Paul Srubas

USA TODAY NETWORK-Wisconsin

Choice program was intended to speed health care services to veterans

De Pere veteran believes program is mired in bureaucracy

Some days, all Jake David can do is sit in excruciating pain and wait.

The De Pere man, a Vietnam veteran with a Purple Heart, spends many of his days writhing on the couch, trying to find a position that doesn’t hurt and finally having to conclude there isn’t one.

“On a 10-point scale, the pain ranges from 2 to 10, depending on how much I try to move,” said David, 66, who says he hears a grinding, gravel noise whenever he moves his leg a certain way. “It hurts. Sometimes you scream, you moan. My wife says I do it in my sleep.

“You wouldn’t treat a dog this way.”

Not the most productive way to pass time for a man trying to run a business out of his home and help care for a disabled wife.

David is convinced he’s not just the victim of a bad hip, but he’s also the victim of an overly bureaucratic U.S. Department of Veterans Affairs.

“Understand, I have nothing but respect for the worker bees at the VA,” he said. “My animosity is toward the administration.”

Specifically, it’s toward the VA’s Choice program. Created in November 2014, the program was designed to accelerate health care for veterans.

It allows private health care organizations to provide health care to veterans who otherwise would have to wait more than 30 days for treatment, who live more than 40 miles from a VA facility or whose local VA facility doesn’t provide the specialty service needed.

David qualifies under two of those criteria: He would have had to wait more than 30 days, and Green Bay’s Milo C. Huempfner VA Outpatient Clinic, 2851 University Ave., doesn’t do hip replacement surgery.

In late February, Zablocki VA Medical Center in Milwaukee told him it could do his surgery April 22.

“I was on crutches three months already,” David said. “I was not happy."

The nurse also told him that he qualified for the Choice program, which held out the possibility of being able to have the surgery in Green Bay rather than Milwaukee, plus beating that nearly two-month delay.

But the nurse cautioned him.

“She said, ‘Jake, be careful. It’s complicated.’”

David quickly found himself overwhelmed by the paperwork, something normally handled by the VA. And he started hearing scary stories about veterans who made mistakes in the process, thereby having to refile and experiencing even longer delays. He even heard about some whose application errors put them in court, with their local provider trying to get them to pay medical bills the veterans mistakenly thought would be covered.

“It seemed to me like I’d be ahead of the game waiting for the VA appointment,” he said. “She scared the bejeezers out of me that, with Choice, I’d wind up going to the back of the line.”

He kept his Zablocki appointment on the calendar and fully expected to just wait it out. Then he found out somehow, miraculously, the Choice program wheels had been turning anyhow and he found himself scheduled for local surgery after all — a week later than the Zablocki appointment.

“It defies human thought how screwed up it is,” he said. “It’s not working.”

Beth Ann Smith, who works with the program for the Milwaukee VA, defends the agency. She wouldn’t speak to David’s specific case because of medical privacy issues, but she said the red tape and the delays aren’t as bad as he characterizes it.

The Zablocki clinic has specialists who help veterans navigate through the red tape, she said.

And while she agreed Choice doesn’t deliver medical care as fast as everyone would like, in general, veterans are getting their care from local providers no more than a week or two later than they would at VA clinics, she said.

The goal is to get veterans to appointments within 30 days, but that doesn’t mean they can expect major surgery that quickly, Smith said.

Maybe, but David believes there’s no way it should have taken this long.

“I should have had the surgery already,” he said. “If the program worked the way it should, I’d be in rehab and, in another week, up and charging already.”

Instead, he’s still two weeks away from surgery.

“And when you’re sitting in a recliner day after day, a day is like a month … and I’m probably one of the lucky ones. There are probably others with worse conditions, just sitting there.”

Help from Washington?

David contacted U.S. Rep. Reid Ribble, R-Sherwood, who has been trying to help. Ribble, also bound by medical privacy laws, declined to talk about David’s case but said veteran complaints about the Choice program are common.

“The primary complaints are centered around the fact that there aren’t enough groups (health providers) locally that are a part of it, and those that are have slowed down the number of veterans they’ll take due to slow payment,” Ribble said.

Payment takes so long that some providers have gone after the veteran for payment, Ribble said. While his office and others have intervened, it’s scared some veterans off from wanting to use the program, and it’s scared some providers off from wanting to get involved.

Florida Today last week published an article about a veteran whose back surgery was delayed an entire year because his local health provider refused to take his case until the VA paid for another veteran’s health care.

That might be an extreme example, but delayed payment causes health care providers to delay or decline participation, and that’s preventing the Choice program from doing what it was designed to do, Ribble said.

“But the VA turned the program over to a third-party provider, which is now managing all contacts and bill-paying and all that, so there’s a whole new bureaucracy with its own set of delays,” he said.

Even as the veteran works with the third-party provider, in this area an organization called Health Net, the veteran needs to continue working with the VA for permission, and that all slows things down, Ribble said.

“The medical systems in Green Bay are terrific, and they want to be part of this program,” Ribble said. “What they’ve told me is they have to have payment at some point and can’t carry it a year or six months. They need to know they’re going to get reimbursed in a timely fashion, and when they don’t, that’s what triggers them not wanting to take part in this.”

The Milwaukee VA has a budget it uses to shortcut payment to local health care providers, to avoid that issue, Smith said.

The Choice program is scheduled to expire Aug. 7, 2017, when it will run out of funding unless Congress opts to reauthorize it. Ribble declined to speculate whether that is likely.

In any case, legislators are looking at a number of initiatives to fix issues within the program, Ribble said. There have been a number of fixes since the program started, but members of Congress are well aware there are still delays, he said.

One repair he has co-sponsored would authorize funds to hire 250 intermediate care technicians who would be assigned to the VA facilities with the longest wait times, he said.

Legislators are also looking for other ways to streamline the entire process.

"If it’s not working, whether there are loopholes in the legislation, it’s the responsibility of the VA and Congress to work these problems out,” Ribble said.

It may be too little too late to help David. His surgery should be over and done with long before legislators find the fix they’re looking for, but he still hopes the program can be improved for the sake of his fellow veterans.

“It’s not the right way to treat people,” David said. “Come on, you guys. You asked us to do something, we did it, and now you’re dumping all over us.”

psrubas@pressgazettemedia.com and follow him on Twitter @PGpaulsrubas