Washington, D.C. – Today, U.S. Senators Bob Casey (D-PA) and John Fetterman (D-PA) and U.S. Representatives Chris Deluzio (D-PA-17) and Summer Lee (D-PA-12) sent a letter to press Veterans Affairs Pittsburgh Healthcare System (VAPHS) Director Donald Koenig for answers on the challenges facing VAPHS, including chronic staffing shortages, the lowest possible rating from the Centers for Medicare & Medicaid Services (CMS), and a patient suicide onsite last year. The Members of Congress asked Director Koenig to identify the causes impacting the health system’s ability to continue to provide high-quality care to more than 84,000 veterans in the region annually and to develop and report action plans to address these issues.
“We appreciate your efforts to improve VAPHS and address some of its pressing needs, including chronic staffing shortages, opening a new outpatient clinic in Monroeville, and the critical structural issues at the 70-year old University Drive hospital,” the Members wrote. “Despite these efforts, challenges remain—some unique to VAPHS and others related to the VA health care system as a whole—degrading the system’s ability to provide the vital care both needed and expected by the region’s veterans. Addressing the barriers to this vital care, including the VAPHS’s shortage of vans for veteran transportation, inconsistent communication between VAPHS management, line leaders, and frontline workers, and uncertain security measures to protect and inform veterans and employees, will ultimately produce the end-results desired by us and you—a health system providing high-quality care and services to its veterans.”
Read the full letter HERE or below:
January 16, 2024
Mr. Donald Koenig
Director, VA Pittsburgh Healthcare System
Pittsburgh VA Medical Center
University Drive C
Pittsburgh, PA 15240
Dear Director Koenig:
Thank you for your work at the Veterans Affairs Pittsburgh Healthcare System (VAPHS) over the last four and half years. Starting the role, you were the sixth medical system director to rotate through VAPHS in five years, following the aftermath of the 2012 Legionnaires’ outbreak. That turnover rate demonstrates the challenges of running a health system operating at the VA’s highest complexity level and serving over 84,000 veterans annually. We appreciate your efforts to improve VAPHS and address some of its pressing needs, including chronic staffing shortages, opening a new outpatient clinic in Monroeville, and the critical structural issues at the 70-year old University Drive hospital.
Despite these efforts, challenges remain—some unique to VAPHS and others related to the VA health care system as a whole—degrading the system’s ability to provide the vital care both needed and expected by the region’s veterans. Addressing the barriers to this vital care, including the VAPHS’s shortage of vans for veteran transportation, inconsistent communication between VAPHS management, line leaders, and frontline workers, and uncertain security measures to protect and inform veterans and employees, will ultimately produce the end-results desired by us and you—a health system providing high-quality care and services to its veterans.
First, although hiring and retention have improved significantly over the last year, we have heard that it consistently takes significant time to post for the hiring of positions, even when management becomes aware of a future need. Additionally, we have heard that, even with the flexibility and incentives provided by PACT Act authorities, VAPHS remains short-handed in several key disciplines, including: Registered Nursing, behavioral health, Medical Support Assistance, and housekeeping. To address these hiring-related concerns, we ask that you develop a system to track the amount of time between VA management becoming aware of a talent need and VA posting a position to hire to address that need and keep us apprised of this information quarterly. We also ask that you identify the causes of your remaining talent shortfalls and actions to address those shortfalls as well as limitations imposed by current VA authorities.
Second, VAPHS was one of only nine VA Medical Centers and Healthcare Systems out of 114 rated to receive a one-star rating from the recent Centers for Medicare & Medicaid Services (CMS) ratings. We realize this year was the first that VA received ratings on the same scale as non-VA health providers, that certain priority metrics do not correlate equivalently due to differing incentive structures at the VA (versus the private sector), and that these metrics provided a dated view of VAPHS’s performance. However, we remain concerned by the ratings and have high expectations for improvement over the current rating period. Please let us know what steps you are taking to improve upon the one-star rating and the degree of improvement that you expect VAPHS to reasonably achieve over the next round of ratings.
Third, we understand that you do not have sufficient vehicles, including handicap-accessible vehicles, to transport veterans to and from appointments and to fulfill other needs across VAPHS. We understand many older vehicles are no longer fit for service and the nationwide microchip shortage has significantly delayed access to replacement vehicles. We encourage you to explore all possible pathways to restoring VAPHS’s ability to provide transportation services to all those veterans in need and ask that you reach out to our offices if you believe that we can support you in this regard.
Fourth, on October 10, a veteran died by suicide at the H. John Heinz III VA Medical Center. We know you have already conducted a thorough investigation of the incident and are continuing to identify and enact security reforms to avoid a future suicide. We have heard from employees at the facility that communication surrounding the incident and the after-action review left room for improvement. We ask that you personally provide a briefing to our offices on the suicide’s circumstances, VAPHS’s root cause analysis and assessment of its security measures, changes made following the analysis and assessment to prevent another suicide from occurring at VAPHS, and, through this entire process, VAPHS’s communications to employees.
Lastly, we have heard that the consistency of communications and quality of relationships between VAPHS management, service line leadership, and union leadership have not yet returned to pre-2017 levels. Your lack of timely and responsive communications with our offices about pressing challenges facing your health system amplifies our concerns. If we find it difficult to get to the bottom of issues involving VAPHS, front-line employees likely face insurmountable challenges. One particular opportunity for improvement we see is the reinstatement of a Labor Management Forum (LMF) at the VAPHS level. We encourage you to restart this forum at the VAPHS level and use it to seek input on VAPHS improvements and align key stakeholders on current and future initiatives, including those enabled by the PACT Act.
We hope you take our suggestions seriously and appreciate your continued partnership in providing the best care available to the veterans of southwestern Pennsylvania and nationwide.
