By CHRISTOPHER QUINN |
The Atlanta Journal-Constitution | Published: February 7, 2020
ATLANTA
(Tribune News Service) — Bruce Barber was hopeful the Department of Veterans
Affairs' latest $16.5 billion program to send former soldiers to private
doctors would speed up access and get him better care.
His
experience has been otherwise. He battled for months last year to qualify for
the program, which began in June. In mid-December, he was finally given an
appointment, 52 days away in mid-February. That’s just for a consultation with
a VA neurologist, the first step to qualify for outside help.
“You
have to be ready for a fight, because it’s a real battle,” said Barber, a
51-year-old resident of Kennesaw and veteran of Operation Desert Storm.
Last
summer’s Mission Act was Congress’ third attempt in less than a decade to
get veterans into the hands of private doctors when VA facilities can’t see
them quickly enough, aren’t located nearby or don’t offer services veterans
need. It was pushed by President Donald Trump and is expected to move more
veterans into privatized care.
The VA
says the overhaul has gotten off to a good start, authorizing more than 1.5
million visits to outside providers between June and December. The program also
allows veterans to visit private walk-in clinics without pre-approval, with 209
of the participating clinics in Georgia alone treating 2,477 veterans during
that period.
But in
Georgia, at least, there are also warning signs that things have gotten worse,
not better. An Atlanta Journal-Constitution review of wait times at metro
Atlanta VA health care facilities showed they grew at many locations since the
program began, with waits as long as 63 days. And an inspector general audit of
a VA district including south Georgia found veterans waited an average of 56
days to receive care last year.
Among
the veterans still on hold is Tony Willis, who has worked without luck for more
than a year — under a previous program and the Mission Act — to get an
appointment with an outside primary care doctor near him. The resident of
Lavonia in north Georgia has conditions ranging from renal problems to
collapsed discs and Crohn’s disease.
The
last phone call with the VA in early January ended with a promise to get back
to him the next day. As of early February, he was still waiting.
“They
need to take every one of them politicians and make then enroll in the VA
system, and I promise you in six months time the VA will be running like a
Timex watch,” said the 52-year-old Desert Shield and Desert Storm veteran.
The VA
health care system is ponderous. Its 400,000 employees and 1,255 clinics and
hospitals make it the largest health care system in the country. About 9
millions veterans, including about 315,000 in Georgia, were enrolled in 2017,
according to VA estimates.
Some
recent studies have shown the VA provides quality care as good or better than
local private hospitals, but the quality rises and falls by locality. Patient
trust in VA care is up to 87.8%, the VA reports, but Georgia veterans recorded the lowest patient
satisfaction scores last year among the country’s 18 treatment
regions. The Atlanta VA Medical Center in Decatur, the largest in
Georgia, suspended routine surgeries last
fall to address problems in operating rooms. It has been restoring capacity
slowly.
Congress
wrote three increasingly refined bills since 2013 to improve and quicken
service by building networks of private practices which could treat veterans.
The
Mission Act eased qualifications. Veterans should be referred to outside care
if they can’t see a VA primary care doctor within 20 days or a specialist
within 28 days. The same rule applies if they live more than 30 minutes from a
VA clinic for primary care or more than an hour from specialty care. Veterans also
qualify if the local VA doesn’t offer a service, if the local VA service has
been graded below VA standards, or if the VA doctor consulting with the patient
decides it’s in the patient’s best interest.
The act
farmed out the coordination of care to third-party contractors, who recruit
doctors and practices to join, handle paperwork, pay the doctors, and then ship
the paperwork to the VA. The VA’s Community Care department also helps with
coordination and paperwork.
Trump
praised the bipartisan Mission Act for letting veterans avoid backlogs at VA
facilities and see doctors they chose.
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“All
during the (2016) campaign, I’d go out and say, ‘Why can’t they just go see a
doctor instead of standing in line for weeks and weeks and weeks?’” he said
after signing the bill. “Now they can go see a doctor. It’s going to be great.”
Since
programs to send veterans to private doctors began in 2014, the number of days
to get primary care nationally dropped from 24 days to 20. Mental health
appointments can now be made immediately. Between 2016 and 2019, VA and private
appointments grew by more than 1.5 million each. About one in three veteran
visits are now to a private practice and that is expected to increase under the
Mission Act.
But the
process for getting an outside referral still starts with an initial
consultation with a VA doctor, and that has been a sticking point for Georgia
veterans who spoke with the AJC. Once they qualified, they also reported
problems getting appointments through contractors.
Appointments
disappear along with paperwork. They spend hours on the phone with little
result. Referrals to outside doctors from VA staff expire before appointments
are made by the contractor.
Larry
Donaldson has gone under VA and private scalpels more than a dozen times, the
result of his wounding in Vietnam and then decades of surgeries to repair
resulting problems. The 73-year-old Acworth resident said he needs another
surgery to fix a hole that hasn’t healed in his abdominal wall from a previous
surgery.
He said
he got VA approvals to go outside the system after June 6, but an outside
contractor wasn’t able make the appointment until early December. Three days
before the appointment, he said the contractor left a voice message that the
scheduled doctor was not in their system, and that he should cancel the visit
unless he planned to pay for it or have private insurance pay for it.
He
ended up going back to a VA surgeon, and in a January consultation was told the
recovery would take more than two months, including two weeks in the hospital.
Because he is in the midst of moving to a new home, he has had to delay the
surgery again.
“In the
meantime, the hole in my stomach continues to grow bigger and bleed more
frequently,” Donaldson said.
Wait
times grow in metro Atlanta; inspector general finds fault in south Georgia
Metro
Atlanta veterans are now waiting longer for appointments at most VA clinics
than before the program started, sometimes by weeks, based on an AJC review of
publicly available VA data.
Fort
McPherson clinic patients waited on average 18 days for an appointment last
April. In January, that had grown to 54 days. Waiting times at the Decatur
medical center on Clairmont Road grew from 26 days to 45 days in the same
period. The Atlanta clinic wait grew from 27 to 46 days; the Hinesville clinic
from 28 to 35 days; the North Gwinnett clinic from 11 to 18 days; and the
Lawrenceville clinic from 14 to 18 days.
The
longest January wait time was 63 days at the Northeast Cobb Clinic, which
opened in April.
Two
improved: The Austell clinic declined from 42 days to 38; and the Stockbridge
clinic fell from 16 days to 4.
In a VA
district that includes a slice of south Georgia, Florida and southeast Alabama,
veterans waited just under two months to receive care in 2019, according to a
VA Office of the Inspector General audit released last month. The audit
found the Community Care department was understaffed and that workers were
poorly organized and inefficient. At the time of the audit, more than 74,000
veterans had not been scheduled, were still awaiting appointments, or the VA
had not completed their paperwork.
The
contractor in Georgia that connects veterans and private doctors has been
TriWest Healthcare Alliance, which has helped coordinate outside care in
previous programs. That will change this month, when a new contractor, Optum,
part of United Health Group, will begin taking over. The transition should be
complete by May. Optum did not respond to requests for comment.
Howard
Sherman, who lives near Helen in north Georgia, tried in July to get a primary
care doctor near him and make an appointment with a urologist. A test done at
the VA had noted blood in his urine, which could be a sign of dangers such as
kidney stones or cancer. He said TriWest tried to refer him as far away as
Murphy, N.C.
“It was
just all messed up,” said the 66-year-old Navy veteran with two active tours on
aircraft carriers.
He
finally got an appointment with a urologist in late September in Gainesville.
After testing, the doctor told him in October that everything looked OK. But
Sherman said he is still waiting to find a primary care doctor that will keep
him from having to make the hour-long drive to Atlanta.
James
Yarbrough in Fairmount, about 60 miles north of Atlanta, is disabled and
struggled through 2019 to get multiple appointments with various specialists,
including a rheumatologist for his lupus and a dermatologist to check him for
skin cancers.
Twice,
a VA doctor sent outside referrals to TriWest for a visit to a rheumatologist.
Twice, TriWest told him they didn’t get the referrals. Two other times he got
sent to doctors for appointments but when he arrived, he was told he had no
appointment, according to the 41-year-old Air Force veteran.
Yarbrough
said he was still waiting to see a rheumatologist in early January, and that it
took months to get to a dermatologist to get a skin cancer removed from his
foot late last year.
“It was
so bad I had to go out and get regular insurance,” Yarbrough said. “I am
dependent upon them for my life, and I really can’t depend on them.”
In an
emailed response to questions, TriWest said the average appointment time for
Georgia veterans dropped from nine days to seven days since the Mission Act,
and that it received only 147 complaints from veterans in the state for all of
2019.
TriWest
said it didn’t make appointments for 7% to 8% of veterans in Georgia in
December because veterans didn’t respond to phone calls or mail, or because
veterans turned down appointments.
Willis,
the Lavonia veteran, said he was still waiting to get a simple appointment with
a primary care doctor. The months-long effort has left him and his wife
Barbara, who does a lot of VA legwork for the disabled veteran, worn out.
The
most recent response from TriWest, according to the couple, was that it needed
a referral from the VA to get him an appointment. But the couple said Willis
has already received three from a VA doctor, which expired after being
unfulfilled by TriWest.
“I
should not have to make a 200-mile round trip just to get another referral and
have them drop the ball again,” he said.
©2020
The Atlanta Journal-Constitution (Atlanta, Ga.)
Visit The Atlanta Journal-Constitution (Atlanta, Ga.) at www.ajc.com
Distributed by Tribune Content Agency, LLC.
Visit The Atlanta Journal-Constitution (Atlanta, Ga.) at www.ajc.com
Distributed by Tribune Content Agency, LLC.
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