringe Festival is back with the beautiful, bizarre and the unexpected.

Aired: June 6, 2019 | Transcript

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