Be Warned.... Claims Processing Are Taking Longer Than Ever

[iraqx2]

I'd recently went to my local VARO to see my VFW service rep to ask about my status ( I know what my results are but just waiting for them to type it up ). My VSO said that the regional office is " really really " backed up in processing claims. They have never mentioned anything like that before in the years that I have been dealing with them.

So now it does make sense. With the floodgates of Vietnam vets filing new claims for agent orange and all those Iraq war vets filing new claims and ALL at the same time, you can feel the VA system bulging worse than ever. Dealing with them for so long, you become accustomed to the usual wait, but this time its different.

[GuaymasJim]

I agree Pete. To be very honest with you, my wife (CHAMPVA) gets faster and better care than I do right in the same VAMC. Some argue that point with me saying vets should come first, but her medical care is really one of MY veterans' benefits. The Tucson VAMC used to be just great for a VA hospital, but all of that has changed.

Now, they just keep building more buildings, covered parking lots, solar panels, gardens and remodeled rooms etc., but are extremely short handed. I might have posted this before but I had the same primary provider for 11 years who really really took good care of me. But then I churned through 5 others some of which I never even met. A couple of years ago one of the "new" providers, a Nurse practitioner, spent about an hour ranting about what SOBs veterans are and how all we wanted was narcotics. She then spent some more time ranting about how screwed up the Tucson VAMC was because the clinic only had one nurse and the doctors were either lazy or had too many patients to see every day. The purpose of my appointment was to reconcile my medication list because of some potentially harmful conflicts and bad labs. She miswrote (I know that's not a verb but I don't know how to describe what she actually did other than to say that she attacked her keyboard in the "hunt and peck" way of typing) EVERY SINGLE PRESCRIPTION in either dosage, quantity to dispense, number of refills, or reason for prescribing it in the first place. For example, she lowered the dosage on simvastatin from 80mg to 10mg telling me that I have to change what I eat. Within a month my cholesterol almost tripled! She then stood up and stormed out of the exam room screaming that she was quitting and actually QUIT HER JOB at the VA right there and then!

Recently I had some stents put in my heart because of "severe 2 vessel coronary heart disease." While spending the night in the hospital for observation after one of the procedures, I was informed by one of the night shift nurses that I was "lucky" because the new policy on CAD was to place whatever stents a patient needed the first time around, but if that patient returned because his/her condition had deteriorated he she would be classified and as a NOW GET THIS "Repeat Offender" and would only be offered "palliative care" rather than additional procedures. It was her understanding that many of the new buildings were nursing home/hospice type facilities to accommodate these repeat offenders. She went on to explain that the new policy will be to severely restrict and reduce veterans' access to expensive and complex procedures, treatment, and medications in favor of, yes, once again, palliative care. I don't know how much of what she said is true, but I over heard the terms "repeat offender" and "palliative care" and "nursing home" being used frequently by some other staff members during that stay and the next two procedures.

I'm sorry this post got a little off the topic of the supposedly underfunded VBA causing the backlog get worse and reporting that the supposedly underfunded VHA is reducing medical "benefits", but I truly believe that in both cases the problem is not lack of $ it is lack of leadership. The money is and has been available; it is just getting grossly misspent. Like the person with responsibility for safe medical care and facilities in Pittsburgh getting an award for being the best bureaucrat in the history of mankind AND a $62,000+ bonus. (I know it has been rescinded.) And the half B B Billion $ written off for an IT medical record system that doesn't work and even more for a claims management system that isn't working.

I have a great deal of respect for Gen. Shinseki, but I believe the entrenched bureaucracies at the Central Office, VISN Offices, Regional Offices, and VAMCs are undercutting his efforts. Until someone with big brass ones and the authority to kick some butts, the dysfunctional VA will be well you know--the dysfunctional VA.

[meghp0405]

Got to disagree with you GuaymasJim. I mean the part about Shinseki. He is the leader of that organization, for him to say he knew nothing of the costs pertaining to their conventions, providing bonuses for an inept organization, he needs to be held accountable! The organization has done nothing but spiraled downhill since he has been in there. The facts speak for themselves...

[Chuck75]

What's "best" for the VA is the VA's working goal, not what's best for the veteran. Bureaucracy, don't you know!

On the subject of claims delay and computerization - - -

Garbage in equals garbage out.

That's the real issue. It turns out that the VA regs and underlying laws defy computerized decision making.

Bad enough, you say? It gets worse!

Although there are "standards" for data organization and computer system storage, the government often chooses to not follow them, due to coast, effort, and so forth.

Document digitization is a sub issue, and complex all by itself. Indexing the digitized records with appropriate search terms is another problem.

To store a document properly, it's usually necessary to store an "image"(picture), as well as the information contained within the image.

The image must be manually or semi-automatically duplicated in a text format that is searchable. (A usually underpaid, very boring, repetitive task that requires quite a bit of subject matter knowledge) This can cause problems in itself, since the images are not always that readable, and medical terms are often complex. Handwritten records are the worst to deal with.

Given the age and large quantity of records, even for recently separated veterans is a task of unbelievable size.

[Chuck75]

Shinseki inherited a deeply flawed bureaucrat's wet dream. "Fixing it", after decades of congressional "benign neglect" is a task that is impossible, without major congressional action is impossible. The VA must be forced to change itself, and pay the penalty when it does not. A "slap on the hand" now and then is not enough. Veterans need to be compensated for excessive delays and improper decisions. As it stands now, the VA and the government benefits financially from the delay, in that money paid out later is better for the government than money paid today.

It will take congressional action, beyond doubt.

One compensation issue/injustice alone will end up costing a very large amount of money. The current 100% rate is quite low in relation to the government's own figures for annual income. (twenty to thirty percent lower) The 100% compensation rate is supposedly equal to loss of income, yet the average income is considerably higher.

[GuaymasJim]

meghp0405, I could have been clearer. I respect Gen. Shinseki for his service to the nation. Having said that, I completely agree that he is responsible for what has happened or not happened on his watch at the VA. The funds the VA has received over is last 5/6 years should have been enough to at least begin to restore some functionality. Seems as if it was just pissed away because not one of the three administrations under the Department of Veterans Affairs works well and I don't believe we've hit bottom in that regard.

As the wars fade from the public's mind, so will veterans for about the 4th time in my life. If history continues to repeat itself, then when the public has to choose between more teacher, police, safe roads and bridges vs. providing medical care (physical and mental) to veterans will lose. Not providing treatment for our newer veterans may lead to some horrific consequences. We are already seeing some of those consequences with the veteran suicide rate. Heaven help us all if that turns into a homicide rate.

[Pete53]

I have come to the conclusion and 22 plus years the VA has not really changed that much. M ore important to a Veteran is the Administrator at the Hospital that they use. We had a bad one in Dallas and now that he is gone Dallas has gotten much better.

Some of the old Administrators policies included do not make any changes cause if you do other Vets will want it also.