By Sandra Basu
WASHINGTON – Robert A. “Bob” McDonald, a West Point graduate who served as chief executive of Procter & Gamble, was nominated last month as secretary of the embattled Department of Veterans Affairs and was expected to be approved by the Senate.
In tapping a corporate executive instead of a retired military leader, as often has occurred in the past, President Barack Obama said his administration was seeking to establish a “new culture of accountability” within the VA, praising McDonald as a man of integrity and calling him “an expert in making organizations better.”
“My bottom line is this,” Obama said. “We’ve got to change the way the VA does business.”
The nomination of McDonald, who is subject to Senate confirmation, received bipartisan support early on. House Speaker John Boehner, R-Ohio, called him “the kind of person who is capable of implementing the kind of dramatic systemic change that is badly needed and long overdue at the VA.”
If confirmed, McDonald would replace retired Gen. Eric Shinseki, who resigned in late May after a VA inspector general’s report confirmed problems of access and treatment delays for veterans at the Phoenix VA Health Care System.
That report found 1,700 veterans waiting for a primary-care appointment who had not been included on the Phoenix VA Health Care System’s electronic waitlist as required. The VA IG is continuing to investigate allegations there and at other VA facilities.
Obama’s announcement of McDonald’s nomination came only days after a scathing White House review found the VHA needs to be “restructured and reformed.” (See box, this page.)
The VA also announced last month that it has initiated a search for a new VHA chief after VA Under Secretary for Health Robert Petzel, MD, stepped down from that position in May.
“This is one of the most important jobs in government today,” said Acting Secretary Sloan Gibson in a written statement. “This is the largest integrated healthcare system in the country. We need a leader who will be a change agent and deliver necessary reforms to provide our veterans timely access to the world-class healthcare they’ve earned and deserve. The expert panel we’ve assembled to recommend our new health chief understands the urgency and the seriousness of the task ahead, and I’m grateful for their efforts.”
VA announced Petzel’s resignation in mid-May, one day after a Senate hearing on the problems at the Phoenix hospital. The announcement of the resignation was criticized by lawmakers, however, because his scheduled retirement in 2014 had previously been publicized.
The VA has been engulfed in a whirlwind of activity since the initial allegations came to light, with Gibson stepping into damage-control mode last month. He vowed that the VA would work to repair its relationship with veterans after revelations of misconduct related to patient wait times.
“We have to earn back trust. Veterans must feel safe when they come to VA for care, and earn it we will. I don’t expect them to give it back to us. I expect us to have to earn it,” he said last month.
Following the IG interim report, a nationwide VA internal audit looking at 731 separate points of access showed that more than 57,000 veterans waited 90 days or longer for an appointment. Another 64,000 veterans enrolled during the past 10 years had not yet been seen for an appointment, the audit found.
In addition, 13% of scheduling staff interviewed indicated they received instructions from supervisors or others to enter a date different from what the veteran had requested in the appointment scheduling system, according to the audit’s findings.
“This data shows the extent of the systemic problems we face, problems that demand immediate actions,” Gibson said in a June 9 statement.
He announced that VA, as of June 19, had reached out to 70,000 veterans to get them off of waiting lists and into clinics.
FBI Director James Comey also told a House committee that the FBI was initiating a criminal investigation into the Phoenix VA allegations and will “follow it wherever the facts take us.”
VA officials said they were committed to fixing the problems. In addition to an initiative to contact more than 90,000 veterans to get them care in VA or arrange it with outside providers, VHA said it was suspending all VHA senior executive performance awards for FY 14 and changing the appointment time limit in goals for employee plans.
The recent audit noted that “meeting a 14-day wait-time performance target for new appointments was simply not attainable given the ongoing challenge of finding sufficient provider slots to accommodate a growing demand for services.”
“Imposing this expectation on the field before ascertaining the resources required and its ensuing broad promulgation represents an organizational leadership failure,” the review concluded.
Gibson also ordered an immediate hiring freeze at the VHA central office in Washington and the 21 VHA Veterans Integrated Service Network regional offices “except for critical positions to be approved by the Secretary on a case-by-case basis.”
“This action will begin to remove bureaucratic obstacles and establish responsive, forward leaning leadership,” a VA statement explained.
VA officials also announced that they met with industry leaders last month, including Kaiser Permanente, Gartner and Mayo Clinic, to discuss best practices and policies for scheduling patients.
“Our top priority is to get our veterans off wait lists and into clinics,” said Gibson in a written statement. “We need to continue to examine the best practices of healthcare systems across the country to find immediate solutions for timely delivery of quality healthcare.”
Outdated Scheduling System
At a congressional hearing last month, Philip Matkovsky, VA assistant deputy under secretary for health for administrative operations, told legislators that the agency faces challenges with technology in its scheduling. Schedulers not only deal with a lack of appointment slots to schedule veterans but also use outdated systems to fill the slots, Matkovsky pointed out.
The current scheduling system has been used since 1985 but has not changed in any appreciable manner since that time, he explained, noting that theVA is working to find a replacement scheduling system.
Acting VA Inspector General Richard Griffin told lawmakers that IG audits over the years have also pointed to outdated scheduling systems.
“A lot of money has been wasted — millions of dollars have been wasted — on contractors trying to create a better system for capturing this data, and over the past 15 years it hasn’t had any success,” he explained.
On Capitol Hill, meanwhile, legislation to help address VA’s woes was making its way through Congress. Both the House and Senate overwhelmingly passed bills last month that would require VA to offer non-VA care at the department’s expense to any enrolled veteran who cannot get an appointment within VA wait-time goals or who lives more than 40 miles from a VA medical facility.
Also read “White House Review Calls for Restructuring of VHA” by Sandra Basu
A facility-specific survey found that 138 of 140 VA facilities reported shortages of medical officers, with psychiatry and primary care positions being the most frequently listed.
When Terrence O’Neil, MD, retired as chief of nephrology at the James H. Quillen VAMC in Johnson City in December 2016, he left in his wake decades of work treating kidney disease—nearly 35 years in the Air Force and DoD, plus 11 more at VA.