clinic
was expected to serve 36,000 veterans annually. July 9, 2015 (Courtesy photo /
Atlanta VA Health Care System)
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.
"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.
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.
Still waiting
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.
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