Paul Muschick: Paul Muschick on veterans health care: Access to more private doctors, urgent care is good news

Jun. 14--Veterans treated at the government medical clinic in Allentown have been complaining for months about the lack of a podiatrist there. To see a foot doctor, they've been driving to the U.S. Department of Veterans Affairs hospital in Wilkes-Barre.

They now may be able to get care closer to home under a new VA program that started June 6.

The agency has loosened eligibility requirements for veterans to get community care -- treatment from private doctors at the government's expense -- instead of traveling to VA facilities that are far away and have wait lists for appointments.

Forty percent of veterans could be eligible for community care under the new system, up from 8% under the previous program, according to Russell Lloyd, director of the veterans medical center in Wilkes-Barre, who briefed local veterans on the changes Thursday.

For the first time, veterans also will be able to use their benefits at urgent care centers.

Lloyd explained the changes during a standing-room only meeting at the Allentown clinic. About 60 veterans and their family members were there.

I've attended several previous briefings in Allentown. They drew only a dozen or so people. There's clearly interest in the new program, especially among veterans who repeated their concerns Thursday about the lack of podiatry services.

Their concerns could be addressed under the Mission Act passed last year by Congress. It aims to strengthen veterans' health care and make it more flexible.

I hope the VA can pull it off, because veterans deserve timely, quality care. The agency doesn't have the best track record for efficiency, though, so it will be important to monitor how this goes. Previous community care programs were problematic at times.

For the Mission Act to work, the VA will have to build a robust network of private physicians who are willing to see veterans and accept payment from the government. It's working on that now.

Most local providers who participated in the previous community care system, the Veterans Choice Program, will be joining this one, Lloyd said. Veterans whose private physicians aren't in the network now can ask the VA to recruit them.

Under the Mission Act, veterans can qualify to see private doctors in several ways:

-- If they would have to drive 30 minutes to obtain primary care, mental health or non-institutional extended care at a VA facility; or 60 minutes to obtain specialty care such as cardiology, podiatry and dermatology.

-- If they would have to wait 20 days for a primary care, mental health or extended care appointment; or 28 days for a specialty care appointment at the VA.

-- If the VA doesn't provide the services that are needed, or doesn't provide them at an acceptable standard.

-- If getting private care is in their "best medical interest."

-- If they previously qualified under the Veterans Choice Program.

Under the previous criteria, veterans could get private treatment if they would have had to travel at least 40 miles to a VA facility, or wait at least 30 days for an appointment.

That locked out most Lehigh Valley veterans because while the medical center in Wilkes-Barre is more than 40 miles away, there are clinics in Allentown and near Bangor. More local veterans may be able to participate under the new criteria.

Pre-approval is required for veterans to have their visits outside of the government system covered by their benefits, so it's important for veterans to contact the VA to determine their eligibility.

Another big change allows veterans to use their VA benefits at urgent care centers, if the center is in the VA's network.

To be eligible, veterans must have received care through the VA or a VA community provider within the past two years. Covered treatments include minor illnesses such as sore throats and earaches and non-life threatening injuries requiring stitches or casts.

Visits can't be for preventative (physicals) or emergency care (heart attacks, strokes). Flu vaccinations are covered.

Pre-authorization is not required, and there is no limit on the number of urgent care visits per year. Co-pays will apply.

The VA's move to expand community care is smart. There's an abundance of local physicians, and tapping them is a way to leverage limited government resources.

That also allows the VA to focus on specialty care for combat-related injuries and post-traumatic stress disorder that the private sector can't always replicate.

The Mission Act tries to address problems in the previous delivery of community care.

A 2017 audit by the VA inspector general said some veterans encountered cumbersome authorization and scheduling processes, and inadequate provider networks, under the Veterans Choice Program. I wrote a column in 2016 about private doctors struggling to get paid for treating veterans.

Scheduling now will be done by the VA instead of a third-party contractor. And new technology has been designed to improve communication with physicians and ensure timely payment.

The law also expands telehealth services, where veterans consult with health care professionals online. The goal is to have all VA primary care and mental health clinicians able to deliver telehealth services by the end of fiscal year 2020.

The local VA system already does quite a bit of that, with a dedicated telehealth physician at the Allentown clinic.

The Mission Act also aims to strengthen the VA's workforce. Medical centers and clinics have struggled to stay at full staff. A good example is how the Allentown clinic has been without a podiatrist after a retirement.

Lloyd said the VA is looking at that need as part of a broader review of what specialty care should be provided in Allentown.

Psychiatrists and psychologists also have been scarce at times, both locally and nationally. Some professionals can earn more in the private sector. And in other areas, such as mental health, there's an overall shortage.

To attract talent, the Mission Act increases the VA's student loan reimbursement program from $120,000 to $200,000 over five years for employees in difficult-to-recruit positions who directly care for patients.

"That's really going to be helpful for us," Lloyd said.

Veterans interested in learning more about the changes to their health care can attend a briefing at 5 p.m.June 20 at the Wilkes-Barre VA medical center, 1111 East End Blvd. They also can watch it on Facebook at https://www.facebook.com/VAWilkesBarre/.

More information, including lists of participating private doctors and urgent care centers, is on the VA's website, missionact.va.gov.

Morning Call columnist Paul Muschick can be reached at 610-820-6582 or paul.muschick@mcall.com

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