A Failing Veterans Health Care Handoff

ISSUE

Massive backlog reveals the dire necessity for simplification, communication and efficiency in processes, systems and government service contracting in DOD and the Veterans Administration. 

BACKGROUND

A recent 3 part special in Time Magazine addresses the serious gaps between treatment, benefits and services processes and systems between the military services and the Veterans Administration:

http://nation.time.com/2013/04/22/what-the-hell-is-going-on-with-va/#ixzz2RnspoSM4

"While awaiting processing, "the veteran’s claim sits stagnant for up to 175 days as VA awaits transfer of complete (service treatment records) from DoD,":


http://veterans.house.gov/sites/republicans.veterans.house.gov/files/2013%2004%2016%20HVAC%20to%20Sec%20Hagel.pdf

After years of work to move toward integrated electronic records that would eliminate this sort of delay, Defense Secretary Chuck Hagel recently conceded that the Defense Department is not holding up its end of the bargain to improve the disability process.

"I didn’t think, we knew what the hell we were doing.":

 http://www.federalnewsradio.com/394/3288748/Hagel-orders-DoD-to-restructure-path-toward-integrated-health-record

HISTORICAL SIMILARITIES
 
The above scenario is not unlike the Walter Reed Army Hospital care fiasco a few years ago, before the facility was shut down and consolidated with the Bethesda Naval facility.

OTHER SYMPTOMS

The VA decided to have those who would actually use the system (claims processors) work with software developers. This process took longer but will create a system more likely to meet the needs of those who actually use it. VA also worked closely with major congressionally-chartered veterans’ service organizations.

This year, 2013, is the year in which regional offices are being transitioned to the new electronic system.

ROOT CAUSE

Both the services and the Veterans Administration use service contractors to perform this type of systems development. Government Computer News (GCN)  carried a story on the difficulties experienced with, "Performance-Based Contracting", which has been made part of the Federal Acquisition Regulation (FAR) in an attempt to pre-establish at contract award those discrete outcomes that determine if and when a contractor will be paid.

Interestingly enough, the article splits the blame for the difficulties right down the middle, stating the government typically has problems defining what it wants as an end product or outcome and looks to contractors to define it for them. More than willing to do so, the contractors detail specific end products or outcomes, set schedule milestones and submit competitive proposals.

The winner is selected based on what the government thinks it needs at the time to fulfill its requirement and a contract is negotiated. Once underway, the government decides it wants something else (usually a management-by-government committee phenomena with a contractor growing his product or service by offering lots of options). The resulting change of contract scope invalidates the original price and schedule, so a whole new round of proposals and negotiations must occur with the winner while the losers watch something totally different evolve than that for which they competed. The clock keeps ticking and the winner keeps getting his monthly bill paid based on incurred cost or progress payments. The link to the GCN article is below:

http://gcn.com/articles/2006/12/01/performancebased-contracting-still-baffles-agencies.aspx

CONCLUSION

The present state of the economy and the needs of our servicemen will not allow the aforementioned to continue. Government agencies are now hard pressed to insure the most "Bang for the Buck". It is in the long term interests of astute contractors to assist in that endeavor. The only way to achieve such an objective is through sound technical, cost and schedule contract definition via an iterative process of baseline management and control.

Our returning soldiers and those who have served before deserve better.

ARE AMERICA'S BEST DAYS BEHIND US?

Comparing US state GDP with countries

This question on Quora attracted our attention.  In response we point out that the US GDP is still the largest in the world. Our high technology cannot be matched. We have enough weapons systems and science to beat all our competitors and solve our problems.

The above graphic and the associated  metrics at "The Economist" linked below leave not doubt with regard to the future potential of the US economy. 
 
http://www.economist.com/node/21014355
 
We believe Mr. Zakaria's Time Magazine article , "How to Restore the American Dream"  is spot on.  It is an interesting analysis and positive future forecast. The link to the article is below:

http://www.time.com/time/magazine/article/0,9171,2026916,00.html
 

Mr. Zakaria addresses how the US is adapting to the "New Normal", which has substantially redefined the American Dream.

When the US ceased being an industrial giant it switched to consumerism and high technology to replace the missing base.

The challenge resulting from that transition has been in leaving the American worker behind and with corporations that are operating globally on a supply and demand basis responding to shifts in demographics, economics and the resulting markets.

In essence the US is climbing on the world economic train as individuals, businesses and as a government and joining those who are on board and leaving the station.

It is requiring a shift in thinking, an emphasis on education, diversity enhancement, strong doses of American ingenuity and hard work.

We are en route to making these adjustments and our position in the global economy will be secured by them. 

Costs of US wars linger for more than 100 years

NBC News:

OLYMPIA, Wash. — If history is any judge, the U.S. government will be paying for the Iraq and Afghanistan wars for the next century as service members and their families grapple with the sacrifices of combat.

An Associated Press analysis of federal payment records found that the government is still making monthly payments to relatives of Civil War veterans — 148 years after the conflict ended.

At the 10-year anniversary of the start of the Iraq War, more than $40 billion a year is going to compensate veterans and survivors from the Spanish-American War from 1898, World War I and II, the Korean War, the Vietnam War, the two Iraq campaigns and the Afghanistan conflict. And those costs are rising rapidly.

U.S. Sen. Patty Murray said such expenses should remind the nation about war's long-lasting financial toll.

"When we decide to go to war, we have to consciously be also thinking about the cost," said Murray, D-Wash., adding that her WWII veteran father's disability benefits helped feed their family.

Alan Simpson, a former Republican senator and veteran who co-chaired President Barack Obama's deficit committee in 2010, said government leaders working to limit the national debt should make sure that survivors of veterans need the money they are receiving.

"Without question, I would affluence-test all of those people," Simpson said.

With greater numbers of troops surviving combat injuries because of improvements in battlefield medicine and technology, the costs of disability payments are set to rise much higher.

The AP identified the disability and survivor benefits during an analysis of millions of federal payment records obtained under the Freedom of Information Act.

To gauge the postwar costs of each conflict, the AP looked at four compensation programs that identify recipients by war: disabled veterans; survivors of those who died on active duty or from a service-related disability; low-income wartime vets over age 65 or disabled; and low-income survivors of wartime veterans or their disabled children.

THE IRAQ WARS AND AFGHANISTAN

So far, the wars in Iraq, Afghanistan and the first Persian Gulf conflict in the early 1990s are costing about $12 billion a year to compensate those who have left military service or family members of those who have died.

Those post-service compensation costs have totaled more than $50 billion since 2003, not including expenses of medical care and other benefits provided to veterans, and are poised to grow for many years to come.

The new veterans are filing for disabilities at historic rates, with about 45 percent of those from Iraq and Afghanistan seeking compensation for injuries. Many are seeking compensation for a variety of ailments at once.

Experts see a variety of factors driving that surge, including a bad economy that's led more jobless veterans to seek the financial benefits they've earned, troops who survive wounds of war, and more awareness about head trauma and mental health.

VIETNAM WAR

It's been 40 years since the U.S. ended its involvement in the Vietnam War, and yet payments for the conflict are still rising.

Now above $22 billion annually, Vietnam compensation costs are roughly twice the size of the FBI's annual budget. And while many disabled Vietnam vets have been compensated for post-traumatic stress disorder, hearing loss or general wounds, other ailments are positioning the war to have large costs even after veterans die.

Based on an uncertain link to the defoliant Agent Orange that was used in Vietnam, federal officials approved diabetes a decade ago as an ailment that qualifies for cash compensation — and it is now the most compensated ailment for Vietnam vets.

The VA also recently included heart disease among the Vietnam medical problems that qualify, and the agency is seeing thousands of new claims for that condition. Simpson said he has a lot of concerns about the government agreeing to automatically compensate for those diseases.

Instead of Cutting Services Because of Sequestration, Why Can't Government Departments just Make Their People Work Harder?

 

The title to this post is from a question asked on Quora by a member at that site:

https://www.quora.com/U-S-Federal-Budget/Instead-of-cutting-services-because-of-sequestration-why-cant-government-departments-just-make-their-people-work-harder

 The following is our response:

The US Government is monumentally inefficient and does not design systems, practices and policies like the commercial venue to save money or make a profit.

Government typically designs systems to spend money and perpetuate bureaucracy. They hire armies of high salaried General Services civilians and large, independent contractors to do so on cost plus and time and materials contracts with a baseline that changes every time the wind blows.  We watched this phenomena from the inside for 36 years, trying to control costs. It was a maddening process.

New buzz words continually surface such as "Performance Based Contracting". We have hands on experience with that one. It was made part of the Federal Acquisition Regulation (FAR) in an attempt to pre-establish at contract award those discrete outcomes that determine if and when a contractor will be paid.

Interestingly enough, the blame for the difficulties goes right down the middle, with the government typically having problems defining what it wants as an end product or outcome and looking to contractors to define it for them. More than willing to do so, the contractors detail specific end products or outcomes, set schedule milestones and submit competitive proposals.
The winner is selected based on what the government thinks it needs at the time to fulfill its requirement and a contract is negotiated. Once underway, the government decides it wants something else (usually a management-by-government committee phenomena with a contractor growing his product or service by offering lots of options).

The resulting change of contract scope invalidates the original price and schedule, so a whole new round of proposals and negotiations must occur with the winner while the losers watch something totally different evolve than that for which they competed. The clock keeps ticking and the winner keeps getting his monthly bill paid based on incurred cost or progress payments. The link to a Government Computer News article on this phenomena is below:

http://www.gcn.com/online/vol1_no1/42691-1.html
 
The present state of the economy will not allow the aforementioned to continue. Government agencies are now hard pressed to insure the most "Bang for the Buck". It is in the long term interests of astute contractors to assist in that endeavor. The only way to achieve such an objective is through sound technical, cost and schedule contract definition via an iterative process of baseline management and control. The following article is our attempt to address that process:

http://www.smalltofeds.com/2009/08/contract-baseline-management-in-small.html

The Truth About the NRA

Other nations do not have an organization like the NRA. Every US citizen should read the full history of the NRA as published by the Washington Post in the article linked below entitled:

"How NRA’s true believers converted a marksmanship group into a mighty gun lobby"

 http://articles.washingtonpost.com/2013-01-12/politics/36311919_1_nra-leaders-nra-officers-mighty-gun-lobby

Here is an excerpt:

"In gun lore it’s known as the Revolt at Cincinnati. On May 21, 1977, and into the morning of May 22, a rump caucus of gun rights radicals took over the annual meeting of the National Rifle Association.

The rebels wore orange-blaze hunting caps. They spoke on walkie-talkies as they worked the floor of the sweltering convention hall. They suspected that the NRA leaders had turned off the air-conditioning in hopes that the rabble-rousers would lose enthusiasm.

What unfolded that hot night in Cincinnati forever reoriented the NRA. And this was an event with broader national reverberations. The NRA didn’t get swept up in the culture wars of the past century so much as it helped invent them — and kept inflaming them. In the process, the NRA overcame tremendous internal tumult and existential crises, developed an astonishing grass-roots operation and became closely aligned with the Republican Party.

Today it is arguably the most powerful lobbying organization in the nation’s capital and certainly one of the most feared. There is no single secret to its success, but what liberals loathe about the NRA is a key part of its power. These are the people who say no."

HAPPY BIRTHDAY TONY ROSE - "ROSE COVERED GLASSES" FOUNDER

TONY (ON RIGHT) AT "ROSE COLORED GLASSES" BOOK RELEASE"JANUARY 2010

In Honor of General H. Norman Schwarzkopf - Dead at Age 78

http://en.wikipedia.org/wiki/Norman_Schwarzkopf,_Jr.

 

He fought a just and honorable war assisting many Middle East allies and other countries to free Kuwait. General Schwarzkopf is a true American hero. You will note he came home and stayed home. His successors then hung around with an imperialist attitude, resented by cultures that have hated that type of control for thousands of years.

These incursions have killed thousands of our finest youth and maimed the lives of countless others. We learned nothing from the Russians, our own experiences in Vietnam and similar outings in the past.

The average American will pay for this ruin in decades to come through taxes supporting hospital care, social services and veteran's homes.

The Real Issue of Gun Control

As  former military men, security specialists and those who have taken lives in combat, we  assure you of the following:

If you are carrying a gun and you are NOT one of the following:


1. A soldier

2. A policeman or a duly authorized security officer

3. A licensed hunter of wild animals in the woods


 You are part of the problem, not part of the solution.

HAPPY HOLIDAYS 2012 FROM ROSE COVERED GLASSES

PLEASE CLICK ON IMAGE TO ENLARGE

VETERANS DAY - 11 NOVEMBER 2012

12 Names on a Wall in Washington D.C.

Forgotten by Many but Not By Me

To those who died serving USAECAV 1966-1968 Countrywide 

The Vietnam Veterans Memorial Wall Page
 

Database of the 58,195 Names on The Wall in Wash,D.C. This is the most accurate database online.

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VOTE TO "DE-CONSTIPATE GOVERNMENT"

VOTE:

The candidates who will make conscious decisions to participate in bipartisan plans to "De-Constipate" government as a first priority.

The laxatives are: Leadership, Listening, Compromise and Action - in that order.

PRACTICAL REALITY IN GOVERNMENT FOR 2013

George Friedman at STRATFOR recently offered two commentaries on our nation and its future leader that we find worthy for consideration on the eve of the 2012 Elections.

PLEASE CLICK ON IMAGE ABOVE TO ENLARGE EXTRACTS AND DOWNLOAD COMPLETE ARTICLES BELOW

http://www.stratfor.com/weekly/purpose-presidential-debates?utm_source=freelist-f&utm_medium=email&utm_campaign=20121024&utm_term=gweekly&utm_content=readmore&elq=8924874ddc944edf9cb519320735b9a2

http://www.stratfor.com/weekly/character-policy-and-selection-leaders?utm_source=freelist-f&utm_medium=email&utm_campaign=20120904&utm_term=gweekly&utm_content=readmore&elq=b785529990204ebfbe83d08a9a9b9051

Mr. Friedman points to a practical reality.  Presidents manage as they must. The real issue for the winner of this election will arise when the Chinese and our other major creditors stop showing up at our bond auctions and our credit and credibility diminish to dysfunctional levels on the world stage.

Until then our stagnated, polarized, congress will kick the can down the road as they have with current legislation that postpones any consideration of the issues until after the election and lays the challenge off on Sequestration, due to begin in early January, 2013.

The new White House occupant (or the same one) will be just as bound and tied by the inability of our elected representatives to compromise. This situation is an economic illness.

We have seen a similar situation take down other countries in recent times and place them at the mercy of the international community.  It has threatened the financial future of Greece and other countries in Europe. 
 
Our country has caught a catchy illness of political diatribe and inaction.  Let us hope for some leadership in Congress that is driven by the practical reality of the world at large and is not based on the rarefied air of financial pocket-lining on the Washington D.C.  Beltway.  

The clock is ticking:

http://www.usdebtclock.org/

A BRIDGE TO THE FUTURE FOR THE COMMON GOOD

On August 1^st, 2007, I was having dinner in a restaurant next to the Highway 61 Bridge in Hastings, Minnesota with a retired businessman, his girlfriend, and a local lawyer and his wife.  Glancing up at the TV over the bar, we were witnesses to the news of the 35W Bridge collapse into the Mississippi River.  

As we left the restaurant we looked up at the underside of the Highway 61 Bridge since we had parked on the land side parking lot beneath it.  We noted the general condition of the structure and wondered if it too was a risky passage, 26 miles further downstream over the same body of water on which the 35W tragedy had occurred.

Within months the Minnesota DOT had come to the conclusion that the bridge was indeed  risky.  They began making immediate temporary repairs while planning for a new span.  The existing Hastings Bridge had been erected in 1951. Its planned replacement, scheduled for 2019, was accelerated to commence in 2010, based on the condition of the structure and the fact it is one of the busiest bridges in the state, handling enormous traffic as a major north/ south artery from the Twin Cities. 

BRIDGE AT HASTINGS IN 2007

“BRIDGING” FEDERAL, STATE, LOCAL AND CONTRACTING INTERESTS  

Planners at the Minnesota DOT are to be applauded for the manner in which this project has proceeded and the people of the community, as well as their civic, government and industry leaders should be congratulated for the businesslike, cooperative and efficient manner in which this project has been conducted. 

Local community meetings solicited input from the citizens on the design. The options were carefully weighed in terms of environmental and aesthetic impact.  Hastings, Minnesota is an old river town with a preservationist ethic that spans generations. That fact was not ignored.  The Highway 61 corridor has remained open, eliminating a major detour for commuters.

The state ran a competitive bidding process.  The winning contractor joint venture was a team of reputable companies who planned to use state of the art pre-stressed concrete as a design to construct the longest such span on the North American Continent, costing millions below the state estimate for the job.

Heavy girders have been manufactured locally in Minnesota and transported from north of Minneapolis to the Hastings site with computer steered special transports involving minimal disruption.  The large, arch frame for the bridge was recently floated downstream from a staging area near Lock and Dam 2 on the Mississippi after having been assembled by skilled union iron workers. 

It was lifted in place on 24 September by the largest heavy lifting equipment company in the world, who traveled from Europe to support the project. 

The Coast Guard, Corps of Engineers, State DOT, Hastings Community and all related support organizations have worked in a cooperative manner to achieve a demanding schedule.  The bridge work will be completed and the new span will open in the near future.  

OUR NEW HORIZON

 POLITICIANS

I have yet to hear a politician or agency official attempt to take credit for this project or pursue some form of attention-seeking advantage as a result of it.  In an election year, considering the nature of politics these days, that is a highly unusual occurrence. 

I am sure there will be events commemorating the project success, as there should be; but it is my hope those events will celebrate the true nature of the achievement.

SUMMARY

It has been a pleasure observing the Highway 61 bridge replacement over the Mississippi at Hastings. Its planning, execution and achievement have been exemplary to an old project manager who has witnessed difficulties with entrenched bureaucracies in industry and government for years.

This has been a shared, community, cooperative venture, worthy of note when considering models for the future of our country and the path it must take to overcome many challenges – political, economic and technological.

Certainly similar projects can be undertaken involving other infrastructure programs such  education using the same form of cooperative, shared, professional action.

Let’s build bridges like this one in many other fields of endeavor!

http://www.dot.state.mn.us/hastingsbridge/

THE UNITED STATES VETERANS ADMINISTRATION - PROGRESS AND PROCLIVITIES

INTRODUCTION

We have noted improvements in the medical element of the U.S Veterans Administration with significant advances in patient care, records keeping and service to soldiers in need when they return from war or fall into circumstances in which they require assistance:

http://www.time.com/time/magazine/article/0,9171,1376238,00.html

We believe the VA medical care veterans are receiving, and the associated facilities are top notch.  We base this belief on having received this care  ourselves and observing the results from others receiving VA medical services around us.

As the US has continued its war fighting incursions into foreign countries, the VA has been required to expand exponentially in terms of coverage, organization, programs and budget from the tax payer coffers. The most current budget request by the Administration for the VA tops $140 Billion for the next fiscal year.

This growth has resulted in administrative and management challenges due to the broad swath the VA must cover across the spectrum of our society and the transitions in which it must participate within people’s lives from the aging vet to the returning combatant.

RECENT DISTURBING TRENDS AND OCCURRENCES

At this juncture it must be noted that the VA is falling into several of the traps that other large federal agencies have encountered.  The government is in the business of spending money, not making it and growth of the type the VA has undergone requires strong management and oversight. 

Below are examples of areas outside the medical care elements of the organization that are never the less posing substantial risk to the care of our veterans.

Blatant Issues in Handling Veterans Care Application  Backlogs

As noted by Time Magazine:

“The Department of Veterans Affairs inspector general reported that paper had piled so high at the VA’s regional office in Winston-Salem, N.C., that it “appeared to have the potential to compromise the integrity of the building.”

http://nation.time.com/2012/08/10/guess-the-va-does-have-a-paperwork-problem/

Mismanagement of Human Resources and Training

As noted by DOD Buzz:

“The chairman and ranking members of the House Veterans Affairs Committee are demanding a complete accounting of where and how the Department of Veterans Affairs has spent money on employee conferences since 2009.

The latest demand comes as the committee’s senior members released additional information gleaned from a preliminary VA Inspector General’s report on two Orlando, Fla., conferences held for VA human resources employees in 2011.

Among the findings, the VA spent $52,000 producing two 8-minute videos in which an actor portraying Army Gen. George Patton laid out the role of VA human resources personnel and exhorted them to meet their mission. A shortened version of the video is available below.

The department also spent $84,000 on VA-branded promotion items, including up to $25,000 for pens, highlighters, post-it notes and hand sanitizers.

Rep. Jeff Miller, R-Fla., and Rep. Bob Filner, D-Calif., want three years worth of data because they say past VA testimony on conference costs has been contradictory, ranging from $20 million in both 2011 and 2012, to $100 million.”

http://www.dodbuzz.com/2012/08/22/va-accounting-questioned-after-ig-report-2/

Mismanagement of Small Business Set-aside Programs

As noted by POGO:

“A new report by the Department of Veterans Affairs Office of Inspector General (IG) has found another large business improperly benefited from federal small business contracts. The offender this time is Health Net,  ranked 221 in the most recent Fortune 500 with $11.9 billion in revenue last year.

As POGO takes great pains to point out, the contractors themselves aren’t entirely to blame for misconduct in federal small business contracting. In this instance, the IG found that VA personnel responsible for administering the contracts were fully aware that Health Net, not ETS, was performing all of the work. The VA also did not properly justify its decision to award the contracts as SDVOSB set-asides rather than through full and open competition.”

http://pogoblog.typepad.com/pogo/2012/08/inspector-general-finds-contractors-government-both-responsible-for-small-biz-contracting-violations.html

CONCLUSION

The areas noted above must have management correction, be controlled and brought to the same standards of performance as the medical arm of the Veterans Administration Community. 

The proclivities involving  lax administration, wasteful human resources process and abuse of small businesses, many of which veterans themselves run, must be corrected. 

Doing so will insure an acceptable level of focus on assistance to the men and women who have served in our armed forces.