Words by Bridget Foster.
In the aftermath of the investigation into the scheduling of medical care at the nation’s VA hospitals, Congress has stepped in to speed up the process. Wary of the Department of Veterans Affairs’ promises to fix the problems uncovered in the probe, both the Senate and the House announced similar bills aimed at making it easier for veterans facing long waits or living more than 40 miles from a VA facility to seek and receive medical care from non-VA providers for the next two years.
While this may be a step in the right direction, there’s evidence that referring patients to outside providers might not be any faster in getting care for veterans than the VA providers have been. A report from the Government Accountability Office presented to Congress this week showed that in a sample of 150 veterans approved for and seeking special outpatient care, about 40% had received treatment at a rate slower than the suggested VA guidelines. Additionally, according to the report, 64 of the 150 never received the requested care.
Compounding the problem is the nationwide shortage of primary care physicians. The Association of American Medical Colleges has projected that by 2020, the nation will face a shortage of 45,000 primary care physicians and 46,000 surgeons and specialists. Rural and inner-city areas face the greatest shortages, so those veterans living more than 40 miles from a VA facility might not be any better off in getting care from a local provider than civilians. The American Medical Association chimed in by recommending that state medical societies create registries of non-VA physicians and specialists willing to provide care to veterans.
The bill passed by the Senate would authorize the VA to lease 26 new health facilities in 17 states and Puerto Rico, in light of the overcrowded conditions at some of the system’s facilities. The bill also provides for $500 million to hire additional doctors and nurses to staff those facilities, though that too may prove difficult, considering the aforementioned shortage. The Senate’s bill would make it easier to fire top VA officials, as does the bill passed by the House.The House version would completely ban bonuses to VA employees through 2016 while the Senate bill would remove the conditioning of bonuses upon prompt scheduling of patient appointments – a provision that many believe was the underlying cause of the widespread use of scheduling manipulations. By eliminating bonuses altogether, Veteran Affairs Committee Chairman Jeff Miller said the VA would save about $400 million annually, which it could then use to expand care.
Prior to submitting his resignation on May 30th, former VA Secretary Eric Shinseki had announced he had taken steps to remove the senior administrators in the Phoenix VA medical system, eliminate performance bonuses for VA administrators in 2014 and remove wait times as a criteria for performance evaluations. Shinseki has been temporarily replaced by one of his deputies, Sloan Gibson. Gibson has taken additional steps to address the problems uncovered by the Inspector General’s investigation, including using mobile units at overburdened facilities, expanding clinic hours and paying for outside provider care for some veterans.
Philip Matkovsky, a top VA official who helps oversee the department’s administrative operations told the House Veteran’s Affairs Committee “This is the start, not the end…we are committed to improvements.”