Telemedicine being used to combat physician shortages

Veterans Administration (VA) healthcare has been under fire after an audit in June found more than 120,000 veterans were unable to get care in a timely manner. That includes 40 veterans who died while waiting for care at the VA in Phoenix, Ariz. Public outrage has sparked investigations and efforts by Congress to provide additional financial support for VA healthcare.

As of July, the total number of veterans on the electronic wait list for Central Arkansas Veterans Healthcare System (CAVHS) in Little Rock was down to 43 and none of them had been waiting more than 60 days. The wait list at the Veterans Health Care of the Ozarks (VHCO) in Fayetteville was down to zero.

CAVHS Deputy Chief of Staff Catina “Tina” McClain, MD, said they have been fortunate here in Central Arkansas that they have never really had big numbers of patients waiting for care.

“Access has been one of our strong suits,” McClain said. “Overall, our access here has been and continues to be doing very well. The numbers have come down since we accelerated care in late May, and we were given the opportunity to outsource some of our procedures to our colleagues in the healthcare community. We do have some capacity issues at times depending on demands for services. For example, one of our neurosurgeons has retired and it took a while to find someone to replace him.”

CAVHS serves about 65,000 veterans and has eight Community-Based Outpatient Clinics (CBOCs) throughout the state. In addition to CAVHS and VHCO, there are sister VA facilities in Memphis, Tenn., Poplar Bluff, Mo. and Shreveport, La., that veterans living nearby in Arkansas can access.

“Most veterans don’t have a great distance to travel to get to a primary care clinic,” McClain said. “A challenge is that some of the clinics are fairly small, with only one or two providers. That may be adequate for the number of veterans, but, if you have a provider who resigns or retires, capacity in those clinics can be cut dramatically. Recently, we had a vacancy in Searcy, and the numbers you see on our electronic wait list are for primary care services in Searcy. We have been actively recruiting to fill that position and want to fill it with very qualified staff. We are choosy to make sure veterans get the best care.”

During the vacancy, veterans in the area can travel to another CBOC or get a telemedicine appointment. There are two physicians who retired from CAVHS who decided to come back and do some fee-based services in Searcy.

McClain said telemedicine is primarily used for specialty care. For example, if a veteran in Mena or Mountain Home needs to see a psychiatrist, he or she can hook up with a VA psychiatrist in Little Rock through telemedicine.

They also have the ability to do retinal eye exams through telemedicine, or a routine screening for veterans with diabetes.

“Telemedicine is a growing program,” McClain said. “We have also started to expand into other specialty areas like pre-op visits. If a veteran from Fayetteville is referred here for surgery, the veteran can be seen via V-Tel secured video conferencing. The pre-op visit can be done at the home facility, and save a trip to Little Rock. We anticipate being able to do post operative visits through telemedicine.”

McClain said they are fortunate to have a wide range of services.

“We have more resources than any other entity I’m aware of with regard to mental health services,” she said. “We have vocational rehab, services for the homeless, and we are a teaching hospital. We work closely with our academic affiliate, the University of Arkansas for Medical Sciences, as well as academic affiliates throughout the state for nursing, physician’s assistants and social work programs.

“We have expanded our services available for post traumatic stress disorder (PTSD). We have been able to grow the number of evidence-based therapies offered to veterans with PTSD. We also have a very active residential treatment program for PTSD that is recognized nationwide. We have veterans from all over the country come to our program here in Little Rock. This is an eight-week, really intense therapeutic intervention. We are really proud of that program.”

The silver lining about the scandals around VA healthcare is that more money is being appropriated to address the problems. McClain said her main concern is that at times negative attention can erode trust.

“We are being very diligent to try to insure we retain the trust the veterans in Arkansas have placed in this center,” she said. “We believe we deliver high quality care and a wide breadth of services. We want to make sure we remain their provider of choice. We want to make sure we do everything we can to exceed their expectations. We know they have other choices, and are glad our veterans have choices. But we certainly want to be their provider of choice.”

Wanda Shull, public affairs officer for VHCO, said at its highest, their waiting list had a little more than 300 veterans. Shull said they have been able to decrease the wait list to one by taking the following steps:

Aggressively recruiting primary care physicians.

Making evening and Saturday clinic appointments available.

Increasing provider panel sizes as appropriate.

Using contracts for providers.

Using nurse practitioners as providers.

Increasing salaries to attract providers.

The salary issue is important because healthcare jobs elsewhere often pay more.

“However, we have recently been able to increase our salaries, which we believe has helped us with recruitment,” Shull said. “Further, our primary care doctors enjoy all of the benefits afforded a federal employee. We are always actively recruiting physicians and nurse practitioners for primary care.”

VHCO has some of the highest patient satisfaction ratings amongst VAs in the country. It was awarded the Robert W. Carey Award for Performance Excellence in 2011, as well as the Circle of Excellence Award in 2012 and 2013. In 2013, it was awarded the Arkansas Governor’s Quality Award.

“Our high standard of care has been validated many times by outside entities, and we are proud that our quality is recognized,” Shull said. “Any veteran who is not currently enrolled in care here is highly encouraged to apply. We believe we have the skills and qualifications needed to serve the unique needs of veterans, and we take pride in our goal to provide quality health care where veterans come first.”

For more information:

www.littlerock.va.gov/

www.fayettevillear.va.gov/