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New study finds rising VA employee engagement key to increased success at nearly 150 medical centers

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The U.S. Department of Veterans Affairs’ (VA) received high marks from an independent March 25 study showing a significant relationship between employee engagement and work performance by VA medical center staff.

The rankings reveal engaged employees perform better, resulting in higher patient satisfaction and increased retention of nurses and mission-critical staff.

The Partnership for Public Service and the Boston Consulting Group analyzed nearly 150 medical centers along with data from the 2016, 2017 and 2018 “Best Places to Work in the Federal Government” engagement scores and Veterans Health Administration’s Strategic Analytics for Improvement and Learning (SAIL) scorecards.

“These findings are representative of our commitment to creating positive work environments for employees, which I believe develops a more holistic experience for our Veterans,” said VA Secretary Robert Wilkie. “I am extremely pleased with our medical center leadership teams as they are integral to our continued mission of improving and transforming VA health care.”

The findings also highlight the successful implementation of employee engagement strategies at the James E. Van Zandt VA Medical Center and the St. Louis Health Care System, which lead to lower staff turnover and higher performance. Examples of employee engagement strategies may include expanding existing training opportunities and recognizing and rewarding staff members.

This continued progress represents another reason Veterans Choose VA for their health care, following a recent Dartmouth study that found VA medical centers ‘outperform private hospitals in most health care markets throughout the country,’ and the Partnership for Public Service ranking VA as one of the top 6 Best Places to Work in the federal government.

These independent analyses further underscore VA’s efforts transform the nation’s largest integrated health care system into a high reliability organization (HRO). VA recently selected 18 medical centers that will lead the way. Lessons learned from these 18 sites will guide a more impactful rollout across every Veterans Health Administration medical facility in 2020.

To learn more about the March 2019 Partnership for Public Service and the Boston Consulting Group study visit


Lack of leadership to blame for the VA's botched 'Forever GI Bill' rollout, report says

Botched GI Bill


The U.S. Department of Veterans Affairs failed to modify its electronic systems and lacked an accountable official to oversee implementation of the "Forever GI Bill," resulting in a bungled rollout last year that affected thousands of college students, a new report from the agency's Inspector General says.

The Forever GI Bill, officially called the Harry W. Colmery Veterans Educational Assistance Act of 2017, was approved unanimously in both chambers of Congress and signed into law by President Donald Trump in the summer of 2017.

The law changed how education benefits are to be applied for Veterans, revising the formula that determines students' stipend amounts and removing a 15-year expiration date included in the previous version of the law.

However, beginning in August, the VA's system could not handle the intricacies of those changes across more than 400,000 claims, the report said. The result was that some students were underpaid and, in some cases, not paid at all.

In November, the VA decided to delay full implementation until Dec. 1, 2019.

According to the Inspector General's report, the VA's failure to appoint an accountable official to lead implementation of the program resulted in "unclear communication of implementation progress and inadequately defined expectations, roles and responsibilities of the various VA business lines and contractors involved."

Additionally, investigators found that the VA's Office of Information and Technology and the Veterans Benefits Administration Education Service did not agree on how to solve problems once they arose.

Investigators found a 10-month gap from the time the Forever GI Bill became law and when the VA received the computer software to implement it. During those months, the VA worked with contractor Booz Allen Hamilton to develop the program.

But without a single accountable manager in charge, people involved were unclear about their roles, the report said.

In November, the VA Secretary Robert Wilkie gave Paul Lawrence, the VA benefits undersecretary, the task of implementing the Forever GI Bill. Members of Congress, unhappy with how Wilkie was handling the issues, called on the Inspector General to dig into what was happening at the agency.

In January, the Forever GI Bill Housing Payment Fulfillment Act was signed by Trump, codifying into law that the agency would repay students who were affected by the troubles.

In February, Wilkie appeared before the House Committee on Veterans Affairs and talked about a new timeline for the Forever GI BIll.

"My first full day in office was Aug. 1 of last year, and it was clear to me we were reinforcing a broken system," Wilkie said. "I expect everything to be on schedule and back to the norms set by the GI Bill either at the end of this year or at the beginning of next year."

Derek Abbey, the director of the Joan and Art Barron Veterans Center at San Diego State, said the majority of the university's roughly 1500 GI Bill recipients were not affected by the VA's trouble with the new version of the law. For those who were, he said, the Veterans Center tried to minimize the impact.

The university didn't charge late fees, Abbey said, adding that his office ensures paperwork is submitted to the VA in a "timely fashion."

Rep. Mike Levin, D-San Juan Capistrano, who serves on the House Veterans Affairs Committee and whose district includes Marine Corps Base Camp Pendleton, said in a statement he was closely monitoring the VA's efforts to fix its problems.

"I am deeply concerned about any undue financial burden placed on our Veterans by these missed and underpaid housing stipends," Levin said.

The IG's office said it would continue to monitor VA's progress in implementing the law.


VA MISSION Act: What is the latest on community care?

VA Mission Act


How VA is transforming Veteran community care under the VA MISSION Act of 2018 and what to expect.

Last June, President Trump signed landmark legislation, known as the VA MISSION Act of 2018, that makes dramatic improvements to how Veterans receive community care—health care provided outside of VA. VA’s goal is to give Veterans greater choice over their health care, allowing VA to deliver world-class, seamless customer service either through a VA facility or community provider.

While the law affects many other VA programs, the changes to community care are among the most complex and far-reaching in recent history. After the legislation was enacted, VA immediately began taking the steps needed to implement the vast changes required.

Current Activities

Understanding the enormous scale of VA health care operations and VA’s responsibility for America’s Veterans, VA has been working hard on many large, interrelated tasks to implement the new Veteran community care program by June 2019. These tasks include the following:

  • Design and launch a new internal operating structure for community care, including the new urgent care/walk-in care benefit
  • Propose access standards as one of the six eligibility criteria for community care
  • VA’s proposed rules for the new Veterans community care program, including access standards, are currently open for public comment until March 25, 2019
  • Award contracts to Third Party Administrators (TPAs) to manage regions of VA’s new Community Care Network (CCN)
  • Plan to implement Veterans Care Agreements to allow VA to purchase hospital care, medical services, or extended care services in certain situations
  • Define competency standards for certain conditions applicable to community providers to make sure Veterans are getting high-quality care when they receive care outside of VA
  • Set up new requirements for prompt payments to community providers
  • Draft regulations to implement the law

What to Expect

So what can Veterans expect when the new program starts this summer? Given the magnitude of the changes, VA is working hard to make sure the rollout goes smoothly. If you are a Veteran enrolled in VA health care, or a Veteran who can receive care without needing to enroll, you can expect:

  • To continue to have access to community care under current programs and then transition to the new program when regulations are final and published
  • To follow an improved process to receive community care under the new program, with better access to community providers and improvements to customer service, such as more streamlined eligibility requirements
  • A new benefit that provides eligible Veterans with access to urgent, non-emergency care for non-life-threatening conditions in VA’s network of community providers
  • Improved care coordination as VA transitions to a single information technology system that better links together VA and community providers
  • Your provider to receive timely payments for bills as VA transitions to better claims processing systems

Going Forward

VA will be providing regular updates on community care as part of this series of articles. Community care will continue to supplement VA health care as part of VA’s broad commitment to modernize and strengthen the VA health care system, expand access, and ensure timely delivery of care to America’s Veterans. VA health care regularly outperforms the private sector, and VA staff are experienced and devoted to meeting Veterans’ specific needs. VA believes Veterans will continue to choose VA when they need timely, high-quality care.


  • Fact Sheet – Veteran Community Care – General Information (VA MISSION Act of 2018)
  • VA’s proposed rules for Veteran community care now open for public comment


Should Veterans have to pay for VA’s benefits errors?

VAs Benefits Errors


A group of Senate lawmakers is again arguing that if Veterans are overpaid on benefits because of accounting errors, they shouldn’t be punished for the federal government’s mistakes.

Legislation introduced Wednesday would require changes to how the Department of Veterans Affairs handles benefit corrections, including limiting the amount they can withhold from Veterans’ future payouts to cover the debt.

“It’s wrong to put the debt from the VA’s accounting mistakes on the shoulders of men and women who have served their country,” Sen. Jon Tester, ranking member of the Senate Veterans’ Affairs Committee, said in a statement. “For some Veterans, these benefits make the difference between paying monthly rent or missing payments.

“We’ve got to stop the VA from pulling the rug out from under Veterans and their families.”

Under current law, VA officials can withhold 100 percent of a Veteran’s monthly benefits to cover past overpayments, even if those mistakes are the fault of federal officials.

The new legislation would limit that withholding to no more than 25 percent of a monthly benefits check and put a five-year limit on the time where VA officials can recover overpayments. The measure would not wipe out all debts related to VA mistakes.

The senators said up to 200,000 overpayment notifications are sent out to Veterans and their families each year.

Bill co-sponsor Sen. John Boozman, R-Ark., called the moves a common-sense step in providing better customer service to Veterans.

“Supporting Veterans and their families by eliminating the potential for hardships caused by the VA’s errors is important to honoring our commitment to their service and sacrifice,” he said in a statement.

Lawmakers proposed similar reforms last session but saw only parts of that legislation become law. Those changes included rewriting VA policy to allow Veterans to update personal information in department systems, in an effort to cut down on potential mistakes in benefits payouts.

This measure goes further, requiring VA to update its computer systems to ease that process and mandating electronic notification of debt notices, including information on how to request hardship waivers.

The legislation, called the Veterans Debt Fairness Act, has not yet been scheduled for a committee hearing.


VA Receives $25 Million Donation to Provide Genetic Testing for Veterans

25 Million Donation


A billionaire philanthropist has donated $25 million to the Department of Veterans Affairs to provide genetic tests for Veterans to help tailor their medical treatments and medications.

The VA and Denny Sanford, a South Dakota banker and Air Force Reserve Veteran, announced the gift March 12. The money is expected to help up to 250,000 Veterans through 2022, starting with those who have received a cancer diagnosis.

According to Sanford Health, the hospital system named for Sanford after he donated $400 million in 2007, the gift will fund the testing program, called Pharmacogenomics Action for Cancer Survivorship, or PHASeR. It aims to use a Veteran's DNA to determine personalized treatment and reduce costly adverse drug reactions.

During the announcement of the donation at the National Press Club in Washington, D.C., VA Secretary Robert Wilkie said the gift will help shape future treatment for all Veterans who receive care at VA.

"The pharmacogenetic testing that we are going to be using as a result of Mr. Sanford's generosity is critical for our nation's Veterans," Wilkie said. "We are all committed to active engagement with medicine and science ... to bring our Veterans the very best care."

Dr. Deepak Voora, with the Duke University School of Medicine's Center for Applied Genomics and Precision Medicine, will oversee the program; a pilot is expected to launch at the Durham, N.C. VA Health System later this year.

"As a physician, it's hard to predict exactly how a patient will respond to a medicine," Voora said at the announcement event. "But this pharmacogenetic testing program can change that by indicating how patients might respond to medications before they even take them."

He added that specialized pharmacogenetic testing largely has been out of reach for VA patients due to cost.

The program is expected to be available at 125 sites by 2022. Test will be taken at local VA facilities and processed at a Sanford Health facility in South Dakota. The tests will examine genetic markers to determine how patients tolerate and metabolize different types of drugs, including antidepressants, blood thinners and pain medications.

Sanford Health plans to supplement Sanford's gift with a matching fundraising effort.

"We recognize that our patients who are Veterans are coming to us with something special on their mind and in their experiences," Sanford Health CEO Kelby Krabbenhoft said. "This is a natural way for all of us at Sanford Health to give back."

Denny Sanford, 83, made his fortune, estimated by Forbes to be at $2.2 billion, in banking and credit card companies. He said on Fox News Sunday on March 17 that he plans to die broke, having given away his fortune. To date, he has donated $1.6 billion to causes that include health care research and services, neglected children, the University of Minnesota, education, the San Diego Children's Zoo, stem cell and breast cancer research.

"It's a joy to help other people," he told Chris Wallace. "I will die broke. Everything is committed to different organizations."


VA releases health care inspection reports and staffing data for more than 100 Community Living Centers

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Today, the U.S. Department of Veterans Affairs (VA) began publicly posting, for the first time, health care inspection reports and staffing data for its nursing home system.

To date, VA has posted 101 health inspection reports of its 134 Community Living Centers (CLCs) with the remainder scheduled to be posted by October 2019.

The health care inspection reports, which cover April 2018 to present, are available here. In the future, VA will post the reports annually.

The health care inspection reports show that, in comparison with non-VA facilities rated by the Centers for Medicare and Medicaid Services (CMS), VA has a lower number of low-performing facilities (VA: 17.2 percent, non-VA: 19.7 percent) and a higher number of higher-performing facilities (VA: 17.2 percent, non-VA: 10.8 percent).

“Overall, VA’s nursing home system compares closely with private sector nursing homes, though the department on average cares for sicker and more complex patients in its nursing homes than do private facilities,” said VA Secretary Robert Wilkie.

Many VA nursing home residents are being treated for conditions such as prostate obstruction, spinal cord injury, mental illness, homelessness, post-traumatic stress disorder, combat injury, terminal illness and other conditions rarely seen in private nursing homes. In fact, 42 percent of 41,076 VA CLC residents in fiscal 2018 had a service-connected disability rating of 50 percent or higher.

When comparing VA CLCs with private sector nursing homes, the VA CLCs care for more complex Veterans with Veteran-specific conditions such as post-traumatic stress disorder (11.6 percent vs. 0.5 percent) and traumatic brain injury (1.7 percent vs. 0.8 percent) in addition to the VA CLCs providing more hospice-related care to include hospice care (10.3 percent vs. 3.7 percent), chemotherapy (1.2 percent vs. 0.4 percent) and radiation therapy (1.4 percent vs. 0.1 percent).

Further, the overall star rating for VA’s nursing homes compared with the 15,487 private sector nursing homes rated by the CMS shows that VA has a significantly lower percentage of one-star, or lowest rated, facilities than the rest of the nation. VA’s latest ratings show that only eight, roughly 6 percent, of VA’s nursing homes received an overall one-star rating.

For more information about VA nursing homes, see here and here. About the reports

The inspection reports are based on yearly, unannounced inspections conducted by an outside contracted agency. As part of the reports, survey teams look at many aspects of life at VA nursing homes, including:

  • The care of residents and the processes used to give that care.
  • How the staff and residents interact.
  • The nursing home environment.

Surveyors also review residents’ clinical records, interview residents and family members, as well as caregivers and administrative staff.


VA’s Private Care Program Headed for Tech Trouble, Review Finds

Private Care


“These people are out of their minds,” one VA doctor said.

As the Trump administration prepares to launch a controversial program to expand private medical care for veterans, the Department of Veterans Affairs is developing a software tool to determine who’s eligible.

But the tool is so flawed, according to an independent review obtained by ProPublica, that it threatens to disrupt the health care of about 75,000 veterans every day.

“This degradation goes against the spirit of the Mission Act to improve the veterans experience and quality of care,” the review said, referring to the 2018 law that authorized the program to expand private care. The program is supposed to start in less than three months.

The review was conducted by the U.S. Digital Service, an elite group of software developers and designers employed by the White House to help federal agencies improve their technology. The USDS team said the VA should scrap the eligibility tool and start over.

The VA needs authorization from Congress to cover the $5.6 million cost of completing work on the eligibility tool, the department said in a March 4 letter to a House appropriations subcommittee. The panel has not yet acted on the request.

On Monday evening, shortly after this article was published House veterans affairs committee chairman Mark Takano called the findings by the USDS “incredibly alarming” and said his panel would hold a hearing to scrutinize the VA’s funding request.

VA spokesman Curt Cashour declined to comment on the USDS review, saying it “remains a work in progress.” The USDS didn’t respond to requests for comment.

The USDS report raised concerns that the eligibility tool was designed in a way that wouldn’t work for VA doctors. The report predicted that the tool would generate errors or run slowly or crash. These glitches would lengthen each appointment by five to 10 minutes, the USDS team estimated, which equates to being able to treat 75,000 fewer veterans every day systemwide.

The USDS said the contractor building the software — a Virginia-based company called AbleVets — is “motivated and capable”; the problem, according to the report, is the task that the VA assigned was rushed and poorly conceived. The tool has to pull data from six separate VA systems, but those connections won’t be set up in time, the USDS found. There also won’t be enough time to test the tool and address any errors, according to the report.

Doctors could balk, interviews conducted by the USDS team indicated. As the leader of primary care physicians at one VA medical center said in the report, “I will instruct every one of my PCPs not to do this.”

Another unnamed physician said of administrators who expect doctors to use the tool: “These people are out of their minds. We aren’t housekeepers, doorkeepers, garbage men.”

A bug in the Mission Act rollout would add to a string of high-profile IT failures for the VA. Last year, the VA’s software system delayed and miscalculated stipends for student veterans under the GI Bill, leading to veterans getting evicted and having their credit scores ruined. The agency’s effort to overhaul its electronic health records has suffered from leadership turmoil and rising costs. The VA blamed its technology infrastructure for delaying the expansion of benefits for family members who take care of injured veterans.

“The Department of Veterans Affairs, as these committees have noted on more than one occasion, has an IT problem,” VA Secretary Robert Wilkie acknowledged at a congressional hearing in December. The VA lacked a permanent IT chief until January; for most of last year, the IT division was led by a Trump campaign alumnus who closely coordinated with three men at Mar-a-Lago whom the president gave sweeping influence over the VA.

Wilkie has said the Mission Act will “revolutionize VA health care as we know it.” But the USDS review said the agency is making only “piecemeal updates” to existing policies and procedures, and has conducted little research to understand how veterans, doctors and staff actually use private care.

The report recommended starting over on a simpler tool that wouldn’t be a drain on doctors’ time because it could be used by nurses or clerks, or even by veterans themselves. The USDS said the simpler tool could be done in time for the private care program’s launch in June.

AbleVets’ CEO, Wyatt Smith, declined to comment.

If the VA doesn’t provide a tool for veterans to check their own eligibility, patients may get into arguments with staff about whether they’re entitled to private care, the report warned, leading “to the public perception that the criteria are arbitrary, inconsistent, or unfair.”

That concern recalls the confusion surrounding the 2014 rollout of an earlier private care program that the Mission Act is replacing. At that time, a convoluted procedure for authorizing and scheduling appointments in the private sector led many veterans to wait more than 30 days, even though getting care faster was the point of the program, according to the VA inspector general.

“I remember very well in 2014 the fiasco that occurred there,” Rep. Phil Roe, the top Republican on the House veterans committee, said at the December hearing. “I’d rather keep doing exactly what we’re doing and implement it a month later than have this thing fall on its face.”


Precision health initiative brings genetic testing to Veterans

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VA and Sanford Health join forces to provide free screenings, improve patient care for cancer survivors

WASHINGTON — Today the U.S. Department of Veterans Affairs (VA) announced that, as part of an innovative partnership, VA and Sanford Health, one of the nation’s largest nonprofit health care systems, will soon provide free genetic testing to some Veterans cared for by VA.

The VA PHarmacogenomics Action for cancer SuRvivorship (PHASeR) testing program will begin a pilot program this year at the Durham VA Health Care System that will enroll all cancer survivors who receive treatment at the facility. The program eventually will expand to enrolling some 250,000 U.S. Veterans at 125 sites.

A recent Dartmouth study found that VA medical centers “outperform private hospitals in most health care markets throughout the country.”

VA Secretary Robert Wilkie lauded the partnership, and said relationships like this will continue to expand the department’s delivery of world class health care.

“This screening test will help providers at the VA prescribe the most appropriate medications at the right dose for cancer survivors,” Wilkie said. “Our goal is to continue delivering the best care possible for our nation’s heroes, and this partnership helps us do just that.”

PHASeR is funded by a $25 million gift from philanthropist Denny Sanford, for whom the health system is named, and an effort by Sanford Health to raise matching funds. The test can help providers determine which medications will be most effective for patients, improving access to appropriate treatments and reducing adverse drug reactions, which research shows costs up to $30 billion per year.

The test results will help with clinical decision making for all types of prescribed medications, including cardiovascular and mental health diseases and pain management. Veterans will be able to access the test at their local VA facilities, and Sanford Health will process the tests at its South Dakota-based Imagenetics facility.

"We have seen firsthand how this testing can positively influence patient care,” said Kelby Krabbenhoft, president and CEO of Sanford Health. “Through the generosity of Mr. Sanford, we are proud to join VA to make the test available to our nation’s Veterans.”

Sanford Imagenetics began in 2014, and more than 90 percent of patients who have been tested have been found to carry a genetic change that could affect medication selection or dosing. Test results are shared with physicians through the electronic medical record to ensure efficiency and accuracy in choosing treatments.

For more information on the PHASeR testing program resources for Veterans visit here.


More than 800 Veterans receive direct access at Montgomery Veterans Experience Action Center

800 Veterans


One-stop access events

On Feb. 6,VA sponsored the Veterans Experience Action Center in the Multiplex at Cramton Bowl Multiplex in Montgomery, Alabama. VA staff members were on hand to process and provide updates on claims and appeals.

State, local and other federal agencies collaborated to provide information on housing, insurance, health care, employment, bereavement and mental health counseling. And a VA mobile Vet center was also on standby for those Veterans making a transition back into civilian life.

Thousands of Veterans and their family members turned out for the event. Many found the center useful, such as Veteran John Campbell, who drove from South Carolina.

“I learned more in 45 minutes than the 5 years my paperwork has been processing,” he said.

MCampbell is not alone. Many Veterans complain about the lag in wait time which can be attributed to backlogs and miscommunication. In some cases, Veterans simply do not understand the filing protocols and benefits available to them, according to Gerald Ruffin, a volunteer peer support specialist.

That’s why VA is hosting these events across the country.

More than 800 Veterans attended, also bringing their family members and friends. Nearly half of the Veterans received services of some kind, 107 claims and 15 appeals were processed, 38 enrolled in VA health care, 120 received information from NCA, 450 took home a VA Welcome Kit, and 44 received their claims decision and rating on-the-spot. $266,826 in retroactive compensation was granted during the event.

John Davis, a U.S. Army Veteran, had been waiting four years for a decision on his claim. After speaking with VBA representatives, he was able to expedite his paperwork. As this new initiative expands to other cities across the country, the Veterans Experience Action Center will promote more awareness and provide holistic care for our heroes and their families, caregivers, and survivors.

See news clips of the event here and here.


Secretary Wilkie announces groundbreaking partnership between VA and Sanford Health

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The VA PHarmacogenomics Action for cancer SuRvivorship (PHASeR) testing program will soon provide free genetic testing to some Veterans cared for by VA. The innovative partnership between VA and Sanford Health, one of the nation’s largest nonprofit health care systems, was unveiled today by VA Secretary Robert Wilkie during a press conference at the National Press Club in Washington, D.C.

The program will begin as a pilot this year at the Durham VA Health Care System where all cancer survivors who receive treatment at the facility will be enrolled. The program eventually will expand to enrolling some 250,000 Veterans at 125 sites.

PHASeR is funded by a $25 million gift from philanthropist Denny Sanford, for whom the health system is named, and an effort by Sanford Health to raise matching funds. The test can help providers determine which medications will be most effective for patients, improving access to appropriate treatments and reducing adverse drug reactions, which research shows costs up to $30 billion per year.

The test results will help with clinical decision making for all types of prescribed medications, including cardiovascular and mental health diseases and pain management. Veterans will be able to access the test at their local VA facilities, and Sanford Health will process the tests at its South Dakota-based Imagenetics facility.

VA Secretary Robert Wilkie lauded the partnership, and said relationships like this will continue to expand the department’s delivery of world class health care.

“This screening test will help providers at the VA prescribe the most appropriate medications at the right dose for cancer survivors,” Wilkie said. “Our goal is to continue delivering the best care possible for our nation’s heroes, and this partnership helps us do just that.”


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