Fact check: Trump hails ‘new’ VA as old prob­lems per­sist

The Progress-Index Weekend - - FRONT PAGE - By Hope Yen

WASH­ING­TON — Pres­i­dent Don­ald Trump speaks with pride about the progress of his over­haul of health care for vet­er­ans, declar­ing that the Depart­ment of Vet­er­ans Af­fairs al­ready “is a whole new place.” Old prob­lems per­sist, though, and some of his steps are not as ad­vanced as he ad­ver­tises.

For Vet­er­ans Day, the White House came out with a twopage state­ment to sup­port the contention that “tremen­dous progress has been made in a short pe­riod of time.” And in Viet­nam on Fri­day, Trump told a small group of U.S. vet­er­ans of the Viet­nam War that Vet­er­ans Af­fairs Sec­re­tary David Shulkin is do­ing an “amaz­ing job” on “things that we are do­ing and in the process of do­ing. “

“In the process” is the key phrase, be­cause some of Trump’s big plans for vet­er­ans are lag­ging, and prob­lems he has de­clared to be cured are still ev­i­dent.

While the VA has made some strides un­der the lead­er­ship of Shulkin, a holdover from the Obama ad­min­is­tra­tion who be­gan work on sev­eral of the changes be­fore Trump took of­fice, the White House

state­ment doesn’t tell the full story. It doesn’t di­vulge that a key Trump ad­min­is­tra­tion ef­fort to im­prove wait times by re­vamp­ing VA’s elec­tronic med­i­cal record sys­tem may not be com­pleted for eight more years — when Trump will be out of of­fice.

Nor does it ac­knowl­edge that a bill re­cently signed into law to re­duce de­lays in pro­cess­ing dis­abil­ity ap­peals from vet­er­ans un­happy with their pay­outs won’t ad­dress the 470,000 pend­ing claims.

Other an­nounced ef­forts, such as the post­ing of VA wait-time data and a new White House com­plaint hot­line, have since been shown to be nar­row in scope or have been crit­i­cized as in­ef­fec­tive by law­mak­ers or vet­er­ans groups.

A look at state­ments and rhetoric on the sub­ject:

WHITE HOUSE: “Pres­i­dent Trump an­nounced that the Depart­ment of Vet­er­ans Af­fairs will adopt the same Elec­tronic Health Record as the Depart­ment of De­fense. VA’s adop­tion ... will ul­ti­mately re­sult in all pa­tient data re­sid­ing in one com­mon sys­tem, en­abling the im­me­di­ate avail­abil­ity of ser­vice mem­ber’s med­i­cal records and seam­less care be­tween the de­part­ments.”

THE FACTS: While the ad­min­is­tra­tion did an­nounce in June that it would over­haul VA’s ag­ing in­for­ma­tion tech­nol­ogy sys­tem, Shulkin ad­mit­ted to Congress last month that the project to re­vamp elec­tronic med­i­cal records won’t be com­pleted for seven to eight years. The full costs of the project also are not known and have yet to be bud­geted.

An up­graded IT sys­tem is key to VA’s ef­fort to re­duce wait times for med­i­cal care as well as ful­fill Trump’s prom­ise of in­creas­ing pri­vate care op­tions for vet­er­ans. Un­der Shulkin’s plan to ex­pand the Choice pri­vate-sec­tor pro­gram, the VA would out­source more rou­tine vet­er­ans’ care to pri­vate providers in­clud­ing Min­uteClin­ics while treat­ing more com­plex in­juries. Suc­cess of that plan re­quires a seam­less shar­ing of med­i­cal records not only with the Pen­tagon but also pri­vate physi­cians, a ca­pa­bil­ity the VA does not cur­rently have.

Shulkin also has yet to ne­go­ti­ate pric­ing for the no-bid con­tract with the com­pany that de­signed the Pen­tagon’s IT sys­tem, es­ti­mated to cost at least $16 bil­lion. The big price tag has spurred bills in Congress to re­quire reg­u­lar up­dates from VA on time­li­ness and cost pro­jec­tions, as well as risks such as breaches to pa­tient pri­vacy.

WHITE HOUSE: “Pres­i­dent Trump signed the Vet­er­ans Ap­peals Im­prove­ment and Modernization Act of 2017, tak­ing ac­tion to stream­line the ap­peals process for dis­abil­ity com­pen­sa­tion claims within the VA. More than 470,000 vet­er­ans are await­ing pend­ing de­ci­sions re­gard­ing their ap­peals.”

THE FACTS: Trump signed the bill in Au­gust, part of a bid to re­duce a rapidly grow­ing claims back­log, but its im­me­di­ate im­pact is over­stated, as it will have no ef­fect on the 470,000 pend­ing claims.

Un­der the leg­is­la­tion, vet­er­ans will be able to file “ex­press” ap­peals if they waive their right to a hear­ing or the abil­ity to sub­mit new ev­i­dence.

While law­mak­ers hope the leg­is­la­tion ul­ti­mately could re­duce av­er­age wait times to less than a year, it ap­plies al­most en­tirely to newly filed ap­peals.

Shulkin has said the VA would need Congress to ap­prove an ad­di­tional $800 mil­lion for “hir­ing surges” of ad­di­tional ap­peals pro­ces­sors if VA hoped to clear its cur­rent back­log within 10 years.

WHITE HOUSE: “Pres­i­dent Trump has en­sured con­tin­ued ac­cess to care in the Vet­er­ans Choice Pro­gram by sign­ing the VA Choice and Qual­ity Em­ploy­ment Act, au­tho­riz­ing $2.1 bil­lion in ad­di­tional funds for the Vet­er­ans Choice Pro­gram.”

THE FACTS: This state­ment glosses over one of sev­eral bud­get short­falls by the VA. Congress was forced in Au­gust to ap­prove $2.1 bil­lion in emer­gency money to keep Choice run­ning af­ter the VA had re­peat­edly un­der­stated costs of the pro­gram, as­sur­ing law­mak­ers for much of the year that money would last un­til Jan­uary. Shulkin sub­se­quently re­vealed an emer­gency short­fall in June that threat­ened med­i­cal care for tens of thou­sands of vet­er­ans.

The $2.1 bil­lion was in­tended to last un­til Fe­bru­ary. But weeks af­ter re­ceiv­ing the money, the VA ac­knowl­edged that money for Choice would again run out sooner than ex­pected, re­quir­ing Congress to ap­prove ad­di­tional stop­gap fi­nanc­ing be­fore the end of the year or face dis­rup­tions to vet­er­ans’ health care.

Law­mak­ers have yet to act, in part as the Trump ad­min­is­tra­tion sorts out longer-term costs to the pri­vate-sec­tor pro­gram.

WHITE HOUSE: “The VA has launched its ‘Ac­cess and Qual­ity Tool,’ al­low­ing vet­er­ans to see on­line the wait times at VA lo­ca­tions.”

THE FACTS: An ef­fort started by Shulkin when he was VA un­der­sec­re­tary of health in the Obama ad­min­is­tra­tion, the VA web­site www.ac­cessto­care.va.gov pro­vides data on wait times as well as vet­er­ans’ sat­is­fac­tion rat­ings in get­ting timely ap­point­ments, some­thing that no other health care sys­tem in the coun­try does.

Still, ma­jor vet­er­ans groups such as Vet­er­ans of For­eign Wars have faulted the data for be­ing mis­lead­ing and not de­pict­ing wait times the way a typ­i­cal per­son would view it.

The Gov­ern­ment Ac­count­abil­ity Of­fice, for in­stance, has noted that the data do not in­clude the amount of wait time from when a vet­eran ini­tially asks for care and when a sched­uler reaches out to set an ap­point­ment, which it said could be lengthy. In ad­di­tion, GAO ear­lier this year con­tin­ued to find ev­i­dence that VA data can be un­re­li­able due to sched­ulers record­ing wrong dates or chang­ing dates out­right, though the VA says it is im­ple­ment­ing new checks and train­ing to help iden­tify “out­liers” in sched­ul­ing.

WHITE HOUSE: “The White House has opened a brand new VA Hot­line staffed prin­ci­pally by vet­er­ans and di­rect fam­ily mem­bers of vet­er­ans to en­sure that no com­plaint goes un­ad­dressed.”

THE FACTS: It opened, but it did not get off to a smooth start. Trump pledged dur­ing the pres­i­den­tial cam­paign to cre­ate a “pri­vate White House hot­line” an­swered by a real per­son 24 hours a day to take com­plaints from vet­er­ans, lead­ing VA to cre­ate a hot­line be­gin­ning June. Orig­i­nally sched­uled to be fully op­er­a­tional by Aug. 15, it has en­coun­tered some de­lays.

In a let­ter to VA last month, Sen. Jon Tester, the top Demo­crat on the Vet­er­ans Af­fairs Com­mit­tee, com­plained “the White House is fre­quently rout­ing these calls back to lo­cal VA of­fices, which are of­ten un­der­staffed and do not have the abil­ity to ad­dress the ad­di­tional case­work in a timely man­ner.”

Tester noted the VA al­ready had sev­eral ex­ist­ing op­tions for re­ceiv­ing com­plaints from vet­er­ans and urged bet­ter co­or­di­na­tion to make sure no one falls through the cracks.

TRUMP: “We ... ex­tended Vet­er­ans’ Choice . ... Can you imag­ine go­ing to your doc­tor and hav­ing him say you’ll have to wait for 11 days? ... And now they go, right out­side, they go to a doc­tor in the area, we pay the bill, and it’s the least ex­pen­sive thing we can do and we save ev­ery­body’s life and ev­ery­body’s happy.” — Sept. 22 rally in Huntsville, Alabama.

THE FACTS: It’s not true that all vet­er­ans need­ing care are get­ting it with­out de­lay. Wait times of more than two months have been recorded dur­ing his ad­min­is­tra­tion.

The Depart­ment of Vet­er­ans Af­fairs’ Choice pro­gram al­lows vet­er­ans to see an out­side doc­tor if they must wait more than 30 days (never mind 11) for a med­i­cal ap­point­ment or travel more than 40 miles to a VA fa­cil­ity. But Choice has faced de­lays of its own, with wait times po­ten­tially as high as 81 days, ac­cord­ing to the Gov­ern­ment Ac­count­abil­ity Of­fice.

Over the sum­mer, an un­ex­pected bud­get short­fall in the pro­gram forced VA to limit the out­side re­fer­rals, lead­ing to ad­di­tional de­lays in care.

Shulkin has ac­knowl­edged prob­lems with Choice even as he seeks to ex­pand it, not­ing that his main leg­isla­tive fo­cus “is get­ting the Choice pro­gram work­ing right.”

Not “ev­ery­body’s happy,” as Trump claimed.

[MARK SCHIEFELBEIN

U.S. Pres­i­dent Don­ald Trump holds up a signed procla­ma­tion honor­ing vet­er­ans Fri­day at the Hy­att Re­gency Danang Re­sort in Danang, Viet­nam.

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