Setting A New Framework For Reforming VA Health Care

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We propose a new framework to meet the needs of the next generation of America’s veterans based on Rebuilding, Restructuring, Realigning and Reforming the VA health care system.

First, Rebuild and sustain VA’s capacity to provide timely, high quality health care.

  • VA must able to recruit, hire and maintain clinical staff in a more expedient manner.
  •  VA must gain the commitment and funding to implement a long-term strategy to repair, maintain, expand and locate, as necessary, usable treatment space to maximize access points where and when veterans need to receive their care.
  • VA must build upon its temporary access initiatives implemented last year by permanently extending hours of operations around the country at CBOCs and other VA treatment facilities to increase access for veterans outside traditional working hours.
  • To provide the highest quality care, VA must sustain and strengthen clinical and biomedical research programs to prepare for veterans’ future health care needs.
  • To support the teaching and research programs and to help support future staffing recruitment efforts, VA must sustain its academic affiliations programs.

Second, Restructure all non-VA care programs into a single integrated extended care network.

  • VA must develop an integrated VA Extended Care Network which incorporates the best features of fee-basis, contract care, ARCH, PC3, “choice,” and other purchased care programs to assure that veterans have timely access to all necessary care when VA is unable to provide such care.
  • VA must develop an appropriate and effective decision mechanism that ensures that veterans are able to access VA’s Extended Care Network whenever medially-necessary, as well as a new, transparent, and dedicated review and appeal process capable of making rapid decisions to ensure veterans have timely access.’
  • VA and Congress must continue to analyze the effect of the temporary “choice” program to assess how it affects veterans health outcomes, commission new, independent research to review private sector access standards and recommend new VA access standards, and allow the Commission on Care to complete its study before making permanent legislative or regulatory changes to the VA health care system.
  • Congress must create a single, separate and guaranteed funding mechanism for the VA Extended Care Network in order to protect it and the VA health care system from funding shortfalls.

Third, Realign and expand VA health care services to meet the diverse needs of future generations of veterans:

  •  VA must establish a nationwide system of “urgent care” services, beginning with VA expanding urgent care clinics with extended operating hours. The VA, like any large health care system should provide walk-in capability to meet the urgent care needs of enrolled veterans. Different than emergency care, these services would be delivered by dedicated doctors and nurses in existing VA facilities, or smaller urgent care clinics strategically situated in new locations around the country, such as in shopping malls.
  • VA must extend access to care further through enhanced web-based and tele-medicine options to reach even the most remote and rural veterans.
  • With veteran demographics continuing to change, VA must eliminate barriers and expand services to ensure that women veterans have equal access to high quality, gender-specific, holistic, preventative health care.
  • VA must also rebalance its long-term supports and services to provide greater access to home- and community-based services to meet current and future needs, including expanding support for caregivers of veterans from all generations.

Fourth, Reform VA’s management of the health care system by increasing efficiency, transparency and accountability in order to become a veteran-centric organization.

  •  VA must begin by developing a new patient-driven scheduling system, including web and app-based programs that allow veterans to self-schedule (and re-schedule) health care appointments, with built-in reminders, rather than only relying on VA scheduling systems.
  •  VA must reform and strengthen its Patient Advocate program to achieve greater independence from VA facility leadership and greater authority to perform their duties to ensure that veterans receive timely, high-quality medical care services.
  •  VA must redesign its Performance and Accountability Report (PAR) to establish new metrics that are focused on veteran-centric outcomes with clear transparency and accountability mechanisms.
  • To increase transparency and accountability in budgeting, VA should implement a PPBE (planning, programming, budgeting and execution) financial control system, which is already working for the Departments of Defense and Homeland Security. Congress should approve pending legislation to bring this PPBE system to the VA.
  • Finally, VA must hold all of its employees – from the Secretary to receptionists – to the highest standards, while always balancing the need to make the VA an employer of choice among federal agencies and the private sector.
  • Joe Lempa

    Most importantly, Congress must appropriate funds to pay for staffing which is competitive to Private Hospitals. Otherwise our best finds are almost assured of better offers elsewhere.. The VA always seems to be seeking funds to improve and when they hit a wall, Congress, like a tail chasing the dog, finds their scapegoat. A VA Doctors workload is likely twice that of a private Hospital’s. A VA Doctor’s time with patients can be affected unless that Veteran is confident enough to advocate for his or herself. Hospitals have hosted Town Hall Meetings but the information [Invitations,] must reach Community Veterans. Many of them have no clue as to how just much they can be helped. God bless our Veterans

    • soldiermom11

      First of all the VA needs to renovate or sell the millions of dollars in vacant real estate on the books. next it shouldnt take 2 years to be approved for disability. next get rid of the unions or at least demand that firing bad employees is acceptable and correct. next work with veteran groups. if we can win ww11 in 3 years we ought to be able to fix the VA. first we need a president with the character and the will to do it.

    • ReadTheConstitution

      If we push for privatization of Veterans healthcare, we risk being migrated to medicaid. Improving the VA is a far more attractive option to me.

  • Peggy Dalton

    Again, the DAV is near the end of the pack of dogs chasing the dilapidated VA vehicle. DAV assumes veterans are “provided timely, high quality health care” and with that I speculate the DAV assumes veterans are “provided timely, accurate claims processing for benefits.”

    Rah-rah DAV! Pat yourselves on the back, and tell your membership looky-looky see what we have done. Reality is your points paper are empty words for all the actions are put on the VA and Congress.

    • Joe

      @peggydalton:disqus: Please note, the line you are referring to does not say what the VA is doing. It says DAV’s proposed framework here is designed to enable the VA to provide the proper service. Clearly, the VA is not meeting its mission now, which is why this reform is so crucially needed. DAV goes on to explain six points that, at the very least, must be completed in order for the VA to provide timely, high quality health care.

      • Lee Delong

        How will they be implemented?

        • DAV

          @leedelong:disqus – We have come up with the framework. We are willing to work with the VA and Congress to work on implementation if their leaders are willing to work together to make it happen.

  • Lee Delong

    Good when they hire people that think of what they’re doing as more than a paycheck.

  • Duane Lee Carter

    I always like the fact that DAV cuts through the clutter, ignores the “quick fix, burn the VA down and start over” approach that is in the public eye, and they come up with a common sense recommendation that will actually go a long way towards fixing the problem. Instead of riding the press releases towards another failed attempt at making everyone happy, let’s look at the issues and come up with a plan that will work, be able to get thru congress and past the unions. Thanks DAV

    • DAV

      Thank you. As a non-partisan organization we are looking for well researched and long term solutions for our brothers and sister veterans and future generations. Both sides have their issues, but we view our approach as a holistic one that benefits all stakeholders with regards to proper funding to meet demand and accountability. The two go hand in hand.

  • Mike Vitelli

    First, the VA needs to change the “bughouser” “good-‘ol-boy” system. Rather than hiring a “license” they to need to hire people that portray empathy and compassion of which there seems to be little of. English is the language that most veterans speak; so should the care givers. Take away “tenure’ and change it to a merit system. Apparently, doctors and nurses in the private sector use the VA health care system to show why socialized medicine is not a good thing. Little phraseology that the writer uses like “Rebuilding, Restructuring, Realigning and Reforming” is rhetoric and cliche proving to me that the DAV is another segment of the VA system.

    • DAV

      Mr. Vitelli – We are independent of the VA. We can make recommendations based on our years of experience to the VA and Congress and advocate on behalf of veterans, but ultimately the decision to do the right thing by veterans is in their hands.

  • Vortex

    I am not in favor of a restructuring, added staff, or plussed up funding solution to our distinctions VA. Instead I am an advocate of a VA that functions in two basic ways for veteran healthcare. First, the VA must continue determining veteran’s disability ratings. Secondly, if relieved there medical care responsibilities the VA can concentrate on timely rating decisions. They can also abandon the old and expensive facilities that still compromise to many of their primary treatment locations. Additional savings are attained from personnel and equipment cuts as patience shift to local, civil care providers who offer better choices at convenient distances and through established referral networks. At the core of this problem is the absence of competition, the endemic problems of a government managed program and the refusal to consider the cost savings and conveniences that veterans need and deserve.

  • ReadTheConstitution

    DAV puts out these letters that reduce to platitudes of “make things more better”. Without recommending very specific changes under each of the framework bullet points, we can expect nothing to change. You have to define the mission before you can hope to complete it. I see generalities that do not tell the VA how to get anywhere.

    So the VA can look at this framework and do nothing and issue press released full of spin to demonstrate their commitment to “making things more better”.

    Does DAV have congressional advocacy or is it a professional club that exists to pat its officers on the back and happens to provide benefits counseling?

    Example: Finally, VA must hold all of its employees – from the Secretary to
    receptionists – to the highest standards, while always balancing the
    need to make the VA an employer of choice among federal agencies and the
    private sector.

    How about listing the barriers to this goal. Find the rules, regulations, labor union issues that keep this from being accomplished and propose reforms to each of those points?
    I am sure there are rules that make firing people difficult. What are they and how can they be changed? Same for employees reporting problems and being able to suggest solutions. How can we manage federal employee unions so that organizational reform can happen?
    What can be done to make the hiring process more attractive to health care providers? What kind of professional development incentives can be devised that would benefit providers and their patients?
    How can we ensure that the OIG meets its obligations?

    There are details that need to be researched so that solutions can be provided. DAV cannot hold the VA accountable without defining specific solutions.

    I know congress is intractable when it comes to protecting their sacred cow of federal bureaucracy, but without doing the work you are guaranteed to achieve nothing.