Trump goes with con­ti­nu­ity in choos­ing Shulkin for VA

Modern Healthcare - - NEWS - By Gregg Blesch

Pres­i­dent-elect Don­ald Trump opted for con­ti­nu­ity in the pur­suit of bet­ter health­care ser­vices for U.S. vet­er­ans.

Cur­rent Vet­er­ans Af­fairs Sec­re­tary Robert McDon­ald won’t keep his job. But rather than tap­ping some­one likely to lead a dra­matic change in di­rec­tion, Trump went with Dr. David Shulkin, the hospi­tal ex­ec­u­tive hired by the Obama ad­min­is­tra­tion to lead its ef­forts to ad­dress the depart­ment’s wide­spread prob­lems en­sur­ing ac­cess to timely care.

Just a few weeks ago Trump and his ad­vis­ers vaguely sig­naled they would pur­sue a plan to al­low more vet­er­ans to com­pletely by­pass VA hos­pi­tals and clin­ics and seek care from pri­vate providers. The Vet­er­ans of For­eign Wars and other vet­er­ans groups have warned that mov­ing too far to­ward pri­va­ti­za­tion would risk un­der­min­ing the VA’s im­por­tant role in co­or­di­nat­ing care and cater­ing to the unique health needs of the pop­u­la­tion. They gen­er­ally re­sponded pos­i­tively when Trump an­nounced Shulkin as his pick dur­ing a news con­fer­ence last week.

The Vet­er­ans Health Ad­min­is­tra­tion op­er­ates 168 hos­pi­tals and more than 1,000 out­pa­tient cen­ters. The sys­tem pro­vides care for about 6.8 mil­lion vet­er­ans each year.

Shulkin, 57, was CEO of Beth Is­rael Med­i­cal Cen­ter in New York from 2005 to 2009 and then pres­i­dent of Mor­ris­town (N.J.) Med­i­cal Cen­ter un­til Obama re­cruited him as un­der­sec­re­tary for health at the VA in 2015. The VA health sys­tem at that time was em­broiled in a

“I think Shulkin will bring some needed sta­bil­ity and con­ti­nu­ity in lead­er­ship to the VA health sys­tem.” NANCY SCHLICHTING Re­tired Henry Ford Health Sys­tem CEO

scan­dal trig­gered by whis­tle-blower ac­counts of a con­spir­acy to cover up ex­ces­sive wait times for care.

Trump, who has called the VA health sys­tem “a dis­as­ter,” in­ter­viewed sev­eral can­di­dates to take the helm of the VA, in­clud­ing Cleve­land Clinic CEO Dr. Toby Cos­grove and re­cently re­tired Henry Ford Health Sys­tem CEO Nancy Schlichting. Both with­drew them­selves from con­sid­er­a­tion.

Schlichting and Cos­grove led a com­mis­sion con­vened by Congress to make rec­om­men­da­tions to im­prove the vet­er­ans health sys­tem. The com­mis­sion’s re­port is­sued last year calls for the VA to main­tain its role as the ex­clu­sive provider for ser­vices, such as be­hav­ioral health­care and spinal cord in­jury care, and also de­velop in­te­grated net­works that in­clude com­mu­nity providers to en­sure bet­ter ac­cess to care.

Schlichting, the com­mis­sion’s chair­per­son, praised Trump’s de­ci­sion to go with Shulkin for the job. “He has been work­ing on im­prove­ment, and cer- tainly he worked with the com­mis­sion dur­ing our time and is sup­port­ive of the com­mis­sion’s re­port,” Schlichting told Mod­ern Health­care. “I think he will bring some needed sta­bil­ity and con­ti­nu­ity in lead­er­ship to the VA health sys­tem.”

Un­der the lead­er­ship of McDon­ald and Shulkin, the VA health sys­tem has ex­panded op­por­tu­ni­ties for vet­er­ans to seek care out­side the sys­tem. The Vet­er­ans Choice Pro­gram pays for vet­er­ans to get care from com­mu­nity providers if they have waited 30 days or more for a VA ap­point­ment or would have to drive more than 40 miles for VA care.

The com­mis­sion de­scribed that pro­gram as flawed. “Vet­er­ans, VHA staff and com­mu­nity providers have been con­fused be­cause of con­flict­ing re­quire­ments and pro­cesses in el­i­gi­bil­ity rules, re­fer­rals and au­tho­riza­tions, provider cre­den­tial­ing and net­work de­vel­op­ment, care co­or­di­na­tion, and claims man­age­ment,” the com­mis­sion wrote in the re­port.

The VA also moved re­cently to im­prove ac­cess to care by ex­pand­ing the scope of prac­tice for ad­vanced prac­tice nurses at VA fa­cil­i­ties be­yond lim­its im­posed by some state laws and reg­u­la­tions.

“We are both ea­ger to be­gin re­form­ing the ar­eas in our Vet­er­ans Af­fairs sys­tem that need crit­i­cal at­ten­tion, and do it in a swift, thought­ful and re­spon­si­ble way,” Shulkin said in a state­ment re­leased by Trump’s tran­si­tion team.

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