Veterans Health Administration increases care provided under MISSION Act

The Veterans Health Administration’s approximately 380,000 employees, one third of whom are veterans, come to work every day with one goal in mind: to serve veterans, their families, caregivers and survivors as well as they have served our country. The president has called this a sacred obligation and there is no higher mission.

For us, veterans are our mission.

Our employees prove daily we will face any challenge and go to any length — including during the worst pandemic in more than 100 years — to ensure that veterans receive the care and services they earned and deserve.

As we strive to lead through the pandemic and beyond, we want veterans to know that our sacred obligation to you includes ensuring your access to quality health care — whether in a Veterans Health Administration (VHA) facility, virtually or in the community.

The 2018 Maintaining Internal Systems and Strengthening Integrated Outside Networks Act — commonly known as the MISSION Act — established criteria as part of the new Veterans Community Care Program allowing eligible veterans to receive care from non-VHA health care providers. Over the past several years, the total volume and percentage of VHA Community Care has rapidly increased. In total, since the MISSION Act was passed, more than 3 million veterans have been authorized for at least one appointment in the community, and about 33 million veteran community care appointments were completed in fiscal year 2021. These are the facts.

VHA’s guidance is clear: Veterans should always be informed about their care options and not be prevented from seeking care in the community. This is not just the law; ensuring that veterans have a choice for community care is the right thing to do. VHA is constantly striving to increase options for care through VHA facilities, via telehealth, and in the community, including in rural and underserved areas.

The pandemic forced health care systems across the nation to make tough choices. No health care facility ever wants to be in a position to have to cancel patient appointments for routine care, but VHA had an ethical responsibility to prioritize patient safety — and our focus has remained on the safety of the veterans who entrust us with their care throughout the pandemic. Like the private sector, VA also saw veterans decide to defer care due to pandemic concerns. The cancellation of appointments has been amplified by groups critical of VHA, but this is only a small part of what is actually an inspiring story. VHA undertook a comprehensive effort to reach out to veterans who had appointments canceled to ensure that necessary care was delivered. Our employees worked tirelessly to ensure that veterans received care, deferring time off and retirement out of their own sense of dedication. A recent study by The Lancet Regional Health found these employees succeeded — and VHA’s strategy likely saved veterans’ lives.

Because of this employee dedication, VHA outpatient care only dropped by 8 percent in FY 2020 — compared to an estimated 31 percent drop in the private sector. That’s because we acted quickly to shift to telehealth and did more outreach than ever before — specifically to ensure veterans needs were met. In FY 2021, VHA provided the most outpatient care ever in our history, with more than 78 million health care visits — surpassing the previous record of 74.2 million set prior to the pandemic in FY 2019.

If you are a Veteran, it’s important you know the VA exists to support you and that the people working at VHA are there to make your journey easier — not harder. We are deeply proud of the work we do for you. We know there will be times when we miss the mark, and when we do, we are going to own it and fix it because that is what veterans deserve.

VHA continues to receive and comply with Freedom of Information Act requests to provide data associated with access and community care appointments, only to see the information selectively used to support the false assertion VHA is not following the MISSION Act. When others suggest VA is not fully complying with the MISSION Act, veterans are being misled. As a VHA leader and a physician, I cannot express how deeply this concerns me. False narratives can have a negative impact on the willingness of some veterans to seek the care they need.  

A release of data Nov. 19, 2021 includes total numbers of scheduled appointments, completed appointments, community care authorizations, and appointments cancelled by VHA provider or patient, as well as the percentage of patients seen within and outside wait time access standards.

This data only represents part of the health care process. It doesn’t show whether cancelled appointments were shifted to virtual care or when they were rescheduled. And it doesn’t show how satisfied veterans who use VHA for their health care are.

VHA data points from the last fiscal year offer a more comprehensive view of access to care across VA: a record number of clinical care visits within VHA health care facilities, more mental health care provided than ever, nearly half of all veterans who use VHA for health care being authorized to use community care, significant increases in rural veteran access to virtual care, urgent referrals to a specialist completed in under an average of two days whether within a VHA facility or the community, and veteran trust scores surpassing 90 percent.

Millions of eligible veterans are being referred to community care under the MISSION Act criteria, one of which is appointment wait time. It is important for veterans to know individual eligibility for community care is determined when they request an appointment be scheduled; it is not ever based on reported national or facility averages.

We know we have work to do, including some challenges getting appointments scheduled with community care providers in a timely manner, and to address this, VHA is working to create a more seamless process of care delivery for the veteran — informed by veteran input. This exemplifies our commitment to ensuring that veterans consistently receive care at the right time and in the way they want to get it.

We are proud of all VHA clinicians, nurses and other employees who took extraordinary actions to care for patients during the height of the pandemic and continue to do so today as we work to ensure our patients return for routine and preventative services. We want veterans to know we’re open. If you need care, we will ensure you get that care. We continue to stand ready to serve you with the commitment, dedication and excellence you should expect from VHA.

Dr. Steven L. Lieberman is acting under secretary for health at the U.S. Department of Veterans Affairs.