Saturday, November 22nd, 2014

The Obameter

Institute electronic record-keeping for the Veterans Benefits Administration


"As president, Obama will transform the paper benefit claims process to an electronic system that will be interoperable with the VA's health network as well as military records. This will reduce error rates, improve timeliness, and enhance the overall quality of the claims decisions."


Updates

Benefit claims are going digital, slowly

Veterans who seek federal benefits for their military service face a system bogged down by paper.

For years, government officials have acknowledged that their process for reviewing requests was slow and prone to unacceptable mistakes.

That's what Barack Obama told voters he would correct if elected president in 2008.

Four years later the campaign pledge isn't fulfilled, but Obama's paperless dream is closer to a digital reality.

The problem: a fragmented system for filing veterans benefit claims

The Veterans Benefits Administration, one of three branches of Veterans Affairs, reviews and grants requests for veterans to receive financial compensation, home loans, college tuition, medical care and more.

The most vivid example of a benefit, and the one Obama seemed to emphasize in his campaign promise, is access to health care from the Veterans Health Administration and its hospitals.

For example, say you're a soldier and you suffered a shrapnel wound from an explosion in combat. Now you're hoping to receive disability compensation and free health care from hospitals run by Veterans Affairs. In general this takes records proving your injury occurred while in uniform and your injury requires medical treatment.

The veterans hospitals must trade information with the military, private doctors' offices and ratings specialists who determine whether veterans are eligible to receive benefits. (These rating specialists also determine how big a benefit a veteran would receive.)

In his campaign promise, Obama talked about "interoperability,” where records from the military and Veterans Affairs could transfer electronically. Instead, what we have today is 1) an electronic health network, which preceded Obama's tenure, 2) a series of electronic pilot projects at the Veterans Benefits Administration and 3) disjointed record systems in different branches of the military. In general the three remain unconnected digitally.

Meanwhile, the two goals the paperless system was supposed to accomplish -- timeliness and accuracy in processing claims -- remain far off.

Several news reports, including stories in the past year from the Center for Investigative Reporting and The New York Times, document long waiting periods -- sometimes beyond a year -- for the government to respond to veterans' claims. Government reports show improved efficiency in processing claims, but also dramatic increases in the number of filed claims -- up 48 percent in the last four years. Among the many reasons for the uptick in claims are a decade of war in Iraq and Afghanistan, increases in the number of medical conditions among today's veterans and expanded benefits available for veterans to claim.

When the inspector general's office within Veterans Affairs reviewed the quality of these evaluations, they also found that its rating specialists often make mistakes, which can lead to incorrect rejections or partial rejections of claims. How often? About 23 percent from a sample of 45,000 disability compensation claims between 2009 and 2010.

Incremental steps to Obama's paperless pledge via pilot projects

The Obama administration has made progress, though. As of October, five of the 56 regional offices had gone digital, with another 13 in the pipeline by the end of 2012. The other 38 are scheduled to go paperless by the end of 2013, though skeptical testimony before Congress by experts at the American Legion and Veterans of Foreign Wars suggest it will take longer.

Meanwhile the heads of the Defense Department and Veterans Affairs have agreed to a general plan for a unified electronic health records system within the military, as Obama wanted. Their stated goal is to have all military records systems connected by 2017.

So, it appears that what Obama promised and what has happened during his presidency will eventually result in a comprehensive paperless benefit claims system. However, less than a third of regional offices will be electronic by the end of 2012, the measuring stick we use for the Obameter. Therefore, we rate this a Compromise.

Sources:

Email interview with Joshua Taylor, press secretary for Veterans Affairs, Sept. 28, 2012

Email interview with Terry Jemison, public affairs specialist for Veterans Affairs, Sept. 27, 2012

Interview with Gerald Manar, deputy director of the National Veterans Service at the Veterans of Foreign Wars (VFW), Oct. 2, 2012

Veterans Benefits Administration, Impact of VBA's new challenge training program, July 10, 2012

Government Accountability Office, Claims processing problems persist and major performance improvements may be difficult, May 26, 2005

Government Accountability Office, Preliminary Findings on Claims Processing Trends and Improvement Efforts, Statement of Daniel Bertoni, Director Education, Workforce, and Income Security, July 29, 2009

The American Legion, VBMS: Silver bullet for claims backlog?, June 19, 2012

Veterans Benefits Administration, Understanding the disability claims process, (accessed Oct. 8, 2012)

Veterans Benefits Administration, VA claims transformation, (accessed Oct. 8, 2012)

The New York Times, Veterans wait for benefits as claims pile up, Sept. 27, 2012

The Bay Citizen, Disabled vets stuck in backlog limbo, accessed Aug. 29, 2012

Defense Department, DOD, VA announce joint health record milestone, May 21, 2012

U.S. House Veterans' Affairs Committee — Subcommittee on Disability Assistance and Memorial Affairs, Reviewing VA's performance and accountability, Witness testimony of W. Scott Gould, deputy secretary of veterans affairs, U.S. Department of Veterans Affairs, Sept. 20, 2012

U.S. House Committee on Veterans' Affairs, Testimony by Gerald Manar, deputy director of the National Veterans Service at the Veterans of Foreign Wars (VFW), June 19, 2012

U.S. House Veterans' Affairs Committee — Subcommittee on Disability Assistance and Memorial Affairs, hearing on underperforming VA regional offices, June 2, 2011 (subscription)

U.S. Department of Veterans Affairs, Office of Inspector General, Systemic Issues Reported During Inspections at VA Regional Offices, May 18, 2011

U.S. Department of Veterans Affairs, 2011 Veterans Affairs Performance and Accountability Report, Nov. 15, 2011

U.S. Department of Veterans Affairs, Veterans Benefits Administration, Annual Benefits Report, Fiscal Year 2011

U.S. Department of Veterans Affairs, Veterans Benefits Administration, 2012 Monday Morning Workload Reports

U.S. Department of Veterans Affairs, Veterans Benefits Administration, Regional Office Websites

U.S. Department of Veterans Affairs, Veterans Benefits Administration, Benefits Fact Sheets

WhiteHouse.gov, Veterans

Office of the Under Secretary of Defense, Personnel and Readiness Information Management, Virtual Lifetime Electronic Record (VLER)

Obama pledges electronic health records to cover troops from active duty to the VA and beyond

President Barack Obama appeared with his secretaries of Defense and Veterans Affairs on April 9, 2009, to pledge support for the creation of electronic health records that would cover troops "from the day they first enlist to the day that they are laid to rest."

"Under the leadership of Secretary (Robert) Gates and Secretary (Eric) Shinseki, the Department of Defense and the Department of Veterans Affairs have taken a first step towards creating one unified lifetime electronic health record for members of our armed services that will contain their administrative and medical information," Obama said.

"I'm asking both departments to work together to define and build a seamless system of integration with a simple goal: When a member of the armed forces separates from the military, he or she will no longer have to walk paperwork from a DOD duty station to a local VA health center; their electronic records will transition along with them and remain with them forever," he added.

Obama noted that Congress has recently approved budget resolutions that support his proposals for increasing funding for veterans services.

When the president brings two Cabinet-level secretaries before the cameras to declare a goal, that's no small use of the bully pulpit. But as Obama noted, it is just a first step and it is likely to take many months for the departments to create such a "seamless" system. So we declare this one In the Works.

Sources:


White House, Remarks by the President on Improving Veterans Health Care , April 9, 2009