FORT MEADE — One size does not fit all when it comes to health care for veterans.

United States Secretary of Veterans Affairs Robert Wilkie spoke about that challenge during a visit to the Fort Meade VA Medical Center on Wednesday.

Outside of Alaska, the Fort Meade VA provides services to the largest geographic area in the VA system, Wilkie said. 

“What fits in the East doesn’t fit out here,” he said.

In order to get services to where veterans live, the VA is working to provide more community-based VA clinics such as the ones in Rapid City and Pierre, Wilkie said.

But they also are in the early stages of a new initiative called the Veterans Community Care Program under the MISSION Act. It was launched on June 6, and allows veterans to seek care at non-VA facilities.

“Our veterans would like to make it to VA facilities, but when you’re this far apart, sometimes it’s challenging to do so,” said Sen. Mike Rounds, R-S.D., who attended a meeting with Wilkie prior to Wilkie’s tour of the VA Wednesday. 

The Veterans Community Care Program replaced the Veterans Choice Program (VCP). New under this program are eligibility criteria and urgent care benefits.

The new urgent care benefit provides eligible veterans with access to non-emergency care for certain conditions in the VA network of community providers. Veterans can go to any urgent care or walk-in care provider in VA’s network without prior authorization from VA.

“We are giving veterans the option of not having to travel to see us, if that is their choice,” Wilkie said.

Gov. Kristi Noem, who accompanied Wilkie on the tour of Fort Meade Wednesday, said the state is collaborating with the VA on improving communication with its network of community providers.

“They are allowing veterans to have a choice, and if they can get care closer to home from a private facility then the VA will pay the bills,” she said.

But reimbursement of veterans for medical care at non-VA facilities has been an issue for the VA in the past.

A federal appeals court ruled in early September that the VA has been wrongfully denying reimbursement to veterans who sought emergency medical care at non-VA facilities.

Wilkie said he is addressing that issue.

“The way we make it better is to pay our bills, so we are doing that,” Wilkie said. “Our objective right now is to just make sure that those who were not paid are paid.” 

Another pressing concern for the VA is that a past community provider, Mayo Clinic in Rochester, Minn., no longer has an active Veterans Care Agreement.

Veterans were notified that as of Sept. 30, the Veterans Care Agreement was no longer recognized at the Mayo Clinic.

Clinic officials said they will continue to serve veterans within the veterans’ Medicare, Medicaid or commercial insurance plans.

That move concerns Wilkie.

“I am going to talk to the Mayo leadership,” Wilkie said. 

Wilkie’s message to Mayo administration is that the VA is a forward moving organization and they want the Mayo Clinic back as a community provider. He said some of the issues that had existed in the past no longer exist.

“In the meantime, if an outfit like Mayo closes its doors, we will find someplace else for that veteran to go,” he said.

When he came to the VA, Wilkie said he decided he was going to focus on two groups — those in rural areas and Native American veterans.

Wilkie spent his youth in southwestern Oklahoma and understands full well the challenges of living in wide expanse of the American west.

“It’s about focusing on how we can get services out to those states where the distances are still unimaginable to people in the East,” he said. “In 2019, we still do not understand the scale of the American west.”

Wilkie said that even in his little world in southwestern Oklahoma, the distances there are nothing compared to what people experience in the region served by the Black Hills Health Care System.

Wilkie said he also will focus on services for Native American veterans.

Wilkie’s visit Wednesday was part of a trip to visit VA facilities in four states in five days.

And because Fort Meade serves 90% of South Dakota’s veterans, it made sense to include it on his itinerary.

“In the time that I had I needed to make the biggest splash and make sure I saw one of our highest performing VA Medical Centers,” he said. “This one is an outstanding facility.”

What makes Fort Meade so outstanding?

Wilkie explained the veterans come from as far away as Missouri and Nebraska to be treated at Fort Meade.

“They could make stops along the way, but they like the sense of community here,” he said. “If you walk these halls, it is very welcoming — everything from the art to the people greeting you.”

Wilkie said that is a testament to the facility when people who live so far away want to come to Fort Meade.

Sandra Horsman, director of the Black Hills Health Care System, said she is constantly awed by the support of veterans in South Dakota.

“There seems to be this dedication to ensuring that we protect those who have protected us and served,” she said. “Our South Dakota delegation, our communities and our community partners have always been there for our veterans.”

Horsman said it was great for Wilkie to interact with the veterans at Fort Meade as well as talk to staff about programs they are a part of.

“His focus right now is rural health and outreach, so we talked about TeleHealth and TeleMed, and outreach to tribal veterans,” she said. 

Wilkie participated in coin recognition ceremonies honoring outstanding workers at the Fort Meade VA during his visit Wednesday.

Wilkie also spoke about the expansion of the VA in Rapid City and how he believes the usage at that new 40,000 square-foot facility will continue to increase.

“We’re getting to the point where my father’s generation, the Vietnam Generation, are coming here more frequently,” he said.

Native American veterans in South Dakota have the same issues as their fellow veterans which include distance and access to health care, Wilkie said.

“My goal is to make sure that we penetrate into the tribal areas as comprehensively as we can,” he said.

Because of the efforts of officials with the Black Hills VA, tribal representatives are equipped with iPads that get veterans access to Fort Meade, Minneapolis and TeleHealth, and access to appointments.

Another focus for Wilkie is expanding suicide prevention programs.

“I’m going to ask the tribal representatives to help us find those veterans that we don’t touch,” he said.

While visiting Alaska, Wilkie said he asked the Federation of Natives to double the number of the tribal representatives they had dealing with veterans’ affairs so that the VA could find those veterans suffering from conditions that could lead to suicide.

Wilkie said he would seek funding for rural agencies and tribal governments to help in combating suicide.

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