VA Secretary David Shulkin recently stepped down after controversy over privatization and misuse of public funds. Right now, Defense Department official Robert Wilkie is acting leader of the department. President Trump’s choice to replace him, White House physician Dr. Ronny Jackson, withdrew his nomination earlier this week. Until another VA secretary takes office, the Department of Veterans Affairs faces many challenges with no leadership in place. To better understand how this VA secretary upheaval impacts veterans, we’ll look at what sets this federal agency apart from all the rest.
VA Secretary Challenge #1: Funding the Veterans Choice Program After September 2018
The Veterans Choice Program uses VA funding to pay for veterans treated at private healthcare clinics and facilities. Since the VA funds this program, veterans need prior authorization for treatment from healthcare providers registered in the VCP network.
However, the VCP program isn’t without some controversy. The VA’s Office of the Inspector General raised serious allegations after auditing the program’s two private contractors, TriWest and HealthNet. The OIG audit shows evidence that two Department of Defense contractors may have improperly spent almost $90 million in taxpayer money. The VA OIG found improper payment rates and duplicate billing issues for both contractors from November 2014 to September 2016.
The OIG’s review concluded that the VA overpaid TriWest and HealthNet almost $100 million over a two-year period. Despite clear evidence that both contractors engaged in abusive billing practices, the VA extended their contracts through September 30, 2018. With hundreds of millions in taxpayer funding paid allegedly in error, why did the VA choose to extend both contracts? According to the federal agency, they had “no other immediate options available to perform the functions of current contracts.”
Hopefully, we’ll have a new VA secretary to review and address these problems before the renewed contracts expire in September. Once confirmed, the next VA secretary will likely work directly with Congress on fixing these VCP budgetary and oversight concerns.
VA Secretary Challenge #2: Fill Critical Agency Jobs and Over 30,000 Medical Staffing Vacancies
The VA manages the nation’s largest integrated health system, which served over 9 million veterans in 2016 alone. That number is expected to double over time. In October 2017, the agency managed over a thousand healthcare facilities nationwide, including:
- 1,231 VA outpatient sites
- 300 VA vet centers
- 145 VA hospitals
The VA is the second-largest federal agency, providing disability compensation to 4.55 million veterans annually. In addition, the VA supervises and administers 6.08 million life insurance policies for eligible veterans and their dependents.
Yet several key agency jobs remain vacant, and the VA’s healthcare system has at least 33,000 clinical staff positions unfilled. Right now, there simply aren’t enough doctors, nurses, mental-health specialists or therapists to serve veterans. Since 20 vets commit suicide daily, the VHA desperately needs more psychiatrists and psychologists working on prevention outreach strategies.
The next VA secretary must also quickly fill any vacant roles. VA undersecretaries are responsible for staffing their individual departments, including the VHA, VBA and Military Service/Medical Records Vault.
The next VA secretary must decide whether the agency’s attempt at giving veterans private healthcare access, the VCP, works. If not, the VA may request federal funding to hire thousands of additional medical staffers and open more healthcare facilities.
Veterans now face longer wait times for treatment than they did before the Choice program started in 2014. A March 2018 audit shows 41% of veterans wait 32 days, on average, for treatment at Choice care facilities. What’s more, TriWest failed to provide required medical documents for 33% of veterans treated at Choice facilities.
The VA secretary could address contract violations through an action plan, or use them to prove privatization doesn’t work. After allegations about wasting taxpayer money and longer wait times for veterans, the VA secretary may terminate the Choice program.
VA Secretary Challenge #3: Ending the Veterans’ Healthcare Privatization Debate
Whether to privatize the VA or not is a debate that’s raged on for years now. But a new Rand study shows that the private sector may not be ready to handle veterans’ unique healthcare challenges. Common health issues that military veterans seek treatment for include pain management, post-traumatic stress disorder (PTSD) and combat-related brain injuries. In fact, doctors diagnose 1 in 5 younger veterans today with PTSD, but don’t have enough psychiatrists to treat them.
For their study, Rand researchers used the following six factors to evaluate provider readiness in New York state:
- Currently accepting new patients
- Adequately prepared to treat and manage conditions commonly found among the veteran population
- Using clinical practice guidelines for high-quality care
- Screening for health-related issues that commonly affect veterans
- Providing accomodations for patients with disabilities or mental health care needs
- Routinely ask if patients are veterans, service members, or military family members and already have a basic understanding of military and veteran culture
The study found timeliness wasn’t a problem. However, when researchers looked at other key factors, only 2% of private providers were adequately prepared to treat veterans’ healthcare needs. These factors involved familiarity with military culture, screenings for military affiliation, and familiarity with conditions that were common among veterans. While the study focused on providers in New York state, it echoed concerns from critics about the push for privatization. Pushing to send veterans outside the VA system to providers who don’t understand how to properly treat them could backfire.
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