Report Finds VA Struggles with Program Implementation Due to Tech Challenges

The Department of Veterans Affairs Mission Act was passed into law to provide veterans with greater access to private sector care, but without the software to determine eligibility, this program may be in trouble. An independent report by U.S. Digital Service (USDS) indicates technology problems could severely hinder the efficacy of the program.

The 2014 VA Choice Act gave veterans the opportunity to seek third-party care when the VA could not provide timely services. The 2018 VA Mission Act expanded upon the 2014 act by establishing a permanent Veterans Community Care program.

According to the report, “The Veterans Community Care programs evolves the legacy Veterans Choice program substantially by expanding Choice eligibility criteria and setting forth additional requirements around sharing medical records, establishing regional medical networks, and maintaining continuity of medical care for Veterans receiving care in the community. Per the Mission Act, the VA must implement new legislative and regulatory requirements by June 6, 2019, one year after the Act was signed into law.”

The USDS conducted an independent investigation of the program’s implementation by speaking with leadership from the agency, program stakeholders, congressional aides, Medicare experts, leaders and project managers from the VA Office of Information and Technology, practicing physicians at two VA Medical Centers, and veterans eligible for the program.

Overall, the report finds a high probability that the VA will meet many of the legal requirements established by the law on time. However, the report did find potential problems in the long-term implementation of these new systems. Therefore, the USDS offered six suggestions based on current concerns:

  • “Redirect static eligibility determination away from the physician’s workflow.
  • Create a Veteran-accessible tool for static eligibility determination
  • Support the continuity of Veterans’ ongoing care when creating scheduling processes and guidelines.
  • Structure new provider contracts to support the continuity of Veterans’ ongoing care
  • Utilize national networks already operated by federal services that currently provide community based care, such as the Department of Defense or Medicare.
  • Prioritize the exchange of electronic health records using Fast healthcare Interoperability Resource APIs, a standard already in use by other parts of the VA, Medicare, and the health industry as a whole.”

The report warns that current eligibility tools and community care networks are relying on outdated technology with a high risk of generating errors, running slowly, or crashing.

These errors may seem slight, but the report predicts that by increasing each appointment time by 5-10 minutes, as the current system would, doctors would be forced to see fewer patients daily. Based on USDS calculations, this would decrease the VA’s nationwide capacity by 75,000 appointments daily.

The VA cannot implement all these changes on their own, and in a March 4, 2019 letter to Congress the agency explained that they required Congressional authorization to cover the $5.6 million cost of creating a modern eligibility tool.

The report ultimately finds, “There are many areas of the Mission Act stature and regulations where Veterans could lose access to a needed doctor or service during bureaucratic transitions… poor implementation and administration of the contracts implementing the statue and regulations pose real, life threatening risks to Veterans.”

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