Milwaukee VA scales back referrals for chiropractic care, massage

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‘Crippling’ pain​

Having chronic pain often means being trapped in a painful cycle. For Marine Corps veteran Bob Wincek, it’s stand, stretch, repeat. He said he has degenerative back pain and can’t stand more than five minutes without needing to stretch.


"Whether it’s the grocery store, State Fair, I’m always (bending over to stretch)," said Wincek. "People look at you weird, like, 'What are you doing?'"

Bob Wincek

A few months ago, the Pewaukee man had weekly appointments at Precision Healing and Wellness in Brookfield. The business provides acupuncture, massage therapy and chiropractic care to veterans. Wincek said the appointments brought him "one to three days a week of relief." Now he’s among the veterans who can no longer afford to visit the business.


"It’s become crippling at times," Wincek said of his back pain.


Novia Gscheidmeier is the owner of Precision Healing and Wellness. She said, since the changes went into effect, former customers tell her they’ve visited the ER for pain relief.

Referral changes​

A letter from the Milwaukee VA Medical Center (VAMC) on April 5 alerted the clinic to the changes.


The letter read, in part: "Milwaukee VA recently conducted an internal review of our community referral process for acupuncture, medical massage therapy, and chiropractic care…We identified some inconsistencies in our practices where authorized care didn’t meet the defined clinical criteria.


"We will be implementing immediate measures to ensure our practices are consistent with national guidelines and our veterans continue to receive clinically appropriate care."

Clement J. Zablocki Milwaukee VA Medical Center

In other words, the community care coverage was being scaled back on a case-by-case basis.


"(The veteran’s) approval to come here would get canceled. Or, they were just getting denied completely," Gscheidmeier said of the fallout.


Gscheidmeier said, before the changes, veterans could get combination therapies – such as massage and acupuncture. Now, those veterans are no longer eligible for multiple services. Other customers who had weekly appointments now qualify for 12 appointments per year.

'Inconveniences'​

Ted Lucier served in the Marine Corps operating heavy machinery. Until last spring, Lucier says he visited Precision Healing and Wellness three times a week for help managing tremors and body pain. Now, his coverage for the year has run out.


"The pain has come back with a vengeance," said Lucier. "I’m shaking all the time."

Ted Lucier

Milwaukee VA Medical Center Executive Director Jim McLain told Contact 6, in part: "Veterans must meet specific community care eligibilities for each care needed...VA staff carefully reviews any new authorization request to assess eligibility and determine whether it is in the clinical interest of the veteran."


McLain said the VA recognizes the changes may be "difficult or confusing" for veterans accustomed to getting care through the VA’s Community Care program, and they regret any "inconveniences."


"However, these updates will ensure veterans receive quality, clinically appropriate care through evidence-based practices that provide the best health outcomes for our patients," said McLain.

What is offered?​

The VAMC said it does offer massage, acupuncture and chiropractic services for pain – as well as physical therapy, pain procedures, medical management, ultrasound guided injections and other services.


Contact 6 asked U.S. Sens. Ron Johnson and Tammy Baldwin about the changes. Johnson’s office did not respond to a request for comment. Baldwin’s office submitted a formal inquiry to the Zablocki VAMC.

Milwaukee VA Medical Center statement

In McLain’s response to Baldwin, he writes that the recent changes to community care referrals "align with the best interest of the veterans we serve."


"While veterans eligible for community care can choose to receive care from VA’s community care network, VA hopes veterans will continue to choose VA since the care we provide has been proven to be the best care in America for veterans," McClain wrote.


McClain said he encourages veterans to work with the VA providers to better understand their therapeutic options.

Coping concerns​

Wincek said he prefers the holistic approach at Precision Healing and Wellness to taking more pain medications. He worries other veterans will turn to alcohol or drugs to cope.


"Many of us don’t have the resources to pay out-of-pocket," said Wincek. "Is that what we want our veterans to be doing?"


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McClain said the Milwaukee VAMC will continue referring for services in the community while following a doctor-ordered care plan.


"The VA continues to ensure that veterans can access world-class care whenever and wherever they need it, including in the community," said McLain.

Clement J. Zablocki Milwaukee VA Medical Center

Full statement​

Full Statement to Contact 6 from Jim McLain, executive director of the Milwaukee VA Medical Center:


"During the pandemic, the Milwaukee VAMC approved community care referrals for acupuncture, massage therapy, and chiropractic care that did not align with national VHA standards and guidance. After performing a comprehensive, clinical review, the Milwaukee VAMC has made changes to ensure all community care referrals align with national VA policies and standards – and to align with the best interest of the Veterans we serve.


"Veterans must meet specific community care eligibilities for each care needed. VA authorizes community care under one authorization, and VA staff carefully review any new authorization request to assess eligibility and determine whether it is in clinical interest of the Veteran. Therefore, community care referrals are not made in perpetuity, and some Veterans who may have previously had eligibility for community care, may find that they are no longer eligible. We recognize that this may be difficult or confusing for Veterans who have grown accustomed to receiving care through the Veterans Community Care program, and we regret any inconveniences experienced due to these changes. However, these updates will ensure Veterans receive quality, clinically appropriate care through evidence-based practices that provide the best health outcomes for our patients.


"When Veterans transition from community care to VA care, we always seek to make that transition for them as seamless as possible – and we are here to help. VA staff work to support Veterans through the entire process, from identifying the care need through scheduling and following up on any additional needs and medical documentation review. We will always work with any Veteran who needs additional support.


"The Milwaukee VAMC remains committed to providing pain management for Veterans, and we continue to work to ensure that Veterans receive clinically appropriate care. Acupuncture, massage therapy, chiropractic care, and other pain management options remain at the Milwaukee VAMC, and in the community. Further, we continue to offer other pain management options including: physical therapy; the VA Pain Clinic; Physical Medicine and Rehabilitation; interventional pain procedures performed by board certified pain specialists; medical management and ultrasound guided injection provided by physical medicine and rehabilitation specialists; our Functional Restoration Group, which is a two-month program; the Whole Health program, which includes classes and resources; and other VA programs and alternatives. Many alternatives are available and can be discussed on an individual basis between Veterans and their VA providers.


"VA continues to ensure that Veterans can access world-class care whenever and wherever they need it, including in the community. We will continue to refer for services in the community pursuant to a doctor-ordered care plan designed to give Veterans the best health care outcome. In fact, VA has delivered all-time record numbers of community care appointments to Veterans during each of the past 6 years – including 46 million appointments in 2023 – and we are on pace to break that record again this year.


"Importantly, the updates at the Milwaukee VAMC are not related to VA’s budget, and there is no change to VA’s nationwide community care program. VA continues to ensure that Veterans can access world-class care whenever and wherever they need it, whether that’s in the community or in the direct VA care system.


"While Veterans eligible for community care can choose to receive care from VA’s community care network, VA hopes Veterans will continue to choose VA since VA care is proven to be the best care in America for Veterans by peer reviewed studies, hospital ratings, and patient satisfaction surveys. That is why we are working to expand access to VA care whenever possible – because Veterans who come to VA have better health outcomes.


"VA remains steadfast in providing Veterans with the world-class care they deserve, whether from us or in the community, and we will stop at nothing less."