Veterans Facilities Face Rising Demand: Area Centers Often Crowded As Former Troops Seek Health Care

By Mary Fortune, Chattanooga Times/Free Press, Tenn.

Apr. 1–On a recent Monday morning at the Chattanooga Outpatient Veterans Affairs clinic, nearly every seat in the large waiting room was taken as more people walked in through the swinging front doors.

“This is a very busy clinic,” said director Rick Finger. “We see 275 to 300 patients a day.”

The next morning, 110 miles away at the Alvin C. York VA Medical Center in Murfreesboro, Tenn., the waiting areas in outpatient care were crowded, and the hallways bustled outside the busy pharmacy.

Patient visits here go up about 6 percent or 7 percent every year, said Dr. George Arana, York’s interim chief of staff. Renovations are nearly constant. In long-term mental health care, the hospital is adding more staff and a dozen more beds, said Dr. James Harris, associate director for patient care services.

Growth in patient numbers has been driven by everything from TennCare cuts to aging veterans to soldiers coming home from war in Iraq and Afghanistan. The average patient age at the Chattanooga clinic has been 59, but “it’s lowering now that we’re getting the younger veterans coming back (from Iraq and Afghanistan),” Mr. Finger said.

At the Chattanooga clinic, about 100 veterans enroll for health care each month. At York, the number is 260, according to the VA.

Despite increased demand, however, the Chattanooga clinic meets two performance benchmarks set by the VA. One is that new enrollees are seen within 30 days; the other is that the noshow rate be below 12 percent, said Dr. Joyce Jones, director of primary care for communitybased outpatient clinics in the VA’s Tennessee Valley Health System.

Another performance measure is that patients are seen within 20 minutes of their appointment time. That happens often, but not always, Mr. Finger said.

At York, the average wait for new enrollees to be seen is 24 days; 90 percent are seen in fewer than 31 days, Dr. Arana said. Iraq and Afghanistan veterans are seen on what’s called a “fasttrack” program that gets them into the health care system as quickly as possible, he said.

GROWING NEEDS

Each month, about 800 people come home to Tennessee from military service in Iraq or Afghanistan, said Donald Samuels, assistant commissioner of the Tennessee Department of Veterans Affairs.

“And that does not necessarily mean that would be all of them. Some could be in the hospital somewhere else or not processed out yet,” he said.

There were 5,728 Tennessee residents deployed in the Global War on Terror as of Jan. 31, according to Department of Defense records.

VA records show 2,455 Iraq and Afghanistan veterans have used the VA’s Tennessee Valley health care facilities since November 2004. That system includes hospitals in Murfreesboro and Nashville, as well as eight outpatient clinics, including the one in Chattanooga.

But the biggest demand on VA health care right now is from older veterans, Dr.

Arana said. The average patient age at York is about 61, officials said.

Dewey Evans, of Jasper, Tenn., is getting care from the Veterans Administration for the first time because he retired from his job and, at 60, no longer has health insurance. A few weeks ago, he sent in an application for VA health care. On a recent Tuesday morning, he began the nearly daylong drill of entering the system at York.

The process includes everything from a new photo ID and an EKG to a personal history. “It’s been great,” Mr. Evans said.

His father and grandfather used this hospital, Mr. Evans said.

At the outpatient clinic in Chattanooga, Archie Taylor, 65, of Dalton, Ga., visited on a recent Monday morning because his elbow was swollen and tender. He used to have health insurance through his job as a chef, but when he became disabled in 1997, he began using VA health care.

He also travels to Murfreesboro — the closest veterans hospital to Chattanooga — to see heart and lung doctors.

“You cannot beat this place,” he said during his visit to the Chattanooga clinic. “Some veterans gripe and complain, but they don’t realize there are (12,000) of them and 10 doctors.”

The Chattanooga clinic is staffed by 10 physicians and two nurse practitioners in primary care.

Traveling remains one of the biggest obstacles to care for area veterans, Dr. Jones said. A van goes daily from the Chattanooga clinic to the VA hospitals in Murfreesboro and Nashville. The VA’s goal is for all veterans to be within 30 miles or 30 minutes of a health care facility.

“We’re not there yet,” Dr. Jones said.

The VA needs a health care facility in Roane or McMinn County, and there are proposed sites there. “But there’s no funding for them,” she said.

There are always delays in funding because the VA gets its budget through appropriations, so the money runs at least a year behind the needs, said Penny Phelps, a nurse manager at York.

MAKING CHANGES

Recent revelations about squalid conditions at a building at Walter Reed Army Medical Center in Washington, D.C., led to reviews of the physical state of all of the VA’s 1,400 hospitals and clinics.

The inspections at the Chattanooga clinic and York revealed mostly cosmetic problems from normal wear and tear, according to the report. The Chattanooga clinic is a maze of hallways lined with exam rooms, the tile floors gleaming white, the walls freshly painted.

At York, a sprawling 100-acre campus with a couple of dozen towering brick buildings built mostly in the 1940s, renovations, additions and inspections are onging. The extra scrutiny did not change that, Dr. Harris said.

“We just continued doing what we were doing every day,” he said.

The inspection report identifies needs at York such as new paint, waiting room furniture and carpet. Those improvements will be made “as funds are available,” according to the report. It also points out that the therapy pool at York has been closed since February 2005 because the building is unsafe. Repairs to that facility are part of a five-year capital plan and will be made “when funds are available,” according to the report.

At the VA hospital in Nashville, inspections found the dialysis area had cracked floors and leaky plumbing. That area is slated to be renovated by March 2008, according to the report.

The Chattanooga clinic was renovated a few years ago. A dozen exam rooms were added, bringing the total to 34. In January 2006, a 10,000-square-foot imaging center opened next door to the clinic, offering services from CT scans and bone density tests to ultrasounds for veterans.

The level of service at the clinic was very different just a few years ago, Dr. Jones said. About four years ago, there was a list of about 1,900 people waiting for an appointment. But the VA did time and motion studies, and streamlined the intake process, Dr. Jones said.

Waits are still sometimes long and the clinic is always busy, said Darin Towry, a 37-year-old Desert Storm veteran, but service has improved overall.

“It’s gotten a lot better since I started coming here in 1997,” he said. “Then you almost felt like you were just a number.”

He worries, though, that as more soldiers return from war the system won’t be up to the demands, he said.

“They are so overwhelmed, and with soldiers coming back from Iraq it’s only going to get worse,” Mr. Towry said.

E-mail Mary Fortune at mfortune@timesfreepress.com SEEKING CARE

As of January, 205,097 of the 631,174 eligible Iraq and Afghanistan veterans had sought treatment at a VA health facility.

This number represents about 4 percent of total patient visits at VA facilities nationwide, a number that is expected to grow as more veterans return from war. Source: Soldiers Returning from Iraq and Afghanistan by Linda Bilmes, Kennedy School of Government, Harvard University GROWING DEMAND Chattanooga Outpatient VA clinic Patients: 2002: 8,370 2004: 12,595 2006: 12,849 Alvin C. York VA Medical Center Patients: 2002: 30,311 2004: 32,625 2006: 39,974 Source: U.S. Department of Veterans Affairs FAST FACT Tennessee Valley VA Health Care System funding (includes hospitals in Murfreesboro and Nashville, and eight outpatient clinics)

2002: $325,347,796

2006: $439,930,576 Source: U.S. Department of Veterans Affairs

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Copyright (c) 2007, Chattanooga Times/Free Press, Tenn.

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