Tag Archives: Veterans Administration

U.S. Veterans Hospitals Quality Ratings FY 2018

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VA Ratings

U.S. DEPARTMENT OF VETERANS AFFAIRS”

“The Veterans Health Administration uses a comprehensive performance improvement tool called Strategic Analytics for Improvement and Learning (SAIL). SAIL is developed for the VA to drive internal system-wide improvement.

Many of the metrics on SAIL are not publicly reported by non-VA hospitals and health systems.  Therefore, it is not appropriate to directly compare evaluation findings derived from SAIL with results from public and private sector hospitals. “


“The metrics are organized into 9 Quality domains and one Efficiency and Capacity domain.  The Quality domains are combined to represent overall Quality.  Each VA medical center is assessed for overall Quality from two perspectives: (1) Relative Performance compared to other VA medical centers using a Star rating system from 1 to 5 and (2) Improvement compared to its own performance from the past year.  Both relative performance and size of improvement are used to guide improve efforts.

In 2018 66% (96 out of 146) of VA Medical Centers Reported on SAIL Showed Improvement Compared to Their Baseline One Year Earlier.

The table below displays relative performance in star rating in the third column and size of improvement in arrows in the fourth column that indicate whether medical center performance has improved, stayed the same or declined over the past year.

VISN Medical Center Relative Performance
Star Rating (1 to 5)
Improvement From
Baseline Scores 2017
2 Albany 3  ↑↑
22 Albuquerque 2  ↑
16 Alexandria 2
4 Altoona 4
17 Amarillo 4 ↑↑
20 Anchorage 3
10 Ann Arbor 3
6 Asheville 5 ↑↑
7 Atlanta  1
7 Augusta  2
5 Baltimore 3
2 Bath 5
10 Battle Creek 2 ↑↑
8 Bay Pines 3
5 Beckley 2
1 Bedford 5
17 Big Spring 1 ↑↑
7 Birmingham 4
20 Boise 3
1 Boston 4
2 Bronx 4
2 Brooklyn 3
2 Buffalo 4 ↑↑
4 Butler 5
2 Canandaigua 4 ↑↑
23 Central Iowa 4
7 Charleston 4
19 Cheyenne 2
12 Chicago 3
10 Chillicothe 4
10 Cincinnati 5
5 Clarksburg 4 ↑↑
10 Cleveland 5
4 Coatesville 5
15 Columbia MO 3
7 Columbia SC 2
10 Columbus 4
1 Connecticut 5
17 Dallas 2 ↑ 
12 Danville 3
10 Dayton 3
19 Denver 2
10 Detroit 3
7 Dublin 3 ↑↑
6 Durham 3
2 East Orange 2
17 El Paso 1 ↑↑
4 Erie 5
23 Fargo 4
16 Fayetteville AR 3
6 Fayetteville NC 2
23 Fort Meade 3
10 Fort Wayne 2
21 Fresno 2
8 Gainesville 3
19 Grand Junction 4
16 Gulf Coast HCS 2
6 Hampton 2
17 Harlingen 2 ↑↑ 
12 Hines 3
21 Honolulu 2
23 Hot Springs 5 ↑↑
16 Houston 3
2 Hudson Valley 3
5 Huntington 4 ↑↑
10 Indianapolis 3 ↑ 
23 Iowa City 3
12 Iron Mountain 5
16 Jackson 2 ↑↑
15 Kansas City 2
8 Lake City 2
21 Las Vegas 2 ↑↑
15 Leavenworth 4
4 Lebanon 5
9 Lexington 4
16 Little Rock 3 ↑↑
22 Loma Linda 1
22 Long Beach 2
22 Los Angeles 3
9 Louisville 3
12 Madison 5
1 Manchester 3
15 Marion IL 2
5 Martinsburg 2
9 Memphis 1
8 Miami 3
12 Milwaukee 3
23 Minneapolis 4
19 Montana 2
7 Montgomery 1
9 Mountain Home 4
9 Murfreesboro 2
19 Muskogee 2
9 Nashville 2
16 New Orleans 3
2 New York 4
12 North Chicago 4
1 Northampton 5 ↑↑
2 Northport 3
19 Oklahoma City 2
23 Omaha 4
8 Orlando 3
21 Palo Alto 2
5 Perry Point 3 ↑↑ 
4 Philadelphia 3
22 Phoenix 1
4 Pittsburgh 4
15 Poplar Bluff 3
20 Portland 3 ↑↑ 
22 Prescott 2
1 Providence 3
20 Puget Sound 2 ↑ 
21 Reno 3
6 Richmond 4
20 Roseburg 2
21 Sacramento 3 ↑↑
10 Saginaw 5 ↑↑
6 Salem 5
6 Salisbury 3
19 Salt Lake City 3
17 San Antonio 3 ↑↑
22 San Diego 3
21 San Francisco 3 ↑ 
8 San Juan 2
19 Sheridan 4 ↑↑
16 Shreveport 3
23 Sioux Falls 4
20 Spokane 3 ↑↑ 
23 St Cloud 5
15 St Louis 3
2 Syracuse 3
8 Tampa 4
17 Temple 3
1 Togus 5 ↑↑
12 Tomah 3
15 Topeka 3
22 Tucson 1
7 Tuscaloosa 3 ↑ 
20 Walla Walla 2 ↑↑
5 Washington 1
8 West Palm 3 ↑↑
20 White City 3 ↑↑ 
1 White River 3 ↑ 
15 Wichita 4
4 Wilkes Barre 3
4 Wilmington 3 ↑↑

*Note: Improvement From Baseline: ↑↑ – Large Improvement; ↑ – Small Improvement; →: Trivial Change; ↓: Large Decline”

https://www.va.gov/QUALITYOFCARE/measure-up/End_of_Year_Hospital_Star_Rating_FY2018.asp

“MILITARY TIMES”

” Veterans Affairs officials claimed improvements at 66 percent of their medical centers across the country last fiscal year, with 18 earning the highest level of excellence in the department’s internal ratings system.

But nine others remain on the VA’s list of underperforming facilities after getting the lowest possible rating. They include the embattled Washington VA Medical Center, which sits just a few miles from the White House and has seen a series of leadership shake-ups in recent years.

The VA ratings — made public in 2016 after a USA Today report on the internal scorecards — grade each of the locations on metrics like patient mortality, patient length of stay, reported accidents and patient satisfaction. Officials have said the system is used to collect best practices from high-performing facilities to use in underperforming ones.

In a statement, VA Secretary Robert Wilkie touted improvements across the 146 medical centers.

“With closer monitoring and increased medical center leadership and support, we have seen solid improvements at most of our facilities,” he said. “Even our highest performing facilities are getting better, and that is driving up our quality standards across the country.”

The number of one-star facilities dropped by six from the start of fiscal 2018 to the end. Of the nine medical centers still at that level, four were cited for significant improvements: El Paso and Big Spring in Texas, Memphis in Tennessee, and Loma Linda in California.

The five others — Washington, Phoenix and Tucson in Arizona, Montgomery in Alabama, and Atlanta in Georgia — saw no overall change.

Earlier this year, VA placed 12 medical centers on a high-risk list for “aggressive” management intervention. Of those, eight were removed from the program after showing sufficient improvement by the end of last month.

Wilkie said while he is pleased with the results thus far “there’s no doubt that there’s still plenty of work to do.”

 

https://www.militarytimes.com/news/2018/10/04/here-are-the-best-and-worst-va-medical-centers/

 

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Veterans Administration Says One In 10 Department Jobs Is Unfilled

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Unfilled VA Jobs

“MILITARY TIMES”

“More than 45,000 department posts are currently unfilled, with about 40,000 in the Veterans Health Administration alone, according to new data released by the department last week.

The rate was even higher among VA staff offices, with more than 2,500 vacancies, nearly 17 percent of the budgeted management posts.”


“More than one in 10 Veterans Affairs jobs is currently unfilled, a vacancy rate being downplayed by department officials but likely to raise serious worries among lawmakers who have already voiced concerns about a lack of medical professionals for veterans programs.

The figures were touted as another step toward transparency in federal government by VA officials, but were mandated to be made public by Congress in the recently passed VA Mission Act. The data was released just before 5 p.m. on the Friday before the extended Labor Day holiday weekend.

VA officials also called the information release positive news for their department, since it shows their employee turnover rates “compare favorably with other large cabinet-level agencies.”

But the number of vacancies — roughly 11 percent of the department’s workforce — is almost 10,000 higher than total open positions reported by VA officials.

For months, Democratic lawmakers have said the rising number of vacancies threatens to undermine VA care and services, and have criticized department leaders for not doing enough to fill the roles.

They have also pressed Republican colleagues to require VA fill many of those open positions before expanding care options outside the VA system, arguing that not properly staffing hospitals and clinics undermines the department’s ability to handle veterans’ medical needs.

In a statement, VA said their health systems’ “workforce challenges” mirror that of the larger American health care industry.

“There is a national shortage of healthcare professionals, especially for physicians and nurses,” officials said. “VHA remains fully engaged in a fiercely competitive clinical recruitment market.”

The department also issued a pre-emptive rebuttal to critics of the staffing issues, calling them in line with other large health care systems and that “the best indicators of adequate staffing levels include veteran access to care and health care outcomes, not vacancies.”

t his confirmation hearing in July, VA Secretary Robert Wilkie said he was not in favor of a “blunderbuss approach to filling the vacancies” because that could lead to a host of unqualified candidates undertaking sensitive department posts.

In a statement on Friday, Wilkie said that his department is “always looking for new ways to recruit high-quality talent, and will continue to do everything we can to provide the best quality care for our nation’s veterans.”

Lawmakers have also been critical of leadership gaps at the department. President Donald Trump has been unable to nominate a new head of VA health services since becoming president in January 2017, and numerous other top jobs have turned over in the last 20 months.”

https://www.militarytimes.com/veterans/2018/09/04/one-in-10-va-jobs-is-unfilled-leaving-gaps-in-veterans-services/

 

 

$2 Billion VA Technology Transfer Process Requires Clarification Says GAO

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VA IP

“FEDSCOOP.COM”

The agency operates a $1.9 billion research program, which has been behind inventions like the pacemaker, early prototypes for the CAT scan and more.

However, this process doesn’t always run as smoothly as it could — GAO found that while the VA’s 3,000 researchers are technically required to disclose their inventions to the agency, they may fail to “consistently” do so.”

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“The Department of Veterans Affairs needs to clear some things up in order to improve its technology transfer pipeline, a new Government Accountability Office report found.

The agency also has a tech transfer office, created in 2000, which works to shift internal health care innovations to the private sector for eventual commercialization, from which the VA can then collect royalties.

Some researchers are unaware of their responsibility to report. First-time inventors, for example, may not know what protocol is.

“VA established an online training program in 2017 covering the invention disclosure process, but the training is not mandatory,” the GAO report reads. “VA provided us with a report from October 2017 indicating that out of over 3,000 eligible researchers, 130 had taken the training.” That’s just four percent.

Second, many of the VA’s researchers also hold positions at universities, and this muddies the reporting process. These researchers may disclose their invention to the university assuming that the university will, in turn, disclose to the VA. But this doesn’t always happen.

Collectively, these two issues contribute to “lost technology transfer opportunities and royalties for VA,” the GAO report states. The watchdog recommends that VA implement a couple of fixes to make sure it is getting the full return on its research investment.

First, the report advises, “make training about invention disclosure mandatory.” And as to the university partnerships, GAO suggests that the VA create a standard method of reporting for all. The VA concurred with both of these recommendations.

The Trump administration recently identified tech transfer as one of its cross agency priority goals (referred to as CAP goals) — benchmarks instituted as a way to operationalize the President’s Management Agenda. CAP goal number 14 seeks to “improve the transfer of technology from federally funded research and development to the private sector to promote U.S. economic growth and national security.”

The administration is keenly interested in maximizing the federal return on research investment.

“Future promises are not enough,” Michael Kratsios, deputy CTO at the Office of Science and Technology Policy, said of federal R&D spending at a recent National Institute of Standards and Technology event. “The taxpayer correctly demands that we justify why our spending is important and why it’s important today. We must focus on maximizing our return on federal investment.”

https://www.fedscoop.com/va-tech-transfer-gao-report/

Minnesota Veterans Stuck with Medical Bills Despite Government Investigation

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Veteran Screwed

“KARE 11”

“Records show veterans in Minnesota continue to be stuck with emergency medical bills they should not owe despite a 2014 investigation by the Government Accountability Office (GAO) that documented similar improper denials by Department of Veterans Affairs.

The GAO report found VA management was only tracking how quickly claims were done. But management was not checking if they were done correctly.”


“Was the expectation that this issue was being fixed?” KARE 11 Investigative Reporter A.J. Lagoe asked Randy Williamson, the GAO’s lead investigator on the project.

“That was the expectation,” Williamson replied.

Beginning in June, KARE 11’s continuing investigation – A Pattern of Denial – has documented how veterans are still being saddled with medical debt they should not owe, some of it even turned over to collection agencies after trips to the emergency room.

RELATED: A Pattern of Denial: One veteran’s story

KARE’s findings mirror what Williamson’s GAO investigation discovered years ago.

A pattern of errors

“It was pretty much a pattern of a lot of errors,” Williamson told members of Congress during a 2014 hearing.

The GAO found the Department of Veterans Affairs was mishandling veteran’s emergency medical bill claims, improperly denying claims that should have been approved.

RELATED: Read GAO report here

“Some veterans were likely billed for care that VA should have paid for,” Williamson told members of the House Veterans Affairs Committee.

RELATED: Read Willimson’s testimony before Congress here

“We found that basically, VA was doing a very poor job,” Williamson recalls. “And they were erroneously denying claims.”

At the request of Congress, the GAO set out to determine how well the Department of Veterans Affairs was complying with the Federal Millennium Act which requires the VA, with a few exceptions, to cover the cost of emergency care for veterans at Non-VA hospitals.

Williamson and his team discovered repeated errors.

“Twenty percent of the cases we looked at were wrong, were denied inappropriately,” Williamson said.

“Is that an acceptable error rate?” Lagoe asked.

“Heavens no,” Williamson replied. “It’s not.”

The GAO found that clerks were denying medical bills without a qualified clinician reviewing them. The investigation also documented cases in which the VA had given veterans pre-approval to go to an outside hospital, but later denied their claim as unauthorized.

That’s exactly what KARE 11 found still happening to veterans like Bob Ramsey.

Bob Ramsey

WATCH: Vet turned over to collections after VA bill denial

Bob called the VA to ask what he should do when experiencing post-surgical leg pain. He says he followed the instructions he was given to seek private emergency care. So, he expected no problems with his bill.

He was wrong. The Minneapolis Non-VA Care Department sent him a letter denying his claim.

“I called for advice, called to ask what they wanted me to do. They told me what to do. I did what they told me to do, and then they refused to pay,” Bob said.

Bob says he tried reasoning with the VA for nearly a year. Meanwhile, his unpaid bill from Maple Grove Hospital was turned over to a collection agency.

Tired of fighting with the VA, and afraid the unpaid bill would hurt his credit, Bob says he paid the bill.

“I paid the bill because it was already in collections. I didn’t want that hurting my credit any more than it already had,” he said.

The day after KARE 11 emailed the Minneapolis VA asking questions about Bob’s case, the VA did a sudden about-face. A VA official left him a voicemail promising to immediately pay the bill they had previously denied.

Williamson said the GAO found denials like that were a systemic problem.

“One of the hospitals that they (VA) rated in their top 10 in the country, we visited and found numerous cases where improper denials had been made,” he recalled.

Speed before accuracy

Why was it happening?

The GAO report found VA management was only tracking how quickly claims were done. But management was not checking if they were done correctly.

“They looked at the timeliness of the claim processing, but they didn’t look at the appropriateness of the denials,” Williamson told KARE 11.

“Nobody was checking?” Lagoe asked.

“Nobody was checking,” Williamson responded. “I would say that it is a case of people not being diligent in doing their jobs, not being thorough in doing their jobs.”

Despite the red flags, the GAO raised to both the Department of Veterans Affairs and Congress, VA insiders tell KARE 11 that little has changed. They say the focus remains on speed with little thought to accuracy.

A current VA employee turned whistleblower said improper ER bill denials continue to happen because medical claim processors are pressured to review complicated files in just minutes.

“Joe” spoke to KARE 11 on the condition that we do not use his last name.

“We are accountable for speed,” Joe said. “And the faster you are, the more your performance goes up – your review does, you get a bonus.”

WATCH: VA whistleblower exposes improper claim rejections

To achieve an “exceptional” employee rating, Joe says examiners can spend, on average, less than three minutes reviewing each claim.

In those few minutes, claims examiners must make a series of determinations. Is the cost covered by other insurance? Was the veteran seen for a service connected issue? Should the veteran have gone to a VA hospital instead? Or should the case be sent to a nurse to review whether it was a true emergency?

Lagoe: “Do you have time to do that?”Joe: “No.”

Lagoe: “Have you been doing that?

Joe: “No, and that’s the truth.”

In fact, Joe says that to meet the performance goals, it’s quicker to simply deny claims than to take the multiple steps needed to approve them.

While GAO did not specifically determine whether the VA’s performance standards were causing veterans to be wrongfully denied, they did find what Williamson described as lax supervision and poor accountability.

Dangerous risks

The GAO also found the wrongful denials were prompting some veterans to take dangerous risks.

Fearing they might be stuck with an emergency bill the VA would not pay, veterans were by-passing the closest emergency room to drive miles to a VA facility.

“One veteran with a gunshot wound had his wife drive him to a Veterans hospital a hundred miles away, rather than go to the nearest facility in the community,” Williamson said.

“Why?” asked Lagoe.

“Because the veteran thought he would be on the hook for the bill and he didn’t want to do that,” Williamson replied.

The GAO report made 12 recommendations, but Williamson told Congress back in 2014 he was concerned VA was not fully implementing them.

Three years later, KARE’s investigation documented continuing problems – case after case of veterans still falling victim to the VA’s pattern of improper denials.

“Based on what we know now, and based on some things I’ve heard from VA, it’s not completely fixed,” Williamson said.

Next steps

In response to KARE 11’s reporting, a different government agency is beginning yet another review of VA’s emergency medical claim processing.

Congressman Tim Walz (D-MN) asked the VA Inspector General to open an investigation.

RELATED: Congressman calls for federal investigation of VA ER denials

The Inspector General recently informed the Congressman it has launched a nationwide inquiry.”

http://www.kare11.com/article/news/investigations/kare-11-investigates-veterans-stuck-with-medical-bills-despite-government-investigation/89-501513641

 

Number of Homeless Veterans Rises For First Time In 7 years

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Homeless Vets

Homeless tents are dwarfed by skyscrapers on Dec. 1, 2017, in Los Angeles. (Jae C. Hong/AP)

“MILITARY TIMES”

“The number of homeless veterans across America increased in 2017 for the first time in seven years, when government officials began their nationwide push to help impoverished former service members.

The estimated number of homeless veterans dropped from more than 74,000 individuals in 2010 to fewer than 40,000 in 2016. But in June, VA Secretary David Shulkin said he no longer saw the previous goal of zero homeless veterans as a realistic target for his department.”

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“The increase reflects estimates from last January, before President Donald Trump took office and any of his new housing policies were put in place. The annual point-in-time count from Housing and Urban Development officials found roughly 40,000 homeless veterans at that time, an increase of nearly 600 individuals from the same mark in 2016.

It’s the first setback for efforts to help homeless veterans since 2010, when then-President Barack Obama made a public pledge to “end veterans’ homelessness.”

The effort was paired with big boosts in funding for community intervention programs at both VA and HUD and saw some immediate results. The estimated number of homeless veterans dropped from more than 74,000 individuals in 2010 to fewer than 40,000 in 2016.

“I think what we learned in this situation is that being able to reach zero is not necessarily the right number,” Shulkin told Military Times. “There is going to be a functional zero, essentially somewhere around 12,000 to 15,000 that despite being offered options for housing and getting them off the street, there are a number of reasons why people may not choose to do that.”

The slight increase in veterans’ homelessness matches national trends. HUD officials said that for the first time since 2010, the overall homeless population increased in America, up about 1 percent from 2016 levels to nearly 554,000 homeless people.

And, similar to the national numbers, most of the increases in the veterans homeless population came from the West Coast. California and Oregon combined saw a rise of nearly 2,500 new homeless veterans.

Meanwhile, the southeast of the country — Alabama, South Carolina, Georgia and Florida — saw a decrease of almost 800 homeless veterans.

Of the 40,000 homeless veterans, almost 25,000 of them are living in temporary facilities. But that leaves more than 15,000 without any reliable shelter.

The impact of Trump administration policies on those numbers won’t be seen until late next year, when details of the January 2018 HUD point-in-time count are released.

But in recent months, homeless advocates have expressed concerns with VA plans to convert funds dedicated to outreach and assistance efforts to general purpose money, with broader authority for regional directors over how to use it.

In a letter to Shulkin in October, officials from the National Coalition of Homeless Veterans said they objected to “any conversion of special purpose homeless program funding for any purpose,” calling it potentially “catastrophic” to progress made in recent years by siphoning money away from homeless priorities.

But VA spokesman Curt Cashour said the goal of that move is designed to give local officials more flexibility.

“VA intends to realign funding from a number of programs, including our permanent supportive housing program (grants),” he said. “These programs are currently managed at VA central office in Washington, D.C., and this move gives control and management of resources to local VA facilities.”

“We have heard from many of our facility directors that they know their communities and the veterans they serve better than anyone else, and we agree.”

https://www.militarytimes.com/veterans/2017/12/06/number-of-homeless-veterans-nationwide-rises-for-first-time-in-seven-years/

 

Congressional Delays Cause Missed Deadline for Contract to Integrate VA and Military Records

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va-records-maze1

EDITOR’S NOTE:  More than $1 billion has been invested in Military Services to Veterans Administration medical record interoperability in recent years but with mixed results. At issue is the seamless medical transition of active-duty troops and reservists to VA care. Veterans have long lamented missing records, repeated exams and frustrating inefficiencies with the dueling department systems.  For further background please see: https://rosecoveredglasses.wordpress.com/2017/05/05/militarys-health-records-maze/

“WASHINGTON TECHNOLOGY”

“The Department of Veterans Affairs is waiting on lawmakers for the OK to sign a multibillion-dollar contract with Cerner for a new electronic heath records system, replacing the agency’s aging, homegrown Vista software.

The VA had a self-imposed November deadline to get the deal out the door, according to court documents that were part of a lawsuit opposing the VA’s decision to make a sole-source award for a new system.”

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“The snag is that VA needs the approval of the House and Senate Appropriations committees to make an initial transfer of $374 million of existing funding between accounts. The VA has made formal requests for the transfer, but so far has not received the go-ahead, according to VA and Capitol Hill sources.

According to a VA official, the contract is finished and can be signed as soon as the money is in the right accounts.

It’s not clear what is holding up the approval. Lawmakers are busy with an end-of-year scramble to pass an appropriations package or a continuing resolution to keep the government open past the Dec. 8 funding deadline, not to mention a host of other measures. A VA official told FCW that the decision to award the contract on a sole-source basis to Cerner was not at issue. ”

https://washingtontechnology.com/articles/2017/12/01/cerner-approps-va-contract.aspx

 

 

 

 

VA Will Shift Medical Records To DOD’s “In-Process” Electronic Medical Records System

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Veterans Gaming the System

Image:  Military Times

Total Investment To Date Now Projected at Nearly $10 Billion

“MILITARY TIMES”

VA has already spent more than $1 billion in recent years in attempts to make its legacy health record systems work better with military systems.

The military’s health record system is still being put in place across that department, more than three years after the acquisition process began. The initial contract topped $4.6 billion, but has risen in cost in recent years.

Shulkin did not announce a potential price tag for the move to a commercial electronic health records system, but said that a price tag of less than $4 billion would likely be “unrealistic.”


“Veterans Affairs administrators on Monday announced plans to shift veterans’ electronic medical records to the same system used by the Defense Department, potentially ending a decades-old problematic rift in sharing information between the two bureaucracies.

VA Secretary David Shulkin announced the decision Monday as a game-changing move, one that will pull his department into the commercial medical record sector and — he hopes — create an easier to navigate system for troops leaving the ranks.

“VA and DoD have worked together for many years to advance (electronic health records) interoperability between their many separate applications, at the cost of several hundred millions of dollars, in an attempt to create a consistent and accurate view of individual medical record information,” Shulkin said.

“While we have established interoperability between VA and DOD for key aspects of the health record … the bottom line is we still don’t have the ability to trade information seamlessly for our veteran patients. Without (improvements), VA and DoD will continue to face significant challenges if the departments remain on two different systems.”

White House officials — including President Donald Trump himself — hailed the announcement as a major step forward in making government services easier for troops and veterans.
Developing implementation plans and potential costs is expected to take three to six months.

But he did say VA leaders will skip standard contract competition processes to more quickly move ahead with Millennium software owned by Missouri-based Cerner Corp., the basis of the Pentagon’s MHS GENESIS records system.

“For the reasons of the health and protection of our veterans, I have decided that we can’t wait years, as DOD did in its EHR acquisition process, to get our next generation EHR in place,” Shulkin said.

Shulkin for months has promised to “get VA out of the software business,” indicating that the department would shift to a customized commercial-sector option for updating the health records.

The VA announcement came within minutes of Trump’s controversial proposal to privatize the nation’s air traffic control system. The president has repeatedly pledged to make government systems work more like a business, and in some cases hand over public responsibilities to the private sector.

Shulkin has worked to assure veterans groups that his efforts to rely on the private sector for expertise and some services will not mean a broader dismantling of VA, but instead will produce a more efficient and responsive agency.

He promised a system that will not only be interoperable with DOD records but also easily transferable to private-sector hospitals and physicians, as VA officials work to expand outside partnerships.

Shulkin is expected to testify before Congress on the fiscal 2018 budget request in coming weeks. As they have in past hearings, lawmakers are expected to request more information on the EHR changes then. ”

http://www.militarytimes.com/articles/va-share-dod-electronic-medical-records-decision

 

 

Military’s Health Records Maze

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VA Records Maze

“MILITARY TIMES”

“More than $1 billion has been invested in medical record interoperability in recent years but with mixed results.

Veterans Affairs Secretary David Shulkin said he is open to adopting the new military electronic health record system for his department but stopped short of promising that will happen this summer.

“We’re exploring all options,” Shulkin told members of the House Appropriations Committee on Wednesday. “It’s a highly complex issue … if there was an easy solution here, it would have been made already.”

The comments came in response to criticism from lawmakers related to the ongoing health records saga, a point of tension for the departments for decades.

“We’ve been giving you all a lot of money, and it’s not fixed,” said Rep. Tom Rooney, R-Fla. “You could be the best VA secretary of all time if you solved this one problem.”

At issue is the seamless medical transition of active-duty troops and reservists to VA care. Veterans have long lamented missing records, repeated exams and frustrating inefficiencies with the dueling department systems.

Last year, defense and VA officials certified that their Joint Legacy Viewer now allows physicians in both departments to share and read those critical health records, eliminating many of those problems.

But the separate back-end systems still prevent VA doctors from editing or updating veterans’ old military records, and vice versa. Shulkin acknowledged that “it is not the complete interoperability we would hope for.”

Earlier this year, officials with the Military Health System announced plans to shift to the new GENESIS system for all personal military health records, allowing easier access for both patients and doctors.

Shulkin said he hopes to settle on a similar new system for VA this summer. He said a number of factors will go into that decision, including long-term viability of the new system, ease of transferability from old systems and interoperability with defense records.

But VA officials have long been resistant to simply adopting the same IT systems as the military because of specific agency needs. Lawmakers pushed Shulkin to break that trend, but he would not commit to any system at the hearing.

He did say that “VA needs to get out of the software development business” and will be looking for more private sector “off-the-shelf” options for health record systems, to minimize the workload of maintaining any future health records systems.

“It’s not an easy project in a single hospital, much less a whole system the size of VA,” he said.

Shulkin’ appearance before the committee was billed as a conversation about next year’s budget request, but so far only a few details of that plan have been released publicly. A full budget is expected to be released by White House officials later this month.

The department would see a 6 percent boost in programming funds under the “skinny budget” outlined by President Trump, one of only a few federal agencies looking at a funding boost under his plan.

Committee members told Shulkin to expect many more questions about the health records issue after the fiscal 2018 specifics are released”

http://www.militarytimes.com/articles/va-dod-health-records-2017-search

 

 

New Website Competes VA Hospitals

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VA Competiton

Image:  “Cartoon Stock”

“MILITARY TIMES”

“WASHINGTON — The Department of Veterans Affairs wants its medical centers to compete over patients, and they’re launching a new online tool to make comparison shopping for health care easier.

The new “access to care” site, launched Wednesday but expected to be refined significantly over the next few weeks, will allow veterans to see how regional VA health centers stack up against each other on wait times, available services and customer satisfaction.

Poonam Alaigh, acting under secretary for health at the department, said the goal is to both increase transparency over the state of VA health services and provide veterans a way to better customize their own care.

Would-be patients willing to travel significant distances can find regional offices with shorter average wait times for primary and specialty care than nearby facilities. Individuals in metro areas can choose between sites based on customer response ratings.

“There’s competition now,” she said. “They’re going to start losing patients if they don’t start watching the patient experience piece.”

The site is the latest step in a three-year response to the 2014 VA wait-times scandal that forced the resignation of several senior department officials, including then VA Secretary Eric Shinseki.

Hospital administrators were found to have manipulated wait-time data to better meet department standards, and in some cases gain bonuses for facility improvements.

Alaigh dismissed concerns about the new public comparison site creating similar incentives for dishonesty, saying the focus is on accountability and public awareness. And she said unrelated to the site, VA has implemented new data-monitoring algorithms to detect similar manipulation in the future.

But she acknowledged the site will highlight “the good and bad” of current facility performance.

For example, on the site now, visitors can track wait times for new patient primary care appointments for every VA facility in the greater Phoenix area, the center of the 2014 scandal. For the VA clinic in nearby Anthem, Arizona, the average wait is 11 days. For the clinic in Casa Grande south of the city, it’s 56 days.

“I want to use this to help build accountability,” she said. “I don’t want this to be a punitive thing. It also has to be a tool for us to redirect resources to needed areas.”

The site also includes comparisons of standardized health data to other regional, non-VA hospitals, although only a small number of VA sites are currently listed. Alaigh said more will be added in coming weeks.

So will a feedback button for veterans to ask questions about facility offerings and better contact information to help veterans contact medical centers. Alaigh called the site “rushed” and “far from perfect” but said officials wanted to get the available data in veterans hands as quickly as possible.

VA officials for years have promised both better access to medical treatments at department clinics and better customer service throughout the agency, but have received mixed reviews on the work so far from veterans groups and lawmakers.

http://www.militarytimes.com/articles/va-website-medical-care-access-competition

 

 

VA By the Numbers: Has the Department Made Progress?

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veterans-admin-progress

“MILITARY TIMES”

“A broader profile than just the medical aspects of the department.

Here’s a look at some key facts and figures on where the department stands today, based on current officials’ own statistics and assessments of operations since current VA Secretary Bob McDonald took office in August 2014.

** The VA budget totals $176.9 billion for fiscal 2017, almost twice the budget total when Obama took office in fiscal 2009 ($93.7 billion) and almost four times the total when the war in Afghanistan began in fiscal 2001 ($48.7 billion).

Of the 2017 total, roughly $77.4 billion is set aside for discretionary programs, and the rest for disability, medical and education benefits, along with other mandatory spending.

** VA employed about 365,000 workers in fiscal 2016, up about 88,000 people from when President Barack Obama took office in 2009. Employee bonuses and discipline has been a constant fight for department leaders in recent years, with critics saying they do too little to root out lazy or incompetent bureaucrats.

In fiscal 2015, about one-third of all VA employees were veterans.

** Roughly 9 million veterans were enrolled in VA health care at the end of fiscal 2016, about 42 percent of the nation’s veterans population. That number was 7.8 million in fiscal 2009, roughly 33 percent of the total U.S. veterans population at the time.

Part of the increase is due to troops returning from wars in Iraq and Afghanistan, but the department has also seen increases in the usage rate from older generations.

** About 58 million medical appointments were scheduled by VA in fiscal 2016, an increase of almost six percent in two years. Almost a third of those appointments were scheduled with doctors working outside the VA system, in private clinics.

** More than 542,000 veterans were rated as 100 percent disabled at the end of fiscal 2016, giving them access to a wide range of payouts and benefits. In fiscal 2009, that number was 265,000. Again, part of that increase is attributable to the current wars, but a large part also reflects an aging veterans populations with worsening service-injuries from decades ago.

** About 93 percent of veterans medical appointments are being scheduled within 30 days, according to department data from December 2016. That’s down about 1 percent from fall 2014, when department officials began tracking patient wait times in the wake of nationwide scandals about delayed appointments and cover ups.

The average wait time for mental health care appointments is 4.5 days, roughly the same as the wait over the previous two years. The wait for primary care is 5.7 days (down from 6.7 in fall 2014) and the wait for specialty care is 10.2 days (up from 7.5 days in fall 2014).

** And 8,481 patients on VA lists have been waiting more than four months for appointment requests, a number that swelled to more than 10,000 in early 2016.

** More than 960,000 veterans received some type of education benefits through VA in fiscal 2016, up from around 265,000 in fiscal 2009.

The biggest contributor to that jump was passage of the Post-9/11 GI Bill in 2010, which offered a full four years tuition at state universities and a housing stipend to troops who served at least three years after 2001.

** An average of 20 veterans a day committed suicide in fiscal 2014, the latest information available. Past research had pegged that number at 22, but those estimates were drawn from fewer states and contained problematic guesses. It’s unclear whether recent mental health efforts by VA have driven down the suicide rate.

** About 96,000 first-time benefits claims were “backlogged” as of Dec. 31, 2016. A claim is considered overdue if it isn’t completed within 125 days.

Obama promised to bring that number down to zero by the start of 2016. The backlog peaked at about 611,000 cases in March 2013 and was down as low as 70,000 cases in fall 2015, when VA officials announced that zeroing out the backlog completely was likely impossible and could unnecessarily rush some cases.

** Another 303,673 benefit cases that are pending in the department’s appeals system, as of Dec. 31, 2016. That’s up from about 181,000 cases at the end of 2009. The cases typically take three or more years to fully complete.

** More than 2.6 million VA home loans were awarded in fiscal 2016, up about 500,000 eight years earlier.

** Federal researchers estimate that 39,472 veterans were homeless as of January 2016. That’s down from about 75,600 veterans on the streets in 2009, when Obama announced plans to house every veteran in America by the end of 2015.

So far, 33 communities and three states have been certified as “effectively” ending veterans homelessness, meaning they have the resources to rapidly house all veterans in in their community facing financial distress.”

http://www.militarytimes.com/articles/va-numbers-obama-trump-new-administration