Rao bulletin 1 October 2016 html edition this bulletin contains the following articles pg Article Subject
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- VA Health Care Enrollment Update 09 ► Investigation Requested
- VA Surgery ► Death/Complication Incidents Decrease
- GI Bill Update 209 ► ITT Closure | Vet Recoupment Legislation
- VAMC Aurora CO Update 18 ► Did VA Lie to Congress About Cost
- VAMC Aurora CO Update 19 ► VA Responds to Subpoena
- VAMC Northport NY ► Fraud Abuse Charges
- Anthony J. Cox
VA Careers Update 01 ► Check Out Their Benefits VA employees have access to a range of benefits, all intended to cater to individual needs and ambitions. VA's mission is to deliver quality care to our Veterans, and we know that strong encouragement and support toward their employees is vital to the success of that mission. From personal to financial support, VA places a high priority on their staff’s happiness. Among some of the benefits, VA employees have access to comprehensive education programs, competitive pay and abundant health care coverage, as well as liability coverage for health care providers. Not to mention a collaborative, friendly environment where teams rely on each other’s expertise in order to make important decisions regarding our patients’ health. Above all, the most rewarding benefit is the chance to give back to our Veterans. Take a look at how a career at VA has benefited their employees and how it could benefit you by clicking on the following links: VA education benefits AAPA accreditation: continuing education opportunities at VA 3 programs paid for by VA VA ensures employees are covered with robust liability benefits 4 reasons to become a VHA physician – Dr. Matt Taking care of our heroes 20 reasons why VHA doctors love their job 5 reasons to drop everything and apply for a VHA OT job Make a difference while traveling the world Work-life balance Create positive experiences as a VHA dentist Travel nurse benefits What’s so good about being a physician at VHA More than a “best place to work” ranking [Source: VAntage Point | September 19, 2016 ++] ***************************** VA Health Care Enrollment Update 09 ► Investigation Requested Minnesota's 1st District Congressman Tim Walz sent a letter to the U.S. Dept. of Veterans Affairs today asking for answers to issues raised in a local EYEWITNESS NEWS investigation highlighting problems with the veterans’ benefits system. A VA Office of Inspector General Report to Congress earlier this year, highlighted 14 cases where benefits fell into the wrong hands, totaling $988,888 including ones that went to non-veterans. The letter highlights the problem why do we have people who exit the military, and then go through a whole new process of re verifying them, that's where the system broke down in this. The OIG report mentioned a woman who claimed to have fought in Afghanistan; investigators later discovered she was incarcerated during the same period she claimed to have served. The 24 year-veteran, Rep. Walz, asked for the VA to explain to him the procedures in place to verify a claimant’s eligibility for benefits, and what the agency does to recoup any fraudulent payments. Walz is pushing to have military records sent electronically when a solider enlists right to the VA, so that later, they don’t have to submit paperwork to prove their veteran status. The committee Walz sits on, the House Veterans Affairs Committee, also asked the VA for answers to how they vet applicants in light of the 5 EYEWITNESS NEWS Investigation. At last check, The VA has yet to respond to the Committee of Veterans Affairs questions. “Tax payers willingly pay their tax dollars to take care of our veterans, but they expect them to be spent well," said Rep. Walz. The St. Paul regional benefits office for the VA couldn’t comment on a specific case but said in a statement, "Veteran service is verified through a variety of means and is always reviewed on a case-by-case basis." [Source: ABC 5 Eyewitness News | September 23, 2016++] ***************************** VA Surgery ► Death/Complication Incidents Decrease Surgery patients in Veterans Affairs (VA) hospitals are much less likely to die or suffer postoperative complications today than they were 15 years ago, a U.S. study suggests. Researchers examined data on more than 700,000 mostly male patients who had surgery at 143 VA hospitals nationwide from 1999 through 2014. The proportion of patients who had major complications dropped from 10 percent to 7 percent during the study period. Among patients who did have major complications, the proportion that died as a result declined from 24 percent to 15 percent. “Our data in many ways mirror trends that we find in the private sector as well,” said lead study author Dr. Nader Massarweh, a researcher at Baylor College of Medicine and the Michael E. DeBakey VA Medical Center in Houston. “Some of what we are seeing is probably the end result of underlying trends that have been occurring over time across all of healthcare relating to our ability to simply provide better care,” Massarweh added by email. At the VA in particular, surgical care may have also improved as a result of a quality initiative started in the 1990s to track surgical outcomes, identify problems and evaluate fixes, Massarweh said. One focus of this effort was to minimize the potential for patients to die after complications develop following surgery, a situation known in the healthcare industry as “failure to rescue.” This might happen, for example, when a patient undergoes a colon operation, develops pneumonia after surgery, ends up in the intensive care unit on a ventilator and then dies, Massarweh said. “Our goal is to minimize the number of patients who experience complications and in those who do to treat them as quickly and definitively as possible,” Massarweh said. “This is one of the reasons failure to rescue has gained traction as measure of quality – it acknowledges that complications do occur, but that timely recognition and treatment are really the things we can control to minimize their impact on patients.” To assess how quality improvement efforts have influenced surgical outcomes at the VA, researchers analyzed data on patients having inpatient surgery or operations for vascular, spinal, orthopedic, neurological, thoracic, genital or urinary issues. They excluded cardiac surgeries from the analysis. Overall, patients were about 64 years old on average and 96 percent were men. During the entire study period, almost 98,000 patients (14 percent) had complications after surgery, and failure to rescue occurred for about 13,000 of them. Roughly 67,000 patients (9.5 percent) had major complications during the study, and failure to rescue happened in about 12,000 cases. The odds of postoperative death or failure to rescue were about 40 to 50 percent lower by the end of the study than at the start, researchers report in JAMA Surgery. Limitations of the study include the lack of a comparison group of hospitals that didn’t implement the VA’s quality control initiative because it was done systemwide, the authors note. The findings also don’t prove what caused any improvements in outcomes. Researchers also lacked data on surgical volume, which can influence the outcome of quality improvement efforts because surgeons are thought to be better at procedures they do more frequently, the authors note. The study doesn’t examine access to care issues including long waits for appointments that have been raised at the VA in recent years. “I think we have to separate out access and quality of care as the current paper does not specifically address surgical access,” said Dr. Jason Johanning, cao-author of an accompanying editorial and researcher at the Nebraska Western Iowa VA Health System in Omaha. “The paper does confirm once again that VA surgical outcomes are comparable to private sector data and that the VA’s quality reporting which has been adopted and replicated in the private sector can provide a robust look at the quality of surgical programs in the nation’s largest integrated healthcare system,” Johanning said by email. [Source: Reuters Health News | Lisa Rapaport | September 22, 2016 ++] ***************************** GI Bill Update 209 ► ITT Closure | Vet Recoupment Legislation An Indiana Republican wants to fast-track a solution to what he calls a "crisis" of veterans losing their education benefits to the collapse of ITT Technical Institute. U.S. Rep. Luke Messer, of Shelbyville, on 13 SEP filed a bill that would let veterans who were attending ITT recoup their Post-9/11 GI Bill benefits and reapply them to future coursework. Messer hopes to attach his solution, titled the Protecting Our Veterans From School Closures Act, to a late-year fiscal bill. "Our goal is to get something passed by year end," Messer said. "Obviously, this puts us on a very tight timeline. This is a crisis that has emerged in the last couple weeks." Passing his proposal as a standalone bill likely would take until next year, Messer said. He called that unacceptable in the wake of ITT's closure, which wasted the military education benefits of thousands of veterans. The Post-9/11 GI Bill gives veterans 36 months of college tuition, plus expenses, to attend the school of their choice. Unlike the federal student loan program, though, it makes no accommodation for students who are enrolled in a school that goes out of business. When Carmel-based ITT Educational Services Inc. announced Sept. 6 that it was closing all of its campuses, the company essentially stranded veterans who had attended classes there without completing their programs. Most colleges and universities don't accept ITT's transfer credits, leaving many veterans with two choices: Start a new program with a reduced pot of GI Bill money, or not return to school. Messer's bill would allow veterans to restore their GI Bill money to attend a new school. Five other Indiana Republicans signed on as co-sponsors: Reps. Susan Brooks, Todd Young, Todd Rokita, Jackie Walorski and Larry Bucshon. Messer is seeking additional co-sponsors. Indiana's congressional Democrats, Reps. Andre Carson, of Indianapolis, and Pete Visclosky, of Merrillville, could not be reached for comment. Several advocacy groups have called for such a policy in recent months. But Washington, D.C.-based Student Veterans of America found little urgency among lawmakers before ITT collapsed under government sanctions. ITT's closure represents what experts say is the largest loss of military education benefits ever caused by a defunct school. When Corinthian Colleges closed last year, only 450 veterans were attending at the time. There were 6,842 GI Bill recipients enrolled at ITT when it closed, according to the U.S. Department of Veterans Affairs. "I would say something of (ITT's) scale is unprecedented," Derek Fronabarger, the policy director for Student Veterans of America, told IndyStar earlier this month. Jim Brown, director of the Indiana Department of Veterans Affairs, said such legislation is necessary. He lamented that ITT and even government agencies were "allowed to string our veterans along rather than informing them" about ITT's troubles in the months leading up to its closure. Messer's bill would apply to veterans who were attending ITT when it closed, as well as aid veterans in the event of future school closings. Early analysis suggests it would cost $40 million to $50 million to restore GI Bill benefits to former ITT students, Messer said. Aside from people who self-fund their education or take out private loans, veterans are the least protected students from failing schools. The U.S. Department of Education has said active ITT students likely will get their federal loans forgiven. Even ITT graduates and dropouts can file claims to get their loans discharged, though acceptance is not guaranteed. "We say of veterans who haven't completed a degree yet, they would get a second bite at the apple," Messer said. [Source: INDY Star | James Briggs | September 13, 2016 ++] ***************************** VAMC Aurora CO Update 18 ► Did VA Lie to Congress About Cost? A bipartisan group of lawmakers formally asked the U.S. Justice Department 22 SEP to investigate whether Veterans Affairs Department executives lied to Congress to conceal massive cost overruns at a Denver-area hospital. Twelve Republicans and nine Democrats on the House Veterans Affairs Committee made the request in a letter to Attorney General Loretta Lynch. “It is an absolute fact that numerous VA officials repeatedly misled Congress regarding cost overruns related to the replacement Denver VA medical center,” committee chairman Rep. Jeff Miller, R-Florida, said as he announced the request. The letter asks for an investigation into statements by Glenn Haggstrom, formerly the department’s top official in charge of construction projects, and Stella Fiotes, director of the VA’s Office of Construction and Facilities Management. No one answered a call to Haggstrom’s home Thursday. Fiotes didn’t immediately return a phone message. VA officials declined to comment on the lawmakers’ letter. Officials at the Justice Department didn’t immediately respond to a request for comment. [Source: Associated Press | Dan Elliott | September 22, 2016 ++] ***************************** VAMC Aurora CO Update 19 ► VA Responds to Subpoena The Veterans Affairs Department turned over documents to Congress on Wednesday in response to a subpoena demanding information about how the cost of a Denver-area VA hospital soared more than $1 billion over budget. VA spokeswoman Linda West said the department gave the House Veterans Affairs Committee some of the documents that lawmakers wanted and that more were on the way. "VA intends to fully comply with the subpoena and continue providing additional materials on a rolling basis," she said. The subpoena, issued three weeks ago, sought documents the VA had gathered during an internal investigation into why a hospital under construction in the Denver suburb of Aurora is projected to cost nearly $1.7 billion, almost triple the earlier estimates. The subpoena also sought documents related to millions of dollars spent on artwork and ornamental furnishings at VA offices nationwide, including more than $6.4 million spent on the Palo Alto, California, health care system. Wednesday, 27 SEP, was the deadline for the VA to comply with the subpoena. Earlier in the day, committee member Mike Coffman (R-CO) said the department had failed to turn over any documents, but about 30 minutes later, he said the VA gave the committee the documents on CD shortly after 5 p.m. Washington time. Congress has repeatedly asked to see a detailed account of the Denver investigation, but the department had previously provided only a summary to the Veterans Affairs Committee. VA Deputy Secretary Sloan Gibson had said releasing details of the investigation would have a chilling effect on similar internal investigations in the future. Coffman and others rejected that argument. A separate investigation by the VA's internal watchdog, released last week, said a former high-ranking VA official knew the hospital was veering toward huge cost overruns but didn't tell Congress when he was called to testify about the price on two occasions. That prompted 21 members of the committee from both parties to formally ask the Justice Department to launch a perjury investigation. The department hasn't said whether it will. [Source: Associated Press Denver | Dan Elliott| September 28, 2016 ++] ***************************** VAMC Northport NY ► Fraud & Abuse Charges Along the winding drive through the 300-acre compound of Long Island’s only veterans’ medical center, banners line the road stating the presumed values of the institution: integrity, commitment, advocacy, respect and excellence. But in recent months, a series of troubling failings and allegations of wrongdoing have called into question the care being provided to thousands of the nation’s military personnel by the Northport Veterans Affairs Medical Center, in Northport, N.Y., with charges of abuse that include widespread billing fraud and the failure to report the death of a patient for months after his body was found in a building on the complex. The problems plaguing the medical center first drew attention after all five of the hospital’s operating rooms were shut down in mid-February, because sand-grain-size black particles had begun falling from the air ducts. Veterans in need of surgery had to go to other hospitals for care, often leading to further delays in their treatment or postponed operations. Representative Lee M. Zeldin, a Republican who represents the First District on Long Island and is a member of the House Veterans’ Affairs Committee, then collected information from whistle-blowers and others and turned it over to the committee, which was scheduled to hold a public hearing at the medical center on 21 SEP. The problems at Northport come two years after whistle-blowers revealed widespread dysfunction and corruption at a V.A. hospital in Phoenix, where it was reported that veterans were dying while waiting for care. It soon emerged that there were systemic problems at medical centers operated by the Department of Veterans Affairs around the country. Despite calls from the White House for the department to be “restructured and reformed,” two years later problems remain and the topic has become fodder for the presidential campaign. At Northport, the failure to properly maintain the operating room facilities may be the least of the issues that the congressional committee will take on. Hospital officials, including the facility’s director, Philip Moschitta, have been called to testify. According to a person familiar with the investigation, who was not authorized to speak and requested anonymity, they will also be asked about allegations of widespread fraud, including the collection of thousands of dollars in fees to care for veterans who were never actually treated. According to internal emails, and current and former employees familiar with the alleged scheme who spoke on the condition of anonymity because they feared retaliation, nurses were directed to make cold calls to veterans and then code those calls to look as though they had been solicited by the patient, not the practitioner, in order to enhance revenue. One former hospital employee likened the practice to your private physician calling you out of the blue to check up on you, then billing your insurance company for the call. The former employee, who asked to speak anonymously to avoid reprisal, said the practice was a means of padding the numbers. The goal of the calls, according to the internal emails, was to contact around 2,000 veterans and thus raise enough money by the end of the current fiscal year, 30 SEP, to patch a large hole in the hospital’s growing deficit, of more than $11 million. In all, the calls apparently generated roughly $1 million in payments for more than 200 veterans, according to the emails. A number of the nurses directed to make those calls appeared concerned about the activities, and a package of their email correspondence was turned over to the House Veterans Affairs’ Subcommittee on Oversight and Investigations. A copy was obtained independently by The Times. Instead of receiving overtime pay for the hours spent logging calls, which might have raised suspicions, the nurses earned comp time, according to the emails. One nurse wrote that the veterans were being used as “cash cows,” which the hospital administration wanted “to milk for $9 million.” The worth of each veteran in the scheme: $4,285.71. “Lots of questions that make me a little uneasy,” one nurse wrote. “What would be the best place to get accurate information on whether this is an ethical move?” Another email complained about the workload. “I also find it unfair to expect this amount of work on already overburdened nurses,” it said. A response read, “Notice how management is tracking the R.N.s and tallying their calls. This will no doubt be used to retaliate — keep track of that. Notice how only comp time is being issued vs overtime to hide any $ going to support said telephone encounter billing fraud.” At another point the same nurse was even more blunt. “I would advise against engaging in this telephone billing fraud,” the nurse wrote. “Nothing has been put it writing and no written guidance/instructions have been disseminated to obfuscate the fraud.” Some of the nurses, on the other hand, boasted of their activities at a meeting of clinical service directors, proudly proclaiming the efforts to re-engage 2,000 patients and bring them back to Northport. When asked who had authorized the efforts, Walinda West, deputy director for media relations at the Department of Veterans Affairs, said only that it was a recommended practice for primary care teams “to follow up with patients who are due for care, or who have preventive care needs.” But according to the emails from the nurses, management was asking “clinical staff to make phone calls that count as appointments with NEW patients, to increase access.” The committee is also looking into the circumstances surrounding the suicide of a veteran, Peter A. Kaisen, 76, in a Northport parking lot on 21 AUG, and why the death in March of Anthony J. Cox, 51, a veteran who was working at Northport and enrolled in a drug rehabilitation program, was not reported even though his body was found on the campus. The circumstances surrounding Mr. Cox’s death and the discovery of his body remain murky. The autopsy report, obtained by The Times, said he had died of a fentanyl compound overdose; fentanyl is a synthetic opioid more powerful than heroin and, according to a recent government report, is responsible for an increasing number of overdose deaths in New York and across the country. According to the police report, Mr. Cox stopped responding to phone calls on a Friday; his body was discovered on a Monday morning. When Mr. Cox’s mother, Judith Wood, 77, a retired nurse and a United States Air Force veteran, arrived from South Carolina to claim her son’s body and learn what had happened, she said she was met with systemic silence at the Northport campus. “No one would tell me anything,” Mrs. Wood said. “I was not allowed to go where he lived; we kept getting the runaround. Everyone shut us down. There’s something screwy about that place.” 
Anthony J. Cox The death of Mr. Cox was never formally announced by the medical center, and it was not reported to the group that accredits and certifies health care organizations, or to local congressional offices as what is known as a sentinel event, an unanticipated death or serious injury. For two months after Mr. Cox was found dead, the medical staff continued to make notes on his chart as if he were alive. “Patient will see me on 5-23. Patient was a no-show. No testosterone will be filled unless he follows us in the clinic,” one clinician wrote in Mr. Cox’s electronic medical records, which The Times obtained from his family. Other notes indicated that offices at Northport had made calls to Mr. Cox. A spokesman for the Northport medical center declined to comment, and said in an email statement that “we look forward to participating in the 21 SEP hearing and providing the committee with information about the high-quality care provided at this facility.” Representative Zeldin expressed frustration with the Department of Veterans Affairs, which he said was “stonewalling congressional efforts to investigate.” In July, congressional investigators submitted questions for Mr. Moschitta, the medical center’s director, but have received no response. Representative Jeff Miller, Republican of Florida and chairman of the House Veterans’ Affairs Committee who will lead the hearing, said in a statement that “with or without the Northport V.A.’s cooperation, we will continue working closely” with Mr. Zeldin’s office “to investigate this matter until all the facts are at hand.” [Source: New York times | Kristina Rebelo & Marc Santora | September 19, 2016++] 
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