An Open Letter to Doug Collins and Paul Lawrence, Secretary and Deputy Secretary of the Veterans Administration (VA)

As we sit on the eve of history being made with our 47th President of the United States, I see this also as an incredible opportunity to make significant changes across our government. What I deal with daily are veterans in crisis or just plain frustrated by their experiences with the Veterans Administration (VA).

I was pretty restless this morning, so I was up early…at least early for me these days. I got up, made some coffee, feed the dogs and got caught up the news and went through the Early Bird as the dogs settled in next to me and went right back to sleep. It’s my morning routine! That said, I decided I needed to get my voice out there as Doug Collins and Paul Lawrence get ready to take the helm of the VA as Secretary and Deputy Secretary. Personally, don’t know either of them, but have followed their work and think they just might get something done.

So, Doug and Paul…this letter is for you. My caveat…I am not an expert in any of this. This letter is based on my experience in in North Georgia {I am curious if these issues are also prevalent in other areas}.

I’d like to highlight just three (3) areas that I strongly suggest being addressed at your level and immediate action taken to fix. I know there are other issues out there, these are the three areas I consistently spend my time dealing with. In no particular order…

1.?????? COMPACT Act. The COMPACT Act is a law that allows Veterans in suicidal crisis to receive “free” emergency mental health care at any VA or community health care facility. The ground truth, it is broken and not working.

The VA has done a very poor job of disseminating information like this to local hospitals. Hospitals simply don’t know what to do with the veteran. To my knowledge, there is no “playbook” of sorts that any medical facility could refer to when a veteran shows up in the ER… in distress. The issue goes beyond that…consider all ambulance services, first responders, and local and state police. What do they do? Who do they contact?? There are so many different ambulance services; I’d bet a paycheck they are not all on the same sheet of music when it comes to how you deal with a distressed veteran. Can you imagine if a veteran were to walk into an ER and be suicidal and try to explain their situation to them? No doctor is going to take them seriously or listen to them.

?Here in North Georgia, knowledge of the COMPACT Act is absent. What that translates to are medical facilities that have no clue what to do from the time someone claims they are a veteran (how do they verify that?), knowing how billing works so the veteran eventually doesn’t get a bill for thousands of dollars (a major issue) or how and where to access resources…especially mental healthcare which is absent in North Georgia. From a medical standpoint, the only way for this Act to become effective and actually working is involvement from decision makers from the VA, VISN 7, representatives from the Georgia Department of Behavioral Health and Developmental Disabilities (DBHDD), whoever oversees ambulance services in Georgia, Georgia Hospital Association, and maybe even the Georgia AG who is the Chief law enforcement officer for the state…to name a few. Through the George Hospital Association, you would disseminate the information to hospital CEOs. Then, it would come down to the ER as a directive instead of an inconvenient option. This is the only true way to get the information to the hospital and force the ER physicians to comply with it. Simultaneously, this would loop in the billing department and hopefully fix those issues as well.

?2.????? Community Care. When the VA provides care to veterans through community providers when the VA cannot provide the care needed. There are criteria that the veteran must meet before this option for care kicks in.

?Why spend hundreds of millions of dollars building and maintaining brick and mortar hospitals or even clinics when this program could be expanded to be the primary means of caring for our veterans?

?I would suggest that all VA hospitals, clinics, annexes, etc., be eliminated. In place of all those facilities, from a federal level, any hospital that receives federal dollars should be required to see/care for veterans and all the criteria a veteran used to have to meet is also eliminated. What that translates to is veterans can then go to their local hospital, clinic, doc-in-a-box, annex, etc., and be seen and the billing is never seen by the veteran. All financial transactions are sent to the VA for processing. Secondly, from a personnel standpoint, it would require major downsizing in the VHA side of the house. As has been talked about with DOGE, there would be severance and an entire timeline, so people just simply don’t lose their jobs.

3.????? Disability Filing. I must say that this area is ripe for fixing when you consider every single veteran that has filed for disability compensation has gotten the run around in one way or another, been pursued by “Sharks”, given empty promises, and just been confused by the entire process.

?Due to the complexities of this process, I would suggest there is a need for a 3d party consultant to come in and completely overhaul the process from soup to nuts. A lot of it is automating the process and a key component (from my foxhole) is proving some sort of feedback loop/mechanism to the veteran, so they are kept informed about their claim. In today’s environment, it’s a fire and forget scenario. You file and you wait…and you wait…and you wait some more. Not a way to run and process that touches thousands of veterans. And we wonder why veteran have a sour taste in their mouth for the VA…it all starts with the filing process and being jerked around.

?Coupled with this are the 3d party medical staff that a veteran must see for their C&P exam. Take some of those doctors impacted by #2 above, work with the Small Business Administration (SBA) and help them stand up their own business and they can be the ones administering the C&P exams.

?4.????? A BONUS. Sen. Elizabeth Dole 21st Century Veterans Health Care and Benefits Improvement Act.

?PLEASE BE PROACTIVE IN IMPLEMENTATION/EXECUTION!

?This omnibus Bill representing more than 90 pieces of legislation has a lot of moving parts and my hope is the VA is being proactive in figuring out how to implement the Act. As we have experiences with the COMPACT Act, based on just how broken it is in implementation (the Act was passed in 2022!), there must be some sort of standardized playbook…directives…guidance from Big VA in Washington, DC. ?Process, process, process!!!

?Some areas covered in the new law…

Home Care and Caregiver Support

?? Full Coverage for Home Nursing Care: Increases the VA’s share of home nursing care costs from 65% to 100%, expanding access to these essential services.

?? Mental Health Grants for Caregivers: Provides grants and contracts to mental health service providers for family caregivers.

?? Streamlined Application Processes: Reduces bureaucratic hurdles for caregivers seeking benefits.

?? Expanded Support Programs: Offers training, financial aid, and mental health resources for caregivers not eligible for VA’s Program of Comprehensive Assistance for Family Caregivers (PCAFC).

?? Home Health Aides Pilot Program: Launches a pilot program to hire nursing assistants for in-home care in underserved regions.

Fighting Veteran Homelessness

?? Higher Per Diem for Transitional Housing: Boosts rates from 115% of costs to 133%, with higher rates for regions with elevated costs.

?? Basic Necessities for Unhoused Veterans: Allows the VA to supply bedding, hygiene products, food, and transportation to medical appointments.

?? Prevention Efforts: Strengthens initiatives to identify veterans at risk of homelessness and includes funding for job training, mental health services, and substance abuse treatment. {This is a very big deal and will require clear guidance and a defined process}

?Access to VA Health Care

?? Home- and Community-Based Care: Allocates funds for in-home care services and related items.

?? Same-Day Scheduling: Mandates a plan for same-day appointment scheduling.

?? Dental Benefits: Establishes a pilot dental program for veterans with heart disease and improvements to existing programs and services.

?? Telehealth Services: Enhances telehealth options for rural and underserved veterans.

?? Rural Ambulance Coverage: Provides reimbursements for ambulance transportation in remote areas.

?? Mobile Mammography: Expands funding for mobile mammography services.

?? Mental Health Services: Strengthens reporting requirements on VA mental health services and suicide prevention efforts, while increasing non-VA mental health support options for veterans in the community.?

Education, Employment, and Economic Benefits

?? Education Benefits: Enhances the Fry Scholarship and the GI Bill housing stipend.

?? Oversight of Institutions: Tightens oversight of educational providers serving veterans.

?? Technology Training: Expands access to high-tech training and education programs for veterans transitioning to civilian careers.

?? Home Loan Adjustments: Introduces changes benefitting Native American veterans.

?? Updated Burial Allowances: Broaden eligibility for burial allowances and revises definitions for surviving spouses.

If nothing else, make the processes 80% standardized and give the VISNs 20% wiggle room to make adjustments.

?In closing, Mr. Secretary and Under Secretary…these areas can be addressed and fixed. Let me put it another way, these areas MUST be addressed and can be fixed. It may cost a bit up front, but the prices we are paying now are veterans LIVES! Please make it priority. You have literally millions of veterans backing you up and hoping this new administration is all about Deeds, Not just Words!!

Your humble servant,

John W. Phillips