New VA rules reignite privatization debate

• The Department of Veterans Affairs proposed new standards to make it easier for veterans to seek care outside the VA. The changes, due to take effect in June, include dropping the wait time requirement from 30 days to 20 days for primary and mental care and 28 days for specialties.
• Changes also include shifting one requirement from driving distance (40 miles) to driving time (30 minutes). For specialty care, the VA is proposing a 60-minute average drive time standard.
• The proposals come several years after the agency got a black eye in a scandal showing officials falsified data on patient wait times and amid fears the Trump administration wants to privatize the agency.

The measures are part of the agency’s implementation of last year’s MISSION Act, which critics say marked another step toward privatizing the VA. The right leaning Koch brothers helped fund these efforts, but most veterans’ groups oppose them. That’s in large part because, in many cases, VA care is exceptionally good — if exceptionally slow.

Veterans who rely most on VA care tend to be younger, poorer and live in rural areas, a 2016 RAND report found, while only 25% of veterans live within an hour of a VA medical facility.

Veterans’ groups held their fire for now while they study the new rules. Still, Rory Riley, a consultant for veterans organizations such as the National Organization of Veterans’ Advocates, called the new access standards a “step in the right direction.”

Changing the driving distance standard to drive time, for example, makes the standards better align with TRICARE. In all, Riley told Healthcare Dive, the VA proposed standards are similar to TRICARE’s existing standards for TRICARE Prime, which many veterans are already familiar with.

“TRICARE hasn’t been ‘privatized’ despite using very similar access standards and utilizing a mix of DoD and community providers. A good policy choice, as opposed to a political one, is integrating the best of both government and community care,” Riley said. “I’m the first one to criticize VA when I think they’ve done something that is misguided, but I actually think these standards are a good faith effort to implement the MISSION Act, which the VA is legally required to comply with.”

Other changes include the ability to access urgent care, as long as the provider is in the VA’s community care network — though they may be charged a copayment.

Leadership at the VA has been in turmoil in recent years, with the fired VA Secretary David Shulkin, warning in a New York Times op-ed days after his ousting that the private sector is “ill-prepared” to handle veterans, “particularly when it involves the mental health needs of people scarred by the horrors of war.”

Current VA Secretary Robert Wilkie tried to get an edge on critics who may lambast the access standards for enabling privatization.

“Although these new standards represent an important win for America’s Veterans, they will not be without controversy,” the secretary said. “Some will claim falsely and predictably that they represent a first step toward privatizing the department.”

He cited recent studies from Rand, Dartmouth and JAMA that show the VA is outperforming the private sector in quality and customer service.

A 2014 Congressional Budget Office report showed 70% of veterans enrolled in the VA’s system already receive most of their care in the private sector.

https://www.healthcaredive.com/news/new-va-rules-reignite-privatization-debate/547247/