VA acts to clear claims back­log

Out­sourc­ing ex­ams may speed ap­proval; crit­ics leery of qual­ity

Baltimore Sun - - FRONT PAGE - By Ian Dun­can

The U.S. Depart­ment of Vet­er­ans Af­fairs, which has strug­gled to elim­i­nate a back­log of dis­abil­ity claims, is plan­ning to out­source more of the med­i­cal ex­ams that are key to de­ter­min­ing ben­e­fits.

The ef­fort could cost more than $1 bil­lion per year.

The depart­ment says such a move could make it eas­ier for vet­er­ans in re­mote ar­eas to be seen, and speed up pay­outs. But the plan has rat­tled VA doc­tors, who say the qual­ity of ex­ams could suf­fer, lead­ing to more dis­putes be­tween vet­er­ans and the depart­ment over pay­outs.

The ex­ams are of­ten a veteran’s first ex­pe­ri­ence with the VA. The depart­ment has been push­ing to en­sure that they are done more promptly as it digs its way out of a mas­sive back­log in of­fices around the coun­try.

At one point, the Bal­ti­more VA of­fice was the slow­est and most er­ror-prone in the coun­try in pro­cess­ing dis­abil­ity claims.

The VA has had suc­cess in curb­ing the back­log, de­fined as vet­er­ans wait­ing for more than 125 days to get their case re­solved. But 20 per­cent of cases na­tion­ally are still over­due, and of­fi­cials say de­mand for ben­e­fits is at an all-time high.

VA of­fi­cials pro­vided redi­rected re­sources to Bal­ti­more to im­prove per­for­mance, bring­ing down a back­log of some 16,800 cases in early 2013 to about 1,300 to­day. But the er­ror rate in Bal­ti­more is 20 per­cent, still greater than the na­tional av­er­age of 12 per­cent.

Beth Mur­phy, a se­nior of­fi­cial in the VA’s ben­e­fits di­vi­sion, said she ex­pects to re­ceive as many as 1.9 mil­lion re­quests for dis­abil­ity ex­ams next year, up from 1.5 mil­lion in 2015.

Con­trac­tors could end up per­form­ing more than 60 per­cent of those ex­ams, which would be a big ex­pan­sion of their role. But Mur­phy said the VA’s own doc­tors re­main the first choice.

A com­puter sys­tem will de­ter­mine each day how many ex­ams the VA’s staff can han­dle. When the depart­ment is over­whelmed, the sys­tem will di­vert work to con­trac­tors.

“When you com­pete some­thing out in the open mar­ket, there are ef­fi­cien­cies and cost sav­ings,” Mur­phy said.

At the same time, she said, “when you have fed­eral em­ploy­ees do­ing a job you can’t just willy-nilly re­place them.”

The union that rep­re­sents most of the VA em­ploy­ees who con­duct med­i­cal ex­ams filed a griev­ance af­ter learn­ing of the out­sourc­ing plan. The union con­tends that con­trac­tors could put prof­its ahead of vet­er­ans’ needs, lead­ing to less scrupu­lous ex­ams.

Con­trac­tors are “re­warded for quickand-dirty,” said Mar­i­lyn Park, a lob­by­ist for the Amer­i­can Fed­er­a­tion of Govern­ment Em­ploy­ees. VA staff, she said, would “miss less” and “give a more thor­ough exam, a more spe­cial­ized exam.”

The VA has con­tracted out some ex­ams for years un­der a patch­work of dif­fer­ent ar­range­ments. Ale­gal change that went into force this month would al­low the agency to stream­line the process.

Lou Celli, an of­fi­cial at the Amer­i­can Le­gion, said the plan is a prac­ti­cal ap­proach to deal with a tight bud­get. But he thinks the VA’s own doc­tors gen­er­ally pro­vide bet­ter ex­ams.

“If we could af­ford it, we’d love for the VA to do them all in-house,” he said.

A re­port by the VA’s in­spec­tor gen­eral in 2005 con­cluded that there was lit­tle dif­fer­ence in qual­ity be­tween ex­ams per­formed by VA staff and those per­formed by con­trac­tors.

But a study con­ducted by pri­vate con­sul­tants soon af­ter the VA be­gan work­ing with con­trac­tors in the 1990s found that the out­sourced ex­ams were much more ex­pen­sive than those done by staff.

Scott Orr, an ex­ec­u­tive at Vet­er­ans Eval­u­a­tion Ser­vices, one of the com­pa­nies that con­tracts with the VA, said his com­pany reg­u­larly turns ex­ams around on sched­ule, and has a higher sat­is­fac­tion among vet­er­ans than the VA’s own doc­tors.

The im­ple­men­ta­tion of the new con­tracts, which could be worth as much as $6.8 bil­lion over five years, has been be­set with prob­lems.

They were first an­nounced in March, but some of the bid­ders protested to the Govern­ment Ac­count­abil­ity Of­fice, which rec­om­mended re­open­ing the process. Last month, the VA again an­nounced that con­tracts had been awarded — only for Orr’s com­pany and an­other firm to again lodge protests.

And within the VA there has been con­fu­sion about ex­actly how the new con­trac­tors will be used — which union of­fi­cial M.J. Burke said is a ma­jor part of the griev­ance.

At an em­ployee town hall meet­ing this sum­mer in Bal­ti­more, Mark Yow, the VA’s chief fi­nan­cial of­fi­cer, and Dr. David J. Shulkin, its top doc­tor, de­scribed sweep­ing plans to out­source al­most all ex­ams, video of the event re­viewed by The Bal­ti­more Sun shows.

But since then, agency of­fi­cials said in in­ter­views that they do not plan to do that.

“The main is­sue is to make sure to be trans­par­ent with our em­ploy­ees,” Burke said. “We can ne­go­ti­ate over the pro­ce­dures if you de­cided to shift work.”

Orr said he’s frus­trated by the lack of a clear pol­icy from the VA.

“Quite hon­estly, it seems like there’s a lot of in­de­ci­sion float­ing around out there,” he said.

The VA has been con­tract­ing at least some ex­ams since 1998. Con­trac­tors han­dled 29 per­cent of cases in 2015.

In re­cent years, the depart­ment has been urged to rely more on con­trac­tors.

A panel of sen­a­tors charged with help­ing the depart­ment cut the back­log of dis­abil­ity claims en­dorsed the idea, writ­ing in a re­port last year that more ex­ten­sive use of pri­vate doc­tors “en­sures that dis­abil­ity ex­ams con­tinue to be com­pleted in a timely man­ner, es­pe­cially in lo­ca­tions where the VA may have higher de­mand for care and lack the fa­cil­i­ties or re­sources to pro­vide these ex­ams quickly.”

In 2014, Ge­orge Turek, the chief ex­ec­u­tive of­fi­cer of Vet­er­ans Eval­u­a­tion Ser­vices, told a con­gres­sional panel that more out­sourc­ing would free up the depart­ment’s doc­tors to fo­cus on treat­ing pa­tients. Turek ad­vo­cated turn­ing over all ex­ams to con­trac­tors.

“The sim­ple re­al­lo­ca­tion of ex­ist­ing as­sets would go a long way to re­solve the back­log of both treat­ment cases and [ben­e­fits] claims,” he said. “This can be done quickly, much more quickly than build­ing new hospi­tals and clin­ics and then hir­ing and train­ing staff.”

But Burke, the union of­fi­cial, said the VA’s own doc­tors have a deep un­der­stand­ing of the con­nec­tions be­tween mil­i­tary ser­vice and dis­abil­i­ties.

With­out that spe­cial­ized knowl­edge, he said, doc­tors could make mis­takes, ul­ti­mately slow­ing down the process of ap­ply­ing for ben­e­fits.

“I think it’s just go­ing to lead to much more frus­tra­tion,” she said.

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