Shulkin was moving at breakneck speed to change VA. His firing ‘slams the brakes’ on reform

There’s little denying that since David Shulkin’s confirmation last February as secretary of the Veterans Affairs Department, he’s been going, going, going.

Now veterans service organizations, who largely applaud Shulkin for the changes he brought to the department, worry President Donald Trump’s decision to fire the VA secretary will brake a long-awaited transformation to a halt.

“There was so much momentum in the past year,” Joe Chenelly, national executive director of AMVETS, said in an interview on Federal Drive with Tom Temin. “We really believe that Secretary Shulkin was a key driver in that momentum. We wanted stability. We wanted to be able to continue to move forward. This firing has slammed the brakes on this reform.”

Shulkin has said the breakneck speed, at least for government, was intentional.

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“Slow, incremental, steady change isn’t what this organization needs,” he told reporters last June. “What we need is bolder, fundamental change, dealing with the issues that — frankly — are really hard to deal with, that go back decades. That means, by definition, we’re going to have to take greater risks.”

In a little more than a year, Shulkin helped Congress pass a series of legislative victories for the White House and veterans, including a new GI bill and the Veterans Appeals Improvement and Modernization Act.

Verna Jones, executive director for the American Legion, named appeals modernization and a new GI bill among the top high points of Shulkin’s legacy.

“He’s very approachable,” Jones said. “One of the things that really resonated for me was there was no veteran or no issue that was too small to bring to his attention.”

Shulkin also called for a new way to think about veterans benefits, began the process of disposing or reselling VA’s vacant or little-used buildings and declared veterans suicide VA’s top clinical priority.

Donning his doctor’s coat during a live demonstration of VA’s telehealth program at the White House, Shulkin announced an expansion of the department’s “anywhere to anywhere” services. He made the decision to open up VA mental health services to veterans who received less-than-honorable discharges from the military.

And in a move that will perhaps define his legacy at VA, Shulkin announced plans to adopt the same commercial, off-the-shelf electronic health record as the Defense Department — a massive undertaking that many believed would never come.

But Shulkin’s departure leaves a deep dent in the probability of the EHR program’s success, said Roger Baker, an independent consultant and former VA chief information officer.

“Large IT programs require frequent hard decisions to stay on track,”  he said. “Shulkin had proven himself willing to take risks and make hard decisions. His departure starts VA down the “delay and defer” path that affects so many large program failures.”

Shulkin paused the contract negotiations with Cerner Corporation at the end of 2017. He last told Congress he hoped VA would be ready to move forward with the vendor “soon.”

In some respects, Shulkin had wanted the pace to pick up more. In January, Shulkin told Congress VA was still “far short of the bold, transformational change that we need to serve veterans in the decades ahead,” adding that the department was still operating incrementally and patching and reacting to problems and crises.

Vacancies at the upper echelons of the department, Shulkin said, slowed further change. The department still lacks an undersecretary for health, a chief information officer and an assistant secretary for accountability and whistleblower protection.

With the naming of Robert Wilkie, DoD’s personnel and readiness undersecretary, to be VA’s acting secretary, VA will have four top leaders in as many years.

“The acting nature of so many senior positions makes progress difficult,” Baker said. “Confirmed politicals typically feel more empowered to make changes and motivated to make something happen during their tenure.”

The Commission on Care, a presidentially-appointed body of veterans and health care experts, said in 2016 that leadership turnover in the department hindered VA from getting things done.

“The turnstile at the top of the organization is very harmful to veterans,” Chenelly said. “Everyone agrees that there is a meaningful, responsible need in the VA, and if you continue to change the head of the organization, that’s never going to happen.”

Veterans service organizations have offered mixed initial reviews of Trump’s permanent pick to replace Shulkin.

Some are skeptical. Rear Adm. Ronny Jackson will be in charge of the second largest federal agency with roughly 370,000 employees. Some of those employees have described low morale within the agency, despite attempts to change’s VA’s bureaucratic culture of complacency.

“We’d love to hear what his top priorities are,” Chenelly said of Trump’s new nominee. “There’s a lot more than just health care up there. We do need him to focus on improving access to quality care, but also we need him to focus on the claims backlog and more importantly, the appeals backlog. We have veterans who are waiting seven-to-10 years for their appeals to be decided upon, and that’s completely unacceptable. We have a lot of veterans who are dying while waiting for that process.”

The American Legion is taking a more optimistic approach. Jones said she sat on the selection committee that convened to interview candidates for the VA undersecretary for health.

Jackson was originally a candidate for that position, but he told the selection committee that the White House wouldn’t release him from the physician’s office if he was picked to lead the VA health agency.

Still, Jackson spoke with the group about his experience, and he seemed genuine, Jones said.

“The president has made his decision, and it’s time for us to move on,” Jones said. “With all the drama with politicals and the infighting, no matter how we feel about what’s happened with Dr. Shulkin … let’s start talking about veterans again and how we improve the lives of our heroes.”