VA Raises the Bar on Improving Veteran Health Services

WASHINGTON — The $1.5 trillion omnibus spending package signed into law by President Joe Biden on March 15 includes funds to modernize the VA infrastructure and allow registered nurses and physician assistants in the U.S. Department of Veteran Affairs to receive a maximum salary to address staffing shortages through the RAISE Act. 

“The RAISE Act will help VHA become more competitive with the private sector in attracting the critical talent needed to care for our Veterans in this highly competitive market…Without the RAISE Act, VA loses talent to private hospitals that can pay more,” said Randal Noller, public affairs officer for the deputy assistant secretary for Public Affairs at the VA, in an email to The Well News.

Included in the nearly 3,000-page package of the Consolidated Appropriations Act of 2022 is the VA Nurse and Physician Assistant RAISE Act, to increase the ceiling on nurse and physician assistant salaries at the Department of Veterans Affairs to help the VA to attract and retain talent within the health workforce.

During the pandemic, the VA experienced the highest rate of workforce turnover in 15 years, according to data from the department. 

Despite the high levels of turnover last year, VHA was able to grow by 2.2%. Unfortunately, in FY 2022, Noller said that there has so far been an overall net decrease in onboard employees. 

A similar pattern is seen in the clinical occupations with FY 2021 turnover of 8.84% and negative FY 2022 growth.

The RAISE Act will increase the cap on pay for physician assistants and advanced practice nurses from level IV to level I and to level II for registered nurses. 

The spending bill funds will allow the VA to make strides in shortening the timeline for hiring employees by directing the Office of Personnel Management to highlight process reforms used by VHA and other agencies during the pandemic to reduce delays in the federal hiring process.

“VA has reduced the time to hire for Title 5 positions by increased utilization of direct hire authority to fill positions and for Title 38 positions by streamlining the onboarding process. VA continues to work with OPM in its efforts to support use of Defense Health Agency for positions where there is a critical need and severe shortage,” said Noller.

The funds from the spending bill will allow the VA to tackle goals of a 10-point infrastructure plan which was released by the department last month. 

The 10-point plan includes actions like covering the costs of childcare, providing greater flexibility for employees outside the traditional workspace, or funding for education and scholarship programs. 

“VA will need legislation and funding to increase bonuses and awards and limits on student loan repayment/tuition reimbursement,” said Noller.

Noller said that other parts of that plan are also underway, such as the REBOOT taskforce — and the recommendations around wellness and burnout, the increased limit on total family income for childcare reimbursement, and review of position descriptions and qualification standards to increase career paths and promotion potential.

The spending bill will also provide $2.4 million to build out the telehealth capacity of the VA through updates to the Electronic Health Record Modernization Program, or EHRM, and fund specific telework services. 

The EHRM was implemented during the pandemic to electronically store health information and track patient care to connect VA medical facilities with the Department of Defense and other community care providers, and allow clinicians to easily access a veteran’s full medical history in one location. 

In July 2021, the VA released the Comprehensive Lessons Learned Report from the strategic review. The findings focused on things like improving the veteran experience, ensuring patient safety, providing enhanced training to frontline employees and building confidence at VA sites. 

Through the report, the VA learned that the patient portal experience was fragmented for veterans at the Mann-Grandstaff VAMC Post-Go-Live, and clinical and interdisciplinary workflows were not tested in a manner that effectively reflected a real-world environment. 

Other concerns noted in the report included gaps in governing and managing data between the EHRM and the Department of Defense. 

“The system clearly seems to be creating safety risk … we don’t have a fully functional system … and yet we’re spending millions and millions and millions of dollars to reintroduce this system at another facility,” said Rep. Matt Rosendale, R-Mont., during a hearing held last year by a House Veterans’ Affairs subcommittee to discuss the release of a strategic review on the EHRM. 

According to Rosendale, as of last November there were 829 patient safety reports since the EHRM went live, with 576 of those tickets directly related to EHRM.

The VA pushed back the second rollout of the EHRM system which was expected to go live on March 5 because of the staffing shortages the department is experiencing.

Now, the funds from the spending package will allow the department to move the needle forward on implementing those EHRM updates. The VA has said the new EHRM go-live date will occur on April 30. 

The omnibus also includes funds to develop more focused efforts from the VA on inclusion, diversity, equity and access through the I-DEA initiative.

On April 1, 2021, Secretary Denis McDonough chartered an 18-member task force to identify strategic opportunities for I-DEA across VA’s vast enterprise. 

The I-DEA Task Force conducted a 120-day enterprise review from April 1, 2021, through July 31, 2021. It conceptualized the agency’s perspective on equity, identified and executed accomplishments to advance equity and conducted outreach to community partners to learn best practices.

The I-DEA Task Force also developed 20 recommendations and 68 sub-recommendations to ensure I-DEA is woven into the fabric of VA. 

“VA is at an inflection point, which provides a remarkable opportunity for the department to proactively examine and improve I-DEA,” said Noller.

“We are focused on creating a culture guided by principles such as empathy and accountability to review and rethink policies and programs that may have caused unintended barriers to serving Veterans. Central to that effort is fostering opportunities to conduct deep listening sessions and gain the perspectives of Veterans, employees and community partners,” continued Noller. 

When it comes to modernizing VA health care facilities, the funding provided in the omnibus will support VHA’s timely, high-quality delivery of care in both VA medical centers and the community, as authorized by the MISSION Act.

On Monday, the Asset and Infrastructure Review Commission at the VA released recommendations for consolidating VA medical facilities in the nation by closing outdated facilities and modernizing and realigning VA facilities, as directed under the MISSION ACT of 2018.

​Under the recommendations from the AIR Commission, the number of outpatient facilities would decrease but would still allow for more than 150,000 veterans to have better access to primary care within 30 minutes from their residence. 

Biden will review the AIR Commission report and recommendations and either approve or deny the recommendations by Feb. 15, 2023. 

Alexa can be reached at [email protected]