Flawed EHR Contributes to $35M Budget Shortfall at VA Medical Center

A projected $35 million shortfall deficit at Mann-Grandstaff VA Medical Center caused largely by the agency's flawed EHR system is forcing the Spokane hospital to reduce its staff, according to reporting from The Spokesman-Review.

Robert Fischer, director of Mann-Grandstaff, sent an email to supervisors on May 9 announcing that the hospital would need to reduce its authorized staffing level by over 15 percent because of the expected budget deficit.

Since the VA hospital began piloting the Oracle Cerner EHR in October 2020, the flawed system has reduced the number of veterans Mann-Grandstaff clinicians can see, leaving the hospital to send veterans to the private sector for care.

The VA hospital also faces a lack of clinicians in certain specialties, contributing to the increased use of private sector care in recent years.

According to separate documents obtained by the news outlet, these factors have put the hospital on track to spend roughly $38 million over budget. Meanwhile, veterans face long waits for care outside of the VA.

Fischer wrote that the new system has affected Mann-Grandstaff's budget in several ways.

Rises in staffing for "Cerner mitigation" in September 2018 and July 2021 have increased payroll costs. He said that pay raises and bonuses aimed at boosting recruitment and employee retention have further increased expenses.

However, because the EHR's flaws slow employees down, they see fewer patients, leading to a lower allocation of funds to the hospital.

"As a consequence of all of these factors, we have no option but to change the trajectory of staffing," Fischer wrote.

In a call with reporters Friday, Shereef Elnahal, VA healthcare chief, said the department had already provided additional funding to the regional office that allocates funds to Northwest VA medical centers to account for the system's impact.

However, in his email, Fischer said Mann-Grandstaff must trim staff because the hospital's bloated payroll is cutting hospitals' budgets in Puget Sound, Portland, and Boise.

In a statement, Sen. Patty Murray (D-WA), who controls federal spending as chair of the Senate Appropriations Committee, said cutting staff in Spokane is "completely unacceptable."

Murray noted that "there is no question" that the VA has the funds to keep the Mann-Grandstaff jobs.

"Facilities operating the new health record should absolutely not be cutting staff," Murray said.

Murray said she brought up the staffing concern when she met with Tanya Bradsher, VA chief of staff and deputy secretary.

"If VA needs more funding, they should ask for it, and they haven't," Murray said. "I will be following this closely to ensure Mann-Grandstaff has the resources it needs to support providers and get Washington state veterans the care they deserve."

A spokesperson for Rep. Cathy McMorris Rodgers (R-WA) said the legislator would "under no circumstances" accept a reduction in staff or services at Mann-Grandstaff, especially due to the Oracle Cerner EHR rollout.

"Even suggesting that as an option is entirely unacceptable, so the congresswoman will be looking at every available option to ensure veterans in Eastern Washington have access to the care they need," the spokesperson said in a statement.