Staff Report – For The Record

Despite a redoubled effort by the embattled U.S. Department of Veterans Affairs (VA) to resolve overwhelming backlogs in veterans’ medical care, and despite Texas physicians signing up to provide community care for veterans, men and women who served in our nation’s military still face care delays and problems.

“This just leaves veterans where they were before: with a lousy system,” said San Antonio pulmonologist John R. Holcomb, MD.

After news of lengthy wait lists for veterans awaiting care (and accusations of falsified records to hide those delays), Congress expanded VA’s ability to contract with private physicians and others under the Veterans Access, Choice, and Accountability Act of 2014. This way veterans could go outside VA to have private-sector physicians (called “community care”) care for them — presumably more quickly than within the VA system. The three-year $17 billion fix allows veterans to see Medicare-enrolled doctors when waiting times at VA facilities exceed 30 days, or if veterans live more than 40 miles from the nearest VA facility. Other provisions call for systems to ensure prompt payment for VA and non-VA care. As the law passed, the Texas Medical Association (TMA) began collecting the names of private physicians wishing to care for veterans. Dr. Holcomb was one of the 350 Texas physicians who enrolled to care for veterans in his private medical practice. Yet two years later, veterans still sit on long waiting lists for care, and now a new problem has emerged, too: The private physicians who do treat them end up on long waiting lists to get paid, reports TMA’s Texas Medicine magazine.

In Texas and the Southwest region, TriWest Healthcare Alliance won a $4.4 billion contract to oversee the community care expansion, known as the Veterans Choice Program. Another $5 billion contract went to Health Net Federal.

Yet after Congress passed the law, TMA contacted one of the local VA networks to share TMA’s physician registry list and see how the doctors could begin seeing veterans. Those outreach efforts largely were met with silence.

An April 2015 Associated Press investigation showed Texas VA facilities were still struggling to have patients seen within 30 days. A July 2015 surveycommissioned by the office of U.S. Rep. Beto O’Rourke (D-El Paso), whose district had one of the worst wait lists in the country, showed wait times for veterans to receive primary or specialty care averaged 77 days. And 56 percent of veterans surveyed said no one adequately explained their ability to participate in the Veterans Choice Program. Texas has the second-largest veteran population (1.7 million) behind California.

I am terribly disturbed by the VA’s inability to fix this problem. The bill that Congress passed is obviously not doing the job,” past TMA President Austin I. King, MD, said in response to the reports.

TMA’s House of Delegates governing body passed a resolution in May 2016 directing the association to look into continuing its physician registry effort while encouraging collaboration between TMA and veterans organizations to educate physicians and veterans about community care options. And the American Medical Association considers new policy this month to support federal legislation urging VA to expand veterans’ health care choices by permitting them to use VA care funds to purchase private health care coverage. Another proposal would support legislation to require transparency in VA’s operation.

VA officials say a comprehensive improvement plan is in the works. Among other things, VA’s Plan to Consolidate Community Care Programs streamlines veteran eligibility and care authorization; improves care coordination and medical records management; and creates a single, automated payment process. Physicians say that plan must clear existing bureaucratic landmines — inadequate physician networks, slow payment, and lack of interaction between VA and the private sector, for instance — that still create fragmented health care for veterans.

“It’s not fair to anybody,” said Corpus Christi surgeon Vicente Juan, MD, who often sees veterans who end up hospitalized because they can’t get the postoperative care they need at their local VA facility. “We’ve always bent over backwards to take care of veterans because we appreciate their sacrifice, and we don’t feel like they are taken care of adequately by the system in place,” he said. Corpus Christi veterans typically must travel to San Antonio for surgery, “but over and over they come to see us because they still have their staples in months after surgery, and they are sent home because they can’t get another appointment for three months.” And his staff must fight to get paid; some bills have been on hold from VA for two years.

TMA is the largest state medical society in the nation, representing more than 49,000 physician and medical student members. It is located in Austin and has 110 component county medical societies around the state. TMA’s key objective since 1853 is to improve the health of all Texans.