‘Centers of Excellence’ for veterans; far from an excellent idea

Unquestionably, the system for providing healthcare to more than 6 million of America’s 22 million veterans needs to be reformed and strengthened. But some ideas being put forth will be bad for veterans, including one plan that sounds benign at face value but, upon closer inspection, is revealed to create fewer options for veterans who most need the VA healthcare system. This proposal would shrink VA healthcare down into a small number of “Centers of Excellence” and move the bulk of veterans’ care into the private sector.

VA already operates a number of “Centers of Excellence” focused on post-traumatic stress disorder, suicide prevention, prosthetics, Parkinson’s disease, epilepsy, geriatrics and vision loss, to name a few.  Each of these “Centers of Excellence” is fully integrated with a VA medical center to ensure that veterans have access to a full continuum of physical and mental health care services.  However, some politicians and pundits have proposed downsizing VA from a comprehensive healthcare system to only a smaller number of “Centers of Excellence” that focus only on specific war wounds or service-connected injuries and illnesses like PTSD, traumatic brain injury, spinal cord injuries, and amputations. For all other care, veterans would be forced to turn to the private sector.

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There are two major problems with this idea: one, it would actually result in less access to healthcare for veterans who choose and rely on VA and two, it would diminish overall quality by making it much harder to coordinate care for severely injured or ill veterans.

Under this proposal, VA’s integrated healthcare system of 150-plus medical centers and 1000-plus outpatient clinics would shrink, forcing veterans into the private sector for all their primary care. With fewer VA “Centers of Excellence” located farther apart, primarily in heavily populated urban areas, hundreds of thousands of veterans with disabling injuries who rely on the VA for their care would likely have to travel farther and wait longer for care.

Fracturing veterans care between “Centers of Excellence” for specialized care and a separate private sector health system for all other care reflects the very opposite of best practices in healthcare delivery, which calls for a single, responsible point of coordination of care to ensure proper treatment and controlled costs. VA’s Patient-Centered Medical Home Model, for example, which the Agency for Healthcare Research and Quality lauds as “transforming how primary care is organized and delivered,” holds one entity accountable for meeting, or at least, coordinating, the “large majority of each patient’s physical and mental health care needs, including prevention and wellness, acute care, and chronic care.” Should this “Centers of Excellence only” proposal come to pass, no single provider, clinic, or hospital would be accountable for coordinating a veteran’s medical care. Instead, different medical professionals would be accountable for discrete aspects of care, resulting in less care coordination, putting veterans at risk of negative health outcomes. 

Yes, we need to improve veterans’ access to healthcare. But let’s not lose sight of the fact that, according to an independent assessment recently mandated by Congress, quality at VA remains high, performing the same or significantly better than non-VA health care on 12 of 14 measures. The answer is not to downsize the VA, which would be the real result of relying only on “Centers of Excellence.” The better answer is to increase access by integrating private community care into the VA system to create veterans health care networks, creating a nationwide system of urgent care for veterans and expanding telemedicine or web-based health services.

“Centers of Excellence” – an idea that sounds excellent until you look at what it really means for veterans’ healthcare. That’s why DAV, representing nearly 1.3 million veterans of all generations, is setting the record straight.

Augustine, a Vietnam-era combat-wounded Army veteran and Maryland resident, is executive director of DAV's Washington Headquarters.

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