[Congressional Record Volume 150, Number 132 (Wednesday, November 17, 2004)]
[House]
[Pages H9787-H9793]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
DEPARTMENT OF VETERANS AFFAIRS HEALTH CARE PERSONNEL ENHANCEMENT ACT OF
2004
Mr. SIMMONS. Mr. Speaker, I move to suspend the rules and pass the
Senate bill (S. 2484) to amend title 38, United States Code, to
simplify and improve pay provisions for physicians and dentists and to
authorize alternate work schedules and executive pay for nurses, and
for other purposes.
The Clerk read as follows:
S. 2484
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
[[Page H9788]]
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Department of Veterans
Affairs Health Care Personnel Enhancement Act of 2004''.
SEC. 2. REFERENCES TO TITLE 38, UNITED STATES CODE.
Except as otherwise expressly provided, whenever in this
Act an amendment is expressed in terms of an amendment to a
section or other provision, the reference shall be considered
to be made to a section or other provision of title 38,
United States Code.
SEC. 3. SIMPLIFICATION AND IMPROVEMENT OF GRADE AND PAY
PROVISIONS FOR PHYSICIANS AND DENTISTS.
(a) Simplification of Grades and Grade Requirements.--(1)
Subsection (b) of section 7404 is amended--
(A) by striking ``(1)'' after ``(b)'';
(B) in the Physician and Dentist Schedule, by striking the
items relating to the grades and inserting the following:
``Physician grade.
``Dentist grade.''; and
(C) by striking paragraph (2).
(2) Subsection (a) of such section is amended by adding at
the end the following: ``The pay of physicians and dentists
serving in positions to which an Executive order applies
under the preceding sentence shall be determined under
subchapter III of this chapter instead of such Executive
order.''.
(b) Simplification and Improvement of Pay Authorities.--
Subchapter III of chapter 74 is amended to read as follows:
``SUBCHAPTER III--PAY FOR PHYSICIANS AND DENTISTS
``Sec. 7431. Pay
``(a) Elements of Pay.--Pay of physicians and dentists in
the Veterans Health Administration shall consist of three
elements as follows:
``(1) Base pay as provided for under subsection (b).
``(2) Market pay as provided for under subsection (c).
``(3) Performance pay as provided under subsection (d).
``(b) Base Pay.--One element of pay for physicians and
dentists shall be base pay. Base pay shall meet the following
requirements:
``(1) Each physician and dentist is entitled to base pay
determined under the Physician and Dentist Base and Longevity
Pay Schedule.
``(2) The Physician and Dentist Base and Longevity Pay
Schedule is composed of 15 rates of base pay designated, from
the lowest rate of pay to the highest rate of pay, as base
pay steps 1 through 15.
``(3) The rate of base pay payable to a physician or
dentist is based on the total number of the years of the
service of the physician or dentist in the Veterans Health
Administration as follows:
``For a physician or dentiThe rate of base pay is the rate payable for:
two years or less...............................................step 1
more than 2 years and not more than 4 years.....................step 2
more than 4 years and not more than 6 years.....................step 3
more than 6 years and not more than 8 years.....................step 4
more than 8 years and not more than 10 years....................step 5
more than 10 years and not more than 12 years...................step 6
more than 12 years and not more than 14 years...................step 7
more than 14 years and not more than 16 years...................step 8
more than 16 years and not more than 18 years...................step 9
more than 18 years and not more than 20 years..................step 10
more than 20 years and not more than 22 years..................step 11
more than 22 years and not more than 24 years..................step 12
more than 24 years and not more than 26 years..................step 13
more than 26 years and not more than 28 years..................step 14
more than 28 years.............................................step 15.
``(4) At the same time as rates of basic pay are increased
for a year under section 5303 of title 5, the Secretary shall
increase the amount of base pay payable under this subsection
for that year by a percentage equal to the percentage by
which rates of basic pay are increased under such section for
that year.
``(c) Market Pay.--One element of pay for physicians and
dentists shall be market pay. Market pay shall meet the
following requirements:
``(1) Each physician and dentist is eligible for market
pay.
``(2) Market pay shall consist of pay intended to reflect
the recruitment and retention needs for the specialty or
assignment (as defined by the Secretary) of a particular
physician or dentist in a facility of the Department of
Veterans Affairs.
``(3) The annual amount of the market pay payable to a
physician or dentist shall be determined by the Secretary on
a case-by-case basis.
``(4)(A) In determining the amount of market pay for
physicians or dentists, the Secretary shall consult two or
more national surveys of pay for physicians or dentists, as
applicable, whether prepared by private, public, or quasi-
public entities in order to make a general assessment of the
range of pays payable to physicians or dentists, as
applicable.
``(B)(i) In determining the amount of the market pay for a
particular physician or dentist under this subsection, and in
determining a tier (if any) to apply to a physician or
dentist under subsection (e)(1)(B), the Secretary shall
consult with and consider the recommendations of an
appropriate panel or board composed of physicians or dentists
(as applicable).
``(ii) A physician or dentist may not be a member of the
panel or board that makes recommendations under clause (i)
with respect to the market pay of such physician or dentist,
as the case may be.
``(iii) The Secretary should, to the extent practicable,
ensure that a panel or board consulted under this
subparagraph includes physicians or dentists (as applicable)
who are practicing clinicians and who do not hold management
positions in the medical facility of the Department at which
the physician or dentist subject to the consultation is
employed.
``(5) The determination of the amount of market pay of a
physician or dentist shall take into account--
``(A) the level of experience of the physician or dentist
in the specialty or assignment of the physician or dentist;
``(B) the need for the specialty or assignment of the
physician or dentist at the medical facility of the
Department concerned;
``(C) the health care labor market for the specialty or
assignment of the physician or dentist, which may cover any
geographic area the Secretary considers appropriate for the
specialty or assignment;
``(D) the board certifications, if any, of the physician or
dentist;
``(E) the prior experience, if any, of the physician or
dentist as an employee of the Veterans Health Administration;
and
``(F) such other considerations as the Secretary considers
appropriate.
``(6) The amount of market pay of a physician or dentist
shall be evaluated by the Secretary not less often than once
every 24 months. The amount of market pay may be adjusted as
the result of an evaluation under this paragraph. A physician
or dentist whose market pay is evaluated under this paragraph
shall receive written notice of the results of such
evaluation in accordance with procedures prescribed under
section 7433 of this title.
``(7) No adjustment of the amount of market pay of a
physician or dentist under paragraph (6) may result in a
reduction of the amount of market pay of the physician or
dentist while in the same position or assignment at the
medical facility of the Department concerned.
``(d) Performance Pay.--(1) One element of pay for
physicians and dentists shall be performance pay.
``(2) Performance pay shall be paid to a physician or
dentist on the basis of the physician's or dentist's
achievement of specific goals and performance objectives
prescribed by the Secretary.
``(3) The Secretary shall ensure that each physician and
dentist of the Department is advised of the specific goals or
objectives that are to be measured by the Secretary in
determining the eligibility of that physician or dentist for
performance pay.
``(4) The amount of the performance pay payable to a
physician or dentist may vary annually on the basis of
individual achievement or attainment of the goals or
objectives applicable to the physician or dentist under
paragraph (2).
``(5) The amount of performance pay payable to a physician
or dentist in a fiscal year shall be determined in accordance
with regulations prescribed by the Secretary, but may not
exceed the lower of--
``(A) $15,000; or
``(B) the amount equal to 7.5 percent of the sum of the
base pay and the market pay payable to such physician or
dentist in that fiscal year.
``(6) A failure to meet goals or objectives applicable to a
physician or dentist under paragraph (2) may not be the sole
basis for an adverse personnel action against that physician
or dentist.
``(e) Requirements and Limitations on Total Pay.--(1)(A)
Not less often than once every two years, the Secretary shall
prescribe for Department-wide applicability the minimum and
maximum amounts of annual pay that may be paid under this
section to physicians and the minimum and maximum amounts of
annual pay that may be paid under this section to dentists.
``(B) The Secretary may prescribe for Department-wide
applicability under this paragraph separate minimum and
maximum amounts of pay for a specialty or assignment. If the
Secretary prescribes separate minimum and maximum amounts for
a specialty or assignment, the Secretary may establish up to
four tiers of minimum and maximum amounts for such specialty
or assignment and prescribe for each tier a minimum amount
and a maximum amount that the Secretary determines
appropriate for the professional responsibilities,
professional achievements, and administrative duties of the
physicians or dentists (as the case may be) whose pay is set
within that tier.
``(C) Amounts prescribed under this paragraph shall be
published in the Federal Register, and shall not take effect
until at least 60 days after the date of publication.
``(2) Except as provided in paragraph (3) and subject to
paragraph (4), the sum of the
[[Page H9789]]
total amount of the annual rate of base pay payable to a
physician or dentist under subsection (b) and the market pay
determined for the physician or dentist under subsection (c)
may not be less than the minimum amount, nor more than the
maximum amount, applicable to specialty or assignment of the
physician or dentist under paragraph (1).
``(3) The sum of the total amount of the annual rate of
base pay payable to a physician or dentist under subsection
(b) and the market pay determined for the physician or
dentist under subsection (c) may exceed the maximum amount
applicable to the specialty or assignment of the physician or
dentist under paragraph (1) as a result of an adjustment
under paragraph (3) or (4) of subsection (b).
``(4) In no case may the total amount of compensation paid
to a physician or dentist under this title in any year exceed
the amount of annual compensation (excluding expenses)
specified in section 102 of title 3.
``(f) Treatment of Pay.--Pay under subsections (b) and (c)
of this section shall be considered pay for all purposes,
including retirement benefits under chapters 83 and 84 of
title 5 and other benefits.
``(g) Ancillary Effects of Decreases in Pay.--(1) A
decrease in pay of a physician or dentist resulting from an
adjustment in the amount of market pay of the physician or
dentist under subsection (c) shall not be treated as an
adverse action.
``(2) If the pay of a physician or dentist is reduced under
this subchapter as a result of an involuntary reassignment in
connection with a disciplinary action taken against the
physician or dentist, the involuntary reassignment shall be
subject to appeal under subchapter V of this chapter.
``(h) Delegation of Responsibilities.--The Secretary may
delegate to an appropriate officer or employee of the
Department any responsibility of the Secretary under
subsection (c), (d), or (e) except for the responsibilities
of the Secretary under subsection (e)(1).
``Sec. 7432. Pay of Under Secretary for Health
``(a) Base Pay.--The base pay of the Under Secretary for
Health shall be the annual rate of basic pay for positions at
Level III of the Executive Schedule under section 5314 of
title 5.
``(b) Market Pay.--(1) In the case of an Under Secretary
for Health who is also a physician or dentist, in addition to
the base pay specified in subsection (a) the Under Secretary
for Health may also be paid the market pay element of pay of
physicians and dentists under section 7431(c) of this title.
``(2) The amount of market pay of the Under Secretary for
Health under this subsection shall be established by the
Secretary.
``(3) In establishing the amount of market pay of the Under
Secretary for Health under this subsection, the Secretary
shall utilize an appropriate health care labor market
selected by the Secretary for purposes of this subsection.
``(c) Treatment of Pay.--Pay under this section shall be
considered pay for all purposes, including retirement
benefits under chapters 83 and 84 of title 5 and other
benefits.
``Sec. 7433. Administrative matters
``(a) Regulations.--(1) The Secretary shall prescribe
regulations relating to the pay of physicians and dentists in
the Veterans Health Administration under this subchapter.
``(2) In prescribing the regulations, the Secretary shall
take into account the recommendations of the Under Secretary
for Health on the administration of this subchapter. In
formulating recommendations for the purpose of this
paragraph, the Under Secretary shall request the views of
representatives of labor organizations that are exclusive
representatives of physicians and dentists of the Department
and the views of representatives of professional
organizations of physicians and dentists of the Department.
``(b) Reports.--(1) Not later than 18 months after the
Secretary prescribes the regulations required by subsection
(a), and annually thereafter for the next 5 years, the
Secretary shall submit to the Committees on Veterans' Affairs
of the Senate and House of Representatives a report on the
pay of physicians and dentists in the Veterans Health
Administration under this subchapter.
``(2) Each report under this subsection shall include the
following:
``(A) A description of the rates of pay in effect during
the current fiscal year with a comparison to the rates in
effect during the fiscal year preceding the current fiscal
year, set forth by facility and by specialty.
``(B) The number of physicians and dentists who left the
Veterans Health Administration during the preceding fiscal
year.
``(C) The number of unfilled physician positions and
dentist positions in each specialty in the Veterans Health
Administration, the average and maximum lengths of time that
such positions have been unfilled, and an assessment of the
reasons that such positions remain unfilled.
``(D) An assessment of the impact of implementation of this
subchapter on efforts to recruit and retain physicians and
dentists in the Veterans Health Administration.
``(3) The first two annual reports under this subsection
shall also include a comparison of staffing levels, contract
expenditures, and average salaries of physicians and dentists
in the Veterans Health Administration for the current fiscal
year and for the fiscal year preceding the current fiscal
year, set forth by facility and by specialty.''.
(c) Initial Rates of Base Pay for Physicians and
Dentists.--The initial rates of base pay established for the
base pay steps under the Physician and Dentist Base and
Longevity Pay Schedule provided in section 7431(b) of title
38, United States Code (as added by subsection (b)), are as
follows:
Base Pay Step: Rate of Pay:
1...............................................................$90,000
2...............................................................$93,000
3...............................................................$96,000
4...............................................................$99,000
5..............................................................$102,000
6..............................................................$105,000
7..............................................................$108,000
8..............................................................$111,000
9..............................................................$114,000
10.............................................................$117,000
11.............................................................$120,000
12.............................................................$123,000
13.............................................................$126,000
14.............................................................$129,000
15.............................................................$132,000
(d) Effective Date.--(1) Notwithstanding the 60-day waiting
requirement in section 7431(e)(1)(C) of title 38, United
States Code (as amended by subsection (b)), pay provided for
a physician or dentist under subchapter III of chapter 74 of
such title, as amended by subsection (b), shall take effect
on the first day of the first pay period applicable to such
physician or dentist that begins on or after January 1, 2006.
(2) Pay provided for the Under Secretary for Health under
subchapter III of chapter 74 of title 38, United States Code,
as amended by this section shall take effect on the first day
of the first pay period applicable to the Under Secretary
that begins on or after January 1, 2006.
(e) Transition Provisions.--
(1) Physicians and dentists.--
(A) Pay.--(i) The amount of the pay payable on and after
the date of the enactment of this Act to a physician or
dentist in receipt of pay under section 7404 or 7405 of title
38, United States Code, as of the day before such date shall
continue to be determined under such section (as in effect on
the day before such date) until the effective date that is
applicable under subsection (d) to such physician or dentist,
as the case may be.
(ii) A physician or dentist appointed or reassigned on or
after the date of the enactment of this Act, but before the
effective date applicable under subsection (d) to such
physician or dentist, shall be compensated in accordance with
applicable provisions of section 7404 or 7405 of title 38,
United States Code (as in effect on the day before date of
the enactment of this Act), until such effective date.
(B) Special pay.--(i) A special pay agreement entered into
by a physician or dentist under subchapter III of chapter 74
of title 38, United States Code, before the date of the
enactment of this Act shall terminate on the date of the
enactment of this Act. However, a physician or dentist in
receipt of special pay pursuant to such an agreement on that
date shall continue to receive special pay under the terms of
such agreement until the effective date that is applicable
under subsection (d) to such physician or dentist.
(ii) A physician or dentist described in subparagraph
(A)(ii) may be paid special pay under applicable provisions
of section 7433, 7434, 7435, or 7436 of title 38, United
States Code (as in effect on the day before the date of the
enactment of this Act), during the period beginning on the
date of the appointment or reassignment of such physician or
dentist, as the case may be, and ending on the effective date
applicable under subsection (d) to such physician or dentist.
However, no special pay agreement shall be required for the
payment of special pay under this clause.
(C) Treatment of special pay.--(i) Special pay paid under
subparagraph (B) to a physician or dentist during the period
beginning on the date of the enactment of this Act and ending
on the effective date applicable under subsection (d) to such
physician or dentist shall be subject to the provisions of
paragraphs (1), (2), (4), (5), and (6) of section 7438(b) of
title 38, United States Code (as in effect on the day before
the date of the enactment of this Act).
(ii) Special pay paid to a physician or dentist under
section 7438 of title 38, United States Code (as in effect on
the day before the date of the enactment of this Act), shall
be fully creditable for purposes of computing benefits under
chapters 83 and 84 of title 5, United States Code.
(D) Preservation of pay.--The amount of pay paid to a
physician or dentist after the effective date of this Act
shall not be less than the amount of pay paid to such
physician or dentist on the day before the effective date of
this Act while such physician or dentist remains in the same
position or assignment.
(2) Under secretary for health.--
(A) Special pay.--(i) The current special pay agreement
entered into by the Under Secretary for Health under
subchapters I and III of chapter 74 of title 38, United
States Code, before the date of the enactment of this Act
shall terminate on the date of the enactment of this Act.
However, the Under Secretary shall continue to receive
special pay under the terms of such agreement until the
effective date that is applicable under subsection (d) to the
Under Secretary.
(ii) An individual appointed as Under Secretary for Health
on or after the date of the
[[Page H9790]]
enactment of this Act and before the effective date
applicable under subsection (d) to the Under Secretary shall
be paid special pay in accordance with the provisions of
sections 7432(d)(2) and 7433 of title 38, United States Code
(as in effect on the day before the date of the enactment of
this Act), during the period beginning on the date of
appointment and ending on such effective date. However, no
special pay agreement shall be required for the payment of
special pay under this clause.
(B) Treatment of special pay.--Special pay paid under
subparagraph (A) during the period beginning on the date of
the enactment of this Act and ending on the effective date
applicable under subsection (d) to the Under Secretary--
(i) shall be subject to the provisions of paragraphs (1),
(2), (4), (5), and (6) of section 7438(b) of title 38, United
States Code (as in effect on the day before the date of the
enactment of this Act); and
(ii) shall be fully creditable for purposes of computing
benefits under chapters 83 and 84 of title 5, United States
Code.
(f) Conforming Amendments.--Section 7404 is amended--
(1) in subsection (c), by striking ``special pay'' and
inserting ``pay''; and
(2) in subsection (d), by striking ``pay may not be paid''
and all that follows and inserting ``pay for positions for
which basic pay is paid under this section may not be paid at
a rate in excess of the rate of basic pay authorized by
section 5316 of title 5 for positions in Level V of the
Executive Schedule.''.
(g) Clerical Amendment.--The table of sections at the
beginning of chapter 74 is amended by striking the items
relating to subchapter III and inserting the following new
items:
``SUBCHAPTER III--PAY FOR PHYSICIANS AND DENTISTS
``Sec. 7431. Pay.
``Sec. 7432. Pay of Under Secretary for Health.
``Sec. 7433. Administrative matters.''.
SEC. 4. ALTERNATE WORK SCHEDULES FOR REGISTERED NURSES.
(a) In General.--(1) Chapter 74 is amended by inserting
after section 7456 the following new section:
``Sec. 7456A. Nurses: alternate work schedules
``(a) Applicability.--This section applies to registered
nurses appointed under this chapter.
``(b) 36/40 Work Schedule.--(1)(A) Subject to paragraph
(2), if the Secretary determines it to be necessary in order
to obtain or retain the services of registered nurses at any
Department health-care facility, the Secretary may provide,
in the case of nurses employed at such facility, that such
nurses who work three regularly scheduled 12-hour tours of
duty within a work week shall be considered for all purposes
to have worked a full 40-hour basic work week.
``(B) A nurse who works under the authority in subparagraph
(A) shall be considered a 0.90 full-time equivalent employee
in computing full-time equivalent employees for the purposes
of determining compliance with personnel ceilings.
``(2)(A) Basic and additional pay for a nurse who is
considered under paragraph (1) to have worked a full 40-hour
basic work week shall be subject to subparagraphs (B) and
(C).
``(B) The hourly rate of basic pay for a nurse covered by
this paragraph for service performed as part of a regularly
scheduled 36-hour tour of duty within the work week shall be
derived by dividing the nurse's annual rate of basic pay by
1,872.
``(C) The Secretary shall pay overtime pay to a nurse
covered by this paragraph who--
``(i) performs a period of service in excess of such
nurse's regularly scheduled 36-hour tour of duty within an
administrative work week;
``(ii) for officially ordered or approved service, performs
a period of service in excess of 8 hours on a day other than
a day on which such nurse's regularly scheduled 12-hour tour
of duty falls;
``(iii) performs a period of service in excess of 12 hours
for any day included in the regularly scheduled 36-hour tour
of duty work week; or
``(iv) performs a period of service in excess of 40 hours
during an administrative work week.
``(D) The Secretary may provide a nurse to whom this
subsection applies with additional pay under section 7453 of
this title for any period included in a regularly scheduled
12-hour tour of duty.
``(3) A nurse who works a work schedule described in this
subsection who is absent on approved sick leave or annual
leave during a regularly scheduled 12-hour tour of duty shall
be charged for such leave at a rate of ten hours of leave for
every nine hours of absence.
``(c) Holiday Pay.--A nurse working a work schedule under
subsection (b) that includes a holiday designated by law or
Executive order shall be eligible for holiday pay under
section 7453(d) of this title for any service performed by
the nurse on such holiday under such section.
``(d) 9-Month Work Schedule for Certain Nurses.--(1) The
Secretary may authorize a registered nurse appointed under
section 7405 of this title, with the nurse's written consent,
to work full time for nine months with 3 months off duty,
within a fiscal year, and be paid at 75 percent of the full-
time rate for such nurse's grade for each pay period of such
fiscal year.
``(2) A nurse who works under the authority in paragraph
(1) shall be considered a 0.75 full-time equivalent employee
in computing full-time equivalent employees for the purposes
of determining compliance with personnel ceilings.
``(3) Work under this subsection shall be considered part-
time service for purposes of computing benefits under
chapters 83 and 84 of title 5.
``(4) A nurse who works under the authority in paragraph
(1) shall be considered a full-time employee for purposes of
chapter 89 of title 5.
``(e) Notification of Modification of Benefits.--The
Secretary shall provide each employee with respect to whom an
alternate work schedule under this section may apply written
notice of the effect, if any, that the alternate work
schedule will have on the employee's health care premium,
retirement, life insurance premium, probationary status, or
other benefit or condition of employment. The notice shall be
provided not later than 14 days before the employee consents
to the alternate work schedule.
``(f) Regulations.--The Secretary shall prescribe
regulations to carry out this section.''.
(2) The table of sections at the beginning of chapter 74 is
amended by inserting after the item relating to section 7456
the following new item:
``Sec. 7456A. Nurses: alternate work schedules.''.
(b) Policy Against Certain Work Hours.--(1) It is the sense
of Congress to encourage the Secretary of Veterans Affairs to
prevent work hours by nurses providing direct patient care in
excess of 12 consecutive hours or in excess of 60 hours in
any 7-day period, except in the case of nurses providing
emergency care.
(2) Not later than one year after the date of the enactment
of this Act and every year thereafter for the next two years,
the Secretary shall certify to Congress whether or not each
Veterans Health Administration facility has in place, as of
the date of such certification, a policy designed to prevent
work hours by nurses providing direct patient care (other
than nurses providing emergency care) in excess of 12
consecutive hours or in excess of 60 hours in any 7-day
period.
SEC. 5. NURSE EXECUTIVE SPECIAL PAY.
Section 7452 is amended by adding at the end the following
new subsection:
``(g)(1) In order to recruit and retain highly qualified
Department nurse executives, the Secretary may, in accordance
with regulations prescribed by the Secretary, pay special pay
to the nurse executive at each location as follows:
``(A) Each Department health care facility.
``(B) The Central Office.
``(2) The amount of special pay paid to a nurse executive
under paragraph (1) shall be not less than $10,000 or more
than $25,000.
``(3) The amount of special pay paid to a nurse executive
under paragraph (1) shall be based on factors such as the
grade of the nurse executive position, the scope and
complexity of the nurse executive position, the personal
qualifications of the nurse executive, the characteristics of
the health care facility concerned, the nature and number of
specialty care units at the health care facility concerned,
demonstrated difficulties in recruitment and retention of
nurse executives at the health care facility concerned, and
such other factors as the Secretary considers appropriate.
``(4) Special pay paid to a nurse executive under paragraph
(1) shall be in addition to any other pay (including basic
pay) and allowances to which the nurse executive is entitled,
and shall be considered pay for all purposes, including
retirement benefits under chapters 83 and 84 of title 5, and
other benefits, but shall not be considered basic pay for
purposes of adverse actions under subchapter V of this
chapter.''.
The SPEAKER pro tempore. Pursuant to the rule, the gentleman from
Connecticut (Mr. Simmons) and the gentleman from Texas (Mr. Rodriguez)
each will control 20 minutes.
The Chair recognizes the gentleman from Connecticut (Mr. Simmons).
Mr. SIMMONS. Mr. Speaker, I yield myself such time as I may consume.
(Mr. SIMMONS asked and was given permission to revise and extend his
remarks.)
Mr. SIMMONS. Mr. Speaker, today the House considers S. 2484, the
Department of Veterans Affairs Personnel Enhancement Act of 2004. This
legislation is designed to improve VA's ability to recruit and retain
physicians and nurses. The bill represents a compromise agreement
between the two bodies and is supported by the administration.
The Department of Veterans Affairs has almost 1,000 vacancies for
full-time physicians, particularly specialists. Inadequate salaries are
one of the biggest obstacles to filling these physician vacancies.
Because VA is not able to hire the physician it needs, it will spend
over a billion dollars this year for non-VA physicians to care for
veterans under contractual agreements.
Thirteen years have passed since Congress last made changes to the VA
[[Page H9791]]
physician and dentist compensation system. Last year, VA submitted a
legislative proposal to allow VA to be more competitive in physician
recruitment. After receiving that proposal, we worked with our Senate
counterparts, the VA and interested organizations to craft the
compromise legislation before the House today.
The largest component of physician compensation for most physicians
would be fixed in statute and adjusted annually. A second component,
market pay, would be determined through an open three-step process.
VA's Under Secretary for Health in formulating recommendations on pay
to the Secretary would solicit the views of concerned employee
representatives and professional organizations. The Secretary would
then provide notice in the Federal Register with a 60-day waiting
period before adjustments to pay bans would be finalized.
Further, the compromise agreement would require VA to provide each
physician and dentist written notice of any decisions made by the VA
concerning their pay.
This compromise agreement would also provide a third component of
compensation that addresses the issue of performance pay for physicians
and dentists. Any award of performance pay would be made on the basis
of an individual physician's or dentist's achievement of specific goals
agreed upon in advance. This provision is very important because it
would ensure that performance payments serve as incentives for good
performance rather than as penalties for lack of performance.
The compromise we are considering today is supported by the VA
employee representatives and professional organizations and is a very
much needed change that should enhance health care for our veterans.
The compromise agreement also includes provisions that would ensure
proper retirement credits to physicians and dentists during the
transition from the current pay system to the new system. It provides a
total VA compensation paid to a physician or dentist in a given year
would not exceed the salary of the President, and the compromise
agreement would also make the new compensation system effective the
first pay period following January 1, 2006.
Our compromise agreement includes several provisions from H.R. 4231,
which was a bill I introduced earlier this year, to authorize
alternative tours of duty for VA registered nurses. This bill passed
the House on September 30, 2004, and the provisions are intended to
make VA's scheduling of nurse duty hours more flexible and more family-
friendly while enabling VA nurses to pursue their careers in VA health
care.
Mr. Speaker, this is a good bill that ought to pass.
Mr. Speaker, I reserve the balance of my time.
Mr. RODRIGUEZ. Mr. Speaker, I yield myself such time as I may
consume.
Mr. Speaker, I rise in support of S. 2484, the Department of Veterans
Affairs Health Care Personnel Enhancement Act of 2004. I am pleased
that this bill is the result of the collaboration of the House and
Senate Committee on Veterans' Affairs' staff working with the
representatives from the VA, the National Association of VA Physicians
and Dentists, and the American Federation of Government Employees.
This legislation has been a long time coming and provides much needed
updated improvements in how the VA physicians and dentists are
compensated. The VA's current system of pay for physicians and dentists
has not been modified since 1991 and has not kept up with the
compensation for doctors in the private and academic sectors. According
to the testimony from the VA in June of this year, the effects of the
noncompetitive pay and benefits are reflected in the dramatic increases
in the VA's reliance on expensive, scarce medical specialist contracts
and fee-based care.
This bill establishes two components that make up the physician's
total salary and also incorporates additional performance pay.
{time} 1530
Under this new system, base pay for doctors is comprised of 15 steps.
Physicians automatically move up one step every 2 years, so a
doctor's base pay is based on the number of years he or she has worked
in the VA health care system. Step increases in base pay are another
way of rewarding the VA doctors for their long-term commitment to
caring for our veterans.
The second component of this particular bill is market pay as set by
the Secretary of Veterans Affairs and will be determined according to
geographic areas, specialty or assignment, board certifications, and
experience.
The VA will rely on national surveys to establish market pay
comparable bands, which are then to be published in the Federal
Register. Market pay helps the VA achieve comparability with the
private sector.
Performance pay makes up the final tier of this new system and is a
result of the VA physicians' annual performance reviews measuring
achievement as well as attainment of VA ``corporate'' goals. This
bipartisan bill also contains special pay for the VA nurse executives,
a bonus of between $10,000 and $25,000, which is based on several
descriptive factors.
This will also help further the VA's ability to recruit and retain
highly qualified nurse executives and adds incentive for those nurses
to move into managerial positions within the VA health care system.
Since one of the major causes of dissatisfaction in the nursing
workforce is inflexible work schedules, a more flexible work schedule
for VA nurses is also provided in this piece of legislation.
This new system of pay for VA physicians and dentists and the
provisions for the nurses greatly improves the VA's ability not only to
recruit, but also to retain top-quality doctors and nurses to care for
our veterans.
I ask my colleagues to join me in supporting this piece of
legislation.
I also want to take this opportunity to thank the gentleman from
Connecticut (Mr. Simmons) for his leadership in this area and also
personally thank him for his kind words. It has been rewarding working
with him on this particular piece of legislation.
Mr. Speaker, I reserve the balance of my time.
Mr. SIMMONS. Mr. Speaker, I yield such time as he may wish to consume
to the gentleman from New Jersey (Mr. Smith), my friend and colleague
and the distinguished chairman of the Committee on Veterans' Affairs.
Mr. SMITH of New Jersey. Mr. Speaker, I thank the gentleman for
yielding me this time.
Mr. Speaker, after 22 years on the House Committee on Veterans'
Affairs, Pat Ryan, our chief counsel and staff director, is retiring
from government service. I want to take this opportunity to pay tribute
to his extraordinary career and his many, many accomplishments.
For over 2 decades, Pat Ryan has made tremendous contributions to
many of the most important new veterans laws that have been approved by
Congress. He worked on numerous bills to expand services for aging
veterans and those in need of long-term health care.
He was instrumental in helping to establish domiciliaries for
homeless veterans and was the principal drafter of legislation to
authorize VA's transitional housing guarantee program to benefit
homeless veterans. Pat played an essential role in helping to establish
the Department of Veterans Affairs and in creating the Court of Appeals
for Veterans Claims.
Pat has been deeply involved in numerous successful committee
initiatives that expanded and strengthened programs to assist surviving
spouses and children of servicemembers killed in action or who later
died of service-related causes. Over the past 20 years, Pat has helped
to increase the Montgomery GI Bill benefit for qualified veterans from
$300 per month when he joined the committee to over $1,000 per month
today.
Using his budget expertise gained from 10 years working for the VA
early in his career, Pat has been an extraordinarily valuable person in
helping the Congress to ensure that the VA's budget has been both
appropriate and responsive and that all funds are well spent. His
extensive knowledge of the law and the inner workings of the VA greatly
aided our committee in its work to create exemplary oversight of
veterans programs.
From managing the committee's professional staff, to drafting
legislation, to overseeing VA's programs and services, Patrick Ryan is
the consummate
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professional. I consider him to be a great friend and a great partner
in all that this committee has accomplished during our time together,
and it has been an honor to work side by side with him.
On a personal level, Pat Ryan has lived his life in a way that has
truly made a difference and has walked to the beat of our Lord's
drummer when He said whatever you do to the least of my brethren, you
do likewise to me. For Pat, that means always looking out for the
little guy. I have such respect and admiration for that character
trait, and it is very strong in Patrick Ryan. What motivates him more
than anything else, and it is first and foremost in his life, is his
love for his wife, Kathy, and their three children: Kerry, Dan, and
Julia. For Pat Ryan, family always comes first.
Pat is ever proud of his father who has passed, William Everest Ryan,
who was a proud Marine and who saw combat during World War II in the
South Pacific where he was wounded and won the Purple Heart award. He
later joined the Justice Department while continuing in the Marine
reserves as an officer in the JAG, retiring with the rank of colonel in
1964. Pat Ryan has spent his entire career in Congress, defending the
same values his father defended on the battlefield and in the
courtroom.
Mr. Speaker, on behalf of his colleagues in the House and members of
the Committee on Veterans' Affairs who know and admire him so much, and
other Members who have known and worked with him, and on behalf of
millions of veterans who have benefited from his work, but have never
known his name, I want to thank Pat Ryan for a distinguished career of
faithful public service. It has been an honor to work with him.
Mr. RODRIGUEZ. Mr. Speaker, I yield 2 minutes to the gentleman from
Illinois (Mr. Evans), our ranking member.
Mr. EVANS. Mr. Speaker, I rise in support of S. 2484, the Department
of Veterans Affairs Health Care Personnel Enhancement Act of 2004.
There are now over 14,000 physicians and dentists who work in the VA
health care system. Unfortunately, the pay system that the VA uses to
pay our doctors has not been updated since 1991, and it is not helping
the VA's efforts to recruit and retain high-quality providers for our
veterans.
The current system is very complex and does not offer the flexibility
needed to respond to the changes of competitive markets, especially for
the highest paid subspecialties.
This legislation offers the VA the opportunity to award its
physicians and dentists for tenure within the VA health care system,
and even adds a performance pay section which acts as a bonus for those
doctors who achieved specific goals and performance objectives outlined
by the Secretary of Veterans Affairs.
Thanks to the efforts of the Senate and House Committee on Veterans'
Affairs, we will have legislation that will greatly enhance the VA's
ability to recruit and retain high-quality physicians and dentists.
I support this legislation, and I ask my colleagues to do the same.
Mr. SIMMONS. Mr. Speaker, I yield myself such time as I may consume.
I want to thank Chairman Specter and Ranking Member Graham of the
Senate Committee on Veterans' Affairs for their diligence on this
important piece of legislation. Again, I thank our very distinguished
chairman, the gentleman from New Jersey (Mr. Smith); our committee
ranking member, the gentleman from Illinois (Mr. Evans); and my
colleague and ranking member on the Subcommittee on Health Care, the
gentleman from Texas (Mr. Rodriguez), for all of their hard work on
bringing this legislation to fruition.
I would also like to recognize the Senate Committee on Veterans'
Affairs Staff Director Bill Tuerk and Bill Cahill, health counsel to
the Senate committee, without whose hard work this compromise simply
would not have been possible. Finally, I want to acknowledge the
excellent staff work conducted by our own committee staff, Pat Ryan,
our committee chief counsel; staff director Kingston Smith, Jeannie
McNally, John Bradley, and Dolores Dunn of the committee staff.
Finally, I would like to associate myself with the remarks made by
the chairman on Pat Ryan. I had the honor a number of years ago to
serve as staff director of a committee, regrettably on the Senate side;
but what I learned from those 4 years was how difficult it is sometimes
to accommodate the differing views of Members, all of whom argue in
good faith for their points of view; and observing Pat over the 4 years
that I have served on this committee, I think he has done an excellent
job. He has been very professional. He has kept his cool under some
difficult circumstances. I wish him all the best in his future
endeavors.
Again, Mr. Speaker, I urge my colleagues to support this reform.
Mr. RODRIGUEZ. Mr. Speaker, I yield myself such time as I may
consume.
Let me take this opportunity also just to thank the gentleman from
New Jersey (Chairman Smith) for his leadership and the bipartisan
manner in which we have conducted this piece of legislation and during
the last 8 years. I want to personally thank the gentleman from New
Jersey (Chairman Smith) for his hard work and for reaching out on
behalf of all veterans in this country. I also wanted to take this
opportunity to thank the gentleman from Connecticut (Mr. Simmons), whom
I have enjoyed working with, and I want to personally thank him also
for all his hard work and for coming down to San Antonio also.
In the same light, I also want to thank Pat Ryan. I know that a lot
of times the Members get all the credit and the staff does all the
work. And I do want to thank the staff from both sides of the aisle and
thank them for their hard work in a bipartisan manner.
Mr. Speaker, I also want to take this opportunity to thank our
ranking member, the gentleman from Illinois (Mr. Evans). From the very
beginning when I first got elected, he came forth to my district in San
Antonio and was there with my veterans, one of the first times; and he
has helped to educate me on a lot of the issues in my district. So I
want to personally thank the gentleman from Illinois (Mr. Evans) for
the opportunity of working with him, and thank him, as well as all the
other veterans here for their service to our country.
Ms. JACKSON-LEE of Texas. Mr. Speaker, I rise today as a strong
supporter of S. 2484 the Department of Veterans Affairs Health Care
Personnel Enhancement Act of 2004 which received unanimous approval in
the Senate and is now before this body for passage. The Veterans
Affairs Health Care Personnel Enhancement Act would set forth important
new pay provisions for physicians and dentists employed by the Veterans
Health Administration.
These physicians and dentists represent the lifeblood of the services
provided by the Veterans Health Administration. There are over
26,550,000 veterans in the United States, the great majority of whom
rely upon these services to maintain a healthy standard of living. In
the 18th Congressional District alone there are more than 38,000
veterans and they make up almost ten percent of the district's civilian
population over the age of 18. These veterans rely upon the great
services offered at the Michael E. DeBakey VA Medical Center in
Houston. Of course any great medical facility is only as good as its
health care personnel, which is why this legislation is so necessary to
correct any pay inequities.
The Veterans Affairs Health Care Personnel Enhancement Act includes
three different components. The first calls for base pay that is
uniform nationwide; which will ensure that entry level personnel will
not be taken advantage and paid lower wages than their counterparts in
other facilities. The second component institutes market pay that
varies based on geographic area, specialty, assignment, personal
qualifications, and individual experience. This component will allow
for varying pay grades based on each individuals experience and
circumstance as opposed to fixed pay rates that do not properly reflect
each individual's contribution to the Veterans Health Administration.
The final component calls for performance pay linked to the achievement
of specific corporate goals and individual performance objectives.
Again, this component will allow individual health care personnel to be
rewarded based on their level of service and it will encourage others
to raise their level of performance in order to collect performance
bonuses. These three components as a whole will provide a more
equitable and just pay scale physicians and dentists employed by the
Veterans Health Administration. As a Member in this body I have always
insisted on our brave veterans receiving the best of care in the finest
health care facilities that we can provide. The Veterans Affairs Health
Care Personnel Enhancement Act will allow those who provide these
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vital health care services to be properly compensated and motivated to
stay within the Veterans Health Administration.
Mr. RODRIGUEZ. Mr. Speaker, I yield back the balance of my time.
Mr. SIMMONS. Mr. Speaker, I yield back the balance of my time.
The SPEAKER pro tempore (Mr. Terry). The question is on the motion
offered by the gentleman from Connecticut (Mr. Simmons) that the House
suspend the rules and pass the Senate bill, S. 2484.
The question was taken; and (two-thirds having voted in favor
thereof) the rules were suspended and the Senate bill was passed.
A motion to reconsider was laid on the table.
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