An Idea Whose Time Has Come?

BY PETE PETERSON, CHAIR,
AND GOVERNMENT AFFAIRS STAFF

The VA is the second largest federal department, trailing only the Department of Defense in number of employees and budget. It comprises three separate entities: the Veterans Benefits Administration, the Veterans Health Administration, and the National Cemetery Administration. If H.R.5644 and S.2768 gain traction, several programs and initiatives may fall under the rubric of a fourth: the Veterans Economic Opportunity and Transition Administration.

This bill, introduced in the House by Rep. Brad Wenstrup (R-Ohio) and in the Senate by Marco Rubio (R-Fla.) and Maggie Hassan (D-N.H.), has been dubbed the Veterans’ Education, Transition, and Opportunity Prioritization Plan—the VET OPP Act of 2018. It would oversee economic opportunity assistance programs for veterans, their dependents, and survivors. It would be headed by an under secretary nominated by the President and confirmed by the Senate.

This administration would take charge of a number of programs currently under the auspices of the VBA. These include vocational rehabilitation and employment programs; housing and loan programs; educational assistance programs; and the verification of small businesses owned and controlled by veterans. It would also bring DoD’s Transition Assistance Program into the fold. It would not, however, remove employment assistance programs for veterans from the U.S. Department of Labor.

This legislation would relieve the oft-beleaguered VBA of responsibility for these programs, which is why creation of such an entity has been one of VVA’s top legislative priorities for the past eight years. We’ve long held that veterans would be far better served if programs related to economic opportunity were organized into their own administration, freeing VBA to focus on essential missions related to claims and appeals for disability compensation.

We’re working with Student Veterans of America and a growing coalition of military and veterans organizations—the Independent Budget, comprising the VFW, DAV, and PVA, has endorsed the essential concept in the past few years—to improve the organization of the VA so that it can better serve veterans now and in the future. The VET OPP Act was scheduled for subcommittee mark-up the week of June 11, and mark up by the full House Veterans’ Affairs Committee for early July.

The chair of the Senate Veterans’ Affairs Committee, Johnny Isakson (R-Ga.), and his counterpart in the House, Rep. Phil Roe (R-Tenn.), are the latest to lead the effort to improve the lives of the veterans they serve.

This year, on the cusp of Memorial Day, they used their considerable political prowess to pass S.2372, the John S. McCain III, Daniel K. Akaka, and Samuel R. Johnson VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act.

This VA MISSION Act is a “minibus.” It consolidates VA community care programs, allowing veterans to receive health care services from private hospitals and doctors. But it does not permit unfettered choice so that veterans can go to whatever private health care provider they choose, with the VA picking up the tab.

The bill also authorizes and appropriates funding to continue the Veterans Choice Program until the new, streamlined Veterans Community Care Program established by this legislation is implemented.

Provisions should improve VA’s ability to hire health care professionals, expand caregiver benefits to catastrophically damaged veterans of all eras, and establish a process to evaluate and reform VA facilities.

In addition, the legislation removes barriers for VA clinicians to practice telemedicine, strengthens processes for prescribing opioids, and eliminates impediments to hiring and retention of VA health care professionals.

The VA MISSION Act was passed by the House of Representatives by a vote of 347-70 and by the Senate, 92-5. Thirty-eight veterans and military advocacy organizations, including VVA, wrote to the House and Senate in support of the Act.

Despite the good feeling engendered by the passage of this landmark legislation, some see clouds on the horizon. Even modest increases to the existing degree of privatization of health care services creates a slippery fiscal slope that can have an impact on the VHA’s ability to attract top medical professionals, even though the new law authorizes additional funds to recruit new VA doctors.

In fact, warned VVA President John Rowan in a June press release, “We are concerned that the VA MISSION Act, the $55 billion spending package, will fall short of accomplishing its intended goals. While we applaud aspects of the bill which serve the needs of our veterans today, of grave concern is the Government Accountability Office’s finding issued the first week of June 2018 that the Veterans Health Administration and the VA medical centers are not able to respond to the needs of the Choice Program because of inadequacies of networks, geographic distribution, and insufficient numbers of community providers.

“Allocating a mere 120 days for the development of regulations to guide the implementation of this massive and complicated overhaul is irrational and unrealistic,” Rowan noted.

“Will Congress still retain authority over this proposed shadow health care delivery system? Oversight with accountability is not spelled out to our satisfaction in this legislation. Who will be responsible? How will it be accomplished? Will HIPAA affect the exchange of information called for in the legislation? What are the penalties for violation of standards of care, malpractice, accreditation, and credentialing of private providers, waste, fraud and abuse?”

Capacity, as noted in the GAO Report, also is a major concern. “How many veterans will actually receive care?” said Rowan. “Expanding the scope of the programs and services of Choice without a firm foundation is a recipe for disaster which will ultimately cheat veterans out of the healthcare they have earned and deserve.”

MISSION’s rosy prognosis will fade if runaway costs to pay for private care blight the overwhelming endorsement of the bill. If the VA is faced with the reality of having to cut back on the services it provides to pay for outside providers, or drastically pare back who is eligible to receive care, Congress will have to rethink its endorsement of privatization, however limited this might be.

At last the VA has officially contracted with Cerner, the same IT giant reworking and upgrading the Defense Department’s system, to overhaul its legacy Vista EHR (Electronic Health Record) system.

It seems the interoperability concerns and staffing shake-ups that have left the contract in limbo for a year after former VA Secretary David Shulkin decided to go with Cerner, have been resolved to the administration’s satisfaction.

The Cerner EHR at the VA will closely parallel the EHR currently in the pilot phase at DoD. Officials at both departments are working together to impart lessons learned into the VA project. It is not all clear sailing, however.

A new and improved, easily updatable IT operation must take into account the special needs of veterans such as mental health. If successful, this will allow seamless data sharing between VA and DoD—and between VA and community providers.

Both systems need to include a complete military history for each service member/veteran, including branch of service, where the individual served, dates of service, MOS, and any special circumstances/activities/events/exposures. Further, every record needs to be coded based on the answers to these questions.

The project is slated to cost $10 billion over the next ten years, with an initial budget of $782 million for Fiscal Year 2018. No one should be taken aback if the development of a safe, reliable EHR that protects veterans’ personal and health information encounters costly glitches along its ten-year development. And, considering the track record of VA—and DoD—initiatives, no one ought to be surprised if the $10 billion cost burgeons by several billion dollars.