FOR IMMEDIATE RELEASE June 10, 2014

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1 FOR IMMEDIATE RELEASE June 10, 2014 AMA Encourages the Federal Government to Utilize Private Sector Physicians to Help Solve VA Crisis Urges Creation of Registries Identifying Physicians Ready and Willing to Meet Veterans Health Care Needs CHICAGO The American Medical Association (AMA) today voted to ask President Obama to provide timely access to entitled care for eligible veterans utilizing the health care sector outside of the U.S. Department of Veterans Affairs (VA) health care system until the VA can provide health care in a timely fashion. Further, the AMA will also urge Congress to rapidly enact longterm solutions so that eligible veterans can always have timely access to entitled care. Facing an access to care crisis where thousands of veterans are unable to receive the care they need and deserve in a timely fashion, a VA audit released this week found that more than 57,000 veterans are still awaiting their first medical appointment at VA medical facilities, while 64,000 who have enrolled in the VA s health care system have never had an appointment. The AMA believes that all Americans should have access to health care, especially those who bravely serve our country, said Incoming AMA President, Robert M. Wah, M.D. Our nation s physicians can and should be a part of the solution to this national crisis to ensure America s veterans get access to the care they need and deserve. As part of the new policy, the AMA is recommending that state and local medical societies develop a registry of physicians who are ready and willing to care for veterans. These registries can then be provided to local communities and VAs across the country to help expedite access to care. Media Contact: Randi Kahn AMA Media & Editorial (202) # # #

2 Side-by-Side Comparison of Key Provisions in S (Sanders/McCain) and H.R (Miller) DRAFT Provision Access to Care outside the VA Eligibility for Care outside the VA Reimbursement The Veterans Access to Care through Choice, Accountability, and Transparency Act of 2014 S (Sanders/McCain) Allows eligible veterans to seek care outside the VA. Directs the Secretary to enter into contracts with outside health care providers, including those participating in Medicare, or any Federally Qualified Health Center, IHS facility, or DOD. Authority sunsets after 2 years no provision for continuation of care after termination of authority. Veteran must be enrolled in VA system, have attempted to obtain an appointment but is unable to schedule an appointment within the current wait-time goals of the VA and, lives more than 40 miles from nearest VA medical facility or lives in a state that lacks certain medical facilities and is more than 20 miles from a VA facility. (We think there is a drafting error and that intent was to allow care outside VA if either veteran can t get an appointment within the wait-time goal OR veterans lives more than 40 miles from facility). Choice Cards will be issued to each eligible veteran to show they are eligible for care outside the VA. Negotiated rates, to be no more than Medicare, unless higher amount necessary because no provider will accept Medicare rate within the wait-time goals of the VA and at a location no more than 40 miles from veteran s The Veteran Access to Care Act of 2014 H.R (Miller) Directs the VA Secretary to contract with non- Department facilities as may be necessary in order to furnish hospital care and medical services to eligible veterans; encourages use of contracts entered into prior to enactment to extent possible. Authority sunsets after 2 years, but allows an episode of care to be completed post-termination of authority Those enrolled in the patient enrollment system and who have waited longer than the wait-time goals of the VHA; have been notified that an appointment was not available within those wait-times; or who reside more than 40 miles from a VA medical facility, including a community-based outpatient clinic; and elects to receive such care at a non-dept. facility Facility to be reimbursed at the greatest of the VA payment rate, Medicare rate or Tricare rate

3 Requirements on non-va Providers Reports on Access to Care residence. No balance billing allowed (same as under current law). Provides for Sense of the Congress on prompt payment by the VA and transfers authority for payment to non- VA providers from the VA s Veterans Integrated Service Networks to the VHA s Chief Business Office. Requires Secretary to establish an efficient nation-wide system for processing and paying non-va provider bills, with regulations within 90 days of enactment to implement system. To be eligible to provide care and services, non-va health care provider must maintain at least the same or similar credentials and licenses as those that are required of VA health care providers, and submit, at least annually, verification of licenses and credentials. Must submit medical records to VA. Requires verification of veteran s eligibility and prior authorization for services to be provided (this is also true currently under the Purchased Care program). Within 30 days of enactment, requires Secretary to contract with an independent third party to assess the appointments scheduling and other health care management processes, including the staffing level and productivity of each VA medical facility, the case load and time spent of each health care provider on non-case load matters (including research and training of VA health care professionals); also includes the processing and tools used to support clinical documentation and coding of inpatient services. Assessment must be completed within 6 months, and three months later, Within 120 days of enactment, requires Secretary to contract with a private third-party to conduct an assessment of hospital care and medical services furnished by the VA. The assessment must include improvement areas and recommendations on how to address such improvement areas. The Secretary must share such assessment with Congress within 10 months of entering into contract, and 4 months later must submit to Congress an action plan to implement the assessment s recommendations Also requires Secretary to provide quarterly reports on hospital care and medical services,

4 Secretary must submit to Congress a report on the assessment. The report must be made public. In addition, requires the Secretary to contract with a technology organization to conduct a review of the needs of the Department regarding the scheduling system and scheduling software; no federal funds may be used for this review. Requires a report to the Secretary and Congress on the results of the review within 45 days of enactment. including: the number of veterans receiving care at non-dept. facilities; the number of veterans opting to wait for an appointment at a Dept. facility; purchase methods and rate of payment for individual authorizations for care at non-dept. facilities; and additional measures. Requires various reports to Congress that include information on the number of eligible veterans for non-va care and a description of the type of care and services furnished; and outlining recommended improvements for access to telemedicine and health care via mobile vet centers. Also creates a Commission on Access to Care which would examine and report on how best to organize the Veterans Health Administration, locate health care resources and deliver care to veterans. Workforce and Training Requires VA IG to annually identify the top 5 health provider occupations with the largest staffing shortages; allows the Dept. to bypass normal hiring procedures and directly hire to fill positions in an expedited manner. Also requires that priority be given in the VA Health Professional Educational Assistance Program to individuals pursuing degrees in high-shortage occupations Requires VA to implement a clinic

5 Funding Miscellaneous management training program for 2 years to all VA managers and health care providers Allows use of unobligated balances in VA s medical care accounts, at the end of FYs 2014 and 2015, for hiring additional health care providers in facilities and geographic areas with the largest shortages. Designates the Act as an emergency to waive pay-go requirements and authorizes such sums as may be necessary. Requires Secretary to publish wait-time goals for scheduling an appointment at VA facilities, and current wait times for appointments in primary care and specialty care at each VA medical center. Requires the VA to improve the information available to veterans regarding the location of residency training in the Our Provider database and make the database more visible. Also requires that VA provide information to veterans on the credentials of surgeons performing procedures prior to such procedures. Extends counseling and treatment to service members who suffered sexual trauma while serving on either active duty for training or inactive duty. Expands eligibility for care and services for Military Sexual Trauma at a VA facility to active duty service members. No referral from the DOD would be required. Requires the VA to report on prevalence of domestic abuse in the veteran population, the types of treatment and care offered and the effectiveness of such care. OMB is directed to transmit an estimate of the budgetary effects of the bill, and if necessary, a request for additional budgetary resources or transfers or reprogramming of existing resources, needed to provide funding.

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