Thursday, February 07, 2013

Some people can justify anything











Dropping back to yesterday afternoon, the US House Veterans Affairs Subcommittee on Disability Assistance and Memorial Affairs held a hearing on the use of temporary disability ratings.

Subcommittee Chair Jon Runyan:  Our hearing topic today will focus on temporary total disability ratings.  Temporary total disability ratings serve a very important function in the benefits scheme.  This type of rating is assigned when it is established by medical evidence that surgery or certain treatment was performed, necessitating a period of recovery during which the veteran cannot work. However, according to a January 2011 report by the VA Office of the Inspector General, VBA has not been correctly processing and monitoring such claims.  As a result, the OIG stated that since January 1993, VBA has overpaid veterans a net amount of $943 million.  The OIG also stated that without timely action, VBA would overpay veterans a projected $1.1 billion over the next five years.  These numbers are troubling, to say the least.  As all of us here today are aware, our nation’s fiscal health is one of this Congress’s top priorities.  Part of this process includes trimming government spending and eliminating government waste.  It is my hope that by bringing attention to this topic, we can ensure that every dollar appropriated to VA is being spent properly on care and benefits for our veterans.  We heard from VA in June of last year during sworn testimony, that these errors were due to a computer glitch.  VA advised that the glitch would be fixed by July 2012.  Nonetheless, two new Regional Office audits issued by the OIG last month found that 50 percent of the temporary 100 percent disability evaluations reviewed were incorrect. The explanations given in the OIG audits stated that the 50 percent accuracy rate occurred because staff did not establish controls to monitor the proposed reductions initially, nor did they schedule future medical examinations as required. So -- something doesn’t add up here.  If the computer glitch was fixed in July 2012 but over 50 percent of temporary total rating claims are still being processed incorrectly as of January 2013, then that leads me to believe that these are human errors, not computer errors.

100% Temporary Disability Rating?  "A total 100% temporary disability rating will be assigned, without regard to the rating schedule, when a service connected disability has required hospitalization treatment by the Department of Veterans Affairs, for a period in excess of 21 days."   Paralyzed Veterans of America's Carl Blake submitted a written statement for the record.  He noted that temporary disability ratings rarely affected members of his organization:

That being said, temporary total disability ratings serve an important and practical purpose for many veterans.  The determination for temporary total disability ratings are governed by the provisions of 38 C.F.R. § 4.29, Ratings for service-connected disabilities requiring hospital treatment or observation, and 38 C.F.R. § 4.30, Convalescent ratings.  Temporary increases to VA disability ratings in accordance with the provisions of Paragraphs 29 and 30 are simple adjustments to running compensation awards that can be accomplished by employees with a minimum of training.  Temporary increases to compensation Paragraph 29 are determined by the verified dates of hospitalization.  Meanwhile, adjustments under the provisions of Paragraph 30 are established by rating action based on available medical information.  In each case, the dates of entitlement are clearly indicated, and with only a small amount of attention to detail, there should be no significant errors.

Runyan continues as Subcommittee Chair.  The new Ranking Member of the Subcommittee is Dina Titus.  There were two panels.  The first panel was Vietnam Veterans of America's Rick Weidman and VA's Assistant Inspector General for Audits and Evaluations Linda Halliday (accompanied by Larry Reinkemeyer and Brent Arronte).  The second panel was the VA's Diane Rubens.  While the issue of overpayment causes alarm in the current fiscal climate, overpayment isn't the only problem.

Ranking Member Dina Titus:  As the Chair mentioned, and it bears repeating, a billion dollars is something to be worried about.  But this doesn't just go one way in terms of overpayments.  At the Reno VA Regional Office, which serves my Congressional district in southern Nevada, the Inspector General found that over half of the 100% disability evaluations were incorrectly processed.  And while a number of these involved overpayments, there were also some underpayments.  And we certainly don't want our veterans to be underpaid.  For example, we found one veteran with service connected bone cancer and prostate cancer who was underpaid nearly $10,000 over a period of three years. 

We'll note one one exchange from the hearing.

Subcommittee Chair Jon Runyan:  Ms. Halliday, in your opinion, why is it the VBA failed to take adequate and timely measures to address the -- the systematic problems?

Linda Halliday:  Reliance that they needed an IT fix.  And that took some coordination between the VBA office and out office of OINT.  We kept telling them it is not just the IT fix.  What we were finding were people -- the VARO [Veterans Affairs Regional Office] staff were not making proper input to put these diaries in place.  Regardless of whether you had an IT fix in place, that action had to occur.  So it's been awhile that I don't believe VBA has been aggressive enough in addressing that -- that piece of it.  I know recently, Ms. Rubens had laid out some corrective action that included training which is consistently recommend in the benefits inspection reviews to try and reduce the human error associated with processing some of these claims.

Subcommittee Chair Jon Runyan:  And -- and going back -- and you mentioned it in your testimony there about the targeted completion date which was moved several times -- to September 30, [20]11, to December 30, [20]11, to June 30, [20]12 and then to December 31st, [20]12.  Do you know if the December 31st, '12 deadline was ever met?  Or has it been pushed back even further?

Linda Halliday: We haven't tested for it, but the evidence would be right now the benefits inspection are still identifying substantial errors.

Subcommittee Chair Jon Runyan:  And then finally, uhm, an alarming statistic in your written testimony says that only 53 regional offices have been inspected since your national audit -- have been fully followed by VBA policy and processing temporary disability claims evaluations.  Can you further elaborate on the extent that these problems are due to human error as opposed to the computer glitch?  And do you agree that -- with VBA's insistence that -- system glitches are the reason for these errors?

Linda Halliday:  Yeah, I'd like to ask Brent Arronte -- since he has spent so much time in our VA regional offices doing the inspections -- to filed that.

Brent Arronte:  What our inspections have-have shown is about 46% of the errors that we've seen with suspense date is what VBA is saying was the result of a systems glitch.  We never found a system's glitch.  To us a glitch means the system was not working as intended.  We spoke with some of the architecture behind this, I think in 2010, and they told us that the system was never developed to put these -- to ensure that these diary dates were populated into the system.  With that, we-we -- Two of the fixes that VBA has indicated that they have implemented, one in 2011 and one in 2012, we have not tested that yet.  We haven't obtained the data to see if those fixes are working systematically.  But what we have seen is about 25% of the errors are related purely to human error -- where staff is not putting in the -- or cancelling reminder notifications inadvertently, not understanding how to process reminder notifications and that results in the same effect of the benefit being paid when there's no evidence showing entitlement.

The Veterans Administration should be embarrassed that a hearing took place where the Inspector General explained that they refused to listen and that they repeatedly moved the date back.  The Secretary of the VA, Eric Shinseki, should be asked to explain how that happened?  He is supposed to be the head of the department, he is supposed to provide leadership.  This is just like, after the scandal of veterans not receiving their education checks, he mentions to Congress that he was informed of this impending problem right after he took over as Secretary of the VA.  He should have been called to the carpet for that but instead everyone apparently agreed to look the other way.  From the October 14, 2009 snapshot covering the House Veterans Affairs Committee hearing that day:

Erick Shinseki: A plan was written, very quickly put together, uh, very short timelines, I'm looking at the certificates of eligibility uh being processed on 1 May and  enrollments 6 July, checks having to flow through August.  A very compressed timeframe. And in order to do that, we essentially began as I arrived in January, uh, putting together the  plan -- reviewing the plan that was there and trying to validate it. I'll be frank, when I arrived, uh, there were a number of people telling me this was simply not executable. It wasn't going to happen. Three August was going to be here before we could have everything in place.

But he didn't bother to let Congress know.  He didn't bother to warn the veterans who might be counting on those checks.  And this all got ignored.  Now we learn that the issue of 100% temporary disability pay has not been fixed and part of the reason for that failure is that they don't want to listen to the Inspector General's office.  Where is the accountability?

Halliday said at yesterday's hearing, "We had expected VBA to keep their commitment to work this national requirement and we just watched slippage upon slippage.  I think you have to ask the Department, VBA, why it took so long."  She might as well have been talking about the electronic record that VA and DoD were tasked with developing.  Mary Mosquera (Federal Computer Week) reported April 9, 2009:
Obama said it was time “to give our veterans a 21st-century VA," adding that there is no comprehensive system that enables a smooth transition of health care records between DOD and VA.
“That results in extraordinary hardship for an awful lot of veterans, who end up finding their records lost, unable to get their benefits processed in a timely fashion,” Obama said. Access to electronic records is essential to modern health care delivery and the paperless administration of benefits, he added.
“That’s why I’m asking both departments to work together to define and build a seamless system of integration with a simple goal: When a member of the armed forces separates from the military, he or she will no longer have to walk paperwork from a DOD duty station to a local VA health center; their electronic records will transition along with them and remain with them forever,” he said.

A seamless system of integration.  It would, Barack said, "give our veterans a 21st-century VA."  He wasn't pulling notions out of thin air.  In 2007, Commissioners Bob Dole and Donna Shalala were named to head The President's Commission On Care For America's Returning Wounded Warriors.  The commission came up with this idea and, in their final report, warned, "Meanwhile, congressional or departmental reform efforts should resist imposing new requirements that may result in duplicative or uncoordinated electronic systems and, instead, encourage the streamlining of today's systems and facilitate communication across them."

Does Shinseki think he can just blow off the tasks he's assigned?  Does he not get how this impacts veterans?  November 11, 2009, the VA's Assistant Secretary of Public and Intergrovernmental Affairs Tammy Duckworth appeared on The Diane Rehm Show (NPR).

Tammy Duckworth: Well what didn't work so well -- this is one of the first things I brought up to [VA] Secretary [Eric] Shinseki when he interviewed me -- was the fact that we did not have a seamless transition of our military records from DoD to VA. When I left Walter Reed with my full medical records and I went to my VA hospital for the first time, I had to strip down to prove that I was an amputee. Even though he could see that I was an amputee and he had the medical records from the surgeon who amputated my legs. And we're immediately fixing that.  Back in May of this year, [Defense] Secretary [Robert] Gates and Secretary Shinseki agreed to a program where we're going to develop virtual, lifetime, electronic records. So that from the day you raise your hand to enlist in the army to the day that you're laid to rest in one of our national shrines, your records follow you. And this will be a monumental change in how VA and DoD hand off and care for our veterans.

So in 2009, Iraq War veteran Tammy Duckworth told him in very concrete terms how this could effect a person transitioning from service member to veteran.  Did he not listen?  Duckworth is now a member of the US Congress, House Rep Tammy Duckworth.  I called out Shinseki this morning and Shirley and Martha advise e-mails felt I was giving Secretary of Defense Leon Panetta a pass because I know him.  I know Leon, I like Leon.  I've held him accountable when needed and haven't worried about 'tone.'  This isn't Leon's issue.  He's out the door, for one thing.  For another, he won't even have 18 months as Secretary of Defense (unless Chuck Hagel's nomination gets tanked).  If Hagel had been confirmed last week and had made the announcement Tuesday with Shinseki, I wouldn't have called out Hagel.  It's not Hagel's issue. 

Shinseki has been the consistent under Barack.  Dropping back to the July 25th snapshot to note that day's House Veterans Affairs Committee hearing:

This morning, US House Rep Jeff Miller noted that "in 1961 John F. Kennedy said we'd put a man on the moon, eight years later, we were there.  We're talking about an integrated electronic health records by 2017.  Why could we put a man on the moon in eight years and we're not starting from ground zero on the electronic health record -- why is it taking so long?" He was asking that of the Secretary of Defense Leon Panetta and the Secretary of Veterans Affairs Eric Shinseki who were appearing before a joint-hearing of the House Armed Services and House Veterans Affairs Committee.  

Of course no real answer was given.  A grinning -- apparently amused -- Shinseki began his non-answer by declaring that "I can't account for the previous ten years."  Though he didn't say it, he also apparently couldn't account for the three years that he's been Secretary of the VA.  Three years and seven months.  You'd think Shinseki would be able to speak to the issue.  He couldn't.  He could offer that he met with Panetta four times this year with plans for a fifth meeting.  This was the same amount he met with former Secretary of Defense Robert Gates but, apparently, in a few months less time.   I have no idea what that or his ridiculous grin was about. 

But I do think Shinseki may have inadvertently provided an answer for the delay when he went on to declare,  "It's taken us seventeen months to get to an agreement that both Secretary Panetta and I signed that describes the way forward."  There's the problem right there. 

Back in March 2011 what was Shinseki bragging about?  As Bob Brewin ( reported, "Veteran Affairs Sectretary Eric Shinseki said Thursday he and Defense Secretary Robert Gates agreed on March 17 that their departments would develop a common electronic health record system."  So that was agreed to in March 2011.  But it took Shinseki and and Gates 17 months to figure out how?  There's your time waster right there.  And it was not needed.  Shinseki and Panette did not need to 'invent' a damn thing.  This is not a new issue.  VA has long ago addressed what they need with regards to records and DoD has identified the same.  And after this had been done (and redone), Robert Dole and Donna Shalala served on the Dole -Shalala Commission coming up with many of the same things.  The Dole -Shalala Commission was established in 2007 and formally known as the President's Commission on Care for America's Returning Wounded Warriors.   Appearing before the House Veterans Affairs Committee February 7, 2008, VA's Dr. James Peake testified that this electronic record was "a critical recommendation in the Dole-Shalala Commission report."

So he and Gates agreed what their departments needed to do in March 2011.  Then, in June 2011, Panetta becomes Secretary of Defense and Shinseki decides to start all over and spend 17 months coming to an agreement with Leon?  This falls on Shinseki.  He has not delivered on the task.  Yet again.

At what point is there accountability?  At yesterday's joint-press conference, Shinseki bragged that he and Panetta had just held the ninth meeting ("in 18 months") and they stressed the "commitment of both of our departments to a single, common, joint integrated electronic health record, the IEHR."  The ninth meeting, Shinskei explained "was about how to get there."  Really?  Panetta's got one foot out the door and you're meeting with him "about how to get there"?  Barack Obama tasked you with this duty back in April of 2009 and, in February of 2013, you're having a meeting "about how to get there"?

There's a lot of confusion as to what's going on.  Patricia Kime (Army Times) does a great job covering where things stand.  The same can't be said for others.  What's taking place is that the actual task is being tossed aside.  Instead, some low rent version of what was asked for is going to be assembled.   Let's quote Senator Patty Murray from yesterday's press release.

“I’m disappointed that the VA and the Pentagon are now backing away from a truly seamless medical records system. While this is a very complex problem, we must provide the best care for our servicemembers and veterans. That means the departments must meet this challenge by working together. What they are now proposing is not the fully integrated, end-to-end IT solution that this problem demands. VA and DOD have been at this for years and have sunk over $1 billion into making this the cornerstone of a nationwide electronic medical records initiative. I intend to follow-up with both Secretaries to find out why this decision was made.”

Senator Murray is the outgoing Chair of the Senate Veterans Affairs Committee.  She's right that, after wasting $1 billion in taxpayer dollars, they're now refusing to live up to what was promised.  

It's not going to be the full medical records -- as people were promised.  Instead, as the Defense Dept revealed through various flunkies on a press call yesterday, "information on prescriptions or information on lab results that will be exchanged on all patients, and most critically, in a standard data format at the point in 2014, so the data looks exactly the same between the two systems."  That is a huge come down from an electronic record that would carry all the patient information and follow the service member on over to the VA.  This was an expensive proposal.  But it was thought that veterans' health was worth it and it was thought that this would also help lower some health costs (both by being paperless and by being a complete record which would mean tests wouldn't be accidentally duplicated since you had a complete record). 
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