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Congress Hears Misguided Proposal for Private Sector Substance Use Treatment

Updated: Apr 27, 2023

Earlier this month, the House Committee on Veterans’ Affairs Health Subcommittee held an important hearing that could potentially lead to the erosion of the veterans’ healthcare system.

During the proceedings, Republican Chairwoman Mariannette Miller-Meeks, an Iowa Republican, and her two hand-picked witnesses led a charge against the current standards that determine access to private sector care under the VA MISSION Act. One witness was Daniel Elkins, Chief of Staff at The Independence Fund – an organization whose allegedly suspect practices and pro-privatization stances have previously attracted scrutiny. The other was Thomas Sauer, CEO and owner of Miramar Health, a private sector substance use disorder (SUD) residential program that is seeking more funding from the VA.

Elkins asked Congress to expand the Veterans COMPACT Act of 2020 “to cover non-suicidal crises like SUD.” (The COMPACT Act currently allows a veteran at emergent risk for suicide to receive immediate care – whether VA or private sector – that is paid for by VA). Elkins added that regulations should, in fact, be changed to bypass VA authorization altogether and “allow civilian providers inside and outside the Community Care Network to authorize care for SUD residential services.” This momentous and misguided change would explode private sector care far beyond the VA MISSION Act’s Community Care Network.

Elkins also proposed that veterans, on their own, could choose care in the private sector if they have any “concern” about an inpatient VA mental health program. Sauer stated that veterans should be started in a residential program like his “anywhere, immediately” in less than 72 hours.

Completely lost in the hearing were objective statements about private sector care that is inferior to that of the VA. No committee members ever acknowledged the testimony of one witness, Dr. Julie Kroviak from the VA Office of Inspector General. She noted:

While this report highlights issues with offering community care to veterans, it does not provide a complete picture of the concerns we have found when veterans are receiving community care. Our office has published reports related to community care detailing delays in diagnosis and treatment, lack of information sharing or miscommunication between providers, and significant quality of care concerns.

Unregulated quality of care in a private sector that prioritizes profits is no trivial matter. To cite just one example, a year ago, two unscrupulous operators of addiction treatment facilities in Florida were convicted of a $112 million fraud scheme that included pseudo admissions and medically unnecessary services.

Since referral to the private sector will inevitably be a supplemental option, VA must create high-quality, evidence-based accreditation requirements for residential SUD treatment programs in its Community Care Network.

Intensive SUD treatment, whether in a daily outpatient setting or within residential care, is, of course, the right disposition when that high level of care is clinically indicated. VA doesn’t have sufficient bed capacity to fully provide rapid initiation, especially for veterans who live too far away to travel daily to an urban medical center. It should have been readily apparent that the best way to hasten the start of SUD treatment is to increase VA staff and facility resources so that it has capacity to meet demand. But not a single member of Congress or witness mentioned this glaringly obvious remedy.

The solution to delays furnishing SUD treatment to veterans is not gutting access eligibility standards, eliminating VA’s role as pre-authorizer, allowing any private provider to approve private sector residential care of unknown effectiveness and that costs on average $4,000 per night, doing away with the Veterans Community Care Program, and paying for residential care when a lower intensity of treatment is clinically warranted.

Those, in fact, would destroy the VA healthcare system by transforming it into a payer rather than a provider of health care.

If Congress wants to help veterans with substance use disorders and avoid the tragedies of overdose and shattered lives, the answer lies first in funding more beds and staff for residential and intensive outpatient treatments provided by the VA.

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