| THE VA: TEAR IT
DOWN BRICK BY BRICK -- PART 2
The second installment of Kurt Priessman's
series asks the question: "Is it a Vision Gone Blind?"
| Editor's
Note from Larry Scott, VA Watchdog dot Org ... It's time
for this series to be written. I do not agree with all
of Kurt's ideas about the VA, but, as a former government
employee with many years of service, Kurt knows the system
inside-out. The proposals in his commentaries should
be open to discussion. You may comment at the bottom of the page.
Kurt's bio and archive of
articles can be found here. |
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THE VA: TEAR IT DOWN BRICK BY
BRICK -- PART 2
Is it a Vision Gone Blind?
by Kurt Priessman
The vision is noble, but the actions of the Department appear to
say something else. The article asks if overall perceptions of
veterans have begun to change.
“To provide veterans the world-class benefits and services they
have earned – and to do so by adhering to the highest standards of
compassion, commitment, excellence, professionalism, integrity,
accountability, and stewardship.” This is the vision of the
Department of Veterans Affairs.
 With
nearly weekly scandals, missed deadlines, and government reports
detailing failure after failure, how well are they meeting their
vision? Is the vision changing too fast for the antiquated
bureaucracy of World War I? Or has the Department’s vision become
corrupted by halls filled with those who haven’t served, know
little about running hospitals, finances, IT systems, benefits,
and quality assurance programs, but do know how to play politics?
Have top-level executives who are veterans forgotten their
brothers and sisters, both past and present?
Have they turned hospitals into healthcare centers run by
administrators at every level who tell doctors and healthcare
providers how to practice medicine? Have administrators changed
healthcare by denying needed diagnostic tests, in-house and
contract referrals for specialists, therapy, and new drugs because
of costs? If the answer is yes, which costs? Is it the escalating
cost of healthcare, or is it the cost of disability compensation
and pension costs, or both?
Let us think for a second. Veteran Service Organizations have
stressed increased funding for healthcare for years. Could they be
wrong? What if administrators have been told to keep disability
compensation and pensions fixed? They could do that by delay and
denial only if
medical records do not reflect a compensable disability or
cause of death.
Therefore, by denying physicians’ diagnostic tests and referrals
to specialists they achieve their goals. Adjudicators cannot award
when there is no diagnosis, and physicians cannot diagnose without
confirmation through tests and consultation with specialists both
of which may be quite expensive. Instead, physicians are routinely
inundated with patients, can spend only minimal time with them,
and have almost no time for documentation of the veterans
concerns.
Then when a
Compensation and Pension examiner reviews the record, what do
they see? No history of concerns, no test results, or specialist
confirmation of a service connected diagnosis, leaving only one
course of action. Denial through the dreaded phrase “it is less
likely than not”.
Have you ever heard of a more win/win situation for the
Department? While controlling disability compensation they control
healthcare costs. A more ideal outcome cannot be found, leading to
the conclusion that administrative denials of care have become
part of the compensation denial model. The same applies for
therapy and treatment; it mostly boils down to treating the
symptoms through medication rather than curing the patient of
their ills.
What is worse, the U.S. Government offers medical students loan
assistance with the massive tuition needed for medical school and
specialty training, but not without strings. Those strings are
offering positions with the Public Health Service (CDC, NIH,
Indian Health Service, and many other agencies), Bureau of
Prisons, DOD, DHS, and the Department of Veterans Affairs for an
agreed number of years to pay back loans.
It also keeps healthcare providers on by offering a
Physician/Dentist, GS-15, Step 5 - $109,411 in base salary, a
Pharmacist, GS-14 Step 5 - $116,829, and a Registered Nurse, Nurse
IV, Step 5 - $92,512 for a day shift. This doesn’t count different
special pay components which pay up to $45,000 for a Chief Medical
Director, $25,000 for longevity of twelve years and more, $2,000 a
year for board certification, and up to $40,000 a year bonus for
hard to find medical specialties.
This total means that when a hard to fill medical specialty signs
with the VHA he/she could make $325,000 and still make additional
dependent on his/her position in the VHA. Add health benefits and
a retirement system. This includes nurses, medical records
administration (certified), x-ray technicians, and others who can
name their price in the open market.
Ethically, if a husband/wife team makes between $300,000 -
$700,000 a year, are paying back their loans, buying a house, etc.
it puts them in a peculiarly bad place as far as “rocking the
boat”,
“whistle-blowing”, or reporting something is amiss with
management, especially if that administrator can influence
management to terminate or not renew a “certain” contract. Do you
believe you could make the morally right decision in those
circumstances?
Wait, that is not all. Now let us add some incentive. The VHA then
offers you this much for 28 - 32 hours of work a week, no tort
liability insurance, and no call (being available on a minute’s
notice). That means you can add to your income by working a second
job at a hospital or university. Think they will spill the beans?
Can you understand now why healthcare providers do not usually get
involved, even when they see injustices, sub-standard healthcare,
and malpractice going on?
Next, a discussion of adjudicators and decision review officers;
do they believe every veteran is a lying scoundrel trying to
defraud the taxpayers of America?
COMING WEDNESDAY 16 SEP 2009,
PART 3 -- How did the DVA Stray so Far From Its Mission and
Structure?
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This article is ©2009 by Kurt
Priessman and is provided exclusively to VA Watchdog dot Org.
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TOPICS:
veterans, veterans' benefits, VA, Department of Veterans' Affairs,
Kurt Priessman, THE VA: TEAR IT DOWN BRICK BY BRICK
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