| THE VA: TEAR IT
DOWN BRICK BY BRICK -- PART 3
The latest article from Kurt Priessman
asks, "How did the VA Stray so Far from Its Mission and
Structure?"
| Editor's
Note from Larry Scott, VA Watchdog dot Org ... It's time
for this series to be written. I do not agree with all
of Kurt's ideas about the VA, but, as a former government
employee with many years of service, Kurt knows the system
inside-out. The proposals in his commentaries should
be open to discussion. You may comment at the bottom of the page.
Kurt's bio and archive of
articles can be found here. |
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THE VA: TEAR IT DOWN BRICK BY
BRICK -- PART 3
How did the VA Stray so Far from
Its Mission and Structure?
by Kurt Priessman
To say that something is terribly wrong inside the Department of
Veterans Affairs (DVA or VA) is not news, but the contention that
they fulfill Lincoln’s promise is blatantly false. What would
change the DVA into a proactive, pro-veteran organization is one
question asked here.
Let us begin to consider that the mission of the VA is to fulfill
President Lincoln’s promise – “To care for him who shall have
borne the battle and for his widow, and his orphan” – by serving
and honoring the men and women who are America’s veterans.
Recently, the Congress passed legislation for funding the DVA for
the next year in a much-ballyhooed attempt to fix an
inconsequential problem. However,
GAO reports have indicated
problems with the Department’s budgeting process, contracting
process, and capital-asset programs making one wonder if and how
advance funding will aid veterans. To compound this problem, it is
very apparent that the
VHA IT system Vista, while lauded as the best healthcare
program in the world, is not capable of generating
 meaningful
epidemiological data on veterans sufficient for planners to
determine the needs of the Agency at the Regions, Medical Centers,
let alone at the Departmental level.
What does this mean? It means that Service Center Managers cannot
determine how many of what resource they will need. It means
Medical Center Directors, Chief Medical Officers and
administrative managers guess at personnel levels for critical
provider and administrative staff, the kinds and quantities of
medical contracts needing emphasis and procurement priority, and
how much of what medical supplies are needed and which capital
assets and equipment need to be purchased or replaced. Those in
the Veterans' Benefits Administration (VBA) do not have any idea
how many claims will need processing, for what kinds of
disabilities, or whether changes in the Work Credit System would
improve quality and reduce backlogs.
Something to consider is the structure of the department. The
diamond is obviously the Veterans Health Administration (VHA)
whose job is to provide the care. The
National Cemetery Administration
(NCA) serves veterans and widows in the provision of burial
plots, markers, and headstones for those eligible for burial in
national and state cemeteries. Unfortunately, there is a problem
in that a veteran must first establish eligibility for healthcare
or burial services through the Veterans Benefit Administration.
Yet in every instance, the politicians and the Veterans Service
Organizations stress increased funding for something that appears
not to be the problem. Are they correct?
Can the Department fulfill its mission, even with funding for the
next year? What major problem does it solve? Does it solve the
backlog of claims? Does it solve the problem of veterans being
denied burials and having their remains found in the basement of
funeral homes? Does it solve the three to six month wait to get
mental health services despite massive influx of resources? Does
it solve the problems many patients have getting an appointment at
their local outpatient clinic or VAMC? Does it solve the problems
the VHA has hiring or contracting for sufficient healthcare
providers, i.e. physicians, specialists, psychologists, nurses,
radiologists, lab technicians and on and on? If your reply is no,
it does not solve any of these things, then why do you think that
is?
When thinking of the massive bureaucracy called the Department of
Veterans Affairs, what would be critical to change in the many
different administrations, staff and program offices, Veterans
Integrated Service Networks (VISNs) fundamental structures that
would make a difference to veterans and those served? What changes
if any would insure both the organization and individuals employed
there are held accountable? Does the premise set down in the
original quote still apply today? This is not a place to spend
time bemoaning all that has happened to you but to think how the
structure could be changed to make the VA better. Here are some
examples:
Structure - If the VAOIG
reported directly to the Attorney General what would happen? If
the
Office of Research and Development or the
Board of Veterans Appeals did not exist would unlawful
experimentation end or adjudication results be more timely and
correct? If the Advisory Committees were citizen advocates instead
of political cronies, would the Department improve?
Law – If employees of the Department of Veterans Affairs could be
held criminally liable for their decisions, failure to apply the
law, or failure to provide healthcare to standards or in a timely
fashion, what would happen? If the VBA used non-union GS-12
Auditors to spot check claims randomly selected or pinpointed as
potentially falling outside of a certain mean, would claims be
awarded faster and inside attempts to defraud the government
caught more rapidly? If the laws were changed to decertify the
AFGE (union) and non-union workers could be hired would it improve
the quality and quantity of work or the honesty of employees?
Processes – If claims were submitted electronically and
adjudicated in thirty days would the VBA have a backlog of
1,000,000 claims? Does it really require 23 pages to file an
electronic claim? If initial awards were made and
C&P exams promptly scheduled to determine the severity of the
disease, injury, et cetera, would the result eventually reduce the
workload and need for massive amounts of labor? If the process
asked for your dependent information upfront, would it reduce the
amount of processing and time by several months? If the Congress
authorized the use of “x-year” appropriations in the VBA and NCA
would there be less of a monetary crunch on the Department?
If you were the Secretary of the
Department of Veterans Affairs what would you change?
COMING FRIDAY 18 SEP 2009, PART
4 -- Planning, Planning, We Don’t Need No Stinking Planning
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This article is ©2009 by Kurt
Priessman and is provided exclusively to VA Watchdog dot Org.
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TOPICS:
veterans, veterans' benefits, VA, Department of Veterans' Affairs,
Kurt Priessman, THE VA: TEAR IT DOWN BRICK BY BRICK
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