The new field general in the bureaucratic battleground of the claims department at the Department of Veterans Affairs got a first-hand look at the carnage last week and promised help is on the way.
Retired Gen. Eric Shinseki, the new VA secretary, told Congress he would move quickly toward an all-electronic claims system that would speed up and improve the overloaded, criticized system.
A former lieutenant in the same war welcomed the new leader and the sentiment, but he warned other strong generals with similar good intentions have tried and failed.
"What's really needed is a change in philosophy, a change in the basic concepts that guide the claims department," said Gary Christopherson, former CIO for the Veterans Health Administration and former senior adviser to the undersecretary for health.
"It's good to hear of [Shinseki's] commitment; however, it worries me that we've heard this before and yet here we are with a broken system," Christopherson said.
Six-Month Delays
Shinseki said he is considering a major overhaul of the VA claims system to phase out the paper-based process that has resulted in six-month delays as standard operating procedure for claims. He told Congress that VA will hire 1,100 more staff this year to deal with the backlog of cases and that eliminating paper might be accomplished by 2012.
Shinseki and the Obama administration are inheriting a troubled VA accused during the Bush administration of not doing enough to meet veterans' growing needs.
The Government Accountability Office recently reported that VA was underestimating medical expenses in reports to Congress at the expense of tens of thousands of patients needing long-term health care.
The move to digital claims will "ensure timely, accurate, consistent decision-making on behalf of our veterans," Shinseki said.
"I'm glad Shinseki is big on health IT," Christopherson said. Health IT "is necessary but it's not sufficient. You can't move forward without it but IT alone won't do the trick," he said.
"I've heard good things about Shinseki, and I truly believe he has the right intentions," Christopherson said."But so did Jim Peake (VA secretary from Dec. 2007 to last month), so did Tony Principi (VA secretary from 2001-2005). They all cared. They all wanted to do the right things, but none of them could pull it off," Christopherson said.
Christopherson's Suggestions
Christopherson, who helped redesign and implement the VistA electronic health record system and the Health eVet systems, said that a military version of the patient-centered medical home model of care would help VA address its benefits problems.
"Just as medical care is centered around the patient, the benefit system should be centered around the veteran," Christopherson said.
The basic technological framework is already in place "to get the ball rolling," Christopherson said, adding, "We could use a good claims processing system, but before that arrives, there's no reason to keep a veteran waiting six months or even six days to determine whether the claim qualifies or not."
Using VistA, Health eVet and veterans' claims reports, VA personnel have enough information to make a quick assessment and decision, according to Christopherson.
VistA, or the Veterans Health Information Systems and Technology Architecture, is perhaps the country's most widely used EHR system. Health eVet is an electronic tool that lets veterans gain access and some measure of control over their individual health records.
"In my opinion, changing the process means giving a veteran a temporary financial benefit at least as soon as the veteran files a claim with basic supporting evidence," Christopherson said.
Christopherson, now in private industry with consulting firm viaFuture, suggests redeploying some of the small army of claims adjudicators as case managers. "At the rate we're going now -- with technology or without -- a lot of these people who are essentially paper pushers now would be much more effective as case managers working directly with veterans," Christopherson said.
"If you really want to do the right things for veterans, you need to change the way you do benefits determinations. You need to get basic information and if the claim meets basic requirements, you have to start the benefits flowing right then and there," Christopherson said.
In his testimony before Congress, Shinseki said the number of VA claims adjudicators is equal in size to the 82nd Airborne Division. The 82nd Airborne Division has approximately 14,500 paratroopers.
Over the past two years, VA claims ranks have grown by about 4,000. And now, Shinseki proposes hiring 1,100 more.
Technology Ironically 'Part of the Problem'
Although lack of technology -- the absence of a workable claims processing software -- is part of the problem creating mountains of paperwork, another part of the technology -- the Internet -- might be helping the mountains to grow.
During Shinseki's testimony before Congress, Rep. Vic Snyder (D-Ark.) said that veterans working on strengthening their disability claims are making Internet searches, printing documents about their disease, injury or condition and adding them to the case files.
"The files will just keep growing," Snyder said, adding, "We've got to get a handle on this whole thing."