A new comprehensive report on Veterans Affairs Department health care calls for a complete overhaul of the system, noting that without change, the department's problems will continue and veterans will be denied the treatment they deserve.

The assessment, out of an independent review mandated last year by Congress, found a system plagued by bureaucracy and leadership challenges that is following an "unsustainable trajectory of capital costs."

It also affirms what many veterans have long maintained — that the VA medical system is difficult to navigate and the quality of care can vary significantly depending on where former troops get their treatment.

"As the assessment reports reveal, the number of issues the Veterans Health Administration currently faces appears overwhelming," according to the report. "In its current state, VHA is not well positioned to succeed in the transformation this analysis suggests."

The review also found a significant leadership crisis within VA as well as staffing shortages, a demoralized workforce, inconsistent care throughout and a system that needs to realign its footprint to serve veterans where they live.

The assessors, led by Mitre Corp. and including analysts from the Rand Corp., McKinsey and Company, the Institute of Medicine and Grant Thorton, examined 12 segments of VA health care, including access to care, staffing, workflow, capabilities, business practices and more.

Analysts found that VA did well in some areas, such as performance metrics against private health care systems, but failed in others, such as budgeting, accountability, management practices and oversight of its private care programs.

The report, dated Sept. 1, made recommendations to implement what analysts said is a needed "system-wide transformation."

Its recommendations for VA include cultivating a culture of service excellence among employees;, holding employees accountable;, instituting systemwide changes in administration, support and services;, fostering respect through performance; and creating an office to oversee and implement change, with the fortitude to request funding to accomplish its goals.

The VA, analysts said, could be a "world class health system" if it undergoes complete system change.

Lawmakers charged with congressional oversight of the department said the report confirms what they have long sought to prove — that issues at VA medical centers and clinics are not confined to certain individual facilities but rather are "deep-seated and systemic."

House VA Chairman Rep. Jeff Miller, R-Fla., and Senate VA Chairman Sen. Johnny Isakson, R-Ga., released a joint statement Friday saying VA could no longer deny it has problems.

"From delays in care and scandal cover-ups, to rampant unaccountability and a lack of leadership, the VA is an organization challenged at every level," the two lawmakers wrote.

But VA officials said they largely are aware of the problems revealed in the more than 4,000 pages of assessments and are actively pursuing a transformation, which the department calls "MyVA."

The report's findings are "fully consistent with the lessons the department has learned and worked to improve upon since the arrival of Secretary Bob McDonald," according to a VA statement. "VA is undergoing a radical transformation. ... VA will work with Congress, veterans service organizations, veterans, and other stakeholders on the recommendations outlined in the independent assessment final report."

The review does hold some good news for VA: It found that on many quality measures for outpatient care, VA outperformed other health care systems, although quality measures for inpatient care were mixed.

VA hospitals also performed the same or significantly better than non-VA hospitals on some effective measures, such as inpatient mortality measures, but significantly worse on other measures like readmission standards.

The autonomy that the VA grants to its medical centers and regional offices to test and pilot new processes, management approaches and technologies also is laudable, assessors wrote.

But they added that much more must be done to ensure VA can meet the needs of future veterans. "In its current state, VHA is not well positioned to succeed in such a transformation," the panel warned.

The independent assessment comes as debate continues over whether VA should outsource or privatize veterans care.

A conservative advocacy group, Concerned Veterans For America, published a plan earlier this year calling for a complete overhaul of VHA, to include partially privatizing services. Under that plan, VA medical facilities would be reorganized under a nonprofit governmental organization and more veterans would be shifted to private health insurance programs.

Pete Hegseth, CVA's chief executive officer, said Friday that the assessment "provides bullet-proof, professional and independent evidence that we need real reform at the VA, not just the changes at the margins that the current VA leadership has proposed through 'MyVA.'

"This report is yet another indictment of the VHA's current inability to deliver timely, quality health care to our nation's veterans, and calls for nothing less than a 'system-wide reworking' of the VHA," Hegseth continued. "In addition, it directly contradicts the VA's assertion that the majority of patients are satisfied with the care they receive."

VA Secretary Bob McDonald has denounced calls to increase privatization of services and says the VA mission to care for veterans is a "sacred trust" that the department will not relinquish.

Addressing a group of injured personnel and their family members Sept. 9 at a forum in Washington, D.C., McDonald noted that VA not only provides medical care for veterans, but also has trained a significant portion of the nation's doctors and funds research for illnesses and injuries unique to service members, which he said the private, for-profit system would not be keen to take on.

"The VA is absolutely essential," McDonald said. "What would you do without the VA?"

Patricia Kime is a senior writer covering military and veterans health care, medicine and personnel issues.

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