Tom Temin: First of all, just give us a 30 second view of the program we’re talking about. What are the benefits that require the exam that you’re administering?
David McLenachen: Sure our biggest program, benefit program for monetary benefits, these are monthly benefit payments to veterans with service connected disabilities as our compensation program. For that program, we have a duty to assist the veteran in providing an examination so that we can evaluate their disability. We have 10 different levels of disability in our program, and you could even get payments beyond that level 10. So the exam is very important. We can’t complete a claim unless we can evaluate the disability, and that’s really been the problem with the pandemic is most of these exams have to be done in person. So a face to face situation with medical examiner. We’ve been unable to do those during the pandemic. We suspended them in early April. Our examiner’s are done through a contract so they’re contract examiners. However, during the pandemic, we did have them doing what we call ACE exams. So that’s acceptable clinical evidence, and they were able to complete some exams by just reviewing medical records and the veterans claims file.
Tom Temin: And what about telemedicine? Some examinations might be able to be manifest that way say if someone is missing a limb or something, then probably you could tell that for sure over a teleexam.
David McLenachen: Yes, just like the Veterans Health Administration, which has moved pretty aggressively to telehealth in the clinical environment, we’ve done the same thing with our CMP examinations. There is some of them that we can do by a what we call a tele-CMP exam. And our contract examiners have been doing those during the pandemic. So luckily, we have had those modes of examination during the pandemic, but still we’ve built up a pretty good set of exams that we still need to get done in person.
Tom Temin: Yeah, that was my question. So a backlog has developed in these three, three and a half months of non human contact?
David McLenachen: That’s correct. Usually, our examiner’s carry inventory of about about 100,000. So that’s their usual working inventory. Currently, we have over 300,000, so about 200,000 exams and excess inventory that we have to get done.
Tom Temin: And where do these exams usually take place? You mentioned set of contractors does it, so it’s not within VA health facilities?
David McLenachen: That’s correct. There’s still a set of examinations that are done by the Veterans Health Administration. Going in the pandemic it was about 25% of exams. So our contractors which the Veterans Benefits Administration, my organization, manages, do about 75% of all exams. And those are not done in a VHA facility, the contractors have their own clinics, but they also subcontract through providers all over the country. So we’re talking about physicians that have offices all over the country or healthcare companies that manage hospitals and have clinicians that subcontract to our providers. And so really it’s all over the country there are providers that are doing these exams.
Tom Temin: So is it accurate to say that at this point in early July, pretty much any veteran who needs to have one of these exams within reasonable distance of his or her home can get it?
David McLenachen: Well, as you said, in the lead into the interview, we have resumed these in person exams. We’ve done it gradually. So on May 28, we got started. What we’re doing is we’re basically following the Veterans Health Administration’s lead, if they conclude that they can do in person outpatient primary care appointments, then in that same area that’s in the jurisdiction of that VA hospital, we’ve authorized our contract vendors to get started on in person exam. So we started out with about 20 locations in the country. Since then we’ve added many others. And now we can do about 75% of our pending exams are in areas where we’ve authorized in person exams take place. Now, that’s been a slow startup, we’ve had to ramp up from zero, so we’re not at full capacity yet and we still have about 25% of the country where we have not authorized those in person exams to start.
Tom Temin: And what are the protocols? What are the requirements physically to be able to have someone go in and have a close up examination by a healthcare practitioner?
David McLenachen: Yeah, that’s a great question because I think as we all know, we’re still in the middle of the pandemic. But what we have done is in the areas where we’ve authorized our examiners to get started, we require them to follow all the CDC guidance that’s out there about how to have these type of contacts with individuals. So that means they have to comply with all the sanitation, personal protective equipment, distancing, all the things that are required in the healthcare industry by the CDC to have these kind of interactions. Our vendors have to follow those requirements and ensure that their providers that they subcontract with also follow them. So it’s important for veterans to come in for these examinations. We want them to come in. We’ve tried to ensure that it’s as safe as possible for them to do that. So not only is it areas where there’s been a determination that it’s safe to do them, but we’re only doing them with all those protective measures in place.
Tom Temin: And do you have a mechanism for making sure that the compliance is there?
David McLenachen: Yes. So the the primary contract vendors are required to do oversight of all the providers that are doing these examinations for them. In addition to that they had to submit to us in VBA a implementation plan. So they had to have a plan in place, it was approved by us, our organization does oversight as well. And if there’s any exam that needs to be done where that protective equipment had to be taken off, they’re not authorized to do those yet.
Tom Temin: Got it. And here’s a question about, say, someone who has a mental disability, say, from PTSD or that kind of thing, how do those examinations work, if they do, say in a psychiatric sense?
David McLenachen: So the same way. All the same requirements apply. Generally, if it’s an in person exam, then all of these protective measures have to be in place regardless of the disability. Now, there are some exams that we’re continuing to do through those other programs through the examination of records or the telehealth type type of examination. We’re continuing to use those, in particular in the areas of the country where we still can’t do in person exams, we’re still using those modes to do all exams that we can. So kind of a mixture of in person where we can do them and then using those other methods as much as possible.
Tom Temin: And do you have a timeline for working down that 300,000 back to the normal float that you have traditionally?
David McLenachen: Well, unfortunately, we don’t. And the reason is we’re kind of in an uncertain environment right now. You know, I think we’ve all seen watching the news that virus cases are increasing in certain areas of the country. So it’s a situation that we just have to continue to monitor. We’re hopeful we can keep going and adding more capacity as we go so we can get back to normal, but it’s a situation that we just have to continue watching. I will say that we’re doing everything we can with our contract vendors to build up that capacity and work all those exams that need to get done. Just real quick for you though everybody should be aware that there’s no harm to any veteran other than the delay. VA pays benefits back to the date of claim. If a veteran has concerns about coming in for an in person exam in areas where we’ve authorized them to be done, they’re not required to come in. We will just hold that exam in advance and wait and decide their claim when they feel that it’s safe to have the exam done.
Tom Temin: David McLenachen is director of the Appeals Management Office at the Veterans Benefits Administration. Thanks so much for joining me.
David McLenachen: Thank you, Tom. Important topic. I appreciate you getting us on.