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CHICAGO -- Physicians should demand that the Department of Veterans Administration do more to improve access to patient medical records and expand healthcare options for veterans in the community, said a approved as policy by the American Medical Association's House of Delegates meeting here this week.
After a lengthy discussion over whether pressing the VA to achieve interoperability for veterans' electronic medical records was a step too far, a policy recommendation which straddled timely "exchange" and the "acceleration of interoperability" of patient medical records was approved.
Don Casey, MD, of the American College of Medical Quality, brought forward the amendment to raise the bar to interoperability. Casey said he spent 3 years trying to sort out the medical records of his father, a WWII veteran former POW, which were split among three different facilities.
Some delegates expressed concern that seeking full interoperability would delay actual implementation.
Massachusetts delegate Tom Sullivan, MD, disagreed. "Exchange is easier, but not as good as interoperability," he said, adding that it might take longer but is more valuable.
The House ultimately voted 394-98 to recommend "that our AMA encourage the acceleration of interoperability of electronic personal and medical health records in order to ensure seamless, timely, secure and accurate exchange of information between VA and non-VA providers and encourage both the VA and physicians caring for veterans outside of the VA to exchange medical records in a timely manner to ensure efficient care."
The House also approved a recommendation to "encourage the VA to engage with physicians providing care in the VA system to explore and develop solutions on improving the healthcare choices of veterans."
Finally, the House debated a final recommendation to expand the , which allows veterans to obtain VA-paid care from community clinics and physicians under certain circumstances.
Delegates from Ohio stressed that dollars should not be shifted from other veterans' programs to expand the Choice program.
Samuel Lin, MD, of the American Medical Group Association (AMGA) said that, according to several military organizations, the VA's recent proposed budget would expand funding to the Choice Program by terminating individual unemployability benefits at age 62. These benefits serve individuals with 60% or higher disability. And since these veterans haven't been able to work, they don't have Social Security, he said.
"I think this is a severe injustice," Lin said, repeating an earlier comment that the AMA discourage Congress from "robbing Peter to pay Paul." The reference committee agreed.
Asked where such funding should come from, an Ohio delegate responded glibly, "from Congress" which has plenty of money.
Vito Imbasciani, MD, a delegate from California and the Secretary for the California Department of Veterans Affairs pointed out that if physicians want the Veterans Choice Act, which expires in August, to be expanded they should encourage the Congress to reinstate the Act.
Imbasciani also noted that the Choice Act finances 1,500 graduate medical positions in VA hospitals but only 350 have been claimed.
Residencies will remain permanently even if the Act is allowed to expire, he said.
The proposed amendment to make explicit that new funding be required for expansion was ultimately approved.
The report was accepted in lieu of another resolution, which sought to allow veterans to use funds spent by the VA on their care, possibly through premium support, to buy private healthcare, and for those over 65 to be able to reduce the costs of their Medicare premiums.
"The [Veterans Choice Program] was an admission that additional mechanisms were necessary to ensure veterans have timely access to the healthcare they need," Gerald E. Harmon, MD, AMA Board of Trustees member and Board Chair-elect said in a press statement. "Not all of our veterans live near VA facilities, and accommodations should be made to ensure they get the care they earned and deserve. The VA has focused on improving the care it provides to veterans and has made substantial strides, but improvements are still necessary."