Will the VA Provide Better Service to Veterans?

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With much fanfare, Dr. David Shulkin, the new Secretary for the Department of Veterans Affairs (“the VA”), has moved quickly to address some of the recurring problems at the VA.

Dr. David Shulkin, VA Secretary

As the first VA Secretary without a military background, Dr. Shulkin appears committed to resolve several pressing concerns:

– Speedier processing of Veteran benefit claims and,

– Eliminate unnecessary bureaucracy and artificial constraints on “out-of-network” support for Veterans (Choice Program).

Indeed, Secretary Shulkin recently unveiled a 10 Point Plan to modernize the VA:

1. Firing bad employees

2. Extending the Choice program

3. Choice 2.0

4. Improving VA infrastructure

5. ‘World-class’ services

6. Better VA-DoD partnerships

7. Better electronic records

8. Stopping suicide

9. Appeals modernization

10. Internal improvements 

While there is little in these Powerpoint presentation bullet points that anyone would quibble with, implementing these broad goals tends to be far more complicated than listing the goals.   Unless there are rigorous benchmarks to assess progress toward achieving these goals, then this “goal-setting” exercise is rather fruitless.

In fact, it is difficult to reconcile the need for increased hiring within the VA unless one sees clear and conclusive evidence that “bad employees” are being fired.  In fact, the VA is recommending a hiring surge to deal with a backlog of benefit claims, a situation that has persisted for 4 years.

Are more employees needed or does the VA lack the “right” mix of employees to implement Shulkin’s 10 point plan?

For instance, State and Local VA coverage varies radically across the US.  For example, NPR reported in 2015 “that spending is nearly $30,000 per patient in San Francisco, and less than $7,000 per patient in Lubbock, Texas. Nationally, the average is just under $10,000. In places where more veterans are enrolled in VA health benefit plans, spending per veteran did tend to be higher.”   Why?  This is a huge variance that is not well explained.

Aligning the VA to Achieve Measurable Goals

As one looks at Shulkin’s proposed goals, it would be useful to determine their priority and the level of commitment (personnel and capital expenditure) that is required to attain them.  Furthermore, what are the benchmarks to chart progress toward achieving those goals.

For instance, “stopping Veteran suicides” is a goal that would find few naysayers.  Nevertheless, it is difficult to reconcile that goal with the sad fact that 30% of suicide watch calls are not currently attended by the Veteran Crisis Center.  Indeed, I find it disturbing that the Suicide Crisis Line has been centralized under the VA in the name of “efficiency.”

Perhaps, Dr. Shulkin and his staff have some measurable goals.  If so, they should be made public and both the Executive Body and Congressional Oversight Committees should receive regular updates from the VA on progress to date in achieving mutually agreeable goals.

Is this likely to happen?  Most certainly not!  This is an anathema to Big Government.

Is Firing Bad Employees Really Going to Occur?

With 365,000 employees, there are certainly going to be a few “bad eggs.”  While Dr. Shulkin praised the vast majority of VA employees, he told a cheering crowd  that “We’re going to make sure that the secretary has the authority to make sure that those (sic “bad”) employees … are leaving the VA system.”

J. David Cox

J. David Cox

Really?  It seems to anyone who has taken more than a cursory look at staffing within the VA, that David Cox, the President of the American Federation of Government Employees, will be calling the shots rather than Dr. Shulkin.

In most cases, distinguishing between a “bad” employee and an inefficient one is largely subjective.  Given the protection afforded by employees at the VA, it is highly unlikely that both the bad and inefficient employees will be “leaving the VA system” anytime soon.

In effect, this places a greater burden on both ” the good” and the many efficient and competent employees within the VA.  With little say or control on managing the workforce, I find it highly unlikely that Dr. Shulkin will be able to fulfill his promise to fire “bad” employees.

More importantly, it is unlikely that he will be able to realign staffing levels to implement his 10-point plan.

And Speaking of Bad Apples:  How About Dr. David Cifu?

If Secretary Shulkin is really serious about dealing with “Veteran suicides” and providing Veterans with alternative treatment for Veterans with PTSD, he would do well to question the credentials of Dr. David Cifu and others within the VA who continue to block Veteran access to better treatment alternatives.

When one looks at Secretary Shulkin’s complex agenda, one should focus on the signs that change is actually occurring.  Personally, I don’t expect to see much change over the next couple of years, unless there are clear bookmarks to measure that change.  Sadly, it seems likely that we will be looking at the same litany of complaints a couple years down the road.

Dr. Shulkin, I admire your bravado and enthusiasm, but question whether you have the right tools and authority at your disposal to bring about a much needed reform within the VA.

Veterans should be hopeful, but not too optimistic.

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SFTT News: Week of Feb 24, 2017

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Found below are a few news items that caught my attention this past week. I am hopeful that the titles and short commentary will encourage SFTT readers to click on the embedded links to read more on subjects that may be of interest to them.

If you have subjects of topical interest, please do not hesitate to reach out. Contact SFTT.

Federal Hiring Freeze Confuses Military Parents
On Wednesday, the base commander informed parents that all part-day Child and Youth Services (CYS) programs at the garrison would end March 1 because they couldn’t replenish employees. That night, the Pentagon granted exemptions from the freeze, according to a Defense Department spokesman. But the exemptions come with disruptions. “This closure is a result of staff shortages due to the Federal Hiring Freeze,” said the Wiesbaden memo from Col. Todd J. Fish. “This hiring freeze prevents CYS from replacing staff who depart for any reason to include normal rotation.”  Read more . . .

Grow the Military the Smart Way
There are real demands for resources across the military, and many personnel and readiness challenges that need fundamental fixes — indeed, these challenges would be masked or even exacerbated by the infusion of more money, people, and platforms. The political debate is focused on quantity but more uniformed personnel is not a solution in and of itself, and lack of money isn’t the only obstacle to smart growth. Troop numbers make for easy talking points, but advocates for rebuilding the military must be able to explain why, what choices come first, and how to sustain it over time.  Update to personnel and readiness practice ought to come as part of this investment — otherwise, we could end up with a large force that isn’t formed to tackle America’s real threats, and undercut needed reforms.  Read more . . .

VA to Scrap Veteran Applications?
A whistleblower in the Atlanta office of the Department of Veterans Affairs warned President Trump on Tuesday that the VA is preparing to throw out hundreds of thousands of benefit applications due to an error the VA itself made during the Obama administration. Scott Davis, a well-known whistleblower who has testified before Congress, wrote an open letter to Trump saying that more than 500,000 of these applications might be scuttled in March unless he intervenes. “I am sending this whistleblower disclosure to your office due to the urgent need for executive intervention,” he wrote. “VA is planning on declaring over 500,000 Veteran applications for VA health care as incomplete and abandoned at the end of March 2017.”  Read more . . .

Dr. David Shulkin, VA Secretary

Dr. David Shulkin Pledges to Rid VA of Abuse
Dr. David Shulkin used his first public statement as the new Veterans Affairs Department secretary on Thursday to pledge management reforms that would remove the VA from a government agency’s “high risk list” for waste, fraud and abuse. “We will implement a plan that directly addresses these risks by building on the progress we have already made,” Shulkin said in response to a Government Accountability Office report naming the VA as a “high risk” agency in its treatment of veterans, handling of claims and efforts to lower wait times.  Read more . . .

Opioid Addiction a Problem for Many Veterans
Former Secretary of Veterans Affairs Robert McDonald said veterans are 10 times more likely to abuse opioids than the civilian population, which likely drives Fayetteville’s numbers up. Jacksonville, another military city in North Carolina, ranks 12th on Castlight’s list of worst locales for opioid abuse. While the military is taking steps now to attack addiction, many veterans question why the military took so long to address a problem the veterans say it created.  Read more . . .

Marijuana PTSD

Clinical Trial for Marijuana to Treat PTSD
The first participant in a clinical trial designed to evaluate the effectiveness of smoking marijuana to treat PTSD in veterans was given cannabis on Monday, according to the organization conducting the study.  The study is the first such trial to evaluate the safety and effectiveness of using marijuana to manage symptoms of post traumatic stress disorder in U.S. veterans, officials with the Multidisciplinary Association for Psychedelic Studies said in a release on Tuesday.  MAPS is a California-based non-profit research organization focused on “the careful uses” of marijuana, according to its website. The study is funded by a $2 million grant from the Colorado Department of Public Health and Environment.  Read more . . .

Drop me an email at info@sftt.org if you believe that there are other subjects that are newsworthy.

Feel you should do more to help our brave men and women who wear the uniform or our Veterans? Consider donating to Stand For The Troops

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Will Much Change at the VA with David Shulkin as Secretary?

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Much was made during the election campaign over the failings of the Department of Veterans Affairs (“the VA”) to serve our Veterans effectively.  While President-elect Trump had vowed to overhaul the VA, his selection of Dr. David Shulkin, an Obama administration holdover, as his nominee raises questions over what may change within the VA.

Dr. David Shulkin, VA Secretary

Indeed, the initial Senate confirmation hearings suggest a “love fest” according to Quil Lawrence of NPR.  Found below is the complete Senate confirmation hearing of the VA secretary-nominee’s testimony to the Senate committee:

Personally, I would like to think that Dr. Shulkin is the right person for the job – and he may well be – but I find it curious that not one of the questions at the confirmation hearing directly addressed the implementation of the Commission on Care recommendations. While some of these issues were addressed obliquely at the hearing, it seems to me that there should be a regular status report to the respective Congressional committees on how (or whether) these programs are currently being implemented.

While a good deal of the confirmation hearing was an opportunity for Senators to showcase their “genuine” concern for Veterans and pontificate on the silly rumors of “privatizing the VA,”  the hearing covered many of the same issues that continue to plague the VA.

Nevertheless, I am encouraged by some of the remarks by Dr. Shulkin at his confirmation hearing which are summarized below:

– Commitment to moving care into the community were it makes sense for the Veteran.  Currently, some 31% of health services are provided by local communities compared to 21% when Dr. Shulkin joined the VA.

– Expand Choice Program to ensure that Veterans are able to seek care in their community.

– Work to eliminate disability claims backlog (already significantly reduced) and seek legislation to reform the “outdated appeals process.”

– Need to address “infrastructure issues” . . . and explore expansion of public/private partnerships rather that build medical centers that have “large cost overruns and take too long to build.”

The Veteran’s Choice Program (“the VCP”) is the result of the Veteran’s Choice Act that was enacted to address chronic wait times for Veterans seeking care at VA facilities.  To a large extent, “the VCP” is the brainchild of Dr. Shulkin.

During the confirmation hearings, Dr. Shulkin agreed that the “mileage” requirement to access private medical services (currently 40 miles from a VA facility) shouldn’t be a deciding factor.  In Dr. Shulkin’s opinion, wait times should be the determining criteria.  Couldn’t agree more.

Furthermore, Dr. Shulkin acknowledged that there was far “too much bureaucratic” red tape involved when a Veteran received the green light to seek private care and the required VA approvals to actually receive it.

While praising the work ethic and dedication of nearly all VA employees, he admitted that he was frustrated by current legal constraints to shed the VA of a few bad apples.  Perhaps, he should enlist the support of government labor leader, David Fox, to join him in helping streamline the VA for the benefit of Veterans.

With 314,000 employees and a VA budget of $180 billion (of which only $76 billion is discretionary), SFTT has long believed that the VA is “too big” to succeed in its mission to provide adequate and responsive care to Veterans in need.

The issue is not the “quality of care” provided by the VA, which according to a recent Rand Corporation study compares favorably with private institutions.   The question remains, who gets access to these quality VA services and when?

During his confirmation hearing, Dr. Shulkin stated that only 61% of interviewed Veterans “trust” the VA (up from 41%).   I am quite sure that as the new VA Secretary, Dr. Shulkin, will seek to improve trust levels among Veterans, but ease of access to urgent medical services – whether at the VA or private facilities – is critical.

Furthermore, Veterans should be provided with a wider range of choices in determining the type of treatment they feel is appropriate for their medical condition.  Specifically, it is simply not acceptable that “gatekeepers” at the VA should determine ALL “eligible” treatment procedures.

Certainly, Dr. Shulkin appears to have the “right” temperament for the job, but in my opinion, far more is needed to turn around this largely non-responsive ship that is currently adrift and aloof from meeting the needs of Veterans.

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