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Is coronavirus causing another VA appointment wait-time scandal?
As the news continues to be dominated by the COVID-19, one important aspect of the conversation is how the illness is impacting veterans, as well as the Department of Veterans Affairs (VA).
Although VA has assured the public that they are prepared to handle the impact of the virus on the veteran population and at its various facilities, few questions have been asked about how VA will respond to the almost certain influx of postponed appointments that will need to be rescheduled in its aftermath.
Unfortunately, VA has a track record of initially glossing over serious issues - as it did during the 2014 wait-time scandal and during the GI Bill payment delays in 2018, for example, only to later backtrack and admit that it needed more resources.
It is important to ensure that VA does not now gloss over what its plans are to address veteran's care in a post-pandemic world.
Despite the fact that VA is publicly saying that it will continue to consider medical appointments and community care appointments on a case by case basis, numerous veterans are complaining on VA's Facebook page that they cannot currently get access to necessary treatment for either COVID19 or other ailments - evidence that a backlog may already be building.
To this end, VA was recently provided with an additional $19.6 billion to buy more testing kits, medical equipment and personal protective equipment for medical staff, boost the department's telehealth capabilities and send veterans outside the VA for emergency care, among other measures. Despite this high price tag, no mention is made of continuity of operations as the pandemic winds down and numerous appointments must be rescheduled.
Further, after receiving funding specifically allocated for community care, VA subsequently announced that it planned to pause its community care program for 90 days "to free space across private health care systems for coronavirus patients and prevent veterans' exposure."
Although VA has no legal authority to pause, even temporarily, the MISSION Act access standards, defying legal authority has unfortunately never stopped the Department in the past from pursuing courses of action in its own best interest, rather than the best interest of veterans.
Given this decision, it is unclear where the additional funding to send veterans into the community is going. It is also unclear whether the VA has the internal capacity to meet veterans' ongoing health care needs, particularly as they relate not only to the coronavirus but also to the backlog of appointments that is compounding.
In other words: Is the current environment ripe for the creation of another appointment wait-time schedule?
With the need to delay numerous appointments, questions about adequate staffing and resources, and thus far a lack of discussion about how operations will resume after the pandemic - it certainly seems like it.
As the VA often reminds its stakeholders, "[t]he majority of veterans who utilize VA health care are collectively sicker and poorer and have fewer support services than age-matched non-veteran patients."
Thus, foregoing even routine and non-urgent medical appointments can have more dire consequences for the average veteran than it does for the average American. This means that veterans may have greater health care needs once they can be seen post-pandemic.
In addition, given the surplus of appointments that will need to be scheduled, a robust community care network to rely on to fill gaps in VA's ability to provide timely care is essential. However, by pausing all community care efforts, VA's community care networks will, unfortunately, be depleted. Neglecting the community care network during this time could have catastrophic consequences in the months ahead.
Fortunately, because the problem has not yet materialized, there is still time to be pro-active and prepare an action plan for how to handle the post-pandemic influx of patients in the coming months.
First, Congress can direct the VA's attention to this impending issue and request a report specifying:
1. The anticipated number of appointments postponed that will need to be rescheduled.
2. VA's plans to timely schedule and address these appointments, i.e, whether they anticipate the need for increased staffing or the use of temporary staffing.
3. What VA's plans are with regard to utilizing and maintaining their community care network to address these appointments.
4. How current resources will be directed towards ensuring that a backlog of medical appointments does not develop due to the pandemic.
5. How VA plans to communicate to Congress and other stakeholders if a backlog of medical appointments does develop.
Second, veterans and stakeholders can work to hold VA accountable. If appointments are not being timely scheduled or VA fails to schedule them at all, they can communicate the issue to lawmakers and Veterans Service Organizations who have direct access to VA leaders. By making sure that the problem is called out in real-time, veterans can help to ensure that it does not balloon out of control.
Finally, Congress can stay up to date on the issue by holding oversight hearings and conducting oversight visits to both VA facilities and community providers to hear from folks on the ground in the several months after the pandemic is over.
As was the case with the appointment wait-time scandal in 2014, it is often whistleblowers and the folks on the ground - both veterans and VA staff - that have the greatest insights into what is happening. Unfortunately, this reality is often disconnected from the talking points presented by politically-appointed leaders in Washington.
Although another appointment wait time scandal as a consequence of the COVID-19 pandemic is a possibility, it does not have to become a reality. Congress and other stakeholders should proactively take the steps needed now to ensure that VA not only has the ability to handle the impact of COVID-19 patients on its overall capacity but that it has the ability to handle the certainly forthcoming influx of appointments thereafter as well.
Rory E. Riley-Topping served as a litigation staff attorney for the National Veterans Legal Services Program (NVLSP), where she represented veterans and their survivors before the U.S. Court of Appeals for Veterans Claims. She also served as the staff director and counsel for the House Committee on Veterans' Affairs, Subcommittee on Disability Assistance and Memorial Affairs for former Chairman Jeff Miller (R-Fla.). You can find her on Twitter: @RileyTopping.