Department of Defense Reverses Course on Tricare: A Lesson for Congress and the VA.

by on February 20, 2024

A recent article in illustrates the danger of outsourcing Veterans Health Administration (VHA) medical and psychological care under the Veterans Community Care Program (VCCP). The funds expended on VCCP and the number of veterans referred under it have increased dramatically. According to the Congressional Budget Office, Veterans Health Administration’s (VHA) expenditures on VCCP have tripled since 2014. Over a quarter of VA patients now receive care in VCCP. This increased utilization has occurred without a systematic review of the cost or quality of care veterans receive in VCCP. Instead, there has been a headlong rush to divert veterans to it without any consideration of the impact of this on veterans’ healthcare and VHA.

The article reports that The Department of Defense (DOD) has decided to strengthen its healthcare system to reduce costs and to preserve the quality of care its facilities provide. Deputy Defense Secretary Kathleen Hicks expressed concern that, “the circumstances at military hospitals have not only affected beneficiaries, they have hindered providers, depriving them of opportunities to maintain their skills.”  Hicks said, “certain elements of the DoD’s health system overhaul, which was mandated by Congress in 2017, have left military treatment facilities, or MTFs, ‘chronically understaffed’ and unable to deliver timely care to all patients. In a memo directing this change, Deputy Secretary Hicks wrote, ‘Realignment of medical personnel, coupled with a challenging health care economy and ambitious private-sector care capacity assumptions, led to chronically understaffed [military treatment facilities] and [dental treatment facilities, or DTFs] that at times cannot deliver timely care to beneficiaries or ensure sufficient workload to maintain and sustain clinical skills,’” ( DOD and Tricare).

DOD’s policy change is instructive. The ever-increasing outsourcing of veterans’ care undermines VHA’s ability to continue to provide the high level care that is clearly demonstrated by numerous studies (Studies Comparing VA and Private Care).  It also threatens VHA’s ability to accomplish its four missions: healthcare, education, research, and national preparedness. Absent funding that maintains a robust and fully staffed organization and a diverse patient population, VHA will not be able to maintain its role as a primary educator of healthcare providers, a leading research organization, and the backbone of the American healthcare system in the time of emergency. VHA’s affiliations with nearly all medical schools will be jeopardized, to the detriment of veterans and the general population.

Compounding this is the crisis in U.S. healthcare providers. Shortages are predicted in physicians, nurses, and nurse practitioners (Healthcare Worker Shortages). Diverting veterans to the private sector facing provider shortages not only disadvantages veterans, it lessens the ability of non-veterans citizens to access care. DOD has certainly found this to be an issue. As reported in the article, “in 2019, lawmakers began complaining that their military constituents were unable to get medical care in the private sector as a result of oversaturated markets and shrinking Tricare networks. In 2022, evidence began emerging that staffing cuts at military health facilities and inflated estimates of the number of available physicians in civilian networks were affecting patient care in North Carolina, New York, the Pacific Northwest, California and Japan.”

A third consideration in problems associated with outsourcing veterans care is the stunning lack of any systematic review of the quality, cost, and availability of care provided under VCCP. The VA Office of the Inspector General conducts routine reviews of VHA facilities and publishes the results, including recommendations and the facilities’ plans to address deficiencies. No such transparency applies to VCCP providers. As a result, little is known about the quality, cost, and accessibility of such care. The reviews that have been completed, however, point to serious issues in the VCCP program. For example, overutilization of expensive tests and procedures that drive up costs are reported by the Congressional Budget Office (CBO Study) and a study published in a Journal of the American Medical Association (JAMA Prostate Treatment Study).

These factors all offer a compelling argument for Congress and the leadership of the VA to halt the growing outsourcing of veterans’ care and to conduct an objective and thorough review of the VCCP before VHA is undermined to extent that recovery might not be possible. Doing otherwise is an extreme disservice to the veterans and to the nation.

Filed under: National Politics