Oversight: Right Time, Right Place, Right Treatment with VA Community Care

Hospitals and Health Care

2025-07-15

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Source: Congress.gov

Summary

This meeting discussed the Department of Veterans Affairs (VA) Community Care Program, examining its effectiveness, challenges, and relationship with direct VA healthcare services.[ 01:08:51-01:09:01 ]

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[ 01:18:48-01:18:51 ]

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 Speakers highlighted both the critical role of community care and significant systemic issues affecting veterans' access to quality healthcare.

Themes

Necessity and Benefits of Community Care

Community care is presented as a vital extension of VA services, particularly for veterans in rural areas or those requiring specialized care unavailable at VA facilities.[ 01:29:09-01:29:17 ]

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 It helps reduce wait times and travel burdens, thereby improving health outcomes and access to care.[ 01:09:24-01:09:32 ]

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 Witnesses shared personal experiences where community providers offered essential specialized treatments, such as chiropractic or acupuncture, and demonstrated more sensitive, trauma-informed approaches than some VA facilities. This choice and flexibility are especially crucial for women veterans, many of whom prefer female providers for specific care needs.

Challenges and Failures within the VA and Community Care System

Significant issues include long wait times for referrals, denials of necessary services, and complications with billing and coordination between VA and community providers. Veterans reported experiencing re-traumatization within the VA system due to a lack of trauma-informed care and repeated questioning about their experiences, leading to severe mental and physical health issues, and in some cases, death. Furthermore, the reduction or elimination of community care services and shorter authorization periods are creating instability and increasing administrative burdens for both veterans and VA staff.[ 02:28:37-02:28:51 ]

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Impact of VA Workforce Issues and External Policies

The VA is facing substantial workforce reductions, with estimates of nearly 30,000 employees departing, including critical frontline staff.[ 01:20:21-01:20:27 ]

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[ 01:20:38-01:20:45 ]

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 These losses are attributed to a "toxic, unpredictable, and hostile" work environment and are leading to increased wait times for appointments and difficulties coordinating care. Additionally, proposed federal budget cuts, such as a $1 trillion reduction to Medicaid, are projected to severely impact rural hospitals, further diminishing community care options for veterans.

Debate Over Quality of Care and Data Utilization

While some argue that VA direct care consistently provides better health outcomes due to its integrated model and military cultural competency, others contend that quality varies between individual providers in both VA and community settings.[ 01:55:56 ]

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[ 01:56:00 ]

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 Concerns were raised about a lack of oversight regarding training for community care providers and the potential for unnecessary medical procedures. Speakers emphasized the need for data-driven decisions and improved information sharing, particularly regarding electronic medical records, to ensure comprehensive and coordinated care across both VA and community systems.[ 02:15:33-02:15:47 ]

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Tone of the Meeting

The meeting maintained a serious and concerned tone, characterized by passionate advocacy for improving veteran healthcare. While there was an underlying consensus on the need for both strong VA direct care and robust community care, debates arose regarding the effectiveness of each system and the implications of current VA policies.[ 01:52:28 ]

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[ 02:04:36 ]

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 Discussions were at times tense, particularly when addressing criticisms of VA performance and the interpretation of data versus personal anecdotes. Despite disagreements, a shared commitment to veterans' well-being was evident throughout the proceedings.[ 02:11:43 ]

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Participants

Transcript

This is a test, test, test.  Okay, this is a test.  Okay, cool, thank you, bye.
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Unknown
Thank you.   No, I can't.   Thank you.   Thank you.
Yes.  I don't know what the order is.
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Ms. Kristina Keenan
I'm guessing that too.  Here I can show you the order.
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Unknown
Right there.  Floor.
Well, you know, with my luck, I would start, you know, like, of course, or, like, start popping in the middle.
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Unknown
It's just, like, it's better to have pop drops just in case.   When we get started, everyone, when do you see the chair?
The members and witnesses to today's hearing.  During this hearing, witnesses will share with us how VA works hand-in-hand with private doctors and providers to meet veterans' specialty care needs throughout the VA Community Care Program.   Data show that veterans like and want community care just as they like and want their VA health care system.  Polling has shown that Americans want veterans to be able to access shorter wait times and drive times to get their health care.  Through the Mission Act, Congress has closed the gap that was crippling the delivery of care by the VA and oftentimes leaving veterans behind, stuck in line, and waiting for an appointment.  This was especially true for specialty care.   By virtue of being in the community, these providers are closer to veterans and their homes than a brick-and-mortar VA facility.  That can mean shorter wait times and drive times for veterans.  Through the Mission Act, the VA Community Care Program created new opportunities for more resources than ever to serve veterans.  Veterans enjoy shorter wait times and drive times for specialty care appointments because VA is allowed to cover specialty care in the community.  Veterans have more specialty care through VA because of community care, not less.   Three key indicators today and on the horizon show that the VA will continue to rely on providers and the community to meet the moment for specialty care for veterans.  First, demand will increase for all specialty care needs as more women use VA for health care.  By 2040, the VA estimates that women will make up 18% of all veterans.  More women veterans means not just an increase in female-specific care, but an increase in specialty care services overall.   Second, VA's workforce challenges mirror those of the health care industry as a whole.  There is a national shortage of health care professionals, especially for physicians and nurses.  The VA recently identified shortages for clinical roles like psychologist, medical technologist, diagnostic radiologist,   technologist, which is the same in the private sector.  And this is true across all VA facilities, even though this committee and the Veterans Affairs Committee has increased pay to providers within the VA health care system.
All of these roles play a part in, if not directly, provide specialty cares for veterans.   The higher the ratio between veterans and health care staff, the more veterans will need community providers for VA-covered specialty care.  Third, and finally, the VA expects significant changes in demand for care in general, including specialty care.  The VA projects major shifts in physical space demands for hospital operations by about 2030.  Estimates range from an $850,000 decrease in needed square feet   in New Orleans, Louisiana,   2,500,000 increase in needed square feet in Orlando, Florida.  So having facilities where they're needed in accordance with the demographic shifts of the country, sometimes we're far behind where that movement occurs.  These are but two of the many estimates projecting dramatic increases and decreases in demand for physical space across the country.  And one of the reasons we introduced the Chippen Act in this committee, as well as increases for funding infrastructure within the VA.   The VA also projects highly variable demand in different facilities across different types of care.  I hope you'll bear with me as I explain the numbers, which paint a compelling picture of the veterans' health care needs.  The VA expects a 50% growth nationwide in outpatient primary and specialty care combined.   Relatedly, the VA also expects a 13% decrease in inpatient acute medicine and surgery nationwide.

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