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Growing VA wait list crisis requires bold solutions

John Newport

John Newport

A recent New York Times article proclaimed: “One year after outrage about long waiting lists for health care shook the Department of Veterans Affairs, the agency is facing a new crisis: The number of veterans on waiting lists of one month or more is now 50 percent higher than it was during the height of last year’s problems, department officials say.” Much of the increase is attributable to escalating demand by aging Vietnam veterans and returning troops from Iraq and Afghanistan.

This latest indictment has particular relevance for Arizona, as the Phoenix VA Hospital was the epicenter of last year’s scandal. More importantly, as chairman of the Senate Armed Services Committee, Arizona Senator John McCain is in a pivotal position to advocate bold solutions.

On top of the escalating demand, a $3 billion budget shortfall threatens to further jeopardize access to care. The cost overrun is reportedly attributable to programs that expedite access to outside doctors, together with a costly drug employed in treating Hepatitis C.

Addressing budget shortfall
In June the New York Times ran a provocative opinion by former Navy pilot and mission commander Ken Harbaugh titled “The Risk of Over-Thanking Our Veterans”. While Harbaugh’s piece is definitely controversial, his candid analysis offers perceptive insights that just might enable the system to resolve the financial crisis undermining its health care mission.

Observing that the department’s budget has nearly tripled since 2000, Harbaugh focuses on disability pay-outs which have risen from $20 billion to $60 billion today. At the outset he expresses his belief, which I concur with, that most veterans receiving disability checks deserve them.

Getting to the crux of the matter he states that “…one of the worst kept secrets among those seeking a disability rating is that the system can be beaten. Claim the right combination of symptoms, whether you are suffering or not, and there is a decent chance you can get a monthly disability check, tax free, for the rest of your life. There are even blogs out there to walk you through the process of claiming an injury that cannot be disproved.”

To remedy this situation Harbaugh, himself a veteran, proposes that Veterans Affairs takes a hard look at how the system is being gamed and seek to end abuses in a manner similar to measures employed in policing phony workers’ compensation claims. Concurrently he advocates that the VA double down on programs like job training to empower veterans to access meaning employment, rather than creating dependencies.

Here’s where my idea kicks in. Suppose, hypothetically, that the VA could recoup $10 billion annually through eliminating inappropriate disability claims. That would eliminate the current budget shortfall and go a long way toward securing the additional resources needed to ensure timely access to care.

Empowering veterans to take charge of their health
As a measure to further cut costs and improve health outcomes, I urge that the VA adopt a modified version of the “Annual Wellness Visit” (AWV) recently made available to Medicare beneficiaries through the Affordable Care Act (ACA).

As distinct from a routine physical, the Annual Wellness Visit is a health enhancement benefit designed to empower recipients to take charge of their health. Offered to Medicare beneficiaries with no co-payment, the AWV includes a one-on-one consultation with a licensed health professional, a comprehensive health risk appraisal, a thorough review of personal and family medical history, and a personalized prevention and health enhancement plan.

If properly conducted the Annual Wellness Visit is an extremely cost-effective tool for motivating participants to take charge of their health and undertake health-conducive life-style changes that could potentially add years – even decades – of healthy living to their life-spans. Of particular relevance to the VA, the AWV could yield phenomenal cost savings through avoiding or postponing onset of serious catastrophic illness including Type 2 diabetes, heart disease and many forms of cancer, while further cutting costs by motivating impaired veterans to undergo substance abuse treatment.

In summary, I believe the VA can get itself out of the hole of unacceptable wait times and concurrent cost overrun through a combination of effectively policing inappropriate disability benefit payments and incorporating Annual Wellness Visits into its core services.

— Dr. John Newport, Ph.D, is a consultant and author based in Tucson specializing in health care reform, a vocal wellness advocate and a former senior health services research and policy analyst at the UCLA School of Public Health.

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