Monday, September 23, 2013

Time for a VA Makeover: Part 2


We thought these concepts worthy four and a half years ago, and believe them even more worthy today.  Ultimately, they will lead to reduced costs in the operations of the Department of Veterans Affairs.

We believe a wholesale change in the training and personnel administration of employees of the Department of Veterans Affairs is what is called for.  And of course, the training and administration of the Veterans Service Officers from the Veterans Service Organizations is seriously in need of being revamped. 
Here is what we propose:
NVLSP Involvement
We would like to see the National Veterans Legal Services Program [NVLSP], an organization that already trains people in the Department of Veterans Affairs Claims system, in conjunction with input from the Department of Veterans Affairs and the various Veterans Service Organizations, develop a classroom training program for employees of the Department of Veterans Affairs and Veterans Service Officers from the Veterans Service Organizations [American Legion, VFW, AMVETS, DAV, Veterans of Modern Warfare, FRA, VVA, and so on.] This warrants a grant from Congress to fund the NVLSP's effort and a warrant from the same authorizing legislation that allows the NVLSP to be the final arbiter in any issues raised by either the Department of Veterans Affairs or the Veterans Service Officers.
The NVLSP would also be responsible for training the training staff comprised of Department of Veterans Affairs Instructors, and Veterans Service Officers from the various Veterans Service Organizations. Trainers would be licensed Veterans Claims Officers and Veterans Claims Training Officers, and would participate in training classes as instructors in various regional locations across the Country. Expenses for the Veterans Service Officers would be funded by their Veterans Service Organizations, but wages for training classes will be paid from the Department of Veterans Affairs Budget – the better trained the Veteran Service Officer is, the more likely a fully developed claim will be filed]. The classes where trainers are trained will lead to Trainer's Licenses. The training of Veterans Service Officers and Department of Veterans Affairs Claim Processors will result in Professional Licensure, required to serve in either capacity. Refresher training shall be required every five years in order to renew the license.
The Program
The training program puts the Veterans Service Officers into the same classrooms at the same time as the Claims Processing Personnel from the Department of Veterans Affairs are trained. That way, every claim processor, and every Veterans Service Officer is on the same page when handling claims. Further, some portion of each training class will be required by all administrative staff. The Secretary and the Undersecretaries and Assistant Secretaries should also be required to complete the same training course as the Veterans Service Officers and the Claims processors in order that all shall know what is required of the Veterans to complete a valid claim for benefits. The medical staff personnel employed in any medical or administrative capacity shall be required to attend the classes so they may also see what the Veteran must go through before they even get to the Doctors and Nurses, and medical administrative staff. Finally, legal staff should also participate in the training program to see first-hand the fruits of their labors. Finally, attorneys and paralegals that work with Veterans Claims and as Veterans Advocates may take the training also, and should be licensed as a requirement to represent a Veterans as well, but at their own expense, at a rate to be determined by the National Veterans Legal Services Program. Their expenses incidental to the training should be at their own expense, including the cost of the training, as they earn money from what they do.
The Details
The course will be covered over a two week period, with classes lasting 6 hours each day, with a half hour break at mid-morning and again at mid-afternoon, and an hour for lunch. The last hour of every day is spent in review exams, review and Q&A sessions. The classroom work ends at the end of a full day of review and preparation for the final exam on the second Thursday. The final exam is on Friday. The Practical Exam, where test claims are filed by the instructors, to be processed by the students on Tuesday and Wednesday.
Successful completion of the course is required for licensure. Course failure will result in the individual waiting until a review course is available, a 7 day, shortened version with the first five days the same as the full course. A second failure will result in termination from the Veterans Service Officer program for Veterans Service Officers, or from Claims Processing positions for Department of Veterans Affairs Claims Processing Officers. The Department of Veterans Affairs may provide alternate employment for those refused licensure, but at no time may that employee ever become a part of the claims process system at any level.
Advancement of these licensed personnel shall be based not just on seniority, but an acceptable level of claim reversals on appeal, or by supervisory personnel, and a satisfactory claim completion rate.

It is highly recommended that all Claims Processing Officers, trainers, supervisors and managers be Veterans of the United States Military.
The Kelley Principle
The indomitable Charles Kelley of the website 2nd Battalion, 94th Artillery, is a strong and dedicated advocate for change in the Department of Veterans Affairs. He emphasizes, among other things, a standardization of ratings, and a common sense/logical approach to claims. If, he posits, a claimant has a head injury and the claim processor approves the claim for 50%, then identical cases of head injuries should automatically be approved for 50%, and after that, if any variations are warranted, a deeper examination of the claim may be in order, to make revisions in the rating, or not. We think it appropriate to call this system of establishing case precedents, the "Kelley Principle".
This, in its simplicity is a major key to reducing any backlog in claims processing. We have embraced his concept from the start, and see it applied here as part of the training.
We believe the claims process should go through a number of steps.
·  Step One: Examine the claim for eligibility based on military record and search for possible service connection.

·  Step Two: Validate Service Connection and select the portion of a claim liable to generate the highest rating. Apply the "Kelley Principle" to Department of Veterans Affairs System records of precedents and if applicable, assign a temporary rating and approve the claim, so payments begin and medical coverage is authorized in the shortest time possible.

·  Step Three: Examine and validate the claim for variations in the initial rating based on Compensation and Pension examinations by Department of Veterans Affairs Medical Staff, adjust accordingly. Increase the rating of the claim based on other and/or secondary conditions as precedents warrant, again checking the Department of Veterans Affairs System for "Kelley Principle" precedents. Adjust the rating accordingly and approve or deny as the claim warrants.

All of the above is subject to review by supervisory staff at each level. Each step is handled by an increasingly senior claim's processor.

Positive Results 2
We think the adoption of this policy, should Congress embrace it, is a common sense no-brainer. It effectively addresses the regional variations in claim ratings and denials, and provides a clear structure to the claims process. It additionally places everyone in the claim process system except the Veteran into a standardized training and operating system that would provide the same results for identical claims at any Regional Office in the Country. It would simplify the claims process, and eliminate the backlog. It would be an efficient method of serving the Veterans of this Nation.

Note: The above is an expanded, revised, and edited version of:


VNVets

”It is a stain on this nation's honor that the Department of Veterans Affairs has become a deadlier and more difficult adversary to the American veteran than any they have ever faced on a battlefield."-- VNVets

"The concept that Agent Orange, and its effects, stopped dead in its tracks at the shoreline is simply too illogical, and too ludicrous to accept. What does that say about the Obama Administration and his Department of Veterans Affairs?"--VNVets

"With malice toward none; with charity for all; with firmness in the right, as God gives us to see the right, let us strive on to finish the work we are in; to bind up the nation's wounds; to care for him who shall have borne the battle, and for his widow, and his orphan--to do all which may achieve and cherish a just and lasting peace, among ourselves, and with all nations." --President Abraham Lincoln

"It follows then as certain as that night succeeds the day, that without a decisive naval force we can do nothing definitive, and with it, everything honorable and glorious."--President George Washington

Copyright © 2005-2013: VNVets Blog -- Now in our Ninth Year of Service to Veterans; All Rights Reserved. Reprinting or copying of the contents of this blog without the express permission of the author is unlawful.

Saturday, September 21, 2013

Time for a VA Makeover - Part 1

Four and a half years ago we published a pair of posts about restructuring the VA.  In light of recent media revelations of the exorbitant bonuses given to non-performing managers and higher ups in the VA [finally!], perhaps it is time to revisit the VA restructuring.  

We started back then with the following: 

Congress's hands are not clean over the Blue Water Navy issue. They have consistantly passed budgets over the years while the DVA takes appropriations away from Veterans to build new facilities. We refer mainly to costly 'Rural VA Health Centers'.

Consider:


  • The DVA had to have money appropriated in its budget to acquire the land for these centers.

  • Then they had to have money appropriated to construct them.

  • Then they had to have money to staff them.

  • Now they have to have money to keep them running.

  • This is a very costly program.

    Consider the alternatives, however. Not having them forces the Veterans to travel very long distances to receive diagnosis and treatment for any conditions thay have or develop. They have to travel to VA Hospitals...

    OR,

    ...Congress could authorize the issuance of a Veterans Health Care Card, with coverage levels based on DVA Categories of eligibility, and with a payment schedule identical to the one Social Security uses for Medicare. There would be no deductibles or copays for full coverage. The Veterans would use the card at any and all medical facilities they choose, and the medical provider would be barred by law from billing the Veteran for any difference in fees and costs. Prescription coverage would be the same as they have with the DVA, based on categories of eligibility.

    The DVA could then sell those costly Rural Health Centers, applying any moneys realized to the next year's infrastructure maintenance budget to repair and modernize any DVA Hospitals to begin to switch their primary role to that of long term care. Staff reductions will further reduce the budget.

    What could be the advantage of this system?

    Politically, the Democrats will embrace it because it is a step closer to universal health care. The Republicans will embrace it because it shrinks government [hundreds of administrative clerks are far cheaper to pay for than thousands of administrators, doctors, nurses, pharmacists and therapists].

    Medical professionals will embrace it because it does not force many of them to take any experience and training they garnered while serving in the Armed Forces and work within the DVA healthcare system. They can work where they want, and their expertise will be spread throughout the nation and be available to all, not just Veterans.

    Veterans should embrace this plan since it allows them to go to their family doctor for treatment, and their local hospital for emergency and long term services.

    This would reduce instances where Veterans go to DVA Hospitals in an emergency only to find they have no Emergency Room, or to be turned away because of a snafu, or by an under-trained staffer who just doesn't care, forcing the Veteran to seek emergency care at a local facility that is NOT DVA, and then be forced to pay the bill.

    Chances are, the Veterans contemplating suicide will receive better judgement on examination in Emergency Rooms of civililan facilities and not be turned away. They would likely receive better care after admission as well.

    Mostly, though, this would eliminate many of the "cracks" that Veterans fall though in their health care system. Quality of care varies greatly from DVA Medical Facility to Facility, making treatment a hit or miss reality for the Veteran. Many of the staff at DVA facilities are simply overburdened, and have become callous to their patients.

    [New edit: Of course, Congress would need to pass a law setting the Medicare rates as the maximum civilian medical facilities can charge for a procedure, test, or treatment, and making it illegal for the Veteran, or the government, to be charged any amount over that standard.] 

    Positive Results

    Let's get the DVA out of the business of being the ones who treat all of our Veterans and into long term care only, and whatever period of time a wounded warrior needs to transition from the active Military to Veteran status and be ready to go out into the civilian world.

    Finally, by freeing up money in the DVA Budget by stopping the acquisition, construction, staffing and running of DVA Rural Health Centers, and divesting itself of them using the above concept, perhaps the DVA could spend more money, time and effort in paying the benefits to Veterans that they fight so hard to deny. It is time to zero in on the DVA and force massive changes in its thinking, and operations. This is one step, and it starts with Congress.

     

    Time to Start Restructuring the DVA


    Perhaps it is time.

    We would advocate the following, as well:

    Do away with bonuses.  

    Instill in the claims department that their first priority is to the Veteran, not the taxpayer.  It is NOT the VA's job to save the taxpayer money.  Indeed, they try when processing claims and yet somehow none of that money is ever returned to the US Treasury.  Let's make sure it goes to the Veterans, not management bonuses.  

    More to follow!

    VNVets

    ”It is a stain on this nation's honor that the Department of Veterans Affairs has become a deadlier and more difficult adversary to the American veteran than any they have ever faced on a battlefield."-- VNVets

    "The concept that Agent Orange, and its effects, stopped dead in its tracks at the shoreline is simply too illogical, and too ludicrous to accept. What does that say about the Obama Administration and his Department of Veterans Affairs?"--VNVets

    "With malice toward none; with charity for all; with firmness in the right, as God gives us to see the right, let us strive on to finish the work we are in; to bind up the nation's wounds; to care for him who shall have borne the battle, and for his widow, and his orphan--to do all which may achieve and cherish a just and lasting peace, among ourselves, and with all nations." --President Abraham Lincoln

    "It follows then as certain as that night succeeds the day, that without a decisive naval force we can do nothing definitive, and with it, everything honorable and glorious."--President George Washington

    Copyright © 2005-2013: VNVets Blog -- Now in our Ninth Year of Service to Veterans; All Rights Reserved. Reprinting or copying of the contents of this blog without the express permission of the author is unlawful.

    Friday, September 13, 2013

    Update on Legislation Efforts


    Recent events regarding the effort to pass HR 543 need to be noted by you. 

    First, in his testimony before the Senate Committee on Veterans Affairs on September 10, 2013, National Commander of the American Legion made the following remarks: 
    “Agent Orange remains a concern, as thousands of veterans exposed to the toxin are left behind when it comes to vital treatment and benefits. The American Legion remains committed to ensuring that all veterans who served in areas of exposure receive recognition and treatment for conditions linked to Agent Orange. Time is running out for those veterans not designated as having “boots on the ground” during the Vietnam War. Studies indicate that “blue water navy” veterans may have experienced higher exposure rates to Agent Orange than those who were on the ground, due to water-desalination systems on the ships; this has never been satisfactorily addressed by VA.
    “The time is now to recognize all Vietnam veterans for their exposure to Agent Orange, not just those veterans who had boots on the ground.”

    Indeed, it is long past due.   The involvement in the Vietnam War began for the US 49 years ago last month with the Tonkin Gulf Incident. 

    We think a half century of obfuscation, denial, and delay on the part of both Congress and the VA is more than abysmal, it approaches criminal malfeasance.  But Veterans Service Organizations like the American Legion, and the VVA, FRA, and others are keeping our issue before Congress.  For that, we owe them a debt of gratitude. 

    In other news, some of our readers are to be congratulated for accomplishing the following additions to the list of members of the US House of Representatives to the list who have signed on to cosponsor HR 543:

    H.R. 543: Blue Water Navy Vietnam Veterans Act of 2013

    Sep 12, 2013 — New Cosponsor
    Sep 11, 2013 — New Cosponsors
    New Cosponsor: Rep. Dina Titus [D-NV1]

    Our thanks go out to those who worked to get these Representatives on board. 

    Keep up the pressure!

    VNVets

    ”It is a stain on this nation's honor that the Department of Veterans Affairs has become a deadlier and more difficult adversary to the American veteran than any they have ever faced on a battlefield."-- VNVets

    "The concept that Agent Orange, and its effects, stopped dead in its tracks at the shoreline is simply too illogical, and too ludicrous to accept. What does that say about the Obama Administration and his Department of Veterans Affairs?"--VNVets

    "With malice toward none; with charity for all; with firmness in the right, as God gives us to see the right, let us strive on to finish the work we are in; to bind up the nation's wounds; to care for him who shall have borne the battle, and for his widow, and his orphan--to do all which may achieve and cherish a just and lasting peace, among ourselves, and with all nations." --President Abraham Lincoln

    "It follows then as certain as that night succeeds the day, that without a decisive naval force we can do nothing definitive, and with it, everything honorable and glorious."--President George Washington

    Copyright © 2005-2013: VNVets Blog -- Now in our Ninth Year of Service to Veterans; All Rights Reserved. Reprinting or copying of the contents of this blog without the express permission of the author is unlawful.