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Congresswoman Ann McLane Kuster

Representing the 2nd District of New Hampshire

After Report Showing Lack of Oversight at VA Community-Based Outpatient Clinics, Kuster, Kilmer, Coffman introduce Bipartisan Reform

Sep 25, 2018
Press Release

(Washington, DC)—Today, Representatives Annie Kuster (D-NH), Derek Kilmer (D-WA), and Mike Coffman (R-CO) introduced legislation directing the Secretary of Veterans Affairs to take immediate action to standardize the level of care delivered at the VA’s Community-Based Outpatient Clinics.

The legislation follows a Government Accountability Office report which found significant weaknesses in the Veterans Health Administration’s oversight of the nation’s more than 700 outpatient clinics. The report concluded the lack of standardization creates “a risk that VHA is not providing one standard of care that is high quality to veterans across VHA-operated and contracted Community-Based Outpatient Clinics.”

“We must work to ensure all veterans in New Hampshire and across our country are able to receive the care they need and deserve,” said Rep. Kuster, the lead Democrat on the House Veterans’ Affairs Subcommittee on Oversight and Investigations. “Particularly in rural areas, community-based outpatient centers (CBOC) play an important role in delivering care to veterans and the VA must have a complete and accurate understanding of the impact of CBOCs on the veteran community. Earlier this year, I discovered the VA was assessing the healthcare needs of veterans in our state with data that listed a non-existent CBOC as having treated some 7,000 patients. This is completely unacceptable. While I took immediate action to fix the error, it is time for a thorough review to help safeguard against future failings.”

The bill introduced today (H.R.6867)  requires the Secretary of Veterans Affairs to update the handbook of standards that every CBOC is supposed to consult as it operates. The bill also requires the handbook to be updated with best practices every five years. Finally, it would better define the facilities that are Community Based Outpatient Clinics and therefore required to meet the VA’s care standards.

“If you serve your country, it should have your back. When veterans walk into a VA facility, they should know they’re going to receive a level of care that’s worthy of the service and sacrifice they gave to our nation” Rep. Derek Kilmer said. “With this bill, Congress can make sure every VA facility is held to the high standards the American public expects the country to provide its veterans. That will improve service and ensure that the VA system is held accountable for providing America’s veterans the benefits they’ve earned and deserve.”

The bipartisan legislation is a direct response to an April 2018 report by the Government Accountability Office which identified weaknesses throughout the outpatient system. The GAO studied more than 700 CBOC’s and identified that the Veterans Health Administration failed to develop guidelines for monitoring the quality and comprehensiveness of care in CBOC’s and that “officials had no plans to do so.”

Rep. Coffman, a Marine Corps combat veteran, said, “it’s hard to believe that the VA does not have uniform standards of care for its community-based outpatient clinics.  Ensuring a uniform standard of care for all VA outpatient clinics will help our veterans receive the quality healthcare that they have earned through their military service.”

The GAO found that the VA-issued annual report on CBOC care quality that could guide officials seeking to standardize care and help lawmakers compare the quality of care between VHA-operated and contracted CBOC’s was inaccurate and incomplete, because 22 percent of the clinics listed as CBOC’s were actually other types of VA care sites.

According to the GAO, the same report included several acronyms and shorthand text that were not defined. The office heard from care providers that guidance and training in the use of the report would be helpful.

Finally, the GAO reported that Veterans Health Administration officials said they expected Veteran Integrated Service Networks and VA Medical Centers to use the annual CBOC report to standardize care. After surveying four Veterans Integrated Service Networks and four VA Medical Centers on whether or not they use the report as expected, just 1 VISN and 1 VAMC actually did.