President Trump actually gave President Obama a vote of confidence in his elevating Dr. Shulkin in rank from Undersecretary for Veterans Health Administration (VHA) to Secretary of the Department of Veterans Affairs.
Consequently, let us all now see how that act of bipartisan comity is going to be repaid with the nomination of Rear Admiral Jackson USN MD.
He is retiring as an Admiral.
The selection of Admiral Jackson is being attacked on the issue of his lack of significant command qualifications.
When he was announced, I was sorry to see the shallow negative quotes about Admiral Jackson to become DVA Secretary and I took an opportunity to praise his selection.
Right now with an “Acting Secretary,” pending the confirmation of Secretary Jackson MD, it is a perfect time to initiate a GAO audit of the ability of DVA employees to make accurate and timely payments to the providers of private medical treatment for disabled veterans, who had used the “Choice” option.
Basically the current DVA “Choice” program means that if a veteran has to wait longer than 30 days or needs to travel over 40 miles as measured by distance the veteran can qualify to be treated by private sector physicians or have medical procedures such as an MRI.
There is a DVA “Choice” fact sheet that is rather accurate in going into much more detail:
A just completed DAV IG audit, which was very professionally done, focused on “Choice” waiting times and availability:
As did a very professional GAO audit, again focusing on waiting times:
However “Choice,” yes or no, is currently just a test of raw political power without all the facts of how it is truly working.
Many professional Veteran Service Organizations (VSOs) see “Choice” as a harbinger of the eventual privatization of the VA, while other more recently charted Veteran organizations are saying “why not?”
Unfortunately the most important component of the “Choice” initiative is not well understood.
Before any changes can be made to expand or contract this relatively new initiative from August 2014, there is a very practical need for a system wide audit to see if ALL the dimensions of “Choice” are good for the veteran and their family.
It is not just about fixing the all-important waiting time issue.
So far, the DVA competence of having timely accurate payment for services is not well understood and reported as going poorly.
US private sector medicine is first rate, the envy of the world and expensive.
The administrative failure in Choice can rest on the fact that in most cases the people running and overseeing the current bureaucratic “pay for service” including any contract support teams are lifetime DVA employees.
A simple auditable question with profound implications is:
Can DVA career employees who have been totally socialized into public sector bureaucracy training and thinking, be successfully trained to the skill sets and financial responsiveness of the best of the private sector medical insurance corporations?
Look at one option legislative and executive branch employees have which is “FedBlue” it is first rate in payout responsiveness and just one of many options for civil service employees.
Good private sector insurance companies understand the need for both rapid “pre-qual” or if emergency medicine is required then make a decision that the emergency care was justified, and either way they are then consumer friendly and responsive to quickly pay their insured client’s legitimate medical bills.
The anecdotal evidence to date says those utilizing the Choice option have had both “pre-qual” administrative issues, and then sadly once treated the current DVA pay out bureaucracy is very weak in rapidly covering their bills.
This unaddressed pay for service weakness cannot be allowed because it must be a zero defect system.
This is because some veterans are facing staggering amounts of unpaid private sector medical bills.
If they die without bills being paid, their widow and orphan will have a terrible time to engage with DVA to have all their love ones delinquent medical bills paid.
Creditors hitting a deceased veteran’s estate for legitimate unpaid medical bills is unconscionable.
American Veterans do not deserve to die alone in the dark nor have their loved ones saddled with any financial liabilities from their earned service connected disability treatment.
I have personally experienced billing buffoonery and also seen other real examples of this type of tragic ineptitude in action.
A comprehensive GAO audit of DVA responsive bill paying is needed before a full “Choice” commitment can be made.
So far all veterans have seen is years of burning through people, with no indication of progress.
To summarize, President Trump and his Secretary Designee Admiral Jackson MD have in my professional judgment a one-time generational opportunity to finally “fix” VHA.
New leadership can begin to start by calling for audit of pay-out times and accuracy to combine with earlier GAO and DVA IG work on waiting times.
When the new Secretary is confirmed a comprehensive fact based total understanding of all the ramifications of the “choice” benefit can be addressed to see if it is a truly viable option for the veteran and their families, or not.
During this essentially a strategic pause, an ‘acting Secretary” must initiate this most important of all audit.
“What gets measured gets managed’” is a true statement.
Calling in the GAO can early on forge a continuing Executive/Legislative bipartisan partnership that will be a significant move to bring all the necessary fact based evidence to the current debate and perhaps finally get VHA health care right for at least a generation.
Ed Timperlake was the first Assistant Secretary of DVA for Congressional and Public Affairs and then Public and Intergovernmental Affairs when VA went to Cabinet Status