Alaska VA increases staffing to improve access, but veterans say they're being cut off from pain therapy

Published: Nov. 1, 2018 at 10:56 PM AKDT
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Healthcare in Alaska is a primary topic in next Tuesday's election. For months, KTUU has heard from veterans about obstacles they've encountered within the VA Healthcare System.

On Thursday, we spoke with the director of the Alaska Veterans Administration about what the VA is doing to improve health services for veterans.

Alaska VA Healthcare Director Dr. Timothy Ballard says the agency’s primary goal in 2018 was to increase staffing to better address veterans' access to healthcare. Ballard says the organization has done that, boosting its workforce by 189 personnel and using third party collections to increase revenue.

But he admits there's more to be done, and some Alaska veterans at a public forum in the Mat-Su Valley on Tuesday agreed.

Many at the forum said they found relief in acupuncture therapy provided through the VA outpatient service.

"I’ve been going since December 2016, and in 2017 I got every visit I wanted,” one woman said. But she said access has dwindled I’m recent months. “I haven't had care in two damn months,” she said, covering her face as she cried while detailing the pain she’s experienced since missing her acupuncture therapy.

Ongoing pain management was one of the major talking points of veterans at Tuesday's forum, many echoing similar issues with being cut off from chiropractic, physical or acupuncture therapy.

One woman at the forum said her 32-year-old husband is 32 years-old lives in chronic pain from his work as a mechanic on heavy machinery. He’s in so much pain, she says, that he has trouble bending over to help with the dishes. Orthopedic surgeons won't consider surgery, she says, because of his age and line of work. So doctors recommended acupuncture.

"Last ditch effort, Mat-Su clinic sent us for acupuncture to try, and holy crap, it's working,” she said excitedly. “Like 70 percent pain reduction. I have my husband back. He hasn't been able to participate or play with our four-year-old in three years."

But, she says her husband’s relief was swept out from under him because of a new VA Healthcare stipulation.

"Now, this mandate is saying ‘Oh, we're not giving you any more visits,’" she said angrily.

Dr. Ballard explains that the VA is a primary care-based system. If the primary care doctor lacks the qualifications to care for the patient’s ailment, the patient is referred to an outside specialist. Ballard says this has led to large numbers of outpatient referrals to pain therapy services like acupuncture.

Ballard says the therapy provided relief to countless patients, and they started relying on it for chronic pain management — running up the bill for the VA.

"So the VA, in response to this, has incorporated what are called ‘Standard Episodes of Care,’ what the normal context of a consult should be,” Ballard said. “So for acupuncture, they decided that 10 visits was appropriate, for chiropractic it's 12, for physical therapy it's 14."

As a result, many of the veterans who had finally found pain relief with those services, hit a wall.

"So here's the bottom line on this,” a man began at Tuesday’s forum. “Is that yes, we have chronic problems. When my back decides to go out, it doesn't go ‘Oh wait a minute, did I have my 12 visits this year?’ No it's going to go out."

Ballard says providers across the country agreed — they couldn't provide effective care in a limited time frame. So the VA asked them to provide thorough documentation as to why the patient requires continued outpatient pain relief services.

"We just asked them, show us your documentation,” he said. “We've asked you to evaluate, treat, make recommendations to get them back to baseline. Show us where you are in that range. And frequently there's not adequate documentation to justify further care."

So what do patients do? Those at Tuesday’s forum said they couldn’t just will the pain away and continue living normal lives.

One man was getting massage therapy every week, and he says it was providing relief.

“You guys went from giving me one a week, basically, over the past three years, to just cutting me off,” he said.

Ballard says the VA spends a lot of money for outpatient care for roughly 23,000 veterans who attend their facility on a regular basis. He says in 2017, the referrals cost around $140 million. That’s why he says they had to make a change. But he says that doesn’t mean Alaska veterans will go without pain relief.

"There are situations where if a veteran truly has a need, they have an acute condition, we're going to certainly get them the care that they need,” Ballard said. “But this benefit isn't going to be that ‘I get physical therapy or acupuncture or chiropractic for the rest of my life because it makes me feel better.’"

Ballard says there are approximately 36,000 veterans enrolled in the Alaska VA Healthcare System, and between 75,000 and 90,000 total veterans living in Alaska.

He says one big step in the VA’s plan is to improve outreach to those thousands of veterans currently living without VA healthcare benefits.