Veterans Health Administration Realizes It Should Buy, Not Build Software

Imagine if you learned a government agency built its own office furniture, HVAC, or telephones. Even if there were a massive amount of corruption in government purchasing, it would be remarkable if a bureaucracy could do a better job building than buying.

Yet, for decades, the Veterans Health Administration has tried to do that with its Electronic Health Record (EHR). I cannot think of another health system that has built its own EHR, rather than buy it from a vendor. It makes as little sense as a health system manufacturing its own MRI machines.

Medicare, Medicaid, Veterans Health Administration At High Risk For Fraud, Waste, Abuse in Government Report

The Government Accountability Office (GAO) has published its biennial update of federal programs “that it identifies as high risk due to their greater vulnerabilities to fraud, waste, abuse, and mismanagement…” Healthcare programs feature high on the list. Medicare, the entitlement program for seniors, and Medicaid, the joint state federal welfare program for low-income households, are longstanding members of the list; and the GAO notes that legislation will be required to fix them:

We designated Medicare as a high-risk program in 1990 due to its size, complexity, and susceptibility to mismanagement and improper payments.

We designated Medicaid as a high-risk program in 2003 due to its size, growth, diversity of programs, and concerns about the adequacy of fiscal oversight.

So, that would be 27 years for Medicare and 14 years for Medicaid. Seen any progress?

This is the second time the Veterans Health Administration has made the list of high-risk programs:

Veterans Deserve Better Health Care

(A version of this column was syndicated by the Tribune News Service.)

President-elect Trump has nominated David Shulkin, MD, to be the next Secretary of Veterans Affairs. In 2015, Doctor Shulkin was nominated by President Obama to be Under Secretary of Health in the VA (the position he currently holds). It is an interesting choice, not only because Mr. Trump is calling on an Obama appointee to take the top job in the VA, but also because it recognizes veterans’ health care is the major pain point in the department.

Can veterans hope for better reform than just more tinkering with the current bureaucracy? Or will they have the opportunity to liberate themselves from it? No other public servants, active or retired, are forced to go to government-owned hospitals for care. Why veterans?

Government Price Controls & Drug Addiction

In a recent print issue of National Review, David French has a sobering article describing how the Veterans Health Administration is overdosing veterans on prescription drugs. A veteran himself, French has plenty of anecdotes about his buddies:

They couldn’t sleep, so they had to take Ambien. They were depressed, so they were taking Lexapro. They had chronic neck and back pain after hanging 90 pounds of gear on their frame day after day, month after month, so they took Lortab. They were anxious, so they took Xanax.

It was as if a VA doctor had simply listened to a list of symptoms, located a pill to address each complaint, loaded up the patient with prescriptions, and called it “treating” a soldier with PTSD. 

In 2014, an inspector-general report found that the VA was systematically over-medicating its patients – even to the point of death.

Wisconsin’s Senate race is being roiled by a report on the VA facility at Tomah, a place so notorious for freely writing narcotics prescriptions that it gained the nickname “Candyland.”

(David French, “Casualties of the VA,” National Review, Vol. LXVIII, No. 12, July 11, 2016, pp. 20-21.)

Billions of Dollars Later, Veterans Health Administration Still Failing

Back in July 2014, I described how Congress was preparing to reward the Veterans Health Administration for its failure to ensure veterans get timely, adequate care, with a multi-billion dollar bailout.

Because Republicans had taken the majority in both Houses of Congress, the bailout was camouflaged as a method of allowing veterans more choice of healthcare providers, outside the government bureaucracy. The results are pretty bad, according to a report by Dr. Sanjay Gupta.

Read the entire entry at NCPA's Health Policy Blog.

One Year After Veterans Waiting List Scandal, Doctors Only 2,000 of 23,000 New VHA Hires

I hate to bring this up right after Independence Day, but the Veterans Health Administration appears to have evolved from an expensive and failing bureaucracy to an even more expensive and failing bureaucracy.

We have  already discussed that waiting lists have grown one year after the scandal broke. Now, see what they’ve done with the billions of dollars Congress handed them in the wake of the scandal.

Read the entire entry at NCPA's Health Policy Blog.

Veterans' Health Waiting Lists Up 50 Percent One Year After Scandal Exposed

Unfortunately, our predictive abilities at NCPA’s Health Policy Blog appear to be holding up pretty well. Last July, I wrote that giving billions of dollars to the Veterans Health Administration to “fix” the problems of long waiting lists for treatment would be viewed by the VHA bureaucrats as a “reward,” and they would react accordingly.

That is exactly what has happened.

Read the entire article at NCPA's Health Policy Blog.

VHA Sitting on Results of 140 Investigations

We recently noted that the government’s own watchdog has noted that the Veterans Health Administration is at high risk for fraud, waste, and abuse. Unfortunately, the public has little ability to see the evidence. USA Today has discovered that  the Veterans Health Administration has not been very forthcoming about the department’s shortcomings:

Read the entire column at NCPA's Health Policy Blog.

GAO: Medicare, Medicaid, Veterans Health Administration at High Risk for Waste, Fraud, Abuse

The Government Accountability Office (GAO) has published its annual update of federal programs “that it identifies as high risk due to their greater vulnerabilities to fraud, waste, abuse, and mismanagement…”

Healthcare programs feature high on the list. Medicare, the entitlement program for seniors, and Medicaid, the joint state federal welfare program for low-income households, are longstanding members of the list; and the GAO notes that legislation will be required to fix them.

Read the entire column at NCPA's Health Policy Blog.

Veterans Wait 3 Months For Primary-Care Appointment Vs. 3 Days For Private Patients

I have noted with dismay that the U.S. government is trying to fix the Veterans Health Administration scandal over wait times by throwing more money at a fundamentally broken system.

Jonathan Bush, CEO of athenaHealth, a leading provider of cloud-base electronic health records (EHR’s) has researched his firm’s database to arrive at a shocking conclusion: Patients wait three days, on average, for a primary-care appointment. And that was for well patients: Sick patients got in in one day.

Read the entire column at NCPA's Health Policy Blog.

The VA Scandal Shows The Problem With Government-Run Health Care

My latest column in the Daily Caller.

Jesse Jackson on Health Reform!

My response at National Review Online.