For four decades, the Office of Inspector General at the Department of Veterans Affairs has played an indispensable watchdog role, helping to ensure that veterans receive high-quality healthcare. Its investigators have repeatedly identified deficiencies in VA patient care and recommended corrections. The Inspector General’s office’s diligence is one reason that the quality of VA’s healthcare consistently outperforms the private sector’s.
However, the Inspector General’s office does not scrutinize private providers with whom the VA contracts nearly as rigorously as it does VA facilities. The gap is highly consequential because private sector providers now deliver over a third of all healthcare services for the nation’s nine million enrolled veterans. Few other transformations in public healthcare delivery have been so speedy with such little oversight.
The VA MISSION Act of 2018 established the Veterans Community Care Program to furnish more private services to veterans. The Inspector General’s office recognized that this expansion necessitated enhanced evaluation and boosted its personnel. In April 2022, it began issuing reports as part of its “Care in the Community” oversight program. And yet, in the following 12 months, only three private sector reports were completed versus 73 inspections of VA in-house care.
The community reviews were not only few in number but narrow in scope, focusing on important but ultimately discrete topics of the adequacy of home dialysis services and whether mammography results were promptly delivered to their referring VA doctors. By contrast, last year, the Inspector General’s office investigated VA services related to many more matters, including broad and worrisome trends among veterans—suicide attempts, violent behavior, prostate cancer, hypertension, alcohol use, congestive heart failure, pain management, and other health conditions.
At U.S. House and Senate hearings in June, Julie Kroviak, a top official with the Office of Inspector General, underscored that, when it comes to care in the private sector, there is “no reasonable assurance that veterans are getting the care they need.” She added, “I can’t tell you what type of quality of care is happening outside of the VA… concerns about the caliber, the credentialling, the experience of the providers…is definitely warranted.”
More inquiry is forthcoming, vowed Kroviak, saying her office was in the “final stages of developing a Community of Care cyclical review.” Unstated was what will be the scope or scale of these reviews.
There are ample opportunities—and indeed a great need—for the Inspector General’s office to probe Veterans Community Care Program services more extensively. For instance, third-party administrators who manage the private care program must forward all veterans’ complaints and grievances to the VA within two days of receipt. Those materials are available to the Inspector General’s office and are ripe for inspection and dissemination to advocates, lawmakers, and the public.
In addition to privatizing many VA services, the MISSION Act directed the VA to establish training standards for private healthcare providers who treat conditions found among veterans, such as post-traumatic stress disorder, sexual trauma, and traumatic brain injury. The VA created tailored training and gave the contracted clinician discretion on whether to take them. Since training records of all providers are supplied to the VA, the Office of Inspector General (and the VA) could determine how many providers have taken them. Then, we’d know whether the contracted professionals are prepared to treat veterans’ complex and unique healthcare conditions as we do for VA providers.
The same question applies to veterans who suffer from toxic exposures. Following recent legislation, the Office of the Inspector General should discover how many private sector providers have comprehensive toxic exposure training.
Similarly, VA providers must perform annual suicide risk screening on veterans. We have no idea how many private healthcare providers, if any, adhere to the same regimen as the VA itself. The Office of Inspector General ought to investigate.
The quality of private healthcare should be audited as vigorously as VA facilities. If more money and personnel are necessary, Congress should find the funds. When the House and Senate invite personnel from the Inspector General’s office to testify about the VA’s healthcare, it should always demand answers about the VA’s contracted private healthcare services. Veterans’ lives depend on it.