Efforts to open access to Veterans Affairs health care have already begun, ahead of proposed legislation intended to give veterans awaiting VA health care more options. For example, the Washington, D.C., VA Medical Center is currently cold-calling veterans who await appointments to offer them the opportunity to receive private-sector care through VA’s fee-basis option.
For veterans who need treatment services, such as consults, diagnostic tests and acute care, these expanded options may reduce extraordinary wait times. For those who require specialty care, such as neurology, cardiology, oncology and orthopedics, non-VA options may also prove viable in instances where a veteran’s disability is relatively mild or moderate.
However, for veterans who require multidisciplinary specialized services, such as spinal cord injury rehabilitation, amputee care and polytrauma, non-VA options remain largely unavailable.
The Department of Veterans Affairs is tasked to provide advanced care, technologies and continuity of services in order to meet the needs of catastrophically disabled veterans who rely on lifelong support and care to maximize their function and independence. This group of veterans includes:
• 2,500 with moderate to severe brain injury-related conditions that required in-patient rehabilitation.
• 38,000 with major limb amputations.
• 21,000 with spinal cord injuries and disorders.
• 50,000 who are blind and visually impaired.
For veterans with spinal cord injuries or dysfunction (SCI/D), appropriate care outside of the VA is limited by geography and the absence of a continuum that mirrors the VA’s comprehensive system of care. The United States has 14 non-VA Model Systems of Care for spinal cord injury that employ physiatrists, therapists and nurses who offer general rehabilitation, sports medicine, pain management and treatment for strokes, orthopedic injuries and spinal cord injuries. However, no non-VA system offers the continuum of care from initial disability to end of life.
Service members who began acute rehabilitation at places like the Shepherd Center in Georgia face disruptions in their rehabilitation when forced to transfer care to a VA facility once discharged or relocate closer to home. VA senior leaders cited an external review conducted by a major consulting firm comparing the VA’s SCI services to those in the private sector and foreign countries. It showed that the VA’s coverage was more comprehensive and provides spinal cord injury and disease services that are lifelong, coordinated and uniquely organized.
Veterans with SCI/D who seek care outside the VA health care system often face providers who understand general rehabilitation but are unfamiliar with SCI-specific issues, such as autonomic dysreflexia and genitourinary dysfunction of neuropathic origin. These well-meaning providers assume that treatment and rehabilitation approaches for conditions that are seemingly similar to spinal cord injury are sufficient.
But the unique challenges presented by SCI/D are well documented yet not-so-well appreciated even in many medical circles. Without access to health records, particularly where the veteran is a poor self-historian or cannot manage his own care, non-VA treatments that a veteran may choose place him at serious risk when those treatments deviate from the accredited standard of care in the VA health system.
Accreditation signifies that a hospital’s program represents the highest quality, value and optimal outcomes for the individuals served. All VA Spinal Cord Injury & Disorders Centers are accredited by the Commission of Accreditation for Rehabilitation Facilities and the Joint Commission, a private nongovernmental agency that establishes guidelines for the operation of hospitals and other health care-related organizations.
Until the private sector meets these standards with a coordinated, nationwide alternative that can be consistently monitored, the VA health care system is the only real choice for the most catastrophically disabled veterans. Absent viable alternatives, access to this proven system of care must be ensured.
Sherman Gillums Jr., a Buffalo native, is associate executive director of veterans benefits for Paralyzed Veterans of America. A Marine Corps veteran, he receives health care at San Diego VA Spinal Cord Injury & Disorders Center.