Veterans Health Administration
Encyclopedia
United States Department of Veterans Affairs
The United States Department of Veterans Affairs is a government-run military veteran benefit system with Cabinet-level status. It is the United States government’s second largest department, after the United States Department of Defense...
(VA) led by the Under Secretary of Veterans Affairs for Health
Under Secretary of Veterans Affairs for Health
The Under Secretary of Veterans Affairs for Health is a position in the United States Department of Veterans Affairs. The Undersecretary is the highest official directly responsible for the largest agency within the department, the Veterans Health Administration, commonly called the 'VA'...
that implements the medical assistance program of the VA through the administration and operation of numerous VA outpatient clinics, hospital
Hospital
A hospital is a health care institution providing patient treatment by specialized staff and equipment. Hospitals often, but not always, provide for inpatient care or longer-term patient stays....
s, medical center
Medical facility
A medical facility is, in general, any location at which medicine is practiced regularly. Medical facilities range from small clinics and doctor's offices to urgent care centers and large hospitals with elaborate emergency rooms and trauma centers. The number and quality of medical facilities in a...
s and long-term healthcare facilities (i.e., nursing home
Nursing home
A nursing home, convalescent home, skilled nursing unit , care home, rest home, or old people's home provides a type of care of residents: it is a place of residence for people who require constant nursing care and have significant deficiencies with activities of daily living...
s).
The VHA division has more employees than all other elements of the VA combined.
The VHA is distinct from the U.S. Department of Defense
United States Department of Defense
The United States Department of Defense is the U.S...
Military Health System
Military Health System
The Military Health System is the enterprise within the United States Department of Defense responsible for providing health care to active duty and retired U.S. Military personnel and their dependents...
of which it is not a part.
History
The origin of the VHA dates to the first federal military veterans hospital (Hand Hospital) in Pittsburgh in 1778.http://www.carnegielibrary.org/locations/pennsylvania/history/pghsts3.htmlUntil the 1980s, it was known as VA's Department of Medicine and Surgery. In recent years, VHA has opened hundreds of outpatient clinics in towns across America, while steadily reducing inpatient bed levels at its hospitals.
In the mid-1980s the VHA was criticized for their high operative mortality. To that end, Congress passed Public Law 99-166 in December 1985 which mandated the VHA to report their outcomes in comparison to national averages and the information must be risk-adjusted to account for the severity of illness of the VHA surgical patient population. In 1991 the National VA Surgical Risk Study (NVASRS) began in 44 Veterans Administration Medical Centers. By 31 December 1993 there was information for 500,000 non-cardiac surgical procedures. In 1994 NVASRS was expanded to all 128 VHA hospitals that performed surgery. The name was then changed to the National Surgical Quality Improvement Program.
Beginning in the mid-1990s VHA underwent what the agency characterizes as a major transformation
aimed at improving the quality and efficiency of care it provides to its patients. That transformation included eliminating underutilized inpatient beds and facilities, expanding outpatient clinics, and restructuring eligibility rules. A major focus of the transformation was the tracking of a number of performance indicators—including quality-of-care measures—and holding senior managers accountable for improvements in those measures.
Evaluation
"Patients routinely rank the veterans system above the alternatives, according to the American Customer Satisfaction Index." In 2008, the VHA got a satisfaction rating of 85 for inpatient treatment, compared with 77 for private hospitals. In the same report the VHA outpatient care scored 3 points higher than for private hospitals."As compared with the Medicare fee-for-service program, the VA performed significantly better on all 11 similar quality indicators for the period from 1997 through 1999. In 2000, the VA outperformed Medicare on 12 of 13 indicators."
A study that compared VHA with commercial managed care systems in their treatment of diabetes patients found that in all seven measures of quality, the VHA provided better care.
A RAND Corporation study in 2004 concluded that the VHA outperforms all other sectors of American health care in 294 measures of quality; Patients from the VHA scored significantly higher for adjusted overall quality, chronic disease care, and preventive care, but not for acute care.
A 2009 Congressional Budget Office
Congressional Budget Office
The Congressional Budget Office is a federal agency within the legislative branch of the United States government that provides economic data to Congress....
report on the VHA found that "the care provided to VHA patients compares favorably with that provided to non-VHA patients in terms of compliance with widely recognized clinical guidelines — particularly those that VHA has emphasized in its internal performance measurement system. Such research is complicated by the fact that most users of VHA’s services receive at least part of their care from outside providers."
Use of Electronic Records
VHA is especially praised for its efforts in developing a low cost open sourceOpen source
The term open source describes practices in production and development that promote access to the end product's source materials. Some consider open source a philosophy, others consider it a pragmatic methodology...
electronic medical records system VistA
VistA
The Veterans Health Information Systems and Technology Architecture is an enterprise-wide information system built around an Electronic Health Record , used throughout the United States Department of Veterans Affairs medical system, known as the Veterans Health Administration .It's a collection...
which can be accessed remotely (with secure passwords) by health care providers. With this system, patients and nurses are given bar-coded wristbands, and all medications are bar-coded as well. Nurses are given wands, which they use to scan themselves, the patient, and the medication bottle before dispensing drugs. This helps prevent four of the most common dispensing errors: wrong med, wrong dose, wrong time, and wrong patient. The system, which has been adopted by all veterans hospitals and clinics and continuously improved by users, has cut the number of dispensing errors in half at some facilities and saved thousands of lives.
At some VHA medical facilities, doctors use wireless laptops, putting in information and getting electronic signatures for procedures. Doctors can call up patient records, order prescriptions, view X-rays or graph a chart of risk factors and medications to decide treatments. Patients have a home page that have boxes for allergies and medications, records every visit, call and note, and issues prompts reminding doctors to make routine checks. This technology has helped the VHA achieve cost controls and care quality that the majority of private providers cannot achieve.
Physicians
Doctors who work in the VHA system are typically paid less in core compensation than their counterparts in private practice. However, VHA compensation includes benefits not generally available to doctors in private practice, such as sovereign immunity from malpractice lawsuits, freedom from billing and insurance company payment administration, and the availability of the government's proprietary VistAVistA
The Veterans Health Information Systems and Technology Architecture is an enterprise-wide information system built around an Electronic Health Record , used throughout the United States Department of Veterans Affairs medical system, known as the Veterans Health Administration .It's a collection...
electronic records system.
Initiatives
The VHA has expanded its outreach efforts to include men and women veterans and homeless veterans.The VHA, through its academic affiliations, has helped train thousands of physicians, dentists, and other health professionals. Several newer VA medical centers have been purposely located adjacent to medical schools.
The VHA support for research and residency/fellowship training programs has made the VA system a leader in the fields of geriatrics
Geriatrics
Geriatrics is a sub-specialty of internal medicine and family medicine that focuses on health care of elderly people. It aims to promote health by preventing and treating diseases and disabilities in older adults. There is no set age at which patients may be under the care of a geriatrician, or...
http://www1.va.gov/grecc/http://www.va.gov/oaa/specialfellows/programs/SF_RWJ.asp, spinal cord injuries http://www.sci.va.gov/, Parkinson's disease
Parkinson's disease
Parkinson's disease is a degenerative disorder of the central nervous system...
http://www.parkinsons.va.gov/, and palliative care
Palliative care
Palliative care is a specialized area of healthcare that focuses on relieving and preventing the suffering of patients...
.
The VHA has initiatives in place to provide a "seamless transition" to newly-discharged veterans transitioning from Department of Defense
United States Department of Defense
The United States Department of Defense is the U.S...
health care
TRICARE
TRICARE, formerly known as the Civilian Health and Medical Program of the Uniformed Services , is a health care program of the United States Department of Defense Military Health System. TRICARE provides civilian health benefits for military personnel, military retirees, and their dependents,...
to VA care for conditions incurred in Iraq
Iraq
Iraq ; officially the Republic of Iraq is a country in Western Asia spanning most of the northwestern end of the Zagros mountain range, the eastern part of the Syrian Desert and the northern part of the Arabian Desert....
or Afghanistan
Afghanistan
Afghanistan , officially the Islamic Republic of Afghanistan, is a landlocked country located in the centre of Asia, forming South Asia, Central Asia and the Middle East. With a population of about 29 million, it has an area of , making it the 42nd most populous and 41st largest nation in the world...
.
The Veterans Health Administration Office of Research and Development
Veterans Health Administration Office of Research and Development
The Veterans Health Administration Office of Research and Development is the research and development agency of the Veterans Health Administration in the United States Department of Veterans Affairs...
's research into developing better-functioning prosthetic limbs, and treatment of PTSD are also heralded. The VHA has devoted many years of research into the health effects of the herbicide Agent Orange
Agent Orange
Agent Orange is the code name for one of the herbicides and defoliants used by the U.S. military as part of its herbicidal warfare program, Operation Ranch Hand, during the Vietnam War from 1961 to 1971. Vietnam estimates 400,000 people were killed or maimed, and 500,000 children born with birth...
used by military
Military
A military is an organization authorized by its greater society to use lethal force, usually including use of weapons, in defending its country by combating actual or perceived threats. The military may have additional functions of use to its greater society, such as advancing a political agenda e.g...
forces in Vietnam
Vietnam
Vietnam – sometimes spelled Viet Nam , officially the Socialist Republic of Vietnam – is the easternmost country on the Indochina Peninsula in Southeast Asia. It is bordered by China to the north, Laos to the northwest, Cambodia to the southwest, and the South China Sea –...
.
Eligibility for benefits
By Federal law, eligibility for benefits is determined by a system of eight Priority Groups. Retirees from military service, veterans with service-connected injuries or conditions rated by VA, and Purple HeartPurple Heart
The Purple Heart is a United States military decoration awarded in the name of the President to those who have been wounded or killed while serving on or after April 5, 1917 with the U.S. military. The National Purple Heart Hall of Honor is located in New Windsor, New York...
recipients are within the higher priority groups.
Veterans without rated service-connected conditions may become eligible based on financial need, adjusted for local cost of living. Veterans who do not have service-connected disabilities totaling 50% or more may be subject to copayments for any care they received for nonservice-connected conditions.
Eligibility for VA dental care and nursing home
Nursing home
A nursing home, convalescent home, skilled nursing unit , care home, rest home, or old people's home provides a type of care of residents: it is a place of residence for people who require constant nursing care and have significant deficiencies with activities of daily living...
care are much more restricted. VA nursing homes are primarily for veterans needing care for a service-connected condition, or who have service-connected disability ratings of 70% or higher. Reservists and National Guardsmen who were called to active duty by a Federal Executive Order qualify for VA health care benefits.
In 2010, there were 1 million veterans receiving disability pensions. 25% of these were Vietnam veterans with the disability of adult-onset diabetes
Diabetes mellitus type 2
Diabetes mellitus type 2formerly non-insulin-dependent diabetes mellitus or adult-onset diabetesis a metabolic disorder that is characterized by high blood glucose in the context of insulin resistance and relative insulin deficiency. Diabetes is often initially managed by increasing exercise and...
. More Vietnam veterans are being compensated for diabetes than any other disease.
Also see: Benefits for US Veterans with PTSD
- CHAMPVA Supplemental Insurance
- GeriatricsGeriatricsGeriatrics is a sub-specialty of internal medicine and family medicine that focuses on health care of elderly people. It aims to promote health by preventing and treating diseases and disabilities in older adults. There is no set age at which patients may be under the care of a geriatrician, or...
- GerontologyGerontologyGerontology is the study of the social, psychological and biological aspects of aging...
- List of Veterans Affairs medical facilities
- Veterans Health Information Systems and Technology Architecture (VistA)VistAThe Veterans Health Information Systems and Technology Architecture is an enterprise-wide information system built around an Electronic Health Record , used throughout the United States Department of Veterans Affairs medical system, known as the Veterans Health Administration .It's a collection...
- Journal of Rehabilitation Research and DevelopmentJournal of Rehabilitation Research and DevelopmentThe Journal of Rehabilitation Research and Development is a peer-reviewed open access medical journal published by the Rehabilitation Research and Development Service of the Veterans Health Administration Office of Research and Development. Itcovers research on rehabilitation medicine. It...
- Retirement communityRetirement communityA retirement community, or active adult community, is a very broad, generic term that covers many varieties of housing for retirees and seniors - especially designed or geared for people who no longer work, or restricted to those over a certain age . It differs from a retirement home which is a...
- Rehabilitation Research and Development ServiceRehabilitation Research and Development ServiceThe Veterans Health Administration Office of Research and Development's Rehabilitation Research and Development Service funds research to improve or restore function in veterans who have become disabled because of injury or disease...
- United States Secretary of Veterans AffairsUnited States Secretary of Veterans AffairsThe United States Secretary of Veterans' Affairs is the head of the United States Department of Veterans Affairs, the department concerned with veterans' benefits and related matters...
External links
- Veterans Health Benefits and Services
- "The Best Care Anywhere" by Phillip LongmanPhillip LongmanPhillip Longman is an American demographer. Presently he is a Schwartz Senior Fellow at the New America Foundation, and he formerly worked as a senior writer and deputy assistant managing editor at U.S...
, Washington Monthly, January/February 2005 - Nonprofit Research Collection on Veteran Health Published on IssueLab