RENEE MONTAGNE, HOST:
It's been nearly two years since the Department of Veterans Affairs came under fire for the length of time veterans had to wait to see a doctor. The agency scrambled to find a fix. One idea was to give the vets the option of seeing a private doctor, an initiative called Vets Choice. That fix is not working, as we've been reporting on this program.
So VA clinics are coming up with other ideas, like one in Clarksville, Tenn. That clinic decided in order to reduce wait times it simply couldn't take new patients. Emily Siner of member station WPLN paid a visit.
ROBERT LIM: Hello, excuse us.
EMILY SINER, BYLINE: Here I am at this clinic in Clarksville, and Robert Lim is leading me through the narrow hallways.
LIM: Let's get out of the way.
SINER: We stand sideways to let people walk by. Unused wheelchairs are being stored in the hall. There are nurses stationed in what used to be a corridor.
LIM: Hi, guys.
LIM: We put people anywhere we can really.
SINER: That's no joke. There's even a computer set up in what used to be a bathroom.
LIM: This is actually - was a converted toilet. We're literally, like, sardine cans in here. So you can't go around without bumping into somebody.
SINER: Lim works for the regional VA health care system that serves tens of thousand of veterans in Tennessee and parts of Kentucky. That means he oversees primary care clinics like the one in Clarksville. And he's not one to sugarcoat the situation. Yes, he says, this is pretty bad.
LIM: If you go into Clarksville, you actually will wonder how in the world do they get things done?
SINER: One problem, as I can see from my tour, is the building's just not arranged well for a growing doctor's office - too many halls and not enough rooms. It opened eight years ago, and Lim says it was the best space the VA could find to lease at the time.
Then add the fact that the veteran population here is growing. It's right next door to Fort Campbell, one of the largest military bases in the country. So in 2014, wait times at the Clarksville clinic were rising at a time when Congress and the VA were clamoring for clinics to see patients faster.
MICHAEL WEST: Patients were calling in and we're saying, well, you can't get an appointment for 90 days, 120 days.
SINER: That's Michael West, the chief medical officer in Clarksville.
WEST: It was just logistically impossible for us to take care of the patients we had, so we had to draw a line and say, look, you know, we've got to do something.
SINER: So last March, they did do something. The clinic in Clarksville would only see veterans who already went there. If someone new wanted an appointment, clerks were instructed to say that the site had temporarily stopped taking new patients. Instead, veterans could go to the VA hospital in Nashville - about an hour's drive away. They could go 35 miles north to a small clinic in Hopkinsville, Ky., or 35 miles west to an even smaller clinic in Dover, Tenn.
They could also apply for the Veterans Choice program, which is when the VA pays for a private doctor, although that's had many problems, too. And it's been like this for more than a year. Lim says not accepting new patients is the best option right now.
LIM: It made sense to actually take care of who we have here already rather than to keep on continuing to take new patients and lack the ability to take care of everybody. So it was the lesser of two evils.
SINER: NPR found nearly a dozen VA health facilities around the country that have done something similar at some point in the last couple of years. For example, a few clinics in Washington state are having trouble hiring enough doctors for all the people trying to get in. It's hard to know for sure how common this is around the country. The national VA keeps a tally of wait times, but it doesn't track which sites are seeing new patients and which are not.
Mike Davies oversees clinic access for the VA, and he says it's very common for clinics to refer at least some patients elsewhere. But he believes this problem is inevitable in a big health care system.
MIKE DAVIES: Remember, VA has 1,700 sites of care. It's hard to have every single clinic open for accepting new patients every single day just because life happens, right? We have providers that get sick. We have providers that move.
SINER: Do you think it's a problem that certain clinics cannot take new patients?
DAVIES: Yes, it is. And we're doing everything we can to provide care as close to home as possible. But if we're in one of those relatively rare situations where the clinic close to home is full, we'll do our best to accommodate you by sending you to the closest, next best place.
SINER: By some measures, that policy works pretty well. Wait times at the Clarksville clinic are now among the lowest in the state. Lim says the patients there, the ones who were already in the system, are much happier, and the staff is less stressed.
But it still means that new patients in Clarksville, when they need a doctor, will get into the VA but not the clinic they want.
MONTAGNE: That's Emily Siner of WPLN in Nashville, Tenn. And she joined us on the line for a bit more. And, Emily, first off, how many people will end up having to go to a clinic that's not, as you suggested there, the one they want?
SINER: Well, this clinic in Clarksville used to take about 50 new patients each week, which is about 2,500 a year. And the VA notes that these veterans can still technically get on the waiting list even here, but in reality they're going somewhere else for their care. So I talked to one couple in Clarksville, Janet and Steve Singleton, who ran into this problem last year.
MONTAGNE: And what was their story?
SINER: Steve was in the Navy for 23 years. Janet was in for 10 years. And they moved to Clarksville last spring to be closer to grandkids. But a few weeks after they moved, Steve got sick. Here's what he told me.
STEVE SINGLETON: I came down with bronchitis and was feeling really bad, and I went in. I showed them my VA card, and they told me that I couldn't be seen because they had no room for any more new patients.
SINER: So since then, they've been paying out of pocket for some care, and for more extensive appointments, they have to drive down to the VA hospital in Nashville, which is about an hour away. They're OK with that for now because they're in their early 60s and can still drive long distances
MONTAGNE: As you say, can still drive long distances, but I'm taking a guess they don't want to.
SINER: Right. Steve told me that driving an hour instead of driving 10 minutes is a pretty big difference.
MONTAGNE: If people who can't get into the clinic at Clarksville are referred somewhere else, doesn't that just make the wait longer at those other clinics?
SINER: Yes, that is a problem. I visited this tiny clinic in Dover, Tenn., which is one of the places where patient who can't get into Clarksville are being referred. The clinic's manager told me that about a third of his new patients are coming from Clarksville, which is making everything busier.
And you can see that in the wait times. Dover now has the highest wait time in the whole region, and in second place is Hopkinsville, Ky., which is the other clinic where Clarksville patients are being referred. So the VA is well aware that those clinics might get overloaded soon if nothing changes.
MONTAGNE: So is there a fix to what started out itself at a fix?
SINER: Yeah. The Veterans Choice Program where the VA pays for private care was supposed to be a fix, but veterans groups in Clarksville say it's not working well there. They say that there aren't enough private doctors signing up to work with the VA.
The VA is planning to build a new facility in Clarksville soon that's three times the size of the current clinic. And that will allow them to finally take new patients again. But that won't be ready for at least another year and even then it might not be big enough to accommodate everyone.
MONTAGNE: That's Emily Siner of WPLN in Nashville. Thanks very much for joining us.
SINER: Thank you, Renee.
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