Access still the main debate for VA health care commissioner, union leader

Following nearly a year of study, the Commission on Care has proposed a “bold transformation” to improve veterans’ access to Veterans Affairs Department health care.  However, the largest government employees union has taken exception to the commission’s recommendations.

Nancy Schlichting, the chair of the commission, said access to care was the main focus group’s report released this week.  “Access is about quality and service.  If people can’t get service on a timely basis it affects the outcome,” she told  Federal Drive with Tom Temin.  Among the report’s 18 recommendations is expanded options for community medical treatment and a new government board to oversee the nation’s largest health care system.

With facilities around the country providing treatment for 6 million veterans per year, the VA health care system is facing a number of challenges. “There are primary physician shortages across the country, we have an aging of the veteran population, and veterans move,” said Schlichting. “In the case of Phoenix, we saw a lot of veterans moving into the area and the Phoenix system could not handle all of the patients they were seeing.”

Nancy Schlichting
Nancy Schlichting

In fact, the problems in the Phoenix VA system were what opened a lot of eyes to VA’s health care issues. Following whistleblower reports that patients were dying while awaiting appointments, and that administrators were issuing phony wait-time data, Congress, the Government Accountability Office and others began inquiries verifying that untimely care, false data and problems with transparency were systemic throughout the VA.

Schlichting, who is CEO of the Henry Ford Health System in Detroit, said her commission proposes the establishment of a community network of care for veterans to include private doctors, hospitals and other health providers credentialed by the government. To be known as the VA Care System, Schlichting said the proposal wouldn’t necessarily move the VA away from the monolithic hospital system of today.  Rather, she argued it would integrate those hospitals with providers in the community that the VA is already using.

“Buying care in the community for veterans has been in place for a long time,” said Schlichting. “Approximately over 20 percent of care is purchased in the community today, but it’s not as well organized.  And what we think should happen, over time, is to organize these integrated networks across all communities so the care is delivered in a more effective way.”

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That lack of integration is why opponents of the report’s recommendations argue that moving outside the system any further is destructive.  “The nice part about the VA system is that it is already integrated,” said J. David Cox, national president of the American Federation of Government Employees.

“We take strong exception to the proposal, just as every veterans service organization takes strong exception to it. The care of veterans is a very unique care. When one goes outside the system, it can be very frustrating for those who work with the system to get reports in a timely manner so they can move forward in treating the veteran properly.  That’s not a problem within the VA,” Cox told the Federal Drive.

One of the report’s key proposals calls for creation of an 11-member board of directors, accountable to the President and responsible for overall governance of the Veterans Health Administration. “To be able to implement transformational change, there’s a real need for sustainable, expert oversight of the process,” said Schlichting.  “One of the challenges with the system today is the turnover of senior level people, and particularly, the undersecretary, who has an average stay time of two-to-three years.”

The board proposed by the commission would work with a proposed new administrator, a chief of the VHA Care System, who would be appointed to a five-year term by the President.

Cox opposes the board and new administration proposal.

“We believe the structure would take away the power of elected officials to give it some corporate board,” he said.

In fact, Cox suggested the process that led to the report was unfair to begin with and had the “corporate” mark all over it.  “Had there been veterans service organizations, VA employees involved in this commission, I believe the report would look a lot different than it does,” he said.

Cox said he was happy that the commission found some good in the VA. “Though [the commission] was stacked with private sector health care executives, not a one of them could avoid the fact that all the data showed that the VA is far from broken,” he said. “In fact, every one of them said the quality of care in the VA had the best health care quality at the lowest possible cost and the best health system in this country.”

Schlichting agreed to a point. “The people of VA are remarkable,” she said. “They are dedicated to the mission, and the quality in the system is very high. They want good leadership, they want change, and they want leaders who drive things in the right direction.”

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One of the big challenges the VA health system faces is the aging of its facilities.  The average age of all of the VA medical centers across the country is 50 years.  That’s compared to 10 years in the private sector.  To deal with the problem, the Commission on Care is proposing a process similar to a BRAC (Base Realignment and closure) system to begin closing facilities.

“We think an objective view of this well help moving forward, but it’s always difficult because of politics,” said Schlichting.  “Frankly, I’ve had to close three hospitals in Detroit over the last 18 years, and sometimes the community is better off, and better facilities are provided to care for patients.   It just makes sense to close some hospitals, and open others in communities where there is more need.”

The BRAC process is out of the question, according to Cox.  “We‘re opposed to that, most veterans are opposed to that, and  most members of Congress I’ve talked to are opposed to that,” he said.

“Step number one is for Congress to do their job in appropriating money for building new medical centers, clinics, and hiring additional staff.   Private business spends billions of dollars each year upgrading their facilities. Government should, too,” Cox said.

And what of those who have questioned whether the report could become the harbinger of a future attempt to privatize the system? “That would be incredibly expensive, there so much value in what’s been created over the years,” said Schlichting.

Cox agreed, but for a different reason. “We need to remember that for every veteran, we are making a 50-to-70 year commitment to their health care,” he said. “We have vets from Afghanistan and Iraq, and this country has continued to have conflicts. Our VA needs to be ready to take care of those veterans.”

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