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White House releases 2019 VA budget request

Jonathan Kaupanger
February 13, 2018 - 2:23 pm
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Last month, I sadly had to give Secretary Shulkin an F when grading his first year as head of Veterans Affairs. Part of the issue was that there just wasn’t enough work going on with six out of Shulkin’s 13 areas where VA needs improvement. The President’s recently released 2019 budget might take care of those six areas.

Or it can make things worse.

Access to care, community care, IT, capital assets, bureaucracy and veteran suicide are the points that didn’t get graded last month. This is what the new FY19 almost $200 billion request says about each of those sections and possibly what can happen.

First, it may help if you understand how the whole VA budget thing works. Fiscal year (FY) 2019 starts on October 1, 2018, so these numbers don’t really do anything until then.  That said, reporting on FY18s actual budget number is impossible at this point because not everything will be reconciled until later this year.  he VA starts this process sometime in the summer with the largest items working its way down to the smaller purchases by the end of August.  The VA’s fiscal department then does their magic and a final report is released by the end of the year.  And this is why you see comparisons to FY 17 budget numbers here. Clear as mud now?

Bureaucracy wasn’t addressed directly in the budget request.  This is something that will need to be sorted in-house.  Just to give you a little idea of what Shulkin has to fix, last year, 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! The president’s budget request asks for $381 million to help fight the opioid epidemic. Sorting out VA bureaucracy alone can pay for this request.

Access to Care and Community Care

Requested amount:                  $70.7 billion for healthcare services

                                                $75.6 billion for advance appropriations (for FY20)

                                                $11.9 billion for community care enhancements

The easiest part of this to sort out is the advance appropriations request. The recent government shutdowns explain why this is massively important to make sure veteran care is uninterrupted. The FY20 request is a 6.9 percent increase over what was requested for this line item for FY19. 

Healthcare services and community care enhancements is a bit trickier and is where the VA can step into trouble with healthcare privatization. Simply throwing money into this line item won’t fix things. The budget request states this will strengthen “VA’s ability to furnish care in its own facilities.” Yet, in the same paragraph, the Veteran Coordinated Access & Rewarding Experiences (CARE) Act is mentioned. 

CARE will cut out a few problems like wait times and distance eligibility criteria for vets. It also consolidates several VA healthcare programs into one.  But, make no mistake, this is the first step in VA privatization.  So furnishing “care in its own facilities” actually means sending vets out to private care. And it comes along with a huge VA problem: paying bills on time and for the correct amount too.  If CARE becomes a law, then the VA is forced to pay claims no later than 45 days after the bill is received. 

Paying for private care has been an issue for VA.  Invoices for medical care aren’t process by the VA, they have contracts with two third-party administrators (TPA) to do this.  Just one of those TPAs, a company called TriWest, recently had to let the VA know that they were being overpaid.  It identified about 58,000 claims that had been improperly paid, resulting in about $35 million of overpayments by the VA.  After doing its own investigation, VA’s Contracting Officer sent a letter to both TPAs identifying approximately $89.7 million in duplicate payments.   

Last year, more than 5.5 million claims had been made through the Choice Program and VA made a bulk payment of $1,987,442,688 to cover this.  VA Inspector General’s audit team reported that the bulk payment process used by the VA “significantly increased the opportunity for payment errors.  The number of duplicate payments is thought to be in the tens of thousands.

IT

Requested amount:                 $4.2 billion for the Office of Information Technology

                                                $1.2 billion for Electronic Health Records system replacement

The request from the White House states that out of the $4.2 billion for OIT, only $204 million goes to VA’s legacy IT system.  In the past about half of the entire IT budget has gone to the legacy systems, so the teeny $204 million might not go very far.  VA is in the process of upgrading everything and that costs money.  Last year the VA scrapped its supply ordering platform because staff didn’t like to use it.  It’s only money, right?

The upgraded Electronic Health Records (EHR) system is a much needed improvement.  But we won’t even have the first EHR test site up this fiscal year.  Once the contract is signed for this upgrade, it will be about a year and a half before the first medical center an even test the product.  After that it will take seven to eight years before the entire VA is on the EHR system.  Do you honestly believe $1.2 billion will last? 

Capital Assets

Requested amount:            $1.8 billion for 91 major and minor construction projects

                                                $1.4 billion for non-recurring maintenance and medical facility modernization

It was reported last year that it will take $18 billion to fix or upgrade all 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.

The FY19 request would allocate $1.1 billion for major construction projects.  Some of these much needed improvements include a community living center in New York a spinal cord injury facility in Texas, expansion of four national cemeteries and $400 million will go to “address critical seismic issues at VA facilities.”  $707 million goes to minor construction projects which includes renovations at regional offices. 

The only part of the budget that shouldn’t give taxpayers agida is this part.  The VA isn’t known for doing well with construction projects.  The soon to open medical center in Aurora, Colorado is explanation enough.  Congress has 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.

Veteran Suicide

Requested amount:              $8.6 billion to expand mental health services

The most wide-ranging study of veteran suicide in our nation’s history was released by the VA last year. The agency looked at over 55 million healthcare records from 1979 to 2014, with all 50 states and territories included for the first time.  Previous suicide reports from the VA have been based on data obtained from only 20 states and 3 million veteran records.  

If there can be any good news in this report, it can be found in the small change to the number of veterans who take their own lives each day. In 2010 that number was 22, but by 2014 that number shrank slightly to 20.  While the number came down, veterans are still 22% more likely to commit suicide than our civilian counterparts.

The VA is working every angle on this.  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 servicemembers.  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 you would like to check out the requested budget, you can go here.  VA’s section starts on page 95.

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