VA care: Like rest of nation, Nevada has problems

When it comes to delays plaguing the Veterans Affairs health system, Nevada generally does better than much of the rest of the nation, but can do better, according to government data reviewed by The Associated Press.

Other areas of the country fared better, including Nevada, but the state still had more than 14,400 medical appointments completed between Sept. 1 and Feb. 28 at the VA’s two hospitals and nine outpatient clinics in Nevada failed to meet the department’s timeliness goal, which calls for patients to be seen within 30 days, according to government data reviewed by The Associated Press.

A year after Americans recoiled at revelations that sick veterans were getting sicker while languishing on waiting lists, VA statistics show that the number of patients facing long waits has not declined, even after Congress gave the department an extra $16.3 billion last summer to shorten waits for care.

In Nevada, the outreach clinic in the northern mining town of Elko faced the worst delays in the state at 7.6 percent. Officials and veterans say a doctor shortage has contributed to the problem.

The town’s small clinic, staffed by two nurses, is visited by a Salt Lake City physician once a month for a week at a time. Otherwise, patients meet with the physician via teleconference.

Of Nevada’s nine VA medical clinics, only four beat the national average for percentage of delayed appointments.

But the Sierra Nevada VA hospital in Reno was ranked 102 among the 940 facilities nationwide for its rate of delays at 5 percent for the six-month period.

Of the cases at the newer Southern Nevada hospital in North Las Vegas, 3.4 percent were delayed for at least 30 days.

But neither of the state’s two VA hospitals, including the Southern Nevada VA hospital that opened in 2013 after going over budget by some $260 million, reported improvements in the number of patients facing delays.

Nearly 894,000 appointments completed at VA medical facilities across the nation from Aug. 1 to Feb. 28 failed to meet the health system’s timeliness goal, which calls for patients to be seen within 30 days. More than a quarter of those appointments involved a delay of longer than 60 days.

Since the summer, the number of vets waiting more than 30 or 60 days for non-emergency care has largely stayed flat. The number of medical appointments that take longer than 90 days to complete has nearly doubled.

Those delays were not spread evenly throughout the VA’s vast network of hospitals and clinics.

Many occurred in a handful of Southern states, often in areas with a strong military presence, a rural population and patient growth that has outpaced the VA’s sluggish planning process.

Of the 75 clinics and hospitals with the highest percentage of patients waiting more than 30 days for care, 12 are in Tennessee or Kentucky, 11 are in eastern North Carolina and the Hampton Roads area of Virginia, 11 are in Georgia or southern Alabama and six are in north Florida. Seven more were clustered in the region between Albuquerque, New Mexico and Colorado Springs, Colorado.

Those 47 clinics and hospitals represent just a fraction of the more than 1,000 VA facilities nationwide, but they were responsible for more than one in five of the appointments that took longer than 60 days to complete.

The analysis reveals stark differences between the haves and have-nots.

In the Northeast, Midwest and Pacific Coast states, few VA sites reported having significant delays. A little less than half of all VA hospitals and clinics reported averaging fewer than two appointments per month that involved a wait of more than 60 days.

But at the VA’s outpatient clinic in Jacksonville, Florida, 7,117 appointments completed between Sept. 1 and Feb. 28 involved a wait of more than 60 days. There were more vets experiencing extended delays there than in the entire states of New York and Pennsylvania combined.

VA officials cite numerous efforts to ramp up capacity by building new health centers and hiring more staff. Between April and December, the system added 8,000 employees. In Fayetteville, the VA is finishing a new 250,000-square-foot health center to help alleviate the delays.

And they say that in one statistical category, the VA has improved: The number of appointments handled by VA facilities between May and February was up 4.5 percent compared to the same period a year earlier. Referrals to private sector doctors are rising.

But they also acknowledge that in some places, the VA is perpetually behind rising demand. Total enrollees in the VA system have ballooned from 6.8 million in 2002 to 8.9 million in 2013.

In the Choice program, between Nov. 5 and March 17, about 46,000 patients had made appointments for private-sector care through the new option — a drop in the bucket for a system averaging 4.7 million appointments per month.