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Change is Near_ Credit goes to President Trump and Vice President Mike Pence!

Dear Mr. President:

The change I refer to is The VA Mission Act , recently signed into law by yourself. The VA Mission Act will replace the current Choice Program that ended May 29th. I have discussed the Act with some knowledgeable people, and some that are ill-informed.

It appears we can expect a learning curve on this legislation. Confusion on the issue abounds. That is to be expected ; like many of the positive changes made by your Administration, learning how the Act works is positive progress for the Veteran.

There is one major difference that I already recognize. At one time, Veterans were often out-sourced to non-VA care , in their community. The medical provider would have responsibility for the care required. Whereas, under The Choice Program , we were "choiced" out for a procedure or treatment, and if the non-VA provider recognized additional treatment was necessary for such condition, the provider would have to fill out a SAR_ Secondary Authorization Request. The request would go to Tri West who would examine it, and send it to the local VA for their approval. This is where it got tricky. The SAR is sent to the VA Dr. who made the original authorization for out-sourced care. This Dr. may not agree with the non-VA provider, and may answer, that the request is denied, or even call the Veteran in for an appointment. The Vet may have waited weeks or even months before his treatment is approved. This is just the surface, Mr. President, but it explains some of the difficulty of the old Choice Program. The cost associated with Tri West has already exceeded $70B.

The VA Mission Act , Sir, will differ in that the non-VA Provider will make the decisions of what treatment(s) is needed by the Veteran. This is a tremendous difference, and U.S. Veterans are quite grateful to you, and Vice President Pence for recognizing such !The new internal operating structure for Community Care, including the Urgent Care/walk-in option benefit is also timely. Veterans' Care Agreements to allow the VA to purchase hospital care, medical services, or extended care services (in certain situations) are also prudent.

There is a need to address competency standards applicable to community providers to make certain Veterans are getting high-quality care when they receive care outside of the VA. I feel competency exams are warranted for VA Doctors also. Changes in medicinal practices are made often, and the VA Dr. should demonstrate that they are up to date with current common procedure.

For example: I was examined by a VA Doctor who was a specialist. He supported his findings with the "Harrison Principals of Internal Medicine". Personal research told me that his information was outdated. I then spoke with Dr. Long, the Editor in Chief of the "Harrison Principals of Internal Medicine". He agreed that the Doctor's findings were outdated, and referred me to an older edition of the journal. Needless to say, the VA Dr. changed his opinion of the case when it was brought to his attention he was reading from an outdated edition. Instances like his do indeed happen. Many of the VA Drs. have been overly tasked, and with little support. It is no wonder that many of the finest professionals retire, or simply leave the service of the VA.

The VA Mission Act as I see it, Mr. President, has the probability of relieving some undue burdens on our Doctors. They should be grateful to you for such. I do have a suggestion, however, that will get The VA Mission Act up and running smoothly, in a short period of time. The VA should streamline the payments to the non-VA Providers. Often, the best ones, will not accept Veterans.

I have gotten letters from medical managements asking for payment ; threatening a negative report to the credit bureaus. This would not be necessary if the VA was more timely with payments. In addition, I suggest that the Veterans, especially those 100% disabled, should be given a form of credit card, so that the caregiver could be paid immediately. This is my opinion, and you, Sir, have an abundance of talent available to make it so.

Thank you for your time. Please accept my most sincere gratitude, President Trump, as well as your outstanding Administration.

Semper Fi

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