the American Association of Colleges of Osteopathic Medicine

This analysis was prepared by McDermott+ Consulting, on behalf of AACOM.

A summary of key provisions relevant to the osteopathic medical education (OME) community can be found below.

Senate Bill – S. 2127

On June 22, the Senate Appropriations Committee approved the Military Construction, Veterans Affairs, and Related Agencies Fiscal Year (FY) 2024 Appropriations Bill with a vote of 28 – 0.

The Committee recommendation includes $296.6 billion for the Department of Veterans Affairs (VA) for fiscal year (FY) 2024, including $161.7 billion in mandatory spending and $134.8 billion in discretionary spending. The Committee also recommends $193 billion in advance appropriations for mandatory benefits and $112.6 billion in advance appropriations for veterans medical care for FY25.

Opioid Use Disorder/Alternative Treatments - Alternative treatments for pain management have been shown to be effective in reducing pain and reliance on prescription opioids. The Committee notes the directive language in the Joint Explanatory Statement accompanying Public Law 117–38 requiring the Department to track the use of osteopathic manipulative treatment to treat back and other pain. The Committee continues to encourage VA to expand the use of alternative treatments to pain management, such as acupuncture, in its delivery of healthcare services. The Committee also urges VA to integrate alternative treatments into VA medical centers and clinics through licensed professionals or on a contract basis.
Vet Center Scholarship Program - The Committee is concerned VA did not conduct a robust outreach and communications campaign to advertise the launch of the VA Readjustment Counseling Service (RCS) Scholarship Program in March 2023. This scholarship program was established by the Commander Scott Hannon Veterans Mental Health Care Improvement Act of 2019 (Public Law 116–171) to provide educational assistance to students pursuing graduate degrees in mental health disciplines, in exchange for a service commitment at a Vet Center. No later than 180 days after enactment of this act, the Department is directed to submit to the Committees on Appropriations of both Houses of Congress a report on lessons learned from the first year of the RCS Scholarship Program, including plans for improving communications and marketing to attract more program applicants and participants, thereby bolstering VA’s Vet Center workforce.
VA Rural Hiring Comparison - The Department is directed to assess and compare hiring for rural and highly rural facilities versus urban facilities and to provide a report to the Committees on Appropriations of both Houses of Congress within 1 year of enactment of this act. This should include a comparison of time-to-fill averages for rural facilities against more urban facilities, an assessment of VA’s ability to conduct market salary surveys in rural areas with limited private sector competition, and overall salary comparison amongst rural physicians and as compared to their urban counterparts.
Access to Clinical Oncology Trials - The Committee continues to support the ongoing collaborative efforts between VA medical centers and National Cancer Institute (NCI)-designated comprehensive cancer centers, but notes the lack of infrastructure for clinical trials in other areas of the country. Expanding access to clinical oncology trials remains a priority and as such the Committee directs that not less than $10 million be allocated to support partnerships between VA medical centers and NCI-designated comprehensive cancer centers, with an emphasis on expanding to new sites outside the current NAVIGATE structure.

For FY24, the Committee provides a total of $121 billion for VA medical care, in accordance with agreements related to the Fiscal Responsibility Act of 2023 (Public Law 118–5). The Committee adjusts the amounts previously advance appropriated for FY24 to provide $69.1 billion for Medical Services, $29.8 billion for Medical Community Care, $12.3 billion for Medical Support and Compliance, and $9.8 billion for Medical Facilities. Additionally, the Committee recommendation includes $938 million for Medical and Prosthetic Research. Medical Care Collections are estimated to be $3.9 billion in FY24. The Committee recommendation also provides $112.6 billion in advance appropriations for VA’s medical care accounts for fiscal year 2025, consistent with the request.

The Fiscal Responsibility Act (Public Law 118–5) directly appropriated $20.3 billon for the Toxic Exposures Fund, of which $17.1 billion is estimated to be for medical care, for a total of $138.1 billion in medical care funding in FY24, consistent with the request.

House Bill – H.R. 4366

On June 13, the House Appropriations Committee approved the FY24 Military Construction, Veterans Affairs, and Related Agencies Subcommittee appropriations bill with a vote of 34 to 27.

The bill provides $299.5 billion for FY24 for the VA, which is a decrease of $3.8 billion below the fiscal year 2023 enacted level. Of the total, $161.7 billion is provided for mandatory benefit programs and $137.8 billion is provided for discretionary programs. Of the total for FY24, $128.1 billion for veterans’ healthcare was advanced in the Consolidated Appropriations Act, 2023 (P.L 117–328).

For fiscal year 2025, the Committee recommendation includes $112.6 billion in advance appropriations for the four discretionary veterans’ medical care accounts and $193 billion in advance appropriations for mandatory benefits programs.

VA/HHS Collaboration on Health Workforce Shortages - The Committee continues to encourage VA to work with the Department of Health and Human Services (HHS) to explore ways the agencies can work together, such as by creating a taskforce, to increase the availability of providers, including in the behavioral health workforce and among physicians specializing in cancer, spinal cord, and neuropsychiatric conditions. This collaboration is urged to examine VA’s recruitment challenges, review programs that could enhance recruitment and retention, and to think creatively on how other Federal agencies like HHS can identify and address provider shortages. VA also is encouraged to consult with the Department of Defense to explore recruiting those who have left military service.
Primary Care Provider Shortages - The Committee is concerned by the growing shortage of primary care providers across the VA Health Care system, and therefore directs VA to provide a report to the Committees on Appropriations of both Houses of Congress within 90 days of enactment of this Act that (1) describes the current benchmark for patient-to-primary care physician ratio, including what the standard is and how many hospitals and clinics fall short of the standard; (2) details which VA clinics have seen a 50 percent or greater reduction of full time primary care physicians in the previous 15 months; and (3) explains how the Department intends to address these primary care physician shortages while reducing individual clinic dependence on VISN floating staff. The report should also include recommendations for legislative or administrative action that could support efforts to address this primary care physician shortage.
Cancer Screening at Veterans Affairs Medical Centers - The Department is encouraged to ensure its healthcare providers screen for the numerous types of cancers that veterans experience so they can receive the best possible care.
Academic Collaborations at Community Based Outpatient Clinics (CBOC) - The Committee encourages VA to expand academic collaborations with CBOCs, as they provide valuable patient care and access to services that can be strengthened by collaboration with educational institutions. Through clinical traineeships and research fellowships, emerging health professionals can gain a better understanding of veterans’ specific healthcare needs, improve patient outcomes, advance specialized research, and increase the talented workforce pipeline. VA is encouraged to consider including public academic medical centers in CBOC collaborations.
Mental Health Screening at Veterans Affairs Medical Centers - The Department is encouraged to ensure its healthcare providers screen for the numerous types of mental health issues that veterans experience so they can receive the best possible care.
Expanding Recruitment - The Committee recognizes the challenge VA has in the recruitment and retention of clinicians. To help VA better keep pace with other providers and continue to train its workforce to improve their service to veterans, the Committee urges VA to explore potential options to enhance recruitment and retention, such as expanding benefits to relocate to underserved VA medical facilities and expanding reimbursement to clinicians for Continuing Professional Education, regardless of individual specialty or board certification.

The bill includes a total of $121 billion for veterans’ medical care. The Fiscal Responsibility Act of 2023 (P.L. 118–5) provided a total of $20.3 billion for the Cost of War Toxic Exposures Fund for fiscal year 2024, including $17.1 billion for veterans’ medical care. The combined total appropriated by this Act and the Fiscal Responsibility Act for veterans medical care is $138.1 billion, equal to the President’s Budget request. In addition, the bill includes a total of $112.6 billion in advance appropriations for fiscal year 2025. The Fiscal Responsibility Act also provided $24.5 billion in advance appropriations for the Toxic Exposures Fund for fiscal year 2025, including $21.4 billion for veterans’ medical care. The combined total appropriated by this Act and the Fiscal Responsibility Act is $134 billion for medical care for fiscal year 2025, as requested. The Committee provides $938 million for Medical and Prosthetic Research for fiscal year 2024, equal to the requested level.