Veterans-For-Change.org

VFC Visitors Counter

005305374
TodayToday919
YesterdayYesterday3715
This WeekThis Week24257
This MonthThis Month87795
All DaysAll Days5305374
Highest 06-21-2016 : 17814
IP: 18.206.15.215
Logged In Users 0
Guests 105
Registered Users 1858
Registered Today 0

Latest News

VA News

Ocasio-Cortez defends VA healthcare to Veterans: 'If it ain't broke, don't fix it'

DVA Logo 33

 

Rep. Alexandria Ocasio-Cortez, D-N.Y., defended the treatment of Veterans by the Department of Veterans Affairs during a town hall event in her district last week.

The freshman congresswoman said privatization of the VA will not help Veterans because of the "for-profit healthcare industry."

"If it ain't broke, don't fix it," Ocasio-Cortez, 29, said, insisting the VA provides "some of the highest quality" healthcare for Veterans. She said people who advocate for a privatized VA are only trying to fix it in favor of pharmaceutical companies.

"Here's the thing, they are trying to fix it. But who are they are trying to fix it for, is the question we gotta ask ...They are trying to fix the VA for pharmaceutical companies, they are trying to fix the VA for insurance corporations, and, ultimately, they are trying to fix the VA for a for-profit healthcare industry that does not put people or Veterans first," she said.

Because people are trying to privatize the VA, Ocasio-Cortez said, "We have a responsibility to protect it."

Calls to privatize the VA were heightened after news broke of secret waiting lists, which delayed many Veterans' care, in 2014. For instance, CNN reported at least 40 people died waiting for time-sensitive care because of the lists at the Phoenix Veterans Affairs Health Care system.

The Nation reported the socialist Democrat said the main problem with the department is that it is understaffed.

"If we really want to fix the VA so badly, let’s start hiring, and fill up some of those 49,000 [staff] vacancies,” she said, adding the VA would be a blueprint if "Medicare for all" were to pass: “If you ask me, I would like VA for all."

Source

Veterans Affairs Cerner EHR Replacement For VistA To Cost 60 Percent More

DVA Logo 26

 

The new Cerner electronic health records replacement for VA’s VistA system will cost 60 percent more after less than one year of implementation, estimated at $16.1 billion.

The original cost estimate for the EHR solution was $10 billion. The agency went back and forth over the Cerner deal, which was inked by Secretary Wilkie before he was confirmed as the replacement for David Shulkin, MD.

Cerner received a no-bid contract for the deal after securing the same for the Department of Defense. Neither contract deal has proceeded as planned with the current cost increases coming out one year after the deal was inked.

The deal received much pushback one year ago when numerous authorities in the field projected the EHR transition has less than a 10 percent chance of succeeding.

One factor raised is the size of the Cerner system and its broadband requirements when communicating inside and outside each facility.

Another issue recently addressed is that the current Cerner EHR system is designed for insurance billing purposes. This means the new system may not adequately address the needs of federal agencies that do not bill insurance companies.

“VA is different. The focus of the VA’s electronic medical record is never about clinical documentation to support billing. It’s about giving the information to the provider at the right time to inform the best care. There are true risks to patients if they don’t do this right,” Heather Woodward-Hagg, PhD, former National Program Director (Acting), Veterans Engineering Resource Centers (VERC) and Founding Director, Veterans Affairs Center for Applied System Engineering (VA-CASE), told ProPublica.

Word is the transition, if it works, will cost tens of billions due to the size and complexity of not only the software but also the hardware required for such a behemoth to operate effectively.

Source

VA office in charge of protecting whistleblowers from retaliation is under investigation... for retaliating on whistleblowers

Whistle Blower

 

The Department of Veterans Affairs office created to protect whistleblowers from retaliation is itself under investigation for — wait for it, wait for it — retaliation against whistleblowers.

According to Eric Katz of Government Executive, the nascent Office of Accountability and Whistleblower Protection has come under investigation by the VA Inspector General by employees who feel "betrayed or neglected by an office they believed was going to help them but ended up doing the opposite."

Established by President Donald Trump through an executive order in April 2017, the Washington, D.C-based OAWP serves to "improve the performance and accountability of VA senior executives and employees" by investigating allegations and concerns sent in by whistleblowers, according to its website.

"Additionally, OAWP provides the protection of valued VA whistleblowers against retaliation for their disclosures."

Except, apparently, when they don't.

Here's Government Executive:

Dan Martin, a chief engineer at VA's Northern Indiana Health Care System, said OAWP failed to protect him when his case came before it. Martin said in 2016 he discovered contracting violations related to a non-functioning water filtration system, but when he reported the problems to superiors he was stripped of his responsibilities and sent to work in an office without heat or air conditioning. The VA inspector general launched an investigation into the contracting practices, and asked Martin to surreptitiously record conversations with procurement officers, Martin said.

It was not until OAWP got involved in the case that Martin's supervisors became aware of that cooperation. When OAWP allegedly shared that information with leadership at his facility, Martin said his supervisors "had no choice but to shut me down" so he could no longer send recordings about the supervisors' "very inappropriate relationships with contractors" to investigators in the OIG.

Although the stories among VA employees shared with Government Executive don't seem to show OAWP directly retaliating against whistleblowers, its apparent practice of sharing the names of who's talking to them with the the people most likely to get in trouble if a whistleblower claim is substantiated seems, uh, well, not so good.

According to a July 2018 Government Accountability Office report, in some cases the actual VA program offices or facilities where a whistleblower reported misconduct was the same office doing the investigation. Which isn't a conflict of interest or anything.

That practice has since been stopped, VA spokesman Curt Cashour told Government Executive.

In a statement to Task & Purpose, Cashour said VA "welcomes the inspector general's oversight, and for the last several months we've been cooperating closely with the IG on its assessment and encouraging the office to release its report as soon as possible."

While Cashour could not comment on specific complaints from the current and former employees — saying they had not provided written consent for him to do so — he added, "we had hoped to receive the IG's report on this assessment in January, when VA Assistant Secretary for Accountability and Whistleblower Protection Dr. Tamara Bonzanto was sworn in so she could use it as a roadmap to ensure OAWP is operating exactly as Congress intended and with maximum efficiency.

Without the benefit of the IG's recommendations, however, Dr. Bonzanto has been assessing OAWP's performance and has been working on a number of key improvements to ensure the office is complying with Congress' intent. These include providing timelier resolutions, more responsive recommendations and enhancing communications with whistleblowers."

Source

VA ensures Veterans have same-day access to emergency mental health care

Emergency Room

 

As part of the U.S. Department of Veterans Affairs’ (VA) efforts to provide the best mental health care access possible, VA is reminding Veterans that it offers all Veterans same-day access to emergency mental health care at any VA health care facility across the country.

“Providing same-day 24/7 access to mental health crisis intervention and support for Veterans, service members and their families is our top clinical priority,” said VA Secretary Robert Wilkie. “It’s important that all Veterans, their family and friends know that help is easily available.”

VA’s Office of Mental Health and Suicide Prevention is the national leader in making high-quality mental health care and suicide prevention resources available to Veterans through a full spectrum of outpatient, inpatient and telemental health services.

Additionally, VA has developed the National Strategy for Preventing Veteran Suicide, which reflects the department’s vision for a coordinated effort to prevent suicide among all service members and Veterans. This strategy maintains VA’s focus on high-risk individuals in health care settings, while also adopting a broad public health approach to suicide prevention.

VA has supported numerous Veterans and has the capacity to assist more. In fiscal year (FY) 2018, 1.7 million Veterans received Veterans Health Administration (VHA) mental health services. These patients received more than 84,000 psychiatric hospital stays, about 41,700 residential stays and more than 21 million outpatient encounters.

Nationally, in the first quarter of FY 2019, 90% of new patients completed an appointment in a mental health clinic within 30 days of scheduling an appointment, and 96.8% of established patients completed a mental health appointment within 30 days of the day they requested. For FY 2018, 48% of initial, in-person Primary Care — Mental Health Integration (PC-MHI) encounters were on the same day as the patient’s PC encounter. During the first quarter of FY 2019, 51% of initial, in-person PC-MHI encounters were on the same day as the patient’s PC encounter.

Veterans in crisis – or those concerned about one – should call the Veterans Crisis Line at 800-273-8255 and press 1, send a text message to 838255 or chat online at VeteransCrisisLine.net.

Source

Secretary Robert Wilkie Outlines Cultural Changes At The Department Of Veterans Affairs

Robert Wilkie 19

 

Robert Wilkie was appointed as the Secretary of U.S. Department of Veterans Affairs last July. Wilkie grew up at Fort Bragg in a military family and still serves as an officer in the Air Force Reserve. As secretary of the cabinet level department, he’s responsible for ensuring the VA serves Veterans’ physical, mental, and emotional needs to the best of its ability.

It’s also a department that has seen its share of controversy over the years, including here in Wisconsin at the Tomah VA Medical Center. That was the center which was embroiled in scandal a few years ago involving the overprescription of opioid narcotics. But Wilkie says it was an opportunity to change.

"The most important lesson from Tomah was that it forced on VA a cultural change," he explains.

The Department of Veterans Affairs reanalyzed how it was prescribing pain medication and explored alternative therapies like tai chi and yoga. They did studies into the efficacy of opioids, compared to aspirin and ibuprofen.

Since then, Wilkie says, "We've reduced the rate of prescriptions for opioids for Veterans by 51 percent and we are the leaders in alternative therapies. So that is what that terrible thing led the entire department to do."

Wisconsin is also at the cutting edge of research into spinal cord injuries, such as those sustained in combat. Milwaukee's Clement J. Zablocki VA Medical Center is considered a hub of spinal cord research, treating injuries that were once usually fatal.

There is no shortage of problems facing U.S. Veterans. Suicide, homelessness, and addiction are all disproportionately high among Veterans when compared to the civilian population. Wilkie says these issues are frequently interconnected and part of complex solutions that must address several problems at once.

"We're talking about a continuum of effect. Opioid abuse, homelessness - suicide is on that continuum - and we just can't treat one of those things in isolation," he says.

Wilkie continues, "A few weeks ago, the president launched a nation-wide effort to tackle suicide, and that is with me in the lead as the representative of this department, but it also brings in the Department of Defense, the National Institute of Health, HHS [U.S. Department of Health and Human Services]. So it is not simply a whole of government effort but a whole of nation effort."

Source

Social workers’ resources lifeline for Veterans

Social Workers

 

“The best networkers there are!”

“We meet people who have nothing, living on the street, no income, not connected with family, battling addiction, just really going through a tough time. I know how instrumental social work can be to get someone’s life back on track.” – Natosha LaCour, Social Work Supervisor.

Michael E. DeBakey VA Medical Center social workers are involved in nearly every aspect of Veteran care.

Social workers are a diverse group, ranging in specialties from mental health counseling to housing homeless Veterans. Many people think they just do discharge planning, but social workers are looking for resources as soon as the Veteran walks through the facility door.

“We are the best networkers there are,” said Claudia Mullin, licensed clinical social worker (LCSW), in the Women’s Inpatient Specialty Environment of Recovery. “Helping to provide, look for, and research all potential options for Veterans really is a strength of our profession.”

Mullin is pictured above providing trauma therapy to a female Veteran.

One of the things that make social workers so valuable is their network of resources. Another is their ability to provide mental health counseling. In fact, they make up the largest group of mental health providers in the country.

Digging deep for the root of the problem

Mullin, who has more than 30 years of experience in mental health, said that social workers look past the diagnosis, digging deeper to find the root of the problem.

“We don’t see patients as their diagnoses,” she said. “The symptom is the tip of the iceberg. We try to address the psycho-social experiences that lead to the symptom. For instance, most substance abusers usually have trauma as a basis for why they’re self-medicating.”

For social workers, it’s about getting to the root of the problem so that the person can make real progress and sustain the results.

“I look at someone as a person, not the sum of his or her problems,” said Natosha LaCour, Community-Based Outpatient Clinic Social Work supervisor. “I believe we all have the power to impact change and help others. We want to empower them to help themselves.”

LaCour, who has worked in several areas of the hospital, said her time in Homeless Services impacted her the most.

Helping Veterans rediscover themselves, find a place to live, get a job, and pay their rent gave LaCour such a sense of service.

“There was a shine in their eyes, a sense of pride,” she said. “They felt complete again. I saw how impactful my role had been. That was the most rewarding time of my career. I’ll see some of my older Veterans from time to time and it’s always a nice reunion. You become a part of their lives. You’re in their homes. There is a different dynamic in the relationship.”

For Mullin, it has been her work with trauma survivors that has been the most impactful.

Observing transformation is “soul satisfying”

“The most rewarding experience for me is the almost miraculous healing that occurs when a survivor truly accepts and believes that they were not responsible in any way for what happened to them,” she said. “Observing the powerful transformation that occurs when victims go from surviving to thriving is soul satisfying.”

Social work allows for many of these types of career moments. It’s a problem solver’s dream.

“I love the challenge of problem solving,” said LaCour. “You’re constantly looking at different problems to come up with a treatment plan to impact a family’s life in a positive way. For every problem, there is a solution. Take things one day and one problem at a time. Every day is a new challenge.”

Source

Former Lockheed Counter-Intelligence Chief Nominated VA Deputy Secretary

James Byrne

 

The new VA Deputy Secretary nominee brings significant experience as Lockheed’s former counter-intelligence legal chief and head of privacy.

What does this mean for internal agency policies and processing Veterans’ benefits claims? How about whistleblower allegations? Is the agency working hard to root out wrongdoing in its higher levels of management or is Byrne overseeing implementation of an agency dragnet?

With his background, folks should be asking lots of questions. But, not much has been said about the senior attorney running most of the agency. Most of the press failed to even make note of his nomination to run the Office of General Counsel two years ago. Why?

James Byrne, President Donald Trump’s nominee, as of Friday, previously served two years as the agency’s head of the Office of General Counsel. His previous roles in the public sector span over 20 years and include working at the Office of Special Counsel and as a DOJ prosecutor in international narcotics.

Byrne served as a Marine infantry officer after graduating from the US Naval Academy with a degree in engineering.

Senator Johnny Isakson (R-Ga) seems pleased with the agency’s selection of Byrne for this role.

“I am glad to see Mr. Byrne nominated to serve in this critical role,” said Isakson. “The deputy secretary of the VA is responsible for working closely with the secretary to make sure the federal government’s second-largest cabinet department is operating effectively, efficiently and in the best interest of our Veterans. I look forward to chairing Mr. Byrne’s confirmation hearing in the coming weeks.”

Before Byrne, the role was held by one of Sen. Isakson’s former staffers Thomas Bowman.

Again, with Byrne’s background, it seems curious that no one in the MSM has written about his assentation within the agency over the past two years. No one wrote about his nomination as of today, either.

Why is that? Why is everyone closed lipped about Byrne’s work at the agency?

Below is the full excerpt from Sen. Isakson’s page, in italics.

Senate Press Release

U.S. Senator Johnny Isakson, R-Ga., chairman of the Senate Committee on Veterans’ Affairs, responded to President Donald J. Trump’s intent to nominate James Byrne to be deputy secretary of the U.S. Department of Veterans Affairs (VA).

Byrne was named acting deputy secretary of the VA in August 2018, and on Jan. 14, 2019, he became the VA’s general counsel performing the duties of the deputy secretary. He was confirmed as VA general counsel in August 2017.

“I am glad to see Mr. Byrne nominated to serve in this critical role,” said Isakson. “The deputy secretary of the VA is responsible for working closely with the secretary to make sure the federal government’s second-largest cabinet department is operating effectively, efficiently and in the best interest of our Veterans. I look forward to chairing Mr. Byrne’s confirmation hearing in the coming weeks.”

The deputy secretary is the VA’s chief operating officer responsible for working in tandem with the secretary to oversee the VA’s nationwide system of health care services, benefits programs and national cemeteries for America’s Veterans and their dependents.

Prior to joining the VA, Byrne served in Lockheed Martin Corp.’s legal department as the chief privacy officer and lead attorney for information technology, cyber security and counterintelligence. Byrne has more than 20 years of experience in the public sector, including service as a deployed Marine infantry officer and a U.S. Department of Justice international narcotics prosecutor. Byrne is a distinguished graduate of the U.S. Naval Academy, where he received an engineering degree and ultimately held the top leadership position of brigade commander.

The Senate Committee on Veterans’ Affairs will hold a hearing on Byrne’s nomination after his nomination paperwork has been completed and submitted to the committee.

Source

Here’s why no one was fired after VA mistakes cost a Veteran his foot

VA Mistakes 001

 

Officials at the Indianapolis Veterans Affairs hospital insist they wanted to fire the administrator whose mistakes led to the amputation of a Veteran’s foot due to missed home care appointments, but couldn’t because the staffer retired before they could act.

“Had (the investigation) been completed before the employee retired, the Roudebush Veterans Affairs Medical Center would have proposed the employee for termination,” Craig Larson, spokesman for the VA’s Chicago District, said in a statement. “The employee chose to retire while the investigation was ongoing, and there was nothing the center could do to stop that.”

Last week, officials from the U.S. Office of Special Counsel said that an administrative decision in 2017 to stop recording home health care consults into a VA’s patient record system jeopardized the health of numerous patients at the Indiana VA hospital, and forced at least one of them to lose his foot to a medical amputation.

That man, who had been discharged from care after a diabetes treatment, was left to change the dressings on his foot wound by himself for several days, even though VA staffers were supposed to do that.

“[His] worsening infection … and subsequent amputation appears to have been related to the delay of the dressing changes by the home care agency,” the report states.

Pete Scovill, public and congressional affairs officer for Veteran Health Indiana, said hospital officials “remain in close contact with the Veteran” today and have offered an apology and “options moving forward.”

He also said that all affected staff have been re-trained to ensure that home health care consults are being properly conducted and recorded.

But the Special Counsel report noted that despite the grave nature of the mistakes, no staffers were fired. A social work assistant chief was reassigned to a different position, and the senior chief retired.

Larson defended the moves, saying center leaders took immediate action in response to the whistleblower allegations. But officials could not prevent the senior chief from retiring, and could not take any adverse job actions after that.

President Donald Trump made accountability at VA a key promise during his election campaign. After less than six months in office, he signed a new department accountability measure into law, speeding up the time in which staffers can be fired and allowing the department to recoup bonuses from individuals later convicted of criminal wrongdoing.

But VA officials said none of those measures would apply in this case.

Overall firings at the department have increased each of the last three calendar years, as the number of VA staff has also continued to climb.

In 2016, VA fired 2,001 individuals through regular removals and probationary terminations. In 2017, that number rose to 2,537. Last year, from January to the end of November, it was 2,889.

But critics have insisted that more firings does not necessarily mean better outcomes for Veterans, especially if administrators making sweeping decisions can avoid punishment.

In a statement in response to the Special Counsel report, American Legion National Commander Brett Reistad said that “increased accountability will improve an already strong VA system” and called for the department to institute a broader plan to prevent future communication mistakes.

“Tragedies such as what happened in Indianapolis should never occur,” he said. “We expect VA to learn from this and act accordingly.”

Source

Employee at Indianapolis VA reassigned after mix-up led to Veteran’s leg amputation

DVA Logo 26

 

WASHINGTON — The Department of Veterans Affairs has reassigned an employee after whistleblower complaints outed delays and miscommunications at an Indiana facility that left a Veteran untreated, leading to the amputation of his leg.

Another employee would’ve been fired but retired before the VA could take action, according to Peter Scovill, spokesman for the Richard L. Roudebush VA Medical Center in Indianapolis.

The U.S. Office of Special Counsel, an independent agency that protects whistleblowers, sent a letter to President Donald Trump this week with its findings about the incident at the medical center. Following up on a complaint from three whistleblowers, the special counsel discovered a policy change at the hospital in 2017 led to “significant delays in care and harm to Veterans.”

The amputation was a direct result of the delays, the agency reported.

Scovill said Thursday in a statement that VA leaders were in close contact with the Veteran and “will be apologizing and advising them of their options moving forward.”

The Office of Special Counsel substantiated whistleblower allegations that leaders within the VA social work service in Indianapolis directed social workers to stop entering home health care consults into a computerized patient record system. The lack of planning, communication and training with the change led to home visits not being properly logged, the special counsel found.

Because of a scheduling mix-up, one Veteran didn’t receive the help that he needed in June 2017 to redress a foot abscess. The wound became infected and eventually led to a below-the-knee amputation, Special Counsel Henry Kerner wrote.

Scovill said Thursday that the assistant chief of social work was removed from that position and assigned to another job with less responsibility. The VA investigated the chief of social work at the time, but the person retired before the VA could fire them.

The hospital did not name the employees.

Since the investigation ended, the Indianapolis VA updated its procedures to allow social workers to enter information into the patient record system. It also has trained all key staff members, the special counsel said.

Kerner wrote to Trump that he commended the VA for taking steps to prevent future problems but was “nonetheless distressed that such a situation occurred in the first place.”

Source

VA secretary’s health care fight could affect the department for decades to come

Robert Wilkie 17

 

Veterans Affairs Secretary Robert Wilkie frequently reminds people that he has only been on the job for eight months. He also knows the decisions he is making now could affect the department for decades to come.

“For the first time since the fall of Saigon, more than half of our Veterans are under the age of 65,” Wilkie told Military Times in an exclusive interview last week. “They have very different attitudes when it comes to care. They want care that’s close to home. They want care that is quick. They’re not from a world where they are comfortable sitting and waiting.”

Starting June 6, Wilkie insists, those Veterans won’t have to wait any longer.

Under the VA Mission Act, passed by Congress last summer, the department is set for a sweeping expansion of its community care program, the rules governing when Veterans can see a private health care provider at taxpayer expense.

“(Now) the Veteran is at the center of his health care, not the institution,” he said, repeating a line he has delivered to Congress multiple times in recent months. “And if there is something we cannot provide, he has the option of going to [the] private sector or waiting for us to provide it. That is a sea change in terms of the way we operate.”

Those congressional appearances are part of a larger offensive by department officials against persistent charges that the upcoming changes will outsource too much of the department’s responsibilities and resources — “privatization of VA,” according to critics.

A coalition of congressional Democrats and Veterans advocates are rallying against the looming changes, saying that pushing too many Veterans into the private sector will hollow out the federal health care system.

On the other hand, President Donald Trump has made “Veterans’ choice” a key talking point of his stump speeches since last summer, praising his administration’s success at bringing better and more convenient care to Veterans even before the new rules are in place.

The 56-year-old Wilkie — a longtime conservative operative who has held key leadership posts under presidents and members of Congress for three decades — is left in the middle, working to calm critics and turn the commander-in-chief’s boasts into reality.

Already well-known and controversial in the Veterans community, Wilkie is poised to see his public profile grow even larger — whether he wants it or not — as that June 6 deadline approaches.

For his part, the secretary calls this “the greatest transformative period in the history of our VA” and says that the changes will dramatically improve operations and public perception of the sprawling Veterans bureaucracy, which employs more than 400,000 people and could see its budget swell to nearly $220 billion next year.

And, he says, the department is ready for it.

A family tradition

Wilkie served in both the Air Force Reserve and Navy Reserve, but he rarely goes into any detail about his time in the military when speaking publicly on Veterans issues.

He does talk extensively about his family’s military lineage. His great-grandfather served in the final Allied offensive of World War II. His father earned three Purple Hearts and five Bronze Stars during the Vietnam War and was severely injured during the invasion of Cambodia before Wilkie was a teenager.

“He had a lifetime of chronic pain,” he said. “But what made his life more difficult was that there was only one record of his medical care and that was 800 pages.”

The difficulties his family faced navigating the Veterans health system inform his work today. Pictures of those family members occupy Wilkie’s sparsely decorated office in Washington, D.C., along with several other family mementos.

And, on the wall opposite his desk is the placard from his previous job as Under Secretary of Defense for Personnel and Readiness, which Wilkie himself didn’t get to see much during that Pentagon stint.

Within three months of being confirmed for the job, Trump tapped him to serve as acting VA secretary, following David Shulkin’s dismissal — a messy firing over Twitter that spurred questions about Trump’s volatility and the legality of operations at the department.

Then, two months into that assignment, Trump announced during a White House event on criminal justice reform that Wilkie would be tapped as the permanent replacement. Wilkie was visibly surprised by the announcement.

“Jim Mattis [the former defense secretary, who was Wilkie’s boss at the time] will tell you it was a surprise to him, too,” Wilkie said.

The current secretary is reluctant to speak about Shulkin’s dismissal, which came amid tensions between VA leadership and the White House over a host of policy issues. Shulkin, the first non-Veteran to hold the top VA job, was also an Obama administration holdover who received lavish praise from Trump initially but was the subject of his scorn by the end.

In between, Trump nominated White House physician Rear Adm. Ronny Jackson to the post, only to see his candidacy withdrawn amid charges of workplace malfeasance. A year later, Wilkie says that his department has worked past “the turmoil” of that time.

“In the last eight months, this place has been fairly calm,” he said. “We’ve got a good leadership team in place now. Almost all of our leaders have extensive military experience. So they speak the language … The department did not have that leadership team in place in the time before I got here.”

The privatization fight

The turmoil has been replaced with an intense focus on the Mission Act, which includes an overhaul of VA caregiver support rules, plans for a base-closing-style commission for VA facilities and the new outside care rules. The measure was signed into law by Trump just a few weeks before Wilkie was sworn in as the department’s 10th secretary.

The caregiver rules and facility review will come later this year. But revising the outside care rules has been the primary challenge facing VA leadership since Wilkie walked into VA headquarters, located less than a block away from the White House.

Currently, taxpayer-funded private-sector medical appointments are available to Veterans who live 40 miles from the nearest VA facility or face a wait of up to 30 days for care. The new rules, developed by Wilkie’s team, would extend eligibility to Veterans who face a 20-day wait or a 30-minute care ride to a VA facility.

“It is not what it has been purported to be, and that is what I would call ‘libertarian choice,’” he said. “You don't give a Veteran a card and say, ‘thank you very much, the private sector is wide open to you.’”

“I’ve heard some people say that the changes in access standards and availability standards were arbitrary, capricious. Well, if they have that charge, they need to go to the members of Congress who wrote the Mission Act. Because the Mission Act gave me very clear instructions on how I come up with access standards.”

But critics are unhappy with more than just the rules as written. They say that Trump’s team is working to undermine VA health care as a viable enterprise, by promoting outside care as a better solution for Veterans’ medical needs.

Groups such as Veterans of Foreign Wars and Disabled American Veterans has voiced concerns that the messaging of the changes emphasizes convenience of care over quality. Outside doctors, they note, don’t necessarily have experience diagnosing post-traumatic stress disorder or burn pit illnesses. They’d rather see efforts put into improving VA access options.

For Wilkie, it’s not an either-or option.

“Our spending on tele-health has gone up at an exponential rate in the last few years,” he said. “We’re on the cutting edge of using it for mental health issues. It also reaches into rural areas and, importantly, we’re allowed to [provide it across state lines], what the rest of the country can’t do.”

Asked if VA will be promoting outside care over VA care to Veterans, Wilkie did not provide a direct answer.

“The Mission Act says up front that it’s the Veterans’ health interest that is first and foremost. So that Veteran will have a care team at VA who will speak with him and talk about the options for him.

“Nine times out of 10, he's been probably going to stay with the people that he knows and the community he knows … The pull of the culture on people to be where they share experiences with others is very different from any other segment of the country.

“And as I said even as VA has had hiccups — and we’ve overcome those hiccups — we’ve actually seen the number of Veterans asking to go into the private sector drop.”

A looming deadline

The rules changes could triple the number of Veterans eligible for health care outside of the VA system, but VA has predicted that they will not see any substantial increase in usage of private care.

Congressional critics have called that laughable.

Last month, a group of 55 lawmakers — all Democrats — sent a seven-page letter to VA officials detailing concerns over how the new rules were crafted and their potential impact, calling it “the first step towards dismantling the system.”

It’s a charge that Trump has invited since before he took office, when he floated the idea of outsourcing some or all of Veterans health care to private providers. It’s also an accusation Wilkie has had to combat since his first day in office.

He believes he has balanced being a cheerleader for the department with enacting the reforms mandated by Congress.

“When it comes to health care, the private sector is not always the best place,” he said. “The Journal of the American Medical Association, as you know, has said that when it comes to primary care and specialty care like cardiology, our wait times are good or better than any.

“We have same-day urgent care. We have same-day primary care. We have same-day mental health care. You can’t find that in most places in the United States.”

But, Wilkie points out, that isn’t the case for every Veteran. Forcing them to wait longer or travel further just to protect the federal system isn’t in their best interests, and it goes against what the president and Congress have promised, he said.

Several members of Congress have suggested slowing the timeline for the implementation, especially in light of Vet groups saying they weren’t included enough in the drafting process. Wilkie said he sees no need for a delay and is confident that the department will be ready.

That’s no small task.

Last fall, tens of thousands of Veterans’ GI Bill benefits were disrupted because of problems with VA technology, issues that some outside groups had predicted months earlier. When the VA Choice program (the precursor to the Mission Act) was unveiled in 2014, similar problems caused massive delays in making payments to outside providers and scheduling appointments.

A recent review conducted by the U.S. Digital Service, a federal government group, raised the specter of similar problems affecting this effort.

Wilkie has pushed back on that and said in his Military Times interview he is assured the systems will be in place by June.

“But we also have in place, as any good military organization will have, redundancies that they will have another system supporting that to get our Veterans what they need,” he said.

He is also confident that the changes will be embraced by Veterans, even if those privatization charges continue to linger.

VA officials will appear before the Senate Veterans’ Affairs Committee to talk about the Mission Act implementation on Wednesday afternoon. Wilkie is also scheduled to testify about the upcoming changes again later this month, and plans to remind lawmakers that they — and not him — ultimately approved the changes.

“The Mission Act told us that we must provide Veterans the option to go outside of our system if we don’t have that service,” Wilkie said. “The Mission Act told us that we had to do the market assessments … The Mission Act told us that we had to divide the country into regions for community care, and how to set up contracts so that we are able to pay private-sector doctors and private-sector hospitals.

“I am following the law that was laid out by the United States Senate and the United States House.”

Source

Copyright © 2016. All Rights Reserved.