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Veterans Health Administration

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Veterans Affairs medical center in Durham, North Carolina

The Veterans Health Administration (VHA) is the component of the United States Department of Veterans Affairs (VA) that implements the medical assistance program of the VA through the administration and operation of numerous VA outpatient clinics, hospitals, medical centers and long-term healthcare facilities (i.e., nursing homes).

The VHA division has more employees than all other elements of the VA combined.

The VHA is distinct from the U.S. Department of Defense Military Health System of which it is not a part.

Healthcare in the United States
Government health programs
Private health coverage
Health care reform law
State level reform
Municipal health coverage

History

The origin of the VHA dates to the first federal military veterans hospital (Hand Hospital) in Pittsburgh in 1778.[1]

Until the 1980s, it was known as VA's Department of Medicine and Surgery. In recent years,[when?] VHA has opened hundreds of outpatient clinics in towns across America, while steadily reducing inpatient bed levels at its hospitals.

In the mid-1980s the VHA was criticized for their high operative mortality. To that end, Congress passed Public Law 99-166 in December 1985 which mandated the VHA to report their outcomes in comparison to national averages and the information must be risk-adjusted to account for the severity of illness of the VHA surgical patient population. In 1991 the National VA Surgical Risk Study (NVASRS) began in 44 Veteran's Administration Medical Centers. By 31 December 1993 there was information for 500,000 non-cardiac surgical procedures. In 1994 NVASRS was expanded to all 128 VHA hospitals that performed surgery. The name was then changed to the National Surgical Quality Improvement Program.[1]

Beginning in the mid-1990s VHA underwent what the agency characterizes as a major transformation aimed at improving the quality and efficiency of care it provides to its patients. That transformation included eliminating underutilized inpatient beds and facilities, expanding outpatient clinics, and restructuring eligibility rules. A major focus of the transformation was the tracking of a number of performance indicators—including quality-of-care measures—and holding senior managers accountable for improvements in those measures.[2]

Evaluation

"Patients routinely rank the veterans system above the alternatives, according to the American Customer Satisfaction Index." In 2008, the VHA got a satisfaction rating of 85 for inpatient treatment, compared with 77 for private hospitals. In the same report the VHA outpatient care scored 3 points higher than for private hospitals.[3]

"As compared with the Medicare fee-for-service program, the VA performed significantly better on all 11 similar quality indicators for the period from 1997 through 1999. In 2000, the VA outperformed Medicare on 12 of 13 indicators." [4]

A study that compared VHA with commercial managed care systems in their treatment of diabetes patients found that in all seven measures of quality, the VHA provided better care.[5]

A RAND Corporation study in 2004 concluded that the VHA outperforms all other sectors of American health care in 294 measures of quality; Patients from the VHA scored significantly higher for adjusted overall quality, chronic disease care, and preventive care, but not for acute care.[6]

A 2009 Congressional Budget Office report on the VHA found that "the care provided to VHA patients compares favorably with that provided to non-VHA patients in terms of compliance with widely recognized clinical guidelines — particularly those that VHA has emphasized in its internal performance measurement system. Such research is complicated by the fact that most users of VHA’s services receive at least part of their care from outside providers." [2]

Use of Electronic Records

VHA is especially praised for its efforts in developing a low cost open source electronic medical records system VistA [6] which can be accessed remotely (with secure passwords) by health care providers. With this system, patients and nurses are given bar-coded wristbands, and all medications are bar-coded as well. Nurses are given wands, which they use to scan themselves, the patient, and the medication bottle before dispensing drugs. This helps prevent four of the most common dispensing errors: wrong med, wrong dose, wrong time, and wrong patient. The system, which has been adopted by all veterans hospitals and clinics and continuously improved by users, has cut the number of dispensing errors in half at some facilities and saved thousands of lives.[7]

At some VHA medical facilities, doctors use wireless laptops, putting in information and getting electronic signatures for procedures. Doctors can call up patient records, order prescriptions, view X-rays or graph a chart of risk factors and medications to decide treatments. Patients have a home page that have boxes for allergies and medications, records every visit, call and note, and issues prompts reminding doctors to make routine checks. This technology has helped the VHA achieve cost controls and care quality that the majority of private providers cannot achieve.[3]

Physicians

Doctors who work in the VHA system are typically paid less in core compensation than their counterparts in private practice. However, VHA compensation includes benefits not generally available to doctors in private practice, such as sovereign immunity from malpractice lawsuits, freedom from billing and insurance company payment administration, and the availability of the government's proprietary VistA electronic records system. [3]

Initiatives

The VHA has expanded its outreach efforts to include men and women veterans and homeless veterans.

The VHA, through its academic affiliations, has helped train thousands of physicians. Several newer VA medical centers have been purposely located adjacent to medical schools.

The VHA support for research and residency/fellowship training programs has made the VA system a leader in the fields of geriatrics [2][3], spinal cord injuries [4], Parkinson's disease [5], and palliative care.

The VHA has initiatives in place to provide a "seamless transition" to newly-discharged veterans transitioning from Department of Defense health care to VA care for conditions incurred in Iraq or Afghanistan.

The VHA's research into developing better-functioning prosthetic limbs, and treatment of PTSD are also heralded. The VHA has devoted many years of research into the health effects of the herbicide Agent Orange used by military forces in Vietnam.

Eligibility for benefits

By Federal law, eligibility for benefits is determined by a system of eight Priority Groups. Retirees from military service, veterans with service-connected injuries or conditions rated by VA, and Purple Heart recipients are within the higher priority groups.

Veterans without rated service-connected conditions may become eligible based on financial need, adjusted for local cost of living. Veterans who do not have service-connected disabilities totaling 50% or more may be subject to copayments for any care they received for nonservice-connected conditions.

Eligibility for VA dental care and nursing home care are much more restricted. VA nursing homes are primarily for veterans needing care for a service-connected condition, or who have service-connected disability ratings of 70% or higher. Reservists and National Guardsmen who were called to active duty by a Federal Executive Order qualify for VA health care benefits.[8]

In 2010, there were 1 million veterans receiving disability pensions. 25% of these were Vietnam veterans with the disability of adult-onset diabetes. More Vietnam veterans are being compensated for diabetes than any other disease.[9]

Also see: Benefits for US Veterans with PTSD

See also

References

  1. ^ Khuri, SF; Daley, J; Henderson, WG (2002). "The Comparative Assessment and Improvement of Quality Surgical Care in the Department of Veterans Affairs". Archives of Surgery. 137 (1): 20–27. doi:10.1001/archsurg.137.1.20. PMID 11772210.
  2. ^ a b Quality Initiatives Undertaken by the Veterans Health Administration Congressional Budget Office Report, August 2009
  3. ^ a b c Vets Loving Socialized Medicine Show Government Offers Savings Bloomberg, October 2, 2009
  4. ^ "Effect of the Transformation of the Veterans Affairs Health Care System on the Quality of Care" New England Journal of Medicine, May 29, 2003
  5. ^ Diabetes Care Quality in the Veterans Affairs Health Care System and Commercial Managed Care: The TRIAD Study Annals of Internal Medicine, August 17, 2004
  6. ^ a b Comparison of Quality of Care for Patients in the Veterans Health Administration and Patients in a National Sample Annals of Internal Medicine, December 21, 2004
  7. ^ "Code Red" by Philip Longman, Washington Monthly, Sept. 7, 2009
  8. ^ VA Health Care Eligibility & Enrollment
  9. ^ Baker, Mike (31 August 2010). "Diabetes tops Vietnam vets' claims". Burlington, Vermont: Burlington Free Press. pp. 1A.
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