Acknowledging the "crisis" last year over long patient wait times, the head of the Department of Veterans Affairs said the agency is "making progress, we’re making improvements, but we’re not where we need to be yet."
VA Secretary Robert A. McDonald, an Army veteran and Procter & Gamble executive who was confirmed in July 2014 after Kauai native Eric Shinseki resigned two months earlier, is in Hawaii on his first trip on the job.
Last month, some on the House Veterans’ Affairs Committee expressed anger that the VA was coming to them late with news of a $2.5 billion budget shortfall for fiscal 2015 as a result of rising veteran health care costs.
The VA asked for flexibility from Congress to close the budget gap, with the agency considering furloughs, hiring freezes and other steps, the Associated Press reported. Last year’s wait time scandal saw some records falsified to cover up long delays.
"Given the extreme pent-up demand for care that was exposed during last year’s (congressional) hearings on wait-time manipulation, VA had ample time to adjust its budgetary needs," U.S. Rep. Jeff Miller, a Florida Republican, said at the June committee hearing.
New hepatitis C treatment for veterans has been extremely costly, officials said. Sloan Gibson, deputy secretary of the VA, testified that the cost is expected to reach about $1.1 billion this fiscal year.
McDonald said in an interview Monday that the problems of 2014 for the VA nationally — and by extension some of its ongoing financial problems — were created in large part by an aging veteran population.
He noted that in 1975 when he graduated from West Point, there were 2 million veterans over the age of 65. By 2017 that number is expected to jump to 10 million, he said.
"So for those Americans who thought the problem that created the (long patient wait times) in 2014 were the wars in Afghanistan and Iraq, they weren’t," McDonald said. "It was Vietnam-era veterans getting older. So in many ways I say that we in VA are the canary in the coal mine for American medicine. We see the problems of American medicine maybe before the rest of the country sees it."
But last year’s VA crisis was a "wake-up call that we’ve got to start building the system today to care for the veterans of Afghanistan and Iraq because as they age, the issues that occur to them in the military are going to become more chronic and more acute," McDonald said.
That means hiring providers and adding infrastructure, he said.
Congress last year approved the Veterans Access, Choice and Accountability Act, a $16.3 billion VA bailout that included $10 billion for private care through the issuance of "Choice" cards.
Nationally the VA has hired more than 1,100 new doctors and more than 2,200 new nurses, McDonald said.
The VA Pacific Islands Health Care System, which covers Hawaii, American Samoa and Guam, has hired about 50 new people, with a goal of bringing in a total of 117 on top of its "normal" level of about 900 employees, said Wayne Pfeffer, the system’s Hawaii-based director.
Last year the Pacific health care system had the longest wait time in the nation for new patients, with veterans waiting an average of 145 days for their first appointment with a primary care physician.
Pfeffer said new patients now can get into the system in about 10 days, with the wait at about five days for existing patients who need another appointment.
McDonald said the VA nationally completed 7 million more appointments this year than last year. Some 81 percent of veterans are eligible for multiple medical care plans.
"So as we continue to improve the VA system, more and more veterans are choosing to come into the system — which is good; we want them to take advantage of that. But we’ve got to build the capacity to do it," McDonald said.
"You can’t fight wars without looking at the cost of taking care of the veterans after the war," he added. "We always look at the cost of the war, but we don’t look at the cost of taking care of veterans after the war."
The VA needs to become much better at forecasting future demand, he said.
About 50,000 veterans are registered in the Pacific system, Pfeffer said. The number of veterans in the system this year is up 8 percent, he said.
McDonald, who will be in Hawaii through Thursday to meet with veterans on Oahu, Maui and Kauai, held a roundtable for disabled veterans with Secretary of Labor Thomas Perez at the Oahu Veterans Center on Monday afternoon.
