February 28, 2017
Leo Shane III | Military Times
WASHINGTON — In appearances before veterans groups this week, Veterans Affairs Secretary Dr. David Shulkin is outlining his 10-point plan for reforming department operations and offerings, with a heavy emphasis on VA medical improvements.
The plan is separate from the 10-point VA plan President Trump unveiled on the campaign trail last summer, but includes some of the same themes of accountability and a more customer-service focus for department employees.
It also includes several provisions championed by Shulkin’s predecessor, former VA Secretary Bob McDonald, who was criticized by Trump and other conservatives for not acting quickly enough on reforms.
During an appearance before the American Legion’s winter conference on Tuesday, Shulkin said his new 10-point plan will “take the best of VA and the best of the private sector, and make that work for veterans.” He also promised to work quickly on the reforms, saying many are facing deadlines or long overdue.
The list includes:
New accountability legislation
“When people lose their values, and deviate from the ethics and values we hold dearly, they no longer have the right to work in VA,” Shulkin said. “We’re going to make sure they don’t work in VA.”
But McDonald struggled with Congress on finding appropriate accountability legislation, sparring over measures he saw as crudely crafted or ineffective in solving department discipline issues. House and Senate leaders could not agree on new firing policies for VA last year because of congressional infighting over the scope of the rules.
House Veterans’ Affairs Committee Chairman Phil Roe, R-Tenn., has promised to mark up a new accountability bill in early March, and said he has worked with Shulkin already on refining those updated rules.
Extend the Choice deadline past August
The controversial VA Choice Card program -- put in place in the wake of the 2014 wait times scandal -- is set to expire later this year. Lawmakers have complained the program has not helped as many veterans as it should, but Shulkin said he sees it as a key program for future VA reforms.
“We need to see that legislation extended beyond August, because we need those resources to provide care for veterans that they deserve,” he said.
Renewing the program will require congressional appropriators to set aside several billion dollars in coming years to fund the outside medical care appointments, a demand that may be difficult to get past fiscal conservatives in the House.
Choice 2.0 Legislation
But Shulkin is also promising that if he gets more money for the Choice Card program, he won’t be simply dumping the funding into a broken system.
“We want to come back and redesign the choice program so it actually works for veterans,” he told the Legion conference. “We know this program was way too complex, there were too many steps to go out and get the care that veterans need.”
Shulkin has already promised to eliminate program rules that limit outside care options to veterans who live at least 40 miles away from a VA facility or face a VA clinic wait time of more than 30 days. But those changes will also require congressional cooperation.
Infrastructure improvements and consolidations
McDonald had pushed for more money for new VA construction projects but also closing of some outdated or underused VA facilities. Shulkin is putting those ideas among his top priorities as well.
“We’re going to be looking towards investments, but we’re also going to have to make some choices,” he said. “There are some parts of the country where facilities are sitting empty, and there is no sense in keeping them empty.”
Both are potentially difficult proposals that will require help from Congress. Lawmakers are often loathe to close facilities in their own districts, and have been critical of the skyrocketing cost of recent new VA hospital constructions.
Enhance foundational services in VA
While Shulkin is open to shifting more routine medical care out of the VA system, he is pledging not to have that move pull away funds from department specialties like prosthetics work, post-traumatic stress disorder care and other veteran-related research.
“There are certain services that VA does better than anybody,” he said. “I want to make sure that we continue to be on the cutting edge, and continue to invest in those.”
VA/DOD federal coordination
Like McDonald, Shulkin is promising better coordination of VA and Pentagon records systems, transition programs and a host of other services overlapping military service and veterans status.
“The Department of Defense needs us, and we need the DoD,” he said. “We’re going to be working closely to make sure we maximize our ability to work together.”
But seamless cooperation between the two bureaucracies has remained elusive in recent years, even with White House pressure for better coordination. And whether both departments can stay focused on joint collaborations may depend on other priorities and distractions in Trump’s military plans.
Electronic medical record modernization
Lawmakers have been frustrated in recent years with the slow pace of modernization efforts for veterans’ electronic medical records. Former VA Secretary Eric Shinseki pushed to move the department from mostly paper records to completely digital files, but Shulkin -- a former medical system director -- sees other areas for improvement.
“These systems desperately need modernization,” he said. “We have to take those steps this year.”
It’s unclear whether that effort will require new funding from Congress, or if existing information technology funds can cover those changes.
Breakthrough in suicide prevention
Shulkin called suicide prevention “our top clinical priority right now” and said he is hopeful for major improvements in treatment in coming years.
Those advances have been disappointingly slow, even with extra funding and focus in recent years. Roughly 20 veterans a day nationwide take their own lives, according to estimates from VA researchers.
The issue is part of a broader push to get more mental health research and experts into the Veterans Affairs system, something that Trump promised on the campaign trail.
McDonald had offered a comprehensive appeals modernization plan to lawmakers a year ago that he insisted would have cut benefits appeals wait times from years to months, but the legislation stalled.
Shulkin is picking up that same initiative, calling it an urgent improvement which would save time and stress for thousands of veterans and their families.
“We need to get that system fixed,” he said. “Veterans should not be waiting anywhere near the amount of time they are to get their appeals heard and decisions made. But until we get a legislative fix, we’re not going to see any progress made.”
Accelerating performance on benefits claims
VA officials brought down the veterans benefits claims backlog by more than 500,000 cases in recent years, but a substantial number of filings still take more than four months to fully process. About 99,000 cases were still backlogged as of Feb. 25.
“Although we have made tremendous progress, we still have more we can do to make faster decisions,” Shulkin said.
The backlog numbers have seen an increase in recent months, raising questions of whether improvements made in the past were temporary fixes instead of systemic changes.