Trump’s VA secretary pick could offer hint on privatization (The Wall Street Journal)
U.S. military veterans’ groups are closely watching for signs of President-elect Donald Trump’s decision on a Veterans Affairs secretary, with some concerned over the prospect of an accelerated move under the new administration toward the privatization of medical care. Officials with Mr. Trump’s transition team said he is considering pushing the Department of Veterans Affairs toward what they said would be a public-private model, prompting some major veterans groups and lawmakers to say they would oppose any such move. Mr. Trump hasn’t released details for proposed changes at the department, which already pays for some veterans health care at private hospitals and clinics. That growing system is struggling with costs and logistics as officials at the department have expanded private-care coverage. “We think we have to have kind of a public-private option, because some vets love the VA, some vets want to go to the VA, so, the idea is to come up with a solution that solves the problem,” a senior Trump transition official told reporters last week. “You know, in the federal government, it’s hard to break things up and start over.” Use of the private sector to provide care for veterans was put in place following World War II, for when the VA couldn’t quickly or effectively deliver care. That system has expanded, and the department last year spent 17% of its health-care budget on private-sector care. The trend toward private care accelerated under the Obama administration. Following revelations in 2014 of long appointment wait times, employee malfeasance and poor patient care, Congress added billions more in emergency funds for private care. Nearly one-third of VA appointments are now in the private sector, up from fewer than 20% in 2014, according to VA Secretary Robert McDonald. In 2016, the VA tallied more-than $11 billion in care in the private sector, or nearly 17% of its health-care costs, according to VA numbers. That translated to more than 25 million appointments outside of the VA system. The Trump administration could move further toward privatization. Transition officials and people who have met multiple times with Mr. Trump publicly advocate for a system where veterans would be free to choose care in the private sector instead of at VA facilities. Mr. Trump made veterans issues a major component of his presidential campaign and called for greater privatization in his public appearances. But many veterans groups, and the department itself, say a quicker move toward a private-sector care program risks leaving former military members navigating a system that isn’t necessarily equipped to handle unique problems including post-traumatic stress and injuries sustained on the battlefield. Sen. Bernie Sanders of Vermont, former chairman of the Senate Committee on Veterans Affairs, promised in a statement to “vigorously oppose” such proposals, joining other key lawmakers and some major veterans groups. “Private care can complement but never replace the continuity and continuum of care that the VA currently provides our nation’s veterans,” said Joe Davis, spokesman for Veterans of Foreign Wars. Mr. Trump has yet to name his nominee for VA secretary. A number of national veterans groups urged him to keep Mr. McDonald, but Mr. Trump has been critical of the department under his leadership and given no indication he will retain him. A senior official at the VA said Wednesday that Mr. Trump hasn’t had a conversation with Mr. McDonald. On Tuesday, Mr. Trump met with Leo Mackay, a former deputy secretary of the VA and Navy pilot, the latest potential candidate. No matter Mr. Trump’s eventual plan, the VA’s system for providing private care needs improvement, say agency officials and outside watchdogs. For instance, in 2015, the VA, as primary payer, made on-time payments to private providers only two-thirds of the time, according to a Government Accountability Office report in May. Two other major government insurance programs, Medicare and Tricare, made 99% of their payments on time, according to the report. The VA likely can’t fix the payment program until 2018 or later, the report said, and risks alienating and losing private providers in the process. Department officials acknowledge private care is integral to serving veterans and is likely to expand in the future. The VA also has launched an initiative to consolidate and improve delivery of private care. “If we’re going to maintain a system where we have both VA care and private care, we have to find the equilibrium between the two,” Mr. McDonald said in an interview. He added that the department needs to make changes gradually. “In my mind, you evolve to a place,” he said. “You don’t go there automatically.” Mr. Trump has met several times with Toby Cosgrove, chief executive of the Cleveland Clinic and a veteran himself, who supported an interim proposal by a group within a congressional commission after the 2014 scandal that veterans be given the ability to choose between VA or private care. That proposal eventually was scuttled in part because of vocal opposition by a number of national veterans groups, including Disabled American Veterans and Paralyzed Veterans of America. Over the holidays, Dr. Cosgrove removed his name from consideration as VA secretary, citing commitments to the Cleveland Clinic. The interim commission’s proposal also was supported by Darin Selnick, an official with the president-elect’s transition team who is affiliated with Concerned Veterans for America, a group that in 2015 proposed allowing veterans to use federal health-care funds anywhere they choose, though they would have to pay fees for care outside a VA facility. Pete Hegseth, the former CEO of Concerned Veterans for America, has met multiple times with Mr. Trump, and at least once brought a copy of the group’s proposal to Trump Tower. Messrs. Selnick and Hegseth declined to comment, and Trump transition officials didn’t respond to requests for comment on their roles or the plans for veterans. Dan Caldwell, Concerned Veterans for America’s director of policy, said most of the VA’s contracts are temporary and the VA controls which patients qualify for outside care. “Just because the VA has some private contracts doesn’t mean that veterans have real choice,” said Mr. Caldwell. Some veterans groups, including Paralyzed Veterans of America, said they caution Mr. Trump not to put forth a plan that could leave the most vulnerable veterans behind. “Trump’s public-private plan must be contingent upon preserving and adequately resourcing specialized services,” said Tracy Shifflett, spokeswoman for the group. “These veterans cannot be overlooked in the greater plan.”
New Congress hears Trump’s campaign call, passes pair of pro-vet bills (Fox News)
President-Elect Donald Trump made U.S. veterans a top priority during the election campaign, and the incoming Congress has taken the baton, passing a pair of bills Tuesday aimed at bringing accountability to the Department of Veterans Affairs. The “Ensuring VA Employee Accountability Act,” the first bill to unanimously pass in the 115th Congress, requires the beleaguered agency to maintain current files of employee disciplinary actions throughout each employee’s tenure for review when under consideration for a bonus, promotion or other advancement. “The reason I introduced this legislation is simple—it allows the Department of Veterans Affairs to maintain accurate records of disciplinary actions against employees,” said Rep. Ryan Costello, R-Pa. “The file can then be taken into consideration when an employee is up for a promotion.” Currently, the VA only keeps disciplinary action in an employee’s file for three years before they are deleted. Costello first introduced the legislation during the last Congress, when it passed in the House, but failed in the Senate. House lawmakers moved along another bill concerning veterans in their first day in session, unanimously passing “The Biological Implant Tracking and Veterans Safety Act of 2017.” Crafted by House Veterans’ Affairs Committee Chairman Rep. Phil Roe, a Tennessee Republican and medical doctor, the legislation would direct the VA Secretary to adopt the Food and Drug Administration’s system for labeling of all biological implants and would implement an automated inventory system to ensure veterans do not receive expired or otherwise contaminated tissue. Roe’s bill comes after a Government Accountability Office 2014 report found that the VA does not use a standardized process for tracking biological tissue from cadaver donors to living veteran recipients. In the same report, the GAO detailed the Veteran Health Administration’s failure to consistently ensure it was purchasing tissue from biological implant vendors that had been registered with the FDA. “These commonsense reforms will help ensure veterans receive the quality health care they deserve while also holding VA employees who fail in their duty to care for veterans accountable,” Roe said. No vote on either bill has been scheduled in the Senate. “Our veterans should always come first, but for too long they’ve been let down by a failed system,” House Speaker Paul Ryan said in a statement. “I’m proud that our very first bills considered in the new Congress help the brave men and women who have served our country in uniform.”
Commentary: Why privatizing the VA won’t do much to help veterans (Business Insider)
You don’t often see Donald Trump pull a punch, but he did it last week. Trump spent his entire campaign deeply angered by how the government treats veterans, particularly regarding their medical care. He promised to overhaul the Veterans Administration (VA) health care system and “take care” of the vets. Everyone has interpreted this as code for privatizing the VA, a long-awaited conservative goal. But last week at Mar-a-Lago, after a meeting with health care executives about his VA plans, Trump told reporters this: “We think we have to have kind of a public-private option, because some vets love the VA. Definitely an option on the table to have a system where potentially vets can choose either/or or all private.” If the current VA system is so reviled, so horrific, so offensive in its unfair treatment of veterans, why do “some vets” love it? Why must it be preserved as a choice? Trump appears to be running up against a typical problem for those favoring total overhaul to tweaks along the edges, especially in health care: People fear change over what they have. In the case of the VA, that’s certainly true for veterans, who like the current arrangement. And it’s also true of the privatization-friendly group of experts who looked at the VA just last year. Let’s back up: The VA is a unique feature of the U.S. health care system, more reminiscent of Britain’s National Health Service. Doctors and medical personnel work directly for the VA, and it owns the facilities where they operate. The rationale is that veterans experience several common combat ailments, from traumatic brain injuries to PTSD to amputations requiring prosthetics. Centralizing care at the VA allows for specialization on the unique needs of veterans, which private hospitals lack. The VA serves more than 8.9 million veterans a year at 1,233 facilities. Trump bases his stance on the VA mostly on a 2014 scandal about backlogs for patient care and falsifications of waiting periods, which led to the dismissal of several top officials. But as The Fiscal Times’ Rob Garver explained, the VA’s new leadership has already acted to reform the system and change the agency’s culture. Pending claims are way down, virtually all VA facilities extend same-day access to care and performance exceeds the private sector by nearly every measure. On top of that, Trump’s preferred option of giving veterans the choice of VA or private care has already been implemented, with interesting lessons. After the backlog scandal, Congress passed a reform bill co-authored by Bernie Sanders, and as part of it, a pilot program gave veterans a Choice Card to use at private facilities if their local VA hospital is more than 40 miles away, or if the wait time is over 30 days. This theoretically ensures that no veteran has to wait for or be inconvenienced by seeking medical care. The rollout has been shaky, mainly because the 90-day deadline Congress demanded for setting up the system meant that the VA had to turn to private contractors with a history of botching health care management. This has led to a secondary waitlist for those seeking difficult-to-access private care, along with numerous billing errors and questions of eligibility. There was also no setup for integrating care between VA and non-VA providers, which meant veterans skipping between the two could get duplicative or substandard care. While some have predictably used this to label the VA as incompetent, it says more about the hurdles to delivering a public/private hybrid. Republicans have responded by advocating for a permanent Choice Card, allowing veterans to go to anywhere they want (oddly, they haven’t offered the same kind of single-payer card for the nation’s other 300 million-odd citizens to present at any medical facility). That mirrors the Trump plan of a “public/private option.” But that would further strain a hobbled scheme private contractors couldn’t figure out for a much smaller universe of patients. It would also double the costs of the current VA. It’s clear that conservatives expect the private market to deliver better service than any public agency. The VA, they expect, would obviously wither on the vine if challenged by the free market. These true believers have perhaps never had to navigate the private health care system and its even longer wait times; comparatively the VA looks like a dream. Republicans tried to lay the groundwork for back-door privatization. The 2014 VA reform legislation mandated a report from a bipartisan Commisson on Care on how to best redesign the VA. This was a stacked deck, widely expected to give Republicans a blue-ribbon pro-privatization report to “prove” their case. Three of the 15 commissioners were CEOs of health care companies that would financially benefit from breaking up VA hospitals; two others had ties to the Koch Brothers, who have bankrolled the privatization front group Concerned Veterans for America for years. But a funny thing happened. The final report of the Commission on Care did not endorse privatization. It recommended enlisting credentialed community provider networks to increase capacity for veterans care, integrated with the VA’s electronic medical records system. The 18 recommendations largely tracked with what VA Secretary Robert McDonald has already been implementing. When considering privatization, the commission sought feedback from the veterans themselves. Consistent with recent polling, the vets didn’t want the VA privatized. They preferred the quality of care at the VA and had problems with outsourcing treatment to non-VA providers. Veterans groups also prefer the current system. Transition officials reportedly met with 30 organizations last month, finding that they held near-unanimous opposition to privatization. American Legion Executive Director Verna Jones said of the VA recently, “there is no better care or value available anywhere in the United States — period.” So like Trump, the Commission on Care pulled its punch. When you can’t even get a commission seeded with conservative ideologues to sign off on VA privatization, it shows the formidable nature of the task. The VA continues to be demonized and maligned in conservative media, for the reading benefit of the large numbers of Americans who have no military experience. (Blaming the VA for over-prescription of opioids rather than the drug companies who relentlessly pushed them on patients as a miracle cure is just one example). But those who know and study the system find it indispensable. Maybe when Donald Trump names a VA secretary, they’ll figure that out too.
Veterans advocate: VA hospitals’ ‘improvement’ doesn’t tell whole story (Wisconsin Watchdog)
The headlines last month declared that most U.S. Department of Veterans Affairs medical centers saw improvement in fiscal year 2016. It seemed like a positive end to another rough year for the VA and the people the government-run health care system is supposed to put first. But a veterans advocate is advising news consumers to read the fine print. While the vast majority of VA hospitals did note improvement in at least one category, that doesn’t mean the broken single-payer system is anywhere near fixed, said Kevin Nicholson, a veteran of two wars and member of the Wisconsin Board of Veterans Affairs. “If you saw an individual facility that did improve a call response time, that’s great. I think we should all be rooting for the VA hospitals to improve,” Nicholson told Wisconsin Watchdog last week on the Vicki McKenna Show, on NewsTalk 1130 in Milwaukee. “But I would not go and say that 82 percent of the hospitals measured in this study saw a collective widespread improvement that would indicate a directional change in the VA that we should be extremely happy about,” he said. Last month, the department finally released its Strategic Analytics for Improvement and Learning Model report after criticizing USA Today for previously publishing the internal ratings. SAIL, as the ratings system is known, “accesses 26 quality measures in areas such as death rate, complications, and patient satisfaction, as well as overall efficiency at individual VA Medical Centers,” according to a department news release. But not all quality categories are created equally. The categories include some measures not necessarily critical to veteran care. Of the 146 medical centers rated, 120, or 82 percent, “improved” in the past year, according to the VA’s fiscal year 2016 ratings. “When they say that 82 percent of facilities saw improvement, what they are saying is amongst these  metrics, 82 percent of hospitals measured bounced up in at least one of these metrics,” Nicholson said. And one area of improvement does not a changed medical center make. The VA’s improvement metrics include a one-star to five-star rating. The Phoenix VA hospital, ground zero of a veteran care wait-time scandal, still ranked among the worst VA medical centers in the country. Wisconsin’s scandal-plagued Tomah VA Medical Center also saw a decline in its rating, dropping to three stars. In 2015, the hospital was the subject of congressional investigations for its prescription policies that led to the death of a Marine veteran. Whistleblowers said they were retaliated against, and some patients who complained were treated terribly, according to multiple sources. Most recently, the medical center earned more unwanted national attention after reports of a dentist potentially exposing hundreds of veterans to serious diseases. The real baseline metric, Nicholson said, should be real improvement at the hospitals in Phoenix and Tomah and the John D. Dingell VA Medical Center in Detroit, which like Phoenix, received a one-star rating. Phoenix, Nicholson said, is the “canary in the coal mine.” “If that individual facility has not improved given the nationwide storm that descended upon it with the problems the Phoenix VA has had, that would indicate that collectively there has been no strong directional change in the VA system,” said the Milwaukee-area conservative who is mulling a 2018 run for the U.S. Senate seat held by Madison Democrat Tammy Baldwin. “This is why I get upset with people like [President] Barack Obama, [U.S. Rep.] Nancy Pelosi and Tammy Baldwin. They just can’t turn their eyes toward these problems and just admit that, yes, there is a problem with huge government-run health care facilities,” Nicholson added. The businessman and veteran of the wars in Afghanistan and Iraq asserts that Tomah is symptomatic of a Titanic federal health system that does not have the will or the means to right the ever faltering ship. And while commendable, Tomah’s new leadership cannot solve the systemic problems of government-run health care, Nicholson said. “If you look at the bureaucratic issues that create this kind of problem in the first place, boy it would be a lot better if something like Tomah were pushed down to the state level or to the private sector where people would be held accountable much, much earlier in the process, when these problems start to pop up and we’d actually see much greater response,” Nicholson said. VA officials earlier said they did not release the internal rating because doing so “would likely confuse our veterans and the general public.” They charged that USA Today was irresponsible for publishing earlier ratings, before lawmakers applied heat on the VA to publicly release them. “It is a disservice to veterans to lead them to believe that a one-star facility means they won’t get care they need,” said David Shulkin, the VA’s under secretary for health. U.S. Reps. Debbie Dingell, D-Mich., and Tim Walberg, R-Mich., said it would be irresponsible for the VA not to release the information. “Veterans, just like every other patient, deserve to know how their hospitals are performing and what services need to be improved,” Dingell and Walberg wrote last week in a letter to VA Secretary Bob McDonald, as quoted by Stars & Stripes. “Having a secret rating system only serves to increase distrust of the VA and may give the appearance that the department has something to hide.”
New House VA panel leader to continue accountability push (FEDweek)
The incoming chairman of the House Veterans Affairs Committee, Rep. Phil Roe, R-Tenn., says he plans to continue many of the initiatives directed toward accountability of agency management and line employees pushed by his predecessor, retiring Rep. Jeff Miller, R-Fla., “As chairman, I will conduct hearings, provide oversight and work to implement policies which will put veterans back in charge of how they receive healthcare from the VA. I will be a consistent advocate for improving the quality and timeliness of care that veterans receive both in and out of VA health care facilities, as well as ensure the benefits earned by our veterans are never delayed, dismantled or reneged upon,” he said in a statement. “Holding senior managers accountable is an important step toward addressing the corrosive culture which has existed within the VA bureaucracy for far too long. Unfortunately, to date, just three employees have been fired for their involvement in the nationwide waitlist scandal – which spanned over 110 VA facilities. This is unacceptable,” he added. He listed as other priorities continued implementation of the 2014 Veterans Access, Choice and Accountability Act, which allows veterans to get care outside the VA system but funded by the VA in certain circumstances; expanding treatment for traumatic brain injury and post-traumatic stress disorder; and better coordination of medical records between DoD and VA.
Homeless veterans’ center faces eviction unless VA comes up with unpaid rent (The Denver Post)
The owners of a building in Denver’s Five Points neighborhood that houses a center for homeless veterans have said they will evict them unless the U.S. Department of Veterans Affairs comes up with unpaid rent. The VA, however, says it has actually overpaid The Matthews Center LLC, which also houses the Bo Matthews Center for Excellence at 3030 Downing St., to the tune of about $60,000 over the five years it has been there. The agency has asked the U.S. Department of Justice to intervene. William “Bo” Matthews is a former NFL running back and University of Colorado Boulder standout who retired in 1981 after an eight-year career with the San Diego Chargers, New York Giants and Miami Dolphins. TMC is run by Barbara Matthews, whose relationship to Bo is unclear. Calls to TMC were not immediately returned Wednesday. The story was first reported by CBS4 News. At issue is an undisclosed amount of money the center says it is owed by the VA, which has leased the building for the Denver VA Community Resource and Referral Center since 2012 at about $5,000 monthly. The VA received a notice of eviction, but court records show no official action has been filed. The government’s lease on the building ends on Jan. 31. “The Department of Justice is providing assistance to the VA in the form of legal counsel and the reviewing of facts in hopes of reaching a resolution,” Justice Department spokesman Jeffrey Dorschner said. The center’s program manager, Missy Mish, referred media calls to the VA’s office of public affairs. VA Eastern Colorado Healthcare Systems spokesman Daniel Warvi said the agencies are “collaborating together to resolve this as quickly as we can.” “This is a solvable issue,” he said. He would not comment on whether the VA is seeking a different location. The center is a popular place for homeless vets, who receive case management and assistance in enrolling for medical and financial benefits. It also offers showers, limited storage and laundry services, as well as employment resources. The building is not without its own troubles. There’s a history of liens filed against The Matthews Center LLC dating back to 2011, ranging from federal tax liens to unpaid sewer bills, according to documents filed with the Denver clerk and recorder’s office. A number of those liens remain unsatisfied, according to those records.
Veterans move from military force to workforce with help from start-up experts (Fox News)
Walk inside Infinitely Fit, a new gym in San Diego, and you’ll find L.J. Eastmead in her element. The retired Marine, who has a proclivity to write Winston Churchill quotes on the wall, bounces around during a recent class. She’s fun but firm, pushing students to strive for their best with a disarming smile. “Fitness is a passion, but really teaching people to be healthy and living a healthy lifestyle is what really resonated with me and I wanted to pass that along to other people,” Eastmead says. But creating her own business wasn’t as easy as leading a workout for Eastmead. “I was on my own for a little while before I was introduced to the Rosie Network, and I will be forever grateful to my friend for introducing me to them,” Eastmead says. The Rosie Network, based in San Diego, is a non-profit that gives veterans the tools they need to successfully start and grow a small business. The veterans receive free training in everything from accounting to human resources while being promoted by the program. “So we’re teaching them to fish, and not just providing the fish. This is a life-long commitment that we’re making to our transitioning veterans and our military spouses,” Stephanie Brown, the founder and CEO of the Rosie Network, says. According to the U.S. Small Business Administration, veterans are 45 percent more likely to start their own businesses than non-military citizens. California leads the nation with more than 250,000 veteran-owned businesses, many of which can be found in or near San Diego, home to the largest concentration of military personnel in the United States. “There is a real push in San Diego to support the military. They’re one of the three legs of our economy,” Phil Blair, who co-chairs the San Diego Economic Development Committee, says. That’s why San Diego has become a hub for veteran start-ups. Fuse Integration, an incubator run by Sumner Lee, a former Navy pilot, sets veterans up with an office space and a chance to work with the defense industry. “I think that veterans provide a background in leadership, in dealing with adverse conditions and being creative under pressure that provides and excellent team capability and an excellent ability to get the job done,” Lee says. Around the corner, Fab Lab, a nonprofit community space, connects veterans with engineers and scientists. “Everybody learns and benefits from each other and I think that’s the most important aspect of this space,” Allen McAfee, a veteran who served in Iraq and the Operation Manager at Fab Lab, says. “Something like this allows us to celebrate that military past but also really enforce that you’re a apart of our community too and I think that’s the biggest thing that cities can look at.” For Eastmead, the transitional training she received not only helped her launch her business but her confidence in its future as well. “The Rosie Network is, not like having a staff so much as having a support system that just says “oh, you can’t pick yourself up today? Well we’ve got you,” Eastmead says.