Mr. Chairman and members of the Subcommittee, thank you for the invitation to appear before you today to discuss how the Department of Veterans Affairs (VA) is making health care more accessible to Veterans in New Mexico.  I am accompanied today by George Marnell, Director of the New Mexico VA Health Care System (NMVAHCS).  I appreciate the opportunity to discuss our ongoing efforts to ensure that Veterans receive timely access to the highest quality care, benefits and services we can provide.  NMVAHCS is a proud member of the VA Southwest Health Care Network, Veterans Integrated Service Network (VISN) 18, located in Mesa, Arizona.  My testimony will provide an overview of NMVAHCS and explain programs and strategies to meet the challenges associated with providing quality care to Veterans across the vast geographic area of New Mexico.

NMVAHCS serves Veterans in New Mexico through VA-staffed community-based outpatient clinics (CBOC) in Artesia, Farmington, Gallup, Raton, Santa Fe and Silver City, and through contract CBOCs in Alamogordo, Durango, Espanola, Las Vegas and Truth or Consequences.  The main campus of the NMVAHCS is the Raymond G. Murphy VA Medical Center (VAMC) in Albuquerque; this is a tertiary care referral facility for Veterans receiving care throughout New Mexico, including those seen by the Clovis CBOC managed by the Amarillo VA Health Care System, the Hobbs CBOC managed by the West Texas VA Health Care System, and the Las Cruces CBOC, managed by the El Paso VA Health Care System.

NMVAHCS is actively deploying approaches to enhance care for Veterans who do not reside near our main facility in Albuquerque.  Many enhancements in quality have been made to CBOCs and rural health programs throughout New Mexico.  For example, NMVAHCS has significantly enhanced the quality of care in all CBOCs as measured by numerous clinical care performance measures.  We accomplished this through careful coordination of several initiatives throughout the ambulatory care setting.  Our facilities now meet more than 85 percent of targeted performance metrics, compared to just over 14 percent in fiscal year (FY) 08.  This significant turnaround was highlighted during a VA regional conference on systems redesign in October 2009. 

NMVAHCS also has installed state-of-the-art telemedicine equipment in all of its six VA-staffed CBOCs (Artesia, Farmington, Gallup, Raton, Santa Fe, and Silver City), as well as the Durango contract CBOC.  Currently tele-mental health services are available, and we have secured equipment and staff to reduce the need for Veterans to travel long distances to the Albuquerque VAMC.  The Alamogordo contract CBOC is very close to installing and activating equipment to provide tele-mental health services.  We are continuing to develop a tele-dermatology program, and we have purchased cameras and lighting equipment for all eleven CBOCs.  CBOC staff will use the equipment to take photographs of skin conditions and send these images electronically to the dermatologist at the Albuquerque VAMC.  The dermatologist will review the photographs and make a medical determination for a treatment plan with the primary care provider in the rural location. 

NMVAHCS has installed and is using tele-retinal cameras for retinal exams of diabetic patients in five of its six VA-staffed CBOCs to eliminate the need to travel to Albuquerque for these exams; VA is leasing additional space at the Santa Fe CBOC to allow it to offer tele-retinal services in April 2010.  NMVAHCS has greatly expanded the number of Veterans receiving Care Coordination Home Telehealth (CCHT), which provides devices Veterans can use in their home to communicate with dedicated nursing and physician staff at the Albuquerque VAMC.  This program grew 24 percent in FY 2009, and NMVAHCS ended the year with an average daily census of 177. 

Additionally, through a national VHA rural health initiative, NMVAHCS has secured $2,337,356 in new funding to further expand this program to 500 additional Veterans.  NMVAHCS has also received $3.8 million from VA’s national Office of Rural Health to expand telemedicine coordination with the Albuquerque VAMC.  These telemedicine services will include pre- and post-operative care, education and follow-up for Veterans.  High resolution telemedicine units for surgical specialties consultative purposes have been purchased for all eleven CBOCs in New Mexico.  The telemedicine units, called total examination cameras, are capable of examining ears, skin, mouth, feet, and surgical sites for post-operative evaluation.

Based on the 2009 Community Homelessness Assessment, Local Education and Networking Groups (CHALENG) Survey, there are approximately 460 homeless Veterans in New Mexico on any given night, many of whom usually reside in urban areas.  NMVAHCS works with community providers across the state to address Veterans’ homelessness issues.  VA supports 80 beds for homeless Veterans through the Grant and Per Diem program, and another 40 beds through the Domiciliary Residential Rehabilitation Treatment Program.  There are 105 Housing and Urban Development/VA Supportive Housing vouchers available to homeless Veterans in New Mexico.

The NMVAHCS Women Veterans Program offers comprehensive primary care, gynecology, cancer screening, and preventive care, while also collaborating with behavioral health programs to offer counseling.  NMVAHCS’ Mammography Program is certified by the Mammography Quality Standards Act and accredited by the American College of Radiology.  NMVAHCS’ Women’s Comprehensive Care Clinic has provided assistance to several homeless women Veterans and provided referral or treatment as necessary.  Of the 16,000 women Veterans in New Mexico, 3,694 are enrolled in VA for health care, and 2,902 are active users.  NMVAHCS is located near Kirtland Air Force Base, and many women Veterans return and settle in Albuquerque after deployment.  VA has seen a six percent increase in the number of women Veterans over the last year, and it expects to serve more than 5,750 women Veterans by 2014. 

VA is also making improvements for Veterans who need to travel long distances for specialized care in Albuquerque.  Congress provided funding to raise the mileage reimbursement rate from 11 cents per mile to 41.5 cents per mile to help defray travel costs for those Veterans who are eligible for beneficiary travel.  In February 2009, NMVAHCS opened an 8-room, 16-bed, on-campus lodging facility with private rooms and baths called Heroes Hall.  We recently finished construction on Phase 2 of this initiative, opening two additional rooms for occupancy.  We expect to fully activate this facility by May 2010; this will double the current capacity and be sufficient to accommodate increased demand.  This temporary lodging is furnished at no charge through the NMVAHCS when Veterans are traveling more than 120 miles one way to the NMVAHCS to receive medical care or a compensation and pension examination.  Veterans who are often accompanied by an adult care provider or a significant other can now spend the night on the hospital grounds just before or after their appointments.

VISN 18 and NMVAHCS continuously strive to improve access for Veterans in rural areas through strategic planning initiatives that identify outreach and rural health opportunities.  We appreciate the opportunity to meet with you and to hear your thoughts, as well as the opinions of the other witnesses here today.  Mr. Chairman, this concludes my statement. I am pleased to answer any questions you may have.