Slow Motion Implosion at the VBA: Or Where Warfighters Become Backlog

By Al Poteet

Introduction by Ed Timperlake Editor Second Line of Defense Forum and Former Assistant Secretary Department of Veterans Affairs.

Al Poteet has perfectly teed up an important key veteran issue which requires political attention and remediation.

Although VA Hospitals (Veterans Health Administration) through a lot of bipartisan Executive and Legislative branch attention along with Veteran Service Organizations oversight have improved tremendously, there are urgent issues to address this year.

In fact the great quote about the approval rating of Congress applies; Congress has a low approval in general, but most individuals often think highly of THEIR Congressman.

Most Veterans I know respect THEIR Hospital but are totally frustrated with the Department of Veteran’s Benefits (DBA) benefit adjudication process.

I have been treated as a combat disabled veteran from South East Asia at the Washington VA Medical Center and it has proven to be a first class, caring hospital staffed with true professionals.

However Al Poteet, with a wealth of experience has captured perfectly the epic failure of the VA benefit system (VBA).

It is long past time to keep kicking the problems which can be remedied down the road.

As Rachael Maddow correctly says this is not a right/center/left issue and it must be fixed, for we are a Nation at war.

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As the backlog of claims continues to grow, Veterans Benefits Administration (VBA) performs word alchemy.  They are now dealing with inventory backlog, not veteran needs.

The VBA is content to  “transform” adjudication processes and to project future claims completion into a land far, far away.

They are mimicking the broader U.S customer experience with new IT  voice mail “customer service,” but this is the VA version being done to the warriors who have returned. They used to be applauded at sports stadiums; now they are backlog.

Instead of customer response, the goal of many American customer service systems is to keep customers pushing an endless chain of voice mail numbers, rather than getting a problem solved.  The VBA has found their own variation of this: join the inventory but not get your claim dealt with expeditiously.

The VBA urgently needs to take a “clean paper” approach to designing a comprehensive, integrated plan with a top-to-bottom reorganization devised to efficiently and quickly adjudicate veterans’ claims.

As if a backlog of over 900,000 claims isn’t enough to give veterans, VA senior management, and tax-payers apoplexy, VBA has decided to use the gentler and politically correct word “inventory” instead of the more sinister word, “backlog” to describe the actual state of affairs.

If you are a veteran who has waited months or even years for the final disposition of your claim, backlog fairly well sums up your predicament but does not suggest an imminent solution.

It appears that senior VBA leaders prefer the more positive connotation of “inventory” that evidently takes the edginess off sinister words such as backlog.

 

Fixing the problems does not require the practice of rocket science.  How about some VBA national leaders listening to   field Regional Office (RO) managers and adopt their recommendations for process improvement.  That would be a revolution.

This attitude leaves the field rank and file with the clear impression that “father knows best” so just follow the playbook and someday and someway you folks in the “inventory que” will become human beings again.

In fact, very experienced, field Directors have retired without the courtesy of an exit interview with senior managers in VA Central Office (VACO) to discuss the potential range of solutions to better manage the growing backlog.

Fast forward to today and once again, the majority of VBA leadership resorts to the tired excuses of yesteryear, explaining by oblique reference, that the failure to reduce the growing backlog isn’t their fault. It was the last Administration’s fault, or the one before that……

They argue that they inherited the mess and so many veterans are filing claims. But the buck stops with them.  And like alchemy turning lead into gold, “future actions” will solve the problem.  Providing change you can believe in, by 2015 or so, we are promised huge productivity gains.

But The future is now.  And the problems need to be addressed now and not after the November 6, 2012 elections.

What are the sources of the problem and what ways can these problems be addressed?

The growing backlog exists due to four external factors.

  1. Ten years of war with increased survival rates;
  2. Post-conflict downsizing of the military;
  3. Additional medical presumptive conditions; and
  4. Successful outreach encouraging more veterans to submit claims.

Although these four “reasons for failure” have been known to VBA for many years, they evidently come as a surprise to some of the overlords who were the architects of previous failed “transformations.” It appears they have repackaged these four factors to explain why the backlog continues to grow out of their control despite their professed Herculean efforts to date.

In fact, these four “external factors” actually parallel a similar situation that occurred at VA during and after the Vietnam War.  However, in VBA, the past is often prolog so veterans continue to be subjected to more half-hearted plans that are essentially dilatory tactics by the Under Secretary’s senior staff.

So the Simon Lagree’s of VBA operations continue to trot out one lame horse after another to explain why the backlog now grows beyond their control.

By taking an old page from prior VBA game plans, the latest “transformation” appears to be designed to kick the can down the road for a few years beyond the 2012 elections while simultaneously claiming spectacular productivity improvements are right around the corner.

Nonetheless, the plain fact is VBA has had numerous, less than successful attempts to reinvent the bureaucracy usually ending with limited strategic success.

As usual, these “half-loaf” transformations sound plausible, complete with the kind of hype and hyperbole we have come to expect from the Under Secretary’s staff.

Sadly, the highly-touted, systemic improvements pledged, mostly delivered broken promises. And veterans claims become transformed into BACKLOG.

VBA’s latest transformation initiative is being led by retired Air Force Brig. General Allison A. Hickey who became the VBA Under Secretary for Benefits in June 2011. Earlier this month, Gen. Hickey rolled out the latest power point presentation entitled, SYNCRONIZING VBA’s TRANSFORMATION dated July 9, 2012, that summarizes VBA’s latest plan to reduce the backlog.

An exceptional amount of staff work must have gone into this most recent “transformation” since the final power point was identified as version 79. This 21 page power point deck is interesting but far from illuminating due to its lack of specificity and details.

The plan rests precariously on a house of cards that requires all component pieces of the plan to be successfully integrated, and work flawlessly in a timely fashion. Not a Washington strong point. 

According to the Hickey Plan, VBA predicts the resulting trajectory of this latest “transformation” will result “in a 45-60 percent increase in productivity and a 14 point increase in quality in 2015 while increasing access and helping to eliminate homelessness.”

Leaving aside the dubious ability of VBA to eliminate veteran homelessness nationwide, this power point is nothing more than a general strategic plan that is insufficient to assess outcomes with any degree of accuracy.

Instead, VBA’s top dog relies on assumptions that will make the intended results impossible to achieve. To steal a line from Mr. Filner, Ranking Minority member of the House Veterans Affairs Committee, a power point is not a plan.

Unfortunately for USB Hickey, she must rely on a senior staff to execute this “transformation,” the very same staff that in many instances delivered failed plans that VBA is trying to grapple with today.

Transformation should indeed be a prime objective for VBA.

However, based on past performance, transformations have been full of good intentions that have proven impossible to successfully execute. The VBA leadership bureaucracy has continued to protect its turf to the detriment of veterans seeking benefits they were promised by a grateful nation.

What other realistic conclusion can be drawn from the latest transition?

Unfortunately, applying bright lipstick to a pig still leaves you with a pig.

As with any significant undertaking, the failure of past “transformations” is in great part due to the capability of the USB staff.

Their apparent unwillingness to plan and execute a wholesale reorganization to remove impediments and facilitate increased productivity again demonstrates style over substance. Instead of relying on black box concepts based on sketchy IT solutions, the promise of significant efficiencies and increased productivity will not be realized.

If VBA executes this most current “transformation” while an avalanche of new, complex claims pour into VAROs, the outcome is likely doomed to failure — as were its predecessors.

The new VBA plan is akin to changing the engine of airplane while in flight – once again, easy to say and impossible to do.

In some quarters, VBA has been notorious for reconfiguring work around methodologies that stop the adjudication clock while ROs actually process claims.  This is an interesting methodology for   reducing the time from claim origination to completion or where “backlogization” becomes king.

This blatant misrepresentation of data makes VBA’s timeliness numbers look better but do not honestly reflect improved timely, service to veterans.

Until the VBA leadership is ready to put a stop to “gaming” the system by designing novel ways to count workload that appears to whittle down the backlog, once again the result will be abject failure.

As Albert Einstein so famously stated, the definition of insanity is doing the same thing over and over again and expecting different results.

We can all quibble about VBA’s statistics and the efficacy of process improvements realized to date.

But undeniably, the steady trend of ever increasing backlogs with more on the way requires something much different than the latest VBA staff transformation plan.

Until VBA and VA senior leadership understand the clear mismatch between the increasing demand for VA benefits and the availability of integrated solutions that efficiently moves the workload through the adjudication pipeline, VBA will continue to lose ground and the backlog will continue to grow for years to come.

A plan to rearrange the deck chairs on the Titanic would have provided a “transformation” but one that had the same inevitable outcome.

It is time to stop kicking the can down the road under the USB Plan and make the difficult decision to completely reorganize VBA.

We need to establish a reinvention blueprint designed to operate in the 21st Century, and not version 79.

The goal of this “reinvention” would be to dramatically improve efficiency and productivity, recruit and train claims development and rating specialists, to reduce significantly claims adjudication timeliness for veterans and their families.

VBA field Directors should be provided with a basic mission framework but encouraged to implement and capitalize on cost-saving initiatives, efficiencies, productivity increases, and time-saving claims processing developed to meet the demand by veterans within their jurisdiction. Contingent with this freedom to solve problems and improve RO processes is accountability. Providing Directors with a VACO “playbook” that dictates instead of empowers the RO Directors will most certainly choke off ingenuity while stifling inventiveness.

The best course of action for VBA to pursue is one that does not overly rely on IT solutions or touts significant productivity increases not based on fact.

It is vital that additional cadre of highly-trained Rating Veteran Service Reps (Rating Specialists) be recruited, hired, and trained at the Super ROs to augment existing adjudication workforce. We need real persons, not the functional equivalent of the private sector endless cycle of voice mail choices.

Additional rating and development staff is mission critical if VBA is to effectively work down the backlog.

VBA’s leadership continues to grapple with systemic problems that require more than IT solutions, automated paperless systems (being piloted at two small ROs), and new telephone capabilities.

With the help of visionary leaders, a “reinvented” learning organization must be quickly designed, approved, and implemented that builds on the lessons learned over many years. Otherwise, new “transformations” will simply leave us with the proverbial train wreck waiting to happen.

Mr. Poteet is a former Army gunship pilot with two tours in the Republic of Vietnam; a registered lobbyist for the Veterans of Foreign Wars;Deputy Assistant Secretary for Congressional Affairs; Director of three VA Regional Offices; a VA Medical Center Director; and Executive Director of the President’s  Task Force To Improve Health care Delivery For Our Nation’s Veterans. He resides in central Texas with his wife Miriam.

 

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2 responses to Slow Motion Implosion at the VBA: Or Where Warfighters Become Backlog

  1. Ed Fahy wrote:

    This is a great article! I’m a 100% disabled Vietnam Vet and it sure would be nice if someone could fix the broken system! Thank you Al! Well said!!

  2. rmnewt wrote:

    What’s in a name? This article acutely highlights the Veteran’s Administration can’t administer medical care to our veterans. Apparently its epidemic across the regions that they’ve concocted schemes that falsely report the sad realities of delayed and often denied care.
    I’ve often thought that the VA is the best example of what is in store for the broader public with the Affordable Care Act/Obamacare. That is an unaffordable, lack of medical care reality. Just follow the money that is ported to the administrators/middlemen instead of the actual care givers, the doctors and nurses.
    Perhaps the next step is to simply rename the agency “the Veteran Healthcare Integrity Administration.” They’ve proven they can’t administer healthcare and at the core of that failing is a total lack of integrity. Don’t get me wrong, there are some really great people in the VA beginning with the Doctors and nurses. We see many of them, the actual caregivers lining up to blow their whistles. I hope we see some accountability soon so keep it up SLD. Awareness is the key for the VA and Nation.

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