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• W3135889433 abstract "The US Veterans Administration (VA), with 1,255 facilities and 9 million patients, is described as the largest integrated health care network in the United States.1Veterans Health Administrationhttp://www.va.govDate accessed: February 4, 2021Google Scholar It has an ambitious mission that includes not just health care but the overall well-being of veterans. The VA employs nearly 6,000 advanced practice nurses,2VA Grants Full Practice Authority to Advanced Practice Registered Nurseshttps://www.va.gov/opa/pressrel/pressrelease.cfm?id=2847 https://www.va.gov/opa/pressrel/pressrelease.cfm?id=2847Date accessed: February 28, 2021Google Scholar including a large contingent of nurse practitioners (NPs) who set standards for clinical practice and policy advances both inside and outside the VA. As of September 2020, NPs in all VA facilities practice without restriction to the full scope of their education and training regardless of any barriers to practice that may still be in effect in the state in which the VA facility is located. I for one am excited to see the effect of this advancement on outcomes. In addition to improving the health of our veterans, perhaps it will also provide renewed momentum to retire remaining state-level practice barriers faced by NPs and our patients. VA patients sometimes seek care outside the VA’s own facilities, and this month, 2 NPs with well-established practices at the VA consider the associated pros and cons of this approach. –Donald Gardenier YES Marsha K. SiegelMarsha K. Siegel, EdD, FNP-BC, is Service Chief, Veterans Integrated Service Network 19 Compensation and Pension Hub, and an NP in clinical practice at the Cheyenne VA Healthcare System in Cheyenne, WY. She has been a registered nurse for more than 43 years and an NP for 32 of those; she has practiced in the VA for a total of almost 18 years. Dr. Siegel is a past president of the American College of Nurse Practitioners and currently serves on the American Association of Nurse Practitioners Political Action Committee as a trustee. She has been a longtime advocate for advanced practice nursing roles and has influenced legislation at both the state and federal levels. Marsha K. Siegel, EdD, FNP-BC, is Service Chief, Veterans Integrated Service Network 19 Compensation and Pension Hub, and an NP in clinical practice at the Cheyenne VA Healthcare System in Cheyenne, WY. She has been a registered nurse for more than 43 years and an NP for 32 of those; she has practiced in the VA for a total of almost 18 years. Dr. Siegel is a past president of the American College of Nurse Practitioners and currently serves on the American Association of Nurse Practitioners Political Action Committee as a trustee. She has been a longtime advocate for advanced practice nursing roles and has influenced legislation at both the state and federal levels. Full disclosure: I believe that because of our singular focus and expertise, the VA should be the sole provider of care for veterans. The reality, however, is that we cannot be. In 2018, the Rural Health Information Hub noted that “a disproportionate share of veterans live in rural America,” citing that of the nearly 20 million veterans in the United States, 4.7 million (23.5%) live in rural areas. They further noted 40.9% were Vietnam era veterans, which would make them primarily 65 or older.3Rural Health Information Hub.https://www.rurahealthinfo.orgGoogle Scholar Although in some sections of our country, “rural” can still be within a reasonable drive to a VA facility, in many areas of the plains and the mountain states, the closest VA may be hours away. In recent years, the VA has developed more rural satellite clinics and mobile units, but it is not always cost-effective to put clinics in many of the less populated areas. Thus, the answer is to fund veterans who live in these areas to receive their care from local non-VA providers. Another issue is that of overcrowding in facilities in the larger population areas. Like many government agencies, the biennial budget increases often fail to cover the actual increases in the cost of delivering services to an ever-growing population. As a federal entity, the VA is subject to legislative mandates that can include implementing programs nationwide without funding to support such programs, spreading limited resources even thinner. The VA is constantly asked to do more with less, which affects a facility’s ability to deliver timely services and care. Overcrowding can be alleviated by letting veterans choose to receive care at community facilities. Lastly, the VA has 170 medical centers of varying sizes and capabilities, and it is not reasonable or cost-effective to offer all of the specialty/subspecialty services at all facilities. But it is also unreasonable to ask veterans to travel sometimes excessive distances to the larger facilities when similar subspecialty care could readily be obtained in the local community. For these reasons, allowing veterans to access care outside of the VA allows us to keep Lincoln’s promise “To care for him who shall have borne the battle.”4Lincoln A. Second inaugural address. Washington, DC; March 4, 1865.Google Scholar NO Jennifer Ballard-HernandezJennifer Ballard-Hernandez, DNP, FACC, FAHA, FAANP, is the cardiology clinical nurse advisor to the office of nursing services for the Department of Veterans Affairs central office. She is field based at the Tibor Rubin VA Medical Center in Long Beach, California, where she works as a cardiology nurse practitioner. She is a member of VA virtual care specialty care expansion workgroup. Dr. Ballard-Hernandez serves on several national committees and is currently appointed to the federal cardiology section leadership council of the American College of Cardiology. Jennifer Ballard-Hernandez, DNP, FACC, FAHA, FAANP, is the cardiology clinical nurse advisor to the office of nursing services for the Department of Veterans Affairs central office. She is field based at the Tibor Rubin VA Medical Center in Long Beach, California, where she works as a cardiology nurse practitioner. She is a member of VA virtual care specialty care expansion workgroup. Dr. Ballard-Hernandez serves on several national committees and is currently appointed to the federal cardiology section leadership council of the American College of Cardiology. Veterans do not need routine access to medical care outside of the VA, which offers them high quality comprehensive primary, specialty, surgical, and mental health care services. As the largest integrated health care system in the United States with widely diverse operating environments, the VA operates hospital facilities in every state, including 170 VA medical centers and more than 1,060 community-based clinics. Together these health care facilities provide care to 9 million veterans each year. The VA offers timely access to care with 86.7% of visits scheduled within 30 days of the requested date.1Veterans Health Administrationhttp://www.va.govDate accessed: February 4, 2021Google Scholar There is an emerging body of evidence showing that VA care often outperforms private sector health care systems and health care providers in a number of important quality-of-care metrics, including preventative care, cancer screenings, influenza vaccination, blood pressure control, diabetes care, cholesterol control, and surgical and procedural outcomes.5Why Choose VA Health Care?.https://www.va.gov/QUALITYOFCARE/initiatives/compare/why-choose-va-health-care.asp#:∼:text=VA%20often%20outperforms%20private%20health,performance%20based%20on%20standard%20measurementsDate accessed: February 28, 2021Google Scholar Satisfaction with VA care is at an all-time high, with veterans rating VA care better than community care in 3 of 4 categories: Overall provider rating, communication, and coordination.6Vanneman M.E. Wagner T.H. Schwartz M. et al.Veterans’ experiences with outpatient care: Comparing the Veterans Affairs system with community-based care.Health Aff (Millwood). 2020; 39: 1368-1376Crossref PubMed Scopus (6) Google Scholar The comprehensive care offered by the VA includes a multidisciplinary patient-aligned care team (PACT) of primary care providers, pharmacists, social workers, nurses, and dieticians who focus on whole health care and lifelong health and wellness. Home-based primary care and telehealth services have expanded access to care, especially in rural areas. My HealtheVet and secure messaging offer veterans electronic real-time access to their care team. Care coordination at the level and scope that the VA provides the distinct advantage of being able to manage veterans’ care anywhere across the nation. As outlined in the MISSION Act, veterans are afforded the opportunity to access care in the community if they are unable to receive care in a VA medical facility due to distance or if the VA medical facility does not provide a specific medical service or procedure. As an adjunct to the comprehensive care offered at VA facilities, it is hard to imagine that any health care service that a veteran might need would not be provided for lack of access.7MISSION act strengthens VA care.missionact.va.govDate accessed: February 3, 2021Google Scholar Donald Gardenier, DNP, FNP-BC, FAANP, FAAN, is a nurse practitioner in clinical practice in gastroenterology at Eisenhower Health in Palm Springs, CA. He is the editor of this column. Dr Gardenier may be reached at [email protected] ." @default.
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• W3135889433 title "Do Veterans Need Access to Care Outside Veterans Administration Facilities?" @default.
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