Friday, March 02, 2012

Cover or don't but drop the half-assed





Tuesday's joint-hearing -- House and Senate Veterans Affairs Committee hearing -- Senate Committee Chair Patty Murray noted that VA Secretary Eric Shinseki would be before the Committee and she would be attempting to get an aswer regarding sequestering from him. Sequestering refers to automatic cuts that would kick in on various federal departments and programs. Along with Senator Murray, Senator Jon Tester and House Veterans Affairs Committee Chair Jeff Miller have noted that the inability of veterans to get a straight answer on this issue is frustrating and that veterans have a right to know what's going on with the budget of the VA.
Chair Patty Murray: [. . .] let me begin the questions by getting this one off the table. It's on the issue of sequestration and cuts to spending. Like I said in my opening remarks I believe that all VA programs including medical care are exempt from cuts but there is some ambiguity between the budget act and the existing law. And when I asked the acting OMB director to adress this issue in a budget hearing two weeks ago, he said OMB had yet to make a final determination. So I am concerned that by not settling this issue now, we are failing to provide our veterans with the clarity they really deserve to have. And so while you're here, I wanted to ask you: Do you believe that all VA programs -- including medical care -- are exempt from any future cuts?
Secretary Eric Shinseki: I think, Madame Chairman, the answer that the OMB director provided you was the same one that I understand. They are still addressing the issue. For my purposes, I would tell you I'm not planning on sequestration. I'mI addressing my requirements and presenting my budget as you would expect me to do. I think sequestration in part or in whole is not necessarily good policy. And I think the President would argue the best approach here is a balanced deficit reduction and that the budget he has presented does that and I would ask that the Congress look at that budget and favorably consider it.
Chair Patty Murray: I think we all hope that is the outcome but we want to provide clarity to our veterans. They are very concerned about this issue.
Murray asked, she attempted to get an answer as to -- yes/no -- whether the VA is a department immune to sequestering. Not only did she ask, she announced in an open hearing the day prior that she would be asking. Shinseki came into that hearing knowing he would be asked.
The answer? Another non-answer. The person in charge of the VA Department has no idea, if sequestering goes into effect, whether or not his department would be affected. That seems like an answer you would need to know for a hypothetical. With sequestration looking more and more likely, that seems like an answer you would need to know in order to plan for worst case scenarios in the department you oversee.
But he can't answer the question and has no knowledge as to whether or not VA would be effected if these cuts kick in.
On the Senate Veterans Affairs Committee, Senator Patty Murray is the Chair. Richard Burr is the Ranking Member. A number of witnesses accompanied Shinseki to the hearing including Dr. Robert Petzel who is the Under Secretary for Health, Allison Hickey who is the Under Secretary for Benefits, Steve Muro who is the Under Secretary for Memorial Affairs, Roger Baker who is the Assistant Secretary for IT (Information and Technology) and W. Todd Grams (Executive in Charge for the Office of Management and Chief Financial Officer).
With that brain trust, you might think they could answer a basic question but you'd be wrong. As was the case in a recent House Veterans Affairs Committee hearing, the problems started with Allison Hickey (she refused to answer Ranking Member Bob Filner's questions and then there was a rush by the VA witnesses to 'wall her off' from Filner's questions -- see the February 15, 2012 snapshot and pay attention to when Filner tells her, "You're not answering the question."). Claims processing was the issue Ranking Member Richard Burr brought up yesterday in the Senate Committee hearing. He was concerned with the diagnosis (it being incorrect and a veteran suffering as a result) and with the timeliness of it. There is a huge backlog -- when Chair Patty Murray held her Virtual Town Hall with veterans February 9th -- sponsored by Disabled American Veterans, full transcript of the exchange can be found here -- the claims backlog was an issue the veterans repeatedly raised. In fact, it kicked off the discussion and Senator Murray noted, "This is one of the most common complaints I hear. And let me say that w know that the claims system is broken." So Ranking Member Burr was asking about an important issue and just asking for basic information: How can, a year from now, they determine whether or not there's been improvement?
Ranking Member Burr noted that the accuracy with diagnoses was at 84% nationally for the VA but at regional centers it varied from 61% to 94%. What part of the budget is going to go to evaluation of the diagnoses? Shinseki passed it to Hickey. As usual, she began speaking at a hearing without turning on her microphone. "I'm glad you're asking about quality because we're very focused on production and quality . . .," she insisted as she avoided Burr's question but continued talking for over two minutes about nothing of importance and nothing that resembled an answer to his question. Ranking Member Burr interrupted her and wanted to know how far into the year will they go before they'll be able to determine if the plan for improvements is working?
Ranking Member Richard Burr: But at some point, you've got to say, "We're going to look at this and see if it's working."
Allison Hickey: We did, sir, absolutely did.
Ranking Member Richard Burr: So?
Allison Hickey: And we did it in local pilots and we are just this week --
Ranking Member Richard Burr: So a year from now, when we get together for the 2014 budget if the quality is not improved or the timeliness down, it will have failed?
Allison Hickey: No, sir, I don't expect the quality not to have improved. We have some very significant decisions and initiatives --
Ranking Member Richard Burr: My point is, what if it doesn't?
Allison Hickey: Sir, then we will adjust as necessary to find the reasons why, we will tackle that hard, but I don't expect that to be the answer. I expect us to see improvement in both quality and production.
Ranking Member Richard Burr: Thank you. We have --
Secretary Eric Shinseki: Senator, Senator, if I might, quality is the function of trained people with the right tools. And we're working on both items right now.
Ranking Member Richard Burr: My question was, Mr. Secretary, at what point we will determine whether what we've implemented is working?
Secretary Eric Shinseki: Fair. We'll be happy to provide that. We set a target of ending this problem with backlog in 2015.
But they haven't even reduced it. House Ranking Member Bob Filner pointed that out in Tuesday's joint-hearing. More people were hired by the VA to work on claims and the backlog has only increased. Whatever the VA's doing thus far, it's not working. Is it a comprehension issue? Does VA just not listen? Senate Ranking Member Burr repeatedly asked how they would measure this year whether the changes were working or not. He got no answer and it appears the VA thinks they'll decide whether things worked or not to improve quality and speed when 2015 comes to an end. Do they not understand the need for regular evaluations? For checking the process? They didn't appear to yesterday before the Senate Veterans Affairs Committee.
You're a veteran and you need help with something, let's say PTSD. Is the VA providing timely care? No. And yet in the proposed 2013 Fiscal Year budget, they're asking for only a 5% increase in funding when it comes to health care providers. Is that really enough, Chair Murray wondered?
Chair Patty Murray: Mr. Secretary, last year, we talked a lot about mental health care and I think we together uncovered a lot of serious issues best summed up by a veteran that I heard from recently who uses the Ann Arbor Medical Center and had to wait months and months to get into counseling but then he had glowing things to say about his mental health care once he got in. So in order to address those types of issues, VA has to be certain it has enough resources to not only keep up with the increasing number of veterans seeking mental health care but also bring down that unacceptably long wait time. Over the course of the last fiscal year, the number of Iraq and Afghanistan veterans who are looking for mental health care went up by about 5% and that's about 18,000 every quarter. So I wanted to ask you this morning if you believe the increase in mental health funding in the budget request is sufficient to accomplish the goals and keep up with this increasing demand?
Secretary Eric Shinseki:: I-I believe that the budget, if you look at the 13 budget request, I think it's adequate for us to meet what we understand our requirements are in 13. Are there issues out there now that we will discover between now and executional budget? I would say if we do, Madame Chairman, I would be the first to tell you. Now you asked us to do a survey and we did. It was very hastily done. Senator Burr referred to some of the output conclusions out of that survey. Out of 27,000 of our health care -- mental health providers, 319 were surveyed and the results were as described. My question of VHA was did you go to the places we thought there would be problems? And the answer was yes, because we were asked to go figure this out. So I would say we got a pretty pure response. What I think we need to do is make sure -- we're going to take another broader look -- to make sure we understand across the larger population what our issues are and where there are opportunities for -- reallocation or to hire more people? I would offer to the Chair, I took a look at what we've done in mental health over the last 4 budgets. If we look at '12 to '13, it's rather unimpressive. I mean, it's 5% and it matches the increase in the medical budget but between '9 and '13 our increase is 39%. in mental health. And if you include the 14 advance appropes [2014 advance appropriations requests] it will go up 45% --
Chair Patty Murray: And that is a result of the number of soldiers who are coming home with the invisible wounds of war which is dramatically increasing, correct?
Secretary Eric Shinseki: Uh, true but we are trying to anticipate that there's going to be a larger requirement in the odd years even if we don't have clarity, we're trying to prepare for that. We want to do a larger survey here as I indicated and then see -- and then see what the outcomes are. But let me turn to Dr. Petzel for any details.
Dr. Robert Petzel: Thank you, Mr. Secretary. Madame Chairman, as a result of the hearing that we had earlier in the year, we have now done two things that are, I think, important and on point with regards to your question. One is that we've developed a staffing model. It is the only staffing model that I know that is available about mental health. It's in the -- in the beginning stages but it is giving us some information about what the need might be. But I think more importantly, we're site visiting all 152 of our medical centers to look at the access to mental health services -- both the initial appointment and subsquent appointments, be it for PTSD patient program, a group program or individual psychotherapy. And what we're finding is that there is -- We do meet the criteria for the first appointment in most every instance. We're having some difficulties in some parts of the country making the next appointment in a timely fashion, getting them -- as you mentioned earlier -- into the specialty services. This could be the result of three things. One, is do we have enough staff out there? Have we given enough positions and enough resources? Two is: are those positions filled? Are they filling those positions up in a timely fashion. And then the third is are we getting the appropriate level of productivity out of each one of those people? If we do discover, as the Secretary just mentioned, that we do have additional needs that are unment, I can guarantee you that we will be in communication with the Commitee about those needs and in for a discussion.
Chair Patty Murray: Okay, I appreciate that. This is a top priority for us this year.
Secretay Eric Shinseki: I would just share that in FY '11, we hired about 897 additional mental health professionals bringing us up to about 20,500 mental health professionals so the interest is there in trying to determine what the requirement is and we're not hesitant about increasing those numbers.
As usual, Senator Daniel Akaka brought up a point that others miss (about the rural nature of Hawaii -- and "others" includes me and I have a house in Hawaii). I'd like to cover that tomorrow but we tried to cover the big issues today (and tried to cover these yesterday but it had to be cut due to space).

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