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VA and IHS exploring mutual aid, not new facilities

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SIOUX FALLS, S.D. - The Department of Veterans Affairs is making a renewed effort to serve veterans in South Dakota while looking for ways to assist the Indian Health Service mission.

Ron Porzio, director and chief operations officer of the VA office in Sioux Falls, the agencies are studying ways to consolidate purchasing and adding to IHS services.

While recent news reports surfacing in a South Dakota daily suggested the VA was going to set up a separate clinic on the Yankton Sioux Indian Reservation, Porzio said VA officials spent the past four months touring health care facilities studying ways to streamline veterans service in partnerships with the Indian Health Service and other rural health care providers to improve the delivery of care.

Even though a series of separate veteran's clinics isn't in the works, the VA is evaluating areas where it can assist IHS to cut costs while increasing its ability to render services for all patients, he said.

A team recently visited the Avera Lake Andes Health Clinic, the Wagner Community Memorial Hospital and Wagner Health Center, an IHS site. A tour through other rural facilities will be a part of the assessment, Porzio said.

Veterans Affairs officials said they are trying to renew contacts in reservation communities and with rural veterans who might have felt neglected in previous years because of the agency's attitude of forcing veterans to seek out services rather than bringing services to veterans.

Often veterans faced a daunting and frustrating task wading through an overwhelming sea of veterans offices to access services and had to drive hundreds of miles to seek health care under veterans benefits.

"The VA sort of sat somewhere and told the veterans to come to them. If it was a benefits issue, they told the people to go to the benefits people," Porzio said.

However, the VA has begun to take a different approach to providing user-friendly services and access. It has an Internet site to help veterans locate facilities, monitor the status of veterans' issues and make contacting veterans services branches easier.

The move to work with other agencies such as IHS has been encouraged on a national level and the VA has initiated similar agreements in the Northwest region where Porzio, who holds a special kinship for American Indian veterans, began working 15 years ago.

"There have been people doing this with the Indian Health Service since the late 1980s. The opportunity is there. I've met with the Indian Health Service and every contact I've had with them has been positive. I'm optimistic," he said.

Porzio, who has headed the Sioux Falls office since February, said VA officials have been touring to evaluate available services in the region, but tribal leaders will have to embrace any relationship between his agency and the IHS before anything is initiated.

"We want to find a way to really get involved with and connect with American Indian veterans. We're going to have to go at the pace tribal leaders set," he said.

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As part of a long-range plan to build rapport and a better relationship with American Indian veterans, his agency is taking time to visit with tribal leaders, giving them a chance to get to know the people in the South Dakota offices.

"It's going to take a while. The tribal council has to feel comfortable with the people they are dealing with and who our staff people are. We need to learn who is there and who our contact people are.

"We need to know what we can do to make this a complete health care package for all veterans and what we can help with to provide care for the rest of the families," he said.

"When we get done with our initial dialogue, I would imagine that the tribal folks would say OK, this would be a better deal for all of our people."

Evaluating the clinical services offered by rural settings will help officials to determine what IHS facilities might need and where services for all veterans may need improvement.

"We have to find out what kind of services they have and what we could enhance. Perhaps if we partner with IHS that increases the resource pool in a way so that more care can be given out to more people."

More talking and more study will be needed before anything could be added to the mix, he said.

"Maybe we have a better economy for pricing so maybe we can share that. Maybe we can utilize pharmacy sources that we have that can take some of the burden off IHS for the Indian veterans so IHS, in turn, would have more ability to extend more services to non-veterans," he said.

The agency will work to build the sharing agreements with an assortment of health care providers.

"This is a sharing agreement, nothing else. It is not like a contract or a community-based outreach clinic," Porzio said.

The VA won't lease space and set up separate clinical facilities to serve specifically veterans, a step that would require congressional approval, he said. Combining the buying power of the two federal agencies allows them to jointly select health care providers. "It would be a shared situation," he said.

Rebuilding rapport and a better relationship with American Indian veterans is part of the agenda to establish trust between the VA and tribal members.

"No matter how good the contract is or how good the buying power, unless people have trust it doesn't happen. I will do what ever it takes and go wherever I have to go to make those things happen," he said.

Porzio said he hopes the cooperative effort will begin to take shape later this year.