VA medical centers provide mission-critical care

On the morning after Philadelphia’s Veterans Day parade, the Veterans Affairs Medical Center in University City was quietly cheerful. A day-after-Christmas high imbued staff and patients alike. The facility itself, from the emergency room to the “canteen,” was brightly lit and spic-and-span clean. Her tone slightly suspicious, Public Affairs Director Fern Billet asked, “What were you expecting?” Well …

Mismanagement of the Department of Veterans Affairs has been public knowledge since the 2014 scandal that originated in Phoenix, where more than 80 vets died while waiting to receive medical attention. In truth, VA health care has been a punching bag for decades, going back to the Vietnam War. 

It’s become a stereotype: The vet whose medical needs are dismissed, ignored or lost in bureaucratic red tape. And while there is truth behind that characterization, it’s also true that the VA has a monumentally difficult task. Sources who asked for anonymity confirmed what is now generally recognized: The VA was unprepared to treat the thousands of veterans injured in Iraq and Afghanistan. “Before 9/11, we thought our biggest challenge would be servicing the needs of aging veterans in the baby boomer generation,” one source said. “The system was not prepared to help the thousands of vets who came home with traumatic brain injuries, missing limbs and PTSD.”

Consider the magnitude and diversity of the VA’s patient population. Veterans Integrated Service Network 4 is composed of nine VA medical centers and 44 outpatient clinics across Pennsylvania, Delaware, New Jersey and Ohio. VISN4 encompasses more than 300,000 vets ages 18 and up. In fiscal year 2016, VA Pittsburgh Healthcare System served 70,119 veterans. And according to the VA, more than 57,500 veterans from their defined Southeast Pennsylvania and southern New Jersey region receive care at the Philadelphia VA medical center each year.

The Phoenix scandal was met with bipartisan reform from Washington. The Veterans Access, Choice and Accountability Act of 2014, sponsored by U.S. Sens. John McCain and Bernie Sanders, quickly passed through Congress and was enthusiastically signed by President Barack Obama. The Veteran’s Choice Act set a 30-day maximum wait time on appointments, rewrote protocols so incompetent managers could be fired and funneled $5 billion to the VA to improve care and hire much-needed physicians, nurses and other medical professionals.

The sweeping changes generated grousing among some VA executives, but not Daniel Hendee. The director of Philadelphia’s VA Medical Center welcomed the reform and the appointments of Robert McDonald as secretary of Veterans Affairs and Dr. David Shulkin as under secretary for health. “Dr. Shulkin set new priorities for VA medical centers that addressed the immediate and long-term medical needs of our veterans,” Hendee said. “In our world, that kind of leadership has to come from the top –
and it did.”

Hendee’s accomplishments over the past year include the establishment of a triage call center. Based in Butler, the call center serves all of VISN4. “When a veteran calls, the phone is answered by a skilled medical professional with the knowledge to help that veteran get the service he or she needs,” Hendee explained – no more voice mailboxes overflowing with unanswered requests
for assistance. That call center powers the Philadelphia VA center’s new same-day service policy. Veterans in crisis are seen in the emergency room, which is now divided into two areas: one for physical health and another for mental health. Less dire situations are addressed by making sure that veterans  are seen by medical professionals within 30 days of their request for an appointment.

Daniel Hendee - Harry L. Maxwell for the Philadelphia VA Medical Center

Ophthalmology and audiology are big areas of concern for aging veterans. To address them, Hendee’s staff rolled out a new direct scheduling policy in October. Veterans can now make appointments for hearing aids and eyeglasses without first getting referrals from their primary care physician. Up next: an expanded women’s clinic scheduled to open in the first quarter of 2017. Staffed by female physicians and nurses, the clinic will be dedicated to the physical and mental health needs of the 6,000 female veterans in the Philadelphia region.

Pittsburgh’s VA medical center opened its women’s health center in 2011. “VA Pittsburgh has been ensuring women veterans using our services receive comprehensive and excellent health care for more than 60 years, whether in-house or through community providers,” said Karin McGraw, the medical center’s director. “We were one of the founding VA health care systems in the development of a national women veterans’ health program in the early 1990s.”

McGraw took command of the Pittsburgh VA medical center in January 2016. Like Hendee, she is part of a relatively new wave of VA health care leaders. Mental health is a big priority for her. “Our understanding of the mental health challenges veterans face has grown significantly over the past several years,” McGraw said. VA Pittsburgh’s newer programs include drop-in clinics, community-based care and home-based care through telemedicine.

Telemedicine, a secure network through which veterans can video chat with their physicians and nurses, was recently introduced at the Philadelphia VA and is scheduled to expand in 2017. Its first component is My HealtheVet, an online system through which veterans can access their electronic medical records, manage their appointments, email with providers and refill prescriptions and track their delivery. “If veterans are homebound for any reason, they can reach out to us from their living rooms,” Hendee explained. “You can’t get to us? We’ll come to you.”

Karin McGraw - photo provided by Pittsburgh VA Medical Center

All of these recent accomplishments are points of pride for McGraw and Hendee, none more so than their staff’s work to help homeless veterans. Their plight was a stain on the VA nationwide. “The VA had a program, but it was bogged down in red tape,” Hendee recalled. “We needed a new way to work with the City of Philadelphia, and we found it.” Hendee credits the swift success of that initiative to former Mayor Michael Nutter and Housing and Urban Development Secretary Julián Castro. In December 2015, Nutter, Hendee and Castro announced an end to veteran homelessness in the city. More than 1,390 vets had been given safe, clean housing.

McGraw is working on the problem with similar fervor. “Ending veteran homelessness is a top priority for VA Pittsburgh Healthcare System,” she said. “No veteran should ever be homeless, and we are committed to helping those who are to find their way to a safe, stable lifestyle.”

While reform seems to be in effect in Pennsylvania, that is not the case nationwide. Phoenix’s VA is still in crisis, and there are horror stories about others. It remains to be seen what President-elect Donald Trump and the Republican Congress will do to meet their pledges of caring for veterans. But Hendee expressed confidence that Pennsylvania’s systems are on the right track. “We are 100 percent dedicated to acknowledging any problems that arise and accepting responsibility for creating solutions for them.” ■