Veterans Affairs Secretary Eric Shinseki resigned on Friday following revelations of excessive wait times for medical appointments at the Veterans Health Administration (VHA), where some veterans may have died waiting for health services on secret lists that clinics maintained to hide long delays. But Shinseki’s decision to step aside, which comes after more than 100 lawmakers called for his ouster, does not resolve the systematic problems plaguing the agency.
According to VA inspector general reports, access issues have plagued the VA for years and VA staff were aware that some were falsifying records in order to cover up delays of treatment since at least the George W. Bush administration.
“What’s needed is to immediately identify and fix what’s broken, to hold people accountable to the maximum extent of the law, and to do whatever is necessary to help restore the full faith and confidence of veterans in their VA,” Joe Davis, Public Affairs Director for Veterans of Foreign Wars (VFW), said. Here are four steps toward that goal:
1. Temporarily extend care outside of the VA.
The Department of Veterans Affairs recently announced that it will allow veterans to use private medical services to meet growing demands for healthcare in areas where the department’s capacity to expand is limited.
Several veterans advocates have also called on Obama to use his executive powers to temporarily expand the Patient-Centered Community Care (PCCC) initiative, which allows VA medical centers to purchase non-VA medical care for veterans through contracted medical providers when VA care is not readily available.
2. Reform the way bonuses are awarded.
Performance reviews that are used to determine raises, bonuses and promotions have created “perverse incentives for manipulating wait-time data,” lawmakers and experts tell the New York Times. Whistleblowers have also revealed that supervisors at veterans hospitals pressured staff to manipulate patient-access numbers to “look good for their supervisors.”
To that end, Shinseki announced on Friday that he has “directed that no VHA [Veterans Health Administration] senior executive will receive any type of performance award for 2014, this year” and that “patient wait times be deleted from VHA employees’ evaluation reports as a measure of their success.”
3. Attract more health care providers.
The Department of Veterans Affairs is currently trying to “fill 400 vacancies to add to its roster of primary care doctors, which last year numbered 5,100.” In the past three years, primary care appointments increased by 50 percent, while the number of primary care doctors has grown by just 9 percent.
The provider shortage reflects larger shortages in the health care system, but staffing the VA may be particularly challenging, since doctors can often receive higher pay in the private health care system. Former Congressman and veterans advocate Patrick Murphy says the government must cast working at the VA as a way for Americans to serve their country and they in turn would receive forgiveness of their student loans.
4. Expand the use of electronic health records.
The agency did not fully implement digital processing of claims nationwide until 2013 and still does not have an efficient system for processing and receiving records from the Pentagon to “determine if an injury is related to a veteran’s time in the military.”
The VA had planned to “build a joint platform for records sharing,” but the project was dropped after multiple cost overruns, the National Journal reports.