By Gina Harkins, senior staff writer at MOAA
The new VA secretary laid out a 10-point plan for improving veterans' health care this weekend - and it doesn't include a move toward privatization.
“One of the things … you're hearing a lot in the news is, 'Why do we need the VA health care system -why can't we figure out ways that the private sector can just take over this role for us?' ” VA Secretary David Shulkin said Sunday during a Disabled American Veterans (DAV) conference outside Washington, D.C.
“… The VA system is a very, very different system than what you would see in the private sector.”
Still, there's a lot of room for improvement at the VA, he said, including the need to make it easier for veterans to seek care close to home, he said. These improvements are vital after trust in the department plunged in 2014 after a series of news stories broke about veterans facing long wait times for care.
“Our currency is your trust,” Shulkin told the DAV members on Sunday. “… We understand that when we lose people's trust, it's hard to build it back up. But we're working hard to do that.”
Here are 10 ways Shulkin plans to shake up the massive bureaucracy during his tenure as secretary.
1. Firing bad employees
At the top of Shulkin's to-do list is improving accountability at VA centers across the country.
Most of the VA's 365,000 employees do terrific work every day, he said. But when even a small number deviates from the department's ethics and values, they need to go.
“We're going to make sure that the secretary has the authority to make sure that those employees … are leaving the VA system,” Shulkin told the cheering crowd.
2. Extending the Choice program
The Veterans Choice program created after the wait-time scandals allows VA patients to seek private doctors closer to home, but it's about to expire. Shulkin said he'll ask lawmakers in Washington to extend it beyond its Aug. 7 expiration date.
“If Congress doesn't act, we will see a significant amount of resources that are dedicated to caring for veterans be removed,” he said. “We can't let that happen.”
3. Choice 2.0
Beyond the extension, Shulkin said Veterans Choice needs to be simplified. The goal: To make it work better for veterans.
Thirty-one percent of VA patients' care is now delivered in their communities, Shulkin said. He wants to continue coordinating with local health care facilities so their systems are further integrated with the VA's.
Shulkin also plans to get rid of rules that restrict veterans from seeking care outside the VA to only those who face more than a 30-day wait or live more than 40 miles away from a VA facility, Stars and Stripes reported Sunday.
“This is not privatization,” Shulkin said. “This is actually [getting] the veteran the very best care in the VA and the very best care in the private system and then working to build that into an integrated system of care.”
4. Improving VA infrastructure
During his speech, Shulkin shared slides showing two aging VA facilities: one built in 1895 and another in 1932.
“Our buildings are too old,” he said. “Many of the facilities frankly should've been remodeled or even torn down and rebuilt.”
Veterans deserve the best equipment, facilities, and health care professionals, he said, which means “reinvigorating our efforts to rebuild our infrastructure.”
5. 'World-class' services
Some health care requirements are unique to the veteran community, and Shulkin said the VA needs to continue enhancing those services. That includes specialized programs for spinal cord or traumatic brain injuries and treatment for post-traumatic stress.
“[These areas] are really important for veterans [and] don't exist in ways that are easily accessible to veterans outside of the VA,” he said. “We're going to make sure that we are focusing on having those to be world class.”
6. Better VA-DoD partnerships
VA and Defense Department officials need to examine ways to leverage existing facilities, Shulkin said.
“When you take a look at the DoD and VA, we have maps where we know that our facilities are close together,” he said. “We could be working closer together.”
That could extend to other federal facilities, he said, as agencies look for ways to share resources and cut expenses.
7. Better electronic records
Towering stacks of paper medical records clogging up the VA system will be a thing of the past if Shulkin gets his way.
The VA has made a lot of progress when it comes to integrating electronic medical records with DoD's system, but there's still work to be done.
“We are now focused on modernizing our information technology systems, so you're going to see some new and bold proposals to be able to make sure that VA continues to have high-quality modern IT systems.”
8. Stopping suicide
Too many veterans are taking their own lives, and the VA is on a mission to stop it - but they can't do it alone, Shulkin said.
“We need everyone's help,” he said. “We need to work with the community and we need to get the messages out to get people help.”
Shulkin said VA officials will release new anti-suicide campaigns in coming weeks, and the VA will be “taking a leadership role in this across the country,” he said.
“Suicide prevention is our top clinical priority right now,” Shulkin said. “It's an area where we are not satisfied.”
9. Appeals modernization
Appealing a VA claim can take years, and it'll require an act of Congress to fix that.
“We know the appeals process is broken - we can only fix it through legislation,” Shulkin said. “We're going to make sure that we work hard to get that done this year.”
VA officials need to partner with Congress to get many of the department's programs fixed. That can be difficult for Shulkin, who admits he doesn't like to sit around and wait for progress.
“I used to always say to my teams when I worked in the private sector, 'What's it going to take to get this done, an act of Congress?' ” he said. “Now, of course, the irony is that everything that I do takes an act of Congress.”
10. Internal improvements
Despite some of the roadblocks that cause things to move slowly within the VA, Shulkin said there's still room for internal improvements. While veterans' satisfaction in the VA has been on the rise, the secretary said their work is far from done.
“We are not satisfied with our performance,” he said. “Even though we've made terrific progress on bringing down our backlog, we think we can do a lot better.”