Few vets getting care through $10 billion VA program

NEW YORK -- A new program that was supposed to get patients off waiting lists at Veterans Affairs medical centers by letting them switch to private-sector doctors is proving to be an even bigger disappointment than initially thought.

The Veteran's Choice program launched Nov. 5 with $10 billion in funding and the expectation it instantly would relieve backlogs at VA hospitals and clinics. But after a hurried rollout that has led to confusion as to exactly who is eligible and what patients need to do to coordinate treatment, officials say only 37,648 medical appointments have been made through April 11.

That figure represents only a tiny fraction of eligible patients. The Choice plan is supposed to be open to patients who live more than 40 miles from a VA hospital or clinic or who have been told they would have to wait more than 30 days for VA care. As of April 1, there were nearly 432,000 appointments pending in the VA's scheduling system involving a wait that long.

VA leaders have acknowledged few vets successfully were using the Choice program, but the new statistic came as a surprise -- as of mid-March, officials were saying more than 45,000 appointments had been completed, and participation had been rising.

A VA spokeswoman said data analysts recently corrected that count to exclude duplicate appointments and "incomplete transactions."

The VA has announced plans to loosen one important eligibility rule, and an analysis is underway to pinpoint why use has been low.

One important factor is that many vets have a long-standing relationship with caregivers at their local VA and would prefer to stay in the system, even if it means having to wait or drive long distances.

Yet, it is unlikely vets have been bypassing the Choice program solely because of lack of interest. Since the program's launch, approximately 1 million phone calls have come into a hotline patients can use to schedule a private-sector appointment, according to the two managed-care companies hired by the VA to administer the system.

Those contractors, TriWest Healthcare Alliance and Health Net Federal Services, said many of those calls were from vets who didn't need care right away and simply wanted information. But advocates for veterans also have raised concerns some veterans interested in the program were deterred by bureaucratic hassles, confusion about procedures or a lack of available, participating doctors.

A survey of about 2,500 veterans conducted over the winter by Veterans of Foreign Wars found only 19 percent of VA patients who believed they were eligible for Choice care because of a long wait time had been offered the option of getting care outside the VA.

Anecdotal stories also abound about lost paperwork and delays getting bureaucratic approvals needed to schedule private-sector care.

"There are a bunch of sharp edges," acknowledged TriWest's president, Dave McIntyre. He attributed most of them to an attempt to build the program from scratch in just 90 days -- a deadline set by Congress when it created the program last summer.

TriWest and Health Net weren't hired to run the program until October. That gave them just weeks to perform a dizzying array of tasks, including designing and mailing millions of eligibility cards, creating a call center, hiring and training new employees to work as appointment schedulers and persuading thousands of health care providers to accept VA patients.

McIntyre said his company had to hire and train 850 people in 10 days.

"Were they trained to an optimal level? No. Because you need about four weeks to do that," McIntyre said. "But Congress didn't give us four weeks."

Executives at TriWest and Health Net said training and bureaucratic procedures are improving.

Slowly, the VA also has been getting its own massive staff up to speed on the program -- a task complicated by the fact Choice is one of several VA programs that allow vets to get private-sector care, each with their own set of eligibility rules that sometimes overlap. The VA says it has been more successful in building those other programs, saying the overall use of VA-approved private-sector care is up 44 percent over the past year.

Patricia Schiller, a psychologist in Eufaula, Alabama, said she experienced some of the Choice program's limitations when she agreed to see a local veteran who had been driving 65 miles from his home in rural Georgia to see a VA clinician in Tuskegee, Alabama.

During his therapy session, Schiller discovered his primary reason for seeking care was he wanted someone to adjust his medication for post-traumatic stress disorder. That meant he needed to see a psychiatrist who could write prescriptions, not a psychologist like her.

"That's where the process broke down," Schiller said. "I couldn't even tell you who the nearest clinical psychiatrist is."

A Health Net directory shows the closest psychiatrist participating in the program practices in Montgomery, Alabama, 85 miles away.

Technically, any doctor approved to treat Medicare patients can see a vet in the program, but they still have to agree to the program's terms. TriWest now has about 100,000 medical providers in its network. Health Net says it has 78,000.

The government came under public pressure to do something about delays at the VA last spring, after revelations thousands of patients were languishing for months on waiting lists.

In August, Congress gave the VA $16.3 billion to shorten waits and improve access to care. Of that, up to $10 billion was designated to fund the Choice program over three years.

An Associated Press analysis of six months of VA appointment data, published earlier this month, found those reforms haven't yet translated into fewer delays. During that period, an average of 128,000 appointments per month took longer than 30 days to complete. Many of those delays were concentrated in a smaller number of problem hospitals and clinics.

Deputy VA Secretary Sloan Gibson said while the program isn't functioning yet as it should, he remains bullish the Choice program ultimately will have a positive impact.

On Friday, the VA is expected to finalize one tweak to program rules it expects to nearly double the number of eligible vets. Initially, the VA measured the 40-mile distance in a straight line, but it has since announced it will change the rule to 40 miles of driving distance.