Rounds Encouraged By VA Facilities Expansion at Hot Springs, Fort Meade at Veterans’ Affairs Committee Hearing
WASHINGTON – U.S. Senator Mike Rounds (R-S.D.), a member of the Senate Committee on Veterans’ Affairs (SVAC), discussed the expansion of VA facilities in Hot Springs, South Dakota and the allocation of additional personnel to Fort Meade near Sturgis, South Dakota at an SVAC hearing. The hearing, titled “Frontier Health Care: Ensuring Veterans’ Access No Matter Where They Live,” highlighted health care needs for rural veterans. Senators heard from a panel of witnesses including Dr. Peter Kaboli, Executive Director of the VA’s Office of Rural Health.
“Dr. Kaboli, I’d briefly like to talk about the need to appropriately resource VA facilities in rural America,” said Rounds. “I'm encouraged that the department is expanding facilities in Hot Springs, South Dakota and allocating additional personnel to Fort Meade, which is near Sturgis, South Dakota.”
“If we would have allowed the AIR [Asset and Infrastructure Review] Commission to move forward, it would have been devastating to some of our rural hospitals,” said Rounds. “And in fact, on a bipartisan basis, we were able to stop the recommendations that were found within that report. And now today, we're talking about what we can do to actually improve rural health.”
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BACKGROUND:
In June 2022, Rounds and his colleagues on SVAC successfully stopped the reduction in services at VA facilities in Hot Springs, Sioux Falls, Sturgis and Wagner by halting nominations to the AIR Commission. Without the approval of nominees by SVAC, no Commission was established and the process of reducing these services as outlined did not move forward.
HEARING TRANSCRIPT:
Rounds: Thank you, Mr. Chairman. First of all, I want to thank our guests for joining us here today and for your service to our country. Dr. Kaboli, I’d briefly like to talk about the need to appropriately resource VA facilities in rural America. I'm encouraged that the department is expanding facilities in Hot Springs, South Dakota and allocating additional personnel to Fort Meade, which is near Sturgis, South Dakota. Can you talk about the importance of appropriately resourcing VA facilities in locations such as these in South Dakota?
Kaboli: Yes, thank you for that question. Senator Rounds. Happy to. So, I'm also in VISN 23 in Iowa. So Hot Springs and Fort Meade are obviously in our VISN, you know. And I know you were involved with the AIR Commission and the reports that came from that. Yeah, I think we all are looking at better ways to provide services and you know, places like Hot Springs and Fort Meade, their being 90 miles apart, you know, what are the things that need to be in one location, what can be shared, what needs to be in both locations? The other thing, you know, I think, in talking more broadly, even outside of South Dakota, is, you know, identifying where there are gaps in care that we either use Care in the Community, or that we establish new sites of care. We've been working with the USDA to try to identify locations that are ripe for adding either VA sites of care or partnering. We're looking at Craven County, North Carolina, which you're familiar with, Senator Tillis. But that's one that you know, is a, it sort of fits all the needs for both distance of how far veterans would have to travel that already live there and what facilities are around there. It also allows us to partner with a local hospital or FQHC that has space. And that's something that we can either lease or, with especially some of the new appropriation or new abilities, but also, whether we partner with an FQHC. There's another in Polk County, Texas, that just sort of fits that perfect circle of where there is not care that we can fill something in.
Rounds: Well, and just to your point, if we would have allowed the AIR commission to move forward, it would have been devastating to some of our rural hospitals. And in fact, on a bipartisan basis, we were able to stop the recommendations that were found within that report. And now today, we're talking about what we can do to actually improve rural health. The AIR commission in my opinion would not have done that, in fact, it would have hurt it, shutting down emergency rooms in some places, but severely restricting access for our rural veterans. In fact, Dr. Kaboli, as you know, a significant number of rural veterans receive acute care from critical access hospitals, like Bennett County Hospital in Martin, South Dakota. It is the only non-IHS emergency room for nearly 100 miles, and its emergency room remains busy caring for an average of 250 patients on a monthly basis. How important is it to make sure that critical access hospitals like Bennett County Hospital are appropriately resourced, and what would be the impact on care for veterans in rural areas if critical access hospitals in these areas are closed?
Kaboli: Well, thank you for that question, Senator. So that's a great example of, you know, why these critical access hospitals play an important role for not only their community, but also for veterans that live in that community because of the distance they would otherwise have to travel to be cared for by somebody like me who's a hospitalist. So for hospital care, 80% of rural veterans get care for their hospitalizations outside the VA, and half of those are in rural hospitals and half are in urban hospitals, because a lot of rural residents live close to an urban center, and they just come in for care. But those rural critical access hospitals are absolutely important for the community and for us. So we need to partner with them. We have a couple of things that we're doing. One is we're starting a pilot program, so that patients that are in those hospitals that are veterans, if they need to be transferred out, that we can take them and take them efficiently. But more importantly, sometimes it's just keeping them there, that we can continue to pay for the care but keep them there in their hospital. They're in their community, and they're there where there's—
Rounds: And in fact, I agree with you, and I don't mean to interrupt, but I have one more question I really want to ask because it's leading right down that line. I've heard from veterans in South Dakota who say that their care is disrupted when they have repeatedly received prior authorizations for their community care appointments. These requests can take weeks and are sometimes seemingly denied, with no apparent reason involved. What is the VA doing to make certain that veterans, especially those in rural communities, aren't experiencing extra hurdles to receive the care in the community that they've chosen? And are you aware of the problem that they're having and in getting, literally having to go back through and get repeated authorizations for this care?
Kaboli: Yeah, thank you, Senator—
Rounds: The answer is yes you are aware?
Kaboli: I am aware. And then I'm going to ask one of my colleagues to maybe help me out with it, too. I'd say two things about it. The first is, you know, as a physician, you know, providing care in the VA, I take it very seriously that patients get the care where they want it, and they're eligible for it locally, that's totally fine to make sure the authorizations go in, and is managed through that office, the Community Care office. There are times when authorizations do expire, or that's for a new condition, and so they have to be renewed. And I think we need to get better at that. We have a referral coordination initiative that's really done amazing things in some sites, I could say Ann Arbor, Michigan, as an example, to make sure that the office handles those, and then gets them into VA care when we can provide it, and when they can't, make sure they get care in the community.
Wade Vlosich: Yeah, the other thing that we're doing is the Department is looking at what we call SEOCs, or episodes of care. And so those standard episodes of care, what we're doing is we're reevaluating them periodically to see how long those authorizations should last. And so you'll see some adjusted, some lengthened, and so we're really focusing in on how can we improve that experience for our veterans. So for instance, in Oklahoma City, one of the initiatives that we've started is called VA chat. So if you have a phone or a computer, and you need to get ahold of your provider or the community care office about your community care provider, you can just put it in the chat and our staff will respond to them immediately to get them a turnaround to get some of those authorizations back in place. And so we've experienced some of that due to the rules, but what we've done is we've allowed our staff locally to look at authorizations and how we can reenact some of those to make it easier for them.
Rounds: I'm really glad you've got to work around on it, but if you need a work around, the chances are the rule may not be right in the first place. But Mr. Chairman, I've used up my time. Thank you for your allowing me the extra time.
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