Mission Act Trying 'Measured' Approach To Reach Rural Veterans

Apr 19, 2019

A program to allow veterans to receive care outside of the VA got mixed reviews over the past few years. Critics say “Veterans Choice” was rushed and poorly communicated. Supporters of the latest “Mission Act” say it addresses some of those shortcomings. We learn more in this week’s Friday Forum:

The U.S. Senate confirmed U.S. Secretary of Veterans Affairs Robert Wilkie in July of 2018. He came into office with a few goals in mind.

“In any military organization, your first job is to assess the folks who work for you and with you,” Wilkie said. “And to make sure that they have everything they need to carry out their job.”

But he says it’s been a tall order.

“My first job was to calm this place down,” Wilkie said.

He says he did that by “walking the post” or visiting veteran’s facilities in Hawaii, Alaska, Florida and in between.

Then, he said the goal was to streamline the record keeping process.

He says when his father concluded his service, including an injury in Cambodia, he was saddled with an 800-page paper record. It’s gotten better since then, but there were still vulnerabilities.

“We need to have an electronic record that is not only operable within the VA, but inter-operable with our private sector partners,” Wilkie said.

He says that could also flag possible misuses of prescribed medications.

His other main objective has been to implement the Mission Act. That meant tying it together with the Veterans Choice Act. Critics say it’s an attempt at privatization. Wilkie disagrees.

“If we were talking about privatization, we would be talking about what I would call the “Libertarian VA,” Wilkie said. “That is giving every veteran a card and saying ‘Thank you very much, now go out in the private sector and find everything that you want.'”

He says the Mission Act offers a veteran the choice to seek care outside of their primary VA facility if it does not offer the specialty they need.

“The Mission Act is clear,” Wilkie said “It says that the veteran’s health is the center of our effort, not the health of the institution, or the prerogatives of the institution, it is what is important to that veteran. If we can't provide that service, then we give the veteran the option which he or she is welcome to take, to go out into the private sector. Privatization would be the exact opposite.”

He says the VA’s budget is also growing as well as more jobs.

“That's a really strange way to privatize,” he noted.

One of the stumbling blocks with Veterans Choice was complaints about how directives were communicated to those who work directly with veterans, often veteran assistance commissions in cities and counties across the country.

“The [Veterans] Choice Act was put together in a very rushed manner,” Wilkie said. “It told an institution this large to change in 90 days.”

He says the Mission Act is trying to take a more measured approach to change. He hopes the expansion will reach more veterans through telehealth.

“It allows us to reach into a veteran's home when the veteran wants it,” Wilkie said. “It also allows our specialists to cut across jurisdictional lines in a way that no other healthcare system in the country can do.”

But with a pocketful of promises, Wilkie is still relatively new to the top post.

Steven Kreitzer is with the Veteran’s Assistance Commission in LaSalle County. His office works with veterans who may need help with mortgage or rent payments, emergency medical prescriptions, or transportation to VA hospitals.

He says the Veterans Choice Act was designed to reduce wait times and offer more options for specialized care outside of the VA facilities. But he agrees it had its fair share of flaws.

“The biggest issue with the [Veterans] Choice Act was that the payment to the vendors were not timely,” Kreitzer said.

He says that meant outside providers dropped out of the system.

“The new [Mission] Act has a lot more teeth,” Kreitzer said. “We've seen a lot of changes. Hopefully we are going to see a lot more providers come back on board.”

Kreitzer says in the last year he has noticed what he characterizes as “leaps and bounds” with the VA’s community care providers, which means the veteran can go to their primary doctor and ask to get referred in the community.

If the doctor feels that it's in the best interest of the veteran, and they can refer them to a community, they don't have to go all the way to Madison or Hines for care that is available much closer.

“Especially if it's something that's re-occurring like dialysis, cancer treatment, or physical therapy,” Kreitzer said.

As far as fears of privatization?

“I don't see it as a move towards privatization,” Kreitzer explained. “I've known a lot of veterans who come through here in the office and they prefer to go to Hines and stay in the system rather than go in the community because the care is so much better than it used to be.”

He says he’s also intrigued with an increase in the use of telemedicine to connect rural veterans with specialists.

That includes a location to engage with a doctor just by going to the local American Legion in Ottawa.

“You can go to that Legion and they'll have all everything set up where you can see the doctor,” Kreitzer said.

Still, Kreitzer says his wish list would be to have a larger, physical medical facility closer to the veterans he works with, but he says he understands it would be a tough sell to build far from a metro area. For now, he says he's appreciative to have the ear of administrators who are serving vets in the larger cities.