Risk Management Issue within the VAMC


concern is that veteran are not getting their treatment in timely manner and are dying at many VA facilities.  solution is Choice Cards and NVCC (non va care consult) placed to send vets outside of VA for their specialized care that the VA cannot curretnly provide.  3 peer reviewed references less than 5 years old


Risk Management Issue within the VAMC


The Veterans Health Administration Program provides integrated health care to millions of veterans each year. The program provides medical coverage to veterans and their beneficiaries across the U.S. Over the recent past, concerns have arisen over the quality of health care provided in VA facilities. Veterans are currently forced to wait for a long time in accessing some forms of health services. This paper will analyze the situation at VA facilities and provide recommendations on the way forward.

Steps that have been set in place or discussed to address the issue

A number of steps were identified as remedy to the aforementioned issues. Use of Choice Cards and non-VA care consult (NVCC) were identified as the most appropriate strategies to remedy the growing concerns at the hospital. Choice Cards are issued under the Choice Program. This program enables veterans to access health care from the larger community without having any impacts on the entitled VA benefits or VA health care (“VA,” 2015). All individuals under the VA health care program are eligible to the use of Choice Cards if two situations apply. These include a situation whereby a veteran is expected to wait for not less than thirty days before receiving medical care at VA, and where a veteran lives outside a forty mile radius from the hospital, or the veteran faces travel challenges. Veterans are required to notify VA for approval to get access to health care from their communities.


Another step taken to improve the quality of health care is use of non-VA care consult (NVCC). Non-VA care consult is a referral program that enable veterans to access health care from outside facilities in situations where VA Hospitals does not have sufficient capacity to provide the specialized care needed (“VA,” 2015). Referrals are facilitated by the use of Computerized Patient Record System (CPRS). Veterans are supposed to issue notification to VA in case of accessing non-VA health care. The NVCC members are supposed to schedule appointments with the non-VA provider. VA Hospital ensures that all patients in non-VA facilities are monitored. This process comes to a close when the veteran is discharged or transferred to a VA facility. Non-VA emergency care is allowed based on a number of conditions. For instance, in a situation where the veteran fails to make improvements after seeking medical care at VA facility for over 24 months.

How the agency determined a path to remedy the problem

The medical fraternity at VA facilities realized that here was need to provide more health care options to veterans. In the recent years, VA facilities have been grappling with capacity issues leading to lengthy wait periods for patients. This problem begun to emerge following the U.S. involvement in military operations in Iraq and Afghanistan. In 2002, VA facilities recorded an enrollment of 6.8 million veterans compared to 8.9 million veterans in 2013, which represents about 30 percent increase. During the same period, there was also a significant increase in the number of outpatient appointments by about 39.9 million. This represents an 85 percent increase in the number of outpatient appointments. Projections indicate that the number of enrollment and outpatient appointments is likely to increase in the coming years. Due to capacity problems, reports had begun to emerge of VA facilities failing to provide health care in a timely manner, leading to severe complications or even death among patients.

VA facilities realized the need to offer non-VA medical care to members after it was observed that some of the member veterans were not accessing treatment in a timely manner or there was lack of specialized treatment to cater for their needs. It is worth noting that VA’s goal is to “provide timely, high-quality health care for veterans.” It is for this reason that a need for use of Choice Cards and non-VA care consult was realized. In 2014, the Veterans Access, Choice, and Accountability Act (VACAA) was signed into law by President Obama (“VA,” 2015). This act requires all VA facilities to develop a program that caters to the health needs of all veterans by allowing them to access medical care outside the VA facilities. The agency realized that in order to solve capacity issues and lack of specialized care, there was need to prove non-VA medical care (“GAO,” 2015).

Valid methods adopted by other facilities to address the same problem

Different methods have been adopted by various facilities in dealing with capacity issues and ensuring quality health care is provided to patients. One of the methods adopted is community collaborations which have the ability to improve health care delivery. Community collaborations involve all stakeholders in health care system (Nadinia & Melissa, 2016). These include government officials, health care providers, citizens, and advocates. All these stakeholders come together to explore challenges and possible solutions in health care delivery. Government involvement in the program is of great importance. Government involvement leads to development of flexible approaches that address the specific problems in health care. Community collaborations work to ensure accessible health care. Accessible health care is defined by three aspects which include prompt treatment, appropriate care and affordability. Community collaborations have successfully been applied by Oregon Department of Health in dealing with capacity issues by lobbying for funds to expand existing facilities.

Other facilities have adopted different approaches. Performance improvement measures have also been adopted by a number of hospitals in order to enhance timeliness in health care delivery. Performance improvement measures involves reducing wastage (Nadinia & Melissa, 2016). It involves lean thinking in order to reduce wastage. In this method, the organization engages in continuous improvement process to streamline services and provide the best quality of health care. Benchmarking has become a common practice in health care facilities for improving delivery of service. Benchmarking involves implementing the best practices from other health care facilities. Benchmarking involves collaboration among a number of health care organizations with an aim of improving practice (Ettorchi-Tardy, Levif, & Michel, 2012). Health care organizations can use benchmarking to develop a healthy competition and improve performance. This helps to measure progress of the benchmarking process and its effectiveness. Benchmarking has successfully been applied in Sam Houston Hospital and the University of Virginia Hospital.

Comparison of the results to the process being developed by the agency.

The process being developed at the agency is short-term in nature compared to the processes adopted by other health care facilities which are aimed for the long-term. The agency has adopted short-term methods such as use of Choice Cards and non-VA care consult. These methods can only serve to alleviate the problem in the short-term. According to GAO (2015), the number of enrolments and outpatient appointments in VA facilities is projected to increase in the coming years. This calls for long-term strategies to solve this problem. Long-term methods such as community collaborations can enable VA facilities improve capacity and quality of health care provided. Community collaborations can enable VA facilities acquire funding necessary to expand inpatient facilities and the emergency department units by lobbying the local and national governments. In addition, VA facilities may be able to obtain funding necessary to improve medical facilities so as to cater for specialized treatment.

Recommendations and conclusion

Due to the sharp increase in the number of patients, it is recommended that VA facilities should improve their capacity as a long-term solution to the crisis. This can be achieved by expanding the current inpatient facilities and emergency department units. It is also recommended that states should play a critical role in helping health care facilities improve capacity and quality of care. States should also be proactive in taking measures to increase the number of medical personnel such as nurses and physicians. For instance, states should provide student nurses with scholarships and other form of incentives in order to boost their enrolment numbers.

In conclusion, VA facilities should enhance timeliness in health care delivery in order to reduce serious complications and death arising from delayed treatment. Currently, VA facilities have adopted two short-term strategies to address the situation. These strategies involve the use of Choice Cards and allowing the veterans to access non-VA medical care. Although these measures have helped to improve the quality of service delivered, there is need for a long-term solution such as expansion of health facilities to cater to the increasing number of patients.



Ettorchi-Tardy, A., Levif, M., & Michel, P. (2012). Benchmarking: A Method for Continuous Quality            Improvement in Health. Healthcare Policy7(4), e101–e119.

Nadinia, A. D., & Melissa, L. (2016). Foundations of Health Information Management. New York, NY:         Elsevier Health Sciences.

U.S. Department of Veteran Affairs (VA). (2015). Veterans Access, Choice, and Accountability Act of           2014. Retrieved from: http://www.va.gov/opa/choiceact/documents/choice-program-fact-      sheet-final.pdf

U.S. Government Accountability Office (GAO). (2015). Managing Risks and Improving VA Health Care.     Retrieved from: http://www.gao.gov/products/GAO-15-290.

NUR492 Signature Assignment:Process Improvement & Change Project Presentation