Representatives from Boise VA Medical Center held a meeting at the Burns Elks Lodge Friday, July 27, to discuss changes coming to the Veterans Affairs (VA) outreach clinic in Burns.

David Wood, director of the Boise VA Medical Center, began by dispelling rumors that the Burns clinic is closing.

He said, “We have no intention of closing the Burns clinic. We’re very supportive of the clinic and want to see it be an entity here. We know it serves you and is a value to this community and to all of you.”

However, Wood acknowledged that the clinic has struggled to recruit and maintain providers since it opened around 2011, and he announced that the clinic’s current provider, Marc Nagel, is leaving Aug. 1.

“I think he’s sad to go. He likes the Burns clinic, but he’s looking for some different experiences in his professional development and so that’s why he is leaving,” Wood explained. “Unfortunately, getting a provider here is a challenge, so while we are kind of seeing how that goes, we are going to utilize some telehealth services here in Burns.”

According to the Mayo Clinic’s website, “Telehealth is the use of digital information and communication technologies, such as computers and mobile devices, to access health care services remotely and manage your health care.”

Wood noted that the Boise VA Medical Center is the telehealth hub for Veterans Integrated Service Network (VISN) 20, which includes Oregon, Washington, Alaska, and Idaho. Boise, Idaho is also the national telehealth hub.

“We are actually building a second addition onto the regional office there in Boise to put basically a whole floor that will be dedicated to telehealth,” Wood said.

He explained that the VA Mission Act of 2018 allows VA providers in Idaho to provide telehealth anywhere in the United States without having to obtain a license in each state.

Local patients who use the VA’s telehealth services will be assigned to physicians in Boise. However, there will be nurses at the Burns clinic to provide hands-on care and connect patients to telehealth providers.

“We need some help and support to do telehealth. We wouldn’t expect veterans just to go and dial in themselves and make it all work. We have to have someone on site to make that work.” Wood said.

He also noted that providers will visit the Burns clinic periodically. Harney County Judge Pete Runnels asked about the frequency of clinic visits, and Wood replied that providers will come to Burns once every quarter.

Wood also reported that the telehealth hub in Boise would like to provide services to John Day, and there will be a meeting in the next couple of weeks to discuss the details.

Wood acknowledged that many veterans have expressed apprehension about using telehealth, but said, “I think, by and large, those who use it find it to be relatively good and effective.”

However, an audience member stated that he’s used telehealth before, and he hates it.

“I absolutely hate talking to somebody on a damn television trying to tell them what’s wrong with me, so I’m not going to use your telehealth,” he said. “I just wanted to let you know that not everybody likes it.”

Another audience member expressed concern about the security of the telehealth connection, stating that computers are easily hacked. However, Wood replied that telehealth is conducted through a secure connection.

Noting that many of the veterans who were present at the meeting grew up using dial phones, the same audience member said, “We’re not millennials, so it’s going to be hard to get telehealth to come across. I’m not saying I’m against the telehealth, I’m just saying that that’s one of the barriers that you’re trying to fight with.”

Wood said, “All of you in the room have options in terms of how you get your health care, whether its via [a] telehealth clinic, whether it’s coming to Boise, whether it’s going out on Choice and getting care in the community. I mean, there are options, and our commitment to you is to help you exercise those options and make those work for each one of you.”

Dr. Andrew Wilper, Boise VA Medical Center chief of staff, noted that some patients choose to drive to Boise to see him in person. However, he acknowledged that it can be a hassle and other options are available.

Wood explained that the Veterans Choice Program allows veterans to receive care in their communities from providers outside of the VA. However, he acknowledged that some providers in the community don’t accept Choice.

Runnels said providers at High Country Health and Wellness Center (which is located in the same building as the Harney County Health Department) are working to obtain credentialing for the Choice program, and he asked for Wood’s help with the process.

Charles Schmidt asked about the aggressiveness of efforts to fill Nagel’s position and when the position is expected to be filled.

Wood replied, “We have not started any recruitment of a replacement of Marc at this point in time. We have put out feelers for providers, [but] I have to tell you, there’s healthy skepticism in being able to recruit someone full time to Burns, just because we’ve been through it several times now. So that’s why we want to use this telehealth model and see if it works. Now, if it doesn’t work, obviously, we’re not going to stick with it. We will keep trying our very best to recruit someone who can take care of our needs here in Burns.”

An audience member asked why there is such a high rate of turnover in the Burns clinic.

“Doctors and other healthcare providers are harder to recruit to live in rural places, so that is just one of the challenges that’s built in for us here in Burns,” Dr. Wilper said. “In fact, the VA developed the telehealth model to actually try to create a bridge so that we wouldn’t end up with clinics with nobody working.”

Wood added that other rural, community-based clinics have the same issues with recruiting and maintaining providers. He said he thinks Burns is a wonderful place to live, but it doesn’t offer as many opportunities for physicians (such as specialty care, a variety of care, and research opportunities) as more urban areas.

An audience member asked whether a more enticing position could be created at the Burns clinic, but Wood replied that Burns doesn’t have the necessary infrastructure. He explained that the Boise VA Medical Center has a research department, building, and instruments, but, “It’s probably not realistic to provide that kind of infrastructure to Burns when we have about 450 veterans enrolled in the clinic currently.”

Noting that it took him seven months to address a shoulder injury, an audience member said he needs help coordinating his medical care among the various entities involved.

Wood said that, because coordination of care is probably the most common complaint among users of the Choice program, additional nursing staff was hired to coordinate care with physicians, veterans, and providers.

Schmidt asked how long the Mission Act will fund the Choice program, and Wood replied that the act provides $5.2 billion for the Veterans Choice fund, but there’s been a lot of discussion about how it will be funded and how long it will endure. He suggested contacting congressional representatives to make sure the issue is on their radar.

Schmidt asked, “If we don’t have providers and we keep referring vets out to use the Choice program…if that money runs out then where are we going to be in places like right here in Burns, Oregon, and John Day, Oregon, and Eastern Oregon?”

He said, “I think VA needs to keep that in the forefront in front of Congress as well.”

Wood said, “We do meet with our congressional representatives and bring that up.”

He added that the private sector is an important partner, but Boise VA Medical Center should provide veterans with a strong infrastructure, and he noted that the medical center is opening a cardiac catheterization lab in the next few weeks.

“In the past, that has been a big hole in the services that we provide in Boise,” he explained.

According to the American Heart Association’s website, cardiac catheterization is a procedure to examine how well the heart is working. During the procedure, a thin, hollow tube (called a catheter) is inserted into a large blood vessel that leads to the heart.

Other infrastructure improvements will include the addition of a parking garage and improvements to the call center.

Ultimately, Wood encouraged veterans to give telehealth a try, but said other options are available for those who prefer in-person care.

“My commitment is we’ll work with each one of you individually to put together that puzzle to make it work,” he said.