Substandard Healthcare Solutions for the Department of Veterans Affairs

Problem and Solutions at the Veterans Health Administration
The chances are good that most Americans have either received health care services from the Department of Veterans Affairs’s (VA’s) Veterans Health Administration (VHA) directly or from a physician that has received training from a VA teaching facility. This likelihood is due to the fact that the VA not only operates the nation’s largest integrated health care network, but also provides vital training opportunities for more than half of the doctors practicing in the United States today. Given the critical role that the VA plays in the nation’s health care system, identifying constraints to the quality of care provided by VA practitioners and opportunities to improve them represent timely and valuable enterprises. To this end, the purpose of this paper is to provide a brief overview of the VA and the wide array of challenges it faces in delivering high quality patient care today and in the future, followed by some recommended solutions to help achieve this outcome. Finally, the paper provides a summary of the research and important findings concerning the current substandard health care at the VA and what can be done to improve this care for the nation’s veteran heroes.
Review and Analysis
The VA’s VHA operates the largest integrated health care system in the United States which provides medical services of all types at 1,255 health care facilities (About VHA, 2020). This total includes 170 tertiary medical centers and 1,074 community-based outpatient clinics which treat more than nine million enrolled veteran patients each year (About VHA, 2020). This figure, of course, means that the VHA handles tens of millions of individual patient visits each years, and it is not surprising that any organization with such a massive caseload would experience some problems from time to time. The problems at the VHA, however, are longstanding and systemic, and many have intensified in severity in recent years despite having been made key organizational priorities.
When something is made a priority it is by definition supposed to get better, so it is clear that there is something wrong with the VHA that defies easy analysis and solutions. First and foremost -- and notwithstanding the critical role that is being played by the entire VA in fighting the ongoing Covid-19 virus pandemic, a fundamental part of the challenges facing the VHA at present and for the foreseeable future is the projected sustained increase in its patient care load as increasing numbers of elderly veterans require intensive care for age-related disorders. Moreover, assuming they receive appropriate care, the growing legions of elderly veterans can be expected to live far longer than their counterparts from just a few decades ago, meaning that a disproportionate percentage of the VA’s annual budget will be needed through mid-century at least. For instance, the results of a comprehensive study by the U.S. General Accountability Office (GAO) found that, “The VA faces a growing demand for its health care services—partly due to the needs of an aging veteran population” (Managing risks and improving VA health care, 2020, para. 3).
Despite doubling the VA’s budget during the period from 2006 to its current level of more than $92.3 billion each year, analysts expect that even more taxpayer resources are going to be needed going forward to even maintain the current substandard levels of care that are being delivered at far too many VHA health care facilities today (Managing risks and improving VA health care, 2020). Indeed, in spite of a growing multi-billion dollar budget each year, the quality of medical care provided at many VA health care facilities across the country has continued to decline over the years to the point where many clinicians are expressing growing concerning over the well-being of veteran patients (DeBeer & Matthieu, 2019).
At present, all VA health care facilities are accredited by the Joint Commission which makes high quality patient care one of its evaluation criteria (Joint Commission standards, 2020). Following the Joint Commission’s most recent series of annual audits of VHA health care facilities, the GAO identified the following five high-risk areas that relate to the VA’s ability to deliver timely access to high quality medical care for veterans:
1. Ambiguous policies and inconsistent processes;
2. Inadequate oversight and accountability;
3. IT challenges;
4. Inadequate staff training; and,
5. Unclear resource needs and allocation priorities (Managing risks and improving VA health care, 2020).
Given the VHA’s poor track record with its massive budget to date, simply throwing more money at these problems is clearly not going to solve them. Although the VHA’s top leadership has made a yeoman’s effort in addressing these five high-risk areas, more remains to be done in order to improve the quality of health care services at the VHA today, including the following:
1. Improve the documentation of patient care incidents to identify problem areas;
2. Improve documentation of employee misconduct and corresponding disciplinary actions to facilitate accurate analysis;
3. Strengthen the credentialing process to ensure that all VHA health care providers are qualified to perform their jobs;
4. Resolve the ongoing problems with online access to the Veterans Choice Program which allows veteran patients to receive community-based care form civilian providers; and,
5. Enforce zero-tolerance policies for patient abuse and neglect and hold those responsible accountable;
6. Further reduce and continuously monitor patient wait times for clinic appointments and surgical procedures; and,
7. Assign key leadership responsibilities and establish clear bureaucratic reporting lines for the VHA’s suicide prevention program’s prevention media outreach campaign to ensure it is achieving is reaching at-risk veteran patients(Managing risks and improving VA health care, 2020).
The foregoing list is not exhaustive, of course, but it does represent an important starting point since it will help reframe the VHA’s organizational culture into one of accountability for substandard care.
Conclusion
With the nation’s understandable focus primarily on the ongoing Covid-19 virus pandemic, it is easy to overlook or even ignore the multiple problems that veterans routinely encounter when seeking health care from the VA’s Veterans Health Administration today. The research showed that despite a multi-billion dollar budget that has increased year-to-year, the VHA continues to suffer from a number of systemic problems that adversely affects it ability to deliver the high quality health care services that the nation’s veterans need and deserve. Perhaps the incoming Biden administration will take the substantive steps that are needed to address these longstanding problems, but millions of veterans will continue to suffer – many in silence – unless and until something is done.
References
About VHA. (2020). U.S. Department of Veterans Affairs. Retrieved from https://www. va.gov/health/.
DeBeer, B. B. & Matthieu, M. M. (2019, January). Quality improvement evaluation of the feasibility and acceptability of adding a concerned significant other to safety planning for suicide prevention with veterans. Journal of Mental Health Counseling, 41(1), 4-7.
Joint Commission standards. (2020). Joint Commission. Retrieved from www.jointcommission. org/standards/.
Managing risks and improving VA health care. (2020). U.S. Government Accountability Office. Retrieved from https://www.gao.gov/key_issues/managing_risks_improving_va_health_ care/issue_summary.