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Patriot Waiting Games

In Southeast Colorado, long wait times are still a problem for vets. The Veterans Administration touts programs for rural veterans, these programs in practice the results are mixed.

Illustration by PULP

Pueblo Marine Corps veteran David Jiron had a stroke this past April. Once out of the hospital he went through the Veterans Administration to seek follow-up treatment at one of its facilities. The VA scheduled the treatment for this coming October.

Rather than wait about half a year to see a medical provider about the aftereffects of the stroke, Jiron used his costly private health insurance to get treatment within the local Parkview health-care system.

The Veterans’ Choice Program is supposed to cut down on VA wait times by allowing veterans to receive treatment at community medical facilities, which in turn would be compensated for their services by the VA. In theory, a veteran making a trip to the family doctor would be no different than being treated by a primary care doctor at a VA facility.

Jiron praises the Choice program for how quickly the VA got him an eye exam (within a week) at a non-VA facility. Yet the VA would not allow him to use the program for his stroke follow-up at Parkview. Jiron also was frustrated that the program won’t pay the tab for the teeth cleaning he needs, and getting it done through a VA facility is difficult because he was told the VA was “short-staffed” when it came to routine dental work. As for wait times at VA facilities, he is still waiting to see a neurologist at an out-of-town VA facility related to his April stroke.

Veterans’ Choice

Jiron is Southern Colorado service officer for Disabled American Veterans. The national nonprofit organization supports the Veterans’ Choice Program, which was established the Veterans’ Choice, Accountability and Transparency Act of 2014. Signed into law by President Barack Obama and then extended by Congress and President Donald Trump this past April, the Veterans’ Choice Act came about after it was widely reported in 2014 that about 35 veterans died while waiting for appointments at VA facilities in Phoenix. Although the Choice Program was extended this year it is still considered a temporary benefit. The extension Trump signed in April and which took effect on Aug. 7 was for $2.1 billion to pay for Choice services nationwide, and when that money runs out, the Choice Program will need another extension from Congress to keep operating.

Andrew Grieb at the Colorado DAV’s Denver headquarters says his organization backs the Veterans’ Choice Program and sees it as playing a role in what the DAV hopes would become an “integrated VA health system.”

Jiron says the VA needs to “turn around” adding that current VA Secretary David Shulkin seems to be the person to do just that. But Jiron is not the only one with issues regarding Veterans’ Choice.

Small-town, big concerns

The town of Springfield in extreme southeastern Colorado has no VA facility making it a prime location for the Choice Program. The Southeast Colorado Hospital District serves Springfield and the towns of Pritchett, Vilas and Campo. David Engel is the CEO of the hospital district, which entices veterans on its Facebook page to take part in the Choice Program at its facilities. Yet despite the promotion Engel says the number of veterans taking part in program is “sparse” for two reasons. The first is that, he says, the VA rejects veterans for the Choice Program if they carry other pricey insurance like a private plan, a plan through work or Medicare. The other is that, once a veteran jumps through the VA hoops and uses Choice to see a primary care provider within the hospital district, that vet again has to clear VA hurdles to see a specialist that the primary care provider recommends. Engel, who’s relatively new to his position at the district, adds that staff members have told him of significant delays in getting reimbursed from the VA through Choice for the hospital district’s services.

Engel says as an alternative to VA Choice Program many veterans living in the communities served by his hospital district drive as far as Amarillo, Texas, to get treatment at VA facilities there.

Telling stats

VA wait times in southeastern Colorado are daunting. Brandy Morrison, congressional liaison and acting public affairs officer for the VA’s Eastern Colorado Health Care System reveals some eye-popping statistics, which were last updated on July 31. The AVERAGE wait time for a new patient to receive care at the VA’s PFC James Dunn Clinic in Pueblo is 69 days; at the VA clinic in La Junta, 54 days; at the VA’s PFC Floyd K. Lindstrom Clinic in Colorado Springs, 52 days; at the VA facility in Lamar, 36 days; at the VA clinic in Alamosa, 29 days. The new-patient wait times at the VA facility in Salida is relatively outstanding at a mere six days. The picture for average primary care wait times for patients already established in the VA system is much, much brighter:  13 days for Alamosa; 11 days for Lindstrom in the Springs; seven days each for Lamar and James Dunn in Pueblo; four days for La Junta; and for Salida, one day.

Morrison adds that a national VA statistics website uses an average of new patient and existing patient wait times for primary care and at least one other factor to come up with its numbers. Using those statistics, the national average VA primary care wait time is 4.9 days compared with 26.68 for La Junta, 22.38 days for Alamosa, 18.35 days for Lamar, 13.99 days for Pueblo’s Dunn Clinic, 12.95 the Springs’ Lindstrom Clinic and 2.88 days for Salida.

Choice restrictions

Morrison says regarding the Veterans’ Choice Program designed to cut down on VA wait times, veterans are eligible to use the program through three avenues. The first is that if wait times for the services they require are greater than 30 days. The second is if veterans needing care live 40 miles or greater from the nearest VA facility. The third is what Morison calls a “geo-burden” which means if a veteran is separated from a VA facility by such obstacles as mountains or bodies of water. Note that a veteran having other forms of insurance is not on Morrison’s list for a veteran being turned down for the Choice Program.

Yet Morrison says relatively few veterans in the Eastern Colorado region choose to take advantage of the Choice Program. In fact, she says, during the third quarter of federal fiscal year 2017 (which runs from Oct. 1, 2016, to Sept. 30) 71 percent of the veterans served by the VA’s Eastern Colorado Health Care System chose to stay with the VA for their primary care needs rather than go through the Choice Program.

Yet for a veteran opting to go into the community to use the Choice Program, Morrison says a VA employee will place them into the program and forward all pertinent medical information to the VA “third-party administrator” or TPA (which is a company called Health Net Federal Services) for appropriate scheduling.

“Once Health Net receives and accepts the referral,” Morrison says, “they begin their scheduling attempts to get the veteran scheduled as timely as possible with the provider of their choice. Since May of 2017, the VA is the primary insurance for all services received through the Veterans Choice Program.”

Regarding payment to Veterans Choice Program providers,

Getting paid

Morrison says she cannot speak to that because Health Net handles all payments to the providers as part of its contract with the VA.

And, as Southeast Colorado Hospital District CEO Engel previously indicated, reimbursements from the Choice Program are hard to come by. And, by way of example, Pulp has learned of one story about an eye care clinic in the Pueblo area having its reimbursement check sent to an eye clinic in Alaska.

Health Net Federal Services communications director, Molly Tuttle, gives a generic response to Pulp’s concerns about delayed Choice Program reimbursements.

“It is our honor and responsibility to serve the veteran community,” Tuttle, who is based in northern California, says. “We strive to provide excellent service to every veteran, every time. Health Net Federal Services has no higher priority than the fulfillment of our Veterans Choice Program obligations in support of our continuing and long-term commitment to the veteran community.

“We strive to address issues as they arise and continue to work with our over 14,000 community providers to service the state’s more than 80,000 Choice eligible veterans in Colorado,” she adds. “Developing a complex and consistent new program like Veterans’ Choice is a team effort, and HNFS is working closely with Congress, the Department of Veterans Affairs, the Colorado VA Medical Clinics, and local health care providers to ensure veterans have the appropriate, coordinated and convenient care they have earned for their service to our nation.”

Congressmen respond

The office of U.S. Rep. Scott Tipton (R-Cortez) representing Colorado’s 3rd District says VA wait times and the Veterans’ Choice Program do have issues. “As the Veterans’ Choice Program has been administered, it has become clear there are problems that need to be addressed, including administrative burdens and red tape in the referral process, as well as issues with payments for Choice providers,” says Liz Payne, the congressman’s communications director, in an email.

“Despite the identified problems, there are countless examples where we have seen the Choice Program work for veterans who had no access to care prior to the program’s implementation, and Congress and the VA continue to work to ensure the programs is as efficient and as streamlined as possible. Congressman Tipton and his staff also continue to work with veterans across (his district) to help them navigate the Choice Program process. We are currently serving over 1,000 veterans on Choice Program-specific casework.”

Colorado 4th District U.S. Rep. Ken Buck (R-Greeley) has this to say in an email about the Veteran’s Choice Program: “I support giving veterans more health care options through the Veterans’ Choice Act, but I recognize the challenges faced by the act over the past few years. Congress needs to continue working to improve this act so that veterans receive the care they need, when they need it.”

Kyle Huwa, Buck’s communications director, says in an email the congressman’s staff is looking into concerns Pulp has raised about long wait times at VA facilities in southeastern Colorado and the effectiveness of the Veterans Choice Act.

“Once he has more information on the specifics of the issue,” Huwa says, “he can address that question.”

Although southeastern Colorado has obvious problems with VA wait times and the Veterans’ Choice Program, there is reason to be upbeat. Air Force Veteran Phil Andreski is pleased with the VA service he receives. “No complaints from me,” he says in an email. “Don’t use VA other than getting hearing aids, and I’m satisfied.”

Andreski is the southeastern Colorado representative for the United Veterans Committee of Colorado, a Denver-based veterans’ advocacy group. He adds that he has not received any complaints from the veterans he knows about long VA wait times or the Veterans’ Choice Program.

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