Trump signs VA Mission Act — this is a health care win for vets

The Department of Veterans Affairs has a mission statement, which reads, “to care for he who has borne the battle, his widow and his orphan” is well-known, even to those who are not directly impacted by the agency.  

Unfortunately, at times, it seems that VA has taken an intermission from its mission statement. In analyzing the VA’s recent drama with choice through a three-act drama structure, it appears that the first act will draw to a close later today when President Trump signs the MISSION Act.

Act one

{mosads}It seems that the VA has had a reputation for favoring the rights of bureaucrats over the rights of veterans, and for favoring performance bonuses over favorable health-care outcomes. Such behaviors do not inherently nurture President Lincoln’s vision for the agency when he made the above-statement in his second inaugural address.

VA’s tendency to forget its mission was recently highlighted by a June 4, 2018, GAO report entitled “Veterans Choice Program — Improvements Needed to Address Access-Related Challenges as VA Plans Consolidation of its Community Care Programs.”

The main findings of the report highlight that the VA is taking an intermission from its mission. Whereas VA’s mission is to care for veterans, the GAO report highlights that VA is simply unable to provide veterans with timely medical appointments, even with the billions of taxpayer resources poured into the Choice Program over the last four years.

Notably, the report found that veterans must wait up to 70 days for medical appointments through the Choice Program, because VA relied on inaccurate and unreliable data, and VA staff often internally changed appointment dates to alter the appearance of wait times. Ironically, this behavior — and the veterans that died waiting for care — is what lead to the passage of the Choice Act in the first place.  

Specifically, the report states:

VHA cannot systematically monitor the timeliness of veterans’ access to Choice Program care because it lacks complete, reliable data to do so. Without complete reliable data, VHA cannot determine whether the Choice Program has helped to achieve the goal of alleviating veterans’ wait times for care.

Timeliness of appointments is an essential component of quality healthcare; delays in care have been shown to negatively impact patients’ morbidity and quality of life.

The events leading up to the GAO report certainly highlight VA’s current intermission.

Act two

Today, President Trump prepares to sign the long awaited VA MISSION Act. The plot leading up to this legislation reminds us not just of the need to improve VA’s ability to coordinate healthcare for veterans outside of its own facilities, but also that in order to do so successfully, VA must re-focus on its mission.

In other words, the MISSION Act is the protagonist in act two of how to care for our veterans.

The act, aptly named by House Veterans’ Affairs Committee Chairman, Phil Roe (R-Tenn.), is an important reminder that, although Lincoln’s words have stood the test of time, the government’s ability to care for veterans through a separately run healthcare system has not.  

In order to embrace Lincoln’s vision, and VA’s mission, we must be willing to fundamentally alter how we approach veterans’ healthcare with new ideas rather than continuously trying to prop up the old ones.

As noted in a recent OpEd by Sherman Gillums, Chief Strategy Officer at AMVETS, hyper-partisan conversations regarding privatization have “inadvertently stifled the one thing the VA needs most: innovation.” Gillums is correct that VA has been plagued by stagnation and lack of progress. Thankfully, this too is being remedied by the MISSION Act.

Tucked away in Section 152 of the act is language that has helped to successfully reform the nation’s two largest government healthcare programs, Medicare and Medicaid — language that creates a center for health-care innovations.  

According to the Centers for Medicare and Medicaid Services website, a statutorily created Innovation Center allows for “programs to test models that improve care, lower costs, and better align payment systems to support patient-centered practices.” The Innovations Center solicits and selects organizations to test new ideas through a transparent, competitive process, and then evaluates those organizations’ performance to implement best practices and improve healthcare delivery.  

One of the early innovations that has proven successful in the context of Medicare and Medicaid is the concept of managed care. Authorized by the Balanced Budget Act of 1997, CMS piloted the concept that became Medicare Advantage, the single most popular and cost effective healthcare program in our nation’s history.  

Seniors no longer have to navigate a massive bureaucracy to access their care. They simply choose their health plan, choose their provider, and the government benefits from the lower costs that result from that competition. Based on that success, managed care has quickly expanded to Medicaid, where more than 3/4 of all enrollees can now choose their plan and their providers.

Act three

Ideas piloted through a VA innovations center, like managed care, have the ability to truly transform VA’s ability to provide timely care to veterans and allow VA to refocus on its mission. They also provide a long-overdue opportunity for taxpayers to see a return on the investment they have made in caring for those “who have borne the battle.”

The MISSION Act provides VA with a chance to write its own third act and to define its own legacy. Either VA can continue along its current path of a Shakespearean tragedy, or it can become the dramatic hero.

Rory E. Riley-Topping served as a litigation staff attorney for the National Veterans Legal Services Program (NVLSP), where she represented veterans and their survivors before the U.S. Court of Appeals for Veterans Claims. She also served as the staff director and counsel for the House Committee on Veterans’ Affairs, Subcommittee on Disability Assistance and Memorial Affairs for former Chairman Jeff Miller (R-Fla.). You can find her on Twitter: @RileyTopping.