VA Adds Primary Care to Contract Program for Veterans' Health

Move Follows AAFP Advocacy to Facilitate Access to Civilian Physicians

August 16, 2014 11:19 am Michael Laff

When stories emerged earlier this year about veterans facing long wait times to obtain medical care, the AAFP was the first physician organization to offer a solution(2 page PDF): Increase veterans' access to community-based primary care.

The Department of Veterans Affairs (VA) announced this week(www.va.gov) it is adding primary care to a list of contracted medical services that can be provided at non-VA facilities as part of the Veterans Health Administration's Patient-Centered Community Care (PC3) program(www.nonvacare.va.gov).

The program allows physicians outside the VA to provide specific types of care for eligible veterans when local VA facilities are unable to do so because of geographical inaccessibility or limited capacity. Before this announcement, care provided through the PC3 program had been restricted to inpatient and outpatient specialty care, mental health services, limited emergency care and limited newborn care for female veterans.

"With the addition of primary care services, VA medical centers can now use PC3 to provide additional types of care in order to reduce wait times," Secretary of Veterans Affairs Robert McDonald said in an Aug. 13 news release. "This modification is another example of how we are working to ensure veterans get the care they need, when they need it and where they want to be seen."

Story highlights
  • The Department of Veterans Affairs (VA) announced this week it is adding primary care to a list of contracted medical services that can be provided at non-VA facilities.
  • The program allows physicians outside the VA to provide specific types of care for eligible veterans when local VA facilities are unable to do so because of geographical inaccessibility or limited capacity.
  • The VA should now focus its efforts on recruiting primary care physicians, says one family physician.

The VA's announcement is the latest in a series of actions taken in response to media reports that veterans were unable to schedule appointments or faced long wait times to see a physician at a VA facility. Earlier this month, President Obama signed the Veterans Choice, Access and Accountability Act into law. The bipartisan legislation provides funding to allow the VA to hire more physicians and makes it easier for veterans to see physicians outside VA facilities, including community-based family physicians. The VA noted in its announcement that it is exploring ways to incorporate the PC3 program into the act.

Arizona AFP President Andrew Carroll, M.D., of Chandler, told AAFP News he was surprised the PC3 program had previously existed solely for specialty care but suspects that it was operating on a limited budget. The VA likely encountered greater difficulty in recruiting specialists than it did primary care physicians to work in its facilities. Yet the program "put the cart before the horse," in his view.

Most patients will consult a primary care physician before even thinking about visiting a specialist, said Carroll, who is also clinical assistant professor in the Department of Family, Preventive and Community Medicine at the University of Arizona College of Medicine in Phoenix.

"Primary care physicians can provide the lion's share of care," he noted. "If they have 10 orthopedists, 10 cardiac surgeons and 10 family physicians, that's a bad proportion."

The VA should now focus its efforts on recruiting primary care physicians, said Carroll, adding that it's important for the program expansion to include accountability measures because Congress is adding a considerable amount of money to the VA budget.

Physicians who want to care for veterans face bureaucratic hurdles because of insurance restrictions and the agency's own rules. For example, Carroll, who provides care for a number of veterans in his practice, has tried to participate in the TRICARE network but said UnitedHealthcare, which operates the program in Arizona, has not allowed him to join.

He also cautions that although it's a step forward that provisions are being made for patients who live in rural areas far away from a VA facility, many of the neediest veterans reside in large metropolitan areas. Numerous retired military members reside in the Phoenix area, for example, having served at nearby Luke Air Force Base.

"Don't build a bridge where there's no water," Carroll said. "A lot of people in metropolitan Phoenix fell through the cracks. We lost veterans who ended up dying because they wanted to see a physician and couldn't."


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