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Fri July 4, 2014
Caring For Veterans Closer to Home
Congress is working on legislative fixes to some of the problems that caused the recent scandal in the VA healthcare system. Among other things, the bills would create a nationwide program patterned after one the agency has been testing in Kansas and a handful of other states. It allows veterans who live a long way from VA medical centers to get care from local doctors. But as Bryan Thompson reports, Senator Jerry Moran is raising concerns about the agency’s plans to end the pilot program before the national version of it is up and running.
Senator Moran is worried that Kansas veterans like Hugh Steadman will be abruptly cut off from the care they need if the pilot program ends before the VA bill is passed, and the agency is ready to implement it nationwide. Steadman - who flew combat missions over Germany as a bombardier during World War II - lives in Great Bend. He used to have to drive two hours to the VA medical center in Wichita, a trip that was getting harder for him to make. Things got a little easier when the VA opened an outpatient clinic in Hays, but Steadman says that’s still more than an hour’s drive each way.
“Well, it’s getting to be quite a problem, because I’m 89 years old now, and my kids don’t like me to drive out on the highways, and I think they’re probably right," Steadman says.
But for the past year, Steadman’s driving time has been cut to just 10 minutes. That’s because a VA pilot project now pays for him to see a doctor in Great Bend. The project is called Access Received Closer to Home, or ARCH. The VA launched the pilot program in Kansas and four other states in 2011--three years after Congress authorized it. Pratt was the Kansas test site, but things didn't go well there.
“It failed pretty miserably.”
Vincent Wilczek is in charge of finances for Pratt Regional Medical Center. Wilczek says primary care doctors in Pratt and the nearby communities of Stafford and St. John signed up to do business with the VA, but were quickly turned off by the process.
“It failed pretty miserably,” he says. "They found it to be very burdensome, cumbersome to work with the VA, because it’s a very authorization-driven system. And then some of the requirements they were requiring of the physicians were just very hard for local physicians to do.”
The providers in the Pratt area stopped participating in 2012. That could have ended the pilot project in Kansas, but it didn’t. Instead, Humana, which administers the program, reached out to providers in other communities. That’s when St. Rose Ambulatory and Surgery Center, in Great Bend, got involved. One of the primary care providers there is Dr. James McReynolds. He says the VA bureaucracy takes a little getting used to, but he’s had no trouble getting authorization for necessary medical care.
“They do authorize a certain number of visits and/or labs and/or x-rays for each patient. It’s variable for each patient, and if you want more, you do have to request more,” he says.
McReynolds says he was happy to participate in a program that made it possible for veterans to get care closer to home. And veterans in Kansas and the other participating states seemed to like it too. Ninety percent of those surveyed by the VA said they would recommend it to other veterans. Hugh Steadman, the World War II veteran from Great Bend, says that's what he would have said if asked.
“I really like it," he says. "I sure do hate to see it quit. I’ve got several friends that go up there also, and it sure made it easy on us old-timers, where we don’t have to drive so far.”
Despite the rave revenues from veterans, the VA recently said it planned to end the ARCH program. Testifying to a congressional committee in June, the VA's Philip Matkovsky said the agency had the authority to extend the program but wasn't planning to.
“ARCH does expire as a contract," he says. "It was a firm-term contract with a base one year and then two option years, which expires I believe September 30th. Andy typically, unless the contracting officer can determine a compelling reason to extend that—and I’m not a contracting officer—we let contracts expire.”
Senator Moran strongly disagrees with that decision…
“ARCH comes about from legislation that I introduced as a House member," he says. "It has a lot to do with my background as a congressman from the First District of Kansas, a congressional district larger than the state of Illinois, but with no VA hospital.”
Moran has been urging the VA for months to continue the program. He sees it as a bridge to the nationwide program authorized in the bill still working its way through Congress.
“The idea that I was pushing about services closer to home over the last 4, 5, 6 years is something that is now front and center in bipartisan legislation that is expected to pass Congress, and be signed by the President," he says. "And yet, we still have a Department of Veterans Affairs who, presumably, is reluctant to implement and pursue these programs in part, I think, because the VA’s funding, if they pay for services outside the VA, it’s less money that they’ve had to use within the VA.”
Still, it appears that Moran may have won a partial victory. He says acting VA secretary Sloan Gibson has verbally agreed to keep the program in place--but only for veterans who already were being served by it. And even that less-than-ideal compromise isn't a sure thing given the VA's recent track record. So, Moran has asked Gibson to confirm that pledge in writing.