Wait times could increase with MISSION Act changes, VA IG warns

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When Congress and the president passed the MISSION Act into law, the aim was to increase opportunities for veterans to get medical care -- either through the Department of Veterans Affairs or private providers, paid for by VA -- and cut wait times. 

But even before MISSION launched, replacing the expired Choice Act in June 2019, at least one VA healthcare network was struggling with wait times in referring vets to care outside VA -- with a nearly two-month delay for appointments in 2018, a recent Inspector General report shows. 

The Veterans Integrated Service Network (VISN) 8 is one of the VA’s regional networks of hospitals. VISN 8 cares for patients in Florida, south Georgia, Puerto Rico and the Caribbean. Serving a population of more than 1.6 million patients it referred more than 206,500 of its cases to non-VA community care providers. Those veterans experienced a 56-day wait on average before getting care, the report said. 

With MISSION in full effect, the VA’s Office of the Inspector General (OIG) says it could worsen wait times that's because the number of veterans who may seek private care is expected to increase from 684,000 to more than 3.7 million. 

The problems in 2018 at VA hospitals in Florida, Georgia, Puerto Rico and the Caribbean are not uncommon for the VA nationwide -- mainly a lack of qualified staff to address the issues.  About 39 percent of veterans were being sent to community providers because VA couldn’t provide care in a “timely manner,” the report said. VA staff also could not tell patients what their wait time would be if they chose community care, because the VA network did not share appointment wait times with contracted providers.

Investigators laid much of the blame on Health Net, a VA contractor responsible for at least part of the system’s referral process. Health Net no longer contracts with VA, but even after the two parted ways, the VA network had difficulty with wait times for community care. 

The staffing issues have been ongoing for years, and investigators found that five out of seven facilities in the area did not have enough administrative staff to handle the workload in 2018. 

The inspector general made several recommendations, including: 

  • Exchanging wait-time data between VA and community care providers;
  • Ensure enough staff to provide care and referrals;
  • Monitor referrals for wait times;
  • Implement plans to address the backlog of appointments and future appointments.

The VA network director agreed with the recommendations and said the network was developing plans to address them. 

VA Sunshine Healthcare Network spokeswoman Mary Kay Rutan told Connecting Vets that the IG report focuses on events from two years ago and highlights that community care providers "had issues getting claims processed through HealthNet." 

The VISN 8 VA network now has an "industry-standard referral and authorization management system" that intends to streamline the process, Rutan said, and VA "no longer does business with HealthNet."

Reach Abbie Bennett: abbie@connectingvets.com or @AbbieRBennett.
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