Wednesday, January 11, 2017

The Future of VA

During his press conference today, Trump announced his choice for Secretary of Veterans Affairs: Dr. David Shulkin, who is currently the undersecretary for health of the Veterans Health Administration, the healthcare arm of VA. (The other two arms are Veterans Benefits and Cemetery/Burial Services.) So Dr. Shulkin comes into this job with a strong knowledge of VA, especially VHA, as well as experience as a leader of other healthcare organizations. I'm hopeful that his appointment will lead to some positive changes in VA, and will signal an overhaul, as opposed to privatization or movement to a voucher system.

VA certainly has problems. As a former employee, I know about many of those issues, some of them from my own experiences. But VA is still the best place for Veterans to receive their care, especially Veterans with conditions directly related to their combat experience: post-traumatic stress disorder, traumatic brain injury, spinal cord injury, polytraumatic injury (multiple traumatic injuries, like both TBI and SCI) and Agent Orange exposure, just to name a few. The nuances of these particular conditions among Veterans make it difficult for them to receive care from providers who are experienced in dealing with these issues when they seek care outside of VA. The experience of a combat Veteran with PTSD is completely different from a sexual assault survivor with PTSD, and the types of treatments best suited also differ. And certain conditions cluster in Veterans in different ways than they do the general population, so a Veteran may need multiple providers in the private sector, when they could get the same quality of care from fewer providers in VA. And VA is exploring many programs and projects that help to deliver care to Veterans who are unable to get to a medical center or clinic (such as their teleHealth and Home Care programs) or who live too far from a large medical center to see particular specialists (projects like SCAN-ECHO).

A voucher system would force Veterans to find providers who can handle their conditions, rather than simply putting the providers best suited for their needs in one place. The quality of Veteran health would go down, and the onus would be entirely on the patient. Obviously, movements like patient-centered care, which focuses on, among other things, educating patients and helping them to share in decision-making about their care, are incredibly important and must continue. But there is a difference between empowering patients and giving them an impossible puzzle to solve.

I'm also hopeful that VA will continue to fund and conduct research to improve care among patients. VA research has resulted in many innovations that are becoming part of care in the private sector: things like daily aspirin regimens, cardiac pace-makers, and deep brain stimulation for Parkinson's disease were developed and informed by VA researchers. And as I've said before, without research, our quality of life - and in this case, our quality of health care - will stagnate.

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