Choice words for VA Choice program - December 14, 2015

Courtesy of NWI Times

December 14, 2015 9:45 am • Giles Bruce giles.bruce@nwi.com, (219) 853-2584

Ten years ago, Carlos Villarreal was serving as a Marine in Iraq when his compound was struck by mortars. He suffered hearing loss, damage to his teeth and post-traumatic stress disorder.

He now needs an MRI to diagnose the severity of his nerve damage from the attack. But he hasn’t been able to get a timely appointment at the U.S. Department of Veterans Affairs hospital in Chicago, despite the fact the agency last year launched the Veterans Choice program, which is supposed to allow former service members to seek care closer to home in such instances.

He’s says he’s been trying since July and still hasn’t been able to have the test done locally.

“In the entire health care system, veterans are the only ones who are told where they have to go for care,” said Villarreal, 30, of Hobart. “The Choice program was supposed to take care of that. It hasn’t.”

Last year, the VA inspector general found that many veterans were waiting months for appointments and that some had even died on while on the wait list. The secretary of the VA resigned over the matter. In response, Congress enacted Veterans Choice.

The program is designed to enable veterans who can’t see a doctor within 30 days or live more than 40 miles from a VA facility to access a local provider. But several Northwest Indiana veterans say they’ve had trouble accessing the program, being kept on hold for long periods of time and not having their calls returned. Nationally, the number of veterans waiting more than 30 days for care has actually grown since Veterans Choice was implemented last year.

John Jonikas, an Army veteran from Munster, recently needed an ultrasound of his abdomen but his appointment at the Jesse Brown VA Medical Center, located on Chicago’s west side, was more than a month out.

He was told that, through Veterans Choice, he could have the test done at a local facility. He lives roughly a half mile from Munster Community Hospital.

But after about a dozen calls to the Choice hotline without getting an appointment, the 68-year-old gave up. He went to the Chicago VA hospital for the ultrasound, driving an hour-and-a-half each way, because of road construction.

“Every other day I was calling. You always get a different person. They want all your information again and look it up and tell you, ‘We’re working on it,'” he said. “What good is this program if they don’t help you?”

Program run by outside vendor

The VA doesn’t run the Veterans Choice program but has outsourced that job to two outside vendors, including Arlington, Va.-based Health Net Federal Services, which handles Northwest Indiana. In 2013, that company signed a five-year, $5.1 billion contract with the federal government to coordinate community-based care for veterans.

Region vets do not make their Choice appointments directly with local hospitals but must have them scheduled through Health Net.

“We’ve heard veterans calling those call centers have had delays in accessing their information,” said Gene Migliaccio, deputy chief business officer for purchased care for the VA. “We’re working with our vendors to ensure we’re toward our goals of appointments within 30 days, scheduled within five.”

He noted the program was recently tweaked so appointment schedulers will now contact veterans after getting an authorization rather than waiting for them to call in. He also said Veterans Choice recently expanded its eligibility requirements to include such factors as the weather, the veterans’ health status and how often they need the service in question.

“We apologize for any frustrations veterans may have had with scheduling their appointments,” said Brad Kieffer, a spokesman for Health Net. “Health Net Federal Services is committed to providing excellent service, and we are making some changes that we expect will improve our service. These improvements include adding staff and strengthening training to improve workflows and expedite the overall scheduling process.”

U.S. Sen. Joe Donnelly, D-Ind., and U.S. Rep. Pete Visclosky, D-Ind., are also asking the VA to consider travel times rather than just distances when deciding program eligibility, taking into consideration traffic congestion and transportation to and from shuttle stops. They have cited as an example Northwest Indiana veterans who have to travel to the VA hospital in Chicago.

Donnelly also sponsored a provision in the recent defense spending law that incentivizes community providers who receive training in veteran-specific health care issues. In a statement, the senator said he’s aware some Hoosier veterans have experienced difficulties with the Choice program and is working with his colleagues in Congress to expand community care for vets.

Kevin Spicer, a spokesman for Visclosky, said veterans unable to access the Choice program should contact the congressman’s office and a caseworker will work with them to schedule an appointment.

According to the VA, of the 1,068 authorizations so far for Veterans Choice patients at Jesse Brown, 851 appointments were scheduled, a success rate of 79 percent. Less than half of those appointments were completed.

Since it signed up for the program the middle of this year, Methodist Hospitals, which has campuses in Gary and Merrillville, has treated only four veterans.

“We’ve reached out the VA to try to expand our opportunities there,” said Matt Doyle, chief financial officer for Methodist Hospitals. “We’ve not had success.”

An economic opportunity

Tom Pappas, a veteran and retired steelworker who lives in Portage, says Indiana lawmakers and health care providers should look at this as an economic issue. He submitted a Freedom of Information Act request with the VA and found that veterans from Northwest Indiana (Lake, Porter, LaPorte, Newton, Jasper and Starke counties) were spending at least $45 million annually on care in Chicago.

“Let’s keep the veterans here. Let’s put that money back into the local economy. Let’s get back some jobs for people,” said Pappas, who himself has had luck with the Veterans Choice program; an official contacted him to let him know he was eligible.

Since the Adam Benjamin Jr. Outpatient Clinic in Crown Point is within a 40-mile drive for many Northwest Indiana veterans, they still often have to drive there, then take a shuttle to the VA hospital in Chicago, turning a medical appointment into an all-day affair.

“We served our country. We didn’t run and hide. We raised our right hands and did what our country told us to do,” Pappas said. “We should have a choice where we get our secondary care at. We should be treated like first-class citizens.”

Bill Stack, a Crown Point veteran, was able to get an MRI through the Choice Program, at St. Mary Medical Center in Hobart. But it took multiple phone calls and hours spent on hold with Health Net, he said.

“It was a positive outcome,” the 70-year-old said. “The hangup I had was when I called the Choice Program. I would talk to this person, that person, for 80, 90 minutes.”

A long wait for an easy procedure

Shawn Sherwood served with the Navy in Afghanistan in 2010 and 2011, injuring his back when his battalion was hit with rocket fire. A few months ago, his bulging discs started acting up, to the point where he was taking days off work and unable to get out of bed for church on Sunday.

Because of claustrophobia caused by PTSD, he can’t get a traditional MRI, the only kind offered at the VA hospital in Chicago. But he was told he could do an open MRI through the Choice Program.

On the first call to Health Net, he said, he was on the line for 18.5 minutes before it was disconnected. The second call lasted 22 minutes before he was hung up on. The third call, 32 minutes.

It took four weeks to determine his eligibility, two months to get an appointment, he said, and that happened only after he reached out to the VA outpatient clinic in Crown Point for help.

“Veterans Choice, if it was run correctly, would be a godsend to us. It just isn’t run properly,” said Sherwood, 44, a South Haven teacher. “You’re supposed to have a ‘choice.’ We don’t.”