Veterans across the country have felt the effects of the Department of Veterans Affairs' battle to retain patients and keep funding since the Mission Act passed, USA Today and CBS8 reported Nov. 2.
The Mission Act was signed by former President Donald Trump in 2018 and was meant to ensure that veterans had access to the highest-quality treatment. It stipulates that if the VA cannot supply adequate care for several reasons, it must pay another private provider to do so.
An investigation by USA Today and CBS8 has unearthed documents showing that the VA has been overruling physicians' recommendations in order to keep patients within its health system in an attempt to save money.
Since the act passed, more of the 9 million enrolled veterans than expected sought treatment outside the VA's health system, the largest in the nation. This forced the agency to spend money on private care and has the potential to shrink the VA's own hospital budgets, according to CBS8. Kathleen Kim, MD, the San Diego VA chief of staff, said sometimes physicians incorrectly refer patients externally.
"Because of the nature of the Mission Act, the VA is sending a lot of care in the community, and frankly we're worried that we're not going to be able to pay our bills," said Dr. Kim. However, a national official of the VA said that they have "sufficient funds" to send patients for private care.
Still, the VA started an initiative to return veterans to its hospitals. Some hospitals set up teams to review medical records and use algorithms to decide whether patients qualify for external care. They can also require checkups at VA hospitals even for patients approved for out-of-system treatment, making care potentially burdensome and complicated.
"It basically defeats the whole purpose of the Mission Act," said Darin Selnick, senior adviser to Concerned Veterans for America and former VA adviser under the Trump administration. "It's about what the patient needs, not what the VA needs."
However, VA officials said that they are following the rules established by the Mission Act and that patient medical need is the deciding factor for treatment options. Hospital physicians and managers at the VA also said that they can deliver the most effective care internally because they can coordinate the care, paperwork and treatment plans far more easily within the system.