After a national scandal, New Mexico’s veterans health care is looking up

Veterans are getting faster care, but new programs aren’t reaching everyone.

 

For years, military veterans have complained about how long it takes to get an appointment with a Veterans Administration health care provider. Although veterans can access health services through VA doctors and clinics for free, seeing a provider hasn’t always been easy — and for some patients, prompt care can be a matter of life or death.

New Mexico has been at the forefront of such concerns since 2014, when an investigation revealed that staff at the Raymond Murphy VA Medical Center in Albuquerque had manipulated records to cover up long wait times. The discovery contributed to a larger national scandal, eventually resulting in the resignation of Department of Veterans Affairs Secretary Eric Shinseki in 2014.

With the scandal now two years in the rearview mirror, however, the VA says things are looking up for the state’s vets.

Thanks to a host of initiatives, including telemedicine, contracts with community clinics, and travel benefits, the state’s VA health care system has recently seen improvements in appointment wait times for veterans.

“Since the beginning of this year, and in 2015, we’ve seen a decrease (in the number of patients with long waits for care),” said Julie Dreike, acting associate director for the New Mexico VA Health Care System.

The numbers bear out Dreike’s claims. In the first patient access audit data report released by the Veterans Health Administration in 2015, 89 percent of patients in New Mexico were able to get an appointment in 30 days or less.

At the beginning of 2016, the number rose to 93 percent.

These days, the New Mexico Health Care System has the fastest service among seven health care systems in Service Network Area 18, a region that includes Arizona and parts of Texas and Colorado.

Yet some veterans remain unsatisfied. For all the progress the state’s VA system has made, it still has work to do.

Although the VA has cut wait times by offering patients appointments at outpatient clinics like the one in Española, some forms of specialty care can be hard to obtain.
Andrew Martinez/Rio Grande Sun

Wait times

Chris Archuleta started getting care from the New Mexico Health Care System between 2008 and 2009.

A six-year veteran of the New Mexico Army National Guard, he was deployed to Iraq in 2007 and 2008.

“When I first started getting care from the VA, I had to go all the way to Albuquerque and their wait times were ridiculous, anywhere from three to six months,” he said.

Although he now visits community-based outpatient clinics in Northern New Mexico, he’s still experienced problems.

“I go to the one in Taos, and just to see my primary care physician takes three months,” Archuleta said. “There’s that wait time, regardless of if you go to the main VA (medical center) or the clinics.”

Although the New Mexico Health Care System has a higher percentage of quick appointments than the national average, long waits still happen. In June 2016, 3,381 appointments across 12 clinics and the medical center were scheduled beyond 30 days statewide.

The Medical Center in Albuquerque had the second-lowest percentage of slow June appointments in the region, second only to a center in Big Spring, Texas.

But those upbeat statistics don’t jibe with the experience of Bernardo Jaramillo, a Purple Heart recipient and a Vietnam veteran who served from 1967 to 1968.

“I, myself, had to wait three months to do a dental appointment,” he said. “They always give me an explanation. They’re backed up sometimes with other patients that need their service.”

Jaramillo, who has been driving veterans from various locations in Northern New Mexico to Albuquerque as part of the Veterans Transportation Program for the past 13 years, said he has heard complaints.

The wait for an appointment, which can be more than 120 days, is dependent on the veteran’s choice of care and the specialty care required, Dreike explained.

The process

The VA does have ways to prevent unnecessarily long waits for care. Patients who are forced to wait for more than 30 days for their next appointment with the health care system have the option to receive care from a contract-based community outpatient clinic.

“The community may have an appointment wait time less than we do, or longer,” Dreike said. “It’s up to the veteran.”

But appointments scheduled beyond 30 days usually involve specialty care, like Jaramillo’s dental appointment. Those services may not always be provided within the community clinic.

To alleviate the wait for specialty care at community clinics, the New Mexico VA system is working toward expanding their telemedical services.

Telemedicine includes Synchronous Telehealth, which involves live video conferencing with patients, and Asynchronous Telehealth, which involves transmitting medical images to a doctor or patient.

“Our telemedicine has expanded greatly in New Mexico,” Dreike said.

Across the Service Network, just over half of the community clinics list any form of telemedicine as a service available for veterans, including 14 of 20 Arizona clinics.

A Veterans Affairs Teleheath Quarterly Newsletter from January claims over 1,200 telehealth clinical technicians among the entire network, although exact numbers are difficult to pinpoint among various private providers of clinics across regions and states.

Currently, only three of 13 clinics in New Mexico — Farmington, Taos and the Northwest Metro Clinic in Rio Rancho — provide telemedical services of any kind to veterans.

Six of the clinics also lack social work services, and some clinics even lack emergency care, forcing veterans to use their own private healthcare at a local hospital or head to a medical center further from home.

The providers

Antonio DeVargas, a Vietnam veteran who served in the United States Marine Corps from 1964 to 1967, doesn’t remember how long he’s received care from Veterans Affairs.

He does remember the difficulty he’s had in securing health care services in recent years, including problems with a system called the Choice Program.

The Choice Program, which is offered to veterans whose appointments are scheduled beyond 30 days and who live at least 40 miles from a medical center, allows patients to receive care from a private provider.

According to DeVargas, however, the system doesn’t always work as planned. “The clinic in Española would refer me to the Española (Hospital) for lab work,” DeVargas said. “Then the VA would refuse to pay and it was affecting my credit.”

The Española Hospital approves appointments through the Choice Program. The program lists 40 doctors at the Hospital and eight other local clinics who are available for veterans in Española — provided the patient can get approved.

But getting approved for care has been a hurdle for some.

“I’m going to physical rehab in Taos, because there’s a rehab program that accepts VA, and (Christus) St. Vincent’s Hospital (in Santa Fe) accepts VA,” DeVargas said. “But Española doesn’t.”

Dreike said any questions about the Choice Program, including questions about surgery or other services, can be voiced directly with the Health Administration Service or the New Mexico Health Care System’s Patient Advocates, whose offices are located at the Medical Center in Albuquerque.

“If it’s a Choice question about getting surgery or getting another service, we may also partner with the patient advocates,” she said. “There are patient advocates in every service to enable the veteran. If they have a concern about any medications, there’s no wrong door.”

Increasing awareness

Although many programs to access care exist, outreach and education efforts don’t always reach their intended targets. DeVargas, who lives north of Ojo Caliente, said the Española Clinic did not tell him about the Beneficiary Travel program, which reimburses veterans for travel to health care providers. He only found out about the program this winter.

“I know a lot of veterans that go over there,” he said. “I bet they don’t even know they’re entitled to travel, and if they do, fill out the travel forms.”

Dave Overson, public affairs and social media specialist at the New Mexico VA Health Care System, said social media has helped veterans understand their benefits and addressing their concerns.

“Whether they’re complaining or commending us, we communicate directly that way with them,” Overson said about the system’s social media presence on Twitter and Facebook.

Overson also cited the patient advocates as a source of information and help in guiding veterans to learn about their benefits.

“That’s all they do all day long, address concerns of the veterans,” Overson said. “Whatever the case may be.” 

Looking ahead

Most clinics provide blood draws, electrocardiograms, evaluations by doctors, routine lab tests and social work services. But veterans wished they had more to offer.

Jaramillo cited numerous services that facilities often lack, including MRIs, eye clinics, and ear clinics.

DeVargas was unhappy with his long travel to Taos to see a physical therapist, and Dreike affirmed his point.

“It doesn’t make sense for somebody to get in a car two hours to see the physical therapist in Albuquerque,” she said. “We’re going to try to get that care in the community. Chiropractic care is similar.”

Archuleta lost his preferred doctor at the Taos clinic last October, and has resorted to seeking service through his own health insurance because of the wait times he’s experienced in securing appointments with a new doctor.

“It just makes it that much harder for us soldiers,” he said.

Many veterans related anecdotes about visiting clinics that had only one doctor for all of their patients.

Dreike said the New Mexico Health Care System strives to retain more healthcare providers.

“A provider may leave and go to work for somebody else or they may retire,” she said. “Based on the literature I look at and hear about, that’s not too unusual in rural health. We’re cognizant of that in our recruitment.”

The quality and availability of doctors may be the most important thing veterans want.

“The doctors at the VA Medical Center in Albuquerque, if you get referred to them, they’re pretty damn good,” DeVargas said. “It’s getting the referrals in a timely manner (that’s the challenge).”

This story is part of the "Small towns, big change" project through the Solutions Journalism Network.