The U.S. Department of Veterans Affairs began distributing choice cards last week to about 900 veterans in central Arkansas who have been waiting more than 30 days to receive health care at a VA facility.
Through the newly established Veterans Choice Program, eligible cardholders should be able to receive health care from approved providers outside of the Veterans Affairs system at the VA's expense.
Leadership in the Central Arkansas Veterans Healthcare System said the legislation behind the program is "complicated," and they're expecting questions from veterans as it rolls out.
"It's a huge piece of legislation that is going to be a change from how the VA has done business," said Robin Porter, assistant chief in the system's central business office. "It's going to be a learning experience for everyone, but I think it's going to get us on our feet and where we want to be."
Tina McClain, acting chief of staff for the central Arkansas system, said veterans won't be able to "go down the street and set up an appointment" with any physician. Instead, veterans must contact the program's call center, which will set up an appointment with a pre-authorized health care provider if the veteran meets the criteria for eligibility.
"We don't want them to be surprised. We don't want them to be frustrated," McClain said. "We want it to go smoothly, but as with any new program, I think there are bound to be unanticipated bumps in the road."
Phase 2 of card rollout
All 9 million veterans enrolled in the VA health care system before Aug. 1, along with veterans who returned from deployment within the past five years, will eventually receive a choice card.
First, the agency started distributing them to people who are already eligible to use them. The decision on who got them was based on where they live or their inability to schedule appointments 30 days from the date preferred by the veteran or determined by a physician.
The VA initiated the program Nov. 5, sending cards to about 300,000 veterans across the U.S. who live more than 40 miles from any VA facility.
There are 3,530 veterans in Arkansas who live more than 40 miles from any of the state's three medical centers or 15 community-based outpatient clinics, said Porter.
In the Central Arkansas Veterans Healthcare System, which serves 46 counties, 1,774 veterans live more than 40 miles from John L. McClellan Memorial Veterans Hospital in Little Rock, Eugene J. Towbin Healthcare Center in North Little Rock, or any of the clinics in Conway, El Dorado, Hot Springs, Mena, Mountain Home, Pine Bluff, Russellville and Searcy.
The VA announced Monday that it's starting Phase Two: distributing approximately 370,000 cards, including 900 in central Arkansas, to those who have waited long periods to receive care.
McClain said her staff began going through appointments in October, adding veterans to the eligibility list if they weren't scheduled to be seen before Dec. 1.
Delays in getting veterans into VA facilities are a result of staff shortages across the board, including in the central Arkansas system, McClain said.
"I think that since the access issues first hit the media, the VA as a whole has looked at what happened that we developed this problem," McClain said, referring to a scandal earlier this year in the Veterans Health Administration in which records at some facilities were manipulated to conceal how long veterans waited to be seen by medical staffs.
"A lot of it was that we had mandates and expectations that we simply were not staffed sufficiently to meet, McClain continued. "It's going to take a little bit of time to staff up to the point that we can get the veterans in within that window of time."
temporary solution
The Veterans Choice Program was included in the Veterans Access, Choice and Accountability Act of 2014, which was passed in response to the scandal and as the result of an internal audit released in June that found that approximately 120,000 veterans were left waiting for care or had never received it.
The legislation -- a $16.3 billion overhaul of the VA -- created the Veterans Choice Program as a temporary solution, McClain said. It will operate for either three years or until the $10 billion allocated to the program runs out.
Also included in the bill is the allocation of $5 billion for VA facilities to hire additional medical staffing. By the time the choice program expires, McClain said she hopes to have hired enough staff members to treat everyone in-house within a 30-day period.
"We want to provide the best possible care as quickly as we can so our patients have the access they need and get the care they need -- that's the name of the game. That's the target," McClain said. "I feel like we are getting there. We've been working on this and doing as best we can here to narrow this down and identify areas we know are issues."
Before President Barack Obama signed the legislation into law in August, newly appointed VA Secretary Robert McDonald ordered each regional facility in the country to hold public forums by the end of September to help restore the public's trust.
At the central Arkansas system's forum held later that month, the most repeated complaint was long waits -- sometimes months -- to receive care.
To eliminate long wait times, McClain said, the Central Arkansas Veterans Healthcare System needs to hire more primary-care doctors or nurse practitioners, as well as specialists, including a new full-time neurosurgeon, dermatologists, rheumatologists, endocrinologists, neurologists and those who treat chronic pain.
"Locally, we had no capacity issue with neurosurgery until one day one of our two neurosurgeons came in and said, 'I'm retiring, effective immediately,'" McClain said. "When you have a very limited resource and you lose 50 percent, all of a sudden what wasn't an access issue today is an issue tomorrow."
Shifts in personnel will cause changes in veterans' eligibility for the Veterans Choice Program, McClain said, pointing to the reason that choice cards will be sent to all veterans enrolled in VA health care and not only to those currently eligible.
"In that scenario, veterans needing an appointment with a neurosurgeon would become eligible, even if they weren't eligible yesterday," she said. "They may need the cards at any point in the future."
The VA will distribute cards to all remaining veterans in December and January, according to a statement from McDonald.
Advocate: Program not ready
Mike Ross, a veteran advocate and former commander of the Arkansas National Guard's 39th Infantry Brigade Combat Team, was present at the central Arkansas system's management advisory committee meeting last month, at which VA leadership informed staff members and others about the roll-out of the program.
Ross said it "wasn't ready to execute," and the VA would get bombarded with calls from veterans confused about how the cards work.
"All these people are going to get these cards and think they can go to a health care provider," Ross said. "They won't know any better, and the next thing you know, they're not going to be getting paid for that care."
McClain said their "hope" in these instances is that private-sector providers will see the card and "understand there has to be a pre-authorization before that can be used."
How it should work, McClain said, is if a veteran meets either the 40-mile or 30-day criteria and he contacts the call center, his name will be submitted to a third-party contractor, which will connect the patient to a provider who is on a list already authorized by the VA. At the same time, an appointment will be scheduled at the closest VA facility, and the veteran can choose between the two.
Porter said there are 1,699 pre-approved providers in the Central Arkansas Veterans Healthcare System service area who are contracted to serve veterans through the choice program.
Unlike at VA facilities, where treatment of service-connected injuries and ailments is completely covered, veterans may be required to pay a copay for such treatment at the outside facilities. The veteran will be informed of a copay before he makes an appointment with the provider, Porter said.
As the program progresses, McClain said, the VA will "adapt."
"I think the intent will not change over time. I think the goal will not change over time," she said. "I think there may be glitches, and we will need to be a little bit nimble. Hopefully our veterans aren't impacted negatively in any way."
SundayMonday on 11/23/2014