Bill Young VA Medical Center cardiology clinic speeds access to care

By WILLIAM R. LEVESQUE | Tampa Bay Times, St. Petersburg, Fla. | Published: August 19, 2014

SEMINOLE, Fla. (MCT) — With frequent media reports of long wait times at veterans hospitals, Melville "Mac" Gibbons didn't know what to expect when he called the C.W. Bill Young VA Medical Center and asked to see a cardiologist.

The answer the Navy veteran got surprised him: Come on down. Now.

The hospital, the fourth-busiest in the Department of Veterans Affairs system, recently launched a new Convenient Cardiology Consult Clinic, or the C-4 Clinic, that allows new cardiology patients to be seen by a heart specialist the same day they are referred by other physicians at the hospital. Such patients had waited an average of 42 days previously, Young VA leaders said.

In the C-4 Clinic, hospital officials said, the average wait is about three hours.

The clinic offers what the VA calls a "one-stop shopping" experience. Previously, cardiology patients might have seen their primary care doctor on one day, gotten a cardiac test on a second and visited a cardiologist on a third.

The C-4 Clinic allows veterans to boil that down to one day, the VA said.

Amid reports of long wait times across the VA system, the Young VA touts the program as one of the ways the agency is working to speed access to care.

"They told me to come down anytime," said Gibbons, 79, a St. Petersburg resident recovering from a heart attack who decided to visit the clinic the day after his request. "That was real nice, really prompt. It was a good surprise."

Beyond aiding veterans, the new clinic is also helping taxpayers' wallets. It saves the VA money by allowing cardiologists to determine what tests and procedures a veteran may require, officials said. Previously, a primary care physician scheduled the tests, often without a cardiologist's input.

Cardiologists, using their expertise, order fewer tests, the hospital said. The Young VA estimates that this has already saved $200,000.

Young VA administrators said veterans get the wrong impression about the quality and speed of VA care due to endless bad publicity this year as the agency weathered the worst scandal in its history.

Problems reported nationally include VA hospitals fudging performance measures such as patient wait times and treatment delays leading to deaths.

"I worry that people who are entitled to the care, who fought for it, who really should get it, will decide that they won't come to the VA for their care based on what they are hearing and won't give us a chance," said Dr. Dominique Thuriere, the Young VA's chief of staff. "This is an enormously well-endowed system. . . . We have really fantastic facilities and we have some awfully good staff."

The clinic started in February as a pilot program and recently was made permanent after positive patient feedback. Its goal, Young VA officials said, is always to see patients with serious symptoms or problems immediately.

The intent is to provide a better experience for veterans while also seeking cost efficiencies, said Dr. Anna Paszczuk, Young's acting chief of cardiology.

"We have always strived to improve patient access," she said.

The Young VA created the clinic mostly with existing resources. Only two additional staff members were hired — a nurse and a clerk. Paszczuk said it was simply a matter of streamlining the process and eliminating fat.

Cardiologists, Paszczuk said, were going to see the patients no matter what.

"It's not necessarily that we have more work," she said. "It's the same work. It just doesn't come with a two-week delay. We would have seen the patients anyway."

A big benefit for patients is the peace of mind that comes with seeing a doctor quickly.

"It's probably nerve-racking when someone says there is something wrong with you, especially when something is wrong with your heart," Paszczuk said. "That promotes a lot of anxiety. So being able to relieve that anxiety is one of the things we're looking for."

The Young VA still operates a separate outpatient cardiology clinic where appointments are scheduled far in advance. But the C-4 Clinic is expected to siphon much of that facility's patient load as veterans become aware of it.

Since the C-4 Clinic's start, about 400 patients have been seen by its 12 cardiologists and support staff. Some 1,000 patients have been seen at the outpatient clinic since Jan. 1. But the C-4 Clinic's numbers are increasing monthly, officials say.

Thuriere, the chief of staff, said the hospital will look at the possibility of extending same-day service to other clinics in the future. Right now, the only other area of the facility with a similar program is mental health.

Despite the VA's reputation as a clumsy, slow-moving bureaucracy, hospital leaders said the organization is actually tolerant of new ideas.

So Paszczuk said she had no fear as the clinic was launched.

"There are very few things that scare cardiologists," she said. "We are by nature pretty adventuresome and tolerant of stress."


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The Bay Pines C.W. Bill Young VA Medical Center.


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