Many veterans are still waiting to see a doctor.
Two years ago, vets were waiting a long time for care at Veterans Affairs clinics across the country. At one facility in Phoenix, for example, veterans waited an average of 115 days for an appointment. Adding insult to injury, some VA schedulers were told to falsify data to make it look like the waits weren't that bad.
The whole scandal ended up forcing the resignation of Eric Shinseki, secretary of the Department of Veterans Affairs at the time.
Congress and the VA came up with a fix: Veterans Choice, a $10 billion program that was supposed to give veterans a card that would let them see a non-VA doctor if they were more than 40 miles away from a VA facility or they were going to have to wait longer than 30 days for a VA provider to see them.
There was a problem, though. Congress gave the VA only 90 days to set up the system. Facing that extremely tight time frame, the VA turned to two private companies to administer the program and help veterans get an appointment with a doctor and then work with the VA to pay that doctor.
Although the idea sounds simple enough, the fix hasn't worked out as planned. Wait times have gotten worse — not better. Compared with this time last year, there are 70,000 more appointments that took vets at least a month to be seen.
The VA says there has been a massive increase in demand for care, but it's apparent the problem has more to do with the way Veterans Choice was set up. The program is confusing and complicated. Vets don't understand it, doctors don't understand it, and even VA administrators admit they can't always figure it out.
Veterans Face Delays And Worry
The problems are evident in Montana, which has more veterans per capita than any state except Alaska.
This winter, when Montana Sen. Jon Tester sent his staff to meet with veterans across the state, Bobby Wilson showed up at a session in Superior. Wilson, a Navy vet who served in Vietnam, is trying to get his hearing aids fixed.
But he says he is mired in bureaucracy. "The VA can't do it in seven months, eight months? Something's wrong," he says. "Three hours on the phone," trying to make an appointment. "Not waiting," he says, "talking for three hours trying to get this thing set up for my new hearing aids."
Tony Lapinski, a former aircraft mechanic with the Air Force, has waited for answers on the phone with Health Net, one of the two contractors the VA selected to help Veterans Choice patients.
"You guys all know the Health Net piano?" he says. "They haven't changed the damn elevator music in over a year!" That elicits knowing chuckles from the audience. In an interview later, he says, "They are the nicest boiler-room telemarketers you have ever spoken to. But that doesn't get your medical procedure taken care of."
Lapinski has an undiagnosed spinal growth, and he is worried. "Some days I wake up and go, 'Am I wasting time, when I could be on chemotherapy or getting a surgery?' " he says. "Or six months from now when I still haven't gotten it looked at and I start having weird symptoms and they say, 'Boy, that's cancer! If you had come in here six months ago, we probably could have done something for ya, but it's too late now!' "
Lapinski finally got to a neurosurgeon, but he didn't exactly feel like his Choice card was carte blanche. Doctors, it turns out, are waiting, too — for payment, he says.
"You get your procedure done, and you find out that two months later the people haven't been paid. They have got $10 billion that they have to spend, and they are stiffing doctors for 90 days, 180 days, maybe a year!" says Lapinski. "No wonder I can't get anyone to take me seriously on this program."
He says he gets it. He used to do part-time work fixing cars, and he would still take jobs from people who had taken more than 90 days to pay him or bounced a check. But he did so reluctantly.
"I had a list of slow-pay customers," he says. "I might work for them again, but everybody else came before them. So why would it be any different with these health care professionals?"
Hospitals, clinics and doctors across the country have complained about not getting paid, or getting paid very slowly. Some have just stopped taking Veterans Choice patients altogether, and Montana's largest health care network, Billings Clinic, doesn't accept any VA Choice patients.
Not cool, Tester says of Health Net and other contractors.
"The payment to the providers is just laziness," he says. "I'm telling you, it's just flat laziness. These folks turn in their bills, and if they're not paid in a timely manner, that's a business model that'll cause you to go broke pretty quick."
The VA now admits the rushed time frame led to decisions that resulted in a nightmare for some patients.
Health Net declined to be interviewed for this story. But in a statement, the company says the VA has recently made some beneficial changes that are helping to streamline Veterans Choice. For example, the VA no longer demands that a patient's medical records be returned to VA before it pays the bill.
Meanwhile, though, veterans continue to wait. "If I knew half of what I knew now back then when I was just a kid, I would've never went in the military," says Wilson. "I see how they treat their veterans when they come home."
Scheduling Lags Also Irk The Doctors' Offices And The VA
On the other side of the coin, doctors are frustrated in dealing with another government health care bureaucracy.
In Gastonia, N.C., Kelly Coward, a surgery scheduler at Carolina Orthopaedic & Sports Medicine, dials yet another veteran with bad news.
"I'm just calling to let you know that I still have not received your authorization for Health Net federal. As soon as I get it, I will give you a call and let you know that we have it and we can go over some surgery dates," she tells a veteran.
The practice sees about 200 veterans. Dealing with Health Net has become a time-consuming part of her job.
"I have to fax and re-fax, and call and re-call. And they tell us that they don't receive the notes. And that's just every day. And I'm not the only one here that deals with it," she says.
Carolina Orthopaedic's business operations manager, Toscha Willis, is used to administrative headaches. They're part of the deal with health care, she says, but she's never seen something like this.
It takes "multiple phone calls, multiple re-faxing of documentation, being on hold one to two hours at a time to be told, 'We don't have anything on file,' " she says. "But the last time we called about it, they had it, but it was in review. You know, that's the frustration."
It can take three to four months just to line up an office visit.
The delays have become a frustration within the VA, too. Tymalyn James, a nurse care manager at the VA clinic in Wilmington, N.C., says Choice has made the original problem worse. When she and her colleagues are swamped and refer someone outside the VA, it's supposed to help the veteran get care more quickly. But James says the opposite is happening.
"The fact is that people are waiting months and months, and it's like a — we call it the black hole," she says. "As long as the Choice program has gone on, we've had progressively longer and longer wait times for Choice to provide the service, and we've had progressively less and less follow-through on the Choice end with what was supposed to be their managing of the steps."
The follow-through is lacking in two ways. The first is the lengthy delay in approving care. And after that's finally resolved, there's a long delay in getting paid for the care.
At least 30 doctors' offices across North Carolina are dealing with payment problems, some that have lasted more than a year.
Carolina Orthopaedic's CEO Chad Ghorley says his practice is getting paid after it provides the care. It's the lengthy delay on the front end that puts a burden on the staff and, he worries, puts veterans at risk. He's a veteran himself.
"The federal government has put the Band-Aid on it, when there's such a public outcry to how the veterans are taken care of, all right?" he says. "Well, they've got the Band-Aid on it to get the national media off their backs. But the wound is still open, the wound is still there."
Those experiences for both veterans and providers are typical. Congress is now working on a solution to the original solution: A bill is expected to clear Congress by the end of the month.
RENEE MONTAGNE, HOST:
Veterans are still waiting to see a doctor. You may remember the news from two years ago - long wait times at VA clinics across the country were a scandal. Congress and the VA came up with a fix, a program called Veterans Choice. But the fix is broken. Reporters from NPR member stations have been talking to veterans and doctors and the officials who run Veterans Choice. And we're going to hear from them about how badly the fix is broken and why. We'll start today with Quil Lawrence.
He covers veterans for NPR, and he's in our studio now. Good morning.
QUIL LAWRENCE, BYLINE: Good morning, Renee.
MONTAGNE: The summer of 2014 - why were veterans then having to wait so long to see a doctor?
LAWRENCE: The root cause was that the VA didn't have enough doctors and nurses at a time when millions of Vietnam and Korea vets are getting old and needing more care, and also a lot of Iraq and Afghanistan vets were entering the VA system. The scandal that summer, which cost the VA secretary his job, was that some VA clinics were cooking the books to hide the fact that vets were waiting so long.
MONTAGNE: So Congress and the VA tried to fix this. So tell us more about what they did.
LAWRENCE: Congress passed a big reform bill. It included $10 billion for the Veterans Choice program, which was supposed to fix this problem. They even sent out a card to all these vets so that they could take that card and go see a private doctor if they live 40 miles away from a VA facility or they'd already been waiting 30 days for an appointment. So it was supposed to be a very simple idea. It didn't turn out all that simple. Despite seeing 3 million appointments outside the VA system in the past year, wait times are worse.
Compared to one year ago, there are 70,000 more vets right now who have waited more than a month to get an appointment.
MONTAGNE: Quil, how did wait times actually go up?
LAWRENCE: The VA says it's because they had a massive increase in demand for care. But when we've been looking at vets trying to use this Veterans Choice system, it doesn't look like the program really made things go smoother for them. From the start, it was so confusing that veterans didn't understand it, doctors didn't understand it and even the VA administrators were admitting that they couldn't really always figure it out. We've been talking to veterans and doctors across the country about this.
MONTAGNE: And we've got two reports coming up right now.
LAWRENCE: Yes, and the first is from my colleague Eric Whitney. He's with the Montana Public radio.
ERIC WHITNEY, BYLINE: Montana has more veterans per capita than any state besides Alaska. This winter, Montana Senator Jon Tester sent his staff to meet with veterans in 28 towns from one end of the state to the other. Scenes like this one were typical.
(SOUNDBITE OF ARCHIVED RECORDING)
BOBBY WILSON: The VA can't do it in seven months, eight months - something's wrong.
WHITNEY: That's Bobby Wilson, a Navy vet who served in Vietnam. He's trying to get his hearing aids fixed, but can't get approval for an appointment to do that.
(SOUNDBITE OF ARCHIVED RECORDING)
WILSON: Three hours on the phone with her. I'm waiting, talking for three hours trying to get this thing set up for my new hearing aids.
WHITNEY: Tony Lapinski is a former air craft mechanic. He's also spent a lot of time on the phone with Health Net, the VA contractor that's supposed to be helping him.
(SOUNDBITE OF ARCHIVED RECORDING)
TONY LAPINSKI: You guys all know the Health Net piano? You know what I'm saying?
LIPINSKI: They haven't changed the damn elevator music in over a year.
WHITNEY: Interviewed after the hearing, he says sometimes he actually gets through.
LIPINSKI: Oh, they're the nicest, you know, boiler room telemarketers you've ever spoke to. That doesn't get your medical procedure taken care of.
WHITNEY: Lapinski has a growth on his spine. He's been trying for months to get authorizations to see specialists to get it diagnosed.
LIPINSKI: Some days I wake up and go, am I wasting time where I could be on chemotherapy or getting a surgery to take this thing out - you know? - or six months from now when I still haven't gotten it looked at and I start having weird symptoms and they look and say, boy, you know, that's cancer. You know, if you'd have come in here six months ago, we probably could have done something for you. But it's too late now.
WHITNEY: When the VA contractor finally connected Lapinski to a neurosurgeon, he says he didn't exactly feel like his Veterans Choice card was carte blanche. Doctors, it turns out, are waiting too - for payment, says Lapinski.
LIPINSKI: You get your procedure done and you find out that two months later that the people haven't been paid? They've got $10 billion that they have to spend. And they're stiffing doctors for 90 days, 180 days, maybe a year. No wonder I can't get anyone to take me seriously on this program.
WHITNEY: Lapinski used to do part-time work fixing cars. He says he understands why his neurosurgeon may not be thrilled to see him.
LIPINSKI: I had a list of slow-pay customers - you know, I mean, slow-pay over 90 days. I might work for them again. But everybody else came before them. So why would it be any different with these healthcare professionals?
WHITNEY: Hospitals, clinics and doctors across the country have complained about not getting paid or only paid very slowly. Montana Senator Jon Tester says Billings Clinic, a network of 12 hospitals, never even signed up to be part of Veterans Choice.
JON TESTER: Biggest healthcare provider in the state of Montana won't deal with Choice. That should tell you something's wrong with the program.
WHITNEY: The VA and its contractors point out that when Congress passed the Veterans Choice law, they only gave them 90 days to get it up and running. And the VA was requiring tons of extra paperwork before outside doctors could get paid. Still, Senator Tester has little sympathy.
TESTER: Ninety days is three months. And all they had to do is schedule appointments, develop partnerships with medical providers and pay them on a timely basis. And they haven't done that.
WHITNEY: Health Net declined to be interviewed for this story. But in a statement, the company says the VA has recently reduced the paperwork requirements, and that's helping to streamline Veterans Choice. Vietnam veteran Bobby Wilson, though, is almost at the end of his rope.
WILSON: If I knew half of what I knew now back then when I was just a kid, I'd have never went in the military. I see how they treat their veterans when they come home.
WHITNEY: For NPR News, I'm Eric Whitney in Montana.
MICHAEL TOMSIC, BYLINE: I'm Michael Tomsic in North Carolina. The Salisbury VA kept army veteran Archie Barrow waiting two months for shoulder surgery, so he got referred to Choice. But when he took the next step, trying to schedule care through Health Net...
ARCHIE BARROW: The first couple phone calls they said I wasn't authorized. I said, well, how am I not authorized? I've got two Choice cards here saying I am. And then I finally called back about the third or fourth time and I got somebody that was able to help me.
TOMSIC: It took another two months for Health Net, the VA, Barrow and a private doctor to get everything sorted out. He had surgery a year ago.
BARROW: And they have still - have not paid for it.
TOMSIC: That puts Barrow's doctor in good company. At least 30 doctor's offices throughout North Carolina are dealing with Veterans Choice payment problems, some that have lasted more than a year, according to the North Carolina Medical Society. It's become a frustration within the VA, too.
TYMALYN JAMES: The fact is that people are waiting months and months. And it's like - we call it the black hole.
TOMSIC: That's Tymalyn James, a nurse care manager at the VA clinic in Wilmington. When she and her colleagues are swamped and refer someone to a doctor outside the VA, it's supposed to help them get care more quickly. But James says the opposite is happening.
JAMES: As long as the Choice program has gone on, we've had progressively longer and longer wait times for choice to provide the service. And we've had progressively less and less follow-through on the Choice end with getting the service for the patient.
TOMSIC: In Gastonia, that leaves Kelly Coward dialing yet another veteran with bad news.
KELLY COWARD: Just calling to let you know that I still have not received your authorization from Health Net Federal. As soon as I get it, I will give you a call and let you know that we have it and we can go over some surgery dates.
TOMSIC: Coward works at Carolina Orthopaedic & Sports Medicine, which treats about 200 veterans. Dealing with Health Net has become a consuming part of her job.
COWARD: I have to fax and re-fax and call and re-call. And they tell us that they don't receive the notes, and that's just every day. And I'm not the only one here that deals with it.
TOMSIC: Carolina Orthopaedic's business operations manager, Toscha Willis, is used to administrative headaches. That's part of the deal with health care. But Willis says she's never seen something like this.
TOSCHA WILLIS: Multiple phone calls, multiple re-faxing of documentation, you know, being on hold for 1 to 2 hours at a time to be told we don't have anything on file. But the last time we called about it, they had it but it was in review - that's the frustration.
TOMSIC: It can take 3 to 4 months just to line up an office visit. Veterans ask if they can even go to Health Net in person.
WILLIS: (Laughter) I mean, they tell - we have patients that say, I'm going to drive there. They get that upset about it, and they don't give their address out.
TOMSIC: For the record, Health Net has regional call centers in eight states, including South Carolina and Florida. The whole process makes Carolina Orthopaedic CEO Chad Ghorley, a veteran himself, furious.
CHAD GHORLEY: The federal government's put the Band-Aid on it when there's such a public outcry at how the veterans are taken care of. All right, well, they've got the Band-Aid on it to get the national media off of their backs. But the wound's still opening. The wound is still there. It's just a Band-Aid.
TOMSIC: Congress is now working on a solution to the original solution. There's a bipartisan bill working its way through the Senate. For NPR News, I'm Michael Tomsic in Charlotte.
MONTAGNE: And NPR's Quil Lawrence, who covers veterans, is still with us. And Quil, we just heard reports from two states where vets and doctors say the program to let vets see a private doctor faster isn't working. Is that pretty typical?
LAWRENCE: Well, some vets have had good luck with the Choice program. But the stories you just heard are pretty typical of what we heard in the half-dozen states we visited for this series. And the bottom line is that the wait times have gotten worse, not better. And this is a program that Congress had the VA try and set up - a $10 billion program in just 90 days.
MONTAGNE: We'll hear more details about what happened in those 90 days on tomorrow's program. Quil, thanks very much.
LAWRENCE: Thank you.
MONTAGNE: And the stories you've just heard are part of a collaboration with NPR's Back at Base project, local member stations and Kaiser Health News. Transcript provided by NPR, Copyright NPR.