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House and Senate Take “First Step” to Addressing VA Shortages; Academic Medicine Stands Ready

August 1, 2014—The Senate July 31 (91-3) and the House of Representatives July 30 (420-5) passed the conference agreement for the Veterans' Access to Care through Choice, Accountability, and Transparency Act of 2014 (H.R. 3230). The bill would help address backlogs within the Veterans Health Administration by authorizing the Department of Veterans Affairs (VA) to hire and train more physicians and allowing veterans access to care at non-VA facilities.

In a July 31 statement, AAMC President and CEO Darrell G. Kirch, M.D., applauded the bill’s passage, stating, “This is an important first step toward ensuring veterans receive the care they need and deserve.”

However, he noted, “The AAMC remains concerned that this legislation does not improve or expedite contracting with non-VA hospitals that treat VA patients. Streamlining these contracting procedures would make it possible for the nation’s medical schools and teaching hospitals to increase the care they already provide to veterans and alleviate delays experienced by some veterans seeking care at VA medical centers.”

Dr. Kirch continues, “We are encouraged by the addition of 1,500 new VA-funded residency training slots included in this bill. However, these new VA positions require corresponding Medicare-supported residencies at affiliate teaching hospitals to satisfy residency training requirements.”

House and Senate conferees announced the deal July 28. Like previous versions [see Washington Highlights, June 13], the measure creates a new Veterans Choice Card for non-VA care.  Eligibility is restricted to veterans enrolled in the VA health care system as of Aug. 1, 2014, and newly discharged combat veterans, provided such veteran is unable to secure an appointment at a VA medical facility within 30 days or resides more than 40 miles from the nearest VA medical facility. The bill caps funding for the program at $10 billion or three years, whichever comes first.

Report language accompanying the legislation "encourages VA to explore options of partnering with private sector and affiliate hospitals who could potentially provide vacant space to VA for care." In response to hospital concerns about timely payment for care, the bill includes a “Sense of the Congress” that the VA comply with the prompt payment rule.

The agreement also provides $5 billion to hire, recruit, and train physicians. An annual report by the VA Office of Inspector General (OIG) will identify the five health provider occupations with the largest staffing shortages throughout VA and allow the VA to utilize direct hire authority to fill these positions in an expedited manner.

The bill instructs VA to add at least 1,500 graduate medical education (GME) residency slots over five years at VA facilities that are experiencing shortages or located within a federally designated Health Professions Shortage Area (HPSA).  Allocation of these slots will be based on the OIG’s report, with a priority given to “residency positions and programs in primary care, mental health, and any other specialty the Secretary determines appropriate.” Priority is also given to VA facilities without existing GME programs and those in areas with a high concentration of veterans.

To help VA recruitment, the conference agreement increases the VA Education Debt Reduction Program’s aggregate cap from $60,000 to $120,000.

In addition to limiting authorized appropriations, the package includes $5 billion in offsets.

Meanwhile, the Senate July 29 voted unanimously to confirm President Obama’s pick for Secretary of Veterans Affairs, Robert McDonald. McDonald is a former CEO of Proctor & Gamble, served as an Army paratrooper for five years, and graduated from West Point Military Academy.


Matthew Shick, JD
Director, Gov't Relations & Regulatory Affairs
Telephone: 202-862-6116


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Washington Highlights, a weekly electronic newsletter, features brief updates on the latest legislative and regulatory activities affecting medical schools and teaching hospitals.

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Jason Kleinman
Senior Legislative Analyst, Govt. Relations
Telephone: 202-903-0806