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Brad Wenstrup and Steve Stivers have strong opinions on how to fix the Department of Veterans Affairs’ delays in medical care, but they’re also interested in hearing what providers on the front line have to say.

That’s why the Republican congressmen, each of whom represents part of Ross County in the House, visited the Chillicothe VA on Monday for a brief tour of the medical center and a sit-down with its top administrators.

The visit comes as the VA system is still reeling from the discovery of secret wait lists at the Phoenix VA that concealed how many veterans were waiting for procedures and consultations.

Wenstrup and Stivers, R-Columbus, are veterans themselves, each having served in Iraq. Wenstrup, who’s also a physician, was named in June to the House’s VA Conference Committee, a bipartisan panel that’s tasked with reconciling differences in proposed reforms to the VA.

“We’re trying to get to as many of the VA (hospitals) and outpatient facilities as we can. The purpose is to listen to the administrators and see what their frustrations are,” said Wenstrup, R-Cincinnati. “One expression I’ve heard since this all began is, ‘If you’ve been to one VA, you’ve been to one VA.’ They’re all different.

“I want to hear what kinds of problems they’re having, what slows them down when providing care and what positives they’re seeing, too.”

In a candid discussion with Wendy Hepker, director of the Chillicothe VA, and Dr. Deborah Meesig, the medical center’s chief of staff, the congressmen aired some of their concerns while also asking the local administrators where their frustrations lie.

Wenstrup emphasized one of his principal arguments — the VA must look to physicians outside its system to help meet the health care demands of veterans.

“I see America wanting to be part of the solution. Doctors outside of the VA are willing to help,” he said. “If we ignore this patriotic willingness to help, it would be silly.”

Private hospitals and practices are driven by the need to be efficient, Wenstrup told The Gazette.

“If’ you’re going to keep your doors open, that patient is an asset to you. You not only want to provide a high quality of care, you have to have productivity,” he said. “I think in a lot of VA settings, there’s good quality, but the productivity is bogged down by more paperwork. When you reward a short wait list rather than high productivity, I think that’s where we get into trouble.”

Veterans are “dying in the waiting line” at the VA, Stivers said, and “part of it is driven by the fact the VA is a separate system that’s closed off to the outside health care world.”

The Chillicothe VA, which treats about 22,000 veterans a year, already is sending its patients to non-VA doctors, said Hepker, who also touted a new system — created within the past 90 days — that follows veterans through their care to ensure they’re being treated.

“We’re partnering with (patients). We’re shifting staff around and adding others to help with the program,” she said.

As of Monday, fewer than 200 patients were awaiting appointments that were still 60 to 90 days out, she said. So far this year, 5,000 veterans served by the Chillicothe VA have been seen by non-VA doctors, she said.

Stivers said he is concerned about some veterans receiving multiple cancellation notices from the same doctor. Hepker acknowledged the issue and said it can stem from physicians who are the only ones in their specialty, but she also cited problems with noncompliance from patients.

Asked whether there were any messages they wanted to send to Congress, Meesig complained about the pay scale for specialists, which she said hurts the VA’s ability to recruit physicians. Meesig said it’s difficult to attract quality candidates when the VA is paying neurologists and pulmunologists the same salary it pays primary care physicians.

Hepker said she would like for VA medical centers to have more “local flexibility.“

“I talk to veterans in my community. I know their needs and I try to structure our system around them,“ she said. “The CEO of Adena (Medical Center) would have a hard time running his facility if he had someone a thousand miles away telling him what he can and can’t do.”

Wenstrup and Stivers both support reform that would allow veterans to more easily seek treatment outside the VA for common medical needs and allow the VA to focus largely on soldier-specific medical issues such as Agent Orange, prosthetic care, traumatic brain injuries and post-traumatic stress disorder.

The two words that keep popping up in VA Conference Committee discussions, Wenstrup said, are “choice” and “competition.”

Stivers is working on a bill that increase veterans’ access to non-VA doctors. The tough part, he said, is finding a way to pay for it.

“One of the ways to pay for it is to tell the VA to focus on fewer things and do them better,” he said. “But that will be a big change for some people and could be controversial.”
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