AUGUSTA, Maine — Less than half of Maine veterans requesting health care since July under a federal program aimed at shortening wait times have gotten appointments, according to data presented to the state’s congressional offices on Thursday.
Maine’s U.S. senators called that “disturbing and unacceptable.” The data were revealed during a rare look into the bureaucracy underlying the $10 billion Veterans Choice Program, which was passed by Congress after a national 2014 scandal over VA wait times.
Veterans qualify for the program — which allows them to be treated by private doctors — if they live 40 miles or more from a U.S. Department of Veterans Affairs facility or if they have waited 30 days for care, are getting services not offered by the VA or require frequent appointments.
Between June 2015 and January 2016, more than 4,300 Maine veterans asked for care under the program, with 2,100 getting appointments, the VA Maine Healthcare System told representatives of Maine’s congressional delegation and other veteran advocates in a Thursday presentation at its Togus campus.
Corey Wilson, who manages non-VA care for Togus, attributed that to a host of problems, including difficulty for patients and providers in contacting Health Net, the company that helps the VA manage the program in the region; long wait times with community providers; and providers not being paid or opting out of the program because of administrative burdens.
He said the “sleeping giant in the room” is that providers will weaken the program by refusing to participate, which St. Mary’s Health System in Lewiston did recently, even though that system still provides regular non-VA care.
Wilson said, “If we don’t address some of these administrative problems in the program,” then “we are going to continually lose providers in the community.”
At times during the meeting — which lasted more than two hours Thursday morning and wasn’t announced to the media — congressional offices and veteran services organizations aggressively questioned representatives of Health Net, the managed health care company based in California.
Wilson said there have been occasions in which the VA has approved care that has been authorized differently by Health Net, including times the firm green-lit in-home sleep studies the VA has deemed inappropriate for certain patients or referred patients to general-practice doctors when subspecialists were requested.
Elizabeth Zande, deputy program manager for Health Net, conceded that mistakes have been made during the program’s quick ramp-up, and law changes are needed to alleviate provider concerns, but that the company recently opened a Tampa call center and plans to hire hundreds of employees there soon, which should help fix waits.
“I am aware of the wait and our leadership is aware of the wait time and we’re working through that as soon as possible,” she said.
But delegation representatives and advocates expressed difficulty contacting Health Net when patients report concerns. Health Net has no Maine-based employees and before representatives exchanged contact information on Thursday, offices had no direct phone number or email address to contact the company.
Adria Horn, director of the Maine Bureau of Veterans Services, said the meeting was the first time advocates met the company’s New Hampshire-based employee handling relations with doctors, which she called “unbelievable.”
U.S. Rep. Chellie Pingree, a Democrat from the 1st District, said in a statement that the program is “simply not working the way it should,” saying that while Congress should consider tweaks to the Choice Program, Health Net should “get up to speed more quickly.”
“They haven’t adequately staffed their call center, they don’t have a single employee in Maine and they aren’t putting enough resources into recruiting more doctors in the state who can see veterans,” she said.
In a joint statement, U.S. Sens. Susan Collins, a Republican, and Angus King, an independent, called the problems plaguing the program “disturbing and unacceptable,” saying they’ll “continue to scrutinize any problems and confront any barriers” with health care.
U.S. Rep. Bruce Poliquin, a Republican from the 2nd District, called the news “extremely frustrating” in a statement.
Reports of problems with the program aren’t new: Veterans brought concerns to the Bangor Daily News in June after Ronald Warner of Brewer said he was told he’d have to wait three months to know if he had cancer. Similar problems have been reported in California, though the VA said in December that 400,000 appointments have been scheduled under the program.
But Horn said it was “very validating” that the data presented Thursday showed “that what we are receiving anecdotally is reflected in the numbers.” Amedeo Lauria, a service officer for the American Legion at Togus, said veterans should be shielded from “inside baseball” with care.
“They’re not interested in all the behind-the-curtain kind of stuff,” he said. “They just want to get their health taken care of and they need to make that as transparent as possible for a veteran.”