Government & Policy

Veterans are still waiting to see a doctor. Two years ago, vets were waiting a long 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 falsify data to make it looks like the waits weren’t that bad. The whole scandal ended up forcing the resignation of the VA secretary at the time, Eric Shinseki. Congress and the VA came up with a fix: Veterans Choice, 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 — 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’s not working. Wait times have gotten worse. There are 70,000 more vets waiting at least a month for an appointment than there were at this time last year. 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’t understand it, doctors don’t understand it and even VA administrators admit they can’t 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 Sen. Jon Tester sent his staff to meet with veterans across the state. Bobby Wilson showed up to a meeting in Superior. He’s a Navy vet who served in Vietnam and is trying to get his hearing aids fixed. Wilson is mired in bureaucracy. “The VA can’t do it in seven months, eight months? Something’s wrong,” he said. “Three hours on the phone,” trying to make an appointment. “Not waiting,” he said, “talking for three hours trying to get this thing set up for my new hearing aids.” [See also: GAO: Veterans finding VA care hard to access.] 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. “You guys all know the Health Net piano?” he said. “They haven’t changed the damn elevator music in over a year!” That elicits knowing chuckles from the audience. Later during an interview, he said when he gets through to a person, “They are the nicest boiler room telemarketers you have ever spoken to. But that doesn’t get your medical procedure taken care of.” Lapinski has an undiagnosed spinal growth and he’s worried. “Some days I wake up and go, ‘Am I wasting time, when I could be on chemotherapy or getting a surgery?’ ” he said. “Or six months from now when I still haven’t gotten it looked at and I start having weird symptoms and they say, ‘Boy, that’s cancer! If you had come in here six months ago, we probably could have done something for ya, but it’s too late now!’ ” Lapinski finally got to a neurosurgeon, but he didn’t exactly feel like his Choice card was carte blanche. Doctors, it turns out, are waiting, too — for payment, he said. “You get your procedure done, and you find out that two months later the people haven’t 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!” said Lapinski. “No wonder I can’t get anyone to take me seriously on this program.” He said 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. “I had a list of slow-pay customers,” he said. “I might work for them again, but everybody else came before them. So why would it be any different with these health care professionals?” 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’s largest health care network, Billings Clinic, doesn’t accept any VA Choice patients. Not cool, said Montana Sen. Jon Tester, of Health Net and other contractors. “The payment to the providers is just laziness,” Tester said. “I’m telling you, it’s just flat laziness. These folks turn in their bills, and if they’re not paid in a timely manner, that’s a business model that’ll cause you to go broke pretty quick.” 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 that VA has recently made some beneficial changes that are helping streamline Veterans Choice. For example, the VA no longer demands a patient’s medical records be returned to VA before they pay. Meanwhile, though, veterans continue to wait. “If I knew half of what I knew now back then when I was just a kid, I would’ve never went in the military,” said Bobby Wilson. “I see how they treat their veterans when they come home.” Scheduling lags also irk the doctors’ offices and the VA And there’s 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. “I’m 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,” she told 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. “I have to fax and re-fax, and call and re-call. And they tell us that they don’t receive the notes. And that’s just every day. And I’m not the only one here that deals with it,” she said. Carolina Orthopaedic’s business operations manager, Toscha Willis, is used to administrative headaches — that’s part of the deal with health care — but she’s never seen something like this. She said it takes, “multiple phone calls, multiple re-faxing of documentation, being on hold one to two hours at a time to be told we don’t have anything on file. But the last time we called about it they had it, but it was in review. You know, that’s the frustration.” 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 Choice has made the original problem worse. When she and her colleagues are swamped and refer someone outside the VA, it’s supposed to help the veteran get care more quickly. But James said the opposite is happening. “The fact is that people are waiting months and months, and it’s like a, we call it the black hole,” she said. “As long as the Choice program has gone on, we’ve had progressively longer and longer wait times for Choice to provide the service, and we’ve had progressively less and less follow through on the Choice end with what was supposed to be their managing of the steps.” The follow-through is lacking in two ways. The first is the lengthy delay in approving care. And after that’s finally resolved, there’s a long delay in getting paid for the care. At least 30 doctors’ offices across North Carolina are dealing with payment problems, some that have lasted more than a year. Carolina Orthopaedic’s CEO Chad Ghorley said his practice is getting paid after it provides the care. It’s the lengthy delay on the front end that burdens his staff and, he worries, puts veterans at risk. He’s a veteran himself. “The federal government has put the Band-Aid on it when there’s such a public outcry to how the veterans are taking care of, all right?” he said. “Well, they’ve 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.” 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 Montana Public Radio, WFAE, NPR’s Back at Base project and Kaiser Health News. The article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

The Nondiscrimination in Health Programs and Activities states that women must be treated equally to men and bans discrimination based on race, color, national origin, age or disability and, for the first time, gender.

Early returns from the Health Care Innovation Awards, a CMS initiative that tests new payment and service delivery models, already "show a wide range of experiences that have resulted in tangible benefits for patients" and have helped the agency develop better policies, said CMS Chief Medical Officer Patrick Conway, MD.

The federal regulatory environment has not kept pace with the progress of mobile health, which is driven by consumers who expect to have all sorts of information, including health data, on their phones.

The Agency for Healthcare Research and Quality will dedicate nearly $2 million for the creation of the PCOR Clinical Decision Support Learning Network, aiming to address the barriers hindering the incorporation of patient-centered outcomes research into CDS tools.

Patricia Flatley Brennan, a professor at the University of Wisconsin at Madison, and a former practicing nurse with a Ph.D. in industrial engineering, will take the lead as director at the National Library of Medicine. The NLM is the world's largest biomedical library and the producer of digital information services used by scientists, health professionals and members of the public worldwide. National Institutes of Health Director Francis S. Collins, MD, announced the pick today. Brennan is expected to begin her new role in August 2016. "Patti brings her incredible experience of having cared for patients as a practicing nurse, improved the lives of homebound patients by developing innovative information systems and services designed to increase their independence, and pursued cutting-edge research in data visualization and virtual reality," Collins said in a statement. For seven years, Brennan worked in both critical care and psychiatric nursing. As Collins sees it, Brennan's combination of skills makes her ideally suited to lead the NLM in the era of precision medicine. She will take charge of the library as it becomes the epicenter for biomedical data science, not just at NIH, but across the biomedical research enterprise, he noted. At the University of Wisconsin-Madison, she is a professor at the School of Nursing and College of Engineering. She also leads the Living Environments Laboratory at the Wisconsin Institutes for Discovery, which is developing new ways for effective visualization of high dimensional data. Brennan is recognized as a pioneer in developing information systems for patients.   She designed ComputerLink, an electronic network to reduce isolation and improve self-care among home care patients. She directed HeartCare, a web-based information and communication service that helps cardiac patients at home to recover faster, and with fewer symptoms. Brennan also directed Project HealthDesign, an initiative designed to stimulate the next generation of personal health records. She also conducts external evaluations of health information technology architectures, and works to repurpose engineering methods for healthcare. She received a master of science in nursing from the University of Pennsylvania and a Ph.D. in industrial engineering from the University of Wisconsin-Madison. Following seven years of clinical practice in critical care nursing and psychiatric nursing, Brennan held several academic positions at Marquette University, Milwaukee; Case Western Reserve University, Cleveland; and the University of Wisconsin-Madison. NLM Acting Director Betsy L. Humphreys led the NLM over the past year, after Donald Lindberg, MD, retired having served more than 30 years. Twitter: @Bernie_HITN Email the writer: bernie.monegain@himssmedia.com Like Healthcare IT News on Facebook and LinkedIn

"With respect to some business practices: It's time to lead, follow or get out of the way," CMS Acting Administrator Andy Slavitt said at the 2016 Health Datapalooza in Washington, D.C. "If you want to lead the way with innovations that help consumers, great; if you want to follow by using established standards for data and measurement and technology, also great," he added. "If you have a business model which relies on silo-ing data, not using standards or not allowing data to follow the needs of patients – pick a new business model or pick a new business." On the heels of the April announcement of the proposed MACRA ruling, Slavitt spoke to healthcare innovators, industry leaders and developers early Tuesday evening. And while he had no further news to share with the specifics of the proposal, it was clear his intentions were firm. "What Vice President Biden said should stick with us: As taxpayers, we did not spend $35 billion so companies could build their own silos," Slavitt said. "At this stage, there's no room for business practices that don’t match the need of patients." On the forefront of Slavitt's thoughts were patients with the least access to care and an "obsession with a plight of the independent physician." However, "physicians are baffled by what feels like the 'physician data paradox.' They're overloaded on data entry and yet rampantly under-informed," Slavitt said. And the majority of providers are seeing a chasm between the time needed to invest in making the IT work and the actual positive results within their practices. "Technology isn’t doing the things we know it can," he added. "Help us make smarter decisions, reduce our wasted time, help us communicate or understand what to expect next." While these issues are troubling, according to Slavitt, the solution isn't the need for more IT inventions. But rather five crucial steps to initiate change in the healthcare industry: the massive release of data; changing incentives to reward providers for patient outcomes; creating "core" quality measures across all payers; advancing interoperability; and the proposed replacement of meaningful use. "These steps are designed to make it easier for you to innovate, to open up competition and to move the focus from designing around regulations, to allowing you to design around patients’ and physicians’ needs," Slavitt said. "The opportunity for you to transform healthcare into an information industry has never been more ripe or more urgent." Twitter: @JessieFDavis Email the writer: jessica.davis@himssmedia.com Like Healthcare IT News on Facebook and LinkedIn

Many physicians have waited with bated breath for the end of meaningful use, looking forward to a new era of less burdensome compliance requirements and more realistic reporting guidelines. This may not be what they had in mind.

The workgroup’s research found productivity hiccups in providers’ coding, and clinical documentation alongside positive impacts for payers in the areas of claims validation and data analytics. But isn’t it too early to tell whether the transition really went well? 

For Vice President Joe Biden, his National Cancer Moonshot Initiative is more than just a government program – it's personal.