He Said VA Needs to Choose Between Being a Provider or Payer
Outgoing VA Secretary Denis McDonough with staff at the Hines, IL, VA Medical Center at Christmastime. He said he is worried about slow hiring. Photo from the Hines VAMC Facebook page.
WASHINGTON, DC — In his final press conference prior to the change in presidential administrations, VA Secretary Denis McDonough discussed what he thinks should be the top priority for incoming department leaders, as well as the state of VA and the hard choices it will need to make in the future.
McDonough said he and other VA leaders had numerous meetings with President Donald Trump’s transition team, and that one thing they wanted to impress on them was the immediacy of the budget issue.
“We want the incoming team to understand the implications of that shortfall, so that they will be prepared for the budget debate when the current [continuing resolution] expires in March,” McDonough said.
Because the continuing resolution essentially keeps funding at the same level as last year’s budget, VA facilities are still having to implement the cost-cutting measures that got them through 2024. That includes delaying purchases of equipment—something that can’t be put off much longer, McDonough said.
“I am increasingly anxious about the fact that our network directors and our VAMC’s CEOs are forced into this Hobson’s Choice where they have to delay certain purchases because we’re going from CR to CR,” McDonough said. “I don’t think at the end of the day it’s more efficiency. I think it’s just more churn, and ultimately I think that’s probably not in the best interest of VA or in the best interest of veterans.”
The new administration has been frank about their intention to make sweeping cuts in the federal government. McDonough declined to talk about any recommendations he might have made to the new team about where not to make cuts, but he did defend VA’s budget needs as a whole.
“We’ve asked for significant increases in the VA budget the last 4 years. We’ve been very clear in how and where we spend that,” he said. “Inevitably, we only need funding because this is a veteran-centered organization, and we’re going to make decisions based on what the veterans need. In terms of what the next administration chooses to do, those will be their decisions.”
Slow Hiring Process
Asked how confident he is in VA’s workforce to continue with the increased workload of the past few years, McDonough said that veteran satisfaction numbers are up, as are employee retention numbers, which indicate that the staff is doing well under the pressure. But he did admit that the department’s slow hiring process has him concerned.
“I’m worried about time to hire at VHA,” he said. “If we start softening on retention, and we don’t do something about this maddeningly stubborn high number of days [it takes to fill a position], we’re going to encounter real problems. I still don’t really understand how we’re not able to crack that code.”
He added, “I still hear these stories in the field of qualified people we’re losing because they just can’t wait 6 months to get a paying job.”
At a previous press conference, McDonough made the bold statement that the nation needs to decide what it wants the VA to look like—a system that provides healthcare or one that pays for healthcare at private providers.
“The most important thing is that veterans continue to tell us what their expectations are,” he said. “The easiest way to do that is through the trust survey, which veterans get after every engagement in a VA health setting, and to which veterans respond at a higher rate than any other healthcare system.”
“An ancillary part of the debate is how [VA manages] its budget,” he continued. “The demands for healthcare are very expensive, especially as our existing veteran patient base ages and reliance on the VA system increases. As veterans, especially Vietnam veterans, enter the most expensive stage of healthcare in their lives, we have to be certain that we are managing prudently those generous resources.”
This does not mean VA should fail to be aggressive in providing care or in bringing new veterans into the system, he noted.
McDonough and VA kept up that aggressive outreach into the final weeks of the administration, adding to its list of presumptive service-connected conditions for veterans who served in the Gulf War and post-9/11 theaters. Those conditions include acute and chronic leukemias, multiple myelomas, myelodysplastic syndromes, myelofibrosis, urinary bladder, ureter and related genitourinary cancers. The affected veterans include those who served at the Karshi Khanabad (K-2) Air Base in Uzbekistan, which was a former chemical weapons site contaminated with uranium.
“This is particularly important to [President Joe Biden], that we get to the bottom of what happened there and the toxic [material] that was there,” McDonough said. “This is the first step in that. But it’s going to require multiple steps, and we’ll make sure that all those pieces are in place for the next team to continue.”
