Choice issues 'much deeper' than originally thought

Choice issues 'much deeper' than originally thought

During an April 26 town hall meeting in Palisade, Colo., American Legion officials heard veterans express frustration with how the Department of Veterans Affairs Choice Program was working – or, in some cases, not working. The next day, those same Legion officials heard similar frustration by staff from the Grand Junction VA Medical Center.

During an American Legion System Worth Saving visit to the medical facility in Western Colorado, VA employees expressed concerns ranging from Choice Program billing issues to never receiving results from tests or imaging done by Choice providers.

Enacted by Congress in 2015 under the Veterans Access, Choice, and Accountability Act of 2014, the program allows veterans waiting longer than 30 days for care, and veterans more than 40 miles from a VA medical facility or facing severe travel burdens, to seek care outside of VA. Patients using Choice schedule their appointments through Health Net Federal Services, a third-party company.

Veterans Affairs & Rehabilitation Chairman Ralph Bozella said it was eye-opening to hear about problems with Choice from VA staff.

“The Choice Program issues are much deeper than I ever imagined. It’s clinical and it’s business. So it has to do with patients’ health care directly. Patient health care is actually leaving the VA through a program called Choice 40. VA doesn’t even know these patients are going on some of these visits. That’s a health-care issue.

"On the business side, there are a lot of problems with the billing. Patients are getting billed for stuff that took place and, in some cases, stuff that didn’t even take place. This is a real problem.”

Bozella was joined on the visit by national Legion staff, Health Subcommittee Vice Chairman James Stanko, Department of Colorado First Vice Commander Jay Bowen, Junior Vice Commander and District 13 Commander Lou Bracket, Colorado Department Service Officer Dean Casey and Auxiliary Department Chaplain Julie Dominguez.

Legion reps spent nearly nine hours meeting with the facility's executive leadership, as well as staff from human resources, finance, the clinical line, the business office, quality manager and the women and homeless veterans programs.

Before the Choice Program was enacted, the Grand Junction VAMC utilized non-VA care to cover services it didn’t provide. Contracts with private sector providers in the community already were in place to provide that care. Staff said it wasn’t a perfect system, but it was a good one that worked better than Choice now does.

The facility is “overwhelmed” when it comes to calls regarding the Choice Program. Staff said the medical center was getting an average of 100 calls a day about the program. Those who have sought help through the Choice Program can often wait up to four months for a consult visit.

The facility has hired a “Choice Champion,” whose focus is on dealing with Choice issues. Additional staff will be needed to continue to address Choice issues. Health Net will say it has called patients numerous times to set up appointments; those patients say they never received a single call.

Patients aren’t billed correctly, and some patients are sent to the wrong location for their appointments. Legion reps were shown letters from Health Net that had one appointment scheduled for 4 a.m.; another that was dated one day after the appointment date.

“Choice has put us in a place where it’s impossible to keep up,” one staffer said of trying resolve the program’s issues. “Before, it was a struggle but we were able to keep up. Now, Choice makes up 50 percent of our calls or walk-ins, in addition to our regular workload.”

On the clinical side, radiology staff said they don’t even know when a veteran uses Choice to receive radiology care. VA is losing “control of the process” because of that. Staff said better linkage between VA and the Choice Program outside providers is needed.

The same issue is occurring with mammograms being done through Choice. Women veterans staff at the Grand Junction VAMC said they have to go through a health-care network to find the results of the mammograms. One staff member said she’d never seen a mammogram taken through the Choice Program returned to Grand Junction staff.

All of those concerns will be shared with decision makers by The American Legion. “The best thing that The American Legion does is advocate for veterans,” Bozella said. “Our job after a visit like this … is to get the VA Central Office, to the President of the United States (and) to Congress … that if they’re going to roll out a program like Choice, it better be well-planned and better be implemented correctly.”

Another issue that came up during the visit was the problem with staffing and turnover. The facility is limited in the amount of specialty fields and services it can offer, staff said. Another issue is the hiring process itself. In the private sector, from start to finish, the process can take as little as 14 days. Within VA, it can take anywhere from six weeks to more than two months. Because of that, potential employees sometimes accept another offer while waiting for the VA process to finish.

Bozella, who receives VA care in Denver, said the Legion came away with a lot of good information from the Grand Junction visit.

“This has been a very productive (visit),” he said. “The administrative team, I feel, was very receptive to our recommendations for improvement. We pointed out what their strengths were. They seemed to agree with most of what we talked about.”