VA Urgent Care, ED Staffing Helped By New Legislation

by U.S. Medicine

February 14, 2017

By Sandra Basu

Phillip Seton, MD, chief of the emergency department at the DCVAMC in Washington provides care for a patient. A new law will aid ED staffing. VA photo

WASHINGTONVA soon will be able to implement flexible work schedules for certain medical professionals to better accommodate patients.

Under current law, the hours of employment of full-time employees is set at not less than 80 hours in a biweekly pay period. A recently-passed law, however, allows VA to modify the hours of a full-time VA physician to more or less than 80 hours in a biweekly pay period, on the condition the physician provides VA with an advance written request and accounts for at least 2,080 hours of employment in a calendar year.

VA officials told U.S. Medicine last month that the new law is anticipated to most affect hospitalists and emergency medicine physicians across VHA. While there is no estimate as to how many physicians will choose to exercise the terms of the provision, the VA said “these physicians will be made aware of this option.”

“This is particularly helpful for VA emergency departments and urgent care clinics, which must staff their departments beyond traditional clinic hours,” VA officials told U.S. Medicine in a statement.

Clinicians from more than 115 emergency departments see approximately 2.4 million veterans per year, according to the agency.

“Hospitalized patients need access to physicians 24 hours a day and, therefore, coverage can result in long days, evenings, nights and weekends. Frequently, in order to maintain continuity of care for inpatients, physicians will work more than 80 hours in a two-week period. Physicians now have the flexibility to do what is best for veterans,” officials explained to U.S. Medicine in a written statement. “The provision also allows VA to arrange flexible work schedules to allow for the hiring and implementation of a hospitalist physician system and to accommodate irregular work schedules in emergency medicine.”

In the past, VA has complained that the lack of flexibility with the 80-hour per federal work period creates complications in hospitals, especially in emergency room settings and makes assuring shift coverage difficult. It also makes it harder for VA to recruit and retain critical professionals, the agency has said.

“The private sector has this flexibility, and it makes sense in running a hospital. This flexibility can both improve hospital operations and help attract the best hospital staff who use and prefer more flexible schedules,” then-VA Secretary Robert McDonald told lawmakers at a hearing last year. The proposal was included last year in President Barack Obama’s proposed 2017 budget request.

VA offices responsible for human resources, pay and work scheduling have been developing a plan to implement the policy by July 31, 2017, according to the agency.

Healthcare Changes

The provision giving VA flexibility to modify the hours of VA physicians was passed in December in the Miller-Blumenthal Veterans Health Care and Benefits Act of 2016. In addition to that provision, the law contained other changes, including some to improve the disability appeals process, but it fell short of the extensive reforms being requested by VA and advocacy groups.

The new law would temporarily expand the U.S. Court of Appeals for Veterans Claims from seven to nine judges through 2020 and require a report on temporary expansions of the Veterans Court. It also would require VA to inform the public about the average length of time it takes to adjudicate an appeal filed within 180 days after the initial decision as well as the average length of time it takes to adjudicate an appeal not filed within 180 days after the initial decision.

         The VA, however, had been pushing for comprehensive reforms to the system so that, by 2021, veterans would be able to receive a final appeals decision within 365 days from when they file an appeal. Under current law, VA said that veterans wait on average five years for final resolution of an appeal.

McDonald had explained the percentage of appeals has stayed relatively steady at about 10% of all disability claims, but that, as the agency has processed more disability claims in recent years, that 10% becomes a “much larger” number of appeals.

“In five years, you could have appeals resolved within one year of filing. The alternative? Devote more resources to the broken system and fund more employees to administer it. And you’ll be waiting 10 years for a final decision on your appeal,” he said last year.

Late last year, McDonald as well as advocacy groups continued to push for passage of the comprehensive appeals reforms. Without passage of the appeals reforms, advocacy groups such as Disabled American Veterans said that they would “renew” efforts to ensure that its critical priorities, including modernizing the appeals process, are addressed this year.

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