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VA panel's final report recommends broader health-care choices for veterans

Commission says Veterans Health Administration has 'profound deficiencies' that require urgent reform; proposes a 'bold transformation.'

Dennis Wagner
The Republic | azcentral.com
The Commission on Care is calling for a transformation in health care for veterans, with expanded options for community medical treatment and a new governing board to oversee the nation's largest health-care system.

A national commission assigned to come up with reforms for the Department of Veterans Affairs is calling for a transformation in health care for veterans, with expanded options for community medical treatment and a new governing board to oversee the nation's largest health-care system.

A commission report contains 18 recommendations to achieve a "bold transformation of a complex system that will take years to fully realize," adding, "We believe these recommendations are essential to ensure that our nation's veterans receive the health care they need and deserve, both now and in the future."

In a document that was scheduled for release Wednesday but was leaked Tuesday, the Commission on Care confirmed prior findings that the Veterans Health Administration suffers "many profound deficiencies," especially with access to care, and those maladies require "urgent reform."

The 292-page report was endorsed by 12 of 15 commissioners. Three members declined to sign, two of them issuing a dissent letter that says the findings and recommendations fall "far short of what is needed" to fix a veterans' health-care system widely regarded as broken.

The commission's majority concluded that the so-called Choice Program, created by Congress to let veterans seek private care when timely medical appointments are not available in VA clinics, is flawed in design and execution. Instead, the commission proposes a new community network of care for all veterans, regardless of wait times or geographic locations. That system would include Department of Defense medical facilities and other federal health providers, as well as private doctors and hospitals credentialed by the VHA.

Under the Choice Program, veterans now qualify for outside care only if they face a wait of more than 30 days for a VA appointment or reside more than 40 miles from the nearest VA clinic. The commission proposes to eliminate those restrictions while granting the highest access for veterans with service-connected conditions.

That "fundamental, dramatic change" apparently would eliminate two middleman firms that were contracted by VHA through the Choice Program to operate a nationwide network of private providers, booking appointments for qualified veterans. Arizona-based TriWest Healthcare Alliance is one of those firms.

One of the report's key proposals calls for creation of an 11-member board of directors, accountable to the president and responsible for overall governance of the Veterans Health Administration. The board would work with a proposed new administrator, chief of the VHA Care System, who would be appointed to a five-year term by the president.

Other recommendations include multiple changes to improve leadership; enhance clinical operations; modernize computer systems; and create a simple-to-use personnel system.

Rep. Jeff Miller, R-Fla., chairman of the House Committee on Veterans’ Affairs, said it would take time to digest the full report, but he noted "the document makes it abundantly clear that the problems plaguing Department of Veterans Affairs medical care are severe. Fixing them will require dramatic changes in how VA does business, to include expanding partnerships with community providers in order to give veterans more health care choices."

Miller said his committee would review the report in detail at a September hearing.

Watchdog: Phoenix VA needs system to cut down on long ER wait times

The Commission on Care was created under a $15 billion reform law, the Veterans Choice, Access and Accountability Act of 2014, amid the nationwide furor over delayed care for veterans. The controversy erupted first within the Phoenix VA Healthcare System, where employees reported that patients were dying while awaiting appointments, and that administrators were issuing phony wait-time data while collecting bonuses.

Revelations in Phoenix led to inquiries across the country by Congress, the Government Accountability Office, the VA Office of Inspector General and the U.S. Office of Special Counsel. Those probes generally verified that untimely care, false data and problems with transparency, whistle-blower retaliation and accountability were systemic throughout the VA.

Secretary Eric Shinseki resigned amid the furor and was replaced by Bob McDonald. Phoenix VA Health Care System Director Sharon Helman was fired, along with several other top administrators.

After nearly a year of meetings, testimony and analyses, the commission concluded that the Veterans Health Administration offers care that is "in many ways comparable to or better in clinical quality" than what is available in private hospitals. However, members concurred with an Independent Assessment Report that determined the VA is plagued by "chronic management and system failures, along with a troubled organizational culture."

Three more Phoenix VA officials fired in aftermath of wait-time, retaliation probes

Commissioners stressed that the proposed reforms cannot be treated as "piecemeal fixes," but must serve as a "foundation for far-reaching organizational transformation." For example, they stressed that the VHA has no qualified senior executive to oversee information technology and operates with "antiquated, disjointed clinical and administrative systems" that affect all other programs.

The commission members were appointed by congressional leaders and the president. Chairwoman Nancy Schlichting is chief executive officer of the Henry Ford Health System.

In the dissent letter, Commissioners Darin Selnick and Stewart Hickey wrote: "The commission's final report is largely a hodgepodge of perfunctory recommendations that, while well meaning, will do little to redirect the VHA's troubled trajectory. The central problem is that these recommendations focus primarily on fixing the existing VHA provider operations, rather than boldly transforming the overall veterans’ health care system.”

Selnick and Hickey said the report will stand as a “monument to a lost opportunity for the bold reform that the VHA needs, and that veterans deserve.”

Selnick is a former VA employee and adviser to Concerned Veterans for America, which advocates a complete transformation of the VHA into a federally chartered non-profit enterprise with an open-choice system for veterans. Hickey is former health-center administrator and past executive at AMVETS, a service organization with about 250,000 members.

Senate investigation finds 'systemic' failures at VA watchdog

Selnick, an Air Force veteran, told USA TODAY that the commission never adequately researched a larger overhaul of VA health care including transforming it into an insurance-type program that would pay for rather than directly provide health care. He also said the commission never voted on which provisions would be included, and the chairwoman declined to include the dissent letter with the final report.

Schlichting could not be reached immediately for a response to those criticisms.

The commission's final report will be submitted to Secretary McDonald and President Barack Obama on Wednesday. Under the Choice Act, the president has 60 days to submit a congressional report assessing the findings and recommendations.

USA Today reporter Donovan Slack contributed to this story.