In looking back, it has been a long time since I wrote two scathing chronicles about the Department of Veterans Affairs (VA) in a single week. But, I could not allow these Department of Veterans Affairs – Office of Inspector General (VA-OIG) reports to age any longer in my inbox. With the Fourth of July fast approaching, as you celebrate, please keep in mind what the VA is purposefully doing to the Veterans, Dependents, and Spouses under their care. America would not be here without her military, and military service produces veterans. But, the VA is producing bodies and bureaucracy instead of helping veterans as they are paid and legally charged to do!
When I first left the US Army, I found myself employed in a telemarketing call center and was never paid the correct amount. 18-months later, I was employed with an Internet Service Provider, who bounced multiple paychecks before going bankrupt underneath the employees. When the VA-OIG reports part-time physicians not being appropriately paid, I can understand the issues this causes.
The VA-OIG randomly selected 134 salary agreements for part-time physicians on adjustable work schedules and found 44% of the physicians were either over or underpaid. One might ask how and why these pay errors occurred. The answer is extreme designed incompetence, not that the physicians will feel any better that they were either overpaid and owe back monies or underpaid and are now owed a considerable check.
From the VA-OIG report, we find the following as causes for the discrepancies:
“This occurred because key management controls were missing or not working. Officials did not make certain that medical facilities complied with policies and procedures. Consequently, the OIG estimated VHA medical facilities had about $8.3 million in questioned costs that year (2019) and an additional $8.3 million in 2020. VHA medical facilities also may have violated the prohibition against voluntary services, and potentially the Antideficiency Act, by not correcting underpayments or by having physicians working above the 1,820-hour cap because their agreements were not properly reconciled” [emphasis mine].
The government officials’ neglect, malfeasance, and misfeasance might be illegal, as they failed to do their jobs properly. Yet, the VA-OIG only issued recommendations. There is potentially $16.6 Million in over or underpayments at stake, plus illegal actions, and people have not been fired or perp-walked into custody. How can government employees get away with behavior that would have seen class-action lawsuits, criminal investigations, media reporting feeding frenzies if similar had occurred anywhere in the private sector?
Yet, the marketing materials produced by the Department of Veterans Affairs – Veterans Health Administration, a division of the VA, claims this is “Defining Excellence in Healthcare in the 21st Century.” If you believe that, then you must believe that buffalo wings come from flying buffaloes. Unfortunately, the problems only continue to worsen.
The VA-OIG reports that a doctor had accumulated more than 4000 alerts from the electronic health record (EHR) system. This means that the computer system notified the doctor that patients needed care, appointments, were seen in the ER, required treatment, pharmacy prescription renewals, and much more. The alerts, called views, are a built-in measure to help patients not get lost or have “adverse clinical outcomes” while receiving care at the VHA. The VA-OIG found that the entire medical facility at the Charlie Norwood VAMC in Agusta, Georgia had similar issues. The doctors were not viewing the patient EHR views as indicated.
What’s worse, the VA-OIG could not tell if “adverse clinical outcomes” had occurred because once the EHR views are settled, there is no record of the patient or why the view was required. Talk about accountability, responsibility, and transparency in the patient-aligned care team (PACT). In reading this VA-OIG report, it looks like when the facility leadership was alerted the VA-OIG was coming, the leadership team did a massive clean-up of the records, knowing they would never get caught and held responsible for any “adverse clinical outcomes.” As a side note, the VA-OIG report claims the doctor with 4000 views is no longer providing care at this VA facility. Heaven help his patients wherever this doctor is now!
So far in 2020, I have had two different primary care providers assigned, and since moving out of Arizona, I will shortly have a third assigned to me. My first primary care provider retired, but before doing so, he set up many EHR problems for his replacement to handle. Including refusing to renew prescriptions, some of which were mine, which caused weeks of not receiving the proper medications. Upon learning of my impending move, my second primary care provider essentially wiped her hands of my care, leaving me without medications and a clinic to contact for help. Great job if you can get it; get hired to treat patients, and then not treat patients. Before you ask, no, knowing I am not alone in this ordeal does not help!
Finally, the VA-OIG has completed a full VISN wide comprehensive healthcare inspection (CHIp) for VISN 10. VISN 10 covering Ohio, Indiana, Michigan and is located in Cincinnati, Ohio. For all intents and purposes, the CHIp went well; the leaders are competent and knowledgeable. Thus, I issue my sincerest congratulations to VISN 10 for their success. The VA-OIG inspected the VISN’s ability to respond to the COVID pandemic appropriately, and the VISN performed well.
Except, this opens a few questions needing address. At two VISN 22 and two VISN 17 facilities, I have experienced four utterly different responses to the COVID policy and masking mandates. None of the facilities have written guidelines that are geographically specific to the patients and weather patterns in those areas. None of the facilities have documented processes for veterans who cannot wear masks, with an approved policy supported, written statement for accommodating these veterans. One facility insists that the veterans who cannot wear masks be arrested, cited, and fined. One facility insists that if you have a letter from your doctor, you are okay. One facility vacillates wildly from day-to-day and person-to-person, and the fourth facility doesn’t have a clue but is still very helpful, with supervisor approval.
Yet, somehow, VISN 10 has all their VAMC’s and VAHCS’ operating to the same sheet of music and behaving similarly. How is this possible VA-OIG? Better still, how does this spread out to other VISN’s and facilities? May I hazard a guess, based solely upon the perceptions of veterans in VISN 10, the masking policy from COVID remains haphazard and improperly applied because Washington, DC, never issued proper guidance in the first place, the VISN leaders never issued written guidance. The policy process on the local level is a quagmire of egos, bureaucracy, unions, all set into a cesspit of inaction and designed incompetence! If COVID has taught any lessons, the number one lesson has to be that the leadership at the VISN and local levels remains inadequate to the task they were hired to perform!
© 2021 M. Dave Salisbury
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