McDonald Pans Proposed VA Governance Board, Says That’s Congress' Job

Veterans Affairs Secretary Bob McDonald on Wednesday pushed back strongly against a recommendation that Congress establish a governance board to shape VA policy and plans, insulate VA leaders from direct politic interaction and ensure that performance measures are met.

"I believe this is the role of this committee and of the Senate Veterans Affairs Committee, working collaboratively with the VA and me," McDonald told the house Veterans Affairs Committee on Wednesday. "All we need to do is have your support and work together."

The 4,000-page assessment cost $68 million, McDonald pointed out, and found many of the same issues and problems that he learned about by visiting facilities and meeting with VA employees and patients across the country after he became VA secretary, he said.

"We're on track with many of the same things [found in the assessment]," he said. "I appreciate the depth of the analysis – I cannot do that myself – but many of these things are already underway and we are seeing the results."

The results include 17 million more completed veteran patient appointments over the last year than before, the addition of nearly 2 million more square feet of VA space, 1,400 new health care providers and more than 3,000 new nurses, he said.

When the assessment was released last month House Veterans Affairs Committee Chairman Rep. Jeff Miller and Sen. Johnny Isakson, who chairs the Senate veterans committee, issued a joint statement saying the findings justified their fears that past problems at VA were "just the tip of the iceberg."

"The VA can no longer deny that its problems, as outlined in this report, are deep-seated and systemic," they said. "From delays in care and scandal cover-ups, to rampant unaccountability and a lack of leadership, the VA is an organization challenged at every level."

McDonald has conceded many of the problems, but said over the past year VA has made progress in the areas the report references.

A part of the assessment McDonald underscored was the "misalignment of [VA] requirements and resources."

He said the health crises that came to light in 2014 was the result a growing demand for VA services that could not be met with the resources it had. Though he did not say so explicitly, McDonald appeared to be referencing the wait-times scandal, in which VA officials and schedulers hid the scope of appointment demand by keeping names on a secret or unauthorized list.

Demand overwhelmed capacity, he said.

He offered the claims backlog as another example, saying VA made progress over in getting it down because it forced employees to work overtime for the past four years.

"This is a classic case where our requirements and the budget we've been given don't match, and we can't have people working mandatory overtime forever," he said.

The independent assessment was drafted after a year-long effort overseen by The MITRE Corp., a not-for-profit that manages federally funded research centers, partnered with RAND Corp. and others.

Richard J. Byrne, senior vice president at MITRE, told lawmakers that panel members visited 87 VA facilities, went through more than 19,000 documents, conducted more than 1,000 interviews, and met with representatives from 10 veterans' organizations and nearly 30 health care associations as part of its work. The assessment was reviewed as well by a "Blue Ribbon" panel made up of 16 private sector health care executives.

Byrne told the lawmakers Wednesday that while many VA facilities were comparable to private sector hospitals and had "pockets of excellence," others have problems, with the result that VA health care facilities "deliver strikingly different patient experiences, apply inconsistent business processes, and differ widely on key measures of performance and efficiency."

In addition to the disconnect in resources and demand that McDonald seized on in his remarks, the assessment also found problems with bureaucracy, inconsistent policies and procedures and leadership and staffing challenges.

The problems are rooted in four areas: governance, operations, data tools and leadership, he said, and will require an "integrated systems approach" successfully transform VA for the long run.

In addition to setting up a governance committee to oversee VA, the assessment also recommends developing a patient-centered operations model that factor in local autonomy and appropriate standardization; deploying a standardized and common set of data and tools for transparency, learning, and evidence-based decisions; stabilizing, growing and empowering leaders by galvanizing them around clear priorities and ensuring a healthy culture of collaboration, ownership and accountability.

-- Bryant Jordan can be reached at bryant.jordan@military.com