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Inside the DoD Reporter's Notebook: DoD still slow to share medical records; New hiring initiative at VA; DISA's $12B IT contract
Friday - 8/29/2014, 6:47pm EDT
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DoD, VA still not moving medical records in a timely fashion
While most of the negative media attention the Department of Veterans Affairs has gotten over the last few months has focused on its healthcare operations, VA has ongoing challenges on the benefits side of the house as well. As of this week, it still has a backlog of 264,000 disability claims — though, notably, that's down from 451,000 at this time last year.
One major reason VA officials have long pointed to as a contributor to the delays in awarding compensation benefits has been the lag time between when VA requests a veteran's medical records from the military and when they hit a claims adjudicator's desk. A new electronic system DoD and VA implemented this year was supposed to go a long way toward solving that, but a new audit finds it's had some stumbles out of the gate.
HAIMS, the Health Artifact and Image Management Solution, was designed to give VA essentially instant access to the complete, certified military medical records of anyone who left service after Jan. 1 of this year. In theory, DoD is supposed to scan the complete records of anyone separating from the military into HAIMS, and from there, they're electronically transferred into VA's new electronic claims processing system, VBMS. Moving the records quickly is important, because in many cases they're a key part of the evidentiary process VA officials use to determine whether and how much disability compensation a veteran is entitled to.
But in reality, the new electronic process isn't much speedier than the old paper one — at least so far — according to a new report VA's inspector general released on Thursday. The audit blames both DoD and VA for sluggishness in transferring patient treatment records.
Between Jan. 1 and June 3, VA asked DoD for 7,300 electronic service treatment records. DoD had only completed 29 percent of those requests at the time of the audit — 71 percent were still pending. And out of the 2,100 requests DoD did complete, only 18 percent were turned around within the 45-day legal deadline. Some 4,200 electronic records requests were still overdue.
And those are just the delays on the DoD side of the information chain. The auditors pointed out that since the two departments are only using the electronic process for newly-separated veterans, the vast majority of VA's new claims still rely on paper treatment records, so HAIMS is unlikely to help matters much even if the electronic process were working perfectly.
For example, the IG's data shows that the biggest single category of brand new claims it received last year came not from Iraq and Afghanistan war veterans, but from vets who served during the Vietnam era. And while all of VA's regional offices are now using the paperless VBMS system to process claims, the service treatment records for any veteran who left the military before this year are still on paper, in giant warehouses in St. Louis, Missouri. Those records eventually make their way into VBMS, but VA is only scanning the paper records into the system after a veteran submits a new claim. There are no plans to proactively convert the entire stockpile of paper records at the National Personnel Records Center and VA's Records Management Center into an electronic form so they're available on demand.
As a result, it takes, on average, 48 days between the time VA claims staff request a record and the time it's available in VBMS. That's on top of the average 63-day span between when a claim is first in the system and VA actually requests a treatment record.
All in all, the average timeline between when a veteran submits a new claim and his or her military treatment record is available to a claims adjudicator is 131 days, auditors found. That process alone is enough to make a claim qualify as backlogged: VA's definition is 125 days.
VA officials did tell auditors they've implemented processes that should considerably shrink that 131-day window. Changes the department made to VBMS beginning in June will automatically request a veteran's military treatment record as soon as a new claim is entered into the system instead of relying on regional office staff to manually request it. The same automatic requests will happen for the new electronic records in HAIMS.
VA says the new process should be fully in place by March of next year.
VA begins recruiting drive
The Veterans Affairs Department is getting a running start at beginning to spend the extra $5 billion Congress and President Barack Obama authorized earlier this month to hire more doctors, nurses and clinicians.
During an address Friday at Duke University, VA Secretary Robert McDonald said the department was kicking off a new recruiting initiative, saying that while VA is using another $10 billion in emergency appropriations to pay for private-sector care for veterans, the long term solution is to beef up the Veterans Health Administration's own medical staff.
"We need the best doctors and nurses serving Veterans, and that is why I will be out recruiting, leveraging the existing relationships and affiliations VA has with many academic institutions, and talking directly to medical professionals about joining us to fulfill our exceptional mission of caring for those who ‘shall have borne the battle,'" McDonald said.
Speaking at an American Legion conference earlier in the week, McDonald suggested a shortage of medical staff was one factor behind the recent waiting list scandals in Phoenix and elsewhere. But rather than asking for more resources to get veterans timely care, managers created secret waiting lists to conceal the true length of their wait times, he said.
But not everyone is convinced a lack of resources is at the root of VA's access problems.
"We will look over the next nine or 10 months at whether physicians at VA are seeing an adequate number of patients," Rep. Jeff Miller (R-Fla.), the chairman of the House Committee on Veterans Affairs told the Legion conference on Wednesday. "There are those who will tell you we don't have enough doctors. I'm here to tell you the doctors that we have aren't seeing enough patients. They will tell you we don't have enough infrastructure. I will tell you that the infrastructure we have is closed during the hours you would want to use it the most. We have to bring the way VA delivers health care into the 21st century."
DISA planning successor to $12 billion Encore II IT contract
Encore II, the Defense Department's huge multiple award contract for buying IT products and services still has a few years of life left in it. But given the vehicle's length and complexity, DoD is getting to work on planning its successor.
The Defense Information Systems Agency, which manages the contract, issued a sources sought notice on Thursday as part of the preliminary effort to build an acquisition strategy for the forthcoming Encore III. The responses, officials say, will help DISA make decisions such as how much of the contract can be set aside for small businesses.
The scope of the indefinite delivery, indefinite quantity contract — IT products and services — won't change much under Encore III, DISA officials told vendors at the agency's annual forecast to industry earlier this month. But some of the changes they'd like to make include better on and off ramps for firms to enter and exit the contract. That's one of the lessons DISA learned during Encore II: 10 years is a long period of performance, and a lot can happen during that time, like contract holders who were small businesses at the outset graduating to larger size standards.
"There has been a reduction in the number of small businesses we can access on that vehicle," Dr. Jennifer Carter, DISA's acquisition executive said. "So one of the things we're looking at is making sure there are opportunities for small businesses and the ability to access large businesses where that's appropriate. We also need to make sure we're optimizing competition for the life of the contract, and if the life is long, we need to keep pace as small businesses evolve into large ones and as new small businesses come on the scene. If we don't make sure there's an opportunity for an on-ramp, we're essentially locking ourselves out of some capabilities and getting behind the market. The approach on Encore II hasn't been everything we'd intended for providing those opportunities."
Encore II, a $12 billion contract DISA originally awarded to 26 vendors in 2008, is good through the end of May 2018. The agency wants to award Encore III before then, but hasn't yet targeted a precise award date. The current schedule calls for a draft RFP in the second quarter of 2015 and a final RFP in the third quarter of 2015.
But the current contract had a base period of five years followed by five one-year option periods, so DISA very well could end Encore II early if its successor is ready in time.
"We're starting very early in the process because this is very hard and very complex, but if this contract is ready to award prior to 2018 given the small business structures I look at, Encore III may implement early," said Douglas Packard, DISA's acting procurement director "Every option under Encore II is not a guarantee, so we may not exercise every option year."