In the spirit of the New Year, the Veterans Healthcare Policy Institute offers a clear and simple set of policy resolutions to Congress, the Biden Administration and Veterans Affairs (VA) leadership.
First, we hope these policymakers acknowledge the serious failings in the private healthcare system, and act assertively protect veterans from them.
Specifically, those in power must begin to rigorously read and respond to credible reports of serious failures in care that has been outsourced to the private sector through the VA MISSION Act of 2018. These issues have are being compiled by journalists and academics, as well as the VA’s Office of the Inspector General (OIG), the Government Accountability Office (GAO), and the Congressional Budget Office (CBO).
A recent OIG report, for instance, documented serious and potentially fraudulent overbilling by private sector providers contracted by the VA’s Community Care Program. The OIG has also documented fraud perpetrated by at least one of the third-party administrators of the MISSION Act. To make matters even worse, the CBO has reported that all this money is flowing into a black box. In a recent report on the Community Care Program, it stated unequivocally, that the quality of care provided to veterans by non-VA healthcare providers is not only “unknown,” but essentially unknowable.
Myriad studies also document the superiority of VA over non-VA care. This applies to care in numerous areas, from the emergency room to mental health, as well as dialysis, diabetes, and COVID-19. You name it and the VA scores higher and delivers care that doesn’t exploit the American taxpayer in the process.
Then there is a slew of information about how the non-VA healthcare system has been decimated by the Covid-19 pandemic which has turned crises, like shortages in primary and mental health care, as well as nursing, into catastrophes. Plus, we learn almost daily of rampant corruption in this market-driven system, which puts profits before patients. Examples include the Sackler-driven opioid epidemic, the fraudulent practices in substance abuse programs, even the misuse of prenatal tests that are supposed to detect rare disorders.
Far too often, lawmakers and their staff zoom in on anecdotal issues at VA rather than providing a holistic comparison of the VA and the private sector. This latter approach, one driven by facts and data, should guide veterans policy moving forward.
Second, there must be far more attention paid to issues around burn pits and the Veterans Benefits Administration (VBA).
Specifically, VBA leaders should immediately meet and collaborate with Gulf War and Burn Pit veterans and their advocates to create, implement, and monitor new training to address VBA's pernicious pattern and practice of improperly denying 80 percent of toxic wound claims.
VHA must similarly collaborate with Gulf War and Burn Pit veterans and their advocates to create, implement, and monitor new training for healthcare providers that recognizes and treats toxic wounds.
VA Secretary Denis McDonough must nominate a permanent Under Secretary for Benefits (and for Health). He must also promulgate regulations to accurately identify all the veterans (by location and dates), the toxins to which they were exposed, and the medical conditions they incurred so that VBA can grant presumptive service connection to veterans suffering from toxic wounds, thus opening access to timely and quality VA care for those veterans
McDonough should also disclose all prior "Gulf War and Health" literature review contracts between VA and theNational Academies of Sciences, Engineering, and Medicine (NASEM). He then must issue new contracts mandating that NASEM consider both human and animal studies for the purposes of granting presumptive service connection for burn pit exposure.
He should also name a "Toxic Wounds Czar" at VA to oversee VA's collaboration with stakeholders as well as the timely implementation of regulations, research, and training for veterans suffering from toxic wounds
Finally, lawmakers should pass the Veterans Culturally Competent Care Act. This bill, co-sponsored by Representatives Blunt-Rochester, Bilirakis and Levin, will go a long way to remedying an abject failure, namely implementation of the MISSION Act’s mandate that competency standards be set for private providers who assess and deliver mental health care to veterans with Posttraumatic Stress Disorder (PTSD), Traumatic Brain Injury (TBI) and Military Sexual Trauma (MST).
MISSION intended to fix the previous Veterans Choice Program’s lack of standards for providers who treat veterans in the private sector. Nowhere was this gap more important than with veterans with signature conditions of PTSD, TBI and MST. Previous other studies revealed that, when compared with VA providers, psychotherapists in the community who treat mental health conditions are less likely to have the skills necessary to deliver high-quality care.
Although the MISSION Act instructed the VA to establish competency standards for private providers who deliver PTSD, MST and TBI treatment, to date, no mandatory credentials, training, and service delivery standards were ever created or implemented. The bill is a good start to ensure that private providers have a minimum level of clinical competence to treat veterans outside the VA. It sets the qualifications for private mental health providers as the same standards and requirements that apply to VA employees who provide such mental health care.
The bill also requires the completion of a VA-developed four-module course, available online, about military culture and four core competencies. Although such abbreviated online courses are focused more on improved evaluation abilities than intervention skills, it’s a positive start.
The bill also requires that non-VA providers have suicide prevention training, as occurs with VA providers, and the requirement that non-VA providers have military cultural competency. The bill recognizes that such cultural training on its own is likely to have little to no impact on clinical outcomes unless it is coupled with required training in the treatment of core mental health conditions.
Importantly, the bill would suspend permission for private providers to treat VA-enrolled veterans until they’ve completed the required training or VA-approved equivalent training, and have confirmed they have credentials that are equivalent to VA’s own high standards. Otherwise, there is a danger that standards may be ignored to enlarge the panel of private providers. Quicker access to care of inferior or unknown quality has life-impacting – and potentially life-threatening – consequences.
The bill is vulnerable to being ignored, given the ongoing lobbying to absolve community providers from having any standards or requirements. Our veterans deserve better.