- The Department of Veterans Affairs (VA) is seemingly always under the microscope regarding a practice issue. Recently, the agency has been under fire for problems in facilitating patient access to healthcare.
But what exactly are the care access issues at VA? And what is the agency doing to resolve them?
Below, PatientEngagementHIT.com discusses the care access complications with the agency, and lists how the agency is reportedly working to alleviate them.
Veterans struggle to obtain primary care
An April report from the Government Accountability Office (GAO) shows that patients’ ability to schedule primary care appointments are lagging. In a survey of 180 veteran’s, GAO found that nearly 30 were unable to schedule a primary care visit because their VA facility does not schedule appointments in accordance with VA policy.
Patients who did manage to obtain an appointment saw lengthy weight times, sometimes between 22 and 71 days.
GAO said these wait times were a significant issue, especially considering the health needs of veterans.
“VA healthcare is a high-risk area,” GAO said. “In several cases, newly enrolled veterans were never contacted to schedule appointments, due to medical center staff failing to comply with VHA policies for scheduling such appointments or medical center staff being unaware of veterans’ requests.”
To add insult to injury, VA officials were quoted diminishing the urgency of this problem following the report’s publication. In an address at a Christian Science Monitor breakfast, VA’s Secretary Robert McDonald likened the wait times at VA to waiting in line at a Disney park, reported Drew Griffin of CNN.
"When you go to Disney, do they measure the number of hours you wait in line? Or what's important?" McDonald said, indicating that the quality of care at VA is more important than wait times. "What's important is what's your satisfaction with the experience?"
Following that incident, McDonald issued a statement explaining his statement and underscoring the agency’s commitment to improving veteran’s access to healthcare.
“It was never my intention to suggest that I don't take our mission of serving Veterans very seriously,” McDonald said. “In fact, improving access to care is my number one priority and the priority I have set for the entire department. For the last two years, the huge majority of VA employees have worked tirelessly to improve the timeliness of the care and benefits we provide to Veterans.”
VA implements care access programs
Per McDonald’s statements, VA has announced several programs in an attempt to fix their care access problems.
At the end of May, the agency proposed a policy to allow advanced practice registered nurses – including certified nurse practitioners, certified registered nurse anesthetists, clinical nurse specialists, and certified nurse-midwives – to practice at the top of their licenses in VA facilities.
This measure was a part of their overall goal of boosting patient access to healthcare by allowing APRNs to administer certain levels of care that they weren’t able to prior.
Several industry groups have praised the move. Most recently, the American Association of Nurse Practitioners (AANP) said this proposal is the move VA needed to make to start improving veteran healthcare.
"The VA, AANP, and Veterans Deserve Care agree: It's time to make care directly and more readily accessible to our nation's veterans and to honor them with the high-quality health care they deserve," said AANP CEO David Hebert, in a press release.
However, other professional organizations caution VA against the proposal, saying that in order for veterans to get the quality of care they deserve, their care teams need to be headed by doctors.
According to the American Medical Association, care teams with physicians at the helm are the next step forward in boosting healthcare for veterans.
“While the AMA supports the VA in addressing the challenges that exist within the VA health system, we believe that providing physician-led, patient-centered, team-based patient care is the best approach to improving quality care for our country's veterans,” said AMA board chair Stephen R. Permut, MD, JD. “We feel this proposal will significantly undermine the delivery of care within the VA.”
VA gets Congressional support for care access proposals
VA has also received support from the Senate, most recently in the form of a proposed bill, the Tribal Veterans Health Care Enhancement Act. If passed, this bill would help enable better patient access to care by facilitating collaboration between VA and the Indian Health Services (IHS).
Often times, veterans seeks care at IHS, but are unable to undergo certain necessary procedures at IHS facilities and are then referred to VA. This bill would allow HIS to pay for those referred procedures, making it possible for their patients to receive care from VA.
While this bill would not alleviate some of the problems with wait times at VA, it would still enable better care for a subpopulation of veterans.
“IHS and VA – two federal agencies that continue to catch headline after headline for all the wrong reasons,” said Senator John Thune, one of the bill’s cosponsors. “The agencies’ failures are long and well-documented, and I am working hard to find solutions to correct these systemic problems that have caused hardship for tribal members throughout the Great Plains area.”
“This bill is part of a broader effort to ensure tribal citizens, specifically those who’ve fought in the U.S. military, receive the quality care they’re owed,” Thune continued. “I’m glad the full Senate will now have the opportunity to consider this common-sense bill.”
Going forward, VA will need to continue to engage in such efforts to boost access to care. In addition to reducing wait times for appointments, the agency will need to focus on ensuring all veterans are able to get the care they need.