Commission to VHA, Congress: Blow up everything!

Decent doctors and nurses working in a vast, bureaucratically dysfunctional system. That’s my interpretation of how the Commission on Care views the Veterans Health Administration. It’s hefty, 300-odd page final set of 17 recommendations stops short of calling for Congress to privatize Veterans Affairs, or it’s biggest bureau.

But the commissioners do say this:  VHA’s actual health care, generally as good or better that that delivered by the private sector, “is inconsistent from facility to facility, and can be substantially compromised by problems with access, service, and poorly functioning operational systems and processes.” They go on to recommend what amounts to the organizational equivalent of a military operation to flatten everything and then rebuild.

Commissioners give the impression that VA has a brick and mortar problem. Anchored in big, old-fashioned hospitals, it lacks enough flexibility to offer more localized care, in more fine-tuned facilities. Even now, VA is trying to finish another albatross of a gigantic, billion dollar hospital outside of Denver. Indirectly, the Commissioners chide Congress on that score. I remember a long-ago VA information technology chief saying in a speech, never forget that each of the VA’s 200-odd hospitals is a big plum in someone’s congressional district.

Even VA’s IT gets special mention for its “antiquated, disjointed clinical and administrative systems” that can’t really support modern medical and administrative processes. The commissioners also recommend VHA get its own Senior Executive Service chief information officer, with only dotted line reporting to the VA CIO, instead of reporting directly to the chief of the VHA Health Care System, or CVCS.

Commissioners envision replacing the hospital-based system with something it wordily describes as a set of “high-performing, integrated, community-based health care networks, to be known as the VHA Care System.” These networks would incorporate what VA already owns and operates. They’d also bring in nearby Defense Department health care providers and “VHA-credentialed providers and facilities.” That’s a nod to the private providers available now to veterans under the Choice program. Commissioners say the Choice enabling legislation and its implementation are flawed. They outline an elaborate process for establishing new networks with their own governing boards.

Recommendations go on and on. They cover capital planning, supply chain management, personnel and governance — lots and lots on personnel, veterans’ appeals, performance and continuous improvement, even access for certain vets with other-than-honorable discharge.

Members of Congress ought to read this report, or have someone on their staffs read it. It depicts a bureaucracy grown brittle and inefficient, even as the veteran population shrinks. How rich that this report publishes just as NASA puts out pictures of its Juno mission. Now it’s time to say to VA, if we can put a satellite around Jupiter…

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