Friday, August 1, 2014
FAIRFIELD-SUISUN, CALIFORNIA
99 CENTS

VA warns of stampede of vets to private care

By
From page B10 | June 15, 2014 |

A report by the Department of Veterans Affairs’ inspector general and a separate “access audit” of appointment scheduling practices across VA health care facilities confirm system-wide abuses to distort wait times for care, which have put patients at risk and shaken confidence in how VA hospitals and clinics are staffed, managed and resourced.

Yet even as the acting IG and another senior VA official confirmed the depth of the patient wait-time scandal at hearing Monday of the House veterans affairs committee, as well as possible criminal activity by some administrators, they cautioned irate lawmakers against sending thousands more VA patients into the private sector for health care needs.

The caution flags haven’t slowed Congress. On Tuesday, the House unanimously passed the Veterans Access to Care Act, HR 4810, from Rep. Jeff Miller, R-Florida, VA committee chairman. It would require VA to offer non-VA care to enrolled veterans who cannot get an appointment within VA wait time goals or who live more than 40 miles from a VA medical facility.

On Wednesday, the Senate voted 93 to 3 for similar language as part of a more comprehensive bill, the Veterans’ Access to Care through Choice, Accountability and Transparency Act of 2014, S 2450, from Sens. Bernie Sanders, I-Vermont, VA committee chairman, and John McCain, R-Arizona.

VA already spends 10 percent of its health care budget, about $5 billion a year, on private sector care. In 2013, VA authorized and reimbursed for 15.3 million non-VA outpatient visits, a 72 percent increase since 2008. Eligibility for such care is complex, however, and varies by veteran status and circumstance. Pre-authorization usually is required.

In response to the appointments scandal, Congress wants VA to experiment for two years with giving many more veterans easier access to non-VA care. Veteran service organizations long have feared such moves as a step toward dismantling their prized, fully integrated VA health system. Big-government critics say it will improve access to care and save tax dollars.

At Monday’s hearing, VA officials, including the acting inspector general, and a health expert from the Government Accountability Office, warned against a rush of veterans into private sector care, saying it could backfire if not carefully coordinated and properly resourced.

Testifying on results of a VA flash audit of patient access and wait times, Philip Matkovsky, assistant deputy undersecretary for health administrative operations, apologized on behalf of VA leaders for a “systemic and totally unacceptable lack of integrity” found in appointment processing at some facilities, calling it “a breach of trust” and “indefensible.”

He also described a $300 million initiative to accelerate access to care in coming months with more medical staff overtime, expansion of VA clinic hours and more referrals to private sector providers as necessary.

Many VA facilities apparently manipulated wait-time data to pretend to meet internal goals for providing timely access to care, which then would qualify senior staff for performance bonuses and promotions.

Richard J. Griffin, acting IG, testified that in addition to the Phoenix VA hospital where a whistleblower physician first exposed data manipulation and said it had led to preventable deaths, IG teams were investigating 69 other VA facilities where there was evidence of data manipulation.

Griffin described two methods used to disguise actual wait times. The most common begins with a veteran calling for an appointment “120 days out because that’s the first available” and yet that appointment gets scored as being the veteran’s desired date. The facility then posts “zero waiting days” though the veteran actually waited four months.

“The other scenario is you get that appointment 120 days out. Two weeks before that appointment, it gets canceled in the system and it gets recreated,” Griffin said. “The veteran is no wiser to the fact his appointment was canceled because it’s been recreated for the same time and date.” But the appointment log shows a wait of two weeks not 120 days.

In Phoenix, the IG reviewed a statistically valid sample of 226 appointments for primary care. On average, patients waited 115 days for appointments. Only 16 percent were seen within the VA goal of 14 days. What the facility reported for those patients, however, was an average wait of 24 days with 57 percent treated within 14 days.

“Those are similar to what we found,” Matkovsky said of a nationwide “access audit” VA recently ran across more than 730 hospitals and clinics.

The IG report is preliminary and doesn’t answer whether vets died from delays in diagnosis or treatment. That will require analysis of VA and non-VA medical records, death certificates and autopsy reports by IG clinical teams. The IG is coordinating these investigations with the FBI.

Only one confirmed death from scheduling delays was discussed at Monday’s hearing. Debra A. Draper, director of health care for the Government Accountability Office, used it as a cautionary tale for lawmakers pressing to give veterans easier access to private-sector care.

Last September, she said, VA diagnosed a veteran as having two aneurisms and scheduled heart surgery. A November operation was canceled due to VA staffing issues. In December VA approved non-VA care, referring the patient to a local hospital. By late December, the non-VA care provider had lost the veteran’s information so VA had to resubmit its surgery request. In February, before surgery could be performed, the veteran died.

Use of more non-VA care will expand capacity but there are “potential pitfalls,” Draper said. For example, VA doesn’t tracked wait times for non-VA care and so it cannot estimate what waits will be for type of local care.

Griffin and Matkovsky also raised caution flags. The IG noted the value of an integrated health system to care for vets with multiple conditions. Matkovsky said transferring records with non-VA providers remains a hurdle.

“We need to ensure that there is sufficient non-VA care coordination staff in facilities. You can’t simply feed into community (care) and assume it’s going to take place,” Matkovsky warned. “We have to coordinate that care.”

Several committee members said they shared his concern. The next day the House passed Miller’s bill to expand access to non-VA care 426-to-0.

Send comments to Military Update, P.O. Box 231111, Centreville, VA, 20120, email milupdate@aol.com or tweet @Military_Update.

LEAVE A COMMENT

Discussion | No comments

The Daily Republic does not necessarily condone the comments here, nor does it review every post. Read our full policy

.

Solano News

‘Boyhood’ mature on music, moments

By Nick DeCicco | From Page: B1

 
Mr. Clean: Dennis Regan offers friendly jokes, with a bite

By Amy Maginnis-Honey | From Page: B1

Gemstones shine at Solano County Fair

By Barry Eberling | From Page: A1 | Gallery

 
Trifecta: ‘The Who’s Tommy’ third play in three months

By Amy Maginnis-Honey | From Page: B1 | Gallery

 
Japan Summerfest returns this month

By Susan Hiland | From Page: A3

 
Solano Tea Party Patriots schedule meet

By Susan Hiland | From Page: A4

 
Details limited after shooting leaves 1 with injuries

By Amy Maginnis-Honey | From Page: A4

Highway 12 to close overnight in Jameson Canyon

By Barry Eberling | From Page: A4

 
Air district calls Spare the Air alert

By Barry Eberling | From Page: A4

Vallejo police arrest suspect in shooting death

By Barry Eberling | From Page: A4 | Gallery

 
Fairfield man settles suit against Raley’s

By Ryan McCarthy | From Page: A4

Stabbing victim dies in Vacaville

By Barry Eberling | From Page: A5

 
Fairfield police log: July 30, 2014

By Susan Hiland | From Page: A12

Suisun City police log: July 30, 2014

By Susan Hiland | From Page: A12

 
.

US / World

Abbas seeks broad support for war crimes charges

By The Associated Press | From Page: A1

 
US, UN announce deal on 72-hour Gaza cease-fire

By The Associated Press | From Page: A1 | Gallery

As US job market strengthens, many don’t feel it

By The Associated Press | From Page: A1

 
Dow plunges as multiple worries vex investors

By The Associated Press | From Page: A1 | Gallery

Wisconsin Supreme Court upholds 2011 union law

By The Associated Press | From Page: A1

 
A look at the impact of Wisconsin’s union law

By The Associated Press | From Page: A1

Union: California prison staff told to fake checks

By The Associated Press | From Page: A1 | Gallery

 
Candidate goes homeless to show economic gap

By The Associated Press | From Page: A5 | Gallery

California ex-mayor sentenced in corruption case

By The Associated Press | From Page: A5

 
Californians to see increase in health plan costs

By The Associated Press | From Page: A5

Appellate court overturns high-speed rail rulings

By The Associated Press | From Page: A5

 
Report: Secrecy enveloped Bay Bridge construction

By The Associated Press | From Page: A5

Yosemite wildfire weakened, evacuations to end

By The Associated Press | From Page: A5

 
US warns against traveling to Ebola-hit countries

By The Associated Press | From Page: A6

Congress races to finish VA, highway bills

By The Associated Press | From Page: A7

 
See-through mice reveal details of inner anatomy

By The Associated Press | From Page: A7

CIA spied on Senate, internal review finds

By The Associated Press | From Page: A7

 
Demoted worker shoots CEO, kills self in Chicago

By The Associated Press | From Page: A7

NASA to test making rocket fuel ingredient on Mars

By The Associated Press | From Page: A7

 
Investigators reach Ukraine jet wreckage site

By The Associated Press | From Page: A7 | Gallery

.

Opinion

Editorial Cartoons: Aug. 1, 2014

By Daily Republic Syndicated Content | From Page: A11

 
To err is human – but not in print

By Bud Stevenson | From Page: A11

Why do so many Americans support Hamas

By Letter to the Editor | From Page: A11

 
Nice guy becomes House majority leader

By Dan Walters | From Page: A11

Should union organizing be a civil right?

By Ben Boychuk and Joel Mathis | From Page: A11

 
.

Living

Today in History for Aug. 1, 2014

By The Associated Press | From Page: A2

 
Community Calendar: Aug. 1, 2014

By Susan Hiland | From Page: A2

My irregular monthly cycles were a symptom of cancer, not menopause

By Kathy Mitchell and Marcy Sugar | From Page: A9

 
Horoscopes for Aug. 1, 2014

By Holiday Mathis | From Page: A9

.

Entertainment

Week in preview Aug. 1-7, 2014

By Amy Maginnis-Honey | From Page: B1

 
Review: Boseman drips with charisma as James Brown

By The Associated Press | From Page: B2

‘Godfather of Makeup’ Dick Smith dead at 92

By The Associated Press | From Page: B2

 
Starz’ ‘Outlander’ brings novels to life vibrantly

By The Associated Press | From Page: B3

 
Dionne Warwick knows her way to San Jose

By The Associated Press | From Page: B3

Entertainment calendar Aug. 1, 2014

By Susan Hiland | From Page: B4

 
‘Sharknado 2′ whipped up storm of viewers, tweets

By The Associated Press | From Page: B5

TVGrid

By Daily Republic Syndicated Content | From Page: B6

 
.

Sports

Chekwa taking reps with Raiders while Hayden sits

By The Associated Press | From Page: B7 | Gallery

 
Safety Bethea finding a groove with new 49ers team

By The Associated Press | From Page: B7 | Gallery

Expos fall short in 10-9 loss to Leghorns

By Paul Farmer | From Page: B7

 
A’s deal Tommy Milone to Twins for Sam Fuld

By The Associated Press | From Page: B7

A’s get Lester, Gomes from Red Sox for Cespedes

By The Associated Press | From Page: B7 | Gallery

 
Another decent start for Woods at Firestone

By The Associated Press | From Page: B8 | Gallery

Ravens’ Rice: His actions ‘totally inexcusable’

By The Associated Press | From Page: B8

 
Dustin Johnson takes leave of absence from golf

By The Associated Press | From Page: B8

Commonwealth Games athlete convicted for assault on rival

By The Associated Press | From Page: B8

 
Lynch ends holdout, arrives at Seahawks camp

By The Associated Press | From Page: B8

Nick Watney leads PGA Barracuda Championship

By The Associated Press | From Page: B8

 
Rich get richer: Rays’ Price traded to Tigers

By The Associated Press | From Page: B8 | Gallery

Dumdumaya takes third in World Junior/Junior Olympic tourney

By Daily Republic staff | From Page: B8

 
AP Source: Trump advances in Bills sale process

By The Associated Press | From Page: B8

Mudcats get 15-7 win in Auburn Classic

By Daily Republic staff | From Page: B8

 
Phelps to compete in 4 events at US nationals

By The Associated Press | From Page: B8

Signups for Friday, Aug. 1, 2014

By Paul Farmer | From Page: B9

 
Derrick Brooks set standard for NFL linebackers

By The Associated Press | From Page: B9 | Gallery

.

Business

Daimler launches new version of tiny Smart car

By The Associated Press | From Page: C1

 
Iliad of France makes surprise bid for T-Mobile US

By The Associated Press | From Page: B11

In San Francisco real estate, $1M won’t buy much

By The Associated Press | From Page: B11

 
Facebook’s Internet.org expands in Zambia

By The Associated Press | From Page: B11

Debit overdraft fees often exceed cost of purchase

By The Associated Press | From Page: B11

 
Panasonic, Tesla to build big US battery plant

By The Associated Press | From Page: B11

SeaWorld, Southwest Airlines ending partnership

By The Associated Press | From Page: B11

 
Target taps outsider as CEO for needed shakeup

By The Associated Press | From Page: B11

.

Obituaries

Clifford C. Hemler

By Nancy Green | From Page: A4, 1 Comment

 
.

Comics

Baby Blues

By Daily Republic Syndicated Content | From Page: A8

 
Beetle Bailey

By Daily Republic Syndicated Content | From Page: A8

For Better or Worse

By Daily Republic Syndicated Content | From Page: A8

 
Wizard of Id

By Daily Republic Syndicated Content | From Page: A8

Peanuts

By Daily Republic Syndicated Content | From Page: A8

 
Get Fuzzy

By Daily Republic Syndicated Content | From Page: A8

Pickles

By Daily Republic Syndicated Content | From Page: A8

 
Baldo

By Daily Republic Syndicated Content | From Page: A8

Zits

By Daily Republic Syndicated Content | From Page: A8

 
Rose is Rose

By Daily Republic Syndicated Content | From Page: A8

Dilbert

By Daily Republic Syndicated Content | From Page: A8

 
B.C.

By Daily Republic Syndicated Content | From Page: A8

Sally Forth

By Daily Republic Syndicated Content | From Page: A8

 
Garfield

By Daily Republic Syndicated Content | From Page: A8

Frank and Ernest

By Daily Republic Syndicated Content | From Page: A8

 
Blondie

By Daily Republic Syndicated Content | From Page: A8

Bridge

By Daily Republic Syndicated Content | From Page: A9

 
Word Sleuth

By Daily Republic Syndicated Content | From Page: A9

Cryptoquote

By Daily Republic Syndicated Content | From Page: A9

 
Crossword

By Daily Republic Syndicated Content | From Page: A9

Sudoku

By Daily Republic Syndicated Content | From Page: A9