August 10, 2016

Sgt. Shaft caricatureDear Sgt Shaft
I know VA Healthcare has been in the news a lot lately.  What improvements if any are in the works?

George O
Via the internet

Dear George
The Department of Veterans Affairs recently released results of The Joint Commission Special Focused Surveys on VA health care facilities. VA invited The Joint Commission to conduct unannounced, focused surveys at 139 medical facilities and 47 community-based outpatient clinics across the country to measure progress on VA access to care, quality improvements and diffusion of best practices across the system. The surveys also assessed barriers that may stand in the way of providing timely care to Veterans. Results indicate VA has made significant progress since The Joint Commission began its surveys two years ago.

“The Joint Commission is one of the most widely-respected health care organizations in the industry,” said VA Under Secretary for Health Dr. David J. Shulkin. “Their analysis shows that VA as national healthcare leader is making progress in improving the care we provide to our Veterans. This affirms our commitment to providing both excellent health care and an exceptional experience of care to all Veterans served.”

The Joint Commission assessed processes related to timely access to care; processes that may potentially indicate delays in care and diagnosis; processes related to patient flow and coordination of care; infection prevention and control; the environment of care; and organizational leadership and culture. For the survey, VA’s Veterans Health Administration provided organization-specific data addressing performance in the key areas targeted for review. .VA was the first system ever to request an assessment with an important focus on access so that deficiencies could be identified and rapidly addressed. The Joint Commission will track and report on the extent to which improvements were sustained, when the same facilities undergo their triennial accreditation surveys. To date, results from 57 hospitals that have undergone full accreditation are promising. We are pleased with VA’s ongoing commitment to quality improvement and patient safety.

Among the top findings:

  • Access to CareFacilities have seen improvements in providing patient appointments: Improvement efforts that were undertaken include leadership teams utilizing data to better understand where particular bottlenecks were and taking corrective actions. As the Joint Commission continues the regularly scheduled triennial surveys of VHA facilities after the special surveys were completed, the findings are encouraging. For example, as of April 1, 2016, 57 facilities have undergone follow-up surveys. Of these 57 sites, only one facility was found to have a repeat requirement for improvement (issue) related to patient access. Staffing continued to be a challenge in this area, but as new staff was hired, the wait times for appointments were more effectively addressed.
  • Choice Act: Early discussions with Veterans indicated a strong preference, and even a loyalty, for their “own” VHA organization, even if it would mean waiting longer to be seen. VHA facilities and Veterans also report that many times appointments in the community could not be made any earlier than would have been possible inside VA.

Efforts to Improve Veterans Access to Care

  • In 2014, VA introduced MyVA. MyVA is the largest transformation in the history of VA, which focuses on the needs of Veterans. As part of that transformation, in 2016, VA’s Veterans Health Administration established and launched MyVA Access. MyVA Access also puts Veterans more in control of how they receive their health care.
  • VA is moving to incorporate same-day access to primary care and mental health services for Veterans when it is medically necessary. At present, 39 VA facilities offer same-day appointments.
  • A new smart phone app called the Veteran Appointment Request App has been developed and is currently being piloted. This app allows Veterans to view, schedule and cancel primary care and mental health appointments as well as track the status of the appointment request and review upcoming appointments. VA expects to make the app available to all Veterans by early 2017.
  • Website enhancements are underway that will allow Veterans to check wait times in real time wherever they live – this includes a new, easy-to-use scheduling software program. The new program is being piloted and is expected to reduce scheduling errors and enhance VA’s ability to measure and track supply, demand and usage.
  • Nationally, VA completed more than 57.85 million appointments from July 1, 2015 through June 30, 2016. This represents an increase of 1.1 million more appointments than were completed during the same time period in 2014/2015.
  • From FY 2014 to FY 2015, Community Care appointments increased approximately 20 percent from 17.7 million in FY 2014 to 21.3 million in FY 2015.
  • In FY 2015, VA activated 2.2 million square feet of space for clinical, mental health, long-term care, and associated support facilities to care for Veterans.
  • VA held two Access Stand Downs, focusing on patients with the most urgent health care needs first. During a nationwide Access Stand Down that took place on February 27, 2016, the one-day event resulted in VA reviewing the records of more than 80,000 Veterans to get those waiting for urgent care off wait lists; 93 percent of Veterans waiting for urgent care were contacted, with many receiving earlier appointments.
  • VA increased its total clinical work (direct patient care) by 11 percent over the last two years as measured by private sector standards (relative value units). This increase translates to roughly 7.4 million additional provider hours of care for our Veterans.
  • VA is also working to increase clinical staff, add space and locations in areas where demand is increasing and extending clinic hours into nights and weekends, all of which have helped increase access to care even as demand for services increases.
  • In FY 2015, 677,000 Veterans completed more than 2 million telehealth visits, providing enhanced access to care.
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