February 18 2015


The Hill Country Veterans Council (HCVC) met with management of the South Texas Veterans Health Care System (STVHCS) in Room 147 of the Kerrville VAMC on February 18, 2015. The meeting began at 1100 hours.

The senior spokesman for the STVHCS was Mr. Joe Perez, Assistant Director, and principal staff including Mr. Paul Gregory, Senior Administration Officer of the Kerrville VAMC.

Representing the HCVC were President Vicki Marsh, Vice President Bill Bacon, Members Maggie Baker and Gary Noller. Other VSOs represented were VFW Kerrville, American Legion Bandera, Fredericksburg and Kerrville, Military Order of the Purple Heart Kerrville. Others attending were Gillespie County VCSO, and Veteran Outreach. A total of 15 veteran representatives were present.

Mr. Perez began the meeting saying that the 2014 STVHCS budget was $627m but ended at $645m. The FY 2015 budget is set for $609m. The decrease is due primarily to the impact of the Choice Act diverting some expenses to other budgets.

Construction at KVA continues with the canteen canopy which is now completed. The VA Police will be moving to the Education BLDG to allow for more space for the mail- out pharmacy program. When asked how many new employees the new pharmacy would employee, no one from STVHCS had the answer. Landscaping will be completed by the end of February 15. It is not only a beautification project but is meant to replace old, worn out plumbing and improve drainage away from the building. Five new construction projects are beginning that focus on infrastructure such as HVAC. Paul Gregory will provide more details at the next meeting ot the HCVC.

Secretary MacDonald visited the STVHCS Audie Murphy. According to Mr. Perez, the meeting went well. The Secretary has reorganized the reporting system of the VA into 5 regions defined by state lines. Mr. Perez did not have any answers as to how the system will work considering some VISNs (16 and 18 for example) cross state lines. They don't know all the specifics and but have a June date for implementation.

The Veterans Choice Card has been mailed to most veterans in the area. There are not a lot of answers yet, but the program goes through a third party administrator, in our case Tri West. One issue related to this program is that the VA loses control of the information learned by the providers so that the veterans' records lose continuity and become incomplete. There is a portal that can be used but it is limited to 350 patients. There are currently 92 providers under contract in the western and northwestern areas of STVHCS including 19 in Kerr County. They did not have that information for Gillespie Co or Medina Co. The information seemed to be incorrect in that 42 providers were in Crockett County (The County Seat is Ozona, and it is one of the lesser populated counties in Texas) In addition there was only one provider in Real Co which was a marriage counselor. Enrollment in Care must be "clinically indicated" by the veteran's Patient Aligned Care Team (PACT) doctor. Specialists in Choice Care are called Choice Champions. For Kerrville VA, they are Paul Gregory and Terry Garza.

Dr. Calvin Leuschen brought up that the Providers in the PACTís may see a patient for only about 5 minutes. Then the Doctor must input the information he learned from that visit into the computer to insure that no information is lost. This may take up to fifteen minutes. The Choice program allows for only one visit that is clinically indicated. This means the Veteran is allowed to see a contract provider who then must relay the information to the PACT Team so the Doctor on the team can input the information into the veteran's file and make such action as deemed necessary such as referrals for diagnostic tests. Therefore, the Doctor saves the 5 minutes of patient visit time, but is required to double his/her administration time.

Several veterans mentioned that the information being sent by the VA is too detailed and complicated to be understood by many of the veterans. Simplification was requested. In addition a suggestion was made to create an advisory committee comprised of Veteran Service Officers from the San Antonio area to review information before it is mailed out. Mr. Perez said that seemed like a very good idea.

The issue of large panels was broached due to the lack of Providers in the PACTS. Mr. Gregory said that the holes in care were being filled by mid-level providers and contract/ providers.

President Marsh asked about a full-time patient advocate, but was told that this medical facility and others in San Antonio do not have them. Rather all patient advocates are located at Audie. Paul Gregory does keep track of complaints that he and Terry Garza handle here.

The authorized overhire facilitates replacement for the Blue Teamís Dr. Chatham who retires soon. The special recruiter Mr. Youngblood promised to have a name for the Green Team doctorís replacement in March. The neurologist position is still being advertised because VAís salary for one is not competitive with the private sector.

A replacement for the Executive Manager will be on board in May and a replacement has been identified for the Dental Hygienist. STVHCS is working on a start date for the audiology technician. An optometrist from Data Point comes 2 days a week. Mr. Gregory will clarify if another one is also coming on those days.

Regarding optician services available every Tues., Mr. Gregory will find out if the same access applies to the Kerrville Campus as it does to the Data Point Clinic.

Hours for the Release of Informationís office are temporarily mornings only while the position is under review.

A speech pathologist has been identified and VA is awaiting acceptance on its offer.
The census remains about 75. That includes the 20-bed transitional care unit. Once the new Executive Manager is on board, then more nursing staff can be added and trained. Current staffing levels limit the census.

The next MAC meeting is scheduled for April 29, 2015.

Taking Notes:
Bill Bacon
Vice President

Comments to us or the V. A. would be greatly appreciated.