WASHINGTON — Congress has confirmed a new secretary and sent billions of dollars into the coffers of the Department of Veterans Affairs, but after months of scandals, what would success look like?
There are some obvious issues veterans advocates want to see addressed: the need for doctors and benefits adjudicators to get rid of the wait lists; the time it takes for a veteran to get care; monitoring of veterans facing mental health issues because 22 a day are killing themselves.
Just as importantly, advocates say, VA must change its culture. They don’t want to hear that veterans were sent home after appealing for help at a VA clinic for help dealing with suicidal thoughts.
They say incoming VA chief Robert McDonald must change biases, attitudes, goals, budgets, management and expectations in a behemoth born in 1930.
Here are seven things at the top of the to-do list:
1. Fill in the blanks: Phillip Carter, senior fellow and counsel at the Center for a New American Security, said VA is short several senior positions, including the undersecretary of Health, the chairman of the Board of Veterans’ Appeals and the assistant secretary of Veterans Affairs. Constance Tobias was nominated for the Board of Veterans’ Appeals in January 2012 — two-and-a-half years ago.
After the scandals that led VA Secretary Eric Shinseki to step down, other people left, including the undersecretary of Health and the principal deputy general counsel.
“The chief doctor of the VA is vacant,” Carter said. “The Senate has to get in gear and confirm those folks because [McDonald] needs all hands on deck.”
2. Work toward quality, not numbers: VA employees work to complete as many claims as they can in a day, rather than to complete as many correct claims as they can, said Joseph Violante, legislative director at Disabled American Veterans. Bonuses and reviews should be based on quality, not quantity.
“The court of appeals for veterans claims referred to it as the ‘hamster wheel,’ ” he said. ” ‘We put out so many decisions.’ That becomes a part of a mentality: ‘I want to get my numbers up. I want to get this decision off my desk.’ ”
The paperwork gets booted to the next person, who also is trying to meet a quota, so it continues up the chain with the errors intact, Violante said.
3. Embrace Millennials and their trappings: “I think VA needs to move into a position of providing care much differently than it has since the ’50s,” Rep. Jeff Miller, R-Fla., said. VA’s system seemed to work well for a different generation of vets, but there’s no reason they should have to drive to the nearest VA for a flu shot, rather than the nearest drugstore, he said.
Carter said VA needs to share data about the vets with the private sector, because if there are problems with environmental exposures, such as trash-burning pits, Agent Orange or sarin gas, outsiders should be allowed to see that there’s a problem and work toward fixing it.
“The VA has to have a transparent, audited, fully accountable system,” he said.
He said veterans themselves need to be “empowered” with access to their records. VA, as well as the Defense Department, has struggled for decades with electronic health records that could be shared between the two agencies or even internally.
4. Treat veterans like consumers, not enemies: Tom Tarantino, chief policy officer for Iraq and Afghanistan Veterans of America said VA’s top officials have not worked to engage the public or the veterans.
“Over half of our members couldn’t name Secretary Shinseki,” he said. Shinseki did not show up for meetings with veterans’ service organizations, where they expressed concerns about what vets faced at VA facilities, he said.
By waiting for Congress to act, Tarantino said, VA has based its culture on “inertia.”
“The VA has to understand that it is a public-facing organization,” Tarantino said. “It has customers. There is no other government organization that has customers.”
VA needs to reach out to veterans, sell its services, rebuild trust and let veterans know what benefits they’ve earned and how to get them, he said.
5. Check the numbers: Acting Secretary Sloan Gibson recently told lawmakers that VA had been providing care based on a budget number, rather than determining the budget number based on necessary care. He asked for $17.6 billion in additional funds to fix VA’s problems. Congress passed a bill this week providing $12 billion for VA to hire doctors and provide private care for veterans stuck on waiting lists, but it did not include a long-term budget for the VA. Violante said VA — and President Obama — need to come back with a real budget number for fiscal year 2016 for Congress to fund.
“Right now, the thing that concerns me the most is VA has publicly admitted that they’ve been underfunded,” Violante said. “I’d like to see the administration step up to the plate, and as they’re looking at the appropriations, say, ‘OK, we’re underfunded in 2016’ and request that Congress increase the 2016 budget for health care. I think that’s critical.”
6. Make an app for that: Tarantino said younger servicemembers depend on technology for everything, but when they try to use VA technology, it’s often broken.
For instance, at the end of May, VA launched a website for veterans to register if they were exposed to potentially hazardous fire or dust during the Gulf War or in Iraq and Afghanistan. The website crashed immediately. Getting technology that connects veterans to care and heath research “could save thousands of lives, as well as decades of time,” Tarantino said.
Tech-savvy veterans used to products that work will quickly give up on VA systems if a basic website doesn’t work.
“They have a captive audience of users to test new applications,” he said.
7. Kill the callousness: Advocates say veterans often face attitudes that make them feel as if they have to prove they were traumatized by war or employees who seem unaware of how serious a situation is. Last month, parents testified that their son went to a VA facility with a mental health crisis, was told there was no room, then sent home after he lay down on the floor and cried. He later killed himself.
“For general health care, VA’s pretty squared away,” Tarantino said. “Mental health is a different beast.”
To counter that, he said, employees need to be “trauma-informed” at every level.
“All the way up to those at the Veterans Benefits Administration who handle claims, there has to be a basic understanding of trauma markers,” he said. Then the employee might go out of his or her way to help a veteran rather than question the claim of distress.
VA needs to “hold bad actors accountable,” he said. “There are people who are clearly breaking the law, clearly acting against their patients, that any civilian company on the planet would have fired, but they’re still working.”
H.R. 3230 –Veterans’ Access to Care through Choice, Accountability, and Transparency Act of 2014 passed the House and the Senate on 7-31-14 and presented to the President on 8-1-2014.