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Spokane, Washington  Est. May 19, 1883

No staff cuts at Spokane VA due to budget deficit, regional director says after visiting Mann-Grandstaff

The Mann-Grandstaff VA Medical Center, photographed Tuesday, Nov. 30, 2021.  (COLIN MULVANY/THE SPOKESMAN-REVI)

WASHINGTON – After visiting Mann-Grandstaff VA Medical Center at the end of May, the Department of Veterans Affairs’ Northwest regional director assured staff that the Spokane hospital won’t cut its workforce as a result of a multimillion-dollar budget deficit.

In a June 1 message to Mann-Grandstaff employees obtained by The Spokesman-Review, Network Director Teresa Boyd said the hospital had “not been asked to cut current staff or reduce services to Veterans to mitigate any effects of the deficit.” That budget shortfall is projected to exceed $35 million by the end of the fiscal year, according to an earlier email from Mann-Grandstaff Director Robert Fischer, largely as a result of the VA choosing Spokane as the testing ground for a new computer system that has been riddled with problems.

The department has indefinitely halted the nationwide rollout of that system – developed by Cerner, now part of the tech giant Oracle – but continues to use it at hospitals and clinics in the Northwest and part of Ohio during what the department is calling a “reset” period. Fischer shared Boyd’s message with staff in Spokane after the regional director met with the hospital’s top leaders on May 30.

“We talked about how Mann-Grandstaff, not unlike any other healthcare system, must critically assess how to provide the best care to Veterans,” Boyd wrote. “I thanked your leadership team for their continuing collaboration and input into the ongoing improvement efforts during the Cerner ‘reset’ period.”

Boyd’s visit followed Fischer telling Mann-Grandstaff supervisors in a May 9 email that the regional office Boyd leads had asked the Spokane hospital to reduce its workforce by attrition – eliminating some vacant positions instead of filling them – to shrink a budget deficit that was effectively pulling funds from hospitals in Seattle, Portland and Boise. She wrote that her message was intended “to clearly address some discrepancies in hiring information that were recently circulated.”

The mandate to reduce the workforce in Spokane by the equivalent of 146 full-time positions, Fischer said in his email, came was made despite the ongoing impact of the new electronic health record system, which has contributed to patient harm and limited the number of veterans each provider can see. To make up for that lost productivity, VA leaders authorized Mann-Grandstaff to hire additional staff in 2018 and 2021, but the hospital’s director wrote May 9 that the department had not allocated enough extra funding to pay those workers without hurting other hospitals in the region.

In her message, Boyd did not directly contradict Fischer’s email, which did not claim Mann-Grandstaff was being forced to lay off current staff, nor that the regional office had imposed a freeze on all hiring. Instead, Fischer explained that hiring would be subject to “considerable scrutiny,” including review by a task force charged with addressing the deficit, and that vacant positions the task force did not agree to fill would be eliminated.

Boyd added that Mann-Grandstaff had hired 122 employees during the fiscal year that began in October 2022, noting that hiring “faster and more competitively” is a priority for the VA. “I ask that each member of the Mann-Grandstaff team remain committed to this priority and to providing our Veterans safe, high-quality care,” she wrote.

In response to follow-up questions from The Spokesman-Review, VA spokesman John Santos said, “Mann-Grandstaff has not been asked to reduce its staffing levels but instead to build a strategic plan for staffing and services that best meets the needs of Veterans in their market.”

“This plan is necessary to ensure that the medical center is best positioned to have the staffing and resources it needs to provide outstanding care to Veterans now and in the future,” Santos said in an email. “There was not and currently is not a prohibition on filling vacancies.”

Such a plan would need to contend with the uncertainty surrounding the Cerner system’s future and its ongoing impact on the hospitals where it has been launched – in Spokane; Walla Walla; Columbus, Ohio; and White City and Roseburg, Oregon – and the outpatient clinics attached to each medical center. After repeatedly postponing the system’s rollout over the past two years, VA leaders have declined to say how long the current pause will last, raising the possibility that the affected hospitals could remain hamstrung for years while Oracle tries to improve its product.

A temporary reduction in productivity is normal when a hospital switches to a new electronic health record system, which employees rely on to track patient information and coordinate care between different providers. In March 2022, then-VA Deputy Secretary Donald Remy said he expected productivity to fully recover within three months of launching the Cerner system at new facilities, but Santos said productivity at Mann-Grandstaff was about 18% lower at the end of the 2022 fiscal year than before the system’s launch two years earlier.

Sen. Patty Murray, a Washington Democrat who sits on the Senate VA Committee and controls federal spending as chair of the Senate Appropriations Committee, said in a statement May 19 that VA leaders hadn’t asked Congress for more money to ensure budget problems related to the Cerner system don’t force staff cuts.

In the emailed statement, Santos said Mann-Grandstaff’s budget problems started before the Cerner system’s arrival and have impacted other hospitals in the region because the VA’s funding model allocates money to each regional office, which in turn distributes funds to each medical center. In her message to staff, Boyd said the Spokane hospital had operated with a budget deficit since 2016 yet had received an average increase in funding of more than 11% each year.

Santos said the regional office and the VA’s health care division – the Veterans Health Administration, or VHA – “have worked hard to address these impacts,” adding that all hospitals in the region “have had appropriate funding to cover their strategic missions,” and that their staffing level had “not been negatively impacted.”

In coordination with the regional office, Santos said, the VHA has “developed and approved a process” to fund all hospitals using the Cerner system “and ensure that any budget deficits related to this implementation are addressed.” Additional funds are provided by the VHA if the regional office can’t cover its needs internally, he said in the statement.

On May 24, Rep. Cathy McMorris Rodgers, a Spokane Republican who has called for the VA to scrap the Cerner system, sent a letter asking VA Secretary Denis McDonough to pledge to use money Congress had already appropriated to prevent cuts to staff or services in Spokane. In a news conference that same day, McDonough said he would respond to McMorris Rodgers directly, but her office said he had yet to do so as of Wednesday.

Since Oracle acquired Cerner for $28.3 billion in June 2022, executives from the Texas-based tech giant have promised to rapidly address the system’s flaws, which include poorly designed features that slow users down and increase the risk of medical errors. But in a House subcommittee hearing May 9, a representative from the nonpartisan Government Accountability Office said only a fraction of the fixes requested by users in Spokane had been made.

The vast majority of the VA’s nearly 1,300 health care facilities across the United States and its territories still use a homegrown electronic health record system called VistA, which remains popular with users despite suffering from years of underinvestment as factions within the VA have fought over whether the government should stay in the software business.

In 2018, the Trump administration gave Cerner a $10 billion sole-source contract to replace VistA with the same system the Defense Department had begun piloting at Fairchild Air Force Base a year earlier, despite a Pentagon report that found the system was “neither operationally effective nor operationally suitable.” On May 16, the VA announced a contract extension that holds Oracle to higher performance standards and could be renegotiated after each of the next five years.

Despite the system’s flaws, VA officials have said continuing to use it at Mann-Grandstaff and the four other hospitals is the best way to make necessary improvements. In a statement April 27, VA spokesman Terrence Hayes said safely reverting those facilities to VistA could take years , in part because the two systems store information differently.

Boyd concluded her message by thanking staff in Spokane for their “commitment to delivering on our humble missions each and every day,” and to deploying the Cerner system and the “important and necessary improvements and maturation” the system needs.

“I look forward to Mann-Grandstaff being well-positioned to meet the unique challenges in its market,” she wrote, “and thus poised to provide robust and sustainable healthcare services that best serve our Veterans, families, survivors, and Caregivers.”