Job One: Timely Access to Healthcare


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When I took the helm of VHA one year ago, my most urgent priority was to immediately begin improving Veterans’ access to the care they’ve earned and deserve.

I knew that addressing this national crisis in prolonged wait times was Job One. Consequently, on November 14, 2015 we executed a nationwide, single-day ‘Stand Down’ event to ensure that Veterans who were at greatest risk were seen first.

As a result of this effort —which involved all of our 168 medical centers— nearly all of the 56,000-plus urgent care consults that we originally identified have been successfully resolved.

Taking a coordinated, system-wide approach to our Stand Down proved to be a key decision. Working together across 168 sites helped us share and learn from one another and plan for future improvements in our system.

In fact, our access-related Stand Down was a learning experience so valuable that it has already begun to make a profound difference in how we provide healthcare to our Veterans. I believe it was a pivotal moment in this organization’s history that has launched us toward our ultimate objective of making timely access to healthcare a sustainable reality.

The Stand Down also accomplished something else, perhaps even more important. It was designed to be an exercise in empowerment. By initiating the national Stand Down we learned that action is better than inaction. We also learned that bold actions require courage and commitment.

Following is a great example of what happens when employees feel empowered to be agents of change. It comes to us by way of NPR, which recently ran a segment called, ‘To Cut Wait Times, VA Tries MinuteClinics in Northern California.’ Here’s an excerpt:

“Struggling with long wait times, the Veterans Affairs Health Care System is trying something new: a partnership with the CVS Pharmacy chain to offer urgent care services to more than 65,000 veterans. The experiment began Tuesday at the VA’s operations in Palo Alto, Calif.

“Veterans can visit 14 CVS MinuteClinics in the San Francisco Bay Area and Sacramento, where the staff will treat them for conditions such as respiratory infections, order lab tests and prescribe medications that can be filled at CVS pharmacies. The care will be free for veterans, and the VA will reimburse CVS for the treatment and medications.”

This is just one example of the changes that I believe are now occurring throughout the Veterans Health Administration. Empowerment is a powerful thing. And empowered employees aren’t afraid to think ‘out-of-the-box’ when it comes to tackling significant challenges.

Now let’s take a look at another recent headline, one that has exciting implications when it comes to improving access to care: ‘VA Moves to Cut Red Tape and Wait Times…Advanced Care RNs Will be Able to Do More.’ It’s a story from KTVZ (NBC-21) out of Bend, Oregon.

An article from FierceHealthcare on the same subject sums it up nicely: “The Department of Veterans Affairs aims to expand the scope of practice of advanced practice registered nurses (APRNs) who work for the agency in order to provide veterans with greater and timely access to care.

“Under a proposed rule published today in the Federal Register, the VA said it intends to expand the pool of qualified healthcare professionals who are authorized to provide primary healthcare…”

Providing our Veterans with timely access to care means we need all hands on deck, and empowering our talented nurses to do the work they were trained to do (and are very, very good at doing) is a major step in the right direction. Empowerment is a powerful thing.

Finally, let’s step away from the broader picture for a moment and focus in on what our wonderful employees are accomplishing at the local level –where the real work gets done—when it comes to improving access to care.

Someone who knows a little bit about this subject is Maria Beltran, an outreach coordinator at the Phoenix VA. She’s one of six social workers there assigned to search for and make contact with homeless Veterans —in parks, under bridges, in shelters or alleyways — and find them a place to live, a job, counseling, healthcare… whatever it is they are in need of.

In Maria’s world, access means that if the Veteran can’t or won’t come to you for help, then you go to the Veteran.

Maria’s good work was highlighted some time ago via a short piece by Joe Dana of KPNX-TV in Phoenix. He writes: “There is a relentless cheerfulness in the voice of retired Army Staff Sgt. Maria Beltran. Whether describing a veteran in the throes of considering suicide, or lamenting the many veterans who fall into the trap of drug addiction, Beltran never seems to waiver from a smiling demeanor of pure optimism.”

“I enjoy it —being able to help our veterans,” Maria states in the article. “They’re the ones who need our help right now.”

This kind of outreach is occurring not just in Phoenix, but at VA locations throughout the country. It is the quiet, unsung work of many thousands, and it makes me proud.

Maria, thank you for the good work you do, and for that bright light you carry around inside you at all times.

And to all our VHA employees: allow me to thank you as well. Thank you for your perseverance and your resiliency during these challenging times. Thank you for your dedication to America’s Veterans. And thanks for making my first year here the most profound, exciting and inspirational 12 months I could have ever asked for.

DAVID J. SHULKIN, MD

Author

David Shulkin

Dr. David J. Shulkin served as the ninth Secretary of Veterans Affairs. Prior to his confirmation as secretary, Dr. Shulkin served as VA’s Under Secretary for Health for 18 months, leading the nation’s largest integrated health care system, with over 1,700 sites of care serving nearly nine million Veterans.

Comments

  1. Peter Pallino    

    So why can’t I see my therapist more than once every six weeks?

  2. James Swinger    

    I think the V.A. has a long way to go. I have to drive 50 miles each way to my V.A. clinic and recieve no travel pay, and there are 2 clinics that are closer to me but not allowed to transfer to one of them. I have had to go to the emergency room in the last 2 months and have had to use the local hospital because the V.A. hospital I have to use is 2 1/2 hours away in Fayetteville, Arkansas. The V.A. would not reimburse any of the expenses and I was told if I have to go to the emergency room I need to go to the V.A hospital 2 1/2 hours away. Are you kidding me, the last time I went I had kidney failure and my blood pressure was 60/30 and if i would have gotten there 5 minutes later I would have been dead and I’m supposed to drive 2 1/2 hours to the emergency room. I volunteered to serve my country and did so for 4 years, and of course when I joined in 1968 we of course was told we would have free health care for life. My wife and i live on $1800.00 dollars a month but because we are at the assett limit I have co pays, no travel pay, have to pay for hospital stays, tests, xrays medications and any other services. I really think that if i have to drive 2 1/2 hours to an emergency room the V.A should reimburse some of the cost’s. You say you are making major improvements I don’t see it. I need to have an MRI and to do so I have to drive the 2 1/2 hours to Fayetteville, after I pay for gas and the MRI and usualy have to rent a motel room it is cheaper to go to the local hospital and pay the difference what Medicaire doesnt pay and it’s cheaper. I believe the V.A. system is a sham and it’s because of our greedy congressmen and senators who use taxpayers money for their personal interests and gain.

  3. Gerald Dixon    

    I though this might interest you. I did read and view your video about Sec of the Veteran Administration. Bob McDonald I apologize for not typing a new letter. I hope you can understand all that I have written. I for one don’t like to be compared to someone waiting to get on a ride at Disney.

    Attention: Veterans Administration Sectary, Bob McDonald
    On April 7, 2016, I posted the below listed problem in this Weeks AT VA, in hopes of getting some answers that I have been trying to get since, May of 2015, I am getting tired of trying to get someone to do something. I have sent messages to Senators, Congressman, and the Inspector Generals office for the VA with no results I have sent this letter to Fox News, Hannity, Cavuto, and MSNBC Matthews. I also sent it to Washington Post. I have heard nothing.

    I had a problem with the VA in Orlando Fl. It is not a little problem. I have made contact with all of the people I know of to contact with no results. My first contact was with Doctor “S” my primary care Doctor. In July of 2014 I went to a Doctor outside of the VA, Because my blood sugar was dropping below 50. On 7/30/2014 I contacted Doctor “S” in regards to not getting my medications this was done by Secure Message. I was in contact with Doctor “S” by Secure Message 9 different times over the next few months or by visit to the Teal team clinic. On 5/11/2015 I went to a clinic that Doctor “S” sent me too. It was nephrology the person there Shelly pointed out that Doctor was getting lazy because I had a lot of Medications that needed to be renewed or updated. On that same day I contact Doctor “S” by Secure Message informing him what Shelly, said I ask him if he would look into the problem with my Medications, because at this time I was out of Medications for the second time and was not receiving any. On 5/14/15 I received a Secure Message from Doctor “S”, He instructed me that I could check my own medications. He wrote back, { BY YOURSELF YOU KNOW}. I wrote back and informed Doctor “S” that I could order refills , that I was well aware of that but if the medications are expired or there are no refills remaining he had to order them. There are a lot more that went on between Doctor “S” and myself, its been an on going problem. I have all of the Secure Messages between him and myself. I have found out that all of the dates for my appointments with Doctor “S” are not available on MyHealtheVet. all that shows up on my appointments is that I saw a Nurse at the teal Team. All of the other appointments have been removed by someone, the list has been altered back to sometime in the year 2014 was the last time I saw a Doctor. Up until I saw him on the 5/28/ 2015, because he said he would rather wait till he saw me before he gave me any medications. On 7/12/15 I contacted the Patient Advocate office concerning my problems with Doctor “S” by means of Secure Message the persons name is “B” in the Hospital office. This woman is supposed to be the person that resolves problems not create them if she had done her job this matter could have been resolved in the facility. She got tired of hearing from me because I didn’t have the capabilities to copy a form she wanted me to sign for change of provider. I told her I went to enrollment and signed the form on 7/16, After I told her I signed the form she blocked me from contacting her on MyHealtheVet. My reasoning for requesting a new provider was based on the fact that Doctor “S” was not working in my best interest. Because on 5/26/2015 I went to the lab to get blood work done for Doctor “S” prior to my visit with him. At the same time I was seeing an allergist outside the VA because when I went to Doctor “S” he said he didn’t know what was causing my problem and he didn’t refer me to any other Doctors. Also on that same day 5/26/2015 after giving blood at the VA I went to Florida Hospital Lab and had blood taken by request of the allergist I was seeing outside the VA, It was a fasting Lab and the Hospital I went to is maybe an hour away from the VA , On 5/28/2015 I went to see Doctor “S” for a scheduled appointment Doctor “S” told me that my Labs looked fine . The same labs that were taken on 5/26/2015 one hour later the same day and fasting labs, I told Doctor “S” what the allergist told me and that a lot of test were conducted and that it was very costly also what the medications cost. He again said he didn’t know what was causing my inching and involuntary jerking motions. I have had this problem since 5/17/15 with no relief .Again Doctor “S” didn’t make any referral to another doctor he did say he was going to check with the Pharmacy to see if it could be caused by medication. On 6/24/2015 I went back to the allergist I was surprised to here from her that I had a urinary track infection, my Vitamin D was very low and some of my other readings were high. All of this happened in a one hour driving time from the VA. to the local Hospital .My original complaint that Doctor “S” said he was going to check with Pharmacy took 21 days for the Doctor to get back to me according to the MyHealtheVet requirements I should have gotten an answer in 3 working days. I called the VA to make an appointment if I had been given another Doctor yet, I was not given an appointment that day. The person that I was talking to said {OH BY THE WAY,} Doctor “S” said my problem could be from a medication I was taking called Tramidol the only problem with that is I have not taken Tramidol for many months I had a reaction to it, in a secure message Doctor “S” told me that I was right, it was stopped and he was sorry. The Doctor is supposed to get back to you in three days not 21 days. I didn’t feel the Doctor was working in my best interest after many times contacting the Doctors Office with no results. It was at that time I requested a new Doctor I would check with the enrollment Office to see if a New Doctor had been assigned yet for me. I was being told every time I inquired at the enrollment office if there was any word on a Doctor assigned for me. I was told by that person I would receive notice in the mail on word of a word new Doctor. I was also told it would take 3 to 6 months to get a new Doctor. So I contacted My Senator Marco Rubio that was a waste of time I never received a response to my complaint from him or any one in his office. I then contacted Veterans Administration Inspector Generals office. After not hearing from them in a few weeks I contacted there office I spoke to a guy named Rich or Rick he informed me it would take 6 weeks for them to decided if they were going to investigate my complaint I never did hear from the IG’s Office as of the date of this letter. After a few months without any contact from the Inspector Generals office for the Veterans Administration. I contacted My Congressman, John Mica’s office I spoke to a lady named Debby she is the service director. I was told by her it would be taken care of and I would have a new Doctor. After several weeks without any contact from his Office I called, I was told that they had to give them 30 days to reply to there investigation, I informed the person it was over 30 days. She informed me she would get back to me on Monday that was back in early January 2016. I still am waiting for a return call from that office I have called once a week since January of 2016, with no results except I was told that Debby Roeder would call me back. So as of today I am waiting for calls from Rubio,VA Inspector General Office, and Congressman Mica office. The last time I saw my primary Care Doctor, still Doctor “S” at the VA was on May 28, 2015 there were no appointment scheduled after that date. My wife called the VA to cancel a different appointment I had with a different clinic and demanded that she speak to someone that could schedule me an appointment to see a Doctor. The person she was talking to transferred my wife to another person. My wife told her that I had not seen a Doctor since 5/28/15 the person she spoke to said they would make an appointment with a Doctor that I needed to be seen. I was given an appointment for 2/ 9, 2016. So from start to finish it took from the 5/ 28, 2015 to 2/ 9 ,2016 for me to get an appointment to see a Doctor. That is over 9 months. I did make that appointment on 2/9/16 and I did have follow up appointment with a nurse. but have not been seen since then, my next appointment is on 5/16/16. I am a Diabetic, Heart Problems Agent Orange, COPD, PTSD, and other problems. I requested medications and some I got other were expired so I was out of those medications. My insulin was changed and I guess will be evaluated on my next visit. This is the Great Care we get from the Veterans Administration. I forgot to include a Letter sent to the Chairman of the Armed Services Committee, Senator John McCain, Jeff Miller,. Thornberry and Jason Chaffetz . senator McCain did reply and said if it comes up for a vote on the senate floor he would consider what I said. As you can see it had nothing to do with a vote. I never did get a reply from Miller, or Thornberry,The letter to Cheffetz was returned to me as undeliverable. This is all documented by me every contact I had with the VA and all others. Please forgive my Typing and punctuation I am not a secretary as you can see. Thank you in Advance for your consideration. Today is 5/12/2016 I have not received any correspondence from anyone I have named in this document. I hope this make sense cause when I am upset I don’t do real well my brain goes faster than my typing and punctuation doesn’t matter. Just for your information I was in contact with the Patient Advocate Office a total of 12 times by way of secure message until my last message I tried to send and was informed that I could no longer send secure messages to that triage group I guess “B” ,got tired of hearing from me. The 12 messages I sent to “B” I received 5 returned Secure Messages asking me to sign and send back the change of provider form and one message telling me she was going to call me sometime on 7/16/2015 she never called on, 7/22/2015 ,she sent me a secure message saying she tried to call me on 7/16/2015 and left me a voice mail that is not true there was no message and my wife works from home and is next to the phone. She said she wanted to know if she should process my change of provider. I was under the impression it had already been filed on or about 7/16, She further said she would send the request to the coordinator for processing. I have checked with My HealtheVet ,secure messaging twice a week to see if there were any messages. This is a big problem with the VA, I read every day that Twenty Two Veteran have taken there own lives, There is no wonder if other Veterans are like me with PTSD and that along with the feeling no one cares about them I guess they feel that he or she, and his family would be better off without there problems. If it were not for the fact that I was seeing my Mental Health Provider all those months I could maybe be a statistic. Veterans deserve better and not just lip service from the high priced administrators. I saw on C-Span Sec. McDonald said they got a 1 for customer service maybe he should visit the clinic in Orlando the people don’t even talk to you they just point to a machine and tell you check in there while they stand around and talk. I am going to end this letter now it is getting to long, If you are interested in what is going on I am always home. On 5/28/16 will be one year and I have seen one Doctor once. I started out with three pages of medications today I am taking five medications when I saw the Doctor he didn’t give me any more.
    Gerald Dixon

    After I posted this letter in the VA paper I got a phone call asking me if I had a problem with the VA? That was on 4/16/16, He said he received a message to contact me. He told me he knew nothing about what was going on and from whom the message came, and didn’t know anything about it. He said he didn’t even know how he got my phone number all he knew was Gerald Dixon , I gave him a short version of what was going on and he didn’t seem to very concerned or he just didn’t know why he called me. He said OH OK if you need anything I will give you my phone number. He gave me the number 407-631-4657, again he said if I needed anything to call ,before he had a chance to hang up the phone I ask him his name all he said was JOE then he hung up. I have not heard from anyone since Joe the guy that knew nothing. MyHealtheVet is supposed so you can have contact with the providers in the VA they are secure messages. Thank You

  4. Harrison Balze    

    If the VA bureaucrats were absolutely serious about ending wait time, they would cut the red tape that all new doctors and nurses must endure before they are hired. It is very common for new hires to spend 3-9 months in the VA’s vetting process before being hired. Who is going to wait that long to get hired when there are plenty of other jobs out there where you can get hired in less than 30 days…with far less effort. What the VA has ended up doing is to poison the well when it comes to new hires. The word gets around real quick about what a bunch of “Tools” they are at the Veterans Administration when it comes to getting hired and working there. Sadly, the VA talks about how they are trying so hard to hire good people but when it comes right down to it they absolutely wear them out in the hiring practice.

    Congress is going to take their own action before too much longer. The wheels are already in motion.

    Because the VA can not take care of the veterans like they should be taken care of, the members of Congress will take money away from the VA and use it to fund something like the Choice Program where vets have a card that authorizes them to go to private physicians in their local communities. I never thought I would say this but “This would be a good thing.” The VA had gotten far too big and unresponsive to the needs of the people. Kind of like government in general.

  5. David Ronald Risner    

    I’ve been waiting for 4 months for an injection to help with neck pain. During this long wait, I have been forced to spend most of my time in my recliner, with a heating pad on my neck. It also took months just to see the doctor that will be doing the injection. I haven’t had much of a life for a long time because of the long waits. I would also like to note that for some unknown reason, the VA does not seem to be able to prescribe medicine that will alleviate the pain while waiting many months for treatment.

  6. Bill barton    

    We need to get rid of the choice card program—- also—– when is the VA going to give veterans timely access to the care they need —– I’m can’t get appointment for my skin cancer and I’m 100 per cent S/C with prostate cancer and heart problems—– billpaints@yahoo.com if you want to know more

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