Veterans in Arkansas fared slightly better than veterans nationwide in getting timely health care in the months since passage of a multibillion-dollar measure aimed at reducing wait times at U.S. Department of Veterans Affairs facilities, according to new data from the department.
Approximately 2.6 percent of care-seeking veterans in Arkansas (10,286 patients) from Sept. 1 through Feb. 28 waited at least 31 days for nonemergency care at the state’s VA hospitals and clinics, the data show.
At 940 VA facilities nationwide, nearly 894,000 appointments, or 2.8 percent, did not meet the VA’s timeliness goal, which says patients should receive nonemergency care within 30 days.
The Veterans Access, Choice and Accountability Act, which Congress passed last year in response to long delays at VA facilities and the discovery of attempts to hide the delays, includes funding to hire staff members, improve infrastructure and start the new Veterans Choice Program, which allows veterans to seek care outside the VA system.
Individually, f ive out of 18 facilities in Arkansas performed worse than the national average: community-based outpatient clinics in Pine Bluff, El Dorado and Conway; the Fayetteville VA Medical Center; and the Eugene J. Towbin Healthcare Center in North Little Rock.
Officials with Arkansas’ veterans health care systems said their problems with delayed access to care are easing. They blamed continued delays on a chronic shortage of medical staff and lower-than-expected use of the new program that allows veterans to receive health care from the private sector.
“One of the biggest things Ozark had with access was related to a loss of a significant amount of primary-care staff,” said Mark Worley, interim director of the Veterans Health Care System of the Ozarks in Fayetteville, of which the medical center is a part.
About the new Veterans Choice Program, Worley said, “It’s been, nationally, a slower rollout than anybody within VA expected or finds acceptable.”
The Associated Press gathered the latest government data to learn whether the law
— and its $16.3 billion price tag — has had an effect on the percentage and duration of delayed appointments.
The data include only completed appointments, not those that are pending.
The Arkansas Democrat-Gazette independently analyzed the data pertaining to Arkansas and neighboring states.
Because of a change in how the VA calculates delays, it’s hard to directly compare the wait times with those experienced about a year ago, when Veterans Affairs Secretary Eric Shinseki resigned in May after it was first reported that veterans were getting sicker while waiting for care.
Under the VA’s old method for calculating delays, the percentage of appointments that took longer than 30 days to complete had been steadily ticking up, from 4.2 percent in May to nearly 5 percent in September, according to the AP.
Under the new calculations, the percentage for September is 2.72 percent.
That new data show little consistent progress from August, the month the overhaul bill was signed, through February. Nationally, 2.43 percent of completed appointments in August were delayed, and 2.85 percent were delayed in February. A low of 2.41 percent were delayed in October.
SOUTH’S POOR RECORD
At Arkansas’ three VA medical centers — in Fayetteville, Little Rock and North Little Rock — and 15 community-based outpatient clinics, 10,286 of almost 400,000 completed medical appointments from Sept. 1 through Feb. 28 were delayed more than 30 days. Data for each state were not available for August.
Delayed patient visits in Arkansas each month ranged from a high of 3.04 percent of appointments in January to a low 2.1 percent in February.
None of Arkansas’ VA medical centers or clinics are among the 100 VA sites with the highest percentage of delayed appointments, though facilities in other Southern states are some of the worst-performing.
The data show eight of the 100 facilities with the highest proportion of delays were in neighboring Tennessee, where more than 15 percent of patients visits were delayed more than 30 days at one clinic and nearly 14 percent were delayed at another.
In Alabama, an average of 9 percent of appointments were delayed at two of its medical centers, both of which fell in the top 100 for most-delayed appointments. Ten of Georgia’s VA facilities were in that group, as were seven facilities in Florida and nine in North Carolina.
Of Arkansas’ VA health care facilities, the Fayetteville VA Medical Center, home base of the Veterans Health Care System of the Ozarks, had the highest proportion of delays with 3.94 percent of its nonemergency appointments delayed at least 31 days. It ranked 152nd out of the 940 facilities in the country for most-delayed patient visits.
In many parts of the country, the VA can boast of being able to deliver care that is just as fast, or even faster, than patients would get in the private sector, the AP reported. Relatively few VA facilities in the Northeast, Midwest and Pacific Coast states reported having significant numbers of patients waiting extended periods for care.
STAFF SHORTAGES
Both Worley, who heads the Fayetteville-based system, and Tina McClain, chief of staff for the Central Arkansas Veterans Healthcare System, said their systems are hiring more medical staff.
In the past year and a half, the Veterans Health Care System of the Ozarks has lost about 53 percent of its primary-care physicians, which led to delays and the creation of an electronic wait list, Worley said.
Since the getting funds resulting from the Veterans Access, Choice and Accountability Act, the Ozarks system has hired enough people to add two primary-care teams, which each include a physician, registered nurse, licensed practical nurse and clerk. The money also enhanced the system’s telehealth and surgical programs, Worley said.
“While we’ve had a wait list in the past for primary care, we now have no wait list. It has essentially evaporated,” he said.
The Ozarks system is currently recruiting for six psychiatrists, two psychologists, two general surgeons, a urologist and an emergency medical technician. Two psychiatrists are set to join the system in July, he said.
Worley said he’s proud of what the wait times are now and that they would “stand up against most private practices in the country.”
“Since last summer, we’ve been under very intense scrutiny,” Worley said of all VA health care facilities. “Every center had a VA team look at their scheduling practices, and when that team left here, they did not find any issues within our medical center. We have always been in compliance with the national scheduling, and we really do pride ourselves in the system doing the best for our veterans.”
At the Central Arkansas Veterans Healthcare System, funds from the Veterans Access, Choice and Accountability Act have been used to hire 40 staff members.
The system, the largest in Arkansas, covers 46 counties and operates the Eugene J. Towbin Healthcare Center and the John L. McClellan Memorial Veterans Hospital in Little Rock, as well as eight community-based outpatient clinics.
In an interview in November, McClain said delays were caused by “mandates and expectations that we simply were not staffed sufficiently to meet.”
The system still has some vacancies to fill and is looking to bring on additional specialty, primary and clinical care staff members.
“We’re fairly pleased with where our access numbers are, but certainly there is room to improve,” McClain said.
In the months after the VA overhaul effort, Towbin was the busiest of any VA health care facility in Arkansas, the data show. It completed 106,245 appointments from Sept. 1 through Feb. 28 but performed slightly worse than the national average for the proportion of appointments delayed.
During that six-month period, 3 percent of patients waited for care more than 30 days.
The central Arkansas system’s primary and mental-health care — the outpatient services with the largest volume of patients — are at Towbin.
Delays were caused by a few vacancies in the hospital’s primary-care staff, McClain said, adding that “we expect those would improve once we get those vacancies filled.”
McClain also said the system is not seeing patients for mental-health care as quickly as it should, and that division is evaluating how new appointment requests are processed.
“Those numbers are not where we want them to be,” she said.
John L. McClellan Memorial Veterans Hospital houses the system’s specialty medicine and surgery clinics. It was the best-performing of the state’s three medical centers with only 1.3 percent of patient visits delayed, the data show.
FEW USE CHOICE
Worley and McClain also cited the lower-than-expected use of the $10 billion Veterans Choice Program as a reason for continued wait times.
Through the program, eligible cardholders should be able to receive health care from approved providers outside the VA system at the VA’s expense.
To get an appointment, veterans nationwide are told to call a customer-service center at (866) 606-8198, which sets up appointments with pre-authorized health care providers if the veterans meet eligibility criteria. At the same time, an appointment is scheduled at the closest VA facility, and the veteran can choose between the two.
Worley said the program has so far been “quite a challenge.”
Cards have been sent to 2,420 veterans in the Ozarks system’s coverage area, which includes 23 counties in Northwest Arkansas, southwest Missouri and eastern Oklahoma. Of those, 1,166 veterans declined their private-sector appointments.
In November, the central Arkansas system sent choice cards to about 4,430 veterans, 900 of whom were waiting more than 30 days from their preferred dates to receive care.
Information was not available for the number of veterans who have used the program to schedule appointments in the private sector, but McClain said it was “much lower” than the number of veterans who are eligible.
The choice program has caused some confusion among veterans, some of whom did not know they would have to contact a third-party contractor to set up an appointment, McClain said.
Worley and McClain also said more veterans are opting to keep their VA appointments rather than choose private medical care.
“One of the things we have found is many of our veterans are actually saying, ‘I’m comfortable with the VA,’ and keeping their appointment with us,” McClain said. “We certainly wish we could get them in quicker in some cases.”
The slow start to the program is a concern nationwide.VAnationwide.VA Secretary Robert McDonald said in February that 27,000 appointments for private-sector care had been made since the program rolled out in November. According to Veterans Affairs, its health care facilities serve approximately 8.75 million veterans each year.
The Washington Post reported there were widespread complaints that the program’s eligibility requirements were too strict. In March, the VA announced a plan to expand eligibility.
Originally, veterans who couldn’t get care within 30 days of their preferred dates and those who lived more than 40 miles in a straight shot from any VA facility were eligible to receive a choice card.
Now the VA changed the guidelines to measure the distance from VA facilities in driving miles instead of the direct distance between two points.
“In some areas in Arkansas, in the mountains, you have to drive 60 miles on the road to get 40 miles as the crow flies,” McClain said. “Changing that will increase the number of vets who would be eligible for choice.”