VA pilot program brings health specialists closer to home for veterans in northern Maine

By JACKIE FARWELL | Bangor Daily News, Maine | Published: May 23, 2014

After Peter Miesburger broke his hip in January, the retired U.S. Air Force master sergeant underwent an operation to have it replaced with an artificial joint at his local hospital in Caribou. His family visited every day while he was recovering, and he drove just a few miles home after he was discharged by his doctors.

Miesburger would have had a lengthy drive to the veterans hospital in Augusta, if he lived in nearly any other part of rural Maine, but Cary Medical Center is among five pilot sites in the country participating in a federal program that allows medical facilities outside the U.S. Department of Veterans Affairs system to provide treatment covered under veterans’ health benefits.

The Access Received Closer to Home, or ARCH, program is designed to allow veterans who live many miles from a VA hospital to get the care they need closer to home. The VA still oversees veterans’ care but contracts with non-VA providers under the program, which is due to expire later this year.

The ARCH program also saves Miesburger regular trips to Togus, the state’s sole VA medical center, for routine appointments. Every three months, a specialist drives from Bangor to Aroostook County to check on his high blood pressure and medications, he said.

“I don’t have to do that 500-mile round trip down to Togus, 10 hours on the road,” said Miesburger, a former state commander of the VFW in Maine.

Veterans young and old who live throughout northern Maine use the program, he said.

“It’s a win-win,” Miesburger said. “The veteran wins, the family member wins and it takes some of the workload off of Togus.”

The VA hospital in Augusta provides top-notch treatment, he said, despite a national scandal involving misconduct at other hospitals in the system.

“The whole system is getting a black eye,” he said. “I’ll tell you, Togus can’t get any better.”

The VA health system is at the center of a federal inquiry in light of allegations that long delays at the VA hospital in Phoenix may have contributed to 40 veterans dying while waiting for appointments.

Government officials are alleged to have falsified records to hide how long veterans waited to see their physicians. Dozens of VA hospitals around the country are now under investigation.

Togus, which served roughly 40,000 veterans last year, is not among them, according to Jim Doherty, a spokesman for Maine’s VA medical center. In 2013, more than 98 percent of established patients at Togus received primary care appointments within 14 days of requesting them, he said.

But new patients and veterans in need of specialty care waited longer. Patients visiting Togus for the first time — about 10 percent of overall number — waited an average of 30 days for an appointment last year, he said.

Doherty attributed the lag to turnover among medical staff, which resulted in patients being matched with new providers. Some patients also requested appointments far in advance, which counts against Togus’ tally, he said.

Patients with urgent health care needs are seen more quickly, sometimes the next day, he said.

“We get them right in,” Doherty said.

In some cases, the ARCH program resulted in shorter wait times for veterans, according to Kris Doody, CEO of Cary Medical Center. Togus patients from Cary’s service area who face a wait in Augusta may be referred to Caribou for earlier appointments, she said. Cary also has referred local veterans to Togus when more timely openings are available there, Doody said.

Veterans receive primary care at a VA-staffed clinic on the Cary campus. Under ARCH, patients can be referred to Cary providers for inpatient and outpatient specialty care, including oncology, orthopedics and physical therapy.

“We’ve had patients come up, even from the Millinocket area, to receive services,” Doody said.

Still, Maine veterans often face delays for specialty care. Togus met its goal of seeing specialty care patients within 14 days only 52 percent of the time last year, according to Doherty. Cary met the goal slightly less often under ARCH, at 49 percent of the time, he said.

Specialty care poses a tougher challenge, Doherty said. In rural areas, such as northern Maine, hospitals often struggle to recruit and retain physicians.

A federal evaluation of the ARCH program found Cary and the other four sites — located in Virginia, Kansas, Arizona and Montana — collectively fell short on specialty care wait times, meeting the two-week goal just 63 percent of the time. However, ARCH met or exceeded quarterly goals for timely primary care, urgent care, consultations and diagnostic services.

Ninety percent of participating veterans said they’d go back to an ARCH provider and would recommend the program to other veterans.

The August 2013 quarterly report, part of ongoing evaluations by health research and consulting firm Altarum Institute, recommended against expanding ARCH until more data is collected from the pilot sites, regarding the program’s cost effectiveness, the quality of care delivered and veterans’ satisfaction.

While Togus is “working to reduce delays wherever possible,” the purpose of the ARCH program is to allow veterans to seek care closer to home, Doherty said.

Since its launch in August 2011, the ARCH program has served 1,400 Maine veterans.

The program proved “tremendous for our veterans in Aroostook County,” including patients who avoided long trips to Augusta on treacherous winter roads, Doody said. It also has boosted patient numbers at Cary to the tune of millions of dollars — much-needed volume the rural hospital wouldn’t otherwise see, Doody said.

“It’s a model for the nation,” she said.

ARCH was due to expire this year, but the U.S. Senate Appropriations Committee approved a $165 billion fiscal year 2015 bill Thursday, which includes $35 million to extend the program requested by U.S. Sen. Susan Collins, a member of the Senate Appropriations Subcommittee on Military Construction and Veterans Affairs.

“I have talked to many Maine veterans who praise this highly effective, indeed life-saving, program. … Often veterans and their families are forced to stay overnight and miss work as a result of the distance they are forced to travel to receive care,” Collins said in a news release.

The bill must still be approved by the full Senate.