Shulkin’s 13 areas for VA improvement: how things are going

gettyimages 126213862 Shulkin’s 13 areas for VA improvement: how things are going

(Photo PAUL J. RICHARDS/AFP/Getty Images)

By Jonathan Kaupanger

Five months ago, VA Secretary David Shulkin gave his assessment of the state of the agency. He found 13 areas where VA needed to improve.  These improvements would be a combination of legislative an administrative fixes.  So, what exactly has happened in the last five months?

Accountability

The Veteran Affairs Accountability and Whistleblower Protection Act was signed into law in June. Since then, the VA has demoted 1,095 employees due to misconduct.  363 people have been suspended for at least 14 days and 57 people were fired.  The Adverse Actions report has grown to 56 pages.

The whistleblower side of things has been getting bad press as recent as yesterday. The Washington Post reported that one whistleblower has said that retaliation under the current administration has become worse.  An opinion piece in the Washington Examiner, written by a whistleblower, states that the Secretary isn’t in a position to pass moral judgement on “other corrupt managers.”

It’s just too soon to tell if the VA’s accountability problems are getting any better.

Staffing

It’s estimated that there are about 49,000 open positions that affect veteran care at the VA. In August of this year, a local news station in Denver reported that 65 to 90 surgeries were either canceled or postponed at the Denver VAMC, due to a shortage of anesthesiologists and certified registered nurse anesthetist.  VA employees in Salt Lake City held a rally earlier this month to bring attention to the vacant positions all over the country.

Last week, while testifying on Capitol Hill, Shulkin told the House Committee on Veterans’ Affairs that Congress gave him the authority to hire 1,000 new mental health professionals. VA hired 900 new workers, but lost 945.  During the hearing, the secretary stated that the agency paid nurses $20 – $30 thousand less per year than civilian hospitals.  The secretary told Congress that legislation needed to change to help with this. Unfortunately, the VA doesn’t  have a position management system, so the department can’t track which jobs are open.

Effort has been made, but nothing seems to be sticking.

Access

Secretary Shulkin describes 2014 as a near death experience for the VA. The Access to Care website at least lets veterans know how long the wait will be at each medical center.  Congress, for its part, infused the VA’s Choice Program with billions of dollars that is expected to run out by the end of this year.

The VA has proposed a new CARE program to replace the Choice Program, which will do away with the 30 day/40 mile problem, which will hopefully help get more veterans in to see a physician. It will also streamline the agencies seven separate community care programs into one.

There’s been quite a bit of work to improve veteran access, it’s just too early to tell on this one right now.

Paying Providers

A letter was sent to Shulkin on Oct. 2 from healthcare providers in the Commonwealth of Virginia, asking for the more than $2 million that VA owes to them for services provided to veterans through the Choice Program. One provider said that 227 of 504 claims are more than 120 days without payment.  A clinic in the southern part of the state says that over the last year the debt the VA owes them went from $28 million to $58 million.  One dentist office is owed $203,000.

The VA’s CARE program should take care of this issue. The legislation calls for the VA to pay claims no later than 45 days after receiving them.

The fix is there for this one, it just needs to become law.

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(Photo  BRENDAN SMIALOWSKI/AFP/Getty Images)

 

Community Care

The VA lost its Deputy Under Secretary for Health for Community Care earlier this month. There’s a lot riding on Community Care, the Choice Program being just one.  The new CARE program will help simplify this some, but we all just need to hold our breath and wait to see what happens.

Quality

The VA’s internal medical center ratings were released last week.  11 facilities that received a one star rating last year – out of a total of five – are still at the bottom of the list this year.  USA Today had an exclusive look at the department’s “Healthcare Improvement Center.” In the article, Shulkin is quoted saying, “it’s much like you would expect an air-traffic-control system to be – that’s what we’re doing in our health care system.”

The center is staffed by over 80 nurses and can check several different data points, allowing the VA to respond with resources where they are needed. This looks like a GREAT idea.  It’s new, so sit back and wait a bit to see if it’s going to work.

Disability Claims and Appeals

About a month ago, the VA unveiled its Decision Ready Claims initiative.  The department is working together with VSOs so that some disability claims can be finalized within 30 days.  In August the President signed the Veterans Appeals Improvement and Modernization Act which will give vets more options on how to appeal benefits decisions.

Lawmakers say they want to make the wait time for these appeals to be less than a year. Check back with Connecting Vets next August and I’ll have a better answer for you on if this is working or not.

IT

About half of the agencies IT budget goes to keep the old systems running. The new electronic health record system will be up at the test site 18 months after the negotiations are finalized.  After that it will take at least seven to eight years before the entire VA can access records electronically.

It’s almost too early to even think about this one.

Capital Assets

It was reported this year that it will take $18 billion to fix or upgrade the department’s buildings. There are about 400 vacant buildings and another 735 under-utilized facilities owned by VA.  It costs $25 million each year to keep up maintenance on these places.  The secretary announced that there aren’t plans to close specific buildings right now, but he is working with Congress to develop a national strategy to modernize VA’s infrastructure.

Construction

There are currently 11 major construction projects on hold right now because the VA and the Army Corps of Engineers are working through the acquisition process. The projects are worth about $1.4 billion.

A 2016 law, the CHIP-IN Act, is a way the VA can get partners outside of the government to help build healthcare facilities.  One project is already underway in Omaha, Nebraska.  The best part about this is it doesn’t cost taxpayers a penny.

One of the biggest stories on this subject is the VA’s medical center in the Denver suburb of Aurora. It’s expected to finish next year but it’s already costing $1.7 billion – triple original estimates.

This one is painful to watch, but that’s all we can do for now. Hopefully the CHIP-IN Act will pick up and more partner-built facilities can happen soon.

Bureaucracy

13 percent of the $2.1 billion that Congress gave to VA for the Choice Program went to pay admin fees. That’s $273 million bucks!  That could have paid off the bill the agency owes to Virginia’s medical companies. There’s a big consolidation effort going on at the VA, as they are trying to slim down the 140 different program offices.

This one seems like it should be easy to fix, but remember it takes an act of Congress to make these changes.  And lately, Congress isn’t the most functional body around.

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(Photo by Chip Somodevilla/Getty Images)

 

 

Waste, Fraud and Abuse

An advisory committee on the subject was established this summer. According to the Government Accountability Office, VA’s improper payment estimate hit at least $5.5 billion last year.  This is not something that can be fixed quickly.

Recently, a VA Inspector General’s report identified a “significantly increased opportunity for payment errors.” A bulk payment of $1,987,442,668 for more than five million claims was made on Aug. 1.  But the VA doesn’t have a review process for these claims before the payment is made.  The number of duplicate payments is thought to be in the tens of thousands.

This is another wait and see.

Veterans Suicide

Combating veteran suicide is the VA’s top clinical priority. This year, the VA released the most wide-ranging study of veteran suicide ever produced and the VA is working every angle on it. Tele-mental health service is now provided through 10 regional hubs across the VA’s healthcare system.  There are now 13 mobile apps that veterans and their families can download and use the tools provided to help manage emotional and behavioral concerns.  Readjustment counselors at the 300 community-based vet centers provide professional readjustment counseling to veterans and active duty service members.  When veterans can’t make it to the Vet Center, one of the VA’s 80 mobile vet centers heads out to reach as many rural-living veterans as possible.

If any good news came from this report it that the daily number of veterans who take their lives has dropped from 22 to 20 each and every day. For more information, veterans who are currently enrolled in VA health care can talk to their VA mental health or health care provider. For a complete list of VA health care facilities, Vet Centers, local suicide prevention coordinator and other resources, you can start here: VeteransCrisisLine.net

All in all, we can see that effort is being put into fixing the VA, but for the most part we are still in a holding pattern on if things are working or not. Stay tuned to Connecting Vets for more as things change.

Connect: @JonathanVets1 | Jonathan@ConnectingVets.com

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