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May/June 2006
GOVERNMENT RELATIONS
BY JOHN MITERKO, CHAIR, VVA GOVERNMENT AFFAIRS COMMITTEE, WITH
VVA GOVERNMENT RELATIONS STAFF
You can count on the VA to give some initiative an uplifting
name and wax poetic about its advantages—all the while attempting
to conceal what it’s really about. Such is the case with
Project HERO.
This misbegotten endeavor had its origins, no doubt,
on the tenth floor of 810 Vermont Avenue, N.W., the VA’s
Central Office. In its zeal to privatize as much of government
as it can, those who “lead” our nation seem to want
to undo many of the achievements of past administrations.
Certain
initiatives make sense. It used to be that all medical materiel
needed by the military were stored at supply depots. Now, strategically
located Defense Supply Centers of the Directorate of Medical Materiel
contract out for supplies as they are needed. This makes for sound
policy and efficient delivery of needed services.
Other initiatives don’t make sense. Like Project HERO. Under
the guise of providing rural veterans with quality health care,
this scheme appears to be the opening salvo that may well lead
to the dismantling of the VA health care system.
VVA has made its
objections to this misconceived venture crystal clear. In a letter
to VA Secretary Nicholson on August 15, VVA National President
John Rowan expressed “strong opposition” and requested “that
you rescind the [Request for Proposal] as written in order to review
current contracting and managerial operation with veterans’ service
organization involvement.”
Rowan went on: “The draft
RFP has nothing to do with what we have been told or with clear
congressional intent, which did not include all medical aspects
of care at the VHA. The current RFP [goes] far beyond the intent
of Congress and would create a ‘fire
sale’ of veterans healthcare to the highest bidder, when
there is absolutely no legal or practical justification to take
this precipitous action.”
On the face of it, Project HERO sounds fine. You live far away
from a VA medical center. You have heart trouble. Or you’re
battling cancer. Or the demons from your tour in I Corps are haunting
you anew. Instead of having to travel to a VA medical center or
outpatient clinic and having to wait in those lines, Project HERO
will give you the opportunity to go to private physicians right
there in your own community. Sounds good, right?
The reality is
not quite so rosy.
Over the past 15 years, the VA has grown into
a well-respected, managed-care, health-delivery system. It has
earned high marks for customer-consumer satisfaction. Its prescription
drug program and its electronic health-record system are first
rate.
Yet there are some who would not be disappointed to see this
system of integrated care go down the tubes.
What damage can Project
HERO, which is to be tested in four VISNs, do? The VISNs are VISN
8, Florida and southern Georgia; VISN 16, Oklahoma, Arkansas, Louisiana,
Mississippi, and portions of four other states; VISN 20, Washington,
Oregon, most of Idaho, and two counties in two other states; and
VISN 23, Iowa, Minnesota, Nebraska, North Dakota, South Dakota,
and portions of five other states.
Adding the increased use of outside vendors to service veterans’ health-care
needs will likely be a management nightmare for VISN directors
and their staffs. If you read through the bid forms, a single entity—be
it a health-care conglomerate, some individual doctors, or practitioners
in small practices—can bid on what they want, which can be
as small as offering a single service. Judging how well they perform
them will hardly save time and expense.
VISNs beleaguered by increased
demand for services and tightened resources (despite the spin put
on the VA health-care funding for FY’07) can be tempted to
choose the most expensive areas. This can have the effect of crippling
the ability of VAMCs to hire and retain gifted practitioners in
these fields.
VVA doesn’t object to the use of outside vendors
when there are no alternatives. Certainly, a veteran who needs
emergency treatment needs to go to the nearest ER; let the bookkeepers
and accountants sort out the billing issues later. Nor do we object
to, say, a veteran in a remote community receiving physical therapy
from a qualified local as per the instructions of the physician
at the VAMC.
But we do object to a blueprint that will institutionalize
the outsourcing of VA services. This has the very real possibility
of resulting in an exodus of physicians from the VAMCs at a time
when it’s difficult to hire and retain qualified doctors
and nurses.
We envision a scenario that can become real very quickly:
a VAMC, with the complicity of the VISN, starts to outsource its
cardiac care to private entities. This causes them to lose the
heart doctors they already employ, who are now underutilized. Which
mandates the VAMC to outsource all of its cardiac care.
And the
dismemberment begins.
VVA and most of the other VSOs are against
this attempt to scuttle the VA health-care system. If you think
this isn’t an attempt,
just look into some of the bureaucratese that litters this proposal.
HERO, by the way, stands for Healthcare Effectiveness through Resource
Optimization.
The VA ought to be making every effort to become more
of a true veterans’ health-care system rather than a system
that has veterans as its clients/patients. Project HERO takes the
VA away from its mission. In the end, all veterans who use the
VA for their health care will suffer.
At press time, we received
the following from the Project HERO program manger, in response
to VVA’s letter of August 15
to Secretary Nicholson:
“VA issued an initial Request for Proposals (RFP) for
Project HERO on August 1st, and interested vendors submitted
clarifying questions about the solicitation from that date until
August 15. In response to the RFP, VA received approximately
600 clarifying questions. Based on the large number of questions
we received, it is evident that the description of our requirements
needs to be further defined and refined. Therefore, VA has decided
to cancel the solicitation at this time in order to better define
and refine our requirements. Additionally, all scheduled due
diligence sessions will be postponed until further notice. VA
wants to ensure that the RFP, when re-issued, will solicit proposals
that address our objective of coordinated care management for
purchased care. We will continue to keep you informed about current
Project HERO activities and planned future directions.”
VVA will stay vigilant in
our fight to insure that veterans, by virtue of their service and
sacrifice, receive the highest quality of care.
IDENTITY THEFT CRISIS: NOT QUITE RESOLVED
Just when the VA announced it was coming to grips
with its painfully obvious failings in protecting the integrity
of information on its extensive network of computers, a desktop
computer was stolen from a VA subcontractor in Reston, Virginia,
who had been hired to help with insurance collections for VA’s
medical centers in Pittsburgh and Philadelphia. Contained on
its hard drive was information on some 20,000 veterans. This
information “may
have,” the VA said, “contained patients’ names,
addresses, Social Security numbers, dates of birth, insurance carriers
and billing information, dates of military service, and claims
data that may include some medical information.
One can only imagine
the explosion on the tenth floor at VA headquarters, when Secretary
Nicholson learned of the latest breach.
If you question why VVA
entered into a lawsuit against the VA, it was precisely to insure
that the department takes all appropriate action to make sure such
data breaches never happen again. Obviously, the VA has a ways
to go before the VA can be established, in the words of Secretary
Nicholson, “as a leader in data and information
security.”
PTSD: A NUMBERS GAME
The issues surrounding PTSD seem to have gained
major media attention—as
well as attention in the corridors of Congress and at VA headquarters.
Most recently, a reanalysis of data collected in the 1980s, reported
in the journal Science, concludes that nearly one out of every
five (18.7 percent) Vietnam veterans had experienced Post-traumatic
Stress Disorder and that nearly one out of every ten (9.1 percent)
Vietnam veterans suffered from chronic and disabling PTSD more
than ten years after the war was over.
While these numbers represent
a decrease, this “authoritative
study reaffirms and confirms our government’s obligation
and need to provide appropriate mental health services for veterans
who were psychologically wounded by their wartime service,” said
VVA President John Rowan. “It is consistent with studies
published earlier this year which suggest that between 11 percent
and 17 percent of soldiers returning from Afghanistan and Iraq
have had symptoms of Post-traumatic Stress upon their return,” Rowan
noted.
“Rather than disputing numbers, our focus must remain on
insuring there are accurate, standardized early screening, diagnosis,
and clinically effective, evidence-based treatment and recovery
programs for all of our veterans suffering psychological trauma
as a result of their military combat experiences. And Congress
must insure there is adequate funding and trained personnel for
both the VA and the Department of Defense to deliver these services
and programs to our nation’s veterans,” Rowan said
in a press release.
“What is beyond argument is that the more combat exposure
a soldier sees, the greater the odds are that he—and increasingly
she—will suffer mental and emotional stress that can become
debilitating. And in wars without fronts, combat support troops
are just as likely to be affected by the same traumas as infantrymen,” Rowan
said.
“VVA also believes that tens of thousands of Vietnam veterans
who have suffered from post-traumatic stress seek neither treatment
nor compensation because of a variety of factors, including pride
and their own self-image. Rather than attempt to minimize the numbers,
the government must acknowledge the clinical damage and provide
the necessary clinical services.
“No one really knows how many of our troops in Iraq and
Afghanistan have been or will be adversely affected by their wartime
experiences,” Rowan
said. “And despite early intervention by psychological personnel,
no one can project how serious their emotional and mental problems
will become, or how chronic will be both the neuro-psychiatric
wounds and their impact on physical health. Given the nature of
the conflicts in Iraq and Afghanistan, VVA has no reason to believe
that the rate of PTSD for veterans of OIF and OEF will be any less
than that of Vietnam veterans.
“The recent study reanalyzing data from the National Vietnam
Veterans Readjustment Study (1988) only underscores VVA’s
belief that the congressionally mandated NVVRS follow-up study
be conducted so that there can truly be a longitudinal study of
Vietnam veterans that will be useful both for us and for the veterans
who follow us,” Rowan said.
“The bottom line must be to make sure that the new generation
of returning veterans gets the assistance and clinical interventions
they need, so that they don’t develop chronic PTSD.”
LEGAL
REPRESENTATION FOR CLAIMS
With the enthusiastic backing of Sen.
Larry Craig (R-Idaho), chair of the Committee on Veterans’ Affairs,
the Senate passed S. 2694, the Veterans’ Choice of Representation
and Benefits Enhancement Act of 2006. This legislation grants veterans
the right to engage legal representation when filing a claim for
compensation before the Veterans Benefits Administration.
Some have
expressed fears that such a bill will only make adversarial a process
that should be cooperative. Others worry that passage of this bill
will herald the demise of veterans service representatives. We
believe that the realities will be just the opposite: that giving
veterans the right to legal representation will make the VA more
cognizant of its obligation to help veterans making claims; and
that service reps will still have more cases than they can handle.
INCREASING
GOVERNMENT EFFICIENCY?
On the other side of the ledger, two misbegotten
bills that could have threatened veterans’ benefits and programs
never made it to the floor of the House, in great measure because
of opposition voiced by veterans organizations and an array of
groups appalled at this attempt to usurp congressional oversight
and authorization responsibilities.
H.R. 5766, the Government Efficiency
Act, and H.R. 3282, the Abolishment of Obsolete Agencies and Federal
Sunset Act, would have forced Congress to consider the legislative
recommendations of commissions created by these acts under an expedited
process, without the possibility of any floor amendments.
When it became apparent that the votes weren’t there for
passage, the Republican leadership retreated. VVA is, of course,
in favor of government efficiencies; these bills, though, under
the guise of promoting efficiency, could eliminate programs and
commissions with little or no public input.
The fear remains that
the bills will again come up for consideration. And if they do,
VVA will again work to shoot them down.
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