About Expanding Liaison Program Improves DoD-VA Synergy in MTF

Last updated on 2009-08-06 09:44:33

Expanding Liaison Program Improves DoD-VA Synergy in MTFs

By Matt Pueschel,
FHP&R Staff Writer

A sign of continuing progress toward improved synergy between VA and DoD in providing health care to injured Service members from OEF/OIF can be found in an innovative program that places VA health care liaisons in military treatment facilities (MTFs).

Aimed at helping make the DoD-VA transition and delivery of care smooth and seamless, the program has expanded greatly since it began in 2003.

In a presentation before representatives from several military and veterans service organizations during a meeting hosted by Force Health Protection & Readiness in late May, Kathleen Dinegar, LICSW, Acting National Program Manager of the VA Liaison Program Care Management and Social Work Service, said the program started six years ago with just one Liaison at Walter Reed Army Medical Center in Washington, D.C., and VA now has 27 full-time social workers and nurses working as Liaisons in 13 MTFs. Five additional MTFs with significant numbers of injured Service members have been identified for future VA Liaison assignments over the next several months.

The program helps injured Active Duty, National Guard or Reserve Service members receive care that VA uniquely specializes in, and also aids Service members who are separating from the military in the transition process to VA. "If you talk to Service members and ask if they are connected with the VA, nine times out of 10 they think about their benefits and forget about their health care. The Liason's job is to help them coordinate their transition to VA health care," Dinegar said. "We're making sure veterans who have health care issues are getting the services they need. VA is working hand in hand with DoD at MTFs to make sure the Service member gets the benefits and care needed."

Each VA Liaison is based out of the Veterans Affairs Medical Center (VAMC) that is located nearest to each participating MTF, and the partnership is outlined in a local Memorandum of Agreement. VA's Central Office funds the Liaison program and provides programmatic oversight of it, while DoD reimburses VA for the care of active duty patients through TRICARE. "VA will treat active duty, and TRICARE pays for the care," Dinegar said. ¿Most VA Medical Centers are TRICARE providers."

Dinegar said there are also local sharing agreements in place between VAs and MTFs so that they will "always have a way to get the Service member care in VA if they need it."

VA Liaisons are integrated with staff at the MTF sites to coordinate care and provide onsite consultation about VA resources and treatment options, and a majority of them are co-located with the military's own case managers. A standardized referral form that outlines the patient¿s medical needs is provided by the MTF case manager to the VA Liaison with attached medical records, so the Service member can be registered into VA's Computerized Patient Record System (CPRS). "We coordinate with the inpatient MTF treatment teams, as well to obtain a referral for specialized rehabilitation," Dinegar said. "VA has a Memorandum of Understanding with DoD to provide specialized rehabilitation, such as blind, SCI, and TBI care."

Dinegar said they transfer Service members as soon as clinically appropriate to the proper VA rehab program, even if they might return to DoD later on, so that the specialized treatment and recovery process is started early. "An MTF clinical team member initiates the referral, but the VA Liaisons are part of those meetings," Dinegar advised. "We offer recommendations to the treatment team and Service member, and help transition care."

For less severely injured Service members, VA also has Liaisons co-located with Army Warrior Transition Units (WTUs, which support wounded Soldiers requiring rehabilitative care) at some MTF sites. The VA Liaison offers care where appropriate, or if Service members are transitioning out of the military, the Liaison will make contact with their local hometown VA, enroll them, help schedule appointments or inpatient beds, and have a contact number ready for when they leave the MTF. "VA Liaisons meet with Service members and their families to inform them about VA care, eligible benefits, (any copayments) and different programs. It is a huge health care system, so having a VA staff member onsite to provide that education directly to the Service member and family (helps greatly)," Dinegar said.

VA has 153 hospitals, over 900 community-based outpatient clinics, over 200 Vet Centers providing readjustment counseling, a women's health program, spinal cord injury and blind rehab centers, inpatient and outpatient PTSD programs, and polytrauma rehab centers. "Each of the 153 medical systems has one go-to person at the receiving VA medical center," Dinegar said. "This is the person we put them in touch with at the MTF. This is their first contact. VA has a wealth of services, so this is why we have VA staff at DoD facilities providing information early in the process.¿

An example of where VA can help DoD provide quality care is for Service members who have suffered visual impairment. Dinegar said that since MTFs have limited services in this area, DoD can partner with the local VA Visual Impairment Services Coordinator and center to provide the injured Service member with early training and equipment. "It is working well," she said.

Meanwhile, Service members who suffer injuries like amputations will usually stay in the MHS at advanced prosthetics and rehabilitation facilities in Brooke Army Medical Center in San Antonio or Walter Reed for a year or longer before returning to active duty or separating from service.

Last year, there were 3,728 referrals from MTFs to VAMCs through the VA Liaisons for Health Care Program. Of those, inpatient transfers to VA were mostly for polytrauma, SCI, blind rehabilitation or TBI care.

Although most of the inpatient transfers to VA are for specialized care programs, Service members can also be provided inpatient psychiatric care or hospice if the VA is closer to their home. Furthermore if a Service member is on convalescent leave from the military, ancillary care such as outpatient counseling for stress relief, for example, can be coordinated through their local VA if they need it, Dinegar advised. "When we first started at the MTFs we were focused on the severely injured, but as circumstances have evolved, the Army set up the WTUs (in 2007), and we've been trying to capture anyone who needs VA care," she said.

Dinegar said VA has many ways to verify a patient's military service, so patients do not need a record of their service in hand to get care. However, since the VA and DoD computer record systems are not completely compatible, Dinegar said Liaisons will still do a lot of faxing to ensure patients receive needed care and clinicians get the required information to deliver it. "We see DoD labs, radiology reports, (reports from regional hospitals like Landstuhl Army Medical Center in Germany), medications, allergies, discharge summaries and some notes. And DoD has a bi-directional health information exchange where they can see a lot of VA's notes," she advised. "We're getting closer. In VA, there is a Joint Patient Tracking System Application where we can see brief notes from theater. (But) gathering medical records or notes from in theater is still a work in progress."

VA Liaisons participate in video teleconferencing between MTF and VA staff, and coordinate referrals with the OEF/OIF Program Manager at the receiving VAMC. Each VA Medical Center has an OEF/OIF Care Management Team, in which a program manager serves as the contact point for referrals from the MTF and coordinates the transition of care, and a case manager provides further services to help manage the care of severely ill or injured patients. Dinegar recommended that MSO/VSO members or other patient advocates call the patient's local VAMC and ask for the OEF/OIF Program Manager to help get the Service member or veteran enrolled to receive needed services. "Anyone injured will be evaluated, and the case manager will follow up and check in with the patient to see if they have any more needs," she said.

The team also consists of a Transition Patient Advocate who serves as a source of help across the patient's episodes and sites of care. "It's someone to help them walk through the process," Dinegar advised. "Many are OEF/OIF veterans, themselves, and have gone through the process."

VA further has two Polytrauma Nurse Liaisons at Walter Reed and the National Naval Medical Center in Bethesda, Md., to ensure that Service members' critical needs are met and they are transferred appropriately to VA's Polytrauma inpatient centers.

If the referred patient is still on active duty while being treated at a VA Polytrauma Center, there is also a DoD liaison available to assist the Service member with active duty obligations and procedures during the recovery process.

Meanwhile, the VA Liaison will inform referred severely injured patients' relevant state VA departments to see if there might be any additional state benefits available to them.

VA Liaisons furthermore collaborate with the new Federal Recovery Coordination Program, which works with the most catastrophically injured Service members, providing case management and ensuring health care is transitioned smoothly from DoD to VA if patients are referred.

There also is a Disability Evaluation System pilot project to examine the possibility of requiring just one medical exam for Service members who may have to go through both the DoD medical evaluation board and VA service compensation processes.