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VA's Purchased Care System Is Complex

• VA has long had the ability to purchase care to fill gaps in capabilities and meet veterans' health care needs. However, the program has evolved in a piecemeal fashion, with inconsistent requirements and conflicting aims.
• Under the Veterans Choice Act, VA can purchase care from non-VA facilities through the completion of an "episode of care," with a per-authorization limit of 60 days. Future refinements in defining episodes of care may be critical to supporting cost-effective care purchases in the future.
• There are inconsistencies in purchased care procedures and data collection, particularly at the local level. Local VA facilities handle referral and contract decisions differently, and that could affect both veterans' treatment and VA costs.

The Use of Purchased Care Is Increasing, and the Purchased Care Landscape Is Being Transformed

• The use of purchased care services has increased steadily since 2002, and the cost to VA has grown alongside this utilization. Purchased care accounted for 10 percent of VA's health care budget in fiscal year 2014, or around $5.6 billion.
• Numerous changes to VA's authorities and mechanisms have been proposed, planned, and implemented. While the proposed policy changes seek to address many recognized problems, their sheer multiplicity suggests that the landscape of purchased care is not just complex but dynamic, adding to confusion among veterans and providers.

VA Lacks an Overall Strategy for Purchased Care

• The intended role of purchased care in the delivery of health care to veterans is unclear. Depending on the objectives for purchasing care outside VA, there may be implications for VA's authority to implement changes.