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Letter to the Editor: July 2, 2015

Published on: July 1, 2015

Dear Editor,

You have probably heard about the $10 billion being set aside for veterans to obtain care with the new VA Choice Program (authorized outside care).

You probably have not heard that this is not “new”  money. It is money sequestered in each VA hospital’s annual budget for authorized outside care. Since it comes out of the hospital’s annual budget, it is obviously going to be in the best interest of the hospital to treat as many of the veterans in-house as possible. So there is an understandable tendency to be inflexible on authorizing outside care.

When veterans qualify for Choice treatment (time and/or distance requirements), a request for authorization of outside care must be made to TriWest Healthcare Alliance, the TRICARE administrator for the Department of Defense. Patients are responsible for contacting TriWest themselves.

The veteran must then wait for the TriWest authorization before proceeding. Predictable frustration sets in because TriWest is disgracefully slow in responding. Many times the wait is over 30 days — which is what initiated the process to begin with — and the veteran ultimately gives up and waits for the first available VA appointment.

If they do wait for the TriWest authorization, when it arrives they can then seek an outside appointment. However, at this point, the community physician must call the VA hospital and verify that the care has been authorized. So another exasperating slowdown occurs. Ultimately, 30 to 50 days later, they are seen and treated. Again, this process was initiated because the veteran could not get an appointment within 30 days.

As noted above, many veterans decide it is not worth waiting for all of this to happen and just wait for an appointment with the local VA hospital. Hence, much of the sequestered money set aside by congress (taken out of the VA’s annual budget) goes unspent.

The Secretary of the VA, Robert McDonald, claiming to be short of cash for veteran’s care in general and faced with an overwhelming increase in the number of veteran patients requiring care secondary to the ongoing military conflicts, has thus requested that some of the sequestered dollars be opened up to other areas that are consequently cash starved. And the politicians, who selected TriWest as the national Tri Care administrator, appear oblivious to their apparent failures and transfer the blame to the VA hospitals. Is this a catch-22 situation or what?

An easy solution would be for the VA hospitals to simply give the veteran a signed authorization form to take to the community physician. But that would be far too easy.

B. Frank Kepley, CAPT USN (Ret)
Oral & Maxillofacial Surgeon
26 years with USN and 15 years with VA
Sun City Center

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