The VA in Cheyenne.
By Tom Lacock
Wyoming Medical Society
Colonel Cherron R. Galluzzo is the Commander of the 90th Medical Group at F. E. Warren AFB in Cheyenne, having come to town in mid-July – her 16th move for the Air Force since 1993. So far it is safe to say her welcome to Wyoming seems to be going well, as illustrated by a recent unexpected greeting from Cheyenne Mayor Rick Kaysen.
“My mom and I were out for dinner downtown and Mayor Kaysen and his wife came over to ask how we were doing,” Galluzzo says. “That simple gesture is a testament to what Cheyenne is all about. The warm reception we have received since we’ve been here makes me excited to be part of such a great community.”
While Kaysen and Cheyenne understand how the 90th Medical Group at F.E. Warren fits into the community at large, few understand the role the medical facilities at the base — and the other two military medical facilities in Wyoming — play in the state’s medical community. Between F.E. Warren and VA Hospitals in Sheridan and Cheyenne, military healthcare facilities take care of roughly 45,000 residents of Wyoming, Montana, as well as parts of Colorado and Nebraska.
Galluzzo leads 228 personnel and manages a $9.8 million budget at F.E. Warren, working under a dual mission – to maintain the health of warfighters, as well as the families of the airmen based in Cheyenne
Galluzzo is a nurse by training, earning her BS in Nursing from the University of Akron. After earning a Masters in Human Resource Development and two more Masters at Maxwell Air Force Base in Alabama, she came to Cheyenne in July. She is a Senior Flight Nurse with more than 600 hours flown and has been deployed in direct support of major operations including Operation New Dawn, Operation Enduring Freedom, and Iraqi Freedom.
Serving with Galluzo is Lt. Col. Luis Otero, MD, the Chief of Medical Staff at F.E. Warren, who arrived in Cheyenne this summer after time in Ohio, Japan, California, South Carolina and the Air War College in Alabama. Awarded the Bronze Star for developing public health procedures during a deployment to Afghanistan, Otero oversees all clinical care on the base. That includes a patient roster of 9,600 and another 11,000 who have access to ancillary services on the base such as use of the pharmacy, or x-ray equipment. Despite the administrative duties he carries, Otero still maintains a day a week in-clinic.
“I love clinic,” says Otero, who attended medical school at University of Miami in Florida. “I went into family medicine because I love seeing patients and I love the variety I get to see. It re-energizes me and I have a passion for it.”
The clinics at F.E. Warren operate under the Air Force Medical Home framework – the military’s version of a Patient Centered Medical Home – and the clinic is NCQA Level 3 certified. The clinic is open to all military members and their families carrying the TriCare Insurance product. TriCare is the military’s health care program for uniformed service members, including active duty and retired members of the military managed by United HealthCare. TriCare Plus members – TriCare’s military supplement – also have access to base clinics and pharmacies.
The medical facilities on the base include a family health clinic with two physicians and three PAs; a Personnel Reliability clinic – dedicated to service members who are a part of the Intercontinental Ballistic Missile mission – featuring three PAs; a Flight Medicine clinic with three physicians; and a mental health clinic with one psychiatrist, two psychologists, and three licensed clinical social workers. An optometrist, a physical therapy clinic, and an alcohol and drug treatment clinic are also housed on the base.
The one piece of the medical puzzle lacking at F.E. Warren is specialists. Capt. Lauren Rodgers is the practice manager for the clinics at F.E. Warren and says the base makes 100 referrals a day to specialists in Cheyenne and Northern Colorado. That has led to some strong relationships within the medical community.
“Because most of our clinics are set up to have primary care with very little specialists, we end up interacting quite a bit with the physicians we are referring to,” Otero says. “Part of my job is to refer out members and get back referral reports. This community does extremely well with those. We have great relationships where information is being passed back to us.”
Otero says specialists interested in joining the mission are encouraged to speak with the United HealthCare representative about getting into the TRICARE network.
Military providers tend to be transferred roughly every four years, as do enlisted personnel. Rodgers says thanks to the PCMH model, electronic health records and programs such as the Exceptional Family Member program, which helps the military track family members with special needs, the transition tends to be seamless.
“You have families coming and going so every time they arrive at a new place, they have to set up a relationship with the providers,” Otero says. “As providers we get moved as well. Both sides have a lot of transition, but luckily our military population is very resilient and tend to respond to that well.”
Two other areas unique to the Air Force has at F.E. Warren are a public health department, which looks into trends on-base, such as occurrence of injuries or event illness/STD’s and an environmental department is in charge of making sure buildings and facilities are up to code and healthy.
The clinic at F.E. Warren is currently overtaken by workers in hardhats and is in the process of an $18.3 million facelift. Rodgers says the plan is to update the 30-year-old clinic which was originally built to be a small, community hospital. The hope is to make patient flow easier.
“My job is all about access,” Rodgers says. “Are we meeting our access numbers? The Air Force has set goals for us, so urgent needs should be seen in 24 hours, future appointments in seven days. I work to see that we are meeting those. What is our population asking for?”
Otero says one of the next steps for his group is to begin to build on the relationships it has developed in the Cheyenne area and look to do the same in Northern Colorado where a large number of airmen who serve at F.E. Warren reside.
VA Facilities in Cheyenne and Sheridan
In addition to F.E. Warren’s active-duty mission, the state has two Veterans Affairs hospitals — in Cheyenne and Sheridan — to serve Wyoming’s veterans. Samuel House, public affairs officer for the Cheyenne VA, says any veteran who served in either stateside or in the combat theatre during time of war is eligible for services at the VA. He said if an individual suffered an injury which was service-related and is compensable is also eligible for services.
Completed in 1932, the Cheyenne VA hospital and surrounding complex features 17 buildings on 50.88 acres. The facility itself is a full-service hospital campus with a total staff of 950, which serves 24,500 veterans in a three-state region. The Cheyenne VA serves patients north from Wheatland/Torrington south to Fort Collins/Greeley, from Rawlins east to Sidney, Nebraska. The VA offers clinics in Fort Collins, Greeley, Sidney, Nebraska, and Rawlins, which feed into the Cheyenne facility. Mobile telehealth through use of a recreational vehicle serves veterans in Wheatland, Torrington, Sterling, Colorado, and Laramie.
“We have 75 beds in our hospital, a 24-7 emergency room, and did 25 surgeries last week,” House says.
Of those 75 beds, five are in the hospital’s ICU, 10 are in the VA’s residential rehab treatment facility for post-traumatic stress disorder, as well as alcohol and substance abuse. It is a residential setting in which the doors are always open. The facility’s Community Living Center offers 35 beds for short-term rehab and long-term veteran stays. The facility also houses a hospice. Service-connected veterans can also get prescriptions at $8 per-month per-prescription while non-service connected vets pay $9 per-prescription per-month.
Like its sister to the south in Cheyenne, the Sheridan VA also serves a large area of the map with responsibilities for over 11,000 patients spread over nearly 70,000 miles of Wyoming. The Sheridan VA has 68 licensed independent providers at its facility including 31 physicians serving the 171-bed facility. The Sheridan facility features primary care, as well as physical rehabilitation, neurology, podiatry, dentistry, mental health and audiology. Sheridan VA also provides long-term and skilled care. A new community transition program in support of serious mental illness will kick off this December.
Acting public affairs officer for the Sheridan VA, Terry Parsley said the Sheridan VA is a tertiary care mental health referral center for veterans throughout Colorado, Montana, Oklahoma, Utah and Wyoming. The new Community Transition Program will provide a comprehensive, evidence-based approach to treatment and rehabilitation of Veterans with serious mental illnesses such as schizophrenia, schizoaffective and bipolar disorders, and other psychosis spectrum disorders. The goal is to provide integrated, recovery-oriented care through an interdisciplinary team that will assist the individual in acquiring new skills to reduce psychiatric relapse, enable him or her to attain the highest level of functioning possible, and to integrate into the community of his or her choice.
“We strive to incorporate medical providers into the mental health treatment teams to facilitate co-management of the Veterans’ physical health conditions while they are actively engaged in the mental health treatment programs,” says Parsley.
Practicing in a VA
Jim Gray, MD, FACP, practices at the Cheyenne VA as a gastroenterologist and says the medicine is nearly the exact same as it is in private practice. The biggest difference is there is admittedly more paperwork and more bureaucracy. However, he said he has worked at VAs in Cheyenne and Amarillo, Texas, and the focus on the patient is one he appreciates.
“The VA, unlike most of my experience in the private sector, is very focused on the patient, and in this case the veteran,” Gray says. “In the VA and in the military the administrators meet every morning and talk about what is happening with patients. You tend not to do that in the private sector.
“It is a great place to work, it really is. We hire an awful lot of doctors called fee-based basis. Instead of them having a full or part-time job, they are out there and available. If we need them and they are available, we put them to work and pay them on the rate that has been agreed upon.
House says the VA has a history of paying about the median of market rate or a little below and admits the hiring process for any position at the VA can be arduous. He says sometimes a physician who has applied for a position with the VA will take another position because of the time involved in the hiring process. While there are several available positions for physicians at the Cheyenne VA, he says getting through the process is worth the effort.
“Although benefits are comparable, physicians from certain disciplines do not earn the same pay as in the private sector,” Gray says. “However, they also do not typically have the same workload and call requirements.”
VA Battles a National Reputation
News media reports over the past two years have documented issues with veterans being asked to wait long periods for an appointment at a VA facility. House said it is the goal of the VA to get every veteran calling for an appointment seen within 14 days of the call. He said the Veterans Choice Act of 2014 allows vets who have been determined eligible and who live 40 miles or more from a VA facility to seek care outside the VA system. The program offered $7 billion for more healthcare staff nationwide and another $10 billion for veteran health care visits within the community. However, he says the performance by the third-party administrator for taking the calls from vets and setting appointments, Healthnet, has been disappointing.
“Many times it would take 45 minutes to an hour and a half to get through on that number,” House says. “It still happens today. (Vets) would be verified, then they would be told by the individual on the phone they would need to wait 72 hours to receive another phone call telling them when they appointment would be. Many times the appointment would be in a different state. Sometimes the appointment would be for a provider that they know is not good, and sometimes they would not get the call.”
A report by the Department of Veterans Affairs released July 6 panned the Veterans Choice program. According to the Associated Press The report recommends replacing the program with community-based delivery networks that it said should improve access, quality and cost-effectiveness.
The report does offer kudos for recent changes in the VA system as a whole, pointing out that in March the VA health system set a record for completed appointments: 5.3 million in VA hospitals and clinics, 730,000 more than in March 2014. The VA also issued twice as many authorizations for government-paid, private care than in a comparable period two years ago. The report adds nearly 97 percent of appointments are now completed within 30 days of the veteran’s preferred date.
House says getting the area’s vets seen quickly has been a priority and is happy with the efforts being made at the Cheyenne office.
“When they call here they are seen quickly,” House says. “Our former director and current director saw the writing on the wall, and they used some of that money to hire additional providers as well as additional schedulers.”