Shulkin offers first glimpse at new VA Choice plan

One day after the Senate passed long-awaited legislation that authorizes new accountability procedures at the Veterans Affairs Department, Congress is turning its focus to the next big debate at VA: the Veterans Choice Program.

The Senate Veterans Affairs Committee began Wednesday the first of many discussions on the topic. Some senators and veterans service organizations reignited a familiar debate: whether VA’s approach will spark an eventual shift toward privatizing veterans health care, and whether it’s a signal of the beginning of the end for what many see as a core function of the department.

Based on the initial debate, the coming decision won’t be an easy one.

Though there were few specific details, VA Secretary David Shulkin offered the first glimpse of his plan to redesign the current Veterans Choice Program.

He’s calling it the Veterans’ Coordinated Access Rewarding Experience (CARE) Program,  and under the new initiative, veterans would no longer access community providers based on a set of arbitrary, administrative rules, Shulkin said.

Currently, veterans can receive an authorization for community care if they live more than 40 miles away from a VA medical facility or if the wait time for care is 30 days or longer.

“The whole idea here is to improve the VA, not to get more care into the community,” Shulkin said during a June 7 hearing before the Senate VA Committee. “The very best way that I know how to improve health care is to give the patient, in this case, the veteran, choice and to make those choices transparent.”

With Shulkin’s new program, a veteran would first speak with a VA clinician. During the consultation, the doctor will provide a clinical assessment and will recommend that the patient either see a VA specialist or a provider in the community.

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“If community care is the answer, then the veterans choose the provider…from a high-performing network,” Shulkin said. “Assessment tools help veterans evaluate community providers and make the best choices themselves. We may help veterans schedule appointments in the community, or in some circumstances, veterans can schedule the appointments themselves. We make sure community providers have all the information they need to treat the veteran. We get the veteran’s record back. We pay the veteran’s bill.”

If VA doesn’t offer the service the veteran needs,  he or she will see a community doctor. If a veteran can’t see a VA doctor quickly or a VA clinician doesn’t meet the department’s quality metrics, the veteran will go to the community.

Veterans could also access a new network of walk-in clinics if they need care immediately, Shulkin said.

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There was no mention of a specific cost for Shulkin’s vision. And the timeline for such a major change remains elusive as well. The department needs legislation to make significant changes to the Choice Program.

VA, however, is under a tight timeline. The president recently signed legislation authorizing VA to spend the remaining funds it has in the Choice Program account until it runs out. Shulkin has said he expects the money to dry up by the end of 2017.

Some senators reiterated: they have no intention of passing legislation that will privatize the VA.

“It in fact, in many ways, is going to put additional pressure on VA and VA health care to provide service to a greater number of veterans,” VA Committee Chairman Johnny Isakson (R-Ga.) said of Shulkin’s proposal.  “I happen to agree with Senator [Jon] Tester (D-Mont.). None of us sitting at this table want to dissolve the VA, do away with VA health care or close anything. On the other hand, we don’t want to perpetuate a problem.”

Yet other senators are far more fearful of VA’s proposals.

According to Sen. Patty Murray (D-Wash.), the department’s plan suggests a series of pilot programs that, from her perspective, sound like the proposals outlined in the VA Commission on Care’s 2016 “strawman” document. Critics of the commission’s draft document slammed the proposals as a push to privatize the department.

“Here’s what’s missing from the conversation: how you plan to actually build and strengthen the VA system for the long term,” she said. “You have not put forward a comprehensive plan to do some of the things that the VA really needs to do, [like] get more front line providers, increase appointments, expand services, build and upgrade facilities [and] bring more veterans into the system. Those, to me, are the things that you do if you’re trying to build and strengthen the VA system that we have, that veterans want.”

Shulkin said he agreed with Murray. He is not recommending VA turn the Choice program into an “unfettered” voucher program, which would offer veterans the option to go to any private sector doctor.

Four veterans service organizations (VSOs) also offered their thoughts on the initial Choice plan. Generally, they acknowledged the VA system isn’t perfect. But the VSOs said once veterans get into the system, they usually like what they receive.

“Almost uniformly they speak highly of the VA care, and they love their VA ,” said Jeff Steele, assistant director of the national legislative division for the American Legion. “It’s just that simple.”

About 75 percent of veterans who use the VA health system have told the Veterans of Foreign Wars that they’re satisfied with the care they receive.

“Our job is to improve to what already works reasonably well and not to dismember it,” Sen. Bernie Sanders (I-Vt.) said. “That is a fear that many veterans service organizations have, and it is a fear that I share.”

Isakson called the Choice program the “most challenging subject” on the department that lawmakers would face this year, and he suggested Congress will need to take a similar approach as it considers coming legislation on the Choice program.

“We have to be as open-minded on making Choice work in the future as we had been on finally getting accountability done yesterday,” he said. “There are going to be some things that some people are going to find hard to take or hard to talk about.”

The debate on accountability had been long and often contentious, but the tone had shifted with Isakson and Tester’s VA Accountability and Whistleblower Protection Act, which passed the Senate yesterday. House leadership will consider the bill next week. It is expected to go the president’s desk for his signature by the end of the month.