- President Donald Trump has signed the VA Choice and Quality Employment Act, allocating $3.9 billion in spending to the Department of Veteran's Affairs (VA), including $2.1 billion for the Veterans Choice Program — which uses government funds to pay for care for veterans living in areas without ready access to VA hospitals and clinics.
- The remainder of the money will be used for hiring additional staff, upgrading existing VA facilities and adding 28 more VA clinics nationwide.
- The choice program, which was created in 2014, has grown rapidly and proved popular among veterans. Visits through the program increased more than 30% in the first quarter of FY2017, according to the New York Times.
In addition to pushing for continued and expanded funding of the choice program, the VA has been busy recently working to catch up with the rest of the field in HIT categories. The agency is still reeling from scandals of the past few years, including issues with disability claims backlogs and wait-time falsifications aimed at masking major scheduling delays at VA medical facilities
Earlier this month, the VA announced plans to expand its telehealth programs into video and online scheduling in an effort to increase access to care for veterans and enable them to get care at home. In announcing the programs, Trump said it would improve mental health and rural care. In 2016, the VA provided telehealth services in more than 50 clinical specialties to about 700,000 veterans, according to VA Secretary David Shulkin.
The VA is also shifting to a new EHR system. Cerner will provide EHR services while the VA continues to use Epic Systems for online appointment scheduling. The first deployment of Cerner’s MHS Genetics EHR went live in February at Fairchild Air Force Base in Spokane, Wash. In mid-July, the EHR’s inpatient components went live at Naval Hospital Oak Harbor in Seattle.
The agency turned to commercial vendors after a string of problems arose trying to use its homegrown EHR, VistA.
Better access to care for veterans through the use of telehealth services and an improved EHR are certainly universal goals, but some lawmakers and veterans groups are concerned that efforts like the choice program are the start of stronger efforts to more fully privatize VA care.
While on the campaign trail, Trump pledged to make VA reform a major focus of his presidency and to make it easier for the VA secretary to fire ineffective officials and employees. He advocated privatizing some veterans care as a way to expand access, reduce wait times and provide a better patient experience.
This choice program is more narrowly focused, and is available for veterans who live far away from existing VA facilities or are told they cannot get an appointment with a VA hospital or clinic within 30 days. If the program continues its current popularity, and if enough private providers want to participate, it could be a springboard for more veterans to receive care outside VA facilities.
The Senate Appropriations Committee approved a $78.4 billion fiscal 2018 VA funding bill last month, which provides $4 billion more than last year’s level. The measure, however, doesn't include any additional spending on the VA’s transition to Cerner’s EHR.