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VA wrestles with health care system changes
November 11, 2016 Frank Marquez   
As a result of a shakeup over life-threatening wait lists at some facilities, General Shinseki resigned as Secretary of Veterans Affairs on May 30, 2014, and President Obama nominated former Proctor and Gamble CEO Robert A. McDonald, who was confirmed by the U.S. Senate on July 29 of the same year. Since then, rural veterans saw at least one improvement, while Veterans Affairs progresses at a snail’s pace on other proposals for change.

Two months ago, in one change, the U.S. Department of Veterans Affairs, expanded transportation services to 80 rural communities across the country, including the VA Black Hills Health Care System (Hot Springs, South Dakota). The program features managers at VA medical centers who coordinate free transportation to and from VA-authorized medical care facilities.

On other issues, McDonald issued a statement this past year addressing President Obama’s Final Assessment on the Commission on Care, which related that the Veterans Health Administration and Choice contractors “created more than 3 million authorizations for veterans to receive healthcare in the private sector from October 2015 to July 2016, and that 97 percent of appointments were completed within a 30-day window … with average wait times of five days for primary care, six days for specialty care and two days for mental health care.”

Although McDonald’s report said, “nearly 90 percent of veterans say they are ‘satisfied’ or ‘completely satisfied,’” statistics do not account for every veteran’s opinion or experiences.

As a veteran, regarding my own care in 2016, scheduling and providing specialty care may have made some strides, but an inconsistent appointment system and satisfying requests for some medical procedures still requires maneuvering through a heavily bureaucratized system, making it, at the very least, a challenge for many veterans, including me. I stopped relying on veterans’ health care services several months ago, realizing that not all VA facilities are created equal.

I have been served by hospitals and clinics in Las Vegas and Reno, Nevada; Washington, D.C., Fort Belvoir, Virginia; the Scottsbluff clinic; and the Hot Springs, South Dakota health center.

“Logistically, resources are lost, be it your time or their time,” U.S. Rep. Adrian Smith (R-Nebraska) said about the inconsistency with managing appointments and overcoming the VA’s track record under Shinseki’s watch. “Without Hot Springs, it’s bound to push veterans to travel farther. That’s another complicating factor, but for veterans who would prefer to receive care locally, I would like to see those options (for expanded services made) available.”

Smith, who spoke to me last Spring, added that he didn’t know about the possibility of expanding services at the Scottsbluff clinic, but he would look into it. “We’re rural here, and it gets a lot more rural than we are here, in other parts of the 3rd Congressional District, and parts of America,” he said. “So, veterans’ needs are different. Communities are different. That’s why I always say we should have some flexibility in policy, and that bureaucracy isn’t standing between his and her care.”

Since then, local veterans received a vague letter two months ago about expanded services in Scottsbluff. However, what remains is a call center in Hot Springs, South Dakota, that manages appointments for local veterans who have registered for healthcare at the Veterans Affair’s health clinic in Scottsbluff. As it stands, hospitals and clinics in the 23 regions nationwide cannot readily share information with patients who relocate across a single network. The Veteran Administrations office and research and development division’s website on Rural Health said, “Our nation’s rural … veteran population is large and dispersed. It is also racially, ethnically, and culturally diverse. Providing comprehensive, high quality health care to these veterans is a challenge.”

According to the Office of Rural Health, there are 5.2 million veterans living in rural communities across the United States, and more than 32.9 million rural veterans rely on the VA for their health care. Rural veterans comprise 41 percent of all enrollees in the VA healthcare system, most of whom receive care at one of 833 community-based outpatient clinics, including Scottsbluff.

Furthermore, according to the research website, of the total number, 435,000 are veterans of our most recent (and ongoing) conflicts in Iraq and Afghanistan, who have been dealing with mental health issues, including Post Traumatic Stress Disorder. High suicide rates have been attributed to this shortfall by several sources.

One of the main issues concerning rural veterans are the long trips to access quality health care; and there are fewer health care providers and nurses per capita in rural areas. The Scottsbluff clinic, under the umbrella of the Black Hills system, promises primary and secondary medical and surgical care, and a residential rehabilitation treatment program, extended nursing home care and psychiatric inpatient services for veterans in South Dakota, portions of Nebraska, North Dakota, Wyoming and Montana.

Driving to facilities at Fort Meade and Hot Springs takes nearly four hours and three hours, respectively. Gordon is the only other location in Nebraska in this region. The nearest Vet Center is in Cheyenne, Wyoming. Yet, accepting services there means crossing over to the Rocky Mountain Network. While there are no rules for registering in either network, if veterans who reside in Scottsbluff or Gering, choose to travel to Cheyenne for specialized services, they cannot opt for services in Scottsbluff. For now, moving from region to region requires a transfer request.

For now, the logistical challenges remain. Although, veterans can be reimbursed for mileage, they must continue to make the drive when seeking critical or emergency care. If care at a local hospital is required, in this case, at Regional West Medical Center in Scottsbluff, the VA must ensure that specialized care is provided. If not, it must be contracted. For veterans with no choice but to receive health care through the VA, they must rely on the free VA transportation services, or kind hearted family members and friends to drive them back and forth to Fort Meade or Rapid City.

According to a letter in response to a delegation representing South Dakota, Nebraska and Wyoming, former VA Secretary Eric Shinseki wrote in a 2012 response letter, “Services such as laboratory and x-ray that are not available in the outpatient clinic(s) will be contracted out …” In 2012, the Black Hills system proposed a realignment of services to be phased in over five years starting in 2012. These services, scheduled to be in place by 2017, would include buying more inpatient and outpatient healthcare services in or near veterans’ hometowns; reducing the distance veterans travel to obtain services; and reducing the veterans’ personal out-of-pocket expenses for travel.

Veterans with input should email comments and suggestions to VABlackHillsFuture@va.gov or write a letter and address it to Director, VA Black Hills Health Care system, 113 Comanche Road, Fort Meade, South Dakota, 57747.

In the meantime, VA Black Hills public affairs officer Teresa Forbes said that veterans working with the Black Hills system who have concerns about obtaining scheduling appointments, care or any other matter concerning their medical care with the VA can speak with a “Choice Champion,” a patient advocate, by calling 605 745-2060.

“We understand that this has not been a perfect roll out, and we’re sorry that veterans are having (negative) experience,” she said. “The VA wants to learn about any issues right away so they can work through these problems and solve them early on.”

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