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As VA hospitals around the country tackle exorbitantly long wait times, San Diego’s system has tried to ease its burden by reaching out to fewer veterans, who might not know the level of care they’ve earned with their service.
Faced with a growing patient load, San Diego’s VA health care system has quietly cut back its outreach efforts to veterans who might qualify for care.
Over the last several years, VA San Diego Healthcare System, or VASDHS, has seen higher numbers of patients at its La Jolla medical center and community clinics, even as veterans of WWII and Vietnam die off and the veteran population in San Diego and Imperial counties starts to shrink.
The widening pool of patients has contributed to long wait times for appointments, an issue that’s plagued VA hospitals nationwide. That epidemic was thrust into the national spotlight when it was revealed officials at a Phoenix VA hospital were vastly underreporting the amount of time it took veterans to receive care.
The local decision to cut back on outreach came from CEO Jeff Gering well before the Phoenix scandal broke, said Cindy Butler, director of public affairs for VASDHS.
“Our growth is more than we can manage, and Mr. Gering’s the one who said we’re not going to go out anymore,” Butler said. “Our waiting time is getting longer, and we’re not getting more resources to manage it. So he doesn’t want to drum up more business.”
The health care system provides a range of inpatient and outpatient treatments at its main medical center and six community clinics in Chula Vista, Escondido, Imperial Valley, Mission Valley, Mission Gorge Annex and Oceanside. They do everything from surgical treatments to mental health services and geriatric care, and VASDHS is responsible for making its presence known to the veteran community.
Not drumming up more business means some veterans, most likely older generations unfamiliar with changing eligibility standards, might not know what care they’re entitled to.
VASDHS still does a considerable amount of outreach. It staffs booths at the Miramar Air Show, a military retiree fair, an annual veterans career and resource fair and is required by the Department of Defense to host day-long transition programs for groups of Marines, for example. Program specialists in mental health and women’s health do their own additional outreach at community events.
It’s primarily smaller community groups that VASDHS says it no longer has the time or resources for.
“If someone’s having an information table somewhere at a fair, we’ve just had to re-evaluate and say we have limited staff,” Butler said. “There is a lot of information out there because San Diego is a pretty robust veterans community. There’s a lot of resources on the web, Courage to Call with 2-1-1 – there’s a lot of ways that people can find out about their benefits.”
The question is whether they know where to look.
“I think the younger veterans are better informed as to eligibility for health care,” Butler said, “but particularly the older veterans like (from) Vietnam … If you go out in the community and have an information table, often the first thing they’d say to you is, ‘Oh, I didn’t know I was eligible for VA health care.’ Because eligibility has changed over the years.”
“We never said that we could not handle more patients, just that we were concerned about patients potentially waiting too long for appointments,” Associate Director Cynthia Abair wrote in an email.
“The truth is that the VA San Diego Healthcare System can handle additional patients,” said Gering.
Between October 2013 and May of this year, VASDHS saw 3,646 patients, a 6 percent increase over the same period last year.
Gering said there are many possible reasons for the influx of patients, “one which we believe is that the growth is due to the strong reputation of the San Diego VA in the community.”
According to the Veterans Health Administration’s national audit in mid-April, 334 new patients couldn’t secure appointments at VASDHS until after 90 days. As of June 15, the latest data available, there were 360 new patients on the Electronic Waiting List.
That number had fallen from June 1 data, which counted 375. The jump from the original count represents veterans who might’ve already been in primary care through the VA, but now need to see a specialist or visit a clinic, Butler said. But she said she couldn’t explain the difference in numbers because the data had come out of the national office, and “we don’t know how they were calculated.”
In an effort to tackle its backlog, VASDHS is using $11 million out of next year’s operating budget to pay for some new patients to be seen by private doctors outside of the VA.
Some San Diego veterans still might be in the dark about available services. Bill York is COO of 2-1-1, a service that wrangles resources for the local veteran community and communicates what’s available to veterans. “I would probably have to agree that older generations that maybe have not connected to the VA in the past might not be aware of these things that they’re eligible for,” York said.
Shrinking outreach efforts haven’t entirely been the local system’s fault. Toward the end of 2012, the federal VA began a gradual process to privatize its transition workshops for service members about to re-enter civilian life. In the workshop’s previous iteration, staff members from the VA benefits office were given four hours for their presentation on disability compensation, Butler said. VASDHS was given a half-hour of that time to overview care and services.
But when the privatized version, called Transition GPS, was rolled out last year, Butler and her team got the directive from Washington they would no longer be allowed to participate. Instead, federal VA contractors give a six-hour presentation on care and compensation during the last day of the five-day workshop, according to a spokesman for Navy Region Southwest, whose separating sailors are required to complete the workshops.
Both by its own hand and because of outside forces, VASDHS has narrowed the scope of its outreach. The impact of that shift might only be felt by those who aren’t actively engaged in San Diego’s veteran community – the ones who could benefit most from access and information.
“We’ve seen seniors not know about the benefits,” York said. “They just never connected in the first place. … Often non-wartime…veterans don’t always even identify and realize that they’re potentially eligible for benefits, so we do see some from those eras – the Cold War era, the mid-’80s, after Desert Storm.”
Even the term “veteran” can be alienating for these service members. “We even ask the question, ‘Did you serve in the military?'” York said. “Depending on when they served, ‘Yeah, well I am but I’m not connected,’ or ‘I’ve never been to the VA.’ There’s an opportunity there.”