Management

13 things that are about to change at VA

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The Veterans Access to Care through Choice, Accountability, and Transparency Act passed the House on July 30 with a vote of 420 to 5.  The Senate followed suit, 91 to 3, on July 31, and the president's signature is all but assured. Once enacted, the law would require outside review of most every aspect of VA operations, including "the competency of leadership with respect to culture, accountability... and performance management."

Scattered through the bill, however, are a number of specific IT and management mandates for the department -- many of which could entail significant new systems. Key provisions include:

  1. Digital Waiting List: The department must create an electronic waiting list on www.myhealth.va.gov that will allow veterans to monitor the status of their position in line, as well as view the average wait times for each facility and type of care. The wait-time information must be available online to the general public.

  2. Claims Processing System: As many veterans will now be able to go outside the VA for covered care, the department must develop an "efficient nationwide system for processing and paying bills and claims for authorized care." Regulations for the system must be drafted within 90 days.

  3. Electronic Medical Records: Electronic medical records have been vital to veterans' health efforts for years. The department must now coordinate with external healthcare providers to ensure that compatible data is fed back into veterans' personal records.

  4. VA Choice Cards: The VA will have 90 days to establish a system to monitor and issue veterans a "Veterans Choice Card," which will "facilitate the receipt of care" from non-VA health providers.

  5. Electronic Notifications: Veterans must be notified electronically -- if that is deemed to be "the most effective means available"-- to describe the care or services they are individually eligible to receive.

  6. Telemedicine: VA has been a leader in telemedicine, but Congress wants more. The department must now ensure that every "mobile medical center" is capable of providing telemedicine services.

  7. Open Data: Data for patient safety, quality-of-care and outcomes must be published as "a comprehensive database" within 180 days. This data must then be fed into the Department of Health and Human Services' "Hospital Compare" website.

  8. Off-the-Shelf Solutions First: The VA's history of developing in-house solutions is also targeted for special scrutiny. The bill calls for careful review of "any interim technology changes or attempts... to internally develop a long-term scheduling solutions [sic] with respect to the feasibility and cost effectiveness ... compared to commercially available solutions."

  9. Outside Assessment of IT Systems and Workflows: The VA must contract with an external assessor to review the systems and workflows used for scheduling, staffing, length-of-care management, and documentation of care. This external review must also cover the department's core "information technology strategies" for furnishing and managing care--"including an identification of any weaknesses and opportunities with respect to the technology used."

  10. Better access control: An additional assessment will explore whether system access ought to be limited to those employees who have been "properly trained" in scheduling appointments.

  11. Technology Task Force: Additionally, newly-confirmed Secretary Robert McDonald has been instructed to establish a "technology task force" that will review the department's scheduling systems and software needs.

  12. Bonuses & Prohibitions: Bonuses based on scheduling and wait-time metrics are no more, and any future falsifications of data concerning wait times will be met serious penalties, up to and including dismissal. McDonald must also ensure that annual awards and bonuses do not exceed $360 million.

  13. Executive Performance: The secretary will be given expanded power to quickly remove VA executives for poor performance, and must report any such dismissal to Congress within 30 days, along with a justification for the decision.

About the Authors

Jonathan Lutton is an FCW editorial fellow. Connect with him at jlutton@fcw.com

Troy K. Schneider is editor-in-chief of FCW. Connect with him on Twitter: @troyschneider.

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Reader comments

Sun, Aug 10, 2014 Bay Pines

We'll see how long this spending spree lasts before very challenge of budgets brought-on the current circumstances. It'll be interesting to watch what happens after the mid-term elections are complete. Many suspect the ruthless reduction mantra might take center stage once again.

Tue, Aug 5, 2014 Sherwood

VA also needs a better system to address issues raised by whistleblowers. At present, most (if not all) agencies forward letters from Congress (responding to an employee) to that employee's boss who then says "Everything is fine." This has to stop. The HQ office must do their own investigation instead of asking the fox if the henhouse is guarded. VA has been broken for a long time. When HQ calls a hospital about a problem, they see it as a turf issue. I agree with the others that VA has too many senior managers who don't know what they are doing. How will VA address that?

Mon, Aug 4, 2014

I have been working for the VA a little over a year now after retiring from the Army. I was hired because of my leadership background and for my ability to take on responsibility and manage as an individual and make decisions appropriate to care for the veterans. During my time here, little over a year, I have witnessed four of my colleges find another job, jobs that pay less, because of our managers attitude, inability to perform her duties, having email wars but will not call you to talk about issues, and talks with subordinates and gossips about her staff. Prior to my arrival two employees quit after she became the manager of the department that I work in. That is why the VA is failing because managers are not mature enough to personal feelings aside and do their job if they know how to do it.

Mon, Aug 4, 2014 American Lake VA, Puget Sound Division

Will this bill change the way VA handles managers that screw and move up, because they feel that it is more of a hassle to fire than to move them out of their site. That have no knowledge of what they are doing, that rate people that they have no visibility over, that needs an assistant manager because they can't perform their duties in a timely manner and most often in meetings for 75 percent of their day. These managers who come in late and leave early because they are on a buddy schedule. Managers who look to subordinates about what they should already know prior to taking over a position or section. I come from a military leadership background and to me a manager who is moved because of unpopularity from her former staff and has no knowledge of her job and is so immature that she will use the term "All the other VISN failed to" after an inspection that she should have passed since I, the employee, gave her training data four times in a two year period but yet she still was not able to maintain my training file, file that she has electronic access to but too lazy to access. I think the VA should have a sensing session about what managers are doing wrong and why the system is broke. Let the people under the managers tell you why it doesn’t work.

Fri, Aug 1, 2014 Kate Woodhouse

Hi all: Can someone give me a quick explanation of what this is about? Seems potentially useful, but very different from our system. Asking because am concerned with high number of UK citizens struggling with effects of trauma - ex-services and otherwise - and wondering how we start to design an effective support service. Background was public health, but following personal trauma am moving into social enterprise. Thank you, and good wishes - Kate Woodhouse

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