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FORUM Editors, Karen Bossi and Margaret
Trinity, recently sat down with Robert
McDivitt, Director of the VA Ann Arbor
Healthcare System (VAAAHS) and Acting
VISN 11 Network Director, to explore the
topic of access—what access means in the
context of the health care Veterans receive,
as well as successes and challenges that VA
Ann Arbor Healthcare System has experienced
around access to care for Veterans.
For the past 35 years, I've worked in a variety
of positions across six medical centers
and three corporate assignments within the
VA health care system. I am also a Veteran
and view access issues from a patient perspective.
Across VA, I've witnessed an evolution
from a system that once focused on inpatient
care to a system focused on outpatient
care, then primary care, and now, health and
wellness in partnership with Veterans. The
focus has shifted to providing care when it
is needed by Veterans and where Veterans
are located. Today, Veterans have access to
care on a real time basis via smartphones.
And most Veterans have experienced at
least one virtual encounter—whether telehealth,
videoconferencing technology, or an
e-consult. At the facility level, I have seen a
pronounced increase in telephone communications
between clinicians and Veterans.
So, in fact, VA is a leader in access to care,
although it has not always been portrayed
as such.
Over the last few years, the VAAAHS has
focused on increasing capacity in both
its primary care and specialty care clinics,
which led us to hire an additional 60 clinicians
as a result of implementation of the
Choice Act. One of our priorities has been
to expand evening and weekend clinics. As
a result, we've seen a 10 percent increase in
outpatient visits from FY 14 to FY 15.
We've also worked hard to improve wait
times for specialty care referrals. One example
is the endoscopy clinic, where in the
past we had hundreds of Veterans on the
wait list for an appointment. Today, we do
not have any Veterans on the electronic wait
list and, for routine screening, we are well
within the 30-day guideline for securing an
appointment. To accomplish these improvements
in access, we expanded staffing in the
endoscopy clinic, and we also redesigned
clinic workflow. The next phase is for us to
expand the physical space within the endoscopy
clinic itself.
Another prime example is improved access
to dermatology consults. We now have a
teledermatology initiative whereby our outpatient
clinics have dermatoscopes so that
images can be forwarded to University of
Michigan faculty physician and a diagnosis
provided within 48 hours. This is just one
example of a telemedicine technology that
VA has aggressively rolled out in the last
decade.
Looking ahead, one of our strategic goals is
to roll out the Patient-Aligned Care Team
(PACT) concept in several specialty clinics.
We feel that the PACT concept has been
successful in primary care in terms of surrounding
Veterans with a team of providers,
and using communication tools that do not
necessarily require the Veteran to physically
travel to the clinic. We anticipate translating
the successes that we saw in primary care
PACT into specialty care.
Our job is working in partnership with Veterans.
At VAAAHS, we are continuously
engaged in a conversation with the Veterans
we serve. We involve Veterans in myriad
ways across our facilities. We recently designed
a new Veterans Welcome Center and
we have Veterans who serve on our governing
board. We've conducted several Veteran
Tele-Townhalls via Facebook with hundreds
of Veterans in virtual attendance. Last
year, VAAAHS conducted a Tele-Townhall
with a congressional representative who was
available to answer questions, much like
a call in radio show; we had 700 Veterans
participating. The Facebook Townhall has
become an important listening post for us.
As a health care executive, my goal is to take
evidence-based research results and implement
them in a way that works in a given
environment. The excellent work undertaken
by HSR&D researchers in the area of
access as well as many other critical topics
has allowed facility leaders such as myself to
roll out best clinical practices from health
system to health system and from VISN to
VISN.
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