Treating Community Care as a High-Risk Transition: A Possible Hospital Medicine Agenda for the Veterans Health Administration

Expanded Veterans Affairs–purchased community care has improved options for veterans but has also changed the core work of Veterans Health Administration (VHA) hospital medicine. The most important inpatient problem is no longer simply optimizing the ward day; it is helping protect continuity across VHA hospitals, community emergency departments, intensive care units, skilled nursing facilities, home health, and primary care. This commentary argues that VHA hospitalists (inclusive of physician practitioners and advance practice practitioners), along with an interdisciplinary inpatient care team, should help treat cross-system transfers and postdischarge handoffs as high-risk transitions (vulnerabilities occurring due to change in care setting or care team), using VHA’s learning-system capacity to measure, coordinate, and improve care across organizational boundaries.