Veterans are still waiting to see a doctor. Two years ago, vets were waiting a time for care at Veterans Affairs clinics. At one facility in Phoenix, for example, veterans waited on average 115 days for an appointment. Adding insult to injury, some VA schedulers were told to to make it looks like the waits weren鈥檛 that bad. The whole scandal ended up the resignation of the VA secretary at the time, Eric Shinseki.
Congress and the VA came up with a fix: , a $10 billion program. Veterans received a card that was supposed to allow them to see a non-VA doctor if they were either 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.
The problem was, Congress gave them only 90 days to set up the system. Facing that deadline, the VA turned to two private companies to administer the program 鈥� helping veterans get an appointment with a doctor and then working with the VA to pay that doctor.
It sounds like a simple idea but it鈥檚 not working. Wait times have gotten worse. Compared to this time last year, there are 70,000 where it took vets聽at least a month to be seen, according to the VA鈥檚 own audit.
The VA claims there has been a massive increase in demand for care, but the problem has more to do with the way Veterans Choice was set up. It is confusing and complicated. Vets don鈥檛 understand it, doctors don鈥檛 understand it and even VA administrators admit they can鈥檛 always figure it out.
Veterans Face Delays And Worry
This is playing out in a big way in Montana. That state has more veterans per capita than any state besides Alaska. This winter Montana sent his staff to meet with veterans across the state. Bobby Wilson showed up to a meeting in Superior. He鈥檚 a Navy vet who served in Vietnam and is trying to get his hearing aids fixed. Wilson is mired in bureaucracy.
鈥淭he VA can鈥檛 do it in seven months, eight months? Something鈥檚 wrong,鈥� he said. 鈥淭hree hours on the phone,鈥� trying to make an appointment. 鈥淣ot waiting,鈥� he said, 鈥渢alking for three hours trying to get this thing set up for my new hearing aids.鈥�
Tony Lapinski, a former aircraft mechanic, has also spent his time on the phone, with Health Net, one of the two contractors the VA selected to help Veterans Choice patients.
Tony Lapinski, a veteran with severe back pain, kisses his wife, Michelle, at their home in Superior, Mont. (Michael Albans/for NPR)
鈥淵ou guys all know the Health Net piano?鈥� he said. 鈥淭hey haven鈥檛 changed the damn elevator music in over a year!鈥� That elicits knowing chuckles from the audience. Later during an interview, he said聽when he gets through to a person, 鈥淭hey are the nicest boiler room telemarketers you have ever spoken to. But that doesn鈥檛 get your medical procedure taken care of.鈥�
Lapinski has an undiagnosed spinal growth and he鈥檚 worried. 鈥淪ome days I wake up and go, 鈥楢m I wasting time, when I could be on chemotherapy or getting a surgery?鈥� 鈥� he said. 鈥淥r six months from now when I still haven鈥檛 gotten it looked at and I start having weird symptoms and they say, 鈥楤oy, that鈥檚 cancer! If you had come in here six months ago, we probably could have done something for ya, but it鈥檚 too late now!鈥� 鈥�
Lapinski finally got to a neurosurgeon, but he didn鈥檛 exactly feel like his Choice card was carte blanche. Doctors, it turns out, are waiting, too 鈥� for payment, he said.
鈥淵ou get your procedure done, and you find out that two months later the people haven鈥檛 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!鈥� said聽Lapinski. 鈥淣o wonder I can鈥檛 get anyone to take me seriously on this program.鈥�
He said聽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.
鈥淚 had a list of slow-pay customers,鈥� he said. 鈥淚 might work for them again, but everybody else came before them. So why would it be any different with these health care professionals?鈥�
Hospitals, clinics and doctors across the country have complained about not getting paid, or only paid very slowly. Some have just stopped taking Veterans Choice patients altogether, and Montana鈥檚 largest health care network, Billings Clinic, doesn鈥檛 accept any VA Choice patients.
Not cool, said聽Montana Sen. Jon Tester, of Health Net and other contractors.
鈥淭he payment to the providers is just laziness,鈥� Tester said. 鈥淚鈥檓 telling you, it鈥檚 just flat laziness. These folks turn in their bills, and if they鈥檙e not paid in a timely manner, that鈥檚 a business model that鈥檒l cause you to go broke pretty quick.鈥�
The VA now admits the rushed timeframe 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 said聽that VA has recently made some beneficial changes that are helping streamline Veterans Choice. For example, the VA no longer demands a patient鈥檚 medical records be returned to VA before they pay.
Meanwhile, though, veterans continue to wait. 鈥淚f I knew half of what I knew now back then when I was just a kid, I would鈥檝e never went in the military,鈥� said聽Bobby Wilson. 鈥淚 see how they treat their veterans when they come home.鈥�
Scheduling Lags Also Irk The Doctors鈥� Offices And The VA
And there鈥檚 another whole side to the coin. Doctors are frustrated in dealing with another government health care bureaucracy.
In Gastonia, North Carolina, Kelly Coward dials yet another veteran with bad news.
鈥淚鈥檓 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,鈥� she told聽a veteran.
Coward works at Carolina Orthopaedic & Sports Medicine Center, a practice that sees about 200 veterans. Dealing with Health Net has become a consuming part of her job.
鈥淚 have to fax and re-fax, and call and re-call. And they tell us that they don鈥檛 receive the notes. And that鈥檚 just every day. And I鈥檓 not the only one here that deals with it,鈥� she said.
Carolina Orthopaedic鈥檚 business operations manager, Toscha Willis, is used to administrative headaches 鈥� that鈥檚 part of the deal with health care 鈥� but she鈥檚 never seen something like this.
She said聽it takes, 鈥渕ultiple phone calls, multiple re-faxing of documentation, being on hold one to two hours at a time to be told we don鈥檛 have anything on file. But the last time we called about it they had it, but it was in review. You know, that鈥檚 the frustration.鈥�
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 is a nurse care manager at the VA clinic in Wilmington, North Carolina. She said聽Choice has made the original problem worse. When she and her colleagues are swamped and refer someone outside the VA, it鈥檚 supposed to help the veteran get care more quickly. But James said聽the opposite is happening.
鈥淭he fact is that people are waiting months and months, and it鈥檚 like a, we call it the black hole,鈥� she said. 鈥淎s long as the Choice program has gone on, we鈥檝e had progressively longer and longer wait times for Choice to provide the service, and we鈥檝e had progressively less and less follow through on the Choice end with what was supposed to be their managing of the steps.鈥�
The follow-through is lacking in two ways. The first is the lengthy delay in approving care. And after that鈥檚 finally resolved, there鈥檚 a long delay in getting paid for the care.
At least 30 doctors鈥� offices across North Carolina are dealing with payment problems, some that have lasted more than a year.
Carolina Orthopaedic鈥檚 CEO Chad Ghorley said聽his practice is getting paid after it provides the care. It鈥檚 the lengthy delay on the front end that burdens his staff and, he worries, puts veterans at risk. He鈥檚 a veteran himself.
鈥淭he federal government has put the Band-Aid on it when there鈥檚 such a public outcry to how the veterans are taking care of, all right?鈥� he said. 鈥淲ell, they鈥檝e 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.鈥�
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.
This story is part of a partnership that includes , , NPR鈥檚 Back at Base project and Kaiser Health News.
CORRECTION: A previous version of this story misstated how many veterans were waiting at least a month for an appointment this year. The 70,000 figure applies to the number of appointments聽in which it聽took vets at least a month to be seen. The story has been corrected to reflect this difference.