Country Veterans Council Meeting
January 19, 2016
Kerrville VA Medical Center
HCVC Officers: President Vicki Marsh, VP Dave Rittenhouse
HCVC Members: Byron Warren, Dennis Birchall, Bill Cantrell, Gary
KVA: Dr. Jennifer McElroy, Dr. Veronica McClean (Primary Care Mental
Health Integration), Kim Wilson, Dr. Aven Senter, Dr. Raymond
Guests: Nick Oprea
A presentation was provided by Dr. McClean on Primary Care Mental
The PACT’s (Patient
Aligned Care Teams) work directly with Patient Centered Medical
Home, referring all patients either by patient request of Primary
Care Physician identification.
The PCMHI PC Team concept consists of “Teamlets”: PCP, RN,
LVN, clerical staff person
An extended team exists to provide additional support:
Psychologists, Clinical Pharmacists, Dietician, SW's, Mid-Level
Providers (NP, PA).
Typical Mental Disorder Sources include PTSD, Agent Orange, and
A Population Based Integrated Mental Health Care concept helps to
achieve maximum effect on the served population.
There are two basic Models of care used throughout the VA system,
plus a Blended version:
Co-Located Collaborative Care Model
Care Management Model
Three Levels of Care are provided:
Primary Care - Screening for MH issues
PC-MHI - Integrated Care
Specialty MH - Secondary and Tertiary Care
Main Line Care includes:
Chronic Disease Management
Comorbidities (secondary or tertiary illness) treatment, especially
patient non-compliance with treatment (ex. Not taking medication)
and adjustment disorders.
Depressive and Anxiety Disorders
Alcohol Misuse and Abuse
PTSD and Adjustment Issues
Insomnia, chronic pain, Panic Attacks, unexplained somatic symptoms,
Specialty MH Programs include:
PTSD Oriented Programs
Residential Treatment Programs
Intensive Outpatient Programs
Opiate Substitution Programs
Serious Mental Illness (STARR, Stepping Stones)
Supported and Therapeutic Employment
Mental Health Intensive Case Management (MHICM) - go into Veterans'
Long Term and Specialized Psychotherapy
Screening is done to categorize PCMHI into both low risk and high
risk categories requiring differing levels of treatment.
One concept includes Shared Group Medical Appointments for Chronic
Disease Management and DIGMA's (Drop In Group Medical Appointments).
Telephone based care is provided at KVA by Kim Wilson for
There is no walk-in clinic; all referrals must come from the
Benefits of the PCMHI to
Reduced wait times
Enhanced treatment engagement and adherence
MH capability has grown significantly since 2004 and it is
considered to be reasonably well resourced in the STVHCS.
Civilian Care cooperation includes working closely with Veteran
Treatment Centers (clinic) which include family oriented care.
Vicki expressed concern that Veterans and the community are not well
enough informed on MH resources and how they are deployed.
There is a PCMHI meeting planned in February for the PACT's at KVA.
There is need to have Mental Health Summits well-advertised in
The HCVC has offered to put key information on its website.
Telehealth contract arrangements exist with the Junction and Del Rio
clinics. To provide this and other telehealth MH services, 2 STVHCS
psychologists are full time telehealth.
There is also home based MH care for those who are home bound.
HIPPA concerns must be properly addressed. For non-emergency cases,
the Veteran is asked for permission to access appropriate contacts.
In the event of emergent situations, there may be a need to waive
some aspects of HIPPA, which is allowed by law.
Status of Fills
The ROI Clerk position has been filled. The may be a new phone
number; not yet resolved.
STVHCS has completed Admin Officer interviews for KVA and final
selection is in progress.
Green and Blue team doctor selections are on track.
The psychologist for GEM, Dr. Mark Floyd, has a March 24 start; he
will transition to full time.
When patients are moved among PACTs once these fills are
accomplished, they will be informed
Vacant custodial positions: 10 total custodial + laundry has 6
The new Dental Hygienist is now at Data Point for in processing.
KVA will be hiring an additional hygienist and additional dental
There is a new Psychiatrist lined up to start in July; in interim
KVA is using telehealth.
The Secretary replacement (for Linda Watts) is pending an overdue
update in position description.
KVA has identified a convenient location for displaying hiring
Relative to posting jobs in KDT, the new HR chief is analyzing this
for effectiveness and efficiency. As the VA budget is not yet
released, but only a continuing authorization, there is in any case
no funding at the moment.
Usajobs.gov now has KVA job postings.
There is a need for local advertising, which may most effectively
further refer to usajobs.gov.
Veteran Emergency Care at PRMC: Due to the continuing issues with
resolving outstanding payments from VA, PRMC has decided to start
billing directly to patients. Jennifer has been meeting with PRMC to
try to resolve the issues, which appear to originate from both
parties. She is trying to set up a face to face meeting.
Jennifer does not know exactly when she leaves, but will attend at
least one more HCVC meeting.
Providers are increasing, there is now a surgery center included.
23,000 Veterans are eligible in STVHCS; about 2,500 have used Choice
according to Tri-West
The "30 day" period is becoming problematic; there are a number of
reasons why there might be more than a 30-day waiting period to
include the Patient can change their appointment date.
Some Veterans Frustrations include:
Community wait standards might be much longer than 30 days.
Choice is not used for second opinions.
VA is working on a more consolidated “VA Care in the Community”
concept for all non-VA Care plus Choice. However, the two programs
remain separately funded.
The chart for Non-VA Emergency Care eligibility has been updated
though the content remains the same.
The KVA telephone tree has problems and Jennifer is addressing this.
The request for a Full Time Wound Clinic has been investigated and
there is not sufficient demand. Veterans currently have 5-day access
to wound care.
Jennifer is unaware of a VA maggot policy (for removal of dead
Jennifer is unaware of VA re-writing RX's from outside providers.
There may be varying medical opinions which can result in PACT not
prescribing something a community provider prescribed.
Why do check in kiosks not work? A problem with the software has
been identified. Houston has not removed their kiosks (as had been
reported) but has relocated some to better locations.
KVA does not normally transport veterans from Freedom's Path.
However, KVA has been working with Freedom's Path on their
organizing a golf cart run by volunteers.
My Healthevet is now administered by Craig Rickaway.
The Museum will likely be provided with its own building; one of the
old houses on the KVA campus.
Comments to us or the V. A. would be greatly appreciated.