MINNEAPOLIS - An independent commission called Wednesday for “urgent reforms “ in the way America provides medical care for veterans – including more options for private health care outside traditional VA hospitals.
The recommendation comes as a new KARE 11 investigation has turned up evidence that hospitals in Minnesota and across the nation are refusing to participate in the existing $10 billion VA “Choice” program because the VA isn’t paying its bills.
Army veteran John McMahon is an example of what critics say is happening nationwide. Last year, he needed shoulder surgery. Little did he know the headaches that would follow.
“I started to lose mobility in the arm,” McMahon said, pointing to medical photos taken before his surgery. “All of these red areas you see inside the shoulder joint had to be scraped away.”
The wait to see a Veterans Affairs surgeon was going take more than 30 days, so McMahon opted to use the Veterans Choice program. That program allows veterans to get medical care outside the VA system if the wait times are too long or if they live more than 40 miles from a VA facility.
But McMahon says the using the program designed to cut wait times had its own delays.
He says it took three weeks after the VA said they could not see him in a timely manner for Veterans Choice to approve him getting an outside consult with a surgeon. It then took another 59 days to get an appointment.
McMahon’s surgery was performed at the Mayo Clinic Medical Center in Lake City. “They gave me just excellent care,” he recalls.
Although his surgery went well, McMahon says it created a new headache – unpaid bills.
With that excellent care came a hefty bill totaling $25,392.
It’s been more than a year since McMahon’s May 2015 surgery. So far, he says, the Veterans Choice program hasn’t paid a dime for the surgery they authorized.
“When they promise to authorize a procedure, that a procedure be done, and have you go through the procedure and then they don’t pay for it. It’s just plain wrong!” McMahon says.
Since the VA hasn’t settled up, McMahon says the hospital billing office has started contacting him asking when they’ll be paid.
McMahon’s is not an isolated story. Some veterans have had their medical bills turned over to debt collectors after Veterans Choice failed to pay the private providers in a timely fashion. It’s been such an issue the VA has set up a hotline to help veterans whose credit has been harmed.
There have been a number of modifications to Veterans Choice since it was created by Congress in response to the wait times crisis and first signed into law by President Obama in 2014.
In April, 2015, KARE 11 shared the story of Paul Walker, a veteran with terminal stage 4 cancer who was denied access to the Choice program because he lived within 20 miles of the Northwest Metro VA Clinic in Ramsey. That clinic provided dental and eye care, but not cancer treatment.
Other veterans told KARE 11 of being denied access to the Choice program because they lived less than 40 miles “as the crow flies” from a VA facility, even though actual driving distance was much further.
Mr. Walker would eventually lose his battle with cancer in January, 2016. But his story caught the nation’s attention.
John Stewart’s “The Daily Show” aired clips from KARE 11’s report about him. “C’mon VA!” Stewart yelled into the camera.
Days later, the VA did away with its “as the crow flies” measurement.
Now, stories of veterans like John McMahon – whose private doctors aren’t getting paid – are threating the credibility of the VA’s Veterans Choice program. In fact, the newly released “Commission on Care“ report recommends replacing the "Choice Program" which it called flawed in design and execution.
The Mayo Clinic hospital system which performed McMahon’s shoulder surgery is no longer accepting veterans through the Choice program.
In a statement to KARE 11, Mayo spokesperson Susan Lindquist wrote, “Similar to many health care providers across the country, Mayo Clinic is not participating in the Veterans Choice Program because of the significant administrative burden, necessary staff increase and costs to meet the requirements of this VA pilot program. Mayo Clinic is committed to serving veterans and is working with policy makers to improve this program for the benefit of veterans. Mayo Clinic continues to serve thousands of veterans and provides their care under a number of commercial and government insurance programs.”
That means veterans like McMahon, who live within miles of some of the best medical facilities in the world, won’t be able to get care there in the future.
“No, not if I go through the VA,” said McMahon. “Plain and simple.”