Many Commission on Care Recommendations Receive Support

Even with the clock ticking on the current election year, President Barak Obama and Congress appear ready to begin implementing at least some of the Commission on Care recommendations. In Senate and House of Representatives committee meetings over the past 2 weeks, a consensus has emerged to implement most of the Commission’s 18 recommendations. Still, most action is expected to take place after the November election, which will change who is in the White House and also could affect leadership within the VA as well as the House and Senate veteran oversight committees.

Currently 22% of veteran appointments are in community settings and the VA has already seen 5 million appointments through the Veterans Choice Program. Still, as VA Secretary Robert A. McDonald told the Senate committee on Wednesday, just 5,000 veterans are using community care only, which McDonald argued was evidence of veterans' strong desire to continue receiving VA care. The Veterans Choice Program is currently scheduled to expire August 7, 2017.  

“I strongly support the Commission's principle that creating a high-performing, integrated health care system that encompasses both VA and private care is critical to serving the needs of veterans,” President Obama said in a letter to the House Committee on Veterans Affairs. “It is critical that we preserve and continue to improve the VA health care system and ensure that VA has the ability to serve veterans.” The President also emphasized the importance of preserving the high quality of VA care, noting, “VA also provides unique, highly specialized care for many medical conditions, such as spinal cord and traumatic brain injuries, which are simply not available to the same extent outside of VA.”

“In our view that VHA must change, and change profoundly, because veterans deserve a better organized, high-performing health care system,” Nancy Schlichting, Commission on Care chairperson told the House committee. “Certainly, some elements of such a high-performing system are already in place. VA has high-quality clinical staff, and this integrated health care system is marked by good care-coordination. VHA today, however, relies significantly on community providers to augment the care it provides directly, although those community partners are not part of a cohesive system.”

According to Schlichting, fixing access issues “cannot be achieved by ‘tweaking’ existing programs or mounting a complex new delivery framework on a weak infrastructure platform.” Instead, the Commission recommended the creation of integrated systems approach to the VA that would re-engineer VA’s fundamental internal systems, both in terms of how it delivers health care as well as the technology it uses.

Veteran service organizations weighed in with cautious approval of many of the Commission’s recommendations, especially those that improved oversight, governance, and access to care, but cautioned against privatizing the VA.

“After two years of spirited and passionate debate about the future of veterans health care, we envision a clear path forward that builds on the strengths of the existing VA system, while expanding access by seamlessly integrating the best of community care to ensure no veteran must travel too far or wait too long for care,” Joy J. Ilem, national legislative director of Disabled American Veterans wrote in a letter submitted to the House committee. “Congress and VA must now begin the steps to finalize plans and move forward with the evolution of veterans health care.”

Despite the emerging consensus, a number of voices expressed concern about the impact of the Commission on Care’s proposals changes. A group of unions and professional organizations that represent VA employees (Association of VA Psychologist Leaders, Association of VA Social Workers, Nurses Organization of Veterans Affairs, Veterans Affairs Physician Assistant Association, American Federation of Government Employees, National Federation of Federal Employees, National Association of Government Employees, National Nurses United, the American Psychological Association, and National Association of Social Workers) expressed its concerns in a letter submitted to the House panel. “As organizations comprised of and representing health care practitioners, researchers, educators, administrators and personnel devoted to serving veterans, we have serious reservations about the report’s major recommendation to replace the current VHA with a new entity, to be known as the VHA Care System.” The letter argues that the proposed VHA Care System “disassembles one of the most effective, innovative features of current VHA care—the Primary Care/Mental Health Integration approach.”

In his Senate testimony, Secretary McDonald also expressed concern with the potential cost of some of the Commission on Care proposals. Currently the VA is spending  $13.5 billion in community care. According to McDonald, the VA would need $17 billion to make the upgrades it outlined in its October Plan to Consolidate Community Care, but he warned “the Commission on Care plan would be much more expensive than that.” More importantly, McDonald insisted, the VA should retain primary responsibility for the care of veterans. "We believe the VA needs to be the care coordinator," he insisted.

Another concern echoed by many of the commenters was the proposal to create an oversight board to provide governance, set long-term strategy, and direct and oversee reform. According to its critics, the proposal not only would undermine the authority of VA leadership, but could reduce congressional oversight as well. “NOVA strongly opposes giving an outside board—made up of civilian health care executives who may have never set foot into a VA facility—the authority to make decisions about the care and services provided America’s veterans,” argued Sharon Johnson, MSN, RN, president of the Nurses Organization of Veteran Affairs.

Mark Takata (D-Calif.) the ranking minority member of the House committee also expressed concern that the changes could impact VA clinicians’ access to high quality research, and clinician training. “The Commission on Care recommendations might in fact weaken the VA health care system,” Takata argued. “Proposals to funnels funding to private contractors and for profit care will take desperately needed resources away from our veterans and should be immediately rejected.... We cannot view expanded choice or the private sector as the panacea for solving the challenges the VA faces.”

Even with the clock ticking on the current election year, President Barak Obama and Congress appear ready to begin implementing at least some of the Commission on Care recommendations. In Senate and House of Representatives committee meetings over the past 2 weeks, a consensus has emerged to implement most of the Commission’s 18 recommendations. Still, most action is expected to take place after the November election, which will change who is in the White House and also could affect leadership within the VA as well as the House and Senate veteran oversight committees.

Currently 22% of veteran appointments are in community settings and the VA has already seen 5 million appointments through the Veterans Choice Program. Still, as VA Secretary Robert A. McDonald told the Senate committee on Wednesday, just 5,000 veterans are using community care only, which McDonald argued was evidence of veterans' strong desire to continue receiving VA care. The Veterans Choice Program is currently scheduled to expire August 7, 2017.  

“I strongly support the Commission's principle that creating a high-performing, integrated health care system that encompasses both VA and private care is critical to serving the needs of veterans,” President Obama said in a letter to the House Committee on Veterans Affairs. “It is critical that we preserve and continue to improve the VA health care system and ensure that VA has the ability to serve veterans.” The President also emphasized the importance of preserving the high quality of VA care, noting, “VA also provides unique, highly specialized care for many medical conditions, such as spinal cord and traumatic brain injuries, which are simply not available to the same extent outside of VA.”

“In our view that VHA must change, and change profoundly, because veterans deserve a better organized, high-performing health care system,” Nancy Schlichting, Commission on Care chairperson told the House committee. “Certainly, some elements of such a high-performing system are already in place. VA has high-quality clinical staff, and this integrated health care system is marked by good care-coordination. VHA today, however, relies significantly on community providers to augment the care it provides directly, although those community partners are not part of a cohesive system.”

According to Schlichting, fixing access issues “cannot be achieved by ‘tweaking’ existing programs or mounting a complex new delivery framework on a weak infrastructure platform.” Instead, the Commission recommended the creation of integrated systems approach to the VA that would re-engineer VA’s fundamental internal systems, both in terms of how it delivers health care as well as the technology it uses.

Veteran service organizations weighed in with cautious approval of many of the Commission’s recommendations, especially those that improved oversight, governance, and access to care, but cautioned against privatizing the VA.

“After two years of spirited and passionate debate about the future of veterans health care, we envision a clear path forward that builds on the strengths of the existing VA system, while expanding access by seamlessly integrating the best of community care to ensure no veteran must travel too far or wait too long for care,” Joy J. Ilem, national legislative director of Disabled American Veterans wrote in a letter submitted to the House committee. “Congress and VA must now begin the steps to finalize plans and move forward with the evolution of veterans health care.”

Despite the emerging consensus, a number of voices expressed concern about the impact of the Commission on Care’s proposals changes. A group of unions and professional organizations that represent VA employees (Association of VA Psychologist Leaders, Association of VA Social Workers, Nurses Organization of Veterans Affairs, Veterans Affairs Physician Assistant Association, American Federation of Government Employees, National Federation of Federal Employees, National Association of Government Employees, National Nurses United, the American Psychological Association, and National Association of Social Workers) expressed its concerns in a letter submitted to the House panel. “As organizations comprised of and representing health care practitioners, researchers, educators, administrators and personnel devoted to serving veterans, we have serious reservations about the report’s major recommendation to replace the current VHA with a new entity, to be known as the VHA Care System.” The letter argues that the proposed VHA Care System “disassembles one of the most effective, innovative features of current VHA care—the Primary Care/Mental Health Integration approach.”

In his Senate testimony, Secretary McDonald also expressed concern with the potential cost of some of the Commission on Care proposals. Currently the VA is spending  $13.5 billion in community care. According to McDonald, the VA would need $17 billion to make the upgrades it outlined in its October Plan to Consolidate Community Care, but he warned “the Commission on Care plan would be much more expensive than that.” More importantly, McDonald insisted, the VA should retain primary responsibility for the care of veterans. "We believe the VA needs to be the care coordinator," he insisted.

Another concern echoed by many of the commenters was the proposal to create an oversight board to provide governance, set long-term strategy, and direct and oversee reform. According to its critics, the proposal not only would undermine the authority of VA leadership, but could reduce congressional oversight as well. “NOVA strongly opposes giving an outside board—made up of civilian health care executives who may have never set foot into a VA facility—the authority to make decisions about the care and services provided America’s veterans,” argued Sharon Johnson, MSN, RN, president of the Nurses Organization of Veteran Affairs.

Mark Takata (D-Calif.) the ranking minority member of the House committee also expressed concern that the changes could impact VA clinicians’ access to high quality research, and clinician training. “The Commission on Care recommendations might in fact weaken the VA health care system,” Takata argued. “Proposals to funnels funding to private contractors and for profit care will take desperately needed resources away from our veterans and should be immediately rejected.... We cannot view expanded choice or the private sector as the panacea for solving the challenges the VA faces.”

Even with the clock ticking on the current election year, President Barak Obama and Congress appear ready to begin implementing at least some of the Commission on Care recommendations. In Senate and House of Representatives committee meetings over the past 2 weeks, a consensus has emerged to implement most of the Commission’s 18 recommendations. Still, most action is expected to take place after the November election, which will change who is in the White House and also could affect leadership within the VA as well as the House and Senate veteran oversight committees.

Currently 22% of veteran appointments are in community settings and the VA has already seen 5 million appointments through the Veterans Choice Program. Still, as VA Secretary Robert A. McDonald told the Senate committee on Wednesday, just 5,000 veterans are using community care only, which McDonald argued was evidence of veterans' strong desire to continue receiving VA care. The Veterans Choice Program is currently scheduled to expire August 7, 2017.  

“I strongly support the Commission's principle that creating a high-performing, integrated health care system that encompasses both VA and private care is critical to serving the needs of veterans,” President Obama said in a letter to the House Committee on Veterans Affairs. “It is critical that we preserve and continue to improve the VA health care system and ensure that VA has the ability to serve veterans.” The President also emphasized the importance of preserving the high quality of VA care, noting, “VA also provides unique, highly specialized care for many medical conditions, such as spinal cord and traumatic brain injuries, which are simply not available to the same extent outside of VA.”

“In our view that VHA must change, and change profoundly, because veterans deserve a better organized, high-performing health care system,” Nancy Schlichting, Commission on Care chairperson told the House committee. “Certainly, some elements of such a high-performing system are already in place. VA has high-quality clinical staff, and this integrated health care system is marked by good care-coordination. VHA today, however, relies significantly on community providers to augment the care it provides directly, although those community partners are not part of a cohesive system.”

According to Schlichting, fixing access issues “cannot be achieved by ‘tweaking’ existing programs or mounting a complex new delivery framework on a weak infrastructure platform.” Instead, the Commission recommended the creation of integrated systems approach to the VA that would re-engineer VA’s fundamental internal systems, both in terms of how it delivers health care as well as the technology it uses.

Veteran service organizations weighed in with cautious approval of many of the Commission’s recommendations, especially those that improved oversight, governance, and access to care, but cautioned against privatizing the VA.

“After two years of spirited and passionate debate about the future of veterans health care, we envision a clear path forward that builds on the strengths of the existing VA system, while expanding access by seamlessly integrating the best of community care to ensure no veteran must travel too far or wait too long for care,” Joy J. Ilem, national legislative director of Disabled American Veterans wrote in a letter submitted to the House committee. “Congress and VA must now begin the steps to finalize plans and move forward with the evolution of veterans health care.”

Despite the emerging consensus, a number of voices expressed concern about the impact of the Commission on Care’s proposals changes. A group of unions and professional organizations that represent VA employees (Association of VA Psychologist Leaders, Association of VA Social Workers, Nurses Organization of Veterans Affairs, Veterans Affairs Physician Assistant Association, American Federation of Government Employees, National Federation of Federal Employees, National Association of Government Employees, National Nurses United, the American Psychological Association, and National Association of Social Workers) expressed its concerns in a letter submitted to the House panel. “As organizations comprised of and representing health care practitioners, researchers, educators, administrators and personnel devoted to serving veterans, we have serious reservations about the report’s major recommendation to replace the current VHA with a new entity, to be known as the VHA Care System.” The letter argues that the proposed VHA Care System “disassembles one of the most effective, innovative features of current VHA care—the Primary Care/Mental Health Integration approach.”

In his Senate testimony, Secretary McDonald also expressed concern with the potential cost of some of the Commission on Care proposals. Currently the VA is spending  $13.5 billion in community care. According to McDonald, the VA would need $17 billion to make the upgrades it outlined in its October Plan to Consolidate Community Care, but he warned “the Commission on Care plan would be much more expensive than that.” More importantly, McDonald insisted, the VA should retain primary responsibility for the care of veterans. "We believe the VA needs to be the care coordinator," he insisted.

Another concern echoed by many of the commenters was the proposal to create an oversight board to provide governance, set long-term strategy, and direct and oversee reform. According to its critics, the proposal not only would undermine the authority of VA leadership, but could reduce congressional oversight as well. “NOVA strongly opposes giving an outside board—made up of civilian health care executives who may have never set foot into a VA facility—the authority to make decisions about the care and services provided America’s veterans,” argued Sharon Johnson, MSN, RN, president of the Nurses Organization of Veteran Affairs.

Mark Takata (D-Calif.) the ranking minority member of the House committee also expressed concern that the changes could impact VA clinicians’ access to high quality research, and clinician training. “The Commission on Care recommendations might in fact weaken the VA health care system,” Takata argued. “Proposals to funnels funding to private contractors and for profit care will take desperately needed resources away from our veterans and should be immediately rejected.... We cannot view expanded choice or the private sector as the panacea for solving the challenges the VA faces.”