One of the 'events' of 2014 was the spotlight that landed on the VA regarding health care, and the lack of it, for veterans. I will not get into the details of what was exposed... but will say that systemic problems have been identified... and people are trying to work, from many angles, to try to fix the problems. The goal is, or should be, timely access to quality health care for veterans... as promised.
There are many veterans who have never had any problems with the care they get through the VA. That is important... there are many veterans who get timely appointments when they need them and receive very good care through the VA.
Acknowledging their successes does not excuse their failures and shortcomings, and bringing attention to those things that need to be fixed does not invalidate their successes.
For the veterans who cannot get a timely appointment, if any... for the veterans who get substandard care including, but not limited to, misdiagnoses and improper medications... for the veterans who have to deal with a system that seems to be set up to treat veterans as an 'inconvenience'... for the families of veterans who died while waiting for adequate care... those successes do not mean a thing. It can even make the feeling worse... if it can be done well for some, why not for all?!
Problems of this sort are not limited to the VA. Similar quality of care issues can be found, to some degree, pretty much anywhere, I'm sure. However... the VA has publicly held itself to a different standard... has historically and publicly committed to providing the best care possible to veterans.
The private results often do not match that public commitment. The most recent spotlights have shown that... and that spotlight has prompted some public moves to make changes.
I received a letter in the mail this past Saturday, Jan 3rd, regarding one of those changes.
The VA has decided that a veteran who lives more than 40 miles from a VA healthcare facility... or gets an appointment that is scheduled more than 30 days out... can make use of this new program, the Veterans Choice Program.
It has a nice ring to it.
The letter came with a card... and instructions to call a number to verify eligibility... the eligibility requirements stated in the letter are... a veteran living more than 40 miles from a VA healthcare facility OR a veteran who has been scheduled an appointment within the VA for more than 30 days out.
I am a US Army veteran with 100% service connected disability. As such, I am eligible for complete health care through the VA at no cost to myself... but have found it nearly impossible to get my care at the KC VA. My current VA doctor is at the Excelsior Springs CBOC (community based outpatient clinic). That is fine for little things, but they have no specialists and just basic equipment. For anything other than the bare minimum, I would have to go to the KC VA. I live more than 40 miles from the KC VA Medical Center. According to the way the letter was worded, I would be able to try to find a local provider who has agreed to participate in this program... and switch my care to them.
Having dealt with the VA, for myself, for the last 15 years, imagine my complete LACK of surprise when I called to confirm my eligibility and was told... no... I was not eligible... and no... that person could not explain the reasons to me... but I could call this other number and find out more. *sigh*
I called the number... and spent about 45 minutes on hold. I explained my reason for calling to Paul, the VA representative. His first response was, "What is this... Kansas Day?" I told him that I didn't know... I'm from Missouri... but that it was Monday, and strange things happen on Mondays. Thankfully, he had a sense of humor. After asking if he could have my name, (I expressed my sympathies to him that he did not have his own), asking if he could have my birth date, (again he had my sympathy), and finally asking if he could borrow my social security number, (if borrowed, may be just fraud rather than identity theft?). **Being on hold for an extended amount of time can be stressful... which often leads to the blatant abuse of humor as a stress relief tool**
After he was able to find my info in their system, we got to the program in question.
Contrary to what the wording of the letter implies, this program is NOT intended to allow veterans, who fit the stated eligibility requirements, to find health care providers, outside of the VA, who are closer to their home or have more flexible scheduling.
The way this program is set up to work is:
Once a veteran is given an appointment (with their own VA provider or VA specialist referred to by their provider)...
IF the appointment is scheduled for more than 30 days out... OR
IF the veteran lives more than 40 miles from the location of the appointment...
Then the veteran must notify the provider that they want to be put on the Choice Program List.
-This list is generated weekly and sent to a third party entity. Those people then go through the list, locate providers near the veteran's home, who A) have agreed to participate in the program (which often means getting paid at the Medicare level, as payment in full... said payments from the VA, prior to this program, often take 8 months or more to be processed), and B) have an opening in their schedule.
-These people then call the veteran with the information regarding their appointment.
The people who work for the third party entity are the people who make the calls to find the providers and set up the appointments. NOT the veterans. Yes, this reduces the potential headache for the veteran as they try to find someone who has agreed to participate in the program... but it does not allow them another thing that the program description and NAME imply... a choice of providers.
What this program allows is for a veteran to get a specific appointment scheduled with someone closer within a reasonable time frame.... as a potential one time visit with said provider... who will then communicate with the veteran's primary care physician regarding the results of that appointment.
I am not eligible to use this Veterans Choice Card... right now... as I do not have an appointment scheduled.
When I said to Paul, the VA rep, "So... I should keep this in my back pocket for possible future use, as any scheduled appointment could possibly be an appointment that would make me eligible to use the program... but I would have to be sure to specifically request to be put on the Choice Program List?", he responded with, "Eureka! You are the first person who has gotten it! You wouldn't believe how many people get angry and hang up before I can even finish explaining!" Hmmm... I told him that maybe that should be taken as a clue that the letter that comes with the blasted card, as well as the name of the program itself, are so misleading!
Clarity, however, has not been the VA's strong suit... not in the time I've dealt with them.
The program could definitely do a much needed job of filling a gap in health care service for some veterans. It could be an avenue to care, tests, procedures... whatever it is they need... at that specific time.
However, it will make continuity of care even more complicated in a system where it is already so hard to get doctors (within the system, where they have access to all of the veteran's information, as it is all paperless) to communicate with each other... or even read any parts of a veteran's chart other than the part that is 'their' responsibility.
This program will give veterans a choice... for individual appointments... between traveling over 40 miles or not... or between being seen sooner or later. It will NOT give them a choice of providers... as the scheduling of each appointment in question will be done by that 3rd party.
This program may assist in access... in a technical way... but it might not wind up to be a practical way.
This program will not do much, if anything, to address the quality of care. Even if the outside provider happens to provide more knowledgeable or more attentive care... it would be for that specific appointment... and that provider would then have to try to communicate with the VA. There would be no guarantee that the next time the veteran needed a similar appointment that they would be able to see that same outside provider.
The name of the program is misleading. The details in the letter sent out with the card are misleading. That would definitely lead to angry veterans who may have been waiting for an opportunity like this... or rather, like the one loosely described in the letter.
The VA medical system is NOT the only health care system with problems. It is, however, an extremely massive system that has, on paper, committed to serving this country's veterans. Many of those veterans don't have much of a choice when it comes to medical care... they can go to the VA and pay little or nothing (after putting their lives on the line in service to this country)... or they can go somewhere else and pay out of pocket. Not much of a choice for so many of them... us.
Do we call this a step in the right direction? How many veterans will actually use it? Or be patient enough to work through the fog to figure out how it is set up to work? Or be able to remember when an appointment is made that there is even an option... and remember that they have to specifically request to be put on the Choice Program List?
Yes... this is a post written out of frustration... and many may not even have read this far. I wouldn't blame anyone... ha ha.
There have been other ideas put forth that I hope are still being considered. I hope that this is not the 'solution' that the VA has come up with. If this is it... it is not good enough.
**** Due to some responses I've received, I am adding this as clarification ****
I firmly believe that the majority of people who work at the VA medical facilities around the country actually do give a damn and are doing the best they can with the limited resources they have been allotted.
I have, however, had to deal with many who are burnt out... have 'taken the job home' for far too long... and, as a result, find it easier to be a clinical and detached as possible... for their own well being. I do not fault them for that. I've also run into people who just don't care... but those can be found anywhere and are not exclusive to the VA.
The problems within the VA are very rarely based at the level of actual interaction with the veterans. The stresses do trickle down, however, to doctors and other staff. I've spoken to many who are frustrated at the limited resources they have to work with... the overwhelming number of veterans who are seeking care from facilities that are outdated (many, not all) and grossly understaffed. Bottom line.... it impacts quality of care! For a veteran seeking routine care... no big deal. For a veteran with a medical crisis or serious health issues, it can lead to devastating results!
The farther up the ladder the decisions are made... the larger the disconnect... the less common sense.
The cries about being underfunded only go so far. There have been plenty of bonuses handed out over the years (though some of that is supposed to have changed)... and the vast majority of those did NOT go to anyone who actually works with the veterans and has a clue about what is really needed!! The people at the top are not hurting for money.... I don't believe it is a lack of funding... but a lack of common freaking sense being applied when deciding how to allocate those funds!!
*sigh*
Pick any government agency... or large corporation, for that matter... and you will find areas of gross waste... you will find people who seriously care about the job they are doing... you will find people who only look at the bottom line without regard for the reality of the whole picture... you will find people who will try to get the most they can by doing the least they can. You will find outstanding individuals... and people who should not even be allowed in the door.
The system is broken... flawed. It is being highlighted now... again... and changes are happening.
This particular change... the way it was described to me by the VA representative I spoke with, at length... seems to me to be yet another decision made at the top with little regard to the reality of how it will work. At the very least, it should be presented in a way that is clear and honest... instead of misleading and difficult to understand... then difficult to get it explained. The way it's presented seems to add insult to injury... give veterans more credit than that.
Some veterans are having no problems with the VA. For the ones that are... the vast majority of those problems are systemic problems... and there is no excuse.
Perhaps the changes will keep coming. I can only hope so.
To all of you who DO work within the VA and who DO give a damn... thank you!!!
I am painfully aware of the fact that the VA does not have the market cornered on 'expectations exceeding the staffing'. Tim had a bone marrow transplant last year as a treatment for Multiple Myeloma. At the time of his transplant, this particular facility had gone through some changes... they had become listed as one of the top bone marrow transplant centers... and they were scheduling over 5 times the number of transplants they had done the previous year. The decisions at the top resulted in a sharp increase in the number of patients... without increasing the staff accordingly. This led to so many mistakes. The entire staff, from doctors to aides, were overwhelmed. They continued to care and to do the best they could with what they had.... but there was NO WAY that it could not impact patient care. I witnessed many mistakes, some of which meant the difference between a good chance of survival and very little. I was able to stop several when it came to Tim... only because I was present, informed, and fast.
These problems did not happen because the staff didn't care... it was a systemic problem... and they have worked hard in the last year to address the problems. They added space and staff... a lot of both... and it made a difference to new patients coming in. The changes there have been positive.... but that doesn't matter to the people whose loved ones suffered as a direct result.
I would have appreciated knowing the truth of the situation prior to walking into it. Tim and I could have better prepared ourselves and not been caught off guard. THAT is why I wrote this piece. Getting caught off guard, frankly, sucks. The letter that came with the card for this program was grossly misleading. Considering I know many vets who would love to be able to access care outside of the VA but are unable to afford it... it just adds insult to injury to be sent something that 'looks' like it could be an answer to a prayer... but turns out to look like something that could just be another difficult step.
So... to all who care enough to do all they can... no matter what the job is... thank you.
Wednesday, January 7, 2015
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