WSJ VA Needs ‘Systemwide Reworking,’ Independent Report Finds Congressionally mandated independent review of Veterans Affairs health-care system identifies widespread problems

Apropos the article a friend reminded me of this YouTube clip:

As noted in the article I do hope this comes to pass: “The independent assessment highlighted systemic, critical problems,” the report said. “Solving these problems will demand far-reaching and complex changes that, when taken together, amount to no less than a systemwide reworking of VHA.” Privatization is often cited as the answer. However, privatization is a simplistic solution to a complex problem. The article points out legitimate flaws needing major changes. These flaws must be fixed – we need a massive reboot, better integration, improved accountability and customer service, not elimination.​

Updated Sept. 18, 2015 5:53 p.m. ET

A sweeping independent review of the Department of Veterans Affairs health-care system made public Friday shows the multibillion-dollar agency has significant flaws, including a bloated bureaucracy, problems with leadership and a potentially unsustainable capital budget.
More than a dozen assessments—from analysts including Mitre Corp., Rand Corp. and McKinsey & Co.—show that the Veterans Heath Administration, the health-care arm of the department known as VHA, is still plagued by long-standing issues, including unsustainable costs in the future and a system that veterans find tough to navigate.

The assessments, weighing in at more than 4,000 pages total, were mandated by the Veterans Access, Choice and Accountability Act, commonly known as the Veterans Choice Act, a more than $16 billion emergency funding measure passed last summer in the wake of a systemwide scandal at the VA that led to the resignation of a number of top officials, including then-Secretary Eric Shinseki. They appear to restate, more thoroughly, many issues that have been previously identified. The assessments will be used by the Commission on Care, also mandated by the act, which is tasked with presenting the VA and Congress a comprehensive reform plan in early 2016.

“The report bears out collectively what I have seen individually, what I have seen in my role as chairman over the past nine months,” said Sen. Johnny Isakson (R., Ga.), chairman of the Senate Committee on Veterans’ Affairs. “There is a huge focus on some glaring deficiencies that need to be addressed.”
Mr. Isakson said the VA suffers especially from a system saddled with a number of different departments that can’t effectively talk with each other, as well as a number of vacancies in leadership positions that need to be filled, though he said the department has been working to correct a number of issues.
“VA is undergoing a radical transformation,” the department said in response to the findings, pointing out a number of efforts to address problems highlighted in the assessments. “VA will work with Congress, veterans service organizations, veterans, and other stakeholders on the recommendations outlined in the Independent Assessment Final Report. VA will especially work closely with Congress on those final report recommendations that specify specific congressional action needed to implement.”
The assessments found VA care outperformed non-VA care by many measures but also showed a system that needs even more change.
“The independent assessment highlighted systemic, critical problems,” the report said. “Solving these problems will demand far-reaching and complex changes that, when taken together, amount to no less than a systemwide reworking of VHA.”
With an annual budget of some $60 billion, 1,600 health-care sites and 300,000 employees, the VHA says it is the largest integrated health-care system in the U.S. Last year, nearly 6 million veterans were treated in the system.
The reports portray the VA as a huge operation that has become difficult to steer and permeated by a bureaucratic system plagued by mismanagement and inconsistent care from hospital to hospital.
“It’s pretty bad for VHA, it’s pretty stinging,” said a senior staff member of the Senate Committee on Veterans’ Affairs. “There’s nothing in here that has surprised me, but seeing it all in one place is probably the hardest thing.”
“They’ll push out a directive and they won’t follow-up to see how it’s implemented,” the congressional staffer said, adding that a large number of leadership positions in the organization remain unfilled or staffed by interim employees.
The report shows that the central office has grown 160% over the past five years, yet key leadership positions down the chain remain empty. More than half of the executives in the organization are eligible for retirement and could leave at any time, which could create even more leadership gaps.
The lengthy and critical reports come as the VA faces questions over whether it should allow more veterans to go outside of the system to receive private care. Recently, according to the assessments, health care obtained outside of the VA accounts for about 10% of VHA expenditures. The Veterans Choice Act of last year was built in large part around funding this type of care.
Questions about further privatization were highlighted recently when Ben Carson, a leading Republican presidential candidate and physician, suggested the VA make a push toward privatization and elimination of the VHA, its health-care delivery arm.
Earlier this week, a number of major veterans groups sent an open letter to Mr. Carson stressing the need to keep the VHA solvent.
The assessments released Friday unfavorably compared the VA’s management style to a number of private health-care providers like Kaiser Permanente.
Sen. Isakson said the Veterans Choice Act, which allows veterans more leeway in seeking care outside the VA, was an emergency measure and not something meant to steer the VA down a privatized path. “The Choice program, contrary to what everyone thought, was not a sinister program to privatize the VA.”
Robert McDonald, who took over as VA secretary last summer, has been praised by many in Congress as well as most major veterans groups for his efforts to reform the VA and his willingness to listen to patients and workers. But he has also been criticized for things like moving too slowly in firing underperforming employees and not supporting efforts to create an environment where employees can point out wrongdoing in the department. Mr. McDonald has said multiple times in the past that he is forcing out bad actors as quickly as possible.
“As a general matter, the president has made it a priority to ensure that America’s veterans are getting the kind of health care and benefits they have so richly earned,” White House press secretary Josh Earnest said Friday, saying he had not seen the substance of the report.
Mr. Earnest said that some of the reforms at the VA have already begun to show progress in improving care.
“But the president, Secretary McDonald and other senior officials at the VA are not going to rest until we have accomplished our goal of making sure that all our veterans are getting the kind of care that they deserve, on time,” Mr. Earnest said.
On Thursday, the U.S. Office of Special Counsel, an independent federal watchdog tasked with protecting government employees, especially whistleblowers, sent a letter to President Barack Obama criticizing what they said was the VA’s reluctance to take disciplinary action against officials responsible for inadequate patient care.
“I have identified recent additional cases in which the VA confirmed serious misconduct brought to light by whistleblowers, yet failed to appropriately discipline responsible officials,” said Carolyn Lerner, the head of the office. Her office criticized the VA for punishing whistleblowers while not punishing those who engaged in misconduct.
“Over the past year, the Department of Veterans Affairs has worked closely and in good faith with the Office of Special Counsel to correct deficiencies in the department’s processes and programs to ensure fair treatment for any whistleblower who raises a hand to identify a problem, make a suggestion or report what may be a violation in law,” the department said in a statement.
Access to VA care has increased dramatically since the mid-1990s, the report said, as changes in policy opened up the system to include not just combat-wounded veterans but many others who have served. Former Secretary Shinseki pushed to have veterans take advantage of their benefits and increased access to those like Vietnam veterans exposed to Agent Orange.
Although the VA has other departments, including a benefits arm, the VHA accounts for nearly 90% of the department’s discretionary budget and employee base. While the total population of veterans in the U.S. peaked around 1980 at 30 million and has declined since then, according to the report, demand for VA care has been steadily increasing as greater numbers of vets take advantage of benefits. The number of enrollees and patients isn’t expected to peak until 2019.
Write to Ben Kesling at