Perspective on VA Healthcare From a Vet
Hot in the news for the last few weeks is the VA healthcare scandal that seems to be spreading across the country. Pundits blaming each other, blaming the Obama administration, blaming the Bush administration; all of them are self-serving and … dead wrong.
Wait times, testing turnaround times and appointment changes have been plaguing the VA healthcare system for decades. Having recently retired from a healthcare position, I became a VA patient. I had partially been under VA for over 40 years because of a war injury, but when I retired I turned my healthcare to the VA in whole. I have said that my experience at the VA hospital was, for the most part, a good experience, and it was; there are very good folks working there. But there are caveats. When I first asked the VA to cover me, I was told I needed a location. Fine, I would become a patient at a VA clinic here in my town, not half a mile from my home. I called and was told, “We are not taking any new patients.” I was dumbfounded. How can they turn down any veteran? They told me to try again in a couple months when they would be in a position to take on new patients. This was nine months ago and as of May 1st, there are still no new patients. Problematic? I would say so.
I became under the care of the general VA hospital about 50 miles away. I set my first appointment up for about two months out. Being a healthcare professional, I knew what would speed things up for the physician I was to see. I printed out health history on myself for the previous five years and took it with me; something a regular vet would not only not know how to do, but wouldn’t have access to much of the information. We spoke of the problems I had been dealing with in my personal heath for the last few years. She suggested the next order of treatment, which I knew was to happen and agreed with her. She said she would put the treatment into the system and that I would be getting a call. Two months went by; no call. So I took it on myself to set up the treatment, using my knowledge of IV therapy and transfusion to force the issue at the VA hospital. My name was on a list to wait for the treatment, and I used my experience with transfusion and ability to talk their “language” to push them to move.
You see the problem here? If I was just a retired vet, without the experience in healthcare, I would have not yet been treated. The normal vet would have waited and waited for someone to call and after several months, the vet may or may not have gotten the call.
Another example is an old friend of mine a few years ago had been having chest pains. The cardiologist said a bypass was in order. He had no insurance so the only choice was care at the VA hospital. The ER where he had been seen for the chest pains sent his test results to the VA and requested the surgery. They set up the surgery date for six months away. He was in shock when he told me this; I was simply angry. No excuse. The healthcare system I worked for was a non-profit system that would commonly do charity care for patients who qualified, either covering the whole treatment or pro-rating the pricing to be affordable for the lower income patient. I used my influence with the company to push his case in our system and within 24 hours, he was in surgery getting the bypass on his heart. VA hospital: 6 months to get surgery. Private facility: 24 hours. Go figure…
Sure, the buck stops at the President’s desk whomever that may be, but it is far more problematic than that. The real problem is the entrenched unchanging bureaucracy that has been part of the VA system for decades – a bureaucracy protected by the Federal Unions. I don’t have a real problem with unions, but I do have a problem with public employee unions. For example, the Operating Engineers union and the big construction companies are up for their biannual contract signing. Representatives from the union and from the companies sit across the table from each other and hash it out in an adversarial discussion. Usually, every two or three years they manage to come up with something that will benefit the workers and not drive the companies into bankruptcy. If they don’t, they strike, and this is actually quite rare. With the government, the Federal workers union representatives across the table with the representatives of the politicians with no adversarial discussions at all. They are both on the same side – both paid and supported by the American people. They decide how much they can get out of the public for benefits for the Feds and decide how much the Federal union will support the local politician.
This coziness with the Federal Unions, the massive administrative bureaucracy and the politicians is the real cause of the entrenched bureaucracy. When he was asked whether VA employees who alter records should be fired, Shinseki’s deputy Robert Petzel said he wasn’t sure “whether that’s the appropriate level of punishment.” What? In the private healthcare sector, not only would that be grounds for firing, but in many cases, including in my old job as a transfusion manager, it would be a long jail term. Eric Shinseki interrupted the testimony and said about 3,000 VA employees had been removed for misconduct. Anyone who knows the Federal workforce, especially the administrative part of the Federal system, are aware that these removed employees were simply reassigned to different jobs. I saw this happen over and over for years in my wife’s previous position as a Federal employee manager. When she had a bad employee, they were never actually fired; just moved.
Administrators and managers who are not susceptible to changes gravitate to government systems. In the private healthcare business, there are constant changes and improvements in every facet of care. And if a private healthcare system doesn’t keep up, they are left in the proverbial dust. This can’t happen to the VA health system, because they are completely and totally funded by the taxpayer. There is no incentive for change.
If I was going to fix the VA healthcare system, and thank God I am not the guy to do this, I would start with levels of bureaucracy. Assistant administrators would be removed from every level of management. There would be one central group running each hospital, no more than five people for a 300 bed hospital. These five would have a certain number of department managers reporting to them spread evenly through all five of them: laboratory, nursing, engineering, housekeeping, etc… Depending on the size of the department and whether they are open 24 hours a day, they may have supervisors who answer to the department managers. This would be the sum total of a 300 bed hospital administration staff. Right now, a 300 bed VA hospital has five times that many people in administration. And last but certainly not least, all Federal unions related to VA healthcare would be ended outright.
I would then take each of the medical disciplines – cardio, oncology, infectious disease, etc. – and create programs of care. Every year, they would come up with a part of their discipline that could be focused on and improved – clinical projects. These improvements would be pushed nationwide to every VA hospital causing changes on at least an annual basis.
For the departments, every one of them would make groups as a region. The VA is already set up regionally. These groups would be designed to make and write standard procedures for each of their jobs, meeting on at least a monthly basis. One representative from several regional VA hospital departments. This is easy and cheap with today’s technology; these department reps can do this remotely. Example, one group meets to cover oncology nursing, one group for chemistry laboratory, one for bio-med engineering, and so on. These groups would come up with the latest in equipment purchases and standards of care and then change and improve as technology and standard of care moves ahead. They would work on all things related to their frontline work no matter how small the issue is. I was involved in many studies of standards of care issues. These change so fast, it takes a group to keep up with them.
Sound familiar? It should. This is how healthcare is run all over the country except in the VA government system. Do I believe this will happen? No, not at all. There will be lots of smoke blown; they will get on television and in self righteous indignation and cry out, “I am mad as hell!” Then the news will move on to something else and nothing at all will have changed. Cynical? Yep. 43 years of dealing with the VA and government bureaucracy has made me very cynical.