RENEE MONTAGNE, HOST:
Veterans are still waiting too long to see a doctor. Back in 2014, we heard a lot about that. It became a national scandal and forced the VA to come up with a fix. Yesterday on this program, we heard how the fix is broken. And today, we'll hear why. And first, some context from NPR's Quil Lawrence, who covers veterans. Good morning, Quil.
QUIL LAWRENCE, BYLINE: Good morning, Renee.
MONTAGNE: Let's just briefly remind people - what was broken?
LAWRENCE: Well, the VA was overloaded. And Congress wanted to move quickly to get care for veterans who'd waited at least 30 days for an appointment or who lived more than 40 miles from a VA clinic. So Congress pushed through a $10 billion program to pay for vets to see a private doctor outside the VA system if they met those conditions. It's called the Veterans Choice Program.
MONTAGNE: A program that, look, if you get right down to it, those veterans needed timely care. It seemed to make sense at the time to try private doctors.
LAWRENCE: Right, that was the idea. The problem was Congress gave the VA just 90 days to set the program up. And this was something they knew would be very complicated. You're talking about setting up a whole new network for millions of veterans with all the right specialties - mental health care, acupuncture, physical therapy, everything. They had to set up a whole new system.
MONTAGNE: And NPR, in cooperation with member stations around the country, has been investigating that system for several months - and, Quil, I gather - finding that the VA plainly did not pull it off.
LAWRENCE: Exactly, this was supposed to be a simple solution. They even mailed out this card that made it seem like veterans could just take this card to any private doctor's office and just charge their care to the VA. But what really happened was the creation of a new layer of bureaucracy that health care providers didn't really understand and the VA didn't really know how to run. And the evidence is that the number of backlogged appointments has gotten worse.
Compared to this time last year, there are 70,000 more appointments that took over a month for a vet to get seen. So today, we're going to dig into how Veterans Choice may have been flawed from the beginning. And we'll start with one veteran's story, which we found is pretty typical.
MONTAGNE: And that story is brought to us by Steve Walsh as part of this month's long investigation. He's a reporter at member station KPBS in San Diego.
STEVE WALSH, BYLINE: Amanda Wirtz served in the Navy on a destroyer. She got out in 2003. She got sick - a rare tumor that makes it hard to swallow.
AMANDA WIRTZ: I'm dealing with pain on a daily basis. So much so - you know, interrupting our sleep, our quality of life, my ability to function.
WALSH: She goes to the VA in San Diego. But last fall when she began having severe headaches, the VA couldn't get her an appointment.
WIRTZ: So the neurology department said, no problem. Would you like to be referred out into the community to the Choice Program?
WALSH: The Choice Program, designed precisely for people in Wirtz's situation. Too long of a wait at the VA? Choice gets you to a private doctor. Except for Wirtz, it didn't work. After six weeks of migraines and still no appointment, she finally heard back from the Choice Program. She showed me the letter.
WIRTZ: This is Feb. 23 for an appointment scheduled March 23. January, I'm considering suicide because I'm in so much pain. I'm asking for relief. The Choice Program is giving me an appointment in March.
WALSH: The Vets Choice Program is broken. And the reason goes back to the beginning - how the VA implemented the program and how it was designed in Congress.
(SOUNDBITE OF ARCHIVED RECORDING)
JEFF MILLER: Ma'am, veterans died. Get us the answers, please.
UNIDENTIFIED WOMAN #1: I understand that, Mr. Chairman.
WALSH: That's Chairman Jeff Miller, a Republican from Florida who heads the House Veterans Affairs Committee. He was grilling the VA back in May of 2014 about the long wait times at VA medical facilities. I spoke with Chairman Miller recently about what happened back then. I was trying to get a sense of why he and others in Congress were in such a hurry.
MILLER: You don't think, given the crisis that erupted in 2014 - was the appropriate time to stand up a program like Choice. I don't know when you'd find a better time. That's the problem. They were causing veterans to wait.
WALSH: Miller pushed the House of Representatives to get a bill through to help veterans waiting to see a doctor. In August 2014, Congress passed the Veterans Access, Choice and Accountability Act. Most of the money, $10 billion, went to pay for a plan to allow vets to go outside the VA to a private doctor or clinic.
(SOUNDBITE OF ARCHIVED RECORDING)
PRESIDENT BARACK OBAMA: If you live more than 40 miles from a VA facility or if VA doctors can't see you within a reasonable amount of time, you'll have the chance to see a doctor outside the VA system.
WALSH: There was only one problem. The VA had only 90 days to figure out how to set up the system that would deliver on the president's promise. But there was confusion from the start. I called the VA to try to understand how the program was set up.
AUTOMATED RECORDING: Someone has entered the conference.
WALSH: Is anybody here yet? Can you hear me?
BALIGH YEHIA: Hi, this is Baligh.
WALSH: Hi, so we're looking at the timeframe of the roll out. How did Veterans Choice roll out the way it did?
YEHIA: Sure, so let me give you a little bit of background. So...
WALSH: That's Baligh Yehia. He runs the Choice Program for the VA. And how he runs it all hinges on decisions made in the 90 days after the law was passed. The first decision the VA faced...
YEHIA: Could we set up the infrastructure to build a network and credential the network in 90 days?
WALSH: Infrastructure - creating the network of private doctors, staffing call-in centers to set appointments, sending member cards to 9 million vets.
YEHIA: We couldn't. We didn't have the resources or the tools available to us to do that.
WALSH: So the VA turned to private contractors to do the job instead. Remember, the VA had only 90 days to get this done. And the clock had started. On Sept. 17, 2014, 41 days after the law passed, the VA hosted what it called an industry day. Fifty-seven companies showed up. The whole idea was to see who might run this new $10 billion program. Nearly all the companies said, no, count us out.
YEHIA: Only four companies said, hey, I'm interested in continuing some conversations. And then two of those companies made it crystal clear that given a 90-day implementation timeline that they're not interested.
WALSH: So when everyone else said, no, the VA turned to the two still standing, TriWest and Health Net. The two companies already had contracts with the VA for a program not too different from the one Congress had just created, a network of doctors and hospitals outside the VA called Patient-Centered Community Care or PC3. I asked Baligh Yehia of the VA about it.
I'm looking at a couple of different IG reports about PC3. And it was not going well. Their network was full of holes. Given that, I mean, how could the VA give them a bigger contract?
YEHIA: Well, I think you have to know the history of the PC3 contract. That PC3 contract wasn't even around for a year to even have the opportunity to reach its full potential before Choice came along.
WALSH: So on Oct. 1, the VA signed a contract with Health Net and TriWest, contractors the VA knew were struggling. Essentially, the VA decided to build a new $10 billion Choice Program on top of an untested model.
YEHIA: This car wasn't designed to run this race. It had a very different purpose. It had a very different intention. In fact, the PC3 contract when it was first rolled out, didn't even have primary care. It was only a specialty care contract. So it gives you the scope of this vehicle was not meant to deliver this vast program.
WALSH: The VA justified the new contract by saying it had to act on a, quote, "hyper-accelerated basis." The 90-day clock was ticking down. There was one month left to get the program up and running - everything from doctors to call centers.
(SOUNDBITE OF ARCHIVED RECORDING)
UNIDENTIFIED MAN: You can also call the VA Choice Card Hotline. This hotline is exclusively for veterans and providers to access the Choice Program.
WALSH: TriWest began setting up call centers around the country.
(SOUNDBITE OF ARCHIVED RECORDING)
UNIDENTIFIED MAN: The Department of Veterans Affairs wants to help you obtain the best healthcare anywhere.
WALSH: It was slow going. Health Net refused several requests for a taped interview. But TriWest invited me to the opening of a call center in San Diego back in September.
UNIDENTIFIED WOMAN #2: And we're very excited about the first day of our operations here in San Diego. And also Kansas City starts today as well.
WALSH: That was last fall. I went back a few months later to see how it was working. Frank Mac Maguire showed me around. He's the chief medical officer for TriWest.
FRANK MAGUIRE: Oh, my God, you expect us to build networks and to have all these processes in place, all these contact centers, be able to do all these things at a very, very abbreviated schedule. And I think a lot of people went, are you crazy?
WALSH: By March, TriWest was opening the last of its 10 call-in centers. TriWest says both the law and VA regulations made Veterans Choice a difficult program to launch. Maguire says the company believes it finally has a network of doctors large enough to handle the patient load for Veterans Choice.
MAGUIRE: Were we crazy? In hindsight, maybe yes. But we're also - we felt like we were up to the challenge. We just want to be given an opportunity to show that it's getting better and it's working.
WALSH: What we found and what internal VA investigations confirm, is that it hasn't worked as advertised. And there are a lot of reasons why. Wait times are actually up at the VA, a year and half after Veterans Choice was created. Thousands of vets referred to the Choice Program are returning to the VA for care, sometimes because the program can't find a doctor for them, and for 28,000 vets, because the private doctor they were told to see was too far away.
The very problem Vets Choice was designed to fix. There's more. VA regulations baffled vets, doctors, even the companies.
MAGUIRE: We had to wait for the veteran to call us.
WALSH: That's Frank Maguire again from TriWest. Until recently, the VA had a rule. The contractor couldn't call the vet.
MAGUIRE: And many veterans were confused. They'd say, why is my appointment not set up? And we'd say, well, unfortunately, we've been waiting for you to call us.
WALSH: TriWest says it's got it figured out now. But it may be too late. Congress and the VA are working to change the program dramatically. The VA might take over the customer service job from the companies, meaning those new call centers might go away after more than $3.5 billion has already been spent.
MONTAGNE: And that was Steve Walsh of NPR member station KPBS in San Diego.
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