Journal of General Internal Medicine

, Volume 34, Issue 1, pp 150–153 | Cite as

Community Health Centers Could Provide Better Outsourced Primary Care for Veterans

  • Richard E. RieselbachEmail author
  • Ted Epperly
  • Greg Nycz
  • Peter Shin


The “VA Mission Act of 2018” will expand the current “Choice Program” legislation of 2014, which has enabled outsourcing of VA care to private physicians. As the ranks of Veteran patients swell, Congress intended that the Mission Act will help relieve the VHA’s significant access problems. We contend that this new legislation will have negative consequences for veterans by diverting support from our VA system of 1300 hospitals and clinics. We recommend modification of this legislation, promoting much greater utilization of Community Health Centers (CHCs) for veterans outsourced primary care. In support of this proposal, we describe (1) features of the “VA Mission Act” relevant to outsourcing, (2) the challenges of the present “Choice Program” and likely future obstacles with the new legislation, and (3) the advantages of expanding CHC VA outsourced primary care. This policy would focus more on providing specialized care for veterans in the VA system, while coordinating with CHCs for the necessary expanded outsourced, holistic primary care. We conclude that failure to develop an incremental, cost-effective alternative as described herein represents a potential threat to adequate future support of our VA hospital system, and thus outstanding care for our veterans.


veterans outsourced care community health centers primary care access VAH care system 



We gratefully acknowledge the efforts of Ms. Grace Compton in preparation of this manuscript.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they do not have a conflict of interest.


  1. 1.
    Werner E, Rein L. Trump signs veterans health bill as White House works against bipartisan plan to fund it. The Washington Post. Available at: Published June 6, 2018. Accessed June 7, 2018.
  2. 2.
    VA Mission Act of 2018. (VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act)Google Scholar
  3. 3.
    Rieselbach RE, Rockey PH, Phillips Jr. RL, Klink K, Cox M. Aligning expansion of graduate medical education with recent recommendations for reform. Ann Intern Med. 2014;161:668–669.
  4. 4.
    Rieselbach RE, Epperly T, Friedman A, et al. A new community health center/academic medicine partnership for Medicaid cost control, powered by the Mega Teaching Health Center. Academic Medicine. 93(3):406–413, 2018.CrossRefGoogle Scholar
  5. 5.
    Shin P. The health care safety net: Community health centers’ vital role. National Institute for Health Care Management Foundation Web site. Available at: safety-net-community-health-centers-vital-role. Published July 2016. Accessed August 30, 2018.
  6. 6.
    Measuring America. United States Census Bureau. December 8, 2016.Google Scholar
  7. 7.
    Nearly one-quarter of veterans live in rural areas, Census Bureau reports. United States Census Bureau. January 25, 2017.Google Scholar
  8. 8.
    GW analysis of 2016 Uniform Data System, Health Resources and Services Administration.Google Scholar
  9. 9.
    HHS makes $350 million available to fight the opioid crisis in community health centers nationwide. U.S. Department of Health & Human Services. Available at: Accessed on August 30, 2018.
  10. 10.
    Durfey SNM, George P, Adashi EY. Permanent GME Funding for Teaching Health Centers. JAMA. 2017;317(22):2277–2278. CrossRefPubMedGoogle Scholar
  11. 11.
    Rieselbach RE, Epperly T, Nycz G, Rockey P. Teaching health centers can meet objectives for state Medicaid innovation. J Grad Med Educ. 2018;10(3):362–366.CrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2018

Authors and Affiliations

  • Richard E. Rieselbach
    • 1
    Email author
  • Ted Epperly
    • 2
    • 3
  • Greg Nycz
    • 4
  • Peter Shin
    • 5
    • 6
  1. 1.University of Wisconsin School of Medicine and Public HealthMadisonUSA
  2. 2.Family Medicine Residency of IdahoBoiseUSA
  3. 3.University of Washington School of MedicineSeattleUSA
  4. 4.Family Health Center of MarshfieldMarshfieldUSA
  5. 5.Health Policy and ManagementGeorge Washington UniversityWashingtonUSA
  6. 6.Geiger Gibson Program in Community HealthRCHN Community Health FoundationNew YorkUSA

Personalised recommendations