In a word-association game, many Americans would pair “VA hospital” with “overworked,” “overwhelmed” or “beleaguered.”
A recently published analysis of VA medical centers over recent years by USA Today indicated long delays for care and troublesome patient-survey results but lower death rates and prevention of post-surgical complications than other facilities. For its part, the Wilmington VA Medical Center has made major changes over the past 12 months:
• Forged a network of nearly 600 local health-care providers to give veterans quicker care.
• Tapped into an existing state information system to get patients’ medical information in minutes rather than hours or days.
• Created the VA’s first embedded nurse navigator system. Now, local veterans have point persons who make their appointments and handle their authorizations.
• Changed its third-party payer system to get physicians in the community compensated more quickly.
• Contracted with OptumServe, a national health-services company, to provide some services for the Wilmington center beginning in June.
The changes lay the groundwork for full implementation this June of the “Mission Act” — the VA Maintaining Systems and Strengthening Integrated Outside Networks Act.
The law, passed with strong bipartisan support and signed by President Trump last June, aims to make it easier for veterans to get health-care outside the VA system. Veterans can get treatment at VA centers, from community providers, through telemedicine phone lines or at retail clinics.
“Now we have a more comprehensive network of providers,” said Jody Searight, who oversees the VA’s community care program. “The intent of the Mission Act is for the VA to become part of a larger health-care network. The VA, in the past, has been more of a silo, and we have just sent veterans to the community when we could not provide the care. We worked very hard last summer to develop a network of providers.”
The Wilmington VA Medical Center serves 31,277 veterans from Delaware and South Jersey. According to the USA Today analysis of data from recent years, the wait time between arrival in the emergency room and admission was 272 minutes, compared to a national median of 257 minutes — in part because the medical center only has 16 acute beds and therefore must spend time transferring patients to other local hospitals.
To serve them more quickly, more Elsmere doctors tapped into the Delaware Health Information Network, a public-private partnership that was the first statewide health-information system in the country when it went live in 2007. The online records system can give doctors answers in minutes instead of hours or days.
For years, the VA rarely used the online system because of strict VA regulations about patient privacy. The solution: The medical center downloads information from DHIN, but it doesn’t upload its information.
Searight said the staff uses DHIN extensively — now. At the beginning of last year, just 37 VA staff members used the system. By year’s end, more than 100 had registered.
Dr. Ruben Nalda, who runs the emergency department at the medical center, said the online information system can save precious time and eliminate duplicate tests.
“Say I have a veteran who comes to the emergency department for a particular complaint, and he lets me know he was at Christiana Care a few days ago in their emergency department,” Dr. Nalda said. “I now have access to that information immediately, where, previously, I would have had to get a consent for a release of information and fill out a form and have the patient sign it and have one of our administrative folks fax it to the hospital and hope their records area is open. If it’s after hours, they may not even be open. If they are open, sometimes it can take an hour or two to get everything done. They have to get the information we need and fax it. Now, I can just look at it on the DHIN.”
The network delivers clinical results, reports, hospital admission data and billing information from doctor’s offices, hospitals and laboratories in minutes.
The rapid results and the new nurse navigators are reaping positive results, doctors said.
A female veteran being treated for breast cancer worked with a nurse navigator who scheduled all her treatment appointments so she didn’t miss any work. One veteran had a scan that showed some abnormalities. The imaging facility was attempting to reach a VA doctor to report the results, but the VA’s nurse navigator had already downloaded the results from DHIN and was working on the next step.
“I think that we’re all very anxious to build a true health-care network and be able to work more smoothly with our community providers,” Searight said. “This is an exciting time for the VA, and I think, at the end of the day, the veterans will receive care that’s timely and well-coordinated by talented nurse navigators.”