Care by Private Doctors Among Big Changes Urged for V.A. Health System


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Robert A. McDonald, the secretary of Veterans Affairs, in Washington in February. He said V.A. hospitals had seen a record number of patients this year and that efficiency had improved.

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Two years after a Department of Veterans Affairs scandal involving long wait times at veterans hospitals, an official report has found that the veterans’ health care system suffers from “profound deficiencies” despite billions of dollars spent in recent years to overhaul it. The report says that the hospital system needs sweeping changes, including a program that would pay for all veterans to see private doctors.

In a document nearly 300 pages long released late on Tuesday, the 15-member Commission on Care, created by Congress after the scandal, contained a list of recommendations to improve the nation’s largest public health care system.

“Although care delivered by V.A. is in many ways comparable or better in clinical quality to that generally available in the private sector,” the report concluded, “it is inconsistent from facility to facility, and can be substantially compromised by problems with access, service, and poorly functioning operational systems and processes.”

The commission, made up largely of health care professionals and leaders of veterans’ organizations, made 17 recommendations to streamline care, including modernizing computerized record systems and creating a team that could shutter underused or redundant veterans’ facilities.

But the recommendation that would more likely have the most impact, and that has sparked the most debate, is the creation of the “V.H.A. care system,” for Veterans Health Administration, which would include a nationwide network of health care providers including doctors from the Department of Veterans Affairs, military hospitals, and the private sector who have been approved by the V.A.

Under the proposal, any veteran could choose to see the Department of Veterans Affairs doctors or private doctors within an approved network. Currently, veterans must get permission from the agency to see an outside doctor, with only certain veterans qualifying.

If implemented, the system would be only the latest effort to send more veterans to private doctors. In 2014, Congress created the $10 billion Choice Plan, which allowed veterans to go to a private doctor if they lived more than 40 miles from a veterans hospital or could not get an appointment within 30 days. It spent another $5 billion to hire and train more health care workers. While the Choice Plan has been used by thousands of veterans, its rollout was plagued by billing delays, with the overall time veterans had to wait for care increasing.

This week’s report predicted that 60 percent of veterans in the system could be using private care by 2034. While that could alleviate crowding at veteran hospitals, the report also cautioned that private care could cost nearly $100 billion more than the current system by 2034 if not carefully managed.

Robert A. McDonald, the secretary of Veterans Affairs, said many of the recommendations were in line with changes already underway, noting that veterans hospitals had seen a record number of patients this year and that efficiency had improved. “However, until all veterans say they are satisfied, I won’t be satisfied. Nobody at V.A. will be satisfied,” he said in a statement released by the department.

Overhauling veterans’ health care has long been a contentious issue. Some veterans groups have pushed for almost a total privatization and creation of a system that would resemble Medicare. Others have vigorously defended the current hospitals, warning that even partial privatization, as the commission has recommended, would sap resources and create larger problems.

Three members of the Commission on Care refused to sign the report in protest and wrote dissents. Darin Selnick, of Concerned Veterans for America, a conservative group, and Stewart Hickey, former director for Amvets, a lobbying and service group for veterans, said in a letter that they favored turning the health care system into a nonprofit public corporation similar to Amtrak. They said the commission’s recommendations would do little to improve care for veterans.

“We’ve gone ahead and punted on some of the most important things,” Mr. Selnick said in a call with reporters on Wednesday. “You could come up with these recommendations over lunch on a napkin.”

Michael Blecker, another commissioner who is the director of the veterans advocacy group Swords to Plowshares, issued a dissenting letter. He said the commission had recommended too much privatization and that the proposed care system could cause uncoordinated health care that would lead to the “degradation or atrophy of important health services that the V.A. provides.”

Larger veterans groups generally support the proposals, with some exceptions. Both the Disabled American Veterans and the Veterans of Foreign Wars objected to a proposed governing board to oversee the health care system, saying it could create a new level of bureaucracy packed with political appointees. Both backed a commission similar to the Department of Defense Base Realignment and Closing Commission that would recommend eliminating unneeded facilities and programs.

“The details need to be worked out, but we think most of these recommendations are a good thing,” said Garry Augustine, director of Disabled American Veterans.

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