A New View for the VA


Increased Hiring Within the VA

Dr. Shulkin. A large part of the Veterans Choice Act funds that were authorized in 2014 were targeted toward new hires. The VA has hired a net increase of 14,000 employees. I think there were 1,600 net new physicians and 3,500 net new nurses. We’ve hired professionals in almost every part of the organization, including homeless coordinators, social workers, and pharmacists. You’ve seen hiring across the board. I think that you will continue to see that, but it will be more targeted toward areas we’ve identified that will impact access the most and where the shortages are the greatest.

Primary care doctors and psychiatrists will be 2 areas where there will be targeted hiring, and there are specialty areas that, depending on the geography, that will be targeted for hiring as well. Depending upon what our budget looks like, which we still don’t yet know for 2016, 2017, and 2018, we will see how much additional flexibility may be there for hiring.

Cost vs Quality of Care Debate: Lessons Learned From Hepatitis C Care

Dr. Shulkin. I think the challenge and the lessons that we’re trying to learn from the hepatitis C example was that when we put our 2015 budget together, we didn’t even know that new hepatitis C drug [cures] existed. We were looking at the older version—the interferons, which of course, weren’t curative in the same way. By the time that our budget actually hit, there was a new drug that offered new hope. Frankly, for the VA, that amounted to about a billion dollars in unfunded monies, because we didn’t know about the drug when we put that budget together. So that is a challenge for us.

Having said that, I’m very proud of the way that VA responded by moving money around to make sure that veterans got the right care. Nobody in this country has treated more veterans with hepatitis C than the VA. Nobody even comes close. More than 35,000 veterans received treatment for hepatitis C that’s curative in 2015. Nobody does it by addressing disparities in health care the way the VA does. We reach out to those that are in most need. Those with the mental health issues. Those that are essentially socially isolated. We’re calling them and bringing them in. No other health system does this. The VA has actually shown why it’s a great organization in responding this way. 2016 and beyond, we are committed to trying to find ways to do that. We will work with our ethics people, our hepatologists, our policy people, Congress, and drug makers to make sure that we can do the best we can for veterans.

Providing Long-term, Quality Care While Offering Options to Veterans

Dr. Shulkin.The VA is not a voucher program. This is not sending people out into the community to find their own care. VA health care is a well-integrated coordinated plan for people who we feel a responsibility for, for life. They are going to be VA patients as long as they want to be VA patients. But this is our responsibility, so that when they go out into the community, their care needs to be coordinated and tied back into VA health care. It can’t be seen as a separate health care system or a fragmented health care system.

That’s the problem that we’ve learned in health care, both in the VA and outside the VA. When you fragment care, when you separate care, that’s where you find quality problems and gaps in care that lead to people missing necessary testing or treatments that they need.

We deliberately designed Veterans’ Choice to address these issues, because these are our patients and our responsibility. When they go into the community, it doesn’t mean they leave VA. It means they’re getting care in the community as part of the VA health care system.


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