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The Department of Veterans Affairs Providing Certain Veterans With Prescription-Only Health Care









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Good morning, Chairman Simmons, Ranking Member Rodriguez, and other distinguished members of the House Subcommittee on Health of the Committee on Veterans Affairs. On behalf of National President Thomas H. Corey, we thank you for the opportunity for Vietnam Veterans of America (VVA) to appear here today to share our views on the issue of "Transitional Pharmacy Benefits" at the Veterans Health Administration facilities of the U.S. Department of Veterans Affairs (VA). I ask that you enter our full statement in the record, and I will briefly summarize the most important points of our statement.

The "Transitional Pharmacy Benefit" would never have been necessary if the veterans health care system were fully and properly funded to take care of the veterans who are statutorily eligible to use the VHA system. If there were anything approaching adequate funding, there would have been no need to promulgate the regulation issued to accomplish the filling of prescriptions written by non-VA physicians as there would never have been waiting periods of longer than thirty days. This would have rendered the premise of VHA Directive 2003-047 (issued August 14, 2003, and affecting veterans enrolled in VA health care by July 25, 2003) and other various legislative proposals moot. This is but one more good reason why we need mandatory funding for health care for America's veterans.

When VVA received notice of this hearing late last week, we sent out messages soliciting thoughts and data from our Service Representatives and from the VVA National and State leadership who are geographically dispersed across the nation. The reports were that it was not utilized therefore there was no waiting list longer than 30 days at the local VA Medical Center, or that the "Transitional Pharmacy Benefit" was working well, and in the manner intended by the Secretary of Veterans Affairs. The reports are consistently favorable. The VA pharmacy service is doing a very good to excellent job with this program, and that veterans and veteran's advocates at the local level are pleased with this benefit, if not the reasons that made it necessary.

It is worth noting that the pharmacy operation has so improved in the last two decades that it is now one of the best-run VA programs. It is generally effective, efficient, and is constantly improving based on clinician and veteran reactions and suggestions. Of all the VA operations, it is the one that appears to be truly operating on the "Demming" method, devised by the late W. Edwards Demming, of constant improvements, with many of these modifications being small but some large, that result in an increasingly more effective operation at the least possible cost. It is indeed ironic that the pharmacy operation should apparently be one of the areas targeted for eventual outsourcing by the Office of Management & Budget (OMB). One could say that this is yet another case of "if it's working, let's break it" by the OMB bureaucracy.

There has been discussion of making the concept of VA filling prescriptions written by non-VA physicians a more far-reaching and permanent program. VVA in the past has not favored such efforts, for a variety of reasons, and not just cost to the medical operations fund at the current inadequate level under discretionary spending.

The most important function of the VA medical system is "to care for he who hath borne the battle" In other words, it should deal with the "veteran-ness" of an eligible person by properly testing and diagnosing all of the maladies, injuries, and illnesses that a veteran may have that are in some way related to his military service. Currently the VA largely has no idea of "who hath borne the battle" among the users of the VA system, even if they are service-connected disabled veterans. For example, VA can only tell at a glance if an individual is a Vietnam-era veteran, and not whether or not they served in the Vietnam theater of operations.

In the five years since the announcement of the "Veterans Health Initiative," the VA has yet to implement a training program for all employees, or even just the new employees and clinicians that defines these special people whom we serve, and what makes veterans different from the general population that one might see in a general hospital. The taking of a complete military history (what branch, when, what duty stations, what military job M.O.S., and what actually happened to them) and utilizing this vital information in the diagnosis and treatment process, is central to the raison-detre of the VA, i.e., that it be a Veterans Health Care System, and not just general health care that happens to be for veterans.

While we are assured that the new Information Technology is being designed to find out complete military histories, and correlate this information with diseases, exposures, and the like which may have affected the veteran, this architecture is not due for realization until FY 2008 at the earliest. VVA commends Undersecretary Robert Roswell for including this in the "20/20 Vision Statement" for the VHA. VVA believes that much more can be done today even without all processes being automated. VVA also commends Secretary Principi for including the taking and using of military history for each veteran in the above-described manner, for the very first time in the "2003-2008 Strategic Plan for VA."

If the VA were taking a complete military history and using it in the diagnosis and treatment processes, then it would become doubly important for those who potentially served at a time and place where they were exposed to toxic substances or diseases that should be evaluated by VA physicians who (at some time in the future) would be trained to spot and to test as appropriate for these potential service related conditions. Attached please find a copy of the web website for the "Pocket Card" that is supposed to be used to train interns, residents, and other new VA professionals. These cards are also supposed to be available to, and used by, all VA clinicians, although that is rarely the case.

If the VHA were working as a true Veterans Health Care system, and when it is again adequately funded to properly care for all veterans who are statutorily eligible, VVA would not favor any program that moves case management outside of the VA.

Since we are where we are with funding and overcrowding today, VVA again congratulates Secretary Anthony J. Principi for moving ahead with this program to provide a short-term fix for those who needed medications but had to endure long waits to secure these already privately prescribed medicines, and to reduce the backlog of veterans waiting to be seen at many facilities, especially in VISN 8 and other areas where particularly long waiting times had become a really sever problem.

Mr. Chairman, that concludes our brief remarks on this issue. I would be pleased to answer any questions you or your distinguished colleagues may have.

Again, thank you for allowing VVA the opportunity to offer our views here today.

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The "Transitional Pharmacy Benefit" would never have been necessary if the veterans health care system were fully and properly funded to take care of the veterans who are statutorily eligible to use the VHA system. If there were anything approaching adequate funding, there would have been no need to promulgate the regulation issued to accomplish the filling of prescriptions written by non-VA physicians as there would never have been waiting periods of longer than thirty days. This would have rendered the premise of VHA Directive 2003-047 (issued August 14, 2003, and affecting veterans enrolled in VA health care by July 25, 2003) and other various legislative proposals moot. This is but one more good reason why we need mandatory funding for health care for America's veterans.

When VVA received notice of this hearing late last week, we sent out messages soliciting thoughts and data from our Service Representatives and from the VVA National and State leadership who are geographically dispersed across the nation. The reports were that it was not utilized therefore there was no waiting list longer than 30 days at the local VA Medical Center, or that the "Transitional Pharmacy Benefit" was working well, and in the manner intended by the Secretary of Veterans Affairs. The reports are consistently favorable. The VA pharmacy service is doing a very good to excellent job with this program, and that veterans and veteran's advocates at the local level are pleased with this benefit, if not the reasons that made it necessary.

It is worth noting that the pharmacy operation has so improved in the last two decades that it is now one of the best-run VA programs. It is generally effective, efficient, and is constantly improving based on clinician and veteran reactions and suggestions. Of all the VA operations, it is the one that appears to be truly operating on the "Demming" method, devised by the late W. Edwards Demming, of constant improvements, with many of these modifications being small but some large, that result in an increasingly more effective operation at the least possible cost. It is indeed ironic that the pharmacy operation should apparently be one of the areas targeted for eventual outsourcing by the Office of Management & Budget (OMB). One could say that this is yet another case of "if it's working, let's break it" by the OMB bureaucracy.

There has been discussion of making the concept of VA filling prescriptions written by non-VA physicians a more far-reaching and permanent program. VVA in the past has not favored such efforts, for a variety of reasons, and not just cost to the medical operations fund at the current inadequate level under discretionary spending.

The most important function of the VA medical system is "to care for he who hath borne the battle" In other words, it should deal with the "veteran-ness" of an eligible person by properly testing and diagnosing all of the maladies, injuries, and illnesses that a veteran may have that are in some way related to his military service. Currently the VA largely has no idea of "who hath borne the battle" among the users of the VA system, even if they are service-connected disabled veterans. For example, VA can only tell at a glance if an individual is a Vietnam-era veteran, and not whether or not they served in the Vietnam theater of operations.

In the five years since the announcement of the "Veterans Health Initiative," the VA has yet to implement a training program for all employees, or even just the new employees and clinicians that defines these special people whom we serve, and what makes veterans different from the general population that one might see in a general hospital. The taking of a complete military history (what branch, when, what duty stations, what military job M.O.S., and what actually happened to them) and utilizing this vital information in the diagnosis and treatment process, is central to the raison-detre of the VA, i.e., that it be a Veterans Health Care System, and not just general health care that happens to be for veterans.

While we are assured that the new Information Technology is being designed to find out complete military histories, and correlate this information with diseases, exposures, and the like which may have affected the veteran, this architecture is not due for realization until FY 2008 at the earliest. VVA commends Undersecretary Robert Roswell for including this in the "20/20 Vision Statement" for the VHA. VVA believes that much more can be done today even without all processes being automated. VVA also commends Secretary Principi for including the taking and using of military history for each veteran in the above-described manner, for the very first time in the "2003-2008 Strategic Plan for VA."

If the VA were taking a complete military history and using it in the diagnosis and treatment processes, then it would become doubly important for those who potentially served at a time and place where they were exposed to toxic substances or diseases that should be evaluated by VA physicians who (at some time in the future) would be trained to spot and to test as appropriate for these potential service related conditions. Attached please find a copy of the web website for the "Pocket Card" that is supposed to be used to train interns, residents, and other new VA professionals. These cards are also supposed to be available to, and used by, all VA clinicians, although that is rarely the case.

If the VHA were working as a true Veterans Health Care system, and when it is again adequately funded to properly care for all veterans who are statutorily eligible, VVA would not favor any program that moves case management outside of the VA.

Since we are where we are with funding and overcrowding today, VVA again congratulates Secretary Anthony J. Principi for moving ahead with this program to provide a short-term fix for those who needed medications but had to endure long waits to secure these already privately prescribed medicines, and to reduce the backlog of veterans waiting to be seen at many facilities, especially in VISN 8 and other areas where particularly long waiting times had become a really sever problem.

Mr. Chairman, that concludes our brief remarks on this issue. I would be pleased to answer any questions you or your distinguished colleagues may have.

Again, thank you for allowing VVA the opportunity to offer our views here today.
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