The Veterans Health Administration is the largest integrated health system in the nation, serving 9 million veterans at 1,293 health care facilities across the country. From our frontline staff at those medical centers, to our leaders in Washington, D.C. we work daily to provide the best care anywhere to those who served. Our priority is to provide veterans timely, well-coordinated access to care.
In 2014, we faced concerns about long wait times. This led to an erosion of trust between VHA, veterans and the public. Since then, VA has undergone tremendous transformation. We are operating with a renewed focus, unprecedented transparency and increased accountability. Today, as demand for our services grows, veterans are telling us they see a real difference and their trust in us is higher than ever. We remain committed to earning and sustaining that trust.
A 2019 Veterans of Foreign Wars survey showed 91 percent of veterans who use VA health care say they would recommend it to another veteran. With recommendations like that, it’s no wonder we are seeing more requests for care at VA than ever before. In fact, in some areas of the country we’re seeing incredible growth in new veterans enrolling in VA care. Notably, far more women veterans are receiving care through the VA as well, accounting for 30 percent of enrollment increases during the last five years. Since 2001, the number of women veterans receiving their care at VA has tripled.
The amount of outpatient care we provide has increased every year since 2014 for both care within VA facilities and through community care, except during the pandemic. In 2020, in-person care across the U.S. health care industry, including VA, dropped by about 40 percent. As the U.S. health care system grappled with this impact, VA leveraged the scope and scale of our integrated system to continue to deliver excellence to veterans — and we went above and beyond to support COVID-19 care in the struggling private sector in 47 states, the District of Columbia and tribal communities. With safeguards in place, VA’s frontline employees shifted their focus to caring for veterans and civilians with coronavirus in a battle against a virus like nothing we’ve seen in our lifetimes. We are incredibly proud of the thousands of VA employees who raised their hands to serve beyond their prescribed VA duties – in support of local communities.
Like the private sector, VA saw many patients cancel their own appointments because they were afraid to be seen. VA had already been a pioneer and leader in telehealth capabilities, and we quickly expanded care options for veterans, increasing the use of telehealth by more than 1,000 percent in a matter of weeks. All veterans with cancelled appointments had, and continue to have, access to care. They have opportunities to shift their care to telephone care, to video appointments, or to reschedule in-person care when safe and clinically appropriate in VA or if eligible, through the Community Care Network.
We’ve also stayed open throughout the pandemic for necessary in-person care, communicating to veterans that VA is always there for them. We closely followed guidance from the Centers for Disease Control and Prevention, American Hospital Association and various state health organizations, always keeping veteran safety and care as our true north. In total, because of these efforts the volume of out-patient care provided in fiscal year 2020 dipped only 8 percent from pre-pandemic levels. Outpatient care provided so far in fiscal year 2021 is at an all-time high — more than any other time in VHA’s 75-year history.
We’re pleased with the progress we have made in improving veterans’ access to care. We got here by listening to veterans, and veteran input will continue to inform our ongoing transformation. In addition to the excellent care provided within the VA system, we know that strong community care partnerships remain critical. In 2014, the Choice Act defined eligibility criteria for community care. In June of 2019 the MISSION Act replaced the Choice Act with a broader set of eligibility criteria. While neither piece of legislation has resulted in eligibility criteria that satisfies everyone, veterans are telling us — by utilizing the system and providing positive feedback — that we’ve made huge strides. Since VA began implementing the MISSION Act, we have authorized more than three million veterans to receive at least one appointment through community care. We have also seen record growth in referrals to the community this year, particularly, since March of this year as our country emerged from a national surge of the COVID-19 pandemic. Community care will continue to be a key part of how the department cares for veterans.
Reaching veterans in high-growth areas and those who live in rural areas presents unique challenges, but VA is up to the task. In areas of growth, health care organizations are competing for a limited number of qualified staff at key positions. In response, we’re taking steps to strengthen and sustain VA’s talent pipeline to include — expediting hiring, offering employment incentives, and supporting leadership and academic development for our expert staff.
As a leader in VA health care, I believe that most often, we can provide better, safer and more coordinated care, resulting in better outcomes for veterans, than anyone else. As VA continues its transformation, we will focus on the moments in the health care journey that matter most to veterans.
The lack of a national standard for measuring access to care means VA has an opportunity to lead. We will go beyond measuring access by wait times alone and center on veteran experience, quality outcomes, continuity of care and equity — because we know these are what matter most to our veterans.
This unwavering focus on serving those who have served our nation is how VA will be the provider of choice for veterans, their families, caregivers and survivors for the next 75 years.
Dr. Steven L. Lieberman is VA’s acting under secretary for health. He leads the Veterans Health Administration (VHA), the largest integrated health system in the nation, managing a budget of over $87 billion and overseeing the care of 9 million veterans. Dr. Lieberman is a board-certified physician in pulmonary and critical care and has over 25 years of experience with VA.
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