U.S. Sen. Thom Tillis has a few suggestions for improving the Department of Veterans Affairs after touring three of North Carolina’s VA Medical Centers earlier this month.

Tillis two weeks ago toured the Salisbury, Durham and Fayetteville medical centers. On Thursday, he sent a letter to VA Secretary Robert McDonald containing several suggestions for improvements in the agency’s North Carolina facilities. In the letter, he based some of his suggestions on experiences during the tour.

“My discussions with VA staff and the medical center leadership has galvanized my belief that a comprehensive transformation plan that focuses on short-, intermediate, and long-term improvement strategies for the people, processes and technology in the VA is essential to addressing the current challenges, while laying the groundwork for continuous improvement,” Tillis wrote in the letter.

His suggestions included, moving more funding from the VA’s regional administration to local medical centers, implementing flex budgeting to account for changes in volume, a new credentialing system for VA providers such as doctors and nurses, enhancing patients’ ability to seek care at private providers and extending medical center hours.

A comprehensive list of goals for the VA as part of a larger plan would be the best way, Tillis said in an interview, to ensure significant progress is made in improving the system. An improvement in wait times for an appointment and final outcomes from appointments are measures that Tillis said could be used to determine the VA’s progress.

Tillis’ first suggestion relates to various regional designations implemented by the VA. Salisbury, for example, is grouped with facilities in North Carolina, Virginia and West Virginia. In his letter, Tillis says the salary cost for management across all regional groups is more than $200 million yearly for about 1,600 staff members.

“Would those costs not be better used at the medical center level to help veterans?” Tillis asks McDonald in his letter.

In an interview about the letter, Tillis said more money is particularly needed in states such as North Carolina, where the veteran population is growing.

He continues by suggesting a flex-budgeting model to help account for changes in need and volume at VA medical centers.

“Now, in terms of the way that they get appropriations, it’s more or less a two-year look back,” he said in an interview. “It’s a backward look versus a forward look for funding. It doesn’t necessarily represent or deal with the increased caseload.”

He said a hybrid approach would be more responsive to bumps in patient population.

The letter addresses a credentialing process that in the letter he says results in a recruiting process for health-care providers that’s too long.

“It’s just trying to streamline the process to make it more likely that providers would be willing to work with us and getting rid of some of the red tape,” Tillis said. “That’s going to be particularly, I think, applicable to getting the choice program on track.”

The VA’s choice program, implemented in November, allows eligible veterans a choice to receive care at private providers. Among the eligibility requirements are a wait that’s longer than 30 days and an excessive burden to travel to the nearest facility. Tillis’ letter suggests the VA should encourage the use of private facilities.

He said a veteran living in Charlotte would likely prefer staying in his or her home city rather than traveling to Salisbury for care. A well-run choice program would require cooperation between community health-care facilities, he said.

“In other words, local control  is the best control,” Tillis wrote in the letter.

One final suggestion Tillis made is to make VA facilities open from 8 a.m. to 5 p.m., which could result in additional veterans being seen on average, Tillis said.

He said the ideas outlined in his letter were mixtures of various conversations with veterans and health-care providers, as well as discussions during the Senate’s Veterans Affairs Committee, on which Tillis serves.

Contact reporter Josh Bergeron at 704-797-4246