MedicalResearch.com Interview with:
David Shulkin, MD
Ninth Secretary, U.S. Department of Veterans Affairs
Washington, District Of Columbia
Shulkin Solutions LLC
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: I came to VA in 2015 as Under Secretary for Health, as a result of the 2014 wait time crisis. At that time, it was determined that in some locations, veterans had been waiting for care for too long and there were allegations that this had resulted in harm to a number of veterans. I was in the private sector at the time, but was asked by President Obama to come and help improve the situation.
Upon my arrival we created systems to determine which veterans were waiting for urgent healthcare and which ones for routine care. From here, we established same day services for all veterans waiting for urgent care through primary care and behavioral health access points. This goal was achieved nationwide at the end of 2016. When I became Secretary in 2017, we began publishing our wait time data for all to see, so that veterans had accurate information on which to base their choices on and to provide transparency into where we were improving and where we needed to focus our efforts. In addition, through programmatic and legislative efforts, we expanded our utilization of private sector options so that veterans with clinical needs would be able to get better access to care.
This study was meant to determine whether our efforts from 2014 had resulted in improvements to access and in addition how access to care in the VA compared to access in the private sector. Despite limitations in the data available from the private sector (since others do not publish their actual wait time data similar to VA) we used a data set that we felt had some applicability for these comparisons.
We found that for the most part, VA wait times are often shorter than in the private sector, and that VA wait times had improved since 2014 while the private sectors access had stayed the same.
MedicalResearch.com: What should readers take away from your report?
Response: The report shows that VA has made real progress since 2014 to improve access and has kept up with, or surpassed, access in the private sector in many cases.
Readers should take away that several factors helped contribute to these findings and are important for policy decisions going forward.
- First, management focus on access has been critical to achieve these improvements. When I came to VA, I established access to care as our top goal for VA.
- Second, transparency makes a difference, and publishing wait times should be a goal for all of healthcare.
- Third same day services should also be a goal for healthcare. It is important to differentiate urgent needs from routine care to get the system designed correctly.
- Finally, from a national policy perspective for veterans, the goal of designing an integrated system between VA and the private sector is something that I believe is important. The policy objective should be to keep a strong VA to serve the unique needs of veterans, working with the private sector to provide access where VA cannot provide timely or the best quality care.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: This study focused on specialties on which Merritt Hawkins published data. An expansion of this study into other specialties, such as mental health, would be important. Additionally, an examination of rural geographic areas, where over 30% of Veterans reside, would be useful for policy planning. As noted by Dr. Stephan Fihn, in an accompanying editorial, an assessment of wait times for established patients would also be significant. Future assessments can also include an evaluation of interventions used and their effects on health outcomes.
MedicalResearch.com: Is there anything else you would like to add?
Penn M, Bhatnagar S, Kuy S, et al. Comparison of Wait Times for New Patients Between the Private Sector and United States Department of Veterans Affairs Medical Centers. JAMA Netw Open. 2019;2(1):e187096. doi:10.1001/jamanetworkopen.2018.7096
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