Tag Archives: Veterans Administration

Wave Of Elderly Veterans Creates Financial Worries For VA’s Nursing Home Services



“More than one million veterans will be eligible for taxpayer-funded nursing home services within the next five years, according to the latest estimates from federal administrators trying to balance the costs of institutional care with alternative options allowing those individuals to stay in their homes.”


“Already, the annual costs of nursing home care have risen to almost $6 billion, Veterans Affairs officials told lawmakers at a congressional hearing last week. By 2024, that number could top $10 billion, a significant portion of the department’s overall budget.

“As veterans age, approximately 80 percent will develop the need for some long-term services and support,” Dr. Teresa Boyd, assistant deputy undersecretary for health at the Veterans Health Administration, told lawmakers. “The aging of the veteran population has been more rapid and represents a greater proportion of the VA patient population than in other healthcare systems.”

By law, VA officials must provide nursing home care for veterans with service-connected disabilities rated 70 percent or more. The department currently maintains 156 state homes across all 50 states.

But a study by USA Today and the Boston Globe last fall found that about two-thirds of those facilities scored worse than private-sector nursing homes in a series of quality indicators last year.

And VA officials acknowledge that many veterans are seeking options to remain at their own homes or with family caregivers rather than enter the institutions, a shift in cultural preferences in recent years.

“There’s an urgent need to accelerate the increase and the availability of the services since most veterans prefer to receive care at home,” Boyd said. “And VA can improve quality at a lower cost.”

Dr. Scotte Hartonft, acting director of VA’s Office of Geriatrics & Extended Care, said programs like adult day care, home-based primary care and tele-health options have been extended significantly in recent years. He called those programs a win for both veterans and the department.

“It provides (veterans a) choice, but it also is much less expensive than nursing home care,” he said.

Two years ago, VA officials launched the Choose Home Initiative to promote and expand more home care initiatives. Hartonft said five VA medical centers are running pilot programs related to that goal, with an eye towards expansion in coming years.

Lawmakers said that work is critical, not only for today’s elderly veterans population but for the long-term issues facing the Iraq and Afghanistan war generation.

“Looking forward to 2035, the veterans of Afghanistan and Iraq will be middle aged, they’ll have health issues much like the Vietnam veterans experience today,” said Rep. Sanford Bishop, D-Ga. “They have the co-morbidities of post-traumatic stress, traumatic brain injury, palliative traumas. How is VA going to address this?”

More information on VA long-term and geriatric care is available at the VA web site.”


VA Software Shuffle To Delay National Rollout Of Patient Scheduling



“The Department of Veterans Affairs’ recent decision to fast-track new patient-scheduling software instead of a successfully piloted platform could mean it will be several more years before veterans facilities nationwide have modernized scheduling functionality. “


“The Cerner-built system will replace the one at the center of the department’s 2014 scheduling scandal, in which several veterans died while waiting for care. That older system, known as VistA, remained in place everywhere except Columbus, where the $32 million pilot by health care software provider Epic and systems integrator Leidos showed great promise. Called the Medical Appointment Scheduling System (MASS), it improved wait times and increased the number of completed appointments after its implementation in 2017.

For a while, Leidos appeared to have the inside track on providing the nationwide replacement system. The VA had entered into a $623 million contract with the company in 2015 to roll out functionality in five years, but work was paused until the 2017 pilot. Leidos said after the pilot it was confident it could deliver nationwide functionality in two years and for less than $350 million.

A separate agreement with Cerner, though, essentially got in the way. Because VA is investing billions in a Cerner-based modernized EHR platform, it’s no surprise that it would choose to also adopt Cerner’s scheduling portal at some point for the seamlessness of the two platforms. But it was anticipated, until recently, that VA would continue developing MASS nationwide before turning to Cerner scheduling down the road.

“Given that Cerner was awarded a no-bid contract to replace VistA, we recognized VA would likely be required to use Cerner scheduling at some point in the future,” Meghan Roh, an Epic spokesperson, told FedScoop in an email. “We thank VA, our partners, and the team at the Columbus VA Ambulatory Care Center for their work on a wonderfully successful scheduling pilot.”

Now, with the progress of the Epic-based MASS abandoned, VA officials aren’t sure exactly when patient scheduling functionality will arrive at medical facilities across the nation. John Windom, executive director of VA’s Office of Electronic Health Record Modernization, told a Senate Appropriations subcommittee Tuesday the VA will look to deploy the Cerner scheduling solution at three select facilities in the Pacific Northwest after March 2020, when those locations reach initial operating capability (IOC) under the larger EHR modernization program. The VA will also likely look to launch the scheduling functionality at other facilities out of sequence with the EHR deployment.

“We have committed to deploying a Cerner scheduling module out of sequence post-IOC,” Windom said. “The intent is to leverage the learnings of IOC to deploy” the scheduling module.

But from there, things are unclear, because, according to Windom and his team, they plan to address the rollout based on the success of the first few sites.

“The timeline for that has yet to be fully flushed out because we have not developed fully our execution strategy, but we expect that to start shortly after we achieve IOC milestones in March of 2020,” he said. He also couldn’t give an estimate for how much the Cerner scheduling portal rollout might cost. And until then, veterans and care providers are stuck scheduling under VistA, the same program at the center of the 2014 crisis.

Lawmakers were disappointed to hear of VA’s decision to abandon the successful MASS for an uncertain start from scratch with Cerner.

“Almost five years after the scheduling problems at the VA came to light, the VA is telling Congress that veterans are going to have to wait another five years or more for nationwide deployment of a modern scheduling system — a system that the VA hasn’t tested and doesn’t know the capabilities of… I have to tell you I’m skeptical,” said Sen. Tammy Baldwin, D-Wisc. “Our veterans have waited too long, and we’ve spent over $30 million on a canceled scheduling pilot that showed tremendous progress and promise.”

Under VA’s plan, it will take a decade from the point of IOC for the Cerner EHR to be fully operational across the U.S. The concern is that the VA and Cerner will roll out scheduling functionality on a similar timeline.

“You’re going to have to find a way to do that much more rapidly,” said Sen. John Boozman, R-Ark., adding that a “10-year reprogramming of that is simply unacceptable.”

James Byrne, acting VA deputy secretary, said it will be “well before 10 years that the scheduling solution will be across the United States.” He said the “separate” but concurrent effort to roll out the scheduling system at facilities not in line with the EHR deployment, that should cut down the time.

“I’m not going to say it’s going to be in four or five years, but that is probably more likely than” 10 years, said Byrne, who is also VA’s general counsel.

“We intend to get scheduling out to our veterans as soon as we possibly can,” Windom said.”

VA Requests Contractor Participation In Veterans Appeals Modernization Project



“The agency recently posted a request for information on FedBizOpps, seeking contractor help with project management, training, help desk support and more.

The project has a 12 month period of performance, with three additional 12 month option periods. Interested entities have until Jan. 14 to respond to the RFI. “


“The Department of Veterans Affairs is seeking additional contractor support as it continues to develop Caseflow, a suite of modern appeals processing tools.

The VA appeals modernization project, aimed at streamlining a complicated and difficult system, began back in 2014. In 2015, the VA Digital Service (DSVA) team started looking into retiring the legacy Veterans Appeals Control and Locator System (VACOLS, developed in 1979) in favor of a new suite of digital solutions called Caseflow. This work has been ongoing — for example, DSVA and the VA launched Caseflow’s first tool, Caseflow Certification, in April 2016.

It is now time, however, for development and implementation to kick into high gear. According to the VA, no Caseflow products are “fully finished” at the moment, but all need to be in a state of minimum viability by the time the Veterans Appeals Improvement and Modernization Act of 2017 goes into effect Feb. 14, 2019. Per the Caseflow GitHub page, there are four products currently in a “mature state” and four others “in heavy development.”

This is where the VA’s call for help comes in.

Caseflow, as is typical of U.S. Digital Service projects, is being developed according to user-centered and agile methodology, so the VA is looking for a contractor that will stick with these same working principles. In response to the RFI, potential vendors are asked to submit a case study that demonstrates that vendor’s ability to fulfill the VA’s needs.”


$350 Million Cost Overrun Hits Program Awarded Last May to Merge VA, Military Health Records



VA Heavy Paper

The weight of paper files at the VA’s Winston-Salem office threatened to collapse the floor.

Related Update from “FEDSCOOP”:  VA refuses to give House lawmakers an answer on when software issue will be fixed


A $16 billion project [begun in May 2018] aimed at finally providing common, easily searchable electronic health records for the VA and the Department of Defense has already been hit with a $350 million cost overrun.

The original estimates for the program had not included the $350 million projected costs over 10 years for the salaries of the government employees who would work on it.”

“At a hearing of the new House Veterans Affairs Subcommittee on Technology Modernization, which was formed in July primarily to oversee the project,  John Windom, executive director of the VA’s new Office of Electronic Health Record Modernization said Congress had been forewarned that the salaries of the employees would not be included in the contract with Cerner Corp., but he was met by skepticism.

“I find it hard to believe that such a basic part of the program — government salaries — could be overlooked,” said Rep. Jim Banks, R-Indiana, the subcommittee’s chairman.

Banks said the cost overrun emerged “before any real work actually began” on the project to make health records of two huge departments compatible.

“How can that be?” he asked.

“I’m not ready to sound the alarm yet,” Banks said, but added that the cost overrun increased his concerns over whether the program was feasible.

“The more I learn, the more daunting it has become,” Banks said. “Some thought we could merely install the Cerner system. That apparently is not enough.”

Windom said he expected efficiencies would be developed as the project proceeds to hold down future costs.

“There are going to be efficiencies gained we can’t forecast at this point,” he said.

Previous attempts to mesh the electronic health record systems have either failed or been abandoned, most recently in 2013 when then-Defense Secretary Leon Panetta and then-VA Secretary Eric Shinseki dropped an integration plan after a four-year effort and the expenditure of about $1 billion.

In the latest effort, then-acting VA Secretary Robert Wilkie in May awarded a $10 billion, 10-year contract to Cerner, of Kansas City, to develop an integrated electronic health record system. Related costs over the course of the contract were estimated to put the total cost at about $16 billion.

In comments at the hearing, and in his questioning of witnesses, Rep. Phil Roe, R-Tennessee, chairman of the full committee, said he had warned Wilkie, who was sworn as VA Secretary in July, of pitfalls in the enormously complex task of meshing VA and DOD health records.

“If we don’t get this right, you and I need to go in the witness protection program,”

Roe said he told Wilkie.

Even if the VA and DOD systems could be successfully merged, “what are we going to do about outside practitioners?” Roe said.

Roe noted that about 35 percent of the veterans currently receiving VA health care have chosen to opt for private care, and that number was expected to rise under the VA Mission Act signed into law by President Donald Trump earlier this year to expand community care.

“That is a challenge, definitely,” said Dr. Laura Kroupa, acting chief medical officer of the VA’s Office of Electronic Health Record Modernization. “We’re working on that.”

Problems have already emerged in Seattle and Spokane, the first sites chosen by the VA for the installation of the new EHR systems, said John Short, chief technology integration officer at the newly established office.

Nearly all of the five-year-old computers in Seattle and Spokane will have to be replaced to adapt to the new system, Short told the subcommittee.”




New Veterans Administration (VA) Consolidated Home Page


New VA Web Site


“Veterans in search of information about benefits now have a brand new homepage — VA.gov.

The site now “consolidates information and places it in one easy to navigate location.Veterans can use their existing MyHealtheVet, DS Login, or ID.me account to sign in. “

“We are so excited for the new VA.gov,” Marcy Jacobs, Executive Director of the VA Digital Service, told FedScoop in an emailed statement. “It marks an important step toward providing the modern digital experience Veterans deserve, and our team will continue to improve and streamline VA’s digital tools and content. Thank you to all of our partners across VA and our contracting teams who helped bring this across the finish line in time for Veterans Day.”

A bit of history: The web ecosystem for information on veterans benefits has for some time been fractured and complex, with hundreds of different sites dedicated to different pieces of the puzzle. VA.gov, the centerpiece, has historically focused on the agency itself — a place for announcements from the Secretary, mission statements and media information. This is generally not what a veteran needs most.

This reality is what led to the launch of Vets.gov in 2015 — a central portal for housing assistance information, health benefits, a new Appeals Status tool and much more. Vets.gov was, in may ways, a success. The site was recently getting as many as 1.8 million users per month, and in October, Jacobs won a Service to America Medal for her work on the project.

Now, Vets.gov and all its tools have a new home on VA.gov — the agency’s primary web address.

The site now “consolidates information and places it in one easy to navigate location,” Secretary Robert Wilkie said in an introduction video.

“I’ve said it many times and I’ll say it again: my main priority as Secretary is simple — to give our customers the best possible experience the minute they encounter VA,” Wilkie said. “Today, we’re doing just that with the new VA.gov — the new online front door of your Department of Veterans Affairs.”

The word “customer” here speaks volumes about how the VA is trying to reformat and recast itself. Vets.gov and VA.gov were both created using user-centered design, but it’s not just about development methods. “It has to be that everyone here has that customer experience mindset,” DSVA lead Jacobs told FedScoop in a recent interview.

“We’re a customer experience organization,” she added.”




New “Pay for Success” (PFS) Employment Program for Veterans With PTSD


Veteran unemployment predicts PTSD symptom severity, says a new study. How can we use this to help unemployed veterans who suffer combat PTSD? 


“The project is a partnership of Social Finance, the U.S. Department of Veterans Affairs, local governments, and impact investors.

Government partners will repay project investors if and only if the project demonstrates positive outcomes for Veterans.”

“The Veterans Coordinated Approach to Recovery and Employment (Veterans CARE) is a $5.1 million Pay for Success initiative that supports unemployed or underemployed Veterans with post-traumatic stress disorder (PTSD) in attaining competitive, compatible employment. The project is a partnership of Social Finance, the U.S. Department of Veterans Affairs, local governments, and impact investors.

Through Veterans CARE, local VA medical centers will deliver Individual Placement and Support (IPS), a personalized approach to supported employment, to up to 500 Veterans over three years.

The Veterans CARE project is the first PFS project in the United States to focus on improving employment and health outcomes for Veterans, and is the first multi-state project of its kind.


  • Support unemployed or underemployed Veterans with PTSD in attaining competitive, compatible employment
  • Expand high quality, evidence-based employment services to Veterans who can’t currently access these services
  • Serve as a demonstration project for the use of the Pay for Success model within the U.S. Department of Veterans Affairs

The U.S. Department of Veterans Affairs provided $3 million in outcomes payments for the project.

The Commonwealth of Massachusetts and the City of Boston serve as matching outcomes payors for this project.

The Tuscaloosa VA Medical Center will support local VA medical centers to offer Individual Placement and Support, an evidence-based employment service, for Veterans with PTSD.

Social Finance supported the design and financial structuring of the project, raised the capital, and will provide active performance management services for the duration of the project.

Westat will lead the evaluation of the project.

Jones Day is serving as legal counsel to Social Finance for this project.

Wilmington Trust is serving as fiscal agent and custodian for this project.

The project’s funders include:

BNP Paribas
Northern Trust
The Dakota Foundation
Deutsche Bank
Robin Hood Foundation”


U.S. Veterans Hospitals Quality Ratings FY 2018


VA Ratings


“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”



” 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.”




Veterans Administration Says One In 10 Department Jobs Is Unfilled


Unfilled VA Jobs


“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.”




$2 Billion VA Technology Transfer Process Requires Clarification Says GAO




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.”



“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.”


Minnesota Veterans Stuck with Medical Bills Despite Government Investigation


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.”