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NEW GAO REPORT: VETERANS' CARE WOES REMAIN --

Months after pledging to improve veterans' care, the VA and

DoD have yet to find clear answers to some of the worst

problems afflicting wounded warriors, such as delays in

disability payments and providing personalized care.

 

 

For more information on other GAO reports about the VA, use the VA Watchdog search engine...click here...
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We have an AP news story...then the highlights of the GAO report below that.

Story here... http://www.chicagotribune
.com/news/nationworld/sns-ap-veterans
-care,1,5856163.story?ctrack=1&cset=true

Story below:

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Report Says Veterans' Care Woes Remain

By HOPE YEN
Associated Press Writer

Months after pledging to improve veterans care, the Bush administration has yet to find clear answers to some of the worst problems afflicting wounded warriors, such as delays in disability payments and providing personalized care, investigators say.

A report by the Government Accountability Office, released Wednesday, offers the first preliminary assessment of improvement efforts initiated by the Pentagon and Veterans Affairs Department after revelations in February of shoddy outpatient treatment at Walter Reed Army Medical Center.

The report found that even though the Army has touted creation of more personalized medical care units so that wounded veterans don't slip through the cracks, nearly half -- or 46 percent -- of returning service members who were eligible did not get the service due to staffing shortages.

The report said after 10 years of review, the Pentagon and VA still remain far away from having a comprehensive system for sharing medical records as injured veterans move from facility to facility.

And despite months of review by no less than eight congressional committees, a presidential task force, a presidential commission and the Pentagon and VA itself, the government has no apparent solution for reducing severe delays of 177 days, on average, in providing disability payments.

"Many challenges remain, and critical questions remain unanswered," GAO investigators John H. Pendleton and Daniel Bertoni wrote in calling for urgent action. "Success will ultimately depend on sustained attention, systematic oversight by DoD and VA, and sufficient resources."

Army spokesman Paul Boyce said Wednesday that officials were working diligently to provide "high-quality medical and mental health care for America's soldiers and veterans." The Army has said it hopes to have full staffing of its medical care units by January 2008. The VA has said it was hiring 1,100 new processors to reduce backlogs.

Responding to delays in sharing medical records, Patrick Dunne, VA's assistant secretary for policy and planning, said the VA and Pentagon had recently completed electronic sharing of veterans data involving allergies, outpatient medications, lab results and radiology. The two departments are using a contractor to study the feasibility and scope of sharing full inpatient records electronically, he said.

Rep. John Tierney, D-Mass., chairman of the House Oversight subcommittee on national security, said he was troubled by the lingering problems. "Taking care of our wounded heroes is too important to not demand that we strive for the highest levels of care and respect," he said.

Following the disclosures of patient neglect at Walter Reed, three high-level Pentagon officials stepped down. The Army quickly pledged to improve care by hiring more mental health counselors and creating new "warrior transition units" -- comprising a doctor, nurse case manager and squad leader -- who could help coordinate care.

The VA, which operates separate facilities for 5.8 million veterans, also said it would boost efforts, with VA Secretary Jim Nicholson vowing to work to improve data-sharing of medical records and to reduce backlogs. Nicholson later announced in July he was resigning and will step down Oct. 1.

On separate fronts, Congress approved additional money for veterans care, while the presidential commission headed by former Sen. Bob Dole, R-Kan., and former Health and Human Services Secretary Donna Shalala recommended changes that would increase benefits for family members, create a Web site for medical records and revamp the way disability pay is awarded.

On Wednesday, the GAO praised these initial steps. But it cautioned that long-standing problems were far from being resolved as the various groups negotiated their various proposals and as the Pentagon and VA faced challenges in hiring needed staff.

As of mid-September, 17 of the 32 warrior transition units had less than 50 percent of the critical staff in place. And in many cases, the Army had filled slots by borrowing staff from other positions, thus providing only a temporary solution as thousands of veterans return from Iraq and Afghanistan.

Regarding disability benefits, the GAO said the government was currently in limbo amid competing proposals to fix the disability ratings system. The Dole-Shalala commission, for example, urged that only the VA -- and not the Pentagon -- provide disability payments, while other proposals gave the Pentagon a limited role.

But in all the proposals, no consideration was given as to how the additional duties would affect the VA, which is straining to reduce backlogs for disability benefits, the report said. Nicholson in recent days has acknowledged that the VA was nowhere close to reducing monthslong delays and cited that as a top challenge for his successor.

"Delayed decisions, confusing policies and the perception that DoD and VA disability ratings result in inequitable outcomes have eroded the credibility of the system," the GAO investigators said. "It is imperative that DoD and VA take prompt steps to address fundamental system weaknesses."

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Complete GAO report here...
http://www.gao.gov/new.items/d071256t.pdf

GAO highlights here...
http://www.gao.gov/highlights/d071256thigh.pdf

Highlights below:

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DOD AND VA

Preliminary Observations on Efforts to Improve Health Care and Disability Evaluations for Returning Servicemembers

 

WHY GAO DID THIS STUDY

In February 2007, a series of Washington Post articles disclosed troublesome deficiencies in the provision of outpatient services at Walter Reed Army Medical Center, raising concerns about the care for returning servicemembers. These deficiencies included a confusing disability evaluation system and servicemembers in outpatient status for months and sometimes years without a clear understanding about their plan of care. The reported problems at Walter Reed prompted broader questions about whether the Department of Defense (DOD) as well as the Department of Veterans Affairs (VA) are fully prepared to meet the needs of returning servicemembers. In response to the deficiencies reported at Walter Reed, the Army took a number of actions and DOD formed a joint DOD-VA Senior Oversight Committee.

This statement provides information on the near-term actions being taken by the Army and the broader efforts of the Senior Oversight Committee to address longer-term systemic problems that impact health care and disability evaluations for returning servicemembers. Preliminary observations in this testimony are based largely on documents obtained from and interviews with Army officials, and DOD and VA representatives of the Senior Oversight Committee, as well as on GAO’s extensive past work. We discussed the facts contained in this statement with DOD and VA.

 

WHAT GAO FOUND

While efforts are under way to respond to both Army-specific and systemic problems, challenges are emerging such as staffing new initiatives. The Army and the Senior Oversight Committee have efforts under way to improve case management—a process intended to assist returning servicemembers with management of their care from initial injury through recovery. Case management is especially important for returning servicemembers who must often visit numerous therapists, providers, and specialists, resulting in differing treatment plans. The Army’s approach for improving case management for its servicemembers includes developing a new organizational structure—a Warrior Transition Unit, in which each servicemember would be assigned to a team of three key staff—a physician care manager, a nurse case manager, and a squad leader. As the Army has sought to staff its Warrior Transition Units, challenges to staffing critical positions are emerging. For example, as of mid-September 2007, over half the U.S. Warrior Transition Units had significant shortfalls in one or more of these critical positions. The Senior Oversight Committee’s plan to provide a continuum of care focuses on establishing recovery coordinators, which would be the main contact for a returning servicemember and his or her family. This approach is intended to complement the military services’ existing case management approaches and place the recovery coordinators at a level above case managers, with emphasis on ensuring a seamless transition between DOD and VA. At the time of GAO’s review, the committee was still determining how many recovery coordinators would be necessary and the population of seriously injured servicemembers they would serve.

As GAO and others have previously reported, providing timely and consistent disability decisions is a challenge for both DOD and VA. To address identified concerns, the Army has taken steps to streamline its disability evaluation process and reduce bottlenecks. The Army has also developed and conducted the first certification training for evaluation board liaisons who help servicemembers navigate the system. To address more systemic concerns, the Senior Oversight Committee is planning to pilot a joint disability evaluation system. Pilot options may incorporate variations of three key elements: (1) a single, comprehensive medical examination; (2) a single disability rating done by VA; and (3) a DOD-level evaluation board for adjudicating servicemembers’ fitness for duty. DOD and VA officials hoped to begin the pilot in August 2007, but postponed implementation in order to further review options and address open questions, including those related to proposed legislation.

Fixing these long-standing and complex problems as expeditiously as possible is critical to ensuring high-quality care for returning servicemembers, and success will ultimately depend on sustained attention, systematic oversight by DOD and VA, and sufficient resources.

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Larry Scott  --