Caring for Those Who Serve: Potential Implications of the Veterans Affairs Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018
Authors: Joel Kupfer, Rachel S. Witmer, Viet Do
Journal: Annals of Internal Medicine (2018)

Ideas and Opinions2 October 2018Caring for Those Who Serve: Potential Implications of the Veterans Affairs Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018Joel Kupfer, MD, Rachel S. Witmer, MHA, and Viet Do, DOJoel Kupfer, MDCarl T. Hayden VA Medical Center and University of Arizona College of Medicine–Phoenix, Phoenix, Arizona (J.K., V.D.), Rachel S. Witmer, MHACarl T. Hayden VA Medical Center, Phoenix, Arizona (R.S.W.), and Viet Do, DOCarl T. Hayden VA Medical Center and University of Arizona College of Medicine–Phoenix, Phoenix, Arizona (J.K., V.D.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M18-1539 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail On 28 May 2018, Congress passed the Veterans Affairs Maintaining Internal Systems and Strengthening Integrated Outside Networks (VA MISSION) Act, setting in motion a paradigm shift in the way health care will be delivered to the nation's veterans (Table). The most important of its many provisions is the replacement of the Choice Program with a new model of health care delivery for veterans based on networks of community providers designed to provide veterans with greater choice. Although the Choice Program expanded access to outside providers, the VA largely determined the circumstances under which those referrals were granted. The new program, ...References1. Hartman M, Martin AB, Espinosa N, Catlin A; The National Health Expenditure Accounts Team. National health care spending in 2016: spending and enrollment growth slow after initial coverage expansions. Health Aff (Millwood). 2018;37:150-60. [PMID: 29211503] doi:10.1377/hlthaff.2017.1299 CrossrefMedlineGoogle Scholar2. Noel-Miller C. Medicare beneficiaries' out-of-pocket spending for health care. AARP Public Policy Institute. 21 November 2017. Accessed at www.aarp.org/ppi/info-2017/medicare-beneficiaries-out-of-pocket-spending-for-health-care.html on 13 July 2018. Google Scholar3. Eibner C, Krull H, Brown K, Cefalu M, Mulcahy AW, Pollard M, et al. Current and Projected Characteristics and Unique Health Care Needs of the Patient Population Served by the Department of Veterans Affairs. Santa Monica, CA: RAND Corporation; 2015. Google Scholar4. O'Hanlon C, Huang C, Sloss E, AnhangPrice R, Hussey P, Farmer C, et al. Comparing VA and non-VA quality of care: a systematic review. J Gen Intern Med. 2017;32:105-21. [PMID: 27422615] doi:10.1007/s11606-016-3775-2 CrossrefMedlineGoogle Scholar5. Anhang Price R, Sloss EM, Cefalu M, Farmer CM, Hussey PS. Comparing quality of care in Veterans Affairs and non-Veterans Affairs settings. J Gen Intern Med. 2018. [PMID: 29696561] doi:10.1007/s11606-018-4433-7 CrossrefMedlineGoogle Scholar6. Landrum MB, Keating NL, Lamont EB, Bozeman SR, Krasnow SH, Shulman L, et al. Survival of older patients with cancer in the Veterans Health Administration versus fee-for-service Medicare. J Clin Oncol. 2012;30:1072-9. [PMID: 22393093] doi:10.1200/JCO.2011.35.6758 CrossrefMedlineGoogle Scholar7. Trivedi AN, Grebla RC. Quality and equity of care in the Veterans Affairs health-care system and in Medicare Advantage health plans. Med Care. 2011;49:560-8. [PMID: 21422951] doi:10.1097/MLR.0b013e31820fb0f6 CrossrefMedlineGoogle Scholar8. Bernard DM, Selden TM. Access to care among nonelderly veterans. Med Care. 2016;54:243-52. [PMID: 26871642] doi:10.1097/MLR.0000000000000508 CrossrefMedlineGoogle Scholar9. Pizer SD, Gardner JA. Is fragmented financing bad for your health? Inquiry. 2011;48:109-22. [PMID: 21898983] CrossrefMedlineGoogle Scholar10. Weeks WB, West AN, Wallace AE, Lee RE, Goodman DC, Dimick JB, et al. Reducing avoidable deaths among veterans: directing private-sector surgical care to high-performance hospitals. Am J Public Health. 2007;97:2186-92. [PMID: 17971543] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Carl T. Hayden VA Medical Center and University of Arizona College of Medicine–Phoenix, Phoenix, Arizona (J.K., V.D.)Carl T. Hayden VA Medical Center, Phoenix, Arizona (R.S.W.)Disclaimer: The opinions in this article are not those of the Veterans Health Administration, the federal government, or the University of Arizona.Acknowledgment: The authors thank Dr. Kathy Carbone and Dr. Caroline Kim for their thoughtful suggestions and help in preparing the manuscript.Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-1539.Corresponding Author: Joel Kupfer, MD, Department of Cardiology, Carl T. Hayden VA Medical Center, 650 E. Indian School Road, Phoenix, AZ 85012; e-mail, joel.[email protected]gov.Current Author Addresses: Dr. Kupfer: Department of Cardiology, Carl T. Hayden VA Medical Center, 650 E. Indian School Road, Phoenix, AZ 85012.Ms. Witmer: Phoenix VA Medical Center, 650 E. Indian Road, Phoenix, AZ 85012.Dr. Do: Mayo Clinic Hospital Arizona, 5777 E. Mayo Boulevard, Phoenix, AZ 85045.Author Contributions: Conception and design: J. Kupfer.Analysis and interpretation of the data: R.S. Witmer.Drafting of the article: J. Kupfer, V. Do.Final approval of the article: R.S. Witmer, V. Do.Administrative, technical, or logistic support: R.S. Witmer.Collection and assembly of data: R.S. Witmer.This article was published at Annals.org on 24 July 2018. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byRacial/Ethnic and Geographic Disparities in Comorbid Traumatic Brain Injury-Renal Failure in US Veterans and Associated Veterans Affairs Resource Costs, 2000–2020Data acquisition process for VA and non-VA emergency department and hospital utilization by veterans with spinal cord injury and disorders in California using VA and state dataHealth Care for Our Nation's Veterans: A Policy Paper From the American College of PhysiciansRyan Crowley, BSJ, Omar Atiq, MD, David Hilden, MD, MPH, and Thomas G. Cooney, MD, for the Health and Public Policy Committee of the American College of Physicians*Antipsychotic initiation and new diagnoses excluded from quality‐measure reporting among Veterans in community nursing homes contracted by the Veterans Health Administration in the United StatesThe Correlation Between Case Total Work Relative Value Unit, Operative Stress and Patient FrailtyDid Access to Care Improve Since Passage of the Veterans Choice Act?Developing network adequacy standards for VA Community CareSource of Post-Transplant Care and Mortality among Kidney Transplant Recipients Dually Enrolled in VA and MedicareA Comparison of Surgical Quality and Patient Satisfaction Indicators Between VA Hospitals and Hospitals Near VA HospitalsVA-Community Dual Care: Veteran and Clinician PerspectivesThe Impact of Trust, Satisfaction, and Perceived Quality on Preference for Setting of Future Care Among Veterans With PTSDPredicting Primary Care Use Among Patients in a Large Integrated Health SystemUnderstanding Maternity Care Coordination for Women Veterans Using an Integrated Care Model ApproachDual Receipt of Prescription Opioids From the Department of Veterans Affairs and Medicare Part D and Prescription Opioid Overdose Death Among Veterans A Nested Case–Control StudyPatience Moyo, PhD, Xinhua Zhao, PhD, Carolyn T. Thorpe, PhD, MPH, Joshua M. Thorpe, PhD, MPH, Florentina E. Sileanu, MS, John P. Cashy, PhD, Jennifer A. Hale, BA, Maria K. Mor, PhD, Thomas R. Radomski, MD, MS, Julie M. Donohue, PhD, Leslie R.M. Hausmann, PhD, Joseph T. Hanlon, PharmD, MS, Chester B. Good, MD, MPH, Michael J. Fine, MD, MSc, and Walid F. Gellad, MD, MPH 2 October 2018Volume 169, Issue 7Page: 487-489KeywordsChild healthHealth careHealth care facilitiesHealth care providersHealth care sectorHealth economicsHealth systems strengtheningMedicareRural areasVeteran care ePublished: 2 October 2018 Issue Published: 2 October 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...