VA Proposes Changes to Choice Program, Provider Payments

On Wednesday, Department of Veterans Affairs officials proposed measures to improve the VA Choice Card program, which aims to help veterans access care more quickly, Modern Healthcare reports (Muchmore, Modern Healthcare, 11/18).

Background

The program was implemented under a VA reform bill (HR 3230) signed into law in August 2014 (California Healthline, 4/9). The program allows veterans to receive federally subsidized care from outside providers if they have been waiting more than 30 days for a VA health care appointment or if they live 40 miles or farther from a VA facility (California Healthline, 2/17).

Choice Program, Access to Care Reforms

During a House Committee on Veterans' Affairs hearing, VA Deputy Secretary Sloan Gibson proposed changes to improve the Choice program by:

• Clarifying the program's eligibility criteria;
• Creating a "high-performing network" of private providers who work with VA;
• Improving how VA shares medical records with outside providers; and
• Streamlining payment protocols.

Gibson said VA would spend $421 million to implement the changes during the upcoming fiscal year. According to VA estimates, the initiatives would cost $400 million to $600 million annually in subsequent years. According to the Washington Times, the changes could cost more if additional patients wish to participate in the program (Shastry, Washington Times, 11/18).

Meanwhile, VA also proposed a plan that would boost veterans' access to emergency departments and urgent care facilities. According to Modern Healthcare, the initiative would cost about $2 billion annually.

Provider Payment Reforms

Further, VA officials during the hearing proposed a plan that would consolidate seven community care programs into one program with standard eligibility rules and provider payment methods.

According to Modern Healthcare, VA reimbursement rates currently vary by provider. Under the plan, VA would adopt Medicare payment rates for private providers for services covered by Medicare. In instances when services are not covered by Medicare, VA would negotiate the payment rates.

In addition, VA would gradually transition its health care system toward value-based payments. Under the initiative, VA would assess private providers' quality and performance. High-performing providers could qualify for higher reimbursement rates, while lower-performing providers could be dropped from VA's network of eligible providers.  

VA Undersecretary for Health David Shulkin said the plan also aims to hasten provider payments by:

• Adopting electronic health records where feasible; and
• Considering automatic adjudication.

The delivery reform plan is expected to cost $1.5 billion to $2.5 billion in its first year. Costs for the initiatives are expected to increase in subsequent years.

Reaction

According to Modern Healthcare, lawmakers at the hearing generally expressed support for the proposals. However, some questioned whether the initiatives would result in meaningful change (Muchmore, Modern Healthcare, 11/18).

Senate Committee Considers Bill To Expand Telehealth Services for Veterans

In related news, the Senate Committee on Veterans' Affairs on Wednesday considered legislation (S 2170) that aims to expand veterans' access to telehealth services, Modern Healthcare reports.

Under current rules, physicians must be licensed in the state where a patient resides in order to provide telehealth services to that patient. Such rules are waived if both the patient and physician conduct the visit from federal facilities.

About 677,000 veterans used telehealth services last year, according to acting VA Assistant Deputy Undersecretary Maureen McCarthy. Further, about 122,000 of those veterans used telehealth to obtain mental health services at their homes. McCarthy noted that such visits have helped to:

• Decrease travel costs;
• Lower the number of missed appointments; and
• Reduce hospital admissions (Robeznieks, Modern Healthcare, 11/18).

Under the Veterans E-Health & Telemedicine Support -- or VETS -- Act, VA physicians would be able to practice across state lines and provide telehealth services, including mental health care, to patients in their homes (California Healthline, 10/14). The rule would apply to VA providers and private providers contracted to provide care through VA.

According to Modern Healthcare, Committee Chair Johnny Isakson (R-Ga.) supports the measure.

While McCarthy has said VA is "thrilled" with the legislation, she noted the department also has some concerns about certain reporting requirements included in the measure. However, she said the concerns were over "minor details" that could be addressed (Robeznieks, Modern Healthcare, 11/18).