McDonald: Proposed Board ‘Abrogation’ of Congress’ Role

by U.S. Medicine

November 4, 2015

Sandra Basu

WASHINGTON — An independent governance board, as defined in a recent report, would be redundant with the role of the congressional committees overseeing the VA, according to Secretary Robert McDonald.

The recently released review was mandated by the Veterans Choice Act, the more than $16 billion emergency funding measure passed last year after the VA waiting list manipulation scandal. It calls for VA to establish an independent governance board, to “develop fundamental policy, define the strategic direction, insulate VHA leadership from direct political intervention, and ensure accountability for the achievement of established performance measures.”

McDonald told lawmakers he opposed the idea, explaining, “What I believe is that this is a unique moment of time, and we have two great committees with two great chairman.Let’s work together. I think we can get it done without the board.”

McDonald made his comments at a House Committee on Veterans’ Affairs hearing in which he testified on the findings of the Independent Assessment of the Health Care Delivery Systems and Management Processes of the Department of Veterans Affairs.

Calling the assessment more than an “instrument” and more than a “tool,” Rep. Jeff Miller (R-FL), House Committee on Veterans’ Affairs chairman, said that veterans “can’t afford to let this assessment become just [number] 138 gathering dust on some shelf, locked away where no one else will see it again.” >>Next Page

Long Term Improvements

Brett Giroir, MD, chair of the Blue Ribbon Panel, which was created by MITRE Corp. to provide support and guidance for the independent assessment, explained that root-cause issues identified are the basis of four overarching recommendations in the area of governance, leadership, operations and data and tools. Addressing these, he said, is essential before any “long term, sustained improvements in access, patient experience, and quality care can be realized.”

McDonald told lawmakers that “for the most part” the independent analysis confirmed his own analysis, and the VA already is taking action in addressing the issues.

“The assessment had a great deal of information on known problems, but also had some new ideas that we are incorporating into the transformation we are doing,” he said.

Still, McDonald made clear that he had concerns with the independent panel’s recommendation regarding the need for an independent governing board. The report stated that Congress and VA should charter the Commission on Care “to explore and identify the governance model that would best enable VHA to complete the proposed transformative efforts and sustain its ability to provide the highest quality health care to veterans.”

McDonald emphasized that oversight is the responsibility of the House and Senate Veterans’ Affairs committees working collaboratively with VA.

“If you, as Congress, really decide you need this board, isn’t that an abrogation of your responsibilities?” McDonald asked. With 25 advisory committees already in existence, he told lawmakers he was seeking to “reduce layers,” not add to them.

MITRE Senior Vice President Richard Byrne, on the other hand, suggested that a VA governance board, as defined in the report, could provide expertise and advice to the congressional committees. He also noted that none of the 25 advisory committees at VA has governance properties.

Moving Forward

On another issue addressed in the review, Giroir suggested reconsideration of whether VHA should aim to be the comprehensive provider for all veteran healthcare needs or whether it should evolve into more-focused centers providing specialized care, leaving non-VHA providers to take care of the rest.

“One of the most urgent strategic priorities is to establish and clearly communicate the future mission of the VHA and for Congress to align resources and authorities to achieve that specific mission,” Giroir said.

In some ways, he warned, “VA is in an impossible situation, because the demand could literally double overnight, depending on how the services are provided and the demand from the veterans.

“So, to specifically define what the VA is going to do, to fund for that and to provide other sources of care for the remaining is the main point.”

Rep. Corrine Brown (D-FL), the ranking Democrat on the committee, suggested that the “elephant in the room” was the desire of some in Congress to “just completely close the VA and privatize the entire VA system.”

Brown called that “totally unacceptable,” and McDonald added, “It would be a big mistake to even think about privatizing it.”

McDonald and VHA Under Secretary for Health David Shulkin, MD, told lawmakers that they think a “hybrid type system” is best for veterans and that they support veterans receiving care outside of VA when necessary.

“Even before the Choice Act, we had many veterans who were going to our medical school affiliates, who were going to the Alaska Native Health System, the Indian Health System and joint DoD-VA facilities,” McDonald said.

Research suggests veterans prefer to come to VA, he pointed out, noting that VA still is in need of more funding. Criticizing a House-passed FY 2016 VA budget proposing a $1.4 billion reduction to VA’s total request, McDonald pointed out that would mean $688 million less — the equivalent of denying VA healthcare services to as many as 70,000 veterans.

Miller disagreed with McDonald’s assessment of the House bill.

“In fact, the VA budget that the House has proposed represents an increase in VA’s discretionary budget and would continue the trend of budget increases that have led to a more than 70% increase in the bottom line over the last six years,” Miller responded.

Further Reading:

Recommendations to Improve Governance at VA

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