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Questions mount on new VA access standards
From Military Update’s Tom Philpott at The News Tribune:
The number of veterans eligible for health care services in their communities, using networks of private sector providers contracted by the Department of Veterans Affairs, is expected to jump this summer when regulations setting new access standards for community care become final.
Veteran service organizations and congressional committees with oversight responsibilities for the Department of Veterans Affairs contend that the barebones details released last week raise many more questions than they answer.
Top among them is whether VA will have the budget dollars, the complex procedures and the enhanced administrative tools in place to avoid the kind of calamitous launch that scarred the Choice program from its inception in late 2014.
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But the community care access rules are drawing the most attention from veteran groups and members of the veteran affairs committees.
Many of them are complaining that after partnering with VA to shape community care reform language in the Mission Act, they’ve been kept largely in the dark by VA Secretary Robert Wilkie and his staff during the months they drafted implementing rules.
As a result, when VA released first details on access standards last week, many previously supportive lawmakers and veterans groups expressed only caution, claiming not to understand from preliminary briefings how decisions were made, how they will impact veterans and VA budgets and how VA procedures and tools can be made ready in time to support a launch in June as planned.
Democrats on the Senate Veterans Affairs Committee criticized Wilkie for lack of transparency and VA’s failure to engage while preparing its new access rules.
“Once briefed, we were disappointed that VA couldn’t provide basic information on how the proposed wait and drive-time standards would affect the Department, the veterans who rely on it for care and the American taxpayer,” the senators wrote in Feb. 5 letter to Wilkie.
Carl Blake, executive director of Paralyzed Veterans of America, and Randy Reese, executive director of Disabled American Veterans, said in separate interviews that they have no choice but to remain cautious on the access standards.
Key questions DAV needs answered, said Reese, are whether the access rules are fully funded, are realistic and feasible to implement. One great unknown, he said, is whether VA-funded community provider networks will be sufficiently staffed to deliver faster, more convenient and quality care to veterans.
With revised network contracts delayed by challenges from a losing bidder, VA conceded to veteran groups that contractors haven’t been able to produce market assessments on the availability of community care for veterans nationwide.
“The assumption is the VA can’t and private providers can. But they don’t know that that’s true,” Reese said.
Investigation of the ‘Mar-a-Lago three’ moves forward
From Jennifer Steinhauer at The New York Times:
The investigation was announced in a letter to Robert Wilkie, the secretary of the Department of Veterans Affairs, from Representative Mark Takano, Democrat of California, the new chairman of the committee. Mr. Takano requested documents and “information about alleged improper influence” of the members, Isaac Perlmutter, Bruce Moskowitz and Marc Sherman, “over policy and personnel decisions of the Department of Veterans Affairs.”
Mr. Takano said the three men exerted inappropriate influence over procurement at the sprawling department.
Mr. Perlmutter is the former chief executive of Marvel Entertainment, Mr. Sherman is a lawyer and Dr. Moskowitz is a doctor. The three do not possess special expertise in veterans health care issues, but were reported to be influential over Trump administration policy, including its plans to push the department’s health care system toward private providers. The three are frequently at Mar-a-Lago, Mr. Trump’s private club in Palm Beach, Fla.
According to a report last year by the nonprofit investigative news organization ProPublica, the three pressured Mr. Trump’s first veterans secretary, David J. Shulkin, then peppered him with demands before ultimately working with personnel in the department to oust him. The group also pushed — in most cases, unsuccessfully — for certain vendors to manage health care records, and had a direct line to the president.
“I think most Americans would agree that wealthy private citizens should not be having back-channel influence” on veterans services, Mr. Takano said in an interview Friday. He said that he could use his subpoena power as a “last resort” if the requested documents were not relinquished. “This doesn’t have to be a drama,” he said. “It is a legitimate request.”
The three men released a joint statement in response to the committee action.
“We were asked by the president and, repeatedly, by the former secretary and his senior staff to assist the V.A. in enhancing the level of service it provides to our veterans,” the statement said. “Our primary focus was to introduce the V.A. to experts in various areas where V.A. staff asked for our help. We do not regret trying to do our small part, and even given the unjust and unrelenting criticism we have faced, each of us would step in to help our veterans again.”
Apple partners with VA on health records
Apple’s Health App will now integrate with veterans’ medical records as part of its new partnership with the VA. ProPublica reported on one of the Mar-a-Lago member’s contact with Apple in a December article. Read the health app announcement at Cult of Mac.
Quick Clicks:
- VAntage Point Blog: The VA exceeded 1 million video telehealth visits in fiscal year 2018
- VA Press Room: The VA and CDC are sharing mortality data to enable “faster analysis and the delivery of more timely healthcare interventions”
- USA Today: A massive conspiracy defrauded the military’s TRICARE insurance program some $65 million
Bill would provide child care for veterans
From Natalie Gross at Military Times:
The Veterans Affairs Department could soon provide free child care for veterans undergoing treatment for mental health and other medical issues — a move some lawmakers hope will make it easier for veterans to get help.
The House of Representatives passed a bill Friday that seeks to make permanent an existing pilot program rolled out in 2011. At the time, a VA survey found that more than 10 percent of veterans had to cancel or reschedule VA appointments because they lacked child care, and one-third said they were interested in child care services.
“We made a promise that our veterans will get the care they’ve earned,” Rep. Julia Brownley, D-Calif., said in an email. “We can’t put insurmountable roadblocks in front of their ability to receive that care.”
The Veterans’ Access to Child Care Act calls for the VA to provide child care on site, pay veterans a stipend for the full cost of child care at licensed facilities, pay the facilities directly or collaborate with other agencies.
Veteran suicides on VA campuses
From The Washington Post:
Veterans are 1.5 times as likely as civilians to die by suicide, after adjusting for age and gender. In 2016, the veteran suicide rate was 26.1 per 100,000, compared with 17.4 per 100,000 for non-veteran adults, according to a recent federal report. Before 2017, VA did not separately track on-campus suicides, said spokesman Curt Cashour.
The Trump administration has said that preventing suicide is its top clinical priority for veterans. In January 2018, President Trump signed an executive order to allow all veterans — including those otherwise ineligible for VA care — to receive mental-health services during the first year after military service, a period marked by a high risk for suicide, VA officials say. And VA points out that it stopped 233 suicide attempts between October 2017 and November 2018, when staff intervened to help veterans harming themselves on hospital grounds.
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Miller called the Veterans Crisis Line last February to report suicidal thoughts, according to the VA inspector general’s investigation.
The responder told him to arrange for someone to keep his guns and to go to the VA emergency department. Miller stayed at the hospital for four days.
In the discharge note, a nurse wrote that Miller asked to be released and that the “patient does not currently meet dangerousness criteria for a 72-hour hold.” He was designated as “intermediate/moderate risk” for suicide.
Although Miller had told the crisis hotline responder that he had access to firearms, several clinicians recorded that he did not have guns or that it was unknown whether he had guns. There was no documentation of clinicians discussing with Miller or his family how to secure weapons, according to the inspector general’s report, a fact that baffles his father.
“My son served his country well,” said Greg Miller, his voice breaking. “But they didn’t serve him well. He had a gun in his truck the whole time.”
Franklin, head of VA’s suicide prevention program, called the suicide rate “beyond frustrating and heartbreaking,” adding that it’s essential that “local facilities develop a good relationship with the veteran, ask to bring their families into the fold — during the process and discharge — and make sure we know if they have access to firearms.”
Note: These tragic stories show the importance of safe storage of firearms and strong community bonds – the focus of the partnership between the VA, the American Foundation for Suicide Prevention (AFSP), and the National Shooting Sports Foundation (NSSF). |
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