VA looks to overhaul pay, ‘antiquated’ hiring processes in major veteran care bill

The Department of Veterans Affairs is preparing to transform its workforce and health care facilities in anticipation of legislation that would deliver a historic expansion of health care to veterans.

The Senate on Thursday passed the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics (Honoring Our PACT) Act. The bill now heads back to the House for final approval before heading to President Joe Biden’s desk.

The legislation, at its core, would expand disability compensation and health care benefits for veterans exposed to toxic substances during their military service.

VA Secretary Denis McDonough told the Senate VA Committee on Tuesday that the PACT Act, combined with the agency’s fiscal 2023 budget request, will give the VA the resources it needs to prepare its health care workforce to treat up to 3.5 million additional veterans.

“This is a very important piece of legislation. I think it’d be very difficult to implement, but oftentimes, the most important things are difficult, and I think we’re ready for it,” McDonough said.

The VA said in a statement last month that the PACT Act would be one of the largest substantive health and benefit expansions in VA’s history, comparable in scale and impact to the 1991 Agent Orange Act.

The VA’s budget request for fiscal 2023 includes $42.2 billion for medical service staffing, and provides for 22,789 full-time equivalent hires, an increase of 14,000 FTEs compared to last year.

McDonough said the PACT Act would give the VA much-needed authority to set higher pay caps for certain health care positions, and that the VA’s ability to get veterans into care more quickly is “obviously impacted by the tightness of the labor market.”

“The first thing we need to do is retain the docs that we have, and you’re giving us new authorities to do that. Pay is a big one, and you’re giving us enhanced recruiting authorities as well. We’re thinking very diligently about this and planning very diligently about making sure that we have the people in the spots, and that we have the buildings for the increased demand that we anticipate seeing,” he said.

White House Press Secretary Karine Jean-Pierre said in a statement last week that the PACT Act marks “one of the most significant and substantive expansions of benefits and services in the Department of Veterans Affairs history,” and that the Senate is taking steps to ensure the VA has the support it needs to effectively implement the legislation.

The Congressional Budget Office estimates the bill would increase spending subject to congressional appropriations by $147 billion through 2031. CBO estimates that 5.4 million veterans, nearly a third of the 19 million veterans in the U.S., will receive some disability compensation this fiscal year.

The PACT Act contains a slew of provisions meant to bolster the VA’s workforce, health care facilities and claims processing capabilities, and is the latest in a series of bills meant to recruit and retain in-demand health care workers and address the agency’s record-high rate of turnover.

Committee Chairman Jon Tester (D-Mont.) and Ranking Member Jerry Moran (R-Kan.) introduced the bill.

Congress in March also passed the RAISE Act, which raises the pay caps for certain VA nurses and physician assistants. McDonough said about 10,000 nurses will see their salary increase next month under that legislation — that’s about one out of every nine VA nurses.

McDonough said the Office of Personnel Management recently gave the VA another year to continue with its direct-hire authority for health care workers.

But even with that expedited hiring authority, Veterans Health Administration officials recently told the committee it’s taking 95 days on average to hire new employees.

“The direct-hire authority, of the many variables in the equation of bringing people on, it’s perhaps the most impactful. It accounts for probably a third of the savings we were able to get, in terms of time to hire. But the hiring and onboarding process is still so sclerotic, that we’re finding things that can change,” McDonough said.

Among the changes the VA is looking at, McDonough said nurses have to write an essay as part of their onboarding process.

“I think that’s antiquated, and we should get rid of that,” he said.

The PACT Act outlines many provisions meant to make the VA a more attractive employer for health care workers in a competitive labor market.

The bill would also give the VA up to $40 million a year to buy out the contracts of certain private-sector health care professionals in exchange for employment at rural VA facilities.

The bill also expands recruitment and retention bonuses for VA employees, including merit awards and pay incentives for employees that have a “high-demand skill or skill that is at a shortage.” The critical-skills pay incentive cannot exceed 25% of an employee’s base pay.

The bill also includes expedited hiring authority for college graduates into competitive service jobs.

The PACT Act also gives the VA 180 days to work with OPM to establish qualifications for each human resources position within the VA, and to establish standardized performance metrics for its human resources positions.

The bill gives the VA a year to submit to the House and Senate committees a plan on how it will recruit and retain HR employees.

The agency would also have 90 days to provide enhanced monitoring of the hiring and other human resources that happen at the local regional and national levels of the department. The agency must also provide at least annual training to human resources professionals in VHA.

VHA officials told the committee last month that non-standardized HR processes at the local level have led to hiring and onboarding inefficiencies across the agency. The legislation, if signed, gives the VA 18 months to develop a national rural recruitment and hiring strategy for VHA.

As part of this strategy, the VA must determine which clinics or centers have a staffing shortage of health care professionals, and develop best practices and techniques for recruiting health care professionals for such clinics and centers. The PACT Act requires the VA to provide the House and Senate VA committees with updates on its progress in implementing the rural recruitment and hiring strategy within 18 months of the bill going into effect and then annually.

The bill would waive pay caps for VHA impacted by the closure or realignment of their official duty stations, which may happen if the agency’s recommendations to the Asset and Infrastructure Review (AIR) Commission come into focus.

The PACT Act also waives pay caps for VHA employees providing care to veterans exposed to open burn pits.

While Senate Majority Leader Chuck Schumer and House Oversight and Reform Committee Chairwoman have opposed the planned closure of VA medical centers in New York, Sen. Richard Blumenthal (D-Conn.) said the VA can’t continue to deliver modern health care in outdated facilities.

“This strategy is untenable. In fact, it’s not a strategy,” Blumenthal said. “There is no way that the Veterans Administration can continue quality care with facilities of that age at a time when technology requires that the entire structure of a facility be designed and built to accommodate the most modern means of delivering care, of monitoring patient health.”

McDonough said that if the AIR Commission process doesn’t move forward, the MISSION Act still requires the VA to conduct four-year reviews of its real-estate needs in each of its regional health care markets.

“We’re watching to see what you all choose to do with the nominees for the AIR Commission. In all cases under the MISSION Act. We’re required to go back and look each four years at what the needs are in each of those markets across the country,” he said.

Meanwhile, the PACT Act authorizes 31 leases for new VA health care facilities across the country.

Bill mandates VA updates on claims automation

The PACT Act also gives the VA 180 days to submit a plan to Congress on the state of IT modernization at the Veterans Benefits Administration.

The report should identify any legacy systems the VA plans to retire or modernize, as well as update Congress on the progress the VA is making in automating claims processing decisions.

The bill states that automation “should be conducted in a manner that enhances the productivity of employees,” but keeps VA employees in charge of making the final decision of granting benefits to claimants.

The bill makes clear that the automation should “not be carried out in a manner that reduces or infringes upon the due process rights of applicants.”

McDonough told the committee that the current claims backlog is 188,000, which is down from 265,000 claims only a few months ago.

The VA announced in January that the automation pilot, through its newly created Office of Automated Benefit Delivery, is processing claims within a day or two, while the traditional method of processing these claims currently takes well over 100 days, on average.

The VA began the pilot by automating claims of service-related hypertension, and is adding three new diagnostic codes each quarter.

McDonough said that by the end of the year, the 12 most common claims will be automatable.

While the Biden administration and some lawmakers have pressed for federal employees to return to the office, McDonough said the VBA productivity increased during the pandemic.

“As we think about questions about do people come back in the office, or do they work virtually, we’re taking that into consideration,” he said.

VA is also in the process of hiring 2,000 additional claims personnel.