May212013
Hearing Transcript on Quality vs. Quantity: Examining the Veterans Benefits Administration’s Employee Work Credit and Management Systems.
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QUALITY VS. QUANTITY: EXAMINING THE VETERANS BENEFITS ADMINISTRATION’S EMPLOYEE WORK CREDIT AND MANAGEMENT SYSTEMS
HEARING BEFORE THE SUBCOMMITTEE ON DISABILITY ASSISTANCE AND MEMORIAL AFFAIRS OF THE COMMITTEE ON VETERANS' AFFAIRS U.S. HOUSE OF REPRESENTATIVES ONE HUNDRED ELEVENTH CONGRESS SECOND SESSION MAY 6, 2010 SERIAL No. 111-77 Printed for the use of the Committee on Veterans' Affairs
U.S. GOVERNMENT PRINTING OFFICE For sale by the Superintendent of Documents, U.S. Government Printing Office
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CORRINE BROWN, Florida |
STEVE BUYER, Indiana, Ranking |
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Malcom A. Shorter, Staff Director SUBCOMMITTEE ON DISABILITY ASSISTANCE AND MEMORIAL AFFAIRS
Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public hearing records of the Committee on Veterans' Affairs are also published in electronic form. The printed hearing record remains the official version. Because electronic submissions are used to prepare both printed and electronic versions of the hearing record, the process of converting between various electronic formats may introduce unintentional errors or omissions. Such occurrences are inherent in the current publication process and should diminish as the process is further refined. |
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C O N T E N T S
May 6, 2010
Quality vs. Quantity: Examining the Veterans Benefits Administration’s Employee Work Credit and Management Systems
OPENING STATEMENTS
Chairman John J. Hall
Prepared statement of Chairman Hall
Hon. Doug Lamborn, Ranking Republican Member
Prepared statement of Congressman Lamborn
WITNESSES
U.S. Department of Veterans Affairs, Diana M. Rubens, Associate Deputy Under Secretary for Field Operations, Veterans Benefits Administration
Prepared statement of Ms. Rubens
American Federation of Government Employees (AFL-CIO), and AFGE National Veterans Affairs Council, Jimmy F. Sims, Jr., Shop Steward, Local 1738, and Rating Veterans Service Representative, Winston-Salem, NC, Regional Office, Veterans Benefits Administration
Prepared statement of Mr. Sims
American Legion, Ian C. de Planque, Deputy Director, Veterans Affairs and Rehabilitation Commission
Prepared statement of Mr. de Planque
CNA, Institute for Public Research, Eric Christensen, Managing Director of Health Research Policy
Prepared statement of Mr. Christensen
Disabled American Veterans, John L. Wilson, Assistant National Legislative Director
Prepared statement of Mr. Wilson
National Organization of Veterans’ Advocates, Inc., Richard Paul Cohen, Executive Director
Prepared statement of Mr. Cohen
National Veterans Legal Services Program, Ronald B. Abrams, Joint Executive Director
Prepared statement of Mr. Abrams
Veterans of Foreign Wars of the United States, James D. Wear, Assistant Director, National Veterans Service
Prepared statement of Mr. Wear
QUALITY VS. QUANTITY: EXAMINING THE VETERANS BENEFITS ADMINISTRATION’S EMPLOYEE WORK CREDIT AND MANAGEMENT SYSTEMS
Thursday, May 6, 2010
U. S. House of Representatives,
Subcommittee on Disability Assistance and Memorial Affairs,
Committee on Veterans' Affairs,
Washington, DC.
The Subcommittee met, pursuant to notice, at 2:00 p.m., in Room 334, Cannon House Office Building, Hon. John J. Hall [Chairman of the Subcommittee] presiding.
Present: Representatives Hall, Donnelly, and Lamborn.
OPENING STATEMENT OF CHAIRMAN HALL
Mr. HALL. Good afternoon. The House Committee on Veterans' Affairs, Subcommittee on Disability Assistance and Memorial Affairs, will come to order for our hearing.
Quality vs. Quantity: Examining the Veterans Benefits Administration's (VBA's) Employee Work Credit and Management Systems is the theme today, and I would start by asking us all to rise for the pledge of allegiance. Flags are at both ends of the room.
[Pledge of Allegiance.]
Thank you, and welcome to today's hearing that is entitled, "Quality vs. Quantity: Examining the Veterans Benefits Administration's Work Credit and Management Systems."
The purpose is to examine how VBA's employee work credit system and its claims processing improvement work management system model may contribute to diminished quality, accountability, and accuracy in compensation and pension claims processing.
Today's hearing continues this Subcommittee's efforts to analyze various elements of the compensation and pension claims process over the 111th Congress and marks our fifth oversight examination this year focused on ensuring that our veterans and survivors properly receive their benefits. It is our collective quest to vanquish VBA's backlog of claims and appeals, which currently exceeds 1 million.
We also intended for today's hearing to provide an opportunity to examine a Congressionally mandated report on the VBA's work and management systems outlined in legislation that was developed by me and other Members of this Committee during the 110th Congress, the Veterans Disability Benefits Claims Modernization Act of 2008, H.R. 5892, codified in Public Law 110-389. The goal of this legislation, among other things, was to provide VBA with a valuable road map to assess and improve its work credit and management systems to produce better claims outcomes for our veterans.
The deadline for this report was October 31, 2009, and I note that we have yet to receive it. However, the VA has authorized an independent research contractor that was retained to complete this report, the Center for Naval Analysis (CNA), to testify before us today concerning a summary of the report's findings and recommendations, the Cliff Notes version of the report, I guess. The U.S. Department of Veterans Affairs (VA) advised the Subcommittee that the report is still under review by the agency and Office of Management and Budget (OMB) and should be submitted to Congress soon.
We look forward to hearing today when the report will be ready and submitted to Congress and to getting a better understanding of why it has not yet been delivered.
Since 2007, the VBA has added over 7,100 claims processing personnel; and Congress has funded these requests. Yet the backlog still climbs. This is not to say that adding additional workforce has not been beneficial. Had Congress not provided these new claims processors, the backlog might be much worse than it is today, given the exponential growth in claims receipts.
As the VA itself acknowledged during Chairman Filner's Claims Roundtable in March, this is a sign of a broken system. The mounting claims backlog is a symptom that cannot be addressed until the VA refocuses itself on adjudicating claims correctly the first time. We need to continue to look at the system with fresh eyes and determine how a new outlook can help VA fix its claims processing system and get the backlog under control.
In convening today's hearing, the Subcommittee seeks to further explore how the VBA work credit incentives and the flawed Claims Process Improvement (CPI) Model might be contributing to delays and errors in the claims process. It is my hope that we will—in continuing to examine this issue—be able to help veterans secure the benefits they deserve and prevent them from suffering further injury as a result of delays in receiving disability benefits.
That is why I want to revisit the issue of partial, provisional, and temporary ratings. I believe that if the VA increases the use of this authority and also awards a credit to claims processing personnel who use it, it will go a long way in making sure that more veterans can begin to receive their benefits more promptly. I would like the VA to address this issue when it testifies.
Today, we will also hear from veterans service organizations (VSOs) and advocacy groups who will explain their vision for how the VA should address this problem. From them, I know we can get a better understanding of the underlying issues that led to such an unmanageable backlog at VBA, as well as if they believe that the efforts of the VA are in the right direction regarding this issue. Specifically, I would like to know if the VSOs and advocacy groups agree with VBA's assertion that it emphasizes quality on a par with quantity and timeliness.
I look forward to your testimony and insightful comments and questions from my colleagues, and I would recognize Ranking Member Lamborn for his opening statement.
[The prepared statement of Chairman Hall appears in the Appendix.]
OPENING STATEMENT OF HON. DOUG LAMBORN
Mr. LAMBORN. Thank you, Mr. Chairman, and I look forward also to this afternoon's hearing on VA's work credit system.
The purpose of this discussion is to ascertain whether proper performance measures are in place to effectively gauge both efficiency and accuracy of work. A system that rewards work credits based on production alone undermines quality; and, as we all know, poor quality work has ramifications throughout the entire system that has contributed to the backlog of claims. At the same time, there is also clearly a need for VA to maintain a high level of efficiency so that veterans can be receiving compensation in a timely manner.
Where does the proper balance lie? True quality means being effective and efficient. The key to achieving this balance lies in how employees are rewarded for the work they accomplish. For too long, it appears that VA has placed too high an incentive on production, but it is simply counterproductive to strive for high numbers if the work has to be revisited at a later time. Yet, it would be equally detrimental to veterans if there was an overemphasis on quality and the average handle time was off the charts.
This Subcommittee passed legislation during the past session to obtain a study of the effectiveness of the VA's employee work credit and work management system. From this, we hope VA will be able to develop a more effective means of improving its claims processing performance. I look forward to working with my colleagues and Department officials to delve into this issue and hopefully identify how the work credit system can help incentivize the proper balance between quality and quantity.
I want to thank the witnesses in advance for their participation and their testimony, and I look forward to our discussion today.
Mr. Chairman, I yield back.
[The prepared statement of Congressman Lamborn appears in the Appendix.]
Mr. HALL. We just had a vote call, but I would like to move ahead with our first witness, and then we will have to break so we can go across the street and vote and ask the rest of you to be patient, as you always are.
So we will first welcome Eric Christensen on our first panel, the Managing Director, Institute for Public Research, CNA.
Your full statement is entered in the record, sir and you are now recognized.
STATEMENT OF ERIC CHRISTENSEN, MANAGING DIRECTOR OF HEALTH RESEARCH POLICY, INSTITUTE FOR PUBLIC RESEARCH, CNA
Mr. CHRISTENSEN. Thank you, Mr. Chairman, distinguished Members. I appreciate the opportunity to testify before you today on the subject of VBA's work credit and work management systems.
As you said, I am Eric Christensen, Managing Director of Health Research and Policy at CNA. CNA is a non-profit firm that provides independent objective analysis to various government agencies.
CNA conducted its analysis of the work credit and work measurement systems between March and September of 2009. We interviewed over 100 VBA employees at six regional offices (ROs) to understand the issues, complexities, and incentives associated with these systems. We note that VBA works in a challenging environment. The number of compensation claims submitted each year increased by 53 percent between fiscal years 1999 and 2008. At the same time, the complexity of claims has also increased.
There are three principal concerns about the current employee work credit system: one, that it emphasizes quantity over quality; two, that production standards are not based on a careful analysis of the task performed; and, three, that work credits and production standards do not reflect changes in claim complexity and additional duties imposed by legislation.
Our study confirmed that employees perceive that quantity is emphasized over quality, as well as confirmed the other two concerns.
To address these concerns, we recommended that VBA redefine the work credits so that work credits account for claim characteristics that are correlated with the amount of work required. For example, accounting for the number of issues and types of medical conditions would likely be important to accurately reflect the work credits on a claim.
Further, we recommended that VA consider two options or frameworks when redefining work credits. The first is to give work credits for only the following broad groups: one, initiating development; two, making a claim ready to rate; three, deciding an award; and, four, authorizing the award. This was the recommendation of a VA work group. At the time of our report, VA was preparing to pilot test this approach at multiple sites.
The second option is to base work credits on a comprehensive, detailed list of all individual activities that employees perform.
As for quality, we recommended that VA conduct more quality reviews to better communicate quality as a priority. Similarly, we recommended that, on internal quality reviews, VA consider deviations from official procedures for claiming work credits as errors rather than as comments. Further, we recommended that there would be work credit deductions for actions with errors.
Turning to VBA's work management system, the concern is that quality and accountability are lacking, because many different people are involved in processing each claim under the Claims Process Improvement, or CPI, Model.
Note that the CPI Model is not VBA's first effort to manage claims processing by dividing it into separate stages and passing a claim through a series of people. In the 1990s, VBA used a similar model called the unit model. In the late 1990s, there was an effort to address these challenges of the unit model. These challenges were lack of individual accountability and an emphasis on quantity over quality. The solution was a case management model in which each case was handled by one veterans service representative (VSR) and one rater. VBA used this model until it adopted the CPI model in response to concerns about problems with timeliness.
At the time of our report, VBA was conducting a pilot study in the Little Rock regional office. The key element to this pilot is processing claims that contain predetermination, rating, and post-determination functions while maintaining the current specialization of VSRs under the CPI model. This model appears to have the potential to improve quality compared to the CPI model, especially if it creates a greater sense of accountability. Consequently, we recommended that VA waits to see the results of this pilot before investigating other alternatives to the CPI model.
Thank you for allowing me to testify. I would be happy to answer any questions you may have.
[The prepared statement of Mr. Christensen appears in the Appendix.]
Mr. HALL. Thank you, Mr. Christensen.
We will just ask you a couple of questions before we break for votes; and if we have any more, we will submit them to you in writing.
But in surveying stakeholders concerning the VBA's employee work credit system, the central issues, as you noted, indicate that you are able to determine, first, that the system emphasizes quantity over quality, that production standards are not based on a careful analysis of the tasks performed, and that work credits and production standards do not reflect the changes in complexity of claims and in Congressional mandates. What would you recommend to address these issues?
Mr. CHRISTENSEN. As I mentioned, what we recommend—the issue is there are very broad categories with which credits are given. So, for example, a claim with zero to seven issues would receive the same work credits if it was one issue or seven. There is a difference in work credits if the claim has eight issues or more compared to something that has less than that. Those are relatively broad categories. We would recommend that narrower variations be given in work credits.
We also recommend that work credits be contingent upon the type of medical condition. There is some variation of work credits, for example, if a veteran has post-traumatic stress disorder (PTSD), but, otherwise, there is really no recognition of type of medical condition. You speak with people at the VA and the people who rate the claims, obviously, a hearing case is much simpler and probably over credited compared to some other types of claims such as one with traumatic brain injury (TBI). So we think that considering those things in the work credits would be important.
As I mentioned a couple of options, there are two really kind of philosophical approaches you can take for credits. One is giving a credit for each individual action that raters perform, and the other is basing credits more on broad categories of moving a claim past key milestones in the process. It is kind of a different philosophical approach to do so. There are advantages and disadvantages to each of those, but those are things that we recommend in terms of production.
The other recommendations of quality are really to create signals to rating personnel that quality is important.
Mr. HALL. Thank you.
And can you give us any insight into why the VA has been unable to release the study which was done by CNA, which I believe you said was completed in September?
Mr. CHRISTENSEN. We completed it in September and delivered it to VBA per our contract. I cannot speak for VA in terms of why they have not provided it to you.
Mr. HALL. Mr. Christensen, the last question I have is, there are two, as you said, seemingly opposite philosophies that may be able to be followed at the same time. The question is, in your opinion, is it possible to provide a partial work credit or a positive employee evaluation for a claims processor who begins the flow of compensation dollars to a veteran for an undisputed part of his or her claim while at the same time doing what many stakeholders, many veterans groups are suggesting, which is to not give the complete work credit until the appeals process or appeals time period has expired and the final resolution of the claim is done? So that I guess the question is, can you speed up the front end while at the same time holding up the back end to make sure that the quality is there?
Mr. CHRISTENSEN. That is not something we looked at specifically. Obviously, you can give work credits however the system is designed and chooses to do so. But that is not something we specifically study.
Mr. HALL. Okay. Thank you very much, sir. We will send you some more questions in writing.
For now, this Subcommittee will recess until after votes; and I ask the rest of your patience, please.
[Recess.]
Mr. HALL. The Subcommittee on Disability Assistance and Memorial Affairs will resume our hearing. Thank you all for your patience.
We welcome our Panel 2: Richard Paul Cohen, Executive Director of National Organization of Veterans' Advocates (NOVA), Inc.; Mr. Ronald B. Abrams, Joint Executive Director of National Veterans Legal Service Programs (NVLSP); James D. Wear, Assistant Director, National Veterans Service, Veterans of Foreign Wars of the United States (VFW); John Wilson, the Assistant National Legislative Director of Disabled American Veterans (DAV); Ian C. de Planque, Deputy Director, Veterans Affairs and Rehabilitation Commission, the American Legion; and Jimmy F. Sims, Jr., Rating Veterans Service Representative (RVSR) from the Winston Salem Regional Office of the Veteran Benefits Administration and Shop Steward for Local 1738, on behalf of the American Federation of Government Employees (AFGE) .
Gentlemen, thank you so much for waiting and for the testimony you are going to give and have given.
You know the routine by now. Your full written statement is already made a part of the record, so you each will have 5 minutes, starting with Mr. Cohen.
STATEMENTS OF RICHARD PAUL COHEN, EXECUTIVE DIRECTOR, NATIONAL ORGANIZATION OF VETERANS’ ADVOCATES, INC.; RONALD B. ABRAMS, JOINT EXECUTIVE DIRECTOR, NATIONAL VETERANS LEGAL SERVICES PROGRAM; JAMES D. WEAR, ASSISTANT DIRECTOR, NATIONAL VETERANS SERVICE, VETERANS OF FOREIGN WARS OF THE UNITED STATES; JOHN L. WILSON, ASSISTANT NATIONAL LEGISLATIVE DIRECTOR, DISABLED AMERICAN VETERANS; IAN C. DE PLANQUE, DEPUTY DIRECTOR, VETERANS AFFAIRS AND REHABILITATION COMMISSION, AMERICAN LEGION; AND JIMMY F. SIMS, JR., RATING VETERANS SERVICE REPRESENTATIVE, WINSTON-SALEM, NC, REGIONAL OFFICE, VETERANS BENEFITS ADMINISTRATION, AND SHOP STEWARD, LOCAL 1738, AMERICAN FEDERATION OF GOVERNMENT EMPLOYEES (AFL-CIO), AND AFGE NATIONAL VETERANS AFFAIRS COUNCIL
STATEMENT OF RICHARD PAUL COHEN
Mr. COHEN. Thank you, Chairman Hall, for allowing NOVA to submit its comments regarding the claims allocation process.
It is no secret that we agree with you that the system is not working well. We have testified in great detail on other occasions about the backlogs, the errors in the ratings, and the hamster wheel phenomenon. There is a fundamental problem not with the individual employees in the trenches who want to do the right thing. There is a problem with the bureaucracy, with the organization.
We all know that the VA has problems acting. A case in point, is Public Law 110-389, which required a report on the work credit system. The report is not out. The VA has not issued the required regulations on substitutions in the case where a veteran dies when the claim is pending. The new Agent Orange presumption regulations were not put out as proposed regulations until there was a lawsuit compelling it.
The VA just is ineffective. It reminds us of trying to correct the course of the Titanic. There seems to be a disconnect between what the Secretary says, what the management says, and what is actually going on in the regional offices.
A case in point is the testimony that you will hear later on from the VA stating that the VA has never emphasized production over quality. Yet, we had a 2005 report from the Office of Inspector General (OIG) showing that the work credit system did emphasize production over quality and inhibited the ability of VA employees to do quality decision making. And, in fact, CNA just testified, and their written testimony says, that their research indicates that work credit system inhibits quality.
So what the VA needs is a total course correction in terms of supervision, and in terms of management.
We have a system where the VA claims to be looking for quality decision making, yet they do not know what their actual error rate is. In their reports, the VA indicates an error rate around 80 percent. But if you do the math and figure out how many claims are denied, how many are abandoned, the remainder that go to the Board of Veterans' Appeals (BVA), and how many are confirmed by the BVA, you will find out that the error rate is probably as high as what they say their accuracy is. Their error rate is about 80 percent if you trace the cases to the BVA and then to the court. So what the VA needs to do is to develop a method for analyzing whether they are doing correct decisions. they need to get it right the first time.
Congress' role is a watchdog. It can't micromanage the VA but has to encourage them to change the whole system. The pod approach—where a team takes credit for the end result—is the way to go, where the credit is not for productivity on an individual basis but is on reaching the correct decision by the pod, by the group. That would solve the problem.
The other thing is that the VA is never going to get a handle on this backlog until they start looking at the crisis on a triage basis. What they need to do is look at those cases which are easy grants. The claim by a combat veteran who has a Purple Heart for benefits based on PTSD needs no further development. That should be a grant. Don't waste time on it. There are harder claims with harder medicine, and harder laws. Those, the VA should spend time on.
They have not been effective in working claims like a true business, but that is what they need to do. They need to bring in business experts to help them do this and, as AFGE has said, true time and motion studies are needed to try to figure out how to save time on what VA's employees do.
But the bottom line here is NOVA and the veterans who our members represent are not that interested in work credits. I know the employees are. I know the VA is. Everyone should be more interested in quality decision making from the outset.
Thank you.
[The prepared statement of Mr. Cohen appears in the Appendix.]
Mr. HALL. Thank you, Mr. Cohen.
Mr. Abrams.
Mr. ABRAMS. Thank you, Mr. Chairman.
I would first like to say that when I listened to the earlier testimony I think that you should be cautioned that it is not a one-way street. Claims are filed, and people are represented. And when we get involved in a case, we try to file the claim as early as we can so a veteran can get the earliest possible effective date.
But that doesn't mean we are going to let the VA adjudicate that claim in 30, 90, or even 180 days. Sometimes it takes us, with all the time that we have to spend on a case, 6 to 8 months to get proper medical opinions; and the VA has to wait until we get that. So it is just not up to the VA to do things in a certain time.
The advocates are also going to submit evidence, and we are going to take our time to get the right evidence. Therefore, if you have a system that stops the clock for the VA when an advocate says, look, we are going out and getting several medical opinions, that would be a good thing. It is not the VA's fault that we are taking our time, and that would encourage them to let us do that.
As you know, veterans cannot shop where they are going to get their VA benefits. They are stuck with the VA. Other people who are shopping for televisions, for cars, if they don't like the quality of a certain brand can buy some other brand. Vets have to go to the VA. And I want to stress that proper attention by VA managers to protect the fairness of the process is counterintuitive to them because it affects the statistics upon which they are evaluated.
For example, control of claims, checking to see where the claim is, slows managers and workers down. If they have to review unnecessarily delayed claims, it takes time and energy to do that. You take people off of production. Development, even Systematic Technical Accuracy Review (STAR) shows that is the biggest error; and, as a result of improper development, claims are just churned. You get on the hamster wheel, and we have talked about that over and over again.
It takes time to carefully analyze a case and recognize all the important issues. As you know, the VA has been doing it wrong for many years. As a result, when a rater gets the case in the regional office, they have to review the entire file if they are going to do the right job, and they might have to correct errors all the way back 30, 40 years ago. This needs to be acknowledged and built into the work credit system.
There is always tension between quality and quantity, and the VA has to establish a natural balance. And what we would like the VA to do is first change its work measurement system so it reflects the needs of the claimants rather than the needs of the people working in the VA. Let them adjust to what really needs to be done correctly.
Second, we should have an independent quality check, one from outside of VBA. That way you are not going to have pressure not to find errors, and I think that would help a great deal.
Thank you very much.
[The prepared statement of Mr. Abrams appears in the Appendix.]
Mr. HALL. Thank you, Mr. Abrams.
Mr. Wear?
Mr. WEAR. Chairman Hall and Members of the Subcommittee, on behalf of the 2.1 million members of the Veterans of Foreign Wars of the United States and our auxiliaries, I would like to thank you for the opportunity to be here today to share our concerns and thoughts regarding VBA's work credit and management systems.
The VFW's chief concern today is a very real perception that VA puts more emphasis on the number of claims that are processed than the accuracy of those claims. This is validated by the over 1.1 million claims for compensation, pension, education, and appeals pending, as reported by the VBA in its weekly Monday Morning Report, as well as many VA OIG reports.
Secretary Shinseki's goal of rating all claims with a 98 percent accuracy in under 125 days is very laudable, But the VFW would be ecstatic if the VA could reach the 98 percent accuracy goal with even the current average wait time of 165 days.
The VFW has developed five immediate actions that we believe will improve VBA's quality now:
First, the VA management team must focus on changing the culture in VBA to award quality over production. VBA must incorporate quality and accountability into its self-imposed work credit measurement system. VBA must determine which employees get it right and which employees get it wrong. VBA must hold every employee and manager accountable. VBA needs to know who is making the errors in order to train the employees accordingly. VBA must provide incentives to employees and managers so that they continuously look for ways to improve quality. The employees and managers must know that quality is the most important aspect of their job. VBA's new slogan could be "Do It Right the First Time."
Second, require two signatures on all awards and ratings prepared by new employees and/or employees with low quality until sustained improvement is shown. A second signature will help to ensure a more experienced set of eyes have reviewed the work of less-experienced employees. Also, it gives managers more opportunities to train on those errors as soon as they are discovered.
Third, require employees and managers to prepare partial rating decisions whenever possible to give the veteran immediate financial assistance and access to VA medical care. This will aid veterans and foster good public relations among veterans. VA must emphasize giving work grade credit for partial ratings to incentivize employees to make this extra effort.
Fourth, publicize VSRs and rating VSRs who have demonstrated consistently outstanding quality. Morale is a large part of motivating employees to work towards organizational goals.
Lastly, VA should share with their claimants the average wait time to process their type of claim in either an e-mail or in the initial development letter. This would let the veteran know up front about how long he might have to wait.
The VFW supports a fully integrated system, one that allows VA to operate in a paperless environment as much as possible. We urge Congress to use its oversight authority to ensure VA successfully transforms from a paper-centric to paperless environment. The VA must enter the 21st Century, which is only achievable with the support and careful attention of this Committee.
This concludes my remarks. I would be happy to address any questions you or your Committee may have.
Thank you.
[The prepared statement of Mr. Wear appears in the Appendix.]
Mr. HALL. Thank you.
Mr. Wilson?
Mr. WILSON. Mr. Chairman, Members of the Subcommittee. I am pleased to have this opportunity to appear before you on behalf of the Disabled American Veterans to address the efforts of the Veterans Benefits Administration to properly balance quality and quantity in the work credit and work management programs.
Too often, VBA has attempted to manage its ever-increasing workload emphasizing production to the detriment of accuracy. DAV is as concerned as the Committee about the large and growing claims inventory, or backlog, the VBA is managing. The problem is not the backlog. Nor is it the root cause of the problem. Rather it is the symptom. It is akin to an individual having a fever. While one can take an Aspirin to reduce the fever, the underlying condition, the cause of fever must be treated. Otherwise, it will return. The patient's condition may worsen. So, too, it is with the claims backlog and the process. The underlying condition is a broken claims processing system that leaves too many veterans waiting too long for rating decisions that are too often wrong.
Until we address the lack of quality, accuracy, and consistency—the root cause of the backlog—then no matter how quickly claims are processed the problem will remain and the backlog will return.
We, therefore, believe that the best and only approach is to take one that emphasizes quality at every stage of production. To achieve this outcome, it is essential that we examine the system of incentives and accountability for employees, management, and leadership.
We have heard Secretary Shinseki says that he intends to break the back of the backlog this year. The only way any such success will be measured at present is through VBA's Monday Morning Workload Reports, which contain measures of production, not accuracy or quality.
Similarly, looking at VBA's dashboard, which provides current performance statistics for each VA regional office, the measure's report primarily relates to pending work inventory and production times, not quality.
With the directive from leadership to break the back of the backlog, it is not surprising that the RO management focuses heavily on production, rather than accuracy or quality. Given leadership's and management's focus on production, it is also not surprising that VSRs and RVSRs feel tremendous pressure to meet production goals.
While accuracy has been and remains one of the performance standards that must be met by employees, we are concerned that the work credit system creates incentives for them to favor production over accuracy. Performance standards are the most important factor in determining the incentives for employees. If performance standards directly or indirectly reward production over quality and accuracy, we must expect employees to work first towards production goals.
The new performance standards have streamlined the measures of production for VSRs from what had been 63 categories of rated work activities to five production categories, now called outputs. Essentially, VSR will receive one output credit for completing each stage of the work process. We have been told that the old work credit system created opportunities for gaming the system, such as delaying requests for routine future exams in order to get additional work credits later. However, we are now concerned that the new streamlined system of measuring only outputs may inadvertently create incentives for cutting corners, since more complex cases get no more credit than simple cases.
We know that VBA has increased the accuracy standard for VSRs, and we certainly agree that accuracy even by the national STAR measures remains too low. However, it is not clear how raising the standard in and of itself will result in increased accuracy.
We also remain concerned about how reliable the employee reviews will be for measuring quality. We have testified previously that coach reviews of five cases per month are not accomplished 100 percent of the time; and, in many cases, coaches do not have sufficient time to comprehensively review each case. Consequently, we do not have confidence that employees performing below or above standard will be consistently measured.
We are also concerned about these local quality reviews being different from station to station. We continue to note that VBA does not have a unified system for aggregating and analyzing results of both coaches' reviews and STAR reviews to provide trend analysis for quality control, improvements, and new training instrument development.
Under the new VSR standards, time limits are established by each RO based on end-of-year station targets. We recognize cycle times will vary from station to station but question whether it is a reasonable expectation to have employees at different stations being held to different standards for the same work.
We also have questions about whether cycle times, which include wait periods and work volume, are the most reasonable measure for holding VSRs accountable, since it is out of their control. For example, is the cycle time for average days awaiting evidence a fair measure, since the admission of evidence by the claimant is not under the control of the VSR?
VSRs will also now be held accountable for meeting the training standard. We question whether this should be a management accountability standard more than an employee standard, since training is critical to keeping staff informed of the ever-revolving nature of claims, whether it is new presumptive service conditions, changes in public law, or recent court cases.
Given some reports, we have heard from the field about management pressuring employees to cut back from time for training to production goals. How is management being held accountable for training being implemented at the regional office level?
That concludes my testimony. I would be happy to answer any questions you may have.
[The prepared statement of Mr. Wilson appears in the Appendix.]
Mr. HALL. Thank you very much.
And, Mr. de Planque, you are now recognized.
STATEMENT OF IAN C. DE PLANQUE
Mr. DE PLANQUE. Thank you, Mr. Chairman. I appreciate the opportunity to express the views of the American Legion on the importance of accuracy in the veterans benefits system.
Before discussing the problem of accuracy in depth, a little bit of perspective is necessary to illustrate why this is such an important component of the VA claims adjudication.
According to most optimistic numbers—and these are VA's public statistics and not those suspected by OIG audit, which are believed to be much lower—VA is operating at approximately 87 percent accuracy rate, or 13 percent error rate.
This year alone, VA expects to receive and process nearly 200,000 claims solely related to the three new presumptive Agent Orange conditions. Statistically, we can thus expect that 26,000 of those claims will be processed in error. Twenty-six thousand veterans will have their claims improperly handled. That figure represents nearly half of the names on the Vietnam Wall in Washington, DC.
Every claim is a life affected. Every claim is more than one life, because veterans have families and loved ones. Veterans have husbands. They have wives. They have children.
We are told VA will process as many as 1 million claims a year within the next year or 2. One must remember that at least 1 percent of inaccuracy represents 10,000 veterans' claims. VA has to do better, clearly.
The inaccuracy of the system contributes to the massive lack of trust in the VA by the veterans' community. When veterans cease to trust the system by which their country returns the promise to them, there must be great concern. VA has to stop asking the veterans of America to trust them, that they will be treated properly, and VA is now in a position to re-earn that trust.
Rather than repeating the number of things that we all have been saying here, not just in this session but for many, many years now, I want to touch on something that Mr. Christensen's report listed this morning. Because we, like you, have not had been an opportunity to see this report until this time.
One of the things that was stated is there were two surveys on the perceptions of quality and quantity and considerations of which is more important and that both surveys had found that the quantity of claims process was believed to be more important, and it said something which is very interesting. It states, this is an important finding, because, even if that perception is incorrect, at least some employees who have that perception will probably change the way they process claims in order to do what they think their supervisors want. Perception is reality. If VA employees think that numbers are what is important, that is what they will work to; and they have nothing to look to that is there to show them that accuracy is the same thing.
We mentioned the daily reports that VA makes, their Monday Morning Workload Reports. They list the number of claims and how long they have been pending. They don't list how accurate the regional offices are performing. You can find those statistics, but you really have to start digging for them.
Transparency gets mentioned a lot in Washington right now. If VA wants to start re-earning that trust from the veteran community, they need to be a lot more transparent. They need to put those numbers up and say this is what we are staking our reputation on. Our reputation is on the accuracy; and if we can't see that, if the veterans can't see that, if the employees working in those offices can't see that that is what VA is putting their priorities to, then they are not going to believe that that is the case. They are going to believe that it is still continuing to be driven by the numbers.
There are ways that they can help do that. Obviously, it takes more time to process a claim effectively; and VA doesn't want to lose ground with the number of claims that they have pending right now. Putting an experienced claims examiner at the beginning of the process to do triage is going to help the VA if they can have someone who can take these cases and say, this is ready to rate. This doesn't need as much development.
It was mentioned earlier a hearing loss case doesn't require near as much work as a TBI case. Put them to the people who can do the work best.
We have mentioned that hiring all of the VA employees is going to take a while to show dividends because of the training times that are involved. Less-experienced employees can handle simpler claims, such as hearing loss. The other ones can be directed to other employees who are more competent and more capable of doing them right.
So if you do better triage at the beginning, if you direct the cases better, you will be able to do them on time and have the time you need to do the ones that take more time.
Making time for training. Making training a priority is also going to show those employees that this is the priority. We are okay with you setting aside some time from those numbers to make sure you understand that it is right, and we are going to take the time to pay attention to what you are doing and get it right.
There are a number of other solutions, and I would be happy to answer any more questions on those, but we would like to state on behalf of the millions of veterans of the American Legion but also the millions and millions of veterans in America, VA needs to earn this trust back, and they need to do that by showing that accuracy is their most important priority.
Thank you.
[The prepared statement of Mr. de Planque appears in the Appendix.]
Mr. HALL. Thank you, Mr. de Planque.
Mr. Sims?
STATEMENT OF JIMMY F. SIMS, JR.
Mr. SIMS. Thank you, Chairman Hall. Appreciate the opportunity to testify today on behalf of AFGE and the VA Council.
In my position as a RVSR and a union steward who has represented numerous employees, I have seen firsthand the impact of VBA's work credit and management system. These systems have placed the VBA on the precipice at a great risk of falling behind on our mission to provide service to the veterans and their dependents. The performance standards under these work management systems established by the VBA do not provide adequate work credit for many of the critical steps involved in the claims process.
The new VSR standards that were issued last month provide no credit for supplemental development such as requesting additional evidence and have reduced the work credits from over 60 categories to only 5. Denying work credits for critical tasks will slow down the process and decrease quality.
The standards also force employees to make daily choices between quality and quantity by including timeliness as a critical element. Many delays, such as awaiting records from the U.S. Department of Defense (DoD) or from private physicians, are outside of the control of the employee and, as such, employees should not be held accountable for these delays.
The implementation of the new VSR standards included a prohibition on variation from the national standards, although current RVSR standards do not. Local VA ROs may arbitrarily increase the production standard, which results in disparity based on geographic location. An RVSR in Seattle may be required to produce 31 percent more daily work than an RVSR in Winston Salem. Variations in local standards are taking their toll on morale and accelerating attrition of senior RVSRs with valuable experience. I fear that the new RVSR standards being developed will continue the systemic problem.
Trainees are also being subjected to these unrealistic standards and working conditions during their initial period of on-the-job training. The minute they hit the floor, they have only 90 days to hit the standard. During this training phase, the receive no time allowance or credit for making corrections to their work. These VBA production standards result in a waste of taxpayer dollars through termination of large number of probationary employees who fail to meet these arbitrary standards during training.
Under the current work credit management system, employees find themselves in a catch 22. If they focus on quality of work, the quantity may fall behind. If they focus on quantity of work, their quality may fall below. Either situation results in the risk of demotion or termination.
Because of the inverse relationship of quality and quantity, many employees find themselves being forced to work off-the-clock to meet their production and quality standard. By doing this, they risk disciplinary action for violating VA directives and Federal wage and hour laws.
One critical element for an effective work credit management system is a scientific time-motion study that accurately measures the process. VBA has conducted no more than a minimal attempt at this. Without an effective analysis of the process, there can be no improvement.
President Obama's executive order on labor management is intended to include the employees and their representatives in development of policies before they are implemented. Unfortunately, VBA is woefully behind in establishing effective partnership. Frontline employees and other stakeholder have ideas to improve the claims process. We are the subject matter experts and wish management would acknowledge and include us in the establishment of the policies.
In closing, AFGE urges you to mandate completion of the scientific study of the claims process for VBA to include stakeholders in the policy development and to end the local variations in the RVSR production standards.
Thank you for this time you have allowed me to provide this insight.
[The prepared statement of Mr. Sims appears in the Appendix.]
Mr. HALL. Thank you, Mr. Sims.
I will start with you, sir, Mr. Sims, and ask you if you could elaborate on your suggestions for VBA so that Rating Veterans Service Representatives, RVSRs, can more accurately rate claims at a pace that allows the VA to meet its goals of timely delivering of benefits to veterans and their families.
Mr. SIMS. One of the primary concerns for the RVSRs in the field is the training that is being provided. Currently, training is done through a computerized system which is on an independent basis, which gives no feedback from a subject matter expert on the issues for which they are training. This lack of proper training is resulting in a delay in the RVSR being able to process the claim due to lack of knowledge.
It also is impacting the overall process of meeting the requirements for the VA. Because as the RVSRs are being slowed down in their process of rating the claims due to lack of proper knowledge, it reduces or it increases a backlog of the claims that we are trying to produce.
Mr. HALL. Can you suggest any specific reforms to the work credit system that would reward claims processors for spending sufficient time developing and adjudicating claims? Is there some way to get around this inverse relationship you talked about between quality and quantity?
Mr. SIMS. The only way that is actually going to be effective is for the time that is required for each element of the claims process to be considered in the work crediting system. Currently, that is not the case.
An RVSR may get a case which contains three issues that may be incredibly complex and requires hours of review of the evidence in rendering the decision. But that time frame that is required to conduct the proper rating is not considered under the production standards. We are required to maintain a certain level of productivity without consideration of the amount of time that is involved in each individual rating. So in order to adjust the production standards properly, there would have to be an adequate time management study done, which indicates the necessary time frame for each individual step in the process.
Mr. HALL. Do you have a comment on I believe it was Mr. Abrams' suggestion that the clock be stopped at the VA for a particular claim if the claim is being developed and documents or medical evidence is being produced by the veteran or representative of the veteran and that is not within the VA's control?
Mr. SIMS. Unfortunately, currently, the receipt of evidence from a third party is strictly based on that third party's willingness to provide the evidence in a timely fashion. Regulations stipulate that certain providers such as the Department of Defense, Social Security, those agencies were required to continue to request that evidence until it is received. Therefore, the time delay that is associated with that process is outside the control of the individual RVSR or VSR. So, currently, the new standards are holding the employee accountable for that process of which they have no control.
If the VA was to consider a time delay in the processing of a claim to allow for that third party to develop the evidence that they wish to submit, then at that point it becomes an issue of timeliness over the overall process, which Congress has indicated that needs to be adjusted.
So the current concept of delaying or stopping the clock to allow for additional evidence to come in may be beneficial on one aspect for the claimant, but then again it will end up in greater delays for the claimant and result in a greater delay in the claims processing overall.
Mr. HALL. Right. And it may be that the VA person who was trying to get the information from Social Security or from DoD or whatever will feel less pressure to harass the other branch of government into coming up with—I understand you are saying we don't want to make the time longer, but at the same time we want—I think we are looking for ways to emphasize, as we have been saying, quality without having the RVSRs or any VA personnel feel that their evaluation of their work will be more negative if they take the time to get it right, and that may be out of their control due to these certain factors.
Mr. Cohen, this question could be for you but also for everybody else on the panel. Could you briefly state if you feel the reforms of the claims process that focus primarily on timeliness and speed of claims will be effective? Do you think that veterans should be and are willing to accept a slightly longer adjudication process if it results in a more accurate claims decision the first time?
Mr. COHEN. I think that veterans and their representatives would accept a longer time period if it was correct the first time around.
One of the things, though, that we need to consider is the biggest delay in processing a claim is in development, is in getting the exams. If the VA were to make it clear to the treating physicians who work for the VA that they are permitted to provide opinions, if they have them, about whether conditions are service-connected or the degree of disability, that might eliminate the need for Compensation and Pension (C&P) exams.
In addition, if 5125 were amended to be mandatory to accept an adequate exam, one that is adequate for rating purposes, then, again, additional medical development could be eliminated.
The biggest part of the time delay is in obtaining these C&P exams. If we can do anything to shortcut that time, the total process will be much shorter.
Mr. HALL. Mr. Abrams.
Mr. ABRAMS. I think any veteran would rather obtain benefits in 8 months than be promptly denied in 3 months. That doesn't seem to be worthy of any more discussion. The idea is to try to get the veteran the benefit as quickly as possible correctly.
Mr. HALL. General agreement on that, or would anybody else like to comment?
Mr. WILSON. I would like to say that we—I would like to see a case take the current 160 days to get done correctly rather than 90 days to get done quickly but incorrectly. The excessive amount of churn you will have in the appellate process is not acceptable to us; and, given the current situation, moving towards speedier decisions without proper development is going to lead to just that.
Mr. DE PLANQUE. I would just like to add, in terms of perspective for this, when you have a rush to judgment, if they are just going to blitz through quickly and get them done in a short period of time, it has to be appealed. And when we talk about the backlog and when we talk about veterans waiting years and years to get their claims, that is not an initial claim. If a veteran is waiting years and years and years to get their claim, that is a claim that is on appeal; and it had to be appealed because there were problems made at the lower level.
The problem is that mistakes at the RO don't take a minute to correct. They take years to correct. Because it has to go out to the Board of Veterans' Appeals, sometimes the courts, because things weren't done right the first time; and that is why waiting a little bit longer, waiting a couple months more to get it done right the first time, I don't think any veteran would argue with that.
Mr. SIMS. If I can add the insight from the employees' perspect
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