Tag Archives: Veterans health care

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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Who’s Really Accountable For Interoperability Between DOD And The VA On E-health Records System?

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VA Maze

“FEDSCOOP”

“The departments of Defense and Veterans Affairs both have billion-dollar modernizations in progress for their electronic health record systems. And they’ve each identified who is accountable for the success of those programs.

But the more important question might be: Who is ultimately accountable for seeing that the EHR systems, when fully developed, work together seamlessly as members of the military retire and becomes veterans?”


“House lawmakers pressed this point this week during the first hearing held by the Veterans Affairs’ Subcommittee on Technology Modernization. They examined the role of the DOD/VA Interagency Program Office (IPO), stood up in 2008 for the exact purpose of ensuring seamless transfer of records. So far, though, that office has no real authority over the interoperability of the two programs —VA’s EHR Modernization and DOD’s MHS GENESIS, both of which are based on Cerner’s commercial EHR platform.

Lauren Thompson, the head of the office, told lawmakers that despite the intention of the 2008 National Defense Authorization Act to make the IPO the single point of accountability for the interoperability of the two departments’ EHRs, “at this point in time, we make recommendations. We do not have the decision-making authority.” IPO is based within DOD.

According to the law, said Carol Harris, director of IT management issues for the Government Accountability Office, “the IPO is supposed to be the single point of accountability. So that would include responsibility, authority and decision-making responsibilities. I think that [the office’s current operation, as described by Thompson], is in conflict with the expectation set out by law.”

The departments and the IPO are trying to sort out the interoperability governance now that VA and DOD each has a massive EHR in development. Though they both are developing instances of the same Cerner platform so that interoperability will be easier to achieve, there are still myriad technical and functional decisions that must align so that the data ultimately matches as it flows from one system to the next. VA, DOD and the IPO are in the process of developing new governance bodies and a new structure with the hope that things can be dealt with at the lowest level possible.

“Clinicians talking to clinicians, technicians talking to technicians,” said John Windom, VA’s acting chief health information officer and program executive officer for the new Office of Electronic Health Record Modernization. When disagreements happen, the issues are elevated to new governance boards, but the goal is to avoid that, he said.

Windom explained that the governance process is “evolving,” and it will take time to get there. “The as-is state of the enterprise with the VA is different than the as-is state of the enterprise within DOD. … Now we’re understanding the gaps between how we sought to implement and how DOD is implementing. And so those gaps have to be reconciled, and they have to be reconciled through governance.”

But even with that model, lawmakers were unhappy because there is no single person or organization accountable. “There’s really no one there to break the ties or resolve the differences,” Rep. Scott Peters, D-Calif., said, pushing for action from the president or Congress to spark the change. “The only person both agencies report to now is the president of the United States.”

Rep. Mike Coffman, R-Colo., said perhaps there’s a place for the IPO in the process, but either the DOD or VA should be given the ultimate decision-making authority.

Harris agreed that a “single executive-level entity that is the point of accountability” with decision-making authority and that binds both departments at the deputy secretary level or higher is “essential.”

She doesn’t have much faith in the IPO, though, at least in its current form — and really for no fault of its own.

“They never had to clout to mediate and resolve issues between DOD and VA,” Harris said. “The IPO was never set up to succeed there because neither of the departments were willing to relinquish control.”

Harris called the IPO’s ability to drive the necessary interoperability “lackluster” in the past decade. “In the past situations, what we’ve seen historically is that when everyone is responsible, no one is responsible. I think that’s what has led us to where we are today,” she said. “Accountability has been so diffused so that when the wheels fall off the bus, you can’t point to a single entity who’s responsible. And that’s a problem.”

https://www.fedscoop.com/dod-va-ehr-interoperability-hearing/

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/

 

 

Federal and State Governments Crack Down on Bogus Veteran Charities

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Veterans Fraud Web Sites

Image:  Federal Trade Commission

“MILITARY.COM”

“The Federal Trade Commission, along with law enforcement officials and regulators from offices in every state, DC, American Samoa, Guam and Puerto Rico, announced more than 100 actions and a consumer education initiative in “Operation Donate with Honor”.

The action was a crackdown on fraudulent charities that con consumers by falsely promising their donations will help veterans and service members.”


“You may have seen them standing outside convenience stores, those guys dressed in camo that vaguely resembles a uniform. They have signs saying claiming they are charities that help veterans. Are they legit?

Well, not all of them are.

Americans are grateful for the sacrifices made by those who serve in the U.S. armed forces,” said FTC Chairman Joe Simons. “Sadly, some con artists prey on that gratitude, using lies and deception to line their own pockets. In the process, they harm not only well-meaning donors, but also the many legitimate charities that actually do great work on behalf of veterans and service members.”

TWO CHARITIES FACE FEDERAL CHARGES

Help the Vets

Neil G. “Paul” Paulson, Sr. and Help the Vets, Inc., (HTV) will be banned from soliciting charitable contributions under settlements with the FTC and the states of Florida, California, Maryland, Minnesota, Ohio and Oregon, for falsely promising donors their contributions would help wounded and disabled veterans.

The defendants were charged with violating federal and state laws related to their actions. According to the FTC’s complaint, HTV did not help disabled veterans, and 95 percent of every donation was spent on fundraising, administrative expenses, and Paulson’s salary and benefits.

Operating under names such as American Disabled Veterans Foundation, Military Families of America, Veterans Emergency Blood Bank, Vets Fighting Breast Cancer, and Veterans Fighting Breast Cancer, HTV falsely claimed to fund medical care, a suicide prevention program, retreats for veterans recuperating from stress, and veterans fighting breast cancer.

In addition to the ban on soliciting charitable contributions, the proposed settlement order bans Paulson from charity management and oversight of charitable assets. To ensure that donors to HTV are not victimized again, HTV and Paulson must destroy all donor lists and notify their fundraisers to do so.

The order imposes a judgment of $20.4 million, which represents consumers’ donations from 2014 through 2017, when HTV stopped operating. The judgment will be partially suspended when the defendants have paid a charitable contribution to one or more legitimate veterans charities recommended by the states and approved by the court.  Paulson must pay $1.75 million – more than double what he was paid by HTV – and HTV must pay all of its remaining funds, $72,000.

Veterans of America

The FTC charged Travis Deloy Peterson with using fake veterans’ charities and illegal robocalls to get people to donate cars, boats and other things of value, which he then sold for his own benefit.

The scheme used various names, including Veterans of America, Vehicles for Veterans LLC, Saving Our Soldiers, Donate Your Car, Donate That Car LLC, Act of Valor, and Medal of Honor. Peterson allegedly made millions of robocalls asking people to donate automobiles, watercraft, real estate, and timeshares, falsely claiming that donations would go to veterans charities and were tax deductible.

In fact, none of the names used in the robocalls is a real charity with tax exempt status. Peterson is charged with violating the FTC Act and the FTC’s Telemarketing Sales Rule.

At the FTC’s request, a federal court issued a temporary restraining order prohibiting Peterson from making unlawful robocalls or engaging in misrepresentations about charitable donations while the FTC’s enforcement action is proceeding.

STATE ENFORCEMENT ACTIONS

States also identified and charged several charities and fundraisers who sought donations online and via telemarketing, direct mail, door-to-door contacts, and at retail stores. These groups falsely promised to help homeless and disabled veterans, to provide veterans with employment counseling, mental health counseling or other assistance, and to send care packages to deployed servicemembers.

Some actions charged veterans charities with using deceptive prize promotion solicitations. Others targeted non-charities that falsely claimed that donations would be tax deductible. Some cases focused on veterans charities engaged in flagrant self-dealing to benefit individuals running the charity, and some alleged that fundraisers made misrepresentations on behalf of veterans charities or stole money solicited for a veterans charity.

NATIONWIDE EDUCATION CAMPAIGN

As a result of these actions, the FTC and its state partners are launching an education campaign to help consumers avoid charity scams and donate wisely.

The FTC has new educational materials, including a video on how to research charities, and two new infographics. Donors and business owners can find information to help them donate wisely and make their donations count at FTC.gov/Charity.”

https://www.military.com/paycheck-chronicles/2018/07/27/feds-crack-down-bogus-veteran-charities.html

 

The Next $10 Billion Chapter In The Veterans Administration Health Care Systems Development Saga

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VA New System

Editors’ Note:  The story herein on “FEDSCOOP” announces the latest trip on a decades- long road of efforts by the Veteran’s Administration to connect the  health care systems of the military with those of the VA and establish state of the art records keeping for veterans.  

This sole source, non-competitive, contract award to CERNER,  a commercial firm in lieu of in-house systems development  is a major change in approach from past efforts that have cost billions and led to shut downs and start overs. 

Having seen these types of government systems management challenges from the inside for over 4 decades I find myself sincerely doubting that both the scope and the price tag are final.   For historical perspective, please see: 

A VETERAN CONNECTS THE DOTS IN THE MILITARY AND VETERANS HEALTH CARE SYSTEMS MAZE   

Ken Larson

_______________________________________________________________________________________

“FEDSCOOP”

“The Department of Veterans Affairs announced Thursday that it has officially signed a contract with Cerner for a new electronic health record (EHR) system.

The inked contract is worth up to $10 billion over 10 years.

“With a contract of that size, you can understand why former Secretary [David] Shulkin and I took some extra time to do our due diligence and make sure the contract does what the President wanted,” acting Secretary Robert Wilkie said in a statement. “President Trump has made very clear to me that he wants this contract to do right by both Veterans and taxpayers, and I can say now without a doubt that it does.”

The new EHR will be “similar” to that used by the Department of Defense, which will allow patient data will be “seamlessly” shared between the two. This has been a major pain point with the Department’s current EHR, the Veterans Information Systems and Technology Architecture, or VistA.

Wilkie reiterated Shulkin’s comments, from March, that the VA will learn from some of the DOD’s challenges in deploying its new EHR, known as MHS Genesis, and will not fall prey to the same pitfalls, which have plagued early pilots of the system and led to a report calling it “neither operationally effective nor operationally suitable.”

“VA and DoD are collaborating closely to ensure lessons learned at DoD sites will be implemented in future deployments at DoD as well as VA,” Wilkie said. “We appreciate the DoD’s willingness to share its experiences implementing its electronic health record.”

“Signing this contract today is an enormous win for our nation’s Veterans,” Wilkie said. “It puts in place a modern IT system that will support the best possible health care for decades to come. That’s exactly what our nation’s heroes deserve.”

However big an announcement this may be, actual rollout of the new EHR will take time. At an event in January, former VA CIO Scott Blackburn told the crowd to expect another 10 years of VistA.”

https://www.fedscoop.com/va-ehr-cerner-10-billion-robert-wilkie/

 

 

Sweeping $52 Billion Veterans Policy Bill Passed Overwhelmingly In The House

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Veterans Policy Bill

The Raymond G. Murphy VA Medical Center in Albuquerque, N.M., is shown on July 8, 2016. On Wednesday, House lawmakers passed a nearly $52 billion veterans policy package that includes an overhaul of VA community care programs and an expansion of veteran caregiver stipends. (Russell Contreras/AP)

“MILITARY TIMES”

“Overhauls outside medical care options for Department of Veterans Affairs patients, expands stipends for veteran caregivers and launches a review of the bureaucracy’s national footprint.

Despite the cost of the plan, the measure easily passed the chamber by a vote of 347-70 and has the blessing of the White House. It’s expected to move quickly through the Senate.”

____________________________________________________________________________________________

“Lawmakers have until the end of the month to finalize legislation, including new funding for the department’s controversial Choice program or risk disrupting health care for tens of thousands of veterans using the account.

House Veterans’ Affairs Committee Chairman Phil Roe, R-Tenn., dismissed concerns from critics about the scope and cost of the measure, particularly charges that the package is part of a slow erosion of VA responsibilities and services.

“Opponents of this bill will tell you, falsely, that it is aimed at eventual privatization of the VA health care system,” he said just before the vote. “That misconception is based on nothing but fear and rhetoric.

“A yes vote is a vote for access, for quality, for choice, for the long-term success and sustainability of the VA health care system, for caregivers and for veterans.”

Among the legislation’s opponents (all Democrats) was the committee’s ranking member, Minnesota Democratic Rep. Tim Walz, who voiced concerns that Republicans rejected proposals to exempt the costs from mandatory budget caps scheduled to take effect in coming years.

He also said that implementation of the massive veterans bill will fall to President Donald Trump’s administration, which “has been 40 days without a VA secretary” since the firing of VA Secretary Shulkin two months ago.

** VA Choice and community care

The legislation, dubbed the VA Mission Act, is the culmination of nearly a year of work on the contentious issue of VA community care.

More than one-third of all VA-funded medical appointments last year took place in offices outside the Veterans Health Administration, but administration officials have pushed for more access to private-sector doctors to increase options for veterans facing long waits or travel for federal care.

In 2014, lawmakers passed the VA Choice program with that same idea. The program handles around 30,000 outside medical appointments a day, but has come under fire from conservatives for being too restrictive and bureaucratic for veterans looking for options outside VA.

Last month, acting VA Secretary Robert Wilkie said the Choice program will run out of money by the end of this month. The VA Mission Act include $5.2 billion in bridge funding to keep that program running for another year, until it is consolidated with other department care programs.

That consolidation is expected to simplify and expand the rules for accessing outside care, but still keeping VA officials involved in veterans’ over health care plans.

It requires veterans become eligible for private-sector care options if VA does not provide adequate medical options for patients, including long travel times, long wait times or poor service ratings. It revises payment rates for community care to Medicare rates, to ease concerns about reimbursement for those visits.

It would also authorize two walk-in visits at local private-sector offices for any veterans who have used department health care services in the last two years. Those appointments may require a co-pay.

Critics of the plan — including federal unions — have said the changes are a major step towards privatizing VA health services by shifting billions of dollars from VA accounts to private companies. They’ve also accused the White House of working towards that goal, in an effort to hollow out VA.

But VA officials have defended the idea as modernizing VA operations, and acknowledging that the medical needs of millions of veterans cannot be shouldered by the department alone.

Numerous House Democrats, who in the past have warned about the privatization push, backed the new legislation, saying it strikes the balance between medical access and preserving the department.

** Caregivers and asset review

In order to attract that Democratic support, Republican House leaders added a dramatic expansion of the current VA caregivers stipend to the measure.

The issue has been a top priority of veterans organizations in recent years, since currently only caregivers of veterans from the post-9/11 era are eligible for monthly stipends through the department. The new proposal would expand that to veterans of all eras, first starting with pre-1975 veterans and later phasing in the remaining group over two years.

The obstacle in getting that expansion has been the cost. The Congressional Budget Office estimates that more than 41,000 caregivers could be added to the program over the next five years, at a cost of nearly $7 billion. But that bill is expected to rise even more in following years.

But the community care overhaul is expected to total more than three times that total by 2023, making it a more palatable concession in the context of the larger legislative package.

The asset review portions of the package resembles the framework of the Defense Department’s base closure and review commissions, although supporters have bristled at the comparison.

Under the plan, the president would establish a nine-member Asset and Infrastructure Review Commission, with representatives from veterans service organizations, the health care industry, and federal facility management.

The panel would meet in 2022 and 2023 to issue recommendations on “the modernization or realignment of Veterans Health Administration facilities.” That could include closing, reducing or expanding a host of VA health facilities across the country.

The cost of that work is unknown. Lawmakers have been reluctant to back new military base closing commissions because of controversies surrounding the 2005 round, which produced disputed savings totals.

But VA officials have repeatedly warned that their current footprint includes hundreds of outdated or obsolete facilities, and department administrators have severe restrictions on managing those locations. Roe said a “politically insulated process” is needed to fix that “massive and misaligned physical footprint” of VA.

The exterior of the Veterans Affairs Department hospital is shown in east Denver on Oct. 4, 2017. On Wednesday, House lawmakers approved a veterans legislative package which includes a review of department medical facilities and an overhaul of VA community care programs. (David Zalubowski/AP)
The exterior of the Veterans Affairs Department hospital is shown in east Denver on Oct. 4, 2017. On Wednesday, House lawmakers approved a veterans legislative package which includes a review of department medical facilities and an overhaul of VA community care programs. (David Zalubowski/AP)

** Veterans support

In advance of the House vote, 38 veterans groups issued a letter of support for the legislation, calling it “a major step towards … making improvements to and investments in the VA health care system, creating integrated networks so that veterans have access to care when and where they need it, and providing the further recognition and assistance to family caregivers of severely disabled veterans deserve.”

The list included the Veterans of Foreign Wars, Disabled American Veterans, Paralyzed Veterans of America, and Iraq and Afghanistan Veterans of America — all organizations that have repeatedly warned members about the threat of privatization to VA operations.

Denise Rohan, national commander of the American Legion, praised Wednesday’s vote as a critical step forward to “streamline and fund the Department of Veterans Affairs’ many community care programs, expand caregiver benefits to pre-9/11 veterans and their families, and review VA infrastructure holdings.”

The measure also received support from Concerned Veterans for America, which has close ties to the current White House and has argued against the privatization label in recent years.

“The Mission Act would go a long way towards resolving problems with the VA’s existing community care programs and stabilizing the VA’s health care system,” CVA Executive Director Dan Caldwell said in a statement. “We’re also encouraged that the MISSION Act mandates a long-overdue review of the VA’s infrastructure across the country.”

No timetable has been set for when the Senate may vote on the measure, but Senate Veterans Affairs Committee Chairman Johnny Isakson, R-Ga., said he hopes to take up the issue “without delay.”

In a gesture to colleagues, lawmakers changed the official name of the legislation to include Sen. John McCain, R-Ariz., Rep. Sam Johnson, R-Texas, and former Sen. Daniel Akaka, D-Hawaii. McCain and Johnson are both former prisoners of war, while Akaka (who died in April) was a longtime veterans advocate in his chamber.”

https://www.militarytimes.com/veterans/2018/05/16/sweeping-veterans-policy-bill-passed-overwhelmingly-in-the-house/

“Warrior Games” Help Veterans Adapt

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Warrior Games

“ARMY TIMES”

“Former Tech Sgt. Joshua Miller and Capt. Mitchell Kieffer, both medically retired, suffered significant injuries during their time in service. 

Those injuries led to a string of surgeries for both veterans and, ultimately, a choice: between reaching out to overcome those injuries or to isolate themselves.”



“Two Air Force veterans who were severely injured during their service, and who suffered from the “invisible wounds” of post-traumatic stress, said they had to overcome fear of the stigma sometimes associated with getting help ― and their own pride ― to recover from their wounds. 

The airmen talked about their roads to recovery during the Air Space Cyber Conference at National Harbor, Md., Monday.

Smith joined the Air Force in 2003 as an aircrew flight equipment specialist and served on active duty for 13 years.

During Combat Survival School, he was injured after being thrown into a culvert, which led to surgeries on both hips, his right shoulder and elbow.

When a friend suggested he join the Air Force Wounded Warrior Program, Smith hesitated because he felt his non-combat injuries didn’t warrant joining the program. He didn’t “fit the bill” of those wounded in combat, he said.


“I felt [the program] was really sacred and that I didn’t belong,” Smith told the audience.
“But everybody has a story. It doesn’t matter if it’s combat or non-combat related,” he said. “So many airmen are kind of afraid to go to their first camp because of what they’re struggling or dealing with,” Smith said.


Being around others who can relate to what you’re going through makes it easier to share your stories and your feelings, he said.


Kieffer, who was injured while on a voluntary deployment with the Army Corps of Engineers in 2011, echoed those sentiments.


“Whenever we go to these [Wounded Warrior] camps and events, we know we’re not going to be judged,” said Kieffer.


He was part of a convoy that was attacked by an improvised explosive device, rocket-propelled grenades and small-arms fire. He sustained seven broken vertebrae and had memory issues. Because of this, Kieffer is rated 100 percent disabled.


For both men, dealing with their physical injuries was difficult, but dealing with the unseen wounds of post-traumatic stress was also quite tough. Perhaps the biggest reason troops don’t want to admit their unseen wounds is pride, they said. Their initial reaction is not to seek help but to tough it out.


“That’s been the biggest issue I’ve seen and dealt with,” Kieffer said. Pride has held a lot of recovery back,” he said. “Stop letting pride affect you.


Becoming involved with Warrior Games was a transformative experience for both airman, they said. Kieffer was the 2015 and 2016 ultimate champion, which is based on five athletic categories. of competition.


“Any time you have the opportunity to tell your story, tell it,” said Chief Master Sgt. Nicole Johnson, chief of the Air Force Wounded Warrior Program. “Your story will help others tell theirs.”


http://www.armytimes.com/news/air-force-times/2017/09/18/letting-go-of-pride-air-force-vets-adapt-to-invisible-wounds/

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

 

 

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 Boosts Budget to Tackle Outstanding Healthcare Claims from Vets

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“MILITARY.COM”

“The Veterans Affairs Department is requesting a budget of $182 billion next year, a nearly $20 billion funding increase designed in part to tackle outstanding health care claims from veterans.

The proposed spending plan unveiled on Tuesday includes nearly $103.6 billion for mandatory programs such as disability compensation and pensions, and more than $78 billion in discretionary funding — mostly for health care.

VA Secretary Bob McDonald, who is scheduled to testify Wednesday before Congress on the budget request, said the agency now has “one of the greatest opportunities in its history to transform the way it cares for our veterans.”

McDonald says the funding will expand health care options to veterans across the country, continue efforts to end chronic veteran homelessness and further reduce the backlog on first-time claims and also on appeals.

Claims appeals, which have increased over the past six years as the VA put more resources and manpower into tackling the first-time claims backlog, is being targeted next year with more money and personnel.

The budget proposes $156.1 million and 922 full time employees for the Board of Appeals, up from about $110 million for a staff of 680 personnel in 2016.
The department’s spending plan marks the last one that President Barack Obama will submit as his second term ends next year and amounts to about double what it was in 2009 when he was sworn in.

After the White House released the budget details, Rep. Jeff Miller, R-Florida, a Republican from Florida and the chairman of the House Veterans Affairs Committee, released a rundown of recent and longstanding department problems, from cost overruns on construction projects to employees not being held accountable for poor performance and alleged wrongdoing.

“I will fight to ensure VA has the resources it needs, but given the complete lack of accountability for the department’s string of past financial failures, this budget request will receive every bit of the scrutiny it is due,” he said in a statement.

The department budgeted $68.6 billion for health care. Of that amount, more than $12 billion is slated to deliver health care to vets in their community.
Another $8.5 billion is for long-term care; $7.8 billion for mental health programs; $1.6 billion to reduce veteran homelessness; $1.5 billion to treat veterans ill with hepatitis C; $601 million for treating spinal cord injuries and $284 million for traumatic brain injuries, according to budget documents.

The VA expects to spend $725 million for caregivers.

To improve claims processing, the VA is continuing to invest in technology, earmarking $180 million to the Veterans Benefits Administration to enhance its electronic claims system and $143 million to the Veterans Claims Intake Program to continue converting older, paper records, including health records, into digital images and data.

The backlog in first-time claims — those not acted on within 125 days of filing — has been reduced from its 2013 peak of 611,000 to about 82,000, McDonald said last month.

Unlike other parts of the federal budget, Congress has authorized the VA to include funding requests one year in advance. As a result, the department included 2018 funding figures that totaled about $174 billion, including $104 billion in mandatory programs, a $1.5 billion increase from the 2017 request, and $470 billion in advance appropriations, an boost of about $300,000 from next year’s amount.”

http://www.military.com/daily-news/2016/02/09/va-boosts-budget-to-tackle-outstanding-healthcare-claims-vets.html