Is the VA trying to keep veterans away from community care?
At the start of the COVID-19 pandemic, the Department of Veterans Affairs began canceling veterans’ appointments. Nearly 20 million were canceled, delayed, or rescheduled, leaving many veterans without much needed medical care during a national health crisis.
But those canceled and delayed appointments are just a piece of the trouble brewing at the VA, dragging up memories of the 2014 Phoenix VA scandal.
Investigative reports in Florida have found VA facilities are inaccurately calculating appointment wait times, resulting in veterans waiting too long for care rather than being referred to community care.
This is in direct violation of standards established by the VA MISSION Act to ensure veterans are getting the care they need, whether from the VA or from community providers.
But it isn’t just a Florida problem.
Earlier this year, Americans for Prosperity Foundation filed a series of Freedom of Information Act requests to get to the bottom of whether the department is complying with VA MISSION Act wait-time standards. After delayed response and a subsequent lawsuit for the records, some results are finally rolling in.
Here’s what we’ve learned so far.
The VA isn’t using updated eligibility standards for community care
Before the VA MISSION Act, non-VA care referrals were made based on whether a patient had to wait more than 30 days for an appointment or drive more than 40 miles to a VA facility.
New standards have been in place for more than two years. They stipulate that veteran can access community care if:
- They have to wait more than 20 days for primary and mental health care.
- They have to wait more than 28 days for specialty care.
- They have to drive more than 30 minutes for primary and mental health care.
- They have to drive more than 60 minutes for specialty care.
Here’s the problem: the VA is still using old scheduling guidance to determine community care eligibility, meaning veterans are being denied access to non-VA care.
Documents from the VA show schedulers often use what is called a “patient indicated date” rather than “date of request” to make appointments. The difference is “patient indicated date” means the date on which the patient would like to be seen, while “date of request” is the date on which the patient contacted the VA to make an appointment.
In practice, using “patient indicated date” means the VA has more leeway to schedule outside the 20/28-day standard, thus making the wait times look shorter and avoiding referrals to community care.
As an example, check out the difference between community care referrals under VA MISSION Act standards and under outdated, but still used, scheduling practices in Tucson, Arizona:
- Primary care under MISSION Act – 21 percent eligible for community care
- Primary care under old method – 4.2 percent eligible for community care
- Specialty care under MISSION Act – 26.7 percent eligible for community care
- Specialty care under old method – 9.3 percent eligible for community care
The VA is gaming the system by canceling and rescheduling appointments
Another way around referrals to community care is for VA schedulers to make an appointment, cancel the appointment, then reschedule the appointment to a later date.
Canceling resets the wait-time clock, so this is simply a way of keeping veterans in the VA system. What’s worse, evidence suggests cancelations are happening without veterans’ consent.
Documents from the North Florida and South Georgia VA show that between January 2020 and May 2021, 682,739 appointments were canceled. About 63 percent of those lacked evidence that the veteran had given permission for the cancelation.
During that same time period in Montana, 93,000 appointments were canceled with no indication of rescheduling.
Is the VA even offering community care? We’re not sure.
Some veterans want to stick with the VA for their health care, which should absolutely be an option. When a veteran chooses to opt out of community care, VA guidelines require documentation of that in a veteran’s file.
However, documentation from the North Florida and South Georgia VA found out of 187,385 appointments scheduled outside the wait-time standards, only about 3 percent had documentation that community care had been declined by the veteran.
So the VA isn’t keeping proper track of community care denial from veterans, or they aren’t offering it in the first place. Either way, it’s not good.
The VA is actively driving veterans away from community care
If you aren’t infuriated yet, you’re about to be.
The VA’s own guidance encourages dissuading veterans from using community care options.
A guidance document for VA employees puts the responsibility on existing patients to ask for a review of eligibility for community care rather than requiring schedulers to offer to review eligibility.
The VA also provides sample scripts to schedulers that use incorrect data about non-VA provider wait times, and puts coordinating community care on the veteran despite the MISSION Act explicitly placing that responsibility on the VA.
The language used in the phone script clearly attempts to dissuade veterans from choosing community care, portraying it as a hassle compared to the VA.
Each of these findings spells a giant disaster in the making. When the VA doesn’t follow the law, veterans suffer. Leaders at the VA need to stop attempting to get around the law and start putting veterans and their care first by implementing and following the VA MISSION Act as intended.
Have you been denied community care? Has the VA coordinated your treatment as it should? Visit My VA Story to share your experience with us and the dozens who have detailed their treatment at the VA. To demand better health care options for veterans, get in touch with your lawmakers today.