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Obama signs VA reform, but changes will take time

Aug. 7, 2014 - 06:00AM   |  
Barack Obama
President Obama signs into law the Veterans Access, Choice, and Accountability Act of 2014, a bill providing the Department of Veterans Affairs the resources to improve access and quality of care for veterans, on Thursday at Fort Belvoir, Va. (J. Scott Applewhite/The Associated Press)
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President Obama signed the new Veterans Affairs Department reform bill into law Thursday, but it will be a while before veterans see any of its effects.

The $16.3 billion measure has been touted by lawmakers, administration officials and veterans groups as an important first step in fixing a department rocked by multiple scandals in recent months. It would expand private care options, fund hiring of new clinicians, lease more medical space and ease rules for the dismissal of VA senior officials for poor performance.

In a statement, VA officials promised “timely and effective implementation of this highly complex piece of legislation.”

But many of those changes will take months to implement, a problematic delay for critics already frustrated with VA operations.

“It’s like turning a battleship around,” said Garry Augustine, executive director of Disabled Veterans of America. “It’s a long process, and we’re going to have to be patient.”

Reducing wait times

The most complex provisions in the measure involve issuing new “veterans choice” cards to existing VA patients facing long wait times or travel of 40 miles or more to their nearest VA facility.

Lawmakers made that the crux of the new law, saying it will give veterans a quick, convenient option to seek private care if VA can’t fix its wait time problems. VA data from mid-July shows more than 35,000 patients still faced wait times of 90 days or more to see a physician.

White House officials noted that VA schedulers have reached out to more than 217,000 veterans in recent months to get them off local wait lists and into clinics, run either by the VA or private practices.

But setting up processes for establishing eligibility for cards, issuing instructions and systemically refunding private doctors for work with veterans will likely take months.

Ian de Planque, deputy director for the American Legion, said he doesn’t expect bureaucrats to be able to finish that work in 2014. “Health experts we’ve talked to said all the details could take more than a year,” he said.

Hiring new clinicians also could be a lengthy process. Last month, then-acting VA Secretary Sloan Gibson said he wants to hire 10,000 clinicians in coming years to help make more appointments available for veteran patients, but the federal hiring process often takes weeks and months to complete.

Plans for leases at 27 new locations could move more quickly, since veterans groups and VA health officials have already identified those locations. Augustine and de Planque both said they hope that new space will be open this fall, and will immediately provide more clinic space and time.

More accountability

The most open-ended provision of the bill might be its most publicized portion. The legislation gives the VA secretary broader authority to fire senior executives for poor performance or mismanagement, and has been touted by lawmakers as a key tool in keeping the department’s workforce accountable.

But the measure covers fewer than 500 VA employees, and it’s unclear whether any face a real threat to their jobs. Incoming VA Secretary Bob McDonald has promised to weed out problematic employees, but many midlevel and top department officials have already stepped aside over the last few months.

Meanwhile, VA leaders have said they’re reluctant or powerless to act on many fireable allegations related to recent scandals until after the VA Inspector General completes investigations into the wrongdoing.

De Planque said he’s focused less on the timeline for the new law’s provisions than the one already set out by McDonald.

In his confirmation hearing last month, the new secretary promised significant improvements within his first 90 days, a clock that started last week. These include quarterly video conferences with regional officials, a new physicians review board to evaluate health care delivery, expanding digital records and processing, and an open invitation to whistleblowers to help shape changes in operations.

“Right now, we’re in a period of less pressure but more watching,” de Planque said. “We want to see what can be done in those 90 days, and be ready to increase the pressure again if we don’t see changes.”

White House officials insist that McDonald has already started that culture change, through a series of messages to staffers about VA’s mission of helping vets. But they also acknowledged more needs to be done.

Augustine is urging his members to be patient, despite the recent controversies.

“Whether Congress is going to be as patient, we don’t know,” he said. “But we know the complexities and problems of this system. It’s going to take time to fix.”

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