Earlier this month the Senate Veterans' Affairs Committee began its work on Veteran Affairs (VA) 2012 budget. In her opening statement, Chair Patty Murray (D-WA) noted that on balance, and given that other agencies are facing budget cuts, the “VA budget is a very good starting place from which to work.”
She noted that the President has requested an overall increase of $5.9 billion in discretionary spending over Fiscal Year 2011 levels, and that while health care spending is in good shape, there are some weaker points in the budget. For example, she pointed to the proposed cuts in spending for construction and non-recurring maintenance are very troubling.
In addition, she noted that the budget documents lay out VA’s vision for a ten-year construction plan, “but what is missing in this budget is detail on how to close the gap between the funding we need to bring facilities up to date and the funding requested of the Congress.”
She also called attention to the proposed $70 million cut for VA research funding and that she is worried that such a cut would imperil some critical projects and shove physician researchers out the door. Ms. Murray also discussed the VA’s problems facing processing disability benefits claims.
Nevertheless, Ms. Murray applauded the budget request for including a series of cost-saving initiatives, including better controls on contract health care, better strategies for contracting, and cutting administrative overhead, all of which I will review with an open mind. Then, the committee heard testimony from the following individuals:
- Honorable Eric K. Shinseki, Secretary of VA
- Maryann D. Hooker, MD, Lead Neurologist, Wilmington DE VA Medical Center, Secretary, AFGE Local 342
- Raymond C. Kelley, Director National Legislative Service, Veterans of Foreign Wars of the U.S.
- Christina M. Roof, National Deputy Legislative Director, AmVets
- Carl Blake, National Legislative Director, Paralyzed Veterans of U.S.
- Tim Tetz, Director National Legislative Commission, The American Legion
- Joseph A. Violante, National Legislative Director, Disabled American Veterans
Maryann D. Hooker
On behalf of the American Federation of Government Employees (AFGE), which represents more than 200,000 employees at the VA, including nearly 120,000 employees who provide direct medical services to veterans within the Veterans Health Administration (VHA), Dr. Hooker’s testimony focused on the VA's proposal to achieve costs savings through staff and resource realignment.
Dr. Hooker expressed concern about the lack of details in the Department's proposal, which assumes a yearly savings of $151 million over two years. The proposal to realign staff and resources would follow on the heels of current VHA efforts to contain costs, including telehealth, team-based care, group appointments, and shorter appointments.
Dr. Hooker cautioned that too often, "new VA health care initiatives are implemented without proper oversight or advance planning, resulting in reduced access and quality of care. Sometimes they even cost the taxpayer more, in the form of costly contract care, less continuity of care, and higher staff turnover."
As a result, AFGE AFL-CIO National VA Council President Alma L. Lee asserted that, “balancing the VA's health care budget by reducing veterans' access to care is not the answer to the country's financial woes.” Instead of reducing access to care, Ms. Lee noted the need for “greater oversight of the VA's current initiatives such as telehealth and Patient Aligned Care Teams (PACT), as well as greater accountability over VA spending used to expand its top heavy management workforce, provide excessive bonuses, and continue unwarranted increases in costly contract care.”
AFGE testimony also conveyed opposition to the VA proposal to eliminate all continuing medical education (CME) reimbursement for physicians and dentists. It was specifically noted how the “VA continues to rely heavily on more costly fee basis care and has difficulty recruiting and retaining clinicians. It is in the best interest of all stakeholders to provide an environment of professional growth.”
As a result, AFGE Secretary Treasurer J. David Cox noted that AFGE “will not sit quietly by while VA returns to the era of hiring freezes and frozen medical center budgets," said. He asserted that the AFGE will “question the way cost-cutting initiatives are designed and implemented and will continue to oppose cost-saving measures that diminish VA's world-class health care system."
While the other members testifying did not focus their testimony on CME, it is crucial that people realize the significant consequences Veterans could face if CME funding for VA health professionals is reduced or eliminated. The men and women who serve our nation deserve the highest standard of medical care and treatment. To give our veterans what they deserve for the sacrifices they have made, doctors working within the VA need to have the latest updates in medicine and technology.
CME is the best resource to achieve a higher standard of care for VA health professionals and to improve patient outcomes. If funding for CME is reduced or eliminated for VA healthcare providers, they will be faced not only with the financial burden of CME courses, but also the limitations of finding relevant, accredited CME courses within a convenient geographic location. They will also have to find programs that are interactive and address the patient populations within the VA, which include a wide array of conditions; anywhere from pain to post traumatic stress disorder.
Ultimately, as many of the international wars continue to deescalate and more soldiers come home, our VA health professionals will need more training and resources, not less. Reducing CME and medical education will not help our service members, and Congress, Veterans, patient advocates, medical professionals, and CME stakeholders must make the Obama Administration clearly aware of that.