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Advocates: Better VA care, not privatization

Fayetteville Observer - 7/28/2018

July 28--Since February, Vietnam War veteran Roland Rochester has been going outside of the Fayetteville Veterans Affairs Medical Center to see a private doctor for treatment of diabetes, anxiety and high blood pressure.

Rochester, 65, said he sees the private doctor and a neurosurgeon with the VA's blessing. He said the VA doesn't have the capability to treat him, so it pays for his treatment to go elsewhere.

"If it was available, I wouldn't have to go to an outside physician," said Rochester, who is junior vice commander of Veterans of Foreign Wars Post 10630 in Hope Mills. "I would prefer it was available."

Rochester is among millions of veterans who use the Veterans Choice Program, which originated after an investigation in 2014 uncovered that at least 40 veterans died while waiting to see a doctor at a Phoenix VA hospital, where wait times averaged 115 days. An audit found wait times weren't much better at the Fayetteville VA, which averaged 83 days.

The Veterans Choice Program originally was designed to ease the burden by allowing veterans to see private physicians if they lived more than 40 miles from a VA hospital or had to wait more than 30 days for a VA appointment.

But the program has been fraught with problems. In Fayetteville, an audit last year found, veterans had to wait an average of 94 days to see a health provider in the Choice network.

The man now tasked with rolling out reforms to Choice, and tackling a long list of other problems, is Fayetteville's Robert Wilkie. Congress overwhelmingly approved the nomination of the Navy veteran last week, after he served as interim VA secretary for several months.

Wilkie says he opposes privatization of the VA but supports allowing private and community care when it best meets the needs of veterans.

His job won't be easy.

There are two main reasons for problems with Choice, said U.S. Rep. Richard Hudson, a Republican whose 8th District includes Fayetteville and Fort Bragg. First, Hudson said, the VA has become overburdened in bureaucracy. Second, VA administrators are reluctant to send patients to private physicians, fearing it will lead to the eventual downfall of the VA system.

"The VA bureaucracy has gotten so massive that it has become an inefficient system," Hudson said.

The scandal that unfolded over wait times in 2014 led to the resignation of VA Secretary Eric Shinseki. But the problems didn't stop there -- two more secretaries have come and gone in the last four years.

Wilkie's predecessor, David Shulkin, says he was forced out because he resisted efforts to privatize the VA system.

Critics of privatization, including many Democrats and most veterans groups, say plans to give veterans better access to private-sector care would bleed money from the VA system and potentially lead to its demise.

But Hudson and other advocates say they have no intention of pushing for full privatization of a VA system that includes more than 1,700 hospitals and 360,000 employees.

"I oppose privatizing the VA, but I support taxpayer-funded private and community care when the VA can't meet the needs of veterans," Hudson said.

So does Mark Erskine, commander of the American Legion Post 230 in Spring Lake and a candidate for commander of District 8 in North Carolina.

For more than three years, Erskine said, the VA in Fayetteville has allowed him to see a private doctor for back and knee pain. Erskine said he opposes privatization, but he plans to continue going to his private doctor until the VA "can take care of us right there on the spot."

----The U.S. Department of Veterans Affairs insists that privatization isn't going to happen. It spells out the reasons on a website post titled, "Debunking the VA Privatization Myth."

In it, the VA notes that its budget has quadrupled in the last 20 years, to $189 billion. The number of employees has grown by nearly 60 percent, to 385,233, and the agency has added 130 medical centers since 2000.

The VA also notes that it has been offering community care programs since 1945.

"No health care provider delivers every treatment under the sun," the VA says on its website. "Referral programs for patients to get care through outside providers ... are as essential to the medical profession as stethoscopes and tongue depressors."

VA officials say problems with the Veterans Choice Program have lessened in recent years.

At the Fayetteville VA, wait times for consults with private health care providers have fallen dramatically in less than a year, according to James Laterza, who has been director of the local VA since April. Wait times were an average of 85 days in October 2017. Now, the average is 14 days.

Regardless, the problems with the program -- and the VA system as a whole -- run deep, critics say.

"Every year I have been in Congress, we have given the VA the most funding it has ever had," Hudson said. "Most VA employees are great people who care deeply for our veterans. In fact, many are veterans themselves. But the bureaucracy at the VA has gotten so massive that it has become an inefficient system that doesn't provide the most timely, quality health care our veterans deserve."

Hudson believes competition between the VA and private health providers will improve the VA's system of care and strengthen its ability to treat more veterans.

"If we give veterans a choice of private care or the VA system, the VA will win, because veterans want to go to the VA," Hudson said. "But the VA will be forced to make improvements and clean up the bureaucracy to compete with the private sector."

The American Legion, which has about 2 million members, understands the need for community care programs, especially in rural areas, said spokesman Joe Plenzler. But his organization is concerned about spending too much money in the private sector, which is more expensive and provides equal or lesser care. The money going to private doctors strains the VA, Plenzler said.

"Left unfettered, it becomes a vicious circle," he said.

Plenzler said the American Legion is "100 percent opposed" to privatization of the VA.

Instead of relying heavily on community care, he said, the American Legion advocates filling the 33,000 vacant positions in the Veterans Health Administration. The organization will ask for those positions to be filled when it meets with Wilkie, he said.

Last year, Hudson introduced the Care Veterans Deserve Act, which would, among other things, make the Veterans Choice Program permanent and allow veterans who have at least a 50 percent service-connected disability to qualify for the program with no questions asked.

Before Hudson's bill could be debated, President Donald Trump in June approved the VA Mission Act. The act, Hudson said, "aims to give veterans more options and flexibility in choosing their health care while streamlining current VA programs."

Hudson said the act will combine the VA's seven community care programs into one cohesive program. It will create a non-partisan process for reviewing the VA's assets to ensure veterans can access the care they have earned, and it will expand the VA's post-9/11 caregiver program to all veterans.

It remains to be seen whether Wilkie's appointment as VA secretary will lead to a shrinking bureaucracy, increased resources and a better level of care nationally and at the VA in his hometown of Fayetteville, where the number of patients is growing faster than anywhere else in the country.

"He doesn't have to ask directions," Hudson said. "That's certainly not a bad thing for us. I think it's important that he knows us and the challenges we are facing."

Hudson thinks Wilkie is the right person for the job, partly because he knows how to deal with bureaucracy. Hudson pointed to the job Wilkie did while working in the Pentagon, when he got the VA and the Department of Defense to make their medical records compatible. Hudson said that simplified the process and made it much more efficient.

----Erskine, the American Legion commander in Spring Lake, said he knows little about Wilkie. He acknowledges that the Fayetteville VA has progressed in recent years, but he says "there is still a lot of veterans having problems."

Erskine rattles off the biggest problems that he hears from veterans. The time it takes getting appointments with the VA and the Veterans Choice Program. Getting medications. Doctors treating patients like numbers.

Laterza, the new VA director in Fayetteville, said he has been working on those issues.

Appointment wait times for new patients has fallen from an average of 55 days to under 30 in all but one department, where the wait time is 31 days, Laterza said.

He said the decreased wait times are partly a result of better scheduling by making sure that no dates go unfilled.

Laterza said the appointment wait time for existing patients wanting routine procedures is now three to five days.

To give doctors more times with patients, Laterza said, the scheduling grids were changed from 20 minutes to 40 minutes for routine procedures, and from 30 minutes to an hour for more serious ones.

"Everything I have seen has been that the VA is improving not only in its image but its responsiveness to the veteran's voice," Laterza said.

One of his main focuses, Laterza said, is to ensure that employees are proud to work for the VA and that they treat every veteran with the same level of care, courtesy and respect.

"I don't want to ever treat a veteran like a number," Laterza said. "Veterans are patients, and we have to treat them like a patient -- just honored ones."

Staff writer Greg Barnes can be reached at gbarnes@fayobserver.com or 910-486-3525.

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