[House Hearing, 114 Congress]
[From the U.S. Government Publishing Office]
U.S. DEPARTMENT OF VETERANS AFFAIRS BUDGET REQUEST FOR FISCAL YEAR
=======================================================================
HEARING
before the
COMMITTEE ON VETERANS' AFFAIRS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED FOURTEENTH CONGRESS
FIRST SESSION
__________
WEDNESDAY, FEBRUARY 11, 2015
__________
Serial No. 114-7
__________
Printed for the use of the Committee on Veterans' Affairs
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COMMITTEE ON VETERANS' AFFAIRS
JEFF MILLER, Florida, Chairman
DOUG LAMBORN, Colorado CORRINE BROWN, Florida, Ranking
GUS M. BILIRAKIS, Florida, Vice- Minority Member
Chairman MARK TAKANO, California
DAVID P. ROE, Tennessee JULIA BROWNLEY, California
DAN BENISHEK, Michigan DINA TITUS, Nevada
TIM HUELSKAMP, Kansas RAUL RUIZ, California
MIKE COFFMAN, Colorado ANN M. KUSTER, New Hampshire
BRAD R. WENSTRUP, Ohio BETO O'ROURKE, Texas
JACKIE WALORSKI, Indiana KATHLEEN RICE, New York
RALPH ABRAHAM, Louisiana TIMOTHY J. WALZ, Minnesota
LEE ZELDIN, New York JERRY McNERNEY, California
RYAN COSTELLO, Pennsylvania
AMATA COLEMAN RADEWAGEN, American
Samoa
MIKE BOST, Illinois
Jon Towers, Staff Director
Don Phillips, Democratic Staff Director
Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public
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C O N T E N T S
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Wednesday, February 11, 2015
Page
U.S. Department of Veterans Affairs Budget Request for Fiscal
Year........................................................... 1
OPENING STATEMENTS
Jeff Miller, Chairman............................................ 1
Prepared Statement........................................... 51
Corrine Brown, Ranking Member.................................... 3
Prepared Statement........................................... 53
WITNESSES
Hon. Robert A. McDonald, Secretary, VA........................... 4
Prepared Statement........................................... 54
Accompanied by:
Dr. Carolyn Clancy M.D., Interim Under Secretary for
Health, VA
Hon. Allison A. Hickey, Under Secretary for Benefits, VA
Mr. Ronald E. Walters, Interim Under Secretary for
Memorial Affairs, VA
Ms. Helen Tierney, Executive in Charge for the Office of
Management, and VBA Chief Financial Officer, VA
And
Mr. Stephen Warren, Executive in Charge and Chief
Information Officer, Office of Information and
Technology, VA
Mr. Carl Blake, Associate Executive Director, Government
Relations, Paralyzed Veterans of American, On Behalf of the Co-
Authors of the Independent Budget.............................. 40
Prepared Statement........................................... 80
Accompanied by:
Mr. Joseph A. Violante, National Legislative Director,
Disable American Veterans
Mr. Ray Kelley, Director, National Legislative Service,
Veterans of Foreign Wars
Ms. Diane M. Zumatto, National Legislative Director,
AMVETS
Mr. Ian de Planque, Legislative Director, The American Legion.... 42
Prepared Statement........................................... 87
FOR THE RECORD
The Independent Budget for the Department of Veterans Affairs.... 92
Secure Sharing of Health Information to Improve Patient Care..... 113
Question for the Record.......................................... 118
Part I Overview Information...................................... 173
U.S. DEPARTMENT OF VETERANS AFFAIRS BUDGET REQUEST FOR FISCAL YEAR 2016
----------
Wednesday, February 11, 2015
U.S. House of Representatives,
Committee on Veterans' Affairs,
Washington, D.C.
The committee met, pursuant to other business, at 10:35
a.m., in Room 334, Cannon House Office Building,
Hon. Jeff Miller [chairman of the committee] presiding.
Present: Representatives Miller, Lamborn, Bilirakis,
Benishek, Huelskamp, Coffman, Wenstrup, Abraham, Costello,
Radewagen, Brown, Brownley, Titus, Kuster, O'Rourke, Rice,
McNerney, and Walz.
OPENING STATEMENT OF CHAIRMAN JEFF MILLER
The Chairman. The hearing will come to order.
We are here to discuss the President's fiscal year 2016
budget request for the Department of Veterans Affairs.
Mr. Secretary, welcome to the committee. I understand that
your testimony will be a little bit different today than what
we are accustomed to with reference to charts to help us better
understand what you are seeing in terms of the challenges that
lay ahead.
And I would say that is indeed a welcomed change. So, too,
is the openness that you have had with me, with the Members of
this committee, and this Congress about your plans to change
the culture at VA.
As your testimony illustrates, you have been extremely
active in visiting VA facilities, I think it is well over 90 at
this point, talking with employees, veteran groups, and your
private sector colleagues with one aim in mind, putting
everyone's focus squarely on the needs of veterans.
Thank you for your willingness to take the job of secretary
and thank you for putting everything that you have into that
job.
Turning to the business of examining the VA budget request,
I see some very positive things, but also there are some areas
where we will have considerable question marks.
The committee's task will be to learn as much as possible
in order to inform our views and estimates letter that is due
next Friday.
On the positive side, Mr. Secretary, you have boldly
tackled a very sensitive issue of VA's aging infrastructure
coupled with a more realistic budget request for VA's major
construction program. Addressing the closure of unsafe, vacant,
or underutilized facilities begins an important conversation
about the future alignment of VA's infrastructure.
I have long argued that we needed a strategic reassessment
of VA's construction program. That is in part what the
independent assessment and the Veterans Healthcare Commission
established in last summer's Choice Act were tasked with
examining.
You have my commitment and this committee's commitment to
work with you as this conversation begins in earnest.
Now, I have several areas of concern that I hope you and
our second panel can address. First, and I am going to be frank
as I have in the past with you on this particular issue, the
proposal to reallocate any portion of the $10 billion
appropriation for the Veterans Choice Program is a non-starter.
I understand there is a great degree of uncertainty about
the program's utilization. But in appropriating the money, the
Congress had to work with the best estimates that we had at the
time to stretch those dollars including limited eligibility
criteria for veterans.
So if there is going to be any reallocation, it is going to
be to further improve and strengthen the program itself and not
address other unspecified needs.
Secondly, the budget requests an additional $1.3 billion
for VA medical care on top of the advanced appropriation for
fiscal year 2016, bringing the total proposed increase to 7.4
percent.
At a threshold level, I do not understand how this request
interacts with the $15 billion that Congress provided last
summer for non-VA care and infrastructure as part of the
Veterans Access, Choice and Accountability Act.
It would appear that there are considerable unknown
variables in this area such as the degree to which the Choice
Program alleviates the workload and resource pressure on VA,
the productivity standards that VA should expect from its
clinical workforce, and the ability for VA to hire medical
professionals in the face of an already large vacancy rate and
a national shortage of healthcare professionals.
I hope to expand on this a bit more during questioning.
Thirdly, I note the 6.5 percent increase for the Veterans
Benefit Administration principally to hire additional staff to
address the workload.
Mr. Secretary, there are several of us on this committee,
the ranking member included, who have long memories on this
issue. We know the disability claims staffing has doubled in
ten years and nearly tripled since I arrived in Congress in
2001. We have invested over a half a billion dollars in VBMS,
millions more in other systems, and we have provided tools to
encourage veterans to file fully developed claims which in turn
enables a quicker decision.
All of these investments were made with a promise that
productivity would markedly improve and shift the department
away from the usual trend of relying on an ever-increasing
workforce and overtime to deal with the workload.
Although I note the production improvement in the backlog
over the last two years, it is a far cry from seeing individual
worker productivity improve given the resources that have
already been provided to the department. Again, this is another
area I hope to address in questioning.
And, finally, a big lesson learned last year is that
veterans are better served with constant and aggressive
oversight. Ms. Brown and I have asked for a larger committee
budget towards that end.
One thing that you and I have talked about is the Office of
Inspector General. I, too, believe that they need an increase
larger than the .3 percent increase provided in the budget. The
proposed amount is not even enough to cover inflationary costs,
let alone the increased oversight we all rely on so heavily.
Again, Mr. Secretary, thank you for what you are doing. I
look forward to your testimony and I look forward to hearing
from the veteran service organizations on the second panel. The
VA system is for them and those they represent, so their input
on budgetary matters is critical in informing the committee and
the Congress on VA's budget request.
[The prepared statement of Chairman Jeff Miller appears in
the Appendix]
And with that, I recognize Ms. Brown for her opening
remarks.
OPENING STATEMENT OF RANKING MEMBER CORRINE BROWN
Ms. Brown. Thank you, Mr. Chairman.
And welcome, Mr. Secretary. I want to say that I am very
happy that you are here this morning and I am looking forward
to hearing how this budget request will meet the needs of our
veterans.
The President has proposed a large increase for VA. For
fiscal 2016, the President has proposed nearly an eight percent
increase in funding for VA healthcare, personnel, construction,
research, and claim processing.
Given this large request, I am looking forward to our
discussion today and how it will assist our work as a committee
to make sure that this proposed budget gives you the dollars
that you need but also assures us how in Congress that every
dollar you receive will be spent wisely.
I certainly wish that my bill, H.R. 216, the Department of
Veterans Affairs Budget Plan and Reform Act of 2015, was the
law of the land. It is an important tool to assist us and you
in matching resources to the needs of our veterans and ensuring
that we are planning for the future to make sure that we don't
let our veterans down.
Mr. Secretary, the first question I will ask is does your
proposed budget give you all of the dollars you need to fix the
problems that you face, meet the goals and initiatives the
department has laid out, keeping in mind that funding provided
by the Choice Act.
I hope that we can discuss whether you have enough
resources to ensure that veterans do not face intolerable
delays in getting access to healthcare. I hope we can discuss
how you are looking down the road to ensure that veterans have
the access to VA care in the future.
I always hear from veterans how they prefer VA care when it
is available. I hope that we are going to all work together to
make sure that healthcare our veterans prefer is available to
them when they need it.
This is the first year that VA benefits programs will be
fully funded under advanced appropriations, how veterans won't
have to worry about what we are doing in Congress, and it won't
affect how we operate.
Finally, I want to hear about your reform and
reorganization efforts and how this budget request will support
these efforts.
I also want to hear about how you are making progress in an
effort to reform and re-energize, invigorate the VA. Too often
all we hear about is the problems VA is having. I would like us
to also consider what we can do to fix those problems and to
point out what VA is getting right.
I am pleased with this budget request and I hope these
dollars can fix what is wrong and strengthen what is right with
the VA.
And with that, Mr. Chairman, I yield back the balance of my
time.
The Chairman. Thank you very much, Ms. Brown.
[The prepared statement of Ranking Member Corrine Brown
appears in the Appendix]
I would like to welcome our first panel to the table this
morning.
Accompanying the Honorable Robert McDonald, Secretary of
the Department of Veterans, is Dr. Carolyn Clancy, Interim
Under Secretary for Health; the Honorable Allison A. Hickey,
Under Secretary for Benefits; Mr. Ronald Walters, Interim Under
Secretary for Memorial Affairs; Ms. Helen Tierney, Executive in
Charge for the Office of Management, and VA Chief Financial
Officer; and Mr. Stephen Warren, Executive in Charge and Chief
Information Officer with the Office of Information and
Technology.
Mr. Secretary, again, thank you for being here and please
proceed with your statement.
STATEMENT OF ROBERT A. MCDONALD, SECRETARY, U.S. DEPARTMENT OF
VETERANS AFFAIRS, ACCOMPANIED BY CAROLYN CLANCY, INTERIM UNDER
SECRETARY FOR HEALTH, U.S. DEPARTMENT OF VETERANS AFFAIRS;
ALLISON A. HICKEY, UNDER SECRETARY FOR BENEFITS, U.S.
DEPARTMENT OF VETERANS AFFAIRS; RONALD E. WALTERS, INTERIM
UNDER SECRETARY FOR MEMORIAL AFFAIRS, U.S. DEPARTMENT OF
VETERANS AFFAIRS; HELEN TIERNEY, EXECUTIVE IN CHARGE FOR THE
OFFICE OF MANAGEMENT, AND VA CHIEF FINANCIAL OFFICER, U.S.
DEPARTMENT OF VETERANS AFFAIRS; STEPHEN WARREN, EXECUTIVE IN
CHARGE AND CHIEF INFORMATION OFFICER, OFFICE OF INFORMATION AND
TECHNOLOGY, U.S. DEPARTMENT OF VETERANS AFFAIRS
STATEMENT OF ROBERT A. MCDONALD
Secretary McDonald. Thank you.
Chairman Miller, Ranking Member Brown, Members of the
committee, thanks for the opportunity to discuss VA's 2016
budget and 2017 advanced appropriations request.
Thank you as well for joining me at 810 Vermont last week
for a groundbreaking town hall meeting.
We deeply appreciate the President's and Congress's
steadfast support for veterans, their families and survivors,
as well as the advocacy of veteran service organizations.
Our Nation is emerging from the longest war in its history.
VA is emerging from one of the most serious crises the
department has ever experienced. We now have before us the
greatest opportunity we have ever had to improve care for
veterans and to build a more efficient and more effective
system. With your support, VA intends to take full advantage of
this remarkable timely opportunity.
Members of this committee and VSOs share my goal to make
the VA a model agency with respect to customer experience and
stewardship of taxpayer resources, an example for other
government agencies.
With efficient and effective operations, we look to be
comparable to the very top private sector businesses. This is
how we best meet the Nation's obligations to all veterans.
The cost of fulfilling those obligations to our veterans
grows and we expect it will continue to grow for the
foreseeable future. We know that services and benefits for
veterans do not peak until roughly four decades after a
conflict ends.
[Chart]
Secretary McDonald. This chart demonstrates the number of
veterans receiving service-connected disability benefits from
World War I peaked in 1958. For World War II, it peaked in
1985. For Korea, it peaked in 1993 and for Vietnam veterans, it
was just last year, 2014, when it peaked.
It is worth remembering that today, almost 150 years after
the Civil War ground to a halt, VA is still providing benefits
to the child of a Civil War veteran. We still have troops in
both Iraq and Afghanistan. And in the last decade, we have
already seen dramatic increases in the demand for benefits and
care.
[Chart]
Secretary McDonald. This chart shows how for 40 years, from
1960 to 2000, the percentage of veterans receiving compensation
from VA was stable at about eight and a half percent. But in
the last 14 years, since 2001, the percentage has dramatically
increased to 19 percent, more than double.
Simultaneously, the number of claims and the number of
medical issues in rating related claims that VA has completed
has soared.
[Chart]
Secretary McDonald. As this chart shows, in 2009, VBA
completed almost 980,000 claims. In fiscal year 2017, we
project we will complete over 1.4 million claims. That is a 47
percent increase. But there has been even more dramatic growth
in the number of medical issues in claims, 2.7 million in 2009
and a projected 5.9 million in 2017. That is a 115 percent
increase over just eight years.
These increases were accompanied by the dramatic rise in
the average degree of disability compensation granted to
veterans. For 45 years, from 1950 to 1995, the average degree
of disability held steady at 30 percent. But since the year
2000, the average degree of disability has risen to 47.7
percent as this chart shows.
[Chart]
Secretary McDonald. So while it is true that the total
number of veterans is declining, the number of those seeking
care and benefits from VA is increasing. Fueled by more than a
decade of war, Agent Orange related disability claims, an
unlimited claims appeal process, increased medical claim
issues, far greater survival rates among those wounded, more
sophisticated methods for identifying and treating veterans'
medical issues, demographic shifts, veterans' demands for
services and benefits has exceeded VA's capacity to meet it.
It is important that Congress and the American people
understand why this is happening. The most important
consideration is that America's veterans are aging. As with any
population, healthcare requirements and the demand for benefits
both increase as veterans age and exit the workforce.
[Chart]
Secretary McDonald. This chart reveals an astounding shift.
In 1975, the year I graduated from West Point, just 40 years
ago, only 2.2 million American veterans were 65 years old or
older, 7.5 percent of our veteran population. In 2017 here on
the far left, we expect 9.8 million will be 65 or older or 46
percent of veterans. That is 7.5 percent to 46 percent, an
astounding increase.
So today we serve a population that is older with more
chronic conditions and less able to afford private sector care.
We predict that benefits for veterans of recent conflicts will
peak around 2055 if we assume that Afghanistan and Iraq are
winding down this year.
And it is fair to imagine that Members of Congress, the
President, and the secretary of Veterans Affairs in 2175 will
be debating resources that will in part help care for the
family members of Iraq and Afghanistan veterans.
Currently 11 million of the 22 million veterans in this
country are registered, enrolled, or use at least one VA
benefit or service. Veterans are demanding more VA services
than ever before. The number of all veterans who are seeking VA
medical care is steadily growing.
The requirement for women veterans, a very important issue
for us, and mental health, another very important issue for us,
have increased dramatically. Over 635,000 women veterans are
now enrolled in VA healthcare and over 400,000 actively use VA
for care. That is double the number using VA care in the year
2000.
We see annual increases in women veterans seeking care of
about nine percent and this trend will continue and probably
even go higher. Our women veteran call center now connects with
over 100,000 women veterans per year.
Over 1.4 million veterans with a mental health diagnosis
are enrolled in VA, an increase of 64 percent from the year
2015. There were approximately 19.6 million mental health
outpatient encounters in 2014. That is an increase of 72
percent from 2005.
Since its inception in 2007 through 2014, the veterans'
crisis line has answered over 1.6 million calls and assisted in
over 45,000 rescues. Over one million veterans received
services through the primary care mental health integration
program begun in 2007 through November 2014. The annual number
of encounters has grown from about 182,000 in fiscal year 2008
to over one million in 2014.
As veterans witness the results of the positive changes VA
is making and regain trust in the VA and as the military
simultaneously downsizes, the number of veterans choosing VA
services will continue to rise. It should and our veterans have
earned it.
We are listening hard to what veterans, Congress,
employees, VSOs, and other stakeholders are telling us. And
what we hear drive us to a historic, unprecedented department-
wide transformation changing VA's culture and making the
veteran the center of everything that we do.
That transformation we call MyVA because that is the way we
want veterans to think about VA. It is theirs. It is
personalized. It is customized. And this transformation entails
many organizational reforms to better unify the department's
efforts.
MyVA focuses on five objectives, which I have shown here on
the bottom. First is improving the veteran experience so that
every veteran has a seamless, integrated, and responsive
customer service experience every single time.
Second, improving the employee experience and eliminating
barriers to customer service to achieve people excellence so
employees can better serve veterans. We have no hope of taking
care of veterans if we don't take care of the employees of VA.
Third, improving our internal support systems and services.
Fourth, establishing a culture of continuous improvement so
local levels can identify and correct problems more immediately
and then replicate proven solutions across our entire network.
And, fifth, enhancing strategic partnerships. MyVA
revolutionizes VA's culture and reorients the department around
the needs of veterans, measuring success by veterans' outcomes
as opposed to some kind of internal metrics.
We intend every veteran to have a seamless, integrated, and
responsive customer service experience every single time.
Reorganizing the department geographically is a first
substantial and important step in achieving this goal.
In the past, VA had nine disjointed geographic organization
structures, one for each line of business. So imagine a
business with nine different businesses, nine different sub-
businesses each having a different organization structure and a
different middle management.
Our new unified organizational framework has one national
structure as shown in this chart.
[Chart]
Secretary McDonald. This new structure has just five
regions aligning VA's disparate organization boundaries into a
single framework. This facilitates internal coordination and
collaboration among business lines, creates opportunities for
integration at a much lower level, and promotes effective
customer service. Veterans will see one VA rather than
individual disconnected organizations.
Last, MyVA is also about ensuring VA is a sound steward of
taxpayer dollars. We will integrate Lean Six Sigma systems and
efficiencies across our operations to ensure we balance
veteran-centric service with operational efficiency, but we
need the help of Congress.
VA cannot be a sound steward of the taxpayers' resources
with the asset portfolio that we are currently carrying. No
business would carry such a portfolio. Veterans deserve much
better. It is time to close the VA's old substandard and
underutilized infrastructure.
Nine hundred VA facilities are over 90 years old and more
than 1,300 are over 70 years old. VA currently has 336
buildings that are vacant or less than 50 percent occupied.
That is 10.5 million square feet of excess, which costs us an
estimated $24 million a year to maintain. These funds could be
used to hire roughly 200 registered nurses for a year or to pay
for 144 primary care visits for veterans or to support 41,900
days of nursing home care for veterans in community living
centers.
We need your support to do the harder right rather than the
easier wrong. These MyVA reforms will take time, but over the
long term, they will enable us to better provide veterans the
services and benefits they have earned and that our Nation
promised them.
Our 2016 budget will allow us to continue this critical
transformation to meet the intent of MyVA. The 2016 budget for
VA requests $168.8 billion, $73.5 billion in discretionary
funds and $95.3 billion in mandatory funds for benefit
programs.
The discretionary request is an increase of $5.2 billion or
7.5 percent above the 2015 enacted level and it provides the
resources necessary to continue to serving the growing number
of veterans who have selflessly served our Nation. The budget
will increase access to medical care and benefits for veterans.
It will address infrastructure challenges including major and
minor construction, modernization and renovation. It will end
the backlog of claims and veterans' homelessness by the end of
calendar year 2015. It will fund medical and prosthetics
research and it will address the IT infrastructure and
modernization.
We know this is a large request, but it is not sufficient
to meet all the requirements for either 2016 or 2017.
Therefore, the President will transmit a legislative proposal
to allow flexibility as necessary to reallocate, if needed, a
portion of the Veterans Choice Act funds to improve VA
operations within a fiscally responsible, budget-neutral
approach to best care for veterans.
[Chart]
Secretary McDonald. As this chart demonstrates, this
proposal is largely driven by our uncertainty of what resources
we need to fund the new Veterans Choice Program. It is
difficult to predict veterans' use of the program or its
interaction with the medical care base budget because it is all
new.
We have no long-term data to draw upon yet. Our current
estimates of demand range from a low of about $4 billion to a
high of about $13 billion over the three-year program. We want
and need the flexibility to move resources if veterans decide
to stay inside VA rather than move outside VA.
This is about ensuring every veteran receives the care they
have earned and deserve regardless of where they choose to get
it from.
Mr. Chairman, Members of the committee, we meet today at a
historically important time for VA and the Nation. March will
mark the 150th anniversary of President Lincoln's solemn
promise to those who had fought the most devastating war in our
country's history. He promised that we would care for those who
shall have borne the battle and for their families and their
survivors.
That is VA's primary mission. It is our only mission. It is
the noblest mission supporting the greatest clients of any
agency in the country, and we count on your support to uphold
that sacred commitment.
Thank you again for your unwavering support for veterans,
for working with us on these budget requests, and for making
things better for all of our great Nation's veterans. We look
forward to your questions.
[The prepared statement of Robert A. McDonald appears in
the Appendix]
The Chairman. Thank you very much, Mr. Secretary, for
your----
Secretary McDonald. Thank you, sir.
The Chairman [continuing]. Testimony. And as we approach
President Lincoln's birthday tomorrow, we are ever mindful of
his commitment to the veterans of this Nation and our
responsibility as a Congress and as an administration.
Can you tell me a little bit about how the $15 billion that
was appropriated last year in addition to the budget, how that
is accounted for in this budget?
Secretary McDonald. Well, sir, as you know, that money gets
obligated only when veterans use the program. So, so far in
terms of Veterans Choice Program, we have had nearly a half a
million calls from veterans about the program, veterans and
providers. So far, we have had roughly 24,000 veterans make
appointments on the program and go outside. So we obligate that
money as it is.
Also, we are in the process of leasing 27 new facilities
and that work is already underway. And we are using the money
to hire more doctors, more medical professionals. We have a net
new increase of over 8,000 medical professionals. That is in
the last nine months. November was our biggest month of hiring.
We hired over 2,000 more medical professionals than we lost.
Our turnover rate is about eight percent, 8.9 percent. The
turnover rate in the industry is about 18 percent, so we are
trying everything we can do to retain the medical professionals
and hire those that we need.
Let me ask Helen. Is there anything I missed, Helen?
Ms. Tierney. Thank you.
Yes, we did have a shift of just over $500 million where we
think the costs will shift to the Choice Program.
The Chairman. Yeah. Could you explain that a little bit
further? I know there was a telephone conference with staff,
but talk about the shift.
Ms. Tierney. So understanding the program is still very
new, we thought that some of the costs that we normally see in
the Fee Program would be picked up by the Choice Program. Right
now, though, our actual results are we are seeing much more
demand for the Fee Program on the VA side of the budget.
The Chairman. Yeah. I would say that is a critical
component to knowing whether this request is adequate or not.
That is why the hesitance to do anything, Mr. Secretary, with
the Choice piece.
Again, we arrived at the 40-mile criteria because we wanted
to have zero. Any veteran out there had a choice. That number
came back from CBO at about 50 billion. We couldn't do that, so
that is where the 40 got.
But there has to be some savings, I would suspect, that are
derived by alleviating some of the pressure within the system
by those that are going outside because of the Choice Program.
Ms. Tierney. And we are going to be looking at that very
carefully. What we also don't understand is what level of
suppressed demand that we had from veterans who did want to use
the services who weren't using the services because of long
wait times, distance. So there is still a lot to understand
about Choice.
Secretary McDonald. Mr. Chairman, I don't know that now is
the time to make a move of any funds. What I am trying to do is
sensitize the committee to the fact that there is a lot of
uncertainty. And in our budget, we have roughly 70 line items
where we have inflexibility. We can't move money from one line
item to another.
And what I am asking is that we work together to have
flexibility so no matter where a veteran goes, we can move the
appropriate money there and make sure that veteran receives
care.
The Chairman. I will commit to helping you have
flexibility, Mr. Secretary, in just about everywhere within
your agency except within that Choice piece because of the
uncertainty that is there. That is what is interesting about
this budget request.
You talk about, Ms. Tierney, about all the uncertainty that
is out there, yet we are asking for increases in FTEs. We are
asking for increases in dollar amounts.
Let me get back real quick. I have got one other question
and then I need to give it to Ms. Brown.
One of the things that I think a lot of us have asked, I
know the physicians on this committee have asked over and over
again, have never really gotten an answer, it is twofold,
number one, how much does it cost for a veteran to be seen
within the VA versus the private sector? The private sector,
Mr. Secretary, you know could answer that right away. We have a
hard time answering that within the department. And then the
other issue is, do we know whether the clinical workforce is
operating at its maximum capacity and efficiency based on the
workload that is out there? There has just been a lot of
anecdotal evidence that has been presented to this committee
that would say that it is not, that physicians are seeing as
few as two patients a day which is just absolutely unheard of.
Dr. Clancy.
Secretary McDonald. Let me ask Dr. Clancy to comment on
that. But before she does, let me say that, as you know, my
first trip was to Phoenix. And when I arrived in Phoenix, I
discovered we were short 1,000 people and each primary care
doctor had one clinical room. And in the private sector today,
a primary care doctor has three clinical rooms.
So we have an issue of both staffing, which the committee
helped with the Choice Act, but we also have an issue on
infrastructure. It is an old infrastructure. We have got women
veterans and we don't have the clinical rooms that are
currently the situation today.
In Boston, I would visit operating rooms where operating
rooms are 35 percent smaller than they need to be. If you have
an operating room which is 90 years old, they didn't use robots
or computers in operating rooms 90 years ago. We need that
equipment today to be able to provide our veterans the best
operating surgery that we can possibly do.
Dr. Clancy.
Dr. Clancy. Yes. So just on the productivity issue which I
think is incredibly important, we have a tool, and we have
discussed this and briefed Representative Wenstrup, called
SPARC where facilities can look at the productivity of
different types of clinics understanding that it is both about
what the clinician is doing about the space issues that
Secretary McDonald just mentioned and also about the efficiency
and capabilities of the people around them who are supporting
those needs.
That tool has been deployed system wide. We are right now
examining some of the data quality issues and very importantly
are having that externally reviewed. So we would be happy to
come back and brief you in more depth.
We think it is a good tool. At this point, it is more
diagnostic than it is kind of in a place where we could give
people grades, for example, but we also want to make sure that
some of the best and brightest minds have taken a look at it,
have kicked the tires and so forth so that we are confident as
we measure productivity.
And I just want to reinforce what the secretary just said a
minute ago. Some of our clinics, some of the better clinics, it
would bring tears to your eyes in terms of how well they are
doing, but they are really, really landlocked. One room almost
feels like a gift much less the two or three that you would see
in the private sector.
The Chairman. Ms. Brown.
Ms. Brown. Thank you, Mr. Chairman.
Before I begin my questions, Mr. Secretary, I understand
that you were down in Orlando last Wednesday meeting with the
Nurses Association. Can you give us an update of how that went?
And also you made an announcement about the opening of a
hospital in Orlando. Can you give us an update on that also?
Secretary McDonald. Yes, ma'am.
I was in Orlando. I spoke to the American Nurses
Association and I was there to tell them about how exciting it
would be to work in VA today. And just like you and the
chairman went with me to the medical schools in Florida to
recruit, we were recruiting. We picked up quite a few people
who were interested in coming to work for VA.
The VA is the largest employer of nurses in the country and
it is important. Our nurses are very important to us and they
do a great job. So that is why I was there.
Separately I did visit the Orlando hospital, Orlando
Medical Center. There are now patients being seen. We are in
the process of moving in. We expect to have a commemoration
ceremony of sorts by Memorial Day.
But between now and then, there will be new clinics being
set up every single week there. It is a fantastic facility and
I think the citizens of Orlando and the area of Florida will
really enjoy going there.
Ms. Brown. Thank you.
Dr. Clancy, it is a lot of discussion on this committee
about, you know, we have doctors on this committee and they
talk about the duties and responsibilities. It is a little
different working with the VA because what we expect of the VA
physicians is a little more comprehensive.
When a person goes in, let's say I am going into the
podiatrist, but they can't just go in and deal with a
podiatrist. It is comprehensive. I mean, it is the blood
pressure. It is a whole different casework.
Can you explain that to us?
Dr. Clancy. So we believe that primary care and care for
the whole veteran, if you will, is really the foundation of the
system. So for the most part, we don't have people just coming
in for podiatry or for a hearing aid, for example, a very
popular use of our facilities, without also checking some of
their other risks to their health and so forth.
We are taking a very, very hard look because our two
overarching goals for this year are getting access right,
whether it is within our facilities, whether it is virtually by
telehealth or something like that, fee care, or with the Choice
Program, that all of that is seamless, and our equally high
second goal is exceptional veteran experience.
We recognize that some veterans actually might choose to
simply come in for podiatry and skip the rest. So we are going
to be looking at different options for doing that by way of
maximizing efficiency and, frankly, making the veteran
experience very satisfactory.
But in general, we have an incredible opportunity because
of the entirety of the department to actually have an impact on
health that no other healthcare system has because a lot of
things affect health besides medical care. That is income. It
is education. It is whether you have a place to live and so
forth.
And the department has tools through VBA and so forth to
actually address all of those needs. So we take that very, very
seriously.
Ms. Brown. The last question I have, what are we doing
working with the Department of Defense as veterans transition
to make it seamless and, you know, the bumps in the road?
I just met a veteran who has been out two years and only
ten percent disability. But the point is he can't get his
paperwork from DoD. What are we doing? And we have asked this
question for years.
Secretary McDonald. It is a great question. I have to say
that Secretary Hagel and I are totally aligned that we want to
have a seamless handoff from the Department of Defense to VA.
That is why we have instituted programs like TAP while the
person is on active duty.
Maybe I will ask Allison to talk about that.
Ms. Hickey. So, Congresswoman Brown, some good news to
report on this front, though it didn't obviously help that
particular veteran two years ago.
We are actively engaged now in the mandatory TAP Program
for all of our separating servicemembers including national
guard and reserve for which there are now nearly a million who
qualify for benefits that did not previously.
Another thing that is starting literally right now is the
mandatory separation health assessment. The choice to the
veteran told at the TAP session is that if you are going to
make a claim to VA for anything, then VA will do a complete
separation health assessment on you top to bottom before you
leave service so that we capture absolutely everything service
connected right there on the spot.
The next thing I will tell you is we have moved
substantially forward with DoD on the new Haines System where
they give us the complete service treatment record, all the
parts and pieces we have talked about before that we used to
call the gold standard.
For a while there, the numbers of late ones were really
high, but they have come down to now about 21 percent of them
are overdue. So they are getting better and we are getting them
faster. And we have built all the IT connections now such that
we simply note in VBMS that we have got a claim. The system
tells the DoD system we are asking for the records and then the
records come back automatically into VBMS and are instantly
loaded up into our VBMS system for the raters to do it. That
has helped substantially.
The last thing I will share with you that we have also done
is we have reduced substantially those folks waiting in the
IDES process and now are getting much better in our timeliness
in the IDES process.
And I can tell you also that the Benefits at Discharge
Program, the backlog has been reduced by a significant amount.
There is only about five or ten percent of those who are now
over 125 days.
Ms. Brown. Thank you very much.
And I yield back the balance of my time.
The Chairman. Mr. Secretary, I just want to read a text
that I just got from a friend of mine. Said had a reason to
deal with the VA in Jacksonville this morning on a home we just
finished for a veteran. A guy named X handled my request and
was very efficient and friendly. I left the conversation warm
and complete. Very good experience. Never had that before.
Thank you.
Secretary McDonald. Mr. Chairman, may I get the name so I
can send a note of recognition?
The Chairman. Yes, you may.
Secretary McDonald. No, I am serious. I do that.
The Chairman. Unsolicited. It just came in while I am
sitting here.
Secretary McDonald. As you know, I have given out my cell
phone number publicly and nationally and I get about 120
contacts a day. And right now I would say 30, 35 percent are
positive. That is not enough. All of us sitting here at this
table want 100 percent of those to be positive and we are
working on it.
The Chairman. You bet ya. I will be glad to provide you his
name.
Ms. Brown. Mr. Chairman.
The Chairman. Yes, ma'am.
Ms. Brown. You did say Jacksonville.
The Chairman. Yeah, I did.
Ms. Brown. All right.
The Chairman. Maybe that is why they never had a good
experience before.
Mr. Lamborn.
Mr. Lamborn. Thank you, Mr. Chairman.
And thank you for being here, Secretary McDonald.
I am pleased to see that you have focused a portion of your
budget on construction efforts. Can you tell me the status of
the southern Colorado National Cemetery Project and when you
anticipate that they will begin accepting earlier burials? I am
very concerned that this project stays on track.
Secretary McDonald. We are as well. We are in the design
phase right now and we think that design phase will take about
a year, year and a half.
Ron, would you like to provide more detail?
Mr. Walters. Yes.
Congressman Lamborn, as you know, we have made progress,
significant progress on establishing the cemetery in southern
Colorado. We acquired the 374 acres at Rolling Hills Ranch in
El Paso County. We do have sufficient funds in the budget right
now to complete the design, complete it through construction
documents, the final phase of design.
Once that is completed, we will begin the solicitation
phase for construction of phase one. Assuming construction
funds are provided in the next budget cycle and that is, you
know, yet to be determined, we would expect the first burials
to occur sometime in calendar year 2018.
Mr. Lamborn. Well, I am disappointed that the time line
seems to be slipping. I will do everything I can to make sure
that those funds are in the budget and I will work with other
folks to try to achieve that, but it sounds like there has been
some slipping to the right and that is disappointing.
Secretary McDonald. We are going through a complete review
right now of our construction management process. As you know,
Sloan Gibson, the Deputy Secretary, is leading that. And we
have asked the Corps of Engineers help. We have got to find a
way to shorten these time lines that we face. And so we will be
looking at that and obviously any work we can do to accelerate
it, we would like to do.
Mr. Lamborn. And I will work with you if any amendments are
necessary or any other legislative action to help you have the
authority to make faster progress in the future on this or
other projects.
Changing subjects, Secretary McDonald, you mentioned that
there are five proposed regions as opposed to 21 VISNs. I guess
that is more efficient. Does that mean that you will have fewer
personnel doing the same job as before which to me is a
hallmark, a result of more efficiency?
Secretary McDonald. Well, as I said in my remarks, this
organization is focused on productivity improvement. We don't
feel like we can come to you and ask for more money unless we
are demonstrating that we are saving money at the same time.
That is why we have identified the buildings that are empty
that cost us money every year.
Think of nine different geographic maps, each one for a
different line of business, whether it is insurance or
disability----
Mr. Lamborn. And I have one other question, so if you could
just summarize.
Secretary McDonald. Okay. It goes to five regions and we
haven't yet determined how many VISNs we will have, but they
have to fit those five regions.
Mr. Lamborn. Okay.
Secretary McDonald. And we have a team of directors looking
at that now. Everybody is trying to fit into that structure.
The point is there will be more efficiency at the middle
management level.
Mr. Lamborn. Good. And I hope that means fewer people doing
the same job which means less budget dollars going to
personnel.
Secretary McDonald. We are trying to put every budget
dollar we can against the veteran experience----
Mr. Lamborn. Okay. Thank you.
Secretary McDonald [continuing]. Making the veteran
experience better.
Mr. Lamborn. Thank you.
And lastly, I know we have touched on this, but the
transition between DoD and VA, and I have 100,000 veterans in
my district and almost that many dependents and other family
members. And the Military Compensation and Retirement
Modernization Committee has just come out with recommendations.
They have said there needs to be better transition.
You have mentioned some things that you are working on.
That is good to hear, but what can be done in the future, what
could be improved to make that transition better?
Secretary McDonald. We met with that committee throughout
their work. I think they have done some excellent work. Some of
the ideas that Allison mentioned are brand new and before that
committee wrote its report. In fact, when they gave us the
report, we mentioned some of these things and they missed the
report. The report was already in printing.
But this idea of the medical exam before the servicemember
leaves the service, that is the biggest idea. And I think the
problems that we have had in the past we will be able to
resolve with that and also with the way we strengthen the TAP
Program. So I think we are getting better, but we are going to
continue to look and see if there are other things we can do.
Mr. Lamborn. Okay. Thank you so much.
The Chairman. Ms. Titus.
Ms. Titus. Thank you, Mr. Chairman.
Thank you, Mr. Secretary. It is nice to see you again.
Secretary McDonald. Good to see you, ma'am.
Ms. Titus. We appreciate you being here. Before I ask kind
of my general question, I am going to bring up what I always
bring up and that is the Reno office. You know, we have been
without a permanent director for about two years. We are on our
second interim.
I understand they haven't started to recruit yet. But if
you moved it to Las Vegas, it would be a lot easier to recruit
a person to come and take that position. So that is my first
point.
Second, you know, the hospital built in Las Vegas was too
small by the time it was completed because they didn't
anticipate the increased usage. We heard Deputy Secretary Sloan
say they were going to move some resources to help with the
hospital that is out from Denver, I believe it is, Aurora. I
want to be sure that you aren't moving any resources from the
Las Vegas hospital to fix the problem in Aurora. So if we could
just follow-up with that.
Now, my general question is, for the last couple of years,
we have focused on the backlog, fixing that problem and also
problems with our hospitals. So I would like to see us as we
move into the next two years look at other areas, of benefits
and make the VA more relevant to our 21st century veterans.
And I appreciated the things that you mentioned in your
testimony. One is women, second is LGBT veterans, and third is
the issue of medical marijuana. These are all big issues during
these times. You talked about how many more women veterans you
expect to have, but really what we don't know is what we don't
know.
And the Women Veterans Task Force recommended two positions
that are data gathering positions so we can get a better handle
on this, a performance analyst and a demographics and research
analyst. So I would like to know if the VA is making those two
positions a priority and if we have your commitment that those
would be positions that would be funded and utilized.
Second, I would ask you, Mr. Secretary, if you would commit
to whether you think the law needs to be changed that prevents
the VA from giving LGBT veterans the same benefits that other
veterans get. They earned them. They deserve them. They just
happen to live in the wrong state. I don't think that is fair.
And, third, with the medical marijuana, as more and more
states are legalizing medical marijuana, VA doctors aren't able
to make any kind of recommendations concerning that. I wonder
how VA policy might be moving to address that issue.
Secretary McDonald. Thank you for the questions.
First on women, I took down a painting in my office that
had probably been on the wall since Omar Bradley was the
administrator of VA and I put up a poster that says women in
the military. And it has a picture of a woman in service in
each branch of the military. And I did that on purpose because
this is going to be a defining issue for those of us leading
the VA right now.
You already heard that our buildings are old. We need space
to be able to create the women's clinics. We just opened a
women's clinic here in Washington, DC, at our facility. I would
encourage you to go see it. It is a beautiful clinic, but it is
different than where the men would want to go.
Ms. Titus. Yes.
Secretary McDonald. And, of course, the care is different
because we have gynecologists and other kinds of care. So this
is a very important issue for us and we are working very hard
to identify where can we put women's clinics with women care.
We just got a building from DoD in Fort McPherson, Georgia,
where we have set up a women's clinic. This is a very big issue
for us and we are going to stay after it.
Relative to LGBT, we are following the law. You know, if
the couple is married in a given state, we will give them
benefits. We need a new interpretation in the law or a change
in the law. We are following the law.
There is an exception to that. In national cemeteries, if
we are able because of the legal authority I have to be able to
bury partners together when they so choose, and in every case
that we have done that, we have looked at the relationship and
we have granted that, so----
Ms. Titus. If I may interrupt you. I appreciate that. But
in state cemeteries, it still remains a problem as I understand
it.
Secretary McDonald. Yes, ma'am. I don't control those.
Ms. Titus. Yeah. But they get funding from the VA, the
state----
Secretary McDonald. Some. Some.
Ms. Titus [continuing]. Veteran cemeteries.
Secretary McDonald. Some.
On the medical marijuana, let me ask Dr. Clancy to comment.
Dr. Clancy. Sure. So a fair number of our clinicians have
veterans who use marijuana, I will put it medically in quotes.
They live in areas where this is legally possible and so forth.
It is very, very early for us to have medical policies, but
there are active discussions going on now and trying to learn
from what we know about treating it for different conditions
which, by the way, are not necessarily identical with those
conditions for which veterans believe that they are helpful.
I actually think that there is an incredible opportunity
for us to learn from some of those experiences, but I think
that we have to be careful given the variation in legal issues.
But we would be happy to provide more detail for the record.
Ms. Titus. Thank you.
Thank you, Mr. Chairman.
The Chairman. Thank you.
I yield to Ms. Brown for 30 seconds.
Ms. Brown. Yeah. On the area of medical marijuana, we have
constantly passed the bill saying that the VA doctors cannot
administer even if the state in the area says it is legal and
they could be charged with a felony. So it passed last year on
the floor. I didn't vote for it. And it is an issue for
Congress. I mean, so if you feel strongly about it, then I
think maybe you should introduce a bill. But as we speak, it is
illegal for a VA doctor to administer marijuana.
Dr. Clancy. Yeah, that is correct, Representative Brown,
and I was not clear enough on that point. That said, again,
trying to be responsive to veterans' experiences and what they
are telling us. We are trying to learn from that and understand
and anticipate what a different future might look like.
Ms. Brown. Oh, absolutely. There are all kinds of
additional kind of therapy, but as we speak now, it is illegal
for a physician to administer it. Am I correct?
Dr. Clancy. [Nonverbal response.]
Ms. Brown. And last year, we passed a bill on the floor
saying it was illegal for a VA physician.
I yield back.
The Chairman. Thank you.
Mr. Bilirakis.
Mr. Bilirakis. Thank you, Mr. Chairman, very much. Thank
you.
First of all, I wanted to thank you, of course, Mr.
Secretary, first of all, for taking the position and being so
accessible to us, but more importantly to our veterans. And,
again, you have made a great deal of progress and we want to
help you make more progress, so thank you for your cooperation
and we are here for you.
First of all, I have some questions with regard to lease
authorizations. First of all, I want to thank you for working
with me to ensure veterans and community stakeholders in my
area are being engaged regarding the Pasco County lease
consolidation located in central Florida.
To ensure the success of its utilization, it is important
that their opinions on potential locations and what specialty
services should be offered are considered. I know you agree.
I am pleased to hear that there will be a potential site
visit. Can you give me an idea of when that might be?
Secretary McDonald. Our staffs are meeting. They met this
morning actually. So I don't know the outcome of that meeting,
but I think it should be imminent, tomorrow or the next day.
Mr. Bilirakis. Thank you.
Again, is there something we can work with you on to
expedite the activation of these leases in general, the leases
in general? I am talking about the 27 leases that were
authorized last year.
Secretary McDonald. Right. As I said, Sloan Gibson, our
Deputy Secretary, is going through a process right now to
understand how can we speed up our ability to design, lease,
construct. And as we go through that, if it looks like there is
an opportunity for legislation, we will come back to you and
ask you for your help. Right now we are not ready for that, but
we are taking a close look at it.
Mr. Bilirakis. All right. My next question has to do with
the future lease authorizations. I understand that there is an
issue between VA and GSA with future lease authorizations, not
the 27 that were authorized last year.
Can you discuss what options are being considered and if
there is enough requested in the budget, should funds for the
full extent of the lease be required? It is so very important
that we plan ahead.
Secretary McDonald. I will start and then maybe Helen can
help.
At one time, over a year ago now, we had a blanket lease
authorization from GSA which would allow us to enter into
leases quickly, easily with our authority. That has been
revoked and it requires us to go to GSA for them to study our
leases. In some cases, if the cost of the lease exceeds, I
think it is $2.85 million, then they actually have to take it
to a committee which takes even more time.
They have been very helpful. We have been working with them
to speed up the process, but we are also trying to see if there
is a totally different way that we can do it. We are applying
Lean Six Sigma technically to see if there is a way we can
improve the process even more.
Helen.
Ms. Tierney. GSA has been working very cooperatively with
us. We are working on getting those processes right and making
sure that we all are working under the same standards for
scoring. So I think that is progressing well right now.
Mr. Bilirakis. Okay. Very good.
Anyone else.
[No response.]
Mr. Bilirakis. Thank you very much.
I do want to discuss with you in the future, Mr. Secretary,
expanding dental healthcare for our veterans within the VA and
some of the clinics.
But I yield back at this time. Thank you, Mr. Chairman.
Secretary McDonald. We would be happy to do that.
Mr. Bilirakis. Thank you.
The Chairman. Ms. Kuster, you are recognized.
Ms. Kuster. Thank you very much, Mr. Chairman.
I want to start by commending you, Secretary McDonald, for
the efforts that your team has done to settle the lawsuit out
in west Los Angeles.
We had a hearing yesterday in the Oversight and
Investigation Committee and we had a discussion about the steps
that will be taken.
A couple of things in follow-up and I will be working with
our subcommittee chair, Mr. Coffman. But one is we want to stay
in very close touch with your team about the plan for the west
LA facility, particularly addressing homelessness of veterans
in west LA, and then we have suggested to have a follow-up
hearing next fall when you come back with your report so that
we can stay closely engaged with that.
Secretary McDonald. We would love to do that. I think what
we demonstrated in west LA more than anything else is this is a
team sport and we all need to play together on the same team.
And it is just silly to think that we have a national issue
with veterans being homeless. And in the city with perhaps the
largest homeless population in the country, we had a lawsuit
going for four years that prohibited us from making progress.
Ms. Kuster. Yeah. And the representative from The American
Legion said it had been 30 years that they have been working on
this problem which obviously goes through a number of
administrations, so----
Secretary McDonald. We got the land in 1880 something.
Ms. Kuster. 1888, yeah. I wanted to go to the opposite end
of the country to my district in New Hampshire and talk briefly
about the Veterans Choice Program. My colleagues in the Senate,
Senator Ayotte and Senator Shaheen, have introduced a bill to
make sure that the Veterans Choice Program, whatever happens
elsewhere, will continue in the states that do not have a full
service VA hospital.
This is critical for us because we have got folks that, and
I know they don't travel the distances that my colleague, Beta
O'Rourke's constitutes travel, but with weather and such
particularly of late, that is important.
Can I ask about how the Veterans Choice Act is working in
those states? And you mentioned briefly about hiring new
physicians and medical personnel for filling the gap. I am
particularly interested in mental health provider and if you
could comment on that, it would be very helpful.
Secretary McDonald. First of all, I want to make sure that
we are clear that the leadership of VA believes that the system
of the future will be a network of both VA and outside care.
Already we, in the last year, we did about 550 million
appointments in outside care. That was up 48 percent above a
year ago. So that is even before the Choice Program.
So we are believers in that because that is the way our
veterans will get served the best. It was misinformation. There
was never intent to either gut the Choice Program or somehow
eliminate the Choice Program. It was simply I was asking for
recognition that we have 70 line items of budget that we can't
move money from.
Imagine your household. You have a checking account for
gasoline. You have a checking account for groceries. The price
of gasoline goes down by half. You are hungry, but you can't
move the money from the gasoline account to the food account.
Well, that is the situation I face. I am trying to serve
veterans and I don't have the flexibility to do that. I ran a
relatively large business. You know, it is very hard to achieve
customer satisfaction when you have all these strictures and
restrictions on how you can take care of customers. So that was
the only point I was making.
The Choice Program is a good program. It is very early
days. As I said, we have had nearly 500,000 calls and about
24,000 appointments, but we are going to be watching it very
closely every single day and we will let you know what we see.
Ms. Kuster. Yeah. Again, that is something that I would
assume the Oversight Committee would want to stay in close
contact.
Secretary McDonald. We invited over, and I will make this
invitation to everyone, we invited over Congresswoman Brown,
Chairman Miller. They came over. They went through our daily--
we have something we call a daily standup. It is a Lean Six
Sigma technique. We review the data from that day and you make
changes to the next day.
Deputy Secretary Gibson leads it. And I would invite any
Member to come over and watch us do that. I would argue that it
might give you confidence in the data that we are giving to you
and you can also see the trend lines.
Ms. Kuster. Thank you very much. My time is expired.
Secretary McDonald. You are welcome. Thank you.
Ms. Kuster. I yield back.
The Chairman. Mr. Coffman.
Mr. Coffman. Thank you, Mr. Chairman.
Mr. Secretary, in the budget submission for the Office of
General Counsel, you list as recent accomplishments, and this
is a quote, ``Defending against complex litigation such as the
construction projects in Orlando and Denver,'' end quote. How
is that a success? You lost that case on every single point.
For the hospital in my district that is hundreds of
millions of dollars over budget and years behind schedule and
the only way the construction could continue was that the
general contractor demanded that the VA construction management
personnel be kicked off the project and that the Army Corps of
Engineers come in and take over the project.
And so, you know, I think that is just characteristic of
your glossing over the extraordinary problems confronted by
your department. This is a department mired in bureaucratic
incompetence and corruption.
And I have got to tell you I think the public relations is
great today, but there is no substance. There is no substance.
And I----
Secretary McDonald. I am highly offended by your comments,
Mr. Coffman.
Mr. Coffman. Let me finish first because I fundamentally
believe that as unfortunate as it is that at the end of the
day, at the end of this President's term that you will not have
made a difference in changing the culture of this organization
by virtue of the fact that you continue to gloss over its
problems.
Secretary McDonald. I am offended by your comment.
Actually, I have been here six months. You have been here
longer than I have. If there is a problem in Denver, I think
you own it more than I do.
I found it ironic that when I went out to LA to solve a
four-year-old lawsuit, you were busy calling for a hearing to
discover what happened five years ago. I am working on the
future, sir, and I am going to correct the past. But I am
working on the future because that is what our veterans want.
Mr. Coffman. For you to say that you are going to the Army
Corps of Engineers to advise you as to how to correct the
extraordinary problems, let me tell you I think what you need
to do is focus on providing the healthcare benefits and the
other benefits that veterans have earned and get out of that
construction management business and to cede it to the Army
Corps of Engineers.
Secretary McDonald. We know that is your point of view
and----
Mr. Coffman. Each major construction project is hundreds of
millions of dollars over budget and years behind schedule. That
is a problem.
Secretary McDonald. I think we work very closely with the
Corps of Engineers. General Bostick is a good friend. He has
also been very helpful. He has told us he does not want total
responsibility for all of VA's construction.
We are going to work with him. We are going to find out the
right balance of that. We are doing it in Denver, as you know,
and we appreciate your help to get that building finished and
get it finished for a good value for taxpayers.
Mr. Coffman. I hope you can make a difference. I hope you
can.
Secretary McDonald. I would just say maybe if you want, I
will give you my cell phone tonight and you can answer some of
the calls and see if I am making a difference for veterans and
see what they say or go on the Web sites, see what the veterans
are saying on the Web sites. Ask the VSOs in the next group.
Mr. Coffman. The fundamental challenge----
Secretary McDonald. I run a large company, sir.
Mr. Coffman. The fundamental challenge is for this
organization to reflect your values and I am not sure that that
is going to happen. And I hope that it does.
Secretary McDonald. I want your help to do that.
Mr. Coffman. Mr. Chairman, I yield back.
Secretary McDonald. I need your help.
The Chairman. Thank you, Mr. Secretary.
Mr. O'Rourke.
Mr. O'Rourke. Thank you, Mr. Chairman.
Mr. Secretary, let me begin by thanking you for your
service. I have only been in Congress a little over two years.
But in that short time, I really feel that you personally have
set a new bar for leadership and accountability and
responsibility for the problems that you encountered that you
are turning around and, in fact, facing the future so that we
build a better VA and do better for the veterans whom we serve.
Case in point, two days after the tragic murder of Dr.
Fjordbak in El Paso, Texas, you were there on the ground
meeting with VA leadership, the incredible staff that works
under Mr. Dancy. You, in fact, ensured that we had Mr. Dancy
there to begin with. You replaced leadership and ensured that
we had someone there who could be transformational and that is
what we need in El Paso right now. So I want to thank you for
that.
I also want to thank you for your willingness to work with
us to do better in El Paso. I mean, again, no need to focus on
the past. We are not a top-tier performer. We want to be and I
want to figure out how we are going to do that.
To some of the points that Mr. Coffman just raised and a,
you know, six or eight hundred million dollar facility now
projected to be $1.1 billion or 1.4 at the high end, we can't
do that anymore.
In El Paso, we have partners like Texas Tech and the four-
year medical school there, University Medical Center, the
public hospital, private providers, Tenet and ACA, all of whom
are desperate to work with us.
I would like your commitment that we are going to in the
short time that we know that you have within this
administration, 22 months, put together a plan and get it to a
point where it is unstoppable so that should we be lucky enough
to have you as secretary in the next administration or your
successor will be able to work with us to implement that.
Can I have that commitment from you publicly to work with
me on that?
Secretary McDonald. As you and I talked when we were there
and we went to the Texas Tech site, what we want to do in El
Paso is exactly what we did in Los Angeles which was we got
everybody together. We looked at all the options and we are
going to make the decision together. We are going to work
together to get this done.
This is a team sport. We can't do it by ourselves and we
know that. And so I look forward to working with Texas Tech. I
look forward to talking to Department of the Army because, as
you know, currently our facility is connected to Beaumont, but
Beaumont is closing. But, yes, we will work together to develop
a plan for El Paso.
Mr. O'Rourke. Thank you.
And I also want to thank you for the presentation you made
at the outset of this meeting. I think you placed our current
problems in context. And they, not all of them, some of them
originate in the VA, but the wars that we choose to engage in,
and you mentioned that, you know, hopefully we are at the
conclusion of our commitment in Afghanistan and Iraq and we are
going to peak in terms of commitments to those veterans in
2055.
I would argue the point that we are still at war in
Afghanistan. We have 10,000 servicemembers there whose lives
are on the line. The NATO commander says expect more U.S.
casualties. We are about to consider an authorization for the
use of military force in Iraq and Syria. We are and have been
in a state of perpetual war and there is a cost to that beyond
sending the servicemember over, funding the assets that follow
him or her. It is the cost to care for them and their family
and their children when they return.
And I just hope that we are all keeping that in mind as we
go forward. There is a much larger cost than the immediate one
that we consider.
The Veterans Choice Act passed this August included a
component to assess VA healthcare processes and it was supposed
to be an independent assessment.
What do you have in this 2016 budget that would fund
implementing the findings from those assessments, if any? And I
don't know when that assessment is supposed to conclude.
Dr. Clancy. Thank you, Representative O'Rourke.
As you said, the Choice Act actually has required a number
of assessments which, frankly, we think are an incredible gift.
I last weekend spoke to a Blue Ribbon panel that they have
assembled who will take a look across all of the assessments.
They will be finished their work by this August and are working
very, very hard, weekends, evenings, whatever they need to make
sure that that happens. And they are looking at all aspects of
our operations.
Mr. O'Rourke. You have dollars in this budget to implement
the recommendations that are made?
Dr. Clancy. I don't think that we have explicit dollars. I
think what we have is we expect that this will be a core part
of management and how we do business. And we are providing them
with all of the data that they need to actually make the
recommendations as actionable and relevant to VA as possible.
So we are very much looking forward to those.
Mr. O'Rourke. Okay. My time is expired, but I would love to
follow-up with you on that----
Dr. Clancy. Great.
Mr. O'Rourke [continuing]. To find out what that might
cost. Thank you.
Thank you, Mr. Chair.
The Chairman. Dr. Wenstrup.
Dr. Wenstrup. Thank you, Mr. Chairman.
And thank you all for being here today.
If I may, I am going to go back to something I touched on
briefly the last time that we met and that is what we actually
spend for the care that is delivered.
And I had asked about knowing the number of how many RVUs
per year does the VA generate with their caregivers, the
relative value units. And that is a common term used both in
private sector and in the VA, and then what the total cost is.
And then by total cost, I don't mean just what the doctor is
getting paid, but you are including everything, administration,
physical plant.
And Mr. Gibson said, oh, we are a long way from coming up
with that number. And my question is, how do you come up with a
budget if you can't say what that number is today? So how much
did we spend on everything to do with healthcare per RVU that
was generated?
And so I am curious why we can't come up with that number
for one because I wonder sometimes when we look at Choice, are
we really determining is it more cost effective and a patient
benefit in some regions to refer out rather than build out, you
know?
And because the cost per RVU to the outside doc is pretty
easily defined. You know what you paid that doctor, but that
doctor is then paying for their physical plant and their staff
and their malpractice and all those other expenditures. So that
is pretty well defined, but we are not being realistic if we
don't look at the overall picture of what we are spending per
RVU.
So if you could comment to those issues.
Secretary McDonald. As Sloan said, that is a system we have
to develop. We are in the process of doing that. It is not
perfected yet. The numbers aren't as valuable yet.
The department has had a history of working to a budget. It
has not worked to a demand or to a customer focus. As a result
of that, Congress would provide a budget and that is what the
department would work toward. That budget would be allocated
throughout the department.
So we are actually, contrary to what Congressman Coffman
thinks, we are actually making some relatively large changes
here to focus the organization on the customer and to be able
to get that data.
Dr. Clancy can talk about the process of doing that, but
this is a big undertaking.
Dr. Wenstrup. So if we know what the budget is for all the
health administration costs and what that is, can't that give
us something to start with? In other words, I feel like we need
a baseline. We can start to look at that more closely at
different facilities as we project out.
I am looking down the road, you know. I am here for the
same reason I think you are, is to make a difference and to
make good decisions, but we have got to come up with those
numbers because you can't decide if Choice is working better or
worse and effectively, especially when it comes to the dollars.
Secretary McDonald. Yeah.
Dr. Clancy. Thank you.
That is part of the independent assessments that we will be
getting as well. One of the wild cards here that I am sure you
are quite familiar with in terms of comparing how efficient and
productive we are, cost per RVU versus the private sector is
that there is a big difference in terms of fixed costs versus
variable costs.
If you have got a building where you have to keep a
cafeteria running and all that kind of stuff, that is the point
that was in the overall opening statement from Secretary
McDonald. In the private sector, they have got a lot more
flexibility.
But we will be looking at that very, very hard because as
we look to a future where, as Secretary McDonald said a few
minutes ago, it is going to be both about what we provide in VA
as well as what we send out to community partners through non-
VA or fee care and Choice and so forth or something like it
possibly with a different name.
We have got to be very, very smart and as strategic as
possible about make or buy decisions and----
Dr. Wenstrup. Well, I look forward to seeing those types of
numbers because that has got to be our guide----
Dr. Clancy. Yes.
Dr. Wenstrup [continuing]. As we try to decide what is best
for the veteran and the VA itself as we go down the road.
Dr. Clancy. Absolutely. And those answers are probably
going to be different in some communities than in others
depending on local capacity and so forth.
Dr. Wenstrup. Sure. No, I think you do have to evaluate
locally, but you can start with what it is in the big picture--
--
Dr. Clancy. Yes.
Dr. Wenstrup [continuing]. And then take a look locally,
because every place is going to have a little different demand
based on VA population, et cetera. So I look forward to working
with you on that and, thank you, I yield back.
Dr. Clancy. Great.
The Chairman. Mr. McNerney.
Mr. McNerney. Well, thank you, Mr. Chairman.
Hey, I am really glad to be back on the committee. I was
here for three terms starting with the 110th Congress. It is a
pleasure to be back.
I want to thank you, Mr. Secretary and the Under
Secretaries for your dedication. This is an enormous challenge,
as you pointed out in your opening remarks. A lot more service
is required, a lot more veterans seeks help and so on. So, I
think we are making progress, but there is still a long ways to
go.
My first question will go to Ms. Hickey, who I have had
that lot of dealings with in the past. I would like to just
give a brief update on the backlog, specifically focusing on
some of the California ROs who had such a problem a few years
ago, and please kind of be brief, if you would.
Ms. Hickey. Absolutely. So let me just start, for all of
you, the backlog is down nationally sixty-two percent and we
are on target to hit our 2015 goal.
Our productivity is up 25 percent, per FTE. We are
producing now, at the claim's perspective, 47 percent more than
we did before we started this transformation effort; a 101
percent from a claims--from a medical issues' perspective.
Our quality, we have not traded for; in fact, it is up
eight percentage points at the claim level at 91 percent, and
at the medical issue level, it is now up at 96 percent.
What I will tell you--a non-rating, by the way, we have not
put off non-rating; we just have a lot of it, it is volume, it
is need. When we do more regular, you know, first-time claims,
it opens the door to more follow-on non-rating opportunity for
our veterans. So, by exactly, when we did record breaking,
never done in our history before, at 1.32 million claims last
year, and as you saw on the chart, the disability level is now
on average at 47.7 percent, you have a wider opportunity for
many more veterans to get that additional benefit as well.
Oakland, since we last saw you here in the room--glad to
have you back, Congressman--phenomenally much better. Their
backlog is down 67.3 percent. Their quality is up at 90 percent
on issue basis and they are doing much better than they were.
They also have done much better on the mail issues, which we
are doing nationally, so I thank this whole Committee, both now
for the funds that you have invested in centralized mail. We
are really starting to see the benefit of that, moving mail
timeliness down from 32 days down to eight days; that is a
phenomenal saving to our veteran, in getting that mail
associated with that client.
Mr. McNerney. Okay. Well, you know President Reagan had a
saying, ``Trust, but verify.'' I am really glad to hear these
numbers, and you know that we are going to be looking into them
to be sure.
Ms. Hickey. Absolutely.
Mr. McNerney. Thank you.
The next question goes to Mr. Secretary. Following up on
Mr. Bilirakis' questioning, I would like you to comment a
little bit on meeting construction challenges. You said in
almost a quote that the VA is not ready for legislative help on
this issue. But I would like to see if you think private
partnerships would be beneficial in moving forward with the
construction backlog or where do you stand on that sort of
issue?
Secretary McDonald. First of all, as I said in my remarks,
on my VA, strategic partnerships is one of the five planks.
This is a really big deal. Historically, VA has not had as many
strategic partnerships as had been possible, and one of the
first things I found as secretary is I had a lot of people
willing to offer help that we did not accept.
So we set up an office of strategic partnerships. We have
somebody leading it. They came from the private sector. We are
hoping to making good progress there.
Secondly, relative to construction, a lot of changes have
been made over the years, probably since the last time you were
on the committee. Number one, originally, a lot of the times,
the design was done by architects. Engineers have now been
added to the design committee and there is a whole design
committee now that reviews it.
Many of the structures that we are building now, frankly,
as an engineer--I am an engineer--I would not have built,
because they are architects' dreams, but they are very
expensive and they will be very expensive to operate.
Secondly, we have looked at that entire process. We are
training, do a better job of training the project managers. We
will implementing GAO recommendations, about how to make the
process more efficient. So there are a number of steps being
taken.
As Congressman Coffman said, we are now also working with
the Corps of Engineers and we have asked them to do a complete
review for us from A to Z of our process and see if we can
improve it, as well as what part of the process could they help
us in.
Mr. McNerney. Well, thank you.
On a parochial issue, in the French Camp Project there is
been some temporary structures put up, but some of the basic
requirements such as disability-accessible bathrooms have not
been met yet, even though the project has been up there for
more than year.
Can I get your commitment to take strong action to make
sure that those basic requirements are met, sir?
Secretary McDonald. We will get into that.
Mr. McNerney. Thank you, Mr. Secretary.
Secretary McDonald. Thank you.
The Chairman. Dr. Abraham.
Mr. Abraham. Mr. Secretary, first, if you for your effort
and your attitude, and that of your staff, for trying to help
our veterans, as great as they are.
Two quick questions. One, on the--we have hit this before
on some of the electronic health record issues, the VA budget
states, and I will quote this, ``In addition to VistA
improvements, the VHA 2016 investment supports our commitment
to achieve interoperability with the Department of Defense
electronic health record and community health care providers,
including those who are participating in the new Veterans
Choice Program.''
My question is this: With a 136 percent increase in EHRs
and VistA funding from fiscal year 2015 to 2016, and given your
stated emphasis on making seamless transition possible, can we
now expect to see third-party administrators and non-VA
providers get access to these systems?
Secretary McDonald. Let me talk on the high level and then
I will ask Steph to talk about specifics.
Mr. Abraham. Okay.
Secretary McDonald. I believe that the electronic medical
record that will win in the future will be a record which is
open-source, free to everyone----
Mr. Abraham. Right.
Secretary McDonald [continuing]. As well as crowd-sourced
in terms of the innovation. Crowd-sourced innovation occurs in
a much more rapid pace than any company with protect their own
innovation rate. So our record is open-source. It is crowd-
sourced in terms of innovations. We get innovations back--I was
at the AMA convention talking about the importance of private
sector providers using our record so we could do a really warm
handoff of our veterans to the private sector and back under
the Choice Program.
Mr. Abraham. Is that working pretty good, the warm handoff?
Secretary McDonald. It is early days. It is early days. But
we have more work to do to make sure that the veteran's record
is there when they get there and to make sure that we get the
annotations back from the doctor in the private sector who
works on them, and that is part of the work that we are doing.
Mr. Abraham. You know, heretofore, some of the private
providers were getting the veteran's health records, but it was
the entire record and sometimes it was hundreds and maybe even
thousands of pages----
Secretary McDonald. Yes.
Mr. Abraham [continuing]. Whereas that provider only needed
maybe the last discharge summary, and it would have taken two
to three hours to get through that stack.
So we need something certainly more seamless, certainly
more efficient----
Secretary McDonald. Yes.
Mr. Abraham [continuing]. For the outside Choice providers.
Secretary McDonald. In a sense, the good news is that we
need that interoperability too, with DoD, too.
Mr. Abraham. Right.
Secretary McDonald. So we need the interoperability back
and we need it forward, and Steph can talk about the steps that
we are taking.
Mr. Warren. Thank you, Mr. Secretary.
If I could submit for the record, actually, four charts
that walk through what is the sharing that we are doing today?
[Chart]
The Chairman. Yes.
Mr. Warren. And it includes sharing with third-party
providers. So we have 31 partners, UC Davis Medical Systems in
terms of where we are sharing data already. There also is a way
of sending the email as--or sending the information to the
third-party provider as an email.
The other piece that we are doing, to recognize your point
about, we would send the full medical record.
Mr. Abraham. Right.
Mr. Warren. We are taking the Janus Viewer which shows a VA
record and the DoD record together and we are going through and
modifying it so we can actually provide that to the third-party
provider. So when we send the veteran out for that third-party
care or through Choice, we are able to send a URL. The provider
can click on the URL and the record comes up.
Mr. Abraham. Do you have a timeline when this might--is
this going to happen within six months? Twelve months?
Mr. Warren. Again, these documents are what is happening
now. It will give you the record in terms of using the existing
systems. The one where we are sending the provider a link so
they can look at, we are about a year away.
Mr. Abraham. Okay.
Mr. Warren. Because we need to make sure when we do it--we
have a Choice issue with respect to veterans opting in to us
sharing that information to somebody outside of the system, and
that is one of the systems that we are working through
programatically.
So, the technology piece, the team is looking at it. We are
using the viewer that we deployed last year to add in the
capability out to third-party providers.
Mr. Abraham. Okay. My second question real quickly, because
my time is limited, going back to the efficiency of the
providers, whether it be a physician, a PA or an NP, and I
understand the limitation of space being one or two exam rooms,
but even with that, is there a measurement for a provider on a
daily basis that we can access or you can access and give it to
us that shows how many patients they are seeing a day? Like
Chairman Miller said, two patients a day, even with one exactly
room is not anywhere close to being acceptable. As a physician,
I know what one exam room can see during a day. And I
understand the complications that VA patients have, as having
multiple-organ system issues, so can you address that, please?
Mr. Warren. The answer is and I will let Carolyn talk about
it.
Dr. Clancy. So, the great news, and as a few of you got to
see last weekend, the secretary invited anyone else who wants
to come, we literally go over these data every single morning,
so it is much more visible how many patients per day providers
are seeing. Understand that some of our providers are also
teaching or doing research and so forth, but we have to be as
transparent about all aspects of that as possible. So this
entire exercise not only gives us close to realtime
information--and we post this publicly every two weeks, in
terms of----
Mr. Abraham. Are we doing anything with the information?
Dr. Clancy. Yes.
Mr. Abraham. Are we incentivizing or maybe--and punishment
is the wrong term--but if that physician or that provider is
not pushing himself a little bit, are you guys pushing him or
her a little bit more?
Dr. Clancy. I think the word would be ``motivating.''
Mr. Abraham. That would probably be a better word.
Dr. Clancy. Yes. Yes.
Secretary McDonald. Given the issues on access, that is not
a problem. Everybody is looking at this data locally and
regionally and nationally because of our issues on access.
Mr. Abraham. Okay. Thank you.
The Chairman. Mr. Walz.
Mr. Walz. Thank you, Mr. Chairman and Ranking Member, and
thank you for the opportunity to be back on this committee. It
truly is one of the greatest honors that I have experienced in
my life.
Mr. Secretary, thank you for being here for numerous
reasons. I say thank you as a veteran. I am glad to know you
are there and that means a lot.
I think this room, when I look around, I mean back here, is
filled with some of the most honorable, patriotic and
professional people I know, at this table, those behind you,
the VSOs, members here. I have to say it is certainly somewhat
objective, but over the last year we have had difficult
conversations, all of us, and we have worked closely together.
They were difficult because all of us understood the
implications of our actions impacted veterans, and if it was
Phoenix or wherever--but trying to find solutions.
And I can say from my experience, and I think it is the one
that you are hearing here, the professionalism and the
willingness to fix this amongst this team has been greatly
gratifying, and I say again, maybe subjectively, but it feels
to me like for the first time in a while, the Department has
its feet back under it. That this idea of moving towards
solutions--and it is not that we will ever going to stop having
accountability of where we are going to stop, whether it is
problems as they bring up, but trying to find those solutions.
So I, for one, accept that and I believe that your
challenge is right; we all are in this together. We have
responsibilities to get this. And when we bring up these
things, these parochial issues, those are the things that our
constituents are talking about. Those are the things.
But I go back to what you said, Mr. Secretary, I do believe
this is a unique opportunity for transformational change, and
this window will close over a certain amount of time, just the
nature of politics and everything else that goes with it, so I
think we need to seize on it. The feeling I have gotten is that
there is a desire.
And I can tell you from the folks that work out there--and
I just came from a meeting with a group of your fantastic VA
nurses and they are committed. They want to get this right.
Their morale is--I care about that, because if we freeze their
pay and we hammer them and we tell them that the VA is not
working, they know that is not true in the cases where they are
out there on every case. So I think when we hear from them, I
hear this feedback, I hear from the different groups and we try
to get it right.
And I just wanted to go on, on this providing solution
things, that I think there are new ideas out there. I think
this new model is starting to get there and I want to tie it
all together. When I first got here eight years ago, the first
thing I worked on was VHA's pain management issue, and this
comes back to me again and again, mainly because it ties in on
so many levels of veterans care, especially mental healthcare.
And I think it is timely in that yesterday we signed in and
tomorrow it will be signed by the President, the Clay Hunt Bill
which is--we recognize one step. I recognize the incredible
work that is already being done at VA, but I think it might be
a new way at looking at this, a new approach, and it ties in
with, again, why we bring these solutions and why we want to
interact with you is, is the Tomah situation with the opiates.
These are all connected. And I agree with you, if I had been
here eight years and Tomah's in my area of operation, I own
some of that, and I get that.
So what I ask is, when we provide and we move forward on
something like Clay Hunt, if we figure out a new model on how
that Act is going to--and before we wait for it to run its
course, we correct and self-correct. So I know it is a--I am
throwing it out to you because I, for one, have bought into
your vision of transformation. I, for one, want to be that
partner and I, for one, want to make sure that I didn't pass a
piece of legislation that added more to your plate and didn't
improve the care of veterans.
Secretary McDonald. We are very much in favor of the Clay
Hunt act or the SAV Act, as it is called. We partnered with
everybody who wants to do it. We are very much in favor of it.
I had the opportunity to be on the Charlie Rose show last
night with the writer of American Sniper with the leader of
Team Rubicon, and I talked about the fact that we at VA are the
canary in the coal mine for American medicine. We see things
because of the battlefields that our veterans go on way before
the American public. Mental health is a big issue in this
country. Any veteran committing suicide is disastrous.
And the work that you have done on the Clay Hunt Act, it
gives us more residencies. It gives us the ability to pay back
student loans. The average medical school student is graduating
with about $185,000 in debt. The Care Act moved it--we can
repay from $60,000 to $120,000. This is $30,000, additionally.
I am working hard to try to get more residencies for mental
health and to get greater throughput for mental health.
But of those 22 veterans who we estimate commit suicide
today, 17 of them aren't committed to the VA, aren't connected
to the VA.
Mr. Walz. That's right.
Secretary McDonald. So one of the things I am working on is
how do we get more people connected, because we do have
treatments for post-traumatic stress. We do know how to
alleviate it, and we just need to get those people connected.
So we are working very, very hard on that.
Mr. Walz. Well, to all of you, again, I am thankful, and
thank you for working as partners in this, and as I said, they
are difficult conversations because our veterans are counting
on us to have those difficult conversations.
I yield back.
The Chairman. Ms. Radewagen.
Ms. Radewagen. Thank you, Mr. Chairman.
Mr. Secretary, I first want to thank you for the
opportunity to have breakfast last week and share with you the
concerns of some of our American Samoan veterans, who, because
of our geographic and economic isolation, don't share in all
the benefits that they are entitled to. And I want to thank you
for presenting me with the seal, the beautiful seal of the
Department.
Our veterans, who make up ten percent of our entire
population, have issues that are basic and comparatively small,
but they are generally taken for granted, here in the States.
In a nutshell, they need a cemetery. We have no map flights. We
need access to better health care. Our local hospital has no
CAT scan, no cancer specialists, so our veterans must always
seek care off-island.
ObamaCare, most of our veterans do not understand. Our
troop store is always out of merchandise and there is always
complaining as to why it is that we don't get merchandise and
services provided to the PXs off-island.
Our veterans have difficulty getting their medical records
to even apply for benefits.
But, Mr. Secretary, what I would like to ask you is: The
VA's budget submission has identified an expected increase in
claims receipts for fiscal year 2015 at $1.3 million and fiscal
year 2016 at $1.4 million. These figures represent an increase
of 17 and 20 percent, respectively, over the 1.14 million
claims received in 2014.
Can you please explain what factors and information you
considered in determining the anticipated volumes of claims
receipts for these two years?
Ms. Hickey. Congressman [sic], absolutely.
Let me just tell you that the largest portion of that is
not going to be the brand-new veteran who is now leaving
service, transitioning to us; it is going to be the fact that
we have done so many veterans claims, 1.32 million, and every
veteran is entitled to come back for any supplemental claim,
which, by the way, is about 67 percent of our workload, meaning
it is the majority of our workload is not our original claim,
it is the, it has been aggravated, it got worse, and so as a
result, you can come back and get another one. That growth
largely attributed to the increased expectation for
supplemental claims, and that is where the majority of it is.
Ms. Radewagen. Thank you, Mr. Chairman.
Secretary McDonald. Ma'am, I would like to--if we can, I
would like to bring our leadership over and sit down with you
and go through all the issues on Samoa and see if we can help
and fix it. We care very much about every veteran and we care
about those in Samoa.
Ms. Radewagen. That would be great, Mr. Secretary.
Secretary McDonald. We would love to do that.
Ms. Radewagen. Thank you, Mr. Chairman.
The Chairman. Ms. Brownley.
Ms. Brownley. Thank you, Mr. Chairman.
And, Mr. Secretary, I, too, want to thank you for your
extraordinary leadership over the last six months, and I feel
very confident that the rudder of the VA is being repaired and
we certainly--I believe we are on a good trajectory for really
righting the ship, and I really want to thank you for that
leadership. And I want to thank you also for today's
presentation and the analysis in the presentation, because I do
think it absolutely demonstrates what the challenges are within
the VA, both in the short and the long-term, and the fact that
all of the challenges that we all must, collectively, tackle
for our veterans. So thank you very, very much for that.
I appreciate the meeting that we had in our office last
week and I was very excited to go home this weekend and talk to
my veterans in Ventura County and to let them know an important
milestone has occurred here, including a new clinic in Oxnard
for our veterans. It was quite clear to me that our veterans
were under-served when I was first sworn into Congress, and I
think this clinic will, indeed, right a wrong, and our veterans
will be better served.
And so I just wanted you to speak to that because I wanted
my veterans in Ventura County to hear from you directly your
agreement for the need of this clinic and what you think the
time estimates will be to acquire the lease and build out the
facility. If you could comment on that, I would really
appreciate it.
Secretary McDonald. Well, first of all, I apologized to you
for not visiting Ventura County when I was in Los Angeles. That
was a relatively quick trip and I was there for one reason,
which was to get a settlement with the community and get the
homeless veterans off the streets of skid row in Los Angeles.
But I will come to Ventura county and get together with you and
perhaps this would be a good topic to talk.
As Deputy Secretary Gibson goes through and looks at our
construction leasing process, I am hoping that the kind of time
we have seen in the past to get something like Oxnard going
will be shortened, and we will work together with you on that.
Right now I don't have any estimates, but we will get together
with you and we will work on that, and I want to meet the needs
of the veterans in Ventura County.
Ms. Brownley. Very good.
And just as a follow-up, could you just describe, briefly,
what the process will be in terms of--are stakeholders, are
veterans being included in this process?
Secretary McDonald. Absolutely. Absolutely.
Just like I have done everywhere else I have gone, I bring
together all of the stakeholders, members of Congress, veteran
service organizations, mayors. Because as I said earlier, and I
really do mean this, this really is a team sport.
And, particularly, in the case of homelessness as an
example, we can't do the right thing unless--we can have all
the HUD house vouchers we want, but if there is not a landlord
in the City of Los Angeles willing to rent at that rate, we are
still going to have a homeless veteran. So, for me, what we did
in Los Angeles is going to be a prototype of what I hope to do
everywhere else in the country, which is VA can be the
lightning rod to call the community together with the local
mayor and work to improve the situation. In this case, we will
work with you on the Oxnard facility.
Ms. Brownley. Thank you very much.
And I think we are making progress on the VHA side, and I
think there is more progress to be done on the benefits side.
This year is 2015. I was just curious to ask--we set an
ambitious goal, your predecessor set an ambitious goal in terms
of the backlog--just your comments in terms of meeting that
goal?
Secretary McDonald. As Allison said earlier, we think the
goal is doable, so we are not changing the goal. But one thing
that is really clear is we do need more people. Even though the
productivity is up, the inflow is so great, the inflow has
grown so much and the repetitive appeals has created a workload
issue, that we have had to work mandatory overtime. Mandatory
overtime is a prescription for disaster with a workforce--I do
have some experience leading large organizations--and as a
result of that, we have got to get more people or find either
further productivity improvements, which we are working on.
But going to the entire digital record has been a big, big
improvement, and one of the nice things about it is we don't
need any more space. We can hire additional people and all the
space that used to be taken up with paper can now be people
working on digital files.
Ms. Hickey. In fact, Congresswoman, I want to thank the
entire committee for increasing VBA's budget. We would not have
been able to accomplish this without the support of this
committee and every person on it.
You saw the growth in the requirement from 2000, so thank
you, Chairman, and thank you Ranking Member for being here long
enough to really see us through that growth. I really
appreciate that.
But one of the things I wanted to tell you is there is a
savings implication to this, we are not yet ready to be able to
realize because we have got--working through the agreements
with DoD on what we do with half a million cubic feet of paper
we no longer touch, and that is 5,000 tons, and equal to ten
Mt. Everests and 200 Empire State Buildings, just to give you a
visual. We don't touch that anymore. Ninety-five percent of
what we are doing now is in a paperless environment. We are
working with DoD on a solution to get that out of the
buildings. When we do, we have some potential lease savings in
the tune of $30 million a year that we can bring back to you
and say, ``This is what the benefit is by our not needing to
house all of those cabinets and all those things anymore.''
We are already realizing a $2.4 million savings in simply
shipping costs of not moving all that paper around on a regular
basis.
Ms. Brownley. Thank you.
And my time is way out, and I yield back.
The Chairman. Mr. Huelskamp.
Dr. Huelskamp. Thank you, Mr. Chairman.
I appreciate the opportunity to visit with you, Mr.
Secretary, particularly last week, and I would like to ask you
a few questions and discuss the Choice Program, which is very
important to me.
As we discussed last week, my district includes 63
counties; it touches four different VISNs, and that creates
some problems. But distance is the main problem and access;
there is no VA hospital in the district. I just had an email
contact from a veteran who drives 340 miles one way for
cardiology. If the VA Choice Program can't provide something
closer for him, then we need to relook at how we are
implementing that.
One thing I would like to ask you, and there is some
concern, particularly with providers, with veterans that are
looking into taking advantage of that, is the fact that it is
only a temporary program. Are you and the Administration
committed to making this a permanent option for our veterans?
Secretary McDonald. As you know, we have had an external
program, and so I think an external program is necessary as we
look forward to a future where the network is both VA care and
outside care. We are also going through an analysis right now--
given the relatively low take rates, but, again, I don't want
to assume that is going to continue, we are talking about how
can we do a better job marketing it, and also, should we look
at that 40 miles and change the interpretation of it, get CBO
to score something differently so we can make sure the program
is robust.
Dr. Huelskamp. And your thoughts on making the Choice
Program permanent, Mr. Secretary?
Secretary McDonald. I am all for it. I am all for whatever
it takes to satisfy veterans, to aid veterans.
Dr. Huelskamp. And I appreciate and thank you for that. I
appreciate the 40-mile discussion, because that creates
problems. If you were in a place, for instance, that a CBOC was
implemented sometime in the last 20 years, all of a sudden,
that keeps you out of the Choice Program. And as I understand,
the interpretation is even if the services aren't provided at
the CBOC, that restricts that access.
So for the gentleman in Dodge City, Kansas, that is asked
to drive to Kansas City, again, 340 miles one way, it is only
because there is a CBOC there and they are never going to
provide the cardiology services that we need. So is that
something that you are willing to look at interpretation or you
are going to require us to pass some changes in the law?
Because I think that can be interpreted that you would have
that flexibility to make that determination.
Secretary McDonald. Actually, it is pretty straightforward
in the law, at least that is what we have heard from CBO and
from others.
But we are going to work on different options. Each option
will have a different estimated price and we will come back to
you and let you know what those options are and together we
will decide what is the best thing to do. I agree with your
point of view that distance from a place you can't get the
service seems like a relatively weak measure, but that is what
has resulted in the current appropriations. So we have got to
work with CBO to score all of those opportunities and decide
together.
Dr. Huelskamp. And I can follow some of that, but as the
crow flies versus as a real person drives, I think that is an
interpretation that can be changed.
But even with the 40 miles that is in the Choice Program,
there is nothing that would prohibit you from using a fee-for-
service approach in this exact same situation, which has
created many of these problems.
Secretary McDonald. Correct.
And that is the marketing that we have to do, too; we have
got to get the word out that that is possible.
Dr. Huelskamp. Well, the word, I think needs to go with the
folks answering the phone at the VA Regional Medical Center,
because that is not what they are told, that you could get your
cardiologist services and drive a hundred miles to Hays, no.
You can go to Wichita, which by the way is only 157 miles, but
he wanted services that were a little bit better, and so they
said you can drive 340 miles when he probably could have gotten
those right in his own hometown.
The answer always should be, Yes, we can, we are going to
look at a way. And if it is not the Choice Program, we have got
the fee-for-service that we should be using--should have been
using all along. And I know it varies if you are in an urban
area, but, again, when I am in a rural area, I actually have 70
community hospitals that are coming to my office and say, Tim,
we would like to serve those veterans and we are not able to.
And the Choice Program, if we can make that permanent and then
expand our understanding of the fee-for-service approach to
that, I think we are going to serve veterans better and give
them access to the care they deserve.
So I appreciate your efforts on that, Mr. Secretary.
Appreciate your commitment to making these programs permanent,
because I think they are critical to making sure that the VA
works long-term, so thank you.
I yield back, Mr. Chairman.
The Chairman. Ms. Rice.
Ms. Rice. Thank you, Mr. Chairman.
So, Mr. Secretary, I wanted--as everyone here has thanked
you, I thank you for spending time with me yesterday. I think
it is incredibly informative, and I, personally--all the brave
men and women that work so hard to protect our freedoms deserve
the help right now. But what they don't--and I know that is
what you are working towards and your whole team is working
towards--but what they don't deserve is a ``knee-jerk, try to
Band-Aid on a gaping wound fix,'' and so I appreciate, as I am
sure everyone on this committee does, the thoughtful way that
you are approaching all of these reforms. Because I think that
they are going to serve the brave men and women that protect us
in the long run.
So I just have a couple quick questions. You mentioned the
22 veterans who commit suicide every day. I think you said 17
of them had not accessed any service within the VA. How are you
going to--and we had spoken briefly about this yesterday--but
how are you going to reach out to them?
Secretary McDonald. There are a number of things we have to
do. Number one, we have to eliminate the stigma in this
country, but it exists across the world, around mental health
care. I am thinking that this is a fortuitous moment in time
because American Sniper, the movie, the largest-selling war
movie, is starting to do that. That is why I went on the
Charlie Rose show last night was to talk about this.
When Congressman O'Rourke and I were together in El Paso--I
will never forget it--we were looking at a private sector
hospital and there was a neon sign at the top of this one
building that said mental health clinic, and there wasn't a car
in the parking lot. And I turned to him at the time and I said,
well, of course, there is not--it wasn't his hospital; it
wasn't our hospital--but, of course, there is not a car in the
parking lot.
What we do is we take our veterans, through the primary
care physician, into the mental health treatment, and as a
result of that, the stigma doesn't exist, and they may not even
know that they are talking to a psychiatrist. So we have got to
get rid of the stigma.
Number two is we have to reach all of the veterans. We have
the ability to put on the TV, a public service campaign that
the Ad Council is working with us pro bono to get people signed
up, but I don't feel, yet, that we are ready for that. That our
capacity is so strained that if we were to get a lot more
people into the system not for mental health, that we might
have issues.
And, third, we have to train the American public. If you
see somebody who you think has an issue--we have an algorithm
or not an algorithm--an acronym called SAV. S is about seeing
and recognizing that the individual may have an issue. We have
a hotline, a 1-800 hotline that you can call to get that person
help and then we go immediately into action.
Those are some of the things we are doing. It is not
everything. The medical exam when you leave DoD is also a big
help, but we have got to get our arms around the 17 veterans
and care for them.
Ms. Rice. Now, I know that there is discussion in terms of
the facilities in California that are vulnerable to
earthquakes. The VA is just outside my district, but I still
claim it as my own, obviously, on behalf of the veterans that
live in my district and have to travel out there.
Superstorm Sandy hit my congressional district harder than
any other place in New York state, and I was wondering if part
of your construction plan included--I mean I understand the
focus on earthquakes in places like California, but in
similarly fragile and vulnerable areas like Long Island, is
there a plan to have some emergency preparedness to prevent
any----
Secretary McDonald. Yes.
Ms. Rice [continuing]. Interruption in services?
Secretary McDonald. When we do our construction management
process, we call it SCIP; it is another acronym. I owe you that
acronym dictionary.
Ms. Rice. We need an encyclopedia of acronyms in
Washington.
Secretary McDonald. But safety is number one, and we
consider seismic and other natural disasters as safety, so that
is always the first priority.
In the case of Sandy, for example, we have a facility near
the Battery, near Battery Park in Lower Manhattan, and it was
devastated. The entire first floor was water. I visited the
facility.
We are now building a wall that can help us keep out higher
levels of water should another storm occur. So express safety
is always number one--and I don't have the specific facts on
the facility in Long Island, but we can get together with you,
and we can go through that.
Ms. Rice. I would appreciate that.
Again, thank you so much, Mr. Secretary and to your entire
team.
Secretary McDonald. You're welcome. Thank you.
Ms. Rice. And I yield back my time.
Thank you, Mr. Chairman.
The Chairman. Dr. Benishek.
Dr. Benishek. Thank you, Mr. Chairman.
Thank you, Secretary Vilsack [sic], for being here with
your team. I think a lot of the members this morning, we asked
a lot of great questions and touched upon a lot of the issues
that I want to talk about. I want to commend Dr. Wenstrup there
for bringing up the costs of care.
And that is something that I am very concerned about, and I
wanted to ask a few more questions about when you think that
you are going to have an idea of when that is going to be or is
this independent review of the VA system, is that going to help
look at that number? Because I know I am very concerned about
it in continuing to implement access to care locally.
Can you just elaborate on that a little bit?
Ms. Hickey. Sure. In addition to the external independent
assessments, which we anticipate will be here around August or
before then, we are also commissioning some internal work,
internal contracts and so forth from some of the leaders in
industry just to figure out how do we get to some of the
questions that you raised in your recent hearing when Dr.
Tuchschmidt presented and so forth.
One of the issues that we struggle with in terms of cost is
this reliance factor, you know, where some veterans use VA for
some of their needs, but they go outside for others. My uncle
recently proudly told me he got his hearing aid, but by and
large, given where he lives, does not actually go to VA for
most of his care; he goes closer to home. So that is part of
the issue that we have got to work through, as well as this
issue of fixed and variable costs.
And, again, I think this is why the secretary raising this
issue of fixed costs that are kind of a drag on the budget in
terms of getting to the issues of access and veteran experience
are so important.
Dr. Benishek. I think that is what Dr. Wenstrup was talking
about, is that, you know, the cost of these half-a-billion-
dollar hospital overruns, that all adds to the costs of taking
care of a patient who walks into the clinic. I just want to
make sure that all of these costs are included in that because
we are supporting a bureaucracy that--are we supporting way too
much of a bureaucracy for the care that we are getting out of
it. I mean that is my concern.
Ms. Hickey. That is a fair question and it is one that----
Dr. Benishek. Let me just ask another question here, and
this is something else that we have talked about in our
subcommittee as well, is this management of pain within the VA.
Because I know it has been over a year that we have talked
about this in my subcommittee and this opioid medication and
the high doses and the number of prescriptions written, and
then this recent troubling incident with the IG in Tomah. What
has been going on in the VA recently to try to address pain
management; is there a better pain management system? Is there
a referral to a pain management specialist?
Tell me a little bit more about what is happening more
recently, and how are we going to put an end to this, you know,
the practice of using opioids on a chronic basis for people
with chronic pain.
Secretary McDonald. I will ask Dr. Clancy to give you the
specifics, but one of the things that I wanted to say at the
beginning is we take this opioid use very, very seriously, and
we track it very closely.
And one of the things that I am very proud of that we do in
the VA that I don't see as much of in the private sector is we
use a lot of alternative approaches, alternative medicines. We
use acupuncture. We use yoga. We have used electronic devices
that have shown to be effective amongst some of our veterans.
Anything we can do to get that veteran off of opioids is
something we want to do. And we are developing quite a broad
array of tools that we can use that allow us to reduce the
opioid use.
Dr. Benishek. Well, I mean that sounds great, Mr.
Secretary, but I think if you look at the numbers of people who
are not on the alternate treatment versus the opioids, you
would find that there are a lot of people on opioids compared
to the number of people that are getting alternate therapies.
Secretary McDonald. There are.
Dr. Benishek. And it is great that you mentioned those
things, but it seems like there should be a lot more people
having access to pain management specialists than are being
treated by their family physician or their primary care
physician with narcotics.
Dr. Clancy. So, really an incredibly important and serious
issue. I think, as you know from your prior hearing--and we,
again, would be happy to brief you in more detail--we actually
track opioid use per facility. Each facility has a dashboard,
and nationwide since we launched this safety initiative, we
have seen the trend line go down, which is a good thing. But we
are also looking at the prescribing patterns of individual
physicians to see--to make sure that an overall positive trend
that is going down isn't masking some practices that we would
consider suboptimal.
We are supporting a lot of research in this area as well,
because the combination of non----
Dr. Benishek. Well, again, that is great, but it is
unfortunate that apparently the situation in Tomah sort of
contradicts what you are saying here today, and we just want to
make sure that we maintain a high vigilance on this problem.
So, I am out of time, but I certainly appreciate your
efforts.
Dr. Clancy. Thank you.
The Chairman. Thank you very much.
Members, Ms. Brown has one final question.
Ms. Brown. Thank you, Mr. Secretary, and thank you for your
service.
I have one question. Just a few minutes ago, the
congressional audit came out, and I don't know whether you have
seen the article, VA health care is at high risk, and I guess
they do this audit every two years. In reading it, it seems
like they were rehashing a lot of the stuff that is going on.
You know, I appreciate you going on television, I just
think we need to respond in our town hall meetings. You know,
we see about seven million people a year that once they get in
the system, they are happy with the service.
So, can you speak to the article that is just coming out
today and whether or not you would be willing to do an updated
piece to USA TODAY, because I think it is important that
veterans are not sidetracked. We are definitely headed in the
right direction.
Secretary McDonald. Yes, ma'am.
I actually met with the comptroller general, and we were
talking about whether or not he should put VA on the high-risk
list. I actually encouraged him to, and the reason I did that
is because we are a healthcare system, and we are going through
a large amount of change right now. And during the time that
any organization goes through a large amount of change, we need
to make sure that we have the appropriate oversight, the
leadership, as well as those responsible for it.
So while I think the VA system is absolutely essential to
American medicine--we train 70 percent of U.S. doctors. We have
developed innovations that are absolutely critical for American
medicine, the first liver transplant, first implantable
pacemaker, nicotine patch, first time bar code is used to
connect patients with medicine. We have got to make sure we
have a robust VA.
And so as we go through this change, I am thankful that you
in your oversight role and others will be helping us get
through this change and develop this robust system that this
country and our veterans need.
Thank you.
Ms. Brown. I want to, again, thank you all for your
service.
The Chairman. Mr. Secretary and everybody at the table,
thank you for being here today. You are excused.
If we could go ahead and have the second panel come to the
table, we need to continue.
I invite the second panel to the table and welcome Mr. Carl
Blake, Associate Executive Director of Government Relations at
Paralyzed Veterans of America who is going to be testifying to
the committee on behalf of the co-authors of the Independent
Budget. Accompanying Mr. Blake is Mr. Joe Violante, National
Legislative Director, DAV; Mr. Ray Kelley, Director, National
Legislative Service, Veterans of Foreign Wars; Ms. Diane
Zumatto, national legislative director, AMVETS, and we are also
going to be having testimony from Mr. Ian de Planque,
Legislative Director, The American Legion.
Mr. Blake, you are now recognized for five minutes.
STATEMENTS OF MR. CARL BLAKE, ASSOCIATE EXECUTIVE DIRECTOR,
GOVERNMENT RELATIONS, PARALYZED VETERANS OF AMERICA, ON BEHALF
OF THE CO--AUTHORS OF THE INDEPENDENT BUDGET, ACCOMPANIED BY
MR. JOSEPH A. VIOLANTE, NATIONAL LEGISLATIVE DIRECTOR, DISABLED
AMERICAN VETERANS; MR. RAY KELLEY, DIRECTOR, NATIONAL
LEGISLATIVE SERVICE, VETERANS OF FOREIGN WARS; MS. DIANE M.
ZUMATTO, NATIONAL LEGISLATIVE DIRECTOR, AMVETS, AND MR. IAN DE
PLANQUE, LEGISLATIVE DIRECTOR, THE AMERICAN LEGION
STATEMENT OF CARL BLAKE
Mr. Blake. Thank you, Mr. Chairman, Members of the
Committee.
On behalf of the co-authors of the Independent Budget
seated here at the table, I would like to thank you for the
opportunity to testify today on the VA's fiscal year 2016 and
2017 budget. I ask that our report, the Independent Budget for
the Department of Veterans Affairs for fiscal year 2016 and
fiscal year 2017, be admitted into the official hearing order.
The Chairman. Without objection.
Mr. Blake. Thank you, Mr. Chairman.
Let me begin by saying we believe this is probably the best
VA budget we have seen in my many years of being up here on the
Hill. That being said, recent media reports have pointed out
that the VA has had hundreds of millions of dollars in unspent
resources carried over in recent years. The IB does not dispute
that fact. In fact, the VA has done a questionable job of
managing the insufficient resources it has been given in the
past. We believe that the access problems and the long waiting
lists identified over the last year clearly affirm that point.
However, we also believe that the VA, prior to this year,
has continuously requested insufficient funds to adequately
provide healthcare and benefit services to veterans. Yes,
Congress has given the Administration virtually everything it
has requested yearly, but that certainly does not mean that the
VA has requested what it truly needs. Perhaps the Office of
Management and Budget would have something to say about this.
This does not mean that the VA should not be properly
scrutinized for what it spends or does not spend; in fact, we
wholeheartedly support this notion. But it should be scrutiny
grounded in facts, not in rhetoric or poorly formulated
assumptions.
The Independent Budget recommendations represent our view
of the actual resource needs of the VA to provide services
across the entire spectrum of programs. Our views are not
clouded by a particular agenda or by politics. Despite the
closeness of our recommendations, the IB is an independent
assessment of the VA budget requirements developed before the
Administration even released this most-recent budget request.
It is not bloated with unnecessary resources and
administrative support. I would call your attention to the
clear differences between our recommendations for such line
items as medical support and compliance, general of
administration and IT to affirm that point. Our recommendations
focus on the areas where service is the linchpin: medical
services, major/minor construction, the Veterans
Administration, the National Cemetery Administration, and other
key areas. A couple of those key areas were recently identified
in our policy agenda that we released back in January. Those
include women veterans programs and Caregiver Support Programs.
We appreciate the emphasis this Committee has put on these two
areas. We certainly appreciate the fact that the Committee held
a hearing back in December to review the Caregiver Support
Program; it is a high priority for many of our members. Those
two issues are particularly critical issues in this year's
Independent Budget.
Clearly, there are wide-ranging opinions about how the VA
manages its capital infrastructure. We have no doubt that VA
construction and contract management has been a disaster. The
only people to suffer the consequences of these failures are
veterans seeking care, particularly in the Denver area. But
none of this changes the fact that the VA has a huge backlog of
valid building projects that are in various stages from initial
planning to near completion.
Nevertheless, we believe the VA has not shown the level or
degree of commitment in its request for resources to get all of
these projects moving in the right direction or to complete
them. We stand with the Committee to resolve these VA
construction management problems and we hope that that will be
done quickly.
Lastly, I would just like to comment on a couple of points
that have been raised here. With regards to the question about
cost for care, we are certainly not experts, but I would
suggest that in all of the briefings I have received about the
VA's Enrollee Health Care Projection Model, that if one wanted
to know how much it cost to do a particular procedure in any
region in the United States, that that model would produce a
number, at least that is what we have been told over the years
when we have been briefed on this.
So what I would expect that if the Committee wanted to know
how much it cost to do a colonoscopy which came up over and
over again in the cost for care hearing, that the VA can
probably produce a number. We appreciate the fact that the VA
is committed to providing better information with regards to
the cost for care. We look forward to having an opportunity to
review that information, as well.
And then lastly, the question about the Choice Program,
which the VA has brought right out into the light of day, I
think the Independent Budget probably agrees with the principle
that the secretary has laid out, that, you know, you shouldn't
be obligated to spend the money you have been given for one
singular purpose. I thought the secretary's analogy he used
about gas versus food is a perfect way to describe the need to
be able to shift money around.
That being said, I'm not sure that we also agree with
taking money from a program right now that is clearly in its
infant stage. I think that program clearly has to be given time
to flush itself out and see what actually occurs. Three months
is certainly not enough time to do a thorough evaluation of
utilization of the Choice Program. So until there has been more
time to really fully evaluate what will happen, I'm not sure
that we fully support what the Administration is requesting.
With that, Mr. Chairman, I would like to thank you again
for the opportunity to testify, and I would be happy to answer
any questions that you or the members of the committee may
have.
[The prepared statement of Carl Blake appears in the
Appendix]
The Chairman. Thank you, Mr. Blake.
Mr. de Planque.
STATEMENT OF IAN de PLANQUE
Mr. de Planque. Good afternoon, Chairman Miller, Ranking
Member Brown, Members of the Committee.
I would also like to thank Secretary McDonald and his staff
for their words today.
I am very fortunate to sit here and speak on behalf of The
American Legion for our National Commander Mike Helm and the
2.4 million members in over 14,000 posts across the country,
who make up the backbone of the world's--the nation's largest
wartime service organization.
We are focused on getting things right, not just for our
over two million members, but for over twenty million members
beyond that who are veterans, people who have worn this. I was
struck by something that Secretary McDonald said earlier today,
``This is a team sport; we can't do it by ourselves.'' I think
everyone agrees that the country owes a great service to the
veterans, that the country owes a lot of things to the
veterans. The country is not just the federal government. The
VA is a piece of that, but I think everyone here, everyone here
at this table, everyone here in this room is also a piece of
that. We all have to work together on this.
I spent two of the last four weekends out at various
grassroots events for The American Legion in Nebraska and
Kansas out there with blue cappers like myself, you know, who
were there, actually out there wanting to go out and go into VA
hospitals and help out in whatever way they can. We had over
7,000 legionnaires donating almost a million hours of volunteer
service to the VA. This only works if we are all on the same
page, if everyone is on the same page.
And, Ranking Member Brown, you mentioned earlier that you
wished H.R. 216 was the law of the land, as an important
resource and tool that would help with that. I think we agree
very much, and I know in the legislative hearing earlier when
it was discussed, I think there was a lot of agreement on both
sides of the aisle on that. We have to be able to look back and
forth and compare these things.
I was speaking with a colleague of mine about VA's
Strategic Capital Investment Plan and whether or not they are
putting enough money into these things. The American Legion
about four years ago was talking about looking at VA's
construction figures. It was going to take them 60 years to
complete the 10-year plan in SCIP if they went forward with
those numbers. But trying to compare the figures together and
what are still there, you are pulling up a budget from one year
and you are trying to hold it next to another--having it all
laid out there, right for you where all stakeholders can
participate in that--I know, Chairman Miller, when that bill
was up in a legislative hearing, you spoke about the importance
of the transparency for it and how you had seen in Armed
Services that they are transparent with that. We need to have
that same kind of transparency with the planning for the VA
budget so we can maximize the resources that everyone is
putting into this.
We have a lot of great organizations. We have a lot of
great veterans who are out there trying to make this a better
system. We believe in a VA system. We believe the Choice card
is important because we have to get access to care for
veterans, but we want to make sure that the veterans still have
access to that system.
It is there because Secretary McDonald talked about the
demand expanding beyond VA's capability to meet that. Well, we
need to make sure the resources are allocated to meet those
demands, but we can't lose sight of the focus that it is the VA
that we want to be needing that. The VA that we want to be the
leader that is pioneering medicine, that is the utmost expert
in so many conditions. You look at a traumatic brain injury,
you look at post-traumatic stress disorder, you look at
amputation injuries, there is no reason that the VA should not
be the world's leading authority on that and we need that to
happen, and that comes from everybody working together, and
that comes from everyone being on the same page.
The American Legion is absolutely devoted to that. We need
to be able to look at these pieces. I think VA's request for an
additional 700, 770 full-time employees to work on the claims
backlog, it is important. I think there is a very good point
that they have been given more staff and that they were
supposed to have been increasing their productivity, but you
can't deny the fact that they have been on mandatory overtime
for four years. Going through four weeks on mandatory overtime
says you might have a little bit of a problem. Going through
four years on mandatory overtime says you might not have enough
people to do that. Now, we don't know exactly how many people
we need in every office, and that is why we all need to be able
to look at these figures on the same page together.
I think working together we can do that. We are very
committed to being a major partner in that and helping to drive
that. We want this system to be the best system that can be for
veterans. I think the Committee has been very generous in
giving budgets to the VA to work with, we just need to keep
everyone working on the same page and I think we can accomplish
that.
Again, I thank you for having The American Legion here to
speak on this. Thank you for having all the veterans' groups to
speak on this, and I look forward to any of your questions.
[The prepared statement of Ian de Planque appears in the
Appendix]
The Chairman. Thank you very much for your testimony. I
would like to ask either of you, if you would, kind of one of
the critical components and probably one of the toughest things
that the secretary is confronted with is going to be closing
outdated, old substandard, or particularly underutilized
facilities. It is not easy politically. It is not easy, as the
secretary has already alluded, but I would like to know if you
feel like that is an important step that the secretary has to
look at.
Mr. Blake. Mr. Chairman, I am going to defer to my
colleague, Crandall Construction, for the IB.
Mr. Kelley. Mr. Chairman, absolutely.
If VA is holding property that it no longer uses or is
underutilized, they need to find out how to get rid of that
property. But in the process of figuring out how to get rid of
it, they also need to have that conversation with the community
to ensure that those veterans understand there are going to be
services still there.
That is the fear in the community, is my hospital is going
away, therefore, my services are going away. They need to
understand that full continuum of care is still going to be in
the community and it is just going to be right-sized for that
community. There is no need to spend three dollars per square
foot to maintain a building that is no longer being used, just
to keep it mothballed.
Mr. de Planque. If I could dovetail onto that, the thing
that comes to mind is Hot Springs which The American Legion has
been very involved in, and that community desperately wants to
keep their medical center. I can absolutely understand if you
have an underutilized building and it is just taking up empty
money that is not serving any veterans in the community. And
certainly there are probably regions where it is just not
effective, but we have to make sure that those veterans are
included as a part of that planning process and that they are
being listened to.
I know there has been a tremendous amount of frustration in
Hot Springs, that the community is adamant, it is vehement, and
it has been organized and has tried to voice its opinion at
every step along the way, that we need this facility here, this
is serving the veterans in this area, and they are very
concerned that that is not being heard.
So, yes, I think that it is important to be able to open up
to some possibilities with that, but let's make sure that we
are also still serving the veterans.
The Chairman. Any other comments?
Mr. Blake. Mr. Chairman, I would only add, too, one thing
we would caution as they make a determination of where
facilities are underutilized or unused, that they be innovative
also. You know, we have talked for years about using some of
these underutilized spaces for the homeless veterans issue.
You know, one of the challenges of homelessness is having
supportive housing that allows them to then transition into
finding a job and being able to sort of become a productive
member of society again. So before they choose to close a
facility, I would hope that they would think outside the box in
some of these areas where these facilities can serve a purpose.
That doesn't mean that some facilities shouldn't just be
closed, especially if they are sitting empty and have been
sitting empty too long.
The Chairman. Mr. Blake, where, specifically, do you think
the administrative costs within VA could be reduced and where
could those funds be reallocated? And, specifically, I guess we
are talking about page 3 in your testimony.
Mr. Blake. Well, I would suggest, Mr. Chairman, from the
perspective of the recommendations we have made, we have sort
of stuck to the same principle over the last couple of years,
that we directed most of our recommendations at the medical
services line where the rubber meets the road for providing
healthcare.
There has been some discussion about plussing up staff like
in the general administration line items, which are a lot of
the offices here in Washington, DC. We have also had some
conversations with the Committee staff on the VHA side about
the administrative costs that exist at the VISN level and
across the various layers that exist within VHA. We were
interested to see the plan to seemingly transition the regional
framework of VA. What we would certainly hope to see--or hate
to see, I should say, is we transition to a five-region
alignment and where we go from 22 VISNs with 125 to 150 staff
to five regions that are just those people shifted into a
regional alignment and you didn't streamline your
administrative support at all.
The Chairman. If I could, the secretary asked Mr. Coffman
to ask a question of the VSOs, and since Mr. Coffman is no
longer here in the room, I will ask the question on behalf of
the secretary: Have you seen a difference in the VA?
Mr. Violante. Mr. Chairman, the fact that the secretary and
his leadership team are still here I think answers that
question. I think we have all been impressed of what he and
Deputy Secretary Sloan Gibson have done in the short time that
they have been here. So I would have to say that, yes, we
appreciate what he is doing and what he is trying to do and
hope that you will work with him to make sure that these
changes happen.
The Chairman. Mr. Kelley.
Mr. Kelley. Yes, we see a difference in spots. There are
going to be areas that are slower to change than other areas,
but we are seeing pockets of improvement.
Just solving the problem in West LA, that land-management
issue in a very short time, something that has been around for
years, is indication that he is hands-on, he is going to get
things done, and he expects people at all levels to do the same
thing.
The Chairman. And if I could--my time has expired, but
could I just get a yes or a no, Mr. Blake?
Mr. Blake. I will give a yes.
The Chairman. Mr. de Planque.
Mr. de Planque. Definitely a yes, and they are starting to
own problems, too, which is a big change.
The Chairman. Ms. Zumatto.
Ms. Zumatto. I would agree with my colleagues.
The Chairman. Okay. Very good. Thank you.
I agree, too. There is a difference, and I would also say
that Ms. Brown's H.R. 216 is scheduled to be marked up
tomorrow, and so we would expect to see that pass very quickly.
Ms. Brown.
Ms. Brown. Thank you.
I would like to associate myself with the remarks of the
gentleman from Florida. I absolutely think there is a change in
VA and it is headed in the positive direction.
And when you talk about VA, I remember going to LA, and we
had four brand new units sitting for over two years that we had
built those units, 400 units, four separate buildings that
stood vacant for two years because we built them, but the State
of California did not have the money to operate it. We have got
to make sure that that does not happen in the future, and I am
very pleased that he was able to go in and resolve those
issues.
For the first time we have forwarding budget in all of the
categories. Can you give me a response as to how you feel about
how this is going to help VA move forward. I just want to hear
from all three.
Mr. Blake. Well, I would say Ms. Brown that, you know, we
offered our support for the legislation at the legislative
hearing a couple of weeks ago. I think Mr. de Planque hit on an
important point, that this would allow for more transparency as
they develop their needs going forward.
I would also suggest that, you know, the secretary--what I
appreciate seeing is I believe this is the first time that I
have seen the VA take serious, this requirement, as part of the
advanced appropriations process. You know, for the last several
years since this was passed, one of our chief complaints has
been that the Congress passes an advance appropriation, as
requested by the VA, and then the next year, there is no real
adjustment or no consideration given to how that should be
adjusted.
And this is certainly the first year that I can remember
where a substantial analysis review and re-estimate for its
need has taken place. So we appreciate the fact that this
leadership team in particular seems to have taken this
requirement far more seriously than in the past.
Mr. de Planque. I also want to note I think the forward
funding, you are not going to have veterans who are worried
about not getting their checks if, for some reason, there is
some friction between the Congress and they can't get a budget
passed. I am not as worried about that immediately, but I mean
that is an important guarantee for them down the road, but I
also think that that planning component that is going along
with your legislation is a critical, like handshake with that
bill. The ability to plan is critical as we are forward-funding
things and to be able to look down the road and see the
anticipated results beyond that. So I think they are kind of
hand in hand with each other and very helpful.
Ms. Brown. One other thing. Let me mention that when I
first came here, we were going through a bright process and, of
course, we support closing some of the VA facilities, but keep
in mind as meant, just as long as you don't close any in
Florida. But that is kind of the mentality of the members of
Congress. So as we work through it, we have to keep in mind it
is a team effort and that those communities need to have input
and involvement as we evolve as to what we want the VA to look
like. Because we are sitting up here saying, This is the right
thing. This is the best thing for the country.
But when we go to some little place in, what, high
springs--Hot Springs?
Mr. de Planque. Hot Springs.
Ms. Brown. Hot Springs.
You know, that community feels that they are going to be
disenfranchised, so the question is: How do we have these other
communities and everybody involved in those decisions?
And don't think that politics doesn't play a part, because
when you get ready to close that, when the senators weigh in
and, you know, some senators say, We don't do that, we are just
interested in what is best for the country. That is not always
the case, as experienced it with brack.
So I want to thank you all for your service and for your
presentation. Any closing remarks? I have thirty seconds.
Mr. Blake. I would say this, Ms. Brown, we have also--it
has been nice to see that some of the folks in central office
have been more open to deal with us on a regular basis. I have
already had two briefings on VHA's model and their cost for
care since the cost for care hearing, which was two weeks ago.
Prior to that, the last hearing or last meeting we had with
VA employees on the healthcare model was back in 2009. So they
are clearly more in tune with the concerns of the Committee,
the concerns we raised and trying to get us more involved in
the discussion so we know what they are doing. Whether we
necessarily wholly support it or not, at least we have a better
idea of where they are going and what they are doing.
Ms. Brown. Well, I feel the same way.
I think I have been over there about four times at 8:00 in
the morning or 7:00-something, and I want to get the entire
committee over there to review like the town hall and the
discussion so that we have a better feel as to what is going on
over there, because I think it is very exciting to have the
employees involved in what we are doing and it is not from top
down, but it is the input of the employees, too. And one-third
of them, I often see are veterans or more.
So, thank you, Mr. Chairman. Thank you for the hearing, and
I yield back the balance of my time.
The Chairman. Thank you very much.
Dr. Abraham.
Mr. Abraham. As a new Congressman and fortunately a new
member of this Committee, I am very honored to be here. And
just six weeks ago I was a practicing physician that was
privileged to see veterans in my clinic. I am jumping up and
down with joy for this Choice Program.
And my question is, on these guys' levels, are you,
Members, are ya'll getting feedback on the implementation of
the Choice? Is it working? Is it fairly seamless? Where does it
stand from ya'll's Members perspectives?
Mr. Kelley. The VFW commissioned a survey through our
membership to get feedback and we are doing a two-part survey.
We cut it off at the beginning of this month, so for a two-
month period. We found that a good portion of veterans who
called for an appointment to VA, when they interacted with VA
to get an appointment, were not told that they had a choice.
But now that we are in the second phase of this survey, we
are finding more of those veterans are understanding that they
have a choice, and VA employees are being educated to provide
that choice. So we are seeing that trend of access go up, but
at the same time, early on, the perception of choice was very
positive or the experience of choice was very positive; there
seems to be a trend that now that it has more people in it,
that there is a slight down-tick in people's opinion of it, of
the care that they received.
It is something that we are going to continue to monitor.
We will have a report very soon that weighs out those
analytics.
Mr. Abraham. Fair enough.
Mr. de Planque. Likewise, I wanted to touch on that
because, again, I just recently talked to a number of people.
One of the biggest earlier concerns was there was a lot of
confusion over whether or not people were eligible. There was a
lot of confusion among the access. I mean we get calls in the
office in DC all the time about this, as well, and so we have
been working hard and I know that VA has been working hard as
well to try and educate better about that.
There is a lot, particularly the 40-mile straight line when
you are in a rural area where the roads aren't that accessible,
the, well, I am close to a clinic, but the clinic doesn't offer
the services I need, as was mentioned I believe by Mr.
Huelskamp in Kansas. You know, when you are driving 340 miles
to get to something. So there was a lot of concern about that
and we have heard a lot of bad feedback from the members.
As far as, you know, whether they want to use the Choice
Program or whether they want to use the VA, it has been mixed.
We have some people that have been very happy with the care
that they got at the VA, they just couldn't get access to it
and they were frustrated by that and they want to get back into
the VA; on the other hand, some people were very excited about
the options of looking out.
So we are continuing to monitor that. The biggest part that
we noticed early on has been a little bit of the confusion
about eligibility, particularly with that sort of 40-mile
circle and whether or not--how that interacted with facilities
that didn't treat the condition they had.
Mr. Abraham. Gotcha.
Mr. Blake. I think the playing field is a little unlevel in
trying to evaluate it right now, too, when you consider that,
one, the VA doesn't have the capacity to meet all the demand as
we see it, and at the same time, we don't know for sure that
the private sector truly has the capacity to meet the demand
that might come from the Choice Program. I think that is a
great unknown.
I think we forget that private healthcare is a business and
they maximize their revenue for their business by not operating
with excess capacity, and so it would stand to reason that when
people try to access the private healthcare system that they
might find challenges. I mean we find challenges using private
insurance now. If I try to get an appointment for specialty
care at George Washington University Hospital right here in
town, it could be six months.
So there are challenges. So the field is not level on the
VA side or the private sector side yet. Until we have had a
little more time to let the program itself even out, allow the
VA to get its footprint more firmly planted by expanding its
capacity, I am not sure that we can do a real thorough
analysis.
Mr. Violante. From DAV's standpoint, we are getting ready
to go out with a survey of our members to see what they are
hearing, and we are not really hearing complaints. There is
some confusion, as has been said, and I get X amount of miles
for beni-travel, but then when I apply for this, they are
telling me that I am not that far away and that is because of
the way the law was written.
But early on, our people were more concerned of being
forced out of the system, thinking that if they lived more than
40 miles away or had to wait longer than 30 days that they
wouldn't be able to come into VA, and that concerned them
greatly.
Mr. Abraham. But that has been dispelled, certainly--that
misinformation has certainly, hopefully been dispelled.
I think what we all envision here is that the veteran, when
he needs primary care, such as a bronchitis--and I don't mean
to minimize a simple bronchitis--he can go maybe to a Choice
doctor, and certainly if he needs specialty, he has the option
to go to any VA facility he wants. We just want it as seamless
for the veteran.
And I guess my question was, are we slowly obtaining that
goal?
Mr. de Planque. I think right now it is a little early and
that is why in terms of making an analysis of what utilization
of the program is, and I understand that the secretary stated
before that, you know, it wasn't so much about what the
utilization was right now, he was kind of trying to give a
warning light that they might need to reappropriate things.
For us, you know, it is a little bit early to make any
decisions about that because people are just starting to get
their feet wet with the program, but it is something that I
know we are, and I know that all the other groups up here are
watching very closely to see how this interacts and how this
works----
Mr. Abraham. Okay. Thank you.
I am out of time. I just wanted to get ya'lls take. Thank
you.
The Chairman. Mr. O'Rourke.
Mr. O'Rourke. Thank you, Mr. Chairman.
Mr. Violante pointed this out earlier, that the secretary
and his team are here, and I really appreciate you saying that.
I just want to make sure that it is noted for the record,
because if we are going to be successful in this team approach,
it is going to take all of us literally being in the same room
and listening to each other. So I thought that was important
that you pointed it out.
I wanted to ask you, any person at the table to respond to
this, that the secretary also mentioned working collaboratively
in terms of how we build and offer medical care, beyond this
question of the Choice Act. An example that we talked about
last week in a hearing was this hospital in Aurora, Colorado,
you know, $604 million now to $1.1 billion, originally supposed
to be affiliated with an academic institution. That affiliation
is broken. I couldn't help but get the sense that veterans in
that area and perhaps VSOs were insistent that that be flagged
solely as a VA facility, and that might have had some cost and
some consequences to that.
What is your openness or what are your thoughts on this
idea of working collaboratively and involving other non-VA
institutions in the provision of healthcare or the development
of facilities or organizing how we deliver that healthcare in a
community like El Paso where I don't know that we need a
hospital--I don't know that we are going to get a $1.1 billion
facility, so we may have to work collaboratively. So, if I
could start with you, Mr. Violante and work rightwards down the
table, I would love to get your response.
Mr. Violante. Sure. We have mixed feelings. I mean we have
seen other facilities, particularly DoD facilities where VA and
DoD have gone in together and sometimes there are problems
because the troops that are stationed there get deployed and
then the services really start lacking. But I think some of the
facilities up in Great Lakes may be working fine with a federal
VA kind of emphasis, so it just depends on the area and how it
is structured.
Mr. Kelley. We have to look at every option. We have to
look at building standalone VA hospitals. We need to look at
public-private partnerships. We need to look at
intergovernmental partnerships. We just have to. It has to be
right-sized and the services need to be in place for veterans.
And so every avenue, not just with university hospital
partnerships, but with county hospitals, with city hospitals. I
think that as they start planning what they are going to
replace for their need, if there is room for VA at that same
campus and it is purchased, it is a co-purchase, it is co-
owned, and services are interoperable, then it is a smart move.
Mr. O'Rourke. To include, you mentioned city, county. To
include private sector, potentially, if there is a capacity and
expertise and a center of excellence in a particular area where
there is a gap in VA care?
Mr. Kelley. Absolutely.
Mr. O'Rourke. Great.
Mr. Blake.
Mr. Blake. I think it would be unreasonable to think that
they shouldn't take advantage of affiliate opportunities and
partnerships if it maximizes opportunity for healthcare. That
being said, you mentioned Aurora, you know, part of the problem
with that over the years was figuring out--I can remember a
time when the vision for that was sort of a joint facility that
had a mix of veteran patients and non-veteran patients,
civilian patients, and you ran into challenges with something
as simple as, you know, identification of two. And then you got
into more complicated issues with like governance and priority
of access and service.
And so you have to be careful when you get into that sort
of concept. The Denver issue is clearly--you know, I think it
is even more unique than the problems that existed in Las Vegas
and New Orleans that are still going on and Orlando. The Denver
project has been going on for 20-plus years now and if nothing
else, veterans are being unsatisfied there because there are
many promises that have been made and still no access to
healthcare there and that is a clearly under-served population.
Mr. O'Rourke. Thank you.
Mr. de Planque. I think it clearly is a team sport. I
think, clearly, it is a country that takes care of veterans,
and we have certainly seen in the past, teaching hospitals
working in conjunction with VA facilities and I think there are
some great partnerships that can be achieved there. Obviously,
the VA has to be the core of that and the taking care of
veterans. There is a reason that a lot of our veterans like to
go to the VA and that is because it is something that
understands them.
But at the same time, if they are going to be innovative,
if they are going to be leading the way, like I was saying, you
know, the leading authorities on TBI, PTSD, et cetera, that is
beginning to involve partnerships. That is going to involve
finding the best people out there, and I think it is absolutely
within their grasp to be able to do that.
Mr. O'Rourke. Thank you.
Mr. Chair, could I have 30 seconds for Ms. Zumatto to
answer? Thank you.
Ms. Zumatto. Thank you.
I would say that while VA certainly has many fine doctors
and experts, they don't corner the market. There are lots of
people in the civilian community who could bring new ideas,
research and other possibilities. So to say that we shouldn't
be considering public-private partnerships I think would be a
serious mistake.
Mr. O'Rourke. Thank you.
Thank you all for your answers and for your work.
The Chairman. Thank you very much.
Ms. Brown, do you have additional comments or questions?
Ms. Brown. No, sir.
Thank you very much for this hearing.
The Chairman. Thank you very much for being here. Thank you
for presenting the Independent Budget; we appreciate that.
Expect questions to the second panel post-hearing questions and
to the first panel. There are some issues that we were not able
to bring up, given the time.
But, Mr. Secretary, thank you, sir, for staying through the
entire budget hearing, and with that, I request that all
Members have five legislative days with which to revise and
extend their remarks.
Without objection, so ordered.
This hearing is adjourned.
[Whereupon, at 1:12 p.m., the committee was adjourned.]
APPENDIX
Prepared Statement of Chairman Jeff Miller
Good morning. This hearing will come to order. We are here to
discuss the President's Fiscal Year 2016 budget request for the
Department of Veterans Affairs (VA). Mr. Secretary, welcome. I
understand that your testimony will be a bit different than what the
Committee is accustomed to, with references to charts to help us better
understand what you're seeing in terms of the challenges ahead. That's
a welcome change. So, too, is the openness that you have had with me,
Members of this Committee and the Congress about your plans to change
the culture at VA.
As your testimony illustrates you've been extremely active in
visiting VA facilities, talking with employees, veterans groups, and
your private sector colleagues with one aim in mind . . . putting
everyone's focus squarely on the needs of veterans. Thank you for your
willingness to take the job of Secretary, and thank you for putting
everything you have in to it.
Turning now to the business of examining the VA budget request, I
see some very positive things but also some areas with considerable
question marks. The Committee's task will be to learn as much as
possible in order to inform our ``Views and Estimates'' letter to the
Budget Committee due next Friday.
On the positive side, Mr. Secretary, you have boldly tackled the
sensitive issue of VA's aging infrastructure. Coupled with a more
realistic budget request for VA's major construction program,
addressing the closure of unsafe, vacant, or underutilized facilities
begins an important conversation about the future alignment of VA's
infrastructure. I have long argued that we needed a strategic
reassessment of VA's construction program. That is, in part, what the
independent assessment and the Veterans Healthcare Commission,
established in last summer's Choice Act, were tasked with examining.
You have my commitment to work with you as this conversation begins in
earnest.
I do have several areas of concern that I hope that you and our
second panel can address.
First, and I will be frank, the proposal to reallocate any portion
of the $10 Billion appropriated for the Veterans Choice Program is a
non-starter. I understand there is a great degree of uncertainty about
the program's utilization. In appropriating the money, the Congress had
to work with the best estimates we had at the time to stretch those
dollars, including limiting eligibility criteria for veterans. If there
is to be any reallocation it will be to further improve and strengthen
the program itself and not to address other, unspecified needs.
Second, the budget requests an additional $1.3 billion for VA
medical care on top of the advance appropriation for Fiscal Year 2016,
bringing the total proposed increase to 7.4%. At a threshold level, I
do not understand how this request interacts with the $15 Billion
Congress provided last summer for non-VA care and infrastructure as
part of the Veterans Access, Choice and Accountability Act. It would
appear that there are considerable unknown variables in this area, such
as the degree to which the Choice Program alleviates workload and
resource pressure on VA, the productivity standards VA should expect
from its clinical workforce, and the ability for VA to hire medical
professionals in the face of an already large vacancy rate and a
national shortage of healthcare professionals. I hope to expand on this
a bit more in questioning.
Third, I note the 6.5% increase for the Veterans Benefits
Administration, principally to hire additional staff to address the
workload. Mr. Secretary, there are several of us on the Committee who
have a long memory on this issue. We know that disability claim
staffing has doubled in 10 years and nearly tripled since when I first
arrived in Congress. We've invested over a half-a-billion dollars in
the VBMS system and millions more in other systems. And we've provided
tools to encourage veterans to file fully- developed claims which, in
turn, enables a quicker decision.
All of these investments were made with the promise that
productivity would markedly improve and shift the department away from
the usual trend of relying on an ever-increasing workforce and overtime
to deal with the workload. Although I note the production improvement
in the backlog over the last two years, it is a far cry from seeing
individual worker productivity improve given the resources that have
already been provided. Again, this is another area I hope to address in
questioning.
Finally, a big lesson learned last year is that veterans are better
served with constant and aggressive oversight. Ms. Brown and I have
asked for a larger Committee budget toward that end. I believe the
Office of Inspector General, too, needs more than a .3% increase. The
proposed amount is not even enough to cover inflationary costs, let
alone the increased oversight we all rely so heavily upon.
Again, I look forward to hearing your testimony, Mr. Secretary. I
also look forward to hearing the views of our VSO panel. The VA system
is for them and those they represent, so their input on budgetary
matters is critical to inform the Committee and the Congress on VA's
budget request.
Prepared Statement of Ranking Member Corrine Brown,
Thank you, Mr. Chairman.
Secretary McDonald, I want to welcome you this morning. I look
forward to hearing how this budget request will meet the needs of our
veterans.
The President has proposed a large increase for VA. For FY 2016 the
President has proposed nearly an 8 percent increase in funding for VA
health care, personnel, construction, research, and claims processors.
Given this large request, I look forward to our discussion today,
and how it will assist our work as a Committee to make sure that this
proposed budget gives you the dollars you need, but also assures us
here in Congress that every dollar you receive will be spent wisely.
I certainly wish that my bill, H.R. 216, the Department of Veterans
Affairs Budget Planning Reform Act of 2015, was the law of the land. It
is an important tool to assist us, and you, in matching resources to
the needs of our veterans and ensuring we are planning for the future
to make sure we don't let down our veterans.
Mr. Secretary, the first question I will ask is does your proposed
budget give you all the dollars you need to fix the problems you face,
meet the goals of the initiatives the Department has laid out?
Keeping in mind the funding provided by the Choice Act, I hope that
we can discuss whether you have enough resources to ensure that
veterans do not face intolerable delays in getting access to health
care. I hope we can discuss how you are looking down the road to ensure
that veterans have access to VA care in the future.
I always hear from my veterans how the prefer VA care when it is
available--I hope that we are going to all work together to make sure
that this health care our veterans prefer is available to them when
they need it.
This is the first year that VA benefit programs are to be funded
under advance appropriations. Now veterans won't have to worry as much
if we here in Congress can't do our job.
Finally, I want to hear about your reform and reorganization
efforts, and how this budget request will support these efforts. I also
want to hear about how you are making progress in your efforts to
reform and reinvigorate the VA.
Too often, all we hear about is the problems VA is having--I would
like us to also consider what we can do to fix these problems and to
point out what VA is getting right.
I am pleased with this budget request, and hope that these dollars
can fix what is wrong and strengthen what is right with the VA.
Thank you Mr. Chairman and I yield back the balance of my time.
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