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| ASSEMBLY EDITION • ORLANDO, FLA |
Thousands of American veterans who seek health care services from the Department of Veterans Affairs get twice the medical care but only half the medical quality. Why? Because, despite ongoing AAFP leadership calls urging a change in policy, VA policy continues to demand duplicative lab tests, physical examinations and other procedures before the VA will pay for prescriptions recommended by veterans' family physicians at home.
Moreover, family physicians may have to wait for months to get medical records of their patients who receive subspecialty or hospital care from the VA health system.
The result endangers patients and wastes precious health care dollars, say family physicians. But two resolutions approved by the Congress of Delegates Tuesday could help shut down the duplicative system and open up communication between the VA and family doctors.
The first resolution directs the Academy to intensify its advocacy efforts with Congress and the Department of Veterans Affairs for a policy that requires the Veterans Health Administration to fill prescriptions written by non-VA physicians. The second calls on the AAFP to encourage the VA to share health information "in a timely manner with family physicians who are treating patients who are concurrently being treated in the VA health system."
Both resolutions mirror those passed by the 2003 Congress of Delegates. Since then, AAFP has written to VA Secretary Anthony Principi, J.D., about the Academy's concerns. In its response, the VA "failed to address the central issue," according to a report to the delegates from the AAFP Commission on Health Care Services.
Wasting money to save money
Individual veterans can save hundreds of dollars a year by filling prescriptions through the VA. But the VA wastes millions of dollars a year by refusing to fill or pay for prescriptions written by non-VA physicians without first requiring veterans to undergo duplicative medical examinations and tests, several delegates said.
"This is a duplication of services," said Iowa alternate delegate John Carroll, M.D., of Carroll. "They get identical lab work, and they may have a (VA) physician telling them they no longer need the prescription. Then I get a call in the middle of the night" when patients develop problems because they dropped needed medications.
Worse, patients may get a prescription that duplicates medication they are already taking, said New Hampshire alternate delegate Paula Leonard-Schwartz, M.D, of Manchester.
"The patients don't realize they're getting a double dose because the name of the (VA-prescribed) medication is different" from the one written by the primary care doctor, she told reference committee members. "This results in poor-quality, if not dangerous, care."
Waiting for communication
On the other end of the care continuum, family physicians often wait months to get medical records of patients who have received subspecialty or hospital care through the VA. The situation means hometown family physicians may be forced to order services that - though possibly provided at the VA health facility - must be repeated because family physicians cannot gain access to records of the services provided at the government facility.
"Patients are meandering in and out of the VA system," said Tim Alford, M.D., of Kosciusko, Miss., chair of the AAFP Commission on Legislation and Governmental Affairs. "The VA is functioning in a vacuum; they're not acknowledging that there are other sources of care for these people."
Though a problem for many parts of the country, the VA's impaired communication isn't universal, and the Congress of Delegates moved to encourage interaction between the VA health service and family physicians.
Pennsylvania VA health officials have made efforts to increase communication with community-based physicians, according to Mary Elizabeth Roth, M.D., of Allentown, AAFP delegate to the AMA.
"More and more, they're realizing their patients are not seeing only VA health service providers," she said.
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