Secretary of Veterans Affairs, James B. Peake, M.D told the new Veterans Rural Health Advisory Committee members how important it is to provide outreach and consistency in care to all veterans whether living in urban or rural areas. The meeting held on September 16th in Washington D.C. was established to examine the programs and policies affecting the many veterans that now live in low populated areas.
Veterans Affairs Under Secretary for Health, Michael J. Kussman, M.D., appeared at the advisory committee meeting to point out that even though there are only seven people per square mile in highly rural areas that still means there are a lot of veterans to treat in those areas. It is especially important to focus on helping veterans with mental health and substance abuse programs. In many of these areas, there are enormous challenges to meet since many of these areas even today do not have good roads and lack the necessary technology to communicate.
Dr. Kussman commented reports that there are 23 million veterans in the U.S., 8 million enrolled in the system, with over 5 million routine users but not necessarily patients. The VA foresees a decline in the overall number of veterans in the future, but expects that veterans 85 and older seeking care will stay pretty constant over the next 5 years.
Dr. Kussman proposes that changes are going to have to be made to accommodate the VA’s needs in the future. For one thing, the VHA is looking ahead and debating what to do with the 157 VA hospitals with 20% located in rural areas with the average age of 57 years. The problem is that hospitals can only be retrofitted with new technology to a certain point. If new technology is installed then larger rooms and different room arrangements are required. The cost to demolish walls and buildings is enormous and building new hospitals can cost $500 to $600 million to build so this means that in the future, the VA will need to look at alternative ways to provide healthcare.
According to the Under Secretary, the question is do we really need to build more hospitals or do we need to move more and more in the direction of ambulatory care. Right now 90-95% of care for veterans is provided in ambulatory settings.
He suggested several options. For example, in a community in rural Texas, if veterans need to go to a hospital, then they have to drive five hours to the hospital in San Antonio. If the right programs were put in place, then 98% of the time, treatment could be provided locally by using a full care center in an ambulatory environment. If some patients needed to be admitted to the hospital, then contacts could possibly be made with some of the best medical facilities in the rural area or a close by town to accept veterans with serious medical needs.
The goal is to put services close by but not necessarily attached to a hospital. Leasing beds in a fully staffed medical facility will save the VA money since the VA wouldn’t need to build their own bricks and mortar hospital and would be able to provide services closer to home. Patients with complex medical situations could still go to a full center providing complete services.
Kara Hawthorne, MSW, Director, Office of Rural Health mentioned several new initiatives serving rural veterans. Three new Veterans Rural Health Resource Centers are to open on October 1, to help improve healthcare for veterans. These centers will serve as satellite offices for the Office of Rural Health. Each resource center will be staffed with administrative, clinical and research staff who will identify disparities in healthcare for rural veterans and develop practices or programs to improve care delivery.
In addition, ten new outreach clinics are scheduled to be opened by 2009 along with four new mobile health clinics to bring primary care and mental health services closer to serve veterans in 24 predominately rural counties in six states.