Shin­seki exit won’t fix VA woes

Modern Healthcare - - NEWS - By Vir­gil Dick­son, Rachel Lan­den and Bob Her­man

Fri­day’s res­ig­na­tion of Depart­ment of Vet­er­ans Af­fairs Sec­re­tary Eric Shin­seki in the midst of the mush­room­ing scan­dal over pa­tient wait­ing times will al­low the VA health­care sys­tem and its new leader to fo­cus on im­prov­ing ac­cess and care for vet­er­ans, Pres­i­dent Barack Obama said in an­nounc­ing Shin­seki’s de­par­ture.

“At this stage, I want some­body who’s spend­ing ev­ery minute of ev­ery day fig­ur­ing out, ‘Have we called ev­ery sin­gle vet­eran that’s wait­ing and have they got­ten a sched­ule?’ ” Obama said dur­ing a news con­fer­ence. He faced grow­ing bi­par­ti­san pres­sure to sack Shin­seki, in­clud­ing from Democrats wor­ried about the scan­dal’s ef­fect on their Novem­ber elec­tion prospects. He named Sloan Gibson as in­terim sec­re­tary. Gibson is a West Point grad­u­ate and for­mer CEO of the USO who joined the VA in Fe­bru­ary as deputy sec­re­tary.

Ex­perts agree the VA’s prob­lems, doc­u­mented in part last week by VA In­spec­tor Gen­eral Richard Grif­fin, will re­quire more than just a change at the top. About 1,700 vet­er­ans in need of care were “at risk of be­ing lost or for­got­ten” af­ter be­ing kept off the of­fi­cial wait­ing list at the VA’s Phoenix fa­cil­ity. His re­port con­firmed al­le­ga­tions of ex­ces­sive wait­ing time for care in Phoenix, with an aver­age 115-day wait for a first ap­point­ment. He also found that “in­ap­pro­pri­ate” sched­ul­ing prac­tices are “sys­temic” through­out the 1,700-fa­cil­ity VA sys­tem.

“Re­plac­ing Sec­re­tary Shin­seki doesn’t (solve) the sys­temic is­sues the pre­lim­i­nary re­port has shown,” said Mike Hartford, di­rec­tor of the vet­er­ans di­vi­sion at Zei­ders En­ter­prises, which pro­vides so­cial and men­tal health ser­vices to the mil­i­tary.

One of those is­sues, sug­gested by the IG’s re­port, is a short­age of physi­cians. The VA re­cently cited 400 va­can­cies for pri­mary-care doc­tors. Its pri­mary-care doc­tors re­port­edly are re­spon­si­ble for about 1,200 pa­tients each, but many now treat up­ward of 2,000 and the VA is re­view­ing how it can ease the pres­sure on doc­tors, the New York Times re­ported. The agency has had trou­ble re­cruit­ing in part be­cause its pri­mary-care doc­tors gen­er­ally earn sig­nif­i­cantly less than pri­vate-sec­tor doc­tors.

The strain on VA staff is go­ing to only in­crease, with an es­ti­mated 1.5 mil­lion ser­vice mem­bers who will be dis­charged over the next two to three years. “There are some real (in­fra­struc­ture) chal­lenges to sup­port not just the cur­rent vet­eran pop­u­la­tion, but also the in­creased pop­u­la­tion,” Hartford said.

Some ex­perts are call­ing for the VA to out­source more vet­er­ans’ care to nonVA fa­cil­i­ties. Darin Sel­nick, a vet­er­ans’ af­fairs ad­viser for the Con­cerned Vet­er­ans for Amer­ica who was a po­lit­i­cal ap­pointee at the VA from 2001 to 2009, said that for vet­er­ans wait­ing more than 30 days for an ap­point­ment, nor­mal preau­tho­riza­tion rules should be waived tem­po­rar­ily, un­til the kinks in the sys­tem are re­solved. “You’ve gotta stop the bleed­ing,” he said. “Vet­er­ans who are wait­ing right now need to be able to see doc­tors.”

Some ob­servers are call­ing for Obama to ap­point a re­spected se­nior mil­i­tary leader to head the VA over­haul ef­fort. But Phillip Long­man, a se­nior re­search fel­low at the New Amer­ica Foun­da­tion who has stud­ied the VA sys­tem, said that would only cre­ate more prob­lems. Mil­i­tary lead­ers “give or­ders and ex­pect other people to ac­tu­ally do stuff,” he said. “It’s just not how the rest of the world works, let alone the VA.”

Pres­i­dent Obama faced grow­ing bi­par­ti­san pres­sure to re­place Eric Shin­seki.

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