Nurse talks to patient in military uniform
March 12, 2018

For much of its recent history, the Veterans Health Administration (VHA) has been plagued with big problems like patient safety and understaffing issues, and scandal.

In a blog post this month, School of Public Health Dean Boris Lushniak and coauthors Dr. Brian J. Miller and Dr. Theresa Cullen propose new solutions to fix the ailing agency.

The three propose a short-term solution to build up staffing at the agency now, and a longer-term solution to turn the entitlement program into one that fosters competition between private insurers.

One of the biggest problems for the VHA is a lack of staffing, the article says. On average, it takes 110 days to hire a nurse and 177 days to hire a nurse practitioner. In April of 2017, then-Surgeon General Vivek Murthy announced that he would commit any of the more than 6,500 US Public Health Service (USPHS) clinicians to provide full-time, direct patient care to veterans in VHA hospitals and clinics in underserved communities.

To date, the VHA has accepted fewer than 10 officers due to administrative delays. The authors suggest strategies to get officers placed at VHA clinical sites for needs-based short- and long-term assignments. Leadership should also work together to create a long-term USPHS career pathway at the VHA, and work with Congress to obtain funding for 1,500 new USPHS commissioned officers to serve at VHA clinical sites.

In addition to addressing short-term staffing concerns, the authors suggest modeling a new VHA health plan after the Medicare Advantage program.

Three years ago, lawmakers passed the Veterans Choice Act of 2014 to try and get veterans seen by a private provider if they are far away from the VHA or have been waiting a long time for care. But the act's implementation has proved difficult, and a 2016 report pointed out there were significant problems with freedom of choice and care equity.

To try and improve care for veterans, the authors point to rebuilding Veteran’s Choice in a model similar to Medicare Advantage — insurance offered by private companies approved by Medicare. Medicare pays a fixed amount for the care each month, and has rules the companies must follow.

The program, the authors say, has been successful. The plans have led to better outcomes for patients, and beneficiaries have up to 25 percent lower health care spending as compared to traditional Medicare beneficiaries.

The VHA would still be critical to veteran’s health experiences, and the expansion would place significant competitive pressure on the VHA clinical system. Veterans would be able to choose among public, private or hybrid delivery of health care services, and the ensuing competition would result in innovation, growth and quality improvement.

“Harnessing the power of competition will embolden innovation in care delivery for veterans, resulting in higher quality, lower cost, and greater choice. Our veterans deserve no less,” the authors wrote.

The full proposal and analysis (Part 1 and Part 2) can be found at

Related Links

Solving The Crisis Of Care At The VA, Part I: A Path To Address Staff Shortages

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Boris Lushniak