Tag Archives: Veterans Administration

New Frontier In “Challenge Procurement” At Veterans Administration

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FCW By Steve Kelman

The basic idea behind a procurement challenge is that the government announces a problem it seeks to have solved. Anyone may then submit their solution, and the government chooses a winner or winners. 

You don’t need to be an expert on government procurement to submit an entry. There is no proposal — it is a great example of the idea of “show, don’t tell” that should be more important in government procurement in general.


“Many blog readers will be aware that I have over the years been a big fan of challenges (also known as prizes) as a procurement technique. 

When it announces a challenge, the government also specifies a monetary prize (hence the moniker “contest”) and further steps the government might take to support the winner or winners.

I first wrote enthusiastically about these way back in 2009, based on a DARPA contest for developing an all-terrain vehicle. Most recently I wrote about the Army using a challenge to develop a better and cheaper ventilator in the context of COVID-19. I have written, and continue to believe, that the use of challenges in procurement is the most significant procurement innovation of the last decade.

Challenges have varied from very elementary and not very consequential (e.g. a contest to develop an agency logo) to much more mission-critical. For example, a few years ago the IRS conducted a challenge to design an online experience that more clearly and easily organizes and presents a person’s tax information, including ways to more easily use tax data to help people with other financial decisions, such as applying for a loan.

However, even more difficult and complex challenges have up to now been one-off efforts: the government publishes the challenge, bidders respond, and the government chooses winners. Now, though, the Department of Veterans Affairs has published an RFI for a challenge that will take this procurement tool where it has never been before. VA officials are seeking to develop approaches to reduce suicide among veterans

The agency is envisioning creation of a user-friendly platform where veterans (and possibly others in at-risk groups) can gain enhanced access to a range of suicide-prevention services, such as scheduling, assessments and mental health resources, while preserving their identities and privacy. The VA also hopes to personalize and customize services to directly meet veterans’ needs and recognize certain risks in users’ personal lives, information about care paths and more.

The VA’s vision is that the platform would involve automated learning to update information provided the user. Data analytics and AI would learn from the “user journey” through the VA ecosystem, adapting and responding to the individual user’s needs, fears and concerns. Over time, the information presented to that user would be increasingly curated for their specific needs. 

Not only is the topic of the challenge difficult and high-visibility — about as far from designing an agency logo as you can get — but the way the challenge will be organized will be far more ambitious than any the government has attempted in the past. The VA will be doing a procurement not for the challenge itself but to manage challenges that then would be put out for submissions.

As the VA puts it in their RFI, “the chosen partner would need to provide management support services necessary to help build the program from the ground up—and seamlessly execute the competition from beginning to end. The dedicated collaborator would support the delivery of everything from the timeline, scope and design of the complex challenge, to technical support, Though VA would provide some of those funds, said. in raising money for the prizes winners will receive. “the hope is the vendor would be able to facilitate outreach and increase fundraising for the prize purse, so that it’s not just taxpayer-funded money that goes to support this effort, but actually potentially private funds from companies and others who are interested in solving this problem,” the VA states.

This will be a complex and large enough activity that the VA doesn’t have the bandwidth to do it with in-house resources. So, to allow development of challenges at scale, it is actually seeking to let a contractor organize that effort.

This is a first, and an amazing innovation by the VA. The idea has been shepherded by the VA’s Chief Innovation Officer Michael Akinyele. It was in the works before COVID-19, but the explosion of unemployment will make the suicide problem worse and hence has prompted the VA to move the effort faster.

If this works, it will add an important new tool to the government’s contracting toolkit, available to others across government. VA, congratulations on a great idea, and good luck making it work.”


Increased Veteran Banking Options Under VA/AMBA Partnership

Image: https://www.blogs.va.gov/VAntage/70643/announcing-veterans-benefits-banking-program/


Some veterans may have better access to banking now, through a partnership between the Department of Veterans Affairs and the Association of Military Banks of America.

It’s especially beneficial for those who haven’t been able to open bank accounts in the past, which hampers their ability to get their VA benefit funds by direct deposit.


“The VA delivers about $118 billion each year in benefits and services for veterans and their families. About 250,000 veterans and beneficiaries receive their benefits through a pre-paid debit card or paper check, and may not have a bank account.

An added plus is that these banks are already familiar with the financial needs and challenges of service members, and can also support veterans with financial education and resources tailored to their needs, said Paul Lawrence, under secretary for benefits for the VA. Some of the participating banks have branches on bases, but they also have a large number of branches outside the gate, which will be accessible to veterans, said Andia Dinesen, vice president of communications and operations for AMBA.

There are currently seven banks participating in the Veterans Benefits Banking Program: Armed Forces Bank; Bank of America; First Arkansas Bank and Trust; Fort Hood National Bank; FSNB; Regions; and Wells Fargo. Dinesen said other banks and credit unions are welcome to join the effort, too.”

For more information, visit https://www.benefits.va.gov/benefits/banking.asp.


VA Developing Cyber Careers Program Filling Gaps In Workforce

Image: Purdue University Global


The Cyber Workforce Management (CWM) plans to identify work roles across every single position within VA and its IT office and establish qualification requirements for each role that all of government can use..”


“The Department of Veterans Affairs is developing a cybersecurity career program to fill gaps in the NICE Cybersecurity Workforce Framework.

VA’s Office of Information Security stood up a Cyber Workforce Management (CWM) program across the broader Office of Information and Technology (OIT), which determined existing NICE Framework roles didn’t meet all of VA’s mission needs. The NICE framework, developed by the National Initiative for Cybersecurity Education, prescribes knowledge, skills, abilities and tasks (KSATs) to work roles like a cyber defense analyst.

“There are gaps in the framework. Medical is not in there, med cyber — jack of all trades, master of medical devices,” Stephanie Keith, CWM program manager, said during a panel discussion at the 2020 Health IT Summit. “But where are the cybersecurity aspects of that? At VA we’re looking at how we develop what that work role looks like.”

“I’m not about unique requirements for an agency,” Keith said. “I’m about federal national standards.”

CWM is also standing up a cyber training academy pilot to teach employees baseline skills associated with the work roles. Baseline skills for, say, a cyber defense analyst should be the same at every agency so they’re portable, Keith said.

Training for new work roles covering positions like healthcare technology managers and informaticists should happen at the device level, not the network level, she added.

VA employees further removed from technical positions still require cyber training as well in areas like early detection and zero trust, said Paul Cunningham, chief information security officer at VA.

“We’re never going to get medical teams to be primarily cybersecurity. It’s not their mission; we shouldn’t expect it,” Cunningham said. “But we should make it very easy for them to help us as first-line defenders recognize when things are not operating correctly.”

“VHA Innovators Network” Connects Inventions To 172 Medical Centers

Photo: “Getty Images


The Veterans Health Administration’s second annual Innovation Experience later this month will include interactive exhibits for the first time, as part of the agency’s overall plan to put emerging technologies in the hands of its medical centers, other agencies and the public.


“The iEx, as the event is known, is one of several ways the agency tries to promote the innovations that spring from its 172 medical centers. VHA is responsible for a number of medical-technology advancements, including the nicotine patch, barcoded medication administration and implantable cardiac defibrillators.

The agency launched the Innovators Network in 2015 to connect the medical centers and scale successful projects and human-centered design, Ryan Vega, executive director of the VHA Innovation Ecosystem, told FedScoop. The annual exhibition is designed to bring more energy to that process.

“Evidence-based solutions or practices sometimes take a decade,” Vega said. “That’s just far too long.”

The event technically started four years ago as Demo Day, where organizations across the country pitched their products and services — but it was a logistical nightmare, Vega said. VHA reorganized it as iEx last year and hosted it at the National Press Club in Washington, D.C. This year’s version returns there Oct. 22-23.

Hands-on experience

All of the interactive exhibits are tied to nascent VHA technologies and projects from either the Innovators Network or the Diffusion of Excellence, a program that disseminates employees’ clinical and administrative best practices throughout the system. The exhibitions will include displays on 3D printing as well as virtual and augmented reality.

VHA medical center personnel will be able to see what other technologies are out there and how they might apply to their own use cases. Industry attendees will be encouraged to consider how they can further such projects and services.

Lesser-known areas of study like proteomics — analysis of proteins in the body that might indicate risk of cancer, Alzheimer’s, heart disease, or diabetes — also will be represented. A pad will be demoed that patients can step on and have biometric sensors detect skin breakdown or ulcers associated with various ailments, Vega said.

The biggest announcements will also be live-streamed on VHA’s YouTube channel.

“We can do the necessary [research and development] to get these technologies to the point where we can operationalize them,” Vega said.

3D solutions

Vega said this year’s 3D printing booth shows how far medical modeling has come. VHA’s work with the technology actually began with incremental funding from the Innovators Networks’ Spark-Seed-Spread program for off-the-wall ideas.

The Puget Sound Health Care System first experimented with 3D printing. Beth Ripley, a radiologist there, now chairs VHA’s 3D Printing Advisory Committee.

A CT scan or MRI creates layers of anatomy to form an image, which can be 3D printed layer by layer into a medical model for surgeons to examine and show to patients. What’s more, layered printing increases the tensile strength of objects — making the process great for developing more affordable, synthetic prosthetics tailored to patients’ anatomies.

Now 25 VHA medical centers use 3D printing, though the excitement lies with bioprinting of tissue and even bone grafts converted from fat cells, Vega said. He believes the printing of fully functional organs will happen within his lifetime.

But VHA doesn’t just want to roll 3D printing out in every medical center because that’s inefficient, Vega said. Instead the agency will only scale the technology where facilities have the right infrastructure, equipment and training.

Medical centers can decide for themselves whether they’re ready after being exposed to 3D printing at iEx. One VHA center can always ship a medical model or prosthetic to another, ensuring technologies reside only in places where quality can be assured, Vega said.”

Millions More Vets And Caregivers Are About To Get Commissary, Exchange Access

Image: Julie Mitchell/AAFES


Starting Jan. 1, Purple Heart recipients, former prisoners of war and all service-connected disabled veterans, regardless of rating, as well as caregivers enrolled in the VA’s Comprehensive Assistance for Family Caregivers program, will be able to shop at Defense Commissary Agency stores and military exchanges.


“The Departments of Defense and Veterans Affairs are gearing up for what will be the largest expansion of patrons to the military commissary system and exchanges in 65 years, making sure that shoppers will be able to get on base and find the shelves fully stocked.

They also will have access to revenue-generating Morale, Recreation and Welfare amenities, such as golf courses, recreation areas, theaters, bowling alleys, campgrounds and lodging facilities that are operated by MWR.

Facilities such as fitness centers that receive funding from the Defense Department budget are not included.

At commissaries, however, there will be an added cost for new patrons who use a credit or debit card to pay for their groceries, in addition to the 5% surcharge commissary patrons already pay.

DoD officials told Military.com on Wednesday that an estimated 3.5 million new patrons will be eligible to shop. However, after analyzing store locations and their proximity to where veterans live, they expect that slightly more than a quarter of those patrons, or 800,000 people, will take advantage of the benefit.

According to Barry Patrick, associate director of MWR and Resale Policy in the Office of the Under Secretary for Personnel and Readiness, the DoD expects veterans in high-cost areas like Guam, Alaska, Hawaii and parts of California to take advantage of the benefit. Stores in states or cities with large populations of service-connected disabled veterans, including Florida, California, parts of Texas and Washington, D.C., may also see an increase in customers.

“Through this data analytics tool that we’ve developed, we’ve been able to provide the services and the resale organizations information … to ensure that [they] can adjust,” Patrick said. “We are working with distributors to ensure that the supply chain is adjusted accordingly, based on high-impact projections, and that the supply chain is also prepared for rapid, agile reaction to any unexpected situation.”

In addition to ironing out the supply chain concerns, Pentagon officials also have been working to guarantee that the new patrons can get to the stores, which often are located on secure military installations, and will be able to make purchases.

The details have required a joint effort for much of the past year between the DoD and the Departments of Veterans Affairs, Homeland Security and Treasury. Homeland Security is involved because Coast Guard Exchanges are part of the deal, and Treasury plays a role, because it is responsible for ensuring that new patrons pay a fee for credit and debit card purchases at the commissaries.

Since most new patrons lack the credentials needed to get on military bases, installations will accept the Veteran Health Identification card, or VHID, from disabled and other eligible veterans. For caregivers, the VA plans to issue a memo to eligible shoppers in the coming months, which will be used in conjunction with any picture identification that meets REAL ID Act security requirements, such as a compliant state driver’s license or passport.

Justin Hall, director of the MWR and Resale Policy in the Office of the Under Secretary for Personnel and Readiness, said that, after Jan. 1, newly eligible patrons should go to the visitors’ center at the base where they plan to do most of their shopping to register their credentials. Thereafter, they will be able to access the base in the same way as CAC and DoD ID card patrons.

According to Hall and Patrick, store computers and registers are being tweaked to scan VHID cards, and employees are being trained on identifying the new patrons.

The most significant difference mandated in the law that created the benefit, the fiscal 2019 National Defense Authorization Act, is that the new customers must pay a fee if they use a credit or debit card at the commissaries. By law, the stores, which receive funding from the Defense Department budget, are not allowed to cover the extra cost of the new users’ card convenience fees.

The initial fee for commercial credit cards will be 1.9%; for debit cards, it will be 0.5%. Patrons can avoid the card fees by paying by cash or check, or by using the Military Star card, a credit card offered by the military resale system, which they will be eligible to apply for beginning Jan. 1.

The card fees will apply only to the new patrons.

The Defense Department is preparing a fact sheet that will contain information on how veterans can get a VHID card if they don’t already have one and how caregivers can obtain the memo they need to access the benefit.

MWR and Resale Policy officials said they also will launch an information campaign to alert service-connected disabled veterans of this new benefit.

“Everybody I’ve talked to is excited,” Hall said. “We’re really hoping to get the word out so veterans will learn about the opportunities.”


Veteran Suicides Rose in 2017

Image: Zachary Hada/Air Force

Veterans suicides rose in 2017 despite concerted efforts in recent years from federal officials and lawmakers to address mental health and emergency intervention services within the military community.


“Veterans Affairs officials noted in a new analysis released Friday that because of a data delay, their report does not take into effect any new initiatives put in place over the last 22 months. They also emphasized in the report that suicide prevention has become a major public health problem throughout the country, not just in the veterans community.

“Veterans do not live, work, and serve in isolation from the community, the nation, or the world,” the report states. “The issue of suicide in the U.S. also affects the veteran population.”

But the increase in the number of veterans who die by suicide represents another setback for advocates who have worked in recent years to address the problem through public awareness campaigns, easier access to psychological treatment and aggressive messaging against the stigma of seeking mental health care.

More than 6,100 veterans died by suicide in 2017, about 17 individuals per day. That’s up about 2 percent from 2016 and about 6 percent over the previous 12 years.

The shift is even more pronounced considering that the total number of veterans in America is decreasing each year, as older generations of former military personnel age. The total number of veterans in America dropped almost 2 percent from 2016 to 2017 (about 370,000 veterans) and was down almost 18 percent from 2005 to 2017.

Department officials in recent years have quoted the rate of veterans suicides across the country as “20 per day,” reflecting past figures which included active-duty military, guardsmen and reservists who served on active-duty, and National Guard and reserve members who were never federally activated.

Officials said they changed this year’s report to focus solely on veterans to avoid confusion about the population they monitor and directly assist. If the other military and never-activated reservist numbers were included, it would have pushed the suicide rate for the total veteran-connected group to about 21 individuals per day.

Nearly 87 Americans die by suicide each day, according to federal statistics.

Women with prior military service are more than twice as likely to die by suicide as their civilian peers, according to the report. Male veterans are 1.3 times as likely to die by suicide as men who never served.

Almost two-thirds of the suicide deaths among veterans in 2017 were individuals who had no contact with the Veterans Health Administration. VA officials in recent years have focused on public outreach efforts to address that problem, noting limited opportunities to share information on support services with veterans who they don’t interact with regularly.

In a letter accompanying the report, Dr. Richard Stone — executive in charge of the Veterans Health Administration — said that suicide “is a national public health problem that disproportionately affects those who served our nation.” He called upon community partners to work with the department on “actionable, manageable steps” to address the problem.

Earlier this year, President Donald Trump announced the formation of a new task force lead by VA Secretary Robert Wilkie to focus on the issue of veteran and military suicide prevention. Among the issues that group of federal officials is considering is how to more quickly compile national suicide data, to provide quicker analysis of how prevention programs are performing.

The task force is expected to issue a formal report early next spring.

The full suicide report is available on the VA web site.

Veterans experiencing a mental health emergency can contact the Veteran Crisis Line at 1-800-273-8255 and select option 1 for a VA staffer. Veterans, troops or their family members can also text 838255 or visit VeteransCrisisLine.net for assistance. “


Why Fewer People Are Using The GI Bill

(Getty Images)


After years of growth, the number of people using the Post-9/11 GI Bill has now fallen substantially for each of the past two fiscal years, federal data indicates.

About 54,000 fewer people used the GI Bill in fiscal 2018 – a 7 percent decline from fiscal 2017, which was itself down about 7 percent from fiscal 2016’s GI Bill enrollment total, according to data from the Department of Veterans Affairs.


“Officials from veterans service organizations and some of the schools that enroll the greatest numbers of GI Bill users said they’re not overly concerned about the falling GI Bill usage – at least not yet.

“It’s something that we just ought to watch,” said Keith Hauk, an associate vice president at University of Maryland Global Campus, a public institution formerly called University of Maryland University College.

“It’s a little bit too early, after only two years of watching this unfold, [to say] that it’s time to be alarmed, because I don’t think it is.”

Experts offered several possible explanations for the declining enrollments, including more vets earning degrees, GI Bill rules that could be discouraging vets from using the benefit and the strong national economy.

Meanwhile, public universities continued to account for the majority of GI Bill students. About 54 percent of students using the Post-9/11 GI Bill attended public universities in fiscal 2018, while 24 percent went to private schools and 22 percent to for-profit institutions, data indicates.

“A lot more of the public and the not-for-profit private [schools] are offering distance education now,” said James Schmeling, executive vice president of Student Veterans of America.

John Kamin, an assistant director with the American Legion, agreed and noted that “the idea of a global campus is, at this point, pretty popular” among public and private nonprofit schools. This is likely reducing the proportion of vets attending for-profit schools, which historically offered more distance learning options than public and private universities.

“I think we’re seeing a bellwether for things to come,” Kamin said.

DeVry University, a controversial for-profit school that remains a very popular destination for GI Bill users, said it has been affected by this trend.

“There’s been more competition with other institutions, particularly … nonprofit colleges and universities,” said Barbara Bickett, DeVry’s director of regulatory affairs.

For years, the for-profit University of Phoenix has enrolled more GI Bill users than any other institution – but it has seen plummeting GI Bill enrollment recently. That trend continued in fiscal 2018, when the school shed more than 5,940 Post-9/11 GI Bill students – about 21 percent — dropping to 22,428 such students.

The school declined to answer questions about its falling GI Bill enrollment, instead sending Military Times a statement that read, in part: “University of Phoenix is designed for the non-traditional adult learner and so often fits the needs of military students who want flexibility, career-focused programs and dedicated support.”

If Phoenix’s enrollment losses continue, the school may soon lose its designation as the top destination for Post-9/11 GI Bill users.

The University System of Maryland, thanks primarily to its distance education campus, is nipping at Phoenix’s heels, with 18,429 GI Bill students in fiscal 2018, 4,000 students shy of the top spot.

University of Maryland Global Campus’ Hauk said his school isn’t focused on which institution attracts the most GI Bill users but instead on how to best educate and support its students. Hauk’s school lost about 3 percent of its GI Bill enrollment in fiscal 2018, but he said that appears to be turning around.

“We’re seeing growth so far in this fiscal year, in terms of the number of new student veterans,” he said.

The recent overall drops in GI Bill usage in fiscal 2018, among all universities, mirror a similar trend affecting military tuition assistance, which saw usage rates decline 6 percent from fiscal 2016 to 2017 and then go down another 2.5 percent from fiscal 2017 to 2018.

The 7 percent declines charted in fiscal 2017 and fiscal 2018 for the Post-9/11 GI Bill were calculated by adding all schools’ GI Bill populations and comparing year-on-year changes. This calculation method can sometimes double-count students if they, for example, attend more than one institution during the fiscal year. In previous years, the Veterans Affairs Department provided separate data that avoided such duplication, but VA was unable to do so for fiscal 2018 data by press time. VA also did not respond to interview requests to discuss declining GI Bill usage by press time.

Regardless, the downward trend in Post-9/11 GI Bill usage is clear – and sharp. In addition to the enrollment losses, the amount of money spent of GI Bill benefits decreased by nearly $287 million in fiscal 2018 to about $4.6 billion, a 5.9 percent drop. Officials offered a variety of theories to explain the falling numbers.

“A reduction in beneficiaries may indicate more veterans successfully complete degrees and are moving into the workforce,” said John Aldrich, a vice president at the country’s fourth most popular GI Bill school, American Military University, a for-profit institution also known as American Public Education Inc.

Aldrich said his school has graduated more than 3,000 GI Bill users in each of the past three years.

Another possible explanation that Aldrich offered: Students may be turning away from the GI Bill because it shrinks their housing stipends if they attend school entirely online. The Post-9/11 GI Bill gives online students only half of the national average housing stipend that in-person students receive.

“They really are forced to make a decision between convenience and flexibility, versus maximizing the amount of housing allowance they receive each month,” Aldrich said. “They may just say, you know, the heck with it.”

Meanwhile, Hauk noted that recent improvements to the Post-9/11 GI Bill may actually be resulting in fewer students going to school right now. The Forever GI Bill, signed into law in August 2017, allowed anyone who left the military after January 2013 to use the GI Bill at any point in the future. Previously, all benefits had to be used within 15 years of separation.

“I think it’s only natural to see that usage rates are going to decline” with the removal of that time limit, Hauk said. “They’ve got the rest of their life to use the benefit.”

In addition, Schmeling, of Student Veterans of America, pointed to a common higher education trend: More people go to college to improve their job prospects in bad economies, while fewer go to school when the economy is strong. That may also explain some of the decrease in GI Bill use, he said.

“The economy has continued to improve,” he said. “There is labor demand and veterans are highly skilled, so there might be fewer going to college because they don’t feel they need to.”


VA-Distributed Video Tablets Deliver Telehealth to Veterans



“The department’s tablet program is one part of VA’s extensive telehealth program. The VA’s use of technology to enhance care options for Veterans is supported by the VA MISSION Act.


“The U.S. Department of Veterans Affairs (VA) was recently recognized in studies by two independent peer-review journals — JAMIA Open and Psychiatric Services — for efforts to deliver trusted, easy access and high-quality online health care services to Veterans with complex health care needs or residing in remote areas.

“Telehealth technology remains a vital platform to provide high-quality health care to all Veterans, regardless of challenges they may face in accessing care,” said VA Secretary Robert Wilkie. “VA’s tablet program is a model that other networked health care systems across the country can mirror, and demonstrates the potential of telehealth capabilities in the years to come.”

According to the JAMIA Open study published Aug. 5, VA’s initiative to distribute video telehealth tablets to high-need patients appears to have successfully reached Veterans with social and clinical access barriers, including Veterans in rural areas and patients with mental health conditions.

The study published by Psychiatric Services, Aug. 5, validates that the initiative also appears to improve access and continuity of mental health services of Veterans with mental health conditions. Furthermore, researchers discovered that VA’s efforts are improving clinical efficiency by decreasing missed opportunities for care.”

Learn more about VA Telehealth Services.


GAO Says More Veterans Heading For Veterans Homes That May Not Be Ready

Image: “Columbiacare.org


“The report, released Aug. 2, found the number of veterans in VA funded nursing home care is expected to total about 44,000 by 2022.

Challenges in contracting with community nursing homes (CNHs), which provide the bulk of that care, could keep the agency from being able to meet demands.


“Although the number of veterans in nursing homes is expected to rise 16% between 2017 and 2022 as veterans who served in Vietnam continue to age, the VA may not be prepared to handle the increase, according to a new report from the Government Accountability Office.

And while some of those issues may be helped by a recent VA healthcare law, known as the Mission Act, concerns remain, auditors wrote.

“While VA expects to continue placing more of the veterans needing nursing home care into CNHs, officials noted some challenges contracting with these homes,” the GAO report states. “Specifically, VA central office officials said that about 600 CNHs had decided to end their contracts with VA over the last few years for a variety of reasons. For example, officials from four of the [VA Medical Centers] we interviewed told us about CNH concerns that contract approvals can take two years, homes have difficulties meeting VA staff requirements, and VA’s payment rates were very low.”

In addition, the homes may not be able to handle the special needs some elderly veterans face, including behavioral issues or dementia, the study found.

“[VA officials] said homes may not have any of the necessary specialized equipment or trained staff, or may not have as many of these beds as needed, to meet certain veterans’ special care needs,” the report said. “VA officials told us that they are working to expand the availability of special needs care in each of the three setting.”

The VA covers the full or partial cost of nursing home care for veterans, depending on availability and the veteran’s disability rating or injuries. Veterans rated at 70 percent or higher for service-connected disabilities or those who are receiving nursing home care as the result of a service-connected disability are fully covered.

The system provides care in three types of homes. CNHs are publicly or privately owned and operated and contracted with the VA. State veterans homes are typically owned and operated under the preview of the state in which they are located. And community living centers, which often provide acute care, are owned and operated by the VA and associated with the local VA hospital.

Auditors found the VA should do a better job monitoring the quality and performance of nursing homes, an improvement that will be increasingly important as the number of veterans using the facilities increases.

VA officials contract out inspections of nursing homes, but do not regularly monitor contractors’ performance to determine whether or not inspections are being done correctly, the report said. And the way the system works with state veteran homes does not flag all quality problems, which keeps the system from tracking them.

Moreover, VA officials haven’t given VA hospital staff instructions on how to conduct on-site reviews of nursing homes without the contractor, which means they can’t hold those facilities accountable for correcting problems, the report said.

“By making enhancements to its oversight of inspections across all three settings, VA would have greater assurance that the inspections are effective in ensuring the quality of care within each setting,” the report said.

The report also recommended that VA clarify its communication on the types of nursing home care are available, giving more information on state veterans homes and how their quality compares to the other options.

VA officials generally concurred with all four recommendations. They said they plan to act on the report’s recommendation to increase oversight of inspectors while changing how issues with state veteran homes are flagged. They argued, however, that their employees don’t have the authority or oversight to inspect community nursing homes directly. They also said they would investigate whether or not it’s feasible to provide data on state veteran home quality.”


VA Says It Migrated 78 Billion Health Records To New Cerner EHR



“The 78 billion health records, including vital signs, lab tests and others, came from all 23.5 million veterans who used the sprawling legacy Veterans Information Systems and Technology Architecture (VistA) system, according to a VA spokesperson.

The milestone comes after a recent Government Accountability Office report found the department did not have an accurate grasp of the cost of maintaining VistA.”


“VistA is a countrywide decentralized system that has been in place for decades. The lack of interoperability between VistA and the Department of Defense’s health records systems has left veterans hauling boxes of paper records to appointments after separating from the military. For the past two decades, the two departments have been “unable to achieve” improvements, according to a 2018 GAO report.

The new cloud-based EHRM system — operated by Cerner Millennium, the same platform at the heart of the Pentagon’s mover to a modernized EHR, which is also in its initial phases of build-out — will help bridge that digital gap between the DOD and the VA. With the DOD and VA using the same system to host veteran and service member data, the VA hopes for a “seamless” transition for veterans.

“For decades, VA and DoD have been struggling to achieve interoperability and seamlessly share patient records between our health systems — placing an unfair burden on our Veterans and their families,” said VA Secretary Robert Wilkie in a news release.

While the VA says that VistA will start to be phased out in some locations as the Cerner system takes over, the full transition will take a decade, a recent GAO report found. During VistA’s continued use, it will require major upkeep costs, numbers the VA has struggled to keep track of. The VA reported it cost $2.3 billion to maintain VistA between 2015 and 2017, but GAO found that figure was likely less-than reality.”