STATEMENT FOR THE RECORD OF

JEFFREY NEUBERGER, RN

ASSOCIATE CHIEF, PATIENT CARE SERVICES

VA MONTANA HEALTHCARE SYSTEM

VETERANS HEALTH ADMINISTRATION (VHA)

DEPARTMENT OF VETERANS AFFAIRS (VA)

BEFORE THE

COMMITTEE ON VETERANS’ AFFAIRS

UNITED STATES SENATE

APRIL 21, 2012

Good afternoon Senator Tester and members of the Committee.  Thank you for the opportunity to be here today to discuss “Improving Access to Quality Health Care for Rural Veterans.”

Let me begin by giving you an overview of the health care system at the Billings, Montana Community-Based Outpatient Clinic (CBOC) and its parent system, the VA Montana Healthcare System (HCS).  The VA Montana HCS consists of a primary medical center - the Fort Harrison VA Medical Center - with an additional 14 points of care, including CBOCs and Primary Care Telehealth Outreach Clinics.  All sites of care have a Mental Health staff, Tele-Mental Health capability, or both.  The system served almost 35,000 Veterans in fiscal year (FY) 2011 with a budget of approximately $208 million, including about $33.5 million in non-VA care.  There are approximately 1,000 full time employee equivalents (FTEE) in the VA Montana HCS.  They provided almost 10,000 inpatient days of care and attended to approximately 340,500 outpatient visits in FY 2011.

The Billings CBOC is located in the largest city in Montana.  Of the 8,000 Veterans in the Billings area who are eligible for care, we currently provide care to more than 5,800.  There are more than 2,000 additional Veterans located within the eastern portion of Montana who are eligible for care but not yet using the HCS.  It is approximately 480 miles, round trip, from Billings to the only VA Medical Center in the State, located in Helena.

Although our frontier state is geographically very beautiful, that same geography can prove extremely difficult when it comes to providing health care close to where Veterans reside, especially in harsh weather.  The state’s small population spread across a vast region adds to the challenge of providing high quality, safe patient care to our Veterans.

To meet these challenges, VA Montana HCS has implemented unique and creative programs to assist our Veterans in getting their health care closer to home.  Under Project ARCH (Access Received Close to Home), eligible Veterans are able to seek care from Humana network providers contracted for inpatient care and consultations.  Project ARCH is a 3 year pilot program that began in Billings in late August 2011.  When the pilot was initiated, we initially focused on providing orthopedic care, but we have since expanded it to include cardiology and neurosurgery.  To date, over 650 episodes of care have been authorized, and we anticipate that by the end of fiscal year 2012, we will have approved more than 1,200 authorizations at a cost of approximately $11 million.

We are expanding health care delivery in Billings by offering additional services, and this effort will be fully complete and operational in late 2013.  A 70,000 net usable square foot leased CBOC was authorized in FY 2011.  This new facility will complement services already being provided at the current Billings CBOC.  The solicitation of bids closed in February 2012, and an award is anticipated for late 2012.  There will be an increase of more than 30 FTEE.  The new CBOC will provide the following services:  outpatient surgery, physical therapy, occupational therapy, dental, audiology/speech pathology and ophthalmology/optometry.  There will also be a Veterans Benefits Administration presence.  The Billings CBOC will provide specialty services to potentially 20,000 Veterans in surrounding rural communities who would otherwise have to travel hundreds of miles to receive these specialty services at the nearest VA facility.  Veterans who have to travel long distances for care may be eligible for beneficiary travel benefits to and from VA facilities.

The VA Montana HCS has worked very closely with the Native American Tribal Nations to improve access to care for Native American Veterans, including the placement of Tribal Veteran Representatives and Tribal Outreach Workers on reservations.  There is also a dedicated Minority Veterans Coordinator in Veterans Integrated Service Network (VISN) 19 who focuses special attention on the needs of these Veterans.

VA Montana HCS has one of the best developed telehealth programs in VA.  For this fiscal year, 3,081 unique Veteran patients have received services via telehealth modalities through 7,340 clinical telehealth encounters at 15 different sites in Montana.  There are over 25 active telehealth programs in place, making it one of the top facility telehealth performers in VA.  Programs include mental health, primary care, home telehealth, retinal screening, physical medicine and rehabilitation, nutrition, patient education, pulmonary, dermatology and wound management.  VA Montana HCS leadership and staff have a strong commitment to telehealth as a means to improve access to Veterans across the state. 

Due to the low population density, VA Montana HCS has historically partnered with the community for mental health services throughout the state.  This allows for increased access and timeliness in the provision of appropriate mental health services to Veterans closer to where they live.  

Every VISN was also assigned a health care recruiter, and the VISN 19 recruiter has been very successful in sourcing potential candidates in historically difficult to recruit medical staff positions, including mental health care providers for VA Montana HCS.  The VISN 19 recruiter began work in October 2011 and has already begun making important contributions by helping fill long-standing vacancies.

Thank you again for the opportunity to testify before you today.  I am pleased to respond to any questions you have.