The Palo Alto system includes inpatient facilities in Palo Alto, Menlo Park and Livermore, plus seven outpatient clinics in a region that runs 90 miles south to Monterey and 130 miles east to Sonora. Those clinics have telehealth capabilities that allow veterans to see a doctor without having to travel 100 miles to a medical center.
That telehealth capacity is important because most veterans can't afford to live in the immediate Palo Alto area close to the medical center, given that the median home value is more than $1 million. Census data for 2008-12 estimated that just 2,675 veterans were living in Palo Alto. “No vet can afford to live within 150 miles of that hospital,” Longman said.
Around the country, many veterans live in rural counties away from the larger VA facilities, VA data show. But VA hospitals traditionally have been located in larger, urban settings in order to be affiliated with academic medical centers like the Stanford University School of Medicine, which shares its physicians with the Palo Alto VA system.
“For elderly veterans who are totally disabled and no longer working, perhaps they can take an entire day to get to (their) VA medical appointments,” Hardie said. “But it's an incredible challenge for veterans who are working and veterans who are students.”
To help address the geographic mismatch problem, in July 2012 the VA announced plans for 13 new community-based outpatient clinics to open gradually through 2015. In April 2013, the GAO reported that the VA was managing the construction of 50 major medical-facility projects ranging from $10 million to hundreds of millions of dollars, including an $800 million replacement hospital near Denver. A bipartisan Senate deal announced June 5 also authorizes the VA to lease 26 new facilities in 18 states.
“One of the reasons for pursuing community-based clinics is because so much care is now on an outpatient basis,” said Dr. Kenneth Kizer, who served as VA undersecretary for health from 1994-99 and is now director of the Institute for Population Health Improvement at UC Davis Health System in Sacramento, Calif. “But there were never going to be enough funds to put facilities in places where veterans had moved.”
Last month, the Palo Alto system cut the ribbon on a 10,000-square-foot welcome center at its Menlo Park location, funded not by the VA but by a California philanthropist. Longman argues that despite being “a jewel,” the Palo Alto system doesn't have enough veterans to serve. It's the same for many other VA facilities around the country, he added.
But there still are many veterans who need care and lack timely, convenient access to it from the VA, according to news reports and the VA Office of the Inspector General.
One partial solution, Kizer said, is to put more focus on telehealth, mobile health and home monitoring, as the Palo Alto system has begun to do. By Kizer's estimates, at least 30% of primary-care visits could be shifted from face-to-face to remote services. “It's not a matter of providing less care but providing smarter and more patient-centered care,” he said.
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