Could VA Hospitals Be Getting an Obamacare-style Makeover?

The developing scandal around a Veterans Administration hospital in Phoenix was one topic of discussion at Monday's White House Daily Briefing, as Press Secretary Jay Carney fielded questions about the investigations underway, and NBC News Chief White House Correspondent Chuck Todd pressed the White House on creating a Healthcare.gov-style emergency team to deal with the V.A. backlog.
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The developing scandal around a Veterans Administration hospital in Phoenix was one topic of discussion at Monday's White House Daily Briefing, as Press Secretary Jay Carney fielded questions about the investigations underway, and NBC News Chief White House Correspondent Chuck Todd pressed the White House on creating a Healthcare.gov-style emergency team to deal with the V.A. backlog.
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The developing scandal around a Veterans Administration hospital in Phoenix was one topic of discussion at Monday's White House Daily Briefing, as Press Secretary Jay Carney fielded questions about the investigations underway, and NBC News Chief White House Correspondent Chuck Todd pressed the White House on creating a Healthcare.gov-style emergency team to deal with the V.A. backlog.

The Veterans Administration is currently embroiled in a sickening scandal over allegations that the Phoenix Veterans Affairs Health Care system kept fraudulent records that delayed treatment for vets, up to 40 of whom may have died while waiting for care. Administrators at the Phoenix VA had been keeping two separate sets of appointment books, in order to make it appear that veterans were getting appointments in a timely fashion, when in reality, they were waiting months. According to CNN, as many as 40 patients died while on the fraudulent waiting list.

When news of the scandal first broke, President Obama told reporters that he took the allegations "very seriously," and that he ordered Department of Veterans Affairs Secretary Eric Shinseki to investigate, in addition to an Inspector General's investigation already underway. These allegations are on top of long-term backlogs in the processing of veterans' benefits claims.

At Monday's briefing, Chuck Todd asked Carney if, given the magnitude of the backlog at the V.A., the White House is considering an emergency response similar to the massive effort undertaken to fix Healthcare.gov in the wake of that disastrous launch.

"Well, I don't have any personnel announcements to make on the V.A., except to say that the President takes the situation," Carney began, then in a pointed aside, added "as he has said, around the Phoenix office very seriously."

Carney continued, "That's why he directed Secretary Shinseki to investigate, and Secretary Shinseki has invited the independent Veterans Affairs Inspector General to conduct a comprehensive review. The President remains confident that Secretary Shinseki is focused on this matter, and he's confident in secretary Shinseki's ability to lead the department, and to take action based on the Inspector General's findings."

Carney pointed to the progress that's been made, the "aggressive effort" to address the backlog, and the fact that one contributor to the volume of the problem has been the decision to include claims for Agent Orange exposure and PTSD.

The backlog at the Veterans Administration, separate and apart from the Phoenix allegations, is the kind of scandalous bureaucratic morass that requires some sort of tipping point in order to overcome the inertia of "steady progress." Todd can't possibly expect Carney to respond, "Why yes, Chuck, there's an emergency team in place, and I just forgot to tell you," but what Chuck can expect is that Carney will take that question to the President. This is one of the ways in which the press can act in the public's interest, by pressing for more urgent action when it's clearly needed.

Then, Chuck asked Carney how he could claim the V.A. was "aggressively taking action, when the issue with Phoenix and another whistleblower actually has to do with lying about the backlog?"

When Carney began to respond that the numbers regarding the claims backlog indicate an aggressive approach, Todd said "Given what happened in Phoenix, it could be all of the system."

Carney replied that "We're talking about an individual matter that is under investigation, and we take it very seriously, as does Secretary Shinseki, and we look forward to the results of that review."

ABC News' Jon Karl also pressed Carney, less productively asking Carney to issue a letter grade for the V.A.'s handling of the backlog, and asserting that "The issue in Arizona is that it seems there was a cover-up to try to hide the true size of the backlog, and we don't know if that was something just liited to Arizona, or if it happened elsewhere, but are you confident you can trust the statistics you have, that in fact, V.A. has made, as you said, progress, a lot of progress dealing with this backlog. At least in this one instance, the suggestion is that the numbers may not be right."

"I can’t prejudge, obviously, a review that’s being undertaken with regard to a specific office and allegations around that office," Carney said. "What I can say is, yes, we are confident that there has been significant progress made in reducing the size of the backlog."

While pressing for more urgent action is commendable, there is a danger in conflating the claims backlog with the kind of malfeasance that's being alleged in Phoenix, and now in San Antonio and Austin, Texas as well, which is that the political and public will can become misdirected and distracting. Although they are both symptoms of an overburdened system, the claims backlog and the waiting list allegations are not related. As Carney has said, there has been progress, and a plan is in place to address the systemic problems that created the claims backlog. The V.A. has set a target of 2015 to have a completely paperless system in all 56 regional offices, and a goal of no claims over 125 days old, with 98 percent accuracy. The V.A. recently reported a 44% reduction in the claims backlog since its peak one year ago. That such efforts were necessary is a disgrace, and if there's anything that can be done to speed this along, it should be done. The backlog has been like the proverbial frog boiling in water, only in reverse. If a DefCon Zeints approach had been tried several years ago, things might be different now, but there is now light at the end of the tunnel.

What is being alleged in these local V.A. offices differs greatly from the claims backlog in several crucial respects. First of all, it is not the result of a systemic failure, but rather, of human beings deliberately circumventing the system that's in place to ensure veterans are given appointments in a timely fashion. There's no tech surge that will fix this problem. In fact, the people in these offices are deliberately circumventing systems that the V.A. already put in place to address this very problem, following  the recommendations of a GAO report on unreliable tracking of wait times.

It's also more urgent, in that the direct consequences of this failure can show up in fairly short order. The claims backlog is keeping veterans from getting disability benefits; these phony wait lists are keeping them from actually seeing a doctor. Now that this rock has been turned over the V.A. should do two things, in addition to investigating these specific allegations. First, they should immediately conduct a direct survey of patients to find out how long they're actually waiting for appointments, in order to identify any other offices that are using this practice.

Secondly, they should (with Congress' help) immediately require that if a V.A. facility misses its own timely appointment window, the patient is then free to make an appointment with a private physician, at the government's expense. If a veteran needs to see a doctor, a veteran must be able to see a doctor. Period.