4 Things Washington Could Do Right Now to Fix the VA

Spoiler alert: None of them involve floor speeches or finger-pointing.

World War II paratrooper Donald R. Burgett, 89, salutes the US flag as he poses for a portrait at his home on April 29, 2014 in Howell, Michigan. Burgett landed in Normandy and fought in the D-Day battle as part of the Able Company, 506th Parachute Infantry Regiment and the101st Airborne Division of the US Army. 
National Journal
Jordain Carney and Stacy Kaper
See more stories about...
Jordain Carney Stacy Kaper
May 22, 2014, 3:59 p.m.

Part Three in a series on Vet­er­ans Af­fairs. Read Part One here and Part Two here.

The worst news: A gov­ern­ment bur­eau­cracy is stand­ing between vet­er­ans and their health care, and vet­er­ans are dy­ing be­cause of it.

The bad news: Wash­ing­ton has already tried, and is now retry­ing, its typ­ic­al re­sponses to a crisis, and they’re not work­ing.

Money has been thrown at the prob­lem and the prob­lem is still there. An ad­min­is­trat­ive head has rolled — and un­der a newly passed House bill, oth­ers would likely fol­low — and the prob­lem is still there. And when politi­cians are done with their spas­tic grand­stand­ing and fin­ger-point­ing, the prob­lem will still be there.

There is no good news.

But there is hope of a sil­ver lin­ing: The vet­er­ans’ deaths can be what gal­van­izes the gov­ern­ment in­to fix­ing a sys­tem that has been far too broken for far too long. And if Pres­id­ent Obama and Con­gress are will­ing to move past politick­ing to search for policy solu­tions, ex­perts say there are steps that could be taken right now to bet­ter con­nect vet­er­ans with the care they need.

Here are four of them:

1. Con­gress could ask doc­tors — not vet­er­ans — to handle the pa­per­work.

Un­der the Vet­er­ans Af­fairs Ad­min­is­tra­tion’s cur­rent sys­tem, vet­er­ans must fill out lengthy and com­plic­ated claims forms if they want re­im­burse­ment for their care, and those forms of­ten ar­rive at the agency either in­com­plete or in­cor­rect.

Com­pare that with the private in­sur­ance car­ried by most ci­vil­ians, whose doc­tors typ­ic­ally sub­mit re­im­burse­ment to the in­surer. Were a sim­il­ar pro­cess to be ad­op­ted by the VA, the agency would be re­ceiv­ing claims by leg­al pro­fes­sion­als or mil­it­ary doc­tors who would be bet­ter trained and more ac­cus­tomed to filling them out — and thus much more likely to file them ac­cur­ately.

So what would it take to re­lieve vet­er­ans of the re­spons­ib­il­ity for filling out forms that most privately in­sured pa­tients are free of?

An act of Con­gress, and a sig­na­ture from Obama.

The VA claims pro­cess is set by stat­ute, and so to change it law­makers would have to pass new le­gis­la­tion al­low­ing for changes. And there are oth­er changes they might con­sider as well …

2. Con­gress could re­quire the VA to give more vet­er­ans the be­ne­fit of the doubt.

If Con­gress wanted to change the pro­cess to make life easi­er for vet­er­ans, they could also scratch the VA’s policy of go­ing through each and every claim filed. The IRS doesn’t in­vest­ig­ate every tax re­turn. Medi­care doesn’t in­vest­ig­ate every doc­tor bill. So why does the VA in­vest­ig­ate each and every claim that vet­er­ans file?

In­stead, the VA could mir­ror the private sec­tor by gen­er­ally ap­prov­ing the ma­jor­ity of claims that look ac­cur­ate, and only audit­ing a sample or those that raise red flags, says Linda Bilmes of Har­vard Uni­versity’s Kennedy School of Gov­ern­ment.

“You should have the kind of pro­cess that you have at cus­toms, where you don’t check every bag. Be­cause if you checked every bag of every­one step­ping off the plane, you’d have a huge back­log,” she said.

The VA ex­pressed ser­i­ous con­cerns about the pro­pos­al. Ac­cord­ing to a VA spokes­per­son, that sys­tem would “res­ult in the ma­jor­ity of vet­er­ans get­ting mon­et­ary com­pens­a­tion for dis­ab­il­it­ies that can­not be de­term­ined to be due to ser­vice.”

And while that may be true, at a time when Con­gress and Obama are de­clar­ing bet­ter care for vet­er­ans a na­tion­al emer­gency, they should be ready to re­quire the VA to err on the side of vet­er­ans.

3. The VA could start re­ward­ing its em­ploy­ees for qual­ity, not quant­ity.

For some re­forms, the VA need not wait for Con­gress.

For ex­ample, the agency could im­me­di­ately start de­vel­op­ing new ways to eval­u­ate its em­ploy­ees who pro­cess claims. The cur­rent sys­tem awards work cred­its to em­ploy­ees when they take a step on a claim — be it a deni­al or an ac­cept­ance. But that pushes an em­ploy­ee to fo­cus on speed, and leaves few pen­al­ties for mis­takes.

Take this hy­po­thet­ic­al: An Ir­aq war vet­er­an ap­plied for a dis­ab­il­ity claim for post-trau­mat­ic stress in Janu­ary and was er­ro­neously denied in March. Then she tried again and was denied two more times in June and in Novem­ber. Say, then, the vet­er­an were to make a fourth at­tempt in Decem­ber, and say the VA were to real­ize it had been wrong all along and award the com­pens­a­tion, the agency would claim cred­it for pro­cessing each at­tempt — without dock­ing points for the fact that they had just wrong­fully denied a vet­er­ans’ claim three times, and kept her wait­ing for nine months.

“What has to change is the way the VA counts its work. As long as VA em­ploy­ees have an in­cent­ive to go fast and not pro­cess claims cor­rectly they will do so. That is so ob­vi­ous,” said Ron­ald Ab­rams, the joint ex­ec­ut­ive dir­ect­or with the Na­tion­al Vet­er­ans Leg­al Ser­vices Pro­gram, who has worked on VA claims for 40 years, in­clud­ing 14 at the agency.

Chan­ging the in­cent­ive struc­ture needs no act of Con­gress, or an ex­ec­ut­ive or­der from Obama — though either would make it more likely to hap­pen. In­stead, the VA has the power to start mak­ing those changes the mo­ment it de­cides to.

It’s not, however, a fix without con­sequences. The trade-off between speed and ac­cur­acy leaves the VA in a bind, as both are go­ing to be needed to re­solve the back­log. But resolv­ing the back­log is mean­ing­less un­less it means get­ting care to the vet­er­ans trapped in it. And as the wait time for claims has dropped, the num­ber of ap­pealed claims has ris­en. (For more on the ap­peals con­tro­versy, see Part One on Obama’s ef­forts to elim­in­ate the back­log.)

4. Con­gress can pres­sure the Pentagon and the VA to share elec­tron­ic files.

The VA stands to be­ne­fit greatly from the De­fense De­part­ment’s in­form­a­tion — and now there is a re­l­at­ively easy way to share it: elec­tron­ic health re­cords. But for whatever reas­on, that isn’t hap­pen­ing, and the VA’s per­form­ance is suf­fer­ing for it.

Claims routinely stall as the VA waits to get ser­vice re­cords from the Pentagon, as VA staffers use those re­cords to help de­term­ine if an in­jury is re­lated to a vet­er­an’s time in the mil­it­ary.

Be­ing able to share health re­cords elec­tron­ic­ally has been a long-stand­ing goal for the de­part­ments, dat­ing all the way back to 1998. And un­der Obama, they planned to build a joint plat­form for re­cords shar­ing. But the pro­ject was dropped in 2013 after costs bal­looned in­to the bil­lions. The Pentagon is now put­ting out a con­tract for a De­fense De­part­ment-wide health re­cord sys­tem, and the VA is among the bid­ders. The agency plans to build upon its cur­rent re­cord sys­tem and see if the Pentagon will pick it.

But though in­teg­ra­tion still re­mains the end goal, the de­tails on how to get there are un­clear at best. The de­part­ments have yet to “dis­close what the in­ter­op­er­able elec­tron­ic health re­cord will con­sist of, as well as how, when, and at what cost it will be achieved,” ac­cord­ing to a Gov­ern­ment Ac­count­ab­il­ity Of­fice re­port re­leased in Feb­ru­ary.

Con­gress has thus far been little help, set­ting ar­bit­rary dead­lines that don’t get met. But the power of the pul­pit pales in front of the power of the purse, and Con­gress has both. If law­makers want to force both the Pentagon and the VA to bet­ter co­ordin­ate, that gives them plenty of pres­sure points: either by writ­ing spe­cif­ic re­quire­ments in­to the budget or freez­ing bo­nuses and oth­er fisc­al good­ies un­til the of­fi­cials get the job done.

What We're Following See More »
Reagan Families, Allies Lash Out at Will Ferrell
55 minutes ago

Ronald Reagan's children and political allies took to the media and Twitter this week to chide funnyman Will Ferrell for his plans to play a dementia-addled Reagan in his second term in a new comedy entitled Reagan. In an open letter, Reagan's daughter Patti Davis tells Ferrell, who's also a producer on the movie, “Perhaps for your comedy you would like to visit some dementia facilities. I have—I didn’t find anything comedic there, and my hope would be that if you’re a decent human being, you wouldn’t either.” Michael Reagan, the president's son, tweeted, "What an Outrag....Alzheimers is not joke...It kills..You should be ashamed all of you." And former Rep. Joe Walsh called it an example of "Hollywood taking a shot at conservatives again."

Clinton No Longer Running Primary Ads
3 hours ago

In a sign that she’s ready to put a longer-than-ex­pec­ted primary battle be­hind her, former Sec­ret­ary of State Hil­lary Clin­ton (D) is no longer go­ing on the air in up­com­ing primary states. “Team Clin­ton hasn’t spent a single cent in … Cali­for­nia, In­di­ana, Ken­tucky, Ore­gon and West Vir­gin­ia, while” Sen. Bernie Sanders’ (I-VT) “cam­paign has spent a little more than $1 mil­lion in those same states.” Meanwhile, Sen. Jeff Merkley (D-OR), Sanders’ "lone back­er in the Sen­ate, said the can­did­ate should end his pres­id­en­tial cam­paign if he’s los­ing to Hil­lary Clin­ton after the primary sea­son con­cludes in June, break­ing sharply with the can­did­ate who is vow­ing to take his in­sur­gent bid to the party con­ven­tion in Phil­adelphia.”

Movie Based on ‘Clinton Cash’ to Debut at Cannes
4 hours ago

The team behind the bestselling "Clinton Cash"—author Peter Schweizer and Breitbart's Stephen Bannon—is turning the book into a movie that will have its U.S. premiere just before the Democratic National Convention this summer. The film will get its global debut "next month in Cannes, France, during the Cannes Film Festival. (The movie is not a part of the festival, but will be shown at a screening arranged for distributors)." Bloomberg has a trailer up, pointing out that it's "less Ken Burns than Jerry Bruckheimer, featuring blood-drenched money, radical madrassas, and ominous footage of the Clintons."

Former Sen. Conrad Burns Dies in Montana
5 hours ago

Conrad Burns, the colorful livestock auctioneer and radio executive from Montana who served three terms as a senator, died on Thursday at age 81. Burns "was ousted from office in 2006 under the specter of scandal after developing close ties to "super-lobbyist" Jack Abramoff," although no charges were ever filed.

Biden Goes Max Biden at the Vatican
5 hours ago

In an exchange not ripped from the page of The Onion, Vice President Biden revealed to a Vatican cardinal that he's been betting reporters on which cars are faster. After meeting privately with Pope Francis, Biden met with Cardinal Pietro Parolin, the Vatican Secretary of State. Within moments of greeting one another, Biden said that he'd met with the pope and, gesturing to the press pool, "I've met with these guys too." Singling out reporter Gardiner Harris, who recounted the exchange, he said, "I had to pay this man $10. He's from the New York Times. We had a bet: which is the faster car, the newer Cadillac or the new [Tesla]. ... The Tesla's two tenths of a second faster. But I lost. I paid my $10." He joked that he's "seeking absolution."