AAFP Discusses Members' Concerns With VHA Officials

A Feb. 14 meeting in Washington between Veterans Health Administration officials and AAFP representatives was the direct result of a Jan. 3 letter from the Academy to the Department of Veterans Affairs. In the letter, the AAFP asked the VA to make changes in the way prescription restrictions and communications between VHA physicians and community-based physicians are handled.

"I came away impressed with the intent of the VHA to better understand the concerns of our members in caring for VHA patients," said the Academy's EVP Douglas Henley, M.D., in an interview after the meeting.

The Jan. 3 letter expressed AAFP members' concerns about the VA's inability -- in most cases -- to fill prescriptions written by non-VHA providers. Veterans with prescriptions from community physicians must have a VHA physician rewrite prescriptions to get them filled at VHA pharmacies, where there may be a cost savings, the Academy wrote. The letter also noted that the Department of Defense allows military facility pharmacies to fill prescriptions from civilian physicians who use the DOD formulary.

During the Feb. 14 meeting, VHA staff members explained the reasons behind the differences between the VA and the DOD, said Henley. "According to the VHA officials, the VA views itself primarily as a provider of health care services," said Henley. "The VA's intent is to provide a primary care physician for every veteran who wants to access the VHA system and not just serve as a pharmacy. So, at appropriate intervals, the VA requires patients who want to keep getting their medications through the VHA to see a VHA health professional, whether or not the patients also see a doctor in the community."

Henley noted that VHA staff members said the VA views the DOD more as a payer for services than a health care provider, and, thus, the DOD allows its active military beneficiaries easier access to its pharmaceutical system. In addition, VHA staff members noted that the VHA drug formulary may be accessed online.

Another concern detailed in the Academy's letter was AAFP members' frustration that as patients move in and out of the VA clinic system, "there is little, if any, communication from the VA health system and its physicians to community physicians who care for those patients."

VHA staff members, said Henley, acknowledged past difficulties. They also demonstrated improvements to the My HealtheVet online program, which is scheduled to be implemented in 2007. "With the patient's permission, a community physician will be able to go into the My HealtheVet system and get visit progress notes, prescribed medications, lab data, hospital discharge summaries and other information," said Henley. "Access to this information should go far to encourage a collegial relationship between non-VHA family physicians and VHA physicians."