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11 a.m. Dec. 22 LIVE CHAT with Stephen DiStasio

Stephen DiStasio is acting director of VA Black Hills Health Care Services

Good morning, Stephen. Are you here?
by Randy Rasmussen12/22/2011 5:52:08 PM
Good morning Randy ...
by Stephen.Distasio12/22/2011 5:52:53 PM
Good to hear from you. We have a few minutes before we start at 11 a.m. Time enough for another cup of coffee.
by Randy Rasmussen12/22/2011 5:53:57 PM
Or the blizzard of paperwork ... thanks
by Stephen.Distasio12/22/2011 5:54:18 PM
Good morning, and welcome to our Live Chat with Stephen DiStasio, acting director of VA Black Hills Health Care Services.
by Randy Rasmussen12/22/2011 6:01:03 PM
Many people in Hot Springs have said they have been assured by the VA in the recent past that the VA was not leaving Hot Springs. How long has the proposal to close most of the VA facilities in Hot Springs been in the planning?
by Randy Rasmussen12/22/2011 6:01:14 PM
In every healthcare system there are discussions about the best way ahead for the delivery of healthcare services. I and other leaders constantly engage in these discussions. The proposal presented last week was developed over the last year.
by Stephen.Distasio12/22/2011 6:02:44 PM
How much weight will public comments have on the VA’s decision to follow through on its plan to reorganize the Black Hills Health Care System?
by Randy Rasmussen12/22/2011 6:03:08 PM
Public comments are always considered and can be directed to me at VA Black Hills, our elected representatives, or both. The comments help us better understand what the Veterans desire for their healthcare and help develop a better set of goals and priorities for improvement.
by Stephen.Distasio12/22/2011 6:08:27 PM
Is the VA proposal a done deal, or do the public meetings have a purpose in influencing the VA?
by Randy Rasmussen12/22/2011 6:08:52 PM
Yes, the public meetings are influential. They give me and my VA partners, and others, input on questions, concerns and ideas. Our proposal is not 'a done deal.'
by Stephen.Distasio12/22/2011 6:10:40 PM
Is there any concern that veterans in western Nebraska, eastern Wyoming, southwestern South Dakota and the reservations will have farther to travel to receive care?
by Randy Rasmussen12/22/2011 6:11:07 PM
This concern has been raised by Veterans and others at each of the meetings I've been a part of. Our proposal is intended to reduce the travel distance for Veterans by purchasing care, at VA expense, closer to their homes.

by Stephen.Distasio12/22/2011 6:13:18 PM
Is it the plan to contract with private health care facilities to provide services to veterans?
by Randy Rasmussen12/22/2011 6:13:45 PM
Part of the plan involves purchasing care from public healthcare facilities in communities throughout parts of South Dakota and Nebraska.
by Stephen.Distasio12/22/2011 6:15:28 PM
Has the VA contacted Fall River hospital and Pine Ridge Hospital about servicing veterans?
by Randy Rasmussen12/22/2011 6:15:43 PM
I met with leaders of the Fall River Hospital yesterday; this is the first time I've been able to do so to talk about a potential partnership. Over the last six years I've had contact with the IHS' Pine Ridge hospital where we already have some VA services located (in Pine Ridge).

by Stephen.Distasio12/22/2011 6:18:15 PM
Thanks, Stephen. Mary Wilson has a question.
by Randy Rasmussen12/22/2011 6:18:45 PM
Is everyone aware that the DOM in Hot Springs can be brought into compliance with ADA requirements by finishing the abandoned renovation for a cost of less than 5 million dollars.
by Mary Wilson12/22/2011 6:18:47 PM
Once we have a clearer idea of what our plan is we need to do a more detailed cost analysis of the options. We have partially renovated one wing of the current Dom at a cost of approx. $5M and not achieved all the goals we desired. I'm concerned that a full renovation of the needed space will exceed the cost of new construction.

by Stephen.Distasio12/22/2011 6:21:24 PM
We have another question on the same subject.
by Randy Rasmussen12/22/2011 6:22:04 PM
if it is not a done deal then why is their 27 million dollars proposed in the 2012 va budget,for a new dom in rapid
by hot springs business man12/22/2011 6:22:07 PM
There is a multi-year process for obtaining funding for renovation and construction projects. We submitted a request for the construction of a new DOM in order to get us an opportunity to compete, and if successful, reduce the amount of time it would take to actually occupy a new building. There is no decision about whether the Dom will be in Rapid City, or Hot Springs, or somewhere else.
by Stephen.Distasio12/22/2011 6:25:04 PM
The federal government often closes facilities it no longer needs. What the VA is proposing, however, is not related to a facility that is no longer needed, but facilities that it believes arein the wrong location. Wouldn't it be less disruptive, as well as less economically devastating to Hot Springs, to provide transportation to veterans to reach existing facilities than to relocate the location of the services?
by Randy Rasmussen12/22/2011 6:27:49 PM
Good question, and a tough one to answer. I hope the discussions we're having now will give us a better sense of the best way ahead. There are certainly pros and cons to any decision we make. In the case you present some Veterans won't mind the transportation, others will. We're also faced with the age and cost of renovation or maintenance of the buildings and the fact that they are not best-suited for the delivery of healthcare services going forward.

by Stephen.Distasio12/22/2011 6:31:18 PM
Here's another question from a viewer.
by Randy Rasmussen12/22/2011 6:32:04 PM
Our citizens feel that the Hot Springs facility is VERY NEEDED! Why would you offer us local services that you can not even provide to us now. It is quicker to drive to Hot Springs. And now you propose to drive to Rapid City or Sturgis? Are you (VA) going to pay for our gas and motel rooms, food?
by Nebraskan12/22/2011 6:32:06 PM
Our proposal does not suggest that Veterans should drive past Hot Springs to go to Rapid City or Fort Meade. We want to continue to offer the same services in Hot Springs as we currently do by having a VA-staffed outpatient clinic and a partnership with the local hospital. In addition, we want to save Veterans travel time and separation from their families by purchasing care at their local healthcare facilities at VA expense.
by Stephen.Distasio12/22/2011 6:34:19 PM
Even though this is only a proposed plan, do you realize what effects it has already done to the businessman and property owners of Fall River County just off this proposal. Construction workers and real estate are already feeling the effects of your public announced so called proposal.
by hot springs business man12/22/2011 6:34:37 PM
I know that the proposal is impacting the community and have been meeting with groups to better understand the impact, and the opportunities our proposal may enable.
by Stephen.Distasio12/22/2011 6:36:31 PM
You mentioned at the town hall meeting about turning the facility into more of a VISN or national call center, has anything more been pursued on this venture?
by hot springs business man12/22/2011 6:36:54 PM
We're talking with our counterparts all the time. I believe that we may first be successful with expanding our existing call center to serve other needs in our region. In the months ahead there is a developing proposal for a call center to coordinate the purchase of non-VA care; I've told the process owners we'd like to be considered first.
by Stephen.Distasio12/22/2011 6:38:54 PM
"by purchasing care at their local healthcare facilities at VA expense"... once again, that healthcare isn't available at our local level. So we go to the VA in Hot Springs. Why fee-based service, which will cost more money in the long run? The VA needs to FINISH the repairs and upgrades that have already been started in Hot Springs, and continue the service through the VA. Not private doctors and contracts.
by Nebraskan12/22/2011 6:39:10 PM
There are many factors in the decision about how to proceed. Our conversations with other healthcare systems include things like partnering to 'hire' specialists that would see both Veterans and non-Veterans in the same facility to make a better quality and business case.
by Stephen.Distasio12/22/2011 6:41:22 PM
Will the reorganization of VA Black Hills Health Care Services save the VA money, or is this an instance of a federal agency coming up with a plan to spend the money because it's in the budget?
by Randy Rasmussen12/22/2011 6:43:00 PM
Our first goal is to ensure the quality of care and improve access to care (both specialists and closer to home). When we have a clearer sense of how we're going to do that we need to do the very detailed cost analysis that are required. With that information I can better answer your question.
by Stephen.Distasio12/22/2011 6:45:23 PM
When logging began to be reduced in national forests, the federal government offered impact aid to counties to replace the lost funds. What happens to the tax base of Fall River County and Hot Springs when the VA reduces its presence and moves its employees elsewhere?
by Randy Rasmussen12/22/2011 6:47:06 PM
We'll know better what the impact of less VA employees will be when we have a definitive plan. I hope that a partnership with the community will include the development of other economic activity that might offset some or all of the decrease.
by Stephen.Distasio12/22/2011 6:49:23 PM
Why are we spending in excess of 20 million dollars per year to outsource patient care at Rapid City Regional hospital? Has an independently verifiable cost benefit analysis been done? has an open bidding process for contracted services been done as required by federal law?
by Mary Wilson12/22/2011 6:50:03 PM
In the last year we spent approx. $26 million to care for Veterans throughout our service area; Rapid City Regional received only a portion of these funds. The $26 million includes inpatient and outpatient care, nursing home care, at home and other services. Most important to me is that the funds helped provide services closer to home and saved Veterans travel to Minneapolis, Omaha and other far-away locations.

by Stephen.Distasio12/22/2011 6:52:39 PM
As of right now Native American veterans are told that they have to use their Veterans rights first, so does this mean that they will have to travel 60 miles or more to get the care they are currently receiving at the Hot Springs VAMC.
by hot springs business man12/22/2011 6:53:36 PM
Our proposal includes providing the same care in Hot Springs that we currently do. I'd also like to investigate the possibility of IHS caring for our Native American Vets at IHS hospitals at VA expense.
by Stephen.Distasio12/22/2011 6:56:00 PM
I'm sorry that we couldn't post all the questions that have been submitted. Is there anything that you would like to add, Mr. DiStasio, before we end our discussion?
by Randy Rasmussen12/22/2011 6:57:04 PM
First - thanks for the opportunity to answer these questions and thanks for the participation. I want to hear about our stakeholders concerns, questions and ideas. Please use our website and e-mail to give us additional input. And ... thank you all for your service. Best wishes for the holiday ...
by Stephen.Distasio12/22/2011 6:58:41 PM
Thank you, Stephen DiStasio, for participating in our Live Chat this morning. Thank you to everyone for joining in and submitting questions.
by Randy Rasmussen12/22/2011 6:59:52 PM