VA Choice Program – My First Experience

(note: Update 23 Mar: VA phoned this AM, and my eye appointment via Choice is okayed but the cancer operation will not be. Further, VA has issued new guidelines regarding its 40 mile rule.) Good move, VA.
(note: Update 25 Mar: VA Under Secretary Gibson will seek legislation to address 40 mile rule re: local clinics not offering required service) Good move, VA.

This week I got bad news on a biopsy which I'd arranged through civilian practitioners because it seemed hard with the VA. I need to have surgery so I can live, and have come to learn a bit more about the new VA Choice Program – and what I learned is disheartening.

I am apparently enrolled in the program, and was sent the Choice identification card to accompany my regular VA service-connected ID.

First, I contacted the local VA clinic and also the nearest VA medical center and left messages for the Choice coordinator but after a couple days contacted the 800-number instead. Surprise – I am not qualified.

I'm 100% VA disabled from Gulf War service, and in their "catastrophically disabled" classification, whatever that means. But as for the VA Choice program I'm not qualified because there is a VA clinic here in our town of Fort Collins.

The clinic doesn't do any surgery and only provides walk-in care, but that still "disqualifies" me because the Choice program is only for vets with VA medical facilities more than 40 miles away. This is regardless of whether or not required care can be provided locally, and regardless of the degree of urgency.

That was a disappointment. I also hoped to qualify on their Choice program provision for care if appointments cannot be made within 30 days, but there too, no luck.

"You're not qualified," gently explained the Choice telephone consultant. This is because nobody at the clinic noted that my scheduled appointment is far beyond the 30 day period addressed by the Choice program. Thus, for follow-up care for my ER visit about a possible detached retina I will be seen by the VA 90 days after my request. I didn't know I could have asked the local clinic for Choice coverage and they didn't offer even though I explained the issues facing me.

Everyone I spoke with was courteous and eager to help. I know the Choice folks and everyone in the local clinic sincerely cared about me. But they were also quite clear that either I'll have to wait months for the care at VA or seek help elsewhere. VA does have programs for contracting for local care, but that requires the veteran's primary care provider to provide a consult to the VA medical center specialist, who will then provide a consult to an outside contractor, who will then consider the case.

For me, with heart disease and other medical complications, and a bad cancer biopsy report calling for prompt surgery, I'm on my own and cannot wait the months for the VA system to respond.

Lessons learned:
• the Choice program is probably a good idea for more routine issues, but fails to meet veterans' needs in situations where local VA clinics trigger the 40-mile from any VA facility clause.
• the veteran must ask for coverage under Choice as the clinic will not offer it
• the need for multiple referrals from the primary care provider on to other layers in VA can make the months of delay in getting care unacceptable...or life-threatening to the point that the veteran is forced to seek care through private means.

A veteran might need a heart transplant or other major surgery, but the presence of any VA clinic within 40 miles even if it only provides routine primary care, disqualifies the vet from any help for any reason through the Choice program.

Congressional Demands for Fort Collins VA Clinic Investigation

A congressional subcommittee wants an "immediate investigation" into the alleged scheduling manipulation at the Fort Collins Veterans Affairs outpatient clinic.

In an April 29 letter to an assistant inspector general with the U.S. Department of Veterans Affairs, obtained by the Coloradoan, Rep. Mike Coffman, R-Colo., called alleged misdeeds by the Fort Collins Community-Based Outpatient Clinic "reprehensible."

Coffman, chair of the Veterans Affairs investigations subcommittee, singles out allegations that:

• The clinical staff falsified dates to make it seem veterans received appointments within 14 days;

• Appointments were scheduled without patients' input;

• Appointments were canceled by VA staff, putting veterans on a waiting list for future appointments.

Coffman, whose district includes east metro Denver and up to Brighton, drew parallels between allegations against the Fort Collins office and Phoenix. Delayed cancer screenings at the Phoenix VA were linked to the death of 23 veterans over four years, according to prior reports.

"Given the dire nature of the allegations and how similar issues are occurring in Phoenix with disastrous results, I am concerned that it is a systemic problem occurring throughout VA," Coffman wrote.

Administrators at the Cheyenne VA Medical Center, which the Fort Collins center falls under, were not immediately available for comment Monday morning.

Document: CMC letter to IG re Fort Collins CBOC

Read a Congressman's call for immediate investigation into Fort Collins Veterans Affairs clinic
CMC Letter to IG Re Fort Collins CBOC

Fort Collins VA Clinic Also Falsified Vet's Records – USA Today

(Blogmaster's Note: I am a patient at the Fort Collins VA Clinic, transferring my care there from Portland last year. I have absolutely no complaints regarding delays, quality of care nor qualify of compassion. As a retired hospital administrator, Air Force retiree and chair of a veterans organization, I'm quite critical of shortfalls. In months here in Fort Collins, have seen none of the issues reported below. This USA Today report stands on its own. I have met Phoenix reporter Dennis Wagner and trust his journalism completely. Thus, today's story leaves me confused and disappointed. This story was also published in the AF Times, Army Times and Navy Times. In a related story, Congressman Mike Coffman R-CO) has demanded an immediate Inspector General investigation into the Fort Collins deceptions.)

Gregg Zoroya, USA TODAY: VA investigation of one of its outpatient clinics in Colorado reveals how ingrained delays in medical care may be for an agency struggling to rapidly treat nearly 9 million veterans a year amid allegations that dozens have died because of delays.

Clerks at the Department of Veterans Affairs clinic in Fort Collins were instructed last year how to falsify appointment records so it appeared the small staff of doctors was seeing patients within the agency's goal of 14 days, according to the investigation.

A copy of the findings by the VA's Office of Medical Inspector was provided to USA TODAY.

Many of the 6,300 veterans treated at the outpatient clinic waited months to be seen. If the clerical staff allowed records to reflect that veterans waited longer than 14 days, they were punished by being placed on a "bad boy list," the report shows.

"Employees reported that scheduling was 'fixed,' " the findings say.

After enduring a year of criticism that the VA took too long to deliver earned compensation to disabled veterans, a new wave of attacks is building over slow medical care.

Department officials revealed last month that 23 deaths of veterans were linked to delayed cancer screenings dating back four years. More recently, a retired doctor, Sam Foote, alleged that 40 other veterans died because of treatment delays at a VA hospital in Phoenix. VA officials say there's no evidence so far to support those claims, but the hospital administrator was placed on leave pending an investigation by the agency's inspector general .

Sally Eliano, an Arizona woman, complained that her 71-year-old father-in-law, a Navy veteran, died after delays at the VA hospital in Phoenix in the treatment of bladder cancer.

The Medical Inspector's probe in the Fort Collins case could not confirm that patients had been harmed "due to the lack of specific cases evaluation."

A key allegation by the whistle-blowing retired doctor in Phoenix is that staff members manipulated records to hide delays. The same practice was found by the VA Office of Medical Inspector at the clinic in Fort Collins.

While investigators found that VA policies were violated, local medical leaders concluded that the violations were less intentional than the result of confusion and no disciplinary action was taken, says a VA statement released Saturday. Retraining and weekly audits were implemented, the statement says.

The VA in 2013 revamped some of its tracking procedures to better gauge wait times for nearly 100 million medical appointments each year at 151 hospitals and 820 clinics.

The agency found that only 41% of new VA medical patients were seen within 14 days last year, down from 90% reported in 2012 under an old, now-abandoned measurement method.

The VA found it wasn't doing so well with first-time mental health appointments, either. The agency reported in 2011 that 95% of new mental health patients were seen within 14 days, but the new tracking system found the rate in 2013 was 66%.

Mike Davies, the VA director of access, says the revised system for tracking new-patient appointments has finally provided accurate measurements on wait times. He says the department's commitment to track every single appointment is far more stringent than industry standards.

"I don't think there's any other health-care system that does this," Davies says.

He says the VA now can better determine what additional resources it needs to make sure veterans are treated more rapidly.

As a result of what happened at Fort Collins — the Medical Inspector's investigation was completed in December — the VA has done four site inspections to see whether timely treatment standards are being met, Davies says.

They found "other instances of misunderstanding" wait-time tracking requirements, "but we have not found any widespread patterns of misunderstanding," Davies says.

But federal investigators say that despite these efforts, the VA health-care system remains plagued by delays in treatment and opportunities to cover them up.

"Data has to be reliable to be useful," says Debra Draper, who directs an investigative staff for the Government Accountability Office. "So if you've people going in there and doing all kinds of things (to change the data), it really is not reliable."

Draper has led investigations into VA health care problems for years and says the agency has been struggling to accurately assess wait times for decades.

Draper says a key problem is a lack of oversight by top VA officials. The Fort Collins problems, for example, came to light only after a whistle-blower stepped forward.

Numbers of outpatient visits are spiraling, in large part because of an aging veteran population and young combat survivors suffering multiple medical and psychological issues.

At Fort Collins and the nearbyVA Medical Center in Cheyenne, Wyo. — which oversees seven clinics, including the one in Fort Collins — officials complained they didn't have enough doctors or supporting staff.

The result is jobs are left undone, VA investigators found. Staff required to follow up with veterans to schedule necessary appointments often didn't have time.

Investigators found that nearly half the clinic's 6,000 veteran patients did not have necessary medical appointments scheduled.

"Many of the (clerks) reported significant stress when trying to explain to veterans why they cannot make earlier appointments for them," the report says. "By entering (false data), the wait time for that patient appears to be zero days. ... The wait times were actually much longer."

Contributing: Dennis Wagner of The Arizona Republic