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Heartland Health Monitor
Tue July 8, 2014
Some Veterans May Lose Needed Health Care If VA Pilot Program In Kansas Ends
A pilot program in Kansas allowing veterans who live far from Veterans Affairs hospitals to get care from local doctors may end, threatening veterans like Hugh Steadman with the cutoff of needed medical care.
Steadman, who flew combat missions over Germany as a bombardier during World War II, lives in Great Bend. He used to have to drive two hours to the VA medical center in Wichita, a trip that was getting more difficult for him to make.
Things became a little easier when the VA opened an outpatient clinic in Hays, but that’s still more than an hour’s drive each way.
“Well, it’s getting to be quite a problem, because I’m 89 years old now, and my kids don’t like me to drive out on the highways, and I think they’re probably right,” Steadman says.
But for the past year, Steadman’s driving time has been cut to just 10 minutes. That’s because a VA pilot project now pays for him to see a doctor in Great Bend. The project is called Access Received Closer to Home, or ARCH.
The VA launched the pilot program in Kansas and four other states in 2011, three years after Congress authorized it. Pratt was the Kansas test site, but things didn't go well there.
"It failed pretty miserably,” says Vincent Wilczek, chief financial officer of Pratt Regional Medical Center.
Wilczek says primary care doctors in Pratt and the nearby communities signed up to do business with the VA, but were quickly turned off by the process.
"They found it to be very burdensome, cumbersome to work with the VA, because it’s a very authorization-driven system," he says. "And then some of the requirements they were requiring of the physicians were just very hard for local physicians to do.”
The providers in the Pratt area stopped participating in 2012. That could have ended the pilot project in Kansas, but it didn’t. Instead, Humana, which administers the program, reached out to providers in other communities.
That’s when St. Rose Ambulatory and Surgery Center in Great Bend got involved. One of the primary care providers there is Dr. James McReynolds. He says the VA bureaucracy takes a little getting used to, but he’s had no trouble getting authorization for necessary medical care.
The VA will authorize a certain number of visits, labs or X-rays for each patient, McReynolds says, but “it’s variable for each patient, and if you want more, you do have to request more.”
He was happy to participate in a program that made it possible for veterans to get care closer to home. And veterans in Kansas and the other participating states seemed to like it, too.
Ninety percent of those surveyed by the VA say they would recommend it to other veterans. Steadman agrees.
“I really like it. I sure do hate to see it quit. I’ve got several friends that go up there also, and it sure made it easy on us old-timers, where we don’t have to drive so far,” Steadman says.
Despite the veterans' rave reviews, the VA recently said it planned to end the pilot program. Testifying to a congressional committee in June, the VA's Philip Matkovsky said the agency had the authority to extend the pilot program but wasn't planning to do so.
“ARCH does expire as a contract. It was a firm-term contract with a base one year and then two option years, which expires, I believe, Sept. 30," Matkovsky told the House Veterans Affairs Committee. "And typically, unless the contracting officer can determine a compelling reason to extend that — and I’m not a contracting officer — we let contracts expire.”
U.S. Sen. Moran, a Kansas Republican, strongly disagrees with that decision.
“ARCH comes about from legislation that I introduced as a House member," ,” Moran says. "It has a lot to do with my background as a congressman from the First District of Kansas, a congressional district larger than the state of Illinois but with no VA hospital."
Moran has been urging the VA for months to continue the program. He says he sees it as a bridge to the nationwide program authorized in a bill still working its way through Congress. The bill would create a nationwide program patterned after the one in Kansas and the other states where ARCH has been tested.
Moran may have won a partial victory. He says Acting VA Secretary Sloan Gibson verbally has agreed to keep the program in place, but only for veterans who already were being served by it.
Even that less-than-ideal compromise isn't a sure thing, however, given the VA's recent track record. So Moran has asked Gibson to confirm that pledge in writing.
“The idea that I was pushing about services closer to home over the last four, five, six years is something that is now front-and-center in bipartisan legislation that is expected to pass Congress and be signed by the president,” Moran says.
“And yet we still have a Department of Veterans Affairs who, presumably, is reluctant to implement and pursue these programs in part, I think, because the VA’s funding, if they pay for services outside the VA, it’s less money that they’ve had to use within the VA.”
Bryan Thompson is a reporter for Kansas Public Radio.
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