As we look for ways to save money, what im concerned of and you are not a part of and if you are, let me know, potentially if we do it in congress or you do administratively, in montana, havent had it for years, walkin and using this and close it down. Same could be said in south dakota. If that were to happen there would be a bipartisan explosion on this committee which would not be a good thing. I bring that to your attention. Im all for getting rid of properties that outlive their usefulness and utilizing those dollars is a Good Government thing and i applaud his efforts but i am going to tell you there are some people that want to do a fullblown break and some of the metrics dont speak to them not because they are not good facilities, they have been staffed. I want to bring that up. In your testimony Suicide Prevention is a top priority. You also mentioned the va integrated Mental Health services to the primary care va centers. Tell me what that means in montana. What it means is the va is leading the strategy across the country where in your primary care office you dont have to say i have been given a number to go and to call for a Mental Health appointment and go down the street to the Mental Health department. You get that as part of your primary care experience. I agree how are you going to do it, you got to have somebody that knows the issue. You have to have Mental Health professionals with primary care people. Colocated. In a small population state like montana we are 20 short right now. The best laid plans, the infrastructure gets back to what you were saying, we have a manpower issue. It is geographically distinct particularly in areas that dont have a lot of medical schools and other places. Even though i wasnt here for senator morans questions, other opportunities, psychiatrists and psychologists and other folks can help, is that proceeding . Is it proceeding well . Are we making some inroads . We talked about a lot of metrics, what populations and what altitude and this stuff. We got to get our arms around the whole baby before we can get to the point we are talking about no other Health System im aware of has Suicide Prevention coordinators, that is a va strategy that is super effective. We are using peer support specialists in a way no other Health System is using and trying to hire traditional Mental Health professionals like social workers, psychologists and psychiatrists. Do you have a comment on penalty therapists . We are encouraging as strongly as we can facilities to hire them, part of their purview. The other thing we are doing to your question about primary or Mental Health integration is using teleMental Health, to provide providers in 2 places they may not hire a Mental Health professional. Can you tell me do they all have telehealth capabilities . Not all of them. We list them on our website which ones do but certainly the rural ones will be more likely to have it than you have in new york city. One of the things i dont know if you have ever seen that amazes me, you go into a primary care office and right there is a digital display that if a primary care doctor wants to dial in a psychologist or psychiatrist they can do it from their office. I dont see that in many places in the private sector. That is the integration we were talking about. I want to go back to manpower. Earlier you testified you were going to try to get 1000 additional Mental Health providers this year. Your testimony said you hired 600 new Mental Health providers. I am not going to ask the difference between traditional and new but is there a net increase in clinicians . You just asked and the answer is no, 23 just keeping us even. We are not succeeding at the net new professionals. I need help doing that. What do we need to do . What we need to do is give us more direct hiring Authority Like you did in the accountability act for the dical center, make it easier for me to hire, we talked about the fact that our recruitment and retention dollars were cut in half. That was shortsighted, we need the tools the private sector has to recruit the best healthcare professionals. If we are serious about tackling this, dont tie one of my hands behind my back. Did we do that . To pay for the legislation, yes. Taken out and keep going. So a competitive process can hire quicker. Recruitment dollars. Flexibility to be able to help expand training. Those are the three areas that would make a difference. There is a National Shortage here. I think we all worry about not just what is happening in va but everywhere, these are important strategies particularly the training one. You know this better than i do, it is a national problem. Veterans, we made a promise to them. Cant have a bunch of excuses, we need solutions, appreciate that. The last point, about to adjourn, have them for the record but i remember the discussion with secretary mcdonald. A series of news stories our members got tempted into amplifying that had to do with training and retention problems you thought were critically important. What we need to do is understand if you are going to make this an attractive place for professionals to come to you better have professional the filament and Retention Program similar to the private sector. Some dollars you are spending on training, i am sure i could find something, i saw the number the va was spending on per employee basis and it was pennies on the dollars compared to what i would have spent as a partner in price waterhouse, you will never get to that ratio but we need to make sure we are not talking out of both sides of the mouth saying we need recruiting and retention resources and micromanage how to go about spending it. Ive never been the head of a major Health System before, you have, the head of one of the biggest in the world. I trust you to make a decision how you have therapists, doctors and other people you want to attract and have a Value Proposition and have your share in the private sector. Another one where we hear one thing and do another, please give me your commitment that you will say that is not a good idea. We will adjourn the Committee Hearing and leave the record open for additional questions for the record. Thank the first panel for being here. Good to see leadership from the va, this meeting is adjourned. [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] we will be back on capitol hill when the Senate Banking committee looks into north korea and the effectiveness of sanctions live at 9 30 a. M. Eastern on cspan3. Next week former chair and ceo of equifax, richard smith, will testify before the house energy and commerce committee, an extensive data breach at equifax exposed private information of 143 million people. Live coverage of that tuesday at 10 am eastern. Also on cspan3 come online at cspan. Org and streaming on the cspan radio apps. Saturday booktv has coverage of the 2017 baltimore book festival. Starting at noon eastern, Michael Eric Dyson discussing his book tears we cannot stop. A sermon to white america. Lauren jacobs with her book you are in the wrong bathroom, and 20 other myths and misconceptions about transgender and other nonconforming people. Andrea ritchie with invisible no more, Police Violence against black women of color, robin spencer, author of the revolution has come, black power, gender and the black Panther Party in oakland