VA launches new VHA review process, leadership search

The acting chief of the Department of Veterans Affairs last week convened a panel of experts to examine a slate of candidates as part of the department's search for the next leader of the VA health care system, and ordered a monthly review of scheduling at VA medical facilities.

The acting chief of the Department of Veterans Affairs last week convened a panel of experts to examine a slate of candidates as part of the department's search for the next leader of the VA health care system, and ordered a monthly review of scheduling at VA medical facilities.

Acting VA Secretary Sloan Gibson assembled the group June 17 to initiate the process of selecting a new under secretary for health to head up the Veterans Health Administration.

Gibson said the department needs a leader who will serve as a "change agent" to institute reforms at the nation's largest integrated healthcare system. 

“This is one of the most important jobs in government today,” Gibson said in a statement. "The expert panel we’ve assembled to recommend our new health chief understands the urgency and the seriousness of the task ahead, and I’m grateful for their efforts.”

The commission includes a mix of nine medical and veterans experts from government, academia and veterans service organizations, including top officials from the Department of Veterans Affairs, Association of American Medical Colleges, Veterans of Foreign Wars, American Academy of Nursing Fellows, Disabled American Veterans, Cleveland Clinic, Army Medical Command, University of California-Davis Health System, and Department of Health and Human Services.

Monthly VHA reviews

Gibson last week also directed all VA Medical Center and Health Care System directors to conduct monthly in-person reviews of scheduling practices in every clinic within their jurisdictions—more than 900 VHA facilities across the country. Additionally, Veterans Integrated Service Network directors have been ordered to conduct similar visits to "at least one" medical center within their area of responsibility every 30 days, and to all the centers in their network every 90 days.

VA said the site inspections "will include observing daily scheduling processes and interacting with scheduling staff to ensure all policies are being followed to deliver veterans the timely care they have earned."

“Our top priority is getting veterans off of wait lists and into clinics,” Gibson said. “Veterans must trust their health care system, and these reviews are an important step towards restoring integrity in all our scheduling activities.” 

CBO: High costs

A Senate bill aimed at improving veterans' access to care at the Department of Veterans Affairs could carry a hefty price tag, according to a preliminary assessment of one portion of the bill by the Congressional Budget Office. The office delivered the preliminary numbers in a letter to Senate Veterans Affairs Committee Chairman Bernie Sanders (I-Vt.).

CBO analyzed a part of the legislation—Title III of the Veterans’ Access to Care through Choice Act (S. 2450)—which it notes will give VA "expansive authority for the next few years to contract with health care providers who are not employed by the VA, and VA would be required to use that authority to ensure that all eligible veterans would receive requested health care in a timely fashion."

The budget office reasons that expanding access to those health care services will translate into veterans seeking more healthcare from the VA than they currently acquire from the department. 

CBO said that VA currently has about 8.4 million veterans enrolled in its health care program—and estimates that another 8 million qualify to enroll, but have not done so. VA currently spends about $44 billion a year providing health care services to vets—about $5,200 per enrollee—or about 30 percent of the total amount of health care those vets use overall.

But under Title III, CBO estimates, enrolled vets likely would want to increase the amount of care they receive from VA by about 60 percent—and some portion of other eligible vets who have not enrolled may do so because of improved access to care.

"Most of the costs incurred to provide that care would be for care financed by other payers, including Medicare; a portion of those costs would thus be offset by savings to the Medicare program," CBO said in its letter. "All told, CBO expects that veterans would ultimately seek additional care that would cost the federal government about $50 billion a year, on net." CBO also estimated that implementing Title III would cost about $500 million in 2014, $10 billion in 2015, and $25 billion in 2016.

Despite the preliminary estimates, CBO said that the "the magnitude of those budgetary effects is highly uncertain." While "a significant number" of vets may well tap into expanded health care benefits under the bill, the office said the exact number of vets—and the resulting costs—would depend on a range of other factors that are "very difficult to predict."

As a result, CBO report stated, "this estimate should be viewed as falling in the middle of a wide range of possible outcomes."

To see more, got to: www.va.gov/opa/pressrel/pressrelease.cfm?id=2558 (VHA search); www.va.gov/opa/pressrel/pressrelease.cfm?id=2559 (review process); and www.cbo.gov/sites/default/files/cbofiles/attachments/s2450.pdf (CBO report).

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