VA facilities yield better patient experience scores for care coordination, communication, and overall provider rating.
Health facilities operated by the Department of Veterans Affairs (VA) still lag behind civilian health centers in timely access to care, although they perform better than non-VA health centers in other patient experience measures, according to new findings published in Health Affairs.
This data, which PatientEngagementHIT obtained via email, has implications for the VA MISSION Act, which expanded veteran access to non-VA, community care sites when they face extraordinary barriers to receiving VA care.
The MISSION Act, which rolled out in June 2019, built upon a previous program from the VA, the Veterans Access, Choice, and Accountability Act of 2014, known as the Choice Act. The Choice Act established the Choice Program, which like the MISSION Act allowed veterans to receive non-VA care when they faced extraordinary barriers to care.
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Those barriers may have included a wait time that was longer than 30 days, extreme geographic barriers, or needing a procedure that was not available at a nearby VA medical center.
This latest data looked at patient satisfaction information about VA healthcare and healthcare received through Veterans Choice. Although that program is no longer in use, it served as the basis for the current VA MISSION Act, and data about the program can still inform patient sentiment about receiving non-VA healthcare, the researchers argued.
The researchers assessed patient satisfaction in VA and non-VA care facilities by utilizing SHEP data, which largely leans on CAHPS survey information. The data source included veteran satisfaction with care in VA facilities as well as facilities to which they were referred as a part of Choice.
Researchers specifically looked at patient satisfaction with timely access to care, provider communication, care coordination, and an overall provider rating.
By and large, veterans rated VA facilities higher in the latter three categories than non-VA facilities. Non-VA facilities outranked VA facilities with regards to timely access to specialty care, although differences in satisfaction were limited between VA and non-VA primary care settings.
And it stayed this way for a while, the researchers added. Throughout the duration of the study, there was a gap between patient experience in VA and non-VA care facilities, although experience did improve over time in both types of settings. In other words, although non-VA facilities improved in patient experience, VA settings improved, too.
Differences in care experiences between the two facilities could be due to some logistical hurdles, the researchers acknowledged. When a patient is used to operating solely within the VA, interacting with the Choice program has proven difficult. It is also difficult for non-VA facilities to coordinate care with VA specialists — like they would have to do as part of Choice — than it is for VA primary care to coordination with VA specialists.
But the other half of the problem could be cultural.
“VA providers with experience treating a large number of veterans would likely have had more military cultural competence and familiarity with veterans’ medical and social issues than community care providers who treated more civilians, even after training in this area,” the researchers pointed out.
As noted above, the current MISSION Act built upon the Choice Act, which was implemented in 2014 after the VA wait time scandal that ended with then-VA Secretary Eric Shinseki’s resignation.
Choice was riddled with flaws, lawmakers said, and still resulted in long wait times for veterans. The program was also exceptionally complex, lawmakers noted.
The MISSION Act aimed to improve upon Choice by streamlining the parameters by which veterans may qualify for community care. Additionally, the MISSION Act got rid of some administrative properties tied to the referral process, ideally reducing the amount of time patients must wait between VA referral and connecting with the third-party clinician. The law expanded VA’s community care program and streamlined it into one program.
The separate programs notwithstanding, the researchers said this data could be used to make decisions about the extent to which VA should lean on community care.
“VA leaders may use these data along with other quality and cost data for make-versus-buy decisions—to justify use of care within the VA versus purchase of care outside the VA,” the researchers said.
This could be done an interpersonal level, as well. Veterans and their VA providers may use this information to determine whether waiting a little longer for VA care would be better than risking the fragmentation that often comes when a veteran accesses non-VA, community care.
VA leaders and providers may consider how patient experience scores can vary across both VA and non-VA facilities, the team recommended. For example, care coordination was rated very well in the study, but certain regions in the country could falter in coordination.
Additionally, policymakers may be mindful of MISSION Act changes that could address issues spelled out in this study. That may include the exclusion of a third-party community care scheduler, which was used in Choice. Getting rid of third-party schedulers may improve continuity of care, the researchers posited.
“Given the VA’s long-standing history of treating veterans, it is not surprising that veterans generally rate the VA outpatient experience more highly than care received through purchased community care,” the team concluded.
“At the same time, some of the observed differences and the persistence of lesser satisfaction with community care over time were not expected. As purchased care further expands under the MISSION Act, monitoring of meaningful differences between settings should continue, with the results used to inform both VA purchasing decisions and patients’ care choices.”
Source: Patient Engagement Hit