On July 16, 2014, the Senate Veterans Affairs Committee held a hearing, “The State of VA Health Care,” to investigate actions taken by the VA since the well-publicized discovery of scheduling irregularities and systemic access issues, as well as coming challenges for the VA to face. The two witnesses at the hearing were Hon. Sloan Gibson, Acting Secretary of the Department of Veterans Affairs, and Philip Matkowsky, Assistant Deputy Under Secretary for Health for Administrative Operations at the Veterans’ Health Administration. Chairman Sanders (I-VT) particularly emphasized the burden of suicide, PTSD, substance abuse, and Traumatic Brain Injury (TBI) on veterans and their families.
While all Senators denounced the lack of timely care at VA facilities, and the absence of accountability displayed by many VA officials, there were differences of opinion in how best to improve veterans’ access. Sen. Tester (D-MT) noted that the greatest obstacle to timely care is an insufficient number of VA service providers, a sentiment echoed by Sen. Murray (D-WA), who asked Secretary Gibson what more the VHA could do to build its workforce. Secretary Gibson responded that an estimated 10,000 additional clinical staff would be necessary to reduce wait times to acceptable levels, 1500 of which would be MDs, and the rest comprised of physicians’ assistants, nurse practitioners, and others. He also cited the possibility of expanding tuition payment and reimbursement programs for health professionals who choose to work for the VA, as well as strengthening VA’s academic affiliations.
Sen. Begich (D-AK) stated, “This [lack of access] is not new. It’s just they [the VA] didn’t get the funding years ago, and now we’re playing catch-up.” Sen. Begich advocated for maximizing the use of available resources, such as Indian Health Service sites and federally qualified clinics as was done in Alaska in order to increase access in a more cost-effective manner. In contrast, Sen. Johanns supported a “choice card” for veterans to access non-VA purchased care, and commented “I think what [the VA] needs, personally, is competition…maybe [a veteran] says ‘that hospital 20 minutes down the road from where I’m at is simply a better situation for me.’” Sen. Moran (R-KS) emphasized that whistleblowers within the VA needed to feel protected from potential retribution in order to bring their concerns regarding practices and care of veterans to light, so that improvements can be made.
Secretary Gibson identified six key priorities for the VA to “begin rebuilding trust”, as well as what has been done so far to accomplish them. These include:
- Get veterans off wait lists and into clinics.
- In the last 2 months, VHA has made over 543,000 referrals for veterans to receive private sector care. Each of these referrals, on average, results in 7 patient visits.
- VHA has been extending clinic hours and aggressively recruiting new clinicans.
- Fix systemic scheduling problems
- VHA is pursuing the use of a “commercial, off-the-shelf, state-of-the-art scheduling system,” in addition to augmenting and improving the current system.
- Comprehensive internal and external audits of the scheduling system.
- Address cultural issues.
- VHA is establishing a new patient satisfaction measurement system to provide real-time, site-specific information.
- The former 14-day access measure has been removed from employee performance plans, to eliminate motives for inappropriate scheduling practices.
- Hold people accountable, where willful negligence and misconduct are documented
- Secretary Gibson personally emailed all VHA staff, stating that retaliation against whistleblowers will not be tolerated.
- All senior VHA executive performance awards for FY 2014 have been suspended.
- Establish regular and ongoing disclosures of information.
- Quantify the resources needed to consistently deliver, timely, high-quality health care.
To view the hearing, click here.