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Hearing of the Health Subcommittee of the House Veterans' Affairs Committee - VA Fee Basis Care: Examining Solutions to a Flawed System


Location: Washington, DC

Good morning. This hearing will come to order.

Welcome and thank you all for being here for today's hearing, "VA Fee Basis Care: Examining Solutions to a Flawed System."

Recent years have seen tremendous growth in VA's Fee Care program, with independent assessments estimating growth of close to 300 percent from fiscal year 2005 to today.

Unfortunately, however, as the program has continued to grow, so have the management and oversight problems that have plagued the system through which the Department of Veterans Affairs (VA) provides care to veterans outside the walls of a VA facility.

It is seriously flawed, if not altogether broken.

In the last three years alone, the VA Inspector General has issued no less than seven separate reports detailing in-depth the serious deficiencies and challenges the Fee Care Program faces, including inadequate fiscal controls that have resulted in hundreds of millions of dollars in improper payments.

Further, last September, the National Academy of Public Administration (NAPA) issued a white paper on VA's Fee Care Program that drew alarming conclusions about VA's ability to effectively manage and oversee care and services under the program.

According to NAPA: VA's Chief Business Office has exercised limited and ineffective oversight of the Fee Care Program; the Program itself lacks operational objectives, performance goals, or, a clearly defined strategy for managing expenditures; and, VA doesn't understand what services are being procured through the Fee Program and at what cost.

There have been some bright spots. Congressionally-mandated pilot programs -- Project HERO and Project ARCH -- have shown promising results in achieving a more patient centered, coordinated, and cost-effective delivery model for fee care.

Small pockets of success - despite VA's reluctance to implement and utilize these programs to the fullest intent of Congress.

Recognizing the substantial deficiencies with the Fee Program, VA has begun implementing two new initiatives -- the Patient-Centered Community Care (PCCC) Program and the Non-VA Care Coordination (NVCC) Program.

The Department is going to testify today that these two initiatives will address all of the challenges the Fee Program faces and, "…ensure veterans receive effective and efficient non-VA care seamlessly."

I wish that I could believe that was true. However, given the history of failure we've seen already, I have serious reservations that the actions VA is taking will address the core challenges VA faces and not simply lead to further fragmented care and an inability to deliver quality care in rural communities.

Most notably, VA lacks the information technology (IT) and administrative services solutions essential to establish in-house the clinical information sharing and electronic claims processing vital to a successful care-coordinated and veteran-centric program.

VA spent approximately $4.6 billion dollars to purchase care in the community for veteran patients last fiscal year. That is billion, with a "b."

We cannot afford to allow VA to continue to flail and struggle to test new programs in an inherently flawed system. We cannot rely on promises from VA that they can finally get it right.

Our veterans are everywhere; VA can't be.

And, at the end of the day, what fee care is about is the effective and efficient delivery of care to veterans where they need it, when they need it.

Getting it right is about honoring their preferences, choices, and daily lives as well as their service to our country.

Getting it right is about telling a Vietnam or Korean-era veteran that he doesn't have to travel 4 hours to the nearest VA medical center for his cancer treatments.

He can go to a hospital closer to his home and spend the time he would have spent on the road getting better.

Getting it right is about telling a Gulf War veteran that she doesn't have to take a day off of work to drive to the VA clinic two towns over for a physical.

She can go to the doctor down the street if she would prefer and get to work on time.

Getting it right is about telling a young veteran, recently home from Iraq or Afghanistan, that he doesn't have to wait all day in a VA waiting room to see his doctor.

He can choose another provider who can see him now and spend the afternoon with the people he missed while he was overseas.

That is what we are talking about today. And those stories -- stories that my colleagues and I hear every day from veterans in our communities who are fed up -- are what I want all of us to keep foremost in our minds this morning as we talk about how to make this program better and get it right.

I now yield to the Ranking Member, Mr. Michaud [ME-SHOW] for any opening statement he may have.

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