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Doctors Must Overcome New Red Tape In Struggle To Treat Veterans


The VA's Veterans Choice Program was supposed to help veterans get care more quickly, but nearly two years after it was created, complaints persist about delays in care and unpaid claims from the program. We've been reporting on how veterans are frustrated with the program as part of an investigation into Veterans Choice. And it turns out that health care providers are frustrated too.

Patricia Murphy from member station KUOW in Seattle reports that red tape has made it harder for providers to see their patients.

PATRICIA MURPHY, BYLINE: Michael Pearce served in the Army, including a tour in Germany. He left the military in the late 1980s. Depression and insomnia plagued him. Pearce had seen VA counselors about his depression, but none clicked until two years ago when he met psychologist Diane Adams, who helped him understand his symptoms.

MICHAEL PEARCE: That was huge. It's like thinking you have terminal cancer and finding out that, no, it's just a cold (laughter). And I just - I can't describe the relief.

MURPHY: Diane Adams devotes a portion of her practice to veterans. It's something she believes is important. Her home office is located at the midpoint of a steep, winding hill in a city outside Seattle.

DIANE ADAMS: Hi, Patricia. Come on in.

MURPHY: Thanks, Diane.

MURPHY: She's provided counseling to veterans as part of the VA's community care programs for nearly a decade. Last July, she got a letter from a company called TriWest about a new program.

ADAMS: We are reaching out to encourage you to work with TriWest health care alliance because going forward, VA will be authorizing the majority of its community health care services for veterans through the Veterans Choice Program.

MURPHY: Adams went online to sign up. She clicked through the screens, checked the box that said she'd provide care through Veterans Choice. It all seemed pretty straightforward.

ADAMS: So we checked that box and waited and waited.

MURPHY: In December, after hearing nothing for five months, Adams finally give TriWest a call.

ADAMS: Yeah, and I spoke with somebody. And yes, they had received my information. And they thought, well, maybe it was just taking a long time from the contractual process.

MURPHY: Adams called back in January and in March. Each time, a courteous TriWest representative took a message. No one called back. TriWest's chief medical officer, Frank Maguire, acknowledges the Veterans Choice Program isn't exactly nimble.

FRANK MAGUIRE: Things have gotten much better. But I'll tell you. We still have persistent educational confusion issues. The program itself is not uncomplicated.

MURPHY: Which means small mistakes could mean big problems. Turns out way back when Adams filled out the first form, she checked a wrong box, and that held everything up. Finally in late March, Adams was told she should have already gotten a welcome letter. She still hasn't gotten it. Maguire says the program needs more time.

MAGUIRE: People want it perfect right away. And it's a new program, and I think it still needs more time to mature.

MURPHY: Now that she's in, Adams faces a new hurdle. Her regular patients like Michael Pearce can't get Veterans Choice to approve visits to see her. Vets are supposed to be able to call the number on the back of their Choice card to get an appointment. But so far, it's been like climbing that steep, winding hill to her office - more phone calls, more faxing, more forms.

ADAMS: I guess what I'm worried about is what happens to the veterans who can't handle it. And they just don't have the internal resources to put up with it. And so they throw up their hands, and they give up. And they don't get care.

MURPHY: And Adams says for some veterans, it's just one more person letting them down.

SIEGEL: That's Patricia Murphy of member station KUOW in Seattle. She joins us now to talk more about this story. And we're also joined by NPR's Quil Lawrence, who covers veterans. You've both done extensive reporting on this new Veterans Choice Program, and you've found serious problems in the way that it's being run. Patricia, just to be clear, it's not just Diane Adams who's unsatisfied with this program.

MURPHY: No, absolutely not. Here in Washington state, it certainly has not improved the system. In trying to get a bead, I started to just cold call TriWest's list of behavioral health providers, and I spoke to about half a dozen. Nobody told me anything positive.

In one case, a behavorial health provider chose to simply not be paid for the visit because he couldn't seem to get through the system to get the bill paid, and he just gave up on it. One other provider was waiting a year to be paid.

This is mental health care. It's scarce. It's one of the most-needed specialties. Providers enter into a level of trust with veterans that goes beyond a simple visit to the doctor. Continuity of care is extremely important.

SIEGEL: Two years ago, the then-Secretary of Veterans Affairs Eric Shinseki stepped down because of the scandal over long wait times for vets. This program was supposed to fix that. Quil, what happened?

QUIL LAWRENCE, BYLINE: Well, as you say, it was created in crisis and out of urgency. Congress handed VA a very tall order. They should have to create an entirely new system where the vet could decide to go get private care in their community if they had been waiting at least 30 days or lived 40 miles from a VA. But Congress only gave the VA only 90 days to set it up. The VA also made some errors by their own admission.

Now, this has - this program has worked for some people, but the bottom line is it has not moved the needle on wait times. There are more vets waiting at least 30 days for an appointment than there were this time last year.

MURPHY: In many ways, this system has created more portals for more problems for providers and patients. It's a system veterans don't understand, the providers don't understand. And even the VA doesn't understand.

SIEGEL: Well, that raises the question of whether anyone understands it well enough to be able to fix it. What do you think?

LAWRENCE: Yeah, there are some bills moving through Congress right now. And they certainly have their work cut out for them because this program and the problems with it have revealed an even bigger mess, which is the VA's half-dozen different programs, each with different rules for getting care outside the VA system.

SIEGEL: That's NPR's Quil Lawrence and also Patricia Murphy of station KUOW in Seattle. Thanks to both of you.

MURPHY: Thank you.

LAWRENCE: Thanks, Robert.

SIEGEL: And tomorrow I'll be talking with Florida Republican Congressman Jeff Miller, a critic of the VA and one of the original sponsors of the Veterans Choice Program. Transcript provided by NPR, Copyright NPR.

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