When the Central Texas Veterans Health Care System opened its Cedar Park community-based outpatient clinic in September 2016, CTVHCS Director Christopher Sandles said the organization had planned for the building to hold five primary care teams.

However, the health care system recently selected its seventh primary care team for the facility on 600 N. Bell Blvd.

"We've had to do moving and shifting of the staff to make seven teams fit," he said.

As population growth has affected industries throughout Central Texas, the regional VA health care system has also felt the impact. In July, the CTVHCS announced the second expansion to the Cedar Park clinic in about two years.

The CTVHCS is planning to lease a roughly 26,000-square-foot facility adjacent to Cedar Park Regional Medical Center, along with maintaining its current property on Bell.

The expansion announcement comes at a time when the U.S. Department of Veterans Affairs is predicting the veteran population across the country will decline, though CTVHCS predictions show several clinics in the Central Texas region could have more veterans to serve in the near future.

“As Austin grows and the surrounding communities grow, obviously we’re seeing the growth in places like Cedar Park,” Sandles said.

Growth in the area

According to the U.S. Department of Veterans Affairs Veteran Population Projection Model from 2016, the total veteran population was predicted to decline from 20 million in 2017 to 13.6 million 2037.

However, Sandles said the Cedar Park clinic has been experiencing a growth rate of about 2-3 percent per fiscal year, and several clinics in the Central Texas VA system are planning to see more patients in upcoming years.

“We do think across the [Central Texas] system we’re going to see considerable growth,” Sandles said. “As we look at our individual sites, what we’ve seen consistently over the past two to three years is that most of the growth is in the Cedar Park and Austin area, and the Temple campus.”

The Central Texas VA signed a lease with Welltower Inc. for the Cedar Park clinic’s expansion in the second medical office building next to Cedar Park Regional Medical Center in June.  Services planned for the new location include primary care, mental health care, and laboratory and imaging services, and the expansion will have space for up to 11 primary care teams.

CTVHCS will also hold onto its current location on Bell, which will be used for the future expansion of specialty care and for Tele-Primary Care, which offers primary care using telemedicine technology.

Utilizing care next door

The expansion of the Cedar Park VA location will be the second clinic the CTVHCS has opened near a private health care facility—the system opened its La Grange campus inside of a private medical center in June.

“This wasn’t something VA mandated that we do; it’s really something that we identified strategically to make sense for us,” Sandles said.

In La Grange, the move prevented the health care system from needing to build its own building and an imaging suite. If a veteran at the future Cedar Park clinic needs specialty care such as physical therapy, Sandles said the patient would be able to go next door for those services.

“Depending upon the veteran’s condition, it might not make sense to ask someone to get in a car and drive 45 minutes or an hour to the Austin [VA] location to go to physical therapy, but it could put them in a position to drive to the same place that they typically go to their VA clinic and have that physical therapy provided right there in the same geographic footprint at CPRMC,” he said. “So it keeps the health care local.”

The entire health care system, including the Cedar Park VA clinic, will also be impacted by the VA MISSION Act of 2018, which President Donald Trump signed into law in June.

The new law allocates $55 billion for the Department of Veterans Affairs, $5.2 billion of which is set aside for the Veteran’s Choice Program. After one year, the choice program will be retired and the Veterans Community Care Program will be established.

According to the office of U.S. Rep John Carter, R-Round Rock, the VA MISSION Act establishes the consolidated program that allows veterans to use private medical care funded by the VA if they live 40 miles or more from a VA facility or if the veteran’s medical needs cannot be met at a VA facility. U.S. Rep. Mike McCaul, R-Texas, said it would also apply if a veteran would wait more than 30 days for an appointment.

Carter said the new clinic will benefit by being next to the CPRMC.

“With the new law that we’ve passed, being that close is very important,” he said. “If we have to use private care, it’ll be right there.”

Serving the veteran community

Mitch Fuller, the senior vice commander with the Leander Veterans of Foreign Wars Post 10427, said members of the veteran community are excited about the Cedar Park clinic’s expansion.

Fuller said the area has seen a high concentration of veterans because many were previously stationed at Fort Hood in Killeen or at Camp Mabry in Austin. He said several choose to retire in the area after their service.

“This is a rapidly growing area, and that also means growth in the number of veterans,” he said.

Fuller said the expansion can provide more resources and more access to care for veterans in the area. He also said one of the big issues for veterans is access to mental health care. Fuller, an Iraq War Veteran, said the post-war generation needs access to resources and helping with PTSD.

Carter said many veterans within his congressional district need care for PTSD, traumatic brain injuries and mental health issues. He said there have been efforts to expand the treatment offered for mental health in Cedar Park, Temple and Waco.

Sandles said the CTVHCS had previously determined the  Cedar Park clinic has been below expected staffing ratios for mental health providers, and he said part of the issue was available space. When the new site opens, Sandles said the facility will have around five additional mental health providers, which Fuller said is vital.

“This is great for the VFW, for our post, and for all veterans who live in this area,” Fuller said.

A hub for telehealth

The Cedar Park clinic has also already been helping those who live outside of the area.

The CTVHCS began offering primary care services using telehealth technology, otherwise known as Tele-Primary Care, in October. Rather than have a veteran travel to a VA hospital or medical center in a larger city, the program uses videoconferencing to connect veterans in an outpatient clinic or in their home with their providers or with specialty care.

Staples said all physicians providing Tele-Primary Care in Texas are employed by CTVHCS, so the Cedar Park clinic serves as a Tele-Primary Care hub for the state. The physicians are provided with a VA health care kit that allows them to videoconference from home or from the Cedar Park clinic.

Utilizing Tele-Primary Care physicians has been useful for some VA clinics throughout Texas, such as ones that are highly rural, Sandles said. Those clinics can have difficulty recruiting primary care providers, which means patients might have to wait long periods of time or drive to another clinic for appointments.

“Being in markets like Cedar Park, where we just haven’t had a lot of difficulty at all recruiting primary care physicians; we can support those sites but do it remotely,” he said.

Deborah Meyer, a spokesperson for the CTVHCS, said Cedar Park was chosen as the hub for Tele-Primary Care because of Sandles’ leadership with new and innovative ideas, along with the need for larger space for the program. She said the expanded Cedar Park clinic will allow the telehealth program to grow as needed.

Sandles said he expects the new Cedar Park clinic to open in about eight months.