Four years after scandal, VA gets praise for health care but falls short on access

Headlines about the Department of Veterans Affairs (VA) in recent months have not been kind:

VA required thousands of ‘unwarranted reexaminations’ for vets getting disability benefits

VA doctor shortage fueled by management issues, poor pay

Painting in VA office, names of Army bases honor traitors

VA tried to intimidate its inspector general

But stories like these (and these are all mine) don’t give the whole picture.

This week of Veterans Day, more than four years after a patient wait-list scandal shamed the department and almost two years into President Trump’s reign, is a good time to take stock of VA.

The department continues to generate controversy. The number of fiscal 2017 VA employee complaints to the Office of Special Counsel over “prohibited personnel practices,” including whistleblower retaliation, far exceeded those of any other agency, including the much larger Defense Department. VA was third on the list of cases per 1,000 employees.

Yet veterans continue to praise VA health care, just as they did when the agency’s reputation swirled in the mud.

Listen to leaders of veterans’ organizations and the department’s inspector general:

Joe Plenzler, Wounded Warrior Project spokesman: “If confidence in VA is measured by our warriors registering with VA, 75 percent receive health insurance through VA, compared to 59 percent in 2014, and 68 percent use VA as their primary health-care provider, and 90 percent of our wounded warriors receive VA disability benefits … but more can be done to get veterans to the care they deserve faster.”

Garry Augustine, executive director of Disabled American Veterans Washington: “There are certainly areas that need improvement, such as timely access to veterans benefits and services. However, our membership feels that VA is doing a good job overall.”

Ryan Gallucci, director of National Veterans Service at Veterans of Foreign Wars: “What we’ve seen over the past months, probably since the summer, is that the situation is improving. There are still significant challenges that need to be addressed … but we think VA is moving in the right direction.”

Roscoe Butler, deputy director of Veterans Affairs and Rehabilitation at the American Legion: “Veterans say when they get into the system, the care they get is as good or better [than the private sector]. The challenge is access. It often takes a much longer time for new patients to get appointments than existing patients because of staffing.”

Michael J. Missal, inspector general: “VA currently faces a number of significant and complex challenges, including implementing the new electronic health records management system, determining the future of community care, modernizing its supply chain management and financial reporting systems, reducing staffing shortages, and generally improving the quality and timeliness of health-care services and benefits programs. VA leadership is working to address these critical issues.” VA’s problems often have common sources, notably, he added, “failures in program leadership and governance, system deficiencies and inadequate staffing. These are often exacerbated by frequent turnover in key positions.”

Frequent turnover in key positions includes the top one. Since Trump took office less than two years ago, the department has had five leaders. That includes Robert Wilkie, who served twice, this spring in an acting capacity and since July as the full-time head. That office is filled, but many others remain empty. The department had over 45,000 vacancies in June, more than the population of Annapolis.

It’s clear from the qualified endorsements that VA health care is good, but access often isn’t.

Beyond the anecdotal comments, that conclusion is backed by studies and data.

“Consistent with previous studies, our analysis found that VA health care system generally provides care that is higher in quality than what is offered elsewhere in communities across the nation,” said Rebecca Anhang Price, senior policy researcher at the Rand Corp., a nonprofit research organization.

Rand cautioned, however, that “there is high variation in quality across individual VA facilities.”

Variation also applies to wait times. The department’s website provides a tool that allows patients to learn average wait times at individual VA facilities. On Tuesday, I found wait times for new primary-care patients ranging from six days to 44 days at 12 locations within 50 miles of Washington. Less than a week isn’t bad. Six weeks is too long. BTW, the Montgomery County VA clinic in Gaithersburg had the shortest wait. The Eastern Baltimore County VA clinic in Rosedale, Md., had the longest.

Missal’s office has examined wait times at individual VA medical facilities and found that many patients are waiting longer. His report on an outpatient clinic in Monterey, Calif., for example, indicates that the percentage of new patients waiting more than 30 days for primary-care appointments jumped from 1.63 percent in the third quarter of fiscal 2016 to 17.34 percent in the second quarter of fiscal 2017, in part because of a physician shortage.

Wilkie insisted, however, it is getting better.

“VA is providing more health-care appointments than ever before, authorizing 32.7 million appointments in FY 2017, nearly 2 million more than in the previous year,” he told the Senate in September. “All VA health-care facilities now provide same-day urgent primary and mental health-care services for veterans who need them. In June 2018, VA completed 95.18 percent of appointments within 30 days of the clinically indicated or veteran’s preferred date; 83.46 percent within 7 days; and 20.29 percent the same day.”

Whatever the numbers, no one said VA’s falsification of wait-list data remains the problem it was in 2014.

“We don’t see any of that,” said Chanin Nuntavong, the American Legion’s director of Veterans Affairs and Rehabilitation.