The commissioners conclude, "America's veterans deserve a better organized, high-performing health care system."
The report indicates the billions pumped into the VA since the wait-list scandal erupted two years ago have failed to relieve many of the problems in delivering health care to veterans. In some cases, the report points out where so-called improvements to the VA system may have actually made things worse.
The 15-member Commission on Care, made up of mostly health care professionals and veterans' organization leaders, outlined a strategy for transforming the agency in a final report submitted to President Barack Obama. The commission was established by Congress after a CNN investigation and watchdog reports revealed VA staffers manipulated data to hide systemic health care delays.
The report, obtained by CNN but slated for public release Wednesday, highlights a variety of "deficiencies" that contribute to health care issues within the agency, including flawed governance, insufficient staffing, inadequate facilities, antiquated IT systems and inefficient use of employees.
The commission also criticized changes that have been implemented since the scandal became known, including the VA's Choice Program. The system was set up in 2014 to alleviate wait times by enabling veterans experiencing month-long delays or more to seek private care. The report states the program has only "aggravated wait times and frustrated veterans" due to confusing eligibility requirements and conflicting processes for coordinating with private health care providers.
As a solution, the commission recommends establishing a "VHA Care System," which would function as a network of VA, Department of Defense and VA-approved private healthcare providers available to all enrolled veterans.
Currently, a veteran must wait more than 30 days or live more than 40 miles from a VA facility in order to obtain private care through the VA. That requirement would be scrapped under the Commission's proposal; instead, veterans could choose from all primary-care providers in the system. Veterans could also choose from specialty-care providers in the system but would need a referral from their primary doctor.
The commission is also recommending that this system be overseen by a new board of directors responsible for implementing the changes and setting a long-term strategy for streamlining VA care.
The report cites need for improved leadership due to what it describes as an overall lack of "strategic direction" within the department.
"VHA must institute a far-reaching transformation of both its care delivery system and the management processes supporting it," the commission concluded.
Despite calls for sweeping transformation, the report states VHA health care is "comparable or better in clinical quality" to care in the private sector, though inconsistent from facility to facility.
The report has received mixed reactions from members of Congress, veterans' service organizations and some of the commissioners themselves.
Commissioners Stewart Hickey, formerly of AMVETS, and Darin Selnick of Concerned Veterans for America wrote a letter of dissent, arguing that the report's recommendations do not go far enough to fundamentally transform the agency.
"The central problem is that these recommendations focus primarily on fixing the existing VHA provider operations, rather than boldly transforming the overall veterans' health care system," the letter states, arguing that veterans should be given even more private options than the report recommends.
Rep. Jeff Miller, R-Florida, the chairman of the House Committee on Veterans' Affairs, agrees that the VA needs significant restructuring but he has not yet endorsed the commission's specific proposals and said he needs time to review the report.
"While the Commission on Care's nearly 300-page report will take time to completely review and digest, the document makes it abundantly clear that the problems plaguing Department of Veterans Affairs medical care are severe. Fixing them will require dramatic changes in how VA does business," Miller said in a statement.
The American Legion cautioned against some of the commission's recommendations on increased access to private care through the VA.
"These 'choices' also come with additional expenses to the veteran. Converting VA health care to an insurance payer will increase out-of-pocket expenses for veterans who rely solely on VA for all of their health care needs," the organization said in a statement.
VA Secretary Bob McDonald said the commission's recommendations overlap with some of the strategies the VA has already begun implementing to improve health care.
Without directly addressing many of the deficiencies described in the report, McDonald said veteran's access to appointments had improved in the past two years.
"As we review the recommendations of the Commission, we will continue to look for other ways to build on the progress we've made to date and ensure we are doing everything possible to faithfully serve those who have served this country," McDonald said in a statement.