Rao bulletin 1 December 2015 html edition this bulletin contains the following articles
VA Health Care Enrollment Update 05
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- VA Vet Choice Program Update 25 ► New VCP Proposal
- VA Pharmacy Update 05 ► 2016 Copay | No Increase
- VAMC Albany NY ► Director Placed on Administrative Leave
- Albany Stratton VA Medical Center Albany, NY
- VAMC Washington DC Update 01 ► Home Care Wait Times
- Washington DC VA Medical Center ********************************* VAMC Richmond VA Update 01 ► OSHA Unsafe Workplace Notices
VA Health Care Enrollment Update 05 ► 30K Post-9/11 Combat Vets Denied Nearly 30,000 post-9/11 combat veterans – some of whom have been waiting for years – are still without Department of Veterans Affairs health benefits due to a technicality more than three months after a whistleblower brought the issue to light. VA officials apologized but say they do not have the authority to automatically enroll the veterans, even though they filled out the proper paperwork and are guaranteed at least five years of enhanced care by law. At issue is an optional means test, which the veterans in question did not fill out. The free care they are guaranteed by a 2008 law does not require them to fill out the means test, but without that information, their applications are automatically placed into “pending” status. When VA program specialist Scott Davis first reported the issue in August, 35,000 combat veterans were on the pending list, half of whom had waited five years or more to be enrolled. The VA did not start reaching out to the veterans until Davis publically reported the problem, and now says there are about 29,000 Iraq and Afghanistan veterans in pending status. Benita Miller, director of the VA’s Health Eligibility Center, said the VA had enrolled 9,000 servicemembers since August. (Roughly 3,000 new veterans applied in that time.) Miller said her office is continuing to reach out to veterans by telephone and by mail. The department has apologized for the problem but also said the system is working as designed and that the vets need to specifically opt out of the means test to move forward, to show that they accept the potential of co-pays. VA Secretary Bob McDonald has repeated the assertion that he does not have the authority to change a veteran’s enrollment status. Davis, who handles the enrollment applications, refutes the VA claim that the department cannot automatically enroll the veterans and says they have in fact done just that in the past. “Those combat veterans are clearly applying for health care; we have always just enrolled the people without asking questions,” he said. McDonald “has a moral, legal and ethical responsibility to enroll these veterans.” When asked by a Stars and Stripes reporter whether VA lawyers had specifically given guidance that the department could not enroll the veterans, Miller demurred. “We didn’t have the guidance to make an agreement to enroll them in VA health care,” she said in a phone interview with Stars and Stripes. The House Committee on Veterans Affairs requested that the VA provide information by 13 NOV about the combat veterans on the pending list, including the list of veterans who may have died while their enrollments were still pending, but they did not receive the information, according to a committee official. “The law hasn’t required a means test from recent combat veterans since 2008, yet VA still hasn’t come up with an efficient way to enroll these veterans in its health care system without one,” committee Chairman Rep. Jeff Miller said in a statement. “This is either blatant incompetence or cold-hearted indifference.” Benita Miller said her team was still compiling the data and did not have statistics on the number of veterans who may have died while awaiting enrollment. Davis said VA’s reluctance to automatically enroll the veterans could be about potentially being responsible for tens of millions of dollars in compensation owed to veterans for the delayed benefits. VA officials would not comment on what kind of compensation, if any, veterans might be owed. If you believe you might be one of the combat veterans affected, you can call 877-222-8387 or visit the VA's Health Benefits page www.va.gov/HEALTHBENEFITS/apply. [Source: VVA Web Weekly | November 19, 2015 ++] ******************************** VA Vet Choice Program Update 25 ► New VCP Proposal Acknowledging that the Veterans Affairs Department's private health care referral system is "too complicated” and “saddled with a confusing array of authorizations and mechanisms,” VA officials pressed lawmakers 18 NOV to consider streamlining several programs into a single initiative designed to improve veterans access to medical services. The ambitious plan would combine seven VA community health care programs, including the newest and largest, VA Choice, into a New Veterans Choice Program, with clearer eligibility rules, improved access to care and faster payments to participating providers. Deputy VA Secretary Sloan Gibson told members of the House Veterans' Affairs Committee that the move is necessary to create the "Choice program of tomorrow." “Consolidation will improve access and make the process easier for veterans to use," Gibson said. "Veterans will have better access to the best care outside VA, providers will be encouraged to participate and to provide higher-quality care, and VA employees will be able to serve both better, while also being good stewards of taxpayer funds." VA was required to submit a proposal for merging its community care programs under the Surface Transportation and Veterans Health Care Improvement Act, passed by Congress in July. The requirement is aimed at eliminating duplication in programs and gaps in the referral system for private care through VA. The VA Choice program was rolled out earlier this year to solve problems with veterans waiting weeks or months for appointments and or living at least 40 miles from a VA hospital or clinic. But the department already had a number of smaller private-care agreements and contracts, creating confusion for patients, VA employees and private doctors. The $16 billion VA Choice program also has been beset with problems, ranging from a lack of awareness of the program among VA employees to payment delays to providers to misunderstandings of the benefit among veterans. And since VA Choice was launched, the number of veterans waiting more than 30 days for an appointment actually has grown — to 550,000 from 300,000. Gibson said the longer wait lists are largely the result of "more veterans coming to us for more care.” “Having said that, we complete mental health appointments within three days, primary care, four days, specialty care about six days ... that’s the average," he said. "We are providing a lot of timely access to good care care, but we fail to do that consistently in every instance." Roughly 10 percent of all medical appointments made through the VA are for private care. Under the New VCP program, VA would establish a single set of eligibility criteria for private care; expand access to emergency treatment and urgent care; simplify the referral and authorization system; and improve the claims, billing and reimbursement processes. The health care network under New VCP would be larger as well. The plan calls for VA and other government health care networks to serve as the core for providing health care services and a large external network of commercial and preferred providers to provide both primary care specialty services. VA estimates the cost of the redesign alone would run between $1.2 billion and $2.4 billion over the first three years. VA spent roughly $7 billion per year on commercial health care services before implementing the Choice program, and officials say Choice is likely to cost $6.5 billion per year if allowed to continue as is. The cost estimates do not include the price tag for improved medical records management, which VA officials say will be necessary to support effective care coordination. To implement the plan, VA needs congressional approval of at least 10 legislative bills, including amendments to existing law and some proposals already in the works. Committee members on both sides of the political aisle seemed receptive to the plan, but it may face opposition in the sharply divided House, where conservatives have spoken in favor of increased privatization of VA care, while liberals have voiced support for increasing the size of the VA.
[Source: MilitaryTimes | Patricia Kime, | November 18, 2015 ++] ******************************** VA Pharmacy Update 05 ► 2016 Copay | No Increase Veterans who fill their prescriptions at a Veterans Affairs Department pharmacy will see no increase in co-payments until at least January 2017, according to a new federal rule. Under the new policy published 16 SEP in the Federal Register, VA will extend a freeze on co-payment increases until at least Dec. 31, 2016. Veterans are required to pay a portion of the cost for prescription drugs they receive for non-service-related conditions if their incomes exceed established threshold limits. They pay either $8 or $9 per 30-day prescription, depending on their eligibility status within the VA health system. According to VA, veterans tend to reduce use of their pharmacy benefits when co-payments rise, which leads to not taking their medications as prescribed. Patients also are at greater risk for adverse drug interactions if they fill some of their prescriptions at VA and others at civilian pharmacies, VA officials say. The freeze is designed to continue providing the benefit to veterans at moderate cost. Some veterans are likely to see a co-payment increase after 2016; according to the rule, the freeze extension will give VA time to develop a tiered co-payment structure similar to those of federal agencies, such as the Defense Department's Tricare program, and the commercial sector. [Source: MilitaryTimes | Patricia Kime | September 17, 2015 ++] ******************************** VAMC Albany NY ► Director Placed on Administrative Leave The sudden removal of Linda W. Weiss, who was placed on administrative leave in early NOV from her job as director of the Stratton Veterans Affairs Medical Center, has renewed focus on the region's central veterans hospital and its history of troubles. Hospital officials credit Weiss with steering Stratton VA to become one of the most efficient veterans hospitals in the nation. She was appointed director in 2010, a year after the end of a decade-long scandal in which the hospital's former drug research director, Dr. James A. Holland, and a former program coordinator, Paul H. Kornak, were convicted of federal crimes that accused them of pushing patients into research programs and hastening the death of one veteran. Current and former employees at Stratton VA contend that Weiss' rigid management style and unchecked patient care issues may have contributed to her removal. There have also been serious misconduct cases involving employees. In the last year, two male nurses at Stratton were accused in separate incidents of stealing and using powerful drugs intended for patients. One of them was charged with federal crimes, and the second nurse, who was found incoherent with a used syringe nearby, was let go from his job but not charged criminally even though it was the second incident involving his illicit drug use. Another nurse remained on duty despite complaints from co-workers that he was sleeping on duty, including in the bed of a patient who had died the night before. Also, a former nurse alleges that patients in a geriatric unit with "treatable" conditions were instead being given morphine, hastening their deaths. A hospital spokesperson denied the allegation.   
Linda W. Weiss (left) fields question about the health care facility during a town hall meeting Sept. 10, 2014 and Keil McCarran, a licensed practical nurse at Stratton VA Hospital, allegedly sleeping on duty Weiss, 62, has worked for the Department of Veterans Affairs for more than 40 years and was appointed director at Stratton, the region's central veterans hospital, in September 2010. Weiss was served with undisclosed administrative charges 9 NOV and, under federal rules, has five business days to file any formal rebuttal. The VA has declined to disclose what led Weiss to be removed from her $165,000-a-year position, and a congressional veterans oversight committee in Washington, D.C., also has not been informed of the details, people close to the matter said. In a brief telephone interview last week, Weiss declined to discuss her case or say what led to her removal. "You know the VA and us well enough to know we never comment on certain matters," she said. "Since I'm on administrative duty, but I am currently an employee of the Department of Veterans Affairs, there's certain things that we never comment on." As the case against Weiss lingers, numerous employees who spoke to the Times Union last week outlined the problems they say have plagued the hospital. Alema Stewart, a licensed practical nurse, said she was fired recently from her job at Stratton VA Hospital because she was late to work multiple times last summer while caring for her grandmother, who has cancer. Stewart said she informed hospital supervisors of her situation, but they were not sympathetic. Stewart said supervisors targeted her for termination, but did nothing when another nurse was caught in May sleeping in the bed of a patient who died the night before. The 23-year-old male nurse, Stewart said, was reported sleeping on duty multiple times. She even gave a supervisor photos of him sleeping in a patient's bed more than six months ago. On 27 OCT, Stewart said, the young nurse fell asleep in a chair at a work station and other nurses had to call a supervisor when they were unable to wake him. The nurse, Keil McCarran, could not be reached for comment. Peter Potter, a hospital spokesperson, said he is limited by federal law in discussing McCarran's case, but he said an employment action was recently initiated. "We would never allow a staffer to sleep in a patient's bed," Potter said. "The only thing that would come close is if we had a crisis situation ... a snowstorm for instance. ... (But) that would not be allowed, not in this place, and I wouldn't expect it to be allowed in any VA." When the Times Union followed up with details on the sleeping allegations, including the fact the first allegation was filed in May, Potter clarified his statements. "If he was laying in a patient's bed, would you get fired for that? Probably not. But it certainly wouldn't be a happy time," he said. Stewart, who worked with McCarran on the hospital's geriatric unit, also alleges that elderly veterans with "treatable" conditions were given morphine and other drugs that may have suppressed their respiratory function and possibly hastened their deaths. "There were patients with treatable illnesses and (a nursing supervisor) and doctor talked the family out of getting care and put them on comfort care but they had treatable illnesses," Stewart alleged. "The thing about it is everybody is aware but nobody wants to say anything. ... One gentleman had a scratch on his big toe and instead of treating with antibiotic, they never gave him an antibiotic and told (us) not to send him to the ER and monitor him only. They put him in a room, and once they put you in this one room with the soft music it was only a matter of time." Potter said the allegations leveled by Stewart were not reported to hospital supervisors. "That has not been something that's been an issue here and is not something that's been reported," he said. Two other Stratton VA employees, who spoke on the condition they not be identified because they fear retaliation, described Weiss as an unforgiving administrator who they said is driven by her desire to climb the ladder and cut expenditures. One of the employees said that her supervisor sends her emails that cannot be printed or forwarded, and that she believes it's done to prevent her from documenting what she characterized as harassment and unfair treatment. She said the rough treatment of many employees was fallout of the management style of Weiss. "It's her way or the door and supervisors are afraid of her," the employee said. But Potter credited Weiss with keeping the Stratton VA facility rated as one of the top and most efficient veterans hospitals in the nation. He noted that the two nurses accused of stealing patient drugs were both reported to the VA's Inspector General and the U.S. Attorney's office by Weiss. He also disputed allegations by several employees that Weiss has been targeted in a high number of unfair-labor complaints. "We've been able to keep our costs down under Linda's direction," Potter said. 
Albany Stratton VA Medical Center Albany, NY In a follow-up statement, Potter defended the hospital's operations. "While we cannot comment on the current situation regarding Linda Weiss at this time, we can comment on the Albany Stratton VA Medical Center, the 1,300 fine men and women who make up our staff and leadership team and their continued commitment exhibited in service to our veterans," he said. "Over the past several years, the Albany VA has risen in our quality standing among VAs nationwide." [Source: Albany Timesunion | Brendan J. Lyons | November 15, 2015 ++] ********************************* VAMC Washington DC Update 01 ► Home Care Wait Times The Department of Veterans Affairs' home and community-based services were so delayed in the Washington, D.C. area that wait times lasted more than a year, for some vets, the agency's inspector general found. One veteran died before receiving the care he requested, according to the IG report No. 14-03823-19 which can be downloaded at http://www.va.gov/oig/pubs/VAOIG-14-03823-19.pdf. Sen. Barbara Mikulski (D-MD) requested the audit, which examined the effect of the increase in the program's services, from $1.3 million for 148 patients in 2010 to $6.7 million for 573 patients in 2014. The sharp rise quickly overwhelmed staff. As the number of patients on wait lists grew significantly at the D.C. facility, the report said a "[Veterans Integrated Service Network] staff member we interviewed shared the opinion that leadership at the facilities felt pressure to work within their budgets even though they could request more money." The VA eliminated the wait list by February 2015, after adding $2 million to the program in June 2014, the report said. VA is also dealing with the problem on a national scale as well. As of March 31, 2015, more than 2,500 patients were on electronic wait lists to get home care. In July 2014, Mikulski's office was alerted of a complaint that a veteran was referred to home care, but remained on a wait list until he died in April 2014. The patient, who was referred to home care in October 2013, was in his 70s and had a series of strokes beginning in August 2013. VA policy places home care priority on veterans with service-connected disabilities. Because the patient's condition did not meet a 50 percent threshold for a service-connected disability, he was placed on an electronic wait list. The inspector general offered three recommendations, including requiring facilities to develop action plans for further address the care needs of patients on electronic wait lists, as well as ensuring compliance and oversight. VA officials concurred with the recommendations and said it had addressed the issues highlighted and would have action plans in place by April 2016. [Source: FederalTimes | Carten Cordell | November 16, 2015++] 
Washington DC VA Medical Center ********************************* VAMC Richmond VA Update 01 ► OSHA Unsafe Workplace Notices The Occupational Safety and Health Administration (OSHA) has issued notices to the Hunter Holmes McGuire VA Medical Center for exposing workers to an unsafe workplace. OSHA says they identified "four willful, two serious, and eight other-than-serious safety violations" in a 20 page report labeling unsafe or unhealthful working conditions. Some of the violations include failure to provide safety and health training for supervisory employees. OSHA says the agency head, did not furnish a place of employment that was free from recognized hazards that caused or were likely to cause death or serious physical harm. The report says the agency did not record each work related fatality, injury or illness case as required by OSHA. The particular violation goes on to list numerous times when nurses and employees suffered injuries while working with patients but it says they were not recorded. Another violation talks about needle stick injuries and cuts from sharp objects that were contaminated with another person's blood, or other potentially infectious material but were not recorded on OHSA's log. OSHA's investigation started May 6, 2015, which was around the same time fired pharmacist and whistleblower Dr. Andrew Carmichael allegedly made similar complaints about patient safety, including a dirty IV room allegedly afflicted with patient safety problems and allegations of poor record keeping and wasting medical supplies. "The safety hazards identified at this facility demonstrate a need for a renewed commitment by the Department of Veterans Affairs to provide a safe workplace for the VA employees who care for our nation's service members, veterans, their families and survivors,” said Stanley J. Dutko Jr., OSHA's area director in Norfolk. “All employers, including federal employers, are responsible for evaluating and determining the extent to which employees may be exposed to physical assault or other forms of workplace violence and taking the appropriate actions to eliminate or minimize that exposure. Every employer is responsible for ensuring their workplaces are safe and healthy for all employees." This is the sixth inspection for the McGuire VA Medical Center since 1992 - four of those inspections resulted in notices. In 2009, the facility received notices for record keeping deficiencies. The employer has 15 business days from receipt of the notices to comply or request an informal conference with OSHA's area director. This is the third time in recent months that OSHA has issued notices related to workplace violence to a Veterans Affairs medical facility. Both the El Paso VA Health Care System and the Atlanta VA Medical Center were cited earlier this year for exposing employees to workplace violence and other hazards. Nationwide, within the past five years, OSHA says 16 inspections of VA facilities resulted in notices issued for record keeping deficiencies. Three of those were classified as repeat. Go to https://www.osha.gov/ooc/citations/Hunter_Holmes_McGuire_VA_Medical_Center_1060427_1106_15.pdf to view the McGuire notices. [Source: WWBT | Diane Walker | November 17, 2015 ++] 
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