Care Collaboration

Department of Veterans Affairs newly appointed Under Secretary of Health, David Shulkin, MD, appeared in front of almost 800 spinal-cord injury and disease (SCI/D)-focused health care providers at the Paralyzed Veterans of America 5th Annual Summit and Expo

Only two months into the job, the Department of Veterans Affairs (VA) newly appointed Under Secretary of Health, David Shulkin, MD, appeared in front of almost 800 spinal-cord injury and disease (SCI/D)-focused health care providers at the Paralyzed Veterans of America (PVA) 5th Annual Summit and Expo in September. Sworn into a government agency riddled with problems blasted nationwide, Shulkin is making an effort to initiate change.

“The VA has come through a very rough time over these past 18 months and this is a year where we’re going to be building upon the momentum to build back the strength and confidence that people have in the VA health system,” Shulkin says. “We’re going to do it in a number of ways and we’re making some terrific progress.”

Core Concentration

Luckily for veterans with SCI/D, Shulkin considers specialty care services a core program of the VA, and an aspect to focus on.
“Specialty care services are really the core of what we do at the VA and it’s what VA does in particular in terms of its emphasis on treating veterans,” Shulkin says. “My role as undersecretary of health is to make sure that we have the right resources and the right allocations of staffing and equipment to make sure that specialty care services are providing state-of-the-art care.”
During his first day on the job, Shulkin met with veterans service organization (VSO) leadership and now, two months later, he continues to build a relationship with PVA at its Summit in Jacksonville, Fla.
“I view our relationships with PVA and other VSOs as absolutely vital. They are our partners and without their help and support we would not  be able to do the type of work that we do every day,” Shulkin says. “And I consider their council and advice and guidance extremely important to the success of our organization and look forward to continued relationships with them.”

Permanent Choice

The buzz at this year’s Summit started in the first breakout session, which focused on one of PVA’s main points of concern with the VA’s health care—the Veterans Access, Choice and Accountability Act—and how it affects specialty care services at the VA.
“One of the things that Paralyzed Veterans of America does besides health policies and besides benefits is we have a legislative agenda. So, we get involved in any legislation or proposed bills that are intended to impact care in some way,” said PVA Deputy Executive Director Sherman Gillums Jr., in that first session.
With news of a recent bill introduced by Sen. John McCain (R-Ariz.) that could make the VA choice program permanent, many Summit attendees and presenters in the sessions expressed concern on how it affects care. Executive Director of the VA SCI/D System of Care Sophia Chun, MD, stepped up in the session to share how the Choice Act threatens comprehensive lifetime care because it “would lend itself to fragmented care.”

Comprehensive vs. Fragmented

In a comprehensive lifetime model, care is given based on a patient’s condition ver-sus a provider’s specialty. This is how VA spinal-cord injury centers are currently run. You can be treated for SCI/D-related complications, like pressure sores, but also receive care for other ailments such as severe urinary tract infections, cancer, etc., from the providers who know your history from life until death.
On the other hand, in a fragmented model, you would go to a cardiology unit when you have a problem with your heart, 
get a separate oncologist if you have cancer, visit a urologist for a urinary tract infection or any doctor available at an urgent 
care center.
“The other thing that I see with this choice is that it’s taking the SCI system of care backwards to the fragmented care era,” Chun says. “ … It basically is a situation where you’re not getting care by staff and clinicians who are familiar with SCI and who have expertise in SCI. And that was the whole reason why spinal-cord injury system of care in the VA system was started.”
Of course, someone with SCI/D could choose care at any of the country’s 14 private spinal-cord injury model systems. However, Chun says those centers only offer comprehensive acute rehab.
“VA is the only system of care that actually has a health care system that’s actually built around a medical condition, which is spinal-cord injury. It’s a complex medical condition and in this model, the patient is at the center, so all the specialties that belong and need to be part of this SCI health care system is all under one umbrella in one location. So it’s a huge sort of shift in thinking for health care,” Chun says. “ … So, certainly on the rehab side if they go to a model system they will get truly an interdisciplinary comprehensive care. But if a patient had medical problems or surgical problems, then you’re still back to the fragmented care where you have to go to a surgeon who really hasn’t had any SCI background or hasn’t seen enough SCI patients to really understand; and so this choice is kind of essentially taking SCI backwards to a time pre-World War II.” 

PVA Summit Advocacy/Clinical Excellence Award winners.


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