Pima County Perspective DIFFICULTIES OF VE TER AN HE ALTH C ARE
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was asked to offer an opinion regarding some of the difficulties the Veterans Administration (VA) faces in delivering timely and quality care to the 9.1 million veterans who are eligible for care under that system today, myself included. I must admit that I am not a VA provider although I was employed by the VA for five years as a surgical resident. The opinions I express are my own and are not a reflection of any federal agency or authority. During my tenure as the Mobilization Assistant to the Assistant Secretary of Defense, Health Affairs, I sat in on many a high level meeting regarding VA Health Care at the Department of Veterans Affairs in Washington D.C. The history of how and why the Department of Veterans Affairs was created dates back to the Lincoln Administration and is very interesting. I myself am a veteran, having served for almost 29 years and having deployed on four occasions to Iraq and Afghanistan. My brother is a veteran, as is my father, so these issues are very real and personal to me. Congress recently enacted and President Obama signed into law the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113-146) (“Veterans Choice Act”), as amended by the Department of Veterans Affairs (VA) Expiring Authorities Act of 2014 (Public Law 113-175), to improve access to timely, high-quality health care for Veterans. Under “Title II – Health Care Administrative Matters,” Section 201 calls for an Independent Assessment of 12 areas of VA’s health care delivery systems and management processes.
Assessing and reporting The bipartisan Fixing Veterans Health Care Task Force report (a worthwhile read) was released in February 2015; the task force was chaired by Bill Frist (R), who represented Tennessee in the Senate from 1995 to 2007, was Senate majority leader from 2003 to 2007, and Jim Marshall (D), who represented Georgia in the House from 2003 to 2011. Frist and Marshall mentioned that they joined this task force because they believe in the VA’s mission. They go on 6
ARIZONA PHYSICIAN | June 2017
Jim Balserak, MD, MPH, FACS, FACE
to say that in learning about the history of the agency and its many iterations, it was easy to see how the VA’s current configuration, “grew out of legislation passed to address immediate needs and competing election cycles.” They propose that the best way to “fix” the VA is to focus on Abraham Lincoln’s promise, “to care for him who shall have borne the battle,” not the agency that dispenses his benefits. The VA engaged the Institute of Medicine of the National Academies to prepare an assessment of access standards and engaged the Centers for Medicare & Medicaid Services (CMS) Alliance to Modernize Healthcare (CAMH)1 to serve as the program integrator and as primary developer of the remaining 11 Veterans Choice Act independent assessments. CAMH subcontracted with Grant Thornton LLP, McKinsey & Company, and the RAND Corporation to conduct ten independent assessments as specified in Section 201, with MITRE conducting the 11th assessment. Drawing on the results of the 12 assessments, CAMH also produced the Integrated Report in this volume, which contains key findings and recommendations. CAMH is furnishing the complete set of reports to the Secretary of Veterans Affairs, the Committee on Veterans’ Affairs of the Senate, the Committee on Veterans’ Affairs of the House of Representatives, and the Commission on Care.1 This report was the result of a perceived crisis of care delivery and leadership within the VA Health Care System after the Inspector General launched investigations of the Phoenix VA hospital – accused of concealing exorbitant patient wait times to see providers which in some cases were felt to be the root cause of many patient deaths and innumerable declines in the health and safety of thousands of others in an investigation that ultimately expanded to 26 VA care facilities nationwide.
Healing the wounded This intense pressure can be linked to numerous factors. I served as a trauma surgeon working in Baghdad, Iraq on two occasions. I was the Chief Surgeon at the Joint Theatre Hospital, Bagram Air Base, Afghanistan. I was the Critical