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VA chief endorses all recommendations of Vision 2025 Task Force, but no full-service hospital

New Hampshire Union Leader

June 14. 2018 10:12AM

Acting VA Secretary Peter O'Rourke
29 recommendations for veteran care in New Hampshire:
  • • Open a Whole Health Community Care Center in Manchester, likely offsite of the VA clinic.
  • • Combine Somersworth and Portsmouth community-based outpatient centers.
  • • Establish an ambulatory surgical center in Manchester.
  • • Rely on other New England VA hospitals for inpatient services.
  • • Grow space and staff in Manchester for patient aligned care team.
  • • Enhance the Manchester women's clinic.
  • • Establish residential and intensive outpatient mental health services in Manchester.
  • • Create a regional center of excellence for amputation care in Manchester.
  • • Enhance primary care via telehealth.
  • • Expand telehealth and virtual services.
  • • Enhance pain and opiate management programs.
  • • Provide seemless connection from initial contact to mental health services in Manchester.
  • • Renovate the existing Manchester facility.
  • • Collaborate with community to establish a full spectrum of mental health services.
  • • Right-size space and staff for rehabilitative services such as audiology in Manchester.
  • • Expand the number of rehabilitation and nursing home beds in Manchester.
  • • Expand rehabilitative service via community outpatient clinics, telehealth and community partnerships.
  • • Right-size the space and staffing for radiology at Manchster.
  • • Expand imaging services to the Community Based Outpatient Centers.
  • • Expand imaging through partnerships.
  • • Expand home-based health services including primary care.
  • • Implement social work management model for medically complex or vulnerable veterans.
  • • Invest in cultural changes.
  • • Evaluate metics that measure quality of care.
  • • Engage with external stakeholders.
  • • Emphasize education and awareness.
  • • Enhance collaboration with the White River Junction VA.
  • • Focus on right care, right place, right time.
  • • Leverage academic affiliations such as Geisel School of Medicine.

MANCHESTER — Manchester VA Medical Center Director Al Montoya received his “to do” list this week — 29 recommendations endorsed on Tuesday by Acting Veterans Affairs Secretary Peter O’Rourke, items designed to upgrade veteran health care in the state but not reopening a full-service VA hospital in Manchester.

Many of the 29 items focus on specialty care at the Manchester VA Medical Center, with a concentration on fields such as mental health care, radiology, pain care and addiction treatment, as well as a center of excellence for amputation care.

Other recommendations address improvements outside the Smyth Road VA campus: telehealth to treat veterans in their communities; a merger of outpatient clinics on the Seacoast; a “whole health community center” in Manchester closer to the city center.

“This is a road map to making sure we’re providing excellent care to veterans in the Granite State,” Montoya said. He said the recommendations will be a model for the country.

“There are many firsts in the Granite State, and this is another one,” he said.

The recommendations came from the Vision 2025 Task Force, which the VA established last summer, after back to back crises: media reports of substandard care at the Manchester VA, followed by a burst pipe that flooded a wing of the hospital. In April, an outside advisory group, the Special Medical Advisory Group, endorsed the Vision 2025 recommendations.

The recommendations received a cool response from members of the state’s congressional delegation. All Democrats, they have for years pledged their support for the return of a full-service acute-care VA hospital to New Hampshire. Three of the four said they are disappointed a hospital is not included.

Reactions from the congressional delegation included:

• Sen. Jeanne Shaheen: “This Manchester model of care includes creative solutions that focus on patient-centered care, embrace preventative measures to avert substance misuse and also make much-needed reforms to improve the culture and leadership at the Manchester VA.”

• Sen. Maggie Hassan: “The key will be ensuring that these recommendations are quickly and effectively implemented, and I will continue working with our congressional delegation to make sure that our brave veterans get the care that they need and have earned.”

• Rep. Annie Kuster: “As the implementation of these plans moves forward, I will be closely monitoring their progress and continue working with New Hampshire veterans to ensure they are receiving the care they deserve.” Kuster is the top Democrat on the House Veterans’ Affairs Subcommittee on Oversight and Investigations.

Some of the recommendations will likely run into the millions.

Montoya said he did not know how much the package will cost, nor when the recommendations will all come to fruition.

Montoya said conversations about paying for the projects have started with VA officials in Washington, and they have been supportive. His program manager has started working on ways to track the progress of the recommendations.

Work on some has already commenced, such as consolidation of the Portsmouth and Somersworth clinics and changing the culture at the Manchester VA.

“When I arrived on the 17th of July, this place was struggling, an organization in crisis. It’s very much a different feeling now,” Montoya said.

The Vision 2025 group included some VA officials but also veterans and representatives of private New Hampshire health care organizations, noted David Kenney, a former Navy commander who was a co-chair of the group 

Kenney said he couldn’t guess at the cost of the recommendations. But he said the VA Mission Act signed into law by President Trump will make some projects easier; the law doubles a threshold of $10 million that allows for quick VA approval of local projects.

A new hospital would far exceed that price tag.

A hospital “is not the way the medical community is going, and we don’t think the VA should be going,” Kenney said. He noted that plans are under way at the Manchester VA for a 13,000-square-foot specialty clinic for hearing and eyesight. He said other plans had been put on hold until the Vision 2025 recommendations were decided.

He believes that the innovative nature of the recommendations will be well received by VA officials in Washington and Boston.

“The committee’s ideas, input and support are most helpful and have assisted the VA in making critical improvements,” O’Rourke wrote to Dr. Jonathan Perlin, chief medical officer of Healthcare Corporation of America and a member of the Special Medical Advisory Group.

The full report can be viewed below:

General News Manchester