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Accessibility for Veteran populations

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The accessibility of healthcare is hot topic in the United States; as cost has led to a healthcare crisis with potential to criple the US economy. Healthcare represents the largest industry in the United States (Hill & Powell, 2009). As a result of the financial impact, accessibility to healthcare is inadequately inconsistent across the country.  Healthcare across America lacks lacks a patient-first approach secondary to delivery being dictated by for profit insurance companies and lobbyist that promote practice restriction to promote corporate revenue. Healthcare is becoming tied up in in profit driven industry neglectful to the underserved population being  denied or delayed Care (Karnick, 2017) inThe Affordable Care act was developed as a result of the healthcare crisis, wither intent of creating affordability and accessibility of health care to all US citizens.  Even with efforts to reform and repeal the ACA under the current Presidential administration still leaves a country divided related to the health care interest of its citizens.  With the healthcare having limitations amongs civilians in the United States, how does the biggest health systems country serving exclusively the Veteran population pair up?

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The unique benefit of our Veteran population is the ability to receive healthcare other services through the Veteran Health Administration (VHA), despite possibly having a primary care provider and other resources in their respective communities. The Department of Veteran Affairs is the largest health system in the United States. It's comprised of 168 Medical Centers and another 1000 or more satellite clinics termed community-based outpatient clinics (CBOCs).  Established in the 1930s, the health system of the department of Veteran Affairs reports to serving 9 million Veterans annually. VHA is one of three administrations under the department of Veteran Affairs. The other two are Veteran Benefits Administration (VBA) and National Cemetary Administration (NCA).

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All Veterans have the ability to register within the VA system for both Primary Care, Mental Health, Social Services, etc.  Through a compensation and benefits assessment,  a Veteran can be determine the level of services connected care they are eligible for within the VA. Disability compensation is monetary benefit allotted to Veterans based on disabilities secondary to disease or injury sustained during service (Veteran Affairs, 2017) The VA health care system has always had some struggle with providing accessible service to the country's Veteran population, but has made significant strides since its inception. by expanding and evolving the health system into what's its widely known for today.

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State of Veteran Healthcare continued...

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State of Veteran Healthcare continued...

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Despite having a service environment specific to Veterans health care needs, ensure all Veterans are able to have their care needs met poses a contradiction. So despite the havinsuch a large system the VA has had challenges with enough Providers at many of its facilities. These deficits lead tocreation  of waiting list in which Veteran had waited for greater than 30 days and in some cases never for critical treatment. Once the scandal was made public the VA was exposed related to its accessibility deficits. In some instances the VA was cited for deaths related to a number of people waiting for care. CNN reported significant deficits in care at several VA Medical Centers, where prognostic test for early detection of cancer were delayed (CNN, 2013). For a health system already in completion with the private sector, this was not positive publicity for the Department of Veteran Affairs. Amid the scandals the Secretary of Veteran Affairs was forced to resign and several top executives were fired. Under the interim Secretary, he VA implemented legislation referred to as the Choice Act. This allowed Veteran to receive Care from private providers if the VA could not meet meet the 30 day, 40 mile rule for care delivery. This law under he new administration has been revised to continue until funds are exhausted versus he expiration date of August 7 2017 for this plan. This ensures continuance until the $10 billion for this plan is exhausted. While this has created some accessibility, has this become a resolve or a bandaid?

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While the Veteran population have the opportunity to receive primary, mental health & specialty care through the VA, the access to clinicians is compromised. Some Medical Centers cannot recruit Providers successfully because salaries are not competitive in some rural and non urban regions compared to the metropolitan sites. As a result provider utilizationI is maximized without any room to allot for walk-ins. These walk-ins are diverted to he Medical Centers ED or Urgent Care due to poor accessibility. To further implicate the unresolve of healthcare access within the VA, the satellite clinics (CBOCs) are so geographically distant from its medical center where specialty services are usually stationed.  Does this presentation of poor accessibility threatening the VA Health Systems reputation have an affect on the individuals actually seeking to utilizing the services?

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Older Veterans tend to be the seekers of VA healthcare versus younger Veteran. This is likely due to perception of the VA by younger Veterans; their expanded options related to benefits received through integration back into the work force; and the fact that the current median age for Veterans is 64 years of age according to the National Center for Veterans Analysis and Statistics.

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impromptuLimited accessibility urges recently discharging military service men and Veterans receiving private insurance from seeking medical and mental and specialty healthcare from the Department of Veteran Affairs.  Health implications include continued potential risk for delay in care, increase risk for patient harm and negative experience, and public citation of negligence within the health system. This writer has witnessed this continued stigma applied to every instances of compromised care. This writer VA Medical Center was involved in a sentinel event involving a Veteran seeking mental health care. The Veteran was seeking to be seen by his provider, but was told he had to wait greater than 30 days to have this visit. Without obvious warning, the Veteran engage in self harm on the grounds of one of is writer's Medical Center's CBOCs. The RCA did reveal the Medical Center was at fault. Unfortunately, the media and political backlash put the Medical Center and its leadership under a lot of scrutiny. A lot of changes to increase accessibility and delivery were implemented. One of which included this writer Virtual Care program creating remote Provider relationships with inter-facility agreements to help us meet Mental Health clinic demands.

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This issue affects all eras of conflict due to this implication affecting the whole system.  However, the era of service typically affected by the VA and its access challenges are the Vietnam Veteran for men. Most women are represented by the Gulf Wars as highest demographic of service era. Peacetime for both male and female Veterans. However, as Veterans continue to age the projected trend is that gulf war Veterans will increase to up to 60% of the Veteran population while Vietnam Veteran will reduce to less than 10% by 2040 according to National Center for Veterans Analysis and Statistics.

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relevantThe VA is looking to create transparency through active research and public display of statistics demonstrating wait times and access to  specialty care compared to national numbers and neighboring private facilities for same services. There is also an increase in services using the medium in which this writer coordinates. More care delivery via virtual care. To go further, e Office of Coordinated Care is creating hub sites were a particular service is abundant and distributing those Provider resources remotely throughout system as needed. As explained by Hill and Powell, 2017,  eHealth is a major factor in countering the crisis secondary to poor accessibility.  The VA has been involved in delivery  health care through virtual care modalities since 2008 and have a strong opportunity to expand utilization of this medium before even the private sector catches on. The VHA Office of Connnected Care provide Veterans with a unique combination of access that is relevant to health information and communication between Veterans and their providers. This is a multidisciplinary approach; in which all service and disciplines can enhance their reach using the Telehealth/virtual care medium as an addendum to traditional face to face encounters. It offers the serviced Veteran population options and that can even offset the need for the Choice Program as well. Another contingency to offset sending our services population out to community for care is to take the same monies being allocated to fund Choice and pay providers/clinicians to compete for positions in rural markets. This writers direct experience with Choice reveals that Veterans are still waiting because of limitations with he network of providers on the Choice list and the long process for getting the VA to pay he bills from visits to community providers through Choice. The wait and limitation of  options contradicts the purpose for creating he act and making it legislation in the first place. It's  this writers perception that the VA will gain long term success of winning back the reliability of its serviced population and its civilian stakeholders; such as the Veteran families and community activist.

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Bronstien, S., Black, N.m Griffin, D CNN Investigations (2013) Hospital
delays are killing America's war veterans. Retrieved May 19, 2017,
from www.cnn.com/2013/11/19/health/Veterans-dying-health-Care-
delays/index.html
Hill, J. W., & Powell, P. (2009). The national healthcare crisis: Is eHealth
a key solution? Business Horizons 52(3), Pp. 265-267 doi:
https//doi.org/10.1016/j.bushor.2009.01.006
Karnick, P.M. (2017) Healthcare crisis: Do Nurses Help or Hurt? Nursing
Science Quarterly 30(1) p. 32
U.S. Department of Veteran Affairs (2016). Veterans Health
Administration. Retrieved May, 15, 2017, from
https://www.va.gov/health/findcare.asp
US Department of Veteran Affairs (2017). Compensation. Retrieved
May 16, 2017 from https://www.benefits.va.gov/disabilityexams/
US Department of Veteran Affairs (2017). Veterans Choice Program:
Access health care closer to home. Retrieved May 20, 2017 from
https://www.va.gov/opa/choiceact/
US Department of Veteran Affairs (2017). Profile of Veterans: 2015
Data from the American Community Survey. Retrieved May 21, 2017
from https://www.va.gov/vet data.
/docs/SpecialReports/Profile_of_Veterans_2015.pdf
US Department of Veteran Affairs (2017). Access and Quality in VA
Healthcare Retrieved May 21, 2017 from
www.accesstocare.va.gov/Healthcare/Overall
US Department of Veteran Affairs. Vantage Point (2017). Relationship
building: Enhancing Veteran Access and the digital healthcare
experience. Retrieved May 25, 2017 from
www.blogs.va.gov/VAntage/35146/relationship-building-enhancing-
Veteran-access-digital-healthcare-experience/

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Intellectual Honesty Certification

The statement for individual assignments is as follows:

I certify that this assignment is presented as entirely my own intellectual work. Any wordsand/or ideas from other sources (e.g. printed publications, Internet sites, electronicmedia, other individuals, groups, or organizations) have been properly indicated using the appropriate scholarly citation style required by the department or College.

I have not submitted this assignment in its entirety to satisfy the requirements of any othercourse. Any parts of this assignment from other courses have been discussed thoroughly with the faculty member before this submission so that there is an understanding that I have used some of this work in a prior assignment.

Student’s Signature: Michael Selby

Course Submitted: 623-903

Term: Spring Quarter 16-17

Date:  May 26, 2017