VA Funding Increases, As Does Backlog
WASHINGTON, Dec. 03, 2002–It took Jim Umble, a Navy veteran of the Korean War, more than a year, he says, before a doctor at the Department of Veterans Affairs Medical and Regional Office Center at Togus could examine his lungs. And when the 68-year-old Carmel resident asked if he could have a test for his damaged hearing, he was told, he adds, that it’d be another two years before that could happen.
“The wait is the main problem at Togus,” Umble said recently.
Gene Bickford of Norway, another Korean War veteran, has had similar experiences. Bickford, 70, says he waited more than a year to see a doctor for a hearing test. At his September appointment, he learned that he needed a hearing aid for his service-connected hearing loss but that the VA could not provide him with one at that time. Since then, Bickford says he’s been billed for his visit, but is still waiting for the hearing aid.
While these veterans agree that the care they receive at Togus is good, they are plagued by the time it takes to be seen by doctors and the lack of equipment at the facilities. Togus spokespeople say hearing aid orders and supplies are not usually significant problems, although the backlog issue is a serious concern. The wait at Togus is not only long but is getting longer by the day as more and more veterans reach the age where they require increased VA medical care.
Korean War veterans are now being joined in Maine by a steadily increasing number of veterans who served in the Vietnam War. Maine not only has a high veteran population but very few facilities to offer treatment. Existing facilities are understaffed, under funded and unable to meet the demand of the growing number of patients. Congress and government agencies have been working to improve this problem.
On Nov. 22, the VA agreed to change federal reimbursement rules, which previously penalized the New England region because it has a large population of older veterans. VA Secretary Anthony Principi announced the new adjustments in the Veterans Equitable Resource Allocation (VERA) formula, which will help New England states by broadening reimbursement categories from three to ten specific areas to better address such states with older populations.
Dave Lackey, director of communications for Republican Sen. Olympia Snowe, said the changes in the formula will help treat Maine more fairly by taking into account older and sicker veterans. According to Lackey, Maine is fourth in the nation in the number of older veterans per capita.
The changes will also commit an additional $25 million for this fiscal year to New England VA hospitals, including Togus. The new money is intended to substantially relieve pressures the hospitals currently face, such as inadequate staffing and yearlong waiting lists for health appointments.
Republican Sens. Susan Collins and Snowe said in a recent joint statement that they expect the additional money to help reduce the backlog at Togus and other hospitals.
“Without adequate funding for VA hospitals, services and quality could slip,” they said. “This is a step in the right direction, and pending appropriations bills offer promise of additional funds that will make a real difference for veterans in Maine.”
Pending in Congress are similar House and Senate Appropriations Committee versions of bills that would provide more than $1 billion in additional funds for the VA, including health services. The new Congress which convenes in January will have a chance to act on this legislation.
“This is a must-pass piece of legislation,” Lackey said, adding that the Bush administration “has made VA health care a greater priority” than previous administrations.
Maine’s senators said they believe their October visit to Togus helped reinforce their argument that New England needs additional VA funds. At that visit Snowe addressed the problems with the backlog:
“This is the wrong message to be sending at this point in time, when we’re asking people to serve our country. Given the potential conflicts around the world, and what we’re engaged in already in the war on terrorism, we need to do everything we can to get this waiting list down.”
While Togus is eager to use the new funds to expand its medical staff, clinical services and building facilities, it is unclear whether those funds will be enough to help alleviate the growing backlog.
From October to November, the number of Mainers waiting to see VA physicians swelled from 5,400 to 5,800. Jim Simpson, a Togus spokesman, said the backlog is now more like 5,900, with the number growing by 500 to 700 a month. As a consequence, he said, veterans are waiting one to two years to get an appointment.
“Resources are being outstripped by the demand we have,” Simpson said.
Furthermore, during the next decade, the number of patients seeking care at Togus and its community-based outpatient clinics in Bangor, Caribou, Calais, Rumford and Saco is expected to rise from nearly 40,000 to more than 60,000, according to a study by the national VA CARES (Capital Asset Realignment for Enhanced Services), a program within the VA’s Veterans Health Administration.
“The numbers speak for themselves,” Simpson said. “We’re confident that people will look at this and realize that this is a problem.”
Although the hospital still awaits additional money, some internal funds from the region’s network have been available for backlog reduction, Simpson said. This money has been used to add doctors and other medical professionals at Togus and Saco and to increase support staff at the Bangor clinic.
But those funds don’t stretch far enough to shrink the expanding waiting line. The last addition at Togus was a wing added in 1991, which, Simpson says, is not large enough to meet the outpatient demand. More money is needed to increase space for primary care, he says.
According to Helen Hanlon, a nurse at Togus and the president of Local 2610 of the American Federation of Government Employees, Togus also hasn’t had equipment replaced since 1991.
“We’ve been shortchanged for a number of years, and with the sense of being understaffed, it’s wearing,” said Hanlon, who noted that the tension level rises this time of year among employees who face mandatory overtime and cancelled vacations. Hanlon added that a current wave of retirements among veterans is bringing many new patients to Togus and that there isn’t enough staff to handle the influx of new patients who are usually elderly, hypertensive and in need of thorough check-ups.
“Veterans understand the bureaucracy and try to be patient, but with rescheduling, waiting and worrying, I’m sure it must be difficult,” she said. “We worry too about what happens to these people who are waiting a year. I certainly wouldn’t want someone from my family to be put in that position.”
On Oct. 3, the VA announced new regulations to provide priority treatment to veterans with service-connected disabilities who have been diagnosed and rated in the top half of all VA patients. The new policy was instituted to ensure that severely disabled veterans receive prompt treatment in VA facilities instead of continuing to rely on the former first-come, first-served basis.
Gail Goza-Macmullan, network communications officer for the VA’s New England Health Care System, said that the policy, which is currently being implemented at Togus, was intended in part as a response to the growing backlog.
“Waiting lists are a fairly new phenomenon, and the extra workload is a recent problem for us,” Goza-Macmullan said in October. “This policy ensures that severely disabled veterans have priority access to care.” She noted that veterans with medical emergencies will continue to receive priority treatment in any VA facility regardless of their disability status.
Ron Conley, national commander of the American Legion, says it takes time and resources to diagnose the thousands of patients and determine which priority group they belong to. Right now Togus is working with a shortage of staff, all of whom are overworked, Conley said.
“VA health care is superb, it’s quality care,” he said in October. “But the problem is, not enough veterans are able to get into that hospital to receive that care.”
Conley also suggested that veterans be allowed to use Medicare to cover costs at VA facilities. Currently, neither Medicare nor Medicaid coverage is accepted. Simpson explained that VA facilities treat service-related disabilities free of charge and accept payment from private insurance companies for non-service-connected treatments.
“VA care is provided in VA facilities,” Simpson said, although he noted that in some cases the patient is referred to a community clinic. This means that many Maine veterans have to drive hours to Togus because they have no other option for free or subsidized care. Under VA standards for access to primary care, veterans should live within 30 minutes or 30 miles of a VA facility, which is not the case in Maine.
In any event, Togus administrators admit that the newly enrolled still are waiting close to two years for their first appointment at Togus.
Similar backlog problems run far and wide in other New England states. Democratic Rep. Bill Delahunt of Massachusetts, an advocate for veterans’ benefits, said in an October statement: “Veterans already face maddening delays at medical clinics from Quincy to Hyannis…. The least we can do is make good on basic commitments to those who sacrificed the most.”
Until the promise of funds turns into dollars in hand, Togus will be operating as usual and working with internal funds. And Jim Umble and Gene Bickford may be happy to hear that Togus is now installing a new hearing test booth.
“We have been backlogged,” Simpson said of the increased demand for hearing tests now that the eligibility for hearing aids has expanded. “But we have made inroads, and we’re clearing it up.” The new hearing test booth, along with the decision to send some patients to Boston for hearing tests, have helped lift the burden, but Simpson said Togus is still not as timely as it would like to be.
Adding booths is just one of the many steps needed to close the gap between resources and demand. More medical staff, physical additions and new equipment are crucial to places like Togus, where veterans from the Korean War are being joined rapidly by Vietnam veterans, inflating the waiting list by the hundreds every month.
A town meeting on Thursday (in the Theater, building 210 at Togus, from 1:00-2:00 PM) will discuss the national VA CARES study. Simpson said the focus of the meeting will be on the dramatic rise in the number of enrollees expected in the coming decade and the resources needed for the next 10 to 20 years, such as additional buildings and new equipment.
“Our purpose is to provide information and get questions from veterans,” he said. “We’ll be looking at redistributing resources within VA and where we might be able to place more clinics.” Plans are to be developed with input from Maine veterans.
“Vets are coming to us in increasing numbers-they need and want VA health care,” Simpson said. “We focus on their needs and we can treat them, from post-traumatic stress to prosthetics. We can provide them with help. We just need more resources.”
Published in The Bangor Daily News, in Maine.
