AUGUSTA — Advocates for Maine veterans said Friday that the rush to implement a $10 billion federal program designed to shorten wait times for veterans seeking medical care is contributing to delayed care, unbooked doctor appointments and billing errors.

“It was doomed for failure before it even hit the streets,” said Gary Laweryson, a retired Marine from Waldoboro who is chairman of the Maine Veterans Coordinating Committee.

There have been a number of reports in Maine and other states that the 2014 Veterans Choice health program is not working as intended. Those complaints, once anecdotal, were validated Thursday in a report produced by the VA Maine Healthcare System showing that only half of the 4,300 veterans who applied for care under the 2014 Veterans Choice program had received appointments since July. The report was presented to veterans advocates and staff for the state’s congressional delegation during an unannounced meeting held at the VA’s Togus campus. The meeting has prompted urgent calls from Maine’s delegation to reform the program.

However, veterans advocates say the program was hastily conceived and carelessly implemented. Those assertions are supported by a U.S. Veterans Health Administration Office of Inspector General report issued in September.

The Veterans Choice program was conceived in 2014 amid a national scandal in which the U.S. Dept. of Veterans Affairs reported that more than 100,000 veterans were experiencing long waits for appointments at VA hospitals. More than 75 percent of the VA hospitals surveyed were affected, prompting Congress to hastily enact a 2014 bill that established the Veterans Choice program. Under the program, qualifying veterans can visit a private doctor if they live 40 miles or more from VA hospital or if they have waited 30 days or more for care.

The choice program is similar to an initiative that allows the VA to purchase health care services from private providers when VA hospitals cannot provide certain services because of geographic inaccessibility or emergencies. The inspector general’s report found that private companies that help the VA manage the program set up inadequate provider networks, increasing veterans’ waiting times and staffs’ administrative workload, and delaying the delivery of care. As a result, the inspector general found that VA hospitals limited their use of the private provider networks even though program managers had received two contracts worth a combined $9.4 billion.

‘A MAN WITH NO STAFF’

Health Net Inc. is one of the program managers cited in the report. It’s also the company charged with managing the Veterans Choice program in Maine and New England.

A representative from Health Net attended Thursday’s meeting at Togus. According to Adria Horn, the director of the Maine Bureau of Veterans Services, the Health Net representative told meeting attendees that one person, located in New Hampshire, was charged with creating and managing the provider network and managing provider claim disputes.

There are 1,800 providers in Maine participating in the Choice program. And Health Net’s New Hampshire manager doesn’t just oversee the Maine network. He oversee all of New England, Horn said.

“He’s a man with no staff,” Horn said. “It’s impossible to think that this single human being – doing network creation, network management and provider claim resolution – can do all that.”

Elizabeth Zande, a representative for Health Net, did not respond to a call seeking comment on Friday.

The VA Maine Healthcare System report mirrored findings in the inspector general’s report. Providers were frustrated with payment processing and the administrative burdens of the choice program.

Meanwhile, thousands of veterans, particularly those in rural areas, haven’t been able to see a doctor.

Amedeo Lauria, a service officer for the American Legion at Togus, said veterans are having a difficult time just getting a call returned from a hotline provided by the choice program. On Thursday, Health Net said a call center in Tampa, Florida, was set up for 500 employees. Only 130 have been hired.

Again, the experience with the Choice program reflects the findings in the inspector general’s report. Health Net was required to create provider appointments within five business days, but a survey by the inspector general found that Health Net took an average of 15 days. The VA contract for Health Net also didn’t include effective performance measures to monitor the adequacy of Health Net’s provider networks, the report found.

Additionally, Lauria said, some veterans who did obtain care received notices that their bills were not paid. In many cases, he said, it’s because providers accustomed to billing VA for veterans care continued send the bills to the VA when they should have sent them Health Net.

“It’s concerning,” Lauria said. “Veterans don’t really care what happens in the background. They just want to know the bill is fixed.”

He added, “Our position is we just want veterans helped. We don’t know how you make the sausage, we just want it made.”

‘SUBSTANDARD’ AND ‘RUSHED’

Laweryson, the chairman of the Maine Veterans Coordinating Committee, said implementation of the choice program “was a substandard performance by the VA.”

“They just rushed to get everything in there,” he said.

Indeed, the problems with the program are not unique to Maine veterans. In November, members of New Hampshire’s congressional delegation heard similar complaints about the program during a meeting in Berlin, New Hampshire, and reports of problems have surfaced in Virginia, North Carolina and several other states.

Brian Corlett, a spokesman for Health Net, told a Virginia public radio station that the company is working to resolve its issues.

“We know there’s been some delays in appointing, some issues with payments to providers,” he said. “Those are being addressed. We still have a lot of work to do. There have been long hold times. We understand that as well, and we are working as quickly as possible to train up new staff. We are putting together a 500-person call center. The first wave of 125 folks have started.”

Lawyerson, whose 90-year-old father-in-law has experienced problems with the system, is skeptical.

“It’s really frustrating for the older veterans,” he said. “They get tired real quick and you have them on the line for 30 minutes. I don’t think the VA has a proper fix on it. Right now they’re just throwing money at it to make it seem semi-smooth.”

 


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