DCs Are First Providers Added to U.S. Veterans Health Care System in 25 Years
"...to care for him who shall have borne the battle and his widow and his orphan..."
President Lincoln, March 1865
Abraham Lincoln's healing words to North and South as the end of the Civil War drew near now serve as the motto and the mission of the U.S. Department of Veterans Affairs (VA). The VA system provides health care for more than 4 million American veterans through a massive nationwide system of hospitals, community-based health clinics and nursing homes. For the last 75 years though, doctors of chiropractic have been outsiders to the VA system and all but excluded from providing care to veterans who seek treatment through their local VA facility. But, this is changing rapidly and the ACA wants to keep its members informed.
Thanks to a decade-long lobbying campaign led by the ACA and the Association of Chiropractic Colleges, and decisive action by VA Secretary Anthony Principi, the VA has officially changed its thinking on chiropractic care. Doctors of chiropractic will soon become the first licensed health care providers added to the VA system in a quarter of a century.
Q: In addition to stating that the VA's goal is to make chiropractic care available system-wide, what pro-chiropractic changes has Secretary Principi ordered in the VA health care system?
- Immediate inclusion of chiropractic care in at least 21 VA facilities around the U.S. through hiring or contracting with an initial group of DCs to provide chiropractic care to veterans through the VA system.
- The integration of chiropractic care for neuromusculoskeletal conditions, including subluxation complex (under applicable state law) into all missions of the VA health care system, including patient care, education, research and response to disasters and national emergencies.
- The full integration of Doctors of Chiropractic as partners in health care teams.
- The inclusion of chiropractic care into the VA's funding of research into treatment of service-connected conditions.
- The inclusion of chiropractic colleges and students in training programs at VA facilities.
- The establishment of a goal to ensure continuity of chiropractic care for newly discharged veterans who have been receiving chiropractic care through the Defense Department health care system.
Q: What is the status of Direct Access to DCs in the VA system?
Secretary Principi did not endorse direct access to DCs, but encouraged shared decision-making regarding treatment options and has sought to establish access safeguards for every VA patient who wants or needs to see a DC. Nevertheless, the ACA strongly supports direct access in the VA system and worked with Congressman Bob Filner (CA) on legislation he introduced in the U.S. House of Representatives in March 2004 that would provide for direct access to DCs in the VA system. The ACA is working to build support for the Filner bill (HR 4051) in Congress while urging the VA to fully implement Secretary Principi's directives without delay. By introducing HR 4051 and continuing to work closely with the ACA on this issue, Rep. Filner has sent a clear message to the VA bureaucracy that delays in making chiropractic care available and accessible to veterans will not be tolerated.
Information on ACA-backed direct access legislation (Rep. Filner's HR 4051) now before Congress: http://www.acatoday.com/media/releases/033104.shtml
Rep. Filner's House of Representatives floor statement on HR 4051: http://frwebgate.access.gpo.gov/cgi-bin/getpage.cgi?dbname=2004_record&page;=E489&position;=all
Q: What are the first steps the VA will take to begin offering chiropractic care?
In announcing his decisions regarding inclusion of chiropractic care in the VA system, Secretary Principi specifically acknowledged that the goal is "to ensure that chiropractic care is ultimately available and accessible to veterans who need it throughout the VA system." To begin the process, each of the 21 VA service regions, known as Veterans Integrated Service Networks or "VISNs," will each select a VA facility to offer chiropractic care and then equip that facility for a doctor of chiropractic to treat patients. The selected facilities will then either hire DCs as full-time or part-time employees or contract with a DC to provide care at the VA facility.
The site selection and the hiring or contracting will fall under the authority of the VISNs and the selected facilities.
Q: Where are the VA facilities located?
Here's a map of the VA's 21 service regions, or VISNs:
http://www1.va.gov/directory/guide/division_flsh.asp?divisionId=1
Here's a map of VA health facilities:
http://www1.va.gov/directory/guide/home.asp?isFlash=1
Q: How should DCs interested in providing care to veterans proceed?
Initially, chiropractic care will be offered at 21 VA facilities (at least one in each VISN) around the U.S. The ACA will be working to ensure that the VA adheres to a prompt timetable for roll-out of chiropractic care and to urge the VA at all levels to pursue the larger goal expressed by Secretary Principi of making chiropractic care available throughout the VA system.
VA will announce when the application process will begin and will provide information on how to obtain application forms, the information that will be needed, and where to send the applications. DCs will be employed under Title 38, which pertains only to health care positions in the VA's Veterans Health Administration. The rules regarding Title 38 employment are different than those used for employment in non-health care positions in the Federal government. Applicants will need to provide information regarding their education, training, licensure, experience, health status, prior privileges at health care facilities, professional references, malpractice history and adverse actions, or criminal violations, as appropriate. The credentialing process used in VA requires primary source verification and screening through the appropriate State Licensing Board and the National Practitioners Data Bank.
As hiring plans and procedures are finalized, ACA's Government Relations team will be in close contact with VA officials. ACA members will receive the most current information available from the VA.
Q: What should every DC know about the VA health care system and its patients?
From just 54 hospitals in 1930, VA's health care system has grown to 163 hospitals, with at least one in each of the 48 contiguous states, Puerto Rico and the District of Columbia. VA operates more than 850 ambulatory care and community-based outpatient clinics, 137 nursing homes, 43 domiciliaries and 73 comprehensive home-care programs, including clinics in Alaska, Hawaii, the Virgin Islands and the Philippines. VA health care facilities provide a broad spectrum of medical, surgical and rehabilitative care. More than 4.5 million people received care in VA health care facilities in 2002. VA is used annually by approximately 75 percent of all disabled and low-income veterans. In 2002, VA treated 564,700 patients in VA hospitals and contract hospitals, 50,267 in nursing homes and 22,541 in domiciliaries. VA's outpatient clinics registered approximately 46.5 million visits.
More than 6.8 million veterans are enrolled in the VA health care system as of October 2002. VA has experienced unprecedented growth in the medical system workload over the past few years. The number of patients treated increased by over 9.5 percent from 2001 to 2002. Since 1996, all veterans have been eligible for care, though Congress has established a priority system to categorize veterans (to view, click on http://www.va.gov/elig/). Fiscal restraints have led VA to curtail enrollment of veterans in Priority 8, those without service-connected disabilities and an income beyond the limits established annually.
VA manages the largest medical education and health professions training program in the United States. VA facilities are affiliated with 107 medical schools, 55 dental schools and more than 1,200 other schools across the country. Each year, about 81,000 health professionals are trained in VA medical centers. More than half of the physicians practicing in the United States have had part of their professional education in the VA health care system. VA's medical system serves as a backup to the Defense Department during national emergencies and as a federal support organization during major disasters.
The VA website is www.va.gov. The VA's Chiropractic Advisory Committee website, which contains Secretary Principi's announcement and additional background information on ACA-backed legislation establishing a permanent chiropractic care benefit for America's veterans through the VA system, can be found at http://www1.va.gov/primary/page.cfm?pg=55.
ACA members with questions, comments or in need of additional information are encouraged to contact ACA Government Relations at 1-800-986-4636 or via e-mail at mowens@acatoday.com.
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