By Stephen Spotswood

WASHINGTON — Funding for veteran healthcare continues to increase in the Obama administration’s latest budget proposal, but legislators had some pointed questions about how well VA is tracking its spending for medical supplies and services.

The administration’s 2013 budget for VA requests $140.3 billion — comprised of $64 billion in discretionary funds, including medical-care collections, and $76.3 billion in mandatory funds. The discretionary budget request represents an increase of $2.7 billion, or 4.5%, over the 2012 enacted level.

VA Secretary Eric K. Shinseki, joined by members of VA's executive staff, testified before the House Veterans Affairs committee on the 2013 VA budget. VA photos by Robert Turtil.

The medical-care portion of the proposed budget totals $52.7 billion — an increase of 4.1% from 2012 and an increase of $165 million above the 2013 advance appropriations enacted by Congress in 2011. VA’s multi-year budget plan assumes $500 million in unobligated balances from 2012 will carry over and remain available for use in 2013.

Also submitted was the advance-appropriation request for 2014 medical-care appropriations — $54.5 billion. This is an increase of $1.8 billion, or 3.3%, over the 2013 budget request. 

When VA Secretary Eric Shinseki presented the proposed budget to the House VA Committee last month, he faced complex questions about how VA spends its funds and how it is able to track what is being spent.

Shinseki admitted that VA still has challenges when it comes to acquisitions — where VA spends the majority of its medical-care budget. “When we arrived three years ago, acquisition was being done in a number of places. We’ve centralized [tracking] now and integrated acquisition into one account, so there’s visibility,” Shinseki told legislators. “Once that’s done and running smoothly, we’ll decide whether to go to the next step to totally centralize acquisition in VA.”

According to Robert Petzel, MD, VA’s under secretary for health, centralizing and standardizing how VA buys its medical supplies is key to lowering costs. “We’ve developed strategic purchasing groups to ensure we’re getting the best price, and we’ve made sure we’ve standardized the purchase of all the medical supplies we have,” he said.

The proposed budget seeks $6.2 billion for mental-health programs — an increase of $312 million over 2012. According to VA, this will be enough to keep up with the growing need for mental healthcare, especially among veterans from Iraq and Afghanistan who suffer disproportionately from conditions such as PTSD.

VA now employs 20,500 clinical professionals, officials said, but legislators questioned whether these resources are actually translating into increased services for veterans.

“Is this [level of mental-health resources] sufficient? That depends on three things,” Petzel said. “Do we have enough people? Are those people actually being hired, and are we filling vacancies as rapidly as we can? And are we getting the appropriate productivity out of those people?”

Those are questions he said VA hopes to answer soon. VA is sending a mental-health team to every VA medical center to evaluate staffing and identify where additional resources are needed.

VA also will embrace new technologies to fill resource gaps, especially for veterans living far from medical centers, he said.

“One new modality that’s becoming more important is telemental health, both for evaluation and treatment,” Petzel noted. “It has been very successful in treating PTSD and other mental-health disorders. I think this is going to become a more common practice as we move forward.”

On a related topic, Rep. Bob Filner (D-CA), ranking Democrat on the House Committee on Veterans’ Affairs, urged Shinseki to embrace out-of-the-box thinking in addressing the backlog of benefits claims, which, according to VA, will reach 1.25 million in 2013.

“I think you need to take some radical step in the short run,” Filner said. “Unless you take [that step] to eliminate a million or 500,000 of them, you’re never going to get there.”

Filner suggested VA consider an IRS-like model, where veterans submitting claims paperwork are automatically accepted and an evaluation is ordered only if the benefits system sees something seriously wrong with the claim.

Shinseki said that VA has examined that kind of system and will be adopting some aspects of it, such as moving to a paperless claims system, which VA hopes to see implemented this summer.

Adopting such a system fully could disadvantage veterans, however. “It shifts the burden of submitting a complete and accurate claim to the veteran,” Shinseki said, “unlike today, where VA has a duty to assist.”

VA Annual Budget Submission (FY 2013)

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