Government and Regulations

Reacting quickly to complaints of caregivers who had their eligibility for Program of Comprehensive Assistance for Family Caregivers (PCAFC) funding revoked, the VA has announced that it will pause revocations while reviewing the program’s implementation. “VA is taking immediate action to review the National Caregiver Support Program to ensure we honor our commitment to enhance the health and well-being of veterans,” said Secretary of Veterans Affairs David J. Shulkin, MD, in a prepared statement. “I have instructed an internal review to evaluate consistency of revocations in the program and standardize communication with veterans and caregivers nationwide.”

An NPR report documented a number of cases of PCAFC support that had been changed recently despite little evidence for change in the veterans’ need for care. According to the NPR analysis, some VA facilities saw significant drops in the number of caregivers who received support; whereas others saw equally significant increases.

According to the VA, veterans who need a VA designated family caregiver to assist with the management of personal care functions that are required for everyday living and are in conjunction with standard care provided by the VA are eligible for the program. A clinical support team evaluates the veteran for eligibility, and the caregiver receives training. The program provides a monthly stipend based on the veterans’ “level of need and required assistance.”

During the review, the VA will continue accepting PCAFC applications, approving applicants based on current eligibility criteria, processing appeals, and monitoring eligible veterans’ well-being at least every 90 days unless otherwise clinically indicated.

 “Caregivers play a critically important role in the health and well-being of veterans, and caring for an injured veteran is a labor of love,” said Dr. Poonam Alaigh, acting VA Under Secretary for Health. “We remain focused on process improvements and support services for our family caregivers so they can take care of our veterans.” 

Reacting quickly to complaints of caregivers who had their eligibility for Program of Comprehensive Assistance for Family Caregivers (PCAFC) funding revoked, the VA has announced that it will pause revocations while reviewing the program’s implementation. “VA is taking immediate action to review the National Caregiver Support Program to ensure we honor our commitment to enhance the health and well-being of veterans,” said Secretary of Veterans Affairs David J. Shulkin, MD, in a prepared statement. “I have instructed an internal review to evaluate consistency of revocations in the program and standardize communication with veterans and caregivers nationwide.”

An NPR report documented a number of cases of PCAFC support that had been changed recently despite little evidence for change in the veterans’ need for care. According to the NPR analysis, some VA facilities saw significant drops in the number of caregivers who received support; whereas others saw equally significant increases.

According to the VA, veterans who need a VA designated family caregiver to assist with the management of personal care functions that are required for everyday living and are in conjunction with standard care provided by the VA are eligible for the program. A clinical support team evaluates the veteran for eligibility, and the caregiver receives training. The program provides a monthly stipend based on the veterans’ “level of need and required assistance.”

During the review, the VA will continue accepting PCAFC applications, approving applicants based on current eligibility criteria, processing appeals, and monitoring eligible veterans’ well-being at least every 90 days unless otherwise clinically indicated.

 “Caregivers play a critically important role in the health and well-being of veterans, and caring for an injured veteran is a labor of love,” said Dr. Poonam Alaigh, acting VA Under Secretary for Health. “We remain focused on process improvements and support services for our family caregivers so they can take care of our veterans.” 

Reacting quickly to complaints of caregivers who had their eligibility for Program of Comprehensive Assistance for Family Caregivers (PCAFC) funding revoked, the VA has announced that it will pause revocations while reviewing the program’s implementation. “VA is taking immediate action to review the National Caregiver Support Program to ensure we honor our commitment to enhance the health and well-being of veterans,” said Secretary of Veterans Affairs David J. Shulkin, MD, in a prepared statement. “I have instructed an internal review to evaluate consistency of revocations in the program and standardize communication with veterans and caregivers nationwide.”

An NPR report documented a number of cases of PCAFC support that had been changed recently despite little evidence for change in the veterans’ need for care. According to the NPR analysis, some VA facilities saw significant drops in the number of caregivers who received support; whereas others saw equally significant increases.

According to the VA, veterans who need a VA designated family caregiver to assist with the management of personal care functions that are required for everyday living and are in conjunction with standard care provided by the VA are eligible for the program. A clinical support team evaluates the veteran for eligibility, and the caregiver receives training. The program provides a monthly stipend based on the veterans’ “level of need and required assistance.”

During the review, the VA will continue accepting PCAFC applications, approving applicants based on current eligibility criteria, processing appeals, and monitoring eligible veterans’ well-being at least every 90 days unless otherwise clinically indicated.

 “Caregivers play a critically important role in the health and well-being of veterans, and caring for an injured veteran is a labor of love,” said Dr. Poonam Alaigh, acting VA Under Secretary for Health. “We remain focused on process improvements and support services for our family caregivers so they can take care of our veterans.” 

Citing his inability to immediately remove a VA employee who was caught watching pornography while with a patient, VA Secretary David J. Shulkin, MD, has called on Congress to enact legislation that makes it easier and faster to remove employees at the VA. “This is an example of why we need accountability legislation as soon as possible,” Dr. Shulkin said in a statement. “It’s unacceptable that VA has to wait 30 days to act on a proposed removal.”

Currently, VA employees receive at least 30 days notice of firing, have a right to a grievance hearing, and must be paid throughout the final adjudication as long as there is no evidence of a crime. However, employees can be removed from patient interaction or placed on administrative leave.

In March, the House of Representatives passed the VA Accountability First Act of 2017 (HR 1259), which would reduce the advanced warning time to 10 days and speed up the appeals process, but the bill has yet to be considered by Senate. “This situation underscores the need for Congress to get VA accountability legislation to President Trump's desk, and I thank Secretary Shulkin for making this a top priority,” Rep. David P. “Phil” Roe, MD (R-Tenn.), chairman of the House Veterans’ Affairs Committee concurred. “I was proud my bill, the VA Accountability First Act of 2017, passed the House with bipartisan support earlier this month. Veterans deserve better. I encourage my Senate colleagues to consider my legislation, and I look forward to working with Secretary Shulkin to change the way VA does business.”

Despite the bipartisan support cited by Rep. Roe, many Democrats have indicated that they are wary of the bill because it strips VA civil servant employees of many employment protections. Ranking Democratic House committee on Veterans’ Affairs member Rep. Tim Walz (D-Minn) warned that the changes in employee protections in the bill make it less likely it will pass through the Senate and that it could face court challenges. “By refusing to compromise on the 1 percent of this legislation we disagree on, Republicans have made it harder to pass the 99 percent of the legislation that is vital to making improvements,” according to a report in Stars and Stripes.

Organizations that represent VA workers also have voiced opposition. The American Federation of Government Employees (AFGE), which represents 270,000 VA employees, also argued that the bill “would render useless” the process that providers use “to protect their voice at work and defend themselves against managers’ retaliation and discrimination.” In a letter to the House committee, AFGE argued that the bill, “weakens the critical protections that VA employees need to speak up against mismanagement and patient harm.”

Citing his inability to immediately remove a VA employee who was caught watching pornography while with a patient, VA Secretary David J. Shulkin, MD, has called on Congress to enact legislation that makes it easier and faster to remove employees at the VA. “This is an example of why we need accountability legislation as soon as possible,” Dr. Shulkin said in a statement. “It’s unacceptable that VA has to wait 30 days to act on a proposed removal.”

Currently, VA employees receive at least 30 days notice of firing, have a right to a grievance hearing, and must be paid throughout the final adjudication as long as there is no evidence of a crime. However, employees can be removed from patient interaction or placed on administrative leave.

In March, the House of Representatives passed the VA Accountability First Act of 2017 (HR 1259), which would reduce the advanced warning time to 10 days and speed up the appeals process, but the bill has yet to be considered by Senate. “This situation underscores the need for Congress to get VA accountability legislation to President Trump's desk, and I thank Secretary Shulkin for making this a top priority,” Rep. David P. “Phil” Roe, MD (R-Tenn.), chairman of the House Veterans’ Affairs Committee concurred. “I was proud my bill, the VA Accountability First Act of 2017, passed the House with bipartisan support earlier this month. Veterans deserve better. I encourage my Senate colleagues to consider my legislation, and I look forward to working with Secretary Shulkin to change the way VA does business.”

Despite the bipartisan support cited by Rep. Roe, many Democrats have indicated that they are wary of the bill because it strips VA civil servant employees of many employment protections. Ranking Democratic House committee on Veterans’ Affairs member Rep. Tim Walz (D-Minn) warned that the changes in employee protections in the bill make it less likely it will pass through the Senate and that it could face court challenges. “By refusing to compromise on the 1 percent of this legislation we disagree on, Republicans have made it harder to pass the 99 percent of the legislation that is vital to making improvements,” according to a report in Stars and Stripes.

Organizations that represent VA workers also have voiced opposition. The American Federation of Government Employees (AFGE), which represents 270,000 VA employees, also argued that the bill “would render useless” the process that providers use “to protect their voice at work and defend themselves against managers’ retaliation and discrimination.” In a letter to the House committee, AFGE argued that the bill, “weakens the critical protections that VA employees need to speak up against mismanagement and patient harm.”

Citing his inability to immediately remove a VA employee who was caught watching pornography while with a patient, VA Secretary David J. Shulkin, MD, has called on Congress to enact legislation that makes it easier and faster to remove employees at the VA. “This is an example of why we need accountability legislation as soon as possible,” Dr. Shulkin said in a statement. “It’s unacceptable that VA has to wait 30 days to act on a proposed removal.”

Currently, VA employees receive at least 30 days notice of firing, have a right to a grievance hearing, and must be paid throughout the final adjudication as long as there is no evidence of a crime. However, employees can be removed from patient interaction or placed on administrative leave.

In March, the House of Representatives passed the VA Accountability First Act of 2017 (HR 1259), which would reduce the advanced warning time to 10 days and speed up the appeals process, but the bill has yet to be considered by Senate. “This situation underscores the need for Congress to get VA accountability legislation to President Trump's desk, and I thank Secretary Shulkin for making this a top priority,” Rep. David P. “Phil” Roe, MD (R-Tenn.), chairman of the House Veterans’ Affairs Committee concurred. “I was proud my bill, the VA Accountability First Act of 2017, passed the House with bipartisan support earlier this month. Veterans deserve better. I encourage my Senate colleagues to consider my legislation, and I look forward to working with Secretary Shulkin to change the way VA does business.”

Despite the bipartisan support cited by Rep. Roe, many Democrats have indicated that they are wary of the bill because it strips VA civil servant employees of many employment protections. Ranking Democratic House committee on Veterans’ Affairs member Rep. Tim Walz (D-Minn) warned that the changes in employee protections in the bill make it less likely it will pass through the Senate and that it could face court challenges. “By refusing to compromise on the 1 percent of this legislation we disagree on, Republicans have made it harder to pass the 99 percent of the legislation that is vital to making improvements,” according to a report in Stars and Stripes.

Organizations that represent VA workers also have voiced opposition. The American Federation of Government Employees (AFGE), which represents 270,000 VA employees, also argued that the bill “would render useless” the process that providers use “to protect their voice at work and defend themselves against managers’ retaliation and discrimination.” In a letter to the House committee, AFGE argued that the bill, “weakens the critical protections that VA employees need to speak up against mismanagement and patient harm.”

Secretary of Veterans Affairs David J. Shulkin, MD, testified before the House Committee on Veterans’ Affairs, promising to tackle the epidemic of suicide and to continue the process to improve the Veterans Choice Act. Dr. Shulkin pledged to begin providing some mental health care service to veterans with other than honorable (OTH) discharges. “We know the rate of death by suicide among veterans who do not use VA care is increasing at a greater rate than veterans who use VA care,” Shulkin told the panel. “This is a national emergency that requires bold action. We must and we will do all that we can to help former service members who may be at risk. When we say even 1 veteran suicide is 1 too many, we mean it.”

Related: Senate, VA Agree—Veterans Choice Act Needs Fixing

The VA estimates that there are more than 500,000 former service members with OTH discharges. Previously, these veterans were not eligible for VA health benefits. As part of the proposal, former OTH service members would be able to seek treatment at a VA emergency department, Vet Center, or Veterans Crisis Line.

“I appreciate Secretary Shulkin taking steps to ensure veterans in crisis with OTH discharges have access to mental health services,” Phil Roe, MD (R-Tenn), chairman of the House Committee on Veterans’ Affairs, said in a written response. “With that said, this must be done in a fair, transparent way that ensures no veteran, especially those who have honorably served, are being skipped over for the care they need. I look forward to continuing this conversation with Secretary Shulkin.”

Related: "Call to Action" on Veteran Suicide Yields Policy Shifts

In addition, Dr. Shulkin revealed that 5.5 million appointments have been made through the  Veterans Choice Act and only 5,000 use community care exclusively. The bulk of veterans access both Veterans Choice and VA health care services. The Choice Act is set to expire in less than 6 months on August 7, 2017, if it does not receive congressional reapproval.

To modernize and consolidating the community care portion of the Veterans Choice Act, Shulkin outlined 7 steps:

1. High performance integrated network, including VA, other federal health care, and community providers;
2. Increase choice for all veterans, starting with those with service-connected health needs;
3. Help veterans get care closer to their homes;
4. Optimize and coordinate veterans’ care with other insurance providers;
5. Maintain affordability for lowest income veterans;
6. Assist in care coordination for veterans with multiple care providers; and
7. Apply industry standards for quality and affordability to the program.

Related: Veteran Suicide Rate Up 32% Since 2001

Secretary of Veterans Affairs David J. Shulkin, MD, testified before the House Committee on Veterans’ Affairs, promising to tackle the epidemic of suicide and to continue the process to improve the Veterans Choice Act. Dr. Shulkin pledged to begin providing some mental health care service to veterans with other than honorable (OTH) discharges. “We know the rate of death by suicide among veterans who do not use VA care is increasing at a greater rate than veterans who use VA care,” Shulkin told the panel. “This is a national emergency that requires bold action. We must and we will do all that we can to help former service members who may be at risk. When we say even 1 veteran suicide is 1 too many, we mean it.”

Related: Senate, VA Agree—Veterans Choice Act Needs Fixing

The VA estimates that there are more than 500,000 former service members with OTH discharges. Previously, these veterans were not eligible for VA health benefits. As part of the proposal, former OTH service members would be able to seek treatment at a VA emergency department, Vet Center, or Veterans Crisis Line.

“I appreciate Secretary Shulkin taking steps to ensure veterans in crisis with OTH discharges have access to mental health services,” Phil Roe, MD (R-Tenn), chairman of the House Committee on Veterans’ Affairs, said in a written response. “With that said, this must be done in a fair, transparent way that ensures no veteran, especially those who have honorably served, are being skipped over for the care they need. I look forward to continuing this conversation with Secretary Shulkin.”

Related: "Call to Action" on Veteran Suicide Yields Policy Shifts

In addition, Dr. Shulkin revealed that 5.5 million appointments have been made through the  Veterans Choice Act and only 5,000 use community care exclusively. The bulk of veterans access both Veterans Choice and VA health care services. The Choice Act is set to expire in less than 6 months on August 7, 2017, if it does not receive congressional reapproval.

To modernize and consolidating the community care portion of the Veterans Choice Act, Shulkin outlined 7 steps:

1. High performance integrated network, including VA, other federal health care, and community providers;
2. Increase choice for all veterans, starting with those with service-connected health needs;
3. Help veterans get care closer to their homes;
4. Optimize and coordinate veterans’ care with other insurance providers;
5. Maintain affordability for lowest income veterans;
6. Assist in care coordination for veterans with multiple care providers; and
7. Apply industry standards for quality and affordability to the program.

Related: Veteran Suicide Rate Up 32% Since 2001

Secretary of Veterans Affairs David J. Shulkin, MD, testified before the House Committee on Veterans’ Affairs, promising to tackle the epidemic of suicide and to continue the process to improve the Veterans Choice Act. Dr. Shulkin pledged to begin providing some mental health care service to veterans with other than honorable (OTH) discharges. “We know the rate of death by suicide among veterans who do not use VA care is increasing at a greater rate than veterans who use VA care,” Shulkin told the panel. “This is a national emergency that requires bold action. We must and we will do all that we can to help former service members who may be at risk. When we say even 1 veteran suicide is 1 too many, we mean it.”

Related: Senate, VA Agree—Veterans Choice Act Needs Fixing

The VA estimates that there are more than 500,000 former service members with OTH discharges. Previously, these veterans were not eligible for VA health benefits. As part of the proposal, former OTH service members would be able to seek treatment at a VA emergency department, Vet Center, or Veterans Crisis Line.

“I appreciate Secretary Shulkin taking steps to ensure veterans in crisis with OTH discharges have access to mental health services,” Phil Roe, MD (R-Tenn), chairman of the House Committee on Veterans’ Affairs, said in a written response. “With that said, this must be done in a fair, transparent way that ensures no veteran, especially those who have honorably served, are being skipped over for the care they need. I look forward to continuing this conversation with Secretary Shulkin.”

Related: "Call to Action" on Veteran Suicide Yields Policy Shifts

In addition, Dr. Shulkin revealed that 5.5 million appointments have been made through the  Veterans Choice Act and only 5,000 use community care exclusively. The bulk of veterans access both Veterans Choice and VA health care services. The Choice Act is set to expire in less than 6 months on August 7, 2017, if it does not receive congressional reapproval.

To modernize and consolidating the community care portion of the Veterans Choice Act, Shulkin outlined 7 steps:

1. High performance integrated network, including VA, other federal health care, and community providers;
2. Increase choice for all veterans, starting with those with service-connected health needs;
3. Help veterans get care closer to their homes;
4. Optimize and coordinate veterans’ care with other insurance providers;
5. Maintain affordability for lowest income veterans;
6. Assist in care coordination for veterans with multiple care providers; and
7. Apply industry standards for quality and affordability to the program.

Related: Veteran Suicide Rate Up 32% Since 2001

In his first address to a joint session of Congress, President Donald Trump promised “heroic veterans will get the care they so desperately need,” that he would eliminate the defense sequester, and called for “one of the largest increases in national defense spending in American history.”

“This looks like an increase in resources for us,” VA Secretary David Shulkin, MD, is reported to have told reporters early in the day at an American Legion meeting. “I'm confident this budget is going to reflect the President’s commitment to his ability to deliver on his promises to make veterans care better and stronger.” According to reports, the White House already has approved 37,000 exemptions from the federal hiring ban to help fill the VA’s  45,000 current job vacancies.

Reports also suggest that the military will receive an additional $54 billion in funding, a 10% increase. Details of where that extra money will go have not been released. The President’s military budget is less than the $640 billion budget proposed by Senator John McCain (R- AZ) and represents a 3% increase over the budget that had been projected by President Obama.

The overall impact on federal health care remains unclear. While President Trump held to his promise to repeal and replace the Affordable Care Act, to “invest in women’s health,” and to “give our state governors the resources and flexibility they need with Medicaid to make sure no one is left out,” there were few details of how those promises would be implemented and where the funding will come from.

In the address, the President outlined 4 necessary elements of an Affordable Care Act replacement:

1.  Americans with pre-existing conditions would have access to coverage, and a stable transition for health care exchanges enrollees;
2. The use of tax credits and savings accounts for purchasing private insurance;
3. Flexibility for states to expand Medicaid coverage; and
4. Legal reforms that “protect patients and doctors from unnecessary costs that drive up the price of insurance and work to bring down the artificially high price of drugs and bring them down immediately.”

The FDA also drew the President’s attention. Calling the approval process “slow and burdensome,” the President charged that the FDA “keeps too many advances… from reaching those in need.” The agency is still waiting on a nomination for its commissioner position, and it is unclear how it can speed up approval while under the federal hiring freeze.

Recognizing the devastation of opioid addiction, the President also promised to “stop the drugs from pouring into our country and poisoning our youth, and we will expand treatment for those who have become so badly addicted.” The President did not specify whether treatment resources would be exempt from the hiring freeze, incorporated into the Affordable Care Act, or handled in a different manner.

In his first address to a joint session of Congress, President Donald Trump promised “heroic veterans will get the care they so desperately need,” that he would eliminate the defense sequester, and called for “one of the largest increases in national defense spending in American history.”

“This looks like an increase in resources for us,” VA Secretary David Shulkin, MD, is reported to have told reporters early in the day at an American Legion meeting. “I'm confident this budget is going to reflect the President’s commitment to his ability to deliver on his promises to make veterans care better and stronger.” According to reports, the White House already has approved 37,000 exemptions from the federal hiring ban to help fill the VA’s  45,000 current job vacancies.

Reports also suggest that the military will receive an additional $54 billion in funding, a 10% increase. Details of where that extra money will go have not been released. The President’s military budget is less than the $640 billion budget proposed by Senator John McCain (R- AZ) and represents a 3% increase over the budget that had been projected by President Obama.

The overall impact on federal health care remains unclear. While President Trump held to his promise to repeal and replace the Affordable Care Act, to “invest in women’s health,” and to “give our state governors the resources and flexibility they need with Medicaid to make sure no one is left out,” there were few details of how those promises would be implemented and where the funding will come from.

In the address, the President outlined 4 necessary elements of an Affordable Care Act replacement:

1.  Americans with pre-existing conditions would have access to coverage, and a stable transition for health care exchanges enrollees;
2. The use of tax credits and savings accounts for purchasing private insurance;
3. Flexibility for states to expand Medicaid coverage; and
4. Legal reforms that “protect patients and doctors from unnecessary costs that drive up the price of insurance and work to bring down the artificially high price of drugs and bring them down immediately.”

The FDA also drew the President’s attention. Calling the approval process “slow and burdensome,” the President charged that the FDA “keeps too many advances… from reaching those in need.” The agency is still waiting on a nomination for its commissioner position, and it is unclear how it can speed up approval while under the federal hiring freeze.

Recognizing the devastation of opioid addiction, the President also promised to “stop the drugs from pouring into our country and poisoning our youth, and we will expand treatment for those who have become so badly addicted.” The President did not specify whether treatment resources would be exempt from the hiring freeze, incorporated into the Affordable Care Act, or handled in a different manner.

In his first address to a joint session of Congress, President Donald Trump promised “heroic veterans will get the care they so desperately need,” that he would eliminate the defense sequester, and called for “one of the largest increases in national defense spending in American history.”

“This looks like an increase in resources for us,” VA Secretary David Shulkin, MD, is reported to have told reporters early in the day at an American Legion meeting. “I'm confident this budget is going to reflect the President’s commitment to his ability to deliver on his promises to make veterans care better and stronger.” According to reports, the White House already has approved 37,000 exemptions from the federal hiring ban to help fill the VA’s  45,000 current job vacancies.

Reports also suggest that the military will receive an additional $54 billion in funding, a 10% increase. Details of where that extra money will go have not been released. The President’s military budget is less than the $640 billion budget proposed by Senator John McCain (R- AZ) and represents a 3% increase over the budget that had been projected by President Obama.

The overall impact on federal health care remains unclear. While President Trump held to his promise to repeal and replace the Affordable Care Act, to “invest in women’s health,” and to “give our state governors the resources and flexibility they need with Medicaid to make sure no one is left out,” there were few details of how those promises would be implemented and where the funding will come from.

In the address, the President outlined 4 necessary elements of an Affordable Care Act replacement:

1.  Americans with pre-existing conditions would have access to coverage, and a stable transition for health care exchanges enrollees;
2. The use of tax credits and savings accounts for purchasing private insurance;
3. Flexibility for states to expand Medicaid coverage; and
4. Legal reforms that “protect patients and doctors from unnecessary costs that drive up the price of insurance and work to bring down the artificially high price of drugs and bring them down immediately.”

The FDA also drew the President’s attention. Calling the approval process “slow and burdensome,” the President charged that the FDA “keeps too many advances… from reaching those in need.” The agency is still waiting on a nomination for its commissioner position, and it is unclear how it can speed up approval while under the federal hiring freeze.

Recognizing the devastation of opioid addiction, the President also promised to “stop the drugs from pouring into our country and poisoning our youth, and we will expand treatment for those who have become so badly addicted.” The President did not specify whether treatment resources would be exempt from the hiring freeze, incorporated into the Affordable Care Act, or handled in a different manner.

“For the first time in U.S. military history, we have the necessary policy to create and maintain a durable, enduring trauma system in times of war and peace,” said David Smith, MD, deputy assistant secretary of defense for Health Readiness Policy and Oversight, in an article for Health.mil.

Dr. Smith is talking about DoD Instruction (DoDI) 6040.47, which codifies clinical guidance for the continuum of patient care.

The move is the latest in a series of steps that began in 2003, when the Joint Trauma System (JTS) was conceived. Although medical care then was well documented in theater, critical patient information wasn’t readily available as a patient moved through multiple hospitals. Moreover, deployed medical teams relied on telephonic coordination for long-term follow-up.

“The new DoD guidelines validate all the lessons learned from the ad hoc processes used out of necessity in establishing the JTS,” said JTS Director Navy Capt Zsolt Stockinger. The DoDI provides operational commanders, clinical providers, and medical planners with the best known combat medical techniques and procedures to minimize trauma-related disability and eliminate preventable deaths after injury.

Stockinger adds, “The JTS DoDI is not meant to dictate ‘how’ and ‘what’ a trauma system should look like, because each environment and location will dictate certain aspects of a trauma system.” Rather, Stockinger says, the JTS team is a resource to help others find the best solutions as they establish and grow their own geographic trauma system.

“For the first time in U.S. military history, we have the necessary policy to create and maintain a durable, enduring trauma system in times of war and peace,” said David Smith, MD, deputy assistant secretary of defense for Health Readiness Policy and Oversight, in an article for Health.mil.

Dr. Smith is talking about DoD Instruction (DoDI) 6040.47, which codifies clinical guidance for the continuum of patient care.

The move is the latest in a series of steps that began in 2003, when the Joint Trauma System (JTS) was conceived. Although medical care then was well documented in theater, critical patient information wasn’t readily available as a patient moved through multiple hospitals. Moreover, deployed medical teams relied on telephonic coordination for long-term follow-up.

“The new DoD guidelines validate all the lessons learned from the ad hoc processes used out of necessity in establishing the JTS,” said JTS Director Navy Capt Zsolt Stockinger. The DoDI provides operational commanders, clinical providers, and medical planners with the best known combat medical techniques and procedures to minimize trauma-related disability and eliminate preventable deaths after injury.

Stockinger adds, “The JTS DoDI is not meant to dictate ‘how’ and ‘what’ a trauma system should look like, because each environment and location will dictate certain aspects of a trauma system.” Rather, Stockinger says, the JTS team is a resource to help others find the best solutions as they establish and grow their own geographic trauma system.

“For the first time in U.S. military history, we have the necessary policy to create and maintain a durable, enduring trauma system in times of war and peace,” said David Smith, MD, deputy assistant secretary of defense for Health Readiness Policy and Oversight, in an article for Health.mil.

Dr. Smith is talking about DoD Instruction (DoDI) 6040.47, which codifies clinical guidance for the continuum of patient care.

The move is the latest in a series of steps that began in 2003, when the Joint Trauma System (JTS) was conceived. Although medical care then was well documented in theater, critical patient information wasn’t readily available as a patient moved through multiple hospitals. Moreover, deployed medical teams relied on telephonic coordination for long-term follow-up.

“The new DoD guidelines validate all the lessons learned from the ad hoc processes used out of necessity in establishing the JTS,” said JTS Director Navy Capt Zsolt Stockinger. The DoDI provides operational commanders, clinical providers, and medical planners with the best known combat medical techniques and procedures to minimize trauma-related disability and eliminate preventable deaths after injury.

Stockinger adds, “The JTS DoDI is not meant to dictate ‘how’ and ‘what’ a trauma system should look like, because each environment and location will dictate certain aspects of a trauma system.” Rather, Stockinger says, the JTS team is a resource to help others find the best solutions as they establish and grow their own geographic trauma system.

After years of preparation, a new electronic health record (EHR) system is now live at Fairchild Air Force Base in Washington. According to DoD officials, the system remains on schedule for the next step in the rollout later this year and the eventual completion in 2022. “This is just the first step in implementing what will be the largest integrated inpatient and outpatient electronic health record in the United States,” said VADM Raquel Bono, director of the Defense Health Agency.

Home to the 92nd Medical Group, Fairchild has a number of outpatient clinics and a pharmacy. According to Col Margaret Carey, the 92nd Medical Group commander, Genesis is being used by all the medical personnel at Fairchild.

For many years, the VA and DoD discussed possibly developing a single EHR across both systems before rejecting the idea for being too costly and complicated. Instead the 2 agencies looked to make their systems interoperable and to improve data sharing across the systems. The 2 agencies developed the Joint Legacy Viewer system to improve data sharing. The Joint Legacy Viewer is a clinical application that provides an integrated, read-only display of health data from DoD, VA, private sector partners, and the current military medical record system in a common data viewer.

The DoD originally awarded the $4.3 billion contract to Leidos in 2014 to develop Genesis, but the system was delayed to address cyber-security concerns. The concerns also caused DoD to reduce a larger rollout to focus initially on Fairchild.

“I can report firsthand from the command center that everything is going as expected,” reported Stacy Cummings, program executive officer for Defense Healthcare Management Systems. “Initial feedback from [health care] providers is positive.”

According to Dr. Paul Cordts, director, functional champion for the MHS at the Defense Health Agency, the biggest change that Genesis will bring is offering open medical notes to patients to “empower our patients to know what medical data are in the medical records and to use that data to improve their health and their health care over time.” Patients will be able to access data through a patient portal.

“This EHR is built to enable a team approach to providing health services to patients,” said U.S. Air Force Surgeon General Lt Gen Mark Ediger, MD. “In medicine today we really leverage a number of different skill sets on a health care team… That’s why in the Air Force we are piloting the addition of a health coaching capability here at Fairchild to leverage capabilities that are in MHS, so that health coaches can interact with patients between visits to work on things like tobacco cessation and weight loss, exercise plans and things of that nature.”

After years of preparation, a new electronic health record (EHR) system is now live at Fairchild Air Force Base in Washington. According to DoD officials, the system remains on schedule for the next step in the rollout later this year and the eventual completion in 2022. “This is just the first step in implementing what will be the largest integrated inpatient and outpatient electronic health record in the United States,” said VADM Raquel Bono, director of the Defense Health Agency.

Home to the 92nd Medical Group, Fairchild has a number of outpatient clinics and a pharmacy. According to Col Margaret Carey, the 92nd Medical Group commander, Genesis is being used by all the medical personnel at Fairchild.

For many years, the VA and DoD discussed possibly developing a single EHR across both systems before rejecting the idea for being too costly and complicated. Instead the 2 agencies looked to make their systems interoperable and to improve data sharing across the systems. The 2 agencies developed the Joint Legacy Viewer system to improve data sharing. The Joint Legacy Viewer is a clinical application that provides an integrated, read-only display of health data from DoD, VA, private sector partners, and the current military medical record system in a common data viewer.

The DoD originally awarded the $4.3 billion contract to Leidos in 2014 to develop Genesis, but the system was delayed to address cyber-security concerns. The concerns also caused DoD to reduce a larger rollout to focus initially on Fairchild.

“I can report firsthand from the command center that everything is going as expected,” reported Stacy Cummings, program executive officer for Defense Healthcare Management Systems. “Initial feedback from [health care] providers is positive.”

According to Dr. Paul Cordts, director, functional champion for the MHS at the Defense Health Agency, the biggest change that Genesis will bring is offering open medical notes to patients to “empower our patients to know what medical data are in the medical records and to use that data to improve their health and their health care over time.” Patients will be able to access data through a patient portal.

“This EHR is built to enable a team approach to providing health services to patients,” said U.S. Air Force Surgeon General Lt Gen Mark Ediger, MD. “In medicine today we really leverage a number of different skill sets on a health care team… That’s why in the Air Force we are piloting the addition of a health coaching capability here at Fairchild to leverage capabilities that are in MHS, so that health coaches can interact with patients between visits to work on things like tobacco cessation and weight loss, exercise plans and things of that nature.”

After years of preparation, a new electronic health record (EHR) system is now live at Fairchild Air Force Base in Washington. According to DoD officials, the system remains on schedule for the next step in the rollout later this year and the eventual completion in 2022. “This is just the first step in implementing what will be the largest integrated inpatient and outpatient electronic health record in the United States,” said VADM Raquel Bono, director of the Defense Health Agency.

Home to the 92nd Medical Group, Fairchild has a number of outpatient clinics and a pharmacy. According to Col Margaret Carey, the 92nd Medical Group commander, Genesis is being used by all the medical personnel at Fairchild.

For many years, the VA and DoD discussed possibly developing a single EHR across both systems before rejecting the idea for being too costly and complicated. Instead the 2 agencies looked to make their systems interoperable and to improve data sharing across the systems. The 2 agencies developed the Joint Legacy Viewer system to improve data sharing. The Joint Legacy Viewer is a clinical application that provides an integrated, read-only display of health data from DoD, VA, private sector partners, and the current military medical record system in a common data viewer.

The DoD originally awarded the $4.3 billion contract to Leidos in 2014 to develop Genesis, but the system was delayed to address cyber-security concerns. The concerns also caused DoD to reduce a larger rollout to focus initially on Fairchild.

“I can report firsthand from the command center that everything is going as expected,” reported Stacy Cummings, program executive officer for Defense Healthcare Management Systems. “Initial feedback from [health care] providers is positive.”

According to Dr. Paul Cordts, director, functional champion for the MHS at the Defense Health Agency, the biggest change that Genesis will bring is offering open medical notes to patients to “empower our patients to know what medical data are in the medical records and to use that data to improve their health and their health care over time.” Patients will be able to access data through a patient portal.

“This EHR is built to enable a team approach to providing health services to patients,” said U.S. Air Force Surgeon General Lt Gen Mark Ediger, MD. “In medicine today we really leverage a number of different skill sets on a health care team… That’s why in the Air Force we are piloting the addition of a health coaching capability here at Fairchild to leverage capabilities that are in MHS, so that health coaches can interact with patients between visits to work on things like tobacco cessation and weight loss, exercise plans and things of that nature.”

After a prolonged period under intense investigation, the VA seems to be one of the few parts of the federal government not under intense scrutiny these days. VA Secretary David J. Shulkin, MD, became the first appointee of the Trump administration to receive a unanimous vote in the Senate. Given Dr. Shulkin’s experience as VA Under Secretary of Health, he is not expected to need much time to get up to speed on VA operations.

Little turmoil is expected in Defense Health either. Defense Secretary James Mattis was one of the first Trump administration confirmations with a 99-1 vote. A new Assistant Secretary of Defense for Health Affairs has not been named, but David J. Smith, MD, is currently performing the duties of that position and VADM Raquel C. Bono is continuing as the Director of the Defense Health Agency.

Positions in other agencies are less settled. Tom Price was confirmed on a party-line vote (53-47) as Secretary of Health and Human Services on February 10th following a bruising confirmation process. At HHS, many of the senior level positions are filled with acting directors, who have limited authority, including a director for Indian Health Service. No name has been officially put forward for the FDA Commissioner position, though former deputy commissioner Scott Gottlieb is rumored to be a leading candidate. One exception is Surgeon General VADM Vivek H. Murthy, MD, MBA, who remains in place as does much of the PHS senior leadership.

At IHS, the lack of a permanent director is particularly concerning, as the agency confronts chronic understaffing and now a federal hiring freeze. “Any freeze in hiring for Indian initiatives, whether temporary or permanent, threatens to make the challenges facing Indian Country worse,” Sen. Jon Tester, (D-Mont), said in a statement.

“Today’s confirmation of Dr. David Shulkin places the first non-veteran to lead the very lifeline to veterans’ health care and benefits—particularly within VA spinal cord injury/disease centers,” said Al Kovach, Jr., president of the Paralyzed Veterans of America. “But it also places a doctor who is intimately familiar with the value and challenges of the VA health care system as it stands at the crossroad of private health care for veterans and veteran-centric care with Congressional oversight… We look forward to working with Dr. Shulkin on the future of veterans’ health care, and ensuring the voices of the most catastrophically injured veterans are heard above the political din.”

After a prolonged period under intense investigation, the VA seems to be one of the few parts of the federal government not under intense scrutiny these days. VA Secretary David J. Shulkin, MD, became the first appointee of the Trump administration to receive a unanimous vote in the Senate. Given Dr. Shulkin’s experience as VA Under Secretary of Health, he is not expected to need much time to get up to speed on VA operations.

Little turmoil is expected in Defense Health either. Defense Secretary James Mattis was one of the first Trump administration confirmations with a 99-1 vote. A new Assistant Secretary of Defense for Health Affairs has not been named, but David J. Smith, MD, is currently performing the duties of that position and VADM Raquel C. Bono is continuing as the Director of the Defense Health Agency.

Positions in other agencies are less settled. Tom Price was confirmed on a party-line vote (53-47) as Secretary of Health and Human Services on February 10th following a bruising confirmation process. At HHS, many of the senior level positions are filled with acting directors, who have limited authority, including a director for Indian Health Service. No name has been officially put forward for the FDA Commissioner position, though former deputy commissioner Scott Gottlieb is rumored to be a leading candidate. One exception is Surgeon General VADM Vivek H. Murthy, MD, MBA, who remains in place as does much of the PHS senior leadership.

At IHS, the lack of a permanent director is particularly concerning, as the agency confronts chronic understaffing and now a federal hiring freeze. “Any freeze in hiring for Indian initiatives, whether temporary or permanent, threatens to make the challenges facing Indian Country worse,” Sen. Jon Tester, (D-Mont), said in a statement.

“Today’s confirmation of Dr. David Shulkin places the first non-veteran to lead the very lifeline to veterans’ health care and benefits—particularly within VA spinal cord injury/disease centers,” said Al Kovach, Jr., president of the Paralyzed Veterans of America. “But it also places a doctor who is intimately familiar with the value and challenges of the VA health care system as it stands at the crossroad of private health care for veterans and veteran-centric care with Congressional oversight… We look forward to working with Dr. Shulkin on the future of veterans’ health care, and ensuring the voices of the most catastrophically injured veterans are heard above the political din.”

After a prolonged period under intense investigation, the VA seems to be one of the few parts of the federal government not under intense scrutiny these days. VA Secretary David J. Shulkin, MD, became the first appointee of the Trump administration to receive a unanimous vote in the Senate. Given Dr. Shulkin’s experience as VA Under Secretary of Health, he is not expected to need much time to get up to speed on VA operations.

Little turmoil is expected in Defense Health either. Defense Secretary James Mattis was one of the first Trump administration confirmations with a 99-1 vote. A new Assistant Secretary of Defense for Health Affairs has not been named, but David J. Smith, MD, is currently performing the duties of that position and VADM Raquel C. Bono is continuing as the Director of the Defense Health Agency.

Positions in other agencies are less settled. Tom Price was confirmed on a party-line vote (53-47) as Secretary of Health and Human Services on February 10th following a bruising confirmation process. At HHS, many of the senior level positions are filled with acting directors, who have limited authority, including a director for Indian Health Service. No name has been officially put forward for the FDA Commissioner position, though former deputy commissioner Scott Gottlieb is rumored to be a leading candidate. One exception is Surgeon General VADM Vivek H. Murthy, MD, MBA, who remains in place as does much of the PHS senior leadership.

At IHS, the lack of a permanent director is particularly concerning, as the agency confronts chronic understaffing and now a federal hiring freeze. “Any freeze in hiring for Indian initiatives, whether temporary or permanent, threatens to make the challenges facing Indian Country worse,” Sen. Jon Tester, (D-Mont), said in a statement.

“Today’s confirmation of Dr. David Shulkin places the first non-veteran to lead the very lifeline to veterans’ health care and benefits—particularly within VA spinal cord injury/disease centers,” said Al Kovach, Jr., president of the Paralyzed Veterans of America. “But it also places a doctor who is intimately familiar with the value and challenges of the VA health care system as it stands at the crossroad of private health care for veterans and veteran-centric care with Congressional oversight… We look forward to working with Dr. Shulkin on the future of veterans’ health care, and ensuring the voices of the most catastrophically injured veterans are heard above the political din.”

Rural health care and the VA seem to be on the front line in the battle over President Trump’s executive order halting travel to the U.S. for citizens of 7 Muslim-majority countries. The executive order, which has been temporarily suspended by a federal judge, could affect as many as 15,000 doctors and possibly even more pharmacists, nurses, and other health care providers. The ban also is expected to impact nearly 9,000 physicians from Iran and another 3,500 from Syria and 1,500 from Iraq.

The VA has long depended on foreign-born health care providers, and given the VA’s challenges in filling its more than 45,000 vacancies, this reliance was only expected to grow.. The Conrad 30 program allows J-1 medical doctors to apply for a waiver to the 2-year residence requirement upon completion of the J-1 exchange visitor program. Over the years, many international medical graduates (IMGs) earned permanent residence by agreeing to work 3 or 5 years in an underserved area or VA facility.

“The United States is facing a serious shortage of physicians. IMGs play an important role in U.S. health care, representing roughly 25% of the workforce,” AAMC (Association of American Medical Colleges) President and CEO Darrell G. Kirch, MD said in a statement. “In the last decade, Conrad 30 alone has directed nearly 10,000 physicians into rural and urban underserved communities. Impeding these U.S. immigration pathways jeopardizes critical access to high-quality physician care for our nation’s most vulnerable populations.”

Related: Medical Organizations Respond to Trump’s Immigration Order

According to an analysis of 2010 census data from the Migration Policy Institute (MPI), foreign-born workers make up 15% of the 1.1 million health care providers in the U.S., which includes a significant proportion of physicians and surgeons (27%) and a smaller, but still significant number of registered nurses (15%), technologists and technicians (12%), and therapists (10%). Among support personnel foreign-born workers range from 19% of health care support workers to 22% of nursing, psychiatric, and home health aides.

In a more recent analysis from the George Mason Institute for Immigration Research, 22% of nursing, psychiatric, and home health aides are foreign born.

Most of the foreign-born health care providers have acquired U.S. citizenship, according to MPI, “with naturalization rates ranging from 55% for those working as nursing, psychiatric, or home health aides to 78% for other health care practitioners and technical occupations. According to American Association of Family Practitioners (AAFP), 42% of office visits in rural America are with foreign-born physicians.

“Many family physicians are IMGs, who have completed all or part of their education and training in the U.S.,” AAFP President John Meigs, Jr, MD, FAAFP, wrote in a letter to President Trump. “They are professionals who dedicate their careers to the service of their patients in communities large and small, urban and rural. In fact, 20% of our membership and over 25% of family medicine residents [comprise] IMGs. The AAFP applauds and supports wholly the contributions of these individual family physicians to their patients and communities and we celebrate their diversity.”

Rural health care and the VA seem to be on the front line in the battle over President Trump’s executive order halting travel to the U.S. for citizens of 7 Muslim-majority countries. The executive order, which has been temporarily suspended by a federal judge, could affect as many as 15,000 doctors and possibly even more pharmacists, nurses, and other health care providers. The ban also is expected to impact nearly 9,000 physicians from Iran and another 3,500 from Syria and 1,500 from Iraq.

The VA has long depended on foreign-born health care providers, and given the VA’s challenges in filling its more than 45,000 vacancies, this reliance was only expected to grow.. The Conrad 30 program allows J-1 medical doctors to apply for a waiver to the 2-year residence requirement upon completion of the J-1 exchange visitor program. Over the years, many international medical graduates (IMGs) earned permanent residence by agreeing to work 3 or 5 years in an underserved area or VA facility.

“The United States is facing a serious shortage of physicians. IMGs play an important role in U.S. health care, representing roughly 25% of the workforce,” AAMC (Association of American Medical Colleges) President and CEO Darrell G. Kirch, MD said in a statement. “In the last decade, Conrad 30 alone has directed nearly 10,000 physicians into rural and urban underserved communities. Impeding these U.S. immigration pathways jeopardizes critical access to high-quality physician care for our nation’s most vulnerable populations.”

Related: Medical Organizations Respond to Trump’s Immigration Order

According to an analysis of 2010 census data from the Migration Policy Institute (MPI), foreign-born workers make up 15% of the 1.1 million health care providers in the U.S., which includes a significant proportion of physicians and surgeons (27%) and a smaller, but still significant number of registered nurses (15%), technologists and technicians (12%), and therapists (10%). Among support personnel foreign-born workers range from 19% of health care support workers to 22% of nursing, psychiatric, and home health aides.

In a more recent analysis from the George Mason Institute for Immigration Research, 22% of nursing, psychiatric, and home health aides are foreign born.

Most of the foreign-born health care providers have acquired U.S. citizenship, according to MPI, “with naturalization rates ranging from 55% for those working as nursing, psychiatric, or home health aides to 78% for other health care practitioners and technical occupations. According to American Association of Family Practitioners (AAFP), 42% of office visits in rural America are with foreign-born physicians.

“Many family physicians are IMGs, who have completed all or part of their education and training in the U.S.,” AAFP President John Meigs, Jr, MD, FAAFP, wrote in a letter to President Trump. “They are professionals who dedicate their careers to the service of their patients in communities large and small, urban and rural. In fact, 20% of our membership and over 25% of family medicine residents [comprise] IMGs. The AAFP applauds and supports wholly the contributions of these individual family physicians to their patients and communities and we celebrate their diversity.”

Rural health care and the VA seem to be on the front line in the battle over President Trump’s executive order halting travel to the U.S. for citizens of 7 Muslim-majority countries. The executive order, which has been temporarily suspended by a federal judge, could affect as many as 15,000 doctors and possibly even more pharmacists, nurses, and other health care providers. The ban also is expected to impact nearly 9,000 physicians from Iran and another 3,500 from Syria and 1,500 from Iraq.

The VA has long depended on foreign-born health care providers, and given the VA’s challenges in filling its more than 45,000 vacancies, this reliance was only expected to grow.. The Conrad 30 program allows J-1 medical doctors to apply for a waiver to the 2-year residence requirement upon completion of the J-1 exchange visitor program. Over the years, many international medical graduates (IMGs) earned permanent residence by agreeing to work 3 or 5 years in an underserved area or VA facility.

“The United States is facing a serious shortage of physicians. IMGs play an important role in U.S. health care, representing roughly 25% of the workforce,” AAMC (Association of American Medical Colleges) President and CEO Darrell G. Kirch, MD said in a statement. “In the last decade, Conrad 30 alone has directed nearly 10,000 physicians into rural and urban underserved communities. Impeding these U.S. immigration pathways jeopardizes critical access to high-quality physician care for our nation’s most vulnerable populations.”

Related: Medical Organizations Respond to Trump’s Immigration Order

According to an analysis of 2010 census data from the Migration Policy Institute (MPI), foreign-born workers make up 15% of the 1.1 million health care providers in the U.S., which includes a significant proportion of physicians and surgeons (27%) and a smaller, but still significant number of registered nurses (15%), technologists and technicians (12%), and therapists (10%). Among support personnel foreign-born workers range from 19% of health care support workers to 22% of nursing, psychiatric, and home health aides.

In a more recent analysis from the George Mason Institute for Immigration Research, 22% of nursing, psychiatric, and home health aides are foreign born.

Most of the foreign-born health care providers have acquired U.S. citizenship, according to MPI, “with naturalization rates ranging from 55% for those working as nursing, psychiatric, or home health aides to 78% for other health care practitioners and technical occupations. According to American Association of Family Practitioners (AAFP), 42% of office visits in rural America are with foreign-born physicians.

“Many family physicians are IMGs, who have completed all or part of their education and training in the U.S.,” AAFP President John Meigs, Jr, MD, FAAFP, wrote in a letter to President Trump. “They are professionals who dedicate their careers to the service of their patients in communities large and small, urban and rural. In fact, 20% of our membership and over 25% of family medicine residents [comprise] IMGs. The AAFP applauds and supports wholly the contributions of these individual family physicians to their patients and communities and we celebrate their diversity.”

Few fireworks are expected as confirmation hearings begin for David J. Shulkin, MD, for secretary of the Department of Veterans Affairs. Dr. Shulkin, who served as under secretary of health during the Obama administration, has widespread support from veteran service organizations, Democrats, and Republicans.  

Related: Shulkin: VA "Not a Political Issue”

“We ask for the speedy confirmation of Dr. David Shulkin,” Randy Reeves, president of the National Association of State Directors of Veterans Affairs wrote in a letter to committee members. “As we all know, Dr. Shulkin is an accomplished physician and leader in healthcare. Most importantly, I think, he has been an important leader in the team that has effected the largest (positive) transformation in VA’s history. We can all agree there is still work ahead and we are confident that David Shulkin will be a great leader for VA, serve our veterans well and continue the MyVA Transformation.”

One of the likely topics in the hearing will be in the impact of the federal hiring freeze implemented by the Trump administration. The Acting Secretary of Veterans Affairs Robert Snyder recently released a memo that insisted that the freeze will not affect many categories of VA employees. The VA will exempt frontline personnel at VA medical centers, outpatient clinics, community-based outpatient clinics, and health centers who “it deems necessary for public health and safety,” Snyder said in a statement. As VA Secretary Nominee, Dr. Shulkin recently told Federal Practitioner, there are currently 45,000 openings at the VA for frontline medical positions.

Related: Shulkin Addresses APRN Rule, Health Care Vacancies, and Access

Recognizing the important role the VA plays in “training the nations health care providers,” the memo also exempted personnel involved in training and residency programs.

Those positions have proven to be difficult to fill. According to an investigation by National Public Radio (NPR) and local member stations, even an infusion of $2.5 billion from the Veterans Choice and Accountability Act of 2014, which was meant to help VA medical centers with the most urgent wait time problems, has not helped. “New hires weren’t sent to VA hospitals with the longest wait times,” NPR reported, “and the VA medical centers that got new hires were not more likely to see improved wait times.”

According to the NPR report, about 13% of the candidates for VA positions withdraw before they are hired due to the “months-long lag time after they are hired.”

Related: Get to Know the Trump Administration VA Secretary Nominee

Few fireworks are expected as confirmation hearings begin for David J. Shulkin, MD, for secretary of the Department of Veterans Affairs. Dr. Shulkin, who served as under secretary of health during the Obama administration, has widespread support from veteran service organizations, Democrats, and Republicans.  

Related: Shulkin: VA "Not a Political Issue”

“We ask for the speedy confirmation of Dr. David Shulkin,” Randy Reeves, president of the National Association of State Directors of Veterans Affairs wrote in a letter to committee members. “As we all know, Dr. Shulkin is an accomplished physician and leader in healthcare. Most importantly, I think, he has been an important leader in the team that has effected the largest (positive) transformation in VA’s history. We can all agree there is still work ahead and we are confident that David Shulkin will be a great leader for VA, serve our veterans well and continue the MyVA Transformation.”

One of the likely topics in the hearing will be in the impact of the federal hiring freeze implemented by the Trump administration. The Acting Secretary of Veterans Affairs Robert Snyder recently released a memo that insisted that the freeze will not affect many categories of VA employees. The VA will exempt frontline personnel at VA medical centers, outpatient clinics, community-based outpatient clinics, and health centers who “it deems necessary for public health and safety,” Snyder said in a statement. As VA Secretary Nominee, Dr. Shulkin recently told Federal Practitioner, there are currently 45,000 openings at the VA for frontline medical positions.

Related: Shulkin Addresses APRN Rule, Health Care Vacancies, and Access

Recognizing the important role the VA plays in “training the nations health care providers,” the memo also exempted personnel involved in training and residency programs.

Those positions have proven to be difficult to fill. According to an investigation by National Public Radio (NPR) and local member stations, even an infusion of $2.5 billion from the Veterans Choice and Accountability Act of 2014, which was meant to help VA medical centers with the most urgent wait time problems, has not helped. “New hires weren’t sent to VA hospitals with the longest wait times,” NPR reported, “and the VA medical centers that got new hires were not more likely to see improved wait times.”

According to the NPR report, about 13% of the candidates for VA positions withdraw before they are hired due to the “months-long lag time after they are hired.”

Related: Get to Know the Trump Administration VA Secretary Nominee

Few fireworks are expected as confirmation hearings begin for David J. Shulkin, MD, for secretary of the Department of Veterans Affairs. Dr. Shulkin, who served as under secretary of health during the Obama administration, has widespread support from veteran service organizations, Democrats, and Republicans.  

Related: Shulkin: VA "Not a Political Issue”

“We ask for the speedy confirmation of Dr. David Shulkin,” Randy Reeves, president of the National Association of State Directors of Veterans Affairs wrote in a letter to committee members. “As we all know, Dr. Shulkin is an accomplished physician and leader in healthcare. Most importantly, I think, he has been an important leader in the team that has effected the largest (positive) transformation in VA’s history. We can all agree there is still work ahead and we are confident that David Shulkin will be a great leader for VA, serve our veterans well and continue the MyVA Transformation.”

One of the likely topics in the hearing will be in the impact of the federal hiring freeze implemented by the Trump administration. The Acting Secretary of Veterans Affairs Robert Snyder recently released a memo that insisted that the freeze will not affect many categories of VA employees. The VA will exempt frontline personnel at VA medical centers, outpatient clinics, community-based outpatient clinics, and health centers who “it deems necessary for public health and safety,” Snyder said in a statement. As VA Secretary Nominee, Dr. Shulkin recently told Federal Practitioner, there are currently 45,000 openings at the VA for frontline medical positions.

Related: Shulkin Addresses APRN Rule, Health Care Vacancies, and Access

Recognizing the important role the VA plays in “training the nations health care providers,” the memo also exempted personnel involved in training and residency programs.

Those positions have proven to be difficult to fill. According to an investigation by National Public Radio (NPR) and local member stations, even an infusion of $2.5 billion from the Veterans Choice and Accountability Act of 2014, which was meant to help VA medical centers with the most urgent wait time problems, has not helped. “New hires weren’t sent to VA hospitals with the longest wait times,” NPR reported, “and the VA medical centers that got new hires were not more likely to see improved wait times.”

According to the NPR report, about 13% of the candidates for VA positions withdraw before they are hired due to the “months-long lag time after they are hired.”

Related: Get to Know the Trump Administration VA Secretary Nominee

People in the military are somewhat nomadic by necessity: They move around a lot, and their medical records should be just as mobile, says Army Brig. Gen. John Cho, deputy chief of staff for support for the Army’s Medical Command, in an article for Health.mil. Cho is the functional champion on development of MHS Genesis, the new electronic health record that is replacing less agile DoD legacy systems.

Related: IHS Pilots Improved Version of Health Records

Developed with input from more than 850 experts in the field around the world, MHS Genesis is intended to fix shortcomings in the current system. It will integrate medical and dental records throughout the continuum of care, from point of injury to the military treatment facility where the care is provided.

Benefits include the ability to monitor a beneficiary’s health status through health data, tracking, and alerting capabilities; improved ability to monitor patient safety, outcomes, and operational and medical readiness; improved access to integrated, evidence-based health care delivery and decision-making; and increased sharing of health information across the spectrum of military operations, the VA, and civilian health care organizations.

Related: How Safe Are Patients’ Electronic Records?

MHS Genesis will support the availability of electronic health records for > 9.4 million DoD beneficiaries and approximately 205,000 MHS personnel globally. The new system is currently being tested, with rollout in the Pacific Northwest scheduled for early 2017. The system expected to be ready throughout the MHS in 5 years.

People in the military are somewhat nomadic by necessity: They move around a lot, and their medical records should be just as mobile, says Army Brig. Gen. John Cho, deputy chief of staff for support for the Army’s Medical Command, in an article for Health.mil. Cho is the functional champion on development of MHS Genesis, the new electronic health record that is replacing less agile DoD legacy systems.

Related: IHS Pilots Improved Version of Health Records

Developed with input from more than 850 experts in the field around the world, MHS Genesis is intended to fix shortcomings in the current system. It will integrate medical and dental records throughout the continuum of care, from point of injury to the military treatment facility where the care is provided.

Benefits include the ability to monitor a beneficiary’s health status through health data, tracking, and alerting capabilities; improved ability to monitor patient safety, outcomes, and operational and medical readiness; improved access to integrated, evidence-based health care delivery and decision-making; and increased sharing of health information across the spectrum of military operations, the VA, and civilian health care organizations.

Related: How Safe Are Patients’ Electronic Records?

MHS Genesis will support the availability of electronic health records for > 9.4 million DoD beneficiaries and approximately 205,000 MHS personnel globally. The new system is currently being tested, with rollout in the Pacific Northwest scheduled for early 2017. The system expected to be ready throughout the MHS in 5 years.

People in the military are somewhat nomadic by necessity: They move around a lot, and their medical records should be just as mobile, says Army Brig. Gen. John Cho, deputy chief of staff for support for the Army’s Medical Command, in an article for Health.mil. Cho is the functional champion on development of MHS Genesis, the new electronic health record that is replacing less agile DoD legacy systems.

Related: IHS Pilots Improved Version of Health Records

Developed with input from more than 850 experts in the field around the world, MHS Genesis is intended to fix shortcomings in the current system. It will integrate medical and dental records throughout the continuum of care, from point of injury to the military treatment facility where the care is provided.

Benefits include the ability to monitor a beneficiary’s health status through health data, tracking, and alerting capabilities; improved ability to monitor patient safety, outcomes, and operational and medical readiness; improved access to integrated, evidence-based health care delivery and decision-making; and increased sharing of health information across the spectrum of military operations, the VA, and civilian health care organizations.

Related: How Safe Are Patients’ Electronic Records?

MHS Genesis will support the availability of electronic health records for > 9.4 million DoD beneficiaries and approximately 205,000 MHS personnel globally. The new system is currently being tested, with rollout in the Pacific Northwest scheduled for early 2017. The system expected to be ready throughout the MHS in 5 years.