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Mr. Chairman and Members of the Committee:

Thank you for this opportunity to present The American Legion’s views on improving access to quality care for this nation’s veterans through Veterans Integrated Services Network (VISN) wide care coordination demonstrations. Recognizing that the VA struggles to meet the current demand for health care services and that the Global War on Terrorism is creating a new era of veterans who are turning to the VA for their health care needs, The American Legion supports the ensuring of timely access to quality health care for America’s veterans and other eligible beneficiaries.

Over the past several years, the Department of Veterans Affairs (VA) has been shifting from institutional, in-patient based care to a more outpatient or non-institutionalized form of health care. Performance measurements, an award winning safety program, quality of care standards and the electronic medical record system have all played a role in the transformation of VA. Once considered the provider of last resort, VA is now considered by many to be the best health care provider in the nation.

The urban battlefield of the Global War on Terror has created new challenges to the VA health care system. Veterans are returning home with severely debilitating injuries to include; loss of limb(s), traumatic brain injury (TBI), mental conditions, stress reactions, post-traumatic stress disorder (PTSD), spinal cord injury and blindness. These types of injuries are very prevalent in this group of wartime veterans.

In addition to the unique injuries affecting this new era of veterans, the demographic of current deployed forces is also unique. The record number of National Guard and Reserve troops, as well as women veterans who are now serving in combat zones, has helped to create a veterans’ population like none other before and VA must be able to treat the unique needs of this population.

The veterans’ health care system, charged with caring “for him who shall have borne the battle and his widow and his orphan,” must continue to evolve and transform as the needs of the future generation of veterans change. The American Legion’s position on the purchasing of care from commercial or other external sources is that it is not in the best interest of VA and, more importantly, America’s veterans and their families.

Comprehensive Contract Care Coordination Demonstration Projects

Public Law (P.L.) 109-114 requires VA to establish a comprehensive managed care demonstration program in three VISNs. Specifically, VA has been tasked, without proper funding, to implement care management strategies that have proven valuable in the broader public and private sectors. Additionally, these programs will be designed to satisfy a set of health system objectives related to arranging and managing care by the end of calendar year 2006. VA is to collaborate with academia and private industry to assist in reaching its goal.

VA currently spends about $2 billion a year on care purchased outside of VA. While The American Legion supports the selective use of contracted care in extreme cases where veterans have few or no other options, we object to the broad blanket approach to the outsourcing of care. Each contract proposal should be evaluated based on its enhancement of services, timely access to care, and quality of care for veterans within respective communities.

In those few cases where VA must turn to outside providers to meet demand, strict oversight of the contracting process must exist to ensure that veterans, who are being treated by a non-VA provider, receive the same level of quality and professionalism inherent to the VA health care system. In order to assure complete compliance, VA must routinely monitor all contracted health care services being provided to veterans. VA must also obtain patient satisfaction feedback on the timeliness and quality of care received from veterans sent to contracted services.

The American Legion has some real concerns as to which services will be provided under these projects. While some basic treatments may be handled effectively by outside contractors, the delivery of more specialized care could prove difficult to access outside of the VA health care system. Mental health care, blind treatment, amputee treatment and long-term care are all unique areas of care, which may prove difficult to administer through contracted care.

Generally, many of VA’s patients are older, poorer and sicker than the general population. That kind of patient demographic is one that many industry leaders shy away from due to the treatment costs involved. The American Legion is deeply concerned that VA patients would be treated differently than other non-veteran patients. Within the VA health care system, patients are a priority -- not just another customer -- and receive holistic care.

VISN involvement in determining who are the contracted care providers is also a concern. The American Legion would like more information on the selection criteria for the contracted care, such as accreditations and licensing requirements for providers. Details should include hours of availability and specific location of the physical facility in relationship to the VAMC. It is also important to know how many health care positions (FTE) are lost at the VAMC or Community Based Outpatient Clinic(s) as a result of the contracted care.

While The American Legion supports providing veterans timely access to quality health care, it is important that we do not create initiatives that will lead to the dissolution of the very health care system created to care for these heroes. Accessibility delays must be solved by enabling VA to meet its obligation through adequate funding levels, not by turning VA into a third-party payer for care.

Academic Affiliations

The Conference Report 109-305 for Military Quality of Life and Veterans Affairs, and Related Agencies Appropriations Bill, 2006 stated that, “It is essential that care purchased for enrollees from private sector providers be secured in a cost effective manner, in a way that complements the larger Veterans Health Administration system of care, and preserves important agency interest, such as sustaining a partnership with university affiliates.”

As one of four statutory missions, VA conducts an education and training program for health professions students and residents to enhance the quality of care provided to patients within the VHA health care system.

VHA has enjoyed a long-standing and exemplary relationship with affiliates since 1946. During the ensuing 60 years, this relationship has grown stronger, continuing today with 107 formal affiliation agreements with VAMCs across the country. There is no doubt that these agreements have a substantial impact on the current and future health workforce of the VA health care system and the nation. Thousands of medical students are trained each year in VA facilities through affiliations. This partnership has decidedly grown into the most comprehensive academic health system partnership in history.

It is crucial that the affiliates be intimately involved with these demonstration programs and that they take advantage of the opportunity to actively participate on VA Executive Steering Committees that will improve health care management strategies. Because they are also an integral part of the VA health care team, the affiliates should be included in all discussions concerning the demonstration projects.

Mr. Chairman, VA provides many specialty services that are not available in the private sector. They are also the experts on war-related injuries, illnesses and diseases. VA understands the exposures that veterans have endured over the years in foreign lands and unfriendly places. This type of expertise is not easily found in the private sector. These demonstration projects will require vigorous oversight. The VA health care system must be maintained as a separate and distinct health care system.

Thank you again for this opportunity to present the views of The American Legion.