WASHINGTON—As VA facilities across the country begin the process of a staggered reopening, most are facing a backlog of appointments, surgeries and disability examinations. While some healthcare needs were able to be met through telehealth during the last few months, many were merely delayed, with some becoming increasingly more pressing as time passed.

Prior to the pandemic, VA was handling about 300,000 outpatients every day. At the height of the pandemic, that had dropped to 100,000. By mid-June, that number was up to around 135,000.

According to VA, as many as 40% of canceled appointments were unable to be replaced with telehealth, and the department is making its way through the list of waiting patients and arranging to get them into a VA facility as soon as possible. VA and community care networks remain strained, however, and the number of new patients each facility is able to take is limited by VA’s reopening plan.

“We’ve seen some dramatic reductions in heart attacks and stroke across America, but I don’t think the comorbidities that cause those have gone away,”  Richard Stone, MD, VHA’s executive-in-charge told the House VA committee last month. “I think the American public has stayed away from the healthcare system, and they need to come in and feel safe. That’s our job—to reach out and erase that backlog.”

But adding new patients to a VA facility operating under COVID-19 protection procedures will be a challenge, he noted.

“In our Phase 1 reopening, we wanted to get to 25% volume,” Stone explained. “That volume challenges the consumption of resources. Every patient and employee is in a mask. Every room is wiped down and cleaned afterward. There’s a period of time a room is left empty to ensure there’s no chance of exposing a patient.”

Some of the backlog might be handled through VA’s community care network, but physicians in that network are operating under the same strain as their VA counterparts.

“Yesterday [June 10], we took a review of Optum’s three regions, including how many physicians were back online,” Stone told legislators. “We found that 60% of physicians in community care were not available for anything but urgent work.”

VA plans to conduct the same review of the other community care regions in its system, then work to prioritize the most time-sensitive patient issues.

“Unfortunately I think over this time we’ve seen some non-time sensitive elective issues become time sensitive,” he said. “And it’s a matter of getting people into care for this. We are tracking these numbers on a weekly basis and making sure we’re getting veterans in and responding to them.”

As infection rates spike following the loosening of physical distancing orders, Stone is worried about the additional strain that will be put on VA and its community care networks.

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