VA’s contract healthcare provider program needs safeguards

The federal workforce includes vast numbers of veterans—about a third of feds are vets and can use services through the Department of Veterans Affairs, with still more in federal families. In short, what happens at VA matters to feds—especially in VA healthcare options.

The federal workforce includes vast numbers of veterans—about a third of feds are vets and can use services through the Department of Veterans Affairs, with still more in federal families. In short, what happens at VA matters to feds—especially in VA healthcare options.

A new report from the Government Accountability Office spotlights a continuing area of concern in VA healthcare options: the safety of outside, contracted care.

Since the 1990s, the VA and its Veterans Health Administration component have undergone a series of modernizations and expansions of preventive and treatment services that include growing use of outside, non-VA providers. In recent years the lead such initiative—the Veterans Choice Program, or VCP—has been supplanted by the Veterans Community Care Program, or VCCP. The GAO report scrutinizes concerns with the VCCP scheme.

“VA has faced challenges in ensuring that its providers, including providers participating in the VCCP, deliver safe and effective care to veterans,” the GAO report states. “We have previously identified situations where providers who were removed from employment by VA medical facilities for quality of care concerns went on to provide care outside VA and to enroll in a community care network of providers, allowing them to care for veterans.”

The central concern here is that providers with revoked licenses or other serious derogatory marks on their records in some cases continue to function under VCCP.

“VA’s contracts with [certain] contractors do not require the verification of providers’ history of license sanctions, including a revoked license, in all states during credentialing,” the GAO report warns, regarding the VCCP. “Only one of the two contractors has a process that includes verifying providers’ licensure history in all states and neither has a sufficient process for continuously monitoring provider licenses.”

The two contractors examined by name in the report include TriWest and Optum, among others.

The GAO report spotlights the urgency and possible scope of the issue, by noting massive and rapid growth in VA-facilitated use of outside health services. “While veterans still receive most of their care from VA medical facilities,” the report said, “the number of veterans that have received community care has increased 77 percent from 2014 through 2019.”

The GAO found that despite several procedures in place to protect the veterans that VHA and its contractors care for, there are still problems with both the vetting procedures in place and the implementation of them.

“VA and contractor policies may not exclude providers who are ineligible under the VA MISSION Act from participating in the VCCP,” the report states. “In particular, providers may not be consistently excluded or removed as appropriate in accordance with section 108 of the VA MISSION Act if they have (1) lost a state medical license in any state for violating the requirements of the medical license; (2) been removed from employment with VA due to conduct that violated VA policy relating to the delivery of safe and appropriate health care; or (3) been suspended from VA employment.”

How could these lacks obtain? Part of the problem, as the GAO report explains, is that some of the major contracts were concluded before the most recent law was passed, the VA MISSION Act—a law that specifically demands such a level of scrutiny. These contracts must be revisited to encompass more recent and more thorough safeguards.

“VHA has a process to identify ineligible providers removed from VA employment for safety concerns, but risks remain,” as the report summarized the situation.

Recommendations

With these overall findings in hand, the GAO report made several recommendations. The report offered at least three that point to how VA might tighten the requirements and contracting procedures used by VCCP—improving the safety of veterans who utilize the program.

The first of the GAO report’s recommendations was the most obvious: the VHA must look into any and all providers’ licensing status, to avoid working with providers who might provide substandard care or pose a danger to veterans.

“The Secretary of Veterans Affairs, in concert with the Undersecretary for Health, should require the Community Care Network contractors to amend their credentialing policies,” the report says of its first recommendation. The report adds specifically VA authorities must move “to ensure that providers who have violated the requirements of medical licenses that resulted in the loss of … medical licenses in any state are excluded from providing care to veterans through the Veterans Community Care Program.”

Second, the report said that the VHA should “develop and implement a process for continuous monitoring of the eligibility requirements” for providers who work with the agency to provide services to veterans.

Finally, the GAO report recommends that VHA scrutinize and eliminate previously terminated providers—in order to determine if they were removed for serious problems, to more effectively guard against working with unsuitable providers.

“[The] Undersecretary for Health could direct VHA to review the list of terminated VA providers generated from our data analysis,” the report states. “[This could be used to] determine whether these providers were removed from VA employment due to conduct that violated VA policy related to the delivery of safe and appropriate health care … and determine whether these providers should be allowed to provide care to veterans through the Community Care Network or a Veterans Care Agreement.”

The report concludes that the VA needs to “require its contractors to have credentialing and monitoring policies that ensure compliance with VA MISSION Act license restrictions,” as well as that the agency “assess the risk to veterans when former VA providers with quality concerns continue to provide VCCP care.”

The report states that, presented with the GAO’s findings, the VA “generally agreed with GAO’s three recommendations.”

For more information on the VHA’s VCCP program, go to the program’s website—and for more on career opportunities for veterans in the federal workforce, go to the Feds Hire Vets website.



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