The VA has issues, but the policy makers (Congress) need to take a look at themselves. Congress put in place policies that encourage coverups. They have created a huge organization with diverse tasks: cemetery management, benefits management (home loans, medical, etc.), research, and medical care. Medical care is only 34% of their budget, and while the number of patients and the level of care needed has greatly increased the number of providers (MD, NPs, RNs) has not even come close to keeping up the pace. Yet, it isnt just the policy from Congress and the White House that is problematic, but internal policy - though that is also frequently pushed by Congress. In DoD facilities a nurse practitioner practices independently, but not at the VA. This unnecessarily slows down treatment and is not consistent with the Department of Defense practice where active duty and retirees get care in a timely manner. Let me offer one more issue that is impacting care. The average provider spends about 50% of his or her time documenting care in the government. While electronic medical records make information more available in principal they are time pumps. As we make every effort to provide evidence based care, the same is not true for documentation. Many requirements are put in place without any evidence that the excess documentation does anything to improve care or outcomes. Maybe it is time to change our approach to health care and revisit why we do what we do: 1. Patient to provider ratios that are adequate based on evidence 2. Full scope of practice for nurse practitioners, which is consistent iwth current evidence 3. Administrators that are clinicians and are able to identify what is reasonable in practice and what is not 4. Policy makers that have worked in facilities, know the strengths and weakness, and recognize what it actually means to care for a patient 5. Documentation requirements that are based on evidence and not driven by lawyers and accrediting bodies that are money driven 6. A revised application system that puts individuals in the private sector on equal footing in the government hiring systems and hiring that is streamlined 7. Workload requirements that are consistent with private practice Sadly, I think Congress, the President, and the appointees that lead the VA care more about politics than veterans.
Posted on: Sat, 17 May 2014 18:36:19 +0000
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