“As a physician I tend to look at things in terms of the way I was trained – assess, diagnose, and then aggressively treat the patient,” he said before outlining the current state of VA, clearly identifying risks the department faces in caring for Veterans.
Watch the briefing online, courtesy of PBS Newshour.
VA now has same-day services for primary care and mental health at all 168 medical centers with 22 percent of patients seen on the same day. Yet Veterans are waiting more than 60 days for new appointments at about 30 locations nationwide. Sixteen percent of primary care clinics are over 100% capacity – meaning Veterans are not being seen soon enough. “We need more clinical and support staff as well as more space in order to solve this problem,” Shulkin said
Community Care, especially VA’s Choice Program, has increased access to care for millions of Veterans with 500,000 community providers in the Community Care Network. However, providers are still frustrated by delayed payments to the point that some of them are leaving the network. VA is encouraging the private sector to use electronic submissions to allow faster adjudication and payment.
VA is currently required to administer eight separate Community Care programs, which is inefficient and causes confusion for Veterans, providers and VA employees alike. Shulkin said, VA has to “reject a minimum of 1 out of 5 community care claims. This is much higher than the private sector and we need Congress to help us fix this. We continue to work with our partners – including the White House, Congress, VSOs, and community providers – to develop and pass legislation that will ensure VA Community Care is easy to understand, simple to administer, and meets the needs of Veterans and their families. We have to pass legislation this year or these issues will persist.”
Quality of care
VA now shares star ratings and comparisons between VA medical centers and local community hospitals to provide Veterans with information to make informed decisions about their care. Upon setting of the website, VA has identified 14 medical centers with 1-star ratings, meaning they are below the community standard of care. VA is actively deploying teams and implementing performance plans at each of these centers to improve care.
“Veterans shouldn’t have to accept low quality care. They deserve our very best,” Shulkin said. “When they aren’t getting our best, they should be able to access the best their community has to offer. That is exactly what we are working to achieve with our new Choice plan. “
Disability claims and appeals
VA currently has more than 90,000 disability claims that are taking more than 125 days to process.The secretary wants to cut that time in half over the next two years.
“The time to get an appeal decision is far too long- taking almost three years for a veteran to get a decision,” Shulkin said. “It takes Congress to fix this, and I am grateful that the House passed legislation last week. We need our friends in the Senate to act as soon as possible.”
More than 20 VA facilities have out of date systems and processes for inventory– making it difficult to ensure doctors and nurses have the supplies and equipment they need to care for Veterans. Currently, 75 percent of VA’s IT budget is spent on sustaining infrastructure, including legacy systems that are at risk of failing – potentially crippling mission–critical operations.
“Our scheduling systems and our financial systems are outdated – contributing to excessive wait times for Veterans. Both systems are in the process of being replaced but it will take a few years to complete this,” Shulkin stated. “We have to modernize our IT systems by using commercial, cloud-based solutions.”
VA facility condition assessments have identified critical infrastructure deficiencies of more than $18 billion that require remediation, including structural seismic, electrical distribution and mechanical systems such as heating and ventilation. On average VA buildings are nearly 60 years old, with only about half built since 1920.
“VA will be working with Congress to implement our plan for modernizing our capital asset infrastructure through a national realignment strategy – allowing us to improve our buildings and facilities to meet local Veteran demand, and provide better healthcare services – all while being a good steward of taxpayer dollars,” Shulkin said.
Under current law, VA must wait at least one month to hold an employee accountable for misconduct or poor performance. VA currently has around 1,500 disciplinary actions pending.
“Our employee accountability processes are clearly broken,” Shulkin said, citing a having to wait more than a month to fire a psychiatrist who was caught on camera watching pornography on his iPad while seeing a Veteran patient. “We need new accountability legislation, and we need it now.”
Currently it takes VA an average of 110 days to onboard a nurse and an average of 177 days for a nurse practitioner. In his remarks, Shulkin called for position management capability to provide the agency structure to create jobs based on specific duties and responsibilities that are required to meet the needs of Veterans. Low salaries for health care providers and prosthetics representatives are also making it difficult to recruit and retain critical positions. As an example, the 2016 median salary for biomedical engineers was $85,620, while the national VA average for a VA biomedical engineer was $65,677 – nearly 25 percent below the private sector.
“If VA cannot compete with private sector salaries, we will be unable to retain qualified providers and support staff,” Shulkin said. “To help with staffing shortages, VA will be pursuing legislation to expand graduate medical education training opportunities.”
Shulkin described VA’s central office as too big and too bureaucratic. “We need faster, clearer decision making authority that gives Veterans more control of their care and services,” he said. “I have directed that VA Central Office remain under a hiring freeze as we consolidate program offices, implement shared services, and reduce our overhead by at least 10 percent.”
Additionally, the secretary is taking action to reduce burdensome regulations that simply do not make sense to make it easier for Veterans to engage with VA.
Fraud, waste and abuse
Detection and prevention of fraud, waste and abuse ensures VA’s resources are spent on what they were meant for – care and services for Veterans and their families. VA has been able to prevent $27 million in fraudulent payments and identified potential duplicate payments of $24 million last year.
The most recent study shows that 20 Veterans a day are dying by suicide. This is a national public health crisis that requires a whole of government approach and key partnerships with communities and private sector organizations.
Shortly after taking the helm of VA, Dr. Shulkin authorized emergency mental health services for those that were other than honorably discharged – a population of service members who are at the highest risk of suicide.
I am confident that we will be able turn VA into the organization Veterans & their families deserve and all of us want to see.
Dr. Shulkin’s overarching plan for VA seems to be fairly simple: Recognize (and admit) the risk to Veterans, develop the best possible solution and eliminate the bureaucracy standing in the way to make it happen. In many cases, the rules will need to be rewritten and in some case the law will have to change.