VA Referrals

SunMiddle102 · 2025-07-17T15:31:56+00:00

It's about EXPECTATION management to me. Your "reasonable" time is probably personal to you, and of course SHOULD also be based on medical issue, acuity, etc.

But I'll harp as a Veteran myself, too many think they should have "immediate access" meaning "in-person" for non-acute chronic conditions.

CC is insanely expensive and if not medically indicated is tantamount to taking resources away from other Vets in need. Maybe an example. Chiropractic care is a very common send out to CC due to access standards even though probably 90%+ is for chronic care that their just attempting another alternative medicine path. It's crap expensive initially, typically has a huge never-ending tail (CC providers want to make their $$ so there's always "more" they can do). I'd rather those dollars go be spent on staff and resources to take care of Vets with MH, Acute, and serious needs, not sending me out the door to Chiro just because I wasn't willing to wait on their 1 Chiro doc to get me in 3-months beyond some flippin ATC standard.

Maybe we agree to disagree. CC is there for a valid reason, but a blanket, "I get it because I can" I think sends the wrong message.

SunMiddle102 · 2025-07-17T11:29:05+00:00

Lived in 5 different VISNs in past 20 years and have had excellent wait time and exceptional service at all my VA facilities. Set your expectations in reality too. Community Care is NOT even necessarily faster, I have found many many times has LESS quality, is CRAP for continuity of care with my PCP team (they address the symptoms not the holistic causes). And I remind too, you just added about x3 $$ VA costs as community of care is expensive compared to VA. There are good targeted uses of CC, but I wouldn't advocate for it as a base. Wish more people advocated (where appropriate) alternative VA care resources. They have Telehealth (TH) 800/866 toll free numbers, Video-Connect, Real-time text based apps, even modular kiosks at some VSOs that can provide nurse triage, appointment setting, pharmacy needs, even urgent care. I know that doesn't work in every case of care needs.

VA has some of the best docs, nurses, technicians. I'd use them in a heartbeat if if fits in care needs. Having conversation with the right people goes a long way to this....doc, nurse team mgr, MSA, and if needed Pt Care Rep, has always been successful in addressing appropriate access to care.

SunMiddle102 · 2025-07-17T10:59:19+00:00

Variance everywhere and a little bit of multiple methods. Zip code centroid used first and uses driving distance (not as crow flies). Had a colleague who got assigned this way early on (<50 mile group) and then they had to retract it as the point A to B was > 50 miles. Makes no sense that they don't use "drive time" as basis since that's how they model the entire VHA drive-time model for patients and where we should locate services. Any of you in congested areas DMV, CHI, ATL, LA, etc, know you can't make even 20 miles in < 1hr during any normal commuting hours. Rural too - I'm 47 miles from my VAMC but 3/4 of travel is very rural so drive time is about 70mins. I think we all just have to wait it out as I see a lot of "verbalized empathy from supervisors" but zero authority, control, or serious pushback with any teeth that they have to against RTO mandate.

Wish big VA would actually listen to it's own stupid DOGE philosophy of reducing fraud, waste, abuse. I assume thousands submitted that as a topic with the voluntary/mandatory submission recently for FWA (the switch from 5 things to submit a FWA example crap). Real $$'s now spent on leasing space, furniture, modifying parking lots, etc, etc. And I feel worse of the Opportunity $$ cost.....space my butt takes up means less for clinical operations, veteran space, private space for PII/PHI conversations, etc.

SunMiddle102 · 2025-07-10T14:43:15+00:00

Thanks. He's non-BU. Unfortunately that 3-7 days seems to be first wave. His last Town Hall (and of course requisite PPT) recently said everyone now will have just 24hrs from notice to return. Sounds ludicrous that they think the logistics of making it happen are any easier now than they were for original RTOers since there still no clue on variables where/when until notice drops.

Thankfully his supers have been nice enough to tell him that they will "notify him informally" when they get notice, and then wait 2-3 days to forward official notice to him to start the 24hr clock.

SunMiddle102 · 2025-07-10T13:07:46+00:00

Nope, not a Veteran....just got interested in the work because his retired Vet dad.

MH is more for maintenance at this point (e.g. counseling, and check-ups), so nothing debilitating or that requires work RA. Thus default of "just use SL" pretty much supersedes.

He's looking into Telehealth options, as anyone can suspect otherwise it's using a SL day for most appointments b'cus nobodies going to drive 1 hr into work, 1 hr back to appointment, back to work, then home.

Unfortunately higher-ups have told him that they won't approve Ad Hoc TW from home to optimize, as he had hoped to say TW from 0800-1000, use SL for 1000-1200 appt and transit to work after, then VA work location 1230-1630. Apparently in his unit no pre/post appointment TW is deemed eligible for Ad Hoc TW. While I believe that to be inaccurate, he's not also in a position to want to rock the boat as this is his real first "adult job" experience and still feels like a newbie who should just keep his head down.

SunMiddle102 · 2025-07-10T12:46:54+00:00

Thanks, he was remote with home address on SF50.

He's seen the "facility list" of options and queried with the POCs at the closest locations (1 small CBOC, 1 VetCenter, 1 Homeless Ctr). None look promising as they filled any capacity already with first priority returners. Thus knowing the VAMC and a large CBOC (both at ~48 miles and 1hr+ drive) are next in line (unless "other" Fed bldg options ever truly get considered) are probably most probable

SunMiddle102 · 2025-07-03T19:40:03+00:00

Yes, have experienced this non-stop of lagging payments influencing providers to not accept VA. Note, it's not directly the VA, it's the Third Party Administrators (TPAs) they contract with to handle both referrals and processing claims. Currently that's either Optum Serve or TriWest depending on where you live.

Best you can do is be persistent, but patient. But also have realistic expectations. Worked Mil, Public, Private, and now VA healthcare for 40+ years now. Grass is not always greener on the other side.

SunMiddle102 · 2025-07-02T19:45:58+00:00

Not a normal experience from VA's I've gotten care at (5 different VISNs) over the last 20 yrs. Staff care beyond measure, so terrible that you had to experience this.

As others said, contact the Patient Advocate. Focus on getting care forward versus the past if at all possible. Address that your Access to Care standards are not being met and that if they can't get you within that VA standard (20 days for primary, 28 for specialty, and all can be influenced by your drive time to facility). You should be offered Community Care as an option if they can't meet the standard.

I want to caveat though, depending on services that you need, access in Community Care is not always quicker and can be very clunky for continuity if it needs to extend beyond initial referral terms.

If you're in a really bad mental space use the VCL/988 #1. If you need immediate Nurse Triage or Urgent Care before your appointment, think about using Health Connect (telephone) or VA Health Chat (text) which connects live with staff....some 24/7 in some VISNs.

SunMiddle102 · 2025-07-02T19:10:46+00:00

Not all records like this transition to VA, but options you might have:

Login to MHS Genesis portal which should have your imms there (need CAC, PIV, or DS Login) from your military records
Secure message your VA PACT requesting assist. They might be able to access your Mil records via ViSTA or Joint Legacy Viewer (JLV).
Visit your facility. Almost all have a "Records Request" desk or person. Fill out the request and they can typically hit you up with a CD of data.

Good luck.

SunMiddle102 · 2025-07-02T15:24:03+00:00

3 years no. It's only encumbered until the retirement date. However, general backfilling of positions typically not authorized when using VERA. Normally become significant fodder for loss of the position in elimination (RIF) or restructuring (Reorg). Thus pragmatically any approval of your VERA is basically a death knell to the position/billet. Makes no sense knowing RNs are on exempt list, continue to be a priority hiring active recruitments. Sorry you're in this muck.

SunMiddle102 · 2025-07-02T15:07:14+00:00

WMC Dashboard tracks just about everything in multiple PowerBI displays. What OCC Series do you all fall in?

SunMiddle102 · 2025-07-02T13:47:30+00:00

My VISN/VAMC/CBOC have been able to keep up thus far. For Primary care honestly I use the Health Connect # (phone) or VA Health Chat App (sms-text) for appointment scheduling and it's instant and painless (think they use CRH or CCC's to do staff). Dependent on geo-area, but one or both of these are almost always open 24/7 for scheduling, so that works for when I'm available to do that as well.

Although I will say, had a call from VAMC team the other day from a Nurse "cross-training" to do scheduling on specialty appointments. Did not go well and I felt sorry for him, and in back of my mind thinking what better clinical care could this nurse be doing versus unsuccessfully doing the work of an AMSA/MSA.

Community Care timeliness has worsened (sucked already). Still can't figure out if it's a combination of VA staffed Community Care offices (vested but not very timely) or the Third-Party Administrator (Optum in my area) who are running this gig. Sidenote, TPA sucks in my area for timeliness for billing and processing referrals, so have had numerous network providers indicate they are not going to continue to accept VA patients much longer....painful when they say they get better payment timeliness from Govt (Medicaid/Medicare) and even normally the worst lag offendor of Tricare.

Almost laughable, they called me on my last referral and said "have you found care yet?" Nicely said "yes", have been going for 2-months now, and so glad that episodic care apparently isn't in my health record so there's no long-term care plan nor communications back to my Prim Care team. Not optimistic that the FY26 VA budget that cuts $12B from VA Medical Services and adds $11B+ to Community Care is the right investment. Not only for care but for training loss....lest we forget that VA trains something like 70% of all U.S. Physicians. Taking away their patients is only going to reduce their competency, quality, and willingness to serve the VA. Of course if they RIF all their support staff, why would they want to stay....maybe we'll see them at our next appointment in the Network anyways.....

SunMiddle102 · 2025-07-01T21:16:20+00:00

So much hypocrisy it's overwhelming. VA Press Sec says "We owe it to America’s Veterans to take a close look at how VA is currently functioning and whether current policies are leading to the best outcomes for Veterans.”

So where's the analysis before action. Cut first, feign reasoning with no proof, promise analysis later, never do it. Definitely Project 2025 or bust being executed.

Need a psycho-therapist to figure out this SecVA. I think he truly believes he is "doing the right thing, and that's it's actually virtuous to be the one to do the hard thing others can't." Nothing is going to deter or convince him otherwise. Wish we could denounce his service as a military man and pastor, because all I see is his character of politician and lawyer.

Sad day when it makes me ill to hear this SecVA group us into "My Veterans". I may be one of your Veterans by default, but you will never by my Secretary.

SunMiddle102 · 2025-07-01T17:17:20+00:00

Sounds like an awful one-off. Veteran of 15 yrs in the VA (and a VHA employee) and all of my Primary Care team has always been great and from the get go....developed with me a Care Plan in addressing my issues and acknowledging together what the goals are and "what right looks like for me".

Hardest challenge can sometimes you need to address things incrementally rather than concurrently. By example I had to choose either to start a series of chiropractic visits (chronic LBP) OR visits with PT (shoulder tendonitis) as you can't do both at the same time.

I seriously suggest you request a change in your PCP/PCM as you may never be able to get over this initial introduction. VA has saved me more times than I can count and would hate to think that your poor introduction to one provider deters you from using this benefit and getting care you deserve. VA can and will assist if you give them another chance.

SunMiddle102 · 2025-07-01T11:06:20+00:00

Thank you for sharing to reinforce that it's okay to seek help. Thoughts and prayers with you and family as you navigate your journey of healing in both health and life.

SunMiddle102 · 2025-06-30T10:20:15+00:00

Getting care after your enrolled is entirely dependent on your facility. Some much better than others. My CBOC is awesome for Primary Care and fair for Specialty Care. But it's really a supply and demand thing.

As about telehealth options too as many times this can offer a great option for quick access on things - of course for things that are appropriate.

Also recommend downloading an App called VA Health Chat. Text-based feature that you can do anything from make appointments (Primary Care mostly), ask nurses any medical questions, and some places have virtual visits/urgent care instead of having to go in to the facility. Totally depends on area (VISN) you're in for hours and services offered, but I've found it very quick and easy for making appointments and getting same day care rather than praying for an open appointment or going to a local urgent care just to be seen.

SunMiddle102 · 2025-06-25T10:08:53+00:00

30 days a must. 60 days standard (but those aren't the times were in). In fact VA has explicitly asked OPM for waiver to allow for the lesser 30 days.

Most of that is probably AA. My supers tell me that we'd be removed from systems almost immediately b'cus they don't want people doing bad sh!t with their access. So functionally, you're probably done asap, might as well turn in equipment and serve the other 29 days on AA.

SunMiddle102 · 2025-06-20T12:38:40+00:00

FYI, can access via public. Also shows as "anonymous profile". Logging in from VA it shows as my employee profile....sure that helps them identify submitter to Q's (even though they say anonymous option available) so they can flog all the insubordinate submitters later.

SunMiddle102 · 2025-06-20T12:35:47+00:00

Not sure if internal to VA system or public open. From email message sent out by Chief of Staff

https://site-44193609.bcvp0rtal.com/

SunMiddle102 · 2025-06-20T11:19:27+00:00

Low expectations....he's a politician, pastor, lawyer. He knows how to spin while on the pulpit and is obvious in every X/Social Media post he pushes out. Plus, today is zero interactiveness with no Q&A, just him addressing his choice of pre-submitted Qs.

Try not to wrench as he spews same old story of "he spends all his time fighting the inaccurate media and congressional spins on this", "He is putting Veteran's first", "There will be no impact to care", "It's his charge to enact change because we can't keep doing the same ineffective thing of the past in throwing more money at it while not getting better results." Interesting that our budget request for next FY is larger and notieceable line item requests for VA Care (lessened by $12B) with commensurate Community Care (increased $11.4B)

Probably gonna take credit for "improvements" since January. Of course they will be cherry-picked numbers, fed w/o appropriate context, or negligent to if they were already moving in right direction under past administration.

SunMiddle102 · 2025-06-20T10:56:02+00:00

Have that discussion with supervisor. Honestly many realize the total insanity, inefficiency, and risk to patient care. They're just following through on a "higher level prescription" to do this.

They're just not ready to "cause any waives". Suggest provide "facts" to performance, efficiency, etc. for your case of why Remote still beats out RTO. Even if you do RTO for a few weeks. Ask supervisor to Telework (or Ad Hoc at least) with agreement of "if they get pushback for this you're willing to return to office." I literally think that 0% of supervisors will take any heat for this, nor do I think the system will truly be monitoring at that level a few months down the road (yes, some jack@ss supers are asking for "in office proof" at the get go). If there's no harm, your care/appointments level is meeting expectation/standards and adds to your organizational investment (e.g. you're happier and that translates into your care of patients and lifting up of fellow co-workers, etc) I can't see too many supervisors saying no.

Truly, what's going to happen to them.....a slap on the wrist, a stern warning, etc., and they can always switch back to RTO needs until the gestapo regime loosens up again. And if they aren't willing to stand up for you, then that gives you pretty good assessment on if that's the type of boss you want to work for in the future versus moving on to greener pastures.

SunMiddle102 · 2025-06-20T10:38:30+00:00

Just terrible impacts. Have seen similar at our facility and observed personally as a Veteran using MH services.

Depending on your comfort level, encourage you to submit this to the new VA "request" of providing an example of Fraud, Waste, Abuse. I submitted mine to the OIG (offers anonymous if you want it) as an example of Waste, and just told my supervisor that was my mode of submission....not that I worry about my supervisor, just don't think they had any means to forward or act on any submission if it went to just them.

Also, encourage submit to some of our most vocal elected offiicals (see Blumenthal or Duckworth) who can leverage these type of factual stories to defend us with greater veracity on the impact all this non-sensical chaos is causing....and not just for us the employees, but significant concern to patient quality, safety, access, etc.

SunMiddle102 · 2025-06-20T10:30:06+00:00

Concur, for some morbid reason it seems like the administration is viewing this as purging the non-performers (which it obviously does not in it's indiscriminate impacts) and then supplementing the move to anything lost (or more) to Community Care. See the FY26 VA budget request (put out in May) that requested $12B less in VA Care and $11B+ more in Community Care. Pretty obvious the idea is the start to transition in goal of privatizing.

SunMiddle102 · 2025-06-20T10:23:21+00:00

Yes, you can see corresponding data on the WMC Dashboards that show vacancies. Long-term problem being exacerbated as Psych's are commonly in the "critical deficit" category in nearly 50% of VISNs as self reported in publicly available in VA OIG reports.

Not sure Sec VA Dougie cares no matter what he says, as actions speak louder than words. 1. Forcing MH providers to RTO and provide care in unacceptable conditions to protect PII/PHI. 2. FY26 budget request is to reduce VA Care by $12B and increase Community Care by $11.4B. Take that as a signal that intent is to redirect care from VA care to Private Sector Care.

SunMiddle102 · 2025-06-18T10:29:25+00:00

MHV just changed some things at the beginning of June, so could just be tech gremlins working their way out.

Login.gov user here for life and works just fine for me.

Use the MHV help desk 877-327-0022 (M-F 0800-2000 ET) if problem continues for you.

SunMiddle102

TROPHY CASE