Roe uses experience, leadership to guide VA evolution

A year into chairing the House Veterans Affairs Committee, Rep. Phil Roe (R-Tenn.) is feeling pretty good about what’s been accomplished in helping veterans access medical care outside the VA community.

To realize just how much change has taken place, Roe suggested looking back three and a half years ago when the wait time scandals at the Phoenix VA came to light, exposing systemic problems at dozens of VA medical centers across the country.

Since 2014, a number of fixes have been put in place to solve the access issue, including the  Veterans Choice Program, the basic law proposed to ensure veterans get timely access to healthcare.

But the Choice Program has not done much to improve wait times. Congress remains deadlocked over a long-term funding for the Choice Program, and President Trump’s much-touted promises to help veterans have yet to show  impact.

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Still, Roe insists things are getting better at VA.

“I’m proud of the work being done around the country to provide veterans with timely access to quality health care, Roe said on Federal Drive with Tom Temin. “There is still an incredible amount of work that must be done, but I’m optimistic about the direction VA is headed.”

By VA’s own measure, most of its medical centers across the country are improving. Of the 146 medical centers rated, 120 of them, or 82 percent, improved in fiscal 2017. Only one hospital — in Tomah, Wisconsin — saw a drop in performance this year.

Regular funding for the Choice Program is Roe’s real goal, but it’s been hard to come by. Two pieces of legislation have passed to extend the troubled program on a temporary basis. But now, Roe has bipartisan support from his committee for a new law he’s been working on since he took over as chair.

It has three key provisions. First, Roe explained, it deals with how veterans access their care outside of VA.

“In my own private health insurance plan I have a primary care doctor who oversees my care. We will have the same thing at the VA and  it’ll be called a PAP team or a primary care team. If you cannot get into that primary care team, you use your Choice program to go outside the VA.”

For seeing a medical specialist, Roe says his Choice program legislation would provide some relief for those wanting to see a specialist in a timely manner. Also, it would let go see that specialist if the VA wait is more than a month. It also waives a previous provision that required non-VA providers be more than 40 miles away.

Roe said the 40-mile limit was a non-starter for him. “Where I live for instance in the mountains of east Tennessee it could be 38 miles (to a clinic), but it might take you an hour-and-a-half because you got to go over a mountain range to get there.”

Also of concern to Roe and others looking at the Choice program, is the monitoring of care offered by outside providers, and getting reimbursements to providers in a timely manner.

Roe said he is confident these and other parts of a future Choice bill can be passed. “The Senate has passed a bill that has a lot of the same provisions. And we will work out the differences between those two bills and hopefully get that done.”

“We need $2.1 billion to fund Choice to get us to Oct. 1,” said Roe. “Then we’ll need about $12.5 billion the first year.  It’s a large number, but veterans seem to like it (Choice) where it’s working.” During his own nine years in Congress, he said, “we have never not supplied the money that veterans have needed for health care.”

Once Roe deals with the Choice program, he has his sights set on the overall mission of the organization and updating that as well.

“The VA needs a transformation,” said Roe.  He cites his experience with his own, local VA facility.  “The VA Medical Center in Johnson City, Tennessee was opened in 1903 for civil war veterans. That’s not how we provide care any longer.  A modern VA healthcare system needs to take the care to the veterans.  That’s why we’ve encouraged outpatient clinics and doing as much of outside the hospital as we can do, saving the hospitals for the more severely ill or complicated cases.”

He also looks forward to modernizing VA’s health care records by fully implementing the new Cerner Electronic Health Records program. VA Secretary David Shulkin selected Cerner in a no-bid contract last June to replace the agency’s legacy Vista EHR as a way to align data between the VA and the Department of Defense, which already runs on Cerner. The contract is estimated at about $10 billion or more.

Roe, drawing upon his own experience as a physician with military experience, said putting any electronic health record system into place is a challenge. “We implemented one in my practice about ten years ago and it is not easy to do. It’s painful for the providers to change how they’re doing it.”

“There has to be a cloud-based system where doctors like me, who weren’t part of the VA, can access V.A. medical records and then send the records back, Roe said. “It’s going to be a enormous undertaking to convert this system.

“What we’ve learned in the private sector through the Medicare Modernization that you need a case manager. So in my bill we whether you get your care at the VA or from an outside provider, it has to be coordinated or be fractionated or it won’t be that the quality of care that you need,” said Roe. “You need that case manager to be sure that that veteran is getting the quality care they need. We provide that in this bill.”

Another issue Roe and his House colleagues must tackle is the glut of facilities in VA’s real estate portfolio.  And with the new emphasis on community care under the Choice program, one wonders about the value of so many giant hospitals.

“We have 1,100 buildings that are either under-utilized or not occupied at all, and we’re going to have to deal with those,” he said. “We find a 100 bed hospital today can carry out what a 500 bed hospital did 40 years ago, just because of the speed of technology that we’ve created to improve patient care.”

Roe said “Yes the VA needs to do that and we’re going to do that. We’re going to take a look at that and try to help the secretary. He is very well positioned to be able to right size the VA to make sure that patients get the quality care that they deserve. “

The House and Senate are expected to debate and vote on their Choice reform bills soon. Differences then will be resolved in a House-Senate conference led by Roe and Sen. Johnny Isakson, (R-Ga.), chairman of the Senate committee.