President Obama signed legislation August 7 instituting major reforms in the Department of Veterans Affairs (VA) that includes initiatives to expand access to mental health care and increase the number of mental health clinicians in the VA’s health system.
The signing came nine days after the Senate unanimously confirmed Obama’s choice of Robert McDonald, a West Point graduate and former Proctor & Gamble executive, to head the troubled department.
The $16 billion legislation provides several incentives for the VA to hire more health care professionals, including psychiatrists. One would raise the cap on medical education debt repayment under the Health Professionals Educational Assistance Program from the current $60,000 to $120,000.
In addition, the number of graduate medical education residency positions in the VA in areas with health professional shortages would increase by up to 1,500 over five years, with priority given to primary care, mental health, and several other specialties.
The law would also fund studies by the VA’s Office of the Inspector General (OIG) to identify which categories of clinicians have the greatest staffing shortages, information that will be used to guide expedited hiring in those professions. Since the OIG earlier noted the need for more psychiatrists, it is likely that the profession will be included among those shortage categories.
“In 2012, the VA Office of the Inspector General identified recruiting and retaining psychiatrists as the VA’s greatest challenge in the mental health area,” said APA President Paul Summergrad, M.D., in a statement. “This legislation puts in place several actions to directly address that shortage and will result in many more veterans having timely access to needed psychiatric services.”
Other provisions in the law include mechanisms for allowing veterans who live more than 40 miles from a VA facility or who can’t get an appointment within 30 days to obtain care from non-VA doctors or hospitals. Such care would still be coordinated by the VA, which would obtain copies of any medical records generated by the private clinician.
Veterans groups have typically opposed measures that would convert the brick-and-mortar VA system into a health insurance program. However, there is an understanding that when care is difficult to obtain, the purchase of outside care is acceptable in certain circumstances.
“We want the VA to be the primary source of health care for veterans,” said Louis Celli, legislative director for the American Legion, in an interview with Psychiatric News. “But veterans are complicated patients, and the VA needs to maintain a complete history and have it available to non-VA providers as needed.”
The final bill allows for outsourced care for a period of three years or until $10 billion is expended.
Provisions in the law will also address some of the issues that led to the resignation of former VA Secretary Eric Shinseki in May.
These include the ability to more easily fire or demote VA officials for poor management. Administrators at several facilities were found to be manipulating reports on wait times in order to receive annual bonuses. The new law requires that wait times be posted online and mandates an independent assessment of services furnished in VA medical facilities.
Several of the workforce measures included in this law echo provisions in the Ensuring Veterans’ Resiliency Act which APA strongly supported, but which did not pass on its own.
“APA will engage the VA in a collaborative effort and will work to ensure a robust and enhanced psychiatric workforce,” said Jeffrey Regan, a deputy director of APA’s Department of Government Relations. ■