At least there’s one constituency that can stir the U.S. Congress to act: the nation’s veterans.
The U.S. House and Senate last week took swift action to address the secret-waitlist scandal at the Department of Veterans Affairs. In a rare feat for today’s Congress on a major issue, the two chambers’ actions attracted nearly unanimous support.
At the core of Congress’ solution to a crisis of access in the VA health care system is allowing more veterans to access non-VA care on the VA’s dime. Both the House and Senate bills would allow veterans who live more than 40 miles from a VA hospital or clinic — a situation that applies to many Maine veterans — and veterans who have been experiencing long delays to more easily seek care outside of the VA system.
Lawmakers have pitched that provision as a short-term fix to a pervasive access problem. The House legislation, for example, allows the expanded non-VA access for only two years. But we doubt that such action will even serve as a short-term fix to the VA’s access problem.
First, as VA patients experience difficulty accessing care, many patients outside of the VA system are experiencing many of the same issues.
The consulting firm Merritt Hawkins recently surveyed wait times for doctors’ appointments in 15 large cities. The results varied widely. In the Boston area, the average wait time to see a physician was 45.2 days, compared with a low of 10.2 days in Dallas. The wait-time disparity for a family physician was even greater: In Boston, it was 66 days, compared with five days in Dallas. The cumulative average wait time for all physicians was 19.5 days.
In the VA system, the agency’s recently released access audit found that 96 percent of the time, veterans waited 30 days or less to secure an appointment time. At the Togus VA Medical Center in Maine, the rate was 99 percent.
The underlying problem is that there are too few doctors in the United States compared with its industrialized peers, and the VA has difficulty filling critical vacancies both for primary care and specialties. The Senate acknowledged this reality with its legislation, which allows the VA to devote $500 million to hiring medical staff.
The VA does have one advantage going for it when it comes to recruiting: It runs the largest clinical health care training program in the U.S.
But even if the provider shortages weren’t an issue outside of the VA, allowing VA patients to more easily seek non-VA care still wouldn’t be a compelling short-term solution. In its assessment of the Senate legislation, the Congressional Budget Office predicts the VA will have difficulty in quickly setting up a system to contract for outside health care. In addition to figuring out the mechanics, the VA needs a mechanism to ensure its patients will receive high-quality care when they are treated outside of the VA.
The VA already regularly refers patients outside of the VA system for specialty care, often to address staffing shortages. It’s a process that requires additional coordination among doctors and additional bureaucratic approvals that can often lengthen delays, according to the Government Accountability Office.
In one example cited by the GAO, a VA patient died earlier this year while awaiting surgery for two aneurysms at a non-VA hospital. (The patient’s death was not related directly to the aneurysms.) During the referral process, the local hospital lost the patient’s information, delaying the scheduling of the surgery. Five months elapsed between the patient’s diagnosis and death.
If non-VA care is to serve as a viable, short-term solution to the VA’s access problem, the vast agency has much work to do to shore up and expedite its referral operations. Even then, there’s little guarantee that the approach will ease access issues that need to be addressed largely by more effective management within the VA — and not more congressional intervention.