The Hippo


Apr 18, 2019








Stan Harris. Photo by Ryan Lessard.

More choice, more problems
A new program causes headaches for vets, recent history shows why

By Ryan Lessard

While many local veterans report a largely positive experience dealing with the Manchester Veterans Administration Medical Center, the Veterans Choice program, which was designed to solve some of the access and waiting issues that plagued the VA system nationwide, is now at the center of most complaints. 

Veterans Choice
The new Veterans Choice program was created to offer VA-paid services through pre-authorized medical providers in the community and in each of the state’s hospitals.
About a dozen veterans came to a recent town hall meeting to discuss the program at the Manchester VA.
Veteran Ted Stachulski said at the meeting that there are ongoing problems with providers not getting paid in a timely manner and providers subsequently refusing to offer Veterans Choice services.
“Dentists, optometrists, chiropractors, acupuncturists, you name it, haven’t been paid and it’s still biting veterans in the behind as we speak,” Stachulski said.
Another veteran, Jim Jensen of Merrimack, said that while the overall quality of service at the VA is superior, he has encountered problems related to Veterans Choice and its contracted administrating organization, Health Net. Jensen said he had difficulty navigating the web portal to obtain authorization for procedures and medication, and authorization codes would expire too early or come too late, like the time he received his code the same day he was scheduled for surgery.
Panelists, including Manchester VA Director Danielle Ocker, said they are working through the problems, but one of the major initial glitches was fixed with legislation that went into effect March 1. They said they’ve already seen a significant improvement — about 2,000 claims with a total value of nearly $550,000 were processed in February and about 5,000 claims with a value of $1.27 million were processed in March.
Still, a major chain of pain clinics, PainCare, may stop offering services through Veterans Choice because the contractor administering the program still owes the company $50,000. Brandon Gray, the owner of PainCare, which operates 11 pain clinics in the state, said the program continues to be slow at making payments to their providers. He said he would reevaluate the relationship in the coming weeks. 
One problem solved, another created
Ocker says many of the issues with Veterans Choice, which rolled out in November 2014, is often related to how new the program is and how quickly it was implemented. Ironically, it was meant to fix nationwide problems with wait times that Manchester had already resolved.
The law provided billions of dollars in funding for VAs across the country to reimburse private practices in certain cases and add staff, but with only four short months to develop the program before it launched, several issues plagued the program in the early years. 
But by the time these issues were in the national media, Manchester had already figured out the issue and fixed it. According to a report by the Veterans Affairs Inspector General released last month, employees at the Manchester VAMC were misusing a 14-day wait time goal and entering fraudulent dates to make wait times seem shorter. Manchester VA staff interviewed by the IG team said they didn’t understand at the time that the 14-day goal was meant to be 14 days from the desired appointment date and they thought they were using the scheduling system correctly. 
This was going on roughly between 2010 and 2012, but the VAIG report says the medical center in Manchester had already taken steps to fix the scheduling process. 
And data from the Veterans Benefits Administration show wait times for pending claims have nearly halved over the past four years. The average wait time for pending claims in January 2012 was 193.6 days, compared to 101.7 days in January of this year. That’s despite a growing population of vets enrolled in Manchester. 
Jensen started getting services from the VA in 2011 and said he never had any problems getting access in a timely manner. 
Others, like Leighanne Cote-Thompson of Kearsarge, who have been connected with the VA in more recent years, also say they’ve had no issues with scheduling. 
“I have been helped. Any questions I had, I got steered into the right direction,” Cote-Thompson said.
Stan Harris of Manchester, a Vietnam vet, says he’s also used to receiving fast service in Manchester. 
“First time, I thought for sure I’d be sitting there for a long time. I don’t think it was more than five minutes,” Harris said.
Future improvements
Ocker said the VA would stand ready to coordinate with PainCare to find alternative pain care providers if the company pulls out, and the VAMC recently expanded its in-house pain clinic by hiring two providers, a nurse and a chiropractor who is also an acupuncturist. A new pain specialist, an anesthesiologist, is expected to come on board by mid-May. She also wants to embed a pharmacist in the pain clinic and is considering offering more alternative therapies like yoga, mindfulness techniques and biofeedback.
Ocker is also looking at eventually improving case management programs, expanding telehealth services and same-day surgical capabilities and increasing research programs and academic affiliations. 

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