The Veterans Affairs Department on Wednesday presented a plan to Congress for overhauling the way veterans receive care outside the VA. It would move toward value-based provider payments and would need at least $1.5 billion to get it started.
The report also calls for increasing veteran access to emergency-care services and basing provider payments on existing Medicare rates. A new deputy undersecretary position would be created to manage the program.
Congress called for the plan as problems have continued for veterans trying to receive community care despite the passage last year of the Veterans Choice Act. That act was in response to reports of excessive wait times and paperwork cover-ups at VA facilities.
In presenting the report to the House Veterans Affairs Committee, VA Deputy Secretary Sloan Gibson said the goal is to consolidate the seven community-care programs into one that has the same eligibility standards and provider payment methods.
Veterans can receive care outside the VA network if they must travel excessive distances or experience long waits to see a VA doctor or when they need a specialist. But several lawmakers spoke of constituents who still had barriers to care or were not getting their care paid for in a timely manner.
The rates at which the VA now reimburses also vary depending on the provider.
The three-phase multiyear plan calls for the VA to adopt Medicare rates on outside services as much as possible and to develop value-based payments as the concept matures. The VA would remain the primary payer. For services not covered by Medicare, the agency would negotiate rates.
Outside providers would be evaluated on performance and quality metrics and potentially receive higher reimbursement or be dropped from the list of eligible providers.
“Providers may be penalized for poor outcomes, medical errors, or increased costs. The CMS is currently piloting various models of value-based care, which the VA can work to replicate, as appropriate,” according to the report.
The VA also hopes to streamline the billing process, which is the cause of frustration and confusion for some providers, many of whom tend to reject VA patients.
The plan would cost between $1.5 billion and $2.5 billion in the first year, and the costs would increase after that. A provision for increased access to emergency departments and urgent-care centers would cost another $2 billion a year.
Much of the cost would come from an anticipated increased reliance on VA care as access and customer service improve.
Dr. Baligh Yehia, the agency's assistant deputy undersecretary for Health for Community Care, said moving to Medicare rates would also make transactions easier for providers, especially in rural areas.
“The smaller providers won't work with us if we have a number of hoops to jump through that Medicare doesn't have,” he said.
Dr. David Shulkin, VA undersecretary for health, said prompt provider payment is another key issue in the plan. The VA would pay on time more often by converting to electronic records where possible and considering automatic adjudication.
Representatives on the committee said they were generally supportive of the report's ideas, but some were still skeptical that meaningful change could occur.
“Every year there are leaders that sit before us and say we're going to change,” said Rep. Mike Coffman (R-Colo.), adding that positive change never seems to occur.
The plan needs approval from Congress. Historically, fiscally conservative lawmakers favor private doctors.