Could Contingent Staffing Save the VA?

Experts say the VA’s problems can be solved—just not easily

By Steve Bates Jun 17, 2014
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The Department of Veterans Affairs’ (VA’s) scandal-ridden health care system will require time and money to repair. And while there is no clear consensus among experts about how to fix the system, contingent staffing options could play a role, they say.

Government reports and testimony at congressional hearings revealed that at least 57,000 former troops waited at least 90 days for their first medical appointment, and that some VA employees faked records to make wait times appear far shorter. Some VA workers also allegedly altered the documents under orders from agency executives.

In June 2014, Congress was fast-tracking legislation designed to reduce patient backlogs in the VA’s Veterans Health Administration (VHA), the largest integrated health care system in the United States, with 150 medical centers and nearly 1,400 community-based outpatient clinics. A Senate-passed bill would allow veterans who cannot get appointments at VHA facilities within a reasonable time to seek care elsewhere at government expense. In addition, the bill would provide $500 million to help the system fill about 400 vacancies for health care providers. That bill and a House-passed measure also would make it easier to fire agency executives deemed responsible for the scandal.

However, Sen. John McCain, R-Ariz., co-sponsor of the Senate bill, told reporters that much more must be done to make the VHA function as intended.

Staffing Shortage Is Not New Issue

One challenge to reforming the VHA will be determining how best to approach staffing changes, even if the agency gets a big budget infusion from Congress. An audit indicated that the VHA did not have an effective method to determine whether staffing levels were adequate at its clinics. And a VHA official said at a June 2014 congressional hearing that the agency was not certain what staffing scenarios—such as adding employees or altering schedules—might help.

Long before now, “the staffing industry could have been a source of assistance” to the VHA, said Andrew Braswell, a research analyst with Staffing Industry Analysts, a global advisor on contingent work, in Mountain View, Calif. The shortage of medical professionals “wasn’t an unknown issue,” he said in a phone interview.

Sean Ebner, president of Irving, Texas-based temporary physician staffing firm Staff Care, noted that the vast majority of large U.S. corporations use contingent staffing and consider a flexible workforce to be a strategic imperative. He told SHRM Online that VHA leaders should “look at the entire system” and study available data to identify backlogs and empower those who hire medical professionals. Agency leaders “need to make the procurement system more proactive and fluid” by acting before shortages occur, by reducing screening requirements for professionals with prior VHA experience and by streamlining the onboarding process, he added.

Ebner also said that physician assistants and others who lack M.D. degrees can be brought in to help the VHA run more efficiently. They can screen incoming patients “so you don’t have primary care physicians looking at sniffles and coughs.”

The plan to let some veterans go outside the VHA for health care also could help relieve patient backlogs. Outsourcing is not new to health care, Braswell said, noting, for example, that “some health systems have outsourced their ER functions.”

Lisa Rosser, founder and CEO of The value of a Veteran, a Northern Virginia-based consulting, training and job assistance organization that works with former service members, questions why the VHA hasn’t outsourced more of its workload already.

“They should have been more willing to work with outside organizations such as private hospitals and clinics,” she told SHRM Online.

The VHA scandal is so politically charged that some prominent consulting firms and staffing industry sources who were contacted for this article declined to comment, citing a contract with the agency or an unwillingness to be seen as critical of any specific organization.

Spokespersons for the VA also did not return multiple calls and e-mails from a reporter.

Problematic Scheduling Has History, Too

The VHA has a history of scheduling problems, too. In recent years, reports from the VA inspector general’s office have cited long patient wait times and their impact on medical care.

VHA guidelines say that veterans should be given appointments within 14 days. But the 14-day standard “was unreasonable from the start” because medical staffing was insufficient, said Rosser.

Some experts say that outsourcing some of the VHA’s workload won’t address its fundamental problems and could be difficult to manage. “You’ve added another layer of administration,” said Rick Cobb, executive vice president of outplacement and career transitioning firm Challenger, Gray & Christmas in Chicago. “This creates another opportunity for things to go wrong.”

The VHA must avoid “degradation in care” if more veterans are treated outside of its system, she said, noting that conditions such as post-traumatic stress disorder “need to be treated holistically,” not simply by writing a prescription for sleeping pills. And she cautioned that when a veteran shuttles between the VHA and private medical caregivers, the various providers might not be aware of what the others have done for the patient.

Bad Rep Equates to Rotten Recruiting Options?

Rosser said the VHA won’t find it easy to boost permanent medical staff. “If you can’t compete in terms of salary, it’s going to be difficult” for the VHA because the private sector offers good wages and benefits.

Cobb said that because of patient backlogs, the agency is not viewed by some doctors and nurses as demonstrating a solid commitment to its core mission—serving veterans. “It’s going to be hard for the VA to recruit.”

The American Federation of Government Employees (AFGE) President J. David Cox Sr., in an op-ed, said that the VHA “must boost frontline staffing of doctors, nurses and others directly involved in patient care.” He suggested cutting “management layers” to help pay for new medical professionals’ salaries. But he did not endorse making it easier to fire executives.

“Blaming those managers for a performance system that was doomed from the start won’t help our veterans get the care they seek any faster,” he wrote.

In another op-ed article, Betsy McCaughey, chairman of the Committee to Reduce Infection Deaths and a former lieutenant governor of New York, criticized the AFGE, which represents more than 200,000 agency workers, for supporting a big increase in full-time employees. She wrote that “encouraging vets on Medicare to use civilian care instead of the Veterans Administration could cut the VA’s patient backlog by as much as half, solving a national crisis.”

Problems Extend Beyond the VA

Alden Bianchi, an expert on health care and an attorney with Mintz Levin in the Boston area, said that the VHA’s problems should be viewed in the context of broader issues in the U.S. health care system. “Something has to shift in the basics of our health care delivery model before we ask how to fix the VA. We have to fix health care system-wide.”

Paying providers based on the volume of medical care they perform rather than the quality of that care is among pressing issues. Hiring and retaining the right people is also a major challenge, he said.

“How do you ensure that you have the full range of professional support staff? Then, how do you deploy them?” Bianchi asked.

Cobb said that, to fix the VHA, “You have to start at the top and work down. Management has to articulate the mission clearly. Then there has to be a cascading order of responsibility, and you have to hold everyone accountable.”

Braswell noted that “satisfaction with quality of care among those who use the VA system is very high. It’s just a matter of getting to see someone. … The staffing industry can help,” he added. “It’s in the business of alleviating shortages.”

Steve Bates is a freelance writer in the Washington, D.C., area and a former writer and editor for SHRM.

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