Veterans With Private Doctors at Higher Risk for Opioid Abuse

According to the VA, veterans fare better at avoiding opioid abuse in the VA system. This is another reason why the VA should not be privatized.

Veterans using a Department of Veterans Affairs program to seek care from doctors in the private sector instead of the VA face a greater danger of becoming entangled in the country’s opioid epidemic, the VA said Tuesday.

Findings from the VA’s Office of Inspector General show that programs allowing veterans to get care from private doctors when appointments aren’t available in the VA system leave veterans vulnerable to overprescription of powerful opioids because of gaps in the process used by the VA to keep track of prescriptions.

The Inspector General said problems still arise when veterans get VA-funded care from the private sector, but when patients are treated entirely within the VA system they fare better, in part due to a VA program designed to combat opioid overprescription and misuse.

“With the expansion of community partnerships, a significant risk exists for patients who are prescribed opioid prescriptions outside of VA,” the report said. “The risk is exacerbated when information about opioid prescriptions is not shared between VA and non-VA providers.”

The report didn’t elaborate on how many veterans may be intentionally skirting the VA system to avoid the department’s opioid tracking system.

The Inspector General launched its investigation into opioid prescription oversight some two years after the department began overhauling two major aspects of its health care.

In 2014, the VA began programs to combat patient overuse of opioids by encouraging doctors to use alternative treatments for pain management, while also enabling them to better track when and how many patients use painkillers.

That year, the VA also launched a multi billion-dollar program for veterans to get care from private doctors, but the program has been plagued with complaints that patient records aren’t always properly reported back to the VA so the department can keep comprehensive files on veterans and monitor their treatment.

The VA’s watchdog recommends the department ensure private-care providers are fully informed of the department’s opioid safety program and intervene when private providers are deemed to be putting veterans at risk. The watchdog also recommends that private sector doctors get full access to the veterans’ medical records and be required to send all opioid prescriptions to VA pharmacies so they are tracked by a central database.

The findings call into question quality-control standards for the so-called Veterans Choice program that allows veterans to seek care in the private sector and which last week was approved by the House of Representatives for an extension of funding. The Senate has yet to vote on the funding.

The VA watchdog found that in 2016 some 14,000 patients filled opioid prescriptions at VA pharmacies after getting medication prescribed outside the VA system, or by both VA and private doctors, indicating that these patients are at risk for overprescription and a lack of oversight by their VA primary care providers.

In Tuesday’s report, inspectors highlighted a patient who sought opioid prescriptions from a VA-approved private care doctor. When asked about the matter by VA doctors the patient stopped coming to the VA for treatment, though was still authorized to use VA funds for private-sector care.

In March, President Donald Trump signed an executive order launching a commission on combating drug addiction and the opioid crisis. The commission released an interim report Monday advocating that the VA, among other hospital systems, better use an existing central database for tracking such prescriptions.

The VA launched its Opioid Safety Initiative in 2014 after it became clear the department’s prescribing practices helped contribute to overprescription. The initiative has had success, according to the VA’s Inspector General, especially when primary care physicians in the department can track prescriptions in the centralized VA pharmaceutical database.

The VA agreed with the findings of the watchdog in their official response to the report. The VA didn’t respond to a request for further comment on the matter.

In 2016, some 870,000 veterans were prescribed opiates, with about 14,000 of those getting their prescriptions outside the VA system in some way.

The number of veterans who get care outside the VA system continues to increase, with some one-third of the department’s appointments sent to the private sector and that number expected to grow, according to VA Secretary David Shulkin.  A $2 billion boost for the program is likely to be passed by Congress and signed by President Donald Trump midmonth.

This was reported by the WSJ, a generally center-right part of the business press that’s one of the most ardent supporters of “free trade” in the world. I don’t read the WSJ that often, but it would surprise me to find it calling for more free markets in prescription drugs and more free trade in doctors. In the case of doctors, people are forbidden from practicing medicine in the United States unless they’ve completed a U.S. residency program. This is a form of protectionism that costs the U.S. between $80 billion to $100 billion a year in increased healthcare costs, since U.S. doctors are payed roughly twice what the doctors of other wealthy countries are payed. The protectionist measures for U.S. doctors results in less competition there, which then results in higher doctor pay.

Is there really anyone who can honestly say doctors from an advanced country such as Germany or Canada are unqualified because they haven’t completed a U.S. residency program?

There are limits on the number of people accepted to U.S. medical schools, and there are also limits on the number of foreign medical school graduates that are accepted into U.S. medical residency programs. It’s illegal for dentists to practice their field in the U.S. unless they’ve either graduated from an accredited American or Canadian dental school. There are also a variety of state laws limiting what would otherwise be more efficient U.S. healthcare.

An amount of $80 to $100 billion for this single limitation adds up to about a trillion dollars a decade, which is approaching a third of what the U.S. pays every year for healthcare, at $3.2 trillion. It’s another significant reform that could still be implemented.