VA says 65% of execs given bonuses in '13

Awards totaled $2.7 million

WASHINGTON -- About 65 percent of senior executives at the Veterans Affairs Department got performance bonuses last year despite widespread treatment delays and preventable deaths at VA hospitals and clinics, the agency said Friday.

More than 300 VA executives were paid a total of $2.7 million in bonuses last year, said Gina Farrisee, assistant VA secretary for human resources and administration. That amount is down from about $3.4 million in bonuses paid in 2012, Farrisee said.

The totals do not include tens of millions of dollars in bonuses awarded to doctors, dentists and other medical providers throughout the VA's nearly 900 hospitals and clinics.

Workers at the Phoenix VA Health Care System -- where officials have confirmed dozens of patients died while awaiting treatment -- received about $3.9 million in bonuses last year, records show. The merit-based bonuses were doled out to about 650 employees, including doctors, nurses, administrators, secretaries and cleaning staff members.

There was confusion Friday about the number of senior executives who received bonuses. During a hearing of the House Veterans' Affairs Committee, both lawmakers and Farrisee had indicated that nearly 80 percent of senior executives had received bonuses. Later, however, the committee provided documents showing that 304 of 470 senior executives, or 64.7 percent, had received bonuses. The committee and a VA spokesman said the 80 percent figure referred to the number of senior executives who received very high ratings, not those who received bonuses.

Farrisee defended the bonus system, telling the Veterans' Affairs Committee that the VA needs to pay bonuses to keep executives who are paid up to $181,000 per year.

"We are competing in tough labor markets for skilled personnel," Farrisee said Friday. "To remain competitive in recruiting and retaining the best personnel to serve our veterans, we must rely on tools such as incentives and awards that recognize superior performance."

Farrisee's testimony drew sharp rebukes by lawmakers from both parties.

Rep. Jeff Miller, R-Fla., chairman of the Veterans' Affairs Committee, said the VA's bonus system "is failing veterans."

Instead of being given for outstanding work, the cash awards are "seen as an entitlement and have become irrelevant to quality work product," Miller said.

Rep. Phil Roe, R-Tenn., said awarding bonuses to a high percentage of executives means that the VA was setting the bar for performance so low that "anybody could step over it. If your metrics are low enough that almost everybody exceeds them, then your metrics are not very high."

Rep. Ann McLane Kuster, D-N.H., said the VA suffered from "grade inflation, or what [humorist] Garrison Keillor would refer to as 'all of the children are above average.'"

Kuster and other lawmakers said they found it hard to believe that so many senior employees could be viewed as exceeding expectations, given the growing uproar over patients dying while awaiting VA treatment and mounting evidence that workers falsified or omitted appointment schedules to mask frequent, long delays. The resulting firestorm forced VA Secretary Eric Shinseki to resign three weeks ago.

Miller noted that in the past four years, none of the VA's 470 senior executives have received ratings of minimally satisfactory or unsatisfactory, the two lowest ratings on the VA's five-tier evaluation system. Nearly 80 percent of senior executives were rated as outstanding or exceeding "fully successful," according to the VA.

"Based on this committee's investigations, outside independent reports and what we have learned in the last few months, I wholeheartedly disagree with VA's assessment of its senior staff," Miller said.

The VA's inspector general has said the bonus system -- which has been suspended amid a criminal probe of wrongdoing at the agency -- contributed to the fake record-keeping, because employees knew that bonuses for senior managers and hospital directors were based in part on on-time performance.

About 13 percent of VA schedulers surveyed by auditors reported being told by supervisors to falsify appointment records to make patient waits appear shorter.

The House and Senate have both approved legislation to make it easier to fire senior executives and hospital administrators. The House bill would ban performance bonuses, while the Senate's would sharply limit them. Lawmakers said they hope to send a compromise bill to the president before the July 4 recess.

Tens of thousands more veterans than previously reported are forced to wait at least a month for medical appointments at Veterans Affairs hospitals and clinics, according to an updated audit of 731 VA medical facilities released Thursday.

The updated report includes new figures showing that the wait times experienced at most VA facilities were shorter than those on waiting lists for pending appointments. For instance, new patients at the Atlanta VA hospital waited about an average of 44 days for an appointment in April, the new report said. But the average wait for pending appointments at Atlanta was 66 days.

Similar disparities in average wait times were found across the country. Pending appointments, for example, don't include patients who walk into a clinic and get immediate or quick treatment, VA officials said. They also don't reflect rescheduled appointments or those that are moved up because of openings after cancellations.

VA officials said the two sets of data complement one another, but both are evidence that many veterans face long waits for care.

The June 9 audit found that more than 57,000 veterans were waiting at least 90 days for their first VA medical appointments, and an additional 64,000 appeared to have fallen through the cracks, never getting appointments after enrolling for VA care within the past 10 years.

More than 56,000 veterans were waiting more than 90 days for an initial appointment, the new report states. About 46,400 veterans have never gotten an appointment despite seeking one over the past decade, the report states.

"In many communities across the country, veterans wait too long for the high quality care they've earned and deserve," acting VA Secretary Sloan Gibson said Thursday.

The department has reached out to 70,000 veterans to get them off waiting lists and into clinics, Gibson said, "but there is still much more work to be done."

The report released Thursday showed that about 10 percent of veterans seeking medical care at VA hospitals and clinics have to wait at least 30 days for an appointment. That's more than double the 4 percent of veterans the government previously said were forced to endure long waits.

Gibson called the increase unfortunate but said it was probably an indication that more reliable data was being reported by VA schedulers, rather than a big increase in veteran wait times.

Administrators at local VA medical centers questioned the results of an audit released June 9, which looked only at pending appointments. The report did not match internal data on completed appointments showing waits actually were far shorter, the local officials said.

In other news, only about half of the veterans diagnosed with post-traumatic stress disorder last year after serving in Iraq and Afghanistan received the recommended therapy despite efforts by the VA to beef up its mental-health staffing, the Institute of Medicine said in a report released Friday.

About 53 percent of the veterans whose primary diagnosis was PTSD got at least eight psychotherapy sessions within a 14-week period in 2013. But that is significantly short of the department's target of 67 percent, according to the report.

The Institute of Medicine also found issues with the way active members of the military dealing with PTSD are treated. It described the Defense Department's treatment programs as "ad hoc, incremental, and crisis-driven, with little planning devoted to the development of a long-range approach to obtaining desired outcomes."

Together, the two departments spent nearly $3.3 billion in 2012 to treat patients with PTSD. And though both are making strides to identify and treat people with PTSD, many obstacles remain before they will have an "integrated and higher-performing" system, the report states.

One of the biggest problems is a lack of data to measure which treatments patients are receiving and whether the patients are getting better, said the study's chairman, Sandro Galea of the Mailman School of Public Health at Columbia University.

"Given that the DOD and VA are responsible for serving millions of service members, families, and veterans, we found it surprising that no PTSD outcome measures are used consistently to know if these treatments are working or not," Galea said. "They could be highly effective, but we won't know unless outcomes are tracked and evaluated."

Galea said tracking does occur with veterans participating in a specific VA program that involves intensive therapy, but that program serves only 1 percent of veterans who have PTSD, and the data suggest the program yields only modest improvement in symptoms.

The panel pointed out that the VA has at least established minimum care requirements nationally. Still, it's unclear whether workers adhere to the standards. The VA's computer health records system allows clinicians to track what medications the patients are receiving, but it does not allow for more complete tracking of the types of therapy being used. A new template was supposed to be available for clinicians beginning last November but was not operational as of late January, the report states.

In a statement, VA officials said they were briefed on the findings this week and will address the issues raised in the report, but they did not go into more detail about how they would do so. A formal response to Congress is due Jan. 1, 2015.

For active military, the report notes that each service branch has established its own prevention programs, trains its own mental health staff, and has its own programs and services for PTSD treatment. It said the service branches lacked an overarching authority to enforce policies related to preventing, treating and screening for PTSD.

The report also said Defense Department leaders aren't consistently held accountable for implementing policies and programs to manage PTSD effectively.

The Defense Department said it's been taking steps to address problems cited in the report.

"We agree with the IOM that although great strides have been made, critical gaps remain. We are already taking practical steps to address many of these issues," said Lt. Col. Cathy Wilkinson, a Defense Department spokesman.

Among the other findings by the Institute of Medicine:

• PTSD has also increased among veterans from long-ago conflicts. In 2013, 62,536 new cases of PTSD were diagnosed in veterans who did not serve in the Iraq and Afghanistan wars.

• Veterans of the Iraq and Afghanistan wars use the VA at rates double those of other veterans, 54 percent for Iraq and Afghanistan veterans versus 27 percent for all other veterans.

• PTSD is the third most common major service-connected disability after hearing loss and ringing of the ears.

The Institute of Medicine is an independent group of experts that advises the federal government on medical issues. Its recommendations often make their way into laws drafted by Congress and policies implemented by federal agencies.

Information for this article was contributed by Matthew Daly and Kevin Freking of The Associated Press.

A Section on 06/21/2014

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