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

Speaker 1: 00:00 Today, the Veterans Health Administration is rolling out a major new program that will allow more veterans to see a doctor outside the Va. KPBS military reporter Steve Walsh says the VA officials from Washington to San Diego hope to learn from past mistakes Speaker 2: 00:16 starting this week. The mission act is changing the way the VA works with outside doctors. Va San Diego Director Robert Smith says some services are brand new. Speaker 3: 00:26 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, um, with no pre authorization, no referral. They can simply drop by and uh, get care for, you know, a bee sting Speaker 2: 00:42 or bronchitis or a stomach flu. Just go right to urgent care. Veterans still have to be enrolled in VA care to qualifying. The mission act is a followup on the choice act. Va Secretary Robert Wilkie says Congress quickly pass choice in 2014 and the wake of the wait time scandal where veterans languished for months on long waiting lists at Phoenix and other vas around the country. Speaker 4: 01:04 Veteran's choice was a very hasty response to the problem in Phoenix. This department was given 90 days to change its direction, change its ethos, and that was absolutely impossible to do. Speaker 2: 01:20 There were problems with billing and lost referrals. Some doctors drop down this time. Congress gave the VA a year to work out the details of the mission act choice also relied heavily on being managed by private contracts. Speaker 5: 01:32 During, ma'am, if you don't mind, I'll let me put you on a brief hold. I'm just gonna check with the point of contact and podiatry. Okay. Speaker 2: 01:41 The VA is taking back some of that control. Tasha Jones is a former army medic who works as a section chief in customer service. Speaker 5: 01:48 It is a lot of work. It is, but long as we have the resources and the staff that we need, I'm confident that the VA can, uh, do the things like customer service and care coordination better. I'm actually excited that it's coming back. Speaker 2: 02:01 Va San Diego hired 60 new people to manage the program. Many of them, schedulers like Jones who arrange appointments and answer billing questions. The is also deploying new software to make it easier for doctors this year. Patient records with the Va VA says the program roughly doubles the number of veterans who can go outside the VA for primary care or mental health. Veterans only have to show their wait time was longer than 20 days or they live more than a half an hour drive from the Va facility. Speaker 3: 02:30 Those are a small number of veterans though, so about 90 95% of the veterans who were under our care would still have the bulk of their care or their coordination of care provided by the Va. Speaker 2: 02:42 Smith says the VA is banking on most people's sticking with VA care even with a year to prepare. It's all coming down to the wire. I interviewed the head of VA San Diego Monday. Some of the details about which providers would be part of the new urgent care benefit still been nailed down. Speaker 3: 03:00 Oh, there's been a lot of contracting that's been going on in the background and kind of filling in the gaps and I actually have not yet seen it. I have a promise of an email later today. I have not seen the complete list for the San Diego community. Okay. And so if you're, but it will be there. June 6th Speaker 2: 03:16 veterans groups lobbied heavily to replace choice with a system more responsive to vets like the VA itself, the VFW and other groups are waiting to see what happens after the new program goes live on Thursday. Speaker 1: 03:28 Journey me as KPBS military reporter Steve Walsh. Steve. Hello. Hi Maureen. So the mission act replaces the choice act, which was put into place because of the long wait times at the Va. Can you remind us about those wait times that prompted all these changes? Speaker 6: 03:47 Well, this was a nationwide scandal. Veterans were kept on waiting lists. I'm waiting for months, if not over a year for care at the Va, uh, in places like Phoenix. But really it was happening in Ed vas around the country. There was a very long wait time in San Diego for mental health care back in the day. Speaker 1: 04:06 Is the fundamental problem here that there are too few VA doctors and clinics available to give care for the increasing number of veterans? Speaker 6: 04:15 Well, well some of this could be, um, they're just, they just need to have more doctors and nurses and staff at the Va. But uh, you know, for certain specialties there, the VA ever since the really the founding of the Va, they've always used, um, the private sector for at least a portion of their care. Speaker 1: 04:33 Yeah. You mentioned that the outside healthcare providers are available to vets if they wait longer than 20 days or if they're more than a half hour drive to a VA facility. Based on what you said, what if a veteran just thinks they can get better care somewhere else with the VA ever foot that bill? Speaker 6: 04:50 Well, that's not really how the whole system works. Uh, and there have been efforts to basically do medicare for all four for events. Um, they've resisted that a, a lot of the, the big veterans organizations and a lot of Democrats don't like the idea of shifting so much money into the private sector that it could actually damage care at the Va, so this is, you still have to be enrolled in VA care. You still have to be a part of the system. A Va doctor is still going to oversee the care. They're still going to coordinate the care, but in many cases it's going to be much easier for many more vets to go see a doctor in out in the community assuming one is available. Speaker 1: 05:33 Yeah. It's kind of unsettling that with a year to prepare. The VA here didn't have a list of providers just before the rollout of this new mission act program. Any reason for that delay? Speaker 6: 05:44 This is all still new. There's a brand new it system that goes along with this that will be tested as soon as this goes live. The benefit that you're mentioning is a new urgent care benefit where you might be able to go to, let's say a Walgreens or some of those places if you have a stomach flu or something without checking with your VA doctor. And they had a, they were working with a number of providers to create those contracts. And you're right, when I talked to the director of the San Diego VA on Monday, they still didn't have a completely finalized list. And we know, you know, the Va is an incredibly large system. Um, any change, uh, there will be a, without a doubt a number of hiccups. Speaker 1: 06:26 I get the feeling of from listening to your story and hearing you talk right now, that there is a lot of politics involved in making these changes to the veteran's administration healthcare program. Can you talk to us about that a little bit? Speaker 6: 06:40 The politics are involved. I think it basically comes down to the reason the choice act was called. The Choice Act is one of the original ideas out there by Senator John Mccain when he was still alive was to have that sort of veterans care for all where that that a veteran could go out in the community with a VA card and get care wherever they want. Basically just like Medicare and there has been an enormous amount of pushback. A lot of the large veteran organizations like the American Legion and the VFW, they worry that if you take too much money from the system that it starts to damage the system as a, as a whole. And keep in mind, uh, the private sector is no panacea. They don't necessarily have a shorter wait times and the care in many cases and in and for many specialties is actually more expensive than just using a VA doctor. Speaker 1: 07:29 Now you said the VA was beefing up its resources and staff for customer service, I guess better customer service. What kinds of services will they be providing? Speaker 6: 07:39 Well, this is one of the real problems. And we reported on this, um, during the early days of the choice program to get this up and running in 90 days, which was with, that was their mandate to do this within 90 days they decided to farm out a lot of this to third party contractors at Tri West in the west and on the east coast, uh, an organization called health net. And they found over the first couple of years that maybe the VA had given away too much control. You had outside schedulers who are in charge of scheduling the appointments. They were the ones that were being the liaison between patients and those doctors instead of somebody at the Va and under the mission act that try to correct that by bringing a lot of that back in house. So there were a number of people who are hired even in San Diego to do this. And for most, most of those people, their role will be that kind of basic scheduling being that liaison between the patient and the VA and the outside doctor. Speaker 1: 08:41 Now the VA says it's still believes that most veterans will stick with the VA for their health care. And I wonder, even with all the problems it's had, does the VA still get high marks among vets? Speaker 6: 08:53 Well, that has been the sort of duality of this story. The, the Va does have a lot of problems and rollouts seem to be among the worst. It takes them a very long time to get new programs up and running. But once if veteran gets into the system, and I can tell you this anecdotally, just from talking to local events, local vets who use VA care for the most part are very happy with it and they give it very high marks and they don't want to go to a private doctor. They want to go where someone understands their needs and honors their service. Speaker 1: 09:27 I've been speaking with KPBS military reporter Steve Walsh. Thank you. Thanks Maureen.