Q&A: ACP calls on policymakers to strengthen care for US veterans

The ACP recently published a paper calling for policies to strengthen the Veterans Health Administration so that it can continue to provide care “to a population with complex needs.”

The United States Department of Veterans Affairs said that enrollment in the Veterans Health Administration, or VHA, doubled during a recent 17-year period. The administration also projected increases in the number of patients and outpatient visits for fiscal year 2022.

The VHA currently faces several challenges, including “an aging infrastructure, implementation of a new health record system, and perhaps most daunting, achieving access and care continuity with non-VHA clinicians,” the authors of the policy paper wrote.

“In my time providing care to our patients in the VHA system, I have seen how the system is designed to meet the specific health care needs of veterans. I’ve also seen how innovations VHA has developed in this dedicated system have improved care for our veterans and served as a model for health care outside our system,” Thomas G. Cooney, MD, MACP, chair of the ACP Board of Regents, said in a press release. “Ensuring that the VHA is able to continue providing top-quality, specialized care to our patients is critical to caring for our nation’s veterans who have sacrificed so much for all of us.”

In an interview with Healio Primary Care, Cooney discussed the importance of the VHA, some of the administration’s greater challenges, and more.

Healio Primary Care: What spurred the recent ACP resolution on the health care of U.S. veterans?

Cooney: The VHA is the United States’ largest integrated health care delivery system, serving over 9 million veterans at nearly 1,300 health care facilities. In addition to its health care mission, VHA has robust research and development programs, trains thousands of medical residents and other health care professionals, which helps the U.S. sustain our health care workforce and conducts emergency preparedness and response activities in support of federal and non-federal entities. Given the crucial role VHA has in American health care, the [ACP] recognized that it needed to update its policies to provide evidence-based input to policymakers to ensure VHA continues to fulfill its core missions.

Healio Primary Care: The policy paper outlines several challenges that the VHA health care system is facing. Of these issues, which ones do you think should be prioritized? Why?

Cooney: In general, we need to ensure that VHA continues to have the funding needed to assure veterans get the highest quality care possible, both within VHA and in VHA’s Community Care program. This program continues to face challenges with staffing and integration of health records into VHA’s health system from care received through the Community Care program. VHA must also assure it continues to offer market-competitive salaries and benefits to all members of their health care team if they are to continue to fully staff VHA facilities. Finally, VHA needs to focus its efforts on specific challenges our veterans face, including PTSD, traumatic brain injury and higher rates of homelessness and suicide.

Healio Primary Care: One of the ACP policy recommendations calls for the VHA to work alongside physicians and others in the health care profession “to identify and eliminate administrative tasks that contribute to burnout.” With physician burnout rates as high as they are, what can each side of this partnership learn from the other?

Cooney: ACP is committed to addressing physician burnout, which is widespread among physicians working both in and outside VHA. Working in a fully integrated, national health system, VHA physicians may face challenges different than those faced by other physicians. However, like their private sector colleagues, they deal with system inefficiencies, documentation burdens, misaligned and unvalidated performance measures, VHA-specific training requirements and staff shortages that reduce the time they can spend with patients. VHA has been a leader in developing and evaluating team-based care models, such as Patient Aligned Care Teams, or PACT, which have been shown to reduce the rate of burnout among team members. The VHA has also done innovative work integrating behavioral health and primary care, which could be emulated by physicians and other clinicians outside the [VHA] system.

Healio Primary Care: The paper briefly mentions that the VHA could potentially use the ACP’s High Value Care Coordination Project as a model for referral improvement efforts. What is this project, and how could it help the VHA improve care?

Cooney: This is a project that ACP, patient groups and several subspecialty societies developed to provide resources that would facilitate more effective and patient-centered communication between primary care and subspecialist doctors. These resources could easily be adapted for VHA’s use in developing model communication methods between VHA and the Community Care health professionals to whom veterans are referred.

References

• ACP calls for policies to strengthen health care for our nation’s veterans https://www.acponline.org/acp-newsroom/acp-calls-for-policies-to-strengthen-health-care-for-our-nations-veterans. Published Oct. 5, 2021. Accessed Nov. 9, 2021.
• Crowley R, et al. Ann Intern Med. 2021;doi:10.7326/M21-2392.
• U.S. Department of Veterans Affairs. FY 2022 President’s Budget Request. https://www.va.gov/budget/docs/summary/fy2022VAsBudgetRolloutBriefing.pdf. Published May 28, 2021. Accessed Nov. 9, 2021.