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Tweaks Made To Veterans Choice, But Overhaul Remains Elusive

A Veterans Choice ID card.

A Veterans Choice ID card. Susan Stephens/WNIJ

Earlier this year, NPR analyzed the length of wait times for veterans to get appointments and treatment at Veterans Affairs medical facilities. Over the next few days, you will hear a Midwestern perspective on a federal program trying to improve veterans care.

Veterans Choice was established in 2014 to speed up the time it took for Veterans to get care. It came in the form of a $16 billion influx to the department of Veterans Affairs. NPR's Quil Lawrence has been following the money to see how it was spent.

"There was a breakdown there of about $10 billion going to what most people think of as the Choice Program," Lawrence explained. "That's $10 billion to get vets appointments outside of the VA system."

The idea was that, for a short time, they would let veterans go outside of the system to take the pressure off the overloaded VA medical centers and overbooked VA doctors. 

"There was also $2.5 billion for hiring new doctors and nurses across the VA system," Lawrence said, "and that is most of the money that NPR followed."

The NPR analysis revealed wait times did not necessarily improve.

"There is a very complicated explanation for why," Lawrence said. "If you ask the VA, they say they saw a lot more people through Choice and they are still using outside-of-the-system doctors to see almost a third of their patients."

The criteria for Veterans Choice.

Photo Credit: Department of Veterans Affairs

That was coupled with an overwhelming demand from both new veterans coming home from Iraq and Afghanistan with more complicated injuries and what Lawrence describes as "a demographic bulge of Vietnam and older veterans who are reaching an age where they need more medical care than they ever had before in their lives."

Lawrence says NPR cast a pretty wide net for those affected by the Choice program. "It wasn't too hard to find people who were involved in the process," Lawrence said. "We had 30,000 cases when we first did this investigation where veterans had gone to the Vets Choice program because they couldn't get to their local VA within 30 days."

He says that was one of the prerequisites to use the program.

"Then they would find the VA appointment they were about to have 45 days from now ended up being sooner and quicker than the Vets Choice appointment that they were making."

As a result, Lawrence says, a program that was supposed to solve the problem ended up being just as slow.

Extension Approved For Choice Program

In April, the Veterans Choice program was extended.

"There have been many tweaks to the program since it went through," Lawrence said.

He says these tweaks are often in the form of renegotiating the contract with third-party advisors. The VA went outside to hire people to do the customer service and coordination. They hired Health Net and TriWest to cover the entire country.

"They've changed their contract with those companies many times since the law passed," Lawrence said. "It seems to be working a little bit smoother now."

He says there may be some confusion about the extension; people might think of it as the government saying it was working great and they want to renew it.

The Vets Choice program was scheduled to expire in August. Lawrence says that meant veterans who needed authorization for a longer medical procedure would not have gotten it without the extension. "What they passed recently was just a stopgap funding measure to keep the people who are using Choice now going so they can keep getting treatment," Lawrence said.

Calls For Overhaul 

Lawmakers on both sides of the political aisle, and at the VA, have said they want to reform Veterans Choice comprehensively. One lawmaker with a close relationship with the VA agrees changes are needed.

U.S. Senator Tammy Duckworth is an Iraq War Veteran and former Assistant Secretary of the Department of Veterans Affairs.

U.S. Senator Tammy Duckworth likes the concept of Veterans Choice, but not the execution.

Photo Credit: Senator Tammy Duckworth's office

"I like the concept of it – I voted for the Choice program – but it’s been very poorly executed," Duckworth said. "I’m here now in the Senate, working to try to fix the way the bureaucracy was set up around how to implement Choice so that it truly makes it easier for veterans – not harder."

Duckworth goes to the Hines VA for health care, but takes part in the Veterans Choice program for some of her women’s health care.  "For example, Hines does not have an obstetrics program. So I was referred to an outside provider for that, and I found that having the Choice program be administered out of Florida, where they don’t know the local communities, the local health-care providers, made it really difficult."

"Figuring It Out As We Go"

Another criticism of the Veterans Choice program was that the benefits were not communicated very well to veterans or Veterans Affairs Commissions at the county level. These are the people who often help shepherd vets through their options or, in some cases, help find transportation for them to hospitals. They admit they've been trying to make the program work without much support. NPR's Quil Lawrence says the "workaround" mentality was seen nationwide. 

"This was a system they set up in a rush. Congress gave them 90 days to set it up, it was unrealistic," Lawrence said. "There was a sense of urgency that there were veterans waiting too long and suffering. As a result, what came out was something that veterans couldn't understand very well. It hadn't been explained to them very well."

Additionally, he says doctors outside of the VA system couldn't understand it very well. "The third party administrators that the VA hired were very confusing for everyone to use; they didn't seem to understand the program very well. The VA itself didn't seem to understand the program very well. So, nobody understood it and that was a clear problem."

As we continue our series, "Veterans Choice: Making It Work," we'll hear from vets themselves, county officers tasked with supporting vets as they navigate their healthcare options, and from hospital administrators.

WNIJ's Victor Yehling contributed to this report.