Wall Street Journal: A Simple Way to Reduce VA Waiting Lists

As the Trump circus show performs, as President Obama and Congress are vacationing, and as Iran is about to receive billions of dollars for giving nothing in return our Vets are still waiting for proper healthcare.

Dr.  Nasser Gayed, a professor in the departments of Medicine and Medical Information Science at the University of Illinois College of Medicine at Urbana-Champaign,  in a Wall Street Journal  Op-Ed recommends: “Veterans who see private doctors should be able to fill prescriptions directly from a VA pharmacy. Standing in line for a VA doctor’s OK is unnecessary.”

Recent news reports suggest that despite efforts by the Department of Veterans Affairs, many veterans continue to wait a long time to get medical care at a VA facility. Yet a simple administrative change could reduce or even eliminate many of the waiting lists.

I recently retired after a 25-year career as a VA physician, the last 14 years of which I spent providing primary care at an outpatient clinic. A large proportion of the veterans I saw were already receiving care from private doctors. However, to get their medications at a lower cost, they had to enroll in the VA system—because VA pharmacies can only fill prescriptions written by a VA health-care provider. So these veterans had to get in line along with the many others who truly do need VA health care.

When veterans who receive care outside the system get an appointment, they bring a list of medications and notes from their private physicians—and the VA physician simply prescribes the same or reasonable substitution to be filled at a VA pharmacy. The vets have to continue to see a VA physician to get additional refills or new prescriptions filled.

Based on my experience, I believe that waiting lists to see VA physicians can be reduced perhaps by a third or more if VA pharmacies can directly fill prescriptions that are written by private physicians outside the VA system. This will free up VA doctors’ and nurses’ time to see other patients.

There is a precedent for changing the current prescription rules. In the early 2000s, an influx of new veterans seeking benefits led to waiting lists exceeding six months. In July 2003 Justice Department lawyers determined that the secretary of Veterans Affairs had the authority “to fill prescriptions written by non-VA physicians for veterans placed on VA waiting lists.” The VA allowed its pharmacies to do so, on a temporary basis.

Many veterans are rightfully irritated and confused at the constant back and forth between their private and VA health-care providers. They may have difficulty getting to VA facilities because of the distances involved, their health conditions, or both. I’ve watched disabled veterans struggle for 10 or 15 minutes to get out of their car or van to the waiting room. They have difficulties getting to any health-care provider, but an additional visit to a VA facility is unnecessary. All this so the VA physician can pretend to provide actual care.

There is another drawback to having to see two doctors. The VA employs hundreds of quality-assurance managers who review the care provided to all enrolled veterans. They collect data and offer feedback to physicians (recommending changes or even disciplinary action) about the care they give. But a VA physician has little or no control over the care of veterans who see private doctors.

VA physicians can refuse to prescribe medication if they disagree with a veteran’s private doctor, but it is rare that they will contradict prior treatment recommendations. Doing so might shake a veteran’s confidence in the care he is getting. That is detrimental to a patient’s health.

So the VA system keeps chugging along, with providers pretending to provide care, quality managers pretending to review such care, and supervisors harassing the providers about the care provided elsewhere. Meanwhile, veterans wait and wait to get care they need.

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