VA secretary delivers first 'State of the VA' address

U.S. Department of Veterans Affairs Secretary David Shulkin delivered his first “State of the VA” address on May 31 to update veterans on the progress the agency is making, while also acknowledging the shortcomings that the VA has identified and will address in the upcoming months.

During the address, which was delivered during a press conference at the White House, Shulkin identified a wide spectrum of issues within the VA, including:

• access to care;

• paying providers;

• community care;

• quality of care;

• disability claims and appeals backlog;

• improving IT infrastructure;

• capital assets;

• construction;

• accountability;

• administration and bureaucracy at VA;

• waste, fraud and abuse; and

• addressing veteran suicide.

“We’ve had 137 different assessment and studies telling VA what’s wrong and how to fix it,” Shulkin said. “And what we’ve done in my first 100 days is to go through these studies – the Commission on Care, Independent Assessment, as well as our own internal assessments – to come up with these 13 areas of risk that I want to share.”

Access to Care

Shulkin said VA has done a significant job of improving access to care for clinically urgent veterans and therefore, people with clinically urgent needs are now being addressed in a much more efficient way. “We’ve developed same-day services in every one of our 168 medical centers for primary care and mental health,” said Shulkin. “And in fact, today, over 22 percent of veterans are seen on a same-day basis.”

In addition, Shulkin said VA recently posted wait-time data, for every single one of its medical centers across the country, in a public forum for everybody to see what’s good and not good. There is no other health system in the country that has done anything like that, and there is no comparison to what VA is doing in terms of transparency and wait times, he said.

“Yet, veterans are waiting 60 days or more for new appointments in primary care and mental health at 30 of our locations nationwide. So we still have more to do,” Shulkin said. “And while we’ve done well with meeting the urgent needs of veterans, 10 percent of the time when a provider wants a follow-up appointment in a specific timeframe, we’re not meeting that provider’s clinically assessed time for a veteran to come back. And that’s something we have to address.

Sixteen percent of our primary care clinics are over 100-percent capacity. When that happens, we can’t fully meet their needs in terms of access to care. Ten percent of our outpatient centers do not offer same-day services today. Now, we are committing by the end of this year that all of our out-patient centers will offer same-day services in primary care mental health. But today, 10 percent are not meeting that.”

Paying providers

Shulkin said VA’s Choice Program has provided increased access for millions of veterans. Today, there are 500,000 community care providers in the network and that number continues to grow.

However, those providers are increasingly frustrated with VA’s ability to get them payments, to the point that some of them are actually leaving the network, according to Shulkin. “It takes more than 30 days to process 20 percent of our clean claims at VA, and that affects about 25,000 providers across the country,” he said. “In addition, we have about $50 million in outpatient bill charges that are six months or older.”

As of April this year, Shulkin said only 65 percent of VA’s claims are handled electronically, which is far below what one would find in the private sector.

“We need private sector help in order to find new solutions to get that number well above 65 percent so we can have faster adjudication of payments to our community providers,” said Shulkin.

Community care

Although VA has made a lot of progress with the Choice Program, Shulkin said VA still has eight separate programs for paying community care. “That just makes it too complex and it’s confusing veterans and our employees alike,” he said. “[Twenty] 20 percent of our claims are rejected. And that’s much higher than what you’d find in the private sector. We need Congress to help us fix those eight separate programs and put them into a single program.”

Due to existing rules and policies, only three Department of Defense (DoD) facilities are currently a part of VA’s Choice Program. Shulkin said veterans who need care in the community should be able to use any DoD facility, as long as it offers the care they need.

“We certainly have to work with Congress and our veteran service organizations to redesign this Choice Program,” said Shulkin. “It will expire essentially at the end of the year, and we need new legislation to make sure that veterans don’t go back to waiting longer than they need to wait to get care in the community. So we have to pass legislation this year.”

Quality of care

Shulkin said VA now publishes its star-rating systems online, as well as the quality of care comparisons between VA and local community hospitals. “And in that, we’ve identified 14 of our VAs that have one-star ratings,” he said. “That means that their quality is below the standard in the community. And so that’s not acceptable to us. We’re deploying teams an implementing performance plans for each of those facilities.”

For Shulkin, veterans shouldn’t have to accept low-quality care, and they deserve the very best.

“When they’re not getting the best they can get in the VA, and the community offers better, that’s what VA is going to work to do in a revised Choice Plan: To allow them to go out into the community if they’re not getting the very best care,” he said.

Disability claims and appeals backlog

VA currently has over 90,000 disability claims that are taking more than 125 days to process. Shulkin said VA’s goal is to cut that in half over the next two years.

“We’re going to be introducing decision-ready claims nationwide on September 1 of 2017,” he said. “And in addition to that, we’re going to be going paperless throughout all of our veterans’ benefit offices by mid-2018.”

Furthermore, Shulkin said if a veteran were to file an appeal today, it could take nearly three years to get a decision. “It’s going to take Congress to help VA fix that system,” said Shulkin. “I’m grateful that the House passed appeals legislation … and we need our friends in the Senate to act on appeals legislation as soon as possible.”

Veteran suicide

Shulkin said nothing is more important to him than making sure that veterans’ lives aren’t lost to suicide. This is a national public health crisis which requires solutions that not only VA will work on, but all of government, other partnerships in the private sector and nonprofit organizations as well, he said.

“[Twenty] 20 veterans a day are dying by suicide,” Shulkin said. “I authorized emergency mental health services for those that were less than honorably discharged just a few months ago. That is a population of veterans that is at very high risk for suicide. And that’s just the beginning.”

On June 1, VA soft launched the White House’s veterans complaint hotline (855-948-2311). Shulkin said the hotline will be fully operational by Aug. 15. “This summer, we’re going to launch a new initiative called Getting to Zero to help us end veteran suicide. And again, that’s my top clinical priority,” he said.

The overall goal, according to Shulkin, is to turn the VA into the organization that veterans and their families deserve, and one that America can take pride in.

“We are guardedly optimistic about the implementation of the complaint hotline,” American Legion National Commander Charles E. Schmidt said in a public statement. “We believe the VA is a system worth saving and that the VA should be the health-care provider of first resort for our nation’s deserving veterans.”

Read more of Shulkin’s address here.