This part of the country is on my bucket list of places I want to visit some day

“El Paso Skyline” by Camerafiend at the English language Wikipedia. Licensed under CC BY-SA 3.0 via Wikimedia Commons – https://commons.wikimedia.org/wiki/File:El_Paso_Skyline.jpg#/media/File:El_Paso_Skyline.jpg

because the   scenery looks spectacular.  However veterans in the region have a tough time accessing VA health services and their complaints to Rep. Beto O’Rourke resulted in a new OIG report (published Dec. 2, 2014).  This system illustrates the hodge-podge nature of care in West Texas which would be fine if it were managed well.  In this case, it’s not. Apparently, the VAMC in El Paso does not provide direct care to the 41,000 enrolled veterans (30,000 active patients).

The VAMC, which is located adjacent to an Army Medical Center, and Community Based Outpatient Clinics provide primary care and specialized ambulatory care services. The VAMC does not directly provide inpatient or emergency room services and instead purchases those services from the Army, local private hospitals, the New Mexico VA Health Care System in Albuquerque, or other VAMCs in the region.

A footnote explains that “The El Paso VAMC is located on Fort Bliss, the second largest U.S. Army installation, which is currently home to 30,000 soldiers and their families.” So is the El Paso VAMC staffed by administrators and clerical employees–no VA physicians?

There are two clinics for veterans but they are essentially competing with active duty servicemen and the civilian community for care.  New veteran patients had the longest waits. Low physician productivity was found in psychology, primary care, cardiology, and urology. Veterans had to wait an average of 73 days to see a cardiologist but I don’t see a cardiologist listed in their “Our Doctors” list although two doctors are certified in cardiac diseases.

El Paso Primary care providers have some valid complaints of their own:

…the “volume of non-credit workload was “astronomical.” One long-time provider reported seeing 18 to 23 patients on average per day when he first came to the facility 19 years ago. The provider expressed the perception that as a consequence of over-emphasis on metrics and “dotting I’s and T’s” his productivity has steadily decreased over time. The provider pointed to secure messaging as an example. Since implementation over the past year, the provider reports receiving between 50 and 100 secure messages from patients per day for which a response is expected. 

This seems like a completely reasonable explanation since I know the feeling of dread I feel if I’ve not checked my email for a few days.  My spouse uses (not abuses) secure messaging to keep an electronic record of his complaints and they are answered by his nurse within a few days. And yes, she sometimes sounds harried.  (If an El Paso PC doc is getting 100 messages a day, what are Minneapolis VA docs getting?)

The East Side El Paso VA Clinic (CBOC) is out sourced but to whom? Tri-West?

My takeaways from this report is that it is not transparent or that helpful because it is silent on system-wide problems.  It doesn’t highlight the paltry number of physicians paid to provide care.  It doesn’t clearly tell us which company staffs the Community Based Outpatient Clinics (CBOC).  The report does not address number of veterans eligible for Veteran Choice cards although Tri-West Alliance is participating in the Choice program in El Paso at a private hospital according to one reporter!  The Tri-West website for veterans is confusing because it just covers the PC3 program.  The OIG report does not provide guidance on outreach even though the public relations department needs a kick in the pants.

OIG’s emphasis on physician productivity is a smoke screen since only a few providers are having severe problems in that area.  We don’t need to see more charts on how a doctor’s day is divided up, how long average lunch breaks are (very short), and so forth.  What we need to see is how they are going to hire (in-house, out-house) providers and retain good ones with appropriate incentives.  And how veterans who live over 40 miles from El Paso, can opt-in and use their Veterans’ Choice cards immediately. Blaming VA-paid private physicians, already suffering from workload burn-out, for VA administrative failures is just going to increase regional physician shortages.  This is a stupid approach if the VA is serious about backlogs and quality care.  (Harumph….)

Ed. Note Kiedove sure hit this one out of the park. We’re seeing this mentality ferment at VAMCs all over the fruited plain and it disturbs me mightily. VA’s mindset is “Okay, fine. We don’t know what we’re doing. Is that what you’re saying? Fine. Then here. You do it and see if you can do any better. Bet cha can’t!”

Instead, they should be looking at the format they’ve imposed and the impossible  regimen-versus-patient workload. A doctor should be allowed to doctor. Anytime you take him away from that primary responsibility and turn him/her into an admin. clerk is ill-advised yet this is what VA has done. It’s the VA micromanagement nightmare of the year. The civilian counterpart is simple.

1)Call nurse or email.

2)Leave message.

3)Wait for nurse to stick head in door and ask doctor quick question.

4)Report back to patient.