Community care deadline looms as VA grapples with software issues

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While the Department of Veterans Affairs says it is on track to implement improvements to community care by June 6 as required by the MISSION Act, the agency is still struggling with software challenges.

The MISSION Act, signed into law in 2018, aims to consolidate the VA’s community care programs into a new, streamlined and more efficient Veterans Community Care Program.

However, according to Richard Stone, MD, executive in charge of the Veterans Health Administration, the software transition for the Veterans Community Care Program is proving to be daunting.

“This is as complex a legislation as you could possibly have,” Stone told a Senate committee earlier this month. “The automated systems to run community care require 11 different software systems—10 of which we’ve got in the field today.”

Since passage of the legislation last year, Stone said the VHA’s Office of Community Care has been working with the VA’s Office of Information and Technology to develop new tools—such as a decision support tool to aid VA staff in making community care eligibility determinations—as well as supporting enhancements to existing tools that will ensure that the capabilities necessary to implement the MISSION Act will be in place by the June 6 deadline.

The decision support tool, which is the eleventh system required for the implementation, brings the other 10 systems “all together” and serves as the linchpin, according to Stone.

However, last month, Pro Publica obtained and published an independent review by the U.S. Digital Service, which found that “the intended workflow and audience for the decision support tool is flawed and could significantly disrupt VA physicians’ ability to see patients.”

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“Some (of the systems for the Veterans Community Care Program) were fielded as far back as last fall, some we’re fielding as we speak,” acknowledged Stone in his testimony. “Are we going to get it all right? No. Are we going to deliver care on June 6? Yes.”

The MISSION Act was supposed to make community care work better for veterans by giving them more options, making appointment scheduling easier, as well as improving care coordination between VA and community providers.

Although the VA says it is doing everything possible to meet the June 6 deadline, Stone acknowledged that initially the agency’s new Veterans Community Care Program might not run as efficiently as it should and that there may be increasing wait times as a result of these difficulties.

“We will get better every day,” concluded Stone. “I’m not going to sit before you and say we’re going to have everything right on June 6. There will be something that doesn’t go in the right direction, and we’ve got to get corrected.”

Adding to the VA’s potential problems is that under the Veterans Community Care Program, the agency is planning to have medical facilities—not third-party administrators—generally be responsible for scheduling veterans’ appointments with community providers.

“VA awarded contracts for administering the VCCP in three of six regions on Dec. 28, 2018,” said Sharon Silas, the Government Accountability Office’s acting healthcare director, during her testimony before the Senate committee. “As of April 3, VA had not yet awarded contracts for the remaining three regions.”

In a separate House hearing held earlier this month on the VA’s implementation of the community care program, House Committee on Veterans’ Affairs Chairman Mark Takano (D-Calif.) called the MISSION Act a “big mandate” that the agency must get right.

“If the technology experts say that VA should cease development on the decision support tool and for VA to rethink its approach to implementation, we want to understand those recommendations and what VA is doing about them,” said Takano. “If a veteran-centric vision is not guiding this implementation, then we need to figure out what needs to change.”

Phil Roe, MD (R-Tenn.), ranking member of the House Veterans’ Affairs Committee, also expressed his concerns about the Veterans Community Care Program.

“I believe in taking the time to get things right—not just getting them in a hurry,” added Roe. “I would rather VA postpone implementation of this program than to rush to implementation in name only and have veterans pay the price for it.”

Nonetheless, Stone tried to reassure the House committee that “once it goes live, the decision support tool will improve efficiency for VA providers, making referrals by helping to simplify decisions about community care eligibility.” He added that the agency plans to develop, test and deploy the tool by June 6.

“In the event that any technical challenges occur, VA will be able to make eligibility decisions using existing and enhanced methods and tools,” Stone concluded. “Veteran care will not be disrupted.”

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