WASHINGTON — There was a big meeting on Capitol Hill to go over nine pieces of legislation that should help with VA’s modernization efforts. The House Committee on Veterans’ Affairs met with VA Secretary Dr. David J. Shulkin and asked specific questions about the draft legislation. Here are a few interesting points from the meeting.
The reports that the VA’s CHOICE Act will run out of money before the end of the year are, according to Shulkin, erroneous. “This is not the case,” he said. “The $2.1 billion that VA received in August will last until the end of the year.” One of the problems with budgeting CHOICE is because VA has to record the payments before providing services. “It’s like looking into a crystal ball and trying to guess what services a veteran will use,” he said.
With the VA’s proposed Coordinated Access and Rewarding Experiences (CARE) Act, the agency would be able to record all obligations at the time of the service. By combining all the different Community Care programs into just one program, Shulkin believes it will be easier to share information and avoid duplicate testing. The Act would also give VA an increased authority in collecting money owed to the agency.
Another new program would be a national network of urgent care. With this, veterans with service-connected disabilities could visit urgent care twice a year without charge. After that, they would be charged a copay to help control the cost of the benefit.
It would also decrease the amount of money VA spends on administrative costs. The cost of this has been, as Shulkin said, extremely high. 13 percent goes towards admin fees. That’s about $273 million out of the $2.1 billion that Congress gave to the agency in August. Shulkin stated that taxpayers will pay “billions less over 10 years,” with the new program than what the VA has now.
Veterans Affairs wants and needs a law passed that gives the agency direct hiring authority for mental health professionals. Earlier this year, Congress gave the VA the ability to hire 1000 new mental health providers. VA hired 900 new mental health employees but lost 945. Shulkin said that they have a similar problem with primary care professionals as well.
There is also a similar problem with VA’s graduate medical residency program. In 2014, Congress authorized 1,500 residency positions, but to date, only half have been filled. The problem, according to Shulkin is that VA only pays for the time the resident is actually working at the VA. The academic partner has to pay for the rest. The result is that the residents don’t remain with the VA. Shulkin suggested that he’d like Congress to come up with a comprehensive hiring and retention act for the VA.
According to the Secretary, there are more US medical school graduates right now than residency spots. “Do it smarter,” Shulkin said. “Let VA pay for the entire cost of resident programs, then tie it back to a service component in VA.” He also wants to suspend the 2014 program and reinvest the money back into a better-designed program. There need to be better incentives for people to apply for the VA’s residency spots. “If VA expands, these will be valuable positions,” Shulkin said.
We also learned that it’s going to take a long time before the VA’s electronic health record system is up and running. Once contract negotiations is final, it will take 18 months before the first test site is up and running. It will take at least 7 – 8 years before the entire VA can access records electronically.
Shulkin, who normally has all the answers, was not aware that veterans who live outside of the United States can’t access the Veterans’, Crisis Line. He stated that they would work with the telecommunications provider and set up a toll-free number. “I don’t see it as a technically difficult process,” he said. “And we should do it.”
Another part of VA’s modernization plan is telemedicine. The VA recently called for changes to the law that requires medical health providers to be licensed in the state where they work. The change would allow VA to greatly expand their mental health and other services. Telemedicine expansion removes geographic, seasonal and distance standards for care. And so will help bring costs down for the Agency.
The final take away from the meeting is best described by Committee Chairman Phil Roe, “This effort is in no way, shape or form intended to create a pipeline to privatize the VA’s healthcare system. I want to be completely clear about that.”