D.47- COORDINATED CARE POLICY FOR TRAVELING VETERANS AUG 2021.pdf

COORDINATED CARE FOR TRAVELING VETERANS

MCP 11-191

Syracuse VA Medical Center Syracuse, NY 13210

Signatory Authority:

Medical Center Director

Responsible Owner:

Traveling Veteran Coordinator

Rescinded Document:

MCP 11-191, Coordinated Care for

Traveling Veterans, dated October 2017

Effective Date:

August 2021

Recertification Date:

August 2026

1. POLICY

This medical center policy (MCP) establishes guidelines regarding coordination of care and medications for traveling Veterans. This policy provides guidance to maximize continuity and consistent, appropriate, and safe care for Veterans requesting healthcare while traveling away from home. This policy does not apply to Veterans who are transferring their care to Syracuse VA Medical care.

2. JUSTIFICATION

This policy is written in accordance with VHA Handbook 1101.11(4), which mandates a local policy be in place that outlines procedures by which traveling Veterans will receive care coordination.

3. RESPONSIBILITIES

a. Preferred Facility Patient-Aligned Care (PACT) Team. The Preferred Facility PACT team is responsible for:

b. Coordinating medical care for Veterans with unexpected non-urgent healthcare needs using the Traveling Veteran Coordinator Network.

c. PACT Primary Care Provider (PCP)/Nurse Case Manager (NCM). The PACT PCP/NCM is responsible for:

(1) Reviewing and coordinating medical needs of Veteran planning to travel away from home facility.

(2) Requesting routine care such as lab testing or non-urgent care (such as physical therapy) by submitting a Traveling Veteran Coordination of Care consult prior to Veteran’s arrival at the Alternate Facility.

d. Specialty Service Provider. The Specialty Service Provider (e.g., Hematology/Oncology, Surgical follow-up) is responsible for:

Attachment D.47 RFP 36C24224R0049

Month Year MCP [NUMBER]

(1) Submitting a Traveling Veteran Coordination of Care consult requesting that specific specialty care is needed while Veteran is on travel.

e. Veteran’s Service Center (VSC)/Administrator on Duty (AOD). The Veteran’s Service Center (VSC) or AOD is responsible for:

(1) Assisting Veterans with required registration at the Syracuse VA Medical Center by determining eligibility via “VistA Register Once”. This is the responsibility of the VSC during administrative hours, and the AOD during non-administrative hours.

f. Pharmacy. The Pharmacy is responsible for:

(1) Assisting Veterans in need of medication by providing refills of existing prescriptions, or “bridge supply” of medications if no refills exist or cannot be processed.

(2) Providing assistance Monday through Friday, 8am to 8pm, at the Outpatient Pharmacy window. Outside of these hours, the Emergency Department will provide limited prescriptions until the pharmacy reopens.

(3) Evaluating requests for medications and/or medical supplies using VistA Web or other remote-access capabilities.

(4) Evaluating remote allergies/adverse drug reactions, remote medication profile, refill history, labs and/or vital signs that pertain to the request to ensure the request is clinically appropriate.

(5) Documenting any allergies or adverse drug reactions (noted in the remote data or reported by Veteran) in the VA Healthcare Upstate New York database.

(6) Entering an electronic progress note titled “Pharmacy Note” and using the “Traveling Veteran” template to document the remote data and their intervention. If the intervention includes medication(s) that are not within the Pharmacist’s scope of practice, the Emergency Department will be contacted to determine which provider to assign as an additional signer on the note.

(7) Relaying the process for arranging a temporary address and obtaining further supplies from the Preferred Facility if the Veteran will be in the area longer than two weeks.

(8) Providing phone numbers for the Preferred Facility or contacting the Preferred Facility on behalf of the Veteran, or directing the Veteran to the My HealtheVet website (https://www.myhealth.va.gov) for contact numbers to the Preferred Facility.

g. Traveling Veteran Coordinator. The Traveling Veteran Coordinator is responsible for:

(1) Assisting Veterans who are unable to be assisted in whole or in part by Pharmacy. The Traveling Veteran Coordinator will provide assistance during https://www.myhealth.va.gov/ administrative hours and any needs during non-administrative hours will be addressed by the Emergency Department.

(2) Addressing nonurgent medical issues with traveling Veteran’s PCP at their Preferred Facility.

(3) Coordinating care for Veterans traveling to the Syracuse VAMC for less than three months who are in need of anticoagulation services.

(4) Coordinating anticoagulation services for Veterans traveling from Syracuse to an Alternate Facility for periods of four to six weeks or more.

h. Emergency Department. The Emergency Department is responsible for:

(1) Conducting medical evaluations for traveling Veterans in need of medications/supplies that are unable to be honored by Pharmacy.

(2) Providing assistance to traveling Veterans seeking medical care or medications/supplies during non-administrative hours.

(3) Evaluating requests for medications/supplies using Vista Web or other remote access capabilities.

(4) Providing an allergy and reactions assessment and taking medication history to ensure the medication/supply request is clinically appropriate.

4. OTHER PARAGRAPHS

a. Medication Needs.

(1) Bridge supply medications.

(a) Bridge supply medications will be limited to a 15-day fill, and patient will be educated regarding and/or assisted with obtaining medications from their Preferred Facility if they will be in the Syracuse area longer than two weeks. When possible, the Outpatient Pharmacy will use the OneVa option in VistA to process the traveling Veteran’s request. If the VistA option is down or the request is for a controlled substance, the following process will be followed.

1. Inclusions

a. Maintenance medications and/or supplies that are documented in the Veteran’s medication record from the Preferred Facility. This may include active medications with or without available refills and recently expired medications.

2. Exclusions

a. Controlled Substances (any C-II, C-III, C-IV or C-V).

b. Antineoplastic agents.

c. Acutely prescribed oral corticosteroids.

d. Medications that require close medication monitoring, the lack of which may lead to patient safety issues (e.g. clozapine).

e. Medications that require routine monitoring that do not appear to have appropriate or recent monitoring at the Preferred Facility (e.g. renally-cleared medications without corresponding renal panel,; antihypertensive agents without vitals within a reasonable timeframe; hypoglycemic agents without pertinent labs, etc.)

f. Acutely prescribed anti-infective agents (antibiotics, antifungals, antivirals).

g. Medications intended for acute conditions (e.g. medication for acute gout attacks, diarrhea, allergic reactions, acute injuries, etc.).

h. Any other specialized medication.

i. Medical supplies, appliances, devices, or durable medical goods that require a consult (e.g. Prosthetics).

3. Non-formulary medications

a. Non-formulary and restricted medications or supply items approved at the Preferred Facility will have remote approvals honored at the Syracuse VA Medical Center.

b. If the medication or supply item is permitted as outlined in the Inclusion/Exclusion criteria above, Pharmacy will process a refill (if available) or enter the prescription in VistA, per policy, under the Chief of Staff’s name. The Veteran will be provided with the medication/supply item(s) as follows:

(1) Active prescription with one or more refills available:

(a) Up to a 15-day supply with the words “Traveling Veteran” and the Preferred Facility provider’s name in the comment section of the prescription order.

(b) Relay the need for contacting pharmacy at their preferred site for temporary address and further refills if necessary.

(2) Expired prescription or no refills provided:

(a) Pharmacists must use clinical judgment to determine whether the request is appropriate (e.g. maintenance medication that the patient has been taking for a long time).

(b) If deemed appropriate, the Pharmacist may provide up to a 15-day supply with the words “Traveling Veteran” and the Preferred Facility provider’s name in the comment section of the prescription order.

(c) Relay the need for contacting medical provider at their Preferred Facility for temporary address and renewals if necessary.

(d) If the Pharmacist judges the request inappropriate, the Pharmacist will direct the patient to the Emergency Department to be evaluated.

c. If the medication/supply item is excluded as noted above, is not permitted to be prescribed under the Pharmacist’s scope of practice, or if the Veteran expresses any health-related complaints, the Veteran will be referred to the Emergency Department for medical evaluation.

d. The Pharmacist will enter an electronic progress note titled “Pharmacy Note” and will use the “Traveling Veteran” shared template to document the remote area and their intervention. The Pharmacist will contact the Emergency Department and will direct the Veteran to the Emergency Department for evaluation.

e. Veterans traveling to the Syracuse VA Medical Center who are unable to be assisted in whole or in part by the Pharmacist, will be referred to the Traveling Veteran Coordinator during normal business hours or to the Emergency Department after normal business hours for evaluation.

b. Anticoagulation Monitoring.

(1) Veterans traveling to the Syracuse VA Medical Center for more than three months in need of anticoagulation monitoring, medication, or dosage review, will be referred to the Syracuse VAMC Anticoagulation Clinic for appropriate laboratory monitoring, review of remote data, provision of medication supply or dose adjustments as required by good clinical practice.

(2) At the discretion of the Pharmacist and Anticoagulation clinic provider(s), and in coordination with Veteran’s Preferred Facility, traveling Veterans may be followed by the Syracuse VAMC Anticoagulation Clinic for over three months if they are visiting from another VA Medical Center where their anticoagulation is managed, without requiring enrollment in the Syracuse VAMC for Primary Care. When feasible, the traveling Veteran should make arrangements for care in advance of their travel.

(3) Where required, traveling Veterans with urgent anticoagulation concerns, or with urgent medical issues who have primary care at another VA medical facility will be referred to the Emergency Department for medical treatment. Nonurgent medical issues will be addressed and followed by the Veteran’s Primary Care Provider at their Preferred Facility, with assistance from the Traveling Veteran Coordinator at each facility.

(a) During non-administrative hours, the Veteran should be referred to the Emergency Department for evaluation and follow-up.

(b) Veterans visiting the Syracuse VAMC for less than three months who are in need of anticoagulation services will be referred to the Syracuse Traveling Veteran Coordinator.

(c) Syracuse VA Veterans on anticoagulation who are traveling from the Syracuse VAMC to another facility for four to six weeks or longer will need to contact the Syracuse Anticoagulation Clinic prior to travel, with dates and location of travel and contact information. The Anticoagulation Clinic provider will enter a consult to the Traveling Veteran Coordinator to ensure appropriate arrangements are made.

c. Prosthetic Needs.

(1) If a traveling Veteran needs repair and/or service to their VA-issued prosthetic appliance and/or device, the Syracuse VAMC Prosthetics Department will contact the Prosthetics Department at the Veteran’s Preferred Facility to confirm enrollment, and that the appliance and/or device was provided by that facility.

(a) The Syracuse VAMC Prosthetics Department will provide Veteran with information relating to the Veteran’s equipment problem, as well as the local vendor information on where the Veteran may obtain repair and/or service.

(b) The Preferred Facility must initiate a purchase order and service will be authorized and provided.

(c) Alternatively, if capabilities exist, the repair may be done by the Syracuse VAMC staff following local policy and procedure.

(2) If a traveling Veteran requires that an appliance and/or device be issued, the Veteran must register at the Syracuse VA Medical Center.

(a) The patient may be referred to the Emergency Department if there is an urgent need for clinical evaluation, and to have an appropriate order entered into the medical record. If there is not an urgent need, it will be handled by the Syracuse VAMC Traveling Veteran Coordinator.

(b) When needed, the Prosthetics Staff at the Syracuse VAMC will call the Prosthetics staff at the Veterans preferred facility to obtain information about prior prosthetics services.

d. Oxygen Needs.

(1) If a Veteran is prescribed oxygen for use in the home or ambulatory setting and they are planning to travel, patients should notify VA at least 2 weeks in advance of travel, so that appropriate arrangements can be made with the Contractor. In the event of emergent travel they should notify the VA immediately. If a patient has traveled to

Syracuse and is in need of travel oxygen Prosthetics can coordinate with the VA where Veteran is enrolled to secure Oxygen needs.

5. DEFINITIONS

a. Alternate Facility. An alternate facility is a VA medical facility at which a Veteran will receive care, as needed, while on extended travel (including community-based outpatient clinics (CBOC) associated with the alternate facility). Care at the alternate facility does not constitute the major portion of a Veteran’s primary care.

b. Bridge Supply of Medications. A bridge supply is a one-time, temporary supply of maintenance medication, generally 10-15 days’ worth, to ensure availability of maintenance medications until the patient can receive a renewal or refill prescription from their preferred facility.

c. Preferred Facility. A preferred facility is the VA medical facility that a Veteran selects as the principal site for receiving VA care and consequently where the major portion of the Veteran’s primary care is provided (including CBOCs associated with the preferred facility). The preferred facility is also where the Veteran’s Primary Care Team (PACT) is located.

d. Traveling Veteran Coordinator. A Traveling Veteran Coordinator (TVC) is a Registered Nurse (RN), Physician’s Assistant (PA) or Licensed Independent Practitioner (LIP) who coordinates necessary or ongoing health care for Veterans on extended travel away from their preferred facility.

e. VistA. The Veterans Integrated Service Technology Architecture (VistA) is the computerized software system that contains a Veteran’s medical and eligibility records and allows processing of orders within the VHA Healthcare system.

f. VistA Register Once. VistA Register Once is an option used to pull a Veteran’s comprehensive record from their principal location of care.

g. VistA Web. VistA Web is the read-only VHA-wide computerized medical record that displays an extensive collection of clinic notes, radiology images, laboratory results, medication lists and provider contact information from all VHA facilities where patients have sought care.

6. REFERENCES

a. VHA Handbook 1101.11(4), Coordinated Care for Traveling Veterans, dated April

22, 2015, DIRECT LINK .

b. OneVA Pharmacy User Guide, dated February 2019, User Guide Template (va.gov) direct link.

7. RESCISSION

Attachment D.47 RFP 36C24224R0049 https://www.va.gov/vdl/documents/Clinical/Pharm-Outpatient_Pharmacy/pso_7_0_p532_um.pdf https://www.va.gov/vdl/documents/Clinical/Pharm-Outpatient_Pharmacy/pso_7_0_p532_um.pdf

MCP 11-191, Coordinated Care Policy for Traveling Veterans, dated October 2017 is rescinded.

8. REVIEW

At minimum at recertification and including when there are changes to the governing document (for example, national policy or a health care accreditation body mandate).

9. RECERTIFICATION

This MCP is scheduled for recertification on or before the last working day of August 2026. This MCP will continue to serve as local policy until it is recertified or rescinded.

In the event of contradiction with national policy, the national policy supersedes and controls.

10. SIGNATORY AUTHORITY

FRANK P. PEARSON, DPT, PA-C

CAPT, USN (Ret) U.S. Department of Veterans Affairs Director, Syracuse VA Medical Center Date Approved: August 4, 2021

NOTE: The signature remains valid until rescinded by an appropriate administrative action.

DISTRIBUTION: MCPs are available at: Syracuse Medical Center Document Control SharePoint (DCS). https://dvagov.sharepoint.com/sites/VHASYR/svdc.