Trump goes with continuity in choosing Shulkin for VA

President-elect Donald Trump opted for continuity in the pursuit of better healthcare services for U.S. veterans.

Current Veterans Affairs Secretary Robert McDonald won't keep his job. But rather than tapping someone likely to lead a dramatic change in direction, Trump went with Dr. David Shulkin, the hospital executive hired by the Obama administration to lead its efforts to address the department's widespread problems ensuring access to timely care.

Just a few weeks ago Trump and his advisers vaguely signaled they would pursue a plan to allow more veterans to completely bypass VA hospitals and clinics and seek care from private providers. The Veterans of Foreign Wars and other veterans groups have warned that moving too far toward privatization would risk undermining the VA's important role in coordinating care and catering to the unique health needs of the population. They generally responded positively when Trump announced Shulkin as his pick during a news conference last week.

The Veterans Health Administration operates 168 hospitals and more than 1,000 outpatient centers. The system provides care for about 6.8 million veterans each year.

Shulkin, 57, was CEO of Beth Israel Medical Center in New York from 2005 to 2009 and then president of Morristown (N.J.) Medical Center until Obama recruited him as undersecretary for health at the VA in 2015. The VA health system at that time was embroiled in a scandal triggered by whistle-blower accounts of a conspiracy to cover up excessive wait times for care.

Trump, who has called the VA health system “a disaster,” interviewed several candidates to take the helm of the VA, including Cleveland Clinic CEO Dr. Toby Cosgrove and recently retired Henry Ford Health System CEO Nancy Schlichting. Both withdrew themselves from consideration.

Schlichting and Cosgrove led a commission convened by Congress to make recommendations to improve the veterans health system. The commission's report issued last year calls for the VA to maintain its role as the exclusive provider for services, such as behavioral healthcare and spinal cord injury care, and also develop integrated networks that include community providers to ensure better access to care.

Schlichting, the commission's chairperson, praised Trump's decision to go with Shulkin for the job. “He has been working on improvement, and certainly he worked with the commission during our time and is supportive of the commission's report,” Schlichting told Modern Healthcare. “I think he will bring some needed stability and continuity in leadership to the VA health system.”

Under the leadership of McDonald and Shulkin, the VA health system has expanded opportunities for veterans to seek care outside the system. The Veterans Choice Program pays for veterans to get care from community providers if they have waited 30 days or more for a VA appointment or would have to drive more than 40 miles for VA care.

The commission described that program as flawed. “Veterans, VHA staff and community providers have been confused because of conflicting requirements and processes in eligibility rules, referrals and authorizations, provider credentialing and network development, care coordination, and claims management,” the commission wrote in the report.

The VA also moved recently to improve access to care by expanding the scope of practice for advanced practice nurses at VA facilities beyond limits imposed by some state laws and regulations.

“We are both eager to begin reforming the areas in our Veterans Affairs system that need critical attention, and do it in a swift, thoughtful and responsible way,” Shulkin said in a statement released by Trump's transition team.