The VA will pay for veterans to see non-VA doctors if they have to wait longer than 20 days or drive more than 30 minutes for primary or mental health care at a VA facility.
Thousands of New York veterans will have expanded access to private health care paid for by the Department of Veterans Affairs under new rules targeting prolonged wait times and poor quality at some VA facilities.
The new eligibility comes after a stream of VA crises since 2014, such as veterans suffering during lengthy waits for care. The exposure of the problems triggered overhauls of the federal medical system that treats millions of vets each year.
The VA will pay for veterans to see non-VA doctors if they have to wait longer than 20 days or drive more than 30 minutes for primary or mental health care at a VA facility, according to the new rules.
For specialty care, they can see private doctors at VA expense if they have to wait longer than 28 days or drive more than an hour to see a VA provider.
Previously, veterans who had to drive more than 40 miles or wait longer than 30 days could choose to see a private doctor paid for by the VA.
VA officials have estimated the new rules could increase the number of veterans eligible for VA-sponsored private care to as many as 2.1 million nationally — up from about 560,000, USA TODAY Network reported.
The rules also allow veterans to go to non-VA urgent care clinics at VA expense without prior approval, though they may have to pay a co-payment.
Some VA officials, however, emphasized they didn’t expect a significant increase in vets leaving for non-VA care.
One is Brian Westlake, group practice manager for the VA Finger Lakes Health Care System, which serves 33,000 veterans across the Rochester and Southern Tier region.
“We have veterans who choose to make the drive, despite the fact it’s over the drive time or wait times because they like the VA care,” Westlake said.
One veteran who’s uniquely positioned to speak to VA service is David Trumbull of Webster. The 68-year-old retired colonel has utilized VA care in New York, Texas and Indiana during his 32-year military career with the Marines and U.S. Army Corps of Engineer.
For the past 11 years, Trumbull has volunteered at the VA’s Rochester outpatient clinic, a post he says offered countless first-hand reviews.
“Many veterans come up to me while I’m working as a volunteer greeter at the door and say how the service is great,” Trumbull said. “I’ve seen no issues, no problems…believe me, I would tell you if I saw any issues.”
The new rules stemmed from the VA MISSION Act, which President Donald Trump signed last June to deliver on a campaign promise to expand veterans’ health care options, USA TODAY Network reported.
The rollout of the expansion of medical care choices will be closely watched by veterans’ groups, who have worried it will divert money from VA health care, causing more veterans to get non-VA care, and ultimately lead to the privatization of the agency.
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Yet despite Westlake’s prediction that many New York vets will stick with VA care, some details for accessing non-VA care have yet to be finalized and raise questions about eligibility.
The issue involved veterans’ ability to seek private care if their local VA facility doesn’t meet standards for quality, one of the criteria cited in the new rules.
World War II veterans were honored in Normandy, France for their D-Day sacrifice 75 years ago. USA TODAY
The problem is those quality standards are still being determined by the VA, meaning there will be delays in rolling out some aspects of the MISSION Act program that launched Thursday.
“Within an organization as large as the VA is, yeah, to make changes in it takes a little time,” Westlake said.
New York VA quality
Still, Westlake expected few Rochester-area vets would seek private health care alternatives based on quality, notwithstanding the lack of details about standards.
He noted the VA hospital in Bath received the highest 5-stars quality rating, and the one in Canandaigua had 4-stars.
“We have some of the higher-performing VA facilities and we’re not concerned about the quality measures and how they will affect eligibility,” he said.
Similarly, the VA Hudson Valley Health Care System in Montrose that treats more than 25,000 vets had 5-stars.
Some VA hospitals serving New York City and Long Island had 3-stars, but the state overall has consistently ranked better than many others with lower-rated VA facilities.
“How is the community care going to compare to the VA, I think that’s going to be a big question,” Westlake said.
Some VA nursing home facilities in New York, however, could be affected by quality standards that require offering private sector alternatives.
For example, the VA community living center in Bath received 2-stars and the VA-contracted Steuben Center for Rehabilitation had 2-stars.
Westlake noted improving nursing homes has been a priority in recent years, citing how the VA Canandaigua Community Living Center’s rating jumped to 4-stars from 1-star.
Similar efforts are ongoing to improve VA facilities across the country, Westlake said, pointing to independent studies last year that found many VA sites have wait times and quality of care that rank as good or better than many private sector alternatives.
“That’s been years of work to bring it to that level,” Westlake said.
Choosing VA care
Currently, about 15,000 medical consultations result in Finger Lakes’ vets being sent to non-VA medical care under the previous rules.
But some of those 15,000 cases include one vet undergoing multiple consultations that led to non-VA care, which makes determining usage difficult statewide, Westlake said.
Westlake said New York veterans typically choose VA care due to its quality, stability and access points across the country.
“Electronic medical records that the VA use are nationwide, and if a veteran travels to San Diego and maybe needs care, that VA has the records,” he said.
VA scandals, reform and transparency
Many of the recent VA quality improvements stemmed from USA TODAY Network investigations into lengthy wait-times and poor quality at some VA facilities shrouded in secrecy, which also led the VA to reveal quality details about its nursing homes and hospitals.
Veterans can check VA quality metrics, such as death rates, bedsores and ER wait times, using publicly available data posted on its website.
USA TODAY Network also analyzed the information to compare 146 VA medical center nationally to private-sector alternatives.
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