Steven A. Davis, a Vietnam veteran, visits the Providence VA Medical Center about once a week.
Davis goes there for a host of reasons: Back pain, sleep apnea and ulcers from years of popping Motrin to ease severe neck pain. Six years ago doctors at the VA hospital in Jamaica Plain removed one of his vertebra and two discs, replacing them with a bone from his hip, fastened by a plate and four metal screws.
“I’m a mess,” said Davis, a Providence resident who served in the Navy from 1971 to 1975, including a year-and-a-half stint on the aircraft carrier Constellation. “But I go to the VA for everything – dental work, checkups, I could get eyeglasses or a wheelchair if I needed it. They do very good by me.”
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Davis is among some 40,000 veterans in Rhode Island and Southeastern Massachusetts who are enrolled to receive medical care at the Providence VA Medical Center on Chalkstone Avenue – a big increase from years past. Without the VA, many vets, like Davis, would likely slip through the cracks of the health-care system, left to subsist on a patchwork of Medicaid, Social Security and free care.
Although the Providence VA Medical Center has been reinvented over the past decade to handle swelling demand, more changes could lie ahead.
In June, the Veterans Affairs Administration began a study called the Capital Asset Realignment for Enhanced Services (CARES), which could lead to an overhaul of the country’s largest integrated health system, with 1,300 facilities and a $48 billion annual budget. The goal is to streamline the massive system’s capital assets to meet the changing health needs of America’s veterans.
CARES measures supply and demand
Government auditors have long criticized the VA health system for waste and inefficiency. The U.S. General Accounting Office called for the CARES study in 1999 after finding that the VA was spending far too much money on maintaining unneeded buildings and obsolete equipment – as much as 25 percent of its overall budget.
Under CARES, consultants have been gathering and analyzing data since June on the country’s 22 regional VA health systems, projecting potential gaps and redundancies in facilities and services based on market share and demand projections 10 and 20 years out.
That data, set for completion next month, will be used to form a plan for each VA market, which could run the gamut from adding services and facilities to closing clinics or even hospitals. Once those plans are drawn up, the VA plans to solicit input from “stakeholders” – patients, employees and unions, medical school affiliates, local and Congressional officials and others. The final decision on the various plans for each VA market will be made by the Secretary of Veterans Affairs in August.
The CARES study has fostered consternation among veterans and VA hospitals in some parts of the country. Under a pilot CARES program in Chicago, the VA decided to discontinue inpatient care at a downtown VA hospital.
Vincent W. Ng, director of the Providence VA Medical Center, emphasizes that there is no way of telling what the study will recommend for the Providence system. But given its rapid growth in recent years, Ng said he doubts there will be any proposals to shutter facilities.
“Upgrades or new additions are possible, but we’ll have to justify those,” Ng said. “The CARES study is going to help us justify future investments and ensure that our capital dollars are being put to the best possible use.”
Added James W. Burrows, the VA Medical Center’s compliance/public affairs officer: “We don’t know what the final decision will be, but I can’t envision a scenario that would say we have more resources than we need. I think Providence will fare very well.”
Explosive growth
The Providence VA Medical Center serves vets from Rhode Island, southern Massachusetts (from Plymouth south, including Cape Cod) and eastern Connecticut. Its patient volume has grown roughly 20 percent annually over the past three years, Ng estimates.
Last year the center treated nearly 25,000 vets. Altogether, 40,000 vets are enrolled to use the Providence VA Medical Center’s services – including 6,000 new enrollees since December – and 4,000 are on a waiting list.
Why the surging demand?
One obvious factor is that veterans are aging and requiring more medical services. But the loosening of eligibility requirements for veterans to receive care at VA hospitals also has added to demand.
Historically, only veterans with “service-connected disabilities” were eligible to receive care. But a law passed by Congress in 1996 opened the floodgates to the VA health system, making eligible any honorably discharged veteran.
Gradually, veterans in southern New England have clamored to enroll in Providence’s VA system. The medical center historically averaged a 10 to 12 percent market share of the veterans in its service area, Ng said. That has jumped to 25 percent in recent years.
“A lot of people jump to the false conclusion that because the World War II population is declining, therefore the workload for the VA is declining too,” Burrows said. “That’s not true.”
Ng added that the reputation of the VA has been transformed over the past decade, and, he asserts that will continue to draw vets to the system.
“We like to say ‘This isn’t your father’s VA,’” Ng said. “It’s not like when you would come to the VA and only get a doctor’s visit. You really do get comprehensive, coordinated health care.”
The Providence VA Medical Center, like other VA hospitals, has shifted away from an inpatient focus to an emphasis on outpatient primary care.
Over the past five years, the Providence VA has opened four new outpatient clinics, bringing its total to five, with clinics in Middletown, New Bedford, Hyannis, Nantucket and Martha’s Vineyard. He said 80 percent of the care provided by the Providence VA is now given on an outpatient basis.
The number of authorized inpatient beds has been trimmed from more than 200 several years ago to just 66 today, as inpatient units have been converted to exam rooms. But the hospital’s occupancy rate runs near 90 percent, Ng said, and he anticipates adding beds in coming years – a rare move in hospitals these days.
Until recently, Providence VA veterans had a sweet deal on prescription drugs: a $2 co-pay for a 30-day supply of most medications. That payment, however, was boosted to $7 earlier this year.
The center also offers long-term care, contracting with about 35 hand-picked nursing homes, as well as home-health agencies, so that veterans can move to a quality provider. The VA even does its own inspections of nursing homes.
Providence VA patients also have access to dental care, optometry services and hearing aids. The hospital, which is a Brown Medical School teaching institution, also oversees a $4 million research budget. It has more than 75 research projects ongoing, Ng said, about half of which are focused on post-traumatic stress syndrome and substance abuse.
In addition, the VA offers an extensive substance-abuse treatment program, mental and behavioral health services – including a post-traumatic stress disorder clinical team – and a strong prosthetics program.
For Davis, the broad scope of services is a godsend.
“I love the VA,” he said. “Without it I wouldn’t have anything.”
