VA: “The problem is that the buck never stops.”

VA-veterans-affairsCrap performance is not a novel thing to the VA, something new that came in with President Obama and former Secretary Shinseki. According to the Wall Street Journal in an article called The VA’s Bonus Culture (use the google backdoor through the paywall if you’re not a subscriber),  the VA has blown off 18 previous reports of scheduling abuse and bonus fraud:

The IG’s recommendations to fix such scheduling “deficiencies” have all been ignored, so don’t expect the 19th report to be the charm.

No such expectation at this address. There is a pervasive culture of pay for piss poor performance. “Throwing more money at the VA would clearly reward failure,” the Journal writes: it’s symptomatic of “a larger dysfunction… To wit, a lack of any market or performance accountability.”

The examples are legion; this is a subset of them:

Bonuses for poor performance appear to be common. The Dayton Daily News reported that in 2010 former Dayton VA Medical Center Director Guy Richardson was awarded $11,874 in performance pay notwithstanding an IG probe that confirmed a dentist had failed to change his latex gloves and sterilize instruments over a span of 18 years. The dental clinic closed for several weeks in August 2010, but patients were only warned about their potential exposure to infectious diseases six months later. In 2011 Mr. Richardson was elevated to Regional Deputy Network Director in Maryland.

Local media have reported that former Pittsburgh VA executive Terry Wolf received a $12,924 bonus in 2011 amid a Legionella outbreak that sickened 21 veterans and killed six. Ms. Wolf ignored the outbreak in her own performance review, hailing the construction of a $38.2 million facility with “innovative extras” like a “rehabilitation pavilion complete with a putting green.”

Regional director Michael Moreland gave her top marks in his review and neglected to mention Legionella. Internal emails showed that Mr. Moreland and other hospital executives resisted Centers for Disease Control and Prevention and media inquiries. A public warning about the outbreak wasn’t issued until Nov. 16, 2012, about the time the White House finalized Mr. Moreland as a recipient of the Presidential Distinguished Rank Award (a lifetime achievement award for civil servants), which came with a $63,000 bonus. The 57-year-old retired six months after an IG report attributed the outbreak to oversight lapses.

VA officials often fly the coop before they are disciplined. Only two “non-probationary” VA executives were fired in 2012 and 2013. However, eight facing disciplinary action resigned or retired. Regional VA executives also often paper over problems at their local VA centers to bolster their own chances of a favorable rating. Only one in 435 VA executives in 2012 received a less than fully satisfactory review. Bonuses are doled out by a performance review board comprised mainly of VA executives.

Meantime, the Government Accountability Office last year reported that 80% of the VA’s 22,500 medical-care providers received $150 million in performance pay in 2011, though there’s no “clear link between performance pay and providers’ performance.”

One radiologist who was reprimanded for incorrectly reading mammograms received a $8,261 bonus. Another physician who was disciplined for refusing to see ER patients—thereby causing six-hour delays in care—was awarded $7,500 because he met one of his 13 self-directed goals. He failed to meet the other 12, including attending staff meetings.

The problem is that the buck never stops.

via The VA’s Bonus Culture – WSJ.

The Washington Post has a similar article, How the VA Developed its Culture of Coverups.  Just a taste:

About two years ago, Brian Turner took a job as a scheduling clerk at a Veterans Affairs health clinic in Austin. A few weeks later, he said, a supervisor came by to instruct him how to cook the books.

“The first time I heard it was actually at my desk. They said, ‘You gotta zero out the date. The wait time has to be zeroed out,’ ” Turner recalled in a phone interview. He said “zeroing out” was a trick to fool the VA’s own accountability system, which the bosses up in Washington used to monitor how long patients waited to see the doctor.

This is how it worked: A patient asked for an appointment on a specific day. Turner found the next available time slot. But, often, it was many days later than the patient had wanted.

Would that later date work? If the patient said yes, Turner canceled the whole process and started over. This time, he typed in that the patient had wanted that later date all along. So now, the official wait time was . . . a perfect zero days.

It was a lie, of course. But it seemed to be a very important lie, one that the system depended on. “Two to three times a month, you would hear something about it,” Turner said — another reminder from supervisors to “zero out.” “It wasn’t a secret at all.”

But all this was apparently a secret to Secretary Eric K. Shinseki, perched 12 levels above Turner in the VA’s towering bureaucracy. Somewhere underneath Shinseki — among the undersecretaries and deputy undersecretaries and bosses and sub-bosses — the fact that clerks were cheating the system was lost.

On Friday, Shinseki resigned and was replaced by his deputy.

But his departure is unlikely to solve the VA’s broader problem — a bureaucracy that had been taught, over time, to hide its problems from Washington. Indeed, as President Obama said, one of the agency’s key failings was that bad news did not reach Shinseki’s level at all.

The Post’s David Fahrenthold, who is of course not a veteran, appeared mystified that the VA became exposed as a shambolic failure so suddenly, when it…

…had been seen as a Washington success story. In the 1990s, reformers had cut back on its middle management and started using performance data so managers at the top could keep abreast of problems at the bottom.

Then that success began to unravel…. when the people at the bottom started sending in fiction, the people at the top took it as fact.

What he doesn’t get is that the perception of Washington “success” hinges always and everywhere on bullshit metrics. There’s no reason for command, top-down, remote-control data-gathering to work any better for veterans’ hospital wait times than it did for Soviet wheat harvests. And the VA’s version of the Soviet nomenklatura is the 450 Senior Executive Service satraps who rise to the top by doing the least, sucking up, and never making waves. Arrived in the upper floors of the organization, they never venture out among the plebes again.

Fahrenthold is on much firmer ground in his entertaining retelling of the origin of VA, which was rooted in corruption and scandal in the Warren G. Harding Administration, and Harding’s reaction. (This President says he’s “madder than hell” but sacks a problem Secretary very reluctantly; that President grabbed his unsat Veterans Bureau head by the stacking swivel and made every conceivable effort to throttle the life out of him, with verbal abuse in the bargain). Fahrenthold makes a thin case that this illegitimate birth led to the underperforming, wasteful bureaucracy of today.

But that, of course, assumes that the VA is something special as far as Federal agencies go.

Now, the media, and the President, are very likely to “move on” and chase the next squirrel, because they’ve made a ritual sacrifice of Shinseki, and therefore the Gods of the Media Cycle have been appeased for now. Except… all of the problems of the VA still exist, just as strong as ever. And the Gods of the Copybook Headings are made of sterner stuff than their pale media imitations.

5 thoughts on “VA: “The problem is that the buck never stops.”

  1. Aesop

    The problem isn’t the head of the VA.
    The problem is the VA.

    What the bureaucracy needs is a lot less managing, and a lot more firing, if not outright dismantling.
    If government wants to deliver healthcare, hand veterans a VA insurance card, let Congress figure out what’s covered in public hearings, and then pay the bills wherever they go with that card.

    Try that for five years, and then show us that you can do this better than Blue Cross.
    Otherwise, when, not if, the experiment monumentally fails, the folks out in Peoria are going to figure out that the solution is to repeal ObamaCare wholesale, and the VA and Medicare will be come the sole government forays into health care, seen properly like a car purchase: as a never-ending expense, not an investment or mechanism of savings. And ideally, ended as mercifully as possible, and replaced with a program of defined benefits that simply covers market expenses, and gains discounts by dint of widespread risk pools.

  2. StukaPilot

    as I said earlier: the VA – and 90% of Sodom-on-the-Potomac – must go away. And, since 40% of every .gov dollar allocated is new debt, this will eventually happen. Sudden-like

  3. RobRoySimmons

    Odds are it will only get worse, my guess is that the powers to be might implement the usual government group punishment plan that will drive out the better employees while leaving the more sociopathic lazy bastards who plain just don’t give a damn in place in the VA web.

    Hate to say it but meddlers are going to meddle till some credible threat of their receiving in their person some kinetic medicinals that gives them good reason to inhibit their impulses to control everything.

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