New proposals and lack of adequate funding could doom VA facilities, College fears
April 19, 2019 (ACP) – As part of ongoing advocacy efforts to preserve the Veterans Health Administration (VHA) system, the American College of Physicians is calling for increased funding and additional resources to enable the VHA to continue to provide comprehensive care to the nation's veterans.
The VHA, an agency under the Department of Veterans Affairs (VA), provides health care to 8.4 million veterans at 1,700 sites across the country and employs more than 14,000 doctors. ACP – which has a significant number of members employed by VHA and many others who received part of their training within the VHA system – has long championed veterans' health issues, producing a policy paper outlining its priorities on this in 2014.
Soon, veterans may be able to receive health care outside of the VHA system based on wait times and distance. That's regulated by what's known as the Mission Act (an acronym for the Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018), which replaced the Veterans Choice Program. ACP recently commented on two rules that fall under the Mission Act in letters to VA Secretary Robert Wilkie and testimony submitted to a House subcommittee considering the 2020 budget for the VA.
Before the Mission Act, veterans could see an outside doctor, considered “community care,” if they had to wait 30 days for an appointment with a VA provider or travel at least 40 miles. One of the new rules, which would take effect in June, would change this to a 20-day wait period or a 30-minute drive for primary care and an hour for specialty care. The 20-day standard would become 14 days next year. Under a second, related proposal for urgent care, veterans would be allowed to go to urgent care centers and walk-in retail health clinics without prior approval.
ACP's overarching concern is that if these two proposed rules go into effect, there would no longer be enough money to go around and the traditional VHA would lose funding in favor of community care options, explained Brian Outland, ACP's director of regulatory affairs.
Jared Frost, a senior associate for legislative affairs with ACP, said that funding for the Mission Act has shifted from being mandatory – meaning outside of the annual budget appropriations process – to now being part of the annual budget. ACP had urged passage of a bipartisan amendment, called the “Complete the VA Mission Funding” amendment, that would have provided sufficient funds to implement the VA Mission Act without diverting money from other VHA programs, but that amendment did not pass. In written testimony to the House, ACP asked for $89 billion in total funding for the VHA for fiscal year 2020 – an amount that would cover the VHA system as well as the Mission Act, Frost said.
ACP believes the stakes are high if the programs don't receive adequate funding.
“If patients cease going to the VHA facilities for care, there could be pressure to close the much-needed facilities,” Outland said. “We don't want patients passing by a VHA to go to a private facility if the care they need can be provided within the VHA system.” ACP has recommended that wait times and average driving time be based on a veteran's proximity to a VA facility that has the capability to address his or her actual needs, not just a general VHA facility, Outland said.
ACP also would like to see the VHA system be sufficiently funded so that it can provide additional services for veterans.
For instance, Outland said, “there are some VA facilities that could operate an urgent care center but don't have resources, so why not provide those resources so that they can extend care capabilities rather than outsource them through the Mission Act?”
Providing care outside of the VHA system jeopardizes continuity of care for patients because “when veterans go outside of the traditional VHA system, they will see doctors who may not be aware of the full scope of their medical conditions,” he said.
Any budget shortfalls also would affect the training of residents, said Frost, adding that an overwhelming number of medical students, residents and physicians take part in graduate medical education training programs through the VHA.
“This is very crucial in training doctors,” he said. “If there is less funding or fewer patients going to VHA, the doctors will treat fewer patients and gain less experience.”
ACP's policy statement on the Veterans Health Administration is available on the College's website.
Recent VA-related advocacy efforts by ACP have included:
- Comments submitted to the VA on community care rules
- Comments submitted to the VA on urgent care rules
- Testimony submitted to the House of Representatives on VA funding
Back to the April 19, 2019 issue of ACP Advocate