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Veterans Crisis Line Badge

Office of Public and Intergovernmental Affairs

Remarks by Deputy Secretary Sloan Gibson

Opening Statement before the House Committee on Veterans’ Affairs
The Veterans Choice Act: Exploring the Distance Criteria
Washington, DC
March 24, 2015

Chairman Isakson, Ranking Member Blumenthal, members of the committee.  With me today is Dr. James Tuchschmidt, VA’s Interim Principal Deputy Under Secretary for Health.

Let me start by being very clear on several points:

First, we fully support implementing the Choice Program effectively to provide Veterans timely, quality health care while ensuring the best use of taxpayer resources.

Second, non-VA care is critical for Veterans.   In 2014, we obligated almost $7 billion for non-VA care for Veterans under programs other than Choice.  In the first quarter of FY15 Veterans completed about 20 million [19.7M] VA appointments—3.3M of those appointments, almost 17% [16.5%], with non-VA providers.

Third, and most importantly, we know that the Choice Program is not working as well for Veterans as it should work.  That assessment is based on input from Veterans, Congress, non-VA care providers, VSOs, and our own employees.

But it’s our program, and we’re working hard to improve it, to quickly overcome issues as we discover them, and to ask for your assistance in areas where we need help.  Here are some of the issues we’re working on:

Many Veterans are frustrated with the Choice Program:

  • The 40-mile straight-line, “as the crow flies,” criteria for eligibility has nothing to do with how far they actually have to travel;
  • They don’t understand why we measure the distance to the nearest VA medical facility even though it may not provide the specific care they need;
  • They do not understand why we can’t take into account the hardships and burdens many face to receive care;
  • Or, they simply do not understand how the Choice Program works.  Such confusion leads to lower use of Choice.

As of March 20, based on daily data received, approximately 46,000 Veterans had received authorizations for care under Choice, and 44,000 have been scheduled with non-VA providers. 

Here’s some of what we’re doing to address these issues.

We’re going to change the distance criteria from straight line to travel distance—similar to the way we measure beneficiary travel payments.  Our original interpretation—straight line distance—was made to conform with what we believed was Congress’s intent as reflected in the Conference Report and as confirmed in meetings with congressional staff.  Based on feedback from Veterans and Members, we believe we need to change it. Our estimate for the impact of this change is that it will roughly double the number of Veterans eligible as well as the costs associated with the 40-mile provision.

Second, we want to work with Congress to find alternatives to measuring 40 miles to any VA medical facility regardless of whether the facility offers the specific care a Veteran needs.  We believe we need statutory authority and your help with this issue.  We’re running analyses on various options to identify alternatives that open the aperture of Veterans’ eligibility for Choice while working within available resources and considering longer-term implications.  As we have meaningful analysis to share in the days ahead, we will bring that to you for review and discussion.

We are also requesting your legislative assistance to broaden VA’s flexibility in determining Choice Program eligibility where traveling for care may present a particular hardship to the Veteran.   To date, just over 100 Veterans have been determined eligible for the Choice Program for “unusual or excessive burden . . . due to geographical challenges.”  Last September, we asked that the “geographical challenges” language be amended to give the Secretary greater flexibility in extending Choice eligibility to Veterans facing hardship or unusual or excessive burdens in reaching VA medical facilities.

We believe legislation providing VA greater flexibility on this issue will enable more Veterans to choose to receive care closer to home.

We will continue to focus on outreach and communicating with Veterans to ensure they understand the Choice program, to include:

  • Establishing a recurring Veterans survey to measure their knowledge of and experience with the program;
  • Expanding our social media activity for Veterans, families, and caregivers;
  • Conducting program-related town halls at VAMCs;
  • Follow on mailing to every Veteran eligible for Choice to further clarify how the program works;
  • And continued training programs for VA staff to help them better explain Choice to the Veterans they serve.

As we work to solve Veterans’ issues, we must also ensure non-VA providers are informed about the program and how to best serve Veterans.  We know that:

  • Collaborative processes with third-party administrators are in place, but immature;
  • Many providers are simply confused about how the Choice Program works.
  • Providers may have difficulty rationalizing among five different non-VA care programs—from sharing agreements with universities to local contracts to individual authorizations to PC3 and Choice—all of which may pay at different rates and have various authorization and payment processes.

We must also improve training and simplify operations so that our own VA employees can best assist Veterans eligible for the Choice Program.   Navigating the different types of non-VA care programs can be confusing and challenging for our own people.   We will continue our outreach to VA facility leadership to improve employees’ understanding of Choice and to address lingering cultural issues that may make our staff reluctant to send patients into the community for care.

This is not an issue about our choice . . . it is about the Veterans’ Choice.

So, in April we will send teams of experts, including Health Net and TriWest staff, to the 15 facilities in each of their catchment areas that have significant wait lists and few Choice referrals.

Finally, we ask for your support to update our authorities to use provider agreements for purchasing non-VA medical care.  This change would let us streamline and speed-up how we purchase care for an individual Veteran, and simplify the burden on providers in the community.

Mr. Chairman, we will continue to work with Veterans, Congress—especially this committee—non-VA care providers, VSOs, and our own employees to ensure the Choice Program is working well and delivering great health care outcomes for Veterans.

We thank the Committee for the opportunity to testify and to work together with you to make things better for all of America’s Veterans and we look forward to your questions.