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September/October Issue

red star bulletThe Veteran Departments : Featured Stories / Letters / President's Message / VVAF Report / Government Relations / Ask The Parliamentarian / Veterans Benefits Update / Membership Affairs Committee Report / Legislators View / ETABO Committee Report / PTSD Substance Abuse Comittee Report / TAPS / Region 7 Report / AVVA Report / SHAD/Project 112 Task Force Report / Veterans Against Drugs Task Force Report / VetsConnect Report / Homeless Veterans Task Force Report / Women Veterans Committee Report / Arts of War / Book Review / Membership Notes / Chapter of The Year / Locator / Reunions

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May/June 2006
GOVERNMENT RELATIONS

BY JOHN MITERKO, CHAIR, VVA GOVERNMENT AFFAIRS COMMITTEE, WITH VVA GOVERNMENT RELATIONS STAFF

You can count on the VA to give some initiative an uplifting name and wax poetic about its advantages—all the while attempting to conceal what it’s really about. Such is the case with Project HERO.

This misbegotten endeavor had its origins, no doubt, on the tenth floor of 810 Vermont Avenue, N.W., the VA’s Central Office. In its zeal to privatize as much of government as it can, those who “lead” our nation seem to want to undo many of the achievements of past administrations.

Certain initiatives make sense. It used to be that all medical materiel needed by the military were stored at supply depots. Now, strategically located Defense Supply Centers of the Directorate of Medical Materiel contract out for supplies as they are needed. This makes for sound policy and efficient delivery of needed services.
Other initiatives don’t make sense. Like Project HERO. Under the guise of providing rural veterans with quality health care, this scheme appears to be the opening salvo that may well lead to the dismantling of the VA health care system.

VVA has made its objections to this misconceived venture crystal clear. In a letter
to VA Secretary Nicholson on August 15, VVA National President John Rowan expressed “strong opposition” and requested “that you rescind the [Request for Proposal] as written in order to review current contracting and managerial operation with veterans’ service organization involvement.”

Rowan went on: “The draft RFP has nothing to do with what we have been told or with clear congressional intent, which did not include all medical aspects of care at the VHA. The current RFP [goes] far beyond the intent of Congress and would create a ‘fire sale’ of veterans healthcare to the highest bidder, when there is absolutely no legal or practical justification to take this precipitous action.”
On the face of it, Project HERO sounds fine. You live far away from a VA medical center. You have heart trouble. Or you’re battling cancer. Or the demons from your tour in I Corps are haunting you anew. Instead of having to travel to a VA medical center or outpatient clinic and having to wait in those lines, Project HERO will give you the opportunity to go to private physicians right there in your own community. Sounds good, right?

The reality is not quite so rosy.

Over the past 15 years, the VA has grown into a well-respected, managed-care, health-delivery system. It has earned high marks for customer-consumer satisfaction. Its prescription drug program and its electronic health-record system are first rate.

Yet there are some who would not be disappointed to see this system of integrated care go down the tubes.

What damage can Project HERO, which is to be tested in four VISNs, do? The VISNs are VISN 8, Florida and southern Georgia; VISN 16, Oklahoma, Arkansas, Louisiana, Mississippi, and portions of four other states; VISN 20, Washington, Oregon, most of Idaho, and two counties in two other states; and VISN 23, Iowa, Minnesota, Nebraska, North Dakota, South Dakota, and portions of five other states.
Adding the increased use of outside vendors to service veterans’ health-care needs will likely be a management nightmare for VISN directors and their staffs. If you read through the bid forms, a single entity—be it a health-care conglomerate, some individual doctors, or practitioners in small practices—can bid on what they want, which can be as small as offering a single service. Judging how well they perform them will hardly save time and expense.

VISNs beleaguered by increased demand for services and tightened resources (despite the spin put on the VA health-care funding for FY’07) can be tempted to choose the most expensive areas. This can have the effect of crippling the ability of VAMCs to hire and retain gifted practitioners in these fields.

VVA doesn’t object to the use of outside vendors when there are no alternatives. Certainly, a veteran who needs emergency treatment needs to go to the nearest ER; let the bookkeepers and accountants sort out the billing issues later. Nor do we object to, say, a veteran in a remote community receiving physical therapy from a qualified local as per the instructions of the physician at the VAMC.

But we do object to a blueprint that will institutionalize the outsourcing of VA services. This has the very real possibility of resulting in an exodus of physicians from the VAMCs at a time when it’s difficult to hire and retain qualified doctors and nurses.

We envision a scenario that can become real very quickly: a VAMC, with the complicity of the VISN, starts to outsource its cardiac care to private entities. This causes them to lose the heart doctors they already employ, who are now underutilized. Which mandates the VAMC to outsource all of its cardiac care.

And the dismemberment begins.

VVA and most of the other VSOs are against this attempt to scuttle the VA health-care system. If you think this isn’t an attempt, just look into some of the bureaucratese that litters this proposal. HERO, by the way, stands for Healthcare Effectiveness through Resource Optimization.

The VA ought to be making every effort to become more of a true veterans’ health-care system rather than a system that has veterans as its clients/patients. Project HERO takes the VA away from its mission. In the end, all veterans who use the VA for their health care will suffer.

At press time, we received the following from the Project HERO program manger, in response to VVA’s letter of August 15 to Secretary Nicholson:

“VA issued an initial Request for Proposals (RFP) for Project HERO on August 1st, and interested vendors submitted clarifying questions about the solicitation from that date until August 15. In response to the RFP, VA received approximately 600 clarifying questions. Based on the large number of questions we received, it is evident that the description of our requirements needs to be further defined and refined. Therefore, VA has decided to cancel the solicitation at this time in order to better define and refine our requirements. Additionally, all scheduled due diligence sessions will be postponed until further notice. VA wants to ensure that the RFP, when re-issued, will solicit proposals that address our objective of coordinated care management for purchased care. We will continue to keep you informed about current Project HERO activities and planned future directions.”

VVA will stay vigilant in our fight to insure that veterans, by virtue of their service and sacrifice, receive the highest quality of care.

IDENTITY THEFT CRISIS: NOT QUITE RESOLVED

Just when the VA announced it was coming to grips with its painfully obvious failings in protecting the integrity of information on its extensive network of computers, a desktop computer was stolen from a VA subcontractor in Reston, Virginia, who had been hired to help with insurance collections for VA’s medical centers in Pittsburgh and Philadelphia. Contained on its hard drive was information on some 20,000 veterans. This information “may have,” the VA said, “contained patients’ names, addresses, Social Security numbers, dates of birth, insurance carriers and billing information, dates of military service, and claims data that may include some medical information.

One can only imagine the explosion on the tenth floor at VA headquarters, when Secretary Nicholson learned of the latest breach.

If you question why VVA entered into a lawsuit against the VA, it was precisely to insure that the department takes all appropriate action to make sure such data breaches never happen again. Obviously, the VA has a ways to go before the VA can be established, in the words of Secretary Nicholson, “as a leader in data and information security.”

PTSD: A NUMBERS GAME

The issues surrounding PTSD seem to have gained major media attention—as well as attention in the corridors of Congress and at VA headquarters. Most recently, a reanalysis of data collected in the 1980s, reported in the journal Science, concludes that nearly one out of every five (18.7 percent) Vietnam veterans had experienced Post-traumatic Stress Disorder and that nearly one out of every ten (9.1 percent) Vietnam veterans suffered from chronic and disabling PTSD more than ten years after the war was over.

While these numbers represent a decrease, this “authoritative study reaffirms and confirms our government’s obligation and need to provide appropriate mental health services for veterans who were psychologically wounded by their wartime service,” said VVA President John Rowan. “It is consistent with studies published earlier this year which suggest that between 11 percent and 17 percent of soldiers returning from Afghanistan and Iraq have had symptoms of Post-traumatic Stress upon their return,” Rowan noted.

“Rather than disputing numbers, our focus must remain on insuring there are accurate, standardized early screening, diagnosis, and clinically effective, evidence-based treatment and recovery programs for all of our veterans suffering psychological trauma as a result of their military combat experiences. And Congress must insure there is adequate funding and trained personnel for both the VA and the Department of Defense to deliver these services and programs to our nation’s veterans,” Rowan said in a press release.

“What is beyond argument is that the more combat exposure a soldier sees, the greater the odds are that he—and increasingly she—will suffer mental and emotional stress that can become debilitating. And in wars without fronts, combat support troops are just as likely to be affected by the same traumas as infantrymen,” Rowan said.

“VVA also believes that tens of thousands of Vietnam veterans who have suffered from post-traumatic stress seek neither treatment nor compensation because of a variety of factors, including pride and their own self-image. Rather than attempt to minimize the numbers, the government must acknowledge the clinical damage and provide the necessary clinical services.

“No one really knows how many of our troops in Iraq and Afghanistan have been or will be adversely affected by their wartime experiences,” Rowan said. “And despite early intervention by psychological personnel, no one can project how serious their emotional and mental problems will become, or how chronic will be both the neuro-psychiatric wounds and their impact on physical health. Given the nature of the conflicts in Iraq and Afghanistan, VVA has no reason to believe that the rate of PTSD for veterans of OIF and OEF will be any less than that of Vietnam veterans.

“The recent study reanalyzing data from the National Vietnam Veterans Readjustment Study (1988) only underscores VVA’s belief that the congressionally mandated NVVRS follow-up study be conducted so that there can truly be a longitudinal study of Vietnam veterans that will be useful both for us and for the veterans who follow us,” Rowan said.

“The bottom line must be to make sure that the new generation of returning veterans gets the assistance and clinical interventions they need, so that they don’t develop chronic PTSD.”

LEGAL REPRESENTATION FOR CLAIMS

With the enthusiastic backing of Sen. Larry Craig (R-Idaho), chair of the Committee on Veterans’ Affairs, the Senate passed S. 2694, the Veterans’ Choice of Representation and Benefits Enhancement Act of 2006. This legislation grants veterans the right to engage legal representation when filing a claim for compensation before the Veterans Benefits Administration.

Some have expressed fears that such a bill will only make adversarial a process that should be cooperative. Others worry that passage of this bill will herald the demise of veterans service representatives. We believe that the realities will be just the opposite: that giving veterans the right to legal representation will make the VA more cognizant of its obligation to help veterans making claims; and that service reps will still have more cases than they can handle.

INCREASING GOVERNMENT EFFICIENCY?

On the other side of the ledger, two misbegotten bills that could have threatened veterans’ benefits and programs never made it to the floor of the House, in great measure because of opposition voiced by veterans organizations and an array of groups appalled at this attempt to usurp congressional oversight and authorization responsibilities.

H.R. 5766, the Government Efficiency Act, and H.R. 3282, the Abolishment of Obsolete Agencies and Federal Sunset Act, would have forced Congress to consider the legislative recommendations of commissions created by these acts under an expedited process, without the possibility of any floor amendments.
When it became apparent that the votes weren’t there for passage, the Republican leadership retreated. VVA is, of course, in favor of government efficiencies; these bills, though, under the guise of promoting efficiency, could eliminate programs and commissions with little or no public input.

The fear remains that the bills will again come up for consideration. And if they do, VVA will again work to shoot them down.

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