Government and Regulations

Inventive ways of identifying and treating patients with health care associated venous thromboembolism (HA-VTE) have garnered awards for 8 hospitals and health care systems in the HA-VTE Prevention Challenge, sponsored by the CDC.

The winners range from small community hospitals to large health care systems: Mayo Clinic, University of California Health, Center for Health Quality and Innovation; University of Wisconsin Health (Madison); Intermountain Healthcare (Murray, UT); Northwestern Memorial Hospital (Chicago); Johns Hopkins Hospital (Baltimore); Harborview Medical Center (Seattle); and Hutchinson (KS) Regional Medical Center.

All improved VTE prevention with innovative, effective, and sustainable initiatives and strategies.

Harborview Medical Center (HMC) developed an electronic tool for efficient, standardized review of HA-VTE. The tool uses natural language processing, allowing the HMC VTE Task Force to quickly gauge the accuracy of risk assessment and appropriateness of prophylaxis. It also developed tools to provide real-time, actionable information at the bedside, including lists that highlight patients who have not received chemical or mechanical prophylaxis in 24 hours. Those who have received vitamin K antagonists are identified to ensure patient/family education and appropriate follow-up. Treatment data “snapshots” are embedded in resident physician and nursing handoff tools to enhance multidisciplinary communication. All process and outcome measures are displayed on an internal web-based dashboard, with improvement opportunities highlighted.

As a result, HMC has had zero potentially preventable VTE events since the measure was implemented in January 2013—a national best practice. Improved VTE prophylaxis contributed to a 15% reduction in HA-VTE between 2011 and 2015. Among postoperative patients, the rate of VTE dropped 21%. Diagnosis, treatment, patient education, and outpatient follow-up have all improved. Moreover, HMC says, the lessons learned have formed the basis of ongoing improvement initiatives.

Four entrants (“Unique Populations and Interventions”) received honorable mentions: Michigan Hospital Medicine Safety Consortium, Ann Arbor; Sheppard Pratt Health System, Baltimore; Rotunda Hospital, Dublin, Ireland; and University of Cincinnati Medical Center.

Inventive ways of identifying and treating patients with health care associated venous thromboembolism (HA-VTE) have garnered awards for 8 hospitals and health care systems in the HA-VTE Prevention Challenge, sponsored by the CDC.

The winners range from small community hospitals to large health care systems: Mayo Clinic, University of California Health, Center for Health Quality and Innovation; University of Wisconsin Health (Madison); Intermountain Healthcare (Murray, UT); Northwestern Memorial Hospital (Chicago); Johns Hopkins Hospital (Baltimore); Harborview Medical Center (Seattle); and Hutchinson (KS) Regional Medical Center.

All improved VTE prevention with innovative, effective, and sustainable initiatives and strategies.

Harborview Medical Center (HMC) developed an electronic tool for efficient, standardized review of HA-VTE. The tool uses natural language processing, allowing the HMC VTE Task Force to quickly gauge the accuracy of risk assessment and appropriateness of prophylaxis. It also developed tools to provide real-time, actionable information at the bedside, including lists that highlight patients who have not received chemical or mechanical prophylaxis in 24 hours. Those who have received vitamin K antagonists are identified to ensure patient/family education and appropriate follow-up. Treatment data “snapshots” are embedded in resident physician and nursing handoff tools to enhance multidisciplinary communication. All process and outcome measures are displayed on an internal web-based dashboard, with improvement opportunities highlighted.

As a result, HMC has had zero potentially preventable VTE events since the measure was implemented in January 2013—a national best practice. Improved VTE prophylaxis contributed to a 15% reduction in HA-VTE between 2011 and 2015. Among postoperative patients, the rate of VTE dropped 21%. Diagnosis, treatment, patient education, and outpatient follow-up have all improved. Moreover, HMC says, the lessons learned have formed the basis of ongoing improvement initiatives.

Four entrants (“Unique Populations and Interventions”) received honorable mentions: Michigan Hospital Medicine Safety Consortium, Ann Arbor; Sheppard Pratt Health System, Baltimore; Rotunda Hospital, Dublin, Ireland; and University of Cincinnati Medical Center.

Inventive ways of identifying and treating patients with health care associated venous thromboembolism (HA-VTE) have garnered awards for 8 hospitals and health care systems in the HA-VTE Prevention Challenge, sponsored by the CDC.

The winners range from small community hospitals to large health care systems: Mayo Clinic, University of California Health, Center for Health Quality and Innovation; University of Wisconsin Health (Madison); Intermountain Healthcare (Murray, UT); Northwestern Memorial Hospital (Chicago); Johns Hopkins Hospital (Baltimore); Harborview Medical Center (Seattle); and Hutchinson (KS) Regional Medical Center.

All improved VTE prevention with innovative, effective, and sustainable initiatives and strategies.

Harborview Medical Center (HMC) developed an electronic tool for efficient, standardized review of HA-VTE. The tool uses natural language processing, allowing the HMC VTE Task Force to quickly gauge the accuracy of risk assessment and appropriateness of prophylaxis. It also developed tools to provide real-time, actionable information at the bedside, including lists that highlight patients who have not received chemical or mechanical prophylaxis in 24 hours. Those who have received vitamin K antagonists are identified to ensure patient/family education and appropriate follow-up. Treatment data “snapshots” are embedded in resident physician and nursing handoff tools to enhance multidisciplinary communication. All process and outcome measures are displayed on an internal web-based dashboard, with improvement opportunities highlighted.

As a result, HMC has had zero potentially preventable VTE events since the measure was implemented in January 2013—a national best practice. Improved VTE prophylaxis contributed to a 15% reduction in HA-VTE between 2011 and 2015. Among postoperative patients, the rate of VTE dropped 21%. Diagnosis, treatment, patient education, and outpatient follow-up have all improved. Moreover, HMC says, the lessons learned have formed the basis of ongoing improvement initiatives.

Four entrants (“Unique Populations and Interventions”) received honorable mentions: Michigan Hospital Medicine Safety Consortium, Ann Arbor; Sheppard Pratt Health System, Baltimore; Rotunda Hospital, Dublin, Ireland; and University of Cincinnati Medical Center.

The Substance Abuse and Mental Health Services Administration (SAMHSA) is providing support to Native American tribes and organizations with great ideas for improving mental and physical health. The Tribal Behavioral Health cooperative agreements (short title: Native Connections) offers grants to programs aimed at preventing and reducing suicidal behavior and substance use, addressing trauma, and promoting mental health among American Indian/Alaska Native (AI/AN) young people.

SAMHSA is now accepting applications for the cooperative-agreement grants. Grants total up to $94.8 million over 5 years. SAMHSA says it expects to fund as many as 94 grant recipients with up to $200,000 each per year for up to 5 years. Currently, Native Connections serves 20 grantees.

Native Connections also provides webinars to guide grantees in developing plans for such programs. One series, for instance, provides cultural considerations in screening and treating young people at risk.

Federally recognized AI/AN tribes, tribal organizations, and consortia of tribes or tribal organizations are eligible to apply for the grants. Applications are available at www.grants.gov and www.samhsa.gov/grants/applying. Applicants must download the required documents from both sites. The due date to receive applications is June 2, by 11:59 pm (ET).

The Substance Abuse and Mental Health Services Administration (SAMHSA) is providing support to Native American tribes and organizations with great ideas for improving mental and physical health. The Tribal Behavioral Health cooperative agreements (short title: Native Connections) offers grants to programs aimed at preventing and reducing suicidal behavior and substance use, addressing trauma, and promoting mental health among American Indian/Alaska Native (AI/AN) young people.

SAMHSA is now accepting applications for the cooperative-agreement grants. Grants total up to $94.8 million over 5 years. SAMHSA says it expects to fund as many as 94 grant recipients with up to $200,000 each per year for up to 5 years. Currently, Native Connections serves 20 grantees.

Native Connections also provides webinars to guide grantees in developing plans for such programs. One series, for instance, provides cultural considerations in screening and treating young people at risk.

Federally recognized AI/AN tribes, tribal organizations, and consortia of tribes or tribal organizations are eligible to apply for the grants. Applications are available at www.grants.gov and www.samhsa.gov/grants/applying. Applicants must download the required documents from both sites. The due date to receive applications is June 2, by 11:59 pm (ET).

The Substance Abuse and Mental Health Services Administration (SAMHSA) is providing support to Native American tribes and organizations with great ideas for improving mental and physical health. The Tribal Behavioral Health cooperative agreements (short title: Native Connections) offers grants to programs aimed at preventing and reducing suicidal behavior and substance use, addressing trauma, and promoting mental health among American Indian/Alaska Native (AI/AN) young people.

SAMHSA is now accepting applications for the cooperative-agreement grants. Grants total up to $94.8 million over 5 years. SAMHSA says it expects to fund as many as 94 grant recipients with up to $200,000 each per year for up to 5 years. Currently, Native Connections serves 20 grantees.

Native Connections also provides webinars to guide grantees in developing plans for such programs. One series, for instance, provides cultural considerations in screening and treating young people at risk.

Federally recognized AI/AN tribes, tribal organizations, and consortia of tribes or tribal organizations are eligible to apply for the grants. Applications are available at www.grants.gov and www.samhsa.gov/grants/applying. Applicants must download the required documents from both sites. The due date to receive applications is June 2, by 11:59 pm (ET).

From 2005 to 2011, emergency department visits related to nonmedical use of narcotic pain relievers rose in all age groups (except for adolescents aged 12 to 17 years).  For “detailed insight on the nature and scope of behavioral health issues” in the U.S., The Substance Abuse and Mental Health Services Administration (SAMHSA) posted its 2015 and 2016 short reports on the National Library of Medicine’s website. The specialized reports, prepared by SAMHSA’s Center for Behavioral Health Statistics and Quality, cover a range of information at the federal, state, and community levels, from state estimates of marijuana use to heroin use in the U.S., and more.

The short reports are available at www.ncbi.nlm.nih.gov/books/NBK343537/. The full range of SAMHSA statistical studies and reports is available at www.samhsa.gov/data/.

From 2005 to 2011, emergency department visits related to nonmedical use of narcotic pain relievers rose in all age groups (except for adolescents aged 12 to 17 years).  For “detailed insight on the nature and scope of behavioral health issues” in the U.S., The Substance Abuse and Mental Health Services Administration (SAMHSA) posted its 2015 and 2016 short reports on the National Library of Medicine’s website. The specialized reports, prepared by SAMHSA’s Center for Behavioral Health Statistics and Quality, cover a range of information at the federal, state, and community levels, from state estimates of marijuana use to heroin use in the U.S., and more.

The short reports are available at www.ncbi.nlm.nih.gov/books/NBK343537/. The full range of SAMHSA statistical studies and reports is available at www.samhsa.gov/data/.

From 2005 to 2011, emergency department visits related to nonmedical use of narcotic pain relievers rose in all age groups (except for adolescents aged 12 to 17 years).  For “detailed insight on the nature and scope of behavioral health issues” in the U.S., The Substance Abuse and Mental Health Services Administration (SAMHSA) posted its 2015 and 2016 short reports on the National Library of Medicine’s website. The specialized reports, prepared by SAMHSA’s Center for Behavioral Health Statistics and Quality, cover a range of information at the federal, state, and community levels, from state estimates of marijuana use to heroin use in the U.S., and more.

The short reports are available at www.ncbi.nlm.nih.gov/books/NBK343537/. The full range of SAMHSA statistical studies and reports is available at www.samhsa.gov/data/.

Jonathan Woodson, MD, stepped down as assistant secretary of defense for health affairs on May 1, 2016, a position he had held since December 2010. Under his leadership, the DoD created the Defense Health Agency (DHA), implemented a new electronic medical records system, and led the mission to combat Ebola in West Africa. Karen Guice, MD, MPP, the principal deputy assistant secretary of defense for health affairs, takes over Woodson’s duties. A new appointee is not expected until after the November presidential election.

According to the DoD, Woodson is returning to Boston University School of Medicine to establish a health systems innovation and policy institute. The institute will focus on leader development, biotechnology, and system design.

One of Woodson’s signature accomplishments was the creation of the DHA, which brought together the previously independent health care operations of the Army, Navy, and Air Force, each having unique cultures, procedures, and technologies. The underlying DHA goals have been to improve interoperability, efficiency, and cost reduction by sharing services.

The DHA operation is massive and cares for a TRICARE-eligible population of 9.5 million, including 1.4 million service members on active duty and more than 1 million inpatient admissions and 95.6 million outpatient visits in 2014.

“Thank you so much for allowing me to be a part of your organization for so long. Each of you has made an indelible impact on my life,” Woodson said at a DoD ceremony. “And as we say in the Army, we’ll see you on the high ground.”

Jonathan Woodson, MD, stepped down as assistant secretary of defense for health affairs on May 1, 2016, a position he had held since December 2010. Under his leadership, the DoD created the Defense Health Agency (DHA), implemented a new electronic medical records system, and led the mission to combat Ebola in West Africa. Karen Guice, MD, MPP, the principal deputy assistant secretary of defense for health affairs, takes over Woodson’s duties. A new appointee is not expected until after the November presidential election.

According to the DoD, Woodson is returning to Boston University School of Medicine to establish a health systems innovation and policy institute. The institute will focus on leader development, biotechnology, and system design.

One of Woodson’s signature accomplishments was the creation of the DHA, which brought together the previously independent health care operations of the Army, Navy, and Air Force, each having unique cultures, procedures, and technologies. The underlying DHA goals have been to improve interoperability, efficiency, and cost reduction by sharing services.

The DHA operation is massive and cares for a TRICARE-eligible population of 9.5 million, including 1.4 million service members on active duty and more than 1 million inpatient admissions and 95.6 million outpatient visits in 2014.

“Thank you so much for allowing me to be a part of your organization for so long. Each of you has made an indelible impact on my life,” Woodson said at a DoD ceremony. “And as we say in the Army, we’ll see you on the high ground.”

Jonathan Woodson, MD, stepped down as assistant secretary of defense for health affairs on May 1, 2016, a position he had held since December 2010. Under his leadership, the DoD created the Defense Health Agency (DHA), implemented a new electronic medical records system, and led the mission to combat Ebola in West Africa. Karen Guice, MD, MPP, the principal deputy assistant secretary of defense for health affairs, takes over Woodson’s duties. A new appointee is not expected until after the November presidential election.

According to the DoD, Woodson is returning to Boston University School of Medicine to establish a health systems innovation and policy institute. The institute will focus on leader development, biotechnology, and system design.

One of Woodson’s signature accomplishments was the creation of the DHA, which brought together the previously independent health care operations of the Army, Navy, and Air Force, each having unique cultures, procedures, and technologies. The underlying DHA goals have been to improve interoperability, efficiency, and cost reduction by sharing services.

The DHA operation is massive and cares for a TRICARE-eligible population of 9.5 million, including 1.4 million service members on active duty and more than 1 million inpatient admissions and 95.6 million outpatient visits in 2014.

“Thank you so much for allowing me to be a part of your organization for so long. Each of you has made an indelible impact on my life,” Woodson said at a DoD ceremony. “And as we say in the Army, we’ll see you on the high ground.”

Veterans can enroll in VA health care by paper (VA Form 10-10 EZ), online, and now by phone, without need for a signed paper application. The change is effective immediately for combat veterans and July 5, 2016, for all veterans. The VA considers accelerating the enrollment of all 31,000 combat veterans with pending enrollment as a “top priority,” and it  is working to complete the review and rework of all pending health enrollment records for living and deceased veterans this summer.

The amended regulation is available at the Federal Register website (www.federalregister.gov). For more information, veterans can contact the Health Eligibility Center Enrollment and Eligibility Division toll free (855-488-8440).

Veterans can enroll in VA health care by paper (VA Form 10-10 EZ), online, and now by phone, without need for a signed paper application. The change is effective immediately for combat veterans and July 5, 2016, for all veterans. The VA considers accelerating the enrollment of all 31,000 combat veterans with pending enrollment as a “top priority,” and it  is working to complete the review and rework of all pending health enrollment records for living and deceased veterans this summer.

The amended regulation is available at the Federal Register website (www.federalregister.gov). For more information, veterans can contact the Health Eligibility Center Enrollment and Eligibility Division toll free (855-488-8440).

Veterans can enroll in VA health care by paper (VA Form 10-10 EZ), online, and now by phone, without need for a signed paper application. The change is effective immediately for combat veterans and July 5, 2016, for all veterans. The VA considers accelerating the enrollment of all 31,000 combat veterans with pending enrollment as a “top priority,” and it  is working to complete the review and rework of all pending health enrollment records for living and deceased veterans this summer.

The amended regulation is available at the Federal Register website (www.federalregister.gov). For more information, veterans can contact the Health Eligibility Center Enrollment and Eligibility Division toll free (855-488-8440).

The VA awarded 4 grants totaling nearly $800,000 to veterans with service-connected disabilities to adapt their homes with assistive technology .

The Specially Adapted Housing Assistive Technology (SAHAT) grants go to individuals, researchers, and organizations that develop assistive technology. The 4 grants awarded are going to Auburn University in Alabama for touch-voice-eye-controlled assistive technology; Philips Research of North America in Massachusetts for personalized location-aware assisted technology for individuals with mild cognitive impairment; Simply Home of Asheville, North Carolina, for an assistive technology link platform that interfaces the Firefly Platform with the Amazon Echo Device; and St. Ambrose University in Iowa for its virtual demonstration and training site for home independence.

Typical home adaptations include ramps, wider halls and doors, and wheelchair-accessible bathrooms. New technology from the SAHAT Grant program will be added to the list of home modification options as they become available.

The VA awarded 4 grants totaling nearly $800,000 to veterans with service-connected disabilities to adapt their homes with assistive technology .

The Specially Adapted Housing Assistive Technology (SAHAT) grants go to individuals, researchers, and organizations that develop assistive technology. The 4 grants awarded are going to Auburn University in Alabama for touch-voice-eye-controlled assistive technology; Philips Research of North America in Massachusetts for personalized location-aware assisted technology for individuals with mild cognitive impairment; Simply Home of Asheville, North Carolina, for an assistive technology link platform that interfaces the Firefly Platform with the Amazon Echo Device; and St. Ambrose University in Iowa for its virtual demonstration and training site for home independence.

Typical home adaptations include ramps, wider halls and doors, and wheelchair-accessible bathrooms. New technology from the SAHAT Grant program will be added to the list of home modification options as they become available.

The VA awarded 4 grants totaling nearly $800,000 to veterans with service-connected disabilities to adapt their homes with assistive technology .

The Specially Adapted Housing Assistive Technology (SAHAT) grants go to individuals, researchers, and organizations that develop assistive technology. The 4 grants awarded are going to Auburn University in Alabama for touch-voice-eye-controlled assistive technology; Philips Research of North America in Massachusetts for personalized location-aware assisted technology for individuals with mild cognitive impairment; Simply Home of Asheville, North Carolina, for an assistive technology link platform that interfaces the Firefly Platform with the Amazon Echo Device; and St. Ambrose University in Iowa for its virtual demonstration and training site for home independence.

Typical home adaptations include ramps, wider halls and doors, and wheelchair-accessible bathrooms. New technology from the SAHAT Grant program will be added to the list of home modification options as they become available.

Agency officials believe the new consolidated program offers physicians’ greater simplicity and flexibility. Which, includes the two payment options: The Merit-based Incentive Payment System, or MIPS, or have a significant amount of their revenue generated under a qualifying Alternative Payment Model, or APM. CMS expects that in the first year of the program year, physicians will choose the MIPS path. According to Dr. Patrick Conway, the CMS’ chief medical officer, APM path reflects traditional Medicare payments in the first two years before it opens to all payers, including Medicare Advantage plans.

The proposed rule, excludes the Bundled Payment for Care Improvement models and Track 1of the Medicare Shared Savings Program. These new quality measures under Medicare Access and CHIP Reauthorization Actin both MIPS AND APM have their pros and cons but the CMS is providing efficient information to keep physicians up to date.

Agency officials believe the new consolidated program offers physicians’ greater simplicity and flexibility. Which, includes the two payment options: The Merit-based Incentive Payment System, or MIPS, or have a significant amount of their revenue generated under a qualifying Alternative Payment Model, or APM. CMS expects that in the first year of the program year, physicians will choose the MIPS path. According to Dr. Patrick Conway, the CMS’ chief medical officer, APM path reflects traditional Medicare payments in the first two years before it opens to all payers, including Medicare Advantage plans.

The proposed rule, excludes the Bundled Payment for Care Improvement models and Track 1of the Medicare Shared Savings Program. These new quality measures under Medicare Access and CHIP Reauthorization Actin both MIPS AND APM have their pros and cons but the CMS is providing efficient information to keep physicians up to date.

Agency officials believe the new consolidated program offers physicians’ greater simplicity and flexibility. Which, includes the two payment options: The Merit-based Incentive Payment System, or MIPS, or have a significant amount of their revenue generated under a qualifying Alternative Payment Model, or APM. CMS expects that in the first year of the program year, physicians will choose the MIPS path. According to Dr. Patrick Conway, the CMS’ chief medical officer, APM path reflects traditional Medicare payments in the first two years before it opens to all payers, including Medicare Advantage plans.

The proposed rule, excludes the Bundled Payment for Care Improvement models and Track 1of the Medicare Shared Savings Program. These new quality measures under Medicare Access and CHIP Reauthorization Actin both MIPS AND APM have their pros and cons but the CMS is providing efficient information to keep physicians up to date.

In separate interviews, VA Secretary Robert McDonald and VA Under Secretary of Health David J. Shulkin, MD, outlined the VA’s ongoing efforts to reduce wait times. “We are not afraid of criticism,” Dr. Shulkin told the House Committee on Veterans Affairs. “The VA is making sweeping changes. We are making progress, but there is significant work that lies ahead.”

The 2 officials outlined plans to offer same-day health care access to primary care and mental health services and expand the use of telehealth to increase access by the end of 2016. Still, as Dr. Shulkin admitted to the House Committee, the goals were aspirational for 2016, “but I am confident that we can get these goals done.”

For now, the focus is on this year. “Knowing we may not be here after December because the President changes office, we have put together the 12 priorities we want to get done this year,” McDonald told C-SPAN reporters.

So far progress is being made. Shulkin testified that prior to the VA’s first access stand-down in November 2015, there was a backlog of 57,000 level-1 urgent consults. Today that number has been reduced to 12,000. “The stand-downs are not a way you sustain improvements, they are declarations of emergencies,” Shulkin told the committee. “When you have urgent patients that aren’t being seen, they are emergencies, and we have to act like that.” The stand-downs have led to what Shulkin described as “sustainable improvements” in the VA’s efforts to redesign access in the system “so that 10 years from now—1 year from now—we are not going to be talking about this in the same way.”

Fixing the VA’s antiquated scheduling system remains a challenge. The current system has been blamed for scheduling errors and contributing to the backlog. Still, the VA surprised many when it put on hold its $624 million program to implement the new Medical Appointment Scheduling System (MASS). The MASS pilot alone was expected to cost $152 million to test at 6 sites. For now, Shulkin explained to the House Committee that the VA will test out a ViSTA Scheduling Enhancement (VSE) that is expected to cost $6.4 million and only use MASS if the VSE system does not work.

Both McDonald and Dr. Shulkin were at pains to emphasize that problems facing the VA built slowly and would take time to fix. As McDonald pointed out in the C-SPAN interview, “The problems in 2014 were not because of the wars in Afghanistan and Iraq, it was because of the aging of the veteran population,” and continued, “We are the canary in the coal mine for American medicine.”

Still, McDonald explained that the VA needs to deal with these problems immediately. “If we do not build the capability today to take care of Iraq and Afghanistan veterans, 4 years from now or 30 years from now, we will have the same crisis on our hands; that is why we’re trying to transform the system.”

In separate interviews, VA Secretary Robert McDonald and VA Under Secretary of Health David J. Shulkin, MD, outlined the VA’s ongoing efforts to reduce wait times. “We are not afraid of criticism,” Dr. Shulkin told the House Committee on Veterans Affairs. “The VA is making sweeping changes. We are making progress, but there is significant work that lies ahead.”

The 2 officials outlined plans to offer same-day health care access to primary care and mental health services and expand the use of telehealth to increase access by the end of 2016. Still, as Dr. Shulkin admitted to the House Committee, the goals were aspirational for 2016, “but I am confident that we can get these goals done.”

For now, the focus is on this year. “Knowing we may not be here after December because the President changes office, we have put together the 12 priorities we want to get done this year,” McDonald told C-SPAN reporters.

So far progress is being made. Shulkin testified that prior to the VA’s first access stand-down in November 2015, there was a backlog of 57,000 level-1 urgent consults. Today that number has been reduced to 12,000. “The stand-downs are not a way you sustain improvements, they are declarations of emergencies,” Shulkin told the committee. “When you have urgent patients that aren’t being seen, they are emergencies, and we have to act like that.” The stand-downs have led to what Shulkin described as “sustainable improvements” in the VA’s efforts to redesign access in the system “so that 10 years from now—1 year from now—we are not going to be talking about this in the same way.”

Fixing the VA’s antiquated scheduling system remains a challenge. The current system has been blamed for scheduling errors and contributing to the backlog. Still, the VA surprised many when it put on hold its $624 million program to implement the new Medical Appointment Scheduling System (MASS). The MASS pilot alone was expected to cost $152 million to test at 6 sites. For now, Shulkin explained to the House Committee that the VA will test out a ViSTA Scheduling Enhancement (VSE) that is expected to cost $6.4 million and only use MASS if the VSE system does not work.

Both McDonald and Dr. Shulkin were at pains to emphasize that problems facing the VA built slowly and would take time to fix. As McDonald pointed out in the C-SPAN interview, “The problems in 2014 were not because of the wars in Afghanistan and Iraq, it was because of the aging of the veteran population,” and continued, “We are the canary in the coal mine for American medicine.”

Still, McDonald explained that the VA needs to deal with these problems immediately. “If we do not build the capability today to take care of Iraq and Afghanistan veterans, 4 years from now or 30 years from now, we will have the same crisis on our hands; that is why we’re trying to transform the system.”

In separate interviews, VA Secretary Robert McDonald and VA Under Secretary of Health David J. Shulkin, MD, outlined the VA’s ongoing efforts to reduce wait times. “We are not afraid of criticism,” Dr. Shulkin told the House Committee on Veterans Affairs. “The VA is making sweeping changes. We are making progress, but there is significant work that lies ahead.”

The 2 officials outlined plans to offer same-day health care access to primary care and mental health services and expand the use of telehealth to increase access by the end of 2016. Still, as Dr. Shulkin admitted to the House Committee, the goals were aspirational for 2016, “but I am confident that we can get these goals done.”

For now, the focus is on this year. “Knowing we may not be here after December because the President changes office, we have put together the 12 priorities we want to get done this year,” McDonald told C-SPAN reporters.

So far progress is being made. Shulkin testified that prior to the VA’s first access stand-down in November 2015, there was a backlog of 57,000 level-1 urgent consults. Today that number has been reduced to 12,000. “The stand-downs are not a way you sustain improvements, they are declarations of emergencies,” Shulkin told the committee. “When you have urgent patients that aren’t being seen, they are emergencies, and we have to act like that.” The stand-downs have led to what Shulkin described as “sustainable improvements” in the VA’s efforts to redesign access in the system “so that 10 years from now—1 year from now—we are not going to be talking about this in the same way.”

Fixing the VA’s antiquated scheduling system remains a challenge. The current system has been blamed for scheduling errors and contributing to the backlog. Still, the VA surprised many when it put on hold its $624 million program to implement the new Medical Appointment Scheduling System (MASS). The MASS pilot alone was expected to cost $152 million to test at 6 sites. For now, Shulkin explained to the House Committee that the VA will test out a ViSTA Scheduling Enhancement (VSE) that is expected to cost $6.4 million and only use MASS if the VSE system does not work.

Both McDonald and Dr. Shulkin were at pains to emphasize that problems facing the VA built slowly and would take time to fix. As McDonald pointed out in the C-SPAN interview, “The problems in 2014 were not because of the wars in Afghanistan and Iraq, it was because of the aging of the veteran population,” and continued, “We are the canary in the coal mine for American medicine.”

Still, McDonald explained that the VA needs to deal with these problems immediately. “If we do not build the capability today to take care of Iraq and Afghanistan veterans, 4 years from now or 30 years from now, we will have the same crisis on our hands; that is why we’re trying to transform the system.”

Golf can be a bridge back into the community for disabled veterans. That’s the rationale behind a specialized golf program launched by the VA in partnership with PGA Reach, the philanthropic arm of PGA of America. PGA HOPE (Helping Our Patriots Everywhere) is a therapeutic program led by PGA professionals certified in golf instruction for veterans with disabilities. The two-step program begins with an introductory clinic.

“When you think of rehabilitation, golf is not always the first thing you think of,” admits VA Secretary Robert McDonald, “but it can play an integral role in the healing process through social interaction, mental stimulation and exercise.”

More than 2,000 veterans have already participated in the 50 programs available. For more information, visit www.pgareach.com. 

Golf can be a bridge back into the community for disabled veterans. That’s the rationale behind a specialized golf program launched by the VA in partnership with PGA Reach, the philanthropic arm of PGA of America. PGA HOPE (Helping Our Patriots Everywhere) is a therapeutic program led by PGA professionals certified in golf instruction for veterans with disabilities. The two-step program begins with an introductory clinic.

“When you think of rehabilitation, golf is not always the first thing you think of,” admits VA Secretary Robert McDonald, “but it can play an integral role in the healing process through social interaction, mental stimulation and exercise.”

More than 2,000 veterans have already participated in the 50 programs available. For more information, visit www.pgareach.com. 

Golf can be a bridge back into the community for disabled veterans. That’s the rationale behind a specialized golf program launched by the VA in partnership with PGA Reach, the philanthropic arm of PGA of America. PGA HOPE (Helping Our Patriots Everywhere) is a therapeutic program led by PGA professionals certified in golf instruction for veterans with disabilities. The two-step program begins with an introductory clinic.

“When you think of rehabilitation, golf is not always the first thing you think of,” admits VA Secretary Robert McDonald, “but it can play an integral role in the healing process through social interaction, mental stimulation and exercise.”

More than 2,000 veterans have already participated in the 50 programs available. For more information, visit www.pgareach.com. 

Secretary of the VA Robert McDonald and Deputy Secretary Sloan Gibson met with the members of the Commission on Care to defend the importance of the VHA and respond to criticism leveled in a recent report. In March, a report cosigned by nearly half the Commission members called for the closure of all VHA facilities and the transfer of patients to private care facilities.

“I know transformational change is not easy, but it is our commitment to the veterans we serve in order to bring them the customer service and the care and benefits they have earned,” McDonald told the Commission on Care.

“We have challenges in VA, and we own them,” Deputy Secretary Gibson added. “The transformation that [Secretary McDonald] talked about is well underway and already delivering measurable results for improving access to care and improving the veterans’ experience.”

Gibson laid out the VA plan to become a more integrated system going forward. By streamlining its supply chain, the VA had redirected $24 million back to veteran care. Real-time customer-satisfaction feedback is now being collected through VetLink, which indicates that about 90% of patients are either “completely satisfied” or “satisfied” with the timing of their appointments. Furthermore, in the most recent Access Stand Down, Gibson reported that VHA staff reviewed the records of more than 80,000 veterans, identified just over 3,300 patients waiting for more than 7 days for a level 1 clinic, and scheduled 80% immediately and 83% within 3 weeks.

Assistant Deputy Under Secretary for Community Care Baligh Yehia, MD, MPP, MSHP, also made a presentation to the Commission on Care on the progress VA has made in its attempt to partner with DoD, Indian Health Service, academic hospitals, and private-sector providers. According to Yehia, the VA has made 1.4 million Choice Care authorizations and the provider network has increased to about 289,000 providers. The VA has also streamlined the system, making it easier for veterans to use and simplified the medical records submission requirements for providers.

In an April 10th speech to the United Veterans Committee of Colorado, McDonald took on the Commission more directly. “Some still argue that VA can best serve veterans by shutting down VA health care altogether. They argue that closing VHA is the kind of ‘bold transformation’ veterans and their families need, want, and deserve,” he said. “I suspect that proposal serves some parties somewhere pretty well. But it doesn’t serve veterans well, and it doesn’t sit well with me. Simple words of the Cadet prayer resonate—‘choose the harder right’ over ‘the easier wrong.’”

“I know business. I know what transformational change means. I know it’s not easy,” McDonald said. “That kind of proposal isn’t transformational. It’s more along the lines of dereliction. President Reagan gave veterans ‘a seat at the table of our national affairs’ nearly 3 decades ago. So let’s keep veterans in control of how, when, and where they wish to be served.”

Mandated by the Veterans Access, Choice and Accountability Act, the 15-member Commission on Care is charged with providing recommendations for reforming veterans’ health care before July 1, 2016.

Secretary of the VA Robert McDonald and Deputy Secretary Sloan Gibson met with the members of the Commission on Care to defend the importance of the VHA and respond to criticism leveled in a recent report. In March, a report cosigned by nearly half the Commission members called for the closure of all VHA facilities and the transfer of patients to private care facilities.

“I know transformational change is not easy, but it is our commitment to the veterans we serve in order to bring them the customer service and the care and benefits they have earned,” McDonald told the Commission on Care.

“We have challenges in VA, and we own them,” Deputy Secretary Gibson added. “The transformation that [Secretary McDonald] talked about is well underway and already delivering measurable results for improving access to care and improving the veterans’ experience.”

Gibson laid out the VA plan to become a more integrated system going forward. By streamlining its supply chain, the VA had redirected $24 million back to veteran care. Real-time customer-satisfaction feedback is now being collected through VetLink, which indicates that about 90% of patients are either “completely satisfied” or “satisfied” with the timing of their appointments. Furthermore, in the most recent Access Stand Down, Gibson reported that VHA staff reviewed the records of more than 80,000 veterans, identified just over 3,300 patients waiting for more than 7 days for a level 1 clinic, and scheduled 80% immediately and 83% within 3 weeks.

Assistant Deputy Under Secretary for Community Care Baligh Yehia, MD, MPP, MSHP, also made a presentation to the Commission on Care on the progress VA has made in its attempt to partner with DoD, Indian Health Service, academic hospitals, and private-sector providers. According to Yehia, the VA has made 1.4 million Choice Care authorizations and the provider network has increased to about 289,000 providers. The VA has also streamlined the system, making it easier for veterans to use and simplified the medical records submission requirements for providers.

In an April 10th speech to the United Veterans Committee of Colorado, McDonald took on the Commission more directly. “Some still argue that VA can best serve veterans by shutting down VA health care altogether. They argue that closing VHA is the kind of ‘bold transformation’ veterans and their families need, want, and deserve,” he said. “I suspect that proposal serves some parties somewhere pretty well. But it doesn’t serve veterans well, and it doesn’t sit well with me. Simple words of the Cadet prayer resonate—‘choose the harder right’ over ‘the easier wrong.’”

“I know business. I know what transformational change means. I know it’s not easy,” McDonald said. “That kind of proposal isn’t transformational. It’s more along the lines of dereliction. President Reagan gave veterans ‘a seat at the table of our national affairs’ nearly 3 decades ago. So let’s keep veterans in control of how, when, and where they wish to be served.”

Mandated by the Veterans Access, Choice and Accountability Act, the 15-member Commission on Care is charged with providing recommendations for reforming veterans’ health care before July 1, 2016.

Secretary of the VA Robert McDonald and Deputy Secretary Sloan Gibson met with the members of the Commission on Care to defend the importance of the VHA and respond to criticism leveled in a recent report. In March, a report cosigned by nearly half the Commission members called for the closure of all VHA facilities and the transfer of patients to private care facilities.

“I know transformational change is not easy, but it is our commitment to the veterans we serve in order to bring them the customer service and the care and benefits they have earned,” McDonald told the Commission on Care.

“We have challenges in VA, and we own them,” Deputy Secretary Gibson added. “The transformation that [Secretary McDonald] talked about is well underway and already delivering measurable results for improving access to care and improving the veterans’ experience.”

Gibson laid out the VA plan to become a more integrated system going forward. By streamlining its supply chain, the VA had redirected $24 million back to veteran care. Real-time customer-satisfaction feedback is now being collected through VetLink, which indicates that about 90% of patients are either “completely satisfied” or “satisfied” with the timing of their appointments. Furthermore, in the most recent Access Stand Down, Gibson reported that VHA staff reviewed the records of more than 80,000 veterans, identified just over 3,300 patients waiting for more than 7 days for a level 1 clinic, and scheduled 80% immediately and 83% within 3 weeks.

Assistant Deputy Under Secretary for Community Care Baligh Yehia, MD, MPP, MSHP, also made a presentation to the Commission on Care on the progress VA has made in its attempt to partner with DoD, Indian Health Service, academic hospitals, and private-sector providers. According to Yehia, the VA has made 1.4 million Choice Care authorizations and the provider network has increased to about 289,000 providers. The VA has also streamlined the system, making it easier for veterans to use and simplified the medical records submission requirements for providers.

In an April 10th speech to the United Veterans Committee of Colorado, McDonald took on the Commission more directly. “Some still argue that VA can best serve veterans by shutting down VA health care altogether. They argue that closing VHA is the kind of ‘bold transformation’ veterans and their families need, want, and deserve,” he said. “I suspect that proposal serves some parties somewhere pretty well. But it doesn’t serve veterans well, and it doesn’t sit well with me. Simple words of the Cadet prayer resonate—‘choose the harder right’ over ‘the easier wrong.’”

“I know business. I know what transformational change means. I know it’s not easy,” McDonald said. “That kind of proposal isn’t transformational. It’s more along the lines of dereliction. President Reagan gave veterans ‘a seat at the table of our national affairs’ nearly 3 decades ago. So let’s keep veterans in control of how, when, and where they wish to be served.”

Mandated by the Veterans Access, Choice and Accountability Act, the 15-member Commission on Care is charged with providing recommendations for reforming veterans’ health care before July 1, 2016.