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New VA clinic plans outlined

Dr. Scott Wise, president of Valor Healthcare, talks about plans for the new Community Based Outreach Clinic in Cody for veterans while  Dr. Alan Schonfeld, regional medical director for Valor, looks on. Dr. Scott Wise, president of Valor Healthcare, talks about plans for the new Community Based Outreach Clinic in Cody for veterans while Dr. Alan Schonfeld, regional medical director for Valor, looks on. Tribune photo by Ilene Olson

About 100 people attended a meeting at the VFW in Cody Monday evening to learn more about the new veterans clinic that will open there around the end of November.

Emotions ran high, with some veterans asking why they had to leave doctors who had been caring for them for many years, while others wondered how the transition will work.

For the last 18 years, the Veterans Affairs Community Based Outreach Clinic has been co-located with Powell Valley Clinic, where four doctors are certified to care for veterans.

However, the outreach clinic went up for a five-year bid this year, and in July, the bid went to Texas-based Valor Healthcare.

Valor Healthcare President Dr. Scott Wise told the nearly full-house audience, “The VA has been making a concerted effort to move away from blended clinics. ... They believe, as do we, that veterans deserve their own dedicated clinic, not shared with private-practice patients.”

Wise said Valor is a subsidiary of Concentra Group Holdings, which is owned by Select Medical.

He said his leadership team has more than a century of combined experience.

Valor’s bid was based on plans to remodel a building at 1432 Rumsey Ave. in Cody to become the new clinic.

“Many have driven by the building, which they knew when it was a warehouse,” said Dennis Brink, Valor facilities director. That has changed, he said, with more changes to come, both inside and out.

“You’ll notice when you walk into this building for the first time, that it is built to be a state-of-the-art medical facility. It is built to VA specifications, from the size of the lab to the size of the exam rooms,” Brink said.

The building will have four telecommunication rooms, each insulated and equipped with white noise to ensure privacy while patients talk electronically to medical providers in other locations, he said.

Dr. Alan Schonfeld, regional medical director for Valor, said the clinic will be staffed with one doctor, who will work from 8 a.m. to 4:30 p.m. Monday through Friday; a nurse practitioner who will work two days per week, probably on Tuesdays and Thursdays; and a nurse and an administrator, both of whom will work full time.

Toni Durrance of Cody has been hired as the clinic operations director while the people hired for three medical positions are all from Cody as well, officials said. Jimmy Phillips, Valor’s outreach coordinator, said he couldn’t release the name of the doctor because the credentialing process hadn’t been completed.

Powell veteran Harold Bjork asked why veterans had to leave four doctors at Powell Valley Healthcare to go to a clinic staffed with only one.

Schonfeld said the VA’s staffing requirements call for a primary care provider panel of 1,200 patients to one doctor, and about 900 patients for one nurse practitioner.

“That said,” Schonfeld added, “if we come into a situation where the enrollment ... of the veterans in this area exceeds the physician’s capacity to see them, then we have the option of working with the VA to add another physician or another nurse practitioner.”

Wise said the outreach clinic in Powell currently has about 1,000 patients enrolled.

“I can assure you that four full-time physicians were not taking care of 1,000 patients,” he said.  “They were seeing private patients on this day, and veteran patients on this day, or private patients down this hallway, and veterans down this hallway. That, in the past, has been pretty typical, what we would call a blended clinic, where the providers in those clinics saw some veteran patents and some non-veteran patients.”

He gave a hypothetical example of problems in the blended clinic model: “What would often — this is not about Powell — but what would happen in the past in a blended clinic, would be that the doctor would go in to give you a flu shot, for example, and go in and say, ‘Ah, you know what, the flu vaccine that we have allocated for veterans is out. Let me just go down the hall and I’ll grab some flu vaccine that I use for my private patients.’ And in many cases, it’s fine. But in many cases, that vaccine and the processes and procedures to make sure that vaccine is safe and kept at the proper temperatures and all that, was not performed by the VA.”

Dr. Valerie Lengfelder — one of the four PVHC doctors who cares for veterans at the outreach clinic in Powell — said later that she was offended by Wise’s example.

“We never did that,” or anything like it, Lengfelder said. “It really upset me that they would even insinuate that. ... We’ve always had high scores, and they [the VA] have always been impressed with us.”

The wife of a Vietnam veteran asked whether veterans who were sent to the emergency room by their doctors would be stuck with the bill for hospital services. She said that happened in Powell, and they ended up with a $65,000 hospital bill that the VA wouldn’t pay.

Schonfeld said the new clinic doctor will be sure to notate on patients’ medical records when they are sent to the emergency room that the ER visit was clinically indicated.

“In those circumstances, the VA has been notified ... and the VA pays the bill,” he said.

Lengfelder stood up. “We do put those notes in,” she said, emphatically.

“Good,” replied Schonfeld. “In answer to her, and in answer to you, the same thing will be put in so the VA is quite well aware that it is a clinically indicated admission.”

A veteran in the audience asked if someone in the new clinic will be able to help solve the problem of specialists and other medical providers not being paid when they see veterans.

“Just about every specialty doctor in this town is not getting paid,” he said. “Right now, it’s been 15 months, and they’re billing me. ... I can probably name six doctors in this town in the last year that say they’re done. They can’t run a business without getting paid.”

Kristina Miller, public affairs officer for the Sheridan VA Healthcare System, said that’s an issue.

“I’ve only been with the VA two months, and I’ve heard that too much,” Miller said. “I don’t have a good answer, but we are trying to address it, and we have regular communications with any provider who’s having problems.”

Schonfeld said a room is built into the reception area of the clinic for veterans to meet with the regional Wyoming Veteran Service officer.

Josh Schmidt, Veteran Service officer for the Big Horn Basin, said he is working with Jennifer Fernandez from Sen. Mike Enzi’s Cody office to document ongoing problems with doctors not being paid for seeing VA patients.

“Sen. Enzi is sending a weekly letter to [VA] Secretary [David] Shulkin about these health care providers that are not getting paid,” he said. “The way it’s working is, the Choice Program is telling the secretary of the VA that all these providers are getting paid. Obviously, he’s up in Washington and has no idea what’s going on in Wyoming.”

He urged veterans who know of providers who are not getting paid to contact him or Fernandez, “and we can get these providers paid, so we can get some of these good providers to stay in the system and take good care of the veterans.”

Many of the questions posed during the meeting concerned the procedure for prescription refills and upcoming doctor visits during the transition from one clinic to the other. Some veterans said they had made arrangements to take care of immediate needs in Powell before the clinic changes over.

Those who will need prescriptions after the new clinic opens should call the clinic or send a secure message online over myhealthevet (www.myhealth.va.gov). For some prescriptions, a visit to the doctor may be required, Wise said.

The most outspoken veteran at the meeting, Bjork said he was unsatisfied with the information provided.

Bjork said he has no problem being seen at a clinic that cares for veterans and private patients.

“I want to go to the same doctor I’ve been seeing,” he said. “What can they offer more than what we’re getting now?”

Bjork said local veterans should have been asked about their preferences before the VA made the decision for them.

“The VA never came to us,” he said. “That’s the BS part. ... We were never consulted about what our needs are.”

7 comments

  • posted by Salty Dawg

    October 30, 2017 3:57 pm

    @chris kuntz...glad to hear of your wonderful time at the Powell VA "CONTRACT" clinic..the local cash cow for certain entities in the PVHC system. But...not all of us had such a wonderful time there,as I stated before I had a very good Doctor in Powell VA "CONTRACT" clinic who left after I did... I am glad to say he has a thriving practice in Southern Colorado. I understand your love for YOUR town..but again..not all of us have had such an experience. I also understand that not all vets were treated like heroes at the Powell VA "CONTRACT" clinic..I know I wasn't before I changed Doctors there and finally got a good one. My daughter was born at PV hospital in 1973 and was delivered by a goo Doctor,however his offspring is quite the reverse.

  • posted by Christopher Kuntz

    October 29, 2017 11:22 am

    The entire VA healthcare system is a FAILURE.

    As for Salty Dawg's comment, He is WAY off base. The VA outreach clinic at PVHC NEVER failed me, like the actual VA Clinic has in Sheridan. My PVHC doctor was AMAZING. Her nurse was AMAZING. The two Social Workers I used were AMAZING. The two ladies in the office who checked me in were AMAZING. The appointment scheduler was AMAZING.

    The Problem...??? The VA compensation & pension adjudicators have never, and will never listen to their professional medical diagnosis. Why? Because the PVHC doctors look at you as a human being, not a nuisance. See, if the VA were forced to adhere to doctors outside the VA proper, the VA would have to pay out actual benefits for service connected disabilities.

    Let's also not forget, the VA wants 22 veterans to commit suicide every day. In fact, I bet they wish more veterans committed suicide. Why? Because those will be 22 less checks the VA has to cut at months end. The VA can then continue to spend its budget on bonuses for corrupt executives, continue to incentivize their corrupt medical professionals, purchase office furniture and spend wildly on lavish departmental get togethers in Las Vegas, staying at top rated hotels, and patting themselves on the back for being Murder Incorporated.

    I have little hope the new VA clinic in Cody will be successful. Poor medical care, not enough physicians, nurses, mental health practitioners from a Poor reputation having company, whom I am sure has hired / indoctrinated / incentivized doctors to misdiagnose.

    See... if the Flu was a 10% disability rating, the VA doctors diagnose you with chills & fever, both symptoms of the flu, so they are medically "Not Wrong", but it's the flu nonetheless.

    FAILURE equals... "the clinic will be staffed with one doctor, who will work from 8 a.m. to 4:30 p.m. Monday through Friday; a nurse practitioner who will work two days per week, probably on Tuesdays and Thursdays; and a nurse and an administrator, both of whom will work full time".

    Can you say Backlog" ?

  • posted by The Handler

    October 28, 2017 1:50 pm

    This move was "political" in nature. Lay it on your U.S. Senators and U.S. Representative here in Wyoming. They endorsed this movement. I have received nothing but EXCELLENT care from Dr. Valerie Lengfelder at the Powell Clinic. Valor Healthcare President Dr. Scott Wise has lost touch with reality uttering his statement about "blended-care" and how it would effect VA medical care. Saturday Night Live continues!!!!

  • posted by John Clark

    October 28, 2017 1:24 pm

    I have utilized a few VA medical and mental hospitals around the US especially the Cheyenne and Denver VA hospitals. I have also used private hospitals and have never paid any thing. Veterans that are having payment problems are not following the procedures. The vet must first be at least 50% disabled, contact the nearest VA hospital after using the private hospital, must show your VA Card and DO NOT show your medicare/medicaid card. If you continue to have problems contact the patient advocate at the nearest VA Hospital

  • posted by WIlliam Shorts

    October 27, 2017 12:08 pm

    I can't say I agree with Salty Dawg. I used the Powell CBOC since 2004. During that time period I received nothing but timely, efficient, and compassionate care from the doctors and staff. Never once did I have to go out of pocket because of errors or blunders of the staff processing billing requests. As for the VA staff persons who worked in the Powell CBOC I can't begin to say enough positive things about them. Those ladies continuously worked for their Vets on a daily basis. They took ownership of their Vets and ensured they were taken care of; even those Vets who were hostile or just plain rude to them. I'm not making excuses for the VA, but the people who were contracted by the VA in Powell, Wy were not the VA. They were contracted to fill a void and they did so commendably. I for one am sorry to see them go. Thanks PVHC for these past 13 years.

  • posted by Salty Dawg

    October 26, 2017 1:28 pm

    Myself,I quit using the Powell VA clinic due to some of the very problems mentioned in this article...my experience with VA,and I have been to many VA hospitals around the West,is they all like passing the buck and blaming others,instead of fixing the problems they help create.As for Powell VA clinic,certain entities have been using the place for a "cash cow" for years,and I think many know who they are.I had a good Doctor there once,and he either got fired or quit,not sure which,since he now has a practice in Southern Colorado.I sincerely hope the local vets who are legitimate enough to have to use the VA get better treatment than I,and some others, did in Powell VA.

  • posted by Rebecca Albanese

    October 26, 2017 12:54 pm

    Kudos to Harold Bjork! My husband and I had business out of town or there would have been even more uncomfortable questions for Valor to answer. It is time to see the over all rating of this company in its' short time in business. Mystery doctors and nurses , part time practitioners and veterans still with no clue of what these creeps are about. This new system is going to usher in a new low for veteran care.

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