January 2008

January 4, 2008

The Veterans Benefits Administration does not have adequate operational controls to ensure that staff schedule or conduct disability reevaluations as necessary, though the agency is planning improvements to some controls, GAO has said.

It said the claims processing software used by VBA, which completed about 17,700 reevaluations in fiscal 2005, does not automatically establish or prompt regional office staff to schedule a time – or "diary date" - to determine whether a disability reevaluation should proceed.

One result is that some cases in need of a reevaluation may never get one, according to GAO-08-75, which is based on an analysis of VBA data, a review of federal regulations and VBA procedures, site visits and interviews with VBA officials.

A diary date triggers a preliminary review of a claim file to see if a fuller reevaluation is needed. If not, reevaluations can be cancelled, but such cancellations are not tracked or subject to quality assurance reviews to ensure adherence to program policies and procedures, the report said.

It said the agency plans to improve some control mechanisms through its claims management system, the Veterans Service Network, including developing the ability to track cancellations. 

However, VBA has no plans to include a prompt for scheduling reevaluation diary dates in VETSNET, according to GAO. 

It said VBA cannot effectively manage the disability reevaluation process because some of the data it collects are inconsistent and it does not systematically collect and analyze key management data. 

While the agency does collect data on the amount of time regional offices take to conduct disability reevaluations, regional offices use different starting points for measuring timeliness, leading to inconsistencies across regions, GAO said. 

It said VBA also does not know the types of disabilities being reevaluated, the length of time before reevaluations are conducted, or the results of the reevaluations, and as a result cannot ensure that it is effectively and appropriately using its resources.



January 4, 2008

Military families living in the U.S. who are enrolled in Tricare can now use a toll-free telephone number to locate and schedule appointments with behavioral care specialists. The toll-free numbers for the new Behavioral Health Care Provider Locator and Appointment Assistance Service are: West Region, (866) 651- 4970; North Region, (877) 747-9579; and in the South Region the number is (877) 298-3514. Hours vary according to region. Those who wish to use the appointment assistance line must first have a behavioral health care referral from their primary care manager. Guidelines stipulate that Tricare Prime active duty family members can receive eight outpatient visits with behavioral health care providers per fiscal year (Oct. 1-Sept. 30) without a referral. As long as they use providers within the Tricare network, they will not have to pay point-of-service cost sharing charges. Tricare also advises that the phone numbers are not hot lines for persons needing immediate help. 


January 4, 2008

Program Aids Most Seriously Injured WASHINGTON (January 4, 2008) - A change in the law that allows certain seriously injured veterans and servicemembers to receive multiple grants for constructing or modifying homes has resulted in many new grants, the Department of Veterans Affairs (VA) announced today. 

Before the change, eligible veterans and servicemembers could receive special adaptive housing grants of $10,000 or $50,000 from VA only once. Now they may use the benefit up to three times, so long as the total grants stay within specified limits outlined in the law.

"Veterans seriously disabled during their military service have earned this benefit," said Secretary of Veterans Affairs Dr. James B. Peake. "This change ensures that every eligible veteran and servicemember has the chance to use the maximum amount afforded to them by our grateful nation."

In order to ensure all previous recipients are aware of this opportunity, VA has mailed more than 16,000 letters to eligible veterans, reaching out to those who used only a portion of their grant or who decided not to use the grant even after initially qualifying. 

The response over the past year has been dramatic, with more than 4,600 applications received thus far. Of these, approximately 3,900 veterans have been determined eligible under the new law, and more than 200 grants already awarded. 

VA has averaged about 1,000 adaptive housing grant applications per year during the past 10 years. Since the program began in 1948, it has provided more than $650 million in grants to about 34,000 seriously disabled veterans. 

To ensure veterans' and servicemembers' needs are met and grant money is spent properly, VA works closely throughout the entire process with contractors and architects to design, construct and modify homes that meet the individuals' housing accessibility needs.

Eligible for the benefit are those with specific service-connected disabilities entitling them to VA compensation for a "permanent and total disability." They may receive a grant to construct an adapted home or to modify an existing one to meet their special needs. 

VA has three types of adapted housing grants available. The Specially Adapted Housing grant (SAH), currently limited to $50,000, is generally used to create a wheelchair-accessible home for those who may require such assistance for activities of daily living. VA's Home Loan Guaranty program and the Native American Direct Loan program may also be used with the SAH benefit to purchase an adaptive home. 

The Special Housing Adaptations (SHA) grant, currently limited to $10,000, is generally used to assist veterans with mobility throughout their homes due to blindness in both eyes, or the anatomical loss or loss of use of both hands or extremities below the elbow.

A third type established by the new law, the Temporary Residence Adaptation (TRA) grant, is available to eligible veterans and seriously injured active duty servicemembers who are temporarily living or intend to temporarily live in a home owned by a family member. 

While the SAH and SHA grants require ownership and title to a house, in creating TRA Congress recognized the need to allow veterans and active duty members who may not yet own homes to have access to the adaptive housing grant program.

Under TRA, veterans and servicemembers eligible under the SAH program would be permitted to use up to $14,000, and those eligible under the SHA program would be allowed to use up to $2,000 of the maximum grant amounts. Each grant would count as one of the three grants allowed under the new program. 

"The goal of all three grant programs is to provide a barrier-free living environment that offers the country's most severely injured veterans or servicemembers a level of independent living," added Peake.

Other VA adaptive housing benefits are currently available through Vocational Rehabilitation and Employment Service's "Independent Living" program, the Insurance Service's Veterans Mortgage Life Insurance program, and the Veterans Health Administration's Home Improvement and Structural Alterations grant. 

For more information about grants and other adaptive housing programs, contact a local VA regional office at 1-800-827-1000 or local veteran service organization. Additional program information and grant applications (VAF-26-4555) can be found at http://www.homeloans.va.gov/sah.htm.  

January 8, 2008

WASHINGTON (January 8, 2008) - The Department of Veterans Affairs (VA) is providing hospice and palliative care to a growing number of veterans throughout the country as the need continues to rise for care and comfort at the end of life. 

VA provides palliative care consultation services at each of its medical centers and inpatient hospice care in many of its nursing homes throughout the country. VA contracts with community-based hospice programs to enhance VA's ability to provide this critical service when and where needed.

"Wherever veterans receive their health care, VA has a system in place to address their hospice and palliative care needs," said Secretary of Veterans Affairs Dr. James B. Peake. "We are dedicated to providing compassionate care and personal assistance to the thousands of veterans and their families who face terminal illnesses."

Nearly 9,000 veterans were treated in designated hospice beds at VA facilities in 2007, and thousands of other veterans were referred to community hospices to receive care in their homes. 

The number of veterans treated in VA's inpatient hospice beds increased by 21 percent in 2007. In addition, the average daily number of veterans receiving hospice care in their homes paid for by VA increased by 30 percent this past year. 

Because of the large number of World War II and Korean era veterans and a tripling of the number of veterans over the age of 85 from 2000 to 2010, the increase in the need for hospice care is expected to continue. The proportion of Vietnam-era veterans over the age of 65 will continue to increase through 2014, when Vietnam veterans will account for nearly 60 percent of all veterans in that age group.

VA's expansion of its hospice and palliative care capabilities came about through a collaboration with community-care providers. In 2001, the National Hospice-Veteran Partnership Initiative began to build partnerships between VA facilities and community hospice providers, funded in part by the VA and by nonprofit groups such as the National Hospice and Palliative Care Organization and the Advanced Illness Care Coordination Center.

To date, VA has partnered with community hospice programs in 35 states to promote hospice services that are not provided directly by VA staff. These partnerships help veterans transition from VA hospitals to their homes in the community. 

Palliative care adds a focus on quality of life and comfort to veterans with life-limiting illness, and their families. Palliative care consultation teams include physicians, nurses, social workers and chaplains. Additional support may be provided by pharmacists, rehabilitation therapists, recreation therapists, mental health professionals and other specialists. 

VA provides palliative care consultation teams at all of its hospitals nationwide, although such services are provided at only about one-fourth of all American hospitals. Nearly half of all veterans who died in VA facilities received care from a palliative care team prior to their deaths. 

"VA is committed to helping veterans spend their final days with dignityand comfort, in the setting that best fits their needs and wishes,"Peake said.

January 16, 2008


By Katherine McIntire Peters kpeters@govexec.com 

Few federal programs have seen the kind of turnaround experienced by the Veterans Affairs Department's health care system in the late 1990s. Formerly a poster child for substandard medical care and incompetent management, VA's health care system now is considered by many to be the best in the country. Its ratings for quality of care and customer satisfaction have risen even as the patient load has increased. Major media outlets have credited the agency's use of electronic medical records, unprecedented even in the private sector, with improving medical care, and Democratic presidential contenders Hillary Clinton and Barack Obama have held up VA's system as a model for nationwide health care reform.

But the department's success is in jeopardy, according to Dr. Kenneth Kizer, undersecretary for health at Veterans Affairs from 1994 to 1999 and the man many credit with leading the management reforms that ultimately fixed the broken health care system. Kizer now serves on the independent Commission on the Future of America's Veterans, which is examining demographic and budgetary trends, as well as changes in both warfare and health care, with an eye to providing the most effective programs and services to veterans.

"We see a future that is not particularly bright for the VA," said Kizer, speaking at a forum in Washington sponsored by the New America Foundation, a nonprofit public policy institute. Rising medical costs, aging infrastructure and an increase in patients with serious, and expensive, medical needs all are contributing to growing concern that medical care for veterans will deteriorate under the current system.

"Economics are going to be driving some very difficult decision-making down the road," Kizer said. For that reason, the commission is planning to recommend later this year that Congress create a government-chartered entity, structured somewhat like the U.S. Postal Service, to manage health care for veterans, he said. The entity's charter would detail its mission, funding, governance and assets, as well as requirements that senior managers hold specific skill sets and areas of expertise.

As a federal agency dependent on congressional appropriations, Veterans Affairs is increasingly ill-suited to manage health care for veterans, Kizer said. The annual appropriations process creates program instability and prevents strategic planning. In addition, the agency cannot exercise the kind of management judgment that corporations routinely exercise.

For example, VA has found it extraordinarily difficult to close underused or outdated hospitals since no member of Congress wants to lose a medical facility in his or her district, Kizer said. As a result, the agency can't close hospitals in areas where they're not needed or build new ones in areas where they are needed.

"The average age of VA hospitals is 50 years old," said William Diefenderfer, former deputy director of the Office of Management and Budget and now a commissioner. "We haven't built a new hospital in 20 years. We need a new hospital in Orlando, but we haven't been able to do it."

A government-chartered entity "would have the authority to buy and sell assets and borrow money against them," Diefenderfer said. It also would be able to create new sources of revenue. For example, it could provide health care to all veterans and their families who have the ability to pay - something the VA cannot do currently.

Arthur Hamerschlag, former chief of staff at the Veterans Health Administration, the health care arm of Veterans Affairs, said he was not necessarily opposed to the creation of a government-chartered health system for veterans, but that a number of issues would first need to be resolved, including how the new entity would negotiate drug prices and whether or not it would accept Medicare - something VHA does not do now.

Veterans Affairs has been able to hold down drug costs because federal law allows the agency to negotiate below-market prices from pharmaceutical companies, something private health care systems would likely protest if a new quasi-private entity were created that could compete for patients, as the commission envisions.

"I think VA will find itself in the medical marketplace in a way it does not now," said Hamerschlag. "That's not necessarily a bad thing, but it will require a different skill set."

January 22, 2008

1. Briefing by Mrs. Gutierrez on the new performance standards. The standards are collected by an independent statics firm hired by the V.A. to evaluate the listed areas and their performance measured by input from a blind survey sent to veterans by mail. The published grafts indicate the results of the data.

2.-A. Funding is approved for new elevators.

   -B. Ultra-sound tech should be starting classes soon.

3. Mailed out 90 plus letters to various veterans’ organizations requesting return letters of support from their membership for the work the HCVC does to fulfill our mandate to keep open the KVA Hospital and to improve services and facilities.

Please check with your organizations to see if they have received our letter and have replied. If there is not an organization in your county, please contact your friends and send us a simple head count stating the number of your friends who support our efforts: address: Bennie M. Hyde, 300 A Manor Dr., Kerrville, Tx. 78028.

There is strength in numbers, they give us clout when we contact the V. A. at all levels, including the Secretary of the V. A., Congressmen and Senators.

Please Click on the following Links for Performance Measure Update of MAX Meeting 1-16-08

-STVHCS Performance Dashboard FY08 - December

-New Pt Access

-Missed Opportunity Access

January 27, 2008

Kerrville civic leaders Sam Barker and Bob Waller have been named to the board of directors of the Hill Country Veterans Council, a group advocating healthcare for the estimated 18,500 former service men and women in the area.

Barker is a retired lieutenant colonel who moved to the Hill Country after retiring from the Army and working for a time in the insurance industry in Corpus Christi. He and his wife Caroline have lived in Kerrville for 15 years. He served two years as president of the local affiliate of Habitat for Humanity which provides low-cost housing for persons who can't afford to buy homes through regular financial channels, and volunteers at both the Kerrville Medical Center of the U.S. Department of Veterans Affairs and the Raphael Community Clinic. A daughter, Shannon, moved to Kerrville recently with her two children after retiring from the Air Force.
Waller, a veteran of Marine Corps service in Vietnam, is head of the local branch of Broadway Bank, Chairman of the Board of the Kerr County YMCA, Chairman-elect of the Kerrville Area Chamber of Commerce, Immediate Past President of the Kerrville Noon Rotary Club, board member of the Kerr County United Way Schreiner University Business Advisory Board, and member of Habitat for Humanity and Kerrville Board of Realty committees.
He and his wife, Sana, moved to Kerrville in 2001. Previously, he had been president and chief executive officer of financial institutions in Dallas and Austin. 
Retired Army Brig. Gen. Walter Schellhase of Kerrville is president of the Hill Country Veterans Council, whose other board members are Jud Ashmore, Dr. Dan Bacon, Joseph Benham, Bennie Hyde, Alan Hill, Bernard Jesko and Bob Weinberg from the Kerrville-Ingram-Hunt-Tierra Linda area; Gene. Higgins of Comfort and Jack Ledford and Joe Strange from Fredericksburg.

The Veterans Council was formed in the mid-1990s to coordinate and lead the fight to keep the Kerrville VA Hospital from being closed or converted into a nursing home, forcing area veterans to go to San Antonio for medical treatment to which as former service men and women they're entitled. 
Further information about the Veterans Council and other data of interest to veterans is available as the organization's website at www.hcvc.org or by telephone at 830-8961157.