Bob McDonald’s legacy: Trying to fix the VA amid constant conflict
By NIKKI WENTLING | STARS AND STRIPES Published: January 18, 2017
WASHINGTON – One late night in August, Gulf War veteran Ron Brown was awake – restless - at his home in Roanoke, Va., when he received a call from a familiar number: (513) 509-8454.
It’s Bob McDonald’s cellphone number, which he famously made public during his first national news conference as secretary of the Department of Veterans Affairs in September 2014. At the time – while taking over a scandal-ridden federal agency facing unprecedented public scrutiny -- McDonald promised to remain accessible to veterans, news reporters and politicians.
To Brown, at least, he’s kept that promise.
“The man called me at 1 a.m.,” said Brown, who is president of the National Gulf War Resource Center. “There has never been a time that I’ve contacted Secretary Bob that he has never responded to me. He has never not returned an email, or even a text message.”
During his two and a half years as the face of the VA, an agency trying to climb its way out of disgrace, McDonald was often criticized. But in his final weeks, he saw an outpouring of support, gaining endorsements from more than 25 veterans organizations to retain his position as VA secretary and continue his transformation initiative, “MyVA.” Many leaders of veterans groups, like Brown’s, praised his receptiveness and hard work.
Many of those leaders, experts and employees have said – and McDonald was ready to admit - the VA has seen some progress in recent years, but not enough.
“I think top line, Bob McDonald stopped the bleeding,” said Paul Rieckhoff, founder of Iraq and Afghanistan Veterans of America. “I think we always knew VA turnaround was going to be long, hard and complicated. It needed to start with stopping the bleeding, creating a baseline of integrity and rebuilding trust. I think Bob McDonald did that.”
Taking over amid scandal
McDonald, a Republican, West Point graduate and former CEO of Procter & Gamble, was brought in to lead the VA at its worst moment.
A collision of factors -- unattainable objectives, a corrosive culture and lack of transparency -- led to some VA staff manipulating data that tracked how long veterans were waiting for care in 2014. In some cases, veterans died while waiting for appointments in Phoenix, according to several investigations into the scandal that year. In the fallout, former VA Secretary Eric Shinseki resigned.
When announcing McDonald’s nomination, President Barack Obama said it would “not be an easy assignment.” Rieckhoff likened the job to “trying to right a ship that’s on fire and is taking on water.”
Wrongdoing at some VA facilities continued to come to the forefront, including doctors at the VA hospital in Tomah, Wis., overprescribing opioids. The VA inspector general faulted the facility for the accidental overdose of a Marine Corps veteran.
McDonald faced bureaucratic issues in firing poor-performing employees, and he came under fire for giving out bonuses to executives.
Some Republican lawmakers and the conservative-leaning advocacy group Concerned Veterans for America were outspoken in their disapproval.
While some other groups were encouraging President-elect Donald Trump to keep McDonald in his post, CVA said his time leading the agency was “mired in lies and incompetence.”
One senator, Roy Blunt, R-Mo., called for McDonald’s resignation in May after McDonald compared veterans' wait for health care to the wait for rides at Disneyland.
During the presidential campaign, Trump called McDonald a “political hack” and vowed to appoint a replacement “whose sole purpose will be to serve veterans.”
Any improvement McDonald started at the agency, Rieckhoff said, won’t be immediately acknowledged by many people in the veterans community.
“Most folks didn’t get to know him up close. They’ll remember the issues like Tomah,” Rieckhoff said. “He did a lot of stuff behind the scenes and with the veterans groups that wasn’t flashy and won’t be appreciated until years from now.”
‘Not there yet’
In the years McDonald led the VA, more patient appointments were completed at VA facilities – 58 million in fiscal 2016, up from about 55 million in fiscal 2014 – and more veterans are getting care outside of the VA with the government paying the bill. In fiscal 2015, about 23 percent of appointments made through the VA were completed with outside providers. In fiscal 2016, it’s estimated that portion jumped to 32 percent, McDonald has said.
In November, the Harvard Business Review issued a case study into the VA. An article about the study stated the agency “made considerable progress after two and a half years.” The article cited a RAND study that determined the VA often outperforms or performs similarly to other health care systems.
Another study published in December and conducted by the University of Pittsburgh found McDonald’s MyVA initiative has improved veterans’ access to urgent care.
Republican Rep. Phil Roe, from Tennessee, recently complimented McDonald’s efforts. Roe is the incoming chairman of the House Committee on Veterans’ Affairs, which often had an adverse relationship with McDonald.
“He’s put his shoulder into this,” Roe told Stars and Stripes last week. “He believes in quality of care for veterans, and I think he’s done an excellent job.”
But there have been growing pains, including complaints from veterans that the system of receiving non-VA care is confusing and from non-VA health care providers that they aren’t receiving timely payments for treating veterans.
In an exit memo in which he listed accomplishments at the department, McDonald also noted what he wasn’t able to simplify the process for veterans to appeal disability claims or restructure how veterans receive outside care.
“I think the VA is still a work in progress,” said Amy Schafer, a research associate with the Center of New American Security, a think tank in Washington. “There are challenges on almost every front: disability compensation, homelessness, streamlining the electronic health record. McDonald has made a lot of strides on a lot of these issues, but none of them are solved.”
Most veterans groups contend they could add to the list of what still needs to be done.
“There are some good things McDonald has done; he’s started to make a dent,” said Rick Weidman, a leader within Vietnam Veterans of America. “But we’re not there yet.”
Many of the VA’s problems could’ve come closer to resolution if Congress had passed provisions last year crafted with the help of the VA and veterans organizations, McDonald has said. In his last public messages, he called on lawmakers to come together for VA reform.
In many cases, McDonald was working as an “Army of one,” Rieckhoff said, without support from Obama or cooperation from Congress.
For years, Brown pushed for more VA benefits for Gulf War veterans affected by toxic exposures.
When Shinseki was VA secretary, Brown attempted for 16 weeks to get a meeting with him about the issue, he said.
With McDonald at the helm, the response was immediate, Brown said. McDonald invited Brown into the VA and had sat down for interviews with him. They worked hand-in-hand in creating a work group on Gulf War veterans and brain cancer.
Brown said he hasn’t seen the results he wanted to, and he has been – and continues to be – critical of some aspects of the VA. But he could never speak negatively about “Secretary Bob,” he said.
“Have we gotten everything we’ve wanted?” Brown said. “No. I’m not going to tell you we have. But it’s not because he personally wasn’t trying to do it.”
Brown saw McDonald’s responsiveness trickle down through the ranks within VA.
“Some of these people inside there never, ever returned an email or a phone call,” Brown said. “The work ethic he brought into the VA opened all that up, and it changed. The emails started getting returned, phone calls started getting returned.”
Scott Blackburn was working as a partner at management consulting firm McKinsey & Co. in 2014, specializing in transforming the culture of large, bureaucratic Fortune 500 companies.
When Shinseki resigned and McDonald took over the VA, Blackburn, an Afghanistan War veteran, was inspired to join his team.
Blackburn moved his wife and three young children from Cleveland, to Washington, leaving behind a lucrative private-sector job. Since November 2014, he has led McDonald’s transformation efforts at the department.
“It was because of Bob,” Blackburn said. “He told me, ‘I don’t know how government works, I don’t understand the bureaucracy, but you have my word that you will be able to drive impact here.’ He kept his word.”
Within the VA, McDonald put the focus back on the veterans, Blackburn said. He also stepped away from stringent bureaucratic rules and asked employees to focus on the VA’s principles when making decisions.
“There are massive legacies Bob will leave. It’s not going to be that he fixed the VA, we still have an awful lot of work to do,” Blackburn said. “He reminded the VA from his first day stepping on here that this is not about the VA, this is about the veteran. I think in 2014, they had forgotten that.”
Though he wasn’t chosen to continue as VA secretary, the legacy that many people in the veterans community see for McDonald – of advancing the department toward an ideal – was validated with Trump’s nomination of David Shulkin as McDonald’s successor, Schafer said.
Shulkin, nominated Jan. 11, worked with McDonald for nearly two years as the VA undersecretary for health. He was one of dozens of candidates Trump considered, including Pete Hegseth, a Fox News contributor who some veterans groups feared might dismantle the agency.
“I think the selection of Shulkin, someone who is a leader at the VA, is a hugely positive referendum on McDonald’s accomplishments,” Schafer said. “The new administration is well aware of the MyVA initiative making progress. Continuity within the department is a good thing, it speaks to McDonald’s legacy.”
After Shulkin’s nomination, McDonald sent a goodbye message to employees. In it, he said he was encouraged by Trump’s choice.
Rieckhoff, though, is less certain that Shulkin will continue down the same path as McDonald.
“Shulkin may end up being a bridge,” he said. “We assume he’s the next best option [to McDonald], but we won’t know until we hear more about his personal opinions and how he’s going to line up or not with Trump. We all have to be appropriately skeptical of these political times.”
By the numbers: The VA under Bob McDonald
• As of Jan. 15, the wait time for primary care appointments was about 5.7 days, down from 6.4 days in October 2014, when the VA began tracking and publishing wait times. For mental health care appointments, veterans are waiting about 4.5 days, slightly up from 4.1 days in 2014. Veterans wait 10 days for specialty care, up from 7.2 days in 2014.
• Nine million veterans were enrolled in VA health care at the end of fiscal 2016, out of a veteran population of 23.4 million. That’s up from 2009, when 7.8 million out of 23.4 million veterans in the United States were enrolled.
• The VA completed 58 million appointments within VA facilities in fiscal 2016, up from about 55 million in fiscal 2014. The VA estimates 32 percent of appointments made by veterans were sent to outside providers in fiscal 2016, while 23 percent of appointments were sent to outside providers in fiscal 2015.
• 4.3 million veterans receive some sort of disability compensation, up from 3 million in 2009. Approximately 40,000 veterans were homeless in January 2016, according to a point-in-time count. A January 2009 point-in-time count found about 75,600 veterans were homeless.
• 71,690 disability compensation and pension claims were backlogged at the end of fiscal 2016, meaning they had been waiting more than 125 days for a decision. That’s down from a peak of 611,073 claims backlogged in March 2013.
• The VA’s budget for fiscal 2017 totals $176.9 billion, an increase of about $2.5 billion from the previous year and from about $94 billion in 2009.
Source: Department of Veterans Affairs