VA in-house healthcare is great; community care efforts have fallen flat so far

VA in-house healthcare is great; community care efforts have fallen flat so far
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Quality health care is delivered at over 1,200 Veteran Healthcare Administration facilities every single day. While there’s no question some veterans require private care options because of personal circumstances and experiences, as Anuradha Bhagwati outlined in a recent op-ed for the New York Times, there is no need to disparage the whole system, which — by every measure — is serving its constituents well, as evidenced by any number of the dozens of customer satisfaction and health outcomes reports and articles published recently.

Like Ms. Bhagwati, I’ve been using VA for my primary care and specialty care needs for over 15 years, since my exit from active duty due to a service injury. I’ve also seen doctors at multiple VA facilities — from Louisville, Ky., and Fayetteville, N.C., to Washington, D.C. — and, like her, I was one of the first patients to utilize the VA Choice program. I’ve also spent the last decade as an outspoken advocate for military and veteran communities. I’ve met and heard Anu speak on numerous occasions, always applauding her very strong advocacy for bettering the lives of the population we belong to, particularly her battles for those who have experienced sexual or gender-based trauma.

That’s where the similarities end. 

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While it took a few years for the staff to stop asking where my husband was after I first started using the VA in the early 2000s, I can honestly say that hasn’t happened in over ten years. And yes, there are still odd male patients who persist in calling me honey or dear, but rarely in a lascivious way, and more in the grandfatherly manner many older generation males do, even in the private sector. I’ve experienced worse behavior at my private care doctors — I won’t go into the details of the civilian doctor who called me ‘little girl’ for two years — none of whom have implemented the bold, consistent anti-harassment campaigns that are visible on every TV monitor at the VAMC I use, or have clearly-defined women’s clinics (with privacy curtains and specially trained women's health providers!) should I need one, as well as the option to request a same-sex witness during my interactions with my health care provider.

Between my personal medical care and my direct observations of the care of the VA patient for whom I am primary caregiver, I’ve never been treated more thoroughly than at the VA. I’ve not had to explain the toxic exposures, the propensity for ailments common to our population, or even why I’m adverse to certain medications — mainly because my entire medical file is at their fingertips, with all of my specialists able to access it immediately and provide appropriate care and testing in one location.

I was excited about the opportunity to use VA Choice care when it launched — the D.C. VAMC is only 11 miles from my home, but anyone familiar with D.C. traffic will understand that is a 45-minute drive on a good day, and an hour and a half on a bad one. Choice seemed like a dream come true… till I tried to use it.

Badly managed from the start by half-trained contractors working on a hurried development/deployment timeline because of urgency imposed by Congress, it offered me nothing but frustration.

Private sector providers in the DC Metro area weren’t open to taking on veteran patients, and they definitely weren’t interested in working for Medicare/Medicaid rates, coupled with the added burden of manually faxing in extra reports and invoices to the VA. The third-party ‘assistance’ by the contractor just muddled the already onerous lines of communication.

After several tries, I found a provider willing to see me once a week, and was then dumbfounded by the fact that the VA did not pay her for nine months. 

It took me walking into an office in D.C. and sitting there for two hours until the finance specialist could figure out the bottleneck and issue payment. When I resumed seeing my doc, the same problem occurred almost immediately, and I paid her out of pocket just to ensure medical debt didn’t end up on my credit report. 

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The VA Mission Act at least has the benefit of the lessons learned from the horrific implementation and fragmented care provided by Choice. The VA will now manage the process internally through their Veterans Community Care Program, and the new access standards will allow more veterans to seek convenient care based on drive times and medical need. One of the many reasons I, and the other VSOs, are still skeptical is that new effort has yet to be clearly defined and resourced — and it definitely won’t surpass the streamlined primary and specialty care programs already in existence at the VA, or the above-standard metrics the VA already meets and exceeds in patient care and satisfaction.

It’s also pretty unlikely, based on independent studies, that there is available capacity and requisite knowledge in community-based providers to absorb additional veteran patients, especially those in highly-populated metro areas, or those with intense, lifelong specialty care issues, like spinal care, traumatic brain injury, and polytrauma needs.

Veterans can’t afford to wait for the problems that will surely occur during the implementation of Mission Act to bubble up: Expansion of private sector care for veterans should be well-defined prior to any live execution efforts, and very few who work in veteran policy feel that has happened yet. Upcoming deadlines for the rollout seem premature — there is a lack of definition around the new Mission Act access standards, uncertainty about who will manage the six Community Care Networks in each region (to date, only three have been awarded), and valid budget concerns following the rising costs of care over the last several years.

So while I completely support veterans accessing timely and quality care when and where they need it, throwing veterans into the civilian healthcare system without intense oversight and clear communication with all stakeholders seems irresponsible. The Mission Act must be implemented in a thoughtful, detail-oriented, easily understood manner.

Bottom line: actual VA medical care is great, navigating the accompanying VA bureaucracy is difficult at best. Let's work to preserve the good, while resolving the bad.

We will be watching closely.

Danielle Corazza is the Vice President of VetsFirst (@Vets_First) at United Spinal Association and a service-disabled U.S. Army veteran.