WHITE RIVER JUNCTION — As the Veterans Health Administration begins to expand veterans’ access to private medical care, the new director of the White River Junction VA Medical Center says he believes veterans will continue to choose to receive care there.
Despite concerns by some Democrats in Congress that a new approach to community care — as outlined in the 2018 Mission Act — set to begin next month will deplete the VA’s resources by resulting in more veterans choosing to receive care outside of the VA system, Dr. Brett Rusch said the law actually aims to strengthen the VA health system.
It will do that, he said in a Thursday interview in his office, by helping recruit providers, modernizing the electronic health record system and investing in care coordination.
“I don’t think there’s any intent to somehow on purpose restrict the services that the VA is able to provide in Vermont and New Hampshire,” Rusch said. “I do believe that Vermont and New Hampshire veterans largely view this VA as their best option.”
The Mission Act removes some barriers to private care, such as requirements that veterans live a certain distance from VA-operated care or that the wait for the VA care be more than a certain amount of time. It creates a network for paying private providers that operates like a private insurance network.
Rusch, a 40-year-old psychiatrist, became the White River Junction VA’s permanent director last month as the system prepares to roll out this new approach, which he described as a “transformation.”
He first came to White River Junction in 2015 to serve as chief of mental health and behavioral science services. He later served as chief of staff under the previous director Alfred Montoya, who is now director of the Manchester VA Medical Center.
Rusch said he was attracted to the White River Junction VA, in part, by its innovative approach to integrating mental health treatment in primary care settings. He made the transition from clinical care to administrative roles partly because as the physician workforce ages, there’s a need for younger leaders to step up and because it was something he felt he was good at, based on his work leading clinical teams both in White River Junction and in Wisconsin, where he worked previously.
Though he is now an administrator, Rusch said he brings a clinical focus to the role, which fits in with the VA’s current evolution. Under the Mission Act, rather than basing the decision of where a veteran will receive care on how many miles away a veteran lives from a VA facility or how long the wait for an appointment is, Rusch said the new approach is to make that choice a clinical decision between a provider and a veteran.
“Those numbers don’t actually equal better care,” Rusch said. “Relying on those numbers does not constitute a decision — certainly not a shared decision.”
The White River Junction VA will be among the first to make the transition to the new system. The current system, Veterans Choice, ends on June 6, and then the VA has a year to develop its new network of community providers, Rusch said. Similar to a private insurance network, the VA will develop contracts with community providers to care for veterans, he said.
The discussion between a veteran and his or her provider will include weighing the advantages of timeliness or proximity against issues of obtaining care outside of a unified system. Providers who work at the VA have more expertise in treating veterans than most private providers do, he said. They also have the advantage of working together under one roof, which can allow for clinical collaborations such as an integrated approach to chronic pain management.
In the shift to more private care, it is possible that new elements of risk could be introduced as veterans’ care may become more fractured, Rusch said.
“A lot of us worry that … by giving increased choice that we are trading on some level choice for safety,” Rusch said. “That is one of our most important missions over the next couple of years to minimize that.”
That requires that the VA focus on the fundamentals of quality and safety, Rusch said.
“I choose to focus on ensuring that everything that we are doing right now is at the highest level possible,” he said.
In addition, Rusch said he is focused on listening to the veterans themselves and responding to what they say they need. For example, he aims to expand access to VA providers through VA Video Connect, a telehealth platform that allows veterans to interact with their providers through electronic devices such as smartphones or tablets.
“That’s the kind of modernization that we’re hearing from veterans that we need to provide,” Rusch said.
On the clinical side, Rusch, who attended the University of Wisconsin School of Medicine and Public Health, said there are some types of care that the VA will always need to provide. One piece of this is providing mental health care in part to reduce the number of veteran suicides. About 20 veterans die by suicide each day, according to VA data.
“Efforts to prevent suicide will always be part of what the VA does,” Rusch said. “I don’t think we get to call ‘mission accomplished’ on that.”
Given that there are a number of younger combat veterans struggling with mental illness related to their service in Iraq and Afghanistan, Rusch said the VA needs to be prepared to care for them for the decades to come.
Veterans need to be able to “count on the VA to be present as a reliable source of health care, including mental health care, for their entire lives,” Rusch said.
To provide that care, Rusch said the VA also is focused on recruiting high-quality medical providers. The Mission Act includes funds to help providers repay their educational loans.
In the face of national shortages of physicians and nurses, Rusch said it’s important to continue to make a pitch to young clinicians in training “about how good a career at the VA can be, especially here in Vermont.”
By continuing to provide the care veterans say they want, Rusch said he believes most will continue to choose the VA for their care. But when a community option is best, veterans will go there despite the fact that it means that funds will follow them, he said.
“We do that because it’s the right thing to do,” he said. The budget will “all work itself out based on doing the right thing, and I think that’s how we have to move forward.”
Though it’s unknown at this point how many of the 26,000 veterans who receive care at the White River Junction VA will choose private care, Rusch said, “We’ll know a lot more in a year.”
Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.
