Secretary Shulkin Bringing Veterans Affairs out of "Critical Condition"

Veterans Affairs Secretary Dr. David Shulkin, today made a rare appearance for a Trump Cabinet Official, addressing plans to revive the VA which he described as being in “critical condition.”

Instead, Shulkin emphasized the need for bold and innovative changes in contrast to previous practices of slow and incremental change to return lost confidence in the veterans served by the VA.

The most controversial innovations proposed by Shulkin and swirling around the halls of Congress has been the Choice 2.0 initiative scheduled to debut this fall.

In testimony given to the Senate Committee on Veterans’ Affairs on June 7^th, Shulkin laid out his proposals to partner the private sector with the VA to address access to care.

Testimony by several veterans organizations raised concerns over a previously undisclosed pilot VA Insurance program that could ultimately lead to the elimination of the VA through insurance for medical care in the private sector.

Carlos Fuentes, of the Veterans of Foreign Wars headquarters in Washinton D.C., told RealClearDefense today that Secretary Shulkin and his team have worked diligently in coordinating with veterans’ groups such as the VFW and others to ensure that the needs of the Veterans are addressed in Choice 2.0.

Shulkin has taken Veterans to heart in his efforts to revive the VA in becoming a “strong and stable” organization that veterans can have confidence in, speaking of his mandate to make bold and innovative changes, to regain the “lost confidence” of veterans.

During Shulkin’s “State of the VA” address at the end of May, he identified 13 major risk areas within the VA ranging from access to care in collaboration with the private sector, to his number one priority, reducing the alarming rate of veteran suicides.

The 13 risk areas are a broad swath of needed reforms within the VA which Secretary Shulkin has proposed as five priorities to be addressed immediately.

Shulkin was careful to acknowledge that this would not lead to a complete privatization of the VA healthcare system, but rather augment the VA Health system.  Simply put, the private sector just isn’t suited to address many of the issues facing veterans, such as post-traumatic stress and suicide. However, there was room for collaboration with the private sector regarding issues like traumatic brain injuries highlighted in professional sports.

also known as VistA, has gone from an expensive legacy system failing to meet the needs of veterans to glowing praise according to a recent Medscape survey of over 15,000 physicians.

Members of Congress have been highly critical of VistA, and Secretary Shulkin also acknowledges the need to change.

Shulkin wants to create the “next generation” Electronic Health Record (EHR) system.  The VA is already in the midst of what Shulkin described as four-month contract negotiations with health information technology information solutions company Cerner. Cerner recently rolled out a test launch of their commercial off-the-shelf system, known as Military Health System (MHS) GENESIS at Fairchild Air Force Base in Spokane, Washington.

The VA plans to integrate MHS GENESIS with the VA's new EHR better, as the DoD system does not fully address the needs of Veterans, the VA Health System and care provided in the private sector. 

An aggressive agenda proposed by Secretary Shulkin, but in line with his call for bold and innovative change. However, there are still obstacles in his way, many of which have stymied his predecessors.

Instilling a culture of service and high morale requires a dedicated workforce committed to the care of America’s Veterans. One step in accomplishing this goal was through the 13^th June passage of the Veterans Affairs Accountability and Whistleblower Protection Act of 2017.

Secretary Shulkin said the act would give the VA the authority rid the administration of employees that fail to adhere to the standard of Veteran care. Employees such as those convicted of successive DWIs, or those caught illegally transferring (stealing) controlled substances such as prescription opioids.  Shulkin plans to delegate this authority down the chain of command but would still require his final approval.

Lastly, but perhaps most important to the future success of the VA system, would be the authority of the VA Secretary to move funds between various VA sections to address needs. Shulkin said that the VA has the money to meet current needs, but cannot move the money from sections with excess funding to those in need. An issue sure to be contested in Congress, but a legitimate concern for a government bureaucracy attempting to compete with the private sector, regarding effectiveness and efficiency.

Shulkin has set an aggressive agenda but has so far moved quickly to make the bold moves he has promised. The question going forward will be whether or not Congress will support him and the VA, and whether veterans feel the impact of those changes.