HELENA — Montana celebrated a monumental day for veterans with the grand opening of the David J. Thatcher VA Clinic in Missoula back in January.
What began as a humble clinic on Orange Street is now the region's largest VA facility.
Now — two months later — a new federal report is laying out big potential changes for some of the VA's smallest facilities across the country, including here in Montana. But there's a long way to go before any of those might become a reality.
Last week, the U.S. Department of Veterans Affairs released its Asset and Infrastructure Review report, a massive document analyzing VA facilities across the U.S. and making recommendations on what changes to make in the system to get it ready to serve veterans into the future.
In Montana, the report recommends closing some VA clinics — though leaders want to make clear that doesn’t mean any immediate changes to their operations.
“I just really want to strongly emphasize that they are recommendations,” said Dr. Judy Hayman, executive director of the Montana VA Healthcare System. “There’s a year-long review process that will be going on, to determine what recommendations are sent forward to the president – and some may not.”
Hayman says the report hasn’t affected how they’re proceeding with updating their facilities, "we’re actually looking at expanding services across the state,” she said.
The Montana VA currently operates 19 locations across the state. The federal recommendations call for closing four of them: rural clinics in Browning, Glasgow and Plentywood, as well as the Miles City Community Living Center, a nursing home.
They also suggest other changes, like shifting the emergency department at the Fort Harrison VA Medical Center to an urgent care center and discontinuing outpatient surgical services at a Billings health care center.
The report says the buildings suggested for closure are seeing relatively low use. In fiscal year 2019, they identified just over 2,000 primary care visits and 150 mental health visits at the Glasgow clinic and 369 primary care and 39 mental health visits at the Plentywood clinic.
The recommendations say services can be shifted to other community providers. However, some veterans’ advocates have concerns about that approach, particularly in rural Montana. Glen Sharbono, commander of the American Legion’s Department of Montana, said outside providers may not have the same expertise in dealing with veterans’ needs – especially mental and behavioral health care.
“Right now they have care in the community, where they outsource a lot of things,” he said. “That works for blood tests and X-rays, but extended care, not so much.”
Sharbono said going to the VA is a much different experience for veterans," it helps when veterans are amongst themselves, a lot better than just a bunch of civilians, not understanding perhaps."
The VA says this process is intended to identify what steps they can take to keep the veterans’ health care system strong into the future. Leaders say they need to address aging facilities, shifting veteran populations and a switch from predominantly inpatient care to predominantly outpatient care.
The report is based on an analysis of each individual market the VA serves. Hayman says, in Montana, that analysis dates back to 2019. Because of that, she says many of the recommendations are already outdated, calling for changes that have happened or are in the works now.
“That was a form of validation about everything that we were doing,” said Hayman.
The recommendations suggest a new, larger VA clinic in Missoula, but the VA already opened a new location there in January. They also suggest creating a new clinic in Butte, to replace the facility in Anaconda. The Butte clinic is set to open next month. In fact, Montana VA has launched seven new clinics around the state in the last few years — most recently in Bozeman last week.
Hayman also said Montana VA is currently looking at finding a new location for the Miles City CLC, to replace the decades-old current building.
This asset and infrastructure review was set up by the 2018 VA Mission Act, a federal law that passed Congress with wide bipartisan support and was signed into law by then-President Donald Trump.
Although U.S. Sens. Steve Daines and Jon Tester voted for the act, they’ve both made clear in statements that they have concerns about the possibility of service reductions coming out of these recommendations. They say they’ll have a lot to say as the process goes forward.
“The report from the VA under Biden that recommends closing veteran clinics across Montana is unacceptable and shows how out of touch D.C. bureaucrats are with rural America,” Daines said. “The Biden administration cannot ignore the unique obstacles that rural health care clinics face and must take that into consideration before closing these clinics. These facilities provide critical care to Montana’s brave men and women who served our nation, and I will not give up fighting to protect access to the care our Montana veterans need.”
“Some people interpret a proposal as a termination of a building; that’s not true,” said Tester. “It’s going to be up to Congress. Congress directed the VA to come out with a proposal on looking at assets and infrastructure to see what wasn’t needed. Now we have to hold those proposals accountable – for example, what metrics did they use, when were the surveys taken, were docs in those offices – and then, we’ve got to talk to the veterans in the area. Look, if they’re going to use it, we’re going to make sure they have the services. That’s my goal.”
President Biden has nominated members to the Asset and Infrastructure Review Commission. They’ll also need to receive approval from the Senate. The commission will hold hearings on the recommendations – specifically including hearings in any regions where they’re proposing to close a facility – before making final proposals.
Once the commission finalizes its recommendations, the president and Congress will also have their own input. All in all, final decisions are likely at least a year — and possibly longer — away.
As leaders consider how to move forward on these proposals, Sharbono hopes they’ll keep the needs of Montana veterans at the top of mind.
“We need to keep our promises we made to the veterans; the veterans need to come first in health care, over and above everything,” he said. “It’s promised since Abraham Lincoln and the Civil War. That’s been the promise: they ship us off, they promise that they’ll bring us back in one piece, and if not, then fix what’s broke. That’s all we’re asking, is to do that.”
