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There's a new cliche being parroted at congressional hearings on veterans' affairs these days: "Community care is VA care." Republican policymakers are intimating that private health care provided to veterans through the Veterans Community Care Program (VCCP) is equivalent to services furnished directly by the Veterans Health Administration (VA). After all, their argument goes, if these two options are interchangeable, there's no downside to redirecting funds from the VA to the VCCP.
But is community care comparable to VA care? Not by a long shot.
If VCCP care was the same as VA care, then:
- Private care appointment wait times would be publicly transparent. They aren't.
- Every veteran seeking VCCP care for post-traumatic stress disorder and depression would be offered the option, if desired, of evidence-based psychotherapy. They aren't.
- Private providers would undergo mandatory training in veteran-specific conditions -- for example, in toxic exposure and military culture. They don't.
- Private providers would conduct annual screenings for suicide, PTSD, substance use and depression. They don't.
- Private care would be closely scrutinized and publicly reported by the inspector general. It isn't.
- A postmortem issue brief would be conducted whenever a veteran in private care dies by suicide. It isn't.
- Private care aggregated quality metric scores would be published on a publicly available website. They aren't.
- Multiple appointments would be offered on the same day, all in one place, through private care. They aren't.
In short, community care doesn't hold a candle to the VA. And it shows.
Veterans who receive care in the VCCP instead of VA hospitals face a higher risk of death. Veterans electing coronary procedures at VCCP hospitals experience equivalent or higher 30-day mortality rates compared to VA facilities. Older VA-enrolled veterans have higher 30-day mortality rates from stroke and heart failure when treated at non-VA facilities rather than VA hospitals. Veterans receiving VA-paid chronic dialysis in community settings have higher two-year mortality rates than those treated within the VA system. Dually enrolled veterans over 65 admitted to community hospitals during the COVID-19 pandemic had higher 30-day mortality rates than their counterparts in VA medical centers. Even suicide rates are greater among veterans who exclusively use VCCP rather than VA care.
The VA's superior outcomes are generally attributed to its higher standards for health care delivery. Broadly speaking, the VA outperforms private-sector care on a wide swath of key quality metrics. In the annual Centers for Medicare & Medicaid Services Hospital ratings, 67% of VA hospitals received four or five stars, compared to only 41% of non-VA hospitals.
Before prematurely proclaiming that "community care is VA care," policymakers should first heed the advice of a Rand Corp. study that suggested elected leaders must "ensure that standards for community care are at least equal to those for VA-delivered care."
The debate isn't about whether veterans should have community options -- they should, particularly in rural areas where VA facilities may be distant. It's about recognizing that these two systems are not interchangeable and that sustaining full funding for VA care benefits the preponderance of veterans. What's at stake is the long-term sustainability of the VA's workforce and physical infrastructure for veteran-centered care, which cannot be replicated in the private sector.
Yet, if the administration follows through on its pledge to slash tens of thousands of jobs, or if the Veterans' ACCESS Act that is being deliberated is ratified, billions of dollars will funnel into community care at the expense of needed investments in the VA. Under those circumstances, the slogan "community care is VA care" will indeed become the reality, though not in its implied meaning.
Should the VA cut 70,000 employees next year, community care will ultimately be VA care, since it will become the only choice left in many areas. Hollowing out a system uniquely positioned to address veterans' health care needs is the not-so-veiled intent of many of those uttering this slick platitude.
-- Russell B. Lemle is a senior policy analyst at the Veterans Healthcare Policy Institute. His recent Military.com article addressed "Speak Up Before VA Health Care Is Gutted."
