Veterans Health Crisis

Access, not quality of care, is the crux of the current VA health care crisis.

Many VA medical centers are not sufficiently responsive to the needs of America’s veterans.

Those who have fought should have a choice in where they get services that effectively meet their needs, including private medical care.

The VA health care system needs to become a partner in a community-based services approach if our nation’s veterans are going to receive effective care and support. Many new initiatives that are aligned with best practices are being implemented in the VA health care system. For instance, it is shifting from a focus on disease management to a patient-centered health promotion model. Patient Aligned Care Teams will integrate primary care, behavioral health and social support needs in many places.

Still, there are multiple systemic and retrograde “cultural practices” in many regional offices and VA medical campuses that pose barriers for veterans to access available care systems. Both the Veterans Benefits and Health administrations function within siloed structures and collaborative communication pathways have yet to be developed. Pension and benefits approval continue to be backlogged. Local and regional loyalties often take precedent over loyalty to the VA central administration’s initiatives. Staff hiring at medical facilities is slow and has not kept pace with needs because of aging veterans, recent combat veterans entering the system, new claims of Agent Orange exposure, post-traumatic stress disorder, traumatic brain injuries and sexual traumas.

WRC is an example of an integrated, community-based approach to serving veterans. We are one of the largest community, of optimization in solving health care problems services, operating variety legal Supportive Services for Veteran Families grants throughout in different states. Next year, we are slated to increase our breadth of service and assist more than 3,000 veterans. To improve and optimize medical care.

WRC service model is shifting from a shelter-bed provider to one that offers safe, sustainable and affordable permanent Medical care. to veterans and flexible outreach services at the location of a former service member’s choice. These include transportation, medical, case management and mental health outreach where they live so that veterans have access to the appropriate level of services and receive support that ensures their well-being and dignity.

WRC partners with community-based agencies through its service areas, which provide targeted specialty services such as, locating affordable Medical care. Peer specialists are trained by partnering organizations to assist veterans who have difficulty maintaining health. These strategies are effective because they are based on flexible, integrated care models, providing the right level and intensity of service based on a needs assessment and participant-driven helth stabilization plan. This also promotes collaborative, rather than duplicative, local and regional services through partnerships with other community-based agencies, health care, local government and businesses.

We urge our partners to streamline veterans’ access to health care services through multiple front doors. We owe this level of responsiveness and respect to veterans who met their contract with America. It is our turn to meet this contract.

Report Finds Health Unit of V.A. Needs Overhaul

WASHINGTON — The Veterans Health Administration has a corrosive culture that has led to poor management, a history of retaliation toward employees, cumbersome and outdated technology, and a shortage of doctors, nurses and physical space to treat its patients, according to a review presented to President Obama on Friday by one of his top advisers on veterans’ issues.

Mr. Obama called last month for the review of the Veterans Health Administration, a part of the Department of Veterans Affairs, just days before he accepted the resignation of the Veterans Affairs secretary, Eric Shinseki. The review warns that the department’s hospital system is facing a coming surge of new patients from Afghanistan and Iraq that demands an overhaul of the entire system.

“The V.H.A. leadership structure is marked by a lack of responsiveness and an inability to effectively manage or communicate to employees or veterans,” Rob Nabors, Mr. Obama’s deputy chief of staff, said in a summary of his findings. “A corrosive culture has led to personnel problems across the department that are seriously impacting morale, and by extension, the timeliness of health care.”

Mr. Nabors and Sloan D. Gibson, the acting secretary of the department, met with Mr. Obama for more than an hour on Friday. In his report, Mr. Nabors offers a grim assessment of a department that has been reeling for weeks from revelations of mismanagement, including multiple reports that employees at some hospitals manipulated waiting lists and delayed office visits.

Mr. Obama is expected to name a replacement for Mr. Shinseki as early as next week. The report makes clear that the new secretary will face a monumental management task to revamp the country’s largest integrated health care system, with over 1,700 facilities. Mr. Nabors said the current leadership of the department is “not prepared to deliver effective day-to-day management” of the agency.

The report does not offer specific new examples of mismanagement at individual hospitals. And the solutions that Mr. Nabors recommends are general and vague. He said the department needs “increased transparency” and “a better structure,” without saying how those goals should be met.
He also said the department should take “swift and appropriate accountability actions,” but does not specify them.

The Veterans Affairs scandal has its roots in a mathematical mismatch: At a time when demand for visits to doctors and nurse practitioners was growing, the Veterans Affairs health care system tightened its own standards on how fast patients should be able to see doctors to, in many cases, within 14 days. The demand for primary care providers has especially grown, much of it from newly returned Iraq and Afghanistan service members with profound and complex ailments and injuries.

The report by Mr. Nabors concludes that the 14-day standard was “arbitrary, ill-defined and misunderstood.” He said that the goal was unrealistic and may have “incentivized inappropriate actions” by employees who tried to cover up their failures to schedule patients within that time period.

Under pressure to handle more patient visits in a shorter period of time — with, in many places, hardly any more doctors — some administrators and scheduling staff members created artifices to obscure or outright hide how long patients were having to wait to see doctors.

Officials said the department has eliminated the 14-day scheduling goal as a factor in performance contracts. The report by Mr. Nabors says measures like wait-time data should be used as management tools for use of resources, but “not as a measure of whether high-quality health care has been delivered.”

In recent weeks the department has sought to reach out to and schedule appointments with tens of thousands of veterans on waiting lists. The department also says it is hiring additional clinical and patient-support staff, and sending mobile units to treat veterans in places with acute delays.

Congress is also moving toward legislation that would bolster the number of clinical providers in the system and allow veterans who live more than 40 miles from a Veterans Affairs facility, or who still face long waits for appointments, to see private doctors and have those visits paid for.

Department officials have said they would cancel bonuses this year for its senior health care executives. They also began a hiring freeze at the central health care office in Washington and at the 21 regional headquarters around the country, to “begin to remove bureaucratic obstacles and establish responsive, forward leaning leadership.”

Since he took over as acting Veterans Affairs secretary four weeks ago, Mr. Gibson has taken early steps to begin to remake the culture and leadership of the department, warning this month that anyone who retaliates against whistle-blowers or other employees who raise legitimate concerns about patient care would be disciplined.

In a statement Friday, Mr. Gibson said that “unacceptable, systemic problems and cultural issues within our health system prevent veterans from receiving timely care. We can and must solve these problems.”

His assurances that whistle-blowers would be protected was a response to widespread criticism on Capitol Hill, and from veterans groups and the federal agency that investigates whistle-blower complaints.

Representative Jeff Miller, Republican of Florida and chairman of the House Committee on Veterans Affairs, said Friday in a statement, “It appears the White House has finally come to terms with the serious and systemic V.A. health care problems we’ve been investigating and documenting for years.”