For The VA's Broken Health System, The Fix Needs A Fix

Mar 23, 2016
Originally published on March 23, 2016 6:30 pm

The fix is broken.

Two years ago Congress created the Veterans Choice Program after scandals revealed that some veterans were waiting months to get essential medical care. The $10 billion program was designed to get veterans care quickly by letting them choose a doctor outside the VA system. Now Congress and the U.S. Department of Veterans Affairs are pushing through new legislation to fix the program.

Irvin Bishop Small served in the Navy for 10 years. Like most VA patients, he doesn't have a war wound — he has a set of worn-out knees and ankles from lugging heavy gear up and down ladders on a ship. Surgery didn't help, and now it hurts to walk.

"For me to just go up and down the deck a couple times, by the time I'm done, my toes are starting to go numb, my ankles are starting to feel like somebody's wrapping a molten metal band around it," says Small, 41. "And if I keep going, I lose all feeling in my feet."

Between the pain and the painkillers, and all his medical appointments, it's been hard to get a job. Small lives with his mother in a split-level house in York, Pa. Driving makes his feet go numb, so his mother takes him to all his appointments.

"Our house here is 50 miles from the Baltimore VA medical center and 45 miles from the Lebanon [Pa.] VA medical center," says Small.

The Choice program is supposed to get local, private health care for vets who live 40 miles away or whom the VA can't see within 30 days.

So when his VA doctor prescribed physical therapy and acupuncture last December, Small called Choice. He navigated the phone menu and was told he would get a call back. Instead it was Small who called back — again and again, for weeks.

He's not alone — the same lawmakers who created Choice now say thousands of veterans are getting lost in the confusing system.

"Bottom line is the Choice program is broken," Sen. Jon Tester, D-Mont., said this month. "We need to fix it and we need to fix it as soon as possible."

Democrats and Republicans are pushing through reforms to the program, which many now admit was hastily passed back in 2014. The law mandated a complicated new health system but gave the VA just 90 days to create it.

The VA turned to outside health care administrators for help, which VA Secretary Bob McDonald says was a primary flaw.

"In my opinion, that was the big mistake with the original Choice act," McDonald told a Senate hearing this month. "We just outsourced customer service to the third-party providers. We would literally just give the veteran a number to call. And that's just not right."

That was the phone number that Small was calling again and again as he tried to get treatment for his chronic pain, which at times drove him into deep depression.

Congress and the VA now agree the system is so confusing that vets, doctors and even the VA itself can't use it well.

Small ran into another problem typical of the program: One of the clinics he had an appointment for stopped accepting Choice patients because the VA has been so slow to reimburse providers.

Choice tried sending him to a clinic that didn't offer the right therapy, and to another that was so far away that he might have just have easily driven 50 miles to the VA in Baltimore.

Wait times — the problem the VA was trying to fix — have actually increased under Choice, though the VA says that's because so many vets are using it.

In the meantime, Small is still in pain.

"I'm considered 90 percent disabled by the VA. I'm not ready to say I'm done with life, and sit and play on my computer for the next 40 years," Small says.

After waiting since last year, he got physical therapy in February. He finally got the acupuncture this week.

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STEVE INSKEEP, HOST:

A $10 billion effort to fix veterans health care is itself in need of repair. That is the conclusion of lawmakers, veterans and the Department of Veterans Affairs. The Veterans Choice Program sounded good when Congress created it. The idea was to get care quickly by letting vets choose a doctor outside the VA system. NPR's Quil Lawrence reports on what went wrong.

QUIL LAWRENCE, BYLINE: Military service is hard on the body. Never mind combat trauma; it's bad backs, wrecked knees and worn ankles the VA treats more.

IRVIN SMALL: For me to walk just up and down the deck a couple of times - by the time I'm done, my toes are starting to go numb. My ankles are starting to feel like somebody's wrapping a molten metal band around it.

LAWRENCE: Irvin Small did 10 years in the Navy.

SMALL: And if I keep going, I lose all feeling in my feet.

LAWRENCE: Between the pain and the painkillers and all his medical appointments, it's been hard to get a job. Small lives with his mom in a split level house in York, Penn. Driving makes his feet go numb, so his mom takes him to all his appointments.

SMALL: Our house here is 50 miles from the Baltimore VA Medical Center and 45 miles from the Lebanon VA Medical Center.

LAWRENCE: The Choice program is supposed to get local private health care for vets who live 40 miles away or who the VA can't see within 30 days. So when his VA doctor prescribed physical therapy and acupuncture last December, Small called the Vets Choice Program.

(SOUNDBITE OF ARCHIVED RECORDING)

UNIDENTIFIED WOMAN #1: Thank you for calling the VA Choice Card Program. If you are a veteran, press or say one.

SMALL: One.

LAWRENCE: Then he waited for a call back.

(SOUNDBITE OF ARCHIVED RECORDING)

SMALL: Hello?

TONYA: Good afternoon. My name is Tonya, a member of the health-med team. Call is on a recorded line.

LAWRENCE: Small requested the appointment. They said he'd hear from them in 48 hours. He didn't, so he called back.

(SOUNDBITE OF ARCHIVED RECORDING)

UNIDENTIFIED WOMAN # 2: I do apologize for your wait. But you should hear from us during the week. If not, please call us back.

SMALL: That's what I got told the last time I called.

LAWRENCE: Small started recording the calls after a few weeks of this. Now, remember, Congress created Vets Choice to fix this problem.

(SOUNDBITE OF ARCHIVED RECORDING)

RICHARD BURR: This bill is very targeted. It's focused specifically on fixing a short-term problem, which is how do we get veterans the care they deserve.

LAWRENCE: That was North Carolina Republican Richard Burr back in 2014, introducing what became the bipartisan Veterans Choice Act. It gave $10 billion over three years for vets to get quick care outside the VA system. And this was Senator Burr last week, introducing the bipartisan Veterans Choice Improvement Act to really do it this time.

(SOUNDBITE OF ARCHIVED RECORDING)

BURR: The Veterans Choice Improvement Act will help veterans across America get the best health care we have to offer.

LAWRENCE: So what happened? Under the pressure of the scandals in 2014, Congress created this new system and gave the VA just 90 days to set it up. It was flawed, as VA Secretary Bob McDonald told the Senate this month.

(SOUNDBITE OF ARCHIVED RECORDING)

ROBERT MCDONALD: We basically just outsourced customer service to the third-party provider. We would literally just give the veteran a phone number to call. And that's just not right.

LAWRENCE: That was the phone number that Navy veteran Irvin Small was calling and calling back again and again. Congress and VA now agree the system is so confusing that vets, doctors and the VA itself can't use it well. Wait times have actually increased, though VA says that's because so many vets are using it. In the meantime, Irvin Small is in pain.

SMALL: Yes. I'm considered 90 percent disabled by the VA. I'm not ready to say I'm done with life and sit and play on my computer for the next 40 years.

LAWRENCE: After waiting since last year, he got physical therapy in February. He finally got the acupuncture this week. Quil Lawrence, NPR News. Transcript provided by NPR, Copyright NPR.