Senator, VA at odds over decision support tool for community care

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A real-time decision support tool is not getting used by Department of Veterans Affairs’ providers and their patients in the way it was intended, according to one senior U.S. senator.

Sen. Jon Tester (D-Mont.), ranking member of the Senate Veterans’ Affairs Committee, said during a hearing last week that he is “concerned by reports that the decision support tool that was supposed to assist veterans and their providers in making decisions on where to get care is being underutilized because providers are choosing not to use it.”

Tester contends that the purpose of the decision support tool is threefold: to help VA providers quickly review the criteria proscribed in the VA Mission Act of 2018; determine whether a veteran is eligible and would be best served utilizing private sector care through the Community Care Program; and document the decision rationale in the veteran’s electronic medical record.

However, Tester and the VA see the value of the decision support tool quite differently.

“The decision support tool is a tool provided for staff to assist them in making decisions, but it was never mandated,” said Christina Mandreucci, VA press secretary, in response to a query regarding Tester’s concerns. “In some cases, like Alaska where every veteran is eligible for community care, it is not needed. In other cases, where a provider is familiar with their patients, they could have those discussions with the patients without the need for a tool to guide the discussions.”

Nonetheless, at last week’s hearing, Tester also charged that “the VA will use a newer referral process that could complicate referrals even more.” The senator added that he “doesn’t understand how creating a team to coordinate this decision is quicker or makes more sense than a veteran and a provider making that decision” together.

In response to Tester’s concerns about the VA’s referral process, Mandreucci commented that the agency uses Referral Coordination Teams at its facilities to ensure veterans who may be eligible for care in the community understand their full range of options before they decide where to receive their care.

“Referring providers are not as likely to have all of the information about specialty care availability at the time they are meeting with the veteran,” said Mandreucci. “These dedicated referral coordination teams include staff with experience and knowledge across specialty services to provide veterans with information about availability of VA specialty providers, benefits related to continuity of care and answer questions to help veterans make the best and most timely care decisions.”

In June, the VA launched the new Community Care Program in fulfillment of the MISSION Act, which was signed into law in 2018 to consolidate the agency’s community care programs into a new, streamlined and more efficient Veterans Community Care Program.

“Expanded eligibility criteria, improvements to processes and technologies, and a growing network of community providers are just some of the ways that the MISSION Act has improved the options that veterans have to address their healthcare needs,” testified Richard Stone, MD, executive in charge of the Veterans Health Administration, at last week’s Senate hearing.

Stone noted that since the launch of the Community Care Program, the VA has placed more than 3.6 million referrals and authorized more than 3.85 million episodes of care.

“In these early referral patterns, it appears veterans have improved access to specialty care,” he added. “Eligibility criteria ensure that the clinical needs of the veteran are accounted for and, when appropriate, that a veteran can work closely with his or her provider to choose the best setting and clinician in his or her best medical interest.”

Overall, Stone said the VA is modernizing its IT systems to “replace a patchwork of old technology and manual processes that slowed down the administration and delivery of community care.” However, he emphasized that once fully implemented, the new IT systems will “speed up all aspects of community care—eligibility, authorizations, appointments, care coordination, claims, payments—while improving overall communication between veterans, community providers and VA employees.”

Still, Tester said that the Senate Veterans’ Affairs Committee must have the VA’s commitment to have these IT systems up and running by the end of the summer to support an expanded Community Care Program.

Even in that timeframe, Tester noted that it would be a full year after the agency was required to complete the project. Under the MISSION Act, the VA was required to implement major parts of the new Community Care Program by June 6, 2019.

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