How To Fix the Department of Veterans Affairs? Let Us Count the Ways …

How To Fix the Department of Veterans Affairs? Let Us Count the Ways …

If you were to perform a search on Google for the phrase “how to fix the VA”, you’ll be returned no less than 190 million results. Surely one of them has to work, right?

Ideas are popping up over the Web at the moment, and not everyone agrees on what that “fix” is. Here are a few (and most, but not all, require money … lots and lots of money):

New blood, veteran blood

David Gergen, CNN
Former advisor to Presidents Nixon, Ford, Reagan and Clinton

“The point is that the VA desperately needs a leader who can overhaul an agency notoriously resistant to change, someone who knows a lot about military culture. After Gates, the next best choice is likely to be his last deputy at DOD, Ashton Carter. (Disclosure: Carter is a friend and esteemed colleague from the Kennedy School.) Carter won very high marks among civilians and military as deputy secretary, the person who “runs the building.” . . . .

Even so, this is not a one-person job. A new secretary will need reinforcements. There are none better than some of the veterans who have come back from Iraq and Afghanistan, peeled off their uniforms, and volunteered to continue their service as civilians — rightful heirs of the World War II generation.”

A list of four

Jordan Carney and Stacy Kaper, National Journal

1. Congress could ask doctors — not veterans — to handle the paperwork.
2. Congress could require the VA to give more veterans the benefit of the doubt.
3. The VA could start rewarding its employees for quality, not quantity.
4. Congress can pressure the Pentagon and the VA to share electronic files.

A list of six

Phillip Carter, Slate

1. Give the VA the resources it needs. “Even with its massive $60 billion health care budget, the VA arguably lacks the funding it needs to treat all veterans.”
2. Allocate VA resources more smartly. “The next secretary needs congressional support to shrink or close underutilized VA facilities, build or lease new clinics (favoring outpatient clinics instead of large hospitals, following the overall direction of American health care), and move VA personnel between facilities to reflect where veterans live now, and where they need care.”
3. Restructure the VA health care system. “The VA divides its health system of 151 hospitals and 820 clinics into 23 regions that don’t align with any other geographic scheme within the federal government. These regions lack the leadership, staff capacity, and authority they need to oversee health care facilities.”
4. Rebuild the VA’s healthcare IT system. “The VA’s antiquated systems contributed to the chaos in Phoenix where, reportedly, front-line employees used DOS-based systems to manage appointments and clinical resources.”
5. Integrate better with the private and nonprofit sector. “Provide veterans with “continuity of care” wherever they get seen.”
6. Build a bridge across the Potomac. “The Department of Defense and the VA failed to create an integrated health records system (or separate systems that would talk to each other), and have failed more broadly to synchronize and align the two agencies’ care for veterans, service members, and military families. The redundancies between these two agencies cost the taxpayers billions of dollars each year, and worse, create gaps for veterans to fall into, such as when claims submitted to the VA can’t be substantiated for lack of Pentagon service records.”

Two for free, one that costs money

German Lopez,

1. Better focus performance incentives. “It’s time for the VA to step back and find the big health measures it wants to focus on, instead of trying to rely on so many complicated metrics all at once.”
2. More transparency and humility could lead to better scrutiny. “To accomplish this, the VA could take greater part in performance-reporting initiatives and expand learning-and-improvement partnerships with outside entities.”
3. The VA could step up its recruitment. “The roots of the VA’s doctor shortage are two-fold: One, physicians can get paid as little as half of what they could make in a private practice. Two, the VA isn’t aggressive enough in its recruitment or in efforts to combat its stigma of bureaucracy.”

Have VA do what it does best, let someone else do the rest

Editorial, BloombergView

“The best way forward is to combine the two approaches: Strengthen the VA’s ability to do what it’s good at and widen veterans’ access to services that don’t demand its expertise.

“To start, that means differentiating between primary and specialty care. The inspector general’s report focused on wait times for primary care, suggesting that’s where the most pressing shortage is. If so, the VA could address much of the problem by paying for primary-care visits with private doctors when timely appointments aren’t available at its own facilities.

“Veterans would continue to rely mostly on VA doctors for specialty care. Congress should ensure those specialists are available by providing more funds where they’re needed.

“For this to work, effective cost control will be crucial. The VA could save money by building a network of civilian health-care providers. Tricare, which provides health benefits to some retired military personnel, pays for outside care when appointments aren’t quickly available at military facilities. And it controls costs by imposing maximum allowable charges through its network of outside providers.”

GOP Weighs In

Brett Loguirato, Business Insider

“The [GOP] leaders tell Obama [in a letter to him] to support recently passed House legislation providing the VA Secretary with the ability to fire or demote senior officials at VA facilities. They urge him to cooperate with House and Senate investigations into the issues at the agency and scold the administration for failing, at times, to provide timely information.

And they say he should find an immediate solution to veterans stuck on waiting lists for care throughout the country, arguing veterans should be able to access care outside the “corrupt” VA system if necessary.”

And according to Google, there may be 189 million other ideas.

What’s yours?