[House Hearing, 115 Congress]
[From the U.S. Government Publishing Office]
PARTNERING, PAYMENT, AND PROVIDER ACCESS:
VA COMMUNITY CARE IN NORTH CAROLINA
=======================================================================
FIELD HEARING
Fayetteville, NC
BEFORE THE
COMMITTEE ON VETERANS' AFFAIRS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED FIFTEENTH CONGRESS
SECOND SESSION
__________
FRIDAY, MARCH 23, 2018
__________
Serial No. 115-55
__________
Printed for the use of the Committee on Veterans' Affairs
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Available via the World Wide Web: http://www.govinfo.gov
__________
U.S. GOVERNMENT PUBLISHING OFFICE
35-468 WASHINGTON : 2019
--------------------------------------------------------------------------------------
For sale by the Superintendent of Documents, U.S. Government Publishing Office,
http://bookstore.gpo.gov. For more information, contact the GPO Customer Contact Center,
U.S. Government Publishing Office. Phone 202-512-1800, or 866-512-1800 (toll-free).
E-mail, [email protected].
COMMITTEE ON VETERANS' AFFAIRS
DAVID P. ROE, Tennessee, Chairman
GUS M. BILIRAKIS, Florida, Vice- TIM WALZ, Minnesota, Ranking
Chairman Member
MIKE COFFMAN, Colorado MARK TAKANO, California
BRAD R. WENSTRUP, Ohio JULIA BROWNLEY, California
AMATA COLEMAN RADEWAGEN, American ANN M. KUSTER, New Hampshire
Samoa BETO O'ROURKE, Texas
MIKE BOST, Illinois KATHLEEN RICE, New York
BRUCE POLIQUIN, Maine J. LUIS CORREA, California
NEAL DUNN, Florida KILILI SABLAN, Northern Mariana
JODEY ARRINGTON, Texas Islands
JOHN RUTHERFORD, Florida ELIZABETH ESTY, Connecticut
CLAY HIGGINS, Louisiana SCOTT PETERS, California
JACK BERGMAN, Michigan
JIM BANKS, Indiana
JENNIFFER GONZALEZ-COLON, Puerto
Rico
Jon Towers, Staff Director
Ray Kelley, Democratic Staff Director
Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public
hearing records of the Committee on Veterans' Affairs are also
published in electronic form. The printed hearing record remains the
official version. Because electronic submissions are used to prepare
both printed and electronic versions of the hearing record, the process
of converting between various electronic formats may introduce
unintentional errors or omissions. Such occurrences are inherent in the
current publication process and should diminish as the process is
further refined.
C O N T E N T S
----------
Friday, March 23, 2018
Page
Partnering, Payment, And Provider Access: VA Community Care In
North Carolina................................................. 1
OPENING STATEMENTS
Honorable David P. Roe, Chairman................................. 1
Honorable Neal Dunn, Member, U.S. House of Representatives....... 2
Honorable Richard Hudson, Member, U.S. House of Representatives,
(NC-8th)....................................................... 3
Honorable Robert Pittenger, Member, U.S. House of
Representatives, (NC-9th)...................................... 4
WITNESSES
David W. Catoe FHFMA, Assistant Vice-President, Patient Financial
Services, Atrium Health........................................ 6
Prepared Statement........................................... 30
Sarah Verardo, Executive Director, The Independence Fund......... 8
Prepared Statement........................................... 31
Staff Sergeant Gary B. Goodwin (Ret.), Veteran, U.S. Army........ 11
Prepared Statement........................................... 33
Chief Master Sergeant Daryl D. Cook, Chief, Fire Emergency
Services, 145th Civil Engineering Squadron/Civil Engineering
Flight, North Carolina Air National Guard...................... 13
Prepared Statement........................................... 36
DeAnne M. Seekins MBA, Network Director, VA Mid-Atlantic Health
Care Network (VISN 6), Veterans Health Administration, U.S.
Department of Veterans Affairs................................. 14
Prepared Statement........................................... 37
Accompanied by:
Mark E. Shelhorse M.D., Interim Medical Center Director,
Fayetteville VA Medical Center, Chief Medical Officer, VA
Mid-Atlantic Health Care Network (VISN 6), Veterans
Health Administration, U.S. Department of Veterans
Affairs
Joseph Enderle, Program Manager, Veterans Choice and VA
Timely Payment Initiative, Delivery Operations, Office of
Community Care, Veterans Health Administration
PARTNERING, PAYMENT, AND PROVIDER ACCESS: VA COMMUNITY CARE IN NORTH
CAROLINA
----------
Friday, March 23, 2018
Committee on Veterans' Affairs,
U. S. House of Representatives,
Washington, D.C.
The Committee met, pursuant to notice, at 10:00 a.m., at
the Fayetteville Technical Community College, General Classroom
Building Rooms 108 and 114, 2817 Fort Bragg Road, Fayetteville,
NC, Hon. Phil Roe [Chairman of the Committee] presiding.
Present: Representatives Roe and Dunn.
Also present: Representatives Hudson and Pittenger.
OPENING STATEMENT OF DAVID P. ROE, CHAIRMAN
The Chairman. The Committee will come to order.
Good morning. I want to thank all of you all for being
here. I want to give a special shout-out to Dr. Larry Keen, who
is President of the community college here, for allowing us to
use this great facility, and I want to thank all of you all who
are here.
This is an official hearing of the Veterans' Affairs
Committee, and I really enjoy these because it is actually
where we bring the government to the people, not the other way
around. I have done many of these around the country and have
found them very beneficial.
My name is Dr. Phil Roe, and I represent Tennessee's 1st
Congressional District, which is just across the line from you
guys. I am a taxpayer in North Carolina, so I think I feel
welcome here.
[Laughter.]
The Chairman. I have a condo in Banner Elk, so I pay taxes
in your great state.
Tennessee's 1st Congressional District is a very historic
district. It is the only district in America that has had two
presidents, Andrew Jackson and Andrew Johnson. Andrew Johnson
was the first person to hold my seat, and we had one other
famous Tennessean who held my seat, and we have all watched him
on TV. Davy Crockett was a congressman from the 1st District,
and I am honored to serve as the Chairman of this great
Committee, the Veterans' Affairs.
I would like to start today by thanking Congressman Hudson
for his enthusiasm for hosting this veteran-specific hearing
today. We have been forced to reschedule this hearing a couple
of times, and I told Richard on Monday, I said this looks like
another train wreck that is about to happen with the budget.
But, Richard, thank you for hosting this.
He has been a true champion for veterans in Washington,
D.C., and I am honored to be here with you today and to deep
dive into the issues and problems.
I also want to thank Congressman Dr. Neal Dunn, who is a
veteran, as I am, who serves on the Veterans' Affairs
Committee. Neal is a pretty old looking freshman, but this is
his first term.
[Laughter.]
The Chairman. I, too, was a very old freshman. And also,
one of your own, Robert Pittenger, who is also joining us.
Robert and I have been great friends since he has come to
Washington.
Dr. Dunn is both a surgeon, as I said, and a veteran, and
he serves along with me. He shares my desire to bring both
private-sector efficiencies and high-quality health care to the
VA to our veterans.
Congressman Pittenger represents North Carolina's nearby
9th Congressional District and literally jumped at the
opportunity to join us at this field hearing for nearly 150,000
veterans living in this area, and I thank both of you all for
joining us.
In this part of the country, as is the case in my backyard,
over the mountains, veterans often face extraordinary burdens
in receiving VA health care, whether at VA facilities or
through an overly complex administrative system of non-VA
authorizations.
My goal for this hearing is to identify opportunities for
VA to build and improve upon its relationship with local health
care entities and hopefully reduce the burden we ask these
veterans and local providers to endure.
I also hope to gain a better understanding of what
resources and support of VA facilities and staffing
requirements are needed for the provisions of appropriate and
timely care in this part of North Carolina. Let's take this
opportunity to look towards the future needs of veterans who
live here to improve the access to and the quality of their
care, and discuss what steps VA can take today to strengthen
community partnerships and team with providers who are also
eager to serve veterans in this catchment area.
Before we begin, I ask unanimous consent that Congressmen
Hudson and Pittenger be allowed to join our Committee
proceedings today.
Without objection, so ordered.
With that, I will yield to Dr. Dunn of Florida for 5
minutes for any opening remarks that he may have.
You are recognized.
OPENING STATEMENT OF HONORABLE NEAL DUNN
Mr. Dunn. Thank you very much, Mr. Chairman. I will not
consume 5 minutes. I just want to say and also convey a thank-
you to my friend and colleague, Representative Hudson, for
inviting me back to Fayetteville. I have known Rich as a very
strong advocate for the active-duty troops and for the veterans
in his district, and indeed across the country in the time I
have been in Washington, and I thank you very much for your
tireless efforts. Rich took me to Afghanistan a few months ago,
and we spent Thanksgiving there serving the troops, and it was
a great experience for me.
I was stationed here at Bragg twice in my military career,
and it is great to come back. It seems like you always come
back to Fort Bragg. There is something funny about that.
I do also want to say thank you to the House Veterans'
Affairs staff that has worked very hard to put this together.
It is always a little extra work to put together a hearing on
the road, but it is worth it. We absolutely know, we have
demonstrated time and time again that we have to come out here
and listen to you, we can't just have people come to Washington
and talk to us. So I am very, very grateful for that
opportunity.
With that, I will also say thank you to my good friend,
Robert Pittenger, who is a local congressman right here.
With that, I will yield back my time.
The Chairman. I thank the gentleman for yielding.
I now recognize Representative Hudson for any opening
remarks he may have.
OPENING STATEMENT OF HONORABLE RICHARD HUDSON
Mr. Hudson. Well, thank you, Chairman. I appreciate this
opportunity and welcome everyone here today. I want to
particularly thank the Chairman for agreeing to host this
hearing here in our community. We have no stronger advocate on
behalf of our veterans than Dr. Phil Roe, Chairman of the
Veterans' Committee. He is just tireless, he himself, for being
a Vietnam-era veteran, and he has been very successful in
getting legislation to President Trump to help our veterans. He
is a tremendous leader, and it is just an honor to have you
here with us, Mr. Chairman.
I also want to thank Congressman Dunn for being here. As he
said, he and I traveled to Afghanistan over Thanksgiving, where
we spent some time with folks from 82nd Airborne down to
Kandahar and some other places we can't tell you about, but it
was really an honor to be there with the troops. Dr. Dunn has a
real heart for our soldiers, and welcome back after serving two
tours here himself as an Army surgeon.
I also want to thank Congressman Pittenger for being here.
Robert Pittenger works hand in hand representing this
community. Robert Pittenger cares deeply about our veterans. I
have seen the work he does on veterans' behalf, and I am proud
to stand shoulder to shoulder with Robert, and I appreciate you
being here with us today.
We also have two outstanding senators here in North
Carolina, Senator Burr and Senator Tillis, who I lean on all
the time to help me with veterans' cases. When they get tough
and I run into a roadblock, I call one of the two senators and
they usually break it for me. They are represented today.
Austin Sheer is here from Senator Tillis' office, and Janet
Bradbury representing Senator Burr, and we appreciate you all
being here with us.
Each and every one of us is here today because we truly
care about our Nation's veterans. It is impossible to ever
repay our veterans for the service and the sacrifice, so
ensuring that we keep our promises that every veteran is
provided with the care they deserve is the most sacred
responsibility I have.
My greatest honor in life is I represent 54,000 men and
women at Fort Bragg and the families and the veterans in this
community. Simply put, these individuals represent the best
among us, the best our Nation has to offer. Every year, more
and more veterans are choosing to relocate or stay right here
in North Carolina after their service, and I think that is a
good thing, but it is also a challenge. We have the fastest
growing veteran population, the fastest growing VA in the
country. That brings us both opportunities and challenges, but
it is something that we are proud of.
But veterans have been provided opportunities to interact
with a very tight-knit military community here, and businesses
are able to capitalize on the expertise of hiring veterans. So
I think it is a tremendous opportunity. However, the challenges
that come along with this rapidly growing veteran population,
one of these challenges is meeting the unique needs of veterans
when it comes to health care.
Generally speaking, I believe the Fayetteville VA Medical
Center does an exceptional job at taking care of the veterans
who seek treatment there. Many of the folks who work there are
veterans themselves. However, there is no way that they alone
can provide all the care in a timely fashion to the veterans of
this community and meet this growing population. That is why it
is critical we continue to work to improve the relationship
between the VA and medical providers in the community, so
veterans have the choice to receive care within the VA system
if they choose, or from a community provider that may better
suit their unique needs.
Every case is different, which is why a one-size-fits-all
approach will never work. Since coming to Congress, I have
worked to expand the ability of veterans to choose their health
care provider, whether that be within the VA or in the
surrounding community. I have legislation called The Care
Veterans Deserve Act that does just that, and many of the same
principles have been incorporated in the Chairman's
legislation, the VA Care in the Community Act, which I am very
proud to have supported.
I am encouraged by the Committee's efforts to simplify and
expand opportunities for programs, and I look forward to
continuing to work to pass meaningful reforms in Congress on
behalf of our veterans. I am excited to hear from our witnesses
today. I want to thank each one of you for making the time to
be here. It is very important.
Mr. Chairman, with that, I will yield back the balance of
my time.
The Chairman. I thank the gentleman for yielding.
I will now yield 5 minutes to Representative Pittenger for
any comments that he may wish to make.
OPENING STATEMENT OF HONORABLE ROBERT PITTENGER
Mr. Pittenger. Thank you, Chairman Roe. I certainly
appreciate and respect your leadership for the veterans. You
are doing an extraordinary job.
I spent a little bit of time with him in the Congress, a
little bit of time off Congress. We played a game of golf
together.
The Chairman. I am not very good, either.
[Laughter.]
Mr. Pittenger. The thing of it is, he never left the
fairway, and I never got in the fairway.
[Laughter.]
Mr. Pittenger. But Richard Hudson, what a remarkable leader
you are for veterans. Thank you for all the efforts that you
have been through to organize this meeting; Chris, your man
right over here, who really did the work. I have a similar man,
Bob Becker, who is here, who serves about 400 to 500 veterans
at any given time. So we are very much acclimated to the
concerns.
Dr. Dunn, thank you for making your way up here from
Florida, and I hope you enjoy our weather.
To each of you all, we are not coming here with an ax to
grind. The old adage of Sergeant Friday, ``Just the facts,
ma'am, just the facts,'' that is all we want today are facts.
We want to know what is best for our veterans. We do believe
that the Veterans' Accountability Act can improve that process,
giving more authority to the director. We certainly have a good
director here. I met him over at Landstuhl in Germany when they
released the hostages. I was sent over there by the White House
to greet them, and he is remarkable. I know you are going to
have great leadership here. I think he is going to do a great
job.
But this is important for this community. It is important
for our veterans. Each of us who represent them and represent
you are here to want the best, and I know that is the interest
of all of us. So I thank all of you for being here, for your
expertise, for what you bring to the table, and what you will
mean to the lives of those who served our country with
distinction, with a great labor of love and commitment, and
they deserve the best from us.
God bless you.
The Chairman. Thank you, Robert. Thanks very much.
Before I introduce our witnesses, can you all hear in the
back? Are we loud enough? I got an open ``yes.'' We will try,
when the witnesses speak, we will try to speak up. I don't know
if you can turn the mics up a little bit or not, because it is
a large room. We will try to get where you can hear us, and I
apologize if you cannot.
But I want to remind everyone today that this is a formal,
official congressional hearing. It will go into the
Congressional Record.
We have one panel of witnesses, and only those invited to
testify will be permitted to speak. Each panelist will have 5
minutes for their opening remarks, and I respectfully ask that
our panelists keep an eye on the timer that we set for you
here. The green light goes on, amber light at 1 minute, and
then the red light when your time has expired.
There will be an opportunity after the hearing for those of
you in the audience who want to come up and speak with myself
or other Members of our staff if you have questions or need
assistance. We will be glad to do that.
Joining us on our first and only panel this morning is Mr.
David Catoe, the Assistant Vice President of Patient Financial
Services for Atrium Health; Mrs. Sarah Verardo, Executive
Director for The Independence Fund. We first met, I believe, at
the White House. Is that correct?
Ms. Verardo. Yes, correct.
The Chairman. I appreciate you being here.
Staff Sergeant Gary B. Goodwin, retired, U.S. Army veteran.
Thank you, Sergeant.
Chief Master Sergeant Daryl Cook. When I went in the
infantry, it was explained to me this way, that the command
structure was God, command in general, and the Chief Master
Sergeant, but not necessarily in that order.
[Laughter.]
The Chairman. I am not sure whether that is still the case
or not, but I suspect that it is.
He is the Chief of Fire Emergency Services for the 145th
Civil Engineering Squadron and Civil Engineering Flight of the
North Carolina Air National Guard. Welcome.
Mrs. DeAnne Seekins, Network Director for the Mid-Atlantic
Health Care Network, or VISN 6, for the Veterans Health
Administration. Thank you so much for being here.
Ms. Seekins is accompanied by Dr. Carl Bazemore, who is the
Acting Chief Medical Officer for VISN 6 for the Veterans Health
Administration. Also accompanying Ms. Seekins is Joseph
Enderle, the Program Manager for Veterans Choice and VA Timely
Payment Initiative, Delivery Operations of the Veterans Health
Administration.
I thank all of you all for being here today and for all the
good work that each of you do to serve our veteran neighbors
here in North Carolina across VISN 6.
Mr. Catoe, we will begin with you. You are now recognized
for 5 minutes.
STATEMENT OF DAVID W. CATOE, FHFMA
Mr. Catoe. Good morning. As a veteran retired Air Force
officer, I want to thank this Committee for the opportunity to
speak on behalf of Atrium Health, formerly known as Carolinas
Healthcare System. Atrium Health has always had an outstanding
relationship with our veterans in all the communities that we
serve, and we consider it a privilege to provide their medical
care. In fact, going back to January 2016 through February
2018, or the past 26 months, Atrium Health has provided care on
approximately 33,000 occasions or times that veterans have
visited our health care system. Our health system has been
recognized numerous times for supporting military personnel and
veterans through awards such as the Secretary of Defense
Freedom Award, the Secretary of Defense Patriot Award, and
being a Top 10 Military Friendly Employer. As we work to
further support our military veterans, I would like to take a
few minutes to highlight some of the issues that Atrium Health
is working to overcome in coordinating claims administration
with the VA programs.
First of all, medical records. Atrium Health often submits
multiple hard-copy medical records to the VA for the same
patient encounter due to VA being unable to locate and match
records with the claims. This burdens hospitals
administratively and presents potential HIPAA privacy concerns.
However, hospitals have no other option but to continue this
process to receive payment. In a recent random sample of 19
claims, on average, Atrium Health had to submit medical records
two-and-a-half times per claim. Sixteen of the 19 claims
required records to be sent at least twice, one was sent five
times, and four were sent four times. Other commercial payers
have portals through which medical records and other
documentation are uploaded to attach the claims, and this helps
avoid printing and mailing sensitive medical record
information. We believe it would be beneficial for VA to
implement a HIPAA-compliant system like the other payers for
this process.
Second, authorizations. During the period of January 2016
through February 2018, Atrium Health received over 2,458
denials for claims totaling $24 million relating to
authorization issues. As recently as two days ago, I received a
congressional inquiry regarding an unpaid VA Choice claim
dating back to March 2017 for a missing authorization number.
When veterans present for medical care at Atrium Health, we
treat them as our priority. Most veterans do not have the
authorization number when they present, and so we have to try
to obtain the number after the fact. Because there is both a
clinical and claims component in the authorization process,
there are often handoffs occurring which have led to trouble
during claims administration. For example, VA faxes
authorizations to a fax number in Clinical Case Management at
our hospital. When we call the VA to obtain an authorization
number, they often cannot provide us that number. It would be
much more efficient and convenient for everyone if the VA could
establish a payer portal so that authorizations could be pulled
by the provider electronically and added to the claim. This
would eliminate unnecessary calls to the VA for the
authorization number and improve the service to our veterans.
Third, excessive hold times. Atrium Health claims
specialists experience excessive hold times when calling for
claims status. It is not uncommon to be on hold from 25 minutes
to three hours before reaching a claims representative. For VA
Choice claims, we are only allowed to ask about three claims at
a time before having to hang up and call back and repeat the
entire waiting process to follow up on additional claims. We
have also had to leave phone messages and emails with provider
relations in the past since we could not contact a live person,
but rarely do we ever receive a reply call. The claims
specialists at Atrium Health who work VA claims are often
frustrated and demoralized due to the stress encountered as
their productivity diminishes when spending so much time
waiting for assistance. More VA claims representatives are
needed to eliminate the volume of calls and the excessive wait
times. The average wait time for a VA claims specialist is 60
minutes on 10 accounts reviewed in February and March. The
longest was 110 minutes, while the shortest was 25 minutes.
Education. VA needs to provide better education to the
providers and veterans in explaining the different requirements
and programs available. Currently, these programs are very
confusing to even an experienced VA claims specialist. I cannot
imagine the confusion that many veterans experience in trying
to coordinate their care within the VA. An excellent example is
the Other Health Insurance amended regulation dated January
9th, wherein VA advised that providers must bill other health
insurance before the VA, and then the VA may be billed
secondary to the other health insurance for emergency services.
VA is an entitlement and not an insurance program. By law,
it is prohibited from paying deductibles, co-insurance, and co-
payments incurred by billing the other health insurance. Yes,
veterans still believe the hospital has the option to bill VA
over other health insurance, and they blame us, of course, when
the veteran is required to pay a $1,000-plus deductible when we
bill the other health insurance, saying we should have billed
VA first. With more communication, awareness, and education
about the programs, there should be less confusion and more
efficiencies in place to better serve our veterans.
Again, thank you for allowing me the privilege to discuss
some of the opportunities that our health system believes can
improve our veterans' experience as we provide medical care and
the subsequent filing of claims with the VA. We are pleased to
work with you and the VA to make the claims process more
streamlined, efficient, and friendlier. Thank you.
[The prepared statement of David N. Catoe appears in the
Appendix]
The Chairman. Thank you, Mr. Catoe.
Ms. Verardo, you are recognized for 5 minutes.
STATEMENT OF SARAH VERARDO
Ms. Verardo. Thank you for having me, Chairman Roe, and
providing the opportunity to testify. I am Sarah Verardo,
Executive Director of The Independence Fund. Our national
headquarters are here in Charlotte, North Carolina.
I want to give special thanks to Representative Hudson for
recommending that we testify today. He is an amazing friend to
The Independence Fund and the strongest of champions for
veterans here in North Carolina, and likewise I would say the
same about Representative Pittenger. Both men have been
incredible friends to my family, to my husband. Representative
Hudson has followed his journey since Walter Reed, and I think
few people were more excited to see my husband walking than
Representative Hudson, so I sincerely thank all of you.
Mr. Chairman, I have submitted a much more extensive
written testimony to your staff, and I ask, sir, that it be
entered into the record in its entirety, please.
The Chairman. Without objection.
Ms. Verardo. On April 24th, 2010, my husband, Michael
Verardo, was catastrophically wounded by an IED in southern
Afghanistan. His left leg and arm were immediately blown off.
While he was dragged to the casualty collection point, the IED
continued to detonate daisy-chain style, resulting in a large
area of third-degree burns over 30 percent of his body. He
suffered a lot of facial trauma. The IED was an old Russian
landmine that the Taliban had connected to two 15-gallon jugs
of homemade high explosive. The debris within the IED blew out
his eardrums, caused severe facial damage, and he wasn't
expected to survive. He had a field non-FDA-approved blood
transfusion to stay alive.
When a servicemember is injured, there are several
classifications of the medical evacuation: not seriously
injured, seriously injured, or very seriously injured. Mike's
Medevac was called in as very seriously injured, expected dead
on arrival. He was not expected to live. He remained in a coma,
but he is a fighter, and for the next five weeks he was listed
as death imminent.
Through incredible efforts of Army medical teams, not only
did Mike survive, his left arm was reattached partially and
reconfigured. He eventually learned to walk on a prosthetic
leg, and now we live outside of Charlotte, North Carolina with
our three young daughters.
While Mike was not retired from the Army until 2013, I must
say the Army medical care and the DoD care within the Warrior
Transition Battalion at both Walter Reed and Fort Sam Houston
was incredible. He endured over 100 surgeries and years of
speech, visual, physical, and occupational therapies, and he
thrived. There were no bureaucratic hurdles within our DoD
process.
Unfortunately, the same cannot be said for our transition
to VA care. While most of the medical providers we have had
have been exceptional, first rate, the medical administration
staff with whom we usually deal appeared disinterested,
skeptical of medical requests, more concerned with preventing
fraud than allowing common sense to prevail, and not interested
in optimizing veteran health care.
For example, after Mike retired from the Army, we moved
back to our home state of Rhode Island, and despite being rated
by the VA with the highest possible rating and being enrolled
in VA health care, no one in VA knew we were coming back to
Rhode Island or who Mike was, and we had to wait seven weeks
for our first appointment even though he still had open wounds,
a poly-trauma case, and exceptionally complex medical regimes.
I went on YouTube to learn how to re-pack his wound dressings
myself, and I had a fire department bring him in and out of the
home because we had not been set up with any type of specially
adaptive housing from VA.
In the same vein, Mike's prosthetic leg was damaged, and we
waited 57 days for a signature on a form authorizing it. In the
meantime, I duct-taped his leg back together.
The catastrophically wounded and disabled veterans we serve
at The Independence Fund have similar stories of the VA health
care system. We believe much of this is because VA standards of
care and formularies do not take into account the complex
issues of the catastrophically wounded. Therefore, Mr.
Chairman, we recommend any future legislation to define when
and where veterans are eligible for non-VA care. They should
establish separate specific access and quality standards for
catastrophically disabled, where they qualify for non-VA care,
even if the standard access and quality standards are otherwise
met.
Mr. Chairman, we share your disappointment. The compromise
VA and caregiver reform legislation you helped negotiate and
you championed was rejected by the minority Members of the
Committee. However, we were concerned that both bills
originally passed by the House and Senate Veterans' Affairs
Committees still relied on VA to determine when and where
veterans can access non-VA care. Again, our experience is the
medical administration bureaucracy will block most attempts of
medical providers to prescribe non-VA care and only will
authorize it if forced to do so.
I would like to give you another example about my husband
for that point. His residual left leg suffers numerous skin
injections that make the prolonged use of prosthetic sleeves
extremely dangerous for him. Because of that, his VA surgeon
prescribed within her own hospital system a specialized
prosthetic sleeve nine different times, and nine times VA's
medical administrators, who have never met or treated my
husband, denied those prescriptions because they were not
formulary.
Mr. Chairman, we cannot rely on VA health care providers
being able to prescribe non-VA care when needed. Those VA
health care providers are powerless to provide non-VA care when
the bureaucrats have every incentive to deny the care and have
every power to do so, far more than the actual providers who
are taking care of these heroes. Only when individual veterans
have the authority to choose their own health care provider
will veterans be able to access optimal care in a timely
fashion.
Finally, we believe that VA's prosthetic and wheelchair
repair/replacement program should be out-sourced to non-VA
providers. Our experience and that of our clients is that the
VA doesn't deliver or make attempts to deliver wheelchair and
prosthetic repairs in a timely manner. For example, we have
requested wheelchair and prosthetic repairs and replacements
from VA, and I have been told four different times within this
VISN that I must bring my husband three hours round trip so
that they can confirm that he does, in fact, still have his
injuries, as though limb loss would be anything other than
permanent. Delays of seven to ten weeks are not unusual for
these requests.
We note the Inspector General report released a week ago
detailing similar problems with wheelchair and prosthetic
repairs in VISN 7. That report noted the VA has no standard for
how long it should take to repair wheelchairs or scooters, no
standard at all. It also found the average wait time was 99
days. Some of these veterans were bedridden for more than 100
days while waiting.
The report detailed an unnecessarily complex repair
authorization process. We recently had the opportunity to meet
with VA Central Office, and we are looking to enter into a
Memorandum of Understanding with VA to help them improve those
processes, and we would love your support, sir, in doing so.
We do not believe that VA will ever be able to adequately
respond to veterans' prosthetic and wheelchair replacement
needs in a timely manner. The rules are simply too cumbersome
and limiting, and we recommend that veterans be allowed
immediate access to non-VA care for the repair or replacement
of prosthetics, wheelchairs, and scooters.
I would like to end, sir, by telling all of you that you
will notice how often in society people say that something
costs an arm and a leg, and my husband's military service
actually did. I will live forever with the consequence of him
raising his hand and saying, ``Send me.'' My children will live
with that consequence of him giving almost everything he has of
himself at 25 years old, becoming eligible for nursing home
care, and here we are nearly eight years later, and our days
will never be normal, they will never be stable. The terrorist
enemy took so much from my entire family and our future.
So, sir, I am not only here as the Executive Director of a
very large national veteran service organization but as a
military spouse and veteran caregiver, begging all of you to
please keep pushing until we get it right for heroes like my
husband, and I thank you.
[The prepared statement of Sarah Verardo appears in the
Appendix]
The Chairman. Thank you for your very compelling testimony,
Ms. Verardo.
Sergeant Goodwin, you are recognized for 5 minutes.
STATEMENT OF STAFF SERGEANT GARY B. GOODWIN
Sergeant Goodwin. Thank you, Mr. Chairman and Members of
the Committee present today. It really is an honor for me to be
here today to offer testimony. I previously offered written
testimony, and I ask that be entered in the Congressional
Record.
The Chairman. Without objection.
Sergeant Goodwin. Thank you, sir.
My name is Gary Goodwin. I am a veteran of the United
States Army, having retired in 2009 after 23 years of service.
Before I offer brief testimony, I want you all to know that my
issues today are in no way with the quality medical care that I
receive from the Fayetteville VA Medical Center. For those
representatives of the VA Medical Center, and I know our new
director is present as well, I want to say thank you. I am 100
percent happy with the quality care that I receive from that
facility. I think it is a shame that the media tends to zero in
on the negative and not accentuate the positive.
I also want to say, Ms. Verardo, thank you so much for you
and your family. I almost feel ashamed to be here today--
Ms. Verardo. No, please.
Sergeant Goodwin [continued].--to offer my testimony,
having heard your compelling story. My heart goes out to you
and your family. It really, really does.
Also, I want to thank my primary care provider here at the
VA Health Care Center, Dr. Abul Azad. Dr. Azad has been my
primary care provider for several years now. He is a great man,
he is a wonderful physician, and he provides me with care and
compassionate service every time I am there, as well as two of
his nurses who I became very familiar with, Ms. Lillian
Figueroa and Ms. Tracy Ford. I always enjoy seeing them
whenever I go to the VA Health Care Center for my care.
The past four years have been kind of medically challenging
for me. I underwent three major surgeries, two minor
procedures, numerous hospitalizations, and countless ER and
urgent care visits. This includes experiences not only directly
with the VA Health Care Center here in Fayetteville, but I have
also received services through Veterans Choice, as well as non-
VA care. So I do have a familiarity with those programs as
well.
But I was asked to speak to you today by Congressman
Hudson--and thank you, sir, for asking me to come today--
regarding a specific issue that has not yet been 100 percent
resolved. If you will bear with me, I will just go ahead and
read from my documentation.
I have encountered an issue with the VA that I have been
unable to resolve on my own after repeated attempts to do so,
and this is regarding non-payment of non-VA medical expenses
that have been approved by the VA for payment. I am offering
testimony regarding this issue as I can only imagine that I am
probably not the only veteran who has ever encountered this
problem.
On July 22, 2016, a Friday evening, I sought ER care at a
non-VA facility for issues related to a recent thoracic
surgery. I followed the appropriate procedures and notified the
Fayetteville VA Medical Center the following Monday, July 25th,
to let them know that I had this non-VA care, that it was
follow-up care within the 90-day global window of the thoracic
surgery that I recently had that had been--I had been sent out
to a local hospital from the VA to have that procedure. After
several inquiries to the VA, I finally received a letter from
the Fayetteville VA, dated January 13, 2017, stating that my ER
visit, that that had been verified as an episode of care, which
is the kind of language that they use, and also that my claim
had been approved by Salem, referring to the Salem VA office
where the payment was coming from, and that payment was
pending.
Well, I can tell you, as of last Friday, after several
inquiries, the bills for the emergency room, the emergency room
physician, and the emergency room radiology service have
finally been paid. That just occurred within the last week and
a half to two weeks. The bill that is outstanding, the one that
I contacted Mr. Hudson's office about, was the EMS bill. The
EMS provider had never been paid by the VA. They took my
account to collections. From there, they initiated garnishment
against any North Carolina tax refund. And when they sent me to
collections, all of a sudden, my credit score with the credit
reporting bureaus went from 820 to 670. In today's world,
credit makes the world go around, and you can't get a loan for
a box of doughnuts when you have a credit score of 670.
I have made repeated contact attempts. I have my file
documentation here of all the phone calls, emails, face-to-face
meetings with personnel at the Fayetteville VA Medical Center,
and the non-VA care office regarding this issue, and they have
all been very helpful. I think it is really the bureaucracy
that has kind of tied their hands.
Last Friday, I had a conversation with the VA
representative in the non-VA care department, and they were
telling me that that bill had been approved for payment, but it
was sent to Texas. When I inquired, ``What do you mean by sent
to Texas?'' nobody could offer me any type of an explanation.
As a matter of fact, the gentleman I was speaking to got rather
frustrated with me, as though my inquiries were kind of hitting
the hot button with him.
So, in a nutshell, that is what I am here about today, just
to offer you testimony regarding my personal experience. I look
forward to working with the VA regarding this issue, and I am
hopeful that in the very near future the VA is going to attend
to the EMS bill that they previously told me in writing they
were going to pay for, and I hope they are going to stand by me
to help restore my good credit.
Mr. Chairman, with that, thank you.
[The prepared statement of Sergeant Gary B. Goodwin appears
in the Appendix]
The Chairman. Thanks, Sergeant Goodwin.
Sergeant Cook, you are recognized.
STATEMENT OF CHIEF MASTER SERGEANT DARYL D. COOK
Master Sergeant Cook. Good morning, Chairman Roe, Dr. Dunn,
Congressman Hudson, Congressman Pittenger, and Members of the
Committee on Veterans' Affairs. It is truly a pleasure to be
provided with the opportunity to share experiences as it
relates to the Veterans Administration and, more importantly,
share many positive experiences. I will also provide some
issues within the program I feel are recommended areas of
improvement. While I continue to serve as the Installation Fire
Chief assigned to the 145th, my testimony is my views and not
those of the 145th Airlift Wing or the North Carolina National
Guard.
As mentioned, I serve as the Installation Fire Chief to the
145th Airlift Wing in Charlotte, where we respond mutually with
Charlotte Fire Department to emergencies at Charlotte Douglas
International Airport, the sixth busiest airport in the
country. Additionally, our mission includes providing emergency
services for Stanly County Airport near Albemarle, North
Carolina. I have 32 drill status Guardsmen and 24 North
Carolina state employees to assist in providing coverage for
these locations.
With varying personnel between military and civilians, I
have the opportunity to serve with many individuals who deal
with the Veterans Affairs, and typically information I receive
is positive in nature. Close to 100 percent of my personnel
have deployed, so many have direct interaction with the VA
prior to and after their deployments. Most of the information I
receive is positive, but as with any program, improvement in
the process and the overall goal of providing the best care to
our veterans can always get better.
I would like to just highlight a few of the folks that I
have dealt directly with on their experiences. And again, most
of these are positive in nature, but I will highlight a few
issues that we have had in the system.
Master Sergeant Chris Johnson, who is actively a member of
the 145th Airlift Wing, when asked about his interaction with
the VA, he had nothing but favorable comments about his
experiences. Staff were very friendly and professional and
informative with the services they provide. The facilities used
were clean and in good condition, and he was able to receive
referrals for things like a nutritionist and eye doctor in a
timely fashion, and when he needed services from the Emergency
Department in Charleston, South Carolina, they were both prompt
and excellent in service.
Retired Chief Master Sergeant Pete Hazleton, previously
assigned to 145th Airlift Wing, now assigned as one of my state
firefighters with the Air National Guard, utilizes the VA's
medication program and primary physician program with positive
success. He actually uses the VA there in Charlotte that is new
and very up to date. There are difficulties and concerns in
scheduling appointments. It takes excessive time to get
appointments, sometimes months out, and the process for making
appointments and getting referrals is not an easy one. When
directed to have lab work done, it typically takes an extended
period of time, and many times orders are not there when you
arrive to have the labs taken.
Finally, Master Sergeant, retired, Donald Willis,
previously assigned to the 145th Airlift Wing, now assigned as
one of my state Assistant Fire Chiefs with the Air National
Guard, originally contacted the VA in January of 2017. He
contacted the Catawba office and asked what services he could
obtain upon his retirement. He was formally informed by them
that finances made him ineligible for VA medical benefits. He
retired from the North Carolina Air National Guard in June of
2017 and went to the VA office in Charlotte in September of
2017 and asked about retiring services for related injuries. He
filled out paperwork, and the VA representative made an
appointment at the VA clinic on 26 October 2017. He went to the
appointment with his medical records that were transferred to
the VA. He started the paperwork for the services related to
his disability. The VA clinic made his next appointment for 26
October 2018.
Last week, he received a letter from the VA indicating that
the appointment had been cancelled and provided some numbers
for him to call to find out why. He then called VA at the 800-
number given and spoke to a representative who indeed verified
that his appointment had been cancelled. He asked for what
reason the cancellation, and she checked the system and said
that it was probably because he made too much money. He did
receive a letter from the VA telling him they were looking into
it and would get back to him.
In closing, I want to thank you for your concerns and
efforts you have put forth in ensuring our veterans receive the
best care available. I appreciate the House Veterans' Affairs
Committee being proactive and seeking out ways to better serve
our Nation's best. Additionally, I would like to thank those
who have served before me, those who I have had the opportunity
to serve with, and those who will serve after me. It is truly
an honor to serve this great Nation. God bless this Committee,
and God bless the United States of America.
[The prepared statement of Master Sergeant Daryl Cook
appears in the Appendix]
The Chairman. Thank you, Sergeant Cook.
Ms. Seekins, you are recognized.
STATEMENT OF DEANNE M. SEEKINS, MBA
Ms. Seekins. Yes. Good morning, Chairman Roe and gentlemen.
Thank you for inviting me here today to have the opportunity to
speak with you about veterans' health care, specifically about
the Fayetteville, North Carolina health care system.
I assumed the role as Network Director in July of 2017, and
I have had the great honor of serving veterans for 34 years
throughout this Nation at various medical facilities and
network offices.
The VISN 6 encompasses all of Virginia and North Carolina,
as you may know. In this health care system we have seven
medical centers, we have 30 outpatient clinics, we have five
health care systems, and also two free-standing dialysis units.
Today I would like to share with you, which Congressman
Hudson already has, that we are the fastest growing VISN in the
country. We have in the last 10 years, VISN 6 alone has grown
by 118 percent, and Fayetteville has grown by 70 percent in the
last 10 years, and those are veterans seeking treatment.
VISN 6 also has many veterans who live in a rural setting,
and out of the 19 counties that are served by Fayetteville, 17
of those counties are deemed rural or highly rural. So to meet
the demand, VISN 6 has had the opportunity to open five new
health care centers in the past four years. All of these health
care centers have been within North Carolina.
Fayetteville alone has added 420,000 square feet to its
existing space and also hired 841 new staff members. So we are
making all the attempts that we can to meet the growing demand
of our veterans.
I would be remiss if I didn't thank each and every one of
you. It is your support that has allowed us to have the
appropriate approvals so that we could open these health care
centers in this highly populated and growing veteran
population.
We also, with your support, have been given approval to
open three additional health care centers, and one of those in
North Carolina.
To provide the needed care to our veterans, we rely heavily
on our partnerships, and those partnerships include our DoD
partners, our academic affiliations, as well as our community
providers. For the VISN, we have 642 provider agreements, which
means we can refer directly to those providers. For
Fayetteville, they have 98 active provider agreements.
VISN 6 also remains on the cutting edge of telemedicine,
and Fayetteville alone provides 11 percent of their care
through telemedicine. So this is something that we will
continue to grow. We will continue to strive so that veterans
may receive their care in their home through what we call
Connect. So VA Connect will allow us to provide those
telemedicine services to our veterans in their home or in their
rural communities.
Through all of these efforts, the VISN is currently, for a
new patient appointment, at 12.8 days. Fayetteville, by having
the opportunity to open our health care center and add the
additional space and staff, has gone from 20.5 days for a new
patient appointment a year ago to 9.3 days, and this is the
best in the VISN. So Fayetteville is doing a very, very nice
job of decreasing their time by adding staff and space.
We were the first network to participate in what is called
a market analysis. The market analysis was conducted by a
third-party contractor. This third-party contractor looked at
Fayetteville/Durham as one market, which is how can we take
both of these facilities and expand our services in the
community, as well as with our DoD partners, so that we can
provide the needed care to this growing population?
Our first expansion will be with Womack. We are currently
doing surgeries. Our VA staff actually go to the Womack Medical
Center and do surgery at that site. So that is just one leg of
our partnership.
Our next leg is also to work with our community partners to
have a stronger partnership and bring services closer to our
veterans.
I have had the opportunity to brief our delegates on the
market analysis, and as we move forward with these initiatives
I plan on working very closely with both of these gentlemen and
others so that we can have the needed services where the
veterans live.
I would also like to take a moment to introduce our new
incoming medical center Director, Mr. James Laterza.
James, if you would stand?
[Applause.]
Ms. Seekins. James is here with his wife, Christie, who is
also a veteran. James served 32 years in the Army as a colonel
at Landstuhl. He was also a former commander here at the Womack
Medical Center in Fayetteville. So the VISN 6 leadership team
is excited to get Mr. Laterza on board, and I will tell you he
has been doing his pre-work and already working with us, but
his first official day is April 2nd. So we are very pleased to
have him join our team.
I want to thank you for this opportunity for us to share
with you the magnificent work that has been going on in VISN 6
and hearing from our panel the work that has yet to happen. So,
thank you again today for allowing us to be here.
[The prepared statement of Deanne M. Seekins appears in the
Appendix]
The Chairman. Thank you all. I appreciate everyone's
testimony.
I will now just yield 5 minutes, and we may have a second
round if the panel wishes to do that.
Mr. Goodwin, we need to repair your good credit. I had
cancer surgery the 31st of July this past year, and by the 15th
of August all the bills were paid in the private sector, and
here you are going on two years with your credit destroyed. We
can do better, and we have to do better. This is not isolated.
I can tell you that I have seen the very same thing in my own
district.
I am going to talk at the 30,000-foot level for just a
minute and sort of give you all an idea about the direction
that we are trying to take at the Veterans' Committee and the
Veterans Department, the VA health care.
The VA is made up of three components. One is disability
claims, two is VA health care, and three is cemeteries. When I
got to Congress in 2009, when I was first on the Committee, we
spent $93.5 billion on all of those three services.
As you all know, in 2011 we passed a bill called the Budget
Control Act, which created the sequester. But during that time
when the military lost a considerable amount of their funding,
the VA funding went from $93.5 billion to the President's
request this year of $198 billion. It has doubled during that
time. So we as a country have stepped up.
Now, I think a lot of the problems have been in
administration and bureaucracy, as Ms. Verardo mentioned,
things that are easily solved with just common sense. But this
country spends more on its veterans than any country in the
world; as a matter of fact, in all of the countries in the
world put together. And for that, I think I am proud that the
American people have never, ever busted me for supporting our
Nation's veterans. I wanted to say that to start with.
The VA has gone from 250,000 employees when I first got
there, and they are now authorized for over 370,000. VA staff
is now larger than the U.S. Navy. So we have got to do better.
Just getting bigger doesn't make you better.
Our vision in the Committee is this, and I know Dr. Dunn
certainly shares this vision, is I really don't care where you
get the care; as a veteran, I want you to get the absolute best
care that this country can give you. I provided that care for
patients for our local VA at home, and what we want to do is
have these provider agreements that she mentioned so that a
veteran can go and get the care, the quickest and the best care
they can get. If the VA can provide it, great. If that is where
the veteran wants to go, great. That is what our Choice bill is
trying to do, is to allow the veteran to have more access.
She mentioned something extremely important, that our
country is changing, the demographics of the country are
changing, and that is one of the reasons why I want the asset
review done, because what she mentioned is look how much growth
there is in this area of North Carolina and Virginia, whereas
the Northeast is actually shrinking. What we want is a nimble
VA, and I think there is no question in my mind from watching
health care over the 40 years, more than 40 years that I have
been a physician, is that we have gone from inpatient care to
outpatient care, and the VA is making that change. There are
over 800 outpatient clinics in the VA around the country.
I was in Medford, Oregon not too long ago. The Congressman
there, Greg Walden, his congressional district has more square
miles than the state of Tennessee does. So that is a different
issue. You have to go across mountain chains to get there. So
you have to have a choice system where veterans can go outside
there if they choose to do so. In a more urban--even though
this may not seem urban, this is compared to that part of
Oregon. Even though this is more urban and growing, we need to
provide more services here, not less.
So the VA needs to be more nimble, and by doing leases with
these CBOCs, you can do that. In 20 years of health care
changes, you can move away. I will promise you that 20 years
from now, health care is going to look much different than it
does today. And I will tell you this, an amazing statistic to
me, hospitalizations maximized in America in 1981. We now have
a 40 percent growth in population, and yet in-hospital care is
down 10 percent. The reason for that is all the advances in
technology that we have had. Look, my cancer surgery, I had
never had an operation in my life, and I have had two major
surgeries in the last 18 months. I have done thousands of
operations. I got on the cutting end this time, the knife end.
I spent less than 48 hours in the hospital for both of them,
which is unheard of, and that is why we have to change the
model, and we are going to do that.
The other thing I want to bring up before my time expires,
incredibly important to do what we are working on now, is this
transformation to a new electronic health record. We have a
system in the whole country, not just the VA, where one system
can't speak to another, and we spend millions of dollars, and
these two systems can't communicate to each other.
So what we are doing now, I talked to a physician in
Seattle, Washington that had acquired some medical practices,
and they had 11 different health record systems in the same
practice. So what we are trying to do is transform the VA from
the system they have, which was cutting-edge many years ago.
They have 130 different health record systems in the VA now.
They are siloed in each medical center. With the new system--
and please, you veterans, be patient, because I put in an
electronic health record system before. It is very difficult to
do. But when we transform that, the goal is to get to the point
where a veteran can leave DoD and seamlessly go to the VA and
their records will be transferred.
I am out in private practice. I have to have a Cloud-based
system where that information goes from VA to the Cloud and
then to me, and then I can send it back seamlessly to the VA.
Until we get that kind of system, you are going to have these
foul-ups that Sergeant Goodwin was talking about.
Lastly, before I turn it over to Dr. Dunn, prompt payment.
Medicare pays 95 percent of claims in less than 30 days, pays
claims in less than 30 days. The VA is way out past that, and
only about 60 percent of their claims are adjudicated in that
same time.
What we have to do to keep providers in the system--
Sergeant Goodwin, the very fine doctors that you saw are going
to get out of the system if you don't pay them, and the EMS
people can't operate an ambulance if they can't buy gasoline to
go in the ambulance.
So that is part of the new electronic health system so that
that system will work better, and be patient, because it is a
huge undertaking and a very expensive one.
I have done something I never do, which is go over my own
time. I usually gavel myself down, and I yield to Dr. Dunn.
Sorry.
Mr. Dunn. No, no. Thank you very much.
He is quite right. He is very careful with the time, and I
owe him a whole bunch of time.
Thank you very much, Mr. Chairman.
Ms. Verardo, let me say thank you for your testimony. I
read it on the flight down, and I was grieving for you. Stories
like yours are the ones that cause us to volunteer to be on the
Veterans' Committee to try to tackle these problems, and let me
offer you my apology for a very embarrassed United States
Government and VA system for your travails.
I want to get you on record as agreeing with me on
something, I hope. Do you believe that specialty medical needs
such as prosthetic care or transplant care are essential to
include in the future legislation for veterans seeking care
outside the VA?
Ms. Verardo. I do, sir, yes.
Mr. Dunn. Thank you.
Mr. Catoe, what are your thoughts on making these specialty
needs a priority in the future to the Choice system? Do you
think this would be an improvement for veterans?
Mr. Catoe. Yes, I think so. I actually used to work for a
DME company. I was the Vice President of Reimbursement for a
national company several years ago and I am quite familiar
with--
Mr. Dunn. Was that during the Choice program time?
Mr. Catoe. No, sir, it is before that.
Mr. Dunn. I will tell you, my practice was in the Choice
program. Our experience was very, very similar in terms of the
payments.
Let me turn my next question to Ms. Seekins. I appreciate
the opportunity to hear from the regional VISNs and what the
local problems are. Clearly, Mr. Goodwin has indicated great
satisfaction with the medical care that he received at the
Fayetteville Veterans Administration hospital, specifically
singling out Dr. Azad, and I hope you will recognize Dr. Azad
for that. His experience does, however, underline that the
payment system is way behind. In my own experience, the average
payment reimbursement to my practice averaged well over 120
days from the VA. Can you address that?
Ms. Seekins. Yes. Thank you for that question. First, I
want to say to Mr. Goodwin that I followed up as soon as I was
aware of your case, and I believe that your payment is being
made.
Mr. Dunn. Now we just have to fix his credit.
Ms. Seekins. Yes, and they are working on that as well, a
credit letter and getting that taken care of. I apologize for
that.
I have Mr. Enderle here, who is our expert with VA
regarding payment, so I am going to defer the question to Mr.
Enderle.
Mr. Dunn. Can you tell us what you are going to do to
remedy this situation? And you are going to give me a level of
confidence in the answer?
Mr. Enderle. Yes, sir, I hope so.
Mr. Dunn. And all in about a minute or so, all right?
[Laughter.]
Mr. Enderle. Thank you, and good morning. This is a great
opportunity to be here to talk to you today. I also want to
apologize to Mr. Goodwin for the difficulties he has been
dealing with with his claim's payment.
The VA realizes that many community providers have
significant challenges with VA payment. Of course, we want to
rectify that situation. Unlike Medicare and unlike Tricare, and
even the TMTA program, unfortunately we have challenges that we
need to overcome, one of those being--
Mr. Dunn. We know you have challenges. We want to hear how
you are going to fix it.
Mr. Enderle. Yes, sir. How we are going to fix it is we are
dedicating additional resources to address the claims
processing time limits. We recently are sending additional
claims to a staffing contract that is supporting us in
processing claims. We expect that over the next--by the end of
September, our claims backlogs will be addressed and resolved.
To address the Choice claims, we are working with third-
party administrators to address their timeliness with the
claim's payments, in addition to the waiting times with the
call center for providers.
Mr. Dunn. Because we are on the clock here, can you give me
a sense of when you think this is all going to be made just
right so the VA acts like Medicare in compensation times?
Mr. Enderle. As soon as the VA has some relief with
legislative changes.
Mr. Dunn. We need that offline, because legislative
language takes a long time to talk about, but we need it. If
you think the legislative changes will fix that, I think I can
guarantee you that the Committee would be very interested in
hearing what those proposals are, real specifically how we are
in the way, because we don't think we are in the way.
Mr. Enderle. Currently, the VA has to pre-authorize care
for veterans who are seen in the community. Because of that
authorization process, we subsequently then process the claims
that come in. We have to match those claims against those
authorizations. So it is important that we ensure that veterans
have authorizations in advance so that we can then seamlessly
process those claims as they come electronically.
Also recently--
Mr. Dunn. So, our time is winding down. I am going to hope
that the Chairman will get us through this and we will have a
second round of questioning.
Mr. Chairman, I yield back.
The Chairman. Thank you, Dr. Dunn.
Mr. Hudson, you are recognized.
Mr. Hudson. Thank you, Mr. Chairman.
As a follow-up to this line of questioning, I think this
deserves a lot more time. Mr. Chairman, I actually have
legislation I am talking with you about a number of times.
My solution to this problem is if you are 50 percent or
more service-connected, the VA will pay for anything whether it
is connected with your injury or not. So if you are 50 percent
or more service-connected, my legislation says you are
automatically into us. That is one solution.
Mr. Catoe, I was really interested in your testimony
talking about the difficulties Atrium Health encounters when
attempting to submit medical records to the VA and when you are
seeking authorization for claims. There is a lot of difficulty
dealing with the VA system, but you said in the private sector
that you have these payer portals that process these much
quicker.
Could you maybe talk through that, exactly how those payer
portals work in the private sector and maybe give us some
advice about how we might use those in the VA system?
Mr. Catoe. I can certainly try. Some of the major payers
that we deal with, you can imagine who they are, but the larger
payers, commercial payers, they have what we call payer portals
where they have a system that we can actually scan records into
our scanners, electronically transmit those records directly to
them so that they can then take that transmission and attach it
to the claim when it arrives and marry the two up. It is a much
quicker process, much more secure. Of course, it is all HIPAA-
compliant and all that, and it just makes it a much easier
process. Plus, we don't have the issue with losing medical
records through the mail, mailing them to the wrong location,
or them ending up being lost at the payer, which used to happen
quite frequently, just like it does with the VA today.
Mr. Hudson. Makes a lot of sense. I can go on my iPhone
with an app and order a pizza, it shows up at my door. I don't
even have to go to the bank to deposit a check anymore; I take
a photo of it. We ought to be able to do payer portals with the
VA and get these records, so you don't have to worry about them
getting lost in the mail and having to re-submit it, you said
sometimes five times.
Mr. Catoe. That is correct.
Mr. Hudson. Absolutely.
Ms. Seekins, I appreciate your time here today, and I want
to thank you for the way you have communicated with our
delegation. Before you arrived, I reached out to the VISN
several times and asked for briefings on some of the concerns,
some that were highlighted here today. But when you first came
into this position, you reached out to us and asked us to meet
with you in open dialogue, and I really appreciate that
approach. I think that is really important.
I know of several companies right here in North Carolina
that would be both willing and able to set up a payer portal
type of system that could streamline this issue for the VA. Can
you shed some light on maybe the VA's efforts to modernize, and
is there a hold up? Is there some resistance within the VA
system to this type of idea?
Ms. Seekins. Thank you, Congressman Hudson. Again, I have
Mr. Enderle here. We at the VISN side and at the Medical Center
side coordinate the clinical care, and then Mr. Enderle's shop
actually handles all of the payments. So again, I am going to
defer to Mr. Enderle.
Mr. Enderle. Thank you. As was explained, the medical
record documentation and being able to transfer to the payer is
complicated, and typically providers have to send that paper
via the mail. It comes through the mailroom, goes to the
medical records, and it is subsequently scanned.
Mr. Hudson. Why can't we go to the payer portal? Do you not
have the authority to do it? Is it someone higher up than you
resistant to the change? What is the hold up?
Mr. Enderle. Actually, we are taking steps to make sure
that we are able to implement a process where those medical
records can be submitted electronically. We currently have
rolled out what we call the referral document tool. It is an
online system where scanned electronic versions of medical
records can be submitted to us electronically. We also have a
tool called--
Mr. Hudson. When you say rolled that out, what do you mean?
Mr. Enderle. It is actually operational now.
Mr. Hudson. So vendors like Atrium Health, are they now
using it?
Mr. Enderle. Some vendors are using it. However, we are
working with the vendors through provider education to share
the process with them so that they can begin using this tool.
Mr. Hudson. It sounds like we have a communications problem
between vendors and--
Mr. Enderle. It has been available for the last probably 60
days. We are still trying to educate providers on that tool and
how to utilize it.
In addition to that tool, we also have what they call
Virtual Probe. It is a mechanism where we can exchange
electronic information via email. It is also encrypted. So we
can reach out to providers and ask them for their clinical
documentation. Once we receive it, then we can load it up into
the medical record at the VA.
There is another system being put into place where probably
over the next three months we will actually be able to accept
clinical documents electronically to a contractor where they
will submit paper documents to the contractor if they don't
have the ability to be able to transfer electronically. We will
be able to scan those clinical documents and then subsequently
turn them into electronic documents, and then release them to
the payment centers to process claims against them.
So we are active in trying to resolve that issue, which we
recognize is a problem.
Mr. Hudson. I appreciate that.
Mr. Chairman, I am over time, but this is breaking news. I
hope maybe we can delve into this a little more and see how
this is being applied.
The Chairman. We will, and it is a system-wide problem. The
VA doesn't need to reinvent the wheel. The systems are out
there now, but the Secretary is very well aware of it, and it
is one of the things that he has committed to get done. This is
something if we don't do, we are going to have good providers
peel off and not see our veterans. We don't want that.
Mr. Pittenger, you are recognized.
Mr. Pittenger. Thank you, Mr. Chairman.
Again, I thank each of you all.
Ms. Verardo, as you may be aware, this past fall the VA
published a rule that restricted the ability for those
requiring prosthetic limbs to seek access to the treatment
outside of the VA. We have a bill that I am a co-sponsor of,
and I think Mr. Hudson is too, the Bill of Rights for Injured
and Amputee Veterans. What impact would that have upon you in
terms of this new rule that is being imposed by the VA
restricting the access?
Ms. Verardo. Sir, our current situation with the VA to
obtain any type of prosthetic device is archaic, at best. It
goes through many channels of both approval, which I understand
must happen when it is over $3,000, and it has to go through a
secondary approval process, of course. But most recently, given
my profile, I decided to go through my husband's most recent
wheelchair issue kind of as a Jane Doe to see what it was
really like, and it was horrifying. It took 18 days--this was
recently, within the last couple of months--18 days for it to
go just from my case management in PCP to the vendor. Had I had
the opportunity to simply call the vendor and say, hey, this
chair is broken, can you guys come on out, the vendor was
incredibly responsive. They were at my house within 12 hours.
So meanwhile I have three very small children, and I have a
husband who is recovering from surgery. I had to basically
stand backwards to push him while holding our children so that
I could get him out of our house.
The amputee clinic at VA also will withhold payment. Right
now they have withheld payment to our vendor. We use hanger
prosthetics because Mike is still in surgical recovery right
now, so he is not weight-bearing, and they won't pay the vendor
for this prosthetic until he puts it on, which is in direct
defiance of his surgeon's orders to not weight bear.
So we are very concerned about having a more streamlined
process right now, integrating community care, but integrating
it directly with the veteran, specifically with the caregiver,
because we don't have that option to go direct to vendor right
now for repair or authorization. We have to go through several
channels within VA, including proving that the servicemember
still requires some of these devices.
Mr. Pittenger. Ms. Seekins, would you like to respond to
that?
Ms. Seekins. I will need to take this for the record to
look into this case specifically. It is very hard for me to
answer that question in a general form.
I know that prosthetics is one of our foundational
services, as you know. The Secretary has asked that we all
focus on our foundational services, and within VISN 6,
specifically at Fayetteville, we have made great progress in
prosthetics with same-day services. I have had the opportunity
to work with Ms. Verardo on specific cases, so we are making
improvements.
Are we where we want to be? No. We are looking at an
orthotics lab. We are moving forward with many things so that
we can provide those services to our veterans in a more timely
manner. But as far as this case, I would need to look into that
specifically.
Mr. Pittenger. Again, Mr. Laterza, we are really grateful
to have you here. Your leadership is extraordinarily important.
The 200,000 servicemen and women who are entrusted to you, the
dedicated professionals there to address their needs is really
of great merit.
Ms. Verardo, I would like for you to take the last minute
or so to give any candid, thoughtful, concerned advice to Mr.
Laterza on what you would hope to see and what you think could
be done to better assist him to do what I know he wants to do.
Ms. Verardo. Thank you. I am very encouraged by new
leadership. Ms. Seekins has been truly a breath of fresh air,
and she and I have a shared goal. Although we are a national
organization, I want VISN 6 to be the best in the country, and
I think we are going to work together to make that happen.
As a caregiver to a catastrophically wounded veteran,
empowering the caregivers is vital. I have had to place my
power of attorney--I make my husband's medical decisions for
the most part. I have had to place power of attorney on file
with each individual different provider within VA. There is no
consistency. Some providers will demand to still speak to my
husband. I explain that it is very difficult for him to speak
by phone or to understand some of the complex medical issues.
So I think empowering the caregiver is vital and really working
with the right community providers for actual choice and much
quicker integration for cases like ours and the clients we
represent at The Independence Fund. We represent thousands of
those that are catastrophically disabled. We have awarded more
than $50 million in direct support to these families.
The catastrophically disabled, something can become--what
is routine for another person is a life or death issue very
quickly. So we would like that special classification and the
formularies that reflect that. Thank you.
Mr. Pittenger. Thank you very much.
My time has expired.
The Chairman. I think we will have enough time for, let's
say, 3 minutes each, if there are any further questions.
I do want to--I know that you have been at Landstuhl. I
will be making my fourth trip there in about a month. For those
of you all who are not familiar, the reason what Ms. Verardo is
saying is so important is all of us have been to Afghanistan. I
have been multiple times. During the Vietnam War, from the time
you were injured until you got to a Level 3 center was 21 days.
It took us that long.
If you are injured on the battlefield today, and I have
been all over Afghanistan, you can go from battlefield injury
to reaching out to Bagram, then a regional surgical hospital,
like in Jalalabad or wherever, to Landstuhl, to Walter Reed,
and you can make that trip sometimes in less than 72 hours.
If you see the flag, the American flag at Bagram, you have
a 95 percent chance of surviving your injury. It is remarkable
what we have done and the improvements that have been made in
care. But it only begins there. We owe these veterans, like
Mrs. Verardo, who is a true hero for me--I want to tell you
that right now. What you have done to advocate, this is a
lifetime commitment. This is not when we get you. This is a
lifetime commitment we have, and I think your special category
that you mentioned is something we can look at.
There are some other things that just make common sense. If
you are a veteran and you have lost a leg, you have lost a leg
and you are not going to have that leg back. And if you need a
wheelchair and it needs to be repaired, why don't we just have
one there for you while your wheelchair is getting repaired? We
should be able to fix that pretty easy, just here is another
one to use, a loaner, just like when you take your car to get
the oil changed sometimes you get a loaner. You do that. So
there are some things we can definitely do that will alleviate
these simple things that you bring up that the bureaucracy gets
hung up on, just little common-sense things.
I want to thank you specifically, because the first time I
met you was at the White House, and then later at our caregiver
roundtable.
Folks, you have a real champion sitting in North Carolina
here, I want to tell you that. She is not just for
catastrophically wounded veterans but just veterans in general.
Mr. Hudson?
Dr. Dunn, I'm sorry.
Mr. Dunn. Thank you very much, Mr. Chairman.
I want to focus on some of the niche areas of medical care.
Sometimes that is internal medicine, like a specialized
neurological problem or an immunological problem or a radiation
treatment problem, or a surgical problem. Since I am a surgeon,
I am going to stick to that area.
Currently, any veteran who goes on the organ transplant
list has to go to one of the 13 Veterans Affairs transplant
centers. There is a rule that compels that on them. And none of
those 13 centers performs all the different types of
transplants. So we have veterans from Fayetteville who have to
go to Michigan or Pittsburgh, or maybe farther than that, to
get transplants.
Now, we know that the veterans who go on the transplant
waiting list, on the veterans list, wait on average 32 to 34
percent longer than people on civilian lists. In fact, they
have higher mortality rates because of that. They fail to get
the transplant and die on the list, if you will.
I am going to ask you about including transplants in the
Choice program. Let the veterans go to a transplant center that
is near them. Transplants are a unique form of surgery, very
time dependent. So we know that the closer you are to the
transplant center where you are being treated, the much better
chance you get the transplant, but also it involves multiple
trips to that transplant center. So if I have to go to Detroit
again and again and again, both pre- and post-op, my chances of
doing well are going downhill.
So I am going to ask you about what do you think the
chances are that we can include or remove this rule to compel
them to stay in the transplant program in the VA and let them
use the transplant centers, the Medicare-approved transplant
centers that are near them. You have two right up the road
here.
Ms. Seekins. Yes. Thank you. This has been in place for
many years, and you are correct, sometimes you have to go to
Minneapolis, sometimes you have to go to Kentucky.
Mr. Dunn. In the winter.
[Laughter.]
Ms. Seekins. They are known as Centers of Excellence for
the transplants. We also have many of our hospitals that have
strong affiliations such as Richmond and VCU, where the
transplants are coordinated between the two.
Dr. Bazemore is our physician on the panel, and I am going
to ask Dr. Bazemore to comment on that, please.
Dr. Bazemore. We do have these Centers of Excellence which
perform transplants, and we had this discussion recently at a
surgical summit in Durham, and the actual surgery office chair
was there. The subject of transplantation came up, is it good
for the VA to be in the transplant business, and it was a
resounding yes. The reason being is that not only is it
providing the care for our veterans, but also the accompanying
services that support a transplant program in these Centers of
Excellence also are being sharpened by having this service
available.
That being said--
Mr. Dunn. We are constrained by the clock again. I want to
talk to you afterwards, but I will point out for the audience
in general that at least one of the Centers of Excellence does
not meet the criteria to be reimbursed under Medicare for
transplants. But we will talk about that after this because my
time has expired.
I yield back, Mr. Chair.
The Chairman. Dr. Dunn mentioned that he was going to poke
around. He is a neurologist, so be careful when--
[Laughter.]
The Chairman. Anyway, Mr. Hudson, you are recognized.
Mr. Hudson. Mr. Chairman, we almost made it through the
whole hearing without you saying something like that.
[Laughter.]
The Chairman. I couldn't help myself.
[Laughter.]
Mr. Hudson. I appreciate that, and I appreciate the focus
Dr. Dunn has on transplants. I just dealt with a soldier, or a
sailor that we were able to get to Duke University to get a
transplant, and he was very close to not making it. He is now
taking 57 pills a day just to not reject that. But it is a very
tough surgery. But being close to your base of support and your
family, your friends, is really important. So I think your work
to keep folks near where their support system is is really
critical, so thank you for that.
This may be the last chance I get to talk, so let me just
say also thank you to Dr. Larry Keen for hosting us here at the
college, one of the best colleges in the country. Certainly, no
college does more for our soldiers and our veterans. Thank you
for all the great programs you have here.
[Applause.]
Mr. Hudson. I also want to introduce my staff, because I
see a lot of folks here and I appreciate you all being here
today. If anyone needs help with an issue with the VA, please
see one of my rock star staff members here. I am going to
introduce them.
I will introduce the general, Chris Carter, but we know the
sergeants do all the work.
[Laughter.]
Mr. Hudson. Chris Johnson, raise your hand. He works here
in our Fayetteville office.
George Lozier, raise your hand. He is the head of our case
work operation across the district.
[Applause.]
Mr. Hudson. These two ladies, they make me look really good
because they do a lot of great work on behalf of our veterans.
If you are here today and you need assistance, please see one
of them before you leave. Don't leave without doing that.
Billy Costand, my district director; and then the bearded
one behind the cameras, Chris Maples, also works here in the
Fayetteville office and also in the Moore County office. Please
see one of these folks if we can assist you in any way.
I wanted to go to Ms. Verardo. Thank you so much for being
here. I kind of choked up a little bit during your testimony,
to be honest with you. When I first met you and Mike was in a
wheelchair and could barely communicate, he was in tough shape.
And then when you walked into my office, it is an emotional
thing. But thank you for what you do and your advocacy. It is
incredible.
In your written testimony you talked a little bit about the
flexibility that the catastrophically wounded have in terms of
being able to choose your provider. Could you talk a little bit
about that?
Ms. Verardo. Absolutely. We think it is vital. We are
insured, of course, through Medicare and Tricare for my
husband. In those systems, he is deemed competent to choose his
own provider, and then suddenly he is in the VA system and he
is deemed incompetent to choose his provider. These are
veterans, active military, that we are trusting to make
tremendous decisions for national security purposes, and then
we are telling them as soon as they enter the VA system that we
deem them incompetent to even see who they can go to, the
doctor of their choice.
We would like to see major reform around that certainly,
but a special category and designation for catastrophically
wounded so that in terms of wait times, priority lists--the VA,
of course, has priority lists and systems that we don't feel--
and I can tell you personally for me, they are not utilized
properly. We would like to see real change around that.
Mr. Hudson. Great. I appreciate that.
Mr. Chairman, I believe I am out of time again, so thank
you.
The Chairman. Thank you.
Mr. Pittenger?
Mr. Pittenger. Thank you, Mr. Chairman.
I would like to also introduce Bob Becker. Bob is our
expert who has dealt with these issues for the last 15 years,
and we really appreciate his work.
Tom Guthrie is with my team, as well as Jake Caldwell is
here in the Fayetteville office, and he will be responsive to
you.
Mr. Chairman, you mentioned that there are around 350,000
individuals who work with the VA around the country. In any
organization you have an A team and a B team, a C team, various
groups of people who respond in a different manner perhaps.
Some are more responsive, more capable, than others.
I would ask you this, Ms. Seekins. Does the Director, Mr.
Shulkin, Mr. Laterza, do they have the adequate authority to
keep the right people, to promote the right people, to fire the
right people, to make sure that we have the best folks? There
have been so many GAO reports, 60 Minutes, so much that has
been done to characterize, maybe good and bad, the VA and the
quality of the care and the quality of the people in VA. That
is really the bottom line to our veterans. Have we done enough
legislatively to enable Mr. Laterza to be the effective leader
that he needs to be?
Ms. Seekins. Thank you for that question. And, yes, the new
legislation, the accountability bill, has given us much more
authority. I have not worked with Mr. Laterza yet as a senior
leader to senior leader, but I have no doubt that he is going
to be a person who holds his staff accountable.
Mr. Pittenger. I wouldn't question him, his ability, but
the appeals process could go on for years sometimes. Have we
streamlined it enough? Have we given it enough teeth for him to
do what he needs to be able to do? He is extremely capable.
Ms. Seekins. Yes. There is only one loophole in the
accountability bill that I have found challenging, and that is
I can hold my staff, I can hold leaders accountable, but if
they file a whistleblower, then any action against them goes on
hold until that case is resolved. So I cannot remove them. It
goes on hold.
Mr. Pittenger. Thank you very much.
I yield back.
The Chairman. I thank you for yielding, and I appreciate
very much everyone being here. To both the Carolina
congressmen, thank you very much for inviting us down, and
thank all of you all. My goodness, I didn't expect a room full
of people. I thank the veteran service organizations who are
here. It is great work you guys do and gals do advocating for
veterans. You do an incredible job. We just finished five
hearings listening to all the veteran service organizations in
the country just in the last week.
Does anyone have any closing comments they would like to
make?
Mr. Dunn. I would just say thank you to both Robert and to
Rich, and to the college president, and to our panel.
Mr. Hudson. I would just like to thank the panel for being
here and giving your testimony. It is very important that we
continue to get this on the record so that we understand. There
has been a lot of work done, but there is a lot of work left to
do, and we have a lot of challenges we continue to face, and it
is important that we not only understand the challenges but
understand how to fix them and where do we need to go to make
this right and get the best care for our veterans that we can
possibly get. I think everyone in this room agrees with that.
That is our end goal.
I want to thank the Chairman again for bringing the
Committee here. I go to Washington every week we are in session
and take your interests and try to represent you the best I
can. In this case, I get to bring Washington to you and let
your voice be heard in that way, too. So I appreciate that
opportunity.
The Chairman. Thank you.
Mr. Pittenger. Mr. Chairman, I would like to say thank you
as well. This means so much to the veterans. And, Richard, the
same to you.
I would say to those of you in a position to lead, I
believe your hearts are in the right place. It is a big
bureaucracy. We need to streamline it down so that it takes
care of that individual person. You don't walk over people to
affect the world. It is one person at a time. So, thank you
very much.
The Chairman. Thank you all.
I want to give a shout out to my team. I would like for
them to stand up. They are a part of my staff in Washington,
D.C. on the Veterans' Affairs Committee.
Alex Larch. Alex has been with me since back at day 1 I
have been in Congress.
Alex?
And Samantha Gonzales, and Christine Hill. Christine is a--
we were driving down the 405 in Los Angeles rather briskly, and
I said, ``Christine, what did you do in the military, in the
Air Force?'' She said, ``I was a B-1 bomber pilot.''
[Laughter.]
The Chairman. And I said, ``Well, maybe we can slow it down
a little bit.''
[Laughter.]
The Chairman. Anyway, thank you all. They have done a great
job of putting all this together.
[Applause.]
The Chairman. I think I can speak for all of us. Truly, you
don't know what you are going to do with your life when you
finally grow up, practice medicine for 31 years. But it is a
true privilege to serve our Nation's veterans.
I had someone text me today about what an awful job we are
doing in Washington, and I said, you know, we are doing some
things that I probably don't agree with, but we are doing some
things right. And the old statement that freedom isn't free is
correct. I think I speak for every one of us up here.
There are a couple of things I never apologize for spending
money on, and we did it yesterday. Number one, if you are a
warfighter, I want you to have whatever you need to take care
of yourself and carry out your mission, number one.
[Applause.]
The Chairman. I have been at the tip of the spear. I know
what that is like.
Number two, I want you to have, when you come home, whether
you have been injured or not, I want this country to provide
for you the things we promised you we would do in a timely
fashion. That is our job here today. It will never be done. We
will never get it all right.
I am a category 8. I am blessed. I have great health
insurance. That category means I make too much money to go to
the VA. I wouldn't want to be in front of a disabled veteran. I
have care outside the VA. I think many of us feel like that. I
speak to veterans every day who feel like that.
But I want to thank everybody. I know this community. I
grew up in Clarksville, Tennessee, which was the home of the
101st Airborne Division. They don't have necessarily good
things to say about here--
[Laughter.]
The Chairman. But anyway, I will keep that to myself. What
happens in Clarksville stays there.
But seriously, I grew up in a community like this, and I
know how important the military, the culture is for this part
of North Carolina, and how deeply the people care about the
active-duty military and veterans in Fayetteville and this
whole region of the country. Thank you for that. That wasn't
the case always. At the end of Vietnam, that was not the case.
I want to thank you for how you treat our veterans today.
It is very much appreciated by this old veteran, I can tell you
that.
If there are no further questions, I want to once again
thank our witnesses for all you said here today, and all the
audience members who have taken your morning to be here with
us. It has been a great pleasure to be in North Carolina where
I don't need a translator to understand everybody. In
California that is not the case, or New York. And I look
forward to taking back these things. I made a few notes, and so
have my staff, and suggestions of little things that maybe we
can get done right quickly.
I ask unanimous consent that all Members have 5 legislative
days to revise and extend their remarks, including extraneous
material.
Without objection, so ordered.
The hearing is adjourned.
[Whereupon, at 11:28 a.m., the Committee was adjourned.]
A P P E N D I X
----------
Prepared Statement of David W. Catoe
Good Morning. I want to thank this committee for the opportunity to
speak on behalf of Atrium Health system, formerly known as Carolinas
Healthcare System. Atrium Health has always had an outstanding
relationship with our Veterans in all communities we serve and we
consider it a privilege to provide medical care to them. In fact, our
health system has been recognized numerous times for supporting
military personnel and Veterans through awards such as the Secretary of
Defense Freedom Award, the Secretary of Defense Patriot Award, and
being a Top 10 Military Friendly Employer. As we work to further
support our Military Veterans, I would like to take a few minutes to
highlight some of the issues Atrium Health is working to overcome in
coordinating claims administration with the VA programs.
1. Medical Records - Atrium Health often submits hard copy medical
records multiple times to the VA for the same patient encounter because
the VA is unable to locate and match up the records with the claims.
This not only places a burden on the hospitals administratively, it
also presents potential HIPAA/Privacy concerns since the VA appears to
be unable to account for all the medical records that it has received
from Atrium Health. Since VA will not pay a claim without the medical
records - hospitals have no option but to continue sending records when
requested time after time again. Our other commercial payers have payer
portals through which we can upload medical records and other required
documents directly to the payer for attachment to the claim - avoiding
the printing and mailing of sensitive medical record information. VA
should implement a HIPAA-compliant system for the electronic transfer
of medical records and other documents needed for payment, similar to
other payers who adjudicate claims.
2. Authorizations - When Veterans present for medical care at
Atrium Health, we treat them as our first priority - regardless of the
administrative workings going on in the background. Most Veterans don't
know the authorization number when they present and we often must
obtain the number after the fact. Because there is both a clinical and
claims component in the authorization process, there are handoffs
occurring which often leads to trouble during claims administration.
For example, VA faxes authorizations to a fax number in Clinical Case
Management (CCM) at our hospital. This can be problematic to ensure
that number also appears on the claim form days or weeks later. VA
Choice often cannot provide us the authorization number when we call
for it. Without this authorization, the claim will not be paid. It
would be much more efficient and convenient for everyone if the VA
could establish a portal so that authorizations could be pulled by the
provider electronically and added to the claim as needed. This would
eliminate unnecessary calls to the VA for the authorization number and
improve the service provided to the Veteran.
3. Excessive Hold Times - Atrium Health claims specialists
experience excessive hold times when calling into the claims center to
check on the status of claims. It is not uncommon to be on hold from 30
minutes to three hours before reaching a VA or VA Choice claims
representative. For VA Choice claims, we are only allowed to ask about
three claims at a time before having to call back and go through the
entire waiting process again to follow-up on additional claims. This is
extremely problematic when we have thousands of outstanding claims with
the VA and VA Choice at any point in time. We have also had to leave
phone messages and emails with provider relations in the past since we
could not contact a live person - but rarely do we ever receive a
reply. The claims specialists at Atrium Health who work VA claims are
often frustrated and demoralized due to the stress encountered as their
productivity is hard to achieve when spending so much time waiting for
assistance. More VA claims representatives are needed to handle the
volume of calls received to avoid these excessive wait times for
assistance.
4. Education - VA needs to provide better education to the
providers as well as the Veterans in explaining the different programs
available for their care and the requirements for each program.
Currently, these programs are very confusing to even an experienced VA
claims specialist. I cannot imagine the confusion that many Veterans
experience in trying to coordinate their care with VA. For example,
many Veterans believe VA acts like an insurance policy when it in fact
does not. An excellent example is the Other Health Insurance (OHI)
amended regulation dated January 9th, 2018 wherein VA advised that
providers should bill any available health insurance before VA and VA
would be secondary to OHI for emergency services. However, VA is an
entitlement and not an insurance program, thus they do not pay
deductibles, co-insurance, or co-payments incurred by billing the OHI.
Veterans still believe the hospital has the option to bill VA over OHI
and we are at fault when the Veteran has a $1,000 plus deductible to
meet - stating we should have billed VA first. The more communication
and awareness there is on how these various programs work, the less
confusion and more efficient processes we can have in place to serve
our Veterans.
Again, thank you for allowing me the privilege to discuss some of
the opportunities our health system believes can improve our Veterans'
experience as we provide medical care and the subsequent filing of
claims with VA, VA Choice, and ChampVA. We are pleased to work with you
and the VA to make the claims process more streamlined, efficient and
friendlier to our Veterans.
Prepared Statement of Sarah Verardo
Dear Chairman Roe, Representative Walz, and Members of the
Committee, thank you very much for inviting me, as Executive Director
of The Independence Fund, to testify before your Committee here today.
I am Sarah Verardo, Executive Director of The Independence Fund,
headquartered here in North Carolina, in Charlotte. I also wish to give
special thanks to Representative Hudson of North Carolina for
recommending The Independence Fund testify today in this field hearing.
Representative Hudson has been an amazing friend to The Independence
Fund, and the strongest of champions for Veterans here in North
Carolina.
Only 10 years old, we were founded in 2007 with the very specific
purpose of assisting the most catastrophically wounded veterans from
the Iraq and Afghanistan conflicts with adaptive mobility devices, and
returning to them, at least in part, their independence. Since those
humble beginnings, The Independence Fund's grown to also provide
assistance for the caregivers of the catastrophically wounded and
disabled, assistance to adaptive athletes and teams, wellness programs
to combat the scourge of veteran suicide and post-traumatic stress
disorder, veteran service programs to navigate the overly complex VA
health care and benefit systems, advocacy programs to change the laws
and regulations that unnecessarily limit veterans access to their
earned benefits, and our newest program, Heroes at Home, which will
assist the children of the catastrophically wounded and disabled.
To date, The Independence Fund's provided more than $50 million in
assistance to the catastrophically wounded and disabled and their
Caregivers. This includes more than 2,200 motorized cross-country
wheelchairs, 1,500 adaptive bicycles, and more than 150 Caregiver
support retreats.
The Problem: An Unresponsive VA Health Care System
But throughout those last 10 years, we've repeatedly found our best
efforts hamstrung by a VA health care system that systematically and
repeatedly fails to serve the very Veterans it was established to
assist. While the medical care given by the individual medical
providers is usually superb, that care is far too difficult to access
and we find the medical care providers repeatedly thwarted by a medical
administration bureaucracy seemingly more intent on preventing fraud
and cutting costs than in optimizing care delivery for Veterans.
The Promises of Health Care Choice
Mr. Chairman, The Independence Fund was heartened by the
President's campaign promises to finally allow Veterans to be the
masters of their own health care choices. Many of our clients are
medically retired from the military due to their catastrophic wounds,
and as such receive Tricare health care benefits. They can choose their
health care providers, both at military treatment facilities and
outside the Department of Defense. Similarly, many of these
catastrophically wounded are eligible for Medicare, where they can
choose pretty much any health care provider they want that participates
in the Medicare program. Finally, the Caregivers under CHAMPVA are
given wide latitude to choose their health care providers within the
CHAMPVA system. In all these systems, the federal government finds the
individual patient fully competent to make their own health care
choices.
But for veteran within the VA health care system alone, none of
those choices are available. The veteran is considered incompetent to
make any of their own health care choices and must rely on the
beneficence of the VA bureaucracy to make proper medical choices for
them. This, despite the stacks of Inspector General reports that finds
that same bureaucracy engaged in deception to hide unqualified doctors
committing malpractice; that details how that same bureaucracy is
unable to deliver mandated health care on anything approaching a
medically indicated schedule; and reveals a repeated unwillingness of
that bureaucracy to critically examine its own practices or procedures,
nor to explore the root causes of its multiple failures.
This year, this Session of Congress, is the time to deliver on the
President's campaign promise and deliver true and real VA health care
choice. All parties involved in this debate understand the current VA
Choice program is a stop gap measure until a consolidated, robust,
system wide network of community care is provided to Veterans. While we
supported the compromise proposal to the recent Omnibus Appropriations
Act - which combined a version of consolidated, expanded access to non-
VA community care, and expansion of the Caregiver program, and a review
process for the VA's capital assets - as of the writing of this
testimony, we joined many other Veteran Service Organizations in our
disappointment that the final deal was not agreed to for lack of
universal agreement amongst all Congressional leaders.
Limiting Non-VA Care to Only That Prescribed by VA Doctors Will Not
Work
Mr. Chairman, we cannot give up on passing real VA choice
legislation. Veterans cannot wait any longer. While we appreciate the
work the House and Senate Veterans Affairs Committees accomplished with
their respective Committee passed bills, we are concerned both bills
continue to rely on the VA to determine when and where Veterans can
access non-VA care.
Again, while the health care providers will usually seek optimal
care for the Veteran, our experience is they are usually thwarted by
the medical administration bureaucracy seemingly more intent on
stopping perceived fraud by the very Veterans who defended this
country, or to save money on the backs of the Veterans whose doctors
believe they need this non-VA care.
Let me give you an example. My husband, Mike Verardo, lost his left
leg and much of his left arm in an IED explosion in Southern
Afghanistan. His residual left leg suffers numerous skin infections
that make the prolonged use of prosthetic sleeves dangerous and expose
him to potential reinfection. Unfortunately, until recently the VA
medical administrators refused to issue Mike more than two prosthetic
sleeves every six months. VA has repeatedly cited this as policy to me
and other amputee Caregivers, and our workaround included numerous
direct appeal from Mike's own VA doctor to others within the same VA
system and Congressional intervention. Mike's VA surgeon has prescribed
a specialized prosthetic sleeves nine times, and each of those nine
times, the VA's medical administrators denied those prescriptions. His
surgeon was never consulted or notified that her prescription was
rejected, it simply was never sent to us.
This, Mr. Chairman, is why we cannot continue to rely on limiting
access to non-VA care to that which is prescribed by a VA health care
provider. Experience has shown the VA health care providers are
powerless to prescribe non-VA care when VA medical administration
bureaucrats have every incentive to deny that care and have every power
to do so. Only when individual veterans have the authority to choose
their own health care provider, whether that be within the VA or be
non-VA care, will Veterans be able to access optimal care in a timely
fashion.
Wheelchairs and Prosthetics
This brings me to the specific issue of wheelchairs and
prosthetics. Mike's and my personal experience, and the experience of
our clients, is that the VA cannot deliver wheelchair and prosthetic
repairs and replacements in a timely manner.
For example, when Mike was retired from the military and we moved
back to Rhode Island, his prosthetic leg was damaged, but we had to
wait 57 days for a VA medical administrator to sign a form authorizing
the repair of the prosthetic. Eventually, the prosthetic vendor grew
disgusted with the VA and provided a new prosthetic without
authorization, risking non- payment. In the meantime, I was forced to
duct tape Mike's leg to keep it even somewhat operational. More
recently when I requested a wheelchair repair or replacement from VA, I
was told that they'd need to evaluate if Mike still had injuries that
required wheelchair use. Please keep in mind that limb loss is
permanent.
The VA Inspector General released a report last week detailing
similar problems with wheelchair and prosthetic repairs in VISN 7. The
first remarkable item in this report is that the VA apparently has no
standard for how long it should take to repair wheelchairs and
scooters. Second, the VA IG found the average wait time was 99 days.
Some of the Veterans researched in this study were bedridden for more
than 100 days while their wheelchairs were being repaired.
Lastly, the VA IG detailed the repair administrative process. That
process seems incredibly complex and unnecessarily duplicative. A
simple process review would likely be able to trim substantial time and
steps from this process. The Independence Fund recently met with the
Central Office Prosthetics and Wheelchairs Department, and we are
hoping to enter some Memorandum of Understanding with the VA to help
them improve those processes. We request your support with the VA to
enter into such an agreement with us.
But again, Mr. Chairman, we do not believe there are any
circumstances where the VA will be able to adequately respond to
Veterans' prosthetic and wheelchair repair and replacement needs.
Having to wait until the point of failure for the VA to even initiate
repair or replacement action and having no spares available for the
Veteran to use in the interim, highlights a system unresponsive to the
basic needs of disabled Veterans. Even the 30-day repair standard the
VA IG arbitrarily applied in their report (since the VA does not have
its own repair/replacement standard), is unacceptably long. Therefore,
we recommend Veterans be allowed immediate access to non-VA care for
the repair or replacement of prosthetics, wheelchairs, and scooters.
Standards of Care and Formularies for the Catastrophically Disabled
There is, unfortunately, a broader issue at hand which we see with
many of our catastrophically disabled clients, Mr. Chairman. For the
catastrophically disabled, even minor delays in accessing medical care
can quickly devolve into life threatening emergencies. What would be a
minor inconvenience for a Veteran suffering from one or two isolated
disabilities, can be a matter of life or death for a catastrophically
disabled Veteran.
Like the example with the prosthetic sleeves, most formularies and
standards of care appear to be designed in isolation for that one
specific malady and fail to consider the interaction of multiple
traumatic wounds and injuries sustained by the catastrophically wounded
and disabled. In such situations, the catastrophically disabled Veteran
finds themselves unable to receive the care they need in time to
prevent additional maladies from occurring which exacerbate the
Veteran's illnesses and disabilities.
The VA community care expansion legislation you recently
negotiated, Mr. Chairman, to provide automatic access to non-VA care
where VA facilities fail to meet established access standards, and to
provide access at the discretion of the Secretary where VA facilities
fail to meet VA established quality standards, may also be insufficient
to protect the health of the catastrophically disabled. The medical
needs of the catastrophically wounded and disabled are far different
than those with non-catastrophic disabilities. Hence the special VA
classification for the catastrophically disabled. But access and
quality standards must also consider the special requirements of the
catastrophically disabled.
Therefore, Mr. Chairman, we recommend any future legislation to
define when and where Veterans are eligible for non-VA care should
establish separate, specific access and quality standards for the
catastrophically disabled which will be applied, and under which
catastrophically disabled Veterans can qualify for non-VA care, even if
the standard access and quality standards are otherwise met. Similarly,
we believe the VA should be directed to establish separate formularies
specifically for the catastrophically disabled that consider the unique
and complex nature of their disabilities.
Thank you again, Mr. Chairman, for the opportunity to appear before
this Committee today. I look forward to answering any questions you may
have.
Prepared Statement of Staff Sergeant (SSG) Retired Gary B. Goodwin
Mr Chairman, House Veterans' Affairs Committee Members present,
Congressman Richard Hudson, other Invitees and Guests. I am humbled
that you have invited me to this field hearing today and welcome you
all to the great city of Fayetteville, North Carolina. Our city motto
is History, Heroes, and a Hometown Feeling and that can be seen
anywhere you travel in Fayetteville. I am proud to call Fayetteville my
home for the past 30 years. Fayetteville is the home of Fort Bragg
where duty, sacrifice and love of our great country is on display 365
days a year.
Before I offer my testimony, I want to make clear to the Committee
and all in attendance that any issue(s) I currently have with the
Fayetteville VA Medical Center (FVAMC) are administrative in nature. I
have been receiving 100% of my medical care thru the FVAMC since 1994
(24 years) and am 100% satisfied with the EXCELLENT level of care
provided to me. I often tell people not to believe all the negative
press they hear about the VA in general. Why? If my experiences with
the FVAMC are any indication of what the VA offers, I am hard pressed
to believe every negative story in the media today. Is the VA system
perfect? No. Show me any large scale medical system in the world that
is!
In that vein, I would like to offer my personal thanks and
recognize my Primary Care Provider Dr Abul K. Azad, MD and his Staff
Nurses Lillian Figueroa and Tracy Ford for all they have done for me.
Time constraints do not allow me to also thank countless FVAMC Staff
Members who have also offered me quality care and compassion. I am
thankful for what they do for this Veteran!!
The past four years have been medically challenging for me. Three
major surgeries, two minor surgical procedures, numerous
hospitalizations and countless ER/Urgent Care visits. This includes
experiences with the FVAMC, Veterans' Choice and Non-VA Care.
I was asked to speak to with the Committee regarding a specific
issue that, as of today, has not been 100% resolved.
I have encountered an issue with the VA that I have been unable to
resolve on my own after repeated attempts to do so. Non-payment of Non-
VA medical expenses that have been approved by the VA for payment. I
offer my testimony regarding this issue as I imagine I can not be the
only Veteran this has happened to.
On July 22, 2016 (Friday), I sought ER care at a Non-VA Facility
for issues related to a recent thoracic/chest surgery. I followed the
appropriate procedure(s) and notified the FVAMC of same the following
Monday (July 25, 2017). After several inquiries, I finally received a
letter from the FVAMC, dated January 13, 2017, stating this episode of
care has been verified, claim approved by ``Salem'' and pending
payment.
I learned recently that the VA has finally began making payments to
the ER providers now 24 months post dates of service. It remains
unknown to me if the VA has communicated with the providers to advise
of payment delays or specific reasons for payment delays. I have
previously made repeated inquiries to the Fayetteville Non-VA Care
Office and the Fayetteville VA Director's Office without success.
I contacted the VA Office of the Inspector General (OIG) and
received a response stating they do not investigate these matters. The
OIG urged me to contact the VA Compliance and Business Integrity Office
(CBI) regarding this matter and provided a name and e-mail address for
contact. I sent an e-mail to the named CBI official seeking assistance.
I have not received an acknowledgement or response to date.
I contacted my Congressional Representative Mr. Hudson on November
6, 2017 for assistance. Mr. Hudson's Deputy District Direct, Georgia
Lozier, has been very helpful in seeking a resolution on my behalf.
I have also been in contact with our local ABC television affiliate
ABC 11 WTVD, in Raleigh. Their Trouble Shooter has been in contact with
the VA on my behalf and is preparing a televised report about their
efforts to assist.
I have extensive documentation/names/dates to support my claimed
inquiries.
The ER providers have been contacting me with threats of lawsuit(s)
or collections. I have provided each ER provider with a copy of the VA
payment letter mentioned above. One provider has now attached a
negative balance due to my credit report with Equian. This has resulted
in my rejection for a home equity loan that was submitted to my
mortgage company in November 2017. Additionally, my credit score has
dropped from 820 to 670 as a result of non-payment by the VA.
The EMS provider turned my account over to collections and posted a
negative balance due to my credit report with Equian. This has resulted
in significant damage to my ability to gain credit for home
improvements, new household furniture and co-signing for my son on his
recent new vehicle purchase. My 25 year old son's credit score is 780.
How does my 25 year old son achieve a greater score than me?? I have
preached to him over the years regarding the importance of financial
responsibility as a good credit standing ``makes the world go around''.
The EMS provider, Brunswick County EMS. is now attaching a
garnishment to any tax refund I may receive from the State of North
Carolina? I am attaching a copy of their letter to me dated 11/30/17
for your review.
I contacted each provider in January 2018 for status:
Brunswick County EMS - Called provider and offered my private
health insurance, United Healthcare (UHC), information for payment.
Same was declined as provider will not bill insurance for services > 1
year old. I submitted a manual claim to UHC for consideration and
pending. UHC will likely not cover as claim filed > 1 year post date of
service 7/22/16.
Novant Health (ER) - Called and spoke to Financial Services
Representative. Novant has written off my entire bill as uncollectable
and the current balance due is $0.
Carolina Health Specialists (ER MD) - Called and spoke to
Representative, provided my private health insurance information.
Provider will file claim with UHC.
Delaney Radiologists PA (ER Radiology) - Called and spoke to
representative, I paid $46 balance due out of pocket.
On February 15, 2018, I received an update from Ms. Lozier and was
advised that an un-named VA Representative providing her the following
statement:
``Good morning Ms. Lozier, Our apologies for the delay in
processing this claim. Our payment center had previously suspended the
claim for Pending VA/Office General Counsel Millennium Health Care Act
decision (Emergent care for a non-service connected condition) because
the Veteran had other insurance and after clinical review it was deemed
that it was unrelated to his service connected condition. The letter
dated 1/23/17 was subsequently sent to the Veteran from the
Fayetteville VAMC, our payment center office was not aware of the
letter, nor was aware that the VAMC had authorized the emergent care as
a result of complications to previous authorized surgery. However, the
VAMC did not enter the authorization into their system until 2/7/18.
The following claims, UB #600609 and HCFAs 2296422, 2306945,
3539367 for providers Novant Health, Delaney Radiologist, and Strand
Physician Specialists were processed immediately after authorization
entry and were sent to payment on 2/9/18. The claims associated to the
hospital are in batches pending release for payment. The ambulance
claim will be processed by the VAMC Beneficiary Travel Office since the
transport is authorized.
We have reached out to the VAMC to share this example with them and
we will make every effort to improve communication between the VAMC
Fayetteville and our payment center office so this issue does not
happen again.
Again, we apologize for the delay in processing payment and the
inconvenience caused to Mr. Goodwin. Please let us know if additional
information is needed''.
On March 3, 2018, I received written notification from the FVAMC
that the ER, ER MD and ER Radiology services have been pain and in what
amounts. There was no mention in the letter that the EMS provider has
been paid and what, if any action(s), the FVAMC would take to assist me
with removing the negative post to my credit report.
On March 15, 2018, I e-mailed a local FVAMC Non-VA Care Supervisor
about the pending payment to the EMS Provider and a conversation that I
just had with member of the FVAMC Beneficiary Travel Office. I have
redacted names and phone numbers due to privacy issues.
``Paragraph 2 from the February 15, 2018 update states the EMS bill
to be paid by VAMC Beneficiary Travel Office. Correspondence I have
received, from other sources regarding the EMS bill, indicated a person
named ``X'' was the point of contact. So, I just called the FVAMC and
asked to speak to ``X'' in the VAMC Beneficiary Travel Office. I then
spoke to ``X''. He stated payment for EMS transport was ``sent to
Texas'' and became somewhat frustrated when I asked for clarification.
He could not or would not say if payment has been made or when?
I asked for his Supervisor's contact information, called
``Supervisor Y'' and left a message for callback regarding payment of
the EMS bill from 7/22/2016 and assistance with removing the negative
entry from my credit report.
The FVAMC Non-VA Care Supervisor called me later in the afternoon
and advised the authorization for payment of the EMS bill was approved
and payment would be forthcoming from a VA Payment Center in Texas. She
could not definitively say when payment would be made or what action
the FVAMC would take to assist me with the removing the negative credit
report posting.
I have yet to receive a response from ``Supervisor Y''.
As of today, and a full 24 months after my ER visit on 7/22/16, I
remain hopeful that the EMS payment in question will be paid and the
FVAMC will offer its full assistance in repairing the damage to my
credit report. I will happily provide the Committee with any documents
they require.
Thank you, Mr. Chairman, the Committee and Mr. Hudson for all you
do to support our nation's great Veterans.
Prepared Statement of CMSgt Daryl Cook
Good morning Chairman Roe, Dr. Dunn, Congressman Hudson and Members
of the Committee on Veterans' Affairs. It is truly a pleasure to be
provided the opportunity to share my experiences as it relates to the
Veterans Administration and more importantly share many positive
experiences. I will also provide some issues within the program I feel
are recommended areas of improvement. While I currently serve as the
Installation Fire Chief assigned to the 145th Airlift Wing my testimony
are my views and not those of the 145th Airlift Wing or the North
Carolina National Guard.
Introduction
As mentioned, I serve as the Installation Fire Chief to the 145th
Airlift Wing in Charlotte where we mutually respond with Charlotte Fire
Department to emergencies at Charlotte Douglas International Airport,
the sixth busiest airport in the country. Additionally, our mission
includes providing emergency services support for Stanly County
Airport. I have 32 Drill Status Guardsmen and 24 North Carolina State
Employees to assist in providing coverage to these locations.
Background
With a varying number of personnel between military and civilians I
have the opportunity to serve with many individuals who deal with the
Veterans' Administration and typically information I receive is
positive in nature. Close to 100% of my personnel have deployed so many
have direct interaction with the VA prior to and after their
deployment. Most of the information I provide is positive in nature but
as with any program, improvement to the process and overall goal of
providing the best care to our veterans can always get better.
Input from the Field
MSgt Christopher Johnson is also assigned to the 145th Airlift Wing
and when asked about his interaction and service with the VA, he had
nothing but favorable comments about his experience: staff was very
friendly/professional and informative with the services they provide;
facilities utilized were clean and in good condition; was able to get
referred to a nutritionist and eye doctor in a timely fashion and when
he needed services from the Emergency Department in Charleston, SC he
received prompt and excellent service.
CMSgt (R) Pete Hazleton previously assigned to 145th Airlift Wing
now assigned as a State Firefighter with the Air National Guard
utilizes the VA's medication program and primary physician program with
positive success. There are difficulties and concerns in scheduling
appointments; it takes excessive time to get an appointment, may be
months out, and the process for making the appointment and getting a
referral is not an easy one. When directed to have lab work done it
typically takes an extended period of time and many times orders are
not there when you arrive to have the labs.
MSgt (R) Donald Willis previously assigned t the 145th Airlift Wing
now assigned as a State Assistant Fire Chief with the Air National
Guard. In January of 2017, he contacted the Veteran's Administrator of
Catawba County to ask questions about the VA benefits that came with
retirement. He was informed by them that his finances made me
ineligible for the VA medical care benefits.
He retired from the NC Air National Guard on 10 Jun 2017. He went
to the VA office in Charlotte in September 2017 to ask about applying
for service related injuries. He filled out the paperwork and the VA
representative made him an appointment with the VA clinic in Charlotte
on 26 October 2017. He went to the appointment and his medical records
were transferred to the VA. He started his paperwork for the service
related disability. The VA clinic made his next appointment for one
year later, 26 October 2018 at 1000 hours.
He received a letter in the mail on 19 March 2018 from the VA
advising him that his appointment for 26 October 2018 had been
cancelled, and providing him some numbers to call and find out why. He
called the 800 number given and spoke to a representative who looked up
his appointment. The representative stated that his appointment was in
fact cancelled. He asked her what the reason was for the cancellation.
She checked the system and stated that it was probably because he made
too much money. He did receive letters from the VA telling him they
were looking into how much he made annually.
Conclusion
In closing I want to thank you for the concern and the effort
you've put forth in ensuring our veterans receive the best care
available. I appreciate the House Veterans Affairs Committee being
proactive and seeking out ways to better serve our nation's veterans.
Additionally, I would like to thank those who have served before me,
those I've had the opportunity to serve with, and those who will serve
after me. It is truly an honor to serve this great nation. God Bless
this committee and God Bless the United States of America.
Prepared Statement of Deanne M. Seekins, MBA
Good morning Chairman Roe, Ranking Member Walz and Members of the
Committee. I appreciate the opportunity to discuss the Department of
Veterans Affairs' (VA) Fayetteville VA Medical Center (VAMC) and the
partnership with the community to provide quality and accessible
healthcare. I am accompanied today by Dr. Mark Shelhorse, Veterans
Integrated Service Network (VISN) 6 Chief Medical Officer and Interim
Medical Center Director at the Fayetteville VA Medical Center, and
Joseph Enderle, Choice Program Manager, Office of Community Care.
Introduction
The Fayetteville VAMC is a Complexity Level 1C facility that
consists of a 58-bed general medicine, surgery and mental health
facility located in the North Carolina Sand Hills within 10 miles of
Fort Bragg and Pope Air Field. The Medical Center also maintains a 69-
bed long-term care Community Living Center (CLC) to care for Veteran
residents and adjacent to the Medical Center is the North Carolina
State Veterans home, a 150-bed long-term nursing home facility. The
Fayetteville VAMC serves 74,000 patients in 19 southeastern North
Carolina counties, which is one of the largest catchment areas in VISN
6. The Fayetteville VAMC operates two Health Care Centers: one in
Fayetteville and one in Wilmington, along with community-based
outpatient clinics (CBOC) in Brunswick, Goldsboro, Hamlet,
Jacksonville, Robeson, and Sanford. The CBOCs provide Primary and
Mental Health Care and offer Tele-health services for other
specialties. Located offsite in Fayetteville, the healthcare system
opened the first freestanding community Dialysis Center in the VA
health system nationwide in 2011. This unit has the capacity to treat
64 dialysis patients daily. In addition, Marine Corps Base Camp Lejeune
and Seymour Johnson Air Force Base are located within the facility's
catchment area.
Growth in North Carolina
Overall, North Carolina's population has grown by 611,000 since
2010, an increase of 6.4 percent. North Carolina is the fifth largest
state for relocation. During this time frame, VISN 6 has led the Nation
in Veteran population growth with a 118 percent increase, and this
trend is expected to continue.
While North Carolina boasts several universities with top-tier
medical and nursing schools and allied health programs, not all North
Carolina residents have ready access to urban or academic-affiliated
health care. The surrounding communities are notably rural, especially
those surrounding Fayetteville, NC. According to the North Carolina
Department of Health and Human Services, between 70 and 80 of the 100
counties in North Carolina are underserved in terms of primary care,
mental health and/or dental resources. As of September 30, 2017, 42
percent of those Veterans receiving services in North Carolina are
deemed rural. In the Fayetteville catchment area 17 of 19 counties are
considered rural.
It is a challenge to provide healthcare in this environment because
there often are not enough providers to meet the demand for care. To
address this challenge, VISN 6 has fully embraced VA's modernization
efforts and is actively focusing on providing exceptional foundational
services while expanding partnerships with community and Department of
Defense (DoD) health care systems to ensure world-class care to all
Veterans, including those residing in rural areas. VISN 6 and the
Fayetteville VAMC have focused heavily on addressing the access
concerns related to the rural nature of the location and the population
growth by making meaningful changes in both VA-provided services as
well as those delivered in partnership with DoD and the community.
Improving Access within the Health Care System
As has been the case across VA, improving access to care has been
among Fayetteville's top priorities for several years, but the efforts
have recently intensified resulting in considerable improvements.
Specifically, 96 percent of time sensitive appointments have been
completed on or before the patient indicated date. Fayetteville's
leadership has been taking steps to improve access using a broad
variety of strategies, including the following:
Partnered with community providers, DoD facilities and
other VA facilities to provide services;
Built internal capacity and access by adding 420,000 new
square feet of clinical space in the past 4 years with a corresponding
increase of 841 new staff;
Established a Patient Aligned Care Team working at Camp
Lejeune;
Expanded hours during the week using 10-hour shifts and
implemented evening and weekend clinics as well as extended hours for
diagnostic radiology;
Increased efficiency by 25 percent in the Fayetteville
Health Care Center primary care by redesigning the clinical area to
accommodate 5 teams in the same space previously designated for 4
teams;
Utilized partnerships with other VAMCs to maximize the
use of telehealth in the areas of primary care, mental health, and
specialty care;
Increased the use of registered nurse clinics and secure
messaging to supplement face-to-face visits with providers;
Implemented Clinical Practice Management guidelines to
promote optimal resource use and maximize the clinical time available
for staff to see Veterans;
Expanded the number of academic affiliations and
established a recent agreement with the School of Osteopathic Medicine
at Campbell University; and
Initiated construction projects to renovate operating
rooms, inpatient units and the Community Living Center.
In addition, Fayetteville is working to provide greater flexibility
and alleviate bottlenecks that potentially impact access by maximizing
its use of community care. Services available to Veterans through
community providers include physical therapy, pain management,
audiology, dermatology, optometry, neurology, obstetrics, cardiology,
orthopedics, rheumatology, podiatry, primary care, sleep medicine,
chiropractic services, and in-patient hospitalization.
Major DoD Sharing Agreements
The VA Mid-Atlantic Health Care Network and the Fayetteville VAMC
consider their partnerships with DoD to be a critical aspect of
providing care to Veterans. Resource sharing agreements are in place
with Womack Army Medical Center on Fort Bragg, the Naval Medical Center
Camp Lejeune, and Seymour Johnson Air Force Base's 4th Medical Group.
The agreement with Womack Army Medical Center provides access to
many specialty services currently not available at the VAMC.
Specifically, VA surgeons are using Womack's operating room suites
during the VA Medical Center's operating room renovation project. In
addition, the Fayetteville Rehabilitation Clinic, a Joint Incentive
Fund initiative with the Womack Army Medical Center, opened in May
2017, and provides physical medicine and rehabilitation services to
both Veterans and active duty Servicemembers. The Naval Medical Center
at Camp Lejeune provides Veterans with access to emergent and inpatient
care while the Fayetteville VAMC provides care for active duty
Servicemembers. Finally, the Seymour Johnson Air Force Base partnership
provides opportunities to share services such as diagnostic x-ray,
physical therapy, mental health, and anti-coagulation clinics.
The Fayetteville VAMC is currently working with the Womack Army
Medical Center to expand their current agreement to create a more
robust and innovative partnership. A final agreement is expected during
the 3rd quarter of fiscal year 2018.
Timeliness of Community Care Payments
On January 3, 2018, VA announced a series of immediate actions to
improve the timeliness of payments to community providers when VA has
purchased community care. In addition, VA's contractors for the
Veterans Choice Program, Health Net Federal Services and TriWest
Healthcare Alliance, are committed to working with VA to improve the
timeliness of payments to community providers and are working
diligently with VA, VISNs and facilities to accomplish that goal.
VA realizes that many community providers have challenges with the
VA payment process, and VA wants to improve its service. Over the past
2 months, VA has focused on the top 20 providers nationally with the
highest dollar value of unpaid claims and created rapid response teams
that are currently working with those providers to resolve those
claims. In addition, VA is increasing the number of claims processed
within 30 days of submission through use of additional contractor
support. Through these efforts, the number of claims processed in the
last 2 months has increased substantially, and we are well on our way
to our goal of eliminating our claims backlog by September 2018.
VA is aware that smaller providers play key roles in more rural
communities in providing continuity of care for our Veterans. Because
of their smaller size and the lower volume of care furnished, the total
value of these providers' unpaid claims would also be less, but VA is
working with facilities to identify smaller providers who are important
providers of Veteran care and will also be working with them. Lastly,
VA realizes that provider education about claims processing is
important in assisting providers in submitting their bills accurately.
VA has been providing education to the providers with the highest
dollar value of unpaid claims as part of the outreach. We have seen the
value of this outreach and will begin offering monthly training calls
in April for the entire provider community. This will allow any
provider to join in and learn about VA processes.
Conclusion
The Fayetteville VAMC has made significant improvements to meet the
needs of our Veterans. In order to sustain these efforts, we ask
Congress' continued support of VA modernization by investing attention
and financial resources into the following: streamlining leasing
process, recruitment and retention incentives for hard-to-hire
occupations and locations, and flexible funding models to improve the
speed and efficiency in which medical centers need to respond to
challenges. These are in addition to improving VA's community care
authorities.
It is critical that we continue to move forward with the current
momentum and preserve the gains made thus far. Your continued support
is essential to providing care for Veterans and their families.
Mr. Chairman, this concludes my testimony. Thank you very much for
your attention. My colleagues and I are prepared to answer any
questions.
[all]