Vox - Scandal at the VAhttps://cdn.vox-cdn.com/community_logos/52517/voxv.png2014-07-31T20:38:00-04:00http://www.vox.com/rss/stream/54887892014-07-31T20:38:00-04:002014-07-31T20:38:00-04:00Congress passed a plan to fix the VA
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<img alt="Senator Bernie Sanders (I-VT) and Representative Jeff Miller (R-FL) talk at congressional negotiations over the Veterans Affairs reform bill." src="https://cdn.vox-cdn.com/thumbor/lYk1EQ-ZbRPRDPUisud291d-JEE=/0x5:2039x1534/1310x983/cdn.vox-cdn.com/uploads/chorus_image/image/36149508/451163254.0.jpg" />
<figcaption>Senator Bernie Sanders (I-VT) and Representative Jeff Miller (R-FL) talk at congressional negotiations over the Veterans Affairs reform bill. | <a href='http://www.gettyimages.com'>Win McNamee / Getty Images News</a></figcaption>
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<p>In the aftermath of <a href="http://www.vox.com/cards/va-scandal-explained/what-went-wrong-at-the-va">the big scandal at the US Department of Veterans Affairs</a>, Congress and the White House have responded with various changes to reform the nation's publicly run health-care system for veterans.</p>
<p>Congress on Thursday, July 31, overwhelmingly approved sweeping changes to the VA's health-care system. The VA reform bill is the largest bipartisan effort passed by the current Congress, and the largest attempt to reform the VA in more than a decade.</p>
<p><q class="right" aria-hidden="true">Congress and the White House have taken steps to fix the issues</q></p>
<p>More than three months ago, allegations began trickling out of the VA hospital in Phoenix that officials had purposely manipulated records to appear like they were seeing patients in a timely manner, when the average wait time was actually <a href="http://www.vox.com/2014/5/28/5758154/report-veterans-in-phoenix-wait-115-days-for-health-care">115 days</a>. Afterward, allegations continued to pop up all over the country, as the fraudulent behavior proved to be widespread and systemic for the VA.</p>
<p>Since then, Congress and the White House have taken separate steps to fix the issues. Combined, the reforms amount to a considerable reshaping of the VA that policymakers and veterans advocates hope will improve a health-care system that simply didn't have the resources to see a growing pool of patients.</p>
<h3>What needs fixing at the VA?<br>
</h3>
<p><img alt="488810847" class="photo" src="http://cdn3.vox-cdn.com/assets/4821628/488810847.jpg"></p>
<p class="caption">The controversial VA hospital in Phoenix. (Christian Petersen / Getty Images News)</p>
<p>The VA scandal came down to three core problems:</p>
<ol>
<li>The VA's hospitals didn't have the doctors and nurses to see veterans — many from the Vietnam War and a growing number from Afghanistan and Iraq wars — in a timely manner.</li>
<li>The VA set wait time goals, which were backed by bonus payments, to see patients within 14 days of a requested date of appointment.</li>
<li>The VA's central office in Washington, DC, engaged in very little oversight over its sprawling system of local hospitals and medical centers.</li>
</ol>
<p>These three issues worked together to create a storm of fraud and cheating at VA facilities across the country. Administrators and schedulers realized they didn't have the resources to see patients in a timely manner, but they still wanted to obtain bonus payments attached to wait time goals. So instead of reporting the lack of resources to higher-ups at the VA's central office, they manipulated scheduling records to make it look like they were seeing patients quickly. Because the VA rarely checked in on these facilities to make sure they were being honest, hospitals were able to get away with this kind of fraud for years.</p>
<h3>What VA reform did Congress approve?</h3>
<p><img alt="129173207" class="photo" src="http://cdn1.vox-cdn.com/assets/4821652/129173207.jpg"></p>
<p class="caption">These guys are finally doing something. (Brendan Hoffman / Getty Images News)</p>
<p>Congress's plan to fix the VA contains various components. The plan sets $10 billion for a pilot program that reimburses private care for veterans who live more than 40 miles from a VA facility or experience long wait times. It also allocates another $5 billion for the VA to hire more doctors and nurses and upgrade medical facilities. And it gives the VA permission to enter into 27 major medical facility leases across the country.</p>
<p>The plan also allows the VA secretary to quickly dismiss or demote senior executive employees for misconduct and poor performance, and it forbids the VA from attaching bonus payments to wait time goals.</p>
<p>Legislators estimate the plan will cost $17 billion. About $12 billion of that is new spending, while $5 billion will be paid for with offsets from the rest of the VA.</p>
<p>The idea is to improve the VA's ability to see patients in a timely manner within the VA system. If that's not possible or a patient can't access a VA facility, a private option is offered as an alternative.</p>
<p>In any remaining situations where the VA can't get patients into care quickly, there will also be less of a financial incentive to manipulate records. And it will be easier for the VA secretary to hold those who continue engaging in fraudulent behavior accountable, even if they hold senior positions.</p>
<h3>What has the Obama administration done?</h3>
<p><img alt="450120940" class="photo" src="http://cdn1.vox-cdn.com/assets/4821668/450120940.jpg"></p>
<p class="caption">Acting VA Secretary Sloan Gibson speaks at the VA hospital in Phoenix, Arizona. (Laura Segall / Getty Images News)</p>
<p>Before Congress passed its own plan, the VA implemented two changes that made it harder to manipulate scheduling records and eliminated the incentive to cheat. First, the VA <a href="http://www.vox.com/2014/6/6/5785912/va-takes-first-steps-to-address-scandal">abandoned</a> its 14-day wait time goal after deeming it unrealistic and a perverse incentive. Second, Acting VA Secretary Sloan Gibson <a href="http://www.vox.com/2014/6/18/5820686/the-va-is-finally-conducting-monthly-inspections-at-hospitals-and/in/5488789">pledged</a> monthly inspections at facilities across the country that will ensure officials are seeing patients as quickly as recorded.</p>
<p>The Obama administration also made leadership changes in response to the scandal. After VA Secretary Eric Shinseki <a href="http://www.vox.com/2014/5/30/5764618/va-secretary-eric-shinseki-will-resign">resigned</a>, the White House temporarily appointed then-VA Undersecretary Gibson. The White House later <a href="http://www.vox.com/2014/6/29/5855420/white-house-to-nominate-former-ceo-to-lead-the-va/in/5488789">nominated</a> and Congress <a href="http://www.vox.com/2014/7/29/5949115/VA-department-veterans-affairs-bob-mcdonald-Senate/in/5488789">approved</a> former Procter & Gamble CEO Bob McDonald to permanently replace Shinseki.</p>
<h3>Are people happy with the changes?</h3>
<p>No one is completely happy with the plan, as staffers <a href="http://www.vox.com/2014/7/26/5937091/va-scandal-congress-bill-budget">acknowledged</a> in the week leading up to the congressional deal. Michael Briggs, a spokesperson for Senate VA Chair Bernie Sanders (I-VT), said, "We're trying to reach a middle ground that probably nobody will be completely happy with, but it will do a lot of good for the VA and for veterans."</p>
<p>Most of the debate came down to funding. The VA requested $17.6 billion in recent weeks, but the final plan allocates only $5 billion. Sanders and Senate Democrats wanted a number closer to the VA's request, while House Republicans were reluctant to allocate any extra funding outside of general budget debates.</p>
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<p><img alt="490832463" class="photo" src="http://cdn1.vox-cdn.com/assets/4821708/490832463.jpg"></p>
<p class="caption">Paralyzed Veterans of America Legislative Director Carl Blake testifies before Congress. (Chip Somodevilla / Getty Images News)</p>
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<p>Veterans advocates praised some of the changes. They applauded putting more funding into the VA system, which is something their <a href="http://independentbudget.org/">independent budget proposals</a> have called on Congress to do for years. Several veterans advocates also spoke favorably of the Obama administration's moves to enforce monthly inspections at VA facilities and repeal wait time goals.</p>
<p>Joe Violante, national legislative director for Disabled American Veterans, said that, although his organization would like to see more funding over time, he's encouraged that the plan does include some extra money to build out the VA's capacity. "I think it's a promising first step," he says. "The last thing we want to see is the infrastructure and the [staff] vacancies not taken care of."</p>
<p>But some advocates took issue with the idea of putting veterans into private care. As they see it, veterans are multifaceted patients with all sorts of injuries, both mental and physical, that need a comprehensive, specialized approach that the VA is built to take on. The private system, on the other hand, is structured more for an everyday patient that might deal with fewer physical and mental health problems.</p>
<p>"I'm not sure that our members would benefit greatly from" the private care option, Carl Blake of Paralyzed Veterans of America previously said. From Blake's perspective, veterans with major disabilities, such as the people his organization represents, are rarely going to find the kind of care they need at a private hospital.</p>
<p>The organization Iraq and Afghanistan Veterans of America <a href="http://iava.org/press-room/press-releases/iava-ceo-passage-va-bill-only-%E2%80%98band-aid%E2%80%99">characterized</a> Congress's plan as a "band-aid" that "will soon fall off." "While there are many good elements to the bill that Iraq and Afghanistan Veterans of America fully support, we are nonetheless outraged that it took the VA scandal to create this kind of urgency in Washington for our veterans," IAVA CEO and Founder Paul Rieckhoff said in a statement. "IAVA maintains that we should not fall victim to the poor standards or low expectations set by the VA and Congress in this matter."</p>
<p>One remaining issue is what Congress will do for the VA in the future. Throughout the congressional negotiations, veterans advocates voiced concerns that Congress would enact short-term fixes and let the system deteriorate after that. In the years ahead, it will be worth watching whether Congress sustains the kind of funding and programs that they approved Thursday.</p>
<p><i>For a deeper dive into the VA scandal, read Vox's <a href="http://www.vox.com/cards/va-scandal-explained/what-went-wrong-at-the-va"><i>full explainer</i></a> on the issue:</i></p>
https://www.vox.com/2014/7/28/5942797/va-scandal-reform-department-veterans-affairs-health-care-veterans-health-administrationGerman Lopez2014-07-29T15:09:49-04:002014-07-29T15:09:49-04:00Senate approves former CEO for VA secretary
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<img alt="Former Procter & Gamble CEO Bob McDonald prepares to testify in front of Congress." src="https://cdn.vox-cdn.com/thumbor/njMI5gqR6cLKcrJsIsW-F8MQWYY=/0x0:2039x1529/1310x983/cdn.vox-cdn.com/uploads/chorus_image/image/36228282/452533192.0.jpg" />
<figcaption>Former Procter & Gamble CEO Bob McDonald prepares to testify in front of Congress. | <a href='http://www.gettyimages.com'>Win McNamee / Getty Images News</a></figcaption>
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<p>The US Senate on Tuesday approved the nomination of former Procter & Gamble CEO Bob McDonald to run the US Department of Veterans Affairs. The Senate's approval means McDonald will become the new head of the troubled agency.</p>
<p>The Obama administration appointed McDonald to the position in June. The White House's pick underscored the management problems uncovered through <a href="http://www.vox.com/cards/va-scandal-explained/what-went-wrong-at-the-va">the VA scandal</a> — by picking a retired corporate executive instead of continuing the tradition of tapping a former military general, the White House signaled that it wanted someone who can seriously change the management structure across the VA's health-care system.</p>
<p><q aria-hidden="true" class="right">The White House's pick underscored the management problems uncovered through the VA scandal</q></p>
<p>Still, McDonald has some ties to the military. He graduated near the top of his class from the U.S. Military Academy at West Point and served in the military for five years.</p>
<p>Later, McDonald took an entry-level job at Procter & Gamble. He eventually worked up the company, which is known for products like Tide detergent and Charmin toilet paper.</p>
<p>McDonald abruptly retired from Procter & Gamble, <a href="http://www.businessinsider.com/pg-ceo-bob-mcdonald-retires-2013-5">Business Insider reported</a>, after analysts and investors complained about reductions in profit forecasts. McDonald went through a few failed experiments during his tenure, including a botched attempt to focus on social and online media to reduce Procter & Gamble's reliance on paid advertising.</p>
<p>On the broader issue of the VA scandal, Congress is currently considering bipartisan legislation to reform the VA. To learn more, read Vox's full explainer about Congress's plan <a href="http://www.vox.com/2014/7/28/5942797/va-scandal-reform-department-veterans-affairs-health-care-veterans-health-administration">here</a> and Vox's cardstack on the VA scandal below:</p>
https://www.vox.com/2014/7/29/5949115/VA-department-veterans-affairs-bob-mcdonald-SenateGerman Lopez2014-07-27T17:30:00-04:002014-07-27T17:30:00-04:00Congress reaches agreement to reform VA
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<img alt="A veteran goes through physical therapy at the VA hospital." src="https://cdn.vox-cdn.com/thumbor/CPuL9ml0ZOicTkfvVUX5Bn8B7mM=/0x0:2039x1529/1310x983/cdn.vox-cdn.com/uploads/chorus_image/image/36104660/71656156.0.jpg" />
<figcaption>A veteran goes through physical therapy at the VA hospital. | <a href='http://www.gettyimages.com'>Jeff Hutchens / Getty Images News</a></figcaption>
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<p><b>Update</b>: To learn more about the final deal, read Vox's <a href="http://www.vox.com/2014/7/28/5942797/va-scandal-reform-department-veterans-affairs-health-care-veterans-health-administration">full explainer</a>.</p>
<p>After <a href="http://www.vox.com/cards/va-scandal-explained/what-went-wrong-at-the-va">the massive scandal</a> at the US Department of Veterans Affairs, Congress reportedly reached an agreement on how to the fix the nation's publicly run health-care system for veterans — despite concerns that both sides would fail to set a deal after negotiations stumbled.</p>
<p>Negotiations between Senate Democrats and House Republicans seemingly broke down on Thursday, July 24, as both sides held dueling press conferences accusing each other of bad faith.</p>
<p>The negotiations appeared to be on much better ground as of the weekend, with staffers from both sides resuming discussions. House VA Chair Jeff Miller (R-FL) and Senate VA Chair Bernie Sanders (I-VT) also agreed to fly back to Washington, DC, if it would push the negotiations forward.</p>
<p><q aria-hidden="true" class="right">The negotiations appeared to be on much better ground as of the weekend</q></p>
<p>On Sunday, July 27, congressional staffers confirmed they had reached a deal. Neither side disclosed details of what, exactly, the final compromise will look like. A joint press conference scheduled for Monday will presumably lay out the details of the plan.</p>
<p>"I can say that an agreement has been reached to deal with both the short-term and long-term needs of the VA," said Michael Briggs, a spokesperson for Sanders.</p>
<p>The debate centered around how Congress should fix a VA health-care system that simply doesn't have enough doctors and staff for the number of patients it sees every year. The lack of capacity is one of the reasons schedulers and administrators in Phoenix and at other VA hospitals around the country manipulated records. The falsified reports made it look like VA hospitals were still hitting goals, which were linked to bonus payments, for seeing patients in a timely manner.</p>
<p>Before Congress reached a deal, they had to work through one remaining hurdle: funding.</p>
<h3>The debate focused on money<br>
</h3>
<p><img alt="451163240" class="photo" src="http://cdn3.vox-cdn.com/assets/4815328/451163240.jpg"></p>
<p class="caption">Senator Bernie Sanders speaks at the VA conference committee. (Win McNamee / Getty Images News)</p>
<p>The Congressional Budget Office <a href="http://www.cbo.gov/publication/45560">estimated</a> that the bill passed by the Senate would cost $35 billion. The final cost will likely change in the final bill, but the high CBO estimate gives a rough idea of just how much money was being debated — and why a highly budget-conscious Congress had so much trouble reaching an agreement.</p>
<p>On Thursday, Miller released what he framed as a compromise between the original House and Senate proposals. <a href="http://veterans.house.gov/sites/republicans.veterans.house.gov/files/7-24-14%20Chairman%20Miller%20VA%20Reform%20Proposal.pdf">The bill</a> would, among other changes, fund a $10 billion, two-year pilot program that would let veterans get private care outside the VA system, allow the VA to hire more doctors, and establish more accountability measures.</p>
<p>But the bill didn't include the full $17.6 billion in funding requested by the VA. The VA said the funds would help expand its infrastructure and hire new staff, including doctors, to get ahead of a surge of veterans coming home from wars in Iraq and Afghanistan.</p>
<p><q aria-hidden="true" class="right">"if there's one thing we've learned over the last few months, it's that we can't trust VA's numbers"</q></p>
<p>Sanders spokesperson Briggs said the senator doesn't necessarily want the final compromise to include all of the VA's requested funding, but he would like to see at least some of it in a compromise.</p>
<p>House Republicans, a staffer said, would prefer to see the additional funding requested by the VA dealt with in separate discussions about broader budget bills. Republicans haven't decided whether the request is too much, but they would like more time to work through the issue in separate budget negotiations to see what justifies such a big increase in funds and how the money should be appropriated.</p>
<p>Miller put it more candidly in a recent statement: "I am committed to giving VA the resources it needs to provide our veterans with the care and benefits they have earned. But if there's one thing we've learned over the last few months, it's that we can't trust VA's numbers. That includes the $17.6 billion in additional funding Acting Secretary Sloan Gibson asked for today."</p>
<h3>No one expected to be completely happy with the final bill<br>
</h3>
<p><img alt="465783917" class="photo" src="http://cdn3.vox-cdn.com/assets/4815320/465783917.jpg"></p>
<p class="caption">A military veteran walks after having his prosthetic leg serviced at a VA hospital. (John Moore / Getty Images News)</p>
<p>Prior to reaching a deal, both sides said they would each need to ultimately give something up if they were to reach a deal in time for the August recess.</p>
<p>"We're trying to reach a middle-ground that probably nobody will be completely happy with," Briggs said, "but it will do a lot of good for the VA and for veterans."</p>
<p>Some veterans advocates, meanwhile, don't like the idea of putting veterans into private care. As they see it, veterans are multifaceted patients with all sorts of injuries, both mental and physical, that need a comprehensive, specialized approach that the VA is built to take on. The private system, on the other hand, is structured more for an everyday patient that might deal with fewer physical and mental health problems.</p>
<p>"I'm not sure that our members would benefit greatly from this legislation," Carl Blake of Paralyzed Veterans of America said. From Blake's perspective, veterans with major disabilities, like those his organization represents, are never going to find the kind of care they need at a private hospital.</p>
<p><q aria-hidden="true" class="right">"I'm not sure that our members would benefit greatly from this legislation"</q></p>
<p>A major concern for veterans groups is that Congress will enact the two-year pilot program for private care, assume the VA's problems have been fixed, and leave the system to deteriorate after the pilot program ends. That, veterans advocates argued, would leave the VA worse off than it is today, because the pilot program would expire at a time more veterans from Iraq and Afghanistan will be entering the system.</p>
<p>Joe Violante, national legislative director for Disabled American Veterans, said adding more funding to the system, as veterans advocates have recommended for years in <a href="http://independentbudget.org/">independent budget proposals</a>, is key to a successful bill that will leave the VA in better shape. He argued, "If they're not going to ensure that there's funding available for the VA to expand during these two years, … I'd rather see them do nothing at this point."</p>
<p>Congressional staffers confirmed on Sunday, July 27, that Congress will do something, although the details of the deal weren't disclosed. As they see it, the final compromise might not satisfy everyone, but it could help alleviate a system that's been clearly strained by too many patients, too few doctors, and misguided regulations for years.</p>
<p><b>Update</b>: This article was updated to reflect the announcement of a deal on Sunday.</p>
https://www.vox.com/2014/7/26/5937091/va-scandal-congress-bill-budgetGerman Lopez2014-06-29T17:37:29-04:002014-06-29T17:37:29-04:00White House to nominate former CEO to lead the VA
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<img alt="Bob McDonald, on the right, meets with Romanian President Traian Basescu." src="https://cdn.vox-cdn.com/thumbor/s0ljuhmSmHEeWRFVYQoie4Yv2y4=/0x4:2039x1533/1310x983/cdn.vox-cdn.com/uploads/chorus_image/image/34982003/104558761.0.jpg" />
<figcaption>Bob McDonald, on the right, meets with Romanian President Traian Basescu. | <a href='http://www.gettyimages.com'>Daniel Mihailescu / AFP via Getty Images</a></figcaption>
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<p>The White House will nominate former Procter & Gamble CEO Bob McDonald to act as the new head of the US Department of Veterans Affairs, a senior Obama administration official confirmed Sunday.</p>
<p><q aria-hidden="true" class="right">The McDonald pick underscores the serious management problems uncovered through the VA scandal</q></p>
<p>The McDonald pick underscores the management problems uncovered through <a href="http://www.vox.com/cards/va-scandal-explained/what-went-wrong-at-the-va">the VA scandal</a>. Late Friday, the White House released <a href="http://www.vox.com/2014/6/29/5850880/white-house-probe-finds-corrosive-culture-at-va">a report</a> that found a lack of accountability at the VA and a culture of distrust between management and staff at the agency. By picking a retired corporate executive instead of continuing the tradition of tapping a former military general, the White House is signaling that it wants someone who can seriously change the management structure across the VA's health-care system.</p>
<p>McDonald does, however, have some ties to the military. He graduated near the top of his class from the U.S. Military Academy at West Point and served in the military for five years.</p>
<p>Later on, McDonald took an entry-level job at Procter & Gamble. He eventually worked up the company, which is known for products like Tide detergent and Charmin toilet paper.</p>
<p>McDonald abruptly retired from Procter & Gamble, <a href="http://www.businessinsider.com/pg-ceo-bob-mcdonald-retires-2013-5">Business Insider reported</a>, after analysts and investors complained about reductions in profit forecasts. McDonald went through a few failed experiments during his tenure, including a botched attempt to focus on social and online media to reduce Procter & Gamble's reliance on paid advertising.</p>
<p>The Senate will need to sign off on the McDonald nomination before he's put in charge of the VA. Democrats <a href="http://www.vox.com/2014/6/10/5785938/life-after-the-nuclear-option-in-the-senate">nuked</a> the minority's power to filibuster nominees earlier this year, and the VA scandal is still a pressing concern to lawmakers. So it seems likely the Democratic-controlled Senate will move quickly on his nomination.</p>
https://www.vox.com/2014/6/29/5855420/white-house-to-nominate-former-ceo-to-lead-the-vaGerman Lopez2014-06-29T13:40:02-04:002014-06-29T13:40:02-04:00White House probe finds corrosive culture at VA
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<img alt="President Barack Obama and White House aide Rob Nabors in a meeting." src="https://cdn.vox-cdn.com/thumbor/Vw8IrNM9pcnfv71TfIpRm4knxiU=/0x0:2039x1529/1310x983/cdn.vox-cdn.com/uploads/chorus_image/image/34951999/84184963.0.jpg" />
<figcaption>President Barack Obama and White House aide Rob Nabors in a meeting. | <a href='http://www.gettyimages.com'>Mandel Ngan / AFP via Getty Images</a></figcaption>
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<p>A new White House report acknowledged serious systemic lapses within the nation's health-care system for veterans.</p>
<p>In <a href="http://cdn0.vox-cdn.com/assets/4684351/VA_Review.pdf">a report</a> released late Friday, <span class="st">Deputy White House Chief of Staff Rob Nabors</span> detailed several problems uncovered during his probe into the US Department of Veterans Affairs and its health-care system.<span> Here are its basic conclusions:</span></p>
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<p><img alt="Va_conclusions" class="photo" src="http://cdn2.vox-cdn.com/assets/4685329/VA_conclusions.jpg"></p>
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<p><span>The White House's probe touches on the three big causes of the scandal: the VA's lack of adequate resources, poor oversight and accountability, and misguided quality metrics. Those issues have been noted in </span><a style="line-height: 1.5; background-color: #ffffff;" href="http://www.vox.com/2014/5/30/5764762/sorry-mr-president-weve-known-about-the-vas-scheduling-problems-for">Government Accountability Office reports</a><span>, </span><a style="line-height: 1.5; background-color: #ffffff;" href="http://www.nejm.org/doi/full/10.1056/NEJMp1406852?query=featured_home">papers</a><span> in </span><a style="line-height: 1.5; background-color: #ffffff;" href="http://www.nejm.org/doi/full/10.1056/NEJMp1406868?query=featured_home">the New England Journal of Medicine</a><span>, and </span><a style="line-height: 1.5;" href="http://www.vox.com/cards/va-scandal-explained/what-have-the-official-investigations-uncovered">other official investigations</a><span>.</span></p>
<p><q class="right" aria-hidden="true">The scandal "can generate political pressure to fix the problems"</q></p>
<p>Colin Moore, a University of Hawaii professor who's studied the history of the VA, says the report addresses some of the system's major issues, but "there's nothing really new here."</p>
<p>Several problems noted in the White House's report are already being worked on by regulators and lawmakers. The VA already pledged to <a href="http://www.vox.com/2014/6/6/5785912/va-takes-first-steps-to-address-scandal">scrap</a> the unrealistic 14-day scheduling goal and <a href="http://www.vox.com/2014/6/18/5820686/the-va-is-finally-conducting-monthly-inspections-at-hospitals-and/in/5488789">conduct</a> monthly inspections of scheduling practices at VA facilities. Both chambers of Congress, meanwhile, are in conference to compromise on <a href="http://www.vox.com/cards/va-scandal-explained/how-does-congress-plan-to-address-the-va">different proposals</a> that would help the VA hire more doctors and outsource some care to private medical providers. The White House, for its part, plans to keep Nabors at the VA to oversee the agency's ongoing changes.</p>
<p>The lack of new information speaks to a deeper problem. As the White House's report notes, the VA's inspector general and Government Accountability Office have been reporting problems with the VA's scheduling system since as far back as 2005. That's nine years of little-to-no action.</p>
<p>"Most of the people who followed the VA had some idea this was going on, although it was worse than we realized," Moore says. "At least one thing with the scandal, it can generate political pressure to fix the problems."</p>
https://www.vox.com/2014/6/29/5850880/white-house-probe-finds-corrosive-culture-at-vaGerman Lopez2014-06-24T09:40:04-04:002014-06-24T09:40:04-04:00VA whistleblower suggests the scandal isn't over
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<figcaption><a href='http://www.gettyimages.com'>Christian Petersen / Getty Images News</a></figcaption>
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<p>Staff at the controversial Veterans Affairs hospital in Phoenix may have continued shady scheduling practices even after <a href="http://www.vox.com/cards/va-scandal-explained/what-went-wrong-at-the-va">the VA scandal</a> broke, according to <a href="http://www.cnn.com/2014/06/23/us/phoenix-va-deaths-new-allegations/index.html">a new report</a> from CNN.</p>
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<p>Scheduling clerk Pauline DeWenter told CNN on Monday that officials at the Phoenix VA facility continued falsifying records to hide patients who died while waiting for care. If true, the accusations mean even more patients could have died waiting for care than the original 40 <a href="http://www.cnn.com/2014/04/23/health/veterans-dying-health-care-delays/">reported by CNN</a> in April.</p>
<p>CNN's report came on the same day the US Office of the Special Counsel released its own<a href="http://www.vox.com/2014/6/23/5834844/report-the-va-ignored-whistleblowers-warnings-for-years"> finding</a> that the VA attempted to hide serious shortfalls in its health-care system. The OSC report, quoting a previous 2013 letter, indicated that the VA "has consistently failed to take responsibility for identified problems."</p>
<p><span>Acting VA Secretary Sloan Gibson already announced the agency will </span><a style="line-height: 1.5; background-color: #ffffff;" href="http://www.vox.com/2014/6/6/5785912/va-takes-first-steps-to-address-scandal">abandon</a><span> scheduling goals that led to perverse incentives for VA staff and </span><a style="line-height: 1.5; background-color: #ffffff;" href="http://www.vox.com/2014/6/18/5820686/the-va-is-finally-conducting-monthly-inspections-at-hospitals-and/in/5488789">conduct</a><span> monthly in-person inspections of scheduling practices at VA hospitals and clinics. Congress also <a href="http://www.vox.com/cards/va-scandal-explained/how-does-congress-plan-to-address-the-va">plans to pass</a> its own fixes, including more funding for the VA system and increased access to <a href="http://www.vox.com/2014/6/13/5806838/the-senate-plan-to-privatize-some-veterans-care-could-cost-500-billion">VA-reimbursed private care</a>.<br></span></p>
<p><span> Whether that will be enough to fix the VA's health-care system, especially if cover-ups are truly ongoing until recently, remains to be seen.</span></p>
https://www.vox.com/2014/6/24/5836828/va-whistleblower-suggests-the-scandal-isnt-over-yetGerman Lopez2014-06-23T13:27:40-04:002014-06-23T13:27:40-04:00Report: The VA ignored warnings for years
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<img alt="Acting VA Secretary Sloan Gibson speaks at the Phoenix VA facility." src="https://cdn.vox-cdn.com/thumbor/FYUC0khbilNHHjhRFNgrjzdzYRw=/2x0:2037x1526/1310x983/cdn.vox-cdn.com/uploads/chorus_image/image/34696983/450121546.0.jpg" />
<figcaption>Acting VA Secretary Sloan Gibson speaks at the Phoenix VA facility. | <a href='http://www.gettyimages.com'>Laura Segall / Getty Images News</a></figcaption>
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<p>The US Department of Veterans Affairs has repeatedly classified serious shortfalls in its health-care system as harmless errors, <a href="http://i2.cdn.turner.com/cnn/2014/images/06/23/osc.va.letter.pdf">a new report</a> from the US Office of Special Counsel (OSC) found.</p>
<p>In two instances, a whistleblower pointed out that two patients with serious mental health conditions went unattended and untreated at VA facilities for more than seven and eight years. Despite the findings, OSC found the VA's Office of the Medical Inspector repeatedly failed to acknowledge the impact of the VA's neglect on these patients' care.</p>
<p>The report goes on to specify multiple instances in which the VA was notified by whistleblowers of serious gaps in VA health care but failed to act.</p>
<p><q aria-hidden="true" class="right">The VA "has consistently failed to take responsibility for identified problems"</q></p>
<p>OSC's analysis also found staff at several VA facilities were told to manipulate scheduling data in a way that made it look like they were seeing and treating patients in a timely manner.</p>
<p>The report notes that its warnings are nothing new. Lerner warned back in a September 2013 letter that the VA "has consistently failed to take responsibility for identified problems."</p>
<p>OSC called on the VA to take the warnings of whistleblowers more seriously. Shortly after the report's release, acting VA Secretary Sloan Gibson in a statement committed to doing just that.</p>
<p>Whether that actually happens remains to be seen. Federal watchdogs have been calling for major changes at the VA for years, receiving timid responses until <a href="http://www.vox.com/cards/va-scandal-explained/what-went-wrong-at-the-va">the ongoing VA scandal</a> first broke. The Government Accountability Office, for instance, asked the VA to fix its scheduling practices in <a href="http://www.gao.gov/products/GAO-13-130">2013</a> and <a href="http://www.gao.gov/products/GAO-14-509T">2014</a> reports.</p>
<p>OSC's letter is just one of many dire reports about the VA released in the past few weeks. As <a href="http://www.vox.com/cards/va-scandal-explained/what-have-the-official-investigations-uncovered">the official investigations</a> pile up, it's becoming clear that the VA had very serious problems <a href="http://www.vox.com/2014/5/30/5764762/sorry-mr-president-weve-known-about-the-vas-scheduling-problems-for">over the years</a> — and some of the issues were known by senior leaders and administrators even as they were <a href="http://www.nytimes.com/2014/06/21/us/every-senior-va-executive-was-rated-fully-successful-or-better-over-4-years.html?hpw&rref=politics">rated highly</a> and <a href="http://www.vox.com/2014/6/17/5818588/as-veterans-waited-for-care-phoenix-va-officials-paid-out-millions-in/in/5488789">obtained millions in pay bonuses</a>.</p>
https://www.vox.com/2014/6/23/5834844/report-the-va-ignored-whistleblowers-warnings-for-yearsGerman Lopez2014-06-18T10:25:05-04:002014-06-18T10:25:05-04:00The VA is finally enforcing monthly inspections
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<img alt="Acting VA Secretary Sloan Gibson visits the Phoenix VA facility." src="https://cdn.vox-cdn.com/thumbor/BCXmBZsS9w0PL_yFoo0o9kYWS9U=/2x0:2037x1526/1310x983/cdn.vox-cdn.com/uploads/chorus_image/image/34495101/450121034.0.jpg" />
<figcaption>Acting VA Secretary Sloan Gibson visits the Phoenix VA facility. | <a href='http://www.gettyimages.com'>Laura Segall / Getty Images News</a></figcaption>
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<p>In response to <a href="http://www.vox.com/cards/va-scandal-explained/what-went-wrong-at-the-va">the Veterans Affairs scandal</a>, the VA announced Wednesday that it will now direct local directors to conduct monthly in-person reviews of scheduling practices in every clinic within their jurisdiction.</p>
<p>"Our top priority is getting veterans off of wait lists and into clinics," acting VA Secretary Sloan Gibson said in a statement. "We need our folks in the facilities to work directly with staff, answer all questions, and ensure our veterans receive the timely care they have earned. Veterans must trust their health-care system, and these reviews are an important step towards restoring integrity in all our scheduling activities."</p>
<p><q aria-hidden="true" class="right">"Certainly, the way the system is set up, if someone wanted to go in and manipulate it, it would not be hard to do"</q></p>
<p>The increase in oversight gets to one of the major problems the Government Accountability Office has been pointing to <a href="http://www.vox.com/2014/5/30/5764762/sorry-mr-president-weve-known-about-the-vas-scheduling-problems-for">for years</a>: Even if the VA manages to set the right policies without any perverse incentives, the lack of federal oversight at local VA hospitals makes it unlikely that any policies are being properly enforced.</p>
<p>"Certainly, the way the system is set up, if someone wanted to go in and manipulate it, it would not be hard to do," Debra Draper, health-care director at the GAO, said in <a href="http://www.vox.com/2014/5/14/5714574/what-the-hell-is-happening-at-the-va">a previous interview</a>.</p>
<p>At the controversial VA hospital in Phoenix, administrators and schedulers allegedly manipulated and falsified scheduling records to continue receiving pay bonuses for seeing patients in a timely manner, even when patients were waiting on average <a href="http://www.vox.com/2014/5/28/5758154/report-veterans-in-phoenix-wait-115-days-for-health-care">115 days</a> for the primary-care appointment. If someone had been watching over the Phoenix VA facility all along, there's a good chance the nefarious scheme could have been prevented or stopped.</p>
<p>Part of the problem, of course, also lies in the perverse incentive created by the VA's wait time goals. Once local VA hospitals realized they couldn't hit the 14-day wait time goal set by federal rules due to rising patient demand and a doctor shortage, many of them resorted to cheating on scheduling records to continue getting their pay bonuses. If the pay bonuses never created an unrealistic goal, the record falsification wouldn't have been incentivized.</p>
<p>One of Gibson's <a href="http://www.vox.com/2014/6/6/5785912/va-takes-first-steps-to-address-scandal">first actions</a> after he replaced former VA Secretary Eric Shinseki was to repeal the 14-day wait time goal. The idea, as emphasized in <a href="http://www.vox.com/2014/6/9/5793794/full-va-audit-highlights-perverse-incentives">the VA's own audit</a>, is to do away with the perverse incentive created by the scheduling goal.</p>
<p>Given that both these fixes just required a new VA leader to make regulatory changes, it's questionable that it took a scandal to actually address such serious problems. Many veteran advocates have complained from day one that some of the problems have been <a href="http://www.vox.com/2014/5/30/5764762/sorry-mr-president-weve-known-about-the-vas-scheduling-problems-for">known for years</a>, but it took reports of patients dying while waiting for care for serious changes to be made.</p>
<h3>Further reading</h3>
<ul>
<li><a href="http://www.vox.com/2014/5/30/5764762/sorry-mr-president-weve-known-about-the-vas-scheduling-problems-for">Sorry, Mr. President. We've known about the VA's scheduling problems for years.</a></li>
<li><a href="http://www.vox.com/2014/6/5/5780306/how-to-fix-the-va-for-free-and-one-that-could-cost-money/in/5488789">Two ways to fix the VA for free — and one that could cost money</a></li>
<li><a href="http://www.vox.com/2014/6/17/5818588/as-veterans-waited-for-care-phoenix-va-officials-paid-out-millions-in/in/5488789">Phoenix VA officials earned $10 million in bonuses while veterans allegedly died waiting for care</a></li>
<li><a href="http://www.vox.com/2014/6/13/5806838/the-senate-plan-to-privatize-some-veterans-care-could-cost-500-billion/in/5488789">The Senate plan to privatize some veterans' care could cost $500 billion</a></li>
</ul>
https://www.vox.com/2014/6/18/5820686/the-va-is-finally-conducting-monthly-inspections-at-hospitals-andGerman Lopez