- Associated Press - Thursday, April 9, 2015

CONCORD, N.H. (AP) - While Veterans Affairs facilities in New Hampshire are doing well in meeting the health system’s timeliness goals, they serve only a quarter of the state’s veteran population. Advocates hope a new program will direct veterans to the VA system and improve the care they receive in other settings across the state.

New Hampshire has the fifth-highest ratio of veterans in the United States, with 115,000 veterans making up nearly 11 percent of the state’s population. But the state does not have an active duty military installation where veterans can easily find support and services, and it is one of a few states without a full-service VA hospital.

In addition to the VA medical center in Manchester - which was downgraded from a full-service facility 15 years ago - smaller outpatient clinics are in Conway, Keene, Littleton, Portsmouth, Somersworth and Tilton. Between September and February, all but Portsmouth ranked above the national average for seeing patients within 30 days, according to government data reviewed by The Associated Press.

Nationwide, wait times haven’t declined since Congress gave the VA $16.3 billion in August to hire more doctors, open new clinics and expand a program designed to make it easier for veterans who cannot get timely appointments to obtain care outside the department’s facilities.

But waits throughout the Northeast, Midwest and Pacific Coast states are generally mild. Many of the delay-prone hospitals and clinics are clustered within a few hours’ drive of each other in a handful of Southern states, often in areas with a strong military presence, a partly rural population and patient growth that has outpaced the VA’s sluggish planning process.

In Portsmouth, 1 in 28 patient visits between September and February involved a delay of at least a month, compared to roughly 1 in 35 nationally. Other New Hampshire clinics performed well, particularly the Keene facility, which was one of 21 nationwide that had no delayed patients during that time. The Manchester facility, which accounts for nearly 86 percent of the state’s total patient visits, 1.5 percent - roughly 1 in 67 - patient visits involved a delay of at least a month.

The numbers in Portsmouth represent normal variation in patient access, and show improvement over time, said Kristin Pressly, a VA spokeswoman. She said the Manchester facility has made several recent improvements, including expanding shuttle service to get patients to the clinic and hiring three new full-time physicians and additional support staff.

In podiatry, the clinic added a technician to help manage low-risk patients, which Pressly said resulted in a significant reduction in wait time for appointments.

“Some of what contributes to improved access is placing the right staff in the right role to provide services,” she said.

Still, only 30,000 of the state’s 115,000 veterans receive their health care through the VA system, said Jo Moncher, head of community-based military programs at the state Department of Health and Human Services. Her office is launching a new program called “Ask the Question” to educate civilians in better serving veterans.

The program, which will be run by Easter Seals NH, will include a statewide campaign to encourage health care providers, social service organizations and others to ask patients and clients if they had served in the military. A second program coming later this spring will train health care providers and others in military culture, which should ensure that providers understand veterans and know where to refer them, Moncher said.

“We really did not have a good picture of the care veterans were receiving across the military and civilian sectors, and we realized, how can we address this issue if we’re not tracking the data?” Moncher said.

Veterans have a host of reasons for seeking care elsewhere - some don’t know they’re eligible, others have other insurance or seek treatment closer to home. Moncher hopes the new programs will bring military and civilian providers together to make sure they don’t slip through the cracks.

“Our goal is to steer them to health care, whether that’s the VA or non-VA,” she said. “The responsibility for serving our military and their families belongs to all of us.”

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