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VA headway
After federal audit, Manchester facility plans improvements

06/26/14



 Employees at New Hampshire’s only VA Medical Center, located in Manchester, didn’t need to see the results of a recent federal audit to know that their veterans are generally happy with the care they receive. 

“Veterans tell us regularly and consistently, before this and now,” said Tammy Krueger, VAMC director. “I have a vase of flowers on my desk. It’s a dozen red roses and a card that says: ‘With sincere appreciation I did get the help that I needed.’”
For the most part, New Hampshire’s vets are receiving relatively speedy, high-quality service, according to both the audit and the vets. 
The May 12 audit was one of the first of 731 VA hospital audits across the nation from May 12 to June 3. It came in the wake of reports of delayed care and falsified records at a VA hospital in Phoenix, which may have resulted in the death of 18 veterans who were on a “secret waiting list,” Sloan Gibson, acting secretary of U.S. Veterans Affairs, stated during a recent press conference. The incident cast a wide and scrutinizing eye on the entire national system, as federal officials vowed to identify problem spots and get veterans better care. 
 
New Hampshire’s results
In New Hampshire, the audit revealed slightly better service than in the rest of the nation, but it did find some weak spots, which Krueger and other officials have begun to address. On the plus side, 98 percent of patients received care within 30 day, while the national average was 96 percent. Of 20,514 appointments (excluding surgeries and procedures) scheduled at the Veterans Affairs Medical Center in Manchester, 20,012 patients saw a doctor within 30 days or less. 
The average wait time for new patients to see a primary care physician was just less than 20 days. For established patients, the wait was just more than one day. 
The average wait for secondary care was a bit longer — about 39 days for new patients and three days for established patients. 
New mental health patients waited an average of nearly 23 days while established ones waited just more than three days. 
The numbers fall short of the 14-day performance goal established by the Veterans Health Administration. But the auditors have called for the removal of that goal, stating that nationally it “was not attainable given growing demand for services and lack of planning for resource requirements.” 
In Manchester, another 2 percent — 502  patients — have an even longer wait, including 118 new patients who have been on an electronic wait list for more than 90 days. 
“Certainly the Medical Center is very pleased with that data. It represents the work we do every day and represents the level of care,” Krueger said. “But there’s 2 percent [with long waits], and we always ask ourselves, ‘How can we improve?”
 
Why the long waits?
The popularity of three programs has caused those longer waits. There’s a high demand for audiology and optometry, which are particularly necessary for the state’s growing number of senior veterans. 
“We’ve seen a little more there primarily because of demand, and the majority of our veterans are in the mid or upper 60s,” said VAMC acting public affairs officer Debra Krinsky. 
To address that, the Medical Center is offering non-VA care to patients who desire shorter waits and don’t mind switching providers for the service. Authorities have also hired a new audiologist, and staff have been calling vets to see if they’d like their appointment sooner. The wait for optometry will soon be minimized as supplemental staff are being introduced, and in July there will be additional resources, Krueger said. 
The pain clinic also has a high volume of need. While the Medial Center has always provided patients the opportunity for non-VA services when waits are too long,  officials are making more concerted efforts to make that option known. 
“Our pain clinic has been tremendously well-received, and it’s very much in demand because of the services that are provided, including medication, pain therapy,” Krinsky said. “We’ve tried to provide aquatic therapy through YMCA passes, and we started a yoga program. … Those are some of the areas we are closely monitoring to make sure we meet veterans’ needs.”
 
Local vets satisfied
Local veterans agree that the services VAMC provides are timely and strong. Michael Theroux, Merrimack VFW post master and sergeant-at-arms for New Hampshire, has been visiting the VAMC to receive treatment and medication since 1968, when he returned from Vietnam. He has recently been diagnosed with Agent Orange and suffers from esophageal cancer as well. 
“I’ve had no issues as far as getting in and seeing doctors, but I hear Manchester is an exceptional branch,” Theroux said. “As far as I’m concerned, the VA is treating me well with my medications.”
Ed Hafey, a Derry resident who served in the military from 1955 to 1968, said that the treatment he received after a heart attack was “unbelievable.”
“They sent me down to [a hospital in] Boston. Everything was awesome. I have no complaints about the VA system at all,” he said. 
Even though the issues aren’t bad in New Hampshire, the publicity of the Phoenix scandal is a good thing, the vets agreed. They are hopeful the negative attention will bring changes to parts of the nation where the system is weaker. 
“I’m in touch with vets across the nation who have issues with their VA hospitals, like in South Carolina, North Carolina and out in Colorado. Some of these guys aren’t very happy,” Theroux said. “It’s about time something did come out for these people and hopefully they get the help that’s needed. … Any time a veteran dies because of lack of responsibility on the government’s part, I feel it’s a disgrace.”
The long wait at other VA hospitals across the state could be the result of a combination of full-service hospitals and the sheer volume of vets, said Peter Mannarini, a vet from Manchester. 
The Manchester hospital isn’t full-service, he said. If there were an emergency and he needed an ambulance, they wouldn’t drive him there, and currently, patients go to either White River Junction in Vermont or the VA in Boston for operations. 
“My feeling is these people who are trying to get appointments are trying to get appointments at full service VAs, where you can get hospital rooms and everything else, and I don’t know what to say about it,” Mannarini said. “If they are not already enrolled in the VA system they could have a problem because it takes time to get paperwork filed and get a card. A lot [of hospitals] don’t have enough room to handle all the vets.”
 
More changes and  upgrades
Manchester VAMC sees 24,000 veterans on a yearly budget of $136 million. That’s about 20 percent of the state’s total veteran population, a number that has leveled out recently. 
While a substantial number of World War II and Korean War veterans have been passing away,  more Operation Enduring Freedom,  Operation Iraqi Freedom veterans and some who served in the Vietnam War are signing up for visits. 
“Vietnam-era veterans, one time they may have been told they weren’t eligible for care because of maybe their income or what services were available, but they are [eligible] now, and those are the folks we’re seeing an increase in enrollment,” said Krinsky, who noted that the center is making efforts to reach out to this group of vets. 
Krueger said there are impending upgrades to the center that she’s particularly excited about.  
Renovations to the currently closed operating room have been in the works for two years, and it’s slated to re-open in July. 
“This will support New Hampshire veterans receiving surgical care for outpatient,” Krueger said. “They have been traveling to White River Junction or Boston, so it’s coming back to Manchester.”
This fall, a new addition with 30 primary care and mental health exam rooms, will open and the construction of an on-site pharmacy will get underway. 
“It will occur over the next year. It’s a large construction and a process that is well overdue,” Krueger said. “I’m very proud of those things. They are some things I think veterans will visibly see.” 
 
As seen in the June 26, 2014 issue of the Hippo.





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