Obama backs 15 of 18 VA commission recommendations

President Barack Obama is backing 15 of the 18 recommendations made by the Commission on Care to improve service delivery at the Department of Veterans Affairs. However, he is resisting a bid to revise the way the VA's health care system is run. The recommendations are included in the commission's final report.

"We must...ensure that VA has the ability to operate this integrated health care system in a rational, efficient and dynamic way that best serves the interests of both veterans and taxpayers," Obama wrote in a Sept. 1 letter to Congress. "For that reason, I have concerns with the commission's proposed governance structure for the VA health care system."

VA Secretary Robert McDonald said in a statement that 12 of the 15 recommendations backed by the administration have been accomplished or are in progress via the MyVA initiative. McDonald also explained the agency's objection to a proposed board of directors for the Veterans Health Administration.

"Such a board is neither feasible nor advisable for both constitutional and practical reasons," McDonald said in a statement. "Most problematically, this proposal would seem to establish VHA as an independent agency, which would frustrate ongoing efforts to improve the veteran's experience by integrating veterans health care and services across VA, making it more difficult for veterans to receive the quality care where, when and how they need it."

On the technology side, the commission recommended adding a CIO position at VHA that would report to the chief of the proposed VHA Care System, with a "dotted-line" to the VA's CIO. The move would to some extent roll back the centralization of technology duties at the agency, which spends more than $4 billion annually on IT.

Harold Gracey, a former VA CIO and chief of staff, told FCW that a VHA CIO is "clearly something that is needed."

"The issue is going to be how that person and...the department CIO interacts and what kind of relationship they can build, and I think that's key in any organization," he said.

Gracey added that VHA is large and complex enough that an internal CIO makes sense.

Other activities that Obama supports in the commission report include "enhancing clinical operations, establishing a more consistent policy for appealing clinical decisions, eliminating disparities in how health care is delivered to veterans from different backgrounds, modernizing IT systems, and establishing new processes for leadership development and performance management."

The report also states that the VA should have a "comprehensive electronic health care information platform that is interoperable with other systems and other health care providers; enables scheduling, billing, claims and payment; and provides tools that empower veterans to better manage their health. Creating a single, uniform, integrated IT platform will promote care continuity, cost savings, and consistent care delivery and business processes."

McDonald will testify before Congress on Sept. 14 about the commission's report.