Group Criticizes VA Commission for Failing to Vote on Recommendations

A veterans group is criticizing as inadequate the work of a congressional commission that concluded the Veterans Affairs Department still has "profound deficiencies" in delivering health care.

The Concerned Veterans for America, an Arlington, Virginia-based organization that advocates for greater choice in veteran health care providers, described the panel -- of which it was a part -- as "broken," in part for failing to vote on its own recommendations.

"Basically we … have a broken commission, and because of a broken commission we have a broken report," said Darin Selnick, senior veterans affairs adviser for organization, which hosted a teleconference on Wednesday after the release of the panel's report.

Selnick, who served on the commission, participated in the teleconference with Stewart Hickey, a fellow commissioner and former executive director for AMVETS, and Dan Caldwell, vice president for political action at the Concerned Veterans for America.

The report includes some recommendations that Selnick and Hickey said they could support, such as creating a board of directors to oversee the Veterans Health Administration, eliminating the 30-day and 40-mile restrictions on using the Choice Act for non-VA care, and adopting a BRAC-like system to shut down unneeded VA facilities.

But they panned the overall package as continuing the status quo. They also criticized the commission for not putting each recommendation to a vote -- something that the chairmen of the House and Senate Veterans Affairs committees had wanted -- and for not publishing on the commission's website a letter dissenting from the recommendations.

Selnick specifically accused Nancy Schlichting, the panel's chairwoman, of preventing substantive changes, and commission member Phillip Longman, senior editor of The Washington Monthly, of using his magazine to smear members such as himself for pressing for reforms to give veterans greater private-sector choices.

"[Schlichting] had her own agenda. She felt that veterans were broken, were old, felt veterans couldn't take care of themselves, so the VHA had to be the one to take care of it," he said, referring to the Veterans Health Administration. "She focused and derailed any efforts that went against her perceived support of the status quo and fixing of the existing choice program."

Caldwell, CVA's political action head, slammed "left-wing news outlets and the Washington-based leadership of certain veterans' organizations" for making false claims that some commission members would profit from reforms that would increase private health care options for veterans.

He singled out Longman for a Washington Monthly report that the libertarian billionaires David and Charles Koch were funding his organization and using it to push for privatization of VA health care. The group's ties to the Koch brothers have long been known and reported on.

Military.com was unable to reach Longman for comment, though Schlichting rejected the idea that she or anyone else on the commission steered its recommendations.

"I can't even understand how anyone can come to that conclusion. We had 12 commissioners," she told Military.com. "It was a consensus to create those recommendations.

"It's a very comprehensive," she said of the review. "It's everyone's work. I chaired the commission but I had no more vote than anyone else."

Hickey is a retired Marine Corps officer, former chief executive officer for Hyndman Area Health Center in Pennsylvania and former national head of AMVETS. He blamed organized labor and veterans service organizations -- in particular the Disabled American Veterans -- for influencing the commission in a way that harmed veterans.

"I just felt that during this whole period, we spent more time listening to the government employee union, [and] veterans service organizations, who represent five or six million veterans out of 22 or 23 million veterans … and they had undue influence over the results that were achieved," he said.

Hickey said he would like to have seen the commission recommend VA health care administered by a non-profit government corporation and run like Amtrak or the U.S. Postal Service, "where we're not getting politics into the mix.

"But once again lobbyists -- which for veterans are the VSOs in DC, worked with some of the commission members and tried to thwart the efforts of those who wanted to see really VA reform," he added.

Two of the leading veteran service organizations -- the Veterans of Foreign Wars and the Disabled American Veterans -- were by and large supportive of the recommendations. But they also had concerns about some of them.

Both organizations said they had reservations about a board of directors overseeing Veterans Health Administration. The Disabled American Veterans said the board would be less answerable to the president than a VA secretary, who is a political appointee and cabinet officer.

Garry Augustine, DAV’s executive director, dismissed Hickey’s talk of VSO influence as sour grapes.

“As far as our influence on the commission, it’s nice to give us the credit but they’re just frustrated they didn’t get what they wanted,” he said.

Concerned Veterans of America has been viewed skeptically by some of the longtime veterans' organizations for some time, though any ill feelings that veterans service organizations had for the Koch-linked group were kept below the surface until recently. Last month, the American Legion -- without identifying Concerned Veterans for America by name -- called it a "mouthpiece" for special interests looking to privatize VA health care.

In all, the commission's final report makes 18 recommendations. Among these:

• VHA should use local expertise to establish high-performing, integrated community-based health care systems across the county;
• Enhance clinical operations with more effective use of providers and other health care professionals, and with improved data collection and management;
• Develop an appeals process that provides protections to veterans at least comparable to those afforded patients in other federally-supported programs;
• Adopt a methodology for continuous improvement to support VHA transformation and consolidate continuous improvement and best practices under the Veterans Engineering Resource Center;
• Eliminate disparities in health care among veterans treated in the VHA system by committing adequate personnel and funding to eliminate the causes of the problems creating the disparity, and ensuring that the VHA Health Equity Action Plan is fully implemented;
• Develop and implement a robust strategy for meeting and managing VHA's facility and capital-asset needs, including a program -- to be established by Congress -- enabling the VA to close down properties it determines are no longer needed;
• Modernize VA's information technology systems and infrastructure to improve veterans' health and well-being and provide the foundation needed to transform VHA's clinical and business processes;
• Transform the management of the supply chain in VHA;
• Establish a board of directors to provide overall VHA care system governance, set long-term strategy, and direct and oversee the transformation process;
• Require leaders at all levels of the organization to champion a focused, clear, benchmarked strategy to transform VHA culture and sustain staff engagement;
• Rebuild a system for leadership succession based on a benchmarked health care competency model that is consistently applied to recruitment, development, and advancement within the leadership pipeline;
• Transform organizational structures and management processes to ensure adherence to national VHA standards while also promoting decision making at the lowest level of the organization, eliminating waste and redundancy, promoting innovation, and fostering the spread of best practices;
• Streamline and focus VHA organizational performance measurement using core metrics identical to those used in the private sector, and establish a personnel performance management system for VHA health care leaders that is distinct from performance measurement, is based on the leadership competency model, assesses leadership ability, and measures the achievement of important organizational strategies;
• Foster cultural and military competence among all VHA care system leadership, providers, and staff to embrace diversity, promote cultural sensitivity, and improve veteran health outcomes;
• Create a simple-to-administer alternative personnel system, in law and regulation, governing all VHA employees, applies best practices from the private sector to human capital management, and supports pay and benefits that are competitive with the private sector;
• Require VA and VHA executives to lead the transformation of human resources, commit funds and assign expert resources to achieve an effective human capital management system;
• Provide a streamlined path to eligibility for health care for those with an other-than-honorable discharge who have substantial honorable service; and
• Establish an expert body to develop recommendations for VA care eligibility and benefit design.

Editor's note: This story has been updated to correct the attribution in the seventh paragraph and the quote in the 15th paragraph.

-- Bryant Jordan can be reached at Bryant.jordan@military.com. Follow him on Twitter at@BryantJordan.