A year after anger about long waiting lists for health care shook the Department of Veterans Affairs, the agency is facing a new crisis: The number of veterans on waiting lists of one month or more is now 50 percent higher than it was during the height of last year's problems, department officials say.
The department is also facing a nearly $3 billion budget shortfall, which could affect care for many veterans.
The agency is considering furloughs, hiring freezes and other significant moves to reduce the gap. A proposal to address a shortage of funds for one drug -- a new, more effective but more costly hepatitis-C treatment -- by possibly rationing new treatments among veterans and excluding certain patients who have advanced terminal diseases or suffer from a "persistent vegetative state or advanced dementia" is stirring bitter debate inside the department.
Agency officials expect to petition Congress this week to allow them to shift money into programs running short of cash. But that may place them at odds with Republican lawmakers who object to removing funds from a new program intended to allow certain veterans on waiting lists and in rural areas to choose taxpayer-paid care from doctors outside the department's health system.
"Something has to give," the department's deputy secretary, Sloan Gibson, said in an interview. "We can't leave this as the status quo. We are not meeting the needs of veterans, and veterans are signaling that to us by coming in for additional care, and we can't deliver it as timely as we want to."
Since the waiting-list scandal broke last year, the department has broadly expanded access to care. Its doctors and nurses have handled 2.7 million more appointments than in any previous year, while authorizing 900,000 additional patients to see outside physicians. In all, agency officials say, they have increased capacity by more than 7 million patient visits per year -- double what they originally thought they needed to fix shortcomings.
But what was not foreseen, department leaders say, was just how much physician workloads and demand from veterans would continue to soar -- by one-fifth, in fact, at some major veterans hospitals over just the past year.
According to internal department budget documents obtained by The New York Times, physician workloads -- as measured by an internal metric known as "relative value units" -- grew by 21 percent at hospitals and clinics in the region that includes Alabama, Georgia and South Carolina; by 20 percent in the Southern California and southern Nevada regions; and by 18 percent in North Carolina and Virginia. By the same measure, physician care purchased for patients treated outside the department grew by 50 percent in the region encompassing Pennsylvania and by 36 percent in the region that includes Michigan and Indiana.
Those data include multiple appointments by individual patients and reflect the fact that patients often now schedule more appointments than they did in the past. But even measured by the number of individuals being treated, the figures are soaring in many places: From 2012 to 2014, for example, the number of patients receiving treatment grew by 18 percent at the Las Vegas medical center; by 16 percent in Hampton, Va.; and by 13 percent in Fayetteville, N.C., and Portland, Ore.
Gibson said in the interview that officials had been stunned by the number of new patients seeking treatment even as the VA increased its capacity. He said he was frustrated that the agency was running short of funds.
"We have been pushing to accelerate access to care for veterans, but where we now find ourselves is that if we don't do something different we're going to be $2.7 billion short," he said.
He said he planned to tell Congress this week that the agency needed to be able to shift funds around to avoid a crisis this fiscal year. That includes using funds from a new program that was a priority for congressional Republicans called the "Choice Card," which allows certain veterans to obtain taxpayer-funded care from private doctors. That money would be used to pay for hepatitis-C treatments and other care from outside doctors.
In future years, Gibson said, more money will be needed. He said he intended to tell lawmakers, "Veterans are going to respond with increased demand, so get your checkbooks out."
A Section on 06/21/2015