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PCS 2022 Accomplishments

patientcare servises 2022 accomplishments
Dr. Saslo

Introduction

I am grateful Patient Care Services (PCS) has yet another opportunity to further VA’s mission to provide the world-class health care our Veterans have earned and deserve. Fiscal Year 2022 was one that demonstrated transition and excellence for PCS as well as Veterans Health Administration (VHA) as a whole. This year it was my privilege and honor to be sworn in the as Assistant Under Secretary for Health for Patient Care Services (PCS) / Chief Nursing Officer and I have been fortunate to serve our Nation’s Veterans, families, caregivers, and survivors for the past 37 years -in a variety of roles. VHA is focused on outcomes for Veterans. With access, advocacy, outcomes and excellence as our fundamental principles, PCS strives to help set the bar on VHA’s six priorities:

  • Hire faster and more competitively
  • Connect Veterans to the soonest and best care
  • Serve Veterans with toxic exposures
  • Accelerate our journey to High Reliability
  • Prevent Veteran suicide
  • Support Veterans’ whole health, their caregivers, and survivors

As we continue to turn these priorities into real-world achievements, it is incredibly gratifying to work with a team that remains focused, skilled, and ready to ensure the continuity, timeliness and commitment to our Veterans, their caregivers, and survivors. It is my pleasure to share some of our accomplishments here on our PCS Annual Report.

-M. Christopher Saslo, DNS, ARNP-BC, FAANP,
Assistant Under Secretary for Health for Patient Care Services,
Chief Nursing Officer

Patient Care Services National Program Offices

Click the links below for an overview of the PCS National Program Office, their accomplishments and highlights.

Care Management & Social Work

Care Management and Social Work Services (CMSW) is a leader in interventions that impact Social Determinants of Health (SDOH), embrace the values of social justice and promote the wellness and enhanced quality of life for all Veterans, service members, their caregivers and loved ones. CMSW develops policy and provides oversight of five national programs and several national initiatives such as guardianship, human trafficking, and Social Work Patient Aligned Care Teams.

Accomplishments

Post-9/11 Transition and Case Management provided personalized transition assistance and coordinated health care from 51 VA Liaisons for Healthcare (VA Liaison) to 4,000+ service members. This is the highest number since the inception of the program.

Over 200,000 Post-9/11 Veterans were screened for case management, and 8,700+ Post-9/11 Veterans received ongoing case management by Post-9/11 Military2VA Case Management teams.

Over 19,700 families were accommodated in VA Fisher Houses, saving over $10.7 million in lodging costs for Veterans and their loved ones.

The Intimate Partner Violence Assistance Program successfully launched a pilot program at 10 VA medical centers to assess the feasibility and advisability of assisting Veterans who experience intimate partner violence or sexual assault.

Highlights

Post-9/11 Transition and Case Management:

  • 95% of service members were satisfied with how the VA Liaison was able to coordinate their care per VSignals responses.
    • 90% of service members who transitioned through a VA Liaison reported increased trust and confidence in VA per VSignals responses.
  • 90% of service members who transitioned through a VA Liaison attended an initial appointment and engaged in VA health care, with another 2% having upcoming appointments scheduled.
  • 800+ Post-9/11 Veterans transitioned from Public-Private Partnerships to VA
    • VA Liaisons coordinate care for Veterans from the Wounded Warrior Project’s Warrior Care Network (four Academic Medical Centers who specialize in brain injuries and Post-Traumatic Stress Disorder).
    • VA Liaison coordination of care services expanded to six Gary Sinise Foundation’s Avalon Network sites.

National Social Work, Fisher House and Family Hospitality and Intimate Partner Violence Assistance programs:

  • 63 VA medical centers implemented the Advanced Care Planning Via Group Visits program, engaging Veterans, their families and caregivers in advance care planning by facilitating a group discussion that elicits experiences and encourages participants to identify a 'next step' to take in the process of planning for future health care needs.
  • The Patient Aligned Care Team Social Work Staffing Program increased interventions provided for Veterans in rural and highly rural areas by 52.55% (8,967/ 26,031 total) compared to FY21.
  • The National Social Work program initiated Human Trafficking education and raising awareness activities across VA by facilitating 22 trainings for internal VA staff and external community providers.
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Caregiver Support Program

The mission of the Caregiver Support Program (CSP) is to promote the health and well-being of Family Caregivers who provide care for our nation’s Veterans. CSP is comprised of two programs: Program of General Caregiver Support Services (PGCSS) and the Program of Comprehensive Assistance for Family Caregivers (PCAFC). Both programs provide services to support and engage caregivers of Veterans as partners in care, integrating caregivers as members of the Veteran’s health care team. PGCSS provides resources, education, and support to caregivers of all era Veterans within four core elements.

Accomplishments

During FY22, VA received over 74,000 unique applications to PCAFC.

In response to the decision from Beaudette v. Denis McDonough, Veterans and caregivers who disagree, in whole or in part, with a VA decision under PCAFC now have expanded appeal options outside the VHA Clinical Appeals process.

Veterans and caregivers have an opportunity to appeal using the following methods: Higher Level Review, Supplemental Claim or the Board of Veteran Appeals.

VHA dispatched nearly 450,000 letters to eligible Veterans and caregivers informing them of their new appeals rights.

VA is engaged in a comprehensive review of the current PCAFC eligibility criteria. During this review period, current participants will remain enrolled in PCAFC and continue to receive support and services unless revoked or discharged for a reason unrelated to reassessment.

On September 21, 2022, VA’s interim final rule (RIN 2900- AR28) was published extending PCAFC eligibility for Legacy Participants, Legacy Applicants and their Family Caregivers through September 30, 2025.

Highlights

VA held listening sessions with multiple external stakeholders, including Veteran Service Organizations (VSO), Military Service Organizations (MSO) and other caregiver and Veteran advocacy groups and staff; meeting with over 70 unique caregivers and Veterans. Leveraging the feedback from listening sessions, VA identified and implemented the following improvements within CSP:

  • VA redesigned the PCAFC wellness contact visit process to make them more centered on the caregiver and Veteran’s overall needs.
  • VA streamlined its approach to the PCAFC assessment process and continues to streamline the assessment with the aim to reduce the burden for the Veteran and their caregiver in completing reassessments.
  • CSP is collaborating with VBA to leverage best practices with eligibility decisions with the aim of implementing strong practices within CSP to process PCAFC applications.
  • VA is addressing the need for better transparency and understanding in PCAFC decisions by updating its notification letter to inform applicants as to the reasons for their application approval or denial.
  • CSP launched three caregiver customer experience surveys with support from the Veteran Experience Office (VEO) to capture the voice of the caregiver and Veteran. This survey will be used to make ongoing improvements within CSP.
  • The Legal and Financial services contract was awarded and will be available to assist Veterans and caregivers.

During FY21, CSP successfully operationalized the development of a Review and Appeals workstream.

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Connected Care

The Office of Connected Care (OCC) focuses on delivering health information technology (IT) solutions that increase Veterans' access to care, support and participation in their own health care. Connected Care works collaboratively to standardize and promote the use of virtual and digital health products and their interfaces. This includes driving the growth and adoption of technologies that help Veterans communicate with their care teams and coordinate, track, and manage their health care. These technology and health solutions are delivered through Connected Care programs including VA Telehealth Services, My HealtheVet, VA Mobile, and Virtual Health Resource Centers.

Accomplishments

More than 2.3 million unique Veterans participated in over 11 million episodes of telehealth.

At the end of FY22, VA completed 41,000 Digital Divide consults, where patients can receive a video-capable device after a referral for telehealth, and more than 110,000 Veterans had a loaned tablet from VA.

VA opened 3 new Advancing Telehealth through Local Area Stations (ATLAS) sites (Advancing Telehealth Through Local Area Stations) in Emporia, KS; Bozeman, MT; and Missoula, MT.

VA launched a Caregiver Connect communications campaign to alert Veterans and caregivers about a scheduling option in VA Video Connect that allows Veterans to invite up to five guests, such as a caregiver or family member, to attend their video telehealth visits.

Highlights

VA continues to see growth in Veteran satisfaction with video-to-home, with 87.4% of Veterans reporting that they felt satisfied with their video-to-home visit in Q4 FY22, an increase from 85.6% in Q1 FY22. Strong preferences remain for video-to-home visits among Veterans who have completed a visit (45.4% for video versus 33% in-person, 5% telephone or 17% no preference).

VA is working to establish a grant program through Section 701 of the John Scott Hannon Legislation, P.L. 116-171 which would offer non-VA entities the opportunity to apply for funding to stand up and sustain an ATLAS site. In support of this legislation, VA completed the Barriers to Telehealth Congressionally Mandated Report and completed a draft of the Telehealth Grant Regulations and the Regulatory Impact Analysis.

In FY22, VA’s patient portal, My HealtheVet (MHV) continued to show strong growth within the user community. MHV grew to 6,464,141 registered users (an 8.3% growth over FY21) and Identity Proofed Accounts (IPA) grew to 4,318,251 (a 10.7% growth over FY21). This growth in both total registered users and IPA’d users provides more users with access to MHV features and services including Rx Refill, Secure Messaging and Appointments.

Use of key MHV services (Rx Refill, Secure Messaging and Appointment Reminders) showed substantial use and growth.

  • 30,083,043 prescriptions were refilled during FY22 (a 15.3% growth over FY21). Rx Refill allows patients to order medications online and have them delivered directly to their residence without having to visit a pharmacy.
  • 31,774,766 Secure Messages were exchanged between VA patients and VA staff (a 22.6% growth over FY21). Secure Messaging permits patients to have direct message exchanges with their health care providers and receive timely responses and guidance on questions and issues.
  • 39,624,528 Appointment Reminders were successfully sent to VA patients (a 39.2% growth over FY21). Appointment Reminders help reduce appointment no shows.

MHV continued to deploy, support, and make available new features and functions.

  • Patient Generated Health Data (PGHD), including Pulse Oximetry and Respiratory Rate, was rolled out to all Premium users. For the Veteran, PGHD allows patients to collect PGHD and share it with their health care providers, thereby using PGHD to foster patient self-care and support virtual care delivery.
  • The re-engineered SM Clinician Portal was deployed to the Liferay portal. The SM Clinician Portal improves VA workflows for staff including performance and reliability enhancements for the over 201,000 active clinician users.
  • Provided easy visibility and access for VA Health Chat to Veterans. Support was provided for the expansion of VA Health Chat to multiple facilities. VA Health Chat, available in facilities in 31 states and 2 territories, allows Veterans to immediately connect with VA health care clinicians over text-messaging about health concerns, refill a VA prescription, and/or schedule an appointment without the need to travel to a VA facility.

MHV migrated Columbus, OH, Walla Walla, WA, Roseburg, OR,  and White City, OR facility users to the Cerner platform. The MHV Team continues to support Veterans and VA staff at migrated sites by collecting feedback and monitoring survey data. Using this information supports continuous improvement for future migrations.

MHV provided direct links to VA services including the Veterans Health Library (VHL), Financial Activities (pay or receive funds), and VA Profile. During FY22, users accessed the VHL 235,263 times from MHV (a growth of 87% over FY21) – much of this growth can be attributed to the direct link from MHV to VHL added during FY22.

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Office of Geriactrics & Extended Care

Geriatrics and Extended Care (GEC) facilitates the delivery of care for Veterans with serious chronic diseases and disabling conditions through a comprehensive spectrum of facility-based (institutional) and home and community based care (non-institutional care) programs. GEC programs are built upon expertise in three specific areas: Geriatrics, Palliative Care, and Long-Term Services and Supports (LTSS).

Accomplishments

As of October 1, 2022, 78 VA medical centers have earned Age-Friendly recognition from Institute for Healthcare Improvement (IHI) in at least one care setting. VHA is the largest Age-Friendly Health System recognized by IHI.

Currently 38 of the VA’s 111 Emergency Departments (ED) have achieved Geriatric Emergency Department Accreditation by the American College of Emergency Physicians (ACEP). 31 additional EDs are working towards accreditation. VHA is the largest health care system to receive system-level recognition from the ACEP.

Highlights

GEC is leading the first VA Age-Friendly Action Community October 2022 through April 2023 to accelerate adoption of the 4Ms (What Matters, Medication, Mentation and Mobility) as a framework to improve and align care with what matters most to Veterans.

GEC began a 5-year expansion of Veteran Directed Care (VDC), Medical Foster Home (MFH), and Home-Based Primary Care (HBPC) in FY22. VDC and MFH will be expanded to all VA medical centers by FY26. HBPC will be expanded by 75 additional teams by FY25.

GEC developed and implemented State Veteran Home Pods (teams) and are having monthly intra-VA pod calls and quarterly VA/SVH calls. GEC implemented a new survey contract, with pod managers reviewing 100% survey reports, de-identified survey reports and 100% review and approval of corrective action plans (CAP) with development of certification letters. GEC received over 50 Registered Nurse (RN) grant applications from 15 states in FY22.

Currently 58% of HBPC Veterans have received Telehealth Services in FY22 (all modalities). 54% of HBPC Veterans have received video HBPC visits in FY22. Two percent of the HBPC population fully vaccinated.

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Office of Health Equity

The Office of Health Equity (OHE) strengthens and broadens the ability of VHA leadership to address health inequalities and reduce health disparities through pursuit of health equity in all policies, operations, oversight, and research. OHE positively impacts the health and health care of vulnerable sub-populations within VHA by working to promote health equity through policies, education / communication, data analysis, and improvement of health outcomes.

Accomplishments

The Office of Health Equity (OHE) uses equity information to guide quality improvement ensuring all Veterans have access to high quality care and can achieve equitable health outcomes. In FY22, this included:

  • Creating a High Equity Reliability Organization framework and curriculum;
  • Expanding the Primary Care Equity Dashboard that includes information about specific disparities, appropriate interventions, and tools and resources;
  • Using a social determinants of health screening tool to match Veterans with social risks to services; and
  • Delivering equity technical assistance to VA program offices and facilities.

OHE awarded over $750K in funding for 24 VHA field projects that focus on equity-related QI interventions to improve health outcomes for Veterans.

OHE conducted a study showing that the completeness of race and ethnicity data has improved over time and data were complete for 92 percent of Veterans receiving care at the VA.

Highlights

During the COVID-19 pandemic, the Office of Health Equity (OHE) was one of the offices activated to ensure all Veterans had equitable access to COVID-19 information, testing, vaccination, and treatment. During FY22, OHE adapted dashboards to supplement regular reports to VA leadership and Congress on the state of disparities in COVID-19 care among Veterans receiving care at VA. Additionally, OHE has drafted a paper and a report exploring VA’s response to COVID-19 from an equity lens.

The Office of Health Equity’s FY22 translation activities focused on raising awareness of and reducing the prevalence of existing health disparities to ensure all Veterans receive access to equitable health care. Through communication efforts aimed at a variety of audiences including Veterans, their families, caregivers and survivors, health care providers, health researchers, national health policy experts, as well as the lay public, OHE aims to further its mission of promoting and achieving equitable care throughout VHA. In FY22, OHE published:

  • 15 Information Briefs
  • 9 Podcast episodes (3 seasons)
  • 8 Cyberseminars
  • Abstracts, journal articles, and a book chapter that were led and co-authored by OHE colleagues.
  • 2 Chartbooks
    • Hispanic/Latino Veterans
    • Primary Healthcare Experiences of Lesbian, Gay, and Bisexual Veterans (LGB SHEP)
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Health Outcomes Military Exposures

Health Outcomes of Military Exposures (HOME) encompasses four distinct programs – Epidemiology, Era Environmental Health, Policy and Environmental Health Operations, as well as field-based clinical programs and research in the War-Related Illness and Injury Study Center (WRIISC) at its three sites.

Accomplishments

The Health Outcomes Military Exposures Office (HOME) leads 14 sections and supports 12 sections of the Honoring our PACT Act, including process and review for creating presumptions, training VA providers on military exposures, research on Military Environmental Exposure topics and planning the establishment of a VA website on federal government-supported, Veteran- focused exposure research.

HOME led the process that resulted in presumptions for three new conditions, nine rare respiratory cancers. These were the first non-legislated presumptions in over a decade.

HOME expanded the Burn Pit Registry eligibility by adding Uzbekistan, Egypt and Syria.

HOME subject matter experts co-authored an International Agency for Research on Cancer (IARC) Monograph on the carcinogenicity of several metals relevant to Veterans with embedded fragments.

The Karshi Khanabad Surveillance Program (K2SP) led an interagency coordination group (DoD/ATSDR/VA) advancing understanding of potential exposures and health outcomes. K2SP also:

  • Conducted briefings to the Secretary of the Department of Veterans Affairs and VA leaders on scientific support for a Gulf War Veteran brain cancer presumption;
  • Successfully concluded a machine learning project on Gulf War illness and
  • Initiated a fourth data collection of the Follow-up Study of a National Cohort of Gulf War and Gulf Era Veterans.

Highlights

HOME subject matter experts (Policy, Operations, Epidemiology, Management), the War Related Illness and Injury Study Centers (WRIISC) and the Toxic Embedded Fragments Depleted Uranium Center briefed VA leaders, Congress and other stakeholders on Military Environmental Exposures (MEEs).

HOME published three newsletters on Agent Orange and MEEs.  HOME developed the American College of Preventive Medicine Level 1 Certification in MEEs. HOME also consolidated six former directives on the exposure registries into a single directive.  Additionally, HOME presented invited lectures at three national professional conferences.

HOME Operations conducted intensive field outreach resulting in a nationwide reduction in pending Airborne Hazards and Open Burn Pit Registry (AHOBPR) examinations that were paused due to the pandemic. HOME published several reports related to AHOBPR improvements and collaborated with the Department of Defense to complete Individual Longitudinal Exposure Repository (ILER) milestones leading to the June 2023 full operational capability (FOC) deadline.

Veterans Exposure Team-Health Outcomes Military Exposures (VET-HOME), a telehealth center for registries and environmental exposure advice, is completing the actions necessary for full operational capacity in 2023. This innovative program will improve VA provider and Veteran understanding of exposures, improve care, improve referral for benefits, improve MEE research and strengthen the nation’s understanding of exposure.

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National Center for Health Promotion & Disease Prevention 

National Center for Health Promotion and Disease Prevention (NCP), a field-based office in Durham, North Carolina, promotes whole health by empowering and equipping Veterans to take charge of their health and well-being, as well as prevent illness and morbidity, and effectively self-manage their chronic conditions. NCP accomplishes this goal by advocating for evidence-based, personalized, proactive patient-centered health promotion, disease prevention and health education, and advising VA leadership on health promotion, disease prevention, and health education policy.

Accomplishments

National Center for Health Promotion & Disease Prevention (NCP) continues to lead COVID-19 vaccination planning and implementation for VHA in FY22. The NCP-led Workgroup updated educational resources and streamlined mandatory training modules to support safe and efficient provision of COVID-19 vaccines, as well as promote COVID-19 vaccine acceptance among Veterans. VA has documented that over 4.3M Veterans received at least one dose of vaccine, more than 4.19M Veterans have completed an initial vaccination series, and more than 2.17M Veterans have at least an initial booster dose recorded in VHA.

The MOVE! Weight Management Program achieved a significant milestone in FY22; since 2006, more than 1M Veterans have participated in MOVE!, with increasing numbers of Veterans accessing MOVE! through VA Video Connect. Since FY17 more than 25% of all new MOVE! participants achieved a clinically significant weight loss (>5%). In FY22, MOVE! implemented a program plan to address weight stigma that included national education call, updating MOVE! program materials and establishing a central location for tools and resources.

During the 2021-2022 influenza season, over 1.71 million flu vaccinations were administered within VHA facilities as part of the Infection Don’t Pass It On (IDPIO) & Flu Program, with 641,551 (37.5%) of those vaccinated receiving an enhanced vaccine formulation. 

Highlights

NCP’s Veterans Health Education and Information Program (VHEI) partnered with other VHA Program Offices to launch the Patient Centered Learning (PCL) Program. PCL will apply a Health Literate Care Model to develop enterprise-wide policy, guidance, standards, training, resources, and evaluation strategies to address Veterans’ and caregivers’ health education needs. Under NCPs direction, PCL will accelerate VHA’s adoption of evidence-based health literacy strategies that will enhance Veterans’ and caregivers’ ability to find, understand and use information and services to inform their health-related decisions and actions.

In FY22, NCP worked with the Preventive Medicine Field Advisory Committee, NCP to develop, update and disseminate 29 evidence-based Clinical Preventive Services Guidance Statements. NCP continued to support facility-based HPDP Program Managers’ and Health Behavior Coordinators’ efforts to assist VHA clinicians in identifying and addressing gaps in delivery of preventive services, particularly those that were most negatively impacted during the COVID-19 pandemic.

In preparation for the 2022-2023 flu season, IDPIO updated flu campaign guidance, resources and communication tools, offered multiple national teleconferences and launched a “One Visit, Two Vaccines” communication campaign to encourage vaccination with both flu and COVID-19 vaccines at a single visit.

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Health Solutions

Health Solutions identifies, measures, and assesses Veteran populations by incorporating non-health care determinants of health. Health Solutions also deploys and refines electronic medical record solutions with a public health approach to support population management.

Accomplishments

Health Solutions continues to lead efforts to oversee and maintain daily COVID-19 vaccine administration reporting to the Centers for Disease Control (CDC) to fulfill requirements for sustained VA vaccine supply. Health Solutions also:

  • Supported electronic health record integration of all nine new COVID-19 vaccine products for reporting.
  • Monitored the transmission and quality of over 1.97M Veteran COVID-19 vaccination records (including 13,900 Oracle Cerner records) and 190,000 employee COVID-19 vaccination records.

Highlights

Health Solutions continued leading efforts to connect VA to the CDC’s IZ Gateway, which allows VA immunization data to automatically and electronically flow to state / local Immunization Information Systems (IIS). In FY22, VA was able to begin reporting VA-administered vaccinations in near real-time to 16 states / jurisdictions through the IZ Gateway. This impacts Veterans, providers, and the community by enabling a more comprehensive understanding of the Veteran’s health status, enhancing Veteran safety, and promoting efficient and coordinated care.

Health Solutions initiated a HealtheRegistry—Performance Measures Crossmatch Effort. The purpose and intent of this effort is to cross-reference and synchronize Oracle / Cerner HealtheRegistries' measures with the Veterans Health Information Systems and Technology Architecture’s (VistA) performance measures.

Health Solutions initiated twice weekly HealtheRegistry office hours serving Oracle / Cerner end users at both VA and Department of Defense (DoD) facilities to promote optimal utilization of HealtheRegistries measures and recommendations. The team established an open forum where end users can learn more about how to navigate HealtheRegistries, complete Power Forms, satisfy recommendations and build population health reports. Office hours were fundamentally established as an opportunity for questions and answers (Q&A), offering virtual training demonstrations as needed.

Health Solutions revamped the HealtheRegistries SharePoint site to provide a central source of information about HealtheRegistries and recommendations. The HealtheRegistry SharePoint site published 63 Tip Sheets this fiscal year describing step-by-step instructions on how to satisfy recommendations and power forms in PowerChart. The SharePoint site added the Frequently Asked Questions (FAQs) section along with information on signing up for the HealtheRegistries listserv and contacting the Health Solutions email group to submit questions and report issues regarding the HealtheRegistry solution.

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LGBTQ+ Health Program

VHA LGBTQ+ Health Program facilitates field-based policy recommendations, establishes metrics, and develops clinical education to support personalized, proactive, patient-centered health care for LGBTQ+ Veterans. LGBTQ+ refers to lesbian, gay, bisexual, transgender, and queer identities. The "+" sign captures identities beyond LGBTQ, including but not limited to questioning, pansexual, asexual, agender, gender diverse, nonbinary, gender-neutral, and similar identities. LGBTQ+ Veterans face increased health risks and unique challenges in accessing quality health care.

Accomplishments

Gender identity and sexual orientation became active and visible fields in the VHA’s legacy electronic Computerized Patient Record System (CPRS) to assist clinicians in personalized assessment and treatment. VHA has begun to implement a new electronic health record system, Oracle Cerner, which already has these data fields.

Veterans can enter and edit their preferred name and gender identity on their profile on VA.gov for display in their CPRS health record. Veterans can directly provide this information without going through a VA staff member. Having a Veteran’s preferred name and gender identity readily visible supports an affirming personal interaction with the individual.

Every VA facility has an LGBTQ+ Veteran Care Coordinator to assist Veterans at their local facility.

In FY22, 283 Transgender E-consults were completed which has assisted providers nation-wide in delivering high quality care.

In addition, the Gender Affirming Program with Speech (GAPS) program delivered voice and communication treatment to 85 Veterans via telehealth to the home.

LGBTQ+ Policy Updates:

As follow-up to the Secretary of the Department of Veterans Affairs’ 2021 announcement, the LGBTQ+ health program office and its many partners drafted a proposed rule to remove an exclusion from the medical benefits package. This proposed rule will allow VA to provide gender affirming surgeries when medically needed. A posted final rule and VHA policy changes are now needed before gender affirming surgeries can be provided in VA.

Highlights

VHA Directive 1340 (Provision of Health Care for Veterans who Identify as Lesbian, Gay, Bisexual and Queer) was updated and recertified. This policy update strengthened language requiring clinicians to assess sexual orientation and conduct a sexual health assessment for all Veterans. This policy affirms LGBQ identities and prohibits efforts to promote heterosexuality as the expectation for everyone.

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Office of Nursing Services

The Office of Nursing Services (ONS) serves as the primary consultant to key VHA and Department officials on all matters relating to nursing and the delivery of patient care. ONS is responsible for the planning and formulation of national policies and activities that impact all nursing staff in the delivery of health care within the Department of Veterans Affairs. Additionally, ONS collaborates inter-professionally to enhance and support evidence-based professional practice, workforce research, education, and the VA nursing workforce to strengthen leadership and teamwork to provide quality, patient-driven care for the nation's Veterans.

Accomplishments

At the close of FY22, there were 110,808 nurses onboard, including 1,105 Certified Registered Nurse Anesthetists, 8,021 Advanced Practice Registered Nurses, 72,919 Registered Nurses, 15,092 Licensed Practical / Vocational Nurses and 13,671 Nursing Assistants.

VHA is building a strong and diverse group of future nurse leaders through the New Executive Training Program, Nurse Executive Mentorship Program, Nurse Manager Institute and the Nurse Manager Passport to Success.

Nurse Residencies / Registered Nurse Transition to Practice Program (RNTTP) supports the transition of recent RN graduates to a complex practice environment across 117 medical centers.

In 2022, VHA monthly non-ventilator hospital acquired pneumonia (NV-HAP) cases ranged between 0.07-0.14/1KBDOC resulting in a 29% reduction in patients with NV-HAP in facilities reporting data.

VA Travel Nurse Corps (TNC) nurses provided over 10,000 hours of manpower while maintaining a 70% deployment rate.

Highlights

ONS developed the VHA Strategic Plan for the Nursing Workforce, which includes the four pillars/strategic goals: (1) Optimizing Nursing Practices (2) Strengthening the Nursing Workforce (3) Reimagining Lifelong Learning and Career Development and (4) Inspiring an Industry-Leading Culture. This is now in further development, comprised of nurses across VHA whose collective focus is to strengthen the nursing workforce through recruitment and retention.

The RNTTP has seen significant growth over the last several years with 468 new nurses participating in 2022. Also in 2022, 115 medical facilities used the Elsevier Mosby Preceptor Program, enabling novice nurses to apply their critical thinking to clinical practice. With its continued growth in 2022, RNTTP also recognized 28 staff members as having participated in a learning experience designed to attract top-quality candidates into the Nurse Recruiter RNTTP training program.

The Hospital Acquired Pneumonia Prevention by Engaging Nurses (HAPPEN) complete oral care program reached every VA health care system in 2021. The work continued in 2022, leading to dramatically improved inpatient outcomes, thanks to mentoring and coaching by ONS program leads.

Sixteen VA TNC nurses completed 1,908 Veteran functional assessments, 1,331 caregiver assessments, 1,312 Veteran assessments, and 4,551 total nursing assessments in support for the Caregiver Support Program, providing much needed support and relief to nurses across the VA system.

With the goal to support improved health care quality, safety, costs, and patient outcomes, ONS continued its partnership with the renowned Helene Fuld Health Trust National Institute for Evidence-Based Practice (EBP). In 2022, 67% of participating facilities had at least one quality improvement outcome; 94% have instituted EBP councils to continue this work to improve Veteran care and outcomes; and 60 VHA staff have received their EBP certificate / certification. Additionally, ONS conducted two highly successful EBP leadership workshops to promote leadership support of EBP where: 97% of participants increased in their knowledge in leading others in EBP; 92% strengthened their confidence in guiding others in EBP; and 95% increased their competence in building and sustaining an evidence-based culture.

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Office of Patient Centered Care & Cultural Transformation

VHA Office of Patient Centered Care & Cultural Transformation’s (OPCC&CT) primary goal is to transform the VA health care system from the traditional model of health care to a personalized, proactive, patient-driven model that focuses on developing and advancing Whole Health for Veterans and employees. OPCC&CT is leading the way with Whole Health, VA’s cutting-edge approach to health care transformation.

Accomplishments

In FY22, 16.29% of all Veterans receiving care through VA also received Whole Health services. This is over 1 million Veterans participating in Whole Health!

Ninety-seven percent of VA medical centers offered Introduction to Whole Health in FY22.

Additionally, Veterans receiving Tele-Whole Health increased by 39% as compared to FY21, and Tele-Whole Health encounters also increased by 32% as compared to FY21.

Highlights

Over 400 participants in Introduction to Whole Health courses were Transitioning Service Members (TSM). Ten percent of these TSMs were referred to local Mental Health Services.

OPCC&CT trained 4,385 employees in Employee Whole Health at national, Veteran Integrated Service Network (VISN), and VA medical facility levels. National employee-focused courses included the Employee Whole Health Coordinator Workshop, Whole Health for Nurse Leaders: Empowering and Equipping Staff, Whole Health for Nurses: Inpatient Care, Trauma Informed Employee Whole Health (now called Employee Peer-to-Peer Support), Resiliency Focused Taking Charge of My Life and Health for Employees, Empowering Your Teams. Whole Health Mandatory Training requirement was approved for all new employees throughout the Department of Veterans Affairs (VHA, VBA, NCA).

In collaboration with the Reduce Employee Burnout and Optimize Organizational Thriving (REBOOT) Task Force, OPCC&CT presented an expansion of the Chief Well-being Officer (CWO) program to the VHA Governance Board based on an OPCC&CT pilot. The VHA Governance Board approved the expansion to establish a CWO position in each VISN in FY23.

Key research included an observational study of 53,412 Veterans to examine how downstream utilization of spine procedures differs between users and non-users of Whole Health. In this study, those who used Whole Health services and complementary and integrative health therapies had a 19-25% decrease from the expected rate of subsequent invasive spine procedures compared to Veterans who did not use these interventions. A second study found that Veterans with depression and anxiety disorders, and / or PTSD who used Whole Health services had 2.3 times higher odds of using an evidence-based psychotherapy for those conditions in the subsequent year, as compared to Veterans who did not use WH services.

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Public Health National Program Office (PHNPO)

The Public Health National Program Office (PHNPO) performs critical public health functions in VA including conducting epidemiologic investigations and surveillance for infectious disease. The office operates the Public Health Reference Laboratory (PHRL) and is responsible for the VHA All-Hazards Emergency Cache (AHEC) Program. PHNPO is instrumental in providing subject matter expertise for public health preparedness, biodefense issues and in developing policy and guidance on public health emergency response.

Accomplishments

VA Public Health Reference Laboratory (PHRL):

  • Co-directed the VA  Sequencing for Research Clinical and Epidemiology (SEQFORCE) program that sequenced SARS-CoV-2 variants from over 35,000 specimens among patients and employees;
  • Supported several PHNPO VHA outbreak and lookback investigations by testing clinical or environmental samples;
  • Supported VHA clinical care through complex infectious disease diagnostic testing;
  • Served as the only VA clinical laboratory performing ortho-pox / monkeypox molecular testing in support of VA clinical care;

PHNPO led VA monkeypox surveillance at the outset of the global epidemic, tracking cases and providing VA leadership with situational awareness.

PHNPO monitored trends in other important infectious diseases (e.g., COVID-19, influenza, Respiratory Syncytial Virus, fungal and sexually transmitted infections) and non-infectious conditions (e.g., lead poisoning) among Veterans.

PHNPO maintained and routinely updated two vaccine dashboards for the field staff (influenza and COVID-19) and collaborated with Centers for Disease Control and Prevention (CDC) on the Surveillance Platform for Enteric and Respiratory Infectious Organisms (SUPERNOVA) at VA medical centers for active and passive surveillance of gastrointestinal and respiratory pathogens in VA.

PHNPO oversaw the AHEC program, which included annual VAMC site training, cache exercises and inspections to ensure VA is prepared for chemical, biologic, radiologic, nuclear, and explosive (CBRNE) events, and is aligned with the interagency Public Health Emergency Medical Countermeasures Enterprise (PHEMCE) Council goals.

Highlights

PHNPO conducted epidemiologic investigations in response to large-scale disclosures at two VA medical centers involving over 7,000 Veterans potentially exposed to bloodborne pathogens. Through process improvement, all samples for lookback testing were performed at the VA PHRL resulting in elimination of incomplete testing. This allowed for complete clinical testing for any evidence of infection and expedited completion of epidemiologic investigations.

PHNPO worked with the Centers for Disease Control and Prevention (CDC) to develop a data sharing collaboration whereby VHA climate-related data such as heat-related illness could be monitored and displayed within a national dashboard tool as part of the National Environmental Public Health Tracking Program. A VHA Public Health Climate Action Plan was drafted to detail the effects of climate change on diseases affecting the Veteran population, and the goals and steps needs to mitigate these effects. Initial high-level strategies related to surveillance, national stockpile of medical countermeasures, and a patient-centered disaster manual are already underway.

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Pharmacy Benefits Management

Pharmacy Benefits Management (PBM) Services provides support to facilitate the highest quality care to Veterans by ensuring safe, effective, and medically necessary management of medications and medication-related supplies. This is accomplished by creating a practice environment that fosters education, professional development, progressive practice initiatives, and innovative technologies to ensure consistent, accurate and reliable medication distribution, use, and information systems.

Accomplishments

Pharmacy Benefits Management (PBM) has supported centralized distribution of COVID-19 and monkeypox (mPox) vaccines and other countermeasure products to help support the health of Veteran patients and employees.

During FY22, the PBM team coordinated the distribution and tracking over:

  • 2.4 million doses of COVID-19 vaccine,
  • 83,442 doses / courses of monoclonal antibodies and antivirals for COVID-19 treatment,
  • 65,000 doses of mPox vaccine and
  • 22 bottles of tecovirimat for mPox treatment.

The Consolidated Mail Outpatient Pharmacy (CMOP) achieved the highest rating by J.D. Power & Associates, an externally validated overall customer satisfaction survey, for all mail order pharmacies in 2022.

Seventy-five Clinical Pharmacist Practitioners (CPPs) were funded through the CPP Rural Veteran Access (CRVA) initiative in primary care, mental health, pain management, and substance use disorder settings and provided high quality care to 36,920 rural Veterans (60% of population) with over 105,649 patient care visits.

Highlights

Pharmacy Benefits Management Clinical Informatics (CI) tested, validated, and collaborated with the EHRM Pharmacy Council on the deployment of system enhancements to the Cerner PharmNet eRx Monitor, the system used to process pending prescriptions. These enhancements align with similar and existing capabilities in the VistA outpatient pharmacy solution and are designed to improve workflow efficiency for the pharmacy staff, allowing a more focused approach to the high-volume prescription workflow of a VA pharmacy.

In FY22, marketing efforts to CHAMPVA beneficiaries increased use of MyHealtheVet by 21% over the previous year improving the timeliness of prescription refills and tracking of medication delivery resulting in increased customer satisfaction.

Over 5,000 highly trained CPPs are on the front lines as part of multidisciplinary collaborative care teams, improving critical access to comprehensive medication management services in both rural and urban settings across primary and specialty care. An additional 70 CRVA CPP positions will be funded in FY24 as part of the work to continue to improve access to care for underserved, rural Veterans with a focus on primary care, specialty care in cardiology and neurology, substance use disorder care, overdose and suicide prevention.

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Physician Assistant Services

Physician Assistant Services (PA) Office oversees the physician assistant program and policy development in VHA. PA Services ensures that the utilization of PAs in VHA is optimized to provide quality and accessible care to Veterans. PAs provide medical care to Veterans across the spectrum of medicine and surgery. The occupation’s flexibility in transitioning to different medical specialties is of significant strategic value when addressing shortages or changes in health care provider workforce needs.

Accomplishments

Physician Assistants practice in all areas of Veteran care and are one of three VHA professions that can diagnose, treat and prescribe. There are 2,693 Physician Assistants in VHA with the largest growth in telemedicine.

Fifty-one Veterans have been awarded full scholarships to become Physician Assistants with a service obligation to VA once they have completed the program.

Physician Assistant Services provides oversight for 11 postgraduate residency programs in Psychiatry, Emergency Medicine, Primary Care, and Geriatrics.

Highlights

PA Services wrote a 2022 legislative proposal for Continuing Professional Education for Physician Assistants. This legislation will permit $1,000.00 annually for PA continued medical education.

Thirty-two PAs graduate annually from their respective PA residencies.

PA Services proposed original language lifting the Physician Assistant and Nursing pay cap from Executive Level IV to Executive I. Public Law 117-103 Department of Affairs Nurse and Physician Assistant Retention and Income Security Enhancement Act – RAISE ACT was passed in 2022.

PA Services participated in the 2022 PACT Act – Section 902: Authority to buy out service contracts for Physicians, CRNAs, PAs and NPs.

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Rehabilitation and Prosthetics Services

Rehabilitation and Prosthetic Services (RPS) oversees program and policy development for rehabilitation services for VHA.  This office administers program and policy development for eight national programs with 11 different rehabilitation disciplines, aligning clinical expertise, clinical and practice guidance, and specialized procurement resources to provide comprehensive rehabilitation, prosthetic and orthotic services across the VHA health care system in the most economical and timely manner. RPS includes Physical Medicine and Rehabilitation, Audiology and Speech, Prosthetic and Sensory Aids, Blind Rehabilitation, Orthotic, Prosthetic and Pedorthic Clinical Services, Recreation and Creative Arts Therapy, National Veteran Sports, and Chiropractic services.

Accomplishments

Telerehabilitation increased access through virtual care by embracing innovation and telehealth platforms. In FY22, rehabilitation specialties provided just under 550,000 telehealth encounters.

In FY22, 39 VA medical centers had Physical Therapy (PT) embedded in Patient Aligned Care Teams (PACT) and 44 additional VA medical centers are in progress. By embedding PT into PACT, the Veteran can more readily access same-day care for musculoskeletal, neurological, and pain complaints.

As of June 2022, over 700 Veterans receiving care for mental health conditions have participated in a pilot program that engages in complementary and integrative health programs such as equine and other animal therapy, agritherapy, and adaptive sports and recreation therapy. Pilot participants have attended over 3,000 complementary and integrative clinical visits.

Highlights

This inpatient program provides specialized integrated rehabilitation care for Veterans and service members with a complex history of multiple TBIs, numerous body injuries, post-traumatic stress disorder, and emotional dysregulation. This program expansion complements the existing services within VHA’s Polytrauma / TBI System of Care supporting DoD to maintain force readiness and resulting in a more comprehensive evaluation and treatment continuum for Veterans living with TBI and associated comorbidities. At the close of FY22, the IETP program had expanded to 29 beds across 4 of the 5 Polytrauma Rehabilitation Centers.

All specialties within Rehabilitation are leveraging virtual care to support vulnerable Veterans requiring rehabilitation services, specifically in rural and highly rural areas.

VHA’s Amputation of System of Care and Surgery Office developed a program to offer osseointegration of lower limbs as a covered benefit for qualified Veterans. Final Clinical Guidance were completed February 2022 to provide this cutting-edge advancement within VHA for Veterans with limb loss. The percutaneous implant system used to achieve direct skeletal attachment of a prosthetic limb, eliminates a socket-based prosthesis, residual limb skin conditions and resulting pain that can limit prosthesis use and function.

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Office of Rural Health

The Office of Rural Health (ORH) implements a targeted, solution-driven approach to increase access to care for three million Veterans living in rural and highly rural communities who rely on the Department of Veterans Affairs (VA) for health care. As VA's lead advocate for rural Veterans, ORH works to see that America's Veterans thrive in rural communities. ORH strives to break down the barriers separating rural Veterans from quality care by working through its five Veterans Rural Health Resource Centers, as well as other partners from academia, state and local governments, and non-profit organizations.

Accomplishments

The Rural Health Access Guidebook was created to disseminate best practices of care models and innovations to be used by the field to improve access for rural Veterans.

Rural Health provided over 66,000 CME/CEU credits throughout VHA focused on rural health training, including:

  • 25,553 VA clinicians,
  • 533 non-VA clinicians,
  • 531 non-clinicians,
  • 1,868 students

Rural Health also implemented, sustained, supported, and spread telehealth programs for rural Veterans through Enterprise Wide Initiatives (EWIs), Rural Promising Practices (RPPs), and five Veterans Rural Health Resource Centers (RHRCs).

Highlights

ORH created additional rural workforce innovations through ORH’s Rural Scholars Program, Rural Interprofessional Faculty Development Initiative (RIFDI), Rural Career Development Awards, and rural clinical training opportunities.

ORH expanded the focus on rural Native American / Alaska Natives through pilot projects, reimbursement agreements, support of the new Office of Tribal Health, and initiation of the first VHA-Indian Health Service Memorandum of Understanding Operational Plan.

ORH supported research on questions critical to our understanding of rural health disparities and interventions to improve rural health through direct funding of research projects at our five Veterans Rural Health Resource Centers, co-sponsorship of a Rural Research State of the Art (SOTA) Conference with the Health Services Research and Development Service, and the publication of 100s of rural research manuscripts and presentations.

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Office of Sterile Processing

The Office of Sterile Processing (OSP) provides consultative oversight and guidance for improvement of Sterile Processing Services (SPS) and reusable medical device (RMD) operations and practices for over 190 SPS locations across the nation.

Accomplishments

Office of Sterile Processing developed a new consultative Reusable Medical Devices (RMD) assessment process and assessment tool to proactively identify vulnerabilities and review Sterile Processing Services (SPS) high level processes for VHA medical facilities in FY22; 27 reviews were conducted for medical facilities in FY22.

SPS education course enhancements were made in the VA Talent Management System (TMS) to include:

  • VHA Level II Certified Registered Medical Supply Technician (CRMST) certification course enhanced to combine all 12 modules into one course in TMS and review course created for preparation and completion of certification exam in TMS.
  • A new TMS course to reinforce education of RMD reprocessing to ensure safe processing of medical equipment at each VA medical center was completed 100% of SPS staff nationally.

In FY22, 21 education sessions were held for SPS leadership and nine virtual SPS Level II certification reviews were held to prepare staff for the CRMST certification.

In FY22, over 200 VHA facility sites received critical support for improvement and system upgrades through the $54M SPS Specific Purpose Funding (SPF) Program.

Highlights

Sterile Processing Service (SPS) Workforce Modernization Efforts

  • Workgroup implemented / sponsored by OSP in collaboration with Workforce Management & Consultation (WMC) and key SPS stakeholders.
  • Developed and submitted revised qualification standards and functional statements for core SPS technical and administrative positions.
  • Conducted salary analysis to justify SPS Special Salary Rates (SSR) resulting in >90 (70% of facilities) that have or are in the process of establishing SSRs.
  • SPS was approved for inclusion in the VA Technical Career Field (TCF) Program in efforts to improve career ladder progression opportunities within VHA SPS.
  • Program established, program manager designated, curriculum and program schedule developed and preceptors selected and TCF trainees selected and are in the initial phase of beginning training.

Document Control Systems (DCS)

  • Assisted facility and Veteran Integrated Service Network (VISN) SPS programs with customer support and development of DCS to standardize business and clinical practices throughout VHA.
  • Initial reviews and full quality checks conducted to determine functionality for all SPS DCS systems.
  • Over 80% of existing DCS sites improved using power automate (this constituted a full rebuild of each system) and full help desk support provided to each facility.

Reusable Medical Device (RMD) Assessment Processes & Data Indicators

  • Implemented special project team focused on analyzing and cross-walking SPS data points to proactively identify risk to develop actions to reduce or mitigate risk in VHA facilities.
  • Point in Time (PIT) Tabletop Exercise designed and conducted to verify national SPS processes and validate sustainability. The exercise required the involvement of many different leaders and stakeholders across each medical center to collectively provide responses with a goal of improving collaboration, cohesiveness and operational support efficiencies in each medical facility in support of safe Veteran care.

SPS Education

  • Implemented the Sterile Processing Education Committee (SPEC) comprised of OSP staff, facility and national SPS leaders to comprehensively support the VHA SPS field by developing SPS leaders and programs through education. The SPEC workgroup developed a four-year strategic plan to standardize education programs for VHA SPS staff, established sub-groups to develop core components of orientation and developed core competencies needed for critical SPS positions to ensure staff trained appropriately to perform reprocessing duties.

SPS Specific Purpose Funding (SPF) Program

  • 100% of program funds tracked, monitored and distributed in line with program goals to standardize, upgrade and improve SPS operations.
  • The SPF program provided field assistance for some of the following critical items in FY22:
    • Borescope Visual inspection scopes and fibers (total of $1,127,215.65 in funding provided to 33 sites). The borescope will be used to inspect surgical instruments to ensure internal lumens are free of biological residue (e.g., skin, bone, blood, and rust) to ensure safe patient care. The implementation of a borescope based SPS inspection protocol will result in improved overall process quality and potentially fewer surgical site infections.
    • Sterilizers both Steam and H202 (total of $4,648,702.70 provided to 21 sites) Sterilizers are used to kill all living pathogens, to include spores, from medical and surgical instruments to prevent disease transmission to patients.
    • Censis equipment / service and subscription assistance ($3,051,418.88 in funding provided to 36 sites). Funding used for the CensiTrac instrument tracking system and included marking services, hardware/equipment, data optimization and service upgrades.
    • Endoscope Lease assistance ($8,900,000.00 provided to 16 VISN’s). Leasing assistance provided for endoscopes which allows facilities to use a cost-per-procedure agreement and the manufacturer will supply the endoscope, computer / video support, clean equipment and provide maintenance services which provides a significant cost savings to the VA and ensures safe quality instruments are used.
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