Improving Community Care for Veterans
On January 22, 2025, the House Committee on Veterans Affairs held a hearing about improving community care for veterans. NAVAPD, along with six other veterans organizations, submitted a Statement for the Record. Their testimony focused on the gap between Congress’s original intent for community care and how it’s actually been implemented by the VA. They discussed the challenges veterans face when receiving care outside the VA, and proposed solutions to improve the system.
One key example shared was of a Gulf War veteran referred to a community cardiologist who quickly recommended a pacemaker, despite the veteran’s doubts. After seeking a second opinion, the veteran learned the pacemaker wasn’t necessary. Other examples included veterans feeling pressured into community care and not receiving the right kind of support, particularly for mental health needs.
While the organizations agreed that community care is necessary when VA services are unavailable, they stressed that the goal should always be to provide timely, high-quality care without undermining VA services.
They identified nine main challenges in the current community care system:
Maintaining consistent quality standards in the program.
Ensuring that VHA authorization isn’t bypassed.
Addressing the impact of community care on VA staffing and overall care quality.
Clarifying what "veterans' health care choice" really means.
Giving veterans clear information to make informed decisions about their care.
Tackling payment models that encourage unnecessary and costly treatments.
Improving communication and data sharing between the VA and community care providers.
Properly integrating telehealth into the VA system.
Ensuring that the VA’s core missions are protected, including staffing and funding.
The MISSION Act of 2018 was designed to provide veterans with community care when the VA couldn’t meet their needs, either because of wait times, distance, or availability. However, it emphasized "quality" care over "choice." Studies have shown that VA care is often higher quality than care from community providers. But recent efforts to expand community care could potentially weaken the VA’s capacity to provide specialized care, especially for conditions like PTSD and TBI, or to train healthcare workers who specialize in veterans’ needs.
The testimony pointed out that community care has been growing rapidly and is becoming financially unsustainable. By 2022, community care accounted for nearly half of VA healthcare spending, and the organizations warned that allowing veterans to bypass the VA’s approval process could further strain the system, leading to staff cuts and facility closures.
Another concern was the rise in unnecessary procedures. For instance, studies found that community care providers were more likely to recommend expensive and risky treatments for veterans with low-risk prostate cancer. These practices are not only costly but can also harm veterans.
Dental care was also mentioned as a growing financial burden. The VA currently spends millions on outsourced dental services, and community dentists often propose treatments that are far more expensive than necessary. Expanding the VA’s in-house dental staff could be a more cost-effective solution.
Additionally, the organizations highlighted issues like lack of transparency in community care provider qualifications, delays in sharing health records, and the need to include telehealth in the VA’s care standards.
Finally, they warned that expanding community care could harm the VA’s role in training healthcare professionals and its ability to respond in emergencies. The VA is the primary trainer for many healthcare workers, including psychiatrists, and plays a critical role in national emergency preparedness.
The organizations proposed the following solutions to improve the community care system:
Establish uniform quality standards and training requirements for both VA and community care providers.
Make wait times and provider qualifications publicly available.
Use predictive modeling to understand how increased community care use will affect the VA’s capacity.
Expand VA staffing to fully meet demand.
Keep the VA in charge of determining eligibility for community care.
Make sure veterans understand that community care is available only when specific criteria are met.
Include timely VA telehealth appointments in care standards.
Ensure that health records are shared quickly between the VA and community providers, with penalties for delays.
Implement stronger monitoring to prevent unnecessary procedures or fraudulent billing by community care providers.
The organizations urged veterans and supporters to contact their Congressional representatives to voice their concerns about the community care program.