Vets brace for possible health care changes

Local veterans are bracing for possible sweeping changes to their health care as recommended in a recent report issued by a Congress-established commission.

U.S. Department of Veterans Affairs Secretary Robert A. McDonald is expected to deliver his agency's response to the Commission on Care report this month.

"The VA is taking the report very seriously," said Bret Bowers, public affairs officer for the Mann-Grandstaff VA Medical Center in Spokane that also operates a Coeur d'Alene clinic.

Veteran Len Crosby, a leader at American Legion Post 143 in Post Falls, said he's leery about some of the report's recommendations because he's pleased with the current service from the local VA facilities in Coeur d'Alene and Spokane.

"The local facilities have been very responsive to concerns raised from veterans in North Idaho," Crosby said. "The VA here has certainly been more responsive than in some larger communities."

Crosby said he's concerned moves toward health care referral systems would create another bureaucracy and make it more difficult for vets in rural areas to access providers.

"They simply would not work as effectively as the VA," he said.

However, Crosby said the report's general intent of exploring how to improve health care for veterans is appreciated.

"The long-term care veterans are going to need for the rest of their lives is an issue," he said.

The Commission on Care submitted its final report to President Barack Obama last month. The effort was in response to nationwide concerns over delays of veterans receiving care through the VA.

Commission Chairwoman Nancy Schlichting, CEO of the Henry Ford Health System, said systemic problems in staffing, information technology, procurement and other core functions threaten the long-term viability of VA's health care system.

"The commission found that no single factor can explain the multiple systemic problems that have frustrated VA efforts to provide veterans consistent timely access to care," a press release states. "Governance challenges, failures of leadership and statutory and funding constrains all have played a role."

However, the report acknowledges the VA has also made strides in urgently-needed changes.

Under the commission's proposal, the VA would continue as veterans' provider of distinct services such as specialized behavioral health care, spinal cord injury care, prosthetics and rehabilitative services.

The commission also proposes the VA establish health networks including both VA and community-based providers who meet VA credentialing requirements.

"The commission recognized that the reforms we're proposing cannot be sustained without fundamentally bolstering governance and strengthening leadership," Schlichting said. "With able leadership and congressional support for these recommendations, VA will be positioned to provide veterans with the quality health care they have earned."

During a 10-month examination of access to health care and how to best deliver it over the next 20 years, the commission reviewed the 4,000-page Independent Assessment Report chartered by Congress, met with stakeholders and made site visits to VA facilities.

"This evidence shows that although care delivered by VA is in many ways comparable or better in clinical quality to that generally available in the private sector, it is inconsistent from facility to facility, and can be substantially compromised by problems with access, service and poorly functioning operational systems and processes," the report states.

"The most public and glaring deficiency was access problems."

Congress attempted to solve the problem with the Veterans Access, Choice and Accountability Act (VACAA) of 2014 that directed the VA to implement a temporary program allowing for more care choices for vets, but the commission found the design and execution of the Choice Program are flawed.

Bowers said local VA leaders don't have a comment on the Commission on Care report as it is under review by Secretary McDonald.

In his initial response to the report, McDonald said he's pleased to see that many of the recommendations are in line with the VA's effort to transform into a "veteran-centric organization."

He said this past March the VA set a new national record of 5.3 million completed appointments — 730,000 more than in March 2014.

"Average wait times are five days for primary care, six days for specialty care and two days for mental health care," McDonald said in response to the report. "Nearly 90 percent of veterans surveyed say they are 'satisfied or completely satisfied' with the timeliness of their appointments."

PHYSICAL THERAPY INCREASE PROMPTS ACTION

Bowers said the Spokane VA's recent action to suspend veterans from using the medical center's physical therapy clinic beyond their prescribed referral wasn't related to the sweeping change recommendations being made on the national level.

He said a letter was sent to about 65 veterans about the action and, of them, 20 to 30 were still using the clinic in such fashion. He didn't know on Friday how many of the letters went to North Idaho veterans specifically.

Bowers said use of the clinic by those who have prescribed referrals has increased 54 percent in the past six years.

"The clinic is not being discontinued for everybody," he said. "There's a small group that is upset that has been using it beyond prescriptions. It's a clinic, not a gym."

Bowers said no other cuts are planned in the immediate future.

Some of the affected veterans said they are concerned about the action because they can't afford other facilities to continue their therapy or exercise.

Bowers said, with the increase in use at the clinic, the VA must focus on providing PT services to vets with a medical need.

"We appreciate all veterans' desire to stay healthy and fit and hope they will continue to exercise using a community-based gym," a written statement from the VA states.

Crosby said he plans to lobby a representative of Sen. Mike Crapo's office next week for funding that supports efforts aimed at keeping veterans healthy.

Crosby said while efforts to keep vets healthy exist, it's unfortunate the VA doesn't offer such programs within its system.

"Such programs are much less expensive than medical treatment after the physical problems have surfaced and have a significant role in preventing the medical condition," he said. "Every time we turn around there's another headline that Americans are obese, yet it's cheaper to encourage healthy lifestyles than treating disease."