Lois
Working in healthcare for greater than twenty years has afforded this future nurse practitioner (NP) the opportunity to see a plethora of approaches regarding the challenges of healthcare delivery. Providing safe, effective and affordable quality healthcare is a challenge is today’s healthcare economy; regardless of being for profit, non-profit or a government institution such as the Veterans Administration (VA) hospitals.
That being said, this future NP cannot begin to understand how such a large integrated health system such as the VA system can overcome their challenges of being “broken” when smaller, more organized health systems struggle every day to maintain streamlined, standardized and process driven organizations. In August 2011, the VA system had 152 hospitals, 804 community outpatient centers and 280 Vet Centers with approximately 8 million veterans receiving health care (Nayar, et al., 2013). In addition, the VA struggles to maintain economic viability while struggling with a fixed “brick and mortar” mentality.
One such way the VA is attempting to overcome being “top heavy” with high-salaried staff as well as a very large administrative staff is to attempt to increase enrollment into the VA system by qualified veterans (Weeks, W & Auerbach,D, 2014). However, such a move also increases the need for more qualified providers and potentially more facilities to be opened. Another way in which the VA has attempted to improve is the implementation of an electronic health record (EHR) system that can be utilized system wide by any provider accessing the veterans medical record; thus, hopefully allowing a more streamlined plan of care.
From a personal experience, seeing patients for women’s health care (who are veterans) presents a challenge of first obtaining a referral letter from a VA physician to obtain speciality services (e.g., well-woman exam). Also, reimbursement by VA to clinics and hospitals are extremely delayed, thus putting a financial burden upon the patient. Another area of concern is the access to mental health care and the need for more mental health providers. Lobbying at the local and state level would be beneficial to expedite access to care of these much needed services. This future NP is in a unique position of having a large military installation nearby, along with a large population of retired military personnel.
References:
Nayar, P., Apenteng, B., Yu, F., Woodbridge, P., & Fetrick, A. (2013). Rural veteran’s perspectives of dual care. Journal of Community Health, 38(1), 70-77. DOI: 10.1007/s10900-012-9583-7
Weeks, W.B., & Auerbach, D. (2014). A VA exit strategy. The New England Journal of Medicine, 371(9), 789-791. Retrieved from http://prx-herzing.lirnnet/login?url=http://search-proquest-com.prx-herzing.lirn.net/docview/1558120346?accountid=167104
Benjamin
PTSD adversely affects the lives of many veterans and their families and is a direct result of serving in the military and in combat. Assimilation can be difficult for those even without PTSD; a heightened sense of vigilance and awareness as well as the dependable structure within the military can make civilian life uncomfortable and difficult (Department of Veterans Affairs, 2016). Policies should provide for more than simple psych evaluations, they should provide for a slower integration back in to society, and acknowledgment of the issues vets may have. I personally would love to see job training offered for those who served in jobs that do not directly translate to the civilian world, and incentives for companies to hire veterans coming straight out of service.
Privatization is a double edged sword. It would most definitely increase efficiency within the system, however, the fear lies in if the quest for increasing profits would adversely affect the care given to our veterans. I do not believe this question can be answered. Access to and efficient provision of care to veterans must be improved, offering population outcome based reimbursement may provide the incentive to cover both efficiency and quality care. There is some discussion of moving VA dollars into Medicaid or Medicare and providing coverage for veterans in this way Zinberg, 2017). This may possibly work as health care systems already accept these as payment, but given the number of VA hospitals there would need to be additions to private health care to absorb these patients without impacting everybody. I have worked with the VA system and outside it and a huge step would simply be for the VA system to be run in the way private systems are, where efficiency and excellency are rewarded, where we are supposed to come under budget not blow the budget. I have personally witnessed gross negligence and waste within the system that would cause employment termination in the private sector and resulted in nothing.
References:
U.S. Department of Veterans Affairs. (2016, October 4). What Is PTSD? Retrieved from http://www.ptsd.va.gov/public/PTSD-overview/basics/what-is-ptsd.asp
Zinberg, J. (2017, January 09). Trump’s path to privatizing VA hospitals – by the numbers. Retrieved July 10, 2017, from http://thehill.com/blogs/pundits-blog/healthcare/313280-trumps-path-to-privatizing-va-hospitals-by-the-numbers
