Scandal at the VA

In the aftermath of the big scandal at the US Department of Veterans Affairs, Congress and the White House have responded with various changes to reform the nation’s publicly run health-care system for veterans.

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.

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.

The Obama administration appointed McDonald to the position in June. The White House’s pick underscored the management problems uncovered through the VA scandal — 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.

Update: To learn more about the final deal, read Vox’s full explainer.

After the massive scandal 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.

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.

The McDonald pick underscores the management problems uncovered through the VA scandal. Late Friday, the White House released a report 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.

A new White House report acknowledged serious systemic lapses within the nation’s health-care system for veterans.

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.”

Staff at the controversial Veterans Affairs hospital in Phoenix may have continued shady scheduling practices even after the VA scandal broke, according to a new report from CNN.

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 reported by CNN in April.

The US Department of Veterans Affairs has repeatedly classified serious shortfalls in its health-care system as harmless errors, a new report from the US Office of Special Counsel (OSC) found.

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.

In response to the Veterans Affairs scandal, 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.

“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.”

The troubled Veterans Affairs hospital in Phoenix paid out roughly $10 million in bonuses to employees as veterans allegedly died waiting for care, The Arizona Republic reports.

Nearly 4,200 bonuses were paid out over three years to more than 2,150 employees, according to records obtained by The Arizona Republic. The bonuses increased over time, as well: $2.5 million in 2011, $3.5 million in 2012, and $3.9 million in 2013.

A recently passed Senate bill could more than double how much the US Department of Veterans Affairs spends on heath care each year.

The analysis from the Committee for a Responsible Federal Budget suggests that providing VA-reimbursed private care to veterans, without setting budgetary caps and oversight, could explode the VA’s health-care budget with an additional $500 billion in spending over the next 10 years.

Moving with surprising speed, the Senate on Wednesday passed a bipartisan bill to address the VA scandal.

Part of the Senate bill allows veterans to access VA-reimbursed care at private hospitals and clinics through a two-year pilot program, instead of relying on VA-operated facilities. The idea is to reduce strain on the VA system by letting veterans access outside sources of care in a more timely manner.

An audit of all Veterans Affairs medical facilities around the country confirmed what we already knew: the VA’s scheduling issues are indeed systemic.

The results released Monday showed 13 percent of staffers across 76 percent of VA facilities were given instructions to schedule patients without regard to the patient’s desired date, which could indicate an attempt to falsify records. But the audit did not determine whether these activities were intentionally fraudulent behavior.

Cleveland Clinic CEO Delos ‘Toby’ Cosgrove will not become the new Secretary of Veterans Affairs, a role the White House asked him to consider last week.

“I am humbled and honored to have been considered for the opportunity to help Veterans across the United States. This is an enormous responsibility and one that deserved careful thought and consideration. As a physician, veteran, and hospital chief executive, I have great respect for the care provided to the Veteran community and for those who work to care for them,” Cosgrove said in a statement.

One major cause of the ongoing Veterans Affairs scandal: The amount of veterans using the VA’s health-care system has massively increased over the years.

Many more veterans use VA health care today

Since 2001, the number of veterans using the VA’s health-care system each year has increased by more than 2 million — a more than 34-percent increase.

The change is among a number of steps the agency is taking to address major causes of the the ongoing VA scandal. The agency also plans to continue medical audits and site inspections going forward.

The scheduling goal created a perverse incentive that was at the heart of the VA scandal. First, the VA asked local hospital administrators to schedule patients quickly, with the promise of financial bonuses if hospitals lived up to the 14-day goal. Then, when local administrators realized the goal was unrealistic, they began to manipulate and falsify the scheduling data so they could still get their financial bonuses. So far, the evidence indicates this is exactly what happened at the Phoenix VA hospital.

As Congress moves to fix America’s health-care system for military veterans, experts and advocates are lining up with their own ideas for improving access to Veterans Affairs hospitals and clinics.

Republicans in particular have latched on to privatizing the system so veterans can more easily get private care. Democrats and veteran advocates, on the other hand, have called for more funding.

The Obama administration is considering nominating Cleveland Clinic executive Toby Cosgrove to run the Department of Veterans Affairs, the Wall Street Journal reported late Tuesday.

Cosgrove is, according to U.S. News and World Report, is a Vietnam veteran. But he’s best known professionally for running one of the country’s largest and most successful health care systems. The Cleveland Clinic regularly hits top marks in health quality and safety rankings. It is an early adopter of some of the programs in Obamacare, that aim to pay doctors based on the quality of the care they provide rather than sheer volume.

Lawmakers and veteran advocates are pushing bills that would make it easier for Veterans Affairs leaders to fire employees. The bills, supporters argue, would make it easier to hold VA officials, particularly health-care executives, accountable for the ongoing VA scandal.

A review of federal workforce data suggests that the Veterans Health Administration already fires a bigger share of employees — at least those classified as general schedule, instead of executive positions — than other federal agencies.

Behind the Veterans Affair scandal is a fairly complicated health-care system for veterans.

The VA operates the Veterans Health Administration, the largest health-care system in the country. It has nearly 9 million enrollees, sees more than 6 million unique patients each year, and operates more than 150 hospitals with a discretionary budget of more than $64 billion.

A new Veterans Affairs audit shows a significant number of workers have tampered with patient wait times.

Thirteen percent of staff were instructed to schedule appointments without regard to a patient’s desired date, which could indicate an attempt to falsify records.

In announcing the resignation of Veterans Affairs Secretary Eric Shinseki, President Barack Obama suggested his administration was never aware of the VA’s massive scheduling problems, particularly those in Phoenix, Arizona.

“This issue of scheduling is one that the reporting systems inside of the [Veterans Health Administration] did not surface to the level where [Shinseki] was aware of it and we were able to see it,” Obama said. “This was not something that we were hearing when I was traveling around the country — the particular issue of scheduling.”

1. It’s good that VA Secretary Eric Shinseki resigned. Shinseki is a great American. But that doesn’t make him a great administrator. As Yuval Levin writes, the interim report of the VA inspector general uncovered “a pattern of exceptionally widespread, systematic, and even criminal deception throughout an agency Shinseki oversees.”

2. President Obama’s reluctance in accepting Shinseki’s resignation speaks to deep problems in the way this White House views its managers. “I think he is deeply disappointed in the fact that bad news did not get to him, and that the structures weren’t in place for him to identify this problem quickly and fix it,” Obama said. But it’s the boss’ job to build the structures that make sure problems are surfaced and can be fixed. Shinseki wasn’t wronged. He failed.

The best-intentioned health care policies don’t always lead to the best outcomes for patients.

This is one problem at the core of the Veterans Affairs’ scandal: administrators received financial bonuses keeping wait times short. The aim of those bonuses was to incentivize good behavior: If there’s money to be made in getting patients seen quickly, the reasoning goes, then hospitals will focus on reducing wait times.

Veterans Affairs Secretary Eric Shinseki will resign in the midst of an ongoing scandal over health care wait times, President Barack Obama announced Friday.

“A few minutes ago Secretary Shinseki offered me his own resignation,” Obama said in a press conference. “With considerable regret, I accepted.”

The call for cabinet officers’ heads to roll in response to bad news is a predictable and often wearying Washington tradition. Generally, serious problems are far deeper and more complicated than the actions or inactions of any one leader. And watching the din of posturing around the VA health care scandal it’s easy to tune out ands fall back on basic partisan assumptions.

But while it’s clearly true that the biggest sins committed here came from deep within the bureaucracy rather than the top of the Obama administration, wrongdoing by high officials really does seem relevant in this case. Veterans Affairs Secretary Eric Shinseki was right to step down. But it’s unfortunate that Obama framed this as something he did reluctantly in order to help quell a political controversy.