The Togus VAMC in Augusta, ME, is the oldest facility for veterans in the nation. It opened in 1866. VA photo
WASHINGTON — VA Secretary Denis McDonough vowed to legislators that the agency will use the lessons it learned during COVID-19 to make the agency stronger going forward.
McDonough, who appeared before the Senate Veterans’ Affairs Committee last month to provide legislators with a snapshot of the state of the department as it heads into the new year, also cautioned that hard conversations are ahead. He was referring to the results of the VA’s Asset and Infrastructure Review (AIR) Commission, a Senate-appointed panel of experts that will look at the department’s physical footprint and where VA should add or subtract resources.
“The state of VA is not just where we are now. It’s about looking around the corner to where we’re going,” McDonough told the committee. “Let’s be honest, there are some real challenges. Looking ahead to this winter, we’re going to be releasing the AIR Commission recommendations. [And I] encourage each of you and your staff to get the briefings from our teams now and look at the market assessments in your states. Because we’re on the verge of some very big decisions here. And you should understand the analytic basis for those decisions.”
McDonough noted that the commission is not complete, with two of the nine spots remaining vacant, however.
“Right now, we have seven commissioners ready to go, with two that still have to come before you to be confirmed,” he said. “This is an aspirational look at our entire footprint. What’s going to be needed and what therefore is not needed over the next 25 years.”
In the near future, VA is preparing for what will likely be another COVID-19 surge as cases of the omicron variant begin to rise across the United States.
“We will learn from everything we’ve done over the past 20 months to meet his moment,” McDonough declared. “We will learn from last year to serve veterans next year.”
Many of those lessons have centered on how to swiftly beef up the department’s workforce. Much of that was achieved with the waiving of certain hiring regulations during the national COVID-19 emergency, which allowed VA to get people in place quickly.
“We have a series of [Office of Personnel Management] waivers that allow us to hire people in as quick as three days during the pandemic,” he explained. “Those are about five or six provisions tied to the national emergency of the pandemic. If that national emergency goes away, we want to work with you to incorporate those hiring authorities into statute.”
Spending Flexibility
VA will also be asking for more flexibility in spending for what he calls “the three ‘r’s”—relocation, retention and retraining.
“That would allow us, within the existing budget, to compete more aggressively to keep our nurses and our docs, including our specialists,” McDonough said.
He also warned legislators that VA might be approaching them next year to do away with the discrepancy between Title 5 and Title 38 employees at VHA. While most healthcare positions are under Title 38, administrative and support staff such as VA police officers, program analysts and human resource specialists fall under Title 5.
“The multiple systems bind us up,” he explained. “And Title 5 is a lot less workable for us in a highly competitive market.”
McDonough committed to coming back to Congress early in 2022 with a full analysis of the healthcare labor market and VA’s hiring and training authorities and what the department will need going forward.
Despite the highly competitive market, VA has managed to keep its employee turnover comparatively low, he noted.
“We’re pretty sticky with our healthcare professionals,” McDonough said. “Turnover is around 9% annually. A little less during the pandemic. People are staying longer. People were coming out of retirement to work.”
The flip side of that success is the tremendous pressure that workforce has been under during the pandemic.
“Our workforce is now 20 months into a pandemic,” McDonough declared. “And there are no mobile work options for clinicians in hospitals and clinics. They’re working under the constant challenge associated with contracting COVID. They’re working under scenarios where their kids are, until the last year, in home schooling. I’m concerned a great deal with making sure we keep that workforce supported.”
One area where VA has lost progress in the past year is in its claims backlog. At the start of the pandemic, there were about 220,000 claims in the backlog. That number tripled during the pandemic, when VA stopped conducting in-person exams.
With hospitals reopening, the number dropped down to 170,000 then shot up again in August when Blue Water Navy veterans began applying for benefits. It shot up again in October with VA’s addition of asthma, sinusitis and rhinitis to the presumptive conditions list. As of December, the backlog stood at 260,000.
According to McDonough, VA plans to use funding from the American Rescue Plan to bring on 2,000 additional claims processors—900 of whom are already hired and beginning their training. With that increase in staff and increased automation in claims processing, McDonough said VA expects to have the backlog below 100,000 cases by April 2024.
