Pilot program in Maine could be model to ease VA backlogs nationally
As policymakers in Washington look to solve the crisis of backlogged patients at Department of Veterans Affairs hospitals, health care leaders and politicians in Maine point to a small program that could serve as a model for reducing wait times.
In Aroostook County, veterans rave about how they can get care at the hospital in Caribou instead of the VA hospital in the Augusta area, saving them from traveling hours for treatment.
“It’s the best thing since peanut butter,” said Pete Miesburger, 77, a Korean War veteran.
Miesburger suffered a broken hip Jan. 30 when he fell at his home in Caribou, but he didn’t have to worry about a 250-mile ambulance ride to the Togus VA Medical Center.
“It was miserable outside, snowing, cold, a typical northern Maine winter day,” said Miesburger, a former Air Force firefighter who retired from the military in 1974. “God only knows what would have happened if I had to go to Togus.”
The four-hour drive to the Augusta area can easily extend to seven or eight hours in snowy weather. But Miesburger just went to Cary Medical Center in Caribou, thanks to a pilot program called Project ARCH, Access Received Closer to Home.
His friends and family were nearby so they could visit him in the hospital after his hip replacement surgery, something they couldn’t have done at Togus, he said.
Through the pilot program, veterans can get specialty care at Cary Medical Center and four other hospitals outside the VA system, in Farmville, Virginia; Pratt, Kansas; Flagstaff, Arizona; and Billings, Montana. The program costs $35 million a year. Veterans who meet certain criteria, including living far from a VA hospital, can be treated at a medical facility closer to home, which gets reimbursed at Medicare rates.
The VA had a primary care facility on the Cary Medical Center campus before the program started in 2011.
Project ARCH was hatched to solve a geography problem. If the program is expanded or a similar one is approved, it would have the potential to relieve backlogs, say Maine politicians, Cary Medical Center’s CEO and a veterans benefits expert.
“Conceptually, it should work. It has potential,” said Francis Jackson, an attorney in South Portland who belongs to a national veterans advocacy group and specializes in veterans benefits. “But I don’t think anyone really knows yet.”
Jackson said the program is too new and the scope is too limited to show whether it could have a dramatic impact on veterans’ wait times for care.
But he said the idea has merit because it provides a structured system for veterans to receive care from private facilities, easing demand on the VA.
POSITIVE IMPACT ON WAIT TIMES
According to a VA audit released Tuesday, 57,000 veterans nationwide have been waiting 90 days or more for appointments. The issue drew national attention after employees at a VA hospital in Phoenix were found to have tried to cover up the problem. Since the scandal broke in Arizona this spring, backlogs have been found to be widespread.
The audit released Tuesday showed that 99 percent of patients at Togus got appointments within 30 days, less time than at many VA hospitals. Project ARCH’s effect on care at Togus, which serves about 41,000 patients, is still mostly anecdotal.
The two hospitals have not studied whether the program has affected wait times at Togus, officials said, but it appears to have helped.
Kris Doody, CEO of Cary Medical Center, said Project ARCH has reduced waits at Togus, especially in orthopedics, and added convenience for veterans in rural northern Maine.
“We’ve been able to work with Togus and alleviate some of the backlogs,” Doody said.
About 1,400 VA patients have received specialty care at Cary Medical Center, according to hospital officials. About 40 percent of them have received orthopedic care.
Doody said the hospital handles veterans’ common medical problems, including joint replacement, carpal tunnel and rotator cuff surgeries.
Ryan Lilly, director of the VA Maine Healthcare System, said that while Project ARCH likely has been a factor in reducing backlogs for orthopedic care, Togus has added orthopedic physicians.
Lilly said demand for orthopedic services has increased as the state’s veterans have aged, and those in their 60s and older have many orthopedic needs.
Togus officials did not provide average wait times for orthopedic care before or after the start of Project ARCH.
“Because we also increased our providers, it’s a little hard to say” specifically what the effect has been, Lilly said, but Project ARCH “has definitely reduced demand.”
CONGRESS TOLD ARCH MAY BE MODEL
U.S. Sen. Susan Collins of Maine touted the program even before the VA scandal broke, and said she has mentioned it to the Republican caucus several times since then.
“They’re probably tired of hearing me talk about it,” said Collins, a Caribou native.
The pilot program is set to expire in August without additional funding, although votes in the Senate signal that it has a good chance of maintaining its current level of funding.
Collins said she believes that veterans in other states could benefit if the program were expanded.
“The veterans absolutely love the program and believe it has saved lives,” Collins said. “I think the success of ARCH offers a model that should be replicated across the country.”
Independent U.S. Sen. Angus King of Maine said that giving veterans a choice for care closer to home would save on transportation costs and make it more likely that veterans would get the care they need. He said Project ARCH could provide a model for dealing with the problems in veterans hospitals.
“When the crisis occurred, we had a real-life experience we could point to for something that works,” he said.
King and Collins pointed to legislation proposed by independent Sen. Bernie Sanders of Vermont and Republican Sen. John McCain of Arizona that could be voted on this week.
While it’s not specifically an expansion of Project ARCH, it contains similar ideas and would give veterans access to care at local hospitals, rather than just VA hospitals. It also calls for building new medical facilities.
PLENTY OF PRAISE FOR PROGRAM
U.S. Rep. Mike Michaud, D-Maine, sponsored the bill that created Project ARCH and said it has been a “well-kept secret” in Washington until recently.
“The VA can’t do it all,” said Michaud, who noted that about 40 percent of veterans live in rural areas. “It’s a great program, and I’m really proud of it.”
Michaud said demand for health care will only increase as veterans from the wars in Iraq and Afghanistan return and the veterans of Vietnam, Korea and World War II age.
For John Wallace of Limestone, 67, an Army veteran who has had a balky knee ever since he jumped out of a helicopter in Vietnam, arthroscopic knee surgery at nearby Cary Medical Center has alleviated chronic knee pain.
“I’m feeling great, although my knee can still predict the weather,” he said. “Any veteran you talk to up here, we’ve all been very happy with the results.”
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