VA Rule Allows Interstate Care Delivery, Promotes Care Access

The US Department of Veterans Affairs (VA) has issued an interim final rule affirming the agency’s current policy that allows interstate care delivery for VA healthcare professionals, ultimately boosting care access.

The VA’s flexibility to hire healthcare professionals from any state and place them in areas of high demand, regardless of conflicting state requirements, is crucial amidst the COVID-19 pandemic.

“As the nation’s largest integrated health care system, it is critical VA healthcare professionals are able to deliver services in regions other than where they may be licensed, registered, certified or limited by a state requirement,” said VA Secretary Robert Wilkie.

“Whether we are assisting states dealing with natural disasters or even more so now with their pandemic response, VA is working diligently to get the appropriate, qualified staff to those communities in need as quickly as possible,” Wilkie continued.

The rule, invoked from the VA’s Fourth Mission, allows VA healthcare professionals to deliver care at other VA medical centers, as well as certain private hospitals, state Veterans homes, and nursing homes regardless of state license, certification, registration or other requirements. Additionally, VA healthcare professionals can bring care to rural locations using mobile health units.

Since the onset of COVID-19, the VA has sent 3,000 healthcare professionals to serve at civilian facilities, the Indian Health Service, State Veterans Homes, and other VA medical facilities that have been affected by COVID-19.

These efforts have helped Veterans and their communities in 47 different states and the District of Columbia by quickly moving staff and equipment to parts of the country that are experiencing critical shortages of healthcare resources.  

This comes as the medical industry continues to stare down a provider shortage problem, especially in rural areas.

A new cross-sectional study published in JAMA Network Open highlights rural primary care workforce disparities. Researchers noted that 82 percent of rural counties are classified as medically underserved, according to research from the National Academies of Sciences, Engineering and Medicine.

Healthcare professionals have been aware of rural access to care issues and have put in place incentives to attract primary care physicians to rural areas in some instances. However, little research has been done to analyze potential changes in the primary care physician distribution over the past decade until this study.

Researchers examined the primary care workforce data of 3,143 counties from the years 2009 to 2017 and found that while both rural and urban areas have seen an increase in primary care clinicians in recent years, the density of providers in urban areas remains higher than in rural areas.

The number of primary care clinicians per 3,500 people increased by approximately 17 percent in urban counties with a median density of 2.26 in 2009 and a median density of 2.66 in 2017. For rural communities, there was approximately a 12 percent increase in the number of primary care clinicians with a 2009 median density of 2.04 and a 2017 median density of 2.29.

The researchers adjusted the data for county-level sociodemographic variables and the rural-urban disparities continued to be substantiated.

The study broke down the trends of primary care clinician density by type of clinician. In rural counties, the average annual percentage change (APC) of the mean density of primary care physicians was 1.7 percent, compared to 2.4 percent in urban counties. Similarly, the APC of the mean density of physician assistants in rural counties was 5.14 percent in comparison to the APC of 6.42 percent in urban communities.

Access to primary care clinicians is key to improving population health and quality of care. With the implementation of the VA’s interim final rule, VA clinicians will be able to serve communities in need of healthcare resources no matter where they are located in the country.