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.”