Washington— A new law designed to reform the U.S. Department of Veterans Affairs should bring improvements in delivery of medical care to Connecticut veterans, though some of the changes will be slow in coming and problems are expected to continue to hamper the VA system.
A scandal that broke this spring over long waits for medical appointments at some VA facilities nationally, and attempts to conceal those wait times, prompted a VA audit of its entire system. That audit found little wrong with wait times in Connecticut — but it did find other problems.
The audit showed Connecticut’s hospitals and clinics hewed closely to a target of no more than 14 days for an appointment, but wait times varied widely among the state’s two VA hospitals — in West Haven and Newington — and six VA outpatient clinics. The average wait time was highest at the Newington VA hospital, an average of 16 days for a patient to schedule a visit for primary care, and lowest at the VA clinic in Winsted, where the average wait was just six days.
Wait times increased in July, however, with more than 6 percent, or about 3,000 Connecticut VA patients, reporting wait times of 30 days or longer. The VA has not determined the cause of the increase.
Sen. Richard Blumenthal, D-Conn., who sits on the Senate Committee on Veterans’ Affairs, is pressing the VA for more information. “I’ve asked for an explanation so I hope to get some answers” he said.
Some vets are very happy with the level of care they have received at state VA facilities.
Bob Royland, a former Marine who lives in New Britain, said he’s received medical attention at Newington for his diabetes and high blood pressure. He recently sought emergency care for a severe case of poison ivy.
“I went to Newington and showed it to someone, and they took care of me right away,” he said.
Nonetheless, David Welsh, a Vietnam War-era veteran who serves as a veteran adviser at Tunxis Community College, said he’s “heard more than one veteran express dissatisfaction.”
“They wait longer than they feel they have to for an appointment,” he said.
Among the shortcomings the VA audit did find in Connecticut was the fact that only about 13 percent of the employees who scheduled appointments were aware of an electronic wait list, which keeps track of backlogged appointment requests. Also, patients were called to remind them of upcoming appointments only 40 percent of the time. Nationally the comparable figures were 49 percent and 58 percent, respectively.
Connecticut VA facilities also scored below average when their staffers were asked “How much notice do providers give you when taking planned leave?” Only 40 percent of the providers gave at least four weeks notice before taking time off, making it difficult for those who schedule appointments to determine when a particular doctor would be available. The national average was 54 percent.
The Connecticut VA scored very well (96 percent) when staffers were asked if they schedule appointments for consultations to determine if a referral is needed for follow-up care suggested by a doctor. Critics say the follow-up care should be scheduled immediately, without further medical consultations that could result in delays and hurdles to obtaining needed care.
Despite those and other problems, the staff at Connecticut’s veteran facilities rated their service a 4.8 on a 1 to 5 scale, with 5 being “excellent.”
The only VA facilities in New England that were found to have severe problems — and are still under investigation — are one in Boston and another in central western Massachusetts.
Giving vets choice
President Obama signed a bipartisan reform bill this summer after the evidence of secret patient wait lists, meant to game the VA’s performance metrics, came to light this spring.
The $16-billion Veterans Choice, Access and Accountability Act is expected to improve delivery of care to veterans in Connecticut and throughout the nation.
Rural veterans are likely to benefit from $10 billion in added funding over the next two years for outside referrals, what the VA calls “Non-VA” or “fee basis” care.
To be eligible for that care, veterans must live at least 40 miles from a VA facility that can treat them, or have to wait more than 30 days for care. According to the VA, the state’s rural eastern section is home to the most veterans in Connecticut.
The bill also establishes an online portal to view how long patients will have to wait for care, and whether seeking outside care represents a more timely option. In order to obtain reimbursement for the outside care, veterans will need a “Veterans Choice Card” that is supposed to be available to eligible veterans within 90 days.
Most of the rest of the bill’s funding goes toward increased staffing and leases of medical facilities. It has not been determined how many new doctors and medical staff will be hired in Connecticut.
Blumenthal said the number of veterans in Connecticut — more than 200,000 — and the proximity of notable teaching hospitals at Yale University and the University of Connecticut should make it easy for the VA to locate new medical staff in the state.
“I would expect that we will receive a good number of those slots,” he said.
The VA is conducting town hall meetings across the nation — including a couple in Connecticut — to help determine how to allocate the new resources. The first one in the state was held in Newington on Sept. 5 and included testimony from state VA officials and Connecticut veterans. But implementing this reform is expected to take time.
The bill also earmarks nearly $5 million for a lease for the Errera Community Care Center in West Haven, allowing it to relocate to a larger building in town and expand its mental health and substance abuse services. The Errera center serves many homeless vets.
“We have outgrown our space,” said Laurie Harkness, director of the Errera center.
Harkness said the money will allow the center to lease 45,000 additional square feet of space, a sizable upgrade from the center’s current 12,000-square-foot facility, which serves about 6,000 vets.
“It will be much bigger and much more welcoming,” Harkness said.
The new law also will improve care for veterans who are victims of sexual assault and extend a program that provides housing for head-trauma victims.
At the behest of congressional Republicans, the new law also makes it easier for the new head of the Department of Veterans Affairs, Robert McDonald, to fire incompetent senior VA officials.
Vets outside the VA
According to the U.S. Department of Veterans Affairs, as of Sept. 30 last year, there were 207,759 veterans living in Connecticut. Most had experienced combat. But not all of them use the VA system. In fact, a majority don’t.
According to the Congressional Research Service, of the nation’s 21.6 million veterans, only about 9 million are enrolled in VA services. That may be because they do not meet service or income requirements, or because they choose to be covered under private insurance or qualify for TRICARE, the health program for active-duty troops.
So, many vets won’t be affected by the reforms.
“I don’t think even the VA knows how many veterans there are outside the system,” said Linda Schwartz, the outgoing head of Connecticut’s Department of Veterans Affairs who was recently confirmed for a key job at the U.S. Department of Veterans Affairs. But, she said, the fact that many are makes it difficult for some to receive care the VA specializes in, especially those suffering from post-traumatic stress disorder or other combat-related mental injuries.
“Are private providers really acquainted with some of the problems our veterans have?” she asked. If not, allowing those in the VA system greater access to care by outside providers may be problematic.
Harkness of the Errera center said veterans prefer to receive care through the VA, which serves as a one-stop shop for other services, including help for homeless vets, and the companionship of other veterans.
The VA scandal cost former Department of Veterans Affairs chief Eric Shinseki and other top agency officials their jobs and brought to a screeching halt the Senate confirmation of several nominees for top VA positions, including Schwartz.
Last year, Obama nominated Schwartz, 69, a Vietnam War vet and former nurse, to head policy and planning efforts at the VA, so she would be in the thick of implementing changes.
But those reforms will have to wait until Schwartz and other top VA nominees win Senate approval. A frustrated President Obama urged quick Senate confirmation when he signed the reform bill into law in August.
“They’re ready to serve. They’re ready to get to work. It’s not that hard,” Obama said.”It’s just the Senate doesn’t seem to move very fast. As soon as the Senate gets back in September, they should act to put these outstanding public servants in place. Our veterans don’t have time for politics.”