John J. Pershing VA Medical Center: Glenn Costie, Chief Executive Officer

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In southeast Missouri, three hours from any major metropolitan city, the John J. Pershing VA Medical Center serves an area that is home to approximately 50,000 veterans, about half of which utilize the hospital’s services.

“That’s a good market share for a VA hospital,” Chief Executive Officer Glenn Costie said. “It reflects the economics of the area and the number of veterans who have actively served and who qualify for a high number of benefits. It’s a very patriotic area with a lot of focus on veterans.”

The main medical center houses 18 general medical beds and 40 long-term care and rehabilitation beds. Primary-care and mental-health services are also provided by outpatient clinics in Cape Girardeau, Sikeston, West Plains, and Farmington, Mo., as well as Paragould, Ark. Overall, they have approximately 560 employees and operate on a $100 million budget.

Bringing physicians and patients together

Because of their relatively isolated location in rural Poplar Bluff, Mo., the John J. Pershing VA Medical Center relies extensively on telemedicine services made possible by electronic-medical and patient-information records. The VA system as a whole is known as a world leader in electronic-records management.

“We can seamlessly transfer a patient from Poplar Bluff to St. Louis,” Costie said. “The doctor can look into the medical record as if he’s sitting in Poplar Bluff and vice versa. We have a very nice partnership between the specialty physicians at St. Louis and the primary care doctors here at Poplar Bluff.”

Because Pershing VA doesn’t have the critical mass of patients required to justify many specialty services, the center doesn’t do surgeries, and they partner heavily with doctors in St. Louis to make sure all of their patients’ needs are met. Telemedicine technology is in widespread use throughout Pershing’s clinics and the main medical center.

“If a patient shows up and they need a mental-health consult … or maybe their surgeon is in St. Louis and they are following up on a hip replacement, we get them together on the TV system and they can see each other and they use cameras that are medically certified that allow very specific focusing and very detailed images,” Costie said. “It’s innovation to bring the patient as close as we can to the physician.”

Treating the whole person

Another focus of the VA, nationwide and at the Pershing VA, is to put an end to homelessness in the veteran population. Department of Veterans Affairs Secretary Eric K. Shenseki has made eliminating homelessness among veterans a top priority, and in 2009, he set forth a five-year plan to that end.

The John J. Pershing VAMC has a number of programs to serve homeless veterans in its 27-county catchment area.

Services are available through primary care, mental-health care, and dental care.  Programs also include community care for the severely mentally ill, treatment groups, emergency housing, employment assistance, case management, and community outreach and collaboration.

“On any given day, around 107,000 veterans are homeless in America with up to 66,000 of them known to be ‘chronically homeless,’” Costie said. “At the Poplar Bluff VA Medical Center, we are committed to using the programs and resources available to us, to help eradicate veteran homelessness in southeast Missouri and northeast Arkansas.”

Patient Aligned Care Teams (PACT) are being put in place to shift the focus of hospital/patient interactions.

“It is something you are starting to hear about in the private sector, but the VA felt this was so important, they really want to lead the charge,” Costie said.

He added, “Normally, when you go see a doctor, you are coming in with a symptom. You’ve got the sniffles or something that hurts, and we treat whatever you came to us about. We usually don’t look at the whole person. We look at your symptom. The change in our culture is that we have now assembled all of our primary caregivers. This includes a doctor, a nurse, the clerk that checks you in, a pharmacist, a mental-health provider—all of them work with the same group of patients.”

Each panel of 1,000 to 1,200 patients is covered by the same group of people. While a veteran is being treated for a symptom, they go ahead and follow up on other health issues, whether it’s how the patient is managing diabetes or high blood pressure or how they might be mentally handling an upcoming holiday season.

“It’s not just treating the symptom, it’s treating the whole patient,” Costie said. “And it is growing into things like chiropractic, acupuncture, and holistic medicine. I have a staff member who runs a clinic one day a week for meditation … He can tell me many stories about patients who have chronic pain who have been able to wean themselves off the pain medication through meditation and find a way to make the pain go away. I don’t know how it works, but he’s been very successful with that. All of this comes together under this patient-aligned care.”

Community Outreach

Pershing VA is currently about a year into a huge outreach effort. Nationwide, veterans tend to remain confused about the benefits they have earned, and the medical center is specifically working to communicate and educate the large population of veterans in the area.

“Whether you served in war or in peacetime, for four years or for two years, by your service, you’ve earned these VA benefits,” Costie said. “There are a lot of rules and regulations about how those benefits roll out, and I understand why there is confusion. We continue to try to alleviate that uncertainty.”

One method they have used is to maintain informational booths whenever there is an event that attracts a lot of people. Whether it’s a county fair or a big agricultural event, they will take their computers to the site and sign patients up on the spot.

“We saw a four percent increase in the number of veterans we served last year primarily because of those outreach efforts,” Costie said.

Another big event that Pershing hosted was a concert for a charity group that supports veterans. They had to apply for the event and ended up being one of 17 cities in the country selected.

Leading in healthcare

“The VA continues to be a leader in healthcare,” Costie said. “You’ve got to keep sharpening your saw. Everybody is getting better. You are seeing other healthcare groups with electronic healthcare records. Our next innovation in getting ahead of the pack is offering these patient-aligned care teams. If you are one of our veterans, you’ll be receiving better care because we are treating you as the whole patient, not just your ailment.”

-by T.M. Simmons

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