    [Senate Hearing 118-151]
    [From the U.S. Government Publishing Office]

                                                            S. Hrg. 118-151

                      STRENGTHENING METHODS OF RECRUITMENT
                        AND RETENTION FOR VA'S WORKFORCE

    =======================================================================

                                    HEARING

                                   BEFORE THE

                         COMMITTEE ON VETERANS' AFFAIRS
                              UNITED STATES SENATE

                        ONE HUNDRED EIGHTEENTH CONGRESS

                                 FIRST SESSION

                                   __________

                                 MARCH 22, 2023

                                   __________

           Printed for the use of the Committee on Veterans' Affairs

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

            Available via the World Wide Web: http://www.govinfo.gov

                                   __________

                          U.S. GOVERNMENT PUBLISHING OFFICE

    53-822 PDF                  WASHINGTON : 2023

                     SENATE COMMITTEE ON VETERANS' AFFAIRS

                         Jon Tester, Montana, Chairman
    Patty Murray, Washington             Jerry Moran, Kansas, Ranking
    Bernard Sanders, Vermont                 Member
    Sherrod Brown, Ohio                  John Boozman, Arkansas
    Richard Blumenthal, Connecticut      Bill Cassidy, Louisiana
    Mazie K. Hirono, Hawaii              Mike Rounds, South Dakota
    Joe Manchin III, West Virginia       Thom Tillis, North Carolina
    Kyrsten Sinema, Arizona              Dan Sullivan, Alaska
    Margaret Wood Hassan, New Hampshire  Marsha Blackburn, Tennessee
    Angus S. King, Jr., Maine            Kevin Cramer, North Dakota
                                         Tommy Tuberville, Alabama
                          Tony McClain, Staff Director
                     Jon Towers, Republican Staff Director

                                C O N T E N T S

                                  ----------

                                 March 22, 2023

                                    SENATORS

                                                                       Page
    Tester, Hon. Jon, Chairman, U.S. Senator from Montana............     1
    Moran, Hon. Jerry, Ranking Member, U.S. Senator from Kansas......     2
    Boozman, Hon. John, U.S. Senator from Arkansas...................     8
    Brown, Hon. Sherrod, U.S. Senator from Ohio......................     9
    Tillis, Hon. Thom, U.S. Senator from North Carolina..............    12
    Hassan, Hon. Margaret Wood, U.S. Senator from New Hampshire......    14
    Blackburn, Hon. Marsha, U.S. Senator from Tennessee..............    16
    King, Jr., Hon. Angus S., U.S. Senator from Maine................    17
    Sullivan, Hon. Dan, U.S. Senator from Alaska.....................    19
    Blumenthal, Hon. Richard, U.S. Senator from Connecticut..........    21

                                   WITNESSES

    Tracey Therit, Chief Human Capital Officer, Department of
      Veterans Affairs; accompanied by Jessica Bonjorni, MBA, PMP,
      SPHR, Chief Human Capital Management, Veterans Health
      Administration.................................................     4

                                    APPENDIX
                               Prepared Statement

    Tracey Therit, Chief Human Capital Officer, Department of
      Veterans Affairs...............................................    27

                           Submissions for the Record

    VA Views on S. 10 VA Clinician Appreciation, Recruitment,
      Education, Expansion, and Retention Support (CAREERS) Act of
      2023...........................................................    33

    MilitaryTimes article dated March 21, 2023, titled ``Dept. of
      Veterans Affairs, union spar over staffing''...................    46

                            Questions for the Record

    Department of Veterans Affairs response to questions submitted
      by:

      Hon. Jerry Moran...............................................    53
      Hon. Mazie Hirono..............................................    59
      Hon. Bill Cassidy..............................................    63
      Hon. Kyrsten Sinema............................................    66
      Hon. Tommy Tuberville..........................................    69
      Hon. Angus S. King, Jr.........................................    75

                           Statements for the Record

    Hon. Kyrsten Sinema..............................................    81
    Alzheimer's Association and Alzheimer's Impact Movement (AIM)....    82
    American Federation of Government Employees (AFGE), AFL-CIO......    86
    Irma Westmoreland, RN, on behalf of National Nurses United.......   103

                             STRENGTHENING METHODS
                          OF RECRUITMENT AND RETENTION
                               FOR VA'S WORKFORCE

                                  ----------

                           WEDNESDAY, MARCH 22, 2023

                                           U.S. Senate,
                                Committee on Veterans' Affairs,
                                                        Washington, DC.
        The Committee met, pursuant to notice, at 3 p.m., in Room
    SR-418, Russell Senate Office Building, Hon. Jon Tester,
    Chairman of the Committee, presiding.
        Present: Senators Tester, Brown, Blumenthal, Sinema,
    Hassan, King, Moran, Boozman, Cassidy, Tillis, Sullivan,
    Blackburn, and Tuberville.

                  OPENING STATEMENT OF CHAIRMAN TESTER

        Chairman Tester. I call this hearing to order. Good
    afternoon. Today we are going to be discussing an issue that is
    the backbone of the VA, its workforce, and I want to recognize
    the VA staff for all that you do. Thank you for bringing world-
    class care and benefits to our Nation's veterans and their
    families.
        We do a lot of work up here to expand access to care and
    benefits to veterans through bills like the PACT Act, and we
    often provide funding to build health care facilities in areas
    with growing veteran populations. In my state it would be a
    place like Hamilton, Montana. But the tires are never going to
    hit the road without folks to staff these efforts.
        I look forward to our conversation today about what the
    needs to build and maintain an effective workforce. I think it
    is no secret the VA's lengthy hiring process is one of those
    reasons that we lose qualified candidates. We want to hear from
    the VA on how to improve that.
        During consideration of the PACT Act, it included a number
    of critical workforce-building provision, authored by myself
    and the good Senator from Arkansas, Senator Boozman, to ensure
    that the VA had the staff to meet the needs of these veterans.
    We also included reporting requirements and guardrails to
    ensure these authorities are being properly utilized, because
    we can give you the tools that you want but the VA will never
    be able to compete in a tight labor market if it is not
    aggressively using those tools.
        The Tester-Boozman VA CAREERS Act was built directly on
    feedback from health care providers in Montana and across this
    country on what they need to staff those facilities that help
    our veterans. They might find it difficult, if not impossible,
    to keep up with local salary rates for physicians. This bill
    revamps the senior clinician pay system to more easily keep up
    with market rates, something that is critically important.
        We are giving the VA the tools to be competitive, not just
    in urban markets like L.A. but also markets like the one in my
    backyard, Great Falls, Montana.
        I know that VA's labor partners have brought up some
    concerns about changing the physician pay system. I would say
    this: we hear you and we are working closely to include
    additional guardrails to ensure this provision works as
    intended. But I am going to tell you, with the PACT Act
    implementation underway and a rapidly aging veteran population
    with increasing health care needs, we cannot delay. And for
    those folks out there that think the VA will survive without a
    competitive market for hiring employees, they are wrong. It
    will not survive.
        And so we need to do something about the way we hire folks
    and the amount of compensation we give them, moving forward, or
    the VA, quite frankly, will cease to exist.
        So with that I am going to turn it over to Ranking Member
    Moran for his opening statement.

                   OPENING STATEMENT OF SENATOR MORAN

        Senator Moran. Chairman Tester, thank you. I thank our
    witnesses for joining us here today. I am interested in hearing
    what the VA can do to improve the hiring and retention of its
    workforce to deliver veterans the quality health care and
    benefits they deserve.
        The VA has several legislative proposals to simplify and
    expand the authorities for hiring and setting the pay for
    doctors. The VA has also presented plans to revamp its hiring
    on the onboarding process to shorten the time it takes for new
    providers to begin patient care, and to do so in a way that is
    as painless as possible for the new employees.
        Our Committee heard from professionals and labor
    organizations last week about just how dysfunctional the
    current onboarding process can be. We have also heard from some
    dedicated frontline VHA staff who are working through those
    challenges and implementing best practices at their facilities.
    VA Central Office should incorporate these best practices in
    any revamp of its current process, and it must engage with the
    frontline hiring managers and recruiters to know which hurdles
    need to be addressed. I also want to hear from the VA how much
    more flexibility in hiring and pay-setting authority will
    improve provider quality and reduce instances of substandard
    care.
        I remain concerned about the VA's policies that allow
    physicians with multiple reported cases of substandard care,
    resulting in patient harm, to continue seeing veterans, and in
    some cases, being promoted to supervisor. VA ought to have the
    tools it needs to recruit and retain the very best physicians,
    nurses, and other clinical providers, but having the very best
    means they cannot accept or tolerate providers who repeatedly
    demonstrate an inability to safely treat our Nation's veterans.
        On this topic of making certain that the workforce is
    supporting our veterans, making certain that our workforce is
    top notch, I want to take a moment of my opening remarks to
    comment on the career and service of our Committee's Republican
    staff director, Jon Towers. Jon has had a long, distinguished
    career--Jon, I could do this myself without reading it, but
    your capable staff have given me words in front of me. But Jon
    has had a long and distinguished career working for both the
    Senate and the House VA Committees, but after nearly 26 years
    of service, five different chairmen and ranking members, he
    will be retiring at the end of this month.
        Jon has been a leader and a resource for Senators, House
    members, and their staffs as we have negotiated serious
    challenges over the years. He was directly involved in
    addressing the wait times and the accountability scandals, and
    he provided a steady hand as Congress worked to finally address
    how the VA deals with military toxic exposures.
        I want to say thank you. I do say thank you to Jon for his
    years of dedicated service. I thank also his fiancee, Lindsee,
    and to his entire family for sharing Jon with us as we took on
    important tasks of supporting our Nation's veterans. Most
    veterans who receive VA benefits, use their GI Bill, or access
    quality health care when and where they need, will not know the
    name of Jon Towers, but nevertheless, each of them personally
    benefits from the dedication, the thoughtfulness, and the
    passion that Jon has put into his work here.
        On behalf of those veterans and on behalf of all of the
    members of this Committee and the committees which you have
    helped lead, we say thank you. Thank you for your service to
    our Nation, to our country's veterans. And from a personal
    side, Jon, it was a significant opportunity for me to be a
    better member of this Committee and to be a better chairman or
    ranking member when you arrived, and I am very grateful for all
    your help and the team that you helped assemble as we try to
    make certain that this Committee does its work on behalf of all
    who serve.
        So Mr. Chairman, on behalf of you and my colleagues in the
    Committee, thank you to Jon Towers for his time with us. Thank
    you, Mr. Chairman.
        [Applause.]
        Chairman Tester. I promised myself I would not bring up
    Towers, but since you brought him up----
        Senator Moran. I thought you promised not to cry.
        Chairman Tester. I have been weeping as you have been
    speaking. It was such beautiful words.
        But I just want to say something. Jon and I have a
    connection because he spells his first name right, and he has
    been, from our side of the aisle, Senator Moran, he has been
    great for us to work with, and he is somebody that we truly
    will miss.
        And I need to point this out for the cameras. He has two
    days left.
        [Laughter.]
        Chairman Tester. So with that I want to welcome Tracey
    Therit, VA Chief Human Capital Officer. She is accompanied by
    Jessica Bonjorni, who is the Chief of VHA Human Capital
    Management. I want to thank you both for being here.
        Ms. Therit, you may begin with your opening statement.

                       STATEMENT OF TRACEY THERIT
                    ACCOMPANIED BY JESSICA BONJORNI

        Ms. Therit. Good afternoon, Chairman Tester, Ranking Member
    Moran, and members of the Committee. Thank you for inviting us
    here today to discuss the Department's hiring efforts and
    present our views on Committee Print of S. 10, the VA Clinician
    Appreciation, Recruitment, Education, Expansion, and Retention
    Support (CAREERS) Act of 2023, and discuss our legislative
    workforce priorities for the 118th Congress. Joining me today
    is the Veterans Health Administration's, Jessica Bonjorni,
    Chief of Human Capital Management.
        VA is dramatically increasing hiring, holding surge events
    to onboard staff more quickly and increasing incentives for
    recruitment and retention. The nationwide onboarding event held
    last November allowed us to hire more new staff at VHA in the
    first quarter of this fiscal year than in the same period in
    any previous year. Five months into the fiscal year, we have
    onboarded nearly 23,000 new hires, resulting in a 2.5 percent
    growth rate. These efforts well position us to meet our goal of
    52,000 new VHA employees in this fiscal year, which would
    result in a growth rate of over 3.3 percent overall size of our
    workforce.
        We are seeing the same sort of success in Veterans Benefits
    Administration hires, as we are continuing to build our claims
    processing capacity.
        We appreciate the close collaboration of the Committee
    staff addressing some of the concerns the VA identified with
    previous versions of the CAREERS legislation in the prior
    Congress, and many of the sections are similar or identical to
    legislative proposals included in VA's fiscal year 2024 budget.
    We believe the current version is much improved and is a
    demonstration of the benefits of VA and Congress working
    together.
        We want to highlight three sections that are VA's top
    priorities.
        First, VA supports Section 201 that would eliminate
    performance pay and base and longevity pay components of the
    physician, podiatrists, and dentist pay system, and add
    optometrist to the pay system. We want to make it clear that
    this elimination would not reduce pay. It will change the pay
    structure and caps for this part of VA's health care workforce.
    In its place, VHA will have a single market pay component. VA
    supports these changes to the physician, podiatrist, and
    dentist pay system as they will allow VHA to be more
    competitive with local labor markets, meet the increased demand
    for critical clinical specialties, and more efficiently and
    effectively compensate providers.
        Without these amendments to the current physician,
    podiatrist, and dentist pay system, VA risks losing high-
    quality providers in complex clinical specialties to the
    private sector, impacting VHA's ability to deliver quality care
    to veterans. The physician, podiatrist, and dentist pay system
    is over 16 years old and significant improvement is greatly
    needed to keep pace with the increasing economy, demographics,
    high market rates, rapid advancements in health care, and high
    costs of critical and complex clinical specialties.
        Second, VA supports Section 202, that would establish a
    separate compensation system under Title 38 for VA occupations
    of Medical Center Director and Veterans Integrated Services
    Network Director, appointed under 38 U.S.C. 7401(4). Under this
    new system, the rates of pay for employees in these positions
    would be set and periodically adjusted by the Secretary of
    Veterans Affairs. The designated positions would remain
    eligible for performance awards in accordance with VA guidance.
    Pay would be determined based on market pay methodology, like
    the market pay authority currently in place for VHA physicians,
    dentists, and podiatrist, at 38 U.S.C. 7431.
        Annual salary for each medical center director and network
    director would consist of a single market pay component, thus
    eliminating the base pay component. Subsequent pay adjustments
    would be based on performance and would be developed
    incorporating salary adjustment features aligned to physician
    performance and other criteria such as complexity of
    assignment, marketplace factors, labor market features,
    qualifications, and experience, as determined by the Secretary.
    The compensation system will have a limit on the annual market
    pay of the basic pay of the President, currently $400,000. Pay
    for performance goals and objectives for the providers will be
    worked into their overall pay under the new pay system.
        VHA continues to face significant challenges addressing the
    rapidly evolving and changing health care industry. To be part
    of this transformation, VHA must have medical center and
    network directors with the skill set to provide enterprise-wide
    solutions to their clients, our Nation's veterans. To recruit
    top health executives, the salary structure of VHA's senior
    health care executives and medical center and network director
    positions must be addressed.
        Third, VA supports, if amended, Section 222, that would
    allow VA to consolidate any restored annual leave that covered
    employees accrued during calendar years 2020, 2021, 2022, and
    2023, under Title 5, into one annual leave account. Employees
    would be allowed to utilize the leave through January 9, 2027.
        In 2018 and 2019, pre-COVID, VA employees had roughly
    101,657 hours of restored leave. In contrast, as of January
    2023, over 29,000 VA employees have restored annual leave
    totalling 1.2 million hours. The individual balances of
    employees range between 1 to 416 hours. Employees would have
    the option to request a lump sum payout for the restored annual
    leave but have to agree to a period of obligated service in
    exchange.
        VA is recommending edits to address certain administrative
    matters concerning the use of the annual leave and
    congressional reporting requirements and updated timeframes,
    based on regulation recently issued by the Office of Personnel
    Management. For example, to ensure employees are not prevented
    from exercising the lump sum payment option due to reaching
    annual aggregate pay limits, VA seeks to provide a provision
    under Paragraph C to exclude the lump sum from the annual pay
    limit.
        With all the provisions of the VA CAREERS Act that VA
    supports, we will continue to work with Members of Congress,
    our sister agencies, our stakeholders to enhance VA's
    workforce.

        [VA Views on S. 10 VA Clinician Appreciation, Recruitment,
    Education, Expansion, and Retention Support (CAREERS) Act of
    2023 appear on page 33 of the Appendix.]

        This concludes my statement, and my colleague and I are
    happy to answer any questions that the members of the Committee
    may have. Thank you.

        [The prepared statement of Ms. Therit appears on page 27 of
    the Appendix.]

        Chairman Tester. Yes, thank you for your statement. We will
    start here.
        Would you say that improving VA's hiring and retention is a
    top priority for the Department?
        Ms. Therit. Chairman Tester, it is our highest priority.
        Chairman Tester. Okay. And by your testimony, lifting pay
    caps, revamping the VA compensation system would be included in
    those priorities?
        Ms. Therit. It would, Chairman Tester.
        Chairman Tester. Okay. The VA CAREERS Act reimagines the
    way we pay VA docs. I believe this is critical. We hear
    complaints from providers in Montana. The biggest complaint is
    probably how long it takes, and we just had a roundtable
    session here a bit ago in Montana, and I believe the last one
    was around 10 months, which is insanely, ridiculously long, and
    the other one is pay.
        How do market assessments currently work for the VA
    physicians?
        Ms. Therit. Chairman Tester, I am going to ask Ms. Bonjorni
    to answer that question.
        Chairman Tester. Sure. You bet.
        Ms. Bonjorni. Sure. So currently we are required in statute
    to do a market pay review every two years, but we do them more
    frequently depending on market conditions. So we review both
    what is going on in the local labor market and whether the
    provider has any additional certifications or experience, and
    make adjustments in concert with their longevity and base
    adjustment.
        Chairman Tester. Are you familiar with the CAREERS Act?
        Ms. Bonjorni. Yes.
        Chairman Tester. How will that change compared to what you
    are doing now?
        Ms. Bonjorni. With the changes in the CAREERS Act we will
    be able to use exclusively a market pay component and it will
    give us more flexibility in doing the pay-setting without the
    adjustments for longevity and base pay. It also removes the
    performance pay component which was put in place to allow us to
    do some very targeted performance pay. We are going to continue
    to do performance pay but just under a new system with this
    model.
        Chairman Tester. Can you briefly--we will just stick with
    you if you want--can you briefly tell me why it is important to
    pull off the caps?
        Ms. Bonjorni. Yes, absolutely. The caps are a real
    constraint for us for our high-level specialties and in high
    cost of living areas. So for specialties such as cardiology,
    neurology, radiology there are physicians coming right out of
    school who are making well over what we are able to offer right
    now to our very tenured providers, so our ability to compete in
    the market is significantly hampered by the caps.
        Chairman Tester. Okay. So we have heard from our labor
    partners that they are concerned that the new system would no
    longer incentivize longevity and performance at the VA. So my
    question to you is what new and existing systems will be in
    place to promote retention and high performance if the CAREERS
    Act were to pass?
        Ms. Bonjorni. We have existing systems to offer
    performance-based awards that we would now incorporate for our
    physician providers to replace the performance pay system. We
    also have the new authorities under the PACT Act that allow us
    to offer additional incentives on top of current pay
    authorities that do not count against the caps. Both of those
    would be used to recruit and retain.
        Chairman Tester. Okay. How does the new system compare to
    how the private sector determines clinician salaries?
        Ms. Bonjorni. It is much more in line with how the private
    sector operates. It will allow us to include different
    components in setting the pay and it gives us flexibility to
    make adjustments at a higher level.
        Chairman Tester. So I talked about the timeframes--and this
    is for either one of you--the timeframes to hire. What is the
    VA doing to reduce those timeframes to hire, if anything?
        Ms. Therit. Senator Tester, we are having onsite hiring
    events that abbreviate the time from a position being announced
    until the individual is offered a tentative job offer. The
    Veterans Benefits Administration had numerous job fairs during
    the month of February, hired over 1,000 individuals, averaging
    100 at those events, so it dramatically decreased the time to
    hire within VBA.
        On the Veterans Health Administration they are also holding
    the onboard surge events, which is the time between the
    tentative offer and the entry on duty, allowing all of the
    steps in the process--the fingerprinting, the credentialing,
    the physicals, the drug testing--to occur at one time, greatly
    abbreviating those timeframes.
        We are also using direct hire authority, which is a tool to
    streamline hiring. It is able to get us larger pools of
    candidates to be able to bring employees on faster, and we are
    seeing the time to hire for those positions between 60 and 40
    days, which is dramatically less than our average, which is
    usually around 100 days.
        Chairman Tester. So 100 days is three months. So what is
    the fastest you have ever hired a doc in the VA? Can you give
    me that answer?
        Ms. Therit. I would ask Ms. Bonjorni to answer the
    question.
        Ms. Bonjorni. Using expedited emergency authorities under
    the COVID emergency authorities we were able to onboard people
    in about two weeks for a physician.
        Chairman Tester. Right.
        Ms. Bonjorni. That means we delayed their credentialing
    until after they onboarded.
        Chairman Tester. And those riders are gone now. Correct?
        Ms. Bonjorni. Correct.
        Chairman Tester. Yes. Well, that is a whole lot different
    than 6, 8, 10 months, and I can tell you that if we are going
    to compete we have got to figure--and by the way, this is not
    just the VA. This is government-wide. If we are going to
    compete we have got to figure out how to make this selection
    process of hiring easier and more user friendly.
        With that I will turn it over to Senator Boozman.

                          SENATOR JOHN BOOZMAN

        Senator Boozman. Thank you, Mr. Chairman, and thank you for
    focusing this hearing on the hiring and retention of the VA
    workforce. Also, I would like to thank you guys for being here.
    I appreciate your hard work.
        The 2022 IG report on VHA's occupational staffing shortages
    identified more than 2,600 severe occupational staffing
    shortages across 285 occupations. This was an increase from
    2021. It is clear we are experiencing staffing challenges. That
    is why Senator Tester introduced the VA CAREERS Act to help
    with the recruiting and retention challenges that VA currently
    faces. It is imperative that we hire and retain the best and
    brightest talents that this country has because our veterans
    and their families deserve the highest levels of care and
    support for the sacrifices that they have made in protecting
    our country.
        The VA CAREERS Act is a crucial piece of legislation aiming
    to reduce vacancies and staffing shortages at the VA. The VA
    continues to be at a disadvantage when it comes to recruiting
    and retaining, as you have testified to, and the most talented
    medical professionals across the country, especially in rural
    areas, simply, it is very difficult to attract and retain.
        Ms. Therit, can you briefly speak to what this legislation
    would mean for the VA and why it is important to ensure that
    the VA has the ability to recruit and retain the best health
    care professionals?
        Ms. Therit. Senator Boozman, thank you.
        Senator Boozman. That is an easy one.
        Ms. Therit. Thank you for that question. We have really
    appreciated the opportunity to work with the staff to develop
    the VA CAREERS Act. Ms. Bonjorni had highlighted some of the
    pay authorities, the top three that we have indicated in our
    testimony. But across the board it looks at both recruitment
    and retention, being able to pay those higher salaries to
    attract the providers into those occupations as well as some of
    the continuing education which allows for occupations to be
    able to grow and evolve in those positions.
        We also add some areas of physician, pharmacist pay, of
    nurse executive pay, that would increase the limits and help us
    to be able to recruit and retain for those occupations as well.
        Ms. Bonjorni, do you have anything to add regarding the
    CAREERS Act and the benefits that it will bring to the VHA
    team?
        Ms. Bonjorni. I think you hit the key points.
        Senator Boozman. Very good. With approximately 3 million
    veterans living in rural communities and more than half of them
    over the age of 65, it is imperative that the rural medical
    facilities are properly staffed. Additionally, these veterans
    often have more complex medical conditions that involve
    specialty care, which requires specific training for VA
    providers.
        Ms. Therit, we addressed the CAREERS Act. Can you tell us,
    though, setting that aside, what initiatives and strategies are
    currently being discussed to improve staffing and training in
    these rural areas?
        Ms. Therit. Senator Boozman, we are grateful for the
    authorities that we have in the PACT Act. We have largely
    implemented all of those authorities. One that we are currently
    working on is the Rural Recruitment and Training Plan that is
    due to the Committee within 18 months of enactment. I know the
    VHA team is working on that piece of the PACT Act, and I am
    going to ask Ms. Bonjorni to elaborate further on some of the
    work that is happening there.
        Ms. Bonjorni. Sure. One of the things we are doing to
    address this is creating new positions that will be a national
    sourcing office. So that is the very first part of the
    recruitment process. And those sourcers will then find talent
    and send them out to our rural facilities so that we are able
    to generate more leads to come into those organizations. And we
    are dedicating additional resources toward our recruitment
    marketing, directly targeting rural areas.
        Senator Boozman. Ms. Therit, we have had a problem with VA
    administrators being there for short periods of time or
    detailed to other places, really having a situation where you
    have got a leaderless VA, which again, is a real problem. Can
    you talk about the importance of having a leader in place at
    our medical centers and how having a director in place leads to
    providing the best care and recruiting the best people, as
    opposed to the opposite of that, where people really just do
    not know where they are at, and it is just a difficult
    situation.
        Ms. Therit. Senator Boozman, leadership at those VA medical
    centers is critical. We appreciate Section 104 of the CAREERS
    Act, which would give us an opportunity to share with you
    information when someone is detailed out of a position, who is
    being identified to replace them, and make sure that those
    periods of time are kept to the least possible so that we have
    permanent leadership at those medical centers.
        We also acknowledge, through our all-employee survey data,
    that employee engagement is higher at those medical centers
    where they have permanent leadership. So we are going to
    continue to work with you and the Committee to make sure that
    you get information when individuals are detailed out of those
    positions and how long it is taking to get permanent leadership
    in those positions.
        Senator Boozman. Thank you very much. Thank you, Mr.
    Chairman.
        Chairman Tester. Senator Brown.

                         SENATOR SHERROD BROWN

        Senator Brown. Thank you, Mr. Chairman. Thanks for how
    seriously you take this issue. I appreciate that.
        Ms. Therit, thanks for your testimony. I want to raise an
    issue that VA employees have talked to me about, and to my
    office, about the executive leadership teams at different
    medical centers have apparently have not worked collaboratively
    enough with local union leaders. I hope that you and folks at
    the VA Central Office remind staff in the field that a strong
    labor management relationship is essential to the effective and
    efficient operation of VA and to improve the provision of care
    and benefits to veterans. And the unions, as you know, unions
    are an important component of that.
        Last year, Congress included several workforce provisions
    in the PACT Act. As I travel the state and do roundtables with
    veterans in every part of the state we can all envision this
    surge in care and the importance of scaling up hiring. So I
    know we have required VA to implement a national recruitment
    and hiring plan. I think of the hospital in Ohio, in
    Chillicothe. There are plenty of community-based outpatient
    clients too that are in rural areas.
        So talk about, given the challenge, provide us with an
    update on that plan, if you would.
        Ms. Therit. Senator Brown, thank you for that question. I
    want to reinforce our commitment to working with our labor
    partners. Our American Federation of Government Employees is in
    town this week, having their semi-annual meeting. I know the
    Secretary is addressing them as well as other leaders within
    the Department. We have also recently reached a memorandum of
    agreement with the National Federation of Federal Employees,
    continuing to find ways to improve hiring. So we are actively
    working with all of our labor partners. I know when the
    Secretary visits our facilities he meets with them and asks
    them about their labor management forums, makes sure that they
    are meeting and actively engaging.
        With respect to the PACT Act, we have implemented every
    provision except for four that are pending: the rural
    recruitment plan, that I mentioned, the one-year plan that we
    owe the Committee on human resources positions, recruitment,
    and retention, as well as the service contract buyout policy,
    which is being drafted and soon to be released. And then,
    finally, we are also working on the final provision with the
    Office of Personnel Management around pay waiver authority.
        But every other authority is available to our workforce. We
    implemented them in waves. The first wave was removing the
    restrictions on hiring housekeeping aides. We know how
    essential those positions are to our medical centers. The
    second wave was ensuring that we are bringing in the next
    generation of talent to the VA. That was expediting hiring of
    college graduates, post-secondary students, and increasing
    limits on student loan repayment program. The third wave was
    around retention, removing some of the caps on bonuses and
    awards for our hardworking VA employees as well, as Ms.
    Bonjorni had mentioned, increasing those special contribution
    award limits so that we can really recognize the great work
    that is happening across the Department.
        The fourth wave focused on our systems. As important as our
    people are, we do not want to lose good people to being
    frustrated with the systems that they have to use to perform
    their daily job. So with respect to our HR system we improved
    some enhancements so that individuals can see where recruitment
    actions are in the process. We added some employee self-service
    capabilities, so employees are able to use those systems to be
    able to do things more effectively and efficiently.
        And the last wave is implementing all of our pay
    authorities. Critical skills incentives are being processed.
    Recruitment, relocation, and retention incentives are being
    processed at the higher limits. Critical pay positions are
    being identified, as well as special salary rates implemented
    to keep up with the tight labor markets and competing with the
    private sector.
        So all of those provisions of the PACT Act are actively
    being rolled out. I know Ms. Bonjorni and her team are
    communicating them to the field so that we are leveraging all
    of these authorities to ensure that we have staff at the levels
    that we need them.
        And I think the events that have been happening in VHA and
    VBA are demonstrating that VHA, as I mentioned, has already
    brought on over 22,000 external hires in five months. That is
    record-breaking. The Veterans Benefits Administration has grown
    by 5 percent in bringing on over 2,000 new hires to process
    claims. And our retention rates are lower, half of what they
    were a year ago. We were seeing 4 percent turnover. This year
    we are about 2 percent turnover.
        Senator Brown. Retention rates are twice, not half.
        Ms. Therit. Our turnover rate is cut in half.
        Senator Brown. Thank you. Thank you. And I just want to
    remind you that this is the most pro-worker, pro-labor
    administration probably in my lifetime, as you work your way
    navigating each of these waves, as you implement the PACT Act.
        One other question, Mr. Chairman. Local VA employee medical
    center directors talk about the human resource modernization
    efforts that started in 2018. Some of us thought that was a
    wrong-headed move by the previous administration of the VA. We
    can put that aside for a moment. But it is clearly harder to
    hire people. There are other factors. I am not putting it all
    on this. It takes longer to get folks--I had never heard the
    word ``onboarded'' until you used it today. I get what that
    means. They leave for a job in the community facilities, I
    mentioned Chillicothe but others, the more urban centers too,
    have been hosting local hiring fairs to get folks hired more
    quickly.
        Tell us why we cannot just move back to a model where local
    HR professionals, who know the facilities' needs, who know the
    communities' needs, why do we not go back to their being
    directly responsible for hiring folks in these facilities?
        Ms. Therit. Senator Brown, I am going to ask Ms. Bonjorni
    to answer the question on the VHA modernization efforts.
        Ms. Bonjorni. Sure. Thank you for the question, Senator. I
    remember being here----
        Senator Brown. I am sorry to interrupt, but from Senator
    Tester's question to both of you about how long it takes a
    doctor to be onboarded. It just does not make sense to me that
    we are not driving this locally, where they know the
    community's needs, they know the facility's needs, and they can
    make it much faster, I would think, than going up to Ann Arbor,
    in my case, or even to Washington.
        Sorry I interrupted. Go ahead.
        Ms. Bonjorni. Sure. If we look at our data on how time to
    hire has trended over time, right now our time to hire has
    returned to pre-pandemic levels. When we had special
    authorities, we were able to hire faster than we are able to
    hire right now. But that is not tied to the organizational
    structure of our human resources.
        In fact, the change that we made to move to shared services
    for human resources allowed us to hire the volumes we have been
    hiring, allowed us to rapidly change policies and practices
    tied to special hiring authorities during the pandemic, and
    allowed us to shift resources. The challenge we had with
    decentralized human resources is that smaller facilities,
    especially, had a challenge keeping HR staff on board, and then
    when they had vacancies they had no one to hire. So moving to
    shared services allows us to shift across an entire region to
    facilitate the hiring process.
        Chairman Tester. Senator Tillis.

                          SENATOR THOM TILLIS

        Senator Tillis. Thank you, Mr. Chairman, and thank you both
    for being here.
        Mr. Chairman, I would like unanimous consent to send forth
    an article that was published in MilitaryTimes talking about
    this subject.
        Chairman Tester. Without objection.

        [The article referred to appears on page 46 of the
    Appendix.]

        Senator Tillis. Yes, and we will make sure you all have a
    copy because I would like you to fact check it. In your
    testimony, some of it you have already affirmed. But it talks
    about some of the structural problems, the workload for
    existing employees and challenges that you all are having. And
    I think that on one hand you have got a lot of people working
    hard serving veterans, and on the other hand we have got a lot
    of vacancies to fill.
        Senator Tester asked about, it is my understanding it is
    now, without the emergency authorities, 100 to 120 days for
    hiring, onboarding process, and I had a report it is somewhere
    close to 80 different steps along the way. I would like to get,
    specifically, what it is, because how many of those steps were
    going to job fairs or job environments, so they are pre-real
    onboarding. They are candidate selection, and then all the
    things you have to go through. Because without the emergency
    authorizations that you had--and, Mr. Chair, I think we should
    go back and say if it is working why did we stop it. I
    understand why but Congress can fix that.
        But, you know, if I am a medical professional, a clinician,
    a nurse, or somebody that you are looking for to ramp up the
    PACT Act or other things, this is a highly sought skill in the
    private sector. And even with your signing bonuses and other
    things you are going to have a very difficult time. And if
    somebody is smart and they are looking at an offer--and most of
    these people are. They are well-educated, well-trained--if they
    got an offer from you and you say, ``Now we have just got to
    complete the remaining 60 steps of the process. We are going to
    make a decision in 100 to 120 days,'' number one, they probably
    have a hedging strategy and they are looking at other
    opportunities, and number two, they are likely not going to be
    there when you need them. Not in every case but in many cases.
        And so just a quick question, for, let us say, specialties
    that you hired under the emergency authorities under COVID. How
    many of those people have you fired, proven to be unqualified
    for the position that they were hired for?
        Ms. Bonjorni. Senator, we can certainly come back to you
    with that information.
        Senator Tillis. I would like to know. My guess is only a
    handful, if any at all. And my point there is one of the
    lessons that we are not learning consistently about the
    emergency orders that we had under COVID, whether it is FDA
    emergency use approvals, whether it is hiring approvals in the
    VA. You got a chance to use it, you got a chance to stress-test
    it. If it proves to be efficacious then you all should be
    coming back to us and saying that these temporary authorities
    need to be reinstated. Because if you are still working with an
    80-step plan and a 100- to 120-day process--some of it was
    imposed by VA, and you should figure out which of those you can
    streamline, some imposed by Congress--we have got to fix it
    because you are not going to be successful no matter how hard
    you work, and I know you are all working hard. I have generally
    very good things to say about the VA, and I think my time on
    this Committee has proven it. I know you are trying to solve a
    problem.
        One thing that I think would be helpful, number one is
    timely response to questions for the record. If you go back in
    my history that are not gotcha questions. They tend to be
    geeky, technically oriented, focused on implementation. But I
    have got QFRs out there since September of last year. So if you
    want us to help you, you have got to help us and give us, at
    least in my case, and I will speak for my questions, I think we
    need a more timely response, and we have got to put a priority
    on that.
        Chairman Tester. Excuse me just for a second. Stop the
    clock. This is really, really, really important. If we have got
    a member, especially off of this Committee, that asks
    information--and look, I have been here when people have given
    you busywork. Stop the clock, because I want him to have his
    minute left.
        Senator Tillis. I had four minutes left.
        Chairman Tester. No, you did not.
        [Laughter.]
        Chairman Tester. To be sure you had 56 seconds left.
        But the truth is if a member of this Committee wants to get
    information it should be a priority. And if Senator Tillis, who
    I do not agree with all the time, by the way----
        Senator Tillis. Most of the time.
        Chairman Tester [continuing]. But I agree with him most of
    the time, has a question out from September and he still has
    not gotten an answer for it, I hate to tell you but on the farm
    they call that bull-something, Okay?
        Senator Tillis. Bull butter.
        Chairman Tester. Go ahead.
        Senator Tillis. And again, it may even be that some of that
    information is not relevant based on where we are today, but
    just a question.
        One thing that I would like to get you all to commit to is
    that in each category, each unique category you have got a
    different story to tell about potential candidates. You have
    got a different story to tell about process execution, how
    long. You have got a different story to tell about people you
    really wanted to hire but they just could not wait the 100 or
    120 days. And then you have also got a story to tell about
    where the market is just not providing enough of these people
    wherever you are going to hire them.
        And we will form it as a QFR, but I think you understand,
    strategically, what I am talking about. If you are heading the
    recruiting and the HR function, you need to know what you need
    for critical staffing levels, and you need to communicate to us
    the ones that you are simply not going to be able to do with
    the current constraints, and some of them you are not going to
    be able to do to fully implement the PACT Act and other things
    that are very important to us.
        So it would be helpful if we got that, to what extent you
    need help to achieve at least a minimum performance, and where
    we have got to think differently about staffing out the VA.
        Thank you, Mr. Chairman.
        Chairman Tester. Senator Hassan.

                      SENATOR MARGARET WOOD HASSAN

        Senator Hassan. Thanks, Mr. Chair, and thanks to our
    witnesses too for the work you do.
        I really appreciate the increased effort by VA to fill
    vacancies in the Veterans Health Administration. We have just
    been talking about some things, and I agree with my colleagues,
    we should be looking at new ways, things we have learned from
    the pandemic if we can.
        But I wanted to drill down on a bill that Senator Braun and
    I worked on that was signed into law. In 2021, we passed the
    bipartisan Hire Veterans Health Heroes Act. And it was signed
    into law. It directs the VA to recruit and hire Department of
    Defense medical personnel who are transitioning out of military
    service for open positions at the VA. Can you discuss how
    implementation of this is going?
        Ms. Therit. Senator Hassan, Ms. Bonjorni's team has been
    implementing that bill so I am going to ask her to answer.
        Senator Hassan. Great. Thank you.
        Ms. Bonjorni. Sure, and thank you for that bill. We are
    very supportive of it and have taken it very seriously in
    implementation. We are working closely with DoD. We have a
    direct marketing campaign that we use, based on the
    occupational code of people transitioning out, where we send
    them messages and encourage them to come work for us. We have
    also established a new physician provider recruiter position at
    facilities, and those are the people who go out to different
    military installations and pitch VA as an employer directly to
    people when they are transitioning out. We also have a
    dedicated location on our VA careers website, not to be
    confused with the bill, that directs transitioning military
    members to come work for the VA.
        Senator Hassan. Are you seeing results?
        Ms. Bonjorni. We are. So right now the physician provider
    recruiters are a new position, so we are waiting to see the
    impact of that. But we do anticipate that we will see more of
    that as we have that boots on the ground support.
        Senator Hassan. Yes. Okay. Thank you.
        Ms. Therit, in response to a letter that I led last year,
    the President's Pay Agent recently expanded competitive
    locality pay to areas in New Hampshire and Vermont that
    struggle to recruit and retain Federal employees. These areas
    include the VA Medical Center in White River Junction, Vermont,
    which provides services to many veterans living in New
    Hampshire.
        How does expanding competitive locality pay help VA recruit
    and retain highly skilled workers in rural areas, including at
    rural VA health facilities?
        Ms. Therit. Senator Hassan, we are members of the Federal
    Prevailing Rate Advisory Committee as well as the Federal
    Salary Council, and we are always looking for opportunities to
    promote the locations where we are seeing that our wages are
    not keeping up with the salaries in that area. So we welcome
    the opportunities to do both, in those forums and other forums,
    bring forward areas where locality pay is lagging or efforts
    need to be made to address those.
        The one challenge that we have with our wage grade
    workforce is that work is done by our Department of Defense
    colleagues, so we need opportunities to both leverage the
    Federal Salary Council as well as the Federal Prevailing Rate
    Advisory Committee so that we can find pay equity across the
    board, not just with our GS, general schedule, positions, but
    also with our wage-grade positions.
        So we welcome opportunities to work with you and other
    members where those locality pay areas need to be adjusted and
    bring those locations forward in those forums.
        Senator Hassan. I would look forward to following up with
    you on that because it is obviously a critical issue not only
    in my area but I think for a lot of the members of this
    Committee and for our constituents and veterans.
        I want to switch topics a little bit. I frequently hear
    from Granite State veterans about how much they appreciate
    their VA nurses, their doctors, their caregivers, but far too
    often they have to get care elsewhere because we have had real
    infrastructure issues in New Hampshire--failures, not just
    issues.
        The VA Medical Center in Manchester is more than 70 years
    old and its facilities are inadequate and frequently fail.
    Twice in the past year Manchester VA Medical Center closed
    portions of its campus because of burst water pipes, and that
    has forced veterans to go elsewhere for care, and reduced
    available treatment spaces, obviously, for clinicians.
        Can you discuss what impact infrastructure failures like
    these have on recruitment and retention challenges that we are
    all talking about today?
        Ms. Bonjorni. Well, Senator, I think that the wage issues
    that Tracey mentioned earlier really are where we can speak to
    that, and making sure that the people who maintain those
    facilities, some of them quite aging, need to be paid effective
    wages. So we have boiler plant operators, HVAC operators,
    engineers, folks who maintain the facilities, we need to be
    able to pay them fairly to keep the facilities running.
        Senator Hassan. Right. But look, I will tell you that no
    matter what your skill as a facility manager, when you have
    pipes that have been soldered with different materials that are
    not particularly good for cold weather, for instance, you can
    be the best manager in the world, and we really need to upgrade
    these facilities. And in my experience, having done a fair
    amount of HR-related work, people look at what their workspace
    is going to be like and whether they are going to have the
    modern tools and spaces they need to provide excellent care,
    and in New Hampshire that is getting harder and harder for our
    clinicians to do.
        So as you get feedback about that as a factor that people
    may be considering in their decisions, you know, highly sought
    after clinicians are going to have choices. And it seems to me
    that if we are providing them with very old infrastructure
    where they cannot be guaranteed that they can give quality care
    to patients, that that is going to be a recruitment problem.
    Thank you.
        Chairman Tester. Senator Blackburn.

                        SENATOR MARSHA BLACKBURN

        Senator Blackburn. Thank you, Mr. Chairman, and thank you
    all for being with us today.
        Ms. Therit, I want to ask you about how we continue to have
    providers who have as many as five documented cases of
    delivering substandard care. And as I have looked through the
    proposed market pay system I really--it is hard to square how
    we would give local leaders more flexibility when we have an
    issue with having these providers that give substandard care.
        And then what I would like to know is do you have a policy,
    is there a policy in place that removes these providers and
    puts them on a do-not-rehire list? So if you will just walk me
    through that.
        Ms. Therit. Senator Blackburn, I am going to ask Ms.
    Bonjorni to speak to the processes that are used to address
    that substandard care and how it would be applied in this
    market pay system.
        Ms. Bonjorni. Sure. Thank you for the question, Senator
    Blackburn. We do have processes in place to do ongoing
    monitoring of the competencies of our providers as well as
    focused evaluations if there is a concern raised. Those
    processes are standard and consistent with how they operate in
    the private sector. And so the number where we have substandard
    care being provided is a very low fraction of our workforce,
    and absolutely we would be making sure that we take those
    seriously and address them through normal disciplinary
    processes, through the Medical Executive Committee in each
    case.
        The compensation structure is not tied to that
    specifically. If we had somebody who was in a situation where
    they were providing substandard care we would address that
    through disciplinary processes or removing their privileges.
    The compensation system is designed to operate for the vast
    majority of providers who are providing excellent care to
    veterans, and so we would look at performance indicators,
    certainly, in that evaluation of setting pay.
        Senator Blackburn. Okay. and then how do you apply this and
    how do you get a waiver on the cap for physicians and dentists
    and professionals, medical professionals, that do not provide
    patient care but are on staff? What is your differentiation
    there?
        Ms. Bonjorni. So we would continue to use the pay table
    structure that we already have for physicians, dentists, and
    podiatrists, and potentially optometrists if the new law
    passes. Usually clinical providers are accounted for in the
    first few pay tables and then the last one is for supervisory
    type of positions that may not provide direct care. So we do an
    evaluation based on how they might be paid in the private
    sector.
        Senator Blackburn. So you use some subjectivity and
    flexibility on that table.
        Ms. Bonjorni. Yes. There are pay ranges for each one of
    them.
        Senator Blackburn. Okay. That is great. Thank you for that.
    And then I have got a question on the PACT Act, because VBA has
    talked about the number of additional claims processors that
    are going to be needed to handle this and to handle the call
    centers for what they are expecting from the PACT Act. And we
    have discussed personnel and being able to meet that demand
    some with the Secretary. And it is hard to kind of look at
    this. So many people are still working remote, and then we have
    this huge backlog, and then we are expecting to have this
    influx.
        So walk me through the hurdles that you have in hiring and
    getting people trained and what the problem is addressing this
    in a timely manner.
        Ms. Therit. So Senator Blackburn, specific to our Veterans
    Benefits Administration, they have done exceptional work with
    their onsite hiring events and being able to staff to the
    levels that they need to process the PACT Act claims.
    Productivity last year was at record levels in terms of having
    a hybrid work environment where they were able to work onsite
    as well as telework and be able to deliver those benefits to
    those who are filing those claims.
        In terms of training, we are working very closely with the
    Veterans Benefits Administration to make sure they have the
    resources that they need so that they are not taking folks off
    the lines to conduct the training and putting them back on to
    process claims. So we are actively working with them and using
    the direct hire authority that the Office of Personnel
    Management gave us over the next five years to be able to hire
    up to 15,000 claims examiners. So really working closely with
    them to make sure that they have the resources on board, using
    every authority available in the PACT Act.
        Senator Blackburn. And, of course, having people still
    working remotely, you have got this backlog that is enormous. I
    mean, I am having a tough time squaring what you all are saying
    you are doing and not getting a specific timeline, and then
    looking at this backlog that continues to grow, continues to
    grow. And it is a tremendous frustration when we have veterans
    that are waiting 100 days in Tennessee for a primary care
    appointment. It is so unacceptable when they cannot get to
    professionals within that system. And then there is hesitancy
    to do community care. We have a lot of frustrated veterans.
        But we appreciate the work that you are doing, and thank
    you, Mr. Chairman.
        Chairman Tester. Senator King.

                       SENATOR ANGUS S. KING, JR.

        Senator King. Thank you, Mr. Chairman. If you are curious
    about status on this Committee, those of us who have our own
    desk, that is a special status, just so you know.
        [Laughter.]
        Chairman Tester. You ain't kidding that is special.
        Senator King. Maybe not in the way that I meant.
        I want to follow up on Senator Brown's question. Why can't
    hiring be local? If the CBOC in Bangor needs a social worker,
    why do they have to have anything to do with Washington or
    Boston? Why can't that decision be made in Bangor? We need
    somebody, we have got the authority, we have got the budget for
    it, we want to post it and hire them. And maybe they can do
    that, but let me know.
        Ms. Bonjorni. Yes, Senator King, thank you for the
    question. They do have the authority to make all the decisions
    about the hiring process at the local level, so the decision-
    making remains local. It is the processing actions that human
    resources takes that are now handled primarily at a shared
    service unit, but there is still HR staff onsite at the
    majority of our facilities.
        The challenge that we face right now in a post-pandemic
    world is it is very difficult to find HR staff who are a
    mission-critical occupation across the Federal Government in
    almost any location and especially in some of our more rural
    sites.
        Senator King. My impression is there are steps that have to
    be involved that take it back to Washington, that decisions are
    made other places other than onsite. Am I wrong about that?
        Ms. Bonjorni. Decisions made in Washington related to
    hiring would be related to executive hiring but not to any
    frontline staff hiring decision.
        Senator King. Okay. Now let me dig into the numbers a bit.
    Well, that is encouraging, by the way. I appreciate that.
        We have been talking about time to onboard someone. I take
    it that is from the time that the job is posted, this 120 days
    we have been talking about?
        Ms. Bonjorni. It is earlier than that. So the time-to-hire
    model that is used across the Federal Government is from the
    date the position is approved to recruit, so that includes
    getting ready to post the job, posting the job----
        Senator King. So I am looking for the number further back.
    How long does it take to get approval to recruit?
        Ms. Bonjorni. Within VHA, getting approval to recruit is
    taking quite some time at this point. So that is taking almost
    as much time right now as it takes to do the rest of the hiring
    process, which is why we are focusing on this full time to
    fill, which is what we call that part of it, from the time the
    vacancy occurs until the time it is no longer available.
        Senator King. So it is really not 120 days. It is 240 days
    or more.
        Ms. Bonjorni. Right now the time to fill in VHA is closer
    to 230 days.
        Senator King. That is a long time.
        Ms. Bonjorni. I agree.
        Senator King. And the other question I wanted to dig in on,
    the 120, 240, 230. I take it that is some kind of average. Are
    there different numbers for different types of jobs?
        Ms. Bonjorni. Yes. We have different targets and different
    averages for different types of jobs, and there is variability
    across the system. Some locations are hiring faster than
    others.
        Senator King. Could you give us a list of occupations and
    give us the time-to-hire number for the various billets, if you
    will?
        Ms. Bonjorni. Absolutely. Some information about time-to-
    hire is already provided in the publicly reported MISSION Act
    505 data, but we can provide you with additional information.
        Senator King. Why does it take so long before you get to
    the posting? Why does it take 120 days? If you have got a
    social worker at the CBOC and they leave, why does it take so
    long to decide you need another one?
        Ms. Bonjorni. This is something that we are working through
    right now. At local facilities each have a process that they
    use to manage resources and determine when positions can be
    backfilled automatically and others have to come back to a
    review to evaluate the budget before they are allowed to
    recruit. So this is something that every single facility is
    very focused on during this fiscal year as we are just now able
    to track that data for the first time this year. So now that
    they can see the data, they can work to improve it.
        Senator King. Well, you used the word ``review.'' Who does
    the reviewing?
        Ms. Bonjorni. The reviewing of whether or not a position
    can be filled?
        Senator King. Correct.
        Ms. Bonjorni. Generally a resource management committee.
        Senator King. And where are they?
        Ms. Bonjorni. At the facility.
        Senator King. At the facility.
        Ms. Bonjorni. Yes.
        Senator King. Not in VISN 1 or----
        Ms. Bonjorni. No. It is a facility decision.
        Senator King. Thank you. Thank you, Mr. Chairman.
        Chairman Tester. Senator Sullivan.

                          SENATOR DAN SULLIVAN

        Senator Sullivan. Thank you, Mr. Chairman, and I want to
    follow up on my good friend, Senator King. We have a great VA
    workforce in Alaska, but they have asked the identical
    questions on this timeline in which you guys get to announce
    vacancies, and then the timeline in which it takes to fill
    them.
        And this was just a very specific question, the identical
    question, really, that a lot of the VA in Alaska, you guys have
    done a great job over the last 4 or 5 years to really surge big
    hiring in my state, and then it has kind of diminished. And one
    of the big challenges, when I talk to the VA employees in
    Alaska, is exactly what Senator King mentioned.
        So is there a way for you guys to look at this and maybe
    come back to the Committee and try to truncate this timeline,
    both on the posting and the time it takes in which to hire?
    Because, you know, you have got people who might be interested
    and they are kind of hanging out there for 6 or 7 or 8 months,
    and then you lose interest or they have another opportunity.
    But it seems kind of like a self-inflicted wound, and this is
    directly what I am hearing from the VA employees in Alaska. So
    can you guys come back to the Committee and maybe say, ``Hey,
    all right, we have thought about it. You have got two different
    Senators raising it. Here is what we can maybe do to kind of
    shorten this timeline to bring on more workers.''
        What do you think?
        Ms. Therit. Senator Sullivan, I would welcome that
    opportunity. We are equally frustrated. I think that is one
    thing our labor partners and we agree on is that it takes too
    long to hire.
        Senator Sullivan. Yes, and if you need statutory authority
    or--no offense, but whenever I hear you say, ``It is done by
    committee at a facility,'' I am just like, oh geez, that is
    going to be a year.
        Ms. Therit. Well, I think we are having the conversations
    that we want to have, but there is a time to fill, which is
    from the time somebody leaves until that next person arrives.
    That is really the impact at the local level. And then there is
    the time to hire, which is the Office of Personnel Management
    model, which gives you all the steps that need to be done, and
    what they say is 80 days is their model. Eighty days is still a
    long time.
        Senator Sullivan. A long time.
        Ms. Therit. And then we talked about----
        Senator Sullivan. Too long.
        Ms. Therit [continuing]. With Senator Tillis the
    authorities that we had to expedite the process, and Ms.
    Bonjorni mentioned two weeks. I mean, that is what we really
    strive for. So when we look at all of this collectively how we
    can work together to achieve that outcome is really what we
    want to do.
        Senator Sullivan. Well, why don't you guys try to come back
    to this Committee and give us your plans, and thoughts and
    ideas on it, because I think it is kind of a win-win. And if
    your employees are telling us--they are certainly telling me--
    and if Senators are raising it, and if you guys agree, and if
    you need authorities we will give them to you, but it does not
    seem like you would need authorities.
        So can I get your commitment you guys will come back to the
    Committee with ideas on tightening that?
        Ms. Therit. You have our commitment, Senator.
        Senator Sullivan. Okay. And then my other quick question
    is, you know, one thing that we do on this Committee is look at
    ways in which our veterans who are getting out, who are still
    on active duty, can plug into like the labor unions, or go
    through an apprentice program with IBEW, and so they are
    plugging into a good job even before they are off active duty.
        I like that idea. We try to do that a lot in Alaska with
    our active-duty military force. But it just seems to me, do you
    guys have a program like that? So do you see what I am saying?
    Like let us say a guy has four more months on active duty. I
    know the State of Alaska actually has a program where you could
    bring in a currently serving military member and say, ``Hey,
    here is some training. Here is what we would like, if you guys
    are interested, and we will hire you the minute you walk out
    the gates of Elmendorf Air Force Base.''
        Does the VA have anything like that, because it would seem
    like that would be a no-brainer. A lot of military guys want to
    join the VA. You guys can train them and entice them while they
    are still on active duty. Do you have a program like that?
        Ms. Therit. So Senator Sullivan, we do partner with the
    Department of Defense on their SkillBridge program.
        Senator Sullivan. Yes, SkillBridge. That is exactly what it
    is.
        Ms. Therit. And we have worked with them. One example is
    with our police officers. Police officers are a shortage
    occupation. We have a law enforcement training center in Little
    Rock, Arkansas. We work with those transitioning servicemembers
    who may be interested in coming to join the VA team after they
    get out, send them through those training programs. The
    challenge is resources and the ability to run those programs.
        Senator Sullivan. Yes. But you do the SkillBridge program?
        Ms. Therit. We do.
        Senator Sullivan. Okay. Good. Thank you, Mr. Chairman.
        Senator King [presiding]. On behalf of the Chairman,
    Senator Blumenthal.

                       SENATOR RICHARD BLUMENTHAL

        Senator Blumenthal. Thank you. Thank you, Senator King.
    Thank you, Mr. Chairman, and thank you for being here.
        I know that the VA is struggling with the same challenges
    that every private employer is, and we see it in Connecticut,
    the need for training and skills and so forth. We have just
    provided you, and I know others have asked about it, with a new
    responsibility in the PACT Act. I want to ask whether you think
    there are different skills required to process these
    applications, considering that there is now a presumption in
    the PACT Act that certain facts will justify a service-
    connection for certain kinds of diseases, and how much of a
    burden will it be in terms of additional skills that will be
    required to implement it?
        Ms. Bonjorni. On behalf of the VBA team, which I am not a
    part of, I think as they look at their claims examiners they
    are designing the new skills that they are going to need to
    evaluate into their training. As far as for our providers, in
    VHA we have provided all the information to them about how to
    make the appropriate evaluation of veterans when they come in,
    and we believe they already have the skill sets they need right
    now to do additional exams for veterans.
        Senator Blumenthal. Are you then equipped, being staffed up
    to do these evaluations now?
        Ms. Bonjorni. We are continuing to staff up. So getting to
    our 52,000 hire goal this year will help us meet that
    expectation, yes.
        Senator Blumenthal. By what time period?
        Ms. Bonjorni. The 52,000 goal is for this fiscal year, so
    by September 30th of this year, but we do also anticipate some
    additional needs related to the PACT Act over the course of the
    next decade. But we think so far, with our attrition rates
    trending downward, we will probably surpass our 52,000 goal
    this year, so I believe we will hit that before the end of the
    fiscal year.
        Senator Blumenthal. So you do not see personnel, that is
    recruitment, as being at all an obstacle to implementation of
    the PACT Act?
        Ms. Bonjorni. Not an obstacle for VHA. VBA, I know, is also
    continuing to recruit. We do not think that is going to be an
    obstacle. It is the same obstacle that we have, though, in
    general, separate from the PACT Act, that the labor market
    continues to be tight and especially for some of our entry-
    level occupations we are still having a hard time competing at
    the lower-wage categories.
        Senator Blumenthal. Is that true in some parts of the
    country more than others?
        Ms. Bonjorni. It is but it is also a national problem that
    we are facing, as well as when you look at more entry-level
    health care positions, like nursing assistants and LPNs, that
    is an area where we are continuing to see high attrition and
    fewer people wanting to go into those careers.
        Senator Blumenthal. Why do you think that is?
        Ms. Bonjorni. The state of the health care environment over
    the last couple of years. They are stressful jobs that are very
    important but they are probably not earning enough money. So in
    the VA we will use the PACT Act to help us entice them to come
    into the occupation.
        Senator Blumenthal. The PACT Act could be a recruitment
    tool.
        Ms. Bonjorni. Absolutely.
        Senator Blumenthal. Great. Thank you very much, Mr.
    Chairman.
        Senator King. I was just making a note to close this
    hearing with a quote from Abraham Lincoln about change, that I
    think is very applicable to this situation. ``The dogmas of the
    quiet past are inadequate to the stormy present. The occasion
    is piled high with difficulty. Therefore, we must rise with the
    occasion. As our case is new so we must act anew and think
    anew, and then we shall save our country.''
        We are in a perfect storm of the PACT Act, the tight
    economy, the aging veteran population, and we have to really be
    thinking anew about how to meet that challenge, because time is
    of the essence. We are in a race with the claims coming in,
    with the aging veterans, and with the tight economy, that is
    very difficult for everyone to obtain new employees. We cannot
    let the veterans down by not meeting that challenge.
        Thank you very much for your testimony and for joining us
    today, and we look forward to continuing to work with you on
    this issue.
        Thanks again. The hearing is adjourned.
        [Whereupon, at 4:10 p.m., the hearing was adjourned.]

                                A P P E N D I X

         [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                                      [all]