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Leeds VA report looks good so far

Aims to make sure all patients seen within 14 days

NORTHAMPTON — The VA Medical Center in Leeds and its community clinics have thus far received positive marks for its patient scheduling practices as investigators conduct a nationwide review of this area at VA health centers, according to staff who met with reviewers during the past month.

Nevertheless, there is room for improvement for the hospital and its five outpatient clinics as it works to get veterans with longer wait times more timely access to care, said Roger Johnson, director of the VA Central Western Massachusetts Healthcare System.

He said an unannounced visit from a criminal investigator with the U.S. Department of Veterans Affairs Office of the Inspector General and separate reviews by an outside team of VA patient scheduling practice experts from upstate New York have been helpful in reinforcing what the region’s VA health system is doing well and identifying what it can do better.

“We clearly have been re-looking at our practices to make sure we’re doing it right,” Johnson said Friday. “I think it’s refreshed our eyes to look at these things. We have to keep a focus on patients. These are veterans who have risked their lives for our country.”

The reviews have been prompted by an investigation at a Phoenix veterans hospital amid allegations of gross mismanagement of VA resources, criminal misconduct by hospital leadership, patient safety issues and possible wrongful deaths.

An interim report released Wednesday by the VA’s Office of the Inspector General confirmed that significant delays in access to care negatively affected the quality of care at that hospital, including 1,700 veterans who were waiting for primary care appointments, but were never placed on official waiting lists. Hundreds of other veterans waited an average of 115 days for their first primary care appointment, according to the report. The VA health system’s goal is meet veterans’ needs within 14 days of their requested primary care appointments.

In addition to the problems uncovered in Phoenix, the OIG’s interim report states that “reviews at a growing number of VA medical facilities have thus far provided insight into the current extent of these inappropriate scheduling issues throughout the VA health care system and have confirmed that inappropriate scheduling practices are systemic throughout VHA.”

The situation on Friday prompted the resignation of U.S. Department of Veterans Affairs Secretary Eric Shinseki, which was announced by President Obama.

External reviews

The VA Central Western Massachusetts Healthcare System, which operates the medical center in Leeds and five community-based out-patient clinics in Fitchburg, Greenfield, Pittsfield, Springfield and Worcester, serves approximately 25,500 veterans annually and estimates it schedules about 300,000 patient visits for those veterans, according to figures provided to the Gazette.

The medical center in Leeds, which has long specialized in mental health services, operates inpatient psychiatric wards, including a 20-bed locked ward and 40-bed open ward that treats substance abuse, and a 25-bed PTSD unit where veterans participate in six-week and three-week programs in addition to various others outpatient mental health services. The medical center is also home to a 32-bed nursing home care unit.

In all, 96 veterans are in residence at the hospital today.

In the current fiscal year, which began last October, the Leeds healthcare system reports that 91.4 percent of its patients are seen within 14 days of their requested date of medical appointments in primary care across its system.

Those numbers appear to be reflected in patient satisfaction surveys by veterans, which Johnson outlined in a May 21 email to all employees in the region’s health care system. He noted that the VACWM consistently scores above the national average for all VA medical centers, scores in the top quartile of all VA facilities for access, communication and provider rating and in the top 10 percent for medication decisions and office staff. In addition, he reminded staff that the New England VA network has the best telephone answering times of all networks with the Leeds response times rating the best.

“The allegations of scheduling impropriety across the system nationally are serious, and must be dealt with accordingly,” Johnson wrote in the email. “Last week here in Central Western Massachusetts, we had the second of what will likely become many external reviews of our scheduling practices. The team that reviewed us found no major issues.”

Still, VA officials say they are redoubling their efforts to reach a group of veterans whose wait times are beyond the 14-day scheduling goal. The medical center could not provide a precise figure on how many veterans are in that category, but Johnson acknowledged that there are veterans who, for a variety of reasons, are 30-days out or more from their desired appointment times.

“We have a few pockets of specialty services where we need to accommodate them,” said Johnson, who became director in 2010 and has spent nearly four decades working in the VA healthcare system.

National drive

Last week, the U.S. Department of Veterans Affairs launched an nationwide initiative designed to accelerate access to care for veterans who are new to VA care, on electronic wait lists or scheduled for any appointments that are more than 30 days out. If VA resources do not exist to meet these veteran’s needs then non-VA medical care will be used, among other measures, such as bringing in staff to work overtime, according to Amy J. Gaskill, a spokeswoman for the VACWM healthcare system.

“It runs the gamut on how they may handle that work,” Gaskill said. “We have to get these people in that are beyond the 30-day window by June 25th.”

Meantime, Gaskill said the region’s staff also are working to help existing patients who have appointments that fall outside the 14-day window obtain follow-up primary care.

While the VACWM reports its at 91.4 percent in the latter category, “we want to be at 100 percent, that’s the goal,” Gaskill said.

‘One of the best’

Local veterans agents working with area veterans say they are aware of veterans who wait to access the VA medical center’s inpatient PTSD treatment programs, for example, though they are not seeing evidence of lengthy wait times for access to primary care.

“I hear more good than bad as far as that goes,” said John O’Connor, Easthampton’s veterans agent. “In this area, I think they do perform better than what I’m hearing in other places.”

Steven J. Connor, director of Northampton’s Veterans’ Services Department, who serves veterans in that city along with seven other area towns and at the VA Medical Center, said it is a struggle at times for some veterans to access the residential treatment programs in Leeds and get appointments when they want them, though he attributed those cases largely to resources.

“Do I hear frustration among veterans waiting to get in there? Sure,” Connor said. “From my observation, the hospital in Leeds is really trying to do a lot with a small hospital. I know there is waiting, but I don’t think they are trying to hide it, either.”

“It’s limited by its size and staff because Congress doesn’t allocated all the money they ask for, plain and simple,” he added.

For more than 30 years, Kenneth Graf, a former U.S. Air Force medic, has been relying on the VA medical center in Leeds for his health care needs. Although he’s been critical of the some administrative procedures in the past, which he said have improved, he’s not had a problem with timely access to care. “Nothing of any consequence,” said Graf, who resides in Cummington.

“We have one of the best,” said Rafael Lopez-Sanchez, a former U.S. Air Force veteran from Amherst and veterans’ advocate who volunteers his time with patients of the VA medical center. “I see what goes on here and I’m very glad we do have this little VA center here,” said Lopez-Sanchez, of Amherst. “It does what it can with the resources it has and it does it well. The workers deserve a lot of credit for what they do.”

Johnson, the VA medical center’s director, said the ongoing national scandal over patient care for veterans, which grew out of the alleged mismanagement and criminal conduct at the Phoenix hospital, has been frustrating and distressing for employees of the VACWM healthcare system. He anticipates additional reviews at the region’s VA network and, even if more bad news develops, that further improvements to patient care will result.

“This is about ethics,” Johnson said. “This is about how we deal with veterans and how we deal with each other. We have a moral obligation.”

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