By – Kathleen Spillane
On Monday, June 23rd, the House Committee on Veterans’ Affairs held a hearing entitled, “Evaluating the Capacity of the VA to Care for Veteran Patients.” The purpose of this hearing was to conduct a check-up on the VA regarding the steps it has taken to implement the “Accelerating Access to Care” initiative and the impact the initiative has had on both decreasing wait times and improving access to care for veterans in need of assistance.
The Committee Chairman, Representative Jeff Miller (R-FL), expressed “serious concerns about the information Congress has received about the initiative,” noting that this is “another example of the VA failing to act in an open and transparent manner.” Prior to the hearing, the Committee received word that, upon the release of the Accelerating Access to Care initiative in late May, there have been 200,000 appointments made between May 15th and June 1st. This, according to the Committee, demonstrates that the Department is taking serious steps to address this crisis, but without reporting this information in a timely and efficient manner, Congress cannot take the necessary and immediate steps toward other long-term issues affecting veterans’ care, such as inadequate facility capacity, personnel shortages, capability issues, and other resource restraints.
In his testimony, witness Dr. Thomas Lynch, the Assistant Deputy Under Secretary for Health for Clinical Operations in the Veterans Health Administration (VHA), began by stating that the Department “acknowledges and is committed to correcting problems with patient scheduling” and that this crisis “is a breech of trust that is indefensible and unacceptable.” Dr. Lynch attempted to clarify the data gaps and inconsistencies that have emerged by addressing improvements that have been achieved in the past months or those that are currently being worked on by the VHA. With a current physician workforce of more than 25,000 and comprehensive information being compiled on each medical center, including proficiency measurements in Relative Value Units (RVUs) and reports on the state of current infrastructure, Dr. Lynch assured the Committee that VHA is taking all the steps necessary to achieve the standards set forth by the Accelerating Access to Care initiative.
Dr. Lynch also noted the importance of outpatient care, citing that the VA has the largest medical home approach with teams that provide face-to-face assistance as well as advice and consultation through varying technologies so that veterans’ chronic conditions are adequately cared for. Dr. Lynch concluded his testimony by assuring the Committee that the ongoing compilation of data regarding VA personnel and infrastructure capacity is allowing the Department to assess what can be provided to veterans facing wait times and to determine the appropriate course of action moving forward. Dr. Lynch’s testimony did not provide a definitive course of action produced by the initiative, however, or a timeline for when that might happen.
The Committee expressed dissatisfaction with this testimony, however, as many of its members couldn’t understand why such data compilation and research measures hadn’t been undertaken by the Department years ago. Chairman Miller began the questioning by asking how quickly clinical physicians could be hired under current authorities. All witnesses admitted that the current hiring processes are too slow and are being addressed. Such vague and indefinite answers seemed to define the question and answer portion of the hearing – further frustrating Committee members who are already skeptical of both the integrity of VA data and the ability of its leadership to confront these serious issues. Many Committee members aimed their lines of questioning to issues facing VA medical facilities in their districts where for some, the wait times, counter to reported national trends, are not improving. Representative Doug Lamborn (R-CO) reported that electronic wait times for the nearest facility in Colorado’s 5th Congressional District were actually increasing following the VA’s recent response to the crisis. Dr. Lynch responded that he did not know about that particular facility but added that electronic wait times are dynamic and unique to each area.
Representative David Jolly (R-FL) was one of the few Committee members whose constituents have provided him with increasingly positive feedback about VA care, but even in his district – Florida’s 13th Congressional District – concerns are still being raised about the VA’s ability to assist in providing care outside of the system from community providers. Dr. Lynch and Dr. Carolyn Clancy, the Assistant Deputy Under Secretary for Quality, Safety, and Value for the VHA, responded to Rep. Jolly and other Committee members who voiced similar concerns by stating that they are actively working with contractors to ensure more fluidity and ease of transition between the VA and community services.
Another important topic of discussion was the Relative Value Unit (RVU) assessment of physicians – a standard of assessing physician proficiency that has not previously been used. Now, the VA is working to ensure that physicians are meeting a “minimum standard” and, if the standard is not met, they are assessing the resources that can be used to increase proficiency. Representative Dan Benishek (R-MI) took issue with how the VA is conducting RVUs, however, suggesting that the VA has no way of compiling and evaluating the thousands of RVUs being entered into their system because they simply do not have the capacity to house this and other data they claim to be analyzing. As such, Rep. Benishek stated that the “whole management and structure needs to be reevaluated [because] if they do not know how much it costs to care for a patient, how can they possibly understand how many physicians and resources they need?” This criticism was also applied by Committee members to concerns around infrastructure needs and innovations as well as other capacity issues the VA faces as its patient population increases.
This hearing, in addressing the important topics and issues that have still not been adequately and fully resolved by the Department of Veterans Affairs, stands as a testament that far more needs to be done to provide quality and timely care to America’s veterans. AMAC will continue to stand up for and support our nation’s veterans in their quest to receive the care that they deserve and were promised. AMAC will never forget the veterans who passed away while waiting for the care they needed in Phoenix nor the countless others who have suffered from this injustice.