Advance Appropriations: A Victory for Veterans

The highest legislative priority of Vietnam Veterans of America has long been the reform of VA healthcare system funding. Our goal, as a member of The Partnership for Veterans Health Care Budget Reform, has been to achieve a timely, sufficient, sustainable, and predictable funding stream for a trio of VA healthcare accounts. That goal, after years of effort, has finally been achieved.

On October 13, the Senate, by voice vote, cleared H.R. 1016, which would authorize appropriations one year in advance for VA medical care programs, beginning with fiscal year 2011. The House had passed this bill by a vote of 409-1. On October 22, President Obama, true to a campaign pledge, signed the bill, making it the law of the land.

Advance appropriations, we believe, is necessary because in 19 of the past 22 years Congress has been late in passing the VA budget. This happened in the current fiscal year as well. Advance appropriations should help VA managers properly plan for hiring critical staff, purchasing state-of-the-art medical equipment, and the initiation of maintenance and small construction projects knowing the minimum funding they will have.

The law now requires the Government Accountability Office to study the adequacy and accuracy of the budget projections for VA health care expenditures for the fiscal year involved and the subsequent four fiscal years. It also requires the President to submit a budget request for the VA’s medical care accounts for the fiscal year after the one for which the budget is submitted. Also, the VA must provide an annual report to Congress by July 31 of each year detailing cost estimates.

In signing the bill, the President called the situation that has prevailed for far too long “inexcusable” and “unacceptable. It’s time for it to stop, ” he said, “and that’s just what we’ll do with this landmark legislation, the Veterans’ Health Budget Reform and Transparency Act.

“I want everybody to know: Today is a victory for all the veterans organizations who fought for years for reform.” He also gave well-deserved plaudits to the chairs of the Senate and House Veterans’ Affairs Committees, Daniel K. Akaka and Bob Filner, and to House Speaker Nancy Pelosi, Reps. Chet Edwards of Texas, Phil Hare of Illinois, and Mike Michaud of Maine, and Sen. Tim Johnson of South Dakota. And we’ll add to this list Sen. Jim Inhofe of Oklahoma, who helped the bill along with a key procedural vote in the Senate, as well as Reps. John Boozman and Henry Brown.

In signing the bill before it went to the President, Speaker Pelosi said, “We reiterate a solemn promise to the members of our armed forces: just as the military pledges never to leave a soldier behind on the battlefield, when they come home we will leave no veteran behind.”

TIME FOR NO EXCUSES
Advance appropriations, the President said, “will mean better access to doctors and nurses and the medical care that [veterans] need—specialized care for our wounded warriors with post-traumatic stress and traumatic brain injuries, and the staffing to welcome back to the VA [a] half-million Priority 8 vets.

“In short, this is common-sense reform. It promotes accountability at the VA. It ensures oversight by Congress. It is fiscally responsible by not adding a dime to the deficit. And it ensures that we will no longer be held hostage to the annual budget battles in Washington.”

Accountability. That’s what the man said. And oversight. VVA has long held that funding alone is no panacea for problems in health care delivery to our nation’s veterans. With advance appropriations now enacted into law, we intend to focus attention on ensuring that VA managers spend the funding they get to improve the health care of the veterans they serve. And we will press Congress to fully exercise its responsibilities for oversight and investigation when it appears that an entity of the VA messes up.

NVVRS TO NVVLS
VA Secretary Eric K. Shinseki announced plans to begin additional research by his department to better understand the health consequences of service in Vietnam.

“The National Vietnam Veterans Longitudinal Study (NVVLS) will allow VA to pursue another valuable research tool, ” Shinseki said: “The insight we gain from this study will help give us an understanding of how to better serve America’s veterans.”

Actually, it is the follow-up to the NVVRS, the National Vietnam Veterans Readjustment Study done in the mid-1980s. It will morph into a true longitudinal study (hence the new name) of the morbidity and mortality of Vietnam veterans upon its completion. Its purpose is to study the Vietnam generation’s physical and psychological health. As a group, how are we faring?
According to a press release, the VA has begun work to solicit bids to conduct the study, which is expected to run from 2011 through 2013.

HOW’S THE VA DOING?
Addressing a hearing of the House Veterans’ Affairs Committee, Secretary Shinseki offered a nine-month progress report on the state of the VA. In his written testimony, he stated that he continues “working to craft a shared vision for the department, one that will be enduring. We remain guided by our determination to be people-centric—veterans and the workforce count in this department; results-driven—we will not be graded on our promises, but by our accomplishments; and forward-looking—we strive to be the model for governance in the 21st century.

“Veterans put themselves at risk to assure our safety as a people and the preservation of our way of life. Not all of them are combat veterans, but all of them were prepared to be. VA’s mission is to care for those who need us because of the physical and mental hardships they endured on our behalf, the cruel misfortunes that often accompany difficult operational missions, and the reality of what risk-taking really means to people in the operational environment.”

Certainly, the VA is faced with increasing demand for health care. More than four million new veterans have been added to the VA’s health care rolls since 2001, Shinseki said. Many of them who served in Afghanistan and Iraq returned to our shores with PTSD, TBI, and other polytrauma injuries, for which the VA seems to have geared up, however belatedly. And the VA is enabling many so-called Priority 8 veterans—those who do not have service-connected health issues and who agree to pay modest co-pays for their care and prescription medications—to gain access to the health care system.

The Secretary also spoke of the Post-9/11 GI Bill, which has challenged the “paper-bound processes” of the Veterans Benefits Administration. What his written testimony seemed to gloss over was the persistent backlog in the paper-bound adjudication of claims benefits.

While some publications slammed the VA for reaching the one million mark in claims awaiting decisions, we believe the VA needs to do a far better job in defining just what constitutes a backlog. As the Secretary noted, “In July, we closed out a VA-record 92, 000 claims in a single month—and received another 91, 200 new ones.

“Reduction of the time it takes for a veteran to have a claim fairly adjudicated is a central goal for VA. The total number of claims in our inventory today is around 400, 000, and backlogged claims that have been in the system for longer than 125 days total roughly 149, 000 cases. Regardless of how we parse the numbers, there is a backlog; it is too big, and veterans are waiting too long for decisions.”

We agree. Whatever the number, the fact is that far too many claims, many for multiple health conditions, take far too long to adjudicate. Why not do as the IRS does: As long as a claimant files through an accredited veterans service representative a “substantially complete” claim, take him or her at his or her word and audit as many claims as is feasible. Concurrently, bring “artificial intelligence” into the claims rating process as the system moves from paper to electrons.

“We are working with the President’s Chief Performance Officer, Chief Technology Officer, and Chief Information Officer to harness the powers of innovation and technology, ” Shinseki said. “In collaboration with our own IT leadership, we intend to revolutionize our claims process—faster processing, higher quality decisions, no lost records, fewer errors. I am personally committed to reducing the processing times of disability claims. We have work to do here. But we understand what must be done, and we are putting the right people to work on it.”
This is one area that VVA intends to push the VA into taking reasonable actions.

The Secretary also announced that “We are close to releasing a Department of Veterans Affairs Strategic Plan.” We have doubts. In the past, they have seemed more an exercise in bureaucratese rather than any real plan. It remains to be seen if anything has changed on Secretary Shinseki’s watch.

STRATEGIC PLAN FOR OUTREACH?
“Out of my discussions with veterans, three concerns keep coming through: access, the backlog, and homeless veterans, ” the Secretary noted. “We want to ensure that any veteran who can benefit from VA services knows the range of services available to them. VA will continue reaching out to all veterans to explain our benefits, services, and the quality of our health care system. A major initiative which will expand access is the President’s decision to relax the income thresholds established in 2003, which prohibited new Priority Group 8 enrollments. We expect up to a half-million new Priority Group 8 enrollees in the next four years.”

The problem is that we have yet to see any overall strategic planning to reach out—to homeless veterans, to veterans who live in rural or remote areas of the country. There are several bills before Congress that address these issues individually. But until the VA comes up with some plan to use everything from billboards to the new social media popular with younger vets (YouTube, Facebook, and the like), they are band-aiding, not healing, something that has been neglected for far too long.

OWNING UP
“In all our missions, ” Secretary Shinseki said in his written testimony, the VA “seeks to become more transparent by providing veterans and stakeholders more information about our performance than ever before. We want veterans to have the
information they need to make informed decisions. We will be sharing more data about the quality of VA health care than ever before. Using our own web sites, we are displaying information on quality including Health Effectiveness Data and Information Set scores, wait times, and Joint Commission results.

“Another element of transparency is disclosure when mistakes are made. We have aggressively disclosed problems with the reprocessing of endoscopes and with brachytherapy at several sites. These issues were found by our own staff and then publicly disclosed. In each of these cases, we notified Congress, the media, VSOs, and the patients. While this process is at times painful, it is the right thing to do for veterans and the nation and will ultimately result in greater trust and better quality.”
For this, the Secretary deserves our compliments. Because when errors are made, the right thing to do is to disclose them, fix them, and put in place procedures to insure, hopefully, that they won’t happen again.

TELEPHONE PRESCRIPTION SCAM
If you get a call from someone alleging he or she is from the VA and needs your credit card number to process or update VA prescription information, tell the person to take a hike.

It seems that callers are misrepresenting the VA to gain personal information over the phone. They say VA recently changed procedures for dispensing prescriptions and ask for the veteran’s credit card number.
The VA has not changed its processes for dispensing prescription medicines. If you have a question about this, contact the nearest VA medical center or call, toll-free, 877-222-8387.


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