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.
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