A Failing Veterans Health Care Handoff

ISSUE

Massive backlog reveals the dire necessity for simplification, communication and efficiency in processes, systems and government service contracting in DOD and the Veterans Administration. 

BACKGROUND

A recent 3 part special in Time Magazine addresses the serious gaps between treatment, benefits and services processes and systems between the military services and the Veterans Administration:

http://nation.time.com/2013/04/22/what-the-hell-is-going-on-with-va/#ixzz2RnspoSM4

"While awaiting processing, "the veteran’s claim sits stagnant for up to 175 days as VA awaits transfer of complete (service treatment records) from DoD,":


http://veterans.house.gov/sites/republicans.veterans.house.gov/files/2013%2004%2016%20HVAC%20to%20Sec%20Hagel.pdf

After years of work to move toward integrated electronic records that would eliminate this sort of delay, Defense Secretary Chuck Hagel recently conceded that the Defense Department is not holding up its end of the bargain to improve the disability process.

"I didn’t think, we knew what the hell we were doing.":

 http://www.federalnewsradio.com/394/3288748/Hagel-orders-DoD-to-restructure-path-toward-integrated-health-record

HISTORICAL SIMILARITIES
 
The above scenario is not unlike the Walter Reed Army Hospital care fiasco a few years ago, before the facility was shut down and consolidated with the Bethesda Naval facility.

OTHER SYMPTOMS

The VA decided to have those who would actually use the system (claims processors) work with software developers. This process took longer but will create a system more likely to meet the needs of those who actually use it. VA also worked closely with major congressionally-chartered veterans’ service organizations.

This year, 2013, is the year in which regional offices are being transitioned to the new electronic system.

ROOT CAUSE

Both the services and the Veterans Administration use service contractors to perform this type of systems development. Government Computer News (GCN)  carried a story on the difficulties experienced with, "Performance-Based Contracting", which has been made part of the Federal Acquisition Regulation (FAR) in an attempt to pre-establish at contract award those discrete outcomes that determine if and when a contractor will be paid.

Interestingly enough, the article splits the blame for the difficulties right down the middle, stating the government typically has problems defining what it wants as an end product or outcome and looks to contractors to define it for them. More than willing to do so, the contractors detail specific end products or outcomes, set schedule milestones and submit competitive proposals.

The winner is selected based on what the government thinks it needs at the time to fulfill its requirement and a contract is negotiated. Once underway, the government decides it wants something else (usually a management-by-government committee phenomena with a contractor growing his product or service by offering lots of options). The resulting change of contract scope invalidates the original price and schedule, so a whole new round of proposals and negotiations must occur with the winner while the losers watch something totally different evolve than that for which they competed. The clock keeps ticking and the winner keeps getting his monthly bill paid based on incurred cost or progress payments. The link to the GCN article is below:

http://gcn.com/articles/2006/12/01/performancebased-contracting-still-baffles-agencies.aspx

CONCLUSION

The present state of the economy and the needs of our servicemen will not allow the aforementioned to continue. Government agencies are now hard pressed to insure the most "Bang for the Buck". It is in the long term interests of astute contractors to assist in that endeavor. The only way to achieve such an objective is through sound technical, cost and schedule contract definition via an iterative process of baseline management and control.

Our returning soldiers and those who have served before deserve better.

THE UNITED STATES VETERANS ADMINISTRATION - PROGRESS AND PROCLIVITIES

INTRODUCTION

We have noted improvements in the medical element of the U.S Veterans Administration with significant advances in patient care, records keeping and service to soldiers in need when they return from war or fall into circumstances in which they require assistance:

http://www.time.com/time/magazine/article/0,9171,1376238,00.html

We believe the VA medical care veterans are receiving, and the associated facilities are top notch.  We base this belief on having received this care  ourselves and observing the results from others receiving VA medical services around us.

As the US has continued its war fighting incursions into foreign countries, the VA has been required to expand exponentially in terms of coverage, organization, programs and budget from the tax payer coffers. The most current budget request by the Administration for the VA tops $140 Billion for the next fiscal year.

This growth has resulted in administrative and management challenges due to the broad swath the VA must cover across the spectrum of our society and the transitions in which it must participate within people’s lives from the aging vet to the returning combatant.

RECENT DISTURBING TRENDS AND OCCURRENCES

At this juncture it must be noted that the VA is falling into several of the traps that other large federal agencies have encountered.  The government is in the business of spending money, not making it and growth of the type the VA has undergone requires strong management and oversight. 

Below are examples of areas outside the medical care elements of the organization that are never the less posing substantial risk to the care of our veterans.

Blatant Issues in Handling Veterans Care Application  Backlogs

As noted by Time Magazine:

“The Department of Veterans Affairs inspector general reported that paper had piled so high at the VA’s regional office in Winston-Salem, N.C., that it “appeared to have the potential to compromise the integrity of the building.”

http://nation.time.com/2012/08/10/guess-the-va-does-have-a-paperwork-problem/

Mismanagement of Human Resources and Training

As noted by DOD Buzz:

“The chairman and ranking members of the House Veterans Affairs Committee are demanding a complete accounting of where and how the Department of Veterans Affairs has spent money on employee conferences since 2009.

The latest demand comes as the committee’s senior members released additional information gleaned from a preliminary VA Inspector General’s report on two Orlando, Fla., conferences held for VA human resources employees in 2011.

Among the findings, the VA spent $52,000 producing two 8-minute videos in which an actor portraying Army Gen. George Patton laid out the role of VA human resources personnel and exhorted them to meet their mission. A shortened version of the video is available below.

The department also spent $84,000 on VA-branded promotion items, including up to $25,000 for pens, highlighters, post-it notes and hand sanitizers.

Rep. Jeff Miller, R-Fla., and Rep. Bob Filner, D-Calif., want three years worth of data because they say past VA testimony on conference costs has been contradictory, ranging from $20 million in both 2011 and 2012, to $100 million.”

http://www.dodbuzz.com/2012/08/22/va-accounting-questioned-after-ig-report-2/

Mismanagement of Small Business Set-aside Programs

As noted by POGO:

“A new report by the Department of Veterans Affairs Office of Inspector General (IG) has found another large business improperly benefited from federal small business contracts. The offender this time is Health Net,  ranked 221 in the most recent Fortune 500 with $11.9 billion in revenue last year.

As POGO takes great pains to point out, the contractors themselves aren’t entirely to blame for misconduct in federal small business contracting. In this instance, the IG found that VA personnel responsible for administering the contracts were fully aware that Health Net, not ETS, was performing all of the work. The VA also did not properly justify its decision to award the contracts as SDVOSB set-asides rather than through full and open competition.”

http://pogoblog.typepad.com/pogo/2012/08/inspector-general-finds-contractors-government-both-responsible-for-small-biz-contracting-violations.html

CONCLUSION

The areas noted above must have management correction, be controlled and brought to the same standards of performance as the medical arm of the Veterans Administration Community. 

The proclivities involving  lax administration, wasteful human resources process and abuse of small businesses, many of which veterans themselves run, must be corrected. 

Doing so will insure an acceptable level of focus on assistance to the men and women who have served in our armed forces.    

Cameo Presentation - Rose Colored Glasses Satire by Tony Rose

With the present day emphasis on the National Debt and Health Care, it seemed only fitting to publish a cameo of the apparently ageless satire by Tony Rose below:

"Economists Coin New Term for Study of Deficit Spending"

"Micro-Electronic Medication of Your Years"

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PLEASE CLICK IMAGE OT TITLE BANNER ABOVE TO ENLARGE