VA Choice program frustrates veterans needing care | PostIndependent.com

VA Choice program frustrates veterans needing care

Randy Essex
ressex@postindependent.com
Earl West
Staff Photo |

FOR HELP

Veterans unable to get results from the VA Choice contractor may contact:

Sen. Michael Bennet’s office:

719-328-1100 or Annie_Oatman-Gardner@bennet.senate.gov

Health Net customer service:

866-606-8198

Earl West, a military veteran from Glenwood Springs, needs surgery after tearing a tendon and ligament in his hip last fall.

As a former Marine who was disabled in 2012 when he inhaled benzene while working on a drilling rig in the Gulf of Mexico, he’s eligible for care from the Department of Veterans Affairs.

Because the nearest VA hospital in Grand Junction is more than 40 miles from his home, he qualifies for a program approved by Congress in 2014 that was meant to dramatically reduce waiting time that veterans faced for care. The VA’s long waiting lists were exposed most pointedly by delays for care in Phoenix, where at least 40 veterans died before their appointments and, it turned out, the VA was covering up how long vets had to wait.

Called Veterans Choice, the program meant to help address that hasn’t come close to working as intended for West and many other vets. Contractors are supposed to coordinate care, taking the task out of the hands of overburdened VA medical centers.

“It’s the opposite of what it was intended to do,” West said. “You’re on hold for 45 minutes when you call. A lot of veterans have prepaid plans and can’t wait 45 minutes on the phone.”

After several calls, West got an appointment with an orthopedic surgeon in Basalt.

“I went there and met him, and he said he only does shoulders,” West said.

So it was back to waiting on the phone while adapting to life using a cane for his sore hip.

“When you do get a human, you’re told you’ll get a call back,” said West, whose military service was as a markmanship instructor in Asia and U.S. Embassy guard in Madrid, Spain. After the appointment in Basalt, “For six consecutive weeks, I was told I’d get a call for an appointment. That didn’t happen.”

No one disputes West’s story or says it’s unusual.

“We have heard similar complaints,” said Adam Bozzi, communications director for Sen. Michael Bennet, D-Colorado. “Their frustrations are justified and this needs to be corrected.”

Sen. Cory Gardner and Rep. Scott Tipton, Colorado Republicans, wrote to VA Director Robert McDonald on Jan. 20 saying, in part, “implementation of the Choice program in rural areas statewide has been unacceptable. Long wait times, the improper transfer of patient information and overall lack of professionalism all illustrate the shortcomings” of the VA “to administer this program effectively.”

Three members of Congress, two Democrats and a Republican, from other states persuaded the Government Accountability Office to audit the program.

Paul Sweeney, customer relations chief for the VA in Grand Junction, said complaints about poor service in the Choice program have been “literally overwhelming.”

With four people working at it, “we have not been able to return the calls as fast as they are coming in,” he said.

BILLIONS SPENT

Sweeney said the VA used to handle nearly all care at its hospitals. Veterans in Garfield County had to trek to Grand Junction for in-person appointments and go to VA facilities in Denver or Salt Lake for some procedures. The system provided some care through “non-VA coordinated care” using contracted physicians.

The Choice program was intended to help vets in rural areas and take them out of the queues for care at VA medical centers.

Two contractors — Health Net and Tri-West — were awarded $5 billion and $4.3 billion, respectively, to implement the program, according to U.S. Rep. Louise Slaughter, D-New York, one of the lawmakers who pushed for the GAO audit.

Health Net, which handles most Colorado cases, acknowledged in an email to the Post Independent that “as we rapidly expand our operations and services to meet the demand of veterans, there may be situations where a veteran does not get care as expeditiously as we would like.”

The company has opened a new service center and expanded existing centers, said Molly Tuttle, Health Net’s director of communications.

“Since the inception of the program in late 2014, Health Net has scheduled over 315,000 medical appointments for veterans,” Tuttle’s email said. “And just in January, we were fielding more than 175,000 phone calls in support of Veterans Choice.”

Bennet supports the GAO review to “help identify the scope and roots of its problems, to share lessons learned and to provide recommendations,” as Bozzi put it, but he and other lawmakers aren’t waiting for the results or letting the VA off the hook.

“We need to improve implementation of the program now,” Bozzi said by email. “That means pressing the contractor and VA. And we should ensure that experiences in Colorado and the lessons we’re learning in the state are incorporated here and across the country moving forward.

“We believe there need to be overall improvements to the way the VA delivers non-VA care, especially in rural areas,” Bozzi said. “Some steps that would help include increasing recruitment and retention of medical professionals, and allowing for more competitive reimbursement rates for local providers.”

WEST GETS HELP

Said Josh Green, a spokesman for Tipton, “The Choice Program was implemented quickly, and clearly there is still work that needs to be done to make it function as it was intended by Congress. The results of the GAO investigation will help determine what next steps are needed to ensure the program is meeting the needs of veterans. Congressman Tipton is working with his colleagues to continue to hold the VA accountable and is focused on making sure that veterans, no matter where they live, have access to the care and benefits they have earned.”

In fact, Tipton’s Grand Junction office got West, the veteran with the bad hip, out of the Choice program’s bureaucratic morass.

The day after visiting with an aide there, West had another appointment, and he since has worked with the Grand Junction VA to arrange his needed surgery at the Salt Lake VA.

His injury occurred Sept. 21.

Sweeney, with the Grand Junction VA, said a solution is badly needed. The nature of veterans’ medical needs is changing, he said.

“We’re seeing more and more vets with increasingly complex medical situations,” he said. “Vietnam-era veterans are entering retirement and seeking care.” Generally less healthy than the rest of the population, many of these veterans need care for cardiovascular disease, advanced complications of diabetes and cancer cases.

Added to that caseload are veterans of war in Iraq and Afghanistan — the latter being the nation’s longest-ever war — who have a range of disabilities, including some who got care more quickly than fighters in earlier wars and survived wounds that would have been fatal in the past.

“Demand has outpaced capabilities” to care for veterans, Sweeney said.


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