Will Outsourcing VA Care Monkey Wrench VistA?

Posted on June 16, 2014 I Written By

When Carl Bergman isn't rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of EHRSelector.com, a free service for matching users and EHRs. For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manger doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst.

The mess over the VA’s waiting times, with luck, will sort itself out with a revised management team and, perhaps, enough money to hire long needed staff.

One solution that’s pending in Congress is to let vets go outside the VA for care. From what I’ve read, most vets like the VA’s care and don’t want to change the main program, just fix it. However, that’s going to take time. The scandal has been around for a long time, at least since 2005 according to the VA’s Inspector General:

The issues identified in current allegations are not new. Since 2005, the VA Office of Inspector General (OIG) has issued 18 reports that identified, at both the national and local levels, deficiencies in scheduling resulting in lengthy waiting times and the negative impact on patient care. As required by the Inspector General Act of 1978, each of the reports listed was issued to the VA Secretary and the Congress and is publicly available on the VA OIG website.

Given the VA’s size and complexity as well as the need to recruit new staff and implement new procedures, permitting vets to use other resources has much appeal that crosses party lines. Two politically apart Senators, Bernie Sanders (I-VT) and John McCain (R-AZ)  started the change with their bill to allow outside care and more:

The Sanders-McCain legislation addresses the short-term problem of access to care by authorizing a two-year trial program that would allow veterans to seek private health care if they reside more than 40 miles from a VA facility or have been waiting more than 30 days for treatment. Long-term, the legislation authorizes the construction of 26 medical facilities in 18 states, and directs $500 million in unspent funds to hire more doctors and other health-care providers.

The House voted for outside providers, but killed any funding changes. The Senate passed the Sanders-McCain bill by a 93 to 2 vote. The next step is uncertain. One house could simply accept the other’s version, which is unlikely. The other alternative is a conference committee, which can draft its own version for both houses to vote on. Given the urgency, though, it’s probable that something will pass before long.

Wither VistA?

The fix, however, may unfix one of the VA’s strengths. It could create a medical record continuity problem separating vets from their records leaving VistA EHR, which tracks veterans healthcare, in the lurch.

How will vets’ records follow them to outside docs? Vets could download their records with Blue Button, but would local docs know what to do with them? When a vet’s encounter is over, how will the information get back to VistA, if at all.

Vets have a single, relatively well functioning medical record system. Here’s hoping the price of needed care doesn’t foul up what’s been working right.