Operation Backbone is Carrying a Heavy Load for Veterans as well as the VA

Mike Sformo, CEO and Founder of Operation Backbone shares how he advocates for the most advanced medical devices & innovations for our military and civilian medical sectors, bringing mental and physical relief to many veterans.

Transcript

Mike Sformo: 0:02

The biggest issue that we can provide and it's even more important to them than the actual surgery if there's a surgery performed, and that is at least some sort of mental relief of knowing what could or most likely is wrong fear sheet. That seems to be the biggest issue. At least Mike I have some sort of idea that my back was broken, or I had a chip in my neck, or I have parts fracture or L fours crushed in my spine. At least I have some sort of now starting point to understand that I'm not crazy, I'm not nuts. And there is real problems with me.

Charlie Malone: 0:41

Welcome to Season Two of the policy vets podcast, engaging with leaders, scholars and strong voices to fill a void in support of Policy Development for America's veterans. With your host, former Secretary of Veterans Affairs, Dr. David Shelton, and the Executive Director of Policy beds, Louis Celli, today's guest Mike's a former CEO and founder of Operation backbone.

Louis Celli: 1:10

Mr. Secretary, you started working at the VA just after they passed the original Choice Act, what was your experience? Oh, really was your experience as a hospital CEO, one of the reasons that you think President Obama sought you out,

Dr. David Shulkin: 1:23

there's no doubt Lou that when the White House called me they were looking for somebody with private sector experience, because the wait time crisis had become such an issue. And they just didn't want to keep using the same solutions. They wanted a new way of looking at this. And I came in with a pretty open mind about what I would find. And what I found was was that the VA was offering unique services that weren't available in the private sector. And that really gave me a very strong conviction that we had to fix the VA system. And so we focused on the wait time issues. And we got, of course, the wait times down to essentially same day services throughout the entire country, for primary care and for behavioral health so that people with urgent medical problems wouldn't be waiting. And I think that the VA is always going to struggle being the largest health care system in the country with this issue of access. And it's one of the reasons why we also published the wait time so that we could be transparent about whether we were continuing to have the type of progress that we had seen before.

Louis Celli: 2:37

Well, you know, I remember working on that bill and all the back and forth about community care and veteran's preference and, you know, third party payer processes. And it was really a watershed moment for VA, you know, we worked closely with Dr. fishnets and his team, while VA transformed from a provider only model to a payer provider model, it was a huge transformation.

Dr. David Shulkin: 2:59

Yeah, VA had really never acted as a significant payer of health care services. And there were certainly bumps in the road. And a lot of providers were having to wait a very long time to get paid. And that just wasn't fair to them. So we worked very closely with Congress and with the White House and worked internally to get a lot of those systems fixed. But again, due to the size of the system, it took a while and even as focused as we were on it. It's still not a perfect system, and it probably never will be a perfect system. But there certainly has been a lot of progress over the years.

Louis Celli: 3:38

That's so true. As a matter of fact, I lost a steak dinner bet to Carl Blake over at PVA because when the first choice program was was being implemented, they specifically said that it was going to be a temporary fix just to get these folks out of the backlog. And and then then we're going to go back to, you know, the the core competencies of the VA and Carl's like, nope, once you give the veterans the choice to go off, you know, to go off and get community care, they're not going to want to go back. And lo and behold, you know, choice turned into the permanent Choice Act that was signed later on by President Trump and then evolved into the mission act.

Dr. David Shulkin: 4:17

Yeah, the difficult part about this, Lou, and I know you understand this is, is that if you're committed to keeping a strong VA system for our veterans, which is really the only way that I know how we can assure that we honor our commitment to those who are returning and need our help, especially for special expertise, is to be able to make sure that the VA focuses on those things that the private sector just simply doesn't do well. prosthetics, orthotics, behavioral health care, rehabilitation like spinal cord injury and ocular traumas, environment No exposures, the expertise that exists in the VA just simply doesn't exist in the private sector. But at the same time, there are things that the private sector is actually doing better than the VA. So what I think we're striving for is a hybrid system where if you put the veteran in the middle, the veterans interests first, and you allow them to take advantage of wherever the best care is, whether that's in the private sector, or the VA. That's really the system that I think that we want for our country's veterans. Well, the

Louis Celli: 5:37

program really has evolved. And I remember working with several providers, you know, who would come to the Legion looking for some help and some relief, you know, who struggled to get paid from VA, and there were lots of growing pains, some providers stopped actually taking VA patients because of it.

Dr. David Shulkin: 5:52

Yeah, that's true Lo. And there's been a lot of effort working to evolve this program. Now, of course, it's become permanent law with the mission act. And I think that not surprising that Carl won that dinner from you, because that's really the way that the system should have been designed right from the beginning.

Louis Celli: 6:16

You know, just as a coincidence, our guest today has been dealing, you know, with this problem, really, from the very beginning of this whole choice movement. He you know, he started before the Choice Act, and then lived through choice one, Choice two, and then the mission act. And, you know, he's helped 1000s of veterans get some of the very specialized care that they've desperately needed. Yeah,

Dr. David Shulkin: 6:39

I'm excited to talk to Mike. He had contacted me several times, you know, he's one of those guys that, you know, when somebody calls you and wants to get your help, that he wasn't going to take no for an answer. And it's not that I wanted to say no, but I was pretty busy. And he just simply said, Well, look, tell me where you are, I'm going to drive to sit down and talk to you. And he did. We met that next morning. And it was really infectious, knowing how dedicated he was how much he wanted to help veterans how much he wanted to work with the VA. And that really got me to follow what he's doing and see the great work that he's doing. So I'm excited to hear from him today.

Louis Celli: 7:26

That's true. And, you know, unfortunately, the will not unfortunately, it just happens to be a fact that the Veterans Health Administration is the law is the largest, you know, integrated health care system in the United States. But, you know, Mike's story, unfortunately, really isn't all that uncommon. Over the years, I've definitely seen an improvement at VA, but you know, it's hit or miss sometimes.

Dr. David Shulkin: 7:47

That's right. So why don't we get Mike in here?

Louis Celli: 7:59

Hey, Mike, welcome to the policy. That's podcast.

Mike Sformo: 8:01

I appreciate it, sir. Thank you for having me. It's it's quite an honor. It's it's pretty cool when you guys are doing so thank you,

Dr. David Shulkin: 8:06

Mike. Thanks. It's a really important topic we want to talk to you about today, because I think you have a unique perspective on the Department of Veteran Affairs, not only with what's recently been happening with the VA, in the pandemic, but I know we've spoken for years, that you've been a resource for veterans that have had difficulty in navigating the VA and getting the type of care that they need. And that's really, I think, the reason why you started and really dove in the operation backbone. But before we get into that, and what you feel about how the VA is doing and caring for veterans, you yourself are a veteran, of course, you spent time in the Navy, why don't you tell us about that?

Mike Sformo: 8:54

Well, I appreciate it, Mr. Secretary, but I have to tell you this the book, and I didn't even tell this to Lou, but the book that you wrote that the title is, it shouldn't be this hard. This seems to be the motto of my kids because we homeschool and they're like why does it have to be this hard? And I said let me tell you something. So I the title of your book is unfortunately with the political environment today it transcends into so many different fields so I appreciate what you've done in in that book so

Dr. David Shulkin: 9:24

Okay, Mike, Mike, let's just get this clear right from the beginning you're not you don't receive commission on my book sales deal.

Mike Sformo: 9:31

No, no, I you know when I when I talked to you and I saw that the title of it and I hear this all the time from people why is it so hard? I don't have these answers but read this book, because he's like the doctor spot so he got he had nothing to do with this. I just wanted to say congratulations on that. That was that was pretty cool thing. In terms of the Navy I was I joined the Navy right out of high school. The youngest for my dad said you're not the smartest kid on the block. So you gotta go do something. So I left low i Little Town Hall. If you were just by Buffalo, New York, and I joined the Navy in the Gulf War San Diego, I was on a sub tender. I was on a fast attack. I'm sorry, a sub tender as 41.

Dr. David Shulkin: 10:11

Okay, Mike, Mike, Mike, let me just stop you here. Now, anybody who can spend time in the submarine? I don't know how many of our listeners. I've been in a submarine. But but for a short period of time, how long would you spend? When you're when you're out on a mission in a sub before you would get out the land?

Mike Sformo: 10:31

Well, let me make sure I clarify this. I was never attached to when I was attached to the submarine base at Point Loma. So I did all the work on there. So my longest was kind of 11 days. And I said The hell with it. This is that's long enough to be how you guys go six or seven months at a time. Forget it. So yes, I just want to clarify those guys are pretty good. And now females on what they do so yes, yeah.

Dr. David Shulkin: 10:53

Yep. That was, that was they're pretty incredible people, the people that serve in the sub,

Mike Sformo: 10:58

anybody that serves is, in my opinion is absolutely outstanding. And so yeah, it was an honor and a privilege to serve in the military. The Navy is what got me where it is today. I'm a huge supporter of the military, and but the Navy, the Navy gave me everything I got today. So I am extremely grateful.

Louis Celli: 11:14

I remember getting quickly schooled one day on the difference between a submariner and a Submariner. So I try not a lot

Mike Sformo: 11:22

of steak. Yeah, there's a lot of schooling out there.

Louis Celli: 11:26

So you know, Mike, this is a great topic, because it touches on several important issues, as the Secretary said, but you started operation backbone a while back as a matter of fact, and we talked about this earlier. You know, when I, when I read through your history, I remember that I had heard this story before

Mike Sformo: 11:41

I reached out to you 2015 2016, I believe when you are still part of the American Legion. Yeah, absolutely. And the real quick version of Operation back when I was when I hurt my neck, I got a bill for $126. And I asked the VA to pay it. And they said, No. And I just remember saying, Well, if you can't take care of my neck, and it's $126, what do you do if you're really jacked up like you're a real warfighter on marine and you're in the middle of nowhere. And the VA didn't have any answers for me. And I was really upset I was I was a little disappointed. And I was fortunate enough to have some resources to go and get what I had to get done. But then I realized there's so many others out there that don't have it. So that's when I started looking more into the the real mission of the VA and the bureaucracy and the red tape. And it was it was rather discouraging. So that's how, that's how we started operation back then.

Dr. David Shulkin: 12:34

Talk to us a little bit more about that you didn't start operation back, well do pay health care bills of veterans, you started because you didn't think veterans were getting the care that they needed in the VA.

Mike Sformo: 12:49

So the real point of the what really got to me was the fact that you had to go through all this, all these different steps along the way in order to go get the treatment in comparison to a civilian that could go online or use his or her own insurance card. And they could walk in and go get what they wanted done. And I said, I, I didn't understand the disconnect on how we are sent six or 9000 miles away to go fight and die. But when we come home, we have to have a bureaucrat tell us where to go, and how to function and are in a for a hospital or in our own medical. So I didn't understand that. So what happened was I said, Well, maybe if we could just take the ones that are the most costly, and the most complex and the most lengthy. And the we wanted to partner. The whole original point was to partner with the VA to simply say, if you got 25 guys on the front line, let us provide another 25. And we could work together. And the whole goal was to simply take the ones that are the most complex and lengthy out of the VA system, we can put them into RS treat he or she and we give them back to the VA so they can continue the outstanding follow up care that they're going to need. And it's been a road. It's been a road. And we've worked on 1000s of soldiers. I'm proud to say, unfortunate, the VA hasn't wanted to play ball for well, even to this day. It's been difficult trying to help some of the folks

Dr. David Shulkin: 14:17

so that's why you like the name of my book. It shouldn't be this hard because,

Mike Sformo: 14:21

you know, it's sad, Mr. Secretary, it's sad when you know what when I when I was talking to you prior? And I said, You know what? Here's I mean, how many people get to serve one president, let alone two and what you've gone through and for you to come out of the White House and write a book like that. It was it was discouraging. It was upsetting and it actually motivated me to keep going so you are you are correct. It's It's hard enough for a former Secretary of the VA to get things accomplished. What is an E four e five supposed to do with no support,

Dr. David Shulkin: 14:56

but that didn't stop you. You've been you've been despite discouragement, despite the lack of, of collaboration, you've been out there just focused on the mission of helping your fellow veterans.

Mike Sformo: 15:09

And I want to make this very clear, the VA is constantly kicked to the curb, and they're constantly getting belittled. So I want to make the distinction between bureaucrats in the VA and the actual workers. So this is not a VA problem. This is a White House problem from any administration that you want to go to. These are bureaucrats that handcuff these outstanding men and women in the VA, to a point where if they were to go out and do extra things, they could actually legally get in trouble on some of these things that they're doing medically. So this is not the men and women on the front lines. This is the guy sitting on their shiny gas on the Hill that are saying this is what needs to be done needs to be done. And then they go use their private insurance somewhere else. And then they handcuff everyone at the VA. So that's that's the distinction that needs to be made.

Dr. David Shulkin: 15:58

Well, thanks. Thanks for making that distinction. And you know, one of the things, Mike, that I wanted to get your thought about was, did you see any difference among this difficulty of navigating the system, once the Choice Act that now called the mission Act was passed, and veterans have a legislative have to be able to get the care in the community that they need?

Mike Sformo: 16:25

Overall? Do I think it's an improvement? Yes, the issue still comes to this. How do you take somebody that is TBI or PTSD? Or is really jacked up? Has opioid issues? How does he or she know how can how can they actually function through the bureaucratic system? Whether it's a Choice Act or not, they still have to have someone to help them navigate through that process. So the overall direction I think, is an improvement. Did I think it solved the problem? No, I did think it has curved some of it. But it has not certainly solved the problem by any stretch.

Louis Celli: 17:01

So what are some of the bigger problems that you see then with with helping these veterans get the, you know, the critical care that they need, in some cases, to be able to walk again, or be able to sit comfortably?

Mike Sformo: 17:12

The biggest issue that I that we have always come in contact with when I asked what did your primary care physician say, and the issue is that when you have a severe back problem or a neck spine issue, you need to go to a specialist, so he or she can do the proper tests, everything has to be done upfront, the first time through, the problem I see within the VA is they go to a primary care physician that is not a specialist in that specific field. Therefore, now the direction is already off, because if they say, we just don't think it's warranted right now for an MRI or a CT or further evaluation, but we can provide some of these opioids or some painkillers to get you through the next six months. This is where I think it all starts to deviate. So the biggest issue is the need to be seen by the right specialist first, so the correct diagnosis and the correct path can be charted out.

Dr. David Shulkin: 18:09

That certainly makes a lot of sense from a clinical point of view. I wonder getting back to this difficulty of of navigating the system. I think we all want to be able to get our veterans the right type of care. When you work with the Department of Defense, are you seeing the same challenges and getting our veterans are covered by the TRICARE system referred to the right people and getting the right care?

Mike Sformo: 18:35

Let me put the analogy like this, Mr. Secretary, because I want to be very diplomatic and respectful. I would look at it as a Tom Brady. This breaks my heart but the Buffalo Bills. Whatever Tom Brady needs

Louis Celli: 18:50

you just you just keep keep right on brother.

Mike Sformo: 18:55

With a Tom Brady asks for something special forces active duty Tom Brady. And those individuals get it because they are on the field, the focus is on them. And they are the ones that can do the operations. When they are now off the field and they're no longer the Tom Brady, they're, they're the second string or third string, it becomes less of a priority. It's not to minimize it. But there is certainly a succession and Special Forces department offense, active duty all those seem to be much easier, not even to navigate but to simply align the star so to speak of what has to happen in the Execute. Once they leave. Like I said they become second and third strength.

Louis Celli: 19:36

So that brings up a really good point of operation backbone is a nonprofit organization who exactly is eligible to get help from Operation backbone.

Mike Sformo: 19:45

So anybody that comes to us that has any types of spine issues or scholar issues, physical ailments, we're happy to take a look at and this is where we've also run into a lot of difficulties with PTSD, trauma, TBI, because it's not our wheelhouse, so we've only looked at the actual images. So for us to sort of qualify sort of speak, we have always had to take a look at a physical image so we can see what damage, if any, and then what process could be moving forward. So that's kind of how we did it.

Dr. David Shulkin: 20:22

Mike, what about the situation where the Department of Veteran Affairs doesn't pay the bill, and the veteran doesn't have any other insurance? Does the patient of their family get a bill from Operation backbone?

Mike Sformo: 20:35

So that's an outstanding question. And I am proud to say there's not one veteran that we've worked on has ever paid one bill at all. And I'll tell you why. Because we have constantly beat on the VA through various members of Congress in the Senate, that their constituents need help. Therefore, we would go to certain members in the office and say, here's the issues. This is what we can provide, this is what we're going to need. And either the military liaison individual get involved or the or the actual senator and or congressman or woman would actually get involved in order to get the referral approved.

Louis Celli: 21:12

So it brings up some great questions. One is how many how many veterans have you helped and how does your nonprofit survive? Do you have sponsors? Do you have individual donations? Do you have a great grandfather?

Mike Sformo: 21:27

No, no, rich grant? No. So I was fortunate enough. When I started this out of buffalo when Terry got involved, Terry owns the Buffalo Bills in the Buffalo Sabres. And then Mr. Jacobs got involved. Mr. Jacobs lives in Buffalo. Mr. Jacobs owns the Boston Bruins. And he built what they call the Jarrod the Jacobs Vascular Institute in Buffalo. It's we're doing minimally invasive upper cranial stroke protocol, protocols. It's very, very impressive organization, you'd be University of Buffalo neurosurgery. And those guys up there, Dr. Levy, and sneaky and, and Dr. Hopkins and Dr. Kenny Snyder, these are the real genesis of what built operation backbone. So I was fortunate enough to have some heavy hitters jump in to help support and fund what we were doing. And I will tell you, as it grew, the frustration mounted for some of these individuals that said, Why am I paying three $400 million a year in tax? What Why? Why are you the one that's running around doing all this? Why do you need my plane? I should be. So that was a big eye opening experience for a lot of people. So it's it was very unique situation that we had very fortunate.

Dr. David Shulkin: 22:42

Okay, Mike, the bottom line here is, is that you're helping veterans, I wonder if you know what percentage of veterans are being helped in the program, and what are the most common types of injuries or issues that you're dealing with when you're dealing with veterans,

Mike Sformo: 22:59

the biggest issue that we can provide, and it's even more important to them than the actual surgery if there's a surgery performed, and that is at least some sort of mental relief of knowing what could or most likely is wrong with your sheet. That seems to be the biggest issue, at least Mike, I have some sort of idea that my back was broken, or I had a chip in my neck, or I had pars fracture, or L fours crushed in my spine, at least I have some sort of now starting point to understand that I'm not crazy, I'm not nuts. And there is real problems with me. So providing that relief to them. And the family has just been absolutely a wonderful God given thing that we've that we've experienced with the families. On the physical side, we also provide a true outcome. And I always say, look, it's like you have 10 fingers, you know, eight of them are just not going to work no matter what happens. So we're going to have to sharpen the two that you have. And those two fingers are now going to have to operate for both hands. So you're going to have to learn to adjust physically, professionally, spiritually, financially, with what you have. So we're able to provide not only a mental better quality of life, but we're at least provide them with some sort of options or relief, or even the bad news to them is good news by saying, but as of now, there's no talent, there's no technology that can do anything. But at least you truly have an idea of what's wrong.

Louis Celli: 24:25

So I want to take you back for a moment. And you know, we talked a little bit about your sponsors, and it sounds like you have some, you know, some really heavy hitters, some really great sponsors, and next year, I think I'll be paying a couple of million dollars in taxes someday. But you know, that's what you asked for. You never know. Yeah, that, you know, that being said. How many patients can you possibly work with? I mean, what does capacity look like for you? And you know, we wanted to talk a little bit about how many of you served already.

Mike Sformo: 24:54

So we have served 1000s of veterans from all over the world actually all over the We I still get calls from any emails from people, how many can we handle, it's not a matter of capacity, it's a matter of the actual vetting process of going through who we can help and who we can't. So the team that we've put together across United States is extremely fast, literally in hours. And as the Secretary will tell you, he understands this stuff that a real expert can look at 25 or 30 patients and have at least some sort of guide idea, you know, these five forget at these. So that's how we're able to go through that process. And then from there, we can narrow down faster and faster and faster, because the complexity of the things that we're doing, there's not that many people that are shot out of helicopters, not that many people that were, you know, in an AMRAP, that flipped 45 feet in the air. So it narrows itself down the scope is not as complex. The complexity is explained in a certain people that this is a PTSD or TBI issue. And it's not for us.

Dr. David Shulkin: 25:52

You had mentioned before that you were not getting the type of cooperation that you had hoped with the Department of Veteran Affairs. And I wonder if you could just tell us, what would you want from the department? What could the VA do to be more cooperative with you?

Mike Sformo: 26:09

So there's one specific ask that I've asked the VA and members of Congress in the Senate, I wanted the president, former President Trump, I wanted President Biden and President Obama. And I never got anywhere, as not with all three. And that was anybody that we accept into our pipeline, the VA automatically signs the referral. That's it. That's all we need is the simple referral sign that says, allow us to go do 123 and bring them back. And that seems to be the the rubber meets the road where the VA says, No, we'll do it. We know what's best. And that's that. So that's been the biggest issue.

Louis Celli: 26:48

So before we go, because we're running short on time here, I just want to make sure that that we get to anything that we didn't get a chance to talk about, is there anything that you want our listeners to know, and how do they contact you if they think that they need your help?

Mike Sformo: 27:01

This is one thing I want everyone to know, again, screaming, and this goes to all the veterans, for the veterans that are screaming and yelling on on social media, or to the VA, if you really want to make things change, if you really want to make things work, you have to actually get involved and screaming and yelling at doctors and the nurses on the frontlines. It's not going to get you anywhere, regardless of what mental or physical ailments that you have. So I would ask all veterans before they express their outrage and frustration that they actually look at the members of Congress in the Senate, the ones actually write the rules, regulations, that's the real that's the real stake in the ground that they can they can start. And the second thing is if there are some soldiers out there and family members that have some severe spine or scholarships, they can always go to Operation backbone, that org. Or they can certainly they can google my name Mike's formo. And there'll be contact links all over. And we'll review what we can and we provide a real quick, candid option, if any. And if we're able to help, we will,

Dr. David Shulkin: 27:59

I think it's pretty clear that operation backbones making a big impact with our veterans. And I just want to thank you for your continued work and dedication to this. I know that this is not easy work. And but it's something for you. That's a real calling and a real mission. And so thank you for talking to us today about this.

Mike Sformo: 28:21

Well, I appreciate the podcast. Thank you for much for your service. Mr. Secretary, Louis, thank you for everything you've done for our country. And God bless all the members of the military out there. Thank you. Thanks, Mike. Thanks, guys.

Louis Celli: 28:34

And that really is all the time that we have for this week. Hey, listen, you're not gonna want to miss next week episode. We have Chairman Mark Takano from the house Veterans Affairs Committee, who's going to be talking about some legislation that he's been working on for a while now. That's going to help a lot of veterans in our community. So tune in next week. We'll see you then.

Charlie Malone: 28:56

Thanks for listening to the policy bets podcast. For more information about projects and other podcasts, go to policy. That's dot org.