A Misleading House Proposal Weaponizes Continuity of Care
Representative Scott Franklin, a Florida Republican, recently proposed an innocuous-sounding bill, which he discussed during a September 11th hearing before the House Committee on Veterans’ Affairs Health Subcommittee. (It passed through a subcommittee in a markup hearing the following week.) The legislation would require that referral decisions for private care via the MISSION Act’s Veterans Community Care Program (VCCP) include consideration of “continuity of care” in weighing the “best medical interest of the patient.”
The bill reflects a sudden recognition among Franklin and his colleagues of the importance of continuity of care to veterans’ health and wellbeing. As studies document, continuity of care is critical to positive health outcomes, which is why it’s the foundation of the VA’s singular, successful, and fully integrated system. Of particular note, VA’s regulations already list the potential of “improved continuity of care” as a key factor to consider on behest of a veteran patient.
Sadly, Franklin and other proponents of the outsourcing of veteran care through the VCCP fail to recognize that this private sector program is singlehandedly the greatest disrupter of veteran care in the hundred-year existence of the veterans’ healthcare system.
Numerous studies show how the VCCP interrupts and often fragments veterans’ care. One 2018 study of VA patients being cared for in the private sector noted that “recent federal policy changes’ attempt to expand veterans’ access to providers outside the [VA] may increase the risk for unsafe prescribing, particularly in persons with dementia.” These dangers were also highlighted in a 2020 JAMA article on VA outsourcing, which warned that “without well-defined mechanisms for 2-way flow of information, it is unclear how easier access to private sector care, potentially at the expense of increased fragmentation, could translate into safer higher-quality care, regardless of the cost implications.”
In a 2022 report to Congress, VA Secretary Denis McDonough further warned that “fragmentation of care is known to be a barrier to quality, but importantly, veteran feedback also shows that this fragmentation is a stressor for veterans.” He added: “Veterans are also experiencing fragmentation of care, duplicative testing and unnecessary and improper billing from community providers.”
Rather than address these serious and increasingly chronic problems, Franklin’s proposal is pure politics, positive sounding but ultimately misleading and even dangerous. Indeed, in their statement for the September 11th hearing, VA leadership did not support the bill, arguing that it was counter-productive, redundant, and confusing.
VHPI wholeheartedly agrees. This bill should not be passed. Instead of enhancing veterans’ care, it appears part of conservative-led efforts to derail action from VA leaders to adopt a series of critical recommendations made by a Red Team Executive Roundtable in March. Authored by a group of six national experts in health care systems and quality, the report concludes that the VCCP has failed in its mission to provide veterans with high quality care delivered in a timely and convenient manner. Based on a thorough study of the data evaluating the VCCP’s outcomes and high cost, the Red Team recommended that, for veterans who live within the travel time standard, the Veterans Health Administration (VHA) – not the VCCP – provide more ER, mental health, oncology and orthopedic care.
As part of this work, the Red Team believes the VHA should repatriate patients who are admitted to private sector hospitals after an ER visit so they can receive good, coordinated follow-up care in VHA facilities. This prescription demonstrates sound clinical judgment. Impressive studies have documented that the VHA delivers emergency and follow up care that is not only of far higher quality – at lower cost – but also life-saving, than that delivered in private sector ERs and hospitals.
Should Franklin’s amendment pass, it will help solidify a false narrative for champions of rampant outsourcing that bringing patients back to the VHA will interrupt their continuity of care and thus be detrimental to veteran health outcomes. This despite the fact that study after study shows veterans fare better in the VHA than in the private sector.
The Red Team also recommends curtailing the excessive use of private sector oncology and orthopedic care. Again, this recommendation is based on sound data. Take oncology care. Veterans who suffer from cancer are more likely to get unnecessary and often invasive procedures from VCCP oncologists who have a strong financial incentive to prescribe costly treatments. VCCP oncologists are also more likely to recommend chemotherapy since they profit from chemotherapy drugs, which are marked up anywhere from 116 to 600 percent. The same financial incentives lead private sector orthopedists to recommend more invasive musculoskeletal surgeries than those in the VHA.
During the September 11th hearing, Franklin specifically lambasted the VA for their handling of mental health care appointments, claiming they are “pushing more veterans back into VA facilities from community care providers without considering continuity of care when deciding in a veteran’s best medical interest. This abruptly cuts off veterans from long time treatment plans and providers they trust.”
His comments conveniently ignore the underlying reasons why VHA wants veterans to receive in-house mental healthcare: because the vast majority of private mental health professionals are not well equipped to handle veterans’ complex mental health conditions and, as the Red Team points out, have consistently refused to engage in VA’s online trainings, even when they are made freely available, to enhance their ability to better understand and treat conditions like Military Sexual Trauma or complex combat related PTSD. Virtually no community mental health providers send treatment health care records back to the VA to warrant continued care. None practice the VA’s standard of practices of “measurement-based care” or “evidence-based psychotherapy.” Asking for a blank check approval without justification is not appropriate.
We fear that, in the name of supporting veteran patients, Franklin’s bill will be used to legislatively circumvent what is in fact in their best medical interest. It’s a cynical ploy to entrap veterans in the fragmented and profit-driven private sector care system, which consistently fails to deliver on its stated promise of providing the highest quality care, in the most convenient location, and in the most expeditious fashion to those who have served and sacrificed for their country.
