In an ambitious effort to reform veterans’ access to health care, the U.S. Congress enacted the Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act. This landmark legislation aimed to broaden the scope of health services available to veterans by enabling access to non-Veterans Affairs (VA) medical providers when appropriate. Recent research examining the real-world impact of the MISSION Act reveals mixed outcomes, highlighting both significant improvements and unexpected challenges in veterans’ cardiovascular care.
A comprehensive study published in JAMA has evaluated how the MISSION Act has influenced travel times for veterans requiring specialized cardiac interventions. This analysis focused on patients undergoing percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG), two critical revascularization procedures used to treat coronary artery disease. These interventions are time-sensitive and outcomes can depend heavily on timely access to specialized care facilities. The study found that for veterans who became newly eligible to receive care outside the VA system due to geographic considerations under the MISSION Act, their average travel time to care facilities decreased substantially.
Decreasing travel time is an essential metric for improved health care access, particularly for veterans who often reside in rural or underserved areas distant from VA hospitals. By allowing these patients to seek care from local, non-VA providers, the MISSION Act successfully reduced the logistical and temporal barriers that previously limited timely treatment. This proxy of accessibility is a significant advancement, as prolonged travel can deter patients from seeking prompt interventions, which are crucial in acute cardiovascular events.
However, the study uncovered a more nuanced, and somewhat concerning, consequence. Despite the marked reduction in travel time, veterans who accessed outside care facilities following the implementation of the MISSION Act experienced worsened 30-day major adverse cardiovascular event (MACE) rates. Major adverse cardiovascular events typically include outcomes such as myocardial infarction, repeat revascularization, stroke, or cardiovascular death, and are critical indicators of quality and safety in cardiology care.
This finding suggests that while geographic access improved, care quality or coordination may not have met the necessary standards outside the VA network. The VA health system is noted for its integrated electronic health records, standardized protocols, and specialized cardiovascular teams, which may not be fully replicated in community-based settings. The disjunction between access and outcomes underscores the complexity of health system transitions and raises pivotal questions about the trade-offs between care accessibility and quality.
Further scrutiny into procedural volumes, provider expertise, and post-discharge follow-up revealed potential drivers of the increased rates of adverse events. Non-VA facilities may vary widely in their experience performing complex cardiac procedures and in managing perioperative care, which can directly influence patient outcomes. Additionally, fragmented communication between VA and outside providers may hinder effective care coordination, a critical component in continuum of care for high-risk cardiac patients.
The study’s implications are profound when placed within the broader context of health policy and veteran care. Legislators and healthcare administrators must balance the imperative of expanding access with safeguards ensuring quality. The findings call for enhanced monitoring of outsourced care, stringent credentialing of non-VA providers, and integrated health information systems that seamlessly bridge VA and community care networks.
Technical evaluation of the MISSION Act’s impact demonstrates that travel time, while an important measure of access, cannot solely predict patient outcomes. Cardiovascular care outcomes depend on a multifaceted interplay of factors including procedural expertise, peri-procedural management, and longitudinal follow-up. Policies designed to expand care networks must therefore incorporate comprehensive quality metrics and support structures that maintain or improve care standards.
Clinicians and researchers emphasize the need for robust data exchange platforms that enable instant and secure sharing of patient records between VA and community providers. Such connectivity can mitigate risks associated with fragmented care, including medication errors, duplicative testing, and delayed complication recognition. Real-time access to electronic health records could empower community providers with critical clinical information necessary to replicate VA care quality.
Moreover, patient selection criteria for community care eligibility may require refinement. Stratifying veterans by clinical risk factors and complexity of cardiac disease could inform guidelines on which cases are suitable for non-VA care versus those requiring direct VA management. Such targeted policies would minimize the inadvertent exposure of high-risk patients to potentially less equipped non-VA facilities.
In parallel, investment in community provider education and certification specifically tailored to the veteran population may improve outcomes. Training programs that align with VA standards and emphasize veteran-centric care can elevate external provider competency and foster trust in community-based services. This collaborative approach promises to merge the strengths of both VA and non-VA systems to better serve aging veterans with cardiovascular disease.
The study epitomizes the delicate balance between policy intentions and clinical realities, revealing that well-meaning legislation like the MISSION Act can yield unintended consequences in outcomes. Moving forward, ongoing surveillance, adaptive policy frameworks, and clinical partnerships are vital to harnessing the full potential of integrated veteran health care systems.
In summary, the MISSION Act has catalyzed meaningful reductions in travel time for veterans needing cardiac revascularization, reflecting a positive stride toward improved health care accessibility. Simultaneously, this expanded access has coincided with increased adverse cardiovascular event rates within 30 days post-procedure, spotlighting pressing quality gaps in non-VA care settings. This dual finding mandates a critical re-examination of veteran health policy ensuring that quality improvements accompany access enhancements, to truly optimize health outcomes for America’s veterans.
Subject of Research: Impact of the MISSION Act on veterans’ access to care and cardiovascular outcomes following percutaneous coronary intervention and coronary artery bypass grafting.
Article Title: Not available in the source content.
News Publication Date: Not provided.
Web References: Not provided.
References: (doi:10.1001/jama.2025.11661)
Image Credits: Not mentioned.
Keywords: Cardiovascular disorders, United States population, Government, Geography, Disease intervention, Coronary artery disease, Health care delivery, Medical tests
