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Reaching Out with Veterans’ Affairs Office of Rural Health

Mary Beth Skupien, Ph.D., MS, RN, director of the Office of Rural Health (ORH) for the U.S. Department of Veterans Affairs (VA), has spent her entire career caring about others and what she can do to help make improvements where they are most needed.

All of her enthusiasm and energy is currently focused on the mission of the ORH; to improve the quality and access to care for the more than three million veterans in rural areas and support their unique needs.

Skupien, a member of the Sault Ste. Marie Tribe of Chippewa Indians, is the former deputy director of the Office of Public Health Support with the Indian Health Service (IHS) and the former director of tribal health for the Sault Tribe.

One of her first tasks when hired by the VA last July was to update a 2003 Memorandum of Understanding (MOU) between the VA and IHS. She coordinated a group of people from both agencies, focusing on topics such as services and benefits, coordination of care, health information technology, electronic health record, payment and reimbursement, cultural awareness and tribal consultation. The group also looked at expanding the Tribal Veterans Representative Program, training benefits coordinators in IHS facilities and developing innovative approaches for the dissemination of best practices, and collaborating on outpatient pharmacy issues. The Under Secretary for Health, Dr. Robert A. Petzel and IHS Director Dr. Yvette Roubideaux, signed the updated MOU on October 1 of last year.

“I am so impressed by the leadership and support of the Secretary of the VA, Gen. Eric K. Shinseki, and the Under Secretary for Health, Dr. Petzel, of how committed they are to American Indians and Alaska Natives. In VA, Rural Health includes every state in the U.S. and Puerto Rico and Guam and our goals are to reach all veterans living in rural and highly rural areas,” Skupien said. “IHS prepared me well, after spending 28 years there and six years with tribal programs I feel like this is where I am supposed to be – I am thrilled and honored to serve the veterans.”

The ORH works very closely with the 12-member Veteran’s Advisory Committee appointed by the Secretary, and as a field-based organization has 21 Veteran Service Integrated Network rural consultants throughout the country that serve as the interface between rural veterans where care is provided, facilitate information exchange and perform outreach functions from each of the 21 facilities. There are also three Veteran Rural Health Resource Centers used as a repository for education in rural health clinical expertise while supporting the ORH by conducting projects, studies and analysis. The three centers are located in White River Junction, Vermont; Iowa City, Iowa; and Sault Lake City, Utah.

Some of the more prominent goals the ORH is working to accomplish are to improve access and quality of care for rural and highly rural veterans. To that end, Skupien said 51 rural community-based outpatient clinics have been funded to improve access to care; over 40 outreach clinics were funded; transportation support projects were implemented and more than 80 12-passenger vans were purchased to help veterans get to their medical appointments. In addition, ORH funded projects for in-home care by expanding the home-based primary care services to the veterans.

There is a big push within the ORH for improving services for mental and behavioral health services. “We funded about $150 million worth of tele-health projects in the last year to bring care closer to home for veterans,” she said. Skupien said many rural veterans use tele-health programs for medical needs such as reading blood sugars or monitoring blood pressures and can then transmit that information to their health care provider. Telemedicine is also used by the ORH for several services such as mental health, dermatology services, radiology and cardiology, among others.

Other goals include providing health care services to the growing number of women veterans and providing training opportunities for rural VA providers, including a web based program. “Our focus this year has been to get a handle on the programs that have worked effectively for the veterans. We have funded over 600 projects and are evaluating them to make sure they are improving quality of life and access to and quality of care,” Skupien said. “Although we are proud of our progress, there is still much to be done to provide rural veterans with the care they deserve.”

Skupien has a BSN/Nurse Practitioner Certificate from Lake Superior State University; a MS degree in primary care/public health nursing from the University of Michigan College of Nursing; and a Ph.D. in public health management and policy from Johns Hopkins University School of Public Health.

Mary Beth Skupien can be contacted by e-mail at: Visit the ORH website at: