VA Program Allows Vets to Access MH Care in Community
Abstract
A new VA program is designed to increase access to care for veterans with mental and substance use disorders. This article is part of a series written in conjunction with APA’s Council on Advocacy and Government Relations whose goal is to encourage members to become active in APA’s advocacy efforts.
A patient starting substance use treatment at a Veterans Administration (VA) Medical Center balked at the hours-long drive she’d need to make on a daily basis from her rural home. She’d had success years ago being treated in a private clinic in her own community and said she’d feel more comfortable returning there.
Under a new program now being rolled out by the VA, veterans may obtain health care in their own community when it can’t be obtained feasibly within the VA system. The Veterans Community Care Program (VCCP) was created in response to national concerns about health care access for veterans, including long waits for appointments and lack of access to specialists and urgent care. The program was created by the VA MISSION Act, which took effect in June 2019. MISSION stands for Maintaining Internal Systems and Strengthening Integrated Outside Networks.
The MISSION Act was created to make it easier for patients living in rural locations or areas where there are no VA hospitals to receive psychiatric care in their community, says Christina Girgis, M.D.
While veterans close to the Edward Hines Jr. VA Hospital in Illinois can typically obtain an intake appointment for mental health or substance use treatment within 24 hours, for patients living in smaller cities or rural areas, it’s not so simple, explained Christina Girgis, M.D., the hospital’s medical director of the Consultation-Liaison Psychiatry Service and an associate professor and director of the psychiatry residency program at Loyola University Medical Center.
“One of the reasons that the MISSION Act was passed is that if you live two and half hours from a VA medical center, that can make it very difficult to go two to four times a week for an appointment, which is the treatment protocol for certain conditions,” she said.
As for the substance use patient described above, Girgis said, “she received approval for community care, she’s had success, and logistically it’s much easier for her.” The program may also be very helpful for patients in need of a specific type of therapy that is not offered by a particular VA facility but can be obtained in their community.
Patients using the VA’s previous community care option, known as the Veterans Choice Program, which VCCP replaces, faced lengthy delays before seeing a doctor, according to reports by the Government Accountability Office (GAO). Problems included inadequate networks of providers, overly complex referral and appointment scheduling processes, and lack of timely payment to providers.
Researchers wrote that the VA needs to make major improvements in data collection and monitoring of these outside care appointments. It is unclear how or whether the VA will be able to solve these problems with VCCP.
Under the new program, veterans are eligible to seek community-based treatment in various circumstances including the following: there is no VA facility in their state or territory, the VA does not offer the care that the veteran needs, the care offered does not meet quality standards, wait times for an appointment exceed 20 days, or drive times exceed 30 minutes.
In all cases, veterans must receive approval from the VA before obtaining care in the community, and health care professionals must be within the VA network or VA approved. Veterans can also access telehealth services nationwide, including telepsychiatry visits, using their mobile device or home computer.
David Peyok, D.O., an APA Council on Government Relations fellow and a fourth-year psychiatry resident at the Jack C. Montgomery VA Medical Center in Oklahoma, said a major advantage of VCCP is that the medications and ancillary testing such as CTs or MRIs needed by participating veterans are fully covered by the VA, so psychiatrists do not need to alter treatments plan due to patients’ inability to pay, as sometimes happens with self-pay patients.
Despite VCCP’s potential for expanding veterans’ access to treatment for mental and substance use disorders, challenges lie ahead for the new system, particularly coordination of care. “Medical record compatibility between the VA system and community providers is nonexistent,” Peyok pointed out. “The most frequent complaint that I hear from veterans when they return to a VA facility after being seen by a community provider is ‘That should be in my record.’ ”
Furthermore, veterans are expected to understand how many visits have been authorized with a community health care professional and keep track of how many visits remain. Under the Veterans Choice Program, many would exceed the number of authorized visits and be billed thereafter. “This would create frustration in all parties and cast a haze over the program,” Peyok said. “This problem could potentially be ameliorated by some sort of reminder system to regularly inform the veteran of how many authorized visits remain.”
While the expansion of telehealth and telepsychiatry in the VCCP is appreciated by many younger patients, it may not be welcomed by middle-aged or older veterans who did not grow up using a smartphone. “The average age of veterans treated by the VA is 55 years old. Most of them have a flip phone, and they don’t like the ‘doc in a box,’ ” Peyok said. “Some patients will drive 50 minutes to Muskogee to meet in person with a physician, only to find out it’s a telehealth visit. They are not happy.”
Finally, patients receiving care in the community might miss out on one of the most valuable features of VA treatment: the camaraderie and group support of other veterans who have had similar experiences. “Being in the military is such a unique aspect of their personal identity, and they may not get this kind of support anywhere else,” Girgis said.
Ultimately, Girgis said, she’s pleased to see that the VCCP covers primary care, urgent care, and mental health/substance use care. “It shows how much we are valuing mental health care and seeing mental health problems as important. This shows we’re continuing to strive for mental health parity.”
APA is advocating for the passage of legislation to improve veterans’ access to mental and substance use disorder treatment, to increase funding for research and programming to boost the MH/SUD workforce, and to address post-deployment mental health concerns, such as PTSD, depression, anxiety, and suicide. ■
