While value-based care or value-based payment is becoming the new model in health care, should the Veterans Administration be required to participate in this approach? We can focus more on outcomes in veteran care, but does VA have enough resources to do this?
With the recent hiring freeze of 90 days that has since been lifted, civil service hiring maintaining a model that is no longer effective in government and at VA, and an infrastructure at various VA facilities aged to the point of health and safety being a major concern to both employees and veterans. We are and have been focused on outcomes but only to an extent, and this may take much more time to improve than we currently vision.
The Veterans Access, Choice, and Accountability Act of 2014 was a new beginning to reducing wait times at VA. While Secretary Robert McDonald and Deputy Secretary Robert Sloan were central to the needs of veterans and employees, and their approaches did improve wait times, the cost to the government for this program was over $6 billion.
The Choice Program was offered to all qualifying veterans, and would be seen as a step in the right direction to ease the burden of those providers who appeared to report burnout due to having large panel sizes. The Choice Program would also make a case to senior level leadership at each facility that more funding could be put toward hiring providers. As this was the intent, the reality was somewhat skewed.
VA does extraordinary work to care for the millions of veterans nationwide. With an aging veteran population and a compromised public health environment, VA has resources to care for veterans and sufficiently respond to adverse events. However, more still needs to be done. Medical budgets have been proposed to increase under the Trump administration by at least 6 percent in 2018. However, Secretary Dr. David Shulkin has also recognized that the Choice Program is unsuccessful in providing veterans with timely, effective, and efficient care using community clinics, centers, and providers.
There is no doubt VA needs to increase public and private partnerships in the future for the benefit of veterans, their families, and the American public. Can we do this with a concerned Congress and a low morale amongst employees? Privatization is not the answer.
The Secretary has worked diligently to reach the public and reassure VA is doing everything possible to manage care for over 9 million veterans nationwide. The new proposal for a “Choice Act 2.0” would remove the 40-mile radius and greater than 30-day wait time for an appointment. This would result in more veterans having the choice to be seen in communities whenever and wherever they choose and asking Congress for significant funding to support this. Is this a step toward privatization? Asking for additional, large scale funding to support veterans receiving care in the communities would not allow us to instead use this for fixing VA facilities, both externally and internally.
We need to invest in VA if we want to keep VA. I think having a primary agenda to fix VA is the answer.
This all begins with a bipartisan congressional agenda to reduce waste and spending, centralize all senior leadership hiring and spending at VA Central Offices, instituting a “Rising, Young VA Employee Leadership Council” who meets quarterly and reports to the Secretary with talking points and innovative ideas, and instead trying to bring people together to be more veteran centric.
President Trump has promised veterans and the American public that the VA crisis would be fixed. I think having a team who intends to save VA for future operability can make a difference. Identifying and doing everything possible to retain employees and future leaders at the Department will make a difference in the future of the Department.
Andrew Vernon, M.Ed. is an employee with the U.S. Department of Veterans Affairs. A U.S. Army veteran, he is board member of the U.S. Selective Service System. A Presque Isle native, he will complete his master of health care administration in health policy and management degree at Columbia University in December, 2017.
