VA, IG warn against rush of veterans into private care

A report by the Department of Veterans Affairs’ inspector general and a separate “access audit” of appointment scheduling practices across VA healthcare facilities confirm system-wide abuses to distort wait times for care, which have put patients at risk and shaken confidence in how VA hospitals and clinics are staffed, managed and resourced.

Yet even as the acting IG and another senior VA official confirmed the depth of the patient wait-time scandal at a hearing Monday of the House veterans affairs committee, as well as possible criminal activity by some administrators, they cautioned irate lawmakers against sending thousands more VA patients into the private sector for healthcare needs.

The caution flags haven’t slowed Congress. On Tuesday, the House unanimously passed the Veterans Access to Care Act (HR 4810) from Rep. Jeff Miller (R-Fla.), VA committee chairman. It would require VA to offer non-VA care to enrolled veterans who cannot get an appointment within VA wait time goals or who live more than 40 miles from a VA medical facility.

On Wednesday, the Senate voted 93 to 3 for similar language as part of a more comprehensive bill, the Veterans’ Access to Care through Choice, Accountability and Transparency Act of 2014 (S 2450), from Sens. Bernie Sanders (I-Vt.), VA committee chairman, and John McCain (R-Ariz.).

VA already spends 10 percent of its health care budget, about $5 billion a year, on private sector care. In 2013, VA authorized and reimbursed for 15.3 million non-VA outpatient visits, a 72 percent increase since 2008. Eligibility for such care is complex, however, and varies by veteran status and circumstance. Pre-authorization usually is required.

In response to the appointments scandal, Congress wants VA to experiment for two years with giving many more veterans easier access to non-VA care. Veteran service organizations long have feared such moves as a step toward dismantling their prized, fully integrated VA health system. Big government critics say it will improve access to care but save tax dollars.

At Monday’s hearing, VA officials, including the acting inspector general, and a health expert from the Government Accountability Office, warned against a rush of veterans into private sector care, saying it could backfire if not carefully coordinated and properly resourced.

Testifying on results of a VA flash audit of patient access and wait times, Philip Matkovsky, assistant deputy under secretary for health administrative operations, apologized on behalf of VA leaders for a “systemic and totally unacceptable lack of integrity” found in appointment processing at some facilities, calling it “a breach of trust” and “indefensible.”

He also described a $300 million initiative to accelerate access to care in coming months with more medical staff overtime, expansion of VA clinic hours and more referrals to private sector providers as necessary.

Many VA facilities apparently manipulated wait time data to pretend to meet internal goals for providing timely access to care, which then would qualify senior staff for performance bonuses and promotions.

Richard J. Griffin, acting IG, testified that in addition to the Phoenix VA hospital where a whistleblower physician first exposed data manipulation, and said it had led to preventable deaths, IG teams were investigating 69 other VA facilities where there was evidence of data manipulation.

Griffin described two methods used to disguise actual wait times. The most common begins with a veteran calling for an appointment “120 days out because that’s the first available” and yet that appointment gets scored as being the veteran’s desired date. The facility then posts “zero waiting days” though the veteran actually waited four months.

“The other scenario is you get that appointment 120 days out. Two weeks before that appointment, it gets cancelled in the system and it gets recreated,” Griffin said. “The veteran is no wiser to the fact his appointment was cancelled because it’s been recreated for the same time and date.” But the appointment log shows a wait of two weeks not 120 days.

In Phoenix, the IG reviewed a statistically valid sample of 226 appointments for primary care. On average, patients waited 115 days for appointments. Only 16 percent were seen within the VA goal of 14 days. What the facility reported for those patients, however, was an average wait of 24 days with 57 percent treated within 14 days.

“Those are similar to what we found,” Matkovsky said of a nationwide “access audit” VA recently ran across more than 730 hospitals and clinics.

The IG report is preliminary and doesn’t answer whether vets died from delays in diagnosis or treatment. That will require analysis of VA and non-VA medical records, death certificates and autopsy reports by IG clinical teams. The IG is coordinating these investigations with the FBI.

Only one confirmed death from scheduling delays was discussed at Monday’s hearing. Debra A. Draper, director of health care for the Government Accountability Office, used it as a cautionary tale for lawmakers pressing to give veterans easier access to private sector care.

Last September, she said, VA diagnosed a veteran as having two aneurisms and scheduled heart surgery. A November operation was cancelled due to VA staffing issues. In December VA approved non-VA care, referring the patient to a local hospital. By late December, the non-VA care provider had lost the veteran’s information so VA had to resubmit its surgery request. In February, before surgery could be performed, the veteran died.

Use of more non-VA care will expand capacity but there are “potential pitfalls,” Draper said. For example, VA doesn’t tracked wait times for non-VA care and so it cannot estimate what waits will be for type of local care.

Griffin and Matkovsky also raised caution flags. The IG noted the value of an integrated health system to care for vets with multiple conditions. Matkovsky said transferring records with non-VA providers remains a hurdle.

“We need to ensure that there is sufficient non-VA care coordination staff in facilities. You can’t simply feed into community [care] and assume it’s going to take place,” Matkovsky warned. “We have to coordinate that care.”

Several committee members said they shared his concern. The next day the House passed Miller’s bill to expand access to non-VA care 426-to-0.

Next scandal...it will take a few months for it to surface. As most scripts are 90 days. DOD MANDATED 4/14/2014 that ALL TRICARE LIFE Retired over 65 Military use Express Scripts or Base dispensary for their daily meds. Cumbersome process. 2 weeks for ES for order or reorder. Base fills what they have, but reorders come out of Pensacola, FL for our region in TN. ES will switch your DAW script for a generic. And keep switching generics for cheaper ones. Drugs such as Synthroid is a ‘small window’ drug, and the generic is crap not enough of the hormone. Result Osteoporosis and other thyroid caused issues. It is a very important hormone, much more so than HRT’s. Synthroid
http://www.rxlist.com/synthroid-drug/side-effects-interactions.htm

29 pills that interact with Thyroid
http://www.worstpills.org/public/page.cfm?op_id=420

There has got to be a money trail, ES has defrauded the tax payer out of hundreds of millions of dollars. Not to mention the bad service. Your meds are stuffed into your mail box by USPS UNSIGNED FOR. Available to kids, teens, and drug thieves.

Express Scripts Accused Of Defrauding State And Consumers Out Of Millions Of Dollars
http://www.ag.ny.gov/press-release/express-scripts-accused-defrauding-state-and-consumers-out-millions-dollars

NY attoney general sues Express Scripts, Benefits firm accused of inflating prices, keeping up to $100 Million
http://www.nbcnews.com/id/5601076/ns/business-corporate_scandals/t/ny-attorney-general-sues-express-scripts/#.U381ECh7SMQ

Express Scripts Extortion Scheme Widens
http://www.consumeraffairs.com/news04/2009/09/express_scripts_breach.html

Express Scripts complaints
http://www.consumeraffairs.com/rx/express_scripts.html

ES Customer Service ranking
http://www.customerservicescoreboard.com/Express+Scripts

Express Scripts RIP OFF
https://www.ripoffreport.com/reports/directory/express-scripts

ES buys out Medco (already a scandal plagued company)
29 Billion
http://www.modernhealthcare.com/article/20120402/NEWS/304029961

When people start shaking off the skull block that is the “wait-time” issue...

We will definitely see how deep the rabbit hole goes...It goes way beyond the lackluster enrollment process, the initial care assessments, what the caregivers can and cannot do at the behest and permission of the non-doctor “desk jockeys” in that government organization...

I simply know that in the time that I was beginning to look at options for a career in High School, back in the late 70’s...

I learned that from people who are Veterans told me that the VA was something you did not want to be around...If it was true back then, why should anyone be surprised that it came to a semi-critical mass during this administration and current political makeup??? Couple that with a citizenry so distracted and with less virtue and loyalty to its very country, why should we expect ANYTHING TO BE DONE ABOUT THIS ANYTIME SOON???

Smoke and mirrors folks...Pay no attention to the man behind that curtain...

We have had our chance to correct this situation for decades, and those responsible have failed, our citizenry has failed in electing people of virtue to correct this and MANY other issues that do need addressing...And they have failed...

The reality is this...The propaganda machine has created a narrative that has replaced news and commentary for the foreseeable future...We cannot politically defeat that aspect anytime soon...We will have to gut out the last 2.5 years of the nonsense that this administration is leading us down...And even if we do manage to get back the Senate, and eventually that White House...

You can bet a dollar to a donut hole that the corrective measures necessary to restore national pride, loyalty, and overall virtue this country used to stand for, will be fought tooth and nail by the opposition and cowed to by the majority...If we manage to snake the majority from these destructive politicos and the pseudo-conservative some send to represent them...

So, if this doesn’t manage to make any impact on anyone’s decision on what YOU send to represent you, then I do not know what will...

November gives us a chance to make a small course change and keep us from hitting that iceberg “dead ahead”...Maybe this will give us time to be ready in 2 years to really put the right kind of pressure on both sides of the political spectrum to poop or get off the pot, or get the hell out of our way, we are DONE with you...

And be very unapologetic about that position!!!

I do not believe I am alone in this evaluation...The sentiments are probably very similar (socially) to the political atmosphere when this experiment was started about 238 years ago...

We may have to experience a re-birth of those founding principles we have forgotten about...And think we know what they truly meant...They have to apply today as well as when it did at the beginning...

Until we start lopping off more of the Cantor’s, the Boehner’s, the Cornyn’s, McConnell’s, Graham’s, Pelosi’s, Reid’s etc etc etc, pick your poison...It can certainly get worse, but there is a lot that could be improved and make it easier to flush the lot of these current occupiers or lofty titles and leather seats...

Until we accept that we (all of us) have failed to be able to be effective in our ability to at least remind these wayward citizens that they exist up there at OUR tolerance, they will fight back against us, if our realistic expectations are not very well received, politically, or socially...

Just remember, when McCarthy is crammed down our throats as the new Majority leader...Just remember, he has a history of being exactly what the problem is for this country...

It all starts with phone calls, emails, make sure you attend local town hall meetings, be prepared to ask the tough questions, expect to be ignored, boo’d, harassed, ostracized...Be unapologetic in your endeavors...First and foremost...

238 years ago, those old fogy, wig-wearing white guys, had some very interesting debates, it got nasty, but at the end of the day, they tossed back a few pints in the pubs down the street together...Put aside those differences and came up with some pretty neat stuff back then...

then they went home to their families knowing that when they succeeded, that a big fight was coming, so they sat down and made musket balls...

That outcome is far from a reality, but the process is the same...

You have to ask yourself this gut-check question, and I have presented it here for years...It is a rhetorical question, not requiring one to be responded to in a publically monitored discussion website like this...We have to be smarter than to advertise our individual intentions...

“What are YOU prepared to do about it, and what are YOU prepared to sacrifice for those goals?”

/rant

“Dems attack Romney for backing healthcare vouchers for veterans” (2011)
Democrats are blasting GOP presidential front-runner Mitt Romney for proposing to give veterans a healthcare voucher that critics say would undermine the Veterans Affairs system.

Romney introduced the idea Friday at a South Carolina campaign event. He said a voucher would give veterans more choices and force the government to compete with the private sector.

Romney’s campaign said the candidate was simply discussing ideas at the event, not laying out new policy proposals. The campaign also pointed out that the Obama administration in 2009 proposed to bill veterans’ private insurance companies for combat-related injuries, before withdrawing the idea within 48 hours in the face of stark opposition from veterans groups.

Read more: http://thehill.com/policy/healthcare/193935-dems-blast-romney-over-healthcare-vouchers-for-veterans-#ixzz34X30u8SN
Follow us: @thehill on Twitter | TheHill on Facebook

Read more: http://thehill.com/policy/healthcare/193935-dems-blast-romney-over-healthcare-vouchers-for-veterans-#ixzz34X2vi4qD
Follow us: @thehill on Twitter | TheHill on Facebook

Read more: http://thehill.com/policy/healthcare/193935-dems-blast-romney-over-healthcare-vouchers-for-veterans-#ixzz34X2l9k5D
Follow us: @thehill on Twitter | TheHill on Facebook

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