VA Management of “Veterans Choice”: Corrupt, or Just Incompetent?

Usually, when you ask the question in the title of this post of any VA program, its failings are adequately explained by the organization’s deep-seated, ossified incompetence, and strange resistance to garbage-collecting the incompetents in its ranks.

But this might just be one time to embrace the power of “and”.

To start with, the VA began squandering money on the program at a ratio of administrative expenses to medical expenses of over ten to one. 

The VA used nearly $165 million to implement the program during its first year, while spending only $16 million on medical care during the same time, the report states.

…and despite that expenditure, the VA seems to have used that system as another means to stall and delay appointments in its own dysfunctional system:

In many cases, veterans were sent back to the VA after waiting 48 days, on average, to get an appointment with a doctor in the private sector. About 98,200 veterans who were still holding out for an appointment in the private sector as of September 2015 were waiting an average of 72 days to be scheduled.

The VA blames the Third Party Administrator (a term with a specific meaning in health insurance) for the problem:

Through the Veterans Choice Program, a third-party administrator was responsible for scheduling appointments for veterans for private-sector care.

But who selected and hired that TPA? The VA, of course. And if it had been any other TPA, would the result be any different? Of course not. It’s the VA. They’d sooner shoot the vets, the patients they’re supposed to be working for, than accept responsibility.

“[T]he procedures used to authorize and schedule appointments under Choice… were cumbersome and required veterans to schedule their treatment without assistance from [the VA],” inspectors wrote. “These procedures placed a greater burden on veterans than seeking treatment at [VA] facilities.”

This “greater burden” was not accidental. The VA modeled Veterans’ Choice on the Jim Crow literacy test, the point of which was not to make sure voters could read, but to make sure the sons and grandsons of slaves didn’t vote. So VC (a fitting acronym) was not to make sure vets saw doctors, but to make sure the VA’s all-precious mangers and workers didn’t get disrupted or face competition.

There’s also the neat trick the VA pulled on vets who wanted to accelerate their care by seeing a private doctor: give ’em an appointment, but with the wrong-specialty barber, on the other side of the whole freaking continent.

Inspectors gave a few examples of how the system led to errors. In one case, the third party scheduled a primary care appointment in New York for a veteran living in Idaho. One veteran in Florida was given an appointment with a specialist in California. Another veteran in south Texas was scheduled with a specialist who couldn’t perform the surgery that he needed.

via VA watchdog: multibillion-dollar program ‘cumbersome’ for veterans – News – Stripes.

We’ll be looking into the OIG report(.pdf) later.

We don’t use the VA. They’ve assigned us to a facility hundreds of miles away in another state, but even if it was up the street, we wouldn’t go there unless indigent, and even then we’d probably roll the dice with Medicaid first.

The vast majority, over 98%, of the injuries and illnesses treated by the VA are injuries and illnesses that civilian hospitals treat all the time. Indeed, most serious VA hospitalizations are for the routine diseases of lifestyle and aging. Why do we need a massive DC and regional bureaucracy to treat these diseases in veterans? Why does it have to be one that crushes competent providers and shields incompetent and corrupt ones?

We have built a system that is nothing but welfare for the bad doctors, nurses and administrators; whilst making a pretty rotten workplace for the good ones. Is it time to disband this thing yet?

5 thoughts on “VA Management of “Veterans Choice”: Corrupt, or Just Incompetent?

  1. Jacobs

    Unrelated, but here’s a question:

    Hognose,

    If you were able to design the Army’s physical fitness test, in order to test physical readiness for a combat environment, what would the you do? I’m not military, but the APFT has never made much sense to me. Then again, I’m decidedly in the fast-twitch muscle fiber camp myself.

    1. Kirk

      The Army Physical Fitness Test, or APFT, is supposed to be a tool to gauge general fitness. I think it sorta works, for that, but it falls way short of the mark for gauging real combat fitness, which is a far different thing.

      The APFT is designed to utilize the subject’st body weight as an integral part of the test; if you are a flyweight tall skinny type that can run like the wind, you’re going to be able to do a lot better on the test than one of your bigger, heavier counterparts. However, huge ‘effing comma, that’s not something that translates into real-world performance out on the battlefield. Consider the our flyweight guy, at say… Six feet, four inches, 150 lbs. How much real work, as defined by the physics term, is that guy doing on a pushup? A situp? His run? Depending on body composition, he may be doing a lot less than that guy next to him who weighs 210, and stands at six feet tall. Then, too, the flyweight may lack real stamina and staying power when it comes to actual work capacity–He can move his own body just fine, but load his ass down with forty pounds of uniform and another sixty pounds of combat gear, and you may just find that your APFT-maxing dude can’t actually do his damn job.

      We’re measuring relative fitness with the APFT, and then expecting it to have some relevance to job-related tasks that are fixed, not relative. Those ammo boxes don’t get lighter because the guy going to pick them up isn’t up to the task; the machine gun doesn’t adjust its weight, either.

      Real combat fitness would have to be tested on a fixed scale, against realistic tasks. We don’t do that, because it would be devilishly complicated to determine what was necessary, and difficult to set up a test that would effectively test those necessities–You’d need a lot of equipment, and it would all have to be standardized across the Army.

      Personally, I’m not really sure what the ideal test would look like. I just know, after 25 years on the enlisted side of the house, the APFT is not an effective test of combat or job fitness. Relative fitness, yeah, sure–But, the thing that everyone has neglected to think through is that the fittest 120lb, 5’4″ female or male out there is nowhere near as capable as a heavier, stronger person of either gender. There are finite limits on what “fitness” brings to the fight, and you may find yourself needing actual strength and mass rather than the nebulous “fitness” the APFT tests.

      Close to my retirement, accumulated injuries left me fairly broken. I was still physically more capable for a lot of tasks than people 20 years my junior who were maxing the APFT. One incident that still makes me laugh was dealing with our S3 shop (I was the S2 NCOIC) who were having problems moving a couple of fairly substantial floor safes around their office, when they were trying to reorganize things. I walk in on three female officers, a couple of junior enlisted, and a male buck sergeant. Six people, struggling to move the safes, and not able to budge them. All six of these folks were basically hobbits, mind you, but still… Six f**king people. Safes were judged “unmovable… We’re gonna have to call someone…”.

      I walked over to gauge the situation, ‘cos I was the guy who’d put those safes where they were in the first damn place, and I’m kinda going “Surely they can’t have gotten heavier…?”. Ten minutes later, my fat ass has both safes moved to where they were supposed to go, and I’m looking at the six members of my audience like “Anything else…?”. I haven’t even broken a sweat.

      Granted, nine-tenths of that was technique, but, still… Every one of those six soldiers could outscore my ass on an APFT, at that point. None of them could do what I could, physically. Six of them together couldn’t do it, either, so you tell me: What the f**k does the APFT really measure, and is it relevant to the job of being a soldier?

      I have my doubts, I do. I used to have a little short fireplug of a Navajo Indian nation guy working for me, who was a constant nightmare to get through the APFT and the tape test. He was just not built for speed, and the way he was proportioned, he had trouble with both the pushup and the situp. However, comma… This kid could literally throw a five-ton truck tire up into the rack. By himself. And, I do mean “Throw”, as in, he got pissed off one day after changing the tire (forget what–someone else in the squad was screwing with him over something), and when he put that tire back up on the rack, he threw it in there hard enough that the truck rocked side-to-side for a good 15-20 seconds. He bent the f**k out of the back side of the rack, which was 3/8″ steel bent into a U-shape, as well as breaking the welds where it was welded onto the mount. Those tires weigh around 200-250lbs. As a feat of strength, I’m pretty sure I couldn’t have matched that, and I don’t think anyone else in the unit at the time could have, either.

      Oddly enough, after witnessing that, people started giving PV2 Sam a pretty wide berth, and the hazing of the new guy came to an abrupt stop. If I had to pick out who to take to war, he’d have been on the top of my list, along with the other dudes who usually had trouble with the APFT, the Samoans. Friend of mine, who went by the nickname of Tui, constantly struggled with his APFT. He’s also a guy who could close the back ramp on an M113 which had suffered a winch failure by himself, and do so hard enough to rock the track forward on its suspension. Tui and Sam were both guys I’d be picking out to go break up a bar fight, if they weren’t already participants–And, believe me, those two would pretty much have ended any fisticuffs far more effectively than one of those little flyweight 300 points on the APFT types ever could have.

    2. Hognose Post author

      The Ranger Regiment has (had?) an excellent combat oriented fitness test with things like a buddy carry in it. Wrote about it here somewhere before….

  2. Steve Temerlin

    I’ve written you before; I’m a retired Navy Emergency Medicine physician. I worked at a large VA for 4 years after leaving the Navy. I left last summer for a variety of reasons and now work in a civilian hospital. I can’t argue with your data, but only want to note that not everyone has had a bad experience with the Choice program. Here on the west coast both Tricare and the Veterans Choice program are managed by the same people, Tricare West. I had a shoulder replacement surgery through the choice program, done at the local university medical center. I know it was easier for me because I found my own surgeon and could navigate the program easier than most, but it was still an straightforward process than the VA paid for completely.
    As far as what it’s like for good physicians working at the VA; yes, it’s miserable. Many have left or are leaving. I still prefer the Internist I see at the VA to the one I’m assigned to at the local Naval Hospital; I hope he stays. The reasons the VA is so dysfunctional are many and I don’t know if it’s salvageable either. But I wish it could be taken away from the federal government and given to the veterans to be managed by USAA or something similar.

    1. Hognose Post author

      Yes, Steve, I remember your earlier comments.

      Choice is also working here in NH. Every hospital in the state and most of the specialists participate, even though they “lose money” on it. Of course we are a small state that does not have its own full-service VA hospital (there’s a clinic in Manchester).

      I think some of the problems are inherent in the nature of Civil Service; it developed as it did for particular reasons, but it has become a corrupt special interest of its own.

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