Improved Accuracy Rates On VA Disability Claims? Or Not?

A few posts back I may have referred to Department of Veterans Affairs (VA) senior officials as “lumbering simpletons,” and for that I must apologize, because they have managed something truly spectacular.  Here are the accuracy averages for veteran disability claim approval rates in 2012, just to give you a picture of how well things were progressing prior to the transition to the new system.  Each “claim” represents a number of “issues,” such as, post-traumatic stress disorder (PTSD) or traumatic brain injury (TBI), for which a veteran requests disability compensation.  Raters have the unenviable job of sorting through hundreds of pages of often confusing medical documentation to decide the severity of each issue, and what disability percentage each claimant is due.  Their accuracy rate has been hovering around the low 80s and some sources suggest that it is actually much lower.  You’ll notice that in September 2012 the target rates jumped up sharply; that is because the VA assumes that through the magic of technology and rater efficiency, they will experience automatic 3 percent annual increases in claim accuracy.  I suppose the blue line never got that message.

Claims Nevertheless, VA Secretary Eric Shinseki has vowed to break the backlog and simultaneously increase veteran benefit claims accuracy rates, from their current position somewhere between 70-85 percent, to 98 percent by 2015.  So they have pioneered a brand new system; they are changing the way they in disability claims.  Sounds great right?  Well it’s all an illusion.  Here’s a scenario for you:

Suppose 20 veterans submit claims with an average of 5 issues per claim.  After raters process these 20 claims, they later find that three of the claims viagra pill have 4 errors total.  The table below describes the current system of measuring accuracy vs. the new system, which I’ve only been made aware of by combing through hours of tedious Congressional testimony.

Claims table

Neither of these systems allows for claims which were technically accurate but are successfully appealed by the veteran.  For example, if a rater or physician made an error in assessing the severity of the disability, and the rating is corrected through the appeals process, this would not be counted in the accuracy rates.  Moreover, accuracy figures for complicated claims, like temporary 100 percent ratings, are measured separately — which fundamentally distorts overall claim accuracy.

A possible solution would be to track both of these measures, and to include all rating endeavors in the accuracy figures.  The VA is already exempt from budget cuts, so what’s the point of all of the dissembling?

 

 

Comments (15)

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  1. Lauren Sabino says:

    Interesting post, I like how you are passionate about keeping the VA accountable. Certainly, the graph you used for the post reinforces this.

  2. Patel says:

    Since the VA is safe from budget cuts, why is it such a hot mess? Certainly the lack of resources cannot be the reason for such errors in processing claims.

  3. Neil says:

    The NCPA has been doing some great work on the VA. Keep it up!

    Maybe the VA should have to explain the efficiencies of their programs and the uses of the money they receive.

  4. Anthony Sombers says:

    VA inefficiencies has been a problem for many decades, but it just seems to keep getting worse. Thanks for the post, Kyle.

  5. Gabriel Odom says:

    The VA is a “hot mess” as you stated BECAUSE of the immunity to budget cuts, not in spite of them. Any time that a manager knows that they will receive the same funding regardless of quality, that manager will have no incentive whatsoever to maintain quality.

  6. Kyle Buckley says:

    Yep. My personal recommendation was that the Inspector General or GAO place personnel in supervisory positions with the power to hire, fire or relocate personnel. Much like in the private sector how EHR personnel are inserted into hospitals. OR give the OIG discretionary access to VA budget allocations.

    Or better yet, do away with the whole system. Retain rating, administrators, and diagnosticians and convert all of that physical overhead into retention surplus for claim fluctuations due to things like, oh I dunno, war. Then just give all vets disability HSA or FSA cards to seek healthcare in the private sector.

  7. Neil says:

    “Moreover, accuracy figures for complicated claims, like temporary 100 percent ratings, are measured separately — which fundamentally distorts overall claim accuracy.”

    – Of course the government would distort claim accuracy. Perception is everything!

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