Until a few years ago Veterans generally had to visit a Veterans Affairs (VA) facility to receive care. Long wait times and long travel times caused problems for Veterans who needed healthcare. In response, the VA MISSION Act (2018) expanded access to community providers and increased benefits for caregivers. A recent supplement in Medical Care explores some of the effects of such changes to the VA.
Urgent Care
Of special interest in the issue is the impact on use of urgent care services in the community. Starting in June 2019, eligible Veterans were able to receive urgent care from providers in the VA’s community network, without prior authorization. The urgent care benefit “provides a new way to deliver unscheduled, low-acuity acute care to Veterans,” according to new research by Anita Vashi and colleagues.
Through the first nine months of the program, 138,305 Veterans made a total of 175,821 urgent care visits to VA community network providers. That accounted for 2.4% of a cohort of 5.9 million potentially eligible Veterans. By comparison, 7.3% of Veterans visited a VA emergency department (ED) or clinic for lower-acuity (non-emergency) conditions during the same period.
Dr. Vashi and colleagues examined trends in community urgent care use. These kinds of visits generally increased over time but varied between regions. Most Veterans using community urgent care lived in urban areas. And most were not very far from VA sources of care. In fact, more than 80 percent lived within 30 minutes of a VA primary care site. And most had no copays for urgent care visits.
A particularly interesting finding was that women and younger Veterans more often took advantage of the urgent care benefit. Driving time was another key factor. Specifically, Veterans who lived more than 60 minutes from a VA ED or VA urgent care center were twice as likely to choose community care services.
The study provides insight into how “early adopters” are taking advantage of the urgent care benefit. We will have to wait, however, to see the full impacts of the benefit.
County-level Predictors of Care
Another article in the supplement focuses on impacts of the 2014 Choice Act [pdf]. The Act was an earlier expansion of community care options for Veterans. Sara Gordon and colleagues aimed to “measure county-level growth in VA community-based primary care . . . and to assess whether this increased in rural counties with limited access to VA facilities.” Data from 2015 to 2018 for 3,132 counties was compiled from VA administrative sources, Area Health Resource Files, and County Health Rankings.
Dr. Gordon and colleagues found that rates of community-based primary care use increased fairly steadily from 2.7% to 7.3%. Rural counties had greater growth and having a VA facility within the county was associated with less growth. A related article extended these findings by examining community-based primary care use at the individual level.
Read More In The Supplement
Other articles in the supplement cover a wide range of topics. These include, for example, rapid turnaround qualitative analysis–a research method with broad applicability to other interventions. Other articles examine the relationships between VA providers and community care providers, care coordination, and media coverage of the VA waitlist scandals. Several excellent articles investigate Veterans’ access to care (here, here, and here) and experiences with care.
Check out the full supplement for some great reading!
Jess Williams