NPR

A Benefit For Rural Vets: Getting Health Care Close To Home

For some rural vets who live far from a VA hospital, getting medical care has meant driving a day or two from home, and missing work. (iStockphoto)

Army veteran Randy Michaud had to make a 200-mile trip to the Veterans Affairs hospital in Aroostook County, Maine, near the Canadian border, every time he had a medical appointment.

Michaud, who was medically retired after a jeep accident in Germany 25 years ago, moved home to Maine in 1991. He was eligible for VA medical care, but the long drive was a problem.

He's one of millions of veterans living in rural America who must travel hundreds of miles round-trip for care.

"If I get an appointment in the winter, I'll cancel that sucker and I'll live with the pain until spring time," he says.

Even in the summer, the trip for Michaud — and other vets like him — meant a day, or sometimes two, of missed work, with a night in a motel, plus the cost of gas. The VA reimburses those costs, but this is not a rich area, and people don't always have the cash upfront.

When they came knocking on my door and said, 'Jim, you got to go to war,' I was there. I went, no questions asked. Now it's your turn. It's your turn to take care of me.
Jimmy Grenier, Vietnam veteran and stroke survivor

Michaud says the worst part is an empty, 100-mile strip of Interstate 95 north of Bangor.

"Especially in the winter time," he says. "That 95 is treacherous, and it's not necessarily always cleared and stuff like that. I've wrecked a couple times on that road. It's just cold, and a lot of these are older veterans; they can't make that trip down there."

To make it easier for vets to get care, the VA started a program called Access Received Closer to Home, or ARCH. A trial program began three years ago in five states.

This summer, Congress extended the program for two years, as part of a law aimed at reforming the VA. It will allow veterans to use private doctors if they live far from a VA hospital or can't get a VA appointment within 30 days.

It means Michaud can make appointments only 10 miles up the road, at the 65-bed Cary Medical Center in the town of Caribou. Kris Doody, a registered nurse, and the center's CEO, says getting care near home and family is healthier for vets, and helps them avoid that 400-mile round trip.

"We actually keep track for the VA the number of patients who are seen every month and what their distance would have been. And the savings — and that's just savings in mileage — was $600,000," Doody says.

The ARCH program is just one part of a plan to use private health care to reach more vets. Private care already accounts for about $5 billion in VA health care spending a year.

Accounting for those funds has been a challenge: The VA inspector general has issued seven reports in recent years documenting errors in payments to private health care providers --errors that wasted about $1 billion.

The new VA reform law creates another $10 billion private care initiative. This one will allow a veteran to walk into almost any clinic and bill the VA by using a voucher.

The voucher system will be the VA's most complicated private care program yet, says Roscoe Butler, deputy director for health care at the American Legion, and retired director of the VA medical center in Minneapolis.

"It's going to be critical to make sure that the services they're paying for [are] actually the services provided," Butler says. "It requires that the VA pay the provider within 30 days ... There are a lot of moving pieces to be coordinated back through the VA."

Vets like Jimmy Grenier, who served in Vietnam, don't much care how the VA handles the accounting. They just like getting care closer to home.

"I got PTSD, if you know what that is," Grenier says. "I got it really bad." It doesn't take much to set him off, he says, adding that for him, the ARCH program is "the best thing that ... ever could have happened up here."

Grenier, 67, did three combat tours, and had a series of minor strokes three years ago. Before the new program, he had to drive 440 miles round trip to see a doctor. He'll never do that again, he says.

"Why should I have to?" says Grenier. "When they came knocking on my door and said, 'Jim, you got to go to war,' I was there. I went, no questions asked. Now it's your turn. It's your turn to take care of me."

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Transcript

STEVE INSKEEP, HOST:

We have a chance this morning to hear how American veterans might receive health care differently. A law passed this past summer is aimed at reforming the Department of Veterans Affairs. It allows veterans to use private doctors if they live far away from a VA hospital or if they cannot get a VA appointment within 30 days. The plan is meant to help with the overloaded Veterans Health Administration and make it easier for vets to get medical care. A pilot program using this approach is already underway. NPR's Quil Lawrence reports from northern Maine.

QUIL LAWRENCE, BYLINE: Millions of veterans live in rural America. For some, that means a 100-mile trip to the nearest VA hospital. In Aroostook County Maine near the Canadian border, the trip is more like 200 miles.

All right, I'm getting French on the radio from over the border. I've been on 95 since dawn, and I'm still only about two-thirds of the way through the drive that a lot of these veterans used to have to make if they wanted to get care at a VA.

Oh, no. Oh, no.

I missed the turn and accidentally drove into Canada.

Oh, no.

RANDY MICHAUD: You went straight, huh? (Laughter). Yeah, that happens.

LAWRENCE: A few hours later, after I made my way back into the U.S., Randy Michaud met me at the VFW Hall in Presque Isle, Maine. He's an Army vet who was medically retired after a Jeep accident in Germany; that was 25 years ago. Michaud moved home to Maine in 1991. He was eligible for VA medical care, but that's a 200-mile drive to the nearest VA hospital.

MICHAUD: If I get an appointment in the wintertime, I'll cancel that sucker, and I'll live with the pain until springtime.

LAWRENCE: Even in the summer, the trip meant the veteran had to miss a day of work, sometimes two, with a night in a motel - that plus the cost of gas. The VA would pay them back, but this is not a rich area, and people don't always have the cash up front. Randy Michaud says the worst part is an empty 100 miles of Interstate 95, north of Bangor.

MICHAUD: Especially in the wintertime, that 95 is treacherous, and it's not necessarily always cleared and stuff like that. I've wrecked a couple times on that road. It's just cold, and a lot of these elderly veterans, they can't make that trip there.

LAWRENCE: To make it easier for vets to get care, the Department of Veterans Affairs started a program called ARCH, Access Received Closer to Home. A trial program started three years ago in five states. The location in Maine is only 10 miles up the road from Randy Michaud's VFW Hall. It's in a 65-bed hospital in the town of Caribou.

KRIS DOODY: I'm Kris Doody. I'm a registered nurse and the CEO for Carey Medical Center in Caribou, Maine.

LAWRENCE: Kris Doody says getting care near home and family is healthier for vets, and it can mean avoiding a 400-mile round-trip for every appointment.

DOODY: We actually keep track for the VA the number of patients who are seen every month and what their distance would've been, and the savings - that's just savings in mileage - was $600,000.

LAWRENCE: Six-hundred-thousand dollars in mileage reimbursement - that may be pocket change at the VA, but the ARCH program is just one part of a plan to use private health care to reach more vets. Private care already accounts for about $5 billion in VA health care spending a year. It's not clear the money's been well-accounted for. The VA's inspector general issued seven reports in recent years documenting errors in payments to private health care providers; that wasted about a billion dollars.

ROSCOE BUTLER: It's going to be critical to make sure that the services they're paying for is actually the services provided.

LAWRENCE: That's Roscoe Butler. He used to work at VA; he's now with the American Legion. The new VA reform law creates another $10-billion private-care initiative. This one will allow a veteran to walk into almost any clinic and bill the VA by using a voucher. Butler says this will be the VA's most complicated private care program yet.

BUTLER: It requires that the VA pay the provider within 30 days. You know, and that's providing the care, authorizing the care up front, so there's a lot of moving pieces to be coordinated back through the VA.

LAWRENCE: The VA says it's fixing the payment system. Vets don't much care how the VA handles the accounting, they just like getting care closer to home, like Vietnam vet Jimmy Grenier, back at the VFW in Presque Isle, Maine. And he admits he's not easy to please.

JIMMY GRENIER: I get aggravated a little. I got PTSD, if you know what that is. I got it really bad; it doesn't take much to set me off. This ARCH program, I think that's - to me, I think that's the best thing that they ever could have up here.

LAWRENCE: Grenier did three combat tours. Now he's 67, and he had a series of minor strokes three years ago. Before the new program, he would've had to drive 440 miles round-trip to see a doctor.

GRENIER: I ain't never going to do it again. Why should I have to? When they come knocking on my door and said, Jim, you've got to go to war, I was there; I went, no questions asked. Now it's your turn; it's your turn to take care of me.

LAWRENCE: Taking care of him where he lives. Quil Lawrence, NPR News. Transcript provided by NPR, Copyright NPR.

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