- Associated Press - Thursday, April 9, 2015

BOISE, Idaho (AP) - Patients seeking care at the Veterans Affairs hospital in Boise continued to experience some of the longest waits for care in the entire VA system, even after Congress appropriated billions of dollars to help fix chronic delays, according to government data reviewed by The Associated Press.

One in 16 medical appointments completed at the hospital between Sept. 1 and Feb. 28 involved a wait of at least a month, according to VA statistics, and 1,000 of those appointments took longer than 90 days to complete.

That means there were more veterans facing delays of more than 90 days at that one hospital in Boise than there were in 45 states.

The Associated Press reviewed six months of medical appointment data at 940 VA hospitals and clinics to identify the facilities struggling the most with long waits and to see how things have improved since last year’s scandal over long wait times and attempts to cover them up.

The analysis showed that, nationally, the number of delayed appointments hasn’t dropped, despite VA reforms, and the passage of law last August that gave the agency an additional $16.3 billion to hire doctors, build new facilities, and expand a program that sends veterans to private-sector doctors if they can’t get timely care at a VA hospital.

Only a handful of VA hospitals in the country struggled more that Boise to meet the department’s timeliness standard, which calls for patients to get care within 30 days.

Wait times are dramatically lower at all other VA facilities in Idaho, where fewer than 2 percent of patients faced delays of more than a month, according to the VA’s numbers. But those facilities - in Twin Falls, Pocatello, Coeur d’Alene and Lewiston - are all clinics that mainly provide primary care. The Boise VA Medical Center is the only VA hospital in the state, responsible for providing treatment for cancer, neurological problems and other specialty medical care.

Grant Ragsdale, associate director of the Boise VA Medical Center, says patients seeking primary care or mental health treatment at his facility are nearly always seen in 2 days or less. It’s the medical specialties that pose a problem, though Ragsdale says the medical center is making strides in addressing the issue.

While the overall number of delayed appointments at the hospital hasn’t budged, the number of patients who have to wait more than 90 days has steadily declined, from 246 in September to 140 in February.

“There’s probably a number of reasons that our times have improved,” Ragsdale said. “The primary one is that all of our issues have been related to access to specialty care, and one of the primary offenders for us has been ophthalmology - access to eye care.”

The facility struggled to recruit an eye doctor for months, Ragsdale said, but in January, an ophthalmologist started at the facility and is now full-time. The facility has also brought on orthopedic surgeons in recent years.

Gastroenterology is a problem area, Ragsdale said, with private providers typically earning more than the federal agency pays. The Boise facility currently contracts with private GI docs.

“Obviously with our population that’s a high demand service,” Ragsdale said. “If two or three knocked on our door today, we would hire them.”

Travis JD Riggs, the local president of the union that represents employees at the Boise facility, said the salaries offered by the VA aren’t competitive, and that leads to turnover and staff shortages for all positions.

“Clerks, nurses, police staff - we’ve been advertising for a plumber to come to our station for months and we’re just not competitive,” Riggs said. “The front-line staffing is definitely the biggest issue, and it’s where we need the most funding.”

Employees typically work through breaks or lunches, but the vacancies are affecting morale, he said.

In August lawmakers passed the Veterans Access, Choice and Accountability Act, intended to ease wait times by giving veterans the option of getting care outside the system if they’ve waited for more than 30 days to see a VA health care provider. Through late March, only 46,000 patients nationwide had made appointments for private-sector care.

Of the Boise VA’s patients who have waited more than 30 days, only 2 percent have exercised the Choice option, Ragsdale said. He said the facility doesn’t leave veterans needing urgent or emergency care waiting, working with outside facilities or referring patients to VA facilities in Seattle and Portland, Oregon.

Meridian resident Carl Oseen, a Korean War veteran who is a patient at the Boise VA hospital, said he’s never had trouble getting timely care at the facility. Oseen, 83, said he has congestive heart failure, eye problems and other issues and generally has at least one appointment a month at the Boise hospital.

“When I needed bypass surgery, since they don’t have a heart clinic in Boise they sent me up to the VA hospital in Portland and everything was done in a timely manner,” Oseen said. “I’ve had no trouble at all - they bent over backwards, they’re fantastic.”

Phone messages left by The Associated Press with Boise-area veterans’ groups weren’t returned.

The number of vets seeking care is expected to increase as those who served in Iraq and Afghanistan age.

Enrollees in the nation’s VA system have ballooned from 6.8 million in 2002 to 8.9 million in 2013. During the same period, outpatient visits soared from 46.5 million to 86.4 million annually.

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