Sweeping VA bill seeks more pay flexibility for health care workers, stricter EHR requirements

The Department of Veterans Affairs would receive additional pay flexibilities for its health care workforce, if a sweeping legislative makes it through Congress.

Top lawmakers on the House and Senate committees introduced the Sen. Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act on Tuesday.

In addition to pay and workforce provisions, the legislative package would set new requirements for the VA to meet before it resumes the rollout of a new Electronic Health Record, which remains on hold as the department addresses issues at sites already using the new system.

The legislation pulls together several bills lawmakers introduced this session of Congress to improve VA health care and benefits delivery.

Senate VA Committee Chairman Jon Tester (D-Mont.) said in a statement the bill is a “common-sense step towards delivering veterans and their families the kind of support they earned and deserve.”

House VA Committee Chairman Mike Bost (R-Ill.) said the bill reflects a year-and-a-half of feedback gathered from veterans and veterans service organizations “to find the gaps within VA’s services and consider commonsense legislation to improve them where we can.”

VA pay flexibilities & staffing updates

The legislative package would give VA additional flexibility to offer pay awards, as well as recruitment, retention and relocation bonuses to its health care workforce.

The bill would allow the VA to waive pay limitations for up to 300 personnel, “if deemed necessary for the recruitment or retention of critical health care personnel.”

The package would also require each VA physician, podiatrist, optometrist and dentist to receive an annual pay evaluation.  VA would have to give Congress an annual report on the outcome of these pay evaluations, and all resulting market pay adjustments.

The bill would also give the VA the authority to pay retroactive compensation to health care employees who exceeded annual pay caps between Jan. 8, 2006, and Dec. 31, 2017.

Lawmakers are also calling on the VA to keep Congress up to date on its staffing needs.

The bill would also require the VA to develop staffing models for its Office of Integrated Veteran Care, Veterans Integrated Services Networks (VISNs), and VA medical centers that will allow the department to “ensure timely access to care and to effectively oversee the provision of care.”

The VA would also have to submit annual reports to Congress and the Government Accountability Office on its efforts to meet these staffing targets.

The VA saw record hiring last year, and now has its largest health care workforce. However, the VA is limiting health care hiring this year to a few targeted areas.

By 2025, the department is looking to reduce its overall headcount by about 10,000 positions — most of them at the Veterans Health Administration. The department expects to manage this headcount reduction through attrition.

New requirements for Oracle-Cerner EHR

VA may also face new requirements to get the rollout of its Oracle-Cerner EHR back on track

The sweeping legislation also pulls together components of EHR reform bills that House and Senate VA committee leaders introduced in recent years.

The bill would restrict the VA from taking steps to roll out the new EHR to additional facilities, until the department submits data showing all facilities currently using the Oracle-Cerner system “have recovered to normal operational levels.”

If passed, the bill would require the VA to end its EHR Modernization Program within two years, unless the department certifies facilities using the Oracle-Cerner EHR have recovered, and that health care quality data shows steady improvement since the system went live at each facility.

The bill would give the VA 90 days to set health care quality metrics for the new EHR, “taking into account relevant differences in size, complexity, and market composition of VHA facilities.”

VHA would also have to certify the system is “fully and accurately built and configured,” that VA facility staff are ready to use the system and that the new EHR meets contractually required uptime requirements.

VA officials say the department’s most recent go-live of the Oracle-Cerner EHR at the Capt. James A. Lovell Federal Health Care Center in North Chicago has been the most successful go-live to date.

The VA is in a “reset” period, and will not roll the new EHR out to additional facilities until it addresses persistent issues at sites already using the system.

Since its first new EHR go-live, VA’s inspector general office has documented instances of the system contributing to patient harm.  The watchdog has also linked the EHR’s performance issues to veteran deaths.

VA Secretary Denis McDonough told members of the House VA Committee last month that the department does not anticipate staying in reset for the entirety of fiscal 2025.

“We’re not staying in reset forever. As we approach the end of this year, I anticipate us being in discussions to get out of reset,” McDonough told the committee.

VA’s 2025 budget request seeks $894 million for EHR modernization. It doesn’t include any funding for additional deployments. The funding would go toward contract payments to Oracle-Cerner, and infrastructure support for VA sites already using the new EHR.

If VA gets out of reset in 2025, and resumes deployment, McDonough told lawmakers that the VA has “prior appropriated money available to us to deploy when we get out of reset.”

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