Sometimes things seem too good to be true. Last year when the Phoenix VA waiting list scandal broke, and even as we began to discover that VA facilities in other parts of the country weren’t meeting wait time standards, things were better in Alaska.
It’s not that Alaska VA didn’t have staffing challenges like facilities in the Lower 48. Some of our challenges like staffing Wasilla with one doctor — who ultimately quit — when two were called for were even more difficult to fix than they might be in the Lower 48 because of our remote location. To its credit, Alaska VA faced up to its recent challenges before they became scandals.
That wasn’t by coincidence. Since 2006 I have been pressing hard on the VA to partner with community health centers, Native health and private practice providers. The VA was highly resistant. These were very tough conversations. I brought the VA Inspector General up to investigate. I published a pretty tough op-ed about the problem. At times old VA hands accused my staff of VA bashing. Whatever. The needs of the veteran came first. Period.
But all that tough love worked. When the VA was facing a waiting list of 900 veterans in need of primary care it outsourced to the Anchorage Neighborhood Health Center. When the VA was told by Secretary Shinseki to stop demanding veterans fly to Seattle for specialty care it quickly formed relationships with the Alaska medical community. When Wasilla’s only doctor moved out of state, her patient load was moved to the Southcentral Foundation’s new clinic. And the VA began paying tribal health facilities to deal with the service connected medical challenges of veterans in rural Alaska. When a ventilation problem caused the shutdown of operating rooms at the new Anchorage clinic the VA leaned heavily on its Joint Venture Medical Treatment Facility with the Air Force. To be sure there was still work to do, but after a decade of work we were seeing steady progress in adapting VA healthcare to the challenges in Alaska — not squeezing Alaska into a national VA model that didn’t work here.
All of that progress came to a screeching halt in recent weeks as the VA Central Office told Alaska to stop this innovation. It turns out the Lower 48 scandal caused the VA to spend its outside care budget much more quickly than it anticipated — eating up money that Alaska VA was relying on to run its innovative programs. And the Choice Program, funded by Congress at $10 billion was hardly being used anywhere.
Rumors flew that the VA was pulling out of the Elmendorf Joint Venture Hospital and that all of the Native partnerships would be cancelled. And some private practices have called my Alaska offices to say the VA told them to cancel appointments because the VA could no longer pay.
To make things clear, while I reluctantly voted for the Choice Card as a Lower 48 solution, I bluntly stated at the time that our history with Medicare and Tricare in Alaska suggested provider support for the strings attached with the Choice Card would be lacking. At no time was I warned that the Choice Program would displace Alaska specific VA programs that were working. In fact, I asked the VA at a hearing in March whether introduction of the Choice Card would result in an erosion of the existing partnerships. VA senior leaders assured me they would not. Now we find out that answer was not entirely true. The VA has a financial problem — a big problem in keeping that promise.
At my request, the deputies to the top VA and Defense Department health officials came to Anchorage trying to sort this mess out. This week I was informed that solutions have been identified to keep the Elmendorf hospital relationship going through the end of the year. Funds have also been found to maintain the VA’s partnership with Native health facilities to treat non-Native veterans. Again only to the end of the fiscal year. The VA has committed to work with the Alaska congressional delegation on long term fixes for these two essential programs.
However there is no good solution for continuing the VA’s Alaska specific purchased care solutions with private practice providers and community hospitals. Every Alaska veteran enrolled for VA healthcare by August 1, 2014 should have a Choice Card. If those veterans need care from a private practice provider or community hospital, they need to try the Choice Card first. There are a number of strings attached to the Choice Card — one of which is that the provider must be willing and credentialed to receive Choice Card patients. The VA and its contractor Triwest are scrambling to sign up Alaska providers for the Choice Card now. For the time being, only if an acceptable Choice Card provider cannot be found and the veteran’s condition is urgent or emergent will the VA be able to rely on its legacy approach to purchase care in Alaska. That is also subject to the availability of funds.
This is not an optimal solution and the VA admits that it is not the way they would prefer to deliver care in Alaska. The union representing Alaska VA employees tell me that veterans who are unable to make Choice work are showing up at the VA clinic with harsh words for the civil servants behind the desks. They say “Choice is no choice.” Or “Choice is forced choice.” Be kind. It’s really not their fault and sadly they may not have the tools to fix it because the Choice Card program runs out of the VA Central Office, not the local facilities.
I am assured by VA senior leaders in Washington that they now understand the severity of the problem in Alaska. I believe they are sincere in trying to fix it. But I have made it clear to the VA that fixing the problem means that veterans get the care they need, where they live and when they need it. Hearing yes, then no, then maybe, and then yes after the congressional delegation inquires isn’t the way things are going to work in Alaska. Senator Sullivan, Congressman Young and I are united and working this problem very hard. Alaska proudly hosts the largest per capita population of veterans anywhere in the country. We will not rest until the earned healthcare benefit is a reality for Alaska veterans wherever in the state they may live.
Lisa Murkowski is Alaska’s senior senator in the U.S. Senate.