Subject: WH Meeting on VA Health Care w- Location: WH Start: Wed 10/4/2017 9:30 AM End: Wed 10/4/2017 10:15 AM Recurrence: (none) Organizer: DJS Categories: White House Apologies for the delay. Wednesday at 130 works for-! Thank you, From? [manta Sent: Thursday, September 28, 2017 2:44 PM @vagov] Subject: RE: RE: VA Healthcare Hi- just checking back with you. From: . Sent: Wednesday, September 27, 2017 10:25 AM To: Cc: Subject: RE: RE: VA Healthcare Would any of the following times work for- next week? 0 Wednesday, October 4 from 1:30-2:30pm - 4:30-5:30pm 0 Thursday, October 5 from 3-5pm Thanks, From: manto Sent: Wednesday, September 27, 2017 10:18 AM 18-07296-F 00028 Subject: RE: RE: VA Healthcare - who can help you with scheduling for-l Kind regards, Frow? av] Sent: Wednesday, September 27, 2017 10:14 AM Subject: FW: RE: VA Healthcare Can you share who would be best to work with setting a meeting up with- Secretary Shulkin and Dr. Carolyn Clancy'? From: Sent: Tuesday, September 26, 2017 1:24:00 PM To: Subject: RE: RE: VA Healthcare 'mbsherma YES we will make ourselves available to learn more and try to be helpful From: DJS [mailto2vacodjsl@va.gov] Sent: Tuesday, September 26, 2017 12:50 PM To: Subject: RE: VA Healthcare 'brucemoskowit?? - I do want to move fonvard with an independent evaluation of our quality comparison methodology. I'm adding Dr_ (who will soon be acting Imdersecretaly for health) who is one of the top quality expelts in the c01u1t1y. She is prepared to review this methodology and make some recommendations 011 an independent review panel- Would it be helpful to have her meet with someone from your of?ce to review Where we are or do you have another suggestion to move forward? We also want to integrate Dr Moskowitz into this approach as he has some very useful approaches to this as well. David Shulkin 18-07296-F 00029 Sent with Good Ori inal Messa From: Sent: Sunday, September 24. 2017 06:04 PM Eastern Standard Time To: DJ S: Cc: biucemoskowit Subject: RE: RE: VA Hea tlcare Please let me know what we can do to help move this along. Good out of the box From: DJS [mailto2vacodjsl@va.gov] Sent: Sunday, September 24, 2017 5:18 PM 'brucemoskown_ Subject: RE: E: VA Healthcare F-I agree with Ike and the team that measm?ing VA against private hospitals is critical - so while MS is not a le to deliver this for months we have now developed om? own tool to do this-we are ?ne tuning the model this week and can share it by friday. If it does not get us where we need to be then working quickly with an independent group would make a great deal of sense. David Sent with Good Ori inalMessaQe-m- From- Sent: Sun ay, Septem er 24. 2017 04: 1 PM Eastern Standard Time rubshermai 'brucemoskowit Subject: RE: VA Healthcare This is a creative i9dea to fast track the process I think it could be as a way of collecting the data quickly by an independent group. If they can spend time with the other raters and get a sense for what they are looking for, perhaps the data they are collecting can be used to help determine the star ratings From: lP Sent: Monday, September 18, 2017 8:58 AM 18-07296-F 00030 'brucemoskowit We have been talking to Dr. Shulkin for many months about identifying the existence of healthcare delivery issues at VA medical centers. There is no doubt that issues exist in abundance and were created by decades of historical federal government hiring practices, regulatory hiring rules and mismanagement. We originally were hoping that the hospitals could be rated (with the star rating system) by CMS, as they do with private hospitals. However, they recently advised that they would not be able to focus on the VA hospitals until December 2018. As an example, we think that some of the VA hospitals are delivering some specialty healthcare when they shouldn't and when referrals to private facilities or other VA centers would be a better option. Not every VA hospital has both the breadth and depth of specialized medical expertise in every specialty, which then creates risk to the patients and the system. One idea discussed was to institute a self- rating program, but self-ratings are rarely of any practical use. Our solution is to make use of the academic medical centers and medical trade groups, both of whom have offered to send review teams to the VA hospitals to help in this effort. The purpose of this email is to see if you know of any impediments to taking them up on this offer and to get your thoughts in general about this approach. All my Best, Ike 18-07296-F 00031