Three years ago, Congress authorized $10 billion to provide a community-based shortcut for veterans seeking health care.
Since then, the Hampton VA Medical Center has more than doubled its staff to keep pace with the program. Yet recent government reports indicate the shortcuts aren't happening as intended across the VA system regionally or nationally.
With the program set to expire in August and a new administration in charge, the future of Veterans Choice remains unsettled.
Under Veterans Choice, patients who wait more than 30 days for an appointment at a VA health provider can be referred elsewhere for care. The same goes for veterans who live more than 40 miles driving distance from the nearest VA health center with a full-time doctor.
The message is simple: Wait too long or live too far away, go outside the VA network to get the necessary care.
But its implementation has been anything but simple.
Stephen Black, Hampton VA interim director, cited improvements in the program since its inception in 2014.That includes faster payouts to community health-care providers and changes meant to speed up communication with veterans.
However, the skyrocketing workload is also evident. Since October 2014, the Hampton VA has logged a 48 percent increase "in overall volume that is going out into the community," Black said.
Before Veterans Choice came along, Hampton and other VA hospitals had staff members to coordinate non-VA care when necessary. Hampton had 23 people to handle this.
It now requires a staff of 51, including some temporary workers. The workload has become heavier and more complex. Veterans Choice requires VA hospitals to coordinate with a third party to make referrals outside the VA system, and that requires a lot of back-and-forth communication.
Black said it's difficult to generalize about the time it takes for Hampton patients to receive care after being referred into Veterans Choice. It depends on the services needed.
The third-party provider that serves as a go-between is California-based Health Net Federal Services (HNFS). Like other health insurance providers, it has a list of providers that have opted into its network. But certain specialties are difficult, such as neurosurgery, Black said. However, if a patient needs outpatient physical therapy outside the VA network, that's easier.
"There are certain things the community is challenged to provide just as the hospital is challenged to provide," he said.
Black said he couldn't provide specific wait-time data for Veterans Choice at Hampton. The national VA and Health Net are working on that data. The goal is to improve access to that data to get more transparency and clarity.
Meanwhile, the increasing workload at the Hampton VA has translated into more work for HNFS. Black gave the third-party provider credit for a faster turnaround of claims.
In a statement emailed to the Daily Press, HNFS spokeswoman Molly Tuttle noted a 132 percent increase in workload from 2015 to 2016 in Virginia and North Carolina.
"Additionally," she wrote, "HNFS partners with more than 23,000 community providers in VISN 6 (which covers Virginia and North Carolina) where wait times for paid claims decreased 70 percent during that period, to 14 days."
However, two studies issued in early March that analyzed sample cases estimated that wait times are much longer than the program originally intended.
The VA Inspector General examined selected veteran hospitals in Virginia and North Carolina from April 2016 through January. Hampton was included in that group. The IG's office estimated the average wait during that time to be 84 days.
"We estimated it took medical center staff an average of 42 days to provide the authorization to Health Net to begin the Choice process and 42 days for Health Net to provide the service," the audit states.
The Government Accountability Office took a different tack. It analyzed six VA medical centers across the country, including one in Durham, N.C. It reviewed 55 routine care authorizations and found a 64-day turnaround time.
Medical centers took 24 days to refer patients to thirty-party providers, which then took average of 14 days to accept them. Another 26 days elapsed after the scheduled appointments to when the veteran actually received care.
Veterans Choice came to Virginia in January 2015, heralded by an announcement from Gov. Terry McAuliffe. It listed 22 sites where veterans could seek care outside the VA network. At the time, it was seen as one way to ease wait times at VA hospitals that caused scandals elsewhere in the country.
But this month's critical IG report prompted a quick comeback from Virginia's two Democratic senators, Tim Kaine and Mark R. Warner.
Warner said IG's findings on Choice were the most troubling part of the overall audit.
"This is particularly problematic because Congress authorized the Choice program specifically to help veterans access care in a more timely fashion," he said.
Kaine said he supports improving the program because it gives veterans more choices.
In a statement emailed to the Daily Press, Kaine said: "While there have been some issues with this program — including the troubling front-end wait times in Virginia I wrote to the VA about last week — veterans want more control of their own health care decisions, which this program provides."
VA Secretary David Shulkin has asked Congress to extend the program beyond its Aug. 7 sunset date. While Choice can be improved, it also provided access to millions of veterans, he said.
The program's long-term future isn't settled, but the short-term picture is clear, at least in Hampton.
"The workload is still going up," said Black. "We've had a consistent increase every month. This is month over month for the last two years. We're going to have to keep growing that program to keep pace."
Lessig can be reached by phone at 757-247-7821.