The transition from military to civilian life can be difficult. The Defense Department runs programs to help service members prepare. For those who risk loss of income or housing, DoD offers what it calls “warm handovers,” a type of personalized, one-on-one help. The Government Accountability Office (GAO) found that thousands of services members slipped through the fingers of warm handovers. For more,  the Federal Drive with Tom Temin spoke with GAO’s Director of Strategic Issues, Dawn Locke.

Interview Transcript: 

Tom Temin Tell us about warm handover. What exactly happens there? And who does the DoD feel that it applies to?

Dawn Locke Sure. So every couple of years, about 500,000 service members transitioned out of the military. And when they do this, they must get the support needed to have healthy, sustainable lives in the civilian world. Warm handovers are supposed to be those extra layers of support for the service members who are most susceptible to challenges when leaving the military. So that warm handover support entails DoD giving the service members, like you said, an in-person contact at an agency that could provide tangible assistance. So, for example, a VA official who can help with disability claims, or a Department of Labor official who can help with finding them a job.

Tom Temin Is this available, by the way, to those with other than honorable discharges?

Dawn Locke This is available to those who are considered at risk if they have an other than honorable discharge. They could potentially, depending on their top counselor, still get a warm handover.

Tom Temin Okay. And do we know roughly of the 500,000 that I believe you said every five years the transition out? It’s a fairly small number that they deem needing the warm handover.

Dawn Locke It could be considered small, I don’t know, depending on what you consider small. So in the two year period that we looked at, there’s about 45,000. There’s more than 45,000 who are considered at risk of challenges when they transition. So for example, they don’t know how they’re going to earn a living. And of these, sadly, more than 4300 who were at risk are slipping through the cracks. So these individuals who are at risk of not potentially having food or shelter or transportation are also not getting the warm handover.

Tom Temin Right. So how did you find that information? You looked at the roles of DoD that they deemed and then the number they actually had a handover for.

Dawn Locke So yes, this is all based on DoD data that we received in their transition assistance data.

Tom Temin And do we know other characteristics of what makes people at risk? Was that part of the study? Do they have mental issues? Do they have post-traumatic stress disorder that kind of thing?

Dawn Locke We did look at the demographics. So they could have have health issues. We did know that the majority, so about 50 to 60% who are at risk are under the age of 24 and typically have four or fewer years of service. And that’s because this particular population tends to struggle more with making informed decisions about finances or housing. But we also saw that those who are having to leave the military quickly. So, for example, for a short term separation or a medical separation may also struggle and could benefit from a warm handover. So for example, they may not have the time they need to prepare for a transition or they’re injured or they’re ill. And a warm handover could help with continued care via the VA.

Tom Temin And warm handovers. Is it just one meeting and goodbye, Charlie, or could the warm handover be a series of meetings or counseling?

Dawn Locke Yeah, hopefully it would be a series and tell that service member gets what they need. So for example, at the VA they could be provided a person who will help with resume writing, a person who will help find them jobs, a person who will help with preparing for an interview, those type of things.

Tom Temin We’re speaking with Dawn Locke. She is the director of strategic issues at the Government Accountability Office. What did you find is the reason so many people, almost 10% of them, are slipping through and not getting that warm handover.

Dawn Locke So unfortunately, DoD does not know the reason that these individuals are slipping through. What we did find is that commanders are struggling to understand their roles and accurately verifying warm handovers. So, for example, only two-thirds of the warm handovers that were given were verified by a commander. And, even more egregious, we found that 77,000 service members were verified as having a warm handover who didn’t actually receive one. In addition to that, we found that DoD doesn’t know whether warm handovers are even helpful because they’re not following up with service members once they become vets, to see if that in-person connection provided tangible help to them.

Tom Temin Yeah, that was my next question you’ve answered is, do they know whether it’s doing any good with respect to people getting jobs and housing and having some stability in their lives?

Dawn Locke Right. And they just don’t, they don’t because they haven’t followed up.

Tom Temin In Veterans Affairs they don’t have much data on that particular piece of it either.

Dawn Locke That is correct. And that is why. So Veterans Affairs is working with DoD to run a pilot to try to collect more information on those warm handovers, but that pilot still is going to provide limited information and will not be able to tell us whether the program is effective.

Tom Temin Wow. So I can imagine what some of your recommendations were. Let’s go over those.

Dawn Locke Yeah, so we did. We made a few recommendations, eight in total. And those boiled down to having DoD better use the data and contact information to ensure a person to person connection happens. We also are, recommending that DoD ensure commanders accurately verify the warm handovers and that they assess and share information on the helpfulness of warm handovers. So that’s key. We need the DoD to determine if these warm handovers are actually helpful. And then we’re also recommending to the DoD Department of Labor and the VA that they identify criteria to determine whether to continue the pilot projects that I spoke of earlier that could help enhance warm handovers.

Tom Temin It sounds like everybody thinks everybody else is responsible for this, and therefore nobody is really taking single ownership of identifying the people, verifying the handovers happen, and then following up to see if they were useful.

Dawn Locke I’m not sure if that is the case. What we did hear from the agencies that they agreed with all of our recommendations, and they each identified steps that they’re going to take to implement the recommendations. So, for example, DoD plans to use the data to better understand the warm handovers while also helping commanders more accurately verify them. And then the VA and DOL did provide statements that they’re committed to making improvements. So, for example, the VA is seeking specific information to determine how to fund its pilot at all the military installations.

Tom Temin In some ways, the biggest beneficiary of this program, potentially besides the service members themselves, is Veterans Affairs, because if people have compounded problems in their lives, it’s going to some way or another end up on the doorstep of VA.

Dawn Locke Correct. They are a huge service provider, as you know, to service members. And it would benefit them greatly to get this right.

Tom Temin And by the way, do we know the percentage of women versus men that are part of the handover program?

Dawn Locke I don’t have the percentage to memory, but there are fewer women who receive a warm handover. Just by the nature of there are fewer women in the military.

The post Warm handovers leave some transitioning service members out in the cold first appeared on Federal News Network.

Chronic kidney disease affects veterans in greater proportions than in the general population. So it is a serious and expensive issue for the Veterans Health Administration. Kidney disease and treatment are also the object of extensive research at VA. For an update on a topic that influences all public health, the Federal Drive with Tom Temin spoke with a leading researcher and the nephrology specialist at the VA medical center in Albuquerque, New Mexico, Dr. Mark Unruh.

Interview Transcript: 

Tom Temin  Doctor Mark Unruh, give us an overview of what is going on in the generalized area of dialysis of kidney disease outcome, because by some measures, it hasn’t advanced much since the 1940s.

Dr. Mark Unruh I think for me, I’m really excited for this moment in care of people with chronic kidney disease. You know, for those of us that take care of patients, the whole point of kind of working with veterans is to prevent people from going on to requiring hemodialysis or transplantation at this moment. There are a number of really exciting medications that have become broadly available for veterans. And, you know, it’s just a really exciting time as a nephrologist to care for veterans. You know, these medications are both related to the management of diabetes and diabetic kidney disease, with the SGLT-2 two medications, which are really kind of becoming more prominent and have like really remarkable effects on preventing and stage renal disease, as well as sort of specific mineralocorticoid antagonists that also seem to be of great benefit. So, I would say, like for general chronic kidney disease, I have not seen medications that have this degree of impact for the past 20 years since we kind of started with angiotensin receptor blockers and Ace inhibitors. And so, you know, this is like a time for veterans to make sure that they’re getting outstanding care in our system.

Tom Temin All right. And you have been concentrating on dialysis for a lot of people with kidney disease. That’s the one step removed from a death sentence is to go on dialysis. And what’s going on in your research? What’s the goal here to try to improve that? Pretty cumbersome, frequent, and tiresome process.

Dr. Mark Unruh For, I guess, time with someone that cares for a lot of veterans who are on dialysis. I have a little bit of a different take. I would say, like in the U.S., we’re actually very fortunate that we have access to dialysis. There are other countries that are under resourced where you don’t have that opportunity. I like to say hemodialysis in particular, as a part time job that doesn’t pay very well. And there are many veterans that can, like, do exceptional things while they’re undergoing dialysis. So, for me, I think it’s kind of a remarkable thing that we’re doing. I agree with you in that, you know, it’s been a while since there’s been market innovation in hemodialysis. You know, fortunately, the kind of VA is sponsoring a number of studies now to kind of push that field forward. You know, we are actually doing a study of less frequent dialysis for people that are starting dialysis. And, you know, this is a concept that we’re sort of taking from peritoneal dialysis, which is a type of analysis where you use the stomach as a way to exchange and pull toxins off, where you use an incremental approach as the patient has a residual renal function, or they make urine. You probably need to do dialysis, the SLAs. And so, in the hemodialysis sector, or like in patients who are receiving hemodialysis right now in the U.S., people just start at three times a week. And that’s just standard operating procedure. So, you know, we’ve been asking the question like what a more veteran centric, pragmatic approach be to start at twice a week and see how people do and then as they need more as their residual renal function or their kidney function or urine output goes down, why not like add another session? And if they still have problems, theoretically you can add another session. We’ve done studies demonstrating that, you know, more frequent dialysis likely is beneficial as well from a quality of life and cardiovascular outcome standpoint. So, I think that, you know, the future state for in center dialysis is one that is very personalized. You know, depending on how much urine you’re making, that we can kind of adjust it to help you meet your goals.

Tom Temin We were speaking with Doctor Marc Unruh, a nephrology specialist at the VA medical Center in Albuquerque, New Mexico. And what about work on maybe the mechanics of dialysis? I mean, when you look at detection of blood sugar levels and stuff, look how far that’s come from constant pins, ticks to little buttons you wear and all kinds of jazz. Dialysis is still a big giant machine. You go to it, you get a book and sit there for three hours. What’s going on in trying to modernize that if it’s possible to do so?

Dr. Mark Unruh Yeah. No, I would say there’s a lot going on. So, with the kind of modernization of the dialysis machine, you know, there are machines. That can be put into people’s homes so that people do hemodialysis that you typically would do in the center in the home. They’re designed to be user friendly. That is not a common option in the United States at this moment. And, you know, I think that is an approach that requires the commitment of a patient who’s very focused on providing care for themselves, as well as a caregiver. In the VA and more broadly, across the U.S., there’s a movement to do home dialysis. That movement is often, peritoneal dialysis. Peritoneal dialysis has been around for a long time. It’s used much more frequently in other countries. It works really well for people that live in rural areas, like veterans who are in rural areas, and otherwise would have to drive a long way to get to a center. So, I think there is a kind of a progress in using PD as an option. There are innovations within kidney disease with dialysis that are kind of emerging. I would say there’s a lot of focus through a federal program, public private program, KidneyX that is focused on a wearable dialysis approach where you would be in effect, like have a backpack that is, doing the dialysis 24 over seven. One could imagine, you know, a future state where that would be an approach and perhaps people would have kind of the increased ability to be social, to work, to like, have a more normal or more standard diet. So those are all very exciting things. In addition, from a transplant standpoint, there was the recent news of xenotransplantation using genetically modified pig kidneys and putting them into humans. And we’re kind of, you know, really watching the outcomes of that sort of approach, because that could really be a terrific approach for our veterans who have end stage renal disease.

Tom Temin And just briefly, what extent of the veterans’ population have this? Is it outnumbering proportionately than the general population?

Dr. Mark Unruh I think that’s a great question. I think for our veterans, they have a little bit higher rate of chronic kidney disease than the general population. You know, across the U.S., if you look at adults, the rate is about 1 in 7. We’ll have mild to moderate to end stage chronic kidney disease. And among veterans, it’s more like 1 in 6. And, you know, among veterans who get their care at VA’s, there’s about half a million that have chronic kidney disease, of which 22,000 received dialysis. So, you know, it is something that impacts a lot of people. For me, that’s why it’s just really exciting to have these novel therapeutics that are emerging that really kind of highlight the link between metabolism and cardiovascular and kidney outcomes. And like, you know, it’s my hope in the future that we can use these medications early enough to forestall the need for dialysis or any sort of transplant.

The post VA research into this disease will benefit the entire health system first appeared on Federal News Network.

VA officials say they’re building on lessons learned from a rocky rollout of the new Oracle-Cerner EHR that started in October 2020.

Since its first new EHR go-live, VA’s inspector general office has documented instances of the new system contributing to patient harm. The watchdog, in a report released last week, also linked problems with the new EHR to the 2022 death of a veteran in Columbus, Ohio.

Under Secretary for Health Shereef Elnahal told reporters at a press conference on Tuesday that VA’s rollout of the new EHR at Capt. James A. Lovell Federal Health Care Center (Lovell FHCC) in North Chicago has been “the most successful deployment we’ve had.”

“We’re going to watch this closely, and we’re going to be on top of it, not just in the next few weeks, but in the coming months, when we start to roll back the direct support and get to normal operations at Lovell,” Elnahal said. “We’ll be watching closely about what these trends are. We’ll be very transparent when problems arise, and we’ll jump on any issue to fix it.”

The VA remains in a “reset” period and won’t schedule any additional go-lives until sites already using the new EHR return to pre-rollout productivity levels.

Elnahal said the five other VA sites using the Oracle-Cerner EHR are “getting closer and closer” to predeployment productivity levels.

“We’re seeing tickets filed when problems are noticed, with quick action. And we’re seeing patient safety incident tickets filed when problems arise,” he said.

VA Secretary Denis McDonough said the department is closely monitoring the performance of sites using the new EHR to “make sure that everything is in good standing.”

“There’s a reason we’re in reset. And these are hard-learned lessons. We’re going to stay in reset until we are confident that we are making the system work in a way that improves veteran outcomes and improves the provider experience in those five sites before we go live any farther,” McDonough said.

VA’s fiscal 2025 budget request seeks $894 million for the VA’s ongoing rollout of a new Electronic Health Record from Oracle-Cerner. For context, the department received a $1.3 billion EHR budget from Congress this year — $529 million less than what the department requested.

The 2025 budget request doesn’t include any funding for additional deployments. The funding would go toward contract payments to Oracle-Cerner, and infrastructure support for VA sites already using the new EHR.

VA officials, however, say the request funding levels are not indicative that a pause of EHR go-lives will continue through 2025.

“We’re not looking to jumpstart and do any fast movements here,” McDonough said. “I think you see that in our budget request. We’re very eyes-wide-open. We’re trying to make sure that we are rolling forward, consistent with what the experience of our providers and of our veterans at those five important go-live sites tells us.”

A successful EHR rollout at the Lovell FHCC would give the VA an opportunity to move on from problems that have hampered the multi-billion dollar project for years.

As a reminder of those persistent challenges, VA OIG released three reports on March 21, highlighting several problems VA facilities have experienced with the new EHR.

VA OIG, in one report, found a scheduling error with the Oracle-Cerner EHR and “inadequate mental health care” at the VA Central Ohio Health Care System contributed to a veteran’s death.

The IG office found a veteran in his 20’s, flagged as a high-risk for suicide, died from an accidental inhalant overdose about seven weeks after he missed an appointment at the VA Central Ohio Healthcare System in Columbus, Ohio.

The IG office confirmed that a system error in the Oracle-Cerner EHR led to VA staff not following up with the veteran 14 days after he missed a VA mental health appointment.

The OIG found that when the patient missed his appointment, although it was updated to no-show status, the EHR didn’t prompt schedulers to follow up with required rescheduling efforts.

“The OIG concluded that the lack of contact efforts may have contributed to the patient’s disengagement from mental health treatment and ultimately the patient’s substance use relapse and death,” the report states.

The veteran had received mental health treatment from the VA since spring 2018. According to the IG report, the department flagged the veteran as a high-risk for suicide, after a suicide attempt in spring 2019.

Elnahal told reporters on Tuesday that the Columbus VA Medical Center has done a “deep dive” into the IG office’s findings, conducted a root cause analysis, “and have made already significant changes to our processes as we interface with the new Electronic Health Record to prevent this from ever happening again.”

“Every single time this happens, we have to learn from it,” Elnahal said.

It’s not the first death linked to the new EHR. Members of the Senate VA Committee said at a March 2023 hearing they were briefed on “six catastrophic events” related to the Oracle-Cerner EHR, four of which resulted in patient deaths.

VA Press Secretary Terrence Hayes said in a statement that when VA became aware of this veteran’s death, “VA began taking action to reduce the risk of tragedies like this from happening in the future.”

“We have fixed the technical issue and the EHRM system now provides appropriate follow-up reminders to VA staff, and VA is further evaluating and standardizing its current policies and procedures for scheduling mental health appointments,” Hayes said.

“There is nothing more important to VA than providing high-quality mental health care to veterans — especially veterans in crisis — and we are deeply saddened by the loss of any veteran who dies by suicide,” he added. “Patient safety concerns are of the utmost importance to VA, and we fully concur with the OIG’s recommendations.”

VA OIG  found, in a second report, that the new EHR impacted medication and allergy safety checks for veterans who receive care from more than one VA facility.

The VA watchdog released its full report on March 21, but testified before members of the  House VA Committee on its findings in a hearing last month.

VA OIG found the department couldn’t automatically check for drug interactions or allergies when patients at VA facilities using the new Oracle-Cerner EHR later sought treatment at another VA site using its legacy EHR system.

Deputy VA IG David Case told lawmakers that about 250,000 veterans since September 2023 have received medication orders or medication allergies documented in the new Oracle-Cerner EHR.

Hayes said in a statement that “to date, there has been no patient harm identified due to this issue.”

“This issue has been fixed for all new medications prescribed since April 2023, and all historical medications will be corrected by the end of August 2024,” Hayes said. “Many medications have already been updated, and our VA providers are conducting manual interaction checks as needed to ensure patient safety until the issue has been fully resolved.”

Hayes added that, “out of an abundance of caution,” the VA is communicating with VA patients at the affected facilities to encourage them to bring their medications, or medication lists, to all in-person and virtual appointments.

VA, he said, encourages veterans to alert their providers if they visit more than one VA facility, have received care through a non-VA facility, or if they have a specific drug allergy.

“These steps are to support quality care so that VA providers can conduct manual order checks as needed,” Hayes said.

VA OIG, in a third report, warned that scheduling system challenges at VA facilities using the new EHR may be exacerbated at larger, more complex medical centers.

VA OIG states the new EHR provides one scheduling system for patients, providers, and schedulers, and was expected to increase scheduler efficiency and reduce scheduling errors.

While some VA clinicians told VA OIG that scheduling appointments in the new EHR is more user-friendly,  the report found schedulers at the three VA medical facilities that have been using the new EHR the longest billed for more than 13,000 hours of overtime last year.

“Although other reports and this memorandum call attention to the problems experienced during the transition to the EHR scheduling system, VHA staff anticipate that positive outcomes are still achievable if facilities take the time to learn from previous deployments, applying lessons learned to either alleviate challenges or better manage them, thereby decreasing the impact to staff and patients,” the report states.

Hayes said in a statement that VA is developing a standard process, outlining the steps VA staff should take to carry out and improve scheduling efforts.

“VA is committed to addressing all issues with the federal EHR system, including scheduling-related functions. Veterans remain the center of everything we do. They deserve high-quality health care that is safe, timely, veteran-centric, equitable, evidence-based and efficient,” he said.

The post Recent VA EHR rollout ‘most successful’ so far, but IG outlines recent problems first appeared on Federal News Network.

The VA saw 25,000 more patients so far in fiscal 2024, compared to the same period in fiscal 2023. New patient appointments also increased by 11% during this period.

The department says 81% of VA medical centers have seen more new patients so far this year, compared to last year.

VA credits a higher volume of medical appointments with recent historic hiring efforts.

The Veterans Health Administration hired more than 61,000 employees in fiscal 2023, its fastest growth rate in 15 years. The agency grew its total workforce by more than 7%, and now has more than 400,000 employees for the first time in its history.

VHA also launched “access sprints” in January, with a focus on increasing appointment availability across three areas of care — cardiology, mental health and gastroenterology.

VA Under Secretary for Health Shereef Elnahal told reporters on Tuesday that every VA medical center is looking at ways to keep this level of appointment growth sustainable in the long term, beyond the access sprints.

“Hopefully a lot of that will stay in place. We have to be mindful of overall staffing, our authorities and our ability to pay things like overtime,” Elnahal said at a press conference at VA headquarters. “Not all of it will be sustained. But we’re asking every medical center and network to look very closely about what we can continue.”

Under the PACT Act, more than 100,000 new veterans have enrolled in VA health care since the legislation was signed in August 2022. That’s out of the more than 500,000 total health care enrollments during the same period.

“We’re expanding access to care, because we know that the influx of new demand for care will be greater because of the PACT Act, because we are welcoming so many more veterans into our doors,” Elnahal said.

Under an accelerated PACT Act implementation timeline, all veterans exposed to toxic substances and other hazards during military service — at home or abroad — became eligible to enroll directly in VA health care without first applying for VA benefits on March 5.

VHA, Elnahal added, will still have the resources it needs to meet higher demand for VA health care, even as the agency prepares to reduce its headcount by roughly 10,000 positions under its 2025 budget request.

Elnahal said the headcount reduction will happen through attrition and “voluntary separation from employment.”

“We’re not considering anything involuntary. We think there is an opportunity to cut our workforce by 10,000, especially in those roles that are not directly veteran-facing,” Elnahal said.

VHA, he added, is more likely to lower its headcount in management and supervisor roles that don’t provide frontline care to veterans.

“That is the category of employees that we think we can attrit down to a level where we’re not compromising capacity for clinical care. And so, we have the room to do that,” Elnahal said.

Elnahal said VHA is “focused overwhelmingly” on making sure workforce retention levels remain high. VHA saw a  20% decrease in turnover between 2022 and 2023.

“We can fill our clinicians’ schedules and we can see those veterans. I’m not concerned about being over capacity, especially when it comes to outpatient services and mental health — key services that we offer,” he added.

VA Secretary Denis McDonough said the VA has “had a good couple of years on hiring nurses,” and credited that success on hiring and retention authorities under the PACT Act.

McDonough also credited increased nurse hiring on the RAISE Act that Congress passed in March 2022. The legislation set high pay caps for VA registered nurses and physician assistants.

He also said he’s heard positive feedback about these changes from VA leaders and employees.

“We had been facing a challenge with retention of everybody, to include very highly compensated specialists, but also especially in this moment of pretty substantial wage growth, frontline providers,” McDonough said. “To hear that testimony about the impact of policy decisions that we’ve taken, and that Congress has taken in the course of the last couple of years, has been really important.”

Despite VHA’s planned headcount reduction, Elnahal said the agency is still looking to hire in a few strategic areas, including mental health care. The agency is also looking to reduce the time it takes to fill vacant positions.

VHA, as of January, took an average 157 days to fill a position once it became vacant. McDonough said he’s “super frustrated at how long it takes to hire,” and has heard those frustrations from VA facilities across the country.

“We lose too many very high-quality and highly qualified providers to our competitors by being slow — and we can’t afford to keep doing that,” McDonough said.

Elnahal said VHA is looking to standardize the hiring process nationwide, and is now holding a “friendly competition” across Veterans Integrated Services Networks (VISNs) to see who can get to the lowest time to fill for critical hires.

“We hope that that will have some benefit here. But we’ve got to get better and we’re very focused on it,” Elnahal said.

VHA task force targets clinician burnout

Elnahal said VHA is taking steps to ensure that, “as we expand the volume of appointments, and offer greater care to veterans across the country, that we protect our clinicians from burnout.”

Michael Charness, chief of staff for the VA Boston Health Care System, is leading VHA efforts to reduce administrative burdens that can contribute to burnout.

“You can’t sprint very far with a heavy backpack, and we were mindful that clinicians everywhere bear heavy administrative burdens,” Charness said. “Many clinicians experience burnout, and reducing administrative burdens is one way to decrease burnout and increase professional fulfillment.”

Charness is leading a task force focused on reducing VHA administrative burdens, based on feedback received from employees.

The task force, he said, learned employees were getting too many “view alerts” on the VA’s Electronic Health Record and getting “inboxes full of clinical messages.”

“Clinical teams manage hundreds of these daily, but some alerts are not clinically important,” Charness said.

The task force, he added, recommended “a few simple tweaks” to the EHR that eliminated clinician view alerts related to appointment scheduling.

“One of the things I hear constantly in the field is the inefficiencies that are created by administrative burden. Efficiency gains are really important for provider morale,” McDonough said. “But ultimately, it also increases their ability to see additional patients.”

Charness said implementing just a few of these changes led to a reduction in view alerts for VA providers in Boston, and that  “clinicians notice the difference.”

The task force, he added, is sharing these administrative burden-reduction efforts with VA clinicians across the country.

“Freeing up more time for clinical care will improve clinic access, while increasing clinician engagement in the most rewarding part of their job,” Charness said.

The post Most VA sites scheduling more medical appointments through ‘access sprints’ first appeared on Federal News Network.

Even in the 21st century, surgery is never a routine matter. Recently, a Veterans Affairs program known as Surgical Pause received a national patient safety award. The Pause is a rapid way of screening surgery patients, who have a higher risk of complications. For the details, the Federal Drive with Tom Temin talked with two medical doctors from the VA Pittsburgh Healthcare System: Daniel Hall, a surgeon and Mark Wilson, National Director of Surgery.

Interview Transcript: 

Tom Temin And let’s begin with surgical pause. What exactly is it and how did you come up with the idea?

Daniel Hall The idea originated in the Omaha VA medical center by a colleague of ours, Dr. Jason Johanning, who is a vascular surgeon who also has some training in geriatrics, and recognized that there was a real opportunity to develop a program to try to improve performance among the highest risk patients that we treat, who tend to be older and physiologically somewhat more frail. These are the kinds of people who are systematically excluded from the medical studies that we typically quote to our patients, to set their expectations for what is likely to occur after surgery. But what we know is that older frailer patients systematically experience outcomes that are not as good as we would hope for them. And that presented the opportunity by which we would try to identify them before we made the decision to operate, so that we could intervene early and try to improve their outcomes as much as possible.

Tom Temin So there are known factors that you kind of put together and then develop some kind of an analytical approach to it.

Daniel Hall Yeah. What we were able to do was develop a very brief patient facing survey, which we called the Risk Analysis Index or the RAI. It takes just about 30 seconds and we administer it to basically every patient coming to see a surgeon, so that we have that score in the surgeon’s hands at the time that they first meet that patient. And that signals to them in the 5 to 10% of cases where the risk is elevated, an opportunity to slow down and pay really close attention to those folks. Most people, they can treat exactly the way that they’ve always treated. They’re extremely efficient at trying to get people rapidly to the services that we know they will benefit from. But this allows them to sort of step away from that rapid assembly line kind of thinking and bring all of the experience that they have garnered over their careers to the people who can benefit from that most.

Tom Temin Well, what can you learn in 30 seconds?

Daniel Hall What you can learn from 30 seconds, at the threshold that we use it, we’re able to identify that portion of the population. It’s about the highest risk 10% of the patients that we treat with surgery who experience at least twice the rate of post-operative mortality, at least twice the rate of readmission after surgery, and at least twice the rate of long term ICU stays. Also increased the rates of long term loss of independence, by which mean people who come to surgery from an independent living environment at home, and then surgery becomes the occasion by which they transition into long term institutionalized living. In 30 seconds, we can have a good idea of who those people might be, and then we can step back and ask ourselves, are there any things that we can do to try to reduce that likelihood? And if so, we can do it, we also can step back and ask and make sure that the proposed treatment is really aligned with the patient’s goals. And some people will sort of say, thank you very much for making me aware of these downstream risks. I’d really prefer that you keep the scalpel in the drawer. Why don’t we try to pursue an alternate strategy for the pain that I have from my hernia for a period of time, because I really would like to avoid the downstream risks that you’ve just outlined for me.

Tom Temin Sure. And, Dr. Wilson, what do we know then about some of the outcomes? How are you measuring this program? What are the measures and what have you learned so far?

Mark Wilson The joint experiences, both in VA, at programs that have implemented, as well as private sector programs in community U.S. and overseas that have implemented have been significant reductions in all cause mortality following surgeries. So the awareness of surgeons regarding the patient risk and the opportunity to intervene, to optimize the patient, to best tolerate to surgery and have the best outcomes if they elect to proceed with the procedures, have really been demonstrated to be substantially improved from risk adjusted and other analysis of outcomes.

Tom Temin So in other words, aside from avoiding the surgery altogether, there are mitigating things that the surgeon can do knowing about this patient to maybe enhance the outcome.

Mark Wilson Both the surgeon and the care team, but also the patient themselves. In some cases, this discussion leads to review of risk factors that are within the patient’s control, that are modifiable, that would improve their individual outcome from the surgery. So it’s an opportunity to discuss with a patient both the aspects of the care team and what they provide to the patient, but also what the patient can elect to do for themselves to decrease risk associated with the procedures.

Tom Temin And how did this all get promulgated throughout the VA system? It sounds like something that’s probably easier to spread than, say, a new surgical technique, for example, where everyone would have to practice and prove they can do it. A 30 second survey sounds like something kind of easy to get everybody on board with.

Daniel Hall Easier than a brand new surgical procedure, but all culture change is hard. So I’ll speak to that a little bit. We’ve been very lucky and blessed to be practicing in the kind of environment that we do. Working with my colleague, Dr. Johanning, I was able to do the data analyzes to bring the high quality data that’s available to us in the VA to substantiate the claims that this very mild and brief intervention really does improve outcomes. I was also then able to use that data to increasingly characterize and describe what the nature of this risk is, and continue to share that information with the surgeons and other care providers and physicians in the interdisciplinary team, again, to build consensus and enthusiasm around it. We initially started by publishing the results in Pittsburgh, and it was really helpful to have national statured, peer reviewed publications that sort of confirmed that what we were seeing was real, and then replicated the results first at the Pittsburgh VA, and then in the private sector at the UPMC hospitals in Pittsburgh. Publishing those results as well garnered the attention of the Diffusion of Excellence program in the VA, which identified the surgical pause as one of the winners in their Shark Tank competition. It’s a little bit like the show that you see on TV, but they try to bring innovations from the field to a competition where directors of medical centers and health systems bid on particular programs. And I was lucky enough to have been selected as one of those winners we replicated at Iowa City. And that was right at the beginning of the pandemic, and there was still enough enthusiasm that diffusion of excellence assigned to the program, a implementation specialist who then helped us scale it across the nation. And over the last three years, we’ve been able to bring it to more than 50 VA medical centers across the nation, always as an opportunity for them to do the right thing. Not a heavy handed stick, you must comply. But here the data are so compelling, don’t you want to get involved? And that has culminated recently with the National Surgery Office adopting it formally as a quality program for continued support and dissemination across the nation.

Tom Temin And you’ve also gotten a national award outside of VA from something called the Joint Commission. And that sounds pretty prestigious.

Daniel Hall Yes, I’m thrilled by this. I describe it to my friends as it’s the Kennedy Center Award for policy wonks in health care. Dua Lipa and Mick Jagger will not be in the green room, but there will be a green room in July when we go and receive this award. But it’s a deep honor jointly awarded by the Joint Commission and the National Quality Forum, these are the two most influential national organizations that organize and shape the policy that hospitals and medical doctors work within, and they’ve been instrumental in improving the quality and outcomes in the United States writ large. So it’s a huge testimony to the innovation that myself and an enormous team of folks have been able to accomplish in a relatively short period of time.

Tom Temin It strikes me that Health and Human Services would want to even glom on to this, because they are the pair of so much surgery that is done in the private sector throughout the nation to almost slingshot this idea throughout the payE system that they regulate and oversee.

Daniel Hall From your mouth to those policymakers ears, please.

Tom Temin All right. And just a final question. It strikes me there might even be a psychological component to the outcomes with the patient knowing that extra attention or extra care knowledge on the part of the surgeon is present before they get that mask on and count backwards in sevens from 103, that somehow I’m in better hands than I thought I might have been.

Daniel Hall We have an enormous amount of qualitative data and quotations from both surgeons and their patients that testify to the fact that this is an opportunity and a way for them to be the doctors that they really want to be, and for patients to obtain the kind of care that they come to expect from the VA. It is so very clear that this allows us to really focus in on what the patients need most and help them feel, not just feel, but to demonstrate to them our commitment to outcomes that are truly aligned, to restoring them to full health and flourishing, rather than just doing procedures because a certain amount of anatomy can be rearranged. It’s a way to really ensure that the anatomy that we are rearranging is being rearranged, so that they can get about the things in their life that really make life worth living.

Mark Wilson And Dr. Wilson, anything to add?

Mark Wilson We’re excited to see that the programs of the VA for innovation are benefiting patients. So often we think about innovation as being focused toward providers or focused toward efficiencies in health care system. But this is an opportunity, an example in which the innovation ecosystem has been very clearly supportive of improving a patient’s outcomes and their perspectives.

The post Veterans Health Administration wins big award for surgical safety program first appeared on Federal News Network.

It’s also taking steps to ensure its benefits workforce can keep up with the pace of this work.

VA announced Tuesday it processed its one millionth veteran benefits claim in fiscal 2024 — reaching that milestone six weeks earlier than it did last year.

The Veterans Benefits Administration, so far this year, has processed 35% more claims than during the same period last year.

Between October 2023 and February 2024, VBA has provided $69 billion in benefits to 6.5 million veterans and their survivors.

Veterans are also applying for benefits at record rates. VA received 4.5% more claims so far this year than in the same period in 2023.

Since President Joe Biden signed the PACT Act in August 2022, veterans and their families have filed more than 3.5 million claims.

The legislation expands VA health care and benefits eligibility for veterans exposed to toxic substances during their military service

To keep up with this workload, the Veterans Benefits Administration is asking Congress to nearly double its overtime budget for fiscal 2025.

But Undersecretary for Benefits Joshua Jacobs says VBA is looking to move away from mandatory overtime, in an effort to reduce employee burnout.

“We are working very hard to move away from mandatory overtime. I don’t think it is sustainable in the long term,” Jacobs told reporters on Wednesday. “We’re actively considering options that will allow us to achieve our primary mission, which is delivering timely, high-quality and equitable decisions for veterans and their survivors, while also ensuring that our workforce can do that sustainably in the long term.”

VBA officials said last November that most employees are expected to complete 20 hours of mandatory overtime each month.

The agency has carved out two “respite periods” – four weeks during the summer, and four weeks in December and January – where employees are exempt from mandatory overtime requirements. VBA employees with disabilities, officials added, are also exempt from the mandatory overtime requirements.

Jacobs added that VBA is looking to “provide a more focused application of that overtime, that isn’t as expansive and prevalent as it has been in the last several years.”

“We have to balance that requirement to both grow and use overtime, with the need to make sure we’re taking care of our people. Over the last several years, we’ve been asking more and more and more of our employees.”

VA processed 221,592 disability compensation and pension claims during January 2024. That’s its most productive month of claims processing, breaking a previous record from May 2023

VBA processed nearly 2 million disability benefits claims from veterans and their survivors — a nearly 16% increase from the year prior — but is expected to break that record again this year.

“The reason we’re delivering more benefits to more veterans than ever before is because we have hired significantly,” Jacobs said. So as we think about our ability to deliver timely, accurate and equitable decisions, the major driver of our ability to do so is our people.”

VBA grew its workforce by 20% last year, to a 32,000-employee workforce, and plans to keep growing its headcount this year. More than half of the VBA workforce are veterans.

VBA providing record level of benefits to women vets

VBA is also delivering a record number of disability compensation benefits to women veterans.

More than 700,000 women veterans are receiving disability compensation benefits from the VA – a more than 25% increase compared to five years ago.

Women veterans are the fastest-growing cohort at the VA. Women veterans make up 16.5% of the veteran population, but received 27.5% of post-9/11 education benefits and 26.4% of veteran readiness and employment benefits last year.

“These historic statistics are a direct result of our concerted efforts to bring women veterans to VA, to encourage them to apply for the benefits that they’ve earned. And to build a VA that meets women veterans where they are, rather than asking them to come to us,” Jacobs said.

The average woman veteran who receives disability compensation benefits from VA has a 68% combined disability rating, and receive an average of $26,809 in earned disability compensation benefits per year from VA.

The average grant rate for women veterans is 89.2%. That means 89% of women veterans who have applied for disability benefits with VA have received benefits for at least one condition.

Deputy Secretary of Veterans Affairs Tanya Bradsher, VA’s first woman veteran deputy secretary, said in a statement that “these record numbers demonstrate that we’ve made tremendous progress in recent years, but they are still just the beginning – we won’t rest until every woman veteran is coming to VA.”

VBA is also scaling up its resources to handle Military Sexual Trauma (MST) claims. Jacobs said the agency has doubled the number of women veterans who are applying for these benefits and reduced average processing times by 13 days.

VBA, he added, has added 100 staff members as “temporary surge support” to help process more MST claims, and that the agency’s MST Operation Center have added more full-time employees. VBA is also providing more training to MST claims processors.

The post VBA looks to move away from mandatory overtime to reduce burnout first appeared on Federal News Network.

The Veterans Affairs Department operates a vast array of programs for its constituents. Sometimes they can be a little tricky to navigate, especially for veterans who were not initially eligible. For more, the Federal Drive with Tom Temin spoke with the staff attorney with the National Veterans Legal Services Program, Abigail Reynolds.

Interview Transcript: 

Tom Temin And I want to talk about discharge upgrades, because people that have been upgraded to eligibility for VA programs might have figured, well, I’m never going to get them, so I’m not going to look into them and need to know what they are. What’s your sense? And I know your organization helps people apply for upgrades. Is this one out of 100,000 or is it a fairly big piece of machinery, the apparatus for veteran discharge upgrades each year?

Abigail Reynolds Yeah, it’s a great question. There are thousands of people that apply every year for discharge upgrades. So, these boards that review them are seeing tons of applications. They’re reviewing a ton of applications. Sometimes I think that the success rate really depends on the facts of the case. So then in NVLP’s program, we will review every single case to determine if there is a good argument. Usually, we’re looking for things like mental health conditions that might have existed during the Veterans service, traumatic brain injuries, instances of sexual assault or sexual harassment that might have impacted their behavior. And then we will help veterans apply for a discharge upgrade, arguing that those conditions mitigate the misconduct that they excuse kind of what happened that led to the less than honorable characterization. And the military kind of has a history of not doing a great job of taking care of service members who suffer from those mental health conditions. So, it’s pretty common for a veteran who perhaps developed PTSD from combat to commit some kind of misconduct and then get kicked out of the military with a less than honorable discharge. And then now they don’t have access to benefits. So, the mechanism to be able to do that with these review boards, to get that discharge upgraded is really impactful and can really change a lot of lives.

Tom Temin And are there some sort of set of criteria, objective criteria operated by VA such as yes, you did suffer sexual abuse or something like that that they use as a yardstick to measure the applications.

Abigail Reynolds Sure. So, the review boards for these applications are actually located within the DoD, Department of Defense. They make changes to the actual official military record, which is something that the VA doesn’t have the authority to do. So that’s kind of the difference of these review boards and really what they’re looking for. They’re reviewing applications under our standards of kind of overall inequities or injustices in the record. And that is where we see a lot of applications be granted, is where we have evidence of these mental health conditions or survivors of sexual trauma, that those conditions mitigate their misconduct. And that speaks to the overall kind of equity of the discharge characterization. We kind of make the arguments that it’s not really fair for them to be punished this harshly when they have these conditions. So those are kind of the criteria that they’re looking for, those overall injustices or overall kind of unfairness in the discharge characterization, usually based on, again, those kind of mental health conditions from sexual trauma, those kinds of things.

Tom Temin And Veterans Affairs has no discretion to be able to give benefits to someone, even if they arrive with an under upgraded discharge.

Abigail Reynolds So the Veterans Affairs or Department of Veterans Affairs does have the ability they can review discharges and find someone’s discharge honorable for VA purposes. But the only thing that does it makes them eligible for benefits of the VA. But it doesn’t give them new paperwork. So, when they get a new discharge or an upgraded discharge from one of these review boards, they have a new discharge certificate. They take that with them everywhere. So, it’s much more broad and in the impact from these review boards than it is from the VA. And the VA also often doesn’t do a great job at actually reviewing the facts and circumstances. We see plenty of veterans that we work with that have very strong discharge upgrade arguments that have tried to go get benefits at the VA, and theoretically, under those regulations that the VA is reviewing under, they should be able to access them because of their mental health conditions, because of the trauma that they experienced. But often they are denied by the VA and for years have not been able to access those, even if maybe they should have been.

Tom Temin So the best course is to get that upgrade.

Abigail Reynolds Yeah, the upgrade is much more far reaching. Like I said, the board in those cases issues a brand-new discharge certificate. The old one is voided out in their record. It is no longer valid. So, they’re able to use that going forward, not only for VA benefits, but also for other things like using it for employment, using it to apply to educational institutions, those kinds of things. The impact of that characterization goes a lot further when you get the paperwork.

Tom Temin We’re speaking with Abigail Reynolds. She’s a staff attorney with the National Veterans Legal Services Program and the NVLSP. He also has published a detailed guide to the programs that are coming from VA for those that are eligible for them. Why did you feel the need to publish a guide? Is it that hard to figure out what you can get out of VA? Just going to Veterans Affairs Office or VA.gov.

Abigail Reynolds Yeah, it definitely can be. So really kind of the motivation behind us creating this guide was we assist veterans with discharge upgrades. That is kind of what our program focuses on. But after the discharge upgrade is received, there’s a whole host of benefits that’s now available. And we were getting questions from a lot of our veterans that we worked with about, what do I do now? Now that I have this upgraded discharge, what can I apply for? What can I get from the VA? And kind of feeling overwhelmed because there are a lot of benefits that now, maybe for decades they hadn’t been able to access. Now they are. And so, we created this manual in an attempt to have a resource for these veterans when they receive that upgrade, so that they have kind of a one stop shop to see all of the common VA benefits that people might apply for. The things that they might want to consider that they haven’t been eligible for in the past, and kind of have that all in one place because, you know, you mentioned it is all available on va.gov. You can go there and search for the specific benefit that you’re looking for. But if you don’t know what you might want to apply for, then you are going to not even look for it. So the manual is really intended to be a resource that compiles all that information in one place, so that you can take a look through and see what might apply to you, what might benefit you in your life, and then you’re able to kind of use those links directly from the manual to the VA website to figure out the application process and submit that application. So yeah, it’s intended to really just be a compilation so that the information is all available and easier to access. That’s really kind of the goal for us.

Tom Temin And in working with veterans, what’s your sense of how well prepared they are to navigate all of this? Because there is supposed to be mustering out training coming from the Defense Department before people do leave.

Abigail Reynolds So my sense is from mostly veterans who received less than honorable discharge characterizations when they left the military. They often aren’t aware of these processes. There are processes by which the DoD is supposed to kind of be informing them of the benefits that they’re eligible for when they leave, but if they have a less than honorable characterization, they might not actually be eligible for it. So, they might not get told, or they might not be in a headspace where they’re able to kind of process that information because they’ve been through this discharge process that is often really pretty difficult for them to deal with. So, I think that in general, they do find the process of the benefits that can be very overwhelming. There are a lot of different eligibility requirements, even just to be able to apply for the benefit, much less actually be granted the benefit. So I think that we’ve created the manual because we saw so many questions coming through of really being concerned about not knowing what to do now that they have the upgraded discharge and how to get to those benefits that they were wanting, or that they might have applied for a discharge upgrade specifically to access those benefits, and then they just don’t know. They’re kind of overwhelmed by the process and the amount of information that there is. So, I definitely think that that was our motivation in creating the manual as a guide for them. And yeah, I think the administrative process in general can be overwhelming, and the veterans are thankful for any kind of help and guidance they have there.

Tom Temin All right. Abigail Reynolds is staff attorney with the National Veteran Legal Services Program. Thanks so much for joining me.

Abigail Reynolds Thank you so much for having me on. It’s great to speak to you, and we hope that this manual is helpful resource for veterans who have just gotten their discharges upgraded.

The post Veterans get help trying to navigate Veterans Affairs’ complex of programs first appeared on Federal News Network.

At the Department of Veterans Affairs, the goal of increasing AI use cases means better health outcomes for veterans, and greater job satisfaction for the VA employees who serve them. Through programs like Stratification Tool for Opioid Risk Mitigation (STORM) and Recovery Engagement and Coordination for Health – Veterans Enhanced Treatment (REACH VET), data is being analyzed to proactively identify veterans that might benefit from a specific intervention. Following the executive order on artificial intelligence, VA was able to identify a few dozen use cases for AI. Radiology is particularly leading the way, with over 75% of FDA approved AI devices being from radiology, but the department notes that AI has the ability to improve functions throughout their operations.

“In general, we see the potential for AI to contribute in the near term across really a wide range of areas at VA. And I think I see that in kind of three main categories. So one category is in reducing health care provider burnout. And in that vein we have actively these AI tech sprints which are part of the AI executive order. We’re running two of them right now. One is around assisting with documenting clinical encounters, and the other is extracting information from paper medical records,” Kimberly McManus, deputy chief technology officer of artificial intelligence at the Department of Veterans Affairs, said on Federal Monthly Insights – Operationalizing AI. “Another area similar to that is broadly improving veteran and staff experience. So this is around how can we  augment our current staff by helping with these tedious tasks and reducing administrative burden… And then the third area is better care for patients. And so that’s where I see a lot of these FDA approved medical devices, such as the ones in radiology. But there’s new ones also in pathology and dermatology.”

One way VA is addressing staff experience is by using optical character recognition to extract handwritten notes to convert them into computer written notes. Once those notes are converted, AI can be used to compile and extract information that a caseworker may be looking for.

“We can potentially use generative technology to better summarize and identify information … and that kind of search and summarization is really applicable across the VA enterprise as well as across many other companies, whether its our health care providers trying to find information in their electronic health records or whether its our benefits adjudicators trying to identify information when they are processing claims,” McManus said.

A top priority for VA is veteran suicide prevention, and AI has a huge role in those efforts. The REACH VET program uses an algorithm that stratifies veterans by high risk or low risk of suicide, and identifies those in need of intervention.

“We have programs that can reach out to and provide supportive services to veterans in one area, and we are looking at a variety of areas, for the future,” McManus said. “Broadly, it involves using factors that we know are clinical risk factors for suicide that are already in their electronic health record, and then putting those together to identify risk score.”

With the health and well being of veterans at stake, and the large volume of their data on hand, the VA puts the highest level of importance on the security of veteran information. They have developed six basic principles to follow for the use of data and AI trustworthiness for themselves and their partners:

• Is it purposeful?
• Is it effective and safe?
• Is it secure and private?
• Is it fair and equitable?
• Is it transparent and explainable?
• Is it accountable and monitored?

“We have an enterprise data platform that’s called Summit that contains much of our EHR electronic health record data as well as other types of data,” McManus told the Federal Drive with Tom Temin. “We have much of our data in our healthcare, in our cloud platforms that we keep on our network. We also work with other organizations such as Oak Ridge National Labs, who does some of our more deep R&D related to data science and AI.”

As the VA introduces more uses for AI, concerns about drift or bias become a larger issue for the organization. VA’s approach to this is to keep humans in the loop, and designing use cases around the human end user. The human factor also allows the agency to evaluate when AI is the proper solution.

“The number one key to any success of AI, machine learning and AI algorithm is that starting from the beginning, really having those end users, those health care clinical experts, the workflow experts, all really at the table. As data scientists, we understand the math and the computers, but how an algorithm will actually fit into a workflow, actually impact end users, that really requires everyone to be at the table from the beginning.” McManus said. “I’m really excited and optimistic about this space. We definitely are keeping a very strong focus on trustworthy AI and safety. And there are just so many areas that AI and ML and new technology has the potential to positively impact our mission to care for veterans. So I am optimistic, and I think we’ve made a lot of progress. We have a long way to go, but, I’m excited.”

The post At VA, AI and data optimization hold the promise of better health outcomes, job satisfaction first appeared on Federal News Network.

The Department of Veterans Affairs and the Defense Department launched a new, interoperable Electronic Health Record (EHR) on Saturday, at the Capt. James A. Lovell Federal Health Care Center (Lovell FHCC) in North Chicago.

The Lovell Federal Health Care Center is DoD’s final go-live site for the new Oracle-Cerner EHR, which it calls MHS Genesis. DoD has now deployed the new EHR at all its sites across the U.S. and internationally.

The VA, however, has only deployed the Oracle-Cerner EHR at five sites. Full deployment would bring it to more than 170 VA medical centers. The Lovell Center is the VA’s most complex EHR rollout to date.

The VA announced an indefinite freeze on new launches of the Oracle-Cerner EHR in April 2023. The department says the current “reset” period won’t end until it addresses the system’s persistent outages and until VA sites already using the Oracle-Cerner EHR show improved performance.

Neil Evans, acting program executive director of VA’s EHR Modernization Integration Office, told reporters Friday that VA’s ability to resume the EHR rollout will depend, in large part, on the success of the system’s launch at the Lovell FHCC.

“This really has been a part of the reset for us, and frankly, is a part of our path to restarting deployment across the rest of deployment, as we learn from this deployment,” Evans said.

The Lovell Center provides complex medical care to over 75,000 individuals per year. That includes 25,000 veterans every year, over 10,000 TRICARE enrollees and 30,000 Navy recruits.

The facility includes a 300-bed hospital and VA outpatient clinics in the greater Chicago area.

“There’s value in going live at a more complex site, with a higher inpatient volume, a broader set of specialties and the like,” Evans said. “We’re going to learn, based on the more complex facility.”

A combined staff of 3,200 VA and DoD employees provides care to veterans at the facility. Up until this point, FHCC has been operating with both VA and DoD’s legacy EHR systems.

“There have been challenges to operate a single, joint facility with two electronic health records,” Evans said.

Meanwhile, the five VA sites already using the Oracle-Cerner EHR are showing improved performance.

“From a technical performance perspective, we’re in a far, far better spot and doing very well,” he said.

Evans said it’s been 319 days since the Oracle-Cerner EHR saw its last full system outage. He said the VA is also seeing a reduction in incidents that affect individual end-users, such as hangs, crashes and lags.

The Lovell Center was created in October 2010, by merging the former North Chicago VA Medical Center and the former Naval Health Clinic Great Lakes.

The facility provides health care to active-duty military, their family members, military retirees, naval recruits, naval students and veterans in the North Chicago area.

Evans called Saturday’s go-live “the culmination of a long journey” to prepare the Lovell Center for the new EHR.

“We have been making improvements over the course of the reset for our five live sites. But evaluating those, and understanding those, at a more complex site, we think, will be more important,” he said.

VA says it won’t schedule additional VA EHR deployments until officials are confident that the new EHR is highly functioning at all current sites and ready to deliver for Veterans and VA clinicians at future sites.

In preparation for the Lovell Center go-live, Evans said the VA has made  “significant changes” to its EHR training.

“In an electronic health record transition, it’s really about, all in, how do we support end users, in adopting the new solution, and part of that is training, learning how the system works,” he said.

VA employees, he added, have gone through computer-based and instructor-led training, as well as training from “superusers” — “people who have learned forward, and said, ‘I’m excited about helping my peers learn this new system.’”

Evans said the VA has also rolled out “learning labs” to get clinicians ready to use the new EHR.

“They’ve been able to come and see in a sandbox environment and practice themselves in a sandbox environment, the work, the series of steps that they would actually be doing in their regular work,” he said.

Bill Tinston, director of the Federal Electronic Health Record Modernization (FEHRM) office, said DoD personnel have also helped the VA prepare for the Lovell FHCC go-live.

“Bringing that expertise is going to be a great advantage, and it’s one of the advantages to being able to do this jointly. In the end, we do it jointly, so that we get the best outcome for the Americans that we serve here. But for the users, they’ll be in a better position, because they’ll have their peers there, helping them through the process of adopting and getting their jobs done, which is what this is all about,” Tinston said.

Oracle-Cerner has provided several recent pharmacy-related updates to the EHR. Those upgrades are in place at the five VA sites already using the EHR, but Evans said they won’t go into effect at the Lovell Center just yet.

“We made a decision — it was really a clinical decision, based on VA’s pharmacy communities — request that we not go live with the functionality until it is fully and completely fixed 100%,” he said. “We are at a point now where we have done additional training for the pharmacy staff at FHCC, so that they are prepared and understand what work they’ll need to do in the absence of that upgrade … We were at a point where the site is, frankly, as ready as they’re going to be for this kind of transition.”

The post VA, DoD launch new EHR at joint site — a major milestone for each agency’s rollout first appeared on Federal News Network.

• The IRS is getting pushback on its return-to-office plans, both for going too far, and not far enough. Rep. Ron Estes (R-Kan.), a member of the House Ways and Means Committee, said the IRS should do more than bring employees back to the office 50% of the time. He said his office got three times more IRS complaints from constituents last year than it did in 2019. Estes said increased telework is to blame for lower customer service. Doreen Greenwald is the national president of the National Treasury Employees Union. She said teleworking IRS employees are just as productive and more likely to keep working for the agency. “Telework works, and I believe telework is here to stay,” Greenwald said.
  (IRS gets pushback on its return-to-office plans — for going too far, and not far enough - Federal News Network)
• Funding for IT modernization at one agency is slated to get a boost. The Department of Housing and Urban Development could see an increase in its IT modernization fund this year. House and Senate appropriations committee lawmakers approved $383 million as a part of the minibus set of bills announced on Sunday. The lawmakers allocated more than $8 million above what the agency received in 2023. Included in the congressional bill is $11.8 million dollars for HUD's move to zero trust, which is $6 million less than HUD requested. Lawmakers also approved HUD's proposal to reorganize its CIO's office.
  (HUD IT modernization fund could see $8M boost in 2024 - House Documents)
• Agencies grappled with a record number of Freedom of Information Act requests last year. The Justice Department reported that agencies received more than 1.1 million FOIA requests in fiscal 2023, a 30% increase over 2022. Agencies also processed a record 1.12 million requests in fiscal 2023. FOIA offices across government have struggled in recent years with soaring records request backlogs. DoJ’s Office of Information Policy said agencies will soon release more details on their efforts to reduce backlogs, as part of their 2023 chief FOIA officer reports.
  (Agencies processed over one million FOIA requests in fiscal 2023 - Justice Department)
• The Army wants to hear from soldiers and their families as it launches its annual tenant satisfaction survey to gather feedback about their housing experiences. More than 100,000 tenants in Army privatized, government-owned and government-leased housing have been asked to participate in the survey. This effort will help the service to improve housing quality and resident services. The survey is confidential and voluntary. Responses are due by April 18. Tenants who didn’t receive the survey email are encouraged to contact their local housing office for further assistance.
  (Army launches its yearly tenant satisfaction survey - U.S. Army)
• The Cybersecurity and Infrastructure Security Agency said hackers are still targeting a widely used virtual private network service. In a new warning, CISA said groups are continuing to exploit multiple critical vulnerabilities in Ivanti products. The agency warned that hackers can trick Ivanti’s internal tools to evade detection. Federal agencies have already been directed to remove Ivanti devices from their networks and rebuild them before continuing to use them.
  (Threat actors exploit multiple vulnerabilities in Ivanti Connect Secure and Policy Secure gateways - CISA)
• The FBI, the U.S. Marshals Service, the Drug Enforcement Administration, the U.S. Attorney's Office, and the Bureau of Prisons are facing cuts to a key budget line item in 2024. The House and Senate appropriations committee approved $19.1 billion for salaries and expenses for all but the Bureau of Prisons. That would be $1.4 billion less than the President requested. The Bureau of Prisons is slated to receive $8.4 billion for salaries and expenses, about $250 million less than it requested.
  (Congress to cut FBI, Marshals Service, Bureau of Prisons salaries, expenses account - Senate Appropriations Committee)
• The Defense Department’s internal watchdog is looking into the Navy’s efforts to prevent and respond to suicides and suicide attempts. As directed by the fiscal 2023 National Defense Authorization Act, the goal of this evaluation is to determine whether the Navy effectively addresses incidents related to suicide and suicide attempts among sailors assigned to sea duty and shore duty. The office of inspector general will also evaluate the office of the under secretary of Defense for personnel and readiness and the Defense Health Agency. Site visits will include Norfolk Naval Air Station in Virginia and Naval Base San Diego in California.
  (Defense Department IG to look into Navy’s suicide prevention efforts - DoD IG)
• The Department of Veterans Affairs will provide abortions and counseling to veterans, in cases of rape, incest, or when the health of the woman is at risk. The VA said its newly finalized rule applies even in states that have limited access to abortion. The VA issued an interim final rule in September 2022, after the Supreme Court overturned its ruling in Roe v. Wade.
  (Ranking Members Takano and Brownley applaud VA’s final rule on abortion access for veterans - House VA Committee)

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VA Secretary Denis McDonough told reporters Monday that the Veterans Health Administration is managing its workforce in a “tighter fiscal picture,” but added that the department is taking a more targeted approach to hiring, after the agency exceeded its hiring targets last year.

“Where we’re not hiring, it’s not because we haven’t been able to hire. It’s because we don’t have a need. Why would we not have a need? Because we just had a great year of hiring,” McDonough said at a monthly press conference at VA headquarters.

McDonough told reporters last month that “as it relates to VHA, there may be times when we determine that there are personnel that we don’t need going forward” — and that the agency may need to manage its overall headcount through attrition.

Federal News Network reported last week that VHA recently advised medical center leaders and human resources professionals on rescinding tentative or final job offers made to prospective employees. VHA, according to emails obtained by Federal News Network, told officials to only rescind job offers only as an “action of last resort.”

McDonough, however, stressed to reporters on Monday that there is no nationwide hiring freeze or hiring pause, and there are no plans for a hiring freeze or reduction in the VA health care workforce.

“The idea that we have a hiring freeze is not correct,” McDonough said. “The idea that we are looking carefully at hiring is correct.”

Under Secretary for Health Shereef Elnhal told reporters that VHA “will continue to “strategically hire in areas where we know veteran care demand will be, and in geographic areas where we know veteran growth is the most.”

“I’ve tried to make that clear to all of our medical centers, clinics and healthcare workers: we will need to hire fewer staff this year. And again, that is because of the excellent hiring year we just had,” Elnahal said.

VHA hired more than 61,000 employees in fiscal 2023, its fastest rate of growth in 15 years. The agency grew its total workforce by more than 7%, and now has more than 400,000 employees for the first time in its history.

In addition, efforts to boost retention have led to a 20% decrease in staff turnover between 2022 and 2023.

Elnahal attributed that lower turnover rate to VHA tapping into retention and recruitment incentives under the PACT Act  “to a very large extent.”

The PACT Act, signed into law in 2022, expands VA health care and benefits eligibility for veterans exposed to toxic substances during their military service.

“Congress put that in the bill, and we asked for those authorities, because we wanted to better retain and recruit the best health care talent out there,” Elnahal said.

McDonough said VHA “did a really good job of hiring last year,” and “as importantly, did a really good job of retaining providers.”

“That will, obviously, inform our decision later this year about how we execute on year two of the five years that we have for these special employment tools that came with the PACT Act,” he said.

While Congress has yet to pass a comprehensive spending deal for fiscal 2024, and must act to avoid a partial government shutdown this Friday, VA and VHA are funded through advance appropriations.

“We believe we have the funding we need across VHA in the health care system to be able to meet veteran care needs and support our base of FTEs,” Elnahal said.

“We are not in a budget shortfall. We have the funding we need to be able to execute on the veteran care mission — and various leaders throughout the system made projections on different scenarios, to be able to manage to that. But I’m not concerned about a funding issue at this point,” he added.

Elnahal said VHA is “taking sensible steps, where we can, to be able to meet the veteran care mission, most importantly, but also live responsibly within what we expect our budget to be, over the next couple of years.”

“I wouldn’t differentiate at all what we’re going from any organization that has a mission, FTEs and a budget,” Elnahal said. “Ultimately, though, I think we have the end-strength, overall, across the system, and we’re providing maximum flexibility to our hospitals and clinics to do what they need to do to execute on that mission.”

VHA is looking to raise workforce productivity, after a record year of hiring, and increase the number of health care appointments available to patients.

“We well exceeded our hiring goals last year, which is a good thing,” Elnahal said. “It means that we are at the end strength that we need to be able to serve veterans. And so, just like any organization does, you have to have an FTE level that’s able to meet the mission and is supported by the budget — and that’s what we’re doing this year.”

Shutdown impacts VA’s veteran outreach to veterans, McDonough warns

Lawmakers passed a third stopgap spending bill last month, keeping current spending levels in place through March 1 for some agencies, and through March 8 for others. Funding for VA expires on March 1.

McDonough said there would be no impact on veteran health care in the event of a government shutdown. Burials would continue at VA national cemeteries, and VA would continue to deliver benefits to veterans — including compensation, pension, education, and housing benefits — as well as process appeals.

“However, we would not be able to conduct most outreach to veterans,” McDonough said.

Most public-facing regional offices would be closed, and regular operations — including career counseling, military transition assistance and cemetery grounds maintenance — would not be available.

“A shutdown impacts our ability to conduct our outreach to veterans,” McDonough said. “I’m concerned about that, and that’s among the reasons I’ve been arguing for months that we need a full-year appropriation from Congress.”

Under the debt ceiling deal that President Joe Biden signed into law last year, if lawmakers don’t reach a comprehensive spending plan by April 30, it would trigger an automatic 1% across-the-board spending cuts in nondefense, discretionary spending.

The threat of a partial government shutdown comes as the VA is accelerating the eligibility timeline to enroll in VA health care under the PACT Act.

On March 5, all veterans exposed to toxic substances and other hazards during military service — at home or abroad — will be eligible to enroll directly in VA health care without first applying for VA benefits.

That includes all veterans who served in the Vietnam War, the Gulf War, Iraq, Afghanistan, the global war on terror, or any other combat zone after 9/11.

President Joe Biden announced this accelerated PACT ACT eligibility timeline last November, on Veterans Day.

The accelerated PACT Act deadline means millions of veterans are becoming eligible for VA health care up to eight years earlier than what was written into the law.

Elnahal said veterans don’t need to be sick or file a claim to be eligible for VA health care. All they have to do is demonstrate they served in one of the given locations, or participated in activities that could have exposed them to toxins or hazards.”

“If you don’t think you need this care today, you might need it tomorrow, or the next day, or 30 years from now,” Elnahal said. “Remember that when you enroll in VA health care that enrollment means access to care for life.”

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On March 5, all veterans exposed to toxic substances and other hazards during military service — at home or abroad — will be eligible to enroll directly in VA health care without first applying for VA benefits.

That includes all veterans who served in the Vietnam War, the Gulf War, Iraq, Afghanistan, the global war on terror, or any other combat zone after 9/11.

Veterans who never deployed but were exposed to toxins or hazards while training or on active duty in the United States will also be eligible to enroll.

President Joe Biden announced this accelerated PACT ACT eligibility timeline last November, on Veterans Day.

The accelerated PACT Act deadline means millions of veterans are becoming eligible for VA health care up to eight years earlier than what was written into the law.

VA Secretary Denis McDonough said in a statement Monday that “VA is proven to be the best, most affordable health care in America for Veterans – and once you’re in, you have access for life.”

“If you’re a veteran who may have been exposed to toxins or hazards while serving our country, at home or abroad, we want you to come to us for the health care you deserve,” McDonough said.

VA Under Secretary for Health Shereef Elnahal said in a statement that, veterans who never deployed but were exposed to toxins or hazards — including chemicals, pesticides, lead, asbestos, certain paints, nuclear weapons, and x-rays  —while training or on active duty in the U.S. are among those eligible to enroll in VA health care under the PACT Act.

“We want to bring all of these veterans to VA for the care they’ve earned and deserve,” Elnahal said.

VA says veterans enrolled in VA health care have better health outcomes than non-enrolled veterans, and VA hospitals outperform non-VA hospitals in overall quality ratings and patient satisfaction ratings. The department also says VA health care is often more affordable than non-VA health care for veterans.

Elnahal told reporters last month that, under an accelerated eligibility timeline, VHA expects that nearly 21,000 additional veterans will enroll in VA health care under the PACT Act in fiscal 2024.

“We’re not talking about huge increases in veteran enrollment, because there are already so many doors that veterans can already enter. But that’s part of the reason why we decided to accelerate that eligibility because we think we can handle that capacity,” Elnahal said.

Over the next five years, VHA expects nearly 55,000 new veterans will enroll in VA medical care under the PACT Act. Over the next 10 years, it expects more than 84,500 veterans will enroll in VA health care under the PACT Act.

“The enrollment numbers go up, because we know that veterans who were engaged in these theatres of deployment, these theatres of war, will likely have an escalating need for health care as they age,” Elnahal said.

The VA is seeing higher-than-expected enrollments in health care under the PACT Act.

Under the PACT Act, more than 100,000 new veterans have enrolled in VA health care since the legislation was signed in August 2022. That’s out of the more than 500,000 total health care enrollments during that same period.

“In general, being present in the community and letting veterans know across the country that VA is an option for them, I think, has led to an overall increase in enrollments over and above what we would have expected,” Elnahal said.

Meanwhile, Elnahal said VHA is seeing “asymmetric growth” in the places where veterans are enrolling in VA health care across the country.

VHA is seeing record numbers of new enrollees in the Southeastern U.S. — including in parts of North Carolina, South Carolina, Georgia and most of Florida.

The agency is also seeing significant enrollment in Chicago, Texas, New Mexico, Arizona, San Diego and Southern California more broadly.

Elnahal said VHA is trying to increase capacity by setting up new VA clinics and hiring more staff.

“These are the areas where we are seeing the most veteran growth and as a result, it’s where we’ve concentrated our hiring efforts and determined where we’ve needed more [full-time equivalents],” Elnahal said.

To keep up with “unprecedented growth” in demand for VA health care under the PACT Act,  VHA is running “access sprints” to increase appointment availability across three areas of care — cardiology, mental health and gastroenterology.

Elnahal said VHA is expanding access to appointments in these areas by offering night and weekend clinics, and by increasing the number of veterans that each VA provider sees for appointments.

“Across the board, we’ve seen increases in the number of appointments delivered,” Elnahal said.

Elnahal said VHA saw “pretty consistent increases week-to-week” for mental health care appointments in December 2023 and January 2024.

VHA, however, isn’t expected to keep hiring at the record rate that it saw last year.

VHA hired more than 61,000 employees in fiscal 2023, its fastest rate of growth in 15 years. The agency grew its total workforce by more than 7%, and now has more than 400,000 employees for the first time in its history.

This year, the agency expects to grow its workforce by about 2%.

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VA has identified over 100 AI use cases so far. VA Chief Technology Officer Charles Worthington told members of the House VA Committee last week that 40 of them are in an “operational phase,” and being put to use in the field.

“The department believes that AI represents a generational shift in how our computer systems will work, and what they will be capable of. If used well, AI has the potential to empower VA employees to provide better health care, faster benefits decisions, and more secure systems,” Worthington told the health subcommittee on Feb. 15.

AI use cases put into practice include an AI model called REACH-VET, designed to predict the veterans who are most at risk of suicide. Worthington said this information impacts what VA providers prescribe when seeing at-risk patients, and how they follow up with them.

Worthington said the VA also used natural language processing (NLP) as “customer experience listening,” to comb through feedback and comments submitted by patients.

“Occasionally, those comments will indicate that this veteran might be at risk or need help. Maybe they are indicating that they are having homeless problems,”  Worthington said.  “So this NLP model can flag comments that might be particularly concerning for follow-up by a professional that can read the comment themselves and decide if some other action is warranted.”

Assistant Under Secretary for Health Carolyn Clancy said the VA is developing AI predictive tools to identify which veterans are likely to do well after initial treatment for prostate cancer, and which are likely to need more frequent monitoring.

Clancy said the VA is particularly focused on “augmented intelligence” use cases of AI that improve the productivity and effectiveness of VA clinicians.

“In other words, the human in the loop is quite important,” Clancy said. She added that the VA is trying “to balance benefits while being very, very attentive to risks.”

Worthington said the VA’s Trustworthy AI Framework, adopted in July 2023, gave the VA “a critical head start on developing policies to govern our use of AI in production.”

Worthington said VA expects to update its strategy in the coming year to reflect the pace of this emerging technology.

“Over the past several years, VA has created the foundational guardrails it needs when considering AI tools have a significant potential to improve veteran health care and benefits,” Worthington said.

Clancy told lawmakers that the VA is in the “middle of the pack, or possibly even further up than that,” when it comes to AI adoption in U.S. health care.

“No system yet has put out in public or has figured out how to take all these steps in a very, very careful way — to balance benefits while being very, very attentive to risks and so forth,” she said. “I think there’s a fair amount of caution all around. But I would expect, by virtue of our size that, in many ways, we may actually be in the lead, which would be a good place to be.”

VA in October launched an AI Tech Sprint, which focuses on how VA can address provider burnout by providing  AI dictation tools to take notes during medical appointments. It also looks at how AI can extract information from paper medical records.

“By investing in these projects, VA aims to learn how AI technologies could assist VA clinical staff in delivering better health care with less clerical work, enabling more meaningful interactions between clinicians and veterans,” Worthington said.

The VA launched its AI Tech Sprint as part of the AI executive order President Joe Biden signed last October, calling federal agencies to step up their use of this emerging technology.

Subcommittee Chairwoman Mariannette Miller-Meeks (R-Iowa) said AI creates possibilities to improve diagnostic accuracy, predict and mitigate patient risk and identify interventions earlier — as well as the administrative burden on employees.

“While AI holds great promise, the reality is that it is a new, developing technology, and we are still figuring out what is possible and practical and ethical,” Miller-Meeks said.

Subcommittee Ranking Member Julia Brownley (D-Calif.) said the VA, as the largest health care provider in the country, will serve as a model for the implementation of AI at other health care systems, “which makes it all the more important that we ensure VA and other AI users establish best practices, procedures, and guard rails early on in the implementation.”

“Even as we find productive ways for AI to be implemented, we must take measures to ensure VA is continuing to robustly hire, retain — and I will emphasize retain — and protect its clinical workforce,” Brownley said.

David Newman-Toker, director of the Armstrong Center for Diagnostic Excellence at Johns Hopkins University, said VA’s health care data environment “is better suited than most” to delivering high-quality data that might train AI systems.

“The rate-limiting step for developing and implementing AI systems in health care is no longer the technology,” he said. “It is the sources of data on which the technology must be trained,” Newman-Toker said.

Newman-Toker said the VA’s data advantage includes a “commitment to health care quality and safety,”  a unified health record offering greater potential for standardizing data capture and a patient population that tends to stay within the VA system.

“These attributes give the VA the opportunity to take a leading role in building high-quality AI systems,” he said.

Meanwhile, Technology Modernization Subcommittee Chairman Matt Rosendale (R-Mont.), however, is urging the VA to notify veterans when their health or personal information is fed into an AI model.

“The problem that I see is that you are literally putting the cart before the horse,” Rosendale said. “You are utilizing AI and you are not disclosing it to the veterans. You are not giving them a choice. And that is dangerous.”

Worthington said that at the VA, “protecting veterans’ data is pretty much job one, especially in the Office of Information and Technology.”

“I think we are lucky that we have a lot of existing policies around how veterans’ data can be used and how it can’t be used,” he said.

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Multiple-award contracts don’t mean everyone who bids get a slot. A new federal circuit court ruling shows that losing companies can protest those who did get an award and maybe knock them off. For details on this important case, the Federal Drive Host Tom Temin  talked with attorney Stephen Bacon of Rogers-Joseph-O’Donnell.

Interview Transcript: 

Tom Temin So this was protested, not to the [Government Accountability Office (GAO)], but to the court in the first place, the Court of Federal Claims. Tell us what happened here. Who’s suing who?

Stephen Bacon So this was a VA procurement, the [Transformation Twenty-One Total Technology-Next Generation (T4NG)] contract for IT services. Some of your listeners may know there’s a T4NG to second generation contract, that this was the first generation contract, and actually an onramp process where the VA was seeking to add contractors to the first generation of the T4NG contract. And so this protest involved a challenge to that competition for the on ramp.

Tom Temin All right. And they were going to add several. And this one company did not make the cut and protested.

Stephen Bacon That’s right. So the solicitation as is often the case for a multiple award contract, it said that the VA intended to add seven awardees, but it gave the agency flexibility to choose the number of awardees, and the agency ultimately made nine awards to proposals that were either good or outstanding. And REV was rated acceptable and so it didn’t make the cut and then challenged that determination by the VA.

Tom Temin So REV losing company challenged the findings of excellent or good of some of the ones that did get awards. And what grounds did they base that on? What information did they have that would allow them to say, hey, they should have been acceptable like us, or we should have been good like them.

Stephen Bacon So REV actually had two categories of allegations. It’s common in a bid protest. In the first instance, they challenged the VA’s evaluation of their own proposal saying instead of acceptable, we should have been rated either good or outstanding because of flaws in the way that the agency evaluated our proposal. But they also challenged six of the awardees and argued that they should have been eliminated from the competition for one reason or another. They made allegations that some of the awardees had organizational conflicts of interest that should have excluded them, or had some other defect in their proposal that rendered them unacceptable under the terms of the solicitation.

Tom Temin Right. So those are pretty serious findings, organizational conflicts of interests. Something that raises eyebrows. But initially at the Court of Federal Claims, they were just ruled out on jurisdictional grounds, standing grounds, I should say.

Stephen Bacon On standing grounds with respect to the second category of allegations. So in a bid protest, one of the key sort of thresholds that you have to get over is to be able to establish if you have standing to protest, meaning that you have the right to even bring your allegations into court. And so that’s a two part test. The first is to decide whether you’re an actual offer or in the competition that has a direct economic interest in the outcome. That’s typically easy to satisfy as long as you’ve submitted a proposal. But there’s the second part of the test that was really at issue here. And that’s showing that there’s prejudicial error that you’re alleging, in other words, that you can show that there was a substantial chance that you would have received a contract if the agency didn’t make whatever error you’re alleging in the protest. And so that prong of the standing test was really kind of the core issue that the Court of Federal Claims used to say that REV didn’t have standing to challenge the awardees, because in the first instance, it didn’t establish that the agency had made any error in assigning an acceptable rating to its proposal. The court took that finding that there was no error in the acceptable finding. And so even if REV was able to successfully eliminate some of the awardees, the court ruled that it didn’t show that it would have had a substantial chance at winning the contract.

Tom Temin We’re speaking with Stephen Bacon. He’s an attorney with Rogers, Joseph O’Donnell. But then REV went to the Federal Circuit Court on appeal then and got a different finding.

Stephen Bacon That’s right. The Federal Circuit reversed, they brought this issue of standing, REV did, to the Federal Circuit, and the Federal Circuit disagreed with the way that the Court of Federal Claims addressed this standing question in the context of a multiple award contract where there’s no set number of guaranteed awardees. And the circuit disagreed with the Court of Federal Claims logic that if the six awardees that REV had challenged were eliminated, that they wouldn’t have had a substantial chance. The circuit agreed with the protester and said, if you had six of those awardees and they had been eliminated, there would have been room for REV to hypothetically get into the winner’s circle if its right about its allegations.

Tom Temin Well, that’s like the San Francisco 49ers saying, well, if it wasn’t for those people from the Midwest and Kansas City, we would have won the Super Bowl. What is the meaning of that of saying, well, if. Because the if didn’t occur, those companies were rated higher.

Stephen Bacon That’s right. So it’s sort of a hypothetical test that the court engages in to decide whether they’re even going to address the merits of your protest. And so this isn’t ruling in favor of the protester on the merits. It’s just simply saying that the court should have grappled with and decided whether those six awardees should have been eliminated because the Court of Federal Claims just didn’t even reach those issues. And so this decision kicks it back to the lower court to say whether there was an organizational conflict of interest or whether there were some reason that the protester pointed out correctly, potentially, that some of those awardees should have been eliminated.

Tom Temin So at this point, then, FEVS has spent a lot of time and money to break new legal ground, but not necessarily to get that contract.

Stephen Bacon That’s right. This doesn’t mean that they’re necessarily going to get into the winner’s circle, but it gives them another opportunity to go back to the Court of Federal claims and have their, at least at a minimum, have their OCI allegations heard and their allegations that some of the other awardees should have been eliminated, heard. And if that’s the case, if they’re able to prevail on that, then in theory they could get an award.

Tom Temin Right. But does that happen automatically? Once the Federal Circuit Court has rendered its opinion, is it up to the company to carry that back and get a new court date and retry the whole thing at the Federal Court of Claims?

Stephen Bacon That’s right. So it will go back remanded. Is the legal term, remanded to the Court of Federal Claims to then decide those other allegations on the merits based on the administrative record before the court. And if the court rules in favor of the protester, then that typically kicks it back to the agency to then look at the court’s findings. And if the protester was correct, that may change the outcome of the new evaluation that the agency has to conduct to comply with the court’s ruling.

Tom Temin And how long could all that take? By the time T4NG two comes out?

Stephen Bacon That’s one of the curious things about this case is they’re fighting over getting on the onramp on to the prior generation contract. And now there’s already been awards under the second generation T4NG contract. So it’s a little curious to wonder what what their real interest is in here. But I suppose there’s still some runway left on this first generation contract, and they’re hoping they can get on it. If the agency continues to award task orders.

Tom Temin In another domain of adjudicating cases, there is the concept of is this case precedential or is it simply routine application of what we already knew. Is this in some sense precedential?

Stephen Bacon Sure. Any time the Federal Circuit rules on a bid protest issue, I kind of think of them like the Supreme Court of government contracts in a sense. There’s very rarely does a bid protest go all the way up to the actual Supreme Court. So typically, the Federal Circuit is the court of last resort for government contracts. And so any time they rule on this kind of issue, it sets a precedent in this particular area. And here with the proliferation and importance of multiple award contracts, this does provide that helpful clarification that protesters really should have a right to go in and challenge awardees, even where there’s some flexibility that the agency has to make a particular number of awards.

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By law and regulation, the Veterans Affairs department is supposed to check out the employees used by its contractors. A recent look-see by VA’s Office of Inspector General found pretty serious non-compliance. For details and why this is so risky, the Federal Drive Host Tom Temin talked with Jeffrey Brown, VA’s deputy assistant IG for audits and evaluations.

Interview Transcript: 

Tom Temin And you looked at 50 contracts that involve supplying people. Tell us the nature of these contracts, the types of services that were being supplied. And then we’ll get into the details of what you found.

Jeffrey Brown The type of contracts that we selected were obviously service contracts, because that would involve the most amount of individuals and personnel that would need background and security checks. And they ranged everything from, health care, exams, unarmed security guards, child care, medical disability exams and janitorial work, anything that would require access to a VA facility.

Tom Temin Right. So that means it included people who actually touch veterans.

Jeffrey Brown That’s correct. Yes.

Tom Temin And you found that 47 out of 50 contract files did not, and I’m reading and you can explain what this means, did not include position designation records that established the position investigative requirements for the contract. Translate that for us.

Jeffrey Brown Sure. The position designation is is key for the kind of the first step in vetting the people that would work for the contractors that support the VA, largely because we don’t want to waste on unnecessary resources in delving into people’s background unnecessarily. So depending on the level of involvement, the level of access to facilities and information, will dictate how much background investigation is required into each individual. So, an individual with computer access, computer technician,  they could possibly steal or violate information security policies would need a certain level of background check. Someone that deals directly with veterans or employees of the VA would need a certain level of background check. And then someone with more limited access, maybe a janitorial service or something like that, would need less of a background check. But they all need some form of vetting. And, that begins with a position designation to establish that security risk.

Tom Temin And these lacked that designation. Did that mean these contracts also lacked the background checks themselves?

Jeffrey Brown In many cases, yes. They did lack the background checks as well. We started off with the position designation because before you can do anything, you have to determine what level of background check is needed for these individuals. And without that, that’s kind of getting off on the wrong foot with the first step.

Tom Temin Right. So I imagine the different individual contracts had different designations. That is, if you’re buying a custodial contract to clean up labs and operating rooms and hallways, that’s probably going to be a different company than is supplying physicians to examine veterans.

Jeffrey Brown Yeah. In the different company, or at least a different level of background check for that individual. Some of these contracts can have several types of individuals, from security guards to janitorial services, as we said, under one contract. But that’s why each position, each body that we’re contracting for has a different position designation to establish that security background check needed.

Tom Temin Right. And then the majority of these cases, you also found that VA did not include the, again I’ll read it, did not include contract language to communicate contractor vetting requirements to the contractor.

Jeffrey Brown That’s correct. When it wasn’t included in the contract. And the company is unaware that this is even needed. It can be fairly certain that it’s not being accomplished the way it should be.

Tom Temin And then ultimately, 215 of 286 contractor employees that you looked at under these contracts, 75% of them had no evidence that they had fingerprint checks. A whole bunch did not have any kind of background investigative work done at all.

Jeffrey Brown That’s correct. It was a large percentage, 75%, as you mentioned. Didn’t have any kind of background check or any documentation of it being done. As auditors we can only say what we find. So it’s hard when you’re looking at 2020 contracts in 2023 to say, no, this wasn’t done. But it’s kind of the record isn’t there, then we can safely assume that it probably wasn’t done. We have to catch it that way, that the documentation wasn’t there because someone could always bring out a, we did have these records. We just mislocated them or something like that.

Tom Temin Yes. If you looked at 50 contracts, the VA has tens of thousands of contracts, but if the bulk of those 50 lacked all of these requirements and weren’t carried out, it’s probably safe. You’re assuming this is a projectable finding across VA writ large.

Jeffrey Brown That’s correct. We think it’s systematic. We looked at as a judge mental sample, so in audit language, a statistical sample is something we’d project across the whole universe of contracts. Our teams tend to be about a four person team is reviewing this. So we have to select a sample that’s big enough that they can accomplish in a timely manner and get the information needed out, but is large enough to capture the view of the whole. So we thought 50 was a good example. And that was across different contracting organizations in the VA. And as we said, different types of contracts or different types of services.

Tom Temin We were speaking with Jeff Brown. He’s deputy assistant inspector general for audits and evaluations at the Veterans Affairs Department. And what raised this issue to the VA, OIG did someone blow the whistle or did someone say, hey, you better look at this.

Jeffrey Brown Well, we’ve actually done a lot of work in this area, another group within our organization has looked into the government side for vetting and granting badges in security cards to government direct government workers. And being in the contracting realm, we looked at the the physical security of contractor IDs prior to this report, in what is termed a PIV card or personal identification verification card. During that review, we found that the background checks in to obtaining those cards were often the documentation wasn’t there, and we started asking the questions. We begin any review, we have the IG hotline, it gets hundreds of thousands of complaints each month. And so we come through that database of hotlines to see if any allegations have been made that support or raise more concern about the area. And as you see, for example, in the report of the Saint Cloud, Minnesota, hospital issue, we did find hotlines that directly related to this. So we investigated those as well as we’re conducting the audit.

Tom Temin Would it be accurate to say this is kind of a hot button? This is something urgent for VA to get after?

Jeffrey Brown Yeah, I believe so. The VA has a has a huge mission and they have a lot on their plate. And so determining the priority of this one issue is probably somewhat above my pay grade. But yes, it is a hot button issue because, I mean, we really want to make sure that our veterans and our workers are safe when they’re doing their job. No one can kind of focus on what they have to do and providing the best care to our veterans. If they have to worry about the support staff they have working with them.

Tom Temin And let’s talk about some of the top line recommendations you made.

Jeffrey Brown We felt that a lot of the issues that generated these problems were a lack of clear guidance. There’s external government wide, regulations from the Office of Personnel Management and other federal entities that apply to any contract or position with the federal government, including VA. And then to build on that, VA has several policies that are meant to implement those regulations. And when you read through them, it isn’t very hard to understand why some of these mistakes might have been made. It’s conflicting, it’s outdated. I think the most recent policy update was in the 2010 timeframe. So you can imagine just how different the world has been in the last 13 years and how security requirements may have changed, including accessing social media of individuals that may be applying for positions, etc.. And so we just felt that hinged a lot on that conflicting guidance in determining responsibility. So that was probably our most key recommendation was to streamline those policies, firmly designate what entities are responsible for what, and make sure that these contractors are being vetted properly.

Tom Temin And do the VA, I guess it’s mostly VHA officials that you dealt with, agree with the findings and the recommendations, generally?

Jeffrey Brown  We made six recommendations, they agreed with all six. The only deliberation between us in the agency was how conflicting or again, who was responsible for editing these policies or ultimately doing the contractor background checks. But we were able to hash that out during the recommendation and comment period. And two of the recommendations currently have already been closed for us to open, but they have corrective action plans in place to try to mitigate those recommendations. And we’ll continue to monitor those and close those when appropriate action has been taken.

Tom Temin Jeff Brown is deputy assistant inspector general for audits and evaluations at the Veterans Affairs Department. Thanks so much for joining me.

 

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