Congressional & VSO Briefing with Upcoming Activities

July 31 | 9 to noon | Seattle Campus (outside landing area between buildings 101 and 100) | VA Puget Sound Resource/Job Fair + Navy Band

July 30 & 31 | 9 a.m. to 3 p.m. | Pierce County Human Services Soundview Building, Tacoma | VA Puget Sound Community House & Outreach Services Housing Resource Fair

August 20 | 1-2 p.m. (tentative) | NAS Whidbey Island | Oak Harbor Official Ribbon Cutting (not open to public)

Given complexities of base access, this will be by invitation only as to not overwhelm the base, so please do not share with your constituents or VSO chapter members. We will have a story published about the clinic, having been caring for some patients there since late May and have proactively been working with Veterans interested in getting their care at that clinic.

September 3 | 1-2 p.m. | Seattle Campus | Q4 Congressional/VSO Briefing (not open to public)

September 23 | 1-4 p.m. | Seattle Campus | Suicide Prevention Think Tank v3 (not open to public)

We launched the Suicide Prevention Think Tank in 2022 as a way to bring together leaders, innovators and frontline stakeholders to:

Spotlight best practices making a difference in suicide prevention
Identify shared challenges and actionable opportunities
Connect experts and resources across organizations
Align efforts to drive real, sustainable impact

We alternative hosting the annual onsite meeting and mid-year touchpoint with WDVA. Our upcoming September meeting will be at VA Puget Sound’s Seattle Campus from 1 to 4 p.m. Our first year, we had Rep. Rick Larsen, Rep. Suzan DelBene and Rep. Pramila Jayapal at the table. We hope to again have members of congress join us. Other’s we expect at the table:

WA Dept. of Health
JBLM and/or Madigan
National Guard
VBA
Seahawks Task Force 12 members
Cohen Military Clinic
UW Forefront
VSOs
Vet Center
State legislators (Rep. Tina Orwall)

September 29 | 5:30 to 6:30 p.m. | Virtual | Women Veterans Town Hall

HIGHLIGHTS: Q3 Congressional + VSO Briefing | June 9 | 12 to 1 p.m.

Attendees:
In person:

Office of Senator Patty Murray: Joseph Najmolhoda, King County Director of Veteran’s Affairs and Grace Hulse, Stars of Valor Fellow
Office of Congresswoman Kim Schrier (WA-08): Trevon Cooper, Veteran Constituent Services and James Oakes, Green & Gold Congressional Aide
Office of Congresswoman Suzan DelBene (WA-01): Ben Studley, Constituent Services Representative
Office or Congresswoman Marilyn Strickland (WA-10): Peter Ramaley, Senior Outreach Representative
Office of Congresswoman Pramila Jayapal (WA-07): Santos Moreno, Outreach Representative
Paralyzed Veterans of America: Matt Mickunas, State Commander
VFW: Kenneth Walters, WA Department Service Officer

By Phone:

Office of Senator Maria Cantwell: Rita Stewart, Constituent Services Director
Office of Congressman Rick Larsen (WA-02): Makennah Little, Constituent Advocate
Office of Congressman Adam Smith (WA-09): Keelyn Bessmer, Constituent Representative
Office of Congresswoman Marie Gluesenkamp Perez (WA-03): Cameron Kockritz, Deputy District Director
Office of Congressman Dan Newhouse (WA-04): Alice Harder, Congressional Caseworker
Office of Congresswomen Marilyn Strickland (WA-10): Rebecca Snyder, Deputy District Director
Office of Congresswomen Emily Randall (WA-06): Katy Crabtree, District Director
American Legion: Easter Luli, Department Service Office
VFW: Gabriel Leach, VFW WA Department Service Officer

Presenters:

VA Puget Sound Executive Director Dr. Thomas Bundt
VA Puget Sound Acting Chief of Staff Dr. John Thomas
VA Puget Sound Medical Director for Primary Care Telemedicine Dr. John Geyer
VA Puget Sound Director for Health Administration Services JoAnne Brougham
VA Puget Sound Medical Director for Community Care Ryan Moore
TriWest Regional Director, Military & Veteran Service Kristine Cothren – (by phone)
VBA Seattle Regional Office Special Mission Program Officer Beorn Kjeldsen
Washington State Department of Veterans Affairs Director David Puente Jr.

SPEAKER HIGHLIGHTS:

VA Puget Sound Executive Director Dr. Thomas Bundt

Continue our work on our new, state-of-the-art clinic in Mount Vernon that will replace the existing one and have moved to the design phase. Once complete, we hope to move to construction phase 2026.
Exploration of our clinic site in the Snohomish: lease continues to be in hold-over status.
We also continue our efforts surrounding our two other micro-clinics are in Olympia and Puyallup in advance of the expirations, which were extended.
- We expect to soon finalize a 3-year extension on the existing Olympia Community Clinic. We are still planning to have the newly constructed, larger multi-specialty clinic there to replace the micro-clinic.
- Specific to our Puyallup micro-clinic (lease expires in 2029), we plan to open a new clinic in Auburn in 2026 (2nd quarter earliest) to best meet the needs of Veteran care in that area.
Our plan for our Community Resource & Referral Center in Renton is to move it nearer to the planned Auburn Clinic, expanding the footprint to South King county.
We expect to hold the official opening of our Oak Harbor Clinic at NAS Whidbey Island August 20. Tami Begasse will send out invitation in coming weeks. Given the complexities of base access, the ceremony will not be by invitation only and not opened to the public.
American Lake Specialty Care Building 201 – pre-design phase completed; expect to award the design build in 2026. We hope to break ground on the new building in 2027.
We do have other projects of course and recently reviewed the listings for those set for construction and demo but many of those are outside the window and have not changed and when/if they do we will update at a future Cong / VSO meeting.

Continue to invest in communication tools not mandated by national office to better reach out Veterans:

Patient Guide – Comprehensive resource that brings together VA services and programs to empower Veterans to navigate health care and benefits more easily. Feedback is of course welcome.
Quarterly Veteran Town Hall – Our June 9 virtual town hall drew a record of over 20,000 total participants. Largest in VA Puget Sound history to date.
Quarterly Veteran “Live Whole Health” newsletter – printed/mailed to about 120,000 Veterans expected in mailboxes by end of July.
Patient Orientation Classes – Monthly in Seattle and moves across most of our community outpatient clinics. Fantastic overview to help new and existing Veterans understand and take advantage of health care programs and services.

VA Puget Sound Acting Chief of Staff Dr. John Thomas

VA Puget Sound’s bioprinting facility opened June 20. It is the VA’s first hospital-embedded production-ready center, equipped with advanced robotics and automation. It is designed to print patient-matched grafts and organs that can be delivered directly to the operating room. This pioneering blueprint for hospital-based manufacturing brings the science-fiction concept of on-demand tissue printing into reality. BioBone is just one example. The solutions coming out of X_Labs are redefining what’s possible across multiple domains of Veterans care.
- Precision dental devices, personalized for individual patients through digital workflows and 3D printing, are restoring both aesthetics and function—giving Veterans back their confidence along with their smile.
- Radiation therapy tools are being produced to protect healthy tissue during cancer treatments—bring an unprecedented level of precision that personalizes care for Veterans.
- VA Puget Sound is also piloting the use of drones for time sensitive lab and pharmacy deliveries across its facilities.
2025 is 100^th Anniversary of VA Research.
- That we’ve risen from the 9^th most active VA research program to number 4 with more human subjects studies than any other VA.
- Our focus is on addresses practical, real issues important to health of our Veterans in all areas of research and includes clinical studies, computer-based investigations, and basic science research
- For example, if you are 45 years of age, you have a series of colonoscopies looming in your future. Colonoscopy is the gold standard for finding and treating Colon Cancer which affects 1 in 24 people and kills about one third of them. Colonoscopy has been associated with a 62% reduction in death from colorectal cancer. However, colonoscopy is time consuming for the patient and doctor, has significant risks, and is terribly uncomfortable. As such, less than half (42%) the persons eligible for colonoscopy participate. Colonoscopy is also expensive: Costing about $2,700 per exam and about 500,000 Veterans needing a colonoscopy. Here at Puget Sound, we’re exploring an alternative to colonoscopy called the Fecal Immunochemical test (FIT). This is a simple, home-based test that costs less than 1% of a colonoscopy. Our very own VA Puget Sound Gastroenterologist is leading this—the largest Cooperative Study in VA history—comparing colonoscopy to the FIT. This study shows that the FIT may be a first line screening test for the majority of us who are not high-risk patients. This would save the VA over 1 billion dollars a year and hundreds of thousands of veterans the unpleasantness of a colonoscopy.
- Our prosthetics in our Center for Limb Loss and Mobility Center is focuses on both limb prevention and high tech biomechanical prosthetic engineering. within some cases, robotic assist. Projects include the Smart Cane, a walking stick that gives real time sensory feedback to the subject and various prostheses systems and assists to increase patient mobility.
- We’re also studying the effects of PTSD in Vietnam Veterans; have developed a growth hormone agonist to treat muscle loss in cancer patients and studying how to prevent falls in the elderly. discovered the use of prazosin in the treatment of nightmares in Veterans with PTSD; and pioneered the use of buprenorphine in the treatment of opioid use disorders.

VA Puget Sound Medical Director for Primary Care Telemedicine Dr. John Geyer

Telehealth and virtual care services are great ways to access VA care from a location convenient to the patient. These services support VA continuity of care by keeping VA specialty and primary care resources accessible to patients who are geographically distant from current care sites. There are a number of new telehealth and virtual care service expansions this fiscal year:

Tele Emergency Care program:

- This is a partnership between our clinical contact center and the national office of emergency medicine.
- This service allows Veterans calling into our regional clinical contact center with urgent or emergent clinical concerns that do not require immediate escalation to an emergency department to be connected with an on-demand VA Puget Sound emergency medicine physician.
- The tele physician can assess the patient via a video visit on an internet connected device or by phone, triage symptoms, facilitate follow-up care coordination or if needed coordinate with a local emergency department to hand-off the patient to emergent in-person care services.
- Since launch at VA Puget Sound, 430 patients have had their clinical concern resolved by the tele ED provider. Prior to the launch of this program, those cases would have been directly referred to an emergency department for triage an assessment.
- So far this has been a well-received service by our Veterans and has the potential to significantly reduce visits to both the VA and community emergency departments when not clinically indicated
- If Veterans require urgent medication for treatment, this can be provided at community pharmacies via the urgent care benefit allowing Veterans to receive the reduced medication cost of medications on the VA formulary as determined by their enrollment group and service connected status.

Synchronous video visits to home:

- All VA Puget Sound primary care and specialty care outpatient clinical services now offer video visits as part of care management options.
- Patients new to primary care can complete their initial appointment by video, which allows Veterans to access primary care services at any of our clinical locations optimizing care resources by matching patients to the timeliest appointment independent of geographic clinic location.
- Video visits allow Veterans to connect with providers over a video conferencing platform and share patient data securely like blood pressure readings or blood glucose logs with their care team in real time.

Patient generated health care date:

- We are growing utilization of remote devices like blue tooth connected blood pressure cuffs and continuous blood glucose monitors that are able to push data patients collect at home to a data portal accessible by VA clinicians for review.

Digital divide:

- For those who don’t have an internet connected device at home to use for video visits but would like to explore using telehealth services, we continue to offer the digital divide service in which the VA can provide an internet connected iPad to eligible patients. Veterans can reach out to their health care team to request a device if they are interested.

Tele screening:

- We are also expanding access to our tele derm, tele eye and community outpatient clinic specialty telehealth services.
- Tele derm allows for Veterans to come to the clinic location closest to their home and receive high resolution imaging of skin conditions that will be reviewed by a dermatologist with care recommendations back to the primary care team.
- Tele eye services allows for Veterans to receive an annual image of their retina to screen for conditions that could result in blindness if not detected early
- Specialty tele services allow Veterans to come to a regional clinic and connect over a high-resolution connection to a VA specialist who is at a different geographic location.

We aim to continue to complement our face to face care services in the next fiscal year with ongoing expansion of telehealth services to support our Veterans in all of the VA Puget Sound catchment area.

VA Puget Sound Director for Health Administration Services JoAnne Brougham

Overall, there are 2 different programs for transportation that veterans can use.

- Beneficiary Travel eligible veterans are eligible to claim mileage Reimbursement by Public Law.
  - Service connected 30% and greater or
  - VA Pension eligibility or
  - Low Income veterans – less than the pension rate or under Means test Income thresholds.

Other non-beneficiary travel veterans are able to use the Veterans Transportation Program

- - Which is free for all
  - Transportation challenges over the last 2 months has created a reduction of services.
    - Due national policy restrictions that prevent contracting out this service, the contract with Around The Sound was cancelled effective June 30. As a result, VA Puget Sound’s Veterans Transportation Service VTS is experiencing a temporary reduction in available drivers.
    - Contract was for six drivers to support VA Puget Sound’s fleet of 10 vehicles. The contract cancellation reduces current drivers from 8 to 2 (six lost). Of the two remaining drivers, one is based in the north and one in the south.
    - VA supports approximately 150-160 per week and this is expected to result in a 75% reduction is rides.
    - VTP is now prioritized by highest health risk for an available seat on the van.
  - If you know of any community resources to help our veterans, please share so that we can put them on the website that we are creating for the veterans on transportation options.

Working closely with our DAV Transportation network for additional options of transport of veterans.

Actively working at recruiting volunteers to drive.

- That program is currently looking to obtain volunteers for DAV
- VTP program is also looking for drivers; we are always looking for more volunteers and could use your support.
Have created a new “Veterans Transportation Options” hand out (copies were made available to those who were in person for briefing). We are featuring the tool on social media, in the upcoming Veteran newsletter, and other public

VA Puget Sound Medical Director for Community Care Ryan Moore

Continue to see a high volume of Veteran’s receiving care in the community, our referral volume is currently 13.8K consults/month, an increase of about 800 consults/month from what we were seeing last quarter.
Shared on the last two quarter visits that Puget Sound Community Care was experiencing an increased backlog in scheduling our consults due to the VA’s cessation of the TriWest Optional Task contract support at the beginning of this year. I am pleased to report we have seen a 17% decrease in our unscheduled consult volume over the last quarter. Our highest volume of unscheduled consults continues to be in the categories of our highest incoming volume, which are Dental, Mental Health, and Physical Therapy. I expect to see a continued improvement as we close out this fiscal year, as our staff just completed training on a new consult management software program to improve efficiency and in addition, we are poised to bring on 6 additional staff members in the final quarter of this year, that we have been waiting for many months. These two factors will help make us even more successful in our mission.
One key change for community care over this last quarter was the implementation of a policy change to the referral process surrounding the “Best Medical Interest” eligibility criteria for community care, under the Senator Elizabeth Dole act. In addition to community care eligibilities of drive time or wait time, a referring provider may now refer the Veteran’s care directly to a community specialty provider without passing through the VA specialty service for additional clinical review. Best Medical Interest community care eligibility is not at this time based on preference of the Veteran, but is a clinical decision made on a case-by-case basis, in which the referring provider may indicate that they feel care in the community would result in an improved clinical outcome for the Veteran.
There is a general sense that with this policy change, we may see an increased referral volume to community care. Prior to this policy change, the BMI eligibility for community care accounted for approximately 14% of our community care referral eligibilities, we will continue to monitor and provide updates.

TriWest Regional Director, Military & Veteran Service Kristine Cothren – (by phone)

Total referrals processed Mar – May = approximately 47K
Total care sites or access points across Western WA area = 65K
Continually monitor network adequacy and meet regularly with the CC team to ensure VAMC and Veteran needs are being met. Last quarter we added 1400 access points.
Response to the question regarding the provider that was dropped from the network without notice.
- Usually, the only reason a provider would be termed is if they fail to recredential, which is required every 3 years. TW reaches out months in advance requesting required documentation to ensure termination does not occur. There are very strict guidelines though when it comes to credentialing and if not renewed timely, the provider is termed on the date their credentials expire.
- Sometimes there are system issue that cause providers to “fall-out” of the system. When that happens, we can work to reinstate them pretty quickly.

[Follow-up since the briefing found that Valley View Health Center Provider Dr. Heather Novak is actually active in both TriWest and VA’s systems.]

VBA Seattle Regional Office Special Mission Program Officer Beorn Kjeldsen

VBA is processing record numbers of disability claims, reaching 2 million claims processed for FY25 in June, faster than at any point in history.
VBA is rapidly drawing down the disability claims backlog. It stood at nearly 238,000 at the end of last fiscal year. Today it is at 184,507.
Seattle is putting Veterans at the center of everything we do, focusing relentlessly on customer service and convenience: We remain in the top 10 of all VBA Regional Offices for production and quality.

Washington State Department of Veterans Affairs Director David Puente Jr.

Serving Those Who Served Conference

- Annual conference August 20 & 21 in Yakima
- Conference is a partnership between your WDVA, the Employment Security Department, and the Washington State Arts Commission.
- Registration is open!
- This Veterans resource providers’ conference helps those who work with Veterans and their families establish better collaboration and connections and provides a wealth of knowledge from industry experts in areas that impact the lives of our Veterans and their families.
- Visit our website at www.dva.wa.gov to register

Capital Projects

- Very encouraged with the passage of the capital budget and our ability to complete a significant HVAC project at our Veterans Home in Port Orchard.
- The building was originally constructed without air conditioning. We were able to leverage grants from the Federal VA as well as get funding from our state legislature to add air conditioning at this facility. The project will be complete in mid-July, just in time for summer!
- We also received $8M to purchase land in Spokane, near the Mann-Grandstaff VA Medical Center, to build a replacement Spokane Veterans Home.
- And we received $500K to conduct a Pre-Design Study for our Tri-Cities Area State Veterans Cemetery. We are working with 2 property owners, and the pre-design study will help us determine which parcel is the most suitable for the project.

The Governor’s Veterans Affairs Advisory Committee:

- Our next Veterans Affairs Advisory Committee (VAAC) Veterans Town Hall will be held in Omak on July 23 at the Elks Hall.
- We encourage Veterans and families in the area to participate, and we will also have a virtual opportunity for Veterans to attend via Zoom.