Focus on the VA

Nov focus

Radiologists around the country join together to provide high-quality care for veterans.

The Department of Veterans Affairs (VA) has faced its share of challenges in recent years. In 2014, the Phoenix VA was at the center of a high-profile crisis surrounding access to care for veterans.

Since the crisis, much progress has been made to improve access to care at Phoenix and throughout the VA system. Dedicated to a model of veteran-centered care, the radiology department at the Phoenix VA currently completes over 95 percent of all radiology exams within 30 days and was recently recognized

by the National Radiology Program Office (part of the VA central office, having governance over all VA radiology) as a high-performing facility for access to MRI and ultrasound exams. In addition to improving efficiency and timeliness of care, VA radiologists search for ways to innovate and modernize the delivery of radiology care for our nation’s veterans.

Launching this year, the Veterans Affairs Partnership to Increase Access to Lung Cancer Screening Implementation Network entails a multi-disciplinary collaboration between pulmonologists, radiologists, thoracic surgeons, radiation oncologists, computer scientists, and radiologists. It is sponsored and funded by the Bristol-Myers Squibb Foundation and the VA Office of Rural Health. The main objective is to increase access to lung cancer screening for patients at a high risk of developing lung cancer, with a focus on rural veterans. It includes a collaboration with the VA National Teleradiology Program to develop a centralized QA program at the Phoenix VA for oversight of low-dose CT scans and interpretations. The project will be conducted over a three-year period to implement a VISTA-integrated International Early Lung Cancer Action Program patient management system at 10 VA medical centers. These centers collectively care for over 700,000 veterans and manage over 1,200 veterans diagnosed with non-small cell lung cancer each year. Currently 58 VA sites are performing lung cancer screening, and the VA is in the process of formulating policy and guidance to offer screening to all eligible veterans.

The VA is also focused on women’s health, including breast imaging, and we exceed the private sector in rates of mammography screening. In 2016, the VA screened 84.5 percent of age eligible women, compared with rates ranging from 69 to 73 percent for Medicare, Medicaid, and commercial settings. The VA has 60 breast imaging programs some sites offering mammograms only, and others full service operating 72 units (mammography machines) and has added 17 new programs since 2012. The Phoenix VA has the only ACR-designated Breast Imaging Center of Excellence in the VA system. The program is home to a comprehensive breast imaging and intervention service.

Phoenix has transitioned entirely to digital breast tomosynthesis (DBT), and in 2014 we were the third VA in the country to offer this technology. Currently, over half of the VA programs offer DBT, with 32 sites operating 36 DBT units. In comparison, only 40 percent of FDA-certified full field digital mammography sites offer DBT.2 Additionally, in 2010, Phoenix pioneered a veteran-centered approach to breast imaging that allowed screening exams to be read online, with immediate evaluation of worrisome findings and alleviation of patient anxiety. They also emphasize veteran education, with multiple initiatives targeted at raising awareness of the importance of ongoing breast health.

The VA continues its mission to educate future health care providers and participate in research meaningful to veteran care. Through its partnerships with affiliated academic institutions, the VA conducts the largest education and training effort for health professionals in the nation, training 70 percent of all U.S. physicians. The VA is a leader in medical research and innovation, playing key roles in developing the pacemaker, artificial limbs, and new diagnostic tests and treatments for traumatic brain injuries (TBI), spinal cord injuries, post-traumatic stress, and more. Phoenix is home to the first PET-MRI in the VA system, where we are actively engaged in multiple research projects, including evaluation of carotid plaque inflammation, rectal cancer staging, and movement disorders. We are also at the forefront of testing the utility of PET-MRI in the assessment of chronic TBI.

As advocates for veteran-centered care, the VA strives to provide greater value to veterans and families. Phoenix is leading several radiology initiatives, including e-consults, in-person interviews of inpatients, and use of tablets to obtain veteran opinion surveys in all radiology modalities. Based on veteran feedback, many changes have been implemented, including a centralized radiology scheduling call center and extended hours of operation. As a result, radiology receives consistently high veteran satisfaction survey scores, with 80 percent of veterans strongly recommending and 20 percent recommending radiology services in Phoenix.

VA radiologists are also involved with organized medicine, including the ACR. Many volunteer with the Commission on General, Small, Emergency, and/or Rural Practice. Earlier this year, the Network Planning Committee introduced the VA Rocks Engage community as a platform to foster better communication among VA radiologists. The Quality and Safety Committee is launching a subcommittee to work on VA initiatives. After a productive gathering at the 2017 ACR meeting, planning is underway for a dedicated educational program for ACR 2018, “VA Radiology: Leadership, Opportunity, and Innovation.” Through a collaborative effort with the ACR, advances in the delivery of radiology care at the VA are anticipated. Due to the dedication and commitment of VA radiologists, the future of radiology in the VA system appears bright.


ENDNOTES
1.National Committee for Quality Assurance. Breast Cancer Screening. Accessed September 7, 2017.
2.U.S. Food & Drug Administration. MQSA National Statistics. Accessed September 7, 2017.

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