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WASHINGTON, DC — With the PACT Act set to officially go into effect this month, legislators are watching VA closely to see how the department deals with the hundreds of thousands of expected new claims. As of mid-December, the VA had already received 165,000 disability claims as a result of the legislation, which expanded benefits and healthcare for veterans with conditions related to toxic exposure suffered during service.
Concerns that were voiced during the early days of the legislation’s creation are being brought up again, namely whether VA is prepared to handle this new influx of beneficiaries without interrupting care for veterans already in the system.
“Earlier this year, we raised concerns about VA’s ability to roll out the PACT Act without severely disrupting services to veterans,” said Rep. Michael Bost (R-IL) at a House VA Committee hearing last month. “[When changes were made to the bill that gave VA more resources,] Secretary McDonough assured us he could implement it without crippling VA operations. How does VA plan to address the backlog of claims? … I’m worried VA is already behind the curve. VA projects that it will take until February of 2025 to work down the backlog. [They’re] relying on an aggressive hiring effort and mandatory overtime.”
Bost noted that it will take time to train new claims personnel and that mandatory overtime can lead to employee burnout.
“It’s not a sustainable solution,” he declared.
On the benefits side, VA leaders are standing behind their hiring surge as key to the department’s readiness. While on the healthcare side, they hope new authorities will help them retain the staff they have and that streamlining physician interactions with veterans will get more patients through the door on a daily basis.
“Hiring faster and more competitively by consistently implementing [the new hiring authorities contained in the PACT Act] across the country is my top priority,” declared VA Undersecretary for Health Shereef Elnahal, MD. “We recently held a national onboarding surge event to fast track candidates’ onboarding experiences. … We completed all the onboarding steps for more than 12,800 new employees, nearly doubling our event’s goal.”
Those new employees include 3,600 new healthcare enrollment specialists, with 1,900 more anticipated in the coming months.
Also key to VA’s strategy are new automated processes that are expected to speed up the claims process.
“It’s not automation, it’s automation decision support,” clarified Joshua Jacobs, the senior adviser currently performing the delegable duties of the Under Secretary for Benefits. “It helps claims processors be more efficient … extract key information in a veteran’s file and summarize it in a succinct way to create an audit trail for potential down-the-line review. … It has accelerated the timeline significantly.”
However, that automation is still in the testing stages.
“We started at four regional offices and recently expanded to eight,” Jacobs explained. “We’re working to validate gradually … to make sure our efforts to implement this more broadly are informed by frontline feedback. … We’re mindful of the history of previous IT projects.”
The personnel training process also is still in the testing stages.
“We’re working to create what is called a train-the-trainer model. [That’s] where we have experts in the compensation service office training a handful of staff in each of our 56 regional offices so they can work to help supplement the training and answer questions and deal with any answers that may arise with the training,” Jacobs said. “Following training and working to evaluate effectiveness … we’ll hold interviews with claims processes and follow-up reviews of the claims to make sure the training is working as designed.”
The legislators noted that success on the benefits side of the equation could provide added pressure to VA healthcare facilities, which will see an influx of patients. Several passed on stories of veterans in their districts who been subjected to long waits for appointments and have had difficulty receiving care at VA.
“I understand there are horror stories and there are great stories. But my question is what are we going to do now to guarantee access to care when you’re going to have a 55% increase potentially of people able to walk through the door?” asked Rep. Chip Roy (R-TX).
According to Elnahal, one of VA’s solutions is to make sure VA clinicians are seeing the maximum number of veterans possible in the time allotted.
Standardized Visit Times
“We want to standardize the amount of time our clinician and specialists spend per patient in each specialty … to maximize the opportunity to bring more veterans into a daily schedule every day. And to ensure our clinicians are spending 80% of that booked clinical time seeing veterans,” he explained. “We want to improve access for current patients and to prepare for that next cohort coming in from the PACT Act.”
VA also will be looking at where they can relieve clinicians from daily administrative tasks that might not always be necessary.
“Do they need every reminder and every alert that might not be necessary in the case of every veteran?” Elhanal said.
The reignited concerns over VA’s ability to handle the influx has at least one committee member, Rep. Elissa Slotkin (D-MI), worried that some legislators might be feeling “buyers’ remorse” and will work to undercut the legislation. She pointed to the $500 million fund set aside specifically for the PACT Act as something that might be vulnerable in the future.
“What I’m worried about is that there’s now a lot of complaints about this fund, and that is cover for wanting to roll back the price tag of the PACT Act. That it’s somehow a back-door way to get rid of it. It makes me very nervous,” Slotkin declared.
Asked whether a dedicated fund is necessary, Elnahal said testified that it absolutely was.
“We should be quite concerned over our ability to implement all of these services and healthcare, if we do not have a toxic exposure fund,” he said. “We do need set aside funds to be able to do this seriously.”
