VeteransFirstActYesterday, the leaders of the Senate Committee on Veterans Affairs held a press conference to announce that they had reached an agreement on a piece of legislation that would bring changes to many areas of the VA. The bill, known as the “Veterans First Act,” is the product of intense negotiations among Senators from both parties in recent months. The 391-page bill contains provisions dealing with accountability, healthcare, compensation, education, homelessness, and more. Below, we’ve summarized some of the key provisions.

Accountability

If you’ve been following the various VA scandals in recent years, then many of the bill’s provisions concerning accountability may sound familiar to you. The Veterans First Act would give the VA Secretary more authority to hire and fire employees, and allow him to make his personnel decisions more quickly. It would also limit the amount of time that employees can be placed on “paid administrative leave” to prevent bad actors from collecting government salaries during lengthy investigations. Under the bill, healthcare executives who lead a VA medical center would be entitled to significant pay raises to match what they would earn in the private sector. Perhaps most interestingly, the bill would establish an independent office within the VA known as the “Office of Accountability and Whistle-blower Protection.”

Health Care

Regarding healthcare, the proposed legislation would require the VA to make prompt payment to private facilities that have agreed to participate in the Veterans Choice program. This provision was likely included in response to the many headlines alleging that the VA owes millions of dollars to outside facilities, and that some private providers were electing to abandon the program altogether because they weren’t being paid. The bill would also expand the rules allowing family members to serve as caregivers for severely disabled veterans, and make it easier for the agency to hire mental health professionals. Additionally, the bill would attempt to address the over-prescription of opiate painkillers.

Disability Compensation

The proposed legislation would require the VA to launch a voluntary pilot program under which veterans who opt-in are forbidden from submitting additional evidence after filing a Notice of Disagreement. In exchange for giving-up this important right, veterans in the pilot program would skip the issuance of a Statement of the Case and go straight to the Board of Veterans’ Appeals where they would receive a final decision within one year of filing their Notice of Disagreement. The bill would also make it easier for the survivors of recently deceased veterans to receive benefits, and would increase the oversight of VA Regional Offices by permitting reviews by the Government Accountability Office.

Education & Employment

The Veterans First Act would expand the availability of Post-9/11 GI Bill funds to mobilized reservists, and authorize additional educational benefits to the spouses and children of veterans. It would also permit the VA to reinstate a veteran’s educational benefits in the event that the school the veteran was attending permanently closes. The bill would also require the VA to coordinate with the Department of Labor and state agencies to help increase the availability of jobs for veterans, and would require a non-governmental study of job counseling, training, and placement services for veterans.

Homeless Veterans

Homelessness among veterans has been a widely-discussed topic in recent years, and the proposed legislation aims at further reducing the number of veterans without a roof over their heads. Among the provisions of the bill is one would would expand the definition of “homeless” to include those veterans who are escaping from domestic violence, thus increasing the availability of benefits and services to such veterans. The bill would also expand the eligibility of the Department of Labor’s Homeless Veterans’ Reintegration Program and authorize the VA to form partnerships in order to provide legal services to homeless veterans.

U.S. Court of Appeals for Veterans Claims

The proposed legislation would once again reauthorize the temporary expansion of the Court from seven to nine judges through the end of the year 2020. This represents a compromise from what has been proposed by several lawmakers and veterans’ advocates which would make the increase to nine judges permanent. Additionally, the Veterans First Act would change some rules concerning the availability of certain benefits for judges, and would alter the manner in which the Chief Judge of the Court was determined.

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Overall, we are pleased with the provisions of the proposed legislation. We will say that we were somewhat surprised that the bill does not contain a complete overhaul of the Veterans Choice program, which has drawn much scrutiny for its failure to reduce the delays veterans face in receiving healthcare. The expansion of the Veterans Court is an important step, but we’re disappointed that Congress hasn’t decided to require more decision-makers in the locations they are most needed: at the Board of Veterans’ Appeals. Finally, we’re skeptical of the proposed pilot program for streamlining the appeal process because, simply put, it misidentifies the problem. The issue with appeals has never been that veterans are bogging-down the process by submitting new evidence, its that the VA doesn’t have adequate procedures or sufficient staff to handle the number of claims it receives. Thankfully, for now at least, the Pilot program is only a test.

The bill represents only a proposal from the Senate, and differs in some key ways from what has been proposed over in the House. We expect there to be some changes to the ultimate legislative package that reaches the President’s desk, and we will do our best to keep you posted on future developments.

Courtesy of: KVOA, Tucson, Arizona

Delays and long wait times are nothing new at the VA. But some veterans say that when they sought emergency medical attention at a VA medical center on Tuesday they were forced to wait well-over 12 hours to see a doctor. The VA claims that this was a fluke, but several veterans report that wait times are often five or six hours. Check out the full story by watching the video above.

EmailInternal VA emails sent last week suggest a new scandal is bubbling to the surface. The latest controversy surrounds the scheduling of medical consultations which, as we have explained before, have been a major source of delay for veterans seeking VA healthcare.

On November 20, Dr. Lara Wagner, the Director of Sleep Medicine Services at the New Mexico VA Medical Center fired-off an email regarding a strange issue she had encountered. According to Dr. Wagner’s email, she noticed that requests for consultations that had been pending for over a year were mysteriously being canceled and then re-entered into the system.

After listing a number of instances where consultations had simply disappeared, Wagner wrote “it is distressing to find out that many of the studies that we ordered have not been performed,” continuing by saying that “it is horrifying to think that these patients are going to fall through the cracks because these consults are being canceled.” Suspicious of why the consultations were being canceled, she inquired “surely we are not canceling [these year-old] consults in order to make it seem that care is not being delayed.”

After sending the message, Dr. Aaron Pierce echoed Wagner’s concerns, saying that he too had noticed that older requests for consultations were being mysteriously canceled and re-entered and asking whether “there is something particularly important/relevant about a consult still being open after a year?” Being more blunt that Wagner, Piece wrote that it “should be documented accurately” if it is “really taking a year for Integrated Care/Triwest to complete” consultations. He also complained that canceling an old consultation requests and creating a new one required him to repeat work unnecessarily.

In response to the messages from Wagner and Piece, Acting Chief of Staff James Groff responded by writing that “we have a major issue with open consults greater than [one year] and we are going through a facility wide herculean effort to resolve many old consults.” Continuing, Groff told the doctors “Do not shoot the messenger- get smart about the process.” What the Acting Chief of Staff meant by this is not clear.

While it is unclear what exactly is going on at the New Mexico VA Medical Center, it seems that doctors at that facility believe that the VA regularly cancels and then re-enters appointments into its computer system in an effort to conceal the amount of time that veterans are waiting for healthcare. When reached by comment on this issue by the Daily Caller, the source that originally broke this story, a VA official said that “no consults are being inappropriately cancelled.”

The VA spokesperson said “in some cases, consults are sometimes cancelled at the request of the patient, or when no longer clinically indicated.” Yet neither of these reasons could explain the issues revealed by the VA doctors, who say that the consults are being canceled and then immediately re-entered into the system. While it is too early to tell, the VA physicians appear to suggest that deleting the delayed consultations and then re-entering them into the system serves to conceal the amount of time that veterans are waiting for treatment.

ChoiceAct-NewDevelopmentDuring a hearing today before the House Committee on Veterans Affairs, several high-ranking VA officials outlined the agency’s plans to overhaul the Veterans Choice program. That program–created in response to scandals concerning the amount of time veterans were waiting for medical appointments–has faced criticism since its implementation last year that it was overly bureaucratic and did not achieve its intended goals. During the hearing, VA officials told Congress that the current system is simply “too complicated.”

The new plan would expand veterans access to healthcare outside the VA system by consolidating various existing programs into larger integrated networks across the country. In his prepared remarks, Deputy Secretary Sloan Gibson said that the changes to the program “will clarify eligibility requirements, build on existing infrastructure to develop a high-performing network, streamline clinical and administrative processes, and implement a continuum of care coordination services.” One of the most notable changes revealed in the VA’s new proposal is the establishment of “a single set of eligibility criteria” for access to private doctors on the VA’s dime. Under the current system, access to outside providers is limited by numerous factors that are confusing to veterans, doctors, and VA employees alike.

The VA said it would need an initial $421 million in the year 2016 to get its ambitious program off the ground. Some lawmakers seemed skeptical of the revised program, with Representative Mark Takano of California saying that the “VA does not have a great track record when it comes to implementation.” But other representatives were quick to jump to the defense of the proposal, with Representative Tim Walz of Minnesota calling the plan “the silver lining out of Phoenix,” a clear reference to the 2014 scandal involving manipulation of wait time data at Arizona facilities.

Yet one of the most significant themes from certain members of Congress was a concern that this was a privatization measure. To this, Assistant Deputy Undersecretary Baligh Yehia  simply said that it did not make economic sense to “provide every [medical] service in every location to every single veteran.” Committee Chairman Jeff Miller of Florida echoed this sentiment saying that the program would “supplement, not supplant” the current VA healthcare system.

Detailed information on the VA’s new plan is sparse as of now, but a general overview can be obtained from reading Gibson’s prepared remarks. We will follow this story and keep you updated as more detailed information becomes available.

More often than not, Congressional hearings are excruciatingly boring. Today’s subcommittee hearing was no different. Luckily for you, I watched the hearing so you don’t have to. You can read my summary below. If however, you have a lot of time to kill, you can watch the full hearing above.

The Subcommittee on Health of the House Veterans Affairs Committee met today to hear remarks on a number of pieces of legislation which would impact healthcare for our nation’s veterans. The goals of these bills varied from decreasing wait times to improving care options for survivors of sexual assault. Given that these bills are very early in the legislative process, it is difficult to know what chance they stand at becoming law, but the fact that a hearing was held at all may be seen as encouraging.

ORourkeOne of the more interesting pieces of legislation discussed during the hearing was the Ask Veterans Act (H.R. 1319). To introduce his bill to the committee, Representative Beto O’Rourke of Texas (pictured) described how, after raising concerns about wait times with VA Officials, the VA told him that what he was “dealing with here are some cranky ornery veterans” and that  “some of these folks you just can’t make them happy.” Because something just didn’t add up between the stories he heard from veterans and the VA’s statements that the vast majority of veterans saw doctors within 14 days, he commissioned a study to determine whether the veterans he spoke with were exaggerating or if the VA was being misleading. His study found that “on average, veterans in El Paso waited over 80 days for a primary care appointment, and over 70 days for a mental healthcare appointment.”

Based on these experiences, O’Rourke crafted the Ask Veterans Act which “would simply require that the VA contract with an independent third party to assess true wait times.” Unlike some VA data which is essentially hidden from the public, O’Rourke’s bill would require the VA to “publish these reports publically on the web for everyone to see and to be held accountable.” This bill stands-out among those discussed during the hearing, and we are hopeful that independent oversight of the VA will become a reality through this legislation.

MosleyNext up was the Military SAVE Act (H.R. 1603) which would amend the Choice Act to allow veterans who were the victims of military sexual trauma to receive treatment at non-VA facilities. The most powerful testimony of the entire hearing came from Susan Moseley (pictured), a veteran who faced sexual assault by a superior during her service. After her discharge, Moseley faced a difficult life but, after sixteen years, was able to find a VA therapist who could help her. Unfortunately, due to staffing burdens, she could only see that therapist once every three weeks. “That was all the VA could offer us,” she said. The Military SAVE Act would answer the lack of specialized VA therapists by allowing survivors of military sexual trauma to seek outside treatment. As explained by LaRanda Holt of American Legion, “this is about trying to find the right treatment and therapy for every veteran, and in the case of [military sexual trauma], unique circumstances can shape treatment and therapy needs.” As people who have represented victims of military sexual trauma in our professional lives, we unreservedly support the Military SAVE Act.

RobyThe only legislation to face any obvious opposition from members of the subcommittee was the Failing VA Medical Center Recovery Act (H.R. 3234). The bill’s sponsor, Representative Martha Roby of Alabama, explained the goals of her bill by saying, “similar to how a state superintendent would take-over the day-to-day operations of a failing school, this legislation requires the establishment of highly-specialized teams to take over the day-to-day operations of the worst VA facilities in the nation.” According to Roby, the worst of the worst among VA medical centers would be managed directly from Washington until they were able to improve. Representative Phil Roe of Tennessee questioned the wisdom of the bill, observing that “just because the VA gets centralized doesn’t mean it gets better.” Citing issues with the Choice Act, Representative Roe expressed that he was “not sure making it more bureaucratic and putting it up to people who are in charge [in Washington] who weren’t successful to begin with is going to work.” While this legislation may sound good at first blush and has some admirable goals, we share Representative Roe’s concern that more bureaucracy might not be the right solution to the problem.

During its hearing, the committee also heard about bills that would address more technical concerns about the delivery of VA healthcare. Citing an instance where a veteran was nearly thrown from his vehicle due to an incorrectly installed chair lock and a case where a veteran’s bumper was ripped-off by a wheelchair lift, Representative Jackie Walorski advocated for her bill (H.R. 3471) which would impose licensing standards on contractors who install wheelchair lifts and similar equipment on vehicles for disabled veterans. Also addressed was a bill (H.R. 1904) aimed at increasing the number of professionals who create prosthetics for veterans by issuing grants to colleges and universities that establish programs to train such workers. Highlighting the importance of such action, the bill’s sponsor Representative Matthew Cartwright of Pennsylvania stated that the number of veteran’s requiring prosthetics has increased 300% since 2000, yet there is a shrinking workforce of professionals who create their prosthetics. The committee also heard testimony on a hyper-technical piece of legislation that would redefine the qualifications for Marriage and Family Therapists employed by the VA (H.R. 2639).

Also discussed were several proposals which have not yet been introduced, including legislation aimed at dealing with over-prescription of narcotic pain killers as well as a proposal that would better facilitate the VA’s arrangement of outside healthcare. We will be certain to keep you posted once ink meets paper on these proposals.

An interview with a former VA hospital appointment scheduler puts the healthcare delay problems in a startling new light. According to Nick McSwain, a man who scheduled appointments by the phone at a Tampa Bay area VA hospital, employees were instructed to manipulate appointment data in order to make the amount of time veterans were waiting appear smaller than it actually was. He quit his job earlier this year to clear his conscience after he realized that his participation in this scheme to fudge-the-numbers may have led to the deaths of veterans. You can watch the full interview above.

(Hat Tip to Fox 13 News of Tampa Bay for breaking this story)

Investigators at a local television station in Minnesota have unearthed some startling information about medical treatment at one of the state’s largest VA medical facilities. According to audio recordings of internal VA meetings, VA doctors raised concerns over patient safety alleging that the doctors were being overworked and that “mistakes are being made.” According to these doctors, they are being assigned far more patients than is deemed safe by the VA, and management covers-up these high workloads by creating false records indicating that patients were assigned to physicians who have not worked at the facility in years.

(Hat Tip to KMSP-TV Fox 9 for its excellent reporting)

If you have ever been to the doctor for something more serious than a cold, you are probably familiar with consultations, the process through which a primary care physician refers a patient to a specialist so that his or her medical issues can be better addressed. According to a report  released yesterday by the VA Inspector General, a breakdown within the VA consultation system may have resulted in the death of a California veteran.

For approximately a year between February 2011 and January 2012, a 70-year-old veteran complained to his doctor about difficulty swallowing and a significant loss of weight was noted. In January of 2012, the veteran’s primary care physician sought a consultation from a neurologist. Nothing more happened for six months until the veteran was finally seen by a neurologist who then requested an additional consultation from a surgeon as to the possibility of giving the veteran a feeding tube. An appointment was scheduled for three weeks later, but the veteran never made it. He passed-away a week after the surgical consultation.

The VA’s Inspector General lays the blame for the veteran’s “poor access to care” at the feet of his primary care doctor. According to the inspector, the doctor failed to properly diagnose the veteran’s problem for nearly a year and that this error, compounded by the long delay in seeing a neurologist, led the veteran to receive sub-par healthcare. Perhaps worse, by the time the primary physician did diagnose the veteran, he failed to comply with the neurologist’s request for additional studies, likely causing the six month delay the veteran experienced in seeing the neurologist.

Ultimately, the Inspector General was unable to conclude that the veteran died as a result of the delay, but this appears to be largely because the veteran did not die in a hospital and there was no autopsy performed. It appears likely that this veteran would not have died when he did if his primary physician had properly diagnosed him earlier or if he had not been forced to wait six months to see a neurologist. The inspector found that the veteran received “poor access to care” which “resulted in poor quality of care.”

It does not appear that this veteran’s experience with the VA healthcare system was an isolated incident. According to the report, the Southern California facility where the veteran was treated had 548 neurology consultations which were pending for longer than 30 days, of which 234 were pending for more than 90 days. After being confronted with this data, the VA staff apparently told the Inspector General that many of the pending requests were simply clerical errors resulting from physicians’ failure to mark the consultations as completed. Nonetheless, the report notes that, as of March 2015, the “the next available appointment for the neurology clinic… was approximately six weeks away,” suggesting that “patients may be experiencing delays in obtaining appointments.”

The fact that veterans must wait to receive treatment is regrettable. The fact that veterans are actually dying while waiting for such care is unforgivable, and is yet another example of how the VA is broken.