More than a million veterans have consulted with the Department of Veterans Affairs about going to a private doctor since the Mission Act rolled out three months ago, but there has been no immediate rush away from the VA health care system, officials said Wednesday.
"The bottom line is that the Mission Act is a success," said Dr. Richard Stone, head of the Veterans Health Administration (VHA). He added that the number of veterans enrolling in VA health care, or choosing to stay in the system, has actually increased since the Mission Act went into effect June 6.
The new enrollments include veterans over the age of 65, when they become eligible for Medicare, he said at a hearing of the House Veterans Affairs Subcommittee on Health.
Stone said the fears of several veterans service organizations and congressional Democrats that the Mission Act would lead to the "privatization" of health care at the VA have not been realized.
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"VA is not privatizing, and veterans are choosing VA" even when presented with the option for private care, he said.
Rep. Julia Brownley, D-California, the subcommittee chairwoman, appeared to agree, saying she is "impressed" with the Mission Act's implementation thus far. But she added that she is "alarmed" by the VA's continuing challenge to enroll female veterans for "high-risk maternity care and fertility treatments."
In his testimony, Stone said there had been more than one million "consults" with veterans on whether they would be eligible for, or their interests would be best served by, a community care provider in the private sector.
He said that the "best medical interest was a factor considered" in 538,000 of those consultations.
Following his testimony, Stone was asked by Military.com whether the one million consults are an indication that a flood of veterans eventually will choose to opt out of VA health care.
He called it a valid question but said, "Oh my gosh, no."
Under the Mission Act, the VA maintains control over whether to authorize payment for private care in consultation with the veteran, Stone said.
He said the VA currently lacks data on how many of the consults were authorized for private care, adding that it likely will not be available for another three or four months.
In her testimony to the subcommittee, Dr. Kameron Matthews, the VA's deputy under secretary for Health for Community Care, said the VA will ultimately "make the determination" on whether the veteran can receive care in the private sector through the VA's network of community care providers.
The community care providers "have to refer back" to the VA on whether the private care is authorized, and the department "can pull that care back" into the VA health care system, she said.
"The VA will maintain oversight" of community care authorizations, and will remain the "integrator" of care coordination, Matthews said.
In his testimony, Stone said early data "shows that veterans are using the Veterans Community Care Program under the Mission Act only slightly more than they were using community care before the June 6 launch."
At the same time, the VA is increasing the number of appointments in the VA health care system, he said.
Through mid-August of this fiscal year, "the VA has completed over 53 million appointments nationwide," Stone said. That was "more than 1.6 million higher than the same timeframe in FY2018, or an increase of 3.1%."
The initial projections for the Mission Act were that the number of veterans currently receiving VA health care who could become eligible for community care would increase from 8% to 40%. More than nine million vets receive care from the VA.
The Mission Act, which stands for Maintaining Internal Systems and Strengthening Integrated Outside Networks Act, was signed into law in 2018 and went into effect June 6 to replace the troubled, inefficient and underfunded VA Choice program. Choice was enacted in haste in 2014 in response to the wait-times scandals at the Phoenix VA Medical Center.
Under Choice, veterans were considered eligible for private care if they lived more than 40 miles from the nearest VA facility or had to wait more than 30 days for an appointment.
The criteria under the Mission Act are 20 days for an appointment and a 30-minute drive; it also considers the veteran's "best interests" as a factor.
President Donald Trump campaigned on expanding private-care options for veterans. When he signed the bill in 2018, he said, "All during the campaign, I'd go out and say, 'Why can't they just go see a doctor instead of standing in line for weeks and weeks and weeks?' Now they can go see a doctor. It's going to be great."
-- Richard Sisk can be reached at Richard.Sisk@Military.com.
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