A recent VA Office of Inspector General (OIG) report highlights the challenges of collaborating with community providers who offer medical care through Choice. Overdose deaths among veterans are elevated when compared to the civilian population, and the OIG reviewed opioid prescribing to determine the risk for patients receiving care within and outside the VA system.
They reported increased risk when patients are prescribed opioids from community providers. Veterans with chronic pain and mental health disorders (63 percent) are at particularly high risk.
The OIG identified several factors for the elevated risk. Stringent opioid prescribing and monitoring guidelines for VA patients may conflict with practices in the community. The risk is exacerbated when information about opioid prescriptions and other medical conditions is not shared between VA and non-VA providers. In addition, VA providers do not routinely check the Physician Drug Monitoring Program (PDMP) database before prescribing, and community providers do not necessarily have access to VA information.
The OIG recommended that all non-VA providers:
- Are held to the same Opioid Safety Initiative guidelines
- Include a medical history and a complete and current list of medications in all requests
- Submit opioid prescriptions directly to a VA pharmacy for dispensing and recording in the patient’s electronic health record
It has been suggested that community providers should not be held to the same standards as the VA, because it would discourage participation in Choice.