POSTED BY: TOM PHILPOTT, SEPTEMBER 8,
2016
PREDICTION:
By
the second quarter of 2017, The VA Health Administration (VHA) will be well on
its way toward “privatization". The Commission on Care was chartered by
Congress. Most of our elected Officials and many prominent private citizens are
fully behind this movement. They have very quietly made extraordinary progress
toward their goal of enriching the private health systems with the money they
will receive from the Federal Government for enrolling Veterans. I had to read
this twice to make sure I wasn't missing something extremely important to
Veterans; Mental Health Care. The 'Commission on Care' report to Congress does not
address this at all. There is a way to remedy the problems inside the
Department of Veterans Affairs. It seems that no one involved in this has any
desire to do the right thing for Veterans. It's going to be a dark day for our
Nation's Veteran population when this report morphs into Law and practice.
Military Update: Commission on Care leaders defended their tough diagnosis and 18-point treatment plan for what ails the VA Healthcare system, including their controversial push to let veterans begin to choose their own primary care doctors from new, integrated networks of VA and private-sector physicians.
Answering critics who say they went too far or not far enough in proposing to transform the Veterans Health Administration (VHA) over the next 20 years, Commission Chair Nancy Schlichting, Chief
Executive Officer of the Henry Ford Health System in Detroit, and Vice Chair Dr. Delos “Toby” Cosgrove, CEO of worldwide Cleveland Clinic hospitals, warned the House Veterans Affairs Committee on Wednesday that VHA is rife with weaknesses. TheThe many “glaring problems,” said Schlichting, include under staffing,aging facilities, obsolete information technology, flawed operating processes, supply chain weaknesses and health outcomes that vary across VHA, all of which “threaten the long-term viability of the system.” Yet VHA’s ability to transform is most hampered by “lack of leadership continuity and strategic focus,” and “a culture of fear and risk aversion,” she said.
By having only two of 15 Commissioners
from the Congressionally chartered panel testify allowed committee members to
focus on what a majority of industry health experts recommend, rather than complaints
of Veterans’ service groups defending the status quo or the unpopular notion of
dismantling the VHA system as backed by the billionaire Koch brothers.
But
Rep. Jeff Miller (R-Fla.), the Committee Chair who will retire in January,
added his own list of VHA weaknesses that have been the focus of House Committee
hearings and press releases: “persistent access failures, noncompliance with
federal prompt pay laws, lack of accountability, a bloated and self-preserving
bureaucracy, and billions of taxpayer dollars lost to financial mismanagement
of construction projects, IT programs, bonuses for poor performing employees.”
The list, Miller said, is “legion and growing.”
But, Miller on one issue
joined with the Obama administration and most Veteran service organizations. He
opposes the Commission’s call to establish a new layer of VHA oversight — a Board
of Directors comprised of health industry experts who would have authority to
direct VHA transformation, set long-term health care strategy and ensure both
are carried out by a VA Under Secretary of Health who would be appointed for
five-year fixed terms.
“Outsourcing the crucial
role of a Cabinet Secretary to an independent board…neither elected nor
accountable to the American people would be irresponsible and inappropriate,
not to mention unconstitutional,” Miller said.
But, Takano, on behalf Veterans’
groups, criticized the Commission’s call to integrate VA medical staff with
networks of screened private care physicians, to allow enrolled Veterans to
choose their own primary care doctors, and to allow their providers in turn to
manage all care including referrals to specialists on VA staffs or approved
outside networks.
The
worry, Takano said, is that too many Veterans will choose private sector care,
driving up VA costs and jeopardizing “the viability of unique VA health
services” to treat spinal cord injuries, polytrauma cases, amputee care,
blindness or traumatic brain injuries. Why didn’t the Commission recommend that
its expanded “choice” model be tested initially to determine the impact on VA
budgets and programs, he asked.
Commissioners did discuss
a phased approach to include testing, Schlichting said, and that is reasonable
considering the complexity of implementing these reforms.
“It’s important to
balance this question of choice — making sure access is really available within
every market across the country — with the issue of how we’re trying to also
control those networks to better serve Veterans,” the commission chair said.
“Finding that balance is really important.”
Schlichting
recalled heated commission debates over how and why to expand patient choice
using the private sector. In the end a consensus of commissioners believe they
have hit a “sweet spot” for expanding choice by preserving VA system strengths
while also allowing access to outside providers carefully screened to provide
quality and Veteran-centric care.
The commission would allow VA-enrolled Veterans
to pick a private care provider even when a doctor was available inside VA.
What data did the commission rely on to decide that would be okay, Takano
wanted to know.
“If you begin to the
think of the VHA care system in the way we did,” Schlichting said, then “it’s
not a question of VA versus provider-in-the-community. It’s one system that
should be operating in a much more integrated way. And every provider within
that VHA care system then would be able to provide access for Veterans. It’s a
different mindset than today.”
Neither of those
commissioners, Schlichting said, “has ever implemented a major change in a
health system as Dr. Cosgrove and I have. I think we recognize the
transformative aspects of what we’re proposing.”
If
Congress embraces recommendations from a majority of commissioners, she said,
it would begin a “process that will take many, many years to complete,
recognizing the complexities of both facilities and staffing issues and
leadership [and] IT interoperability…And to say that what we’re proposing is
not transformative I think is just untrue.”
Cosgrove,
a former Air Force surgeon, emphasized that a first step toward transforming VA
health care must be replacing a woefully outdated electronic health records
system with an off-the-shelf commercial system that allow providers and
patients to schedule their own appointments.
He and Schlichting also
stressed that VHA can’t be transformed without an Undersecretary for Health who
sticks around, and the backing of some sort of oversight team of experts to
demand adherence to sustained progress. Congressional oversight, they argued,
just isn’t enough.
THE MILITARY.COM GUIDE TO MILITARY AND
VETERANS’ BENEFITS
CTRL
& CLICK ON LINK:
https://www.military.com/benefits
