The Veterans Health Administration is a behemoth on the U.S. healthcare landscape. It’s the nation’s largest integrated healthcare system, with 170 Veterans Affairs (VA) medical centers and over 1,000 healthcare facilities. Over 9 million vets are enrolled in the government’s VA healthcare program. With an annual budget of around $68 billion, it shouldn’t be surprising to learn that such a complex system has unique challenges.
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An Overview of the VA Healthcare System
By law, the Department of Veterans Affairs must provide veterans hospital care and outpatient care services that are considered “needed”. They must also provide care or services that will promote, preserve, or restore health. The VA system has grown extensively to achieve this. There are over 306,000 full-time healthcare professionals and support staff to handle this need, spread across 1,240 healthcare facilities, 170 VA medical centers, and 1,061 outpatient facilities. There are also over 73,000 active volunteers, 127,000 health profession trainees, 15,000 affiliated medical faculty members, and 18 veterans integrated service networks that provide help.
Additionally, VHA domiciliaries provide care for illnesses or problems considered to be medical, vocational, psychiatric, educational, or social. The VHA also trains 70% of the nation’s doctors and most of the nurses in the U.S. Furthermore, the VA offers health programs and treatment for several conditions, such as blindness rehabilitation, PTSD, radiation exposure, and alcohol/drug dependence.
The Challenges VA Hospitals Face
In recent years, the VA has come under scrutiny due to lack of transparency and low patient satisfaction. The biggest factors – or challenges – in achieving patient satisfaction include wait times and staffing times. For instance, 36% of patients had to wait over a month for an appointment, and 82% of patients who were added to the Choice lists and received approval for appointments outside the VA had to wait over 30 days.
Studies also show that 13% of job candidates drop out during lengthy lag times months after getting hired. This negatively affects VA staffing, even though the 2014 Choice Act enabled the VA to hire 12,000 doctors, nurses, and other medical staff.
However, not all the prioritized medical centers obtained more resources than others. In 2014 – the year of the Veterans Choice Act – the Long Beach VA received 10% of resources, compared to 4.3% received by the San Diego VA and the 1.9% received by the Los Angeles VA. To make things more dicey, whistleblowers have reported fires in the operating room, permanent disability due to neglect, unqualified physicians doing procedures wrong, and more.
In 2014, the Veterans Access, Choice, and Accountability Act was passed to provide funding, new authorities, and other tools to help reform and support the VA. Fortunately, current research shows that VA hospitals now outperform non-VA hospitals in some areas, such as patient safety and mortality and re-admission rates.
VA Efforts Toward Improvement
After being selected by President Trump, now-former Secretary of Veterans Affairs David Shulkin called a White House briefing to outline 13 areas in critical need. Since the briefing, the VA has rolled out numerous measures to pave its road toward improvement.
One of these measures is the access and quality tool. This online tool allows veterans to view a VA facility’s wait time, patient experience with scheduling appointments, timeliness of urgent care appointments, and care quality compared with local private sector hospitals.
Another tool is the healthcare improvement center, a control center that tracks VA hospitals’ clinical performance concerning death rates, wait times, staffing levels, and avoidable complications, with the promise of offering aid before issues hit crisis stage. The center uses data to drive internal management systems across the whole agency, as opposed to individual hospital. An example of this in action: A spike in nurse vacancy rates in Little Rock, Arkansas, prompted the center to help set up a job fair and offer same-day employment to dozens of nurses. 84 nurses ended up accepting employment.
Skulkin’s initiatives have also led to other steps toward improvements. One of these improvements involves establishing a 24-hour White House hotline for veterans’ complaints. Another improvement is linked to publishing “Best Care Everywhere,” a 450-page report of successful practices at VA hospitals that can potentially be replicated at other hospitals. The establishment of a special office to protect whistleblowers has also been established.
Offering a Hand
To show improvement and achieve care quality and patient satisfaction goals, the VA is working with hospitals and universities throughout America. Regis College is proud to be part of NERVANA, a group of academic institutions and VA hospitals working in concert to improve health care for vets. Plus, as a Yellow Ribbon Institution, Regis College works with vets to advance their education. By choosing to study at Regis, students are helping to support the university’s mission to educate and empower veterans.