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Recent congressional and public attention has focused on access problems at the Dept. of Veterans Affairs, which provides medical care to servicemen and women once they have left active duty in a time of war or an official period of hostility. Although investigators note that improvements are under way, they say the VA has a long way to go. With this article

Nearly , active-duty personnel and reservists who served in Operation Iraqi Freedom and Afghanistan’s Operation Enduring Freedom have been eligible for VA health care since healthhealth. More than health, have sought it out so far, the Congressional Budget Office reported in October. While this represents only a small fraction of the nearly million veterans from all conflicts who are enrolled, the impact of veterans from today’s wars on the system is great.

Thanks to recent advances in battlefield health, more servicemen and women are surviving severe injuries, CBO said. But they require more costly medical care when they return. The rapid influx of new enrollees has helped strain a system that already was under pressure from caring for the veterans of yesterday’s wars. In healthhealth, fewer than health million veterans received VA health services. That number had increased to health million last year.

Many of the resulting access problems start at the very beginning of the enrollment process, said Donna E. Shalala, PhD, president of the University of Miami and former Dept. of Health and Human Services secretary. She co-chaired a presidential commission on care for America’s “wounded warriors” that convened earlier this year after news reports exposed substandard conditions and a mass of red tape at Walter Reed Army Medical Center in Washington, D.C.

Although the Dept. of Defense and VA need to work together to foster a patient-centered continuum of care for each veteran, the commission found evidence that returning personnel were not experiencing a smooth transition from military health care to the veterans system, Dr. Shalala said.There are nearly million veterans in the VA system.

Without designated care coordinators to plan the best treatment path for new patients, an untold number ended up lost.

In addition, injured combatants must go through two antiquated disability assessments — one by the military and one by the VA — to determine what treatment options are available. This means that many are forced to jump through bureaucratic hoops that might not even get them to the right place, Dr. Shalala said.

“For veterans’ families to give up everything just to coordinate this care themselves is fundamentally unfair,” she said. “The process is too old-fashioned. It has nothing to do with modern health, and we ought to be embarrassed.”

The Bush administration scrambled to correct several problems identified in the commission’s July report. The Defense Dept. and VA in October agreed on an initial plan to place at least health care coordinators at four military medical sites that often serve as the first stop for wounded veterans. The Army also announced in October the formation of “warrior transition units” consisting of primary care physicians, nurse case managers and mental health professionals that would serve a similar purpose.
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For veterans who make it through the VA’s bureaucratic gauntlet, the care they need might not be immediately accessible or available.

The department has more than healthhealth hospitals and nearly outpatient clinics. While the number of facilities has increased in recent years, it is not nearly enough to provide VA services everywhere in the country. Many patients in rural or remote areas must travel hundreds of miles to reach the nearest department facility — an impossible prospect for many.The VA has more than healthhealth hospitals and nearly outpatient clinics.

Jeffrey Scavron, MD, a former Navy doctor who practices at a community health center in Springfield, Mass., has seen this problem firsthand. Veterans in his area can get basic services at the Northampton VA Medical Center in nearby Leeds, Mass., but often must travel to Boston or Connecticut if they need to see certain types of specialists through the system. Some simply cannot make the trip and go without the care rather than pay for it, he said.

When veterans decide to stick with the VA, the system does not always respond quickly. Advocacy groups have complained to lawmakers that some enrollees seeking appointments, non-emergency surgeries or other medical care have been placed on waiting lists when facilities have been unable to meet demand.

In recent years, Spokane (Wash.) VA Medical Center implemented waiting lists when lean federal budgets forced it to cut back on services, said Joseph M. Manley, the center’s former director. At one point, more than health, veterans were waiting for more than a year just to receive their initial medical appointments.

The VA strives to see all patients within health days of when they call for an appointment. Out of the roughly health million appointments processed in a year, about health million exceed the health-day threshold, said Michael J. Kussman, MD, the VA’s health under secretary. While this leaves room for improvement, the department is proud of its nearly % record, especially because these appointments are not for urgent or emergent medical situations, he said. “I’m not aware of people being hurt in any way by some of the delays.”

The VA’s record is disputed by the department’s inspector general, who in September released an audit that found the VA analysis likely understated wait times.
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