Proposals from VA Commission on Care popping up in new legislation

Specific suggestions that came from the congressionally-appointed Veterans Affairs Commission on Care are beginning to appear in new pieces of legislation.

The 15-member commission developed a series of 18 recommendations in its report to Congress nearly a year ago. Among them were proposals to create an alternative personnel system for all employees within the Veterans Health Administration and incorporate more private provider options into VA’s network of care.

Bits and pieces of the commission’s 300-page report have popped up in other pieces of legislation. The president, for example, signed new legislation into law that changes accountability procedures for VA employees and senior executives. The changes in the  VA Accountability and Whistleblower Protection Act apply to all employees at the department, not just those who work in veterans health care.

But some senators are beginning to introduce new bills that include highly specific recommendations from the commission.

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A new CIO?

A new bill from Sen. Ted Cruz (R-Texas) suggests VA should create an entirely new leadership position to serve as the chief information officer specifically for the Veterans Health Administration.

This person would sit within the Office of the Undersecretary for Health at VA and would report to the department’s undersecretary for health “on all matters regarding the procurement, acquisition and management of information technology systems and services for the Veterans Health Administration,” the legislation said.

“Modernizing the VA’s IT infrastructure is a critical step to improving the agency’s delivery of health care and remedying the long wait times that have compromised the health and safety of veterans who have honorably served our nation,” Cruz said in a statement. “The time for VA reform cannot wait any longer.”

Sens. John Cornyn (R-Texas), Marco Rubio (R-Fla.) and Todd Young (R-Ind.) are also sponsors of the VA Information Technology Restructuring Act.

Cruz’s suggestion practically mirrors one of the commission’s original recommendations. However, the commission’s report offers more detail into the proposal.

Under the commission’s recommendation, the VHA CIO would be responsible for developing and implementing the health administration’s IT policy and budget. The VHA CIO would also be in charge of procuring and overseeing a commercial off-the-shelf IT system for the health agency, rather than modernize the department’s current approach, the Veterans Health Information Systems and Technology Architecture (VistA).

Under Cruz’s bill, it’s unclear what role the VHA CIO would play in the department’s recent decision to abandon VistA and purchase a commercial, off-the-shelf electronic health record from Cerner Corporation, the same product the Defense Department is attempting to deploy at military bases across the country.

The sense of Congress

A second bill, the Veterans Health Administration Reform Act, would make several significant changes to VA’s health arm.

The bill, which Sen. Mike Crapo (R-Idaho) introduced using feedback from two surveys he conducted of his state’s veterans, would streamline all non-VA health care programs into one “Care in the Community” program.

But the bill also describes the “sense of Congress,” which tasks the VA secretary to “take every effort” possible to address many of the reforms included in the VA Commission on Care report.

Specifically, it asks the VA secretary to clarify the roles and responsibilities of VA’s central office, the Veterans Integrated Service Networks, the individual medical centers at the department, its community-based outpatient clinics and other organizational entities in VHA.

In addition, the bill asks VA to ensure it “provides the decision-making rights, authorities and responsibilities to the lowest appropriate level,” the legislation reads. “Such decision making rights, authorities and responsibilities should be articulated by level, organization and role, and should be standardized to the extent possible while allowing local flexibility based on local needs.”

It also asks the VA secretary to assess the department’s Office of Information and Technology’s effectiveness and determine whether a CIO specific to VHA would serve as an “effective advocate for the information technology needs of the Department of Veterans Affairs for health care delivery.”

The legislation includes provisions to help ensure VA pays community providers in a more timely fashion, something the department has consistently struggled with since VA began working with more community providers.

In addition, the bill requires VA develop a training program to better inform the department’s employees on administering non-VA health programs. Another provision requires VA to set up a similar program designed to educate veterans about all their options for receiving care, both inside and outside the department.

The Senate Veterans Affairs Committee will consider the bill at a legislative hearing next Tuesday. The committee’s chairman, Sen. Johnny Isakson (R-Ga.), will unveil his legislative proposal to redesign the Veterans Choice Act.

The Veterans Access, Choice and Accountability Act of 2014 mandated Congress appoint a 15-member commission to study veterans’ access to health care and the overall organizational structure of VHA.

President Barack Obama last summer said his administration concurred with 15 of the 18 recommendations from the commission’s report. The Obama administration at the time praised recommendations to improve clinical operations, more consistently deliver health care to veterans, set up a more efficient appeals process, modernize IT and set up new professional development and performance management procedures. But it remained fearful of any proposals suggesting privatization of core VA functions.