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New Hampshire Vets To Receive More Non-VA Care Following Audit


New Hampshire veterans who have been waiting more than three months for an appointment to see a specialist at the Manchester VA Medical Center now have the option of receiving treatment from a non-VA physician.

Staff at the center are in the process of contacting 118 Granite State veterans who are on an “electronic wait list” of former troops who have been unable to see a VA physician in 90 days or less, said Tammy Krueger, director of the Manchester VA Medical Center.

Veterans’ hospitals and medical centers have the authority to arrange fee-based care for patients outside the veteran’s health care network. But in the wake of an audit by the Department of Veterans Affairs that identified more than 57,000 American veterans who have been waiting more than 90 days to see a doctor, the choice of non-VA treatment is being expanded.

“We prefer to offer VA services internally,” Krueger said. “But when that timeliness is not available, certainly to offer the care in the community is an alternative. It is minimal, and we will continue to try to keep it minimal, but we want to insure that we are providing timely care to all veterans.”

The Manchester VA Medical Center and its four community-based clinics treat about 24,000 veterans a year – about 20 percent of the state’s total veteran population – on an annual budget of $136 million.

In addition to new veterans returning from Iraq and Afghanistan, who appear to be relying on VA services to a greater extent than veterans of other conflicts, an aging Vietnam-era population is putting more strain on the system.

This week’s audit findings revealed fewer problems in Manchester compared to some other VA facilities.

For instance, 98 percent of veterans seeking care at the Manchester facility were able to see a doctor within 30 days. That’s better than the national average of 96 percent.

The audit – a snapshot of data collected May 15 - found that newly enrolled veterans wait an average of almost 20 days to see a primary care physician at the Manchester facility. That’s six days longer than the VA's 14-day scheduling goal, but on par with the national average.

In the area of specialty care, however, wait times begin to get longer. New patients seeking mental health treatment had to wait an average of 23 days for an initial appointment, and wait times for other specialists average about 38 days.

New Hampshire veterans seeking appointments in two specialty areas – pain management and audiology – are waiting the longest for treatment, Krueger said. To meet the growing demand, the Manchester VA is recruiting and hiring more staff in both areas.

Krueger said the Manchester VA has worked hard the last two years to increase veterans’ access to mental health care, an area that came under scrutiny in 2012.

That’s when the Manchester VA’s former mental health administrator told the Senate Committee on Veterans’ Affairs that the center’s staff was “gaming the system” to meet performance measures that were tied to executive pay and bonuses.

The allegations by the former administrator, Nicholas Tolentino, were similar to the findings of a VA inspector general’s report released two weeks ago that showed appointment schedulers in Phoenix had falsified data to conceal long delays in veterans' treatment.

Krueger, who has been at the Manchester VA for three years and was named director in February, said mental health staffing has doubled since 2012, to about 60, and that the department is still growing. “With future positions that have been funded, we’ll be up to 68 employees once we recruit those positions,” she said.

The Manchester VA has taken steps to improve its scheduling process, Krueger said. Those steps include new competency standards, mandatory re-training for schedulers and regular audits of their work.

“Certainly as an organization we take this work seriously,” Krueger said. “We work regularly with the staff to identify what’s working and how we can change our practices to make it even better, and we certainly incorporate veterans' feedback into how we can improve on a day-to-day basis.

“There is always room for improvement and we will continue to strive for that.”

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