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Publication Briefs

Veterans' Concerns on Using Community Emergency Services

Through the Veterans Choice program, and more recently, the MISSION Act, VA aims to consolidate and streamline existing community care programs. Further, recent changes to community emergency care policies include expanding VA’s network of community emergency departments (EDs). Given the growing interest in consumer decision-making around ED use, and the complexities of how VA provides coverage for community emergency care, it is imperative to understand Veterans’ experiences navigating coverage for this care. This qualitative study explored Veterans’ experiences with VA coverage when accessing community emergency care. The study team contacted Veterans between November 2018 and February 2020 who had an ED visit (VA or community) in the prior year. The 50 Veterans who participated in this study were geographically diverse; 78% were male, and 80% used community emergency departments. Veterans in this study self-presented (i.e., referred themselves) to community emergency care.


  • Veterans emphasized three major concerns when navigating community emergency care: 1) they lack information about benefits and eligibility when they need it most; 2) they require assistance with medical billing to avoid financial hardship and future delays in care; and 3) they desire multimodal communication about VA policies or updates in emergency coverage.
  • After using community emergency care, Veterans were often subject to out-of-pocket medical expenses including co-pays, uncovered medical bills, ambulance fees, and prescription costs. Veterans emphasized stress and frustration associated with these financial issues and debt.
  • Veterans recommended ways VA could improve and tailor communication about community emergency care coverage and updates in policies, including emails, letters, text messaging, phone calls, and face-to-face conversations. Overwhelmingly, a one-size-fits-all approach to disseminating this information was not


  • To strengthen VA’s transformational efforts, the following strategies should be considered: 1) increasing transparency regarding eligibility and estimated out-of-pocket costs for community emergency care; 2) resolving billing errors and rejections in a timely fashion; 3) improving access to prescriptions and ambulance services for community emergency care; and 4) maximizing communication preferences by using multifaceted, bi-directional strategies.

NOTE: Since the study was completed, VA's Office of Community Care has implemented practices to reduce the financial/billing concerns noted, in part via a national call center and online portal to notify VA when a Veteran has been seen in the community.


  • After study completion, VA processes for community emergency care underwent transformations to better address Veterans' challenges; therefore, ongoing feedback from Veterans is needed.

This study was funded by HSR&D. Drs. Nevedal and Vashi, and Mss. Wong and Urech are part of HSR&D’s Center for Innovation to Implementation (Ci2i) in Palo Alto, CA.

Nevedal A, Wong E, Urech T, Peppiatt J, Sorie M, and Vashi A. Veterans’ Experiences with Accessing Community Emergency Care. Military Medicine. May 24, 2021; online ahead of print.

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What are HSR Publication Briefs?

HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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