U.S. Department of Veterans Affairs (VA) Secretary David Shulkin spoke at The American Legion’s 58th annual Washington Conference during the Commander’s Call on Feb. 27 to provide an update on what the VA accomplished last year and its goals for 2018.
“This has been a pretty good year in terms of making progress for veterans,” Shulkin said. “Without The American Legion’s support, we would not be having the type of progress that we’ve been making at the VA.”
For the first time ever, Shulkin said the VA recently established a Family Caregivers Advisory Committee to help change how department officials do business. The department also launched a White House VA Hotline last June, which is now fully staffed by live agents who answer thousands of calls 24 hours a day, seven days a week.
Other achievements that Shulkin noted included improving the Choice Program to eliminate the 30-day/40-mile rule; implementing accountability and reform measures; as well as granting mental health benefits to all discharged servicemembers.
In terms of the VA’s top five priorities, Shulkin said they include giving veterans greater choice about where and how they receive services and health care; modernizing the VA; improving timeliness of services; focusing resources based on what’s most important to veterans; and preventing suicide.
Giving veterans access to care
Shulkin said giving veterans a choice about where and how they receive services and care is about making sure that the VA is modernizing and transforming its systems to meet veterans’ needs. Department officials are now working, through current legislation, on expanding the ability for veterans to have more choice.
“Right now, you have to be 40 miles away and wait 30 days to be able to get access in the community. We want to change that to be more clinically-based so allowing veterans to have access to walk-in care right in their communities,” Shulkin said. “Wherever there is a situation where the quality may not be up to VA standards, you shouldn’t be locked into a system that’s not working for you. So, we’re working hard to make this a seamless system that works better for veterans and gives them more choice.”
Modernizing the VA
Because the VA has been around a long time and experienced neglect over the years, Shulkin said the department will adopt the same Electronic Health Record as the Department of Defense, replacing VA’s current Veterans Health Information Systems and Technology Architecture system.
“For at least 17 years, there’s been calls by Congress and billions of dollars spent trying to get these systems to work together,” Shulkin said. “From the very time you enlist all the way through the end of life if that’s what you choose, there will be a single system with all of your records and all of your information. It will be maintained and updated on a regular basis because it’s being run by one of the large electronic health record companies across the country.”
In addition to improving its management practices, Shulkin said the VA will also update and modernize its medical facilities so that family members can stay overnight with their loved ones.
“This is the type of facility that we believe all veterans deserve and we’re well on our way now to moving toward single rooms and updating our facilities,” he said. “One of the ways that we’re doing that is by eliminating or disposing of buildings that are vacant or underutilized.”
Last year, Shulkin announced that the VA would do away with 1,200 vacant or underutilized facilities to reinvest in the infrastructure of its current facilities.
“The new infrastructure build that you’ve heard the president talk about recently allows VA to take those proceeds and reinvest them into our current facilities,” Shulkin said. “That will be another way of our facilities assessment and making sure that we are investing back into those facilities that veterans are using.”
Improving timeliness of services
Shulkin said the department has made a lot of progress since 2014, with timeliness of services. About 96 percent of VA appointments are done within 30 days, 85 percent are done within seven days and 22 percent are done on a same-day basis.
Most importantly, Shulkin said the VA now has same-day services for primary care and mental health in every one of its facilities. If veterans have an urgent medical need or emotional issue, they’ll be able to get same-day services at any one of VA’s medical facilities.
“That’s something to assure that we never get into this situation that we had back in Phoenix,” he said. “We are the only health system in the country that publicly posts its wait times.”
In order to prevent another incident like the 2014 Phoenix VA scandal, Shulkin said the VA launched a new online wait time tool last year to give veterans an opportunity to compare distance, wait times, services, quality and feedback for VA medical facilities within a specific mile radius.
“When we do look at whether the VA is doing better than the private sector, the VA is actually better on average. Often, 40 percent better in terms of wait times,” Shulkin said. “This doesn’t mean that we don’t have work to do or we’re not continuing to try to shorten our wait times. We are working on that hard.”
One of the ways that the VA is providing access to care, particularly in rural areas, is by using a telehealth system. Shulkin said no other health system in the country has one like the VA, which the department invests over $1 billion a year and 750,000 veterans use.
Moreover, Shulkin said the VA is working on the timeliness of disability claims.
“Not too long ago we had over 611,000 disability claims (with) more than 125 days in waiting. Today, we have about 75,000 (claims) and by the end of the year we’ll have less than 50,000,” Shulkin said. “Even more important, we’re redesigning our systems. We’re using a new system called the Decision Ready Claim where if veterans choose to use that option, we’ll be able to get them an answer in 30 days or less. And increasingly, we’re finding ways to make that system to work better because we want to get those claims resolved and get answers and benefits to our veterans as soon as we can.”
Thanks to the Veterans Appeals Improvement and Modernization Act of 2017, Shulkin said the Board of Veterans Appeals is on target to complete 81,000 decisions.
“That’s about 25,000 more than last year,” he said. “We’re seeing advances as people begin to start opting into this new process, called the (Rapid Appeals Modernization Program) RAMP, where they are able to get decisions quicker instead of waiting six years. We’re able to resolve these in just really a matter of weeks. We’re going to continue to work at this.”
Shulkin said the VA still has a lot of work to do as there are about 450,000 appeals and claims in the backlog.
“If we didn’t have your support in getting this law changed and getting resources we needed, the situation would just continue to get worst every year,” Shulkin said. “But now I think we’re headed on the right path.”
Focusing resources on things that matter to veterans
When it comes to offering world-class resources and services, Shulkin said the VA’s objective is to be the best in the world compared to the private sector.
“Veterans have a higher incidence of hepatitis C than the general population. About 18 months ago, we had close to 160,000 veterans who had hepatitis C,” Shulkin said. “We started focusing on that by calling our veterans, bringing them in and using drugs that have more than a 95 percent cure rate. We will soon, in the next couple of months, be at 20,000. We’re committed to being the first system in the country to eliminating hepatitis C from an entire population.
“Other things that we know matter to veterans is the opioid crisis. VA has been working on this for the last five years. We’ve seen about a 46 percent decrease in the use of opioids. But we are now posting our opioid rates publicly. No other system in the country is doing this – we’re the first.”
Shulkin said veterans will be able to see what the opioid prescription rate is at their local medical facility, what progress has been made and areas that still need improvement.
“We’re not taking away opioids from people who need them,” he said. “(About) 90 percent of progress that we’ve made is not starting veterans on opioids, but instead giving them alternatives and choices about how to deal with pain and how to manage. By doing that and working together with the doctor and the veteran, we’re doing things that I think the rest of the country is learning from and seeing how we make a difference (by) not getting people addicted to these medications.”
Shulkin said nearly 20 veterans die from suicide every day, a number that he deems is staggering and completely unacceptable.
“We focused our resources on trying to get this number down,” Shulkin said. “Over the last 15 years, veterans who have utilized the VA, the rate of suicide have gone up by 5.4 percent. Those same veterans over the last 15 years who have not used VA services, their rate went up 38.4 percent.
“With women veterans, this is even more significant. Those that used VA services over the last 15 years, their rate actually declined in terms of suicide. But compared to the women veterans that did not use VA services, their rate went up over 80 percent. This really shows that connecting people with the right services and the right help saves lives. This is one of the reasons why we’re fearful in the privatization of the VA, where we’re sending people out in the community where access is even more limited and they don’t get the right care.”
In order to help prevent suicide, Shulkin said the VA recently launched a national campaign for veterans and servicemembers called #BeThere. The White House also took action by signing a new executive order that grants mental health services to all transitioning servicemembers.
“Only 40 percent of active servicemembers who leave the military today are eligible for VA services,” Shulkin said. “But thanks to the president’s leadership, 100 percent of servicemembers who leave the military will have access to mental health services for a 12-month period, which is the highest risk period for suicide that we now know of today.”
Shulkin said another attempt that the VA is taking to prevent suicide is by ending veteran homelessness. While the department has seen close to a 50 percent reduction, there are still nearly 45,000 homeless veterans in the United States.
“We know homelessness is a risk for suicide. When you don’t have stability in your life and you don’t have a place where you feel safe, that increases the risk of suicide,” he said. “We’ve recently expanded mental health coverage for those with other than honorable discharges. Fifteen percent of veterans leave the military with an other-than-honorable discharge that may have been linked to a behavioral issue due to some of the stressors experienced during the military. This is a group that’s at a higher risk for suicide.”
When it comes to the president’s commitment to veterans, Shulkin said the VA is pleased with the $198.6 billion budget request for 2019. This is a budget that not only invests back into the VA, but also allows the department to continue providing health care options as it seeks to gain the public’s trust.
“Our way of measuring whether we’re doing something right is by asking veterans if they trust in the VA," Shulkin said. "Back in 2014, with our crisis, only 46 percent of veterans said that they trusted the VA. Today, that number is about 70 percent. We’re not satisfied but we do see that we’re headed in the right direction. We’re going to continue to focus and fight for you and do what’s right for veterans in order to make sure that we gain your trust.”
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