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A little more than a year ago, the U.S. Department of Veterans Affairs of Veterans Health Administration facilities that showed Honolulu’s Spark M. Matsunaga VA Medical Center had the longest average wait time for a new patient seeking a primary care appointment — a shocking 145 days — in the entire, national VA system.

To say the finding caused outrage might be an understatement. Hawaii’s congressional delegation responded to the news with a level of anger best illustrated by U.S. Rep. Tulsi Gabbard, who called the audit results “infuriating and deeply disappointing.”

“Last week, as I traveled all across Hawaii holding a Veterans Listening Tour,” Gabbard said at the time, “I heard from veterans of every conflict since World War II, from every county, about their challenges accessing VA healthcare. Some came with tears streaming down their face, as they begged for someone to please help them.  It makes me sick knowing that our returned warriors are subject to begging for care when they come home.  The time for immediate action has come and gone.”

What a difference a year makes. Former Veterans Affairs Secretary Eric Shinseki, who was blamed for long waits for what was often substandard care in VA centers around the country, resigned following the audit findings and was replaced by Robert McDonald, the former chairman, president and CEO of Procter & Gamble who spent several days in Honolulu this week.

Thanks to aggressive moves by VA Pacific Islands Health Care System Director Wayne Pfeffer in a little more than one year on the job, McDonald encountered a very different story at Matsunaga, where things have changed dramatically.

The average wait time for a new patient appointment has dropped to 10 days — an improvement of 135 days. How did they do it? Through a combination of smart administrative, staffing and facilities moves that have significantly improved access and helped the VA to catch up with its fast-growing patient population, among them:

• Pfeffer explained to Civil Beat Thursday that his administration increased the “panel size” or number of patients assigned to each physician from 1,200 to 1,300, which in turn made available 350 additional appointment times each month. (While on the high end of the range for VA panel size, it’s actually smaller than private sector measures.)
• In addition to providing more appointment slots, Pfeffer requires one to two slots per day, per physician, be dedicated to new patients, helping them get into the system more quickly. The VA also opened Saturday clinics, further expanding access to outpatient care. Pfeffer noted that physicians were being slowed down by the VA’s shortage of support staff — mostly nurses and clerks — so more were hired, allowing doctors to get to more patient care.
• Through the Choice and Accountability Act passed last year by Congress, in fact, more than $8 million in new funding was made available this fiscal year for 117 new positions — physicians, nurses, schedulers and other staff providing direct support to physicians, most of whom will be located on Oahu. Another 80 are expected to be added in the 2017 fiscal year. With a patient base that is growing by 8 percent annually, the funding is allowing VA Pacific Islands Health Care System to keep up with rising demand, said Pfeffer.

Those changes have had a significant impact on timely patient care, but other coming improvements promise more sweeping changes. A new medical facility is on the way — the Advance Leeward Outpatient Health Access (ALOHA) Multi-Speciality Outpatient Clinic on the Ewa Plain — that will double the amount of net square footage donated to outpatient veteran care on Oahu. VA outpatient services are currently crowded into about 70,000 square feet at Tripler Army Medical Center “and space is very tight,” Pfeffer says.

The ALOHA facility will be a closer option for outpatient care for one third of the island’s enrollees — about 15,000 veterans in an area spanning the Leeward side of the island up to the North Shore.

In advance of the ALOHA Clinic coming online in 2021 (perhaps earlier, if VA conversations taking place now bear fruit), Pfeffer is negotiating two emergency leases to open more space — one for an outpatient clinic for vets on the Windward side, in the Kaneohe area, and a second space near the airport for administrative staff, who would be moved from Tripler to allow more exam rooms to be opened there.

By increasing the number of patients assigned to each physician, the VA made 350 more appointments available monthly. The VA also required doctors to dedicate one or two appointments to new patients each day and opened Saturday clinics to improve access.

He expects that the new resources being trained on veteran care may become helpful in an area that has seen little success in Honolulu — veterans homelessness. Honolulu is part of a group of cities nationwide with significant homeless veteran populations that have committed to ending veteran homelessness in their cities.

But Honolulu stands alone among those cities in that the problem here has gotten worse since it joined the coalition. Other cities, meanwhile, are working aggressively toward ending veterans homelessness by the end of this year — the original deadline set by the group.

Many homeless vets struggle with mental illness and drug problems. By getting such individuals into care more quickly, the VA is able to address what might be more manageable challenges before they spiral into complicated, costly problems, Pfeffer says.

He pointed further to additional action being taken to address veteran homelessness: Secretary McDonald met on Thursday with Honolulu landlords at Honolulu Hale to encourage more to rent to homeless vets.

In all of this, Pfeffer’s experience has helped him mount an effective rapid response to the dynamics that drew such ugly headlines last year — dynamics Pfeffer learned about in his first days on the job, just before the audit containing the patient wait figures was made public. A 40-year professional in the VA who worked his way up through financial systems into overall hospital management, Pfeffer, 63, served as head of the Louisville, Ky., VA for eight years before accepting the top job last year in Honolulu.

He doesn’t exactly miss last year’s media spotlight. “Now that patient access is much, much better and more veterans are coming to us, we don’t have much (media) attention,” said Pfeffer. “We need to continue to make gains. But what we’re doing hasn’t been very newsworthy in that we’re doing well.”