He’s getting an F for his first year in charge.

Shulkin’s 13 areas for VA improvement

Jonathan Kaupanger
January 24, 2018 - 12:54 pm

(Photo by Oliver Contreras)

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We’re coming up on Secretary Shulkin’s anniversary at the head of the Department of Veterans Affairs.  In his first speech as head of the VA, he pointed out 13 areas where the agency needed to improve.  Here’s how things are going one year into his term.

Before we even get going, about half of these get an incomplete and we won’t even touch on them here.  They are access, community care, IT, capital assets, bureaucracy and veteran suicide.  Everything with the exception of veteran suicide is either being discussed in Committee or there just hasn’t been enough time to get anything going.  For veteran suicide, as long as there is even one happening, not enough work is being done and so it deserves an incomplete.

That said, my overall grade for Shulkin and the VA this first year is an F, and here’s why. 

Accountability

The Secretary is being held accountable, at least he was by members of the Senate’s Committee on Veterans’ Affairs last week.  Senator Jerry Moran (R-KS) all but yelled “liar, liar, pants on fire” to Shulkin during a committee meeting last week.  Even committee chairman, Johnny Isakson (R-GA) started the meeting by saying, “Let me say at the outset that this meeting is not about what’s happened in the past, it’s about what’s happening right now to correct some of the things that have happened in the past.  This is an accountability meeting.”

He went on to put the Secretary and VA on blast.  “There are no excuses,” Isakson said and then listed several sticky issues that the VA has been fighting with for many years.  Things like hiring practices, problems with IT and veterans’ appeals are some of the issues the secretary was asked about.

On the VA side of things, the Veteran Affairs Accountability and Whistleblower Protection Act was signed into law in June. Part of the law was intended to make it easier for Shulkin to fire VA employees who weren’t preforming up to standards. Since last summer, at least 70 VA employees had discipline delayed so that a better investigation could be conducted.  Right now, 41 of those cases are still open.  It’s really just too early to tell if this is working or not. You can find records of the removals, suspensions and demotions on the VA’s Office of Accountability and Whistleblower Protection (OAWP) webpage. 

Last year, the VA fired 2,537 employees.  The information on the OAWP site shows that about 1,400 people were fired last year, but according to the Office of Personnel Management (OPM), if you add in probationary terminations the number grows to 2,537.  The last year of President Obama’s term, the VA fired 2,662 employees.  Despite the new law, firings at the VA have actually declined by about 5 percent.

I have to give the VA a D here.   A report on this was to have been submitted to Congress by December but the VA didn’t do it.

Staffing

When we last looked at this, there were about 49,000 open positions that directly affect veteran care. Since then, laws have been past, people have been hired, people have quit.   Last year, VA hired around 40,000 new staff, but with attrition and turnover, the agency only had a net gain of 8,300 people. 

VA hired 266 new physicians but has an opening for 2,400 more.  1,400 nurses were added to the VA roll last year, but the agency needs about 5,500 more.  For mental health professionals, the VA hired 900 last year, but lost 945.  You can see a trend forming at this point.

Shulkin is trying a new way of attracting employees.  Cold.  Hard.  Cash.  During last week’s committee hearing, the top Democrat brought up how understaffed the VA is in his home state of Montana.  Shulkin explained how the VA is working to attract new, good medical staff in the state.  The educational debt reduction for primary care physicians has been boosted by $120,000.  VA is offering psychologists and nurse practitioners a $10k signing bonus.  Social workers get $5,000 too.

VA did get direct hiring authority when the VA Choice and Quality Employment Act was signed into law last year as well.  With this, the VA has worked with OPM to approve 15 positions to fall under direct hiring.  They are accountants, biomedical equipment support specialist, boiler plant operators, general engineers, specialists for the veterans’ crisis line, health technicians, histopathology technicians, human resources assistants and specialists, information technology specialist, personnel security specialist, police officers, realty specialist, utility systems operators and repair specialists. 

When you hold that list of jobs up to Shulkin’s 13 points of improvement, you can see that staffing is a major problem for VA.  Oh and four of the VA’s top jobs are vacant.  Undersecretary for Benefits, Undersecretary for Health, Assistant Secretary for Information Technology and Assistant Secretary for Accountability and Whistleblower Protection.  The Benefits position has been open since October 2015.

I might be harsh on this, but I’m giving Shulkin a C here.  He’s made efforts, but are they the right ones?

Paying Providers

Why this is an issue is beyond me.  Last month hundreds of vets found out that they would be on the hook to pay for services provided through the VA’s Choice Program.  In one case, the VA took more than two and a half years to pay a medical provider for one person.  On Jan. 3, the VA came out with this plan to pay community providers. 

About $10 billion was spent on the Community Care program.  The VA’s Office of Inspector General found several problems with transaction obligations, liquidation of unfulfilled authorizations and reconciliation.  Another weakness was financial reporting. 

And get this, the VA reported that its compensation and burial benefits liability for last year was $2.8 trillion!  That’s a TON of money and gives room for all sorts of issues to pop up.  Another favorite is that while VA has a Chief Financial Officer, each part of the VA; Veterans Health Administration, Veterans Benefits Administration and the National Cemetery Administration each have their own CFO and they don’t report to the VA’s CFO.

Veterans who use the VA for medical services, whether in a VAMC or with a community provider should not be billed for the VA’s problems.  This is a very hard F.

Quality

I’m thinking a C is best for quality.  I’m basing this on the VA’s own medical center ratings.  There are 14 one star hospitals in the VA system.  Three went down a star from last year.  30 two-star VAMCs with two dropping from four to two stars, and 10 slipping down from three to two.  Two medical centers went from one star up to the double star rating last year, so that’s a bit of an improvement. 

Five hospitals moved from a five score to a four. 

There’s plenty of room for improvement.  Basically, the good is really good and the bad is pretty bad.

Disability Claims and Appeals

The Veterans Appeals Improvement and Modernization Act of 2017, which became law in August.  The secretary said that the new appeals process will be fully implemented by 2019, but major improvements have already happened. 

There are, according to Shulkin’s testimony, 470,000 appeals waiting for judgements right now.  This year, the Appeals Board is expected to produce over 81,000 decisions – 30,000 more than last year – in fiscal year 18.  The Rapid Appeals Modernization Program was launched in November last year.  It’s still a volunteer appeals process and to date, 3 percent of veterans who have been waiting for the VA decision have used this new program.  Instead of waiting for years, decisions are being made within 30 days and 75 percent of these are going in the veterans favor.

Improvements are being made, but I’m still giving the VA a D here.

Construction

Only five years late and more than a $1 billion over budget, the VA’s long awaited medical center in Aurora, Colorado is finally opening this summer.  The person who was originally in charge of construction and responsible for the mess got a promotion out of it and was put in charge of the VA’s Office of Construction and Facilities Management.

Congress, playing parent here, stepped in and decided that construction projects that cost more than $10 million would no longer be controlled by the VA, the Army Corps of Engineers manages those now.  Rep. Mike Coffman (R-CO), wants to take things even further and limit the VA’s control to only projects that cost less than $10 million.

F.  And honestly I want to say it one more time just to make myself feel better here.  F!

Waste, Fraud and Abuse

First off, see above.

VA announced a collaboration with the Department of Health and Human Services to work on this today.   The VA’s financial reporting system was created 26 years ago and to get things to work properly today it takes extensive manipulations, journal entries and manual processes.  The Inspector General said in his report that the system is “terribly out of date.”

VA gets an F with this, too.

Using my simple scoring system: 5 points for an A, 4 for a B, C’s get three points, D’s give two, F’s actually get one point and nothing for incompletes.  The VA got 13 out of 65 possible points.  At least there’s room for improvement for year two.