Posted on Aug 27, 2015
White Paper: Crowd-sourcing a Solution to the Dept of Vet Affairs
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All Con. Based on recent running discussions, it is beyond obvious that there is an issue with the Department of Veterans Affairs.
At the urging of COL Mikel J. Burroughs a few members of the RP Community are developing a "White Paper" with a proposal on how to "Fix" this issue.
The major advantage of the RP community is not only its size, but it's breadth of Knowledge, Experience, but also the fact that we care about this issue. We have a vested interest in seeing that it is corrected.
Below is a "Draft Outline" for a "Running Topic" where we can contribute information, and ask Research questions for this White Paper.
YOU are the Subject Matter Experts. YOU come from all walks of life now. YOU have experienced these issues, and can provide both Anecdotal, and Empirical Data needed to make changes to the system.
That said, below is what I initially suggested in a related topic, as a concept. I realize it's not a 100% fix. It's not intended to be. It's intended to be a "Philosophical Shift" which gets us towards that Fix. This will likely evolve as the discussion goes on, and WE research and determine what is or isn't feasible.
Think of this as a Planning Committee. We're developing Courses of Action. We can see the problems. We're looking for solutions. We're looking for second & third order effects to our solutions, but we're not here to just gripe about the VA (which I myself am as bad as anyone).
Thank you for your consideration in this matter.
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Overview: The key to correcting the issues with the VA is mirroring the Military Medicine system. In essence, taking a system that is non-functional or only partially functional, and making it resemble as closely as possible one that is mostly or fully functional. More specifically one that is familiar to the community which it is being applied.
Issues/Concerns/Problems with current System: The Dept of VA (et al) is a Cabinet level organization of the US Government. As such, it possessed both the strengths and the weaknesses of an Administration that size. It is "roughly" the same size personnel wise as the US Navy (being smaller than the USAF, and larger than the USMC) sitting at 300~K personnel.
Any organization of that size IS a Bureaucracy. There are a few disadvantages that have readily presented themselves in regards to the VA itself however. It is "entirely" Civilian ran, as opposed to a hierarchical structure like the Services. Second, there is a "hard" transition administratively getting information for Veterans moving from the Services to the VA, upon exodus. Third (a product of the first), is the ability to remove "low performers" from the VA, because of way the system is set up.
Philosophy of Solution: "In theory" the VHA supports nothing but "Military" (Retirees & Vets) therefore why can't we use a Hierarchical Support System like we do with "Military Medicine?" Or more aptly, why can't we use the "Military Medicine" system to support the VHA?
- Initial Suggest was using a system like the USPHS (Uniformed Service, not Armed Force) to replicate the Military Medicine System. It does not have to be the USPHS. Any "like" organization will work, and the concept of a "Military Medical Command" (MMC) has been mentioned.
In essence, replace on a 1:1 basis "Commanders, and Command Staff" at VA facilities with "Military" personnel. This changes the Oversight & Accountability of the "Directors" of these facilities. These personnel will still have oversight to the SecVA, but unlike their predecessors can be relieved for cause quickly, without the "red tape" that we deal with. This promotes a change in "Command Philosophy," which alters the "leadership environment."
The second piece is the transition of records from "DoD" or Service Level to VA. As it stands now, this is an "Active" process requiring user interaction to accomplish. This is a MAJOR drawback of the system. We need the system to be as seamless as possible going from DoD to VA to the point of Automation. There needs to be a singular system. As 100% (rare exception) of VA "customers" are former DoD "customers", this should be feasible.
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Edit (1): Removed Section(Quoted from original thread) & Placed as Response to Topic, much like CPT (Join to see) with her comments from the other thread(s):
Edit (2): Removed a couple of "tagged" people below who have responded to the thread, since there is a 20 person limit, to allow me to add more. This is "administrative" in nature (not because their input is not valuable). Please feel free to tag others or make recommendations on others who you think should be tagged.
Edit (3): Added post, below, Research Requests. Will keep them as a running tally. Feel free to link in thread, or message me if you come up with any of the date requested.
Edit (4): Added Issues/Concerns/Problems section to above.
Edit (5): Added Philosophy of solution section to above.
Edit (6): Added --------------------- breaks for ease of reading.
Note: Expect edits as necessary. Nothing is set in stone. Happy to change things as new ideas come in. Happy to debate anything and everything. The goal is to make what doesn't work, work.
At the urging of COL Mikel J. Burroughs a few members of the RP Community are developing a "White Paper" with a proposal on how to "Fix" this issue.
The major advantage of the RP community is not only its size, but it's breadth of Knowledge, Experience, but also the fact that we care about this issue. We have a vested interest in seeing that it is corrected.
Below is a "Draft Outline" for a "Running Topic" where we can contribute information, and ask Research questions for this White Paper.
YOU are the Subject Matter Experts. YOU come from all walks of life now. YOU have experienced these issues, and can provide both Anecdotal, and Empirical Data needed to make changes to the system.
That said, below is what I initially suggested in a related topic, as a concept. I realize it's not a 100% fix. It's not intended to be. It's intended to be a "Philosophical Shift" which gets us towards that Fix. This will likely evolve as the discussion goes on, and WE research and determine what is or isn't feasible.
Think of this as a Planning Committee. We're developing Courses of Action. We can see the problems. We're looking for solutions. We're looking for second & third order effects to our solutions, but we're not here to just gripe about the VA (which I myself am as bad as anyone).
Thank you for your consideration in this matter.
------------------------------------------------------------------
Overview: The key to correcting the issues with the VA is mirroring the Military Medicine system. In essence, taking a system that is non-functional or only partially functional, and making it resemble as closely as possible one that is mostly or fully functional. More specifically one that is familiar to the community which it is being applied.
Issues/Concerns/Problems with current System: The Dept of VA (et al) is a Cabinet level organization of the US Government. As such, it possessed both the strengths and the weaknesses of an Administration that size. It is "roughly" the same size personnel wise as the US Navy (being smaller than the USAF, and larger than the USMC) sitting at 300~K personnel.
Any organization of that size IS a Bureaucracy. There are a few disadvantages that have readily presented themselves in regards to the VA itself however. It is "entirely" Civilian ran, as opposed to a hierarchical structure like the Services. Second, there is a "hard" transition administratively getting information for Veterans moving from the Services to the VA, upon exodus. Third (a product of the first), is the ability to remove "low performers" from the VA, because of way the system is set up.
Philosophy of Solution: "In theory" the VHA supports nothing but "Military" (Retirees & Vets) therefore why can't we use a Hierarchical Support System like we do with "Military Medicine?" Or more aptly, why can't we use the "Military Medicine" system to support the VHA?
- Initial Suggest was using a system like the USPHS (Uniformed Service, not Armed Force) to replicate the Military Medicine System. It does not have to be the USPHS. Any "like" organization will work, and the concept of a "Military Medical Command" (MMC) has been mentioned.
In essence, replace on a 1:1 basis "Commanders, and Command Staff" at VA facilities with "Military" personnel. This changes the Oversight & Accountability of the "Directors" of these facilities. These personnel will still have oversight to the SecVA, but unlike their predecessors can be relieved for cause quickly, without the "red tape" that we deal with. This promotes a change in "Command Philosophy," which alters the "leadership environment."
The second piece is the transition of records from "DoD" or Service Level to VA. As it stands now, this is an "Active" process requiring user interaction to accomplish. This is a MAJOR drawback of the system. We need the system to be as seamless as possible going from DoD to VA to the point of Automation. There needs to be a singular system. As 100% (rare exception) of VA "customers" are former DoD "customers", this should be feasible.
---------------------------------------------------------------------
Edit (1): Removed Section(Quoted from original thread) & Placed as Response to Topic, much like CPT (Join to see) with her comments from the other thread(s):
Edit (2): Removed a couple of "tagged" people below who have responded to the thread, since there is a 20 person limit, to allow me to add more. This is "administrative" in nature (not because their input is not valuable). Please feel free to tag others or make recommendations on others who you think should be tagged.
Edit (3): Added post, below, Research Requests. Will keep them as a running tally. Feel free to link in thread, or message me if you come up with any of the date requested.
Edit (4): Added Issues/Concerns/Problems section to above.
Edit (5): Added Philosophy of solution section to above.
Edit (6): Added --------------------- breaks for ease of reading.
Note: Expect edits as necessary. Nothing is set in stone. Happy to change things as new ideas come in. Happy to debate anything and everything. The goal is to make what doesn't work, work.
Department of Veterans Affairs (VA)
Politics
Health
Disability
Reform
Edited >1 y ago
Posted >1 y ago
Responses: 20
6
6
0
Without insulting anyone here, the day USPHS takes over the VA, I will be amazed. Lets look at the two organizations. The VA is a cabinet level position, USPHS falls under Health and Human Services, they don't even have a seat at the table, so that would be a step down for Veterans everywhere. As no one is going to remove USPHS from HHS and make them cabinet level. If you think the VA is willing going to go down without a fight, not going to happen.
Now lets look at the residency program within the VA. Most VA facilities are tied to a Major University. My facility is tied to Stanford, down the road SFVA is tied to UCSF, people who get into these top tier schools normally go on from here for another 3-4 years of higher level education in a given specialty. Our chance to recruit the best and brightest get slim. Why you ask, what can I offer a Doctor that they could not get at a clinic at Stanford? Money, they got us beat, equipment, can't compete. Cutting edge research, while we do a fair share of research, we don't have Nobel level research that some universities are doing. A ten year commitment and give up a weekend? You don't work with a lot of Doctors do you? It will sound good at first, till they get a better offer and debt reduction from another facility without the 10 year obligation. Keep in mind with the Passing of the Affordable Care Act, facilities nationwide are scrambling to get more doctors, PA's and RNP's to aid with the influx of new patients. It is a sellers market right now.
Pay and benefits, depending on where you live, pay and benefits for Federal employees do not keep pace with what the local economy is doing. That applies to healthcare as well, which is why so few stay the course in USPHS to retirement.
Now to get more Active Duty about to leave the service into the VA:
Change Federal Hiring criteria to give Uniformed Service Members the same ability to transfer from their respective service to Federal employment as a Federal employee (Career Status, if honorably discharged)
For honorably discharged Veterans, almost the same but career conditional, which means you can still apply like most federal employees but their is time frame you get to keep this status.
Now what does the VA do: Healthcare, Student Services, Home Loan Services, continued...
Now lets look at the residency program within the VA. Most VA facilities are tied to a Major University. My facility is tied to Stanford, down the road SFVA is tied to UCSF, people who get into these top tier schools normally go on from here for another 3-4 years of higher level education in a given specialty. Our chance to recruit the best and brightest get slim. Why you ask, what can I offer a Doctor that they could not get at a clinic at Stanford? Money, they got us beat, equipment, can't compete. Cutting edge research, while we do a fair share of research, we don't have Nobel level research that some universities are doing. A ten year commitment and give up a weekend? You don't work with a lot of Doctors do you? It will sound good at first, till they get a better offer and debt reduction from another facility without the 10 year obligation. Keep in mind with the Passing of the Affordable Care Act, facilities nationwide are scrambling to get more doctors, PA's and RNP's to aid with the influx of new patients. It is a sellers market right now.
Pay and benefits, depending on where you live, pay and benefits for Federal employees do not keep pace with what the local economy is doing. That applies to healthcare as well, which is why so few stay the course in USPHS to retirement.
Now to get more Active Duty about to leave the service into the VA:
Change Federal Hiring criteria to give Uniformed Service Members the same ability to transfer from their respective service to Federal employment as a Federal employee (Career Status, if honorably discharged)
For honorably discharged Veterans, almost the same but career conditional, which means you can still apply like most federal employees but their is time frame you get to keep this status.
Now what does the VA do: Healthcare, Student Services, Home Loan Services, continued...
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CW3 Kevin Storm
They also perform business loans and other services. Now how many of us have positions that directly transfer over to those areas, when we hung up the uniform for the last time? I know I didn't. Which is why I think the DoD would be wise to bring back a program they had in the 1990's for Apprenticeship. The DoD matched half of an employees salary or hourly wage for two years. This afforded the employee a chance to learn a skill and the employer a break by hiring a vet. This could be beta tested at the VA, then done at other Federal Agencies.
I would also propose to improve Small Disadvantaged Business (SDB) which many a Vet has a small business under this category be modified, that that the National Contracting Office (NCO) be given a set-aside budget. Example currently if I need something that goes over my credit card limit, I have to go NCO, they put it out to bid, but if they feel is it is SDB I get screwed as the price can widely fluctuate. So my $3001 item can end up costing $5235, who pays the difference, my service does. This proposal would allow SDB to compete without the discrimination factor, as NCO would be the ones paying the difference. My service would pay the $3001, and NCO would pay the $2234 difference. I know this one may be confusing to some of you, but it is a hated thing in purchasing, as it screws your budget nine ways to Sunday. This would give Vets, and other small disadvantaged business a better opportunity to work with the Feds.
Just a few idea to help improve Veterans access to the VA.
I would also propose to improve Small Disadvantaged Business (SDB) which many a Vet has a small business under this category be modified, that that the National Contracting Office (NCO) be given a set-aside budget. Example currently if I need something that goes over my credit card limit, I have to go NCO, they put it out to bid, but if they feel is it is SDB I get screwed as the price can widely fluctuate. So my $3001 item can end up costing $5235, who pays the difference, my service does. This proposal would allow SDB to compete without the discrimination factor, as NCO would be the ones paying the difference. My service would pay the $3001, and NCO would pay the $2234 difference. I know this one may be confusing to some of you, but it is a hated thing in purchasing, as it screws your budget nine ways to Sunday. This would give Vets, and other small disadvantaged business a better opportunity to work with the Feds.
Just a few idea to help improve Veterans access to the VA.
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Sgt Aaron Kennedy, MS
CW3 Kevin Storm I agree there are "Obstacles" and I think for the sake of "brevity" I have likely created confusion by using the VA instead of the terms VHA (Veterans Health Administration), VBA (Veterans Benefits Admin), & Dept of VA, in the above.
I am not suggesting that the USPHS take over the entirety of the Dept of the VA. I am suggesting that specific "Office" (USPHS) from USHHS take OPCON of the VHA, while the Dept of VA retains ADCON. In essence, we have two same tiered entities, but operational control is being transferred to an organization that is actually designed to cover "Health" (USHHS) and has "Uniformed Services" Oversight (USPHS).
I'm not ignoring the rest of your post, but I wanted to address that part first. I will respond to the rest later.
I am not suggesting that the USPHS take over the entirety of the Dept of the VA. I am suggesting that specific "Office" (USPHS) from USHHS take OPCON of the VHA, while the Dept of VA retains ADCON. In essence, we have two same tiered entities, but operational control is being transferred to an organization that is actually designed to cover "Health" (USHHS) and has "Uniformed Services" Oversight (USPHS).
I'm not ignoring the rest of your post, but I wanted to address that part first. I will respond to the rest later.
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CW3 Kevin Storm
Public Health and Healthcare are not one in the same. While in concept this sounds good, think about it, VHA is the largest single healthcare provider in the country, do you want it overnight taken over by people who don't run huge multi-billion dollar healthcare facilities? One of the roles that the VA is to back up the DoD in times of War, not a USPHS mission. We respond to disasters, we have facilities nationwide, across the Pacific, and Puerto Rico. Now how many Hospitals does USPHS run? What you ask for is liking asking Coast Guard to take over the Navy and the Marine Corp at the Same time. Service Members as Healthcare Providers...that would require Service Member's to maintain all their respective certifications, and have a state certification or licensure. Many weekend providers do not maintain certs, they don't have to. Only professionals do. The VA is a paperless provider, try teaching that to Weekend Warriors.
There are things that can be fixed, things that can be improved upon, using the USPHS and the DoD to fix the VA is not the cure. Using your power to pick up a pen with suggestions that are workable to present to your elected officials is the best way to go. Keep in mind, many, many veterans who are in the system are happy with it, and will fight you tooth and nail if you try to change it. It all gets down to where you are. One of the biggest problems is staffing, the VA as a whole is understaffed with people who are fully qualified.
There are things that can be fixed, things that can be improved upon, using the USPHS and the DoD to fix the VA is not the cure. Using your power to pick up a pen with suggestions that are workable to present to your elected officials is the best way to go. Keep in mind, many, many veterans who are in the system are happy with it, and will fight you tooth and nail if you try to change it. It all gets down to where you are. One of the biggest problems is staffing, the VA as a whole is understaffed with people who are fully qualified.
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CPT (Join to see)
CW3 Kevin Storm What if we could offer them something such as an opportunity to have some portion of their student loan debt removed (the BIA does this to get them to work in their clinics), what if we offered a J1 Visa? There are some who are very bright but unable to afford to attend these institutions.
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The following was also a part of the original thread as recommendations for items to be covered in a white paper. "The V.A. has 9 million enrolled veterans (6 million who seek care on a regular basis), 320,000 employees, 151 medical centers, 820 outpatient clinics, 300 storefront "Vet Centers" and over 50 regional offices. It has a budget of $60 Billion for healthcare but an overall budget of $165 Billion. Where is the other $100 Billion going? Anyone know where to find the records from the Oversight committee? We always hear the funding isn't available as an excuse for why some service members are not receiving the care they need. As you can see the numbers are disproportionate. V.A. resources need to be allocated more smartly in the future. The continued influx of new Veterans and larger numbers are yet to come as the Soldiers from conflicts Vietnam and the Cold War are replaced by those of the Gulf War and beyond. The population is far more dispersed now than it was before. The changing demographics has resulted in the V.A. not having resources where they are most needed (Urban and Coastal areas). V.A. personnel can be moved from one facility to another to help off set some of this problem. This way experience is not lost.
Currently the V.A. health care system is broken into regions creating small kingdoms. This is why we see so many veterans giving drastic different accounts of their experiences in dealing with the V.A. clinics and hospitals. The Director of the V.A. needs to be able to establish National policy that will apply to all regions. Currently our government representatives don't work together with regards to V.A. resources but instead each works for his/her district leading again to more uneven care availability. We need to bring them together to develop a better V.A. Health System Nationally.
Upper management needs to be selected based on their ability and track records as managers not on the length of time they spent deployed.
The Information Technology System in the V.A. is woefully behind. Not just in terms of processing but also in terms of software and hardware. It is time for the DOS based system to go. It is difficult to use, it fails, the regional systems are not linked together for record access, the regions are unable to communicate because they have developed their own individual software systems. Inventory software needs to be upgraded and sharable between regions. This is also a part of why there is difficulty in integrating with the public health care providers (they have upgraded their systems) .....
Another large problem with the V.A. is the way it is organized from the top down. Their integrity from the top down is in question. Not to oversimplify but replacing the Director of the V.A. does little to fix a systemic problem. Accountability must be happening at all levels."
Edit
Currently the V.A. health care system is broken into regions creating small kingdoms. This is why we see so many veterans giving drastic different accounts of their experiences in dealing with the V.A. clinics and hospitals. The Director of the V.A. needs to be able to establish National policy that will apply to all regions. Currently our government representatives don't work together with regards to V.A. resources but instead each works for his/her district leading again to more uneven care availability. We need to bring them together to develop a better V.A. Health System Nationally.
Upper management needs to be selected based on their ability and track records as managers not on the length of time they spent deployed.
The Information Technology System in the V.A. is woefully behind. Not just in terms of processing but also in terms of software and hardware. It is time for the DOS based system to go. It is difficult to use, it fails, the regional systems are not linked together for record access, the regions are unable to communicate because they have developed their own individual software systems. Inventory software needs to be upgraded and sharable between regions. This is also a part of why there is difficulty in integrating with the public health care providers (they have upgraded their systems) .....
Another large problem with the V.A. is the way it is organized from the top down. Their integrity from the top down is in question. Not to oversimplify but replacing the Director of the V.A. does little to fix a systemic problem. Accountability must be happening at all levels."
Edit
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COL Mikel J. Burroughs
CPT (Join to see) This is an awesome amount of good information from one of our own here on RP. LTC Christopher Sands Thanks for all the information. I would like to get your opinon on what we are working on? Please be candid with us. Thanks. If you would like to communicate in private, please accept the connection request that I sent you on RP.
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CPT (Join to see)
LTC Christopher Sands The difficulty is in how the IT structure evolved, instead of a centralized IT management site it was divided into regions and each medical center had it's own IT service. IT decisions for each center were made by the center director and the local IT leadership. This made the speed of responsiveness better from the IT service provider faster but it made the system less secure and standardization nearly impossible to achieve.
Any new system put in place is going to be riddled with bugs and cause further delays in processing claims. I'm sure you are familiar with the the issue that the programs are only as good as the programmer inputting the desired programming language.
Yes I'm well aware of the fire with occurred in 1972. It is unfortunate that duplicate copies of these records were not maintained. Luckily some information pertaining to these records was able to be recovered. Do the "B" and "R" registry files help you at all?
Do you find the system where you do computer training to be helpful or to be cumbersome? Was you initial start up into this phase difficult as in were you given what you needed when you needed it or did you have to wait for someone to make the system available to you and were you given your access codes in a timely fashion or was there delay. I'm asking these question because I'm trying to ascertain how much initial time is used in preparing (training) for the systems.
cc: COL Mikel J. Burroughs
Any new system put in place is going to be riddled with bugs and cause further delays in processing claims. I'm sure you are familiar with the the issue that the programs are only as good as the programmer inputting the desired programming language.
Yes I'm well aware of the fire with occurred in 1972. It is unfortunate that duplicate copies of these records were not maintained. Luckily some information pertaining to these records was able to be recovered. Do the "B" and "R" registry files help you at all?
Do you find the system where you do computer training to be helpful or to be cumbersome? Was you initial start up into this phase difficult as in were you given what you needed when you needed it or did you have to wait for someone to make the system available to you and were you given your access codes in a timely fashion or was there delay. I'm asking these question because I'm trying to ascertain how much initial time is used in preparing (training) for the systems.
cc: COL Mikel J. Burroughs
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LTC Ian Murdoch
As a VA employee, I know that there are a number of initiatives underway to address the problem of multiple, obsolete IT systems that don't "talk" to each other. This is a very complex problem given the large number of data sources and business requirements out there, hence, it is very expensive. The "MyVA" Task Force and others have been bringing capablities online to make delivery of benefits and services more seamless for Veterans. It's a huge undertaking, though, and it won't hppen quickly, especially in the current budget environment.
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I think your ideas/solutions are very viable and well thought through. When everything is finished with the planning, let me know and I will forward it to my boss, Congressman Chris Gibson, a retired Colonel.
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PFC Joseph Levi
I have been talking with COL Mikel J. Burroughs often lately. He has all my contact information.
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COL Mikel J. Burroughs
PFC Joseph Levi I really appreciate your friendship and assistance on this matter. We have assembled a great team of veterans, smart guys, and super intelligent individuals that will come together with some very good working solutions. I appreciate you help in providing us with the right path and avenue to approach the presentation down the road.
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PFC Joseph Levi
Like I said before, I will be happy to pitch this idea around. This is his last term in office, which ends in January 2017, so hopefully we can get something together before that. I'm sure that won't be a problem!
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