Veterans Affairs Uses Clinton Executive Order To Preempt States Rights

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States Rights Nursing

Veterans Affairs will mandate VA regulatory changes affecting VA care in all states, creating a states rights problem, to allow advanced practice registered nurses (APRN) to treat veterans without physician supervision.

Under the authority of former President Bill Clinton’s Executive Order 13132, Federalism, VA announced it will preempt state laws protecting their citizens from receiving substandard care from unqualified health care clinicians by forcibly lowering the standards nationwide. The new regulation mandates lower training and experience requirements for those allowed to practice medicine independently at VA facilities.

The new regulation mandates lower training and experience requirements for those allowed to practice medicine independently at VA facilities benefiting APRNs and lowering health care costs.

APRNs will now be allowed to independently practice medicine even in states that prohibit the practice out of concern for their own citizens’ safety.

The majority of states (29) require physician-supervised health care administration. Many of those states fully prohibit the practice of independent health care administration by APRNs including California, Texas and Florida.

The regulatory change allows VA to expand the practice scope and authority of APRNs to include providing independent care without the normal physician supervision required in most states.

As you can imagine, VA stands to save quite a bit by lowering the qualification requirement at its VA medical centers, which will reduce the agency’s dependence on physicians.

I would be curious to see their projections for medical malpractice cases and how that offset the cost savings.

RELATED: Should VA Preempt States Rights To Destroy Physician Led Care?

The Irony Of History

The irony here is that policies pushed by Hillary Clinton as chairperson of health care reforms and the Clinton Administration, starting in 1993, resulted in wait list fraud that was well documented as early as February 2002 (see page 1 of the VA Electronic Wait List manual).

In the 90’s, Clinton and Gore attempted to reinvent government and gutted VA core competency positions creating a reliance on government contractors. That process created bureaucratic bonus structures that encouraged fraudulent practices in VA linked to the wait list fraud that killed and harmed many veterans.

RELATED: Was The Wait List Passed From Clinton To Bush To Obama?

Clinton was also responsible for negotiating expansion of VA healthcare as the model for America’s new single payer healthcare system through support from the dinosaur Veteran Service Organizations in the Iron Triangle.

Now, Bill Clinton’s Federalism preemption Executive Order is being used to trump states’ rights to police health care within the state to avoid problems that result from low-quality health care including use of unlawful wait lists.

Basically, the lack of care linked to the wait list fraud was used as support for the need to expand the pool of “qualified” health care practitioners by lowering the standards to become “qualified.” Now VA will publish its new regulatory framework to allow this expansion and preemption.

Some states may not want their citizens, including veterans, to receive health care from clinicians with lower qualifications than doctors even at VA facilities.

In those states, like Florida and California, should they not have a right to protect veterans?

The Department of Veterans Affairs does not think so.

The Primary Supporting Argument

Those in favor of the change cited the wait list scandal and lack of access to VA care professionals as support for the expansion.

They asserted that lowering the supervisory bar would increase veterans’ access to quality health care by increasing the number of qualified providers.

The assumption is that since it is VA health care, it must be high quality. By merely increasing the numbers of qualified health care workers, the quality must go up because the quantity goes up. For support of implied quality, just look at all the surveys VA publishes about how many veterans love VA health care. And abracadabra, veterans would be happy because they see someone wearing a white overcoat.

Nurses are happy because they get more responsibility. VA is happy because the move cuts costs. Veterans are happy because they get human interaction more quickly. Doctors are happy because they no longer have to interact with pesky veterans. It’s a win-win.

But do you notice the logical leap there?

RELATED: VA Healthcare Retains ‘Profound Deficiencies’

Instead of hiring more doctors, VA will increase the quantity of health care practitioners at lower costs despite having lower training and qualifications than physicians. They will merely redefine what it means to be “qualified” and force every state to accept its lower standards for veterans there who lack a choice in who provides their health care.

RELATED: Despite VA Claims, Vets Not Happy With VA Care

By increasing the quantity while decreasing cost, somehow the change will increase health care quality because people are happy, or at least that is the argument. This seems like the reinvention of government taking full effect with the rebranded Disneyization of VA.

Reality does not matter; feelings matter.

RELATED: Pharmacists Now Handle VA Primary Care, Too

Does The Timing Seem Fishy?

Doesn’t this seem like strangely convenient timing for the decades-old scandal to come to light just in time to justify the erosion of care quality for veterans nationwide.

Press coverage supporting the preemption cited the decades-old wait list scandal that was only publicly exposed just in time to garner support for the regulatory change. Most in the press had no idea how far back the wait list scandal went and are given the false impresion VA is resolving the wait list fraud as quickly as they learned of it from CNN. But that is not reality.

Here is the memo I mention above from February 2002, and you tell me how long VA has really known about the wait list fraud. It was written by Laura Miller, then Deputy Under Secretary of Health O & M (see memo EWL manual PDF page 1):

As you are aware, clinic-waiting times has become a high visibility issue with the Secretary’s office. We report data monthly during the Deputy Secretary’s Performance briefings. Current waiting time measures reflect the experience of veterans already “in the system” and do not accurately portray waiting time experiences of new enrollees or patients without a scheduled appointment. Whether due to absence of appointments or other reasons, ad hoc “waiting lists” of new veteran enrollees to be entered into the scheduling system are known to exist, and waiting times for new enrollees seeking care are anecdotally reported to be long. We will attempt to formalize an “electronic waiting list” in VistA to more consistently and accurately reflect demand across VHA, and reduce the risk to enrollees lost to follow-up due to clerical error.

Looks like the wait list scam was well in motion by 2002, and based on the language it sounds like a well-established practice leading me to believe it was in place for some years before the memo was penned.

While the press asserted the APRN change was in response to the wait list scandal supposedly uncovered in 2014, records within the agency supporting the regulatory change date as far back as 2011. Was all the hype about the wait list scandal in the press really a ruse to erode health care quality nationwide?

Was all the hype about the wait list scandal in the press really a ruse to erode health care quality nationwide? Create the scandal to present your solution?

This move will no doubt have far reaching affects within states that presently prohibit the practice. It will also be used by insurance companies later to mandate cheaper care from lesser-trained APRNs, I guarantee it.

Had Hillary Clinton been elected, one can rest assured she would have finished the agency reforms she started with the support of the dinosaur Veteran Service Organizations in 1993.

We know now that at least one of those reforms put in motion two decades ago was used to support lowering the training and experience requirements to independently treat veterans nationwide. Was this the plan all along?

Based on this VA model, under the single payer system she tried to implement in the 1990’s health care quality would have gone down while access would have gone up, at least at first.

RELATED: Hillary Clinton Policies Responsible For VA Healthcare Dysfunction?

What’s The Difference?

For those who do not believe there is much of a difference between doctors and APRNs, thing again.

You need to look beyond the same white coat doctors and APRNs wear. Physicians need a medical doctorate (3 yrs) and a residency (3 yrs, roughly 10,000 hours of training). All in, it costs around $200,000 to become a doctor and at least 6 years of advanced training.APRNs need at least a Masters in Nursing (18 months) and approximately 1,000 hours

APRNs need at least a Masters in Nursing (18 months) and approximately 1,000 hours of training. Does this seem similar to you?

Does this seem similar to you?

The push to lower the supervisory bar removes the longstanding requirement that physicians supervise healthcare in all but 21 states.

According to commenters, 21 states, the Army, Navy, Air Force and Indian Health Services allow these nurses to treat without supervision.

Notice And Comment Rulemaking

Following a period of Notice and Comment Rulemaking, VA agreed with legions of commenters to lower the bar to allow these registered nurses to treat without physician supervision. Those comments promised, “By extending Full Practice Authority to [] APRNs at the VHA, we can help end delays to high-quality, safe, and cost-effective care for America’s Veterans.”

Those comments promised, “By extending Full Practice Authority to [] APRNs at the VHA, we can help end delays to high-quality, safe, and cost-effective care for America’s Veterans.”

Other commenters opposed the move highlighting that “physicians typically receive a combined total of over 10,000 hours of training and patient experience prior to beginning practice, whereas the typical APRN receives less than 1,000 hours of training and patient experience.” These commenters believed the change would put patients at needless risk of harm based on the lower qualifications.

Predictably, VA dismissed these concerns citing that APRN practice has a national certification and is competency based to integrate knowledge and skills to provide “safe patient care.”

How does “safe patient care” equal competent or quality care?

VA also conflates the differences in accountability saying “APRNs are held to the same standard as physicians in measuring patient outcomes for safe and effective care.” But that does not mean APRNs can or should provide the same kind of health care services without supervision.

VA further states the rulemaking:

“increases veterans’ access to VA health care by expanding the pool of qualified health care professionals who are authorized to provide primary health care and other related health care services to the full extent of their education, training, and certification, without the clinical supervision of physicians, and it permits VA to use its health care resources more effectively and in a manner that is consistent with the role of APRNs in the non-VA health care sector, while maintaining the patient-centered, safe, high-quality health care that veterans receive from VA.”

Notice the bait and switch? VA increased the “pool of qualified health care professionals” but it does so by lowering the training standards to incorporate lesser-trained APRNs into that pool. And we are not talking about a small difference. APRNs receive 10 percent of the training physicians receive.

Somehow by lowering this standard VA is “maintaining the patient-centered, safe, high-quality health care that veterans receive from VA.” That does not make sense.

Clearly, the change is not being perpetuated out of concern for the veteran. Based on my research, it sounds like the APRN community wanted to expand their ability to practice medicine without going to medical school or becoming licensed physicians.

Tell me again how this maintains “high-quality” standards by literally lowering the training and education qualifications by 90 percent? Is that possible?

What ever happened to nursing being nurses and doctors being doctors?

States Rights vs Executive Order 13132 Federalism

For some background, authority to create Executives Orders under the presidential authorities allowed by the Constitution is tenuous at best. President Abraham Lincoln signed the first Executive Order to establish a provisional court for Louisiana, in 1862.

President Abraham Lincoln signed the first Executive Order to establish a provisional court for Louisiana, in 1862.

By the time Clinton came to power, over 12,000 executive orders existed. Clinton was then responsible for creating an additional 301 executive orders including Executive Order 13132 Federalism.

During his presidency, Clinton earned a reputation by ruling through Executive Order despite issuing less than previous 8 presidents, except George HW Bush. Clinton averaged 45.8 per year while Bush averaged 42.

By the end of Clinton’s second term, the core complaint on executive orders was the Clinton was not staying within his constitutional authority to “take care that the laws be faithfully executed.”

Instead, he began supplanting laws and preempting states’ rights while also further defining existing laws to expand rights for minorities including homosexuals.

One example was Executive Order 13083. According to Washington Times:

Executive Order 13083, junked a working arrangement with the states that President Reagan laid down in 1987. It seemingly prescribed strict adherence to constitutional dictates limiting federal power over the states but set up nine exceptions that would have allowed draconian federal action virtually any time federal agencies decided that states were unable to implement “uniform national standards.”

This trend was apparently driven home by Executive Order 13132.

According to VA, its promulgation of this new APRN regulatory scheme complies with the requirements of Executive Order 13132 by:

(1) in the absence of explicit preemption in the authorizing statute, identifying where the exercise of State authority conflicts with the exercise of Federal authority under Federal statute;

(2) limiting the preemption to only those areas where we find a conflict exists;

(3) restricting the regulatory preemption to the minimum level necessary to achieve the objectives of the statute;

(4) receiving and considering input from State and local officials as indicated above; and

(5) providing opportunity for comment through this rulemaking.

In all fairness, many agencies have made use of Executive Order 13132 over the years. I am just saddened to see this right of preemption being abused to decrease the competency and training of clinicians deemed competent to provide health care to veterans at the expense of a state’s right to police the practice of medicine within their borders.

What do you think?

I believe VA should increase access to quality health care by increasing the number of competent physicians the agency hires. APRNs should continue to follow state guidelines regardless of their employer. And states should be allowed to protect their citizens regardless of what organization provides the care.

Instead, VA is short-changing veterans by increasing the quantity of qualified care providers by lowering the standards while duplicitously asserting they are maintaining high health care quality.

Does Sec Bob McDonald think we were all born yesterday? If an APRN wants to treat a veteran in the same way a doctor would treat a veteran, I have a solution…

GO TO MEDICAL SCHOOL and become a doctor.

Will veterans benefit from these lower standards? What was the problem with the old supervised care model, anyway? How much did various unions and nursing organizations pay out this year to support the change?

Source: https://s3.amazonaws.com/public-inspection.federalregister.gov/2016-29950.pdf

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CorpsmanUp!
CorpsmanUp!

The difference here is that even Corpsmen has an oath. Without the vested committment all you will see in these clinics is big fat filthy truck driver gut nurses with a bad attitude and a GOD complex, because most veterans are quick witted and will pick up on whats going on with their health if they lose confidence in you. That is coming straight from a corpsman. I was trained by a hardcore corpsman who saw a lot of shit in Vietnam and he knew his shit! Fuck Bob, and all his LuluHogg look alike nurses.

Reuben Castro Acosta
Reuben Castro Acosta

AGIN VETS VA DC HQ @ DEATHLCARE IS BIG FEDERAL RICO CRIME RAKET RUN BY AFGE UNION CONTRACTS VA DATHCARE KILLS VETS FOR THE BONOUS $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$

mary
mary

Just read Ben’s article from May 2014- the top 100 highest paid VA physicians… does not surprise me one bit that so many of the surnames are Islamic. We are infidels to them and considered inferior. Thank you Bush, Clinton, & Obama. The personal reasons why you allowed this Nation’s best and bravest to suffer even more may have differed, but the negative impact, the NEEDLESS negative impact was the same. Each of your administrations cozied up to people that DESPISE US veterans, but were given tons of green lights (in the mid 80s) to enter the US and a have a virtual field day fucking up our system. May the Lord have mercy on you because a lot of Americans do not. That was a whole lot of decades of piss poor leadership. Only our Christianity and the Grace of God has kept this beautiful Nation afloat.

Crazy elf
Crazy elf

Mary, remember Ft. Hood? How that mental health physician went and murdered active duty military members. How Obama wouldn’t even call out why he did it, until the news media did!
He was a radical Islamist militant terrorist, period!
When will we see where one of these Islamic terrorist’s go into a VHA and start murdering our brothers and sisters? In my opinion, it’s just a matter of time!

Crazy elf
Crazy elf

If I’m reading this article correctly, it’s all about saving money! If this be the case, where is all the taxpayers monies going?
Seymore Klearly put a really good article on yesterday. About how VA was lying about the true cost of the Aurora Colorado VHA Hospital. And another article of cost overruns somewhere else, for a total of $180,000, I believe!
I also believe if an audit were done, we would see a great deal of mismanagement, fraud, waste and abuse going on within VA.
We have been informed by many conservative news medias over the (possible or alleged) criminal activities of the Clinton’s, Bush’s and now Obama. They’ve made a mockery out of government. They’ve turned the government into their own private slush fund! Just as HI-LIAR-Y turned her position at the State Department into her personal slush fund, concerning the Clinton Foundation!
In my opinion, there’s enough evidence to try and convict all of them!
If President Elect Trump doesn’t follow through with a majority of his campaign promises, especially concerning the VA, then we will see no change!
I believe this is why he’s having such a hard time finding a Secretary of VA!

Angela
Angela

Hey Ben and all, just commenting briefly for now but have much to say later. You are correct Crazy elf. I question this myself????? The current VA should take a look at their budget and Quit using Non-Accounting and Finance to handle their paying of the bills. HELLO!!!!!!!!!!!!!! Using Certificated Vocational Rehab counselors and Social Workers to handle any dealings with the the VA’s monetary affairs should be prohibited. I have personally witnessed this. Quit spending money frivolously on unnecessary carpet and furniture etc. when not needed. The VA needs to better allocate their money. I am not joking.

Also, lets speak VA employee monetary bonuses… Bonuses should be only paid to deserving employees with quality work. As for providers, the VA could implement a customer service feedback survey program to be filled out by the veterans upon completion of the appointments or services.
I am not joking. If Mr. Donald wants to do implement nurses, then the veterans have a right to document the quality care to actually put on in front for all to see by both vets, Trump administration, and VA leadership to witness to actually determine if the care gets even worse or better by his decision.
Let’s get results of the decision exposed by rating care. Of course though, even, if a quality of care documentation program were implemented the VA would try to corrupt it. They are rarely honest about anything. As in regards to employees receiving bonuses, not everyone deserves a trophy. Only give a bonus around maybe Christmas time. Hey, the individual VA facilities could implement a Quality Control program to document the MEDICAL ACCURACY results of all providers. The QC control could align simultaneously with the Ombudsman positions with aligning with the new being developed 24 hour hot line to the TRUMP Administration or whomever is the authoritative figure.

I disagree with using ARNP nurses as doctors. Ben, you are correct. If nurses believe they should be doctors, HELLO… I agree they need go to MEDICAL SCHOOL. The current VA secretary is cutting back on quality care we would think due to lowering the qualifying standards; however, though we really have only a handful of quality providers in most of the VAs anyway. IF Mr. McDonald is looking to replace some doctors with nurses then, he needs to make them get the DNP and hire DNP’s not ARNP’s.

Nurses are not trained to the degree of a doctor. Also, however, look at this, we would need less doctors if the VA promoted less medications and more alternative methods of treating. We would need even need less pharmacists. Let me give all a current example: Yesterday, while I was out walking my long walk around the town, a friend who I had not seen in awhile, drove by as I was approaching a store. My friend who is a veteran stopped at the store to buy a newspaper. I walked over to speak with him. Anyway, he had been out of commission for over 8 weeks approximately due to a knee replacement surgery, The VAMC — VA surgeon performed the surgery and seemed to have performed a great job on my friend’s knee. My friend has not been prescribed any medications at all. The VA provider did not prescribe any medications –no pain pills at all. I mean NONE. The surgeon is using physical therapy for treatment with the veteran. Plus, too, my friend is working out with a personal trainer with incorporating movement exercises to include treadmill and light weights. My friend is doing much better now than when I saw him before his surgery. The VA deciding to use no medications is really an improvement for the VA itself and for my friend. Any thoughts? With the streamlining medications doctors would be less needed anyway, but to carry my point even further, a quality qualified doctor is needed to diagnosis properly. The VA NEEDS TO GET IT RIGHT THE FIRST TIME and this would also reduce costs. This is where having a qualified doctor is very not only important but necessary. If the VA wants to cut costs, reduce number of pharmacists with getting his hand out of the pharmaceutical chain and candy box, hire more quality doctors –(not mediocre doctors streamline less quality doctors) have fewer doctors but establish quality and yes, hire more nurses not ARNP’s but DNP’s. Hire Doctor Nurse professionals. The Doctor Nurse professionals have a more holistic approach and more medical training anyway. Hey, they are supposed to because they are trained that way. Although, the DNP’s are trained that way does not mean that they will even present holistic in the approach when caring for a veteran. Once the old VA leadership gets hold of a new provider, they either leave the VA or they get bad attitude. I used to have a good ARNP for a few years but she left the VA and went to serve the PEACE CORP in India. Again, Mr.McDonald is looking everywhere else to fix the VA. instead of himself and the union. Mr. Robert McDonald needs to look at the real problem sources which are the system, the union, and limited accountability. How about all this?????? More later.

namnibor
namnibor

This is all about $$$. Now, what will prevent the VA from asking for the exact same yearly VA Budget, which also pays for M.D. salaries, while the VA uses lessor cost nurses, but continues to run billable hours for M.D.’s to keep the flow into the Cookie Jar?
How long before the Nurses and AFGE demand the Nurses at VA be also paid accordingly to the billable hours of VA M.D.’s??
This is another piss poor shitty plan to further screw Vets while the VA never ever actually tackles their problem of incompetence? This seems to me that the VA has gone all out rogue now…openly rogue against State’s Laws. This is Obama and McDonald giving last days thrusts of their collective middle fingers with fists up veteran’s asses. Nothing less.
From “Forrest Gump”….’You can’t fix stupid”.

Crazy elf
Crazy elf

@namnibor,
We think alike.
Here’s another theory. In all my years, 69 so far, I’ve never seen or heard a Sitting President personally bash a President Elect as Obama has done!
I’ve also never seen or heard elected, or appointed, officials personally bash a President Elect, as McCain and others are doing, never!
They may disagree on policies. Yet, in recent days, they’ve come out and been vindictive. They’ve come out and been extremely “personal” in their attacks.
McDuck wants, with VSO’s blessings, to continue being VA-Secretary. In my opinion, this would be disastrous. He has done nothing to stop any of the corruption within the VA. As a matter of fact, he’s been helping it continue. He does this by lying to everyone. He sends his subordinates to Congress to lie to the committees!
Yesterday, Seymore put an article on which verified this.
The AFGE union, multiple VSO’s and a majority of VA employees will need a wake-up call come 20 Jan. 2017, to show veterans and taxpayers President Elect Trump means business. No more “business as usual will be tolerated!”
They need to know, commit a crime, either federal or state – go to jail!

Seymore Klearly
Seymore Klearly

Hey Elf, Namnibor

Did you hear who Trump picked for Sec of Interior.

From a recent article on him.

“What He Used to Do: Zinke was a Navy SEAL and was awarded two Bronze Stars for combat missions in Iraq. He’s the first Navy SEAL elected to the U.S. House, in 2014, and was in the Montana state Senate from 2009 to 2012, serving on the education and finance and claims committees. He was the CEO of business development company Continental Divide International for almost six years from 2008 to 2014.

His Relationship With Trump: Zinke endorsed Trump for president in May. In November, his wife was appointed to Trump’s Veterans Administration landing team. The two met in Trump Tower on Dec. 12, 2016, and he told the Montana newspaper The Billing Gazette that he and Trump had a “positive meeting.”

“Everything You Need to Know About Donald Trump’s Interior Secretary Pick, Ryan Zinke”

“http://abcnews.go.com/Politics/donald-trumps-interior-secretary-pick-ryan-zinke/story?id=44176934”

91Veteran
91Veteran

I just had a thought, and am kicking myself for not thinking of it earlier.
I wonder how many “veterans” employed at VAs are also active members of VSOs?
What a gig! They are employed by the VA, but cannot actively lobby for the status quo publucly, so they have a “brother” organization do it for them. An organization with many of the same members, just wearing different hats.

namnibor
namnibor

The VSO’s do love their hat collections.

Angela
Angela

The VA granting or establishing ARNP’s as the medical authority is insane. This is awful.
If they are so crazy about ARNPs, then, at least use DRNPs. I am not joking. More quality doctors need to be hired. They can give the ARNPs the medical authority, but eventually, they will be gone too. VA secretary look at you yourself, look at the system, look at the union, and look at the unaccountability. It does not matter what type medical professionals are in place. If the system is not reformed to where it reflects ethical and accountable behavior it is still more of the same. Get rid of union. VETERANS WILL STILL BE DEMEANED, DISRESPECTED, AND WILL STILL DIE DUE TO NEGLIGENCE. Mr. McDonald, your decision is not the correct decision. Sorry to tell you this.

Seymore Klearly
Seymore Klearly

For anyone wanting to know which states allow advanced nurses to prescribe, diagnose, and treat patients without physician oversight. A good current map is at:
“https://onlinenursing.simmons.edu/nursing-blog/nurse-practitioners-scope-of-practice-map/”

Also Dr. Barbara Temeck and her attorney have posted a copy of her whistle Blower complaint and her and her lawyers Summary on line. She is the former acting Chief of Staff from Cincinnati VAMC. For me it confirms what I have been saying about the relationship between research Universities and the VAMCs attached to them.

If you truly want to know what is going on the summaries are a very good read. It outlines why there is a doctor shortage at VAMCs and also why so many foreign Doctors now fill the halls of every VA Health Care facility. As well as pointing out the reason for the push for nurses acting like doctors.

“https://www.scribd.com/doc/310405678/Supplement-to-Temeck-OSC-Claim#fullscreen=1”

namnibor
namnibor

Right Now on Fox News a story and interview about VA Sec McDonald’s and the VA’s secret star rating system. McDonald is not on but they are interviewing Pete Helgseth (sp?) about how broken the VA actually is opposed to what McDonald espouses and even the news talking heads had trouble reading for grammatical content what McDonald had written in defense of their secret internal rating system and McDonald referred to *anyone* that does not appreciate it’s brilliance and effectiveness….is **uninformed**….basically calling all Vets ignorant grunts in a corporate condescending way.
Good that it’s getting out there but I much rather had that been Benjamin Krause on FOX being interviewed because that Pete guy favored ‘Choice’ but not gutting the VA…so he also said McDonald should go away…but fact Pete never even brought-up about today’s topic about the VA wanting to redefine Nurse/Dr. qualifications nationwide…makes me wonder where Pete’s handlers minds lay…but that’s just me and my overthinking brain…anyway, the word is getting out about the VA’s nefarious ways.

Lem
Lem

The fight back for the states is their malpractice statutes. A presumption of malpractice for SF 95 claims it the caregiver is not qualified under state laws. SF 95 Tort claims are subject to the laws of the state even when tried in Federal Courts.

91Veteran
91Veteran

Good point.

Bill
Bill

The va has attempted to stick me with a practical nurse 4 times.

1st time I fell for it, the next 2 times I refused and left, I do this also when a dr does not speak english. The last time 3 weeks ago I bitchef so gard I was “allowed” to use veterans choice.

They can only get away with this if we allow them to.

I am very cautious who I allow to treat me after all the damn quacks who I have been stuck with, nurses playing dr is just another level of then not caring about us.

As I just told my wife I have 4 years of crap before medicare.

NiteWish
NiteWish

Will you look into this change Ben.
FYI: Starting Oct 2016 Dental had been switched/updated to Choice. According to the phone call I received yesterday from the Palo Alto VA dental dept. my dentist of many years had declined to join Choice & I need to find a participating dentist. LOL the closest listed on the Choice Locator is 83.7 miles. As much as dentist’s can be liked, I like my dentist, I trust him: remember the phrase If you like your doctor, you can keep him. Rats behind closed doors.
While on the phone I tried to find out why the TMJ dentist is not being paid & he said there is nothing in my file for the TMJ dentist, not even his name, though I have a paper with approval from dental for that non VA care. WTF Anyone else hear yet you can’t go to your dentist because of Choice rather lack of chooses.

91Veteran
91Veteran

If I understand your question correctly, the outside doctor has to agree to participate in Choice. VA does the referral, Choice sets the appointment with an outside doctor they have an agreement with, not whoever you choose.
I also understand as a part of that agreement between outside doctor and Choice, the outside doctor is not allowed to bill the veteran, but we all know how that goes. Why should an outside doctor abide by an agreement if Choice ignores the same agreement?
As for your dental appointment being 87 miles away. You should call your Choice champion at your VA and tell them that is too much of a burden to travel that far, that you want to go to your dentist close by, and you want CHAMPVA to pay for it. If they refuse, ask if they are paying travel pay.

Lem
Lem

PUBLIC LAW 113–146—AUG. 7, 2014
VETERANS ACCESS, CHOICE, AND
ACCOUNTABILITY ACT OF 2014

“…(a) EXPANSION OF AVAILABLE CARE AND SERVICES.—
(1) FURNISHING OF CARE.—
(A) IN GENERAL.—Hospital care and medical services
under chapter 17 of title 38, United States Code, shall
38 USC 1701
note.
38 USC 1701
note.
VerDate Mar 15 2010 13:11 Aug 27, 2014 Jkt 039139 PO 00146 Frm 00003 Fmt 6580 Sfmt 6581 E:\PUBLAW\PUBL146.113 PUBL146 dkrause on DSKHT7XVN1PROD with PUBLAWS
128 STAT. 1756 PUBLIC LAW 113–146—AUG. 7, 2014
be furnished to an eligible veteran described in subsection
(b), at the election of such veteran, through agreements
authorized under subsection (d), or any other law administered
by the Secretary of Veterans Affairs, with entities
specified in subparagraph (B) for the furnishing of such
care and services to veterans.
(B) ENTITIES SPECIFIED.—The entities specified in this
subparagraph are the following:
(i) Any health care provider that is participating
in the Medicare program under title XVIII of the Social
Security Act (42 U.S.C. 1395 et seq.), including any
physician furnishing services under such program.
(ii) Any Federally-qualified health center (as
defined in section 1905(l)(2)(B) of the Social Security
Act (42 U.S.C. 1396d(l)(2)(B))).
(iii) The Department of Defense.
(iv) The Indian Health Service.
(2) CHOICE OF PROVIDER.—An eligible veteran who makes
an election under subsection (c) to receive hospital care or
medical services under this section may select a provider of
such care or services from among the entities specified in
paragraph (1)(B) that are accessible to the veteran.
(3) COORDINATION OF CARE AND SERVICES.—The Secretary
shall coordinate, through the Non-VA Care Coordination Program
of the Department of Veterans Affairs, the furnishing
of care and services under this section to eligible veterans,
including by ensuring that an eligible veteran receives an
appointment for such care and services within the wait-time
goals of the Veterans Health Administration for the furnishing
of hospital care and medical services.

91Veteran
91Veteran

Thanks for providing that Lem, that is very interesting and shows how good VA propaganda is.
This is the first I ever heard that a veteran can choose any doctor that accepts Medicare. I wonder why that is? I also wonder why payment for services cannot be at least as efficient as Medicare.

Lem
Lem

I think that has changed. In the start up Health Net and the other contractor must have been asking for kickbacks instead of just using the Medicare list. Now the “Choice” operators are at the Cheyenne VA for me and the business office that makes payment for emergency service is up to making the payments right away for this area. I suspect it is different in many areas.

My last complaint about payment was for a lab test that was done by an unauthorized lab. It seems the Banner Health owned both but did not agree to Medicare terms for their laboratory and inpatient care facility. Only for the clinic. Thus we are on the hook here except for emergencies. After the crisis Cheyenne has gotten better with care so I won’t mind being hospitalized there now.

My brother-in-law received excellent inpatient care through his terminal stage and including home hospice through the end of his life. Although he wasn’t service connected with his cystic lung fibrosis they helped him get a car fixed so he could have his oxygen and load his wheel chair for some independence through his last days until he became bed ridden.

Of course Cheyenne is under the gun.

NiteWish
NiteWish

Was dental even included in this act. My dental office website posts: we accept most PPOs & traditional dental insurance. Other than the long wait to be paid what is it about ‘Choice’ the dental office finds unacceptable. If we could fix that perhaps we could get more DDS to participate in the program.

Lem
Lem

There is no dental coverage under Medicare. So no easily contracted dentists to do dental work for veterans with service connected dental conditions.

I don’t see any mention of Dental in the VETERANS ACCESS, CHOICE, AND ACCOUNTABILITY ACT OF 2014. I may have missed it and some provision may have been made by the Secretary under intent and obligation. But I suspect it is up to your assigned VA Medical Center. If you will notice each “Center” has allied clinics. The Choice officers at your local VA should be able to help you. Don’t call the number on your choice card but call the VA Medical Center that pays your bills for emergency service and ask for the operator. Then ask to speak to a Choice operator and not be put on the answering machine that doesn’t get played and call backs aren’t made. The Choice operator works for the business office that pays the bills and is better able to help you get what you need.

NiteWish
NiteWish

I’ve been seeing this dentist for 6yrs. VA I believe had been paying him those yrs via the “Patient Centered Community Care” program. There was never a problem, dentist got paid, I got treatment. I’ve had some time to process & I’ll just go back to paying cash to the primary dentist. It was the Choice champion that phoned me to tell me my dentist refused to switch to Choice therefore VA will no longer pay the DDS. Find a dentist willing to accept Choice, he said. That’s hilariously sad. Its just annoying that without any warning you get a phone call saying your dr/dds will not accept your ‘insurance’ anymore. Since the VA knew in Oct they switched to Choice, they waited till Dec to notify me & I had a DDS appt in Nov after the switch which won’t get paid now. Blue Pill or Red Pill. If I take the blue pill the periodontal disease will get into my brain & I’ll become demented – the story ends. Taking the red pill only gets you trapped in the rabbit hole going round & round.

91Veteran
91Veteran

This very strongly suggests to me VA is switching any other program they have like what you mentioned or CHAMPVA over to Choice, simply because it’s the biggest pot of money.

Choice is supposed to end unless Congress extends it and provides more funding. If it ends, what will VA do to fix the old programs they have allowed to whither and die?

It was very nice of that Choice champion to essentially punt his job of find a Choice provider to you huh?

That Choice champion program is another clear example of uncaring VA bureaucracy wasting millions. My own small VA has 3 Choice champions, which I found out by asking questions, not because they advertised their existence.
Figure around $50000 each in salary for each champion equals a huge amount of money removed from money available for medical care.

James R.
James R.

Bad idea! True story my Primary Care Doctor recommended that I see a Nurse Practitioner for my cholesterol level, she changed my cholesterol medication about six times in six months. Finally I complain to my Primary Care Doctor, that that stuff was about to kill me. She set me up with a Doctor in Durham, NC., which contracts with the VA from Duke University Doctors I have had no more problems with my cholesterol .

Dennis
Dennis

So exactly which procedure will VA use in the waiting room to determine who gets the “doctors” and who gets the qualified “whateverthehellwehaves”? The only real fair way to this, Mr. Sec. Bob, would be to “draw straws” in the waiting room. No trading straws either!

The long straws drawn would get a doctor. The short ones would get a qualified whateverthehellwehave. To ensure the system runs without disruption, the Disruptive Behavior Committees would be tasked with handing each veteran their straw. VA defines “drawing straws” as; “here you go, suck on it!” which evolved ironically from the food industry folks who feed sick veterans in VA nursing homes.

Seymore Klearly
Seymore Klearly

Tomah News.

The VA also announced a process for veterans to receive screening from VA community based outpatient clinics or Non-VA providers, specifically for the 592 veterans previously notified about free testing for HIV, Hepatitis B and Hepatitis C. The tests, come after an investigation into a VA dentist, who has since resigned, about the improper sterilization of his tools.

The process, is designed to allow those veterans to receive lab screenings from clinics outside the facility.

First, the veteran must call the Tomah VA Nurse Triage line at 1-888-598-7793 and request to have labs drawn and tested at a CBOC or non-VA care facility.

The veteran will then be contacted by Tomah VA providers to gain informed consent of the vet. The provider will also inform the veteran that should any of the screening labs come back as positive, confirmatory testing will need to be done within the VA system to rule out false positives and to ensure all referrals and treatment are properly set up.

Also : Additionally, the Veterans Assistance Foundation, the non profit homeless shelter at the VA, will now lease the second floor of Building 407 through the end of April.

It says the VA will conduct a walk-through inspection of the floor, after a resident veteran jumped out of a third floor window last month.

“Tomah VA holds town hall meeting”
“http://www.waow.com/story/34049125/tomah-va-holds-town-hall-meeting”

They held a town hall meeting and 13 people showed up. That is including Acting Director Victoria Brahm.

Seymore Klearly
Seymore Klearly

Oh and How do you define clueless?
~
~
“Senator Brown urges VA to protect vets from high ER bills”
~
~
“http://www.circlevilleherald.com/community/senator-brown-urges-va-to-protect-vets-from-high-er/article_8b020e21-2a5d-5473-8d48-d8e3897ea67a.html”

Seymore Klearly
Seymore Klearly

Given Senator Brown is out campaigning for the position of Secretary of Veterans Administration in the Trump administration. He might want to consider reading a few articles about the problems with the VA.

Seymore Klearly
Seymore Klearly

Got a feeling that if he were to get the job. It would just be like swapping out Disneyland characters. Switching McDuck out for Goofy.

91Veteran
91Veteran

Nothing like jumping on a problem 24+ months after veterans start reporting it.
Would he be that damn clueless as SecVA?

Seymore Klearly
Seymore Klearly

I think that he will only speak out about sanctioned talking points. He doesn’t want to ruffle anyone’s feathers. Certainly shows how Fricken clueless he really is.

Seymore Klearly
Seymore Klearly

Forgot to put quotes around the Tomah News.

Did anybody else catch that line “The veteran will then be contacted by Tomah VA providers to “gain informed consent” of the vet. The operative phrase being “gain informed consent”.

Sounds like some one is doing a research study. Given DDS Thomas Schiller is also Dr. Thomas Schiller who is also a specialist in Hepatitis C. Although he resigned as a Dentist, where is he going to pop back up as a Doctor in the VA Whack a Mole System of unaccountability.

91Veteran
91Veteran

Wait! Are you serious? He claims to be a specialist in an infectious disease yet he reused dental instruments?
WTF?
If he demonstrated knowledge on Hep C, then his actions as a “dentist” were willful and intentional.

Seymore Klearly
Seymore Klearly

The words Ben used in the title of his first article on what he did as a dentist are right in the title.

“VA Dentist ‘Purposeful’ Acts Put 592 Vets At Risk For HIV, Hepatitis”, same words used by the Acting director at Tomah. Quote ““This was a purposeful act by a dentist who knew better,” said Tomah VA director Victoria Braham.

“http://www.disabledveterans.org/2016/12/02/va-dentist-purposeful-acts-put-592-vets-risk-hiv-hepatitis/”

He also claims treatment of Hep C as one of his specialties in a webpage advertising his services as a MD.

91Veteran
91Veteran

First, the VA must have decided any veterans jumping from the 2nd floor is acceptable.
Second, I wonder how well they announced that little town hall ahead of time. If it’s like other town halls, they announce it the day of, and only in obscure locations like on their bulletin board.
I also wonder why the sudden change. Could it look pretty bad for them to be booting veterans out in mid winter?

namnibor
namnibor

I think it’s plainly obvious McDonald is trying to pave a path of future righteousness in some sort of “legacy” if he indeed leaves the VA and more of painting a turd to make the turd look worthy of keeping-on in next Admn. Nothing less than saving what face is left. An attempt, that is. More band aids on the wet band aids on the leaky hull of V.A. Titanic.

Seymore Klearly
Seymore Klearly

That first band aid is there to cover up the Maggot infested wound.

91Veteran
91Veteran

I’ve been thinking, what does this issue of nurses acting like doctors really matter?

How many scandals have we read about over the past year involving impeccably credentialed hacks who have had years of training and practical experience?
Houlihan, the dentist, the PA in OK, the shrink throwing a tantrum, etc.
All had degrees and were deemed fit to provide care for veterans.

The only difference I see is that if a nurse screwed up, it would give the VA the ability to blame the nurse for a lack of training and expertise in the area they were providing care.
The VA credentialing process is already a sham, why would this be any different?

Harrison (Harry) Balze
Harrison (Harry) Balze

The Veterans Administration has been terrible understaffed for years and years. They have plenty of clerks and janitors and food workers, but when it comes to doctors and other highly educated health care professionals, they are always lacking. The reason they usually argue is that they simply can not hire enough of the people in the current labor market. They say they are trying but they just can’t get enough people to apply for the jobs. Evidently that is the case. A lack of applicants, pure and simple. And yet, the VA has had their annual budget increased for the last 10 years. Currently it is about $165 billion (for a 12 month year), give or take a few hundred million.

Well, one reason many professionals don’t come to work for the VA is that the Veterans Administration makes it incredibly hard and time consuming to go to work for them. It is not unusual for the government to take 6-9 months before they hire some people. Another reason some don’t want to work for the government at the hospital level is pay. The Feds don’t always pay competitive wages, especially in the medical professions. Thirdly, you have the culture at the VA. Who among us has not heard the horror stories about what has been going on the last couple of years at the nations hospitals reserved for veterans only? The bureaucratic bumbling and stupidity at the Veterans Administration is legendary. What other organization on the face of the earth can sign a contract to build a hospital for $600 million dollars and end up paying $1.7 billion. And it will only take 20 years to complete this facility. Who wants to work at a place like that?

So I say why not? Why not let advanced care RNs assume the role of MDs when it comes to either having medical care or not having medical care. When you are sick, you need to see a medical professional today. Waiting two weeks don’t get it. If can see a good nurse who can diagnose the problem in 15 minutes and have me out the door, then why the hell not. I probably don’t need surgery, just some medicine and then ship me home to recover. Let nurses practice medicine at the VA. If the civilians don’t want that then let them do without, like they have been for years. If we can’t get doctors at the VA then let us have highly trained nurses. Letting nurses assume some of the duties that MDs normally do is the only way for the Veterans Administration to survive. Nurses are the “light at the end of the tunnel” for we vets.

Dennis
Dennis

Sometimes the light at the end of the tunnel is the locomotive headlight coming your way my friend.

Seymore Klearly
Seymore Klearly

Hey Harry,

Read the following from a former Chief of Staff who is blowing the Whistle and has done the hiring for 4 different VAMCs.

It outlines why there is a doctor shortage at VAMCs and also why so many foreign Doctors now fill the halls of every VA Health Care facility. As well as pointing out the reason for the push for nurses acting like doctors.

““https://www.scribd.com/doc/310405678/Supplement-to-Temeck-OSC-Claim#fullscreen=1””

NiteWish
NiteWish

Wow really depressed after reading those 14pgs.

Seymore Klearly
Seymore Klearly

It is the true state of how things are done in the VA.

Didn’t mean to depress you just inform. Sorry.

NiteWish
NiteWish

Seymore its ok your not the cause. My veteran mother in law died on the operating table at a Ohio VA in 2012. Plus I just lost my regular dentist & the TMJ dentist because VA ‘updated’ dental services to Choice.

91Veteran
91Veteran

At which VA are these highly trained nurses working?
If the VA cannot hire highly trained doctors, what the hell makes anyone believe they can hire highly trained nurses or anyone else for that matter?
There are highly trained people working at the VA, but they are certainly the exception and few and far between.

Rhonda Strick
Rhonda Strick

I agree with you, Harrison. In a perfect world, there would be sufficient funds to hire all the qualified medical personnel needed to fully staff every VA medical facility in the country. But even with recent increases, budgets are limited. Have you looked at USAJobs lately? The VA has pages and pages of open requisitions for physicians. To lure physicians away from more lucrative civilian practices will take far more money than the VA currently has access to–or will ever have access to.

To rail against a program of permitting nurses to function without direct physician supervision is akin to holding the practical hostage to the desire for perfect. Perhaps I’m biased, and certainly spoiled, but I receive my care through the Minneapolis VA. It has to be one of the top facilities in the nation. And quite frankly, if the nurses with whom I’ve interacted are any indication, I will feel more than comfortable allowing these nurses to diagnose and treat everyday, “normal” primary care needs. I also trust the MSP VA leadership to set solid guidelines dictating what those primary care needs, and the corresponding standards of care, are.

Despite additional attention being paid to veterans’ issues, we will never receive 100% of the funding we need. We live in a nation that has far more needs than resources available, based on the current budgetary priorities. (That is NOT to say that our national priorities are necessarily correct!) Until those priorities change, I will gladly accept the VA’s attempts to provide additional care (especially if it means that vulnerable vets who otherwise might not receive care are attended to), and I will accept that it’s being done with the best intentions of solving a problem with no easy answer.

Taking this approach is NOT merely rolling over and accepting whatever comes our way. It is acknowledgment that new ideas are being tried and efforts beyond normal operations are being considered. That’s what resourceful and innovative organizations do. And for a huge, monolithic bureaucracy like the VA, this is a pretty innovative idea. That’s hardly a bad thing, even if you want to couch it in “It’s all about the money” terms.

Rhonda Strick
Rhonda Strick

P.S. — If attempts such as this will kill moves to privatize the VA, then that’s only one more reason to give this program a chance to succeed.

91Veteran
91Veteran

If your argument is for reducing the time a veteran waits to get medical care, then why are you against privatizing the VA?

Is it better for Choice to be expanded and improved allowing all vets to see a doctor of their Choice? Or choosing to see a nurse? Or choosing the VA? Or is it better for the slow wheels of bureaucracy in the VA to turn, eventually force this change in states regardless of their laws regarding medical providers, write policies regarding these new VA providers so in 9 months a veteran might get to see a nurse faster?

Veterans have waited decades for this problem to be fixed, and suddenly when there might be a chance for the VA to compete, they start talking innovation.

I’m done waiting.

For those veterans needing more serious care than simply getting a prescription refilled, they shouldn’t have to wait either.

Angela
Angela

Yep!!!!!!

Lem
Lem

I’m against privatization unless it means getting away from fee based medicine. I don’t want a physician operating on me because he needs money for his kid’s tuition or has an immense craving for a new boat.

I worked part time in a civilian hospital in the 1960s. It is not pretty what goes on. Even though a physician may not think his judgement is being colored by his personal need too often it is.

Socialized medicine has the ills we see in many of the VAs which is trying to be addressed by bonuses. But the bonuses are going to the wrong people and are too easily gamed because good controls have not been implemented.

Angela
Angela

Right on target Lem. I see your point. The money issues —-look at what has turned up again with the IRS . More corruption here too, using taxpayer dollars to fund their luxurious lifestyle. The whole damn government needs busted up. This is where the American taxpayer dollars are going instead of taking care of the real business issues and American people and infrastructure of this country. Then, the IRS goes after innocent people like conservative groups. 🙁

Seymore Klearly
Seymore Klearly

Fuck off Rhonda Strick you VA Troll!!!

91Veteran
91Veteran

BULLSHIT!

It is ALL about money and nothing more.

Why not try the innovative idea of determining whether VA doctors are actually seeing enough veterans now? There have been several reports of VA doctors having a much lighter caseload than those in the civilian world. What is needed is an innovative idea to motivate them.

If you are willing to accept substandard practices in behalf of all veterans, what other substandard practices are you willing to accept on behalf of all of us? Dentists reusing their instruments? Cutting corners on sterilizing other equipment?

As one who was stuck with an incompetent nurse who falsified my records which were changed to reflect what happened after I caught it, I am not willing to accept that for myself, let alone all veterans.

You as a former Captain should know better.

Angela
Angela

Agree with you 91Veteran. Let’ s speak doctors. A recent doctor made a statement to me that he came to the VA, to get a life. Well, how does that figure?Maybe he has gotten in trouble with his own private practice in civilian sector. In the VA the doctors basically call their own shots which may not be even any shots at all. Not saying that this doctor is a poor doctor, because he did half way help me out. Half measures care with prescribing 3 out 4 medications products with decent judgment. One med that he prescribed could contribute to cognitive damage. I chose not to take it. Anyway, getting by to medical providers, I agree it is all about money. It does not carry the same weight like it used to. I mean the passion and conviction are rare qualities in alot of today’s medical professionals. The VA would have money to hire some quality physicians if it was a frugal and a miser agency. The VA probably does not even track where all its money goes. The captain who made the comment if this were a perfect world ……well, to the captain, here is what I say….captain, you are not on a yet level playing field with most of the other veterans as in you seem as though you have not been at the bottom and had to climb out of a hopeless whole. If you were desperate, you would not have put out the message that you did. Never settle for less when it comes to a human life. Maybe drive a beat up car, maybe choose to shop at the dollar store, maybe buy a 10 dollar shirt instead of a 100 dollar shirt, but when it comes to human life, the life is to be valued above and beyond a material product. After all we are a precious creation from the Lord Jesus Christ above. With what I am trying to say, the VA does not place emphasis on human life. They had rather pay themselves bonuses, buy new carpet and the list goes on. They pay these private contractors too much. Trump needs to step into this issue in the VA just like he is doing with the Boeing contract with Air Force One. The VA gets money. From what I have noted, items are not budgeted or allocated with frugality. If course though, these are just my observations. Who am I to the VA leadership? Nobody. Just number with current leadership. I do not agree with Advanced Nurse Registered Practitioners being the diagnosing authority. I will never agree. I value a life more than just to play with it. Now, nurses are wonderful providers and can be great providers but they will never fill the role of a quality doctor. Thanks.

91Veteran
91Veteran

In a perfect world, having nurses see veterans as PCPs would be a great way of reducing wait times, once they got the bureaucracy out of the way, and defined what that perfect world would look like.
That perfect world would be those veterans seeing nurses as PCPs having the right to see the supervising doctor of that shift of PCP nurses that same day as soon as the veteran requested it.
If there was a question or dispute over the direction in care, the veteran could address it that day during the same appointment…not driving back home and waiting weeks for a referral to another doctor, then having that appointment canceled at the last minute.
The real world is as follows.
A few years ago I went to the VA ER because I couldn’t put any weight on one leg because of a messed up knee. I already had 4 prior surgeries on it and knew what living with a painful knee was like. After being seen in the ER, getting a prescription for pain meds, I was told I would have to see Ortho, and the ER doc said he expected my knee would be in a jar on some doctors desk since I needed it replaced.
I waited weeks to hear about an appointment with Ortho, only to find out I had to see a PCP first. He was a PA, but good. I told him I wanted an MRI before I saw Ortho so he would know what he was facing, and I wouldn’t have to face further delays in getting care for a leg I couldn’t put weight on. The PCP PA told me the VA doesn’t like to do that, and wouldn’t order the MRI before I saw Ortho.
Weeks later, I had the Ortho appointment, and had the MRI just prior to it because of several calls I had made.
I eventually had that knee replacement surgery 3 1/2 months after first going to the ER, and only then because I pushed hard for it. I could have survived longer without getting the surgery within that timeframe, but how many other veterans with more serious conditions are waiting longer either because they don’t push for more timely care, or because the VA throws up delaying roadblocks.
Having nurses see vets as PCPs would work in a perfect world, but years of VA history shows it would simply add to the disaster it already is.

Angela
Angela

Hey 91Veteran, nurses can reduce wait times. I agree. I do not agree with the APRN being the diagnosing authority though. I just do not. Once a quality doctor makes a diagnosis, then, the nurses could then direct rest of care. Then, at the end of or towards end of care, then, have doctor do an updated quick evaluation to determine status. Again, I say, if the designated diagnosing authority would or could get it right the first time, this action would really be a feather in the VA’s
cap. The problems exist mainly because of lack of accountability, unqualified medical professionals and the union. Heck, the chapter 31 could invest in some of these young veterans to become doctors with stipulation to work for the VA down the road. But you know what 91Veteran, the VA looks everywhere else except investing in a veteran. I am not joking. Many veterans have alot to offer and have tremendous leadership skills from having been in the military. 91Veteran, though, once the veterans get into system for care, the VA wants to sell them short. When vets get out of military some may just need guidance from readjustment counselors to adapt, but hey it turns into a world of crap because they get entangled with the system. Then, veterans get stuck forever.VA could do the right thing but the leadership appears to not know how.
I agree with you about your entire message.

Lem
Lem

It is not just about money. It is also about availability. Look at how many brain drain physicians are not only in the VA but also in private health care. It is about the money in the sense we cancelled the scholarships for Americans to get through med school in favor of placing potential American Doctors in deep debt to the banks at interest rates far too high. This may work for less intelligent students who don’t realize the student loan debt will follow them far too long in their life. But those who are going to need double the amount of a civil engineer or an education graduate are able to look at their budget potential. Thus students from wealthy families in other countries fill too many of our medical school billets and others go unfilled to our detriment creating a shortage of physicians much to the liking of the AMA because it means more money for AMA members in the supply and demand to fill medical professional positions.

Go back to Eisenhower economics for much of the recovery of this default.

Paul J
Paul J

Harrison and Rhonda, thank you for those rational assessments. This is a matter of providing timely care vs providing no care. Hiring more doctors is not realistic, VA can’t compete with the private sector on salary. Using PA’s or NP’s may not be the ideal solution, but it is an attempt to address the wait time problem.

Hondo
Hondo

What’s next, PhD candidates (PhD (c) providing mental health care………

RO raters are going to love this APRN side show……….

namnibor
namnibor

@Hondo- You are probably correct. I can see it now where a Veteran has notes in medical file put there by an APRN and the VARO Raters come back and state the APRN opinion or diagnosis requires supporting evidence and confirmation of a M.D…..but it was quite okay to use the APRN on the treating end but I can just see the VA using this to add to the growing BVA wait list. The VHA chasing it’s own tail with the Veteran stuck in the middle of the spin trying to decide who really is qualified to do what. The staging of the VA circle jerk…wait for it……

James R.
James R.

I wondered why I were scheduled a Hepatitis C test with my regular blood test in October. I didn’t know about the Dentist story.

Ex va
Ex va

@ James R. I wish the best for you on your results for testing.

91Veteran
91Veteran

So they never bothered to notify you?

namnibor
namnibor

It’s just another secret list that could cause desired outcomes.

J.Klapper
J.Klapper

This is actually irreverent since the INS & the AMA have for DECADES, insisted that States and the Federal Government accept the MBBS, MBChS, MBBCh, etc.etc, a BACHELOR DEGREE with a MD or DO a DOCTORAL Degree. As someone that has taught pre-med courses at a collegiate level I have no difficulty detecting the difference, however the Houston VA tried shoving one of them off on me that my sister, who’s degrees are in Anthro not Biology was able to tell that this person was simply did not have the quality of knowledge one should be able to expect from a Primary Care Physician…
Might I suggest you investigate this even longer and more common of an issue concerning the poor medical treatments that are acceptable in the US before going on another Clinton (and DOLE btw, but you would have to remember who all was involved in the failed attempt to put a medical system in place to include people that were not members of the Democratic Party) bashing spree…

Wingnut737
Wingnut737

And the Nurse practitioners unlike The MD’s will have the benefits and protection of the UNIONS!

Seymore Klearly
Seymore Klearly

Lets not forgot they will also have a great health insurance plan. That is Not VA Care.

ANutterVet
ANutterVet

This Executive Order will allow lower the bar to what is the definition of substandard care. The VA will also be able to hire more Nurses to treat patients for less cost. Most of these Nurses will not be required to be a specialist in order to treat Veterans with certain medical conditions. Therefore, the Presidential Executive Order 13132 will surely benefit the image of the VA [truly a façade and white wash], will reduce the fixed and flexible costs in treating Veterans, and the VA will be protected even more from lawsuits filed for medical malpractice.

91Veteran
91Veteran

Clearly this is a bastardization of any EO by the VA to force this lunacy on the state’s. There are any number of areas where states do better and do not need to raise (lower) their standards to the federal level. At the same time, there are any number of instances where the Fed’s have claimed jurisdiction over states in the name of meeting some lofty standard, and they fail miserably at that, unless your purpose is to increase federal bureaucracy and over reach. USDA good or meat inspections are 2 examples. If the Fed’s do such a great job at that, why do people still get sick from eating tainted food?
So now states will have their rights trampled on because a federal agency can’t do their jobs properly.
Now, since this scheme has been around for 14 years, imagine the bonuses obtained fraudulently because they claim wait times are so good. The wait times have gotten much worse in reality, and rolling out this bullshit won’t fix that. If they ARE implementing this because of wait times, how does that square with so many in upper VA management claiming they have seen such huge improvements over the past 2 years on wait times.
Which VSO cheerleading McDonald can explain why this is needed if the wait times are improving? Such a change would suggest wait times will get even worse.
Before lowering these standards, the VA should provide the data to prove what they claim. Produce clear evidence that VA doctors currently have a reasonable caseload or are overwhelmed. That should be easy to prove. How many patients does Dr. Bigknuckles see each week? How many patients are seen each week in the private sector?

I bet those numbers would be shocking, and prove there is no need to lower standards.
Now, even if they implement this disaster, will they measure outcomes appropriately? I bet the VA and the worthless VSOs will be cheering how much faster a veteran is seen, while ignoring how many veterans actually have to wait LONGER to see a real doctor after the nurse is convinced to refer them.
Reality will be a veteran needing to see a specialist will be required to go through this nurse at least once, perhaps a few times before the referral, then the veteran will have to wait weeks longer to get to see that specialist.

They can offer all the bullshit excuses they want, but it boils down to cost, which is what they should think of before sending us to war.

As I have said before, a percentage of anything spent on war should go directly into a fund used only to provide medical care for those fighting it.

Frederick Payne
Frederick Payne

O.K. The owner of this website is a highly trained Legal Expert (Respected by many of Us) with the background needed to challenge issues like this, what is being done. The VA regulations states that all professional medical personnel must have a License from a state in order to practice in the VA, Since the Federal Government does not issue License’s. So I will use Nebraska for example because that is where I live, If the VA states that a individual must comply with their individual states requirements for licensing, and that state limits the Scope of Care to defined parameters. How can the VA be allowed to violate the States right to limit or control how their licensed health care professional practice. The State should be allowed to suspend or revoke the license of any individual which violates the terms of their License. If the VA wishes to allow what is beyond what a certain state requirements are then the employee should be forced to license in a state that allows what the VA proposes. If no State Authorizes a policy proposed by the federal government, and considers the proposal a violation of the States Right in Licensing or standard of care then it should be considered Illegal and not a enforceable act by the federal government. Simply Put the Federal Government is claiming Sovereign Immunity against the 50 States to knowingly violate State License requirements. It is time for a Federal Lawsuit on a fast track for a hearing at the Supreme Court.

Kat
Kat

Doctors are quitting, they refuse to work for the VA because of the corruption. The VA cannot keep doctors. So they say..why not? Let’s put nurses in place of doctors!
Several Doctors that did work at the Phoenix VA are now gone, they bailed. I don’t blame them, I wouldn’t work there neither.

Jo3n
Jo3n

What money are they saving? At last VA clinic, twice I saw a kid. I have four grandchildren older. The VA nurse? I had to see, didn’t have a doctor. I have no idea what the kid psychiatrist was. Dr.’s isn’t where the VA needs to save money.

Angela
Angela

Agree wholeheartedly.

ANutterVet
ANutterVet

@Jo3n- The VA will be saving money by not hiring more Physicians. But by not hiring Physicians, the medical services for Veterans will be degraded even more. And, by not having a Nurse Practitioner or Physician Assistant overlooked by a Physician is an exponential downgrade. This is not in the best interests for Veterans that’s for sure.

Angela
Angela

APRN’S in place of doctors is awful. There are DPRN’s or DPN’s. Use instead of APRN’s.

To Secretary McDonald, this is a lousy decision. I guess your are still at Disney Land.

You are right, ANutteVet, about the APRN decision with not being in the best interest of the veterans.

Mr. McDonald, will you please see a APRN for your health care diagnosing instead of a doctor? You might think twice about pushing your agenda on the backs of all the vets. Give you a taste of your own medicine.

Susanne Sheffer
Susanne Sheffer

Hard to keep decent physicians and nurses so PA’s have enormous responsibilities, But a nurse is no substitute for a doctor and THERE MUST BE OVERSIGHT.
The one thing the VA appears to have plenty of is ADMINISTRATIVE BEAN COUNTERS AND PENCIL PUSHERS. YOU KNOW- the same ones that advance themselves a raise whenever they think THEY DESERVE A RAISE.
Util now, I thought Congress was the only entity to have such powers.

namnibor
namnibor

Benjamin- Your ‘Bad VA Art’ today is kind of menacing to my mind because back when I utilized the VA for part of my medical crap I had a pain management M.D. that looked exactly like the Mohamed in white coat in that picture and he always had that same condescending mug on his face but it became hostile because see, one of the three drugs in this powerful RX I have to take actually can cause a false positive for THC and it’s even written specifically in the large paper fold-out from the drug manufacturer, but that idiot refused to believe it, saying I was a drug user and I really was not, do not even drink, but this ass tried to tell me I would have to go into drug counseling before my pain management could, if ever, be reinstated. I even obtained a freaking letter from my private infectious disease Dr. verifying that and in order to confirm a false positive a more elaborate comprehensive spectrum test needed performed to discount it. “Mohamed” would not even take that as medical gospel and I have not been back to the VA since, using Medicare and private providers.
I try to remain open-minded but that was the last straw for my patience on the camel’s back, mind the pun, and I simply do not wish to be seen by condescending towel-heads. I know it makes me sound like an intolerant ass but I simply did not feel safe.
I am not on any pain management these days because the liability even in the private medical is insane because they are treating we responsible medicine takers as if we are drug-seeking thugs while never addressing the actual problem of either overprescribing or actual drug seekers…they have lopped us all in the same bag.
So now I DO partake in medical cannabis and guess what? It helps both my pain and PTSD better than ANY big pharma RX. Fuck You VA and the camels Mohamed and family arrived in. Fuck You!

ANutterVet
ANutterVet

Who pays for the freedom of this country? Veterans do! Shame on you media cartels for not keeping the public abreast and up to date pertaining to the continuous scandalizing practices that are continually happening at VA Medical Centers and Clinics.

All you ambulance chasing investigative reporters need to do is to read this blog, than ask been for permission to reprint. Better yet, if you’re truly concerned for the safety of Veterans, contact Ben directly and ask him for permission to reprint, give him FREE space to publish his articles, or on a regular basis interview Ben for the hot issues that directly deal with the Veterans Administration.

Media outlets, you truly are being a disservice to Veterans [that’s a given]. And, due to your influence your not serving your other readers in a professional by not keeping the life threatening circumstances that are occurring at the VA Medical Centers and Clinics. You wonder why many Veterans don’t support your paper.

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