Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester.
VA Central Western Massachusetts Healthcare System, Leeds.
Med Care. 2021 Jun 1;59(Suppl 3):S252-S258. doi: 10.1097/MLR.0000000000001545.
Congress has enacted 2 major pieces of legislation to improve access to care for Veterans within the Department of Veterans Affairs (VA). As a result, the VA has undergone a major transformation in the way that care is delivered to Veterans with an increased reliance on community-based provider networks. No studies have examined the relationship between VA and contracted community providers. This study examines VA facility directors' perspectives on their successes and challenges building relationships with community providers within the VA Community Care Network (CCN).
To understand who VA facilities partner with for community care, highlight areas of greatest need for partnerships in various regions, and identify challenges of working with community providers in the new CCN contract.
We conducted a national survey with VA facility directors to explore needs, challenges, and expectations with the CCN.
The most common care referred to community providers included physical therapy, chiropractic, orthopedic, ophthalmology, and acupuncture. Open-ended responses focused on 3 topics: (1) Challenges in working with community providers, (2) Strategies to maintain strong relationships with community providers, and (3) Re-engagement with community providers who no longer provide care for Veterans.
VA faces challenges engaging with community providers given problems with timely reimbursement of community providers, low (Medicare) reimbursement rates, and confusing VA rules related to prior authorizations and bundled services. It will be critical to identify strategies to successfully initiate and sustain relationships with community providers.
国会颁布了两项主要立法，以改善退伍军人事务部（VA）退伍军人的医疗服务获取。因此，VA 在向退伍军人提供医疗服务的方式上发生了重大转变，更多地依赖社区为基础的提供商网络。目前还没有研究调查 VA 和签约社区提供商之间的关系。本研究调查了 VA 设施主任在与 VA 社区护理网络（CCN）内的社区提供商建立关系方面的成功和挑战。
了解 VA 设施与谁合作提供社区护理，突出各个地区合作伙伴关系的最大需求领域，并确定新 CCN 合同中与社区提供商合作的挑战。
我们对 VA 设施主任进行了一项全国性调查，以探讨 CCN 的需求、挑战和期望。
最常见的转介给社区提供商的治疗包括物理治疗、脊椎按摩、骨科、眼科和针灸。开放式回答集中在三个主题：（1）与社区提供商合作的挑战，（2）与社区提供商保持良好关系的策略，以及（3）重新与不再为退伍军人提供护理的社区提供商合作。
VA 在与社区提供商合作时面临挑战，原因是社区提供商的及时报销问题、（医疗保险）低报销率以及与事先授权和捆绑服务相关的混乱 VA 规则。至关重要的是，要确定成功启动和维持与社区提供商关系的策略。
