Post cspans guest this week on newsmakers, is david shulkin. Easily cabinet secretary that is a holdover from the obama administration, the only secretary unanimously confirmed by the senate. He is a practicing physician still in oversees the secondlargest Cabinet Department with 1700 sites he is responsible for in an agency that serves 9 million veterans. Thank you for being our guest. Let me introduce our two reporters. Been castling is making a , national visit securities and Veterans Affairs reporter for the washington journal. And the Capitol Hill Bureau chief for military times. Leo, you are asking the first question . I wanted to start with the issue of accountability. It is the threeyear anniversary of the phoenix, the wait time scandals at the v. A. And we got news that you have demoted the Medical Center director there. You have made accountability a big issue in the early days, but i wonder has that been the missing piece with Reform Efforts and missing years recent years, and should we expect Real Progress on accountability soon . Sec. Shulkin the issue was actually an Inspector General report which was brought to my attention that i was concerned about patient safety. And you will see, wherever there is a concern about safety, we will take immediate action. That is signaling a change in v. A. , the culture. They are the best in the country. They are serving with great dignity and with mission. But where we find we are having people who dont miss that meet our standards, we will take Decisive Action to make sure they are not harming the organization and not in leadership positions. Leo you have endorsed a bill floundering in the senate now. You endorsed that as a way to more easily fire some of these bad actors, folks involved in either incompetence or criminal activity. Is that that a matter of finding scapegoats for some of these problems, or do you feel they will bring a more systemic cultural change that folks on the top of the hill have asked for . Sec. Shulkin everything starts with leadership. It is important you have the right leaders in place if you want to make sure the organization is moving in the right direction and running the way it should be. I am grateful to the house and particularly the chairman wrote for his leadership for making sure we do have an accountability bill through the house. I wouldnt describe the bill as floundering in the senate. I think there is strong support and i do expect we will see action coming out of the senate as well. This is a bill that not only allows us to remove people that should be removed, it allows them due process which i believe in strongly. To make sure they are not barriers to making the right decision. It is a bill that helps us reach higher and recruit and retain the best and health care. So it is an accountability bill that colleges both ends of the spectrum, hiring and removal. Reporter to followup on that for legislation. As the legislative priority for your predecessor was dealing with appeals reform. I wonder if that is a priority for you at this point and if you are pushing for the legislators in the house and the senate, which seem to be getting along with each other at this point, the democrats and the republicans, are you pushing to repeal a form go through repeals reform go through quickly . David shulkin it is one of my legislative priorities. This was legislation last written in the and we know that 1930s, without legislative changes, our appeals process will remain broken and get worse. A veteran soon will wait six years to get a decision when they make an appeal. That is totally acceptable. We need legislative action and i am hopeful and optimistic that we will see that in this congress. There is support in the house and the senate side to get this legislation through. We have worked closely with the Veterans Service organizations and other groups to make sure we have the best legislation we could come up with. And now, there is the momentum to move that across the line. Reporter where do things stand right now with backlogs . Over time, the claims backlog has started to tick back up after it was tackled pretty well by your predecessors, it dropped by hundreds of thousands. At that number is starting to go up a little bit. And the appeals backlog is starting to go up for folks who might not understand it when a , veteran puts in a claim for disability, they can wait some time to get that process. The initial backlog. And after that initial appeal, there is the appeals backlog. It is a twotier system. Could you talk a little bit about where that stands . David shulkin we did talk about the appeals. The backlog stands at about 450,000 cases. If we dont get legislation to fix the process that is going to , continue to grow and that is totally unacceptable. Why we need legislation for appeals. On the disability claims, i think you are correct. We have seen a tiny bump up and it is something we are now addressing. You have to remember, 2. 5 years ago we had 611,000 disability claims above 125 days. Today, we are at about 100,000. So we have made significant progress from where we were. But 100,000 isnt good enough. And we are looking at a number of new strategies. Decision ready claims. Going paperless. Changing some of our systems to make sure we can get that number down significantly. And that is one of my priorities, to get that number down to a much smaller number than where it is today. Host there is a federal hiring freeze and im wondering how it will affect you getting the kind of people in to the claims are review that you need . David shulkin the federal hiring freeze is over. As of april 12, we no longer have the federal hiring freeze. We are committed to filling the positions that are necessary. We are taking a close look at every position we fill to make sure that they are absolutely necessary. As you know, we are trying to do government more efficiently and smarter and making sure that we really are looking at every dollar the taxpayer pays to make sure it is necessary. But in areas like getting the disability claims processed, where we are at 100,000, we had a freeze on those positions. It is really important that we get the people in place so we tik sure we are taking cking that number down. Because veterans deserve better. They deserve faster decisions. Reporter i want to followup with one more thing. Are you saying the federal hiring freeze did affect the vas far as processing claims and that the decision to put a hold on hiring did negatively affect you and what you could do . David shulkin yes, v. A. Has a dramatic need to have positions filled. We had about 45,000 positions throughout the country that were open on usa jobs. We requested an exemption for 41,000 of the 45,000 that we determined were in the interest of Public Health and safety. We needed to hire doctors, nurses, pharmacists and physical therapist to keep our veterans safe. We did have an administrative freeze on about 4000 positions. Many of them disproportionately were in administrativetype positions. Many of them in the veterans benefit organizations. So we did have a negative impact on the ability to process claims as people left jobs and we didnt fill them. Im now pleased that we are going back and making sure we are filling those positions that are necessary. We have to get those claims down. Reporter i want to take a step back on this whole issue because people would hear 100,000 claims backlog and a secure wait for appeals. These are not do issues to the a. A. T to v is it something you have been dealing with for years, even before you got there as the director of health. So what do you see has changed now . Or is it an accumulative affect of improvements made that we will eventually see things . Basically, why optimistic that you will see changes on the appeals and backlog . Ive said said i dont expect a change in the appeals without legislation. And that is why it is absolutely critical. One of my priorities that im working with the house and senate on is to make sure we get appeals legislations done in this congress. I am optimistic that we will continue to make improvements on the disability claims for a couple of reasons. Number one is that we are now seeing the benefits of our investing in modernization of our technology and i. T. Systems. We are announcing a campaign to go paperless on all disability claims. We have six offices that are now completely paperless and we will be rolling that out across the country. And we are continuing to look at how we can refine and improve the processes. Decisionready claims is an example where veterans will be able to opt for a system where they can get faster decisions on their disability claims. It will be their option to do that. So changing processes and investing in technology at the modernization of our systems i do expect that we will see , continued improvement. Reporter from legislative hope to one legislative victory of already had you did have the , Choice Program extension passed by congress. And you had said that was critical to make sure that the program did not expire in august and you can serve veterans. You have promised that we will see major changes to the program. Could you talk about when we will see them and what the timeline is for one Congress Might have something to vote on . David shulkin leo, i think you got it right. It was absolutely critical that the house and congress act to extend the current Choice Program because veterans were beginning to be extended impacted negatively. And because of the leadership that we have with the full congress, we got that passed. The president is looking for to sign that on april 19. It will be an important event for us. But that is just the beginning. We need to make sure that this Choice Program not only continues, but it works for veterans. We know it has not worked way we wanted it to work. It is too complex, too hard to use. We are working harder now with congress to redesign a better, improved way of accessing care in the community. We will be working with them in the next several weeks to get what that package looks like. And we hope to be able to bring that to legislative decision in the early fall. Because we need a Replacement Program by the end of this calendar year. Reporter if you bring it to congress in early fall, is there enough time to get it through if the money runs out at the end of the year . David chilton shulkin that is only need new legislation. I am confident that when it comes to protecting and honoring our commitment to our veterans, that congress and the president is committed to doing whatever it needs to do to make sure that we meet that timeframe. Reporter that choice legislation, whatever it may be, one of the reasons it seems that you stayed on was because of what you did at the Veterans Health administration, the health care arm of the v. A. Allowing more choice. Morewould say it allows choice and others say it pushes the organization towards privatization. Could you talk about what the difference between choice and privatization is . If that is just semantics . Or if there is a difference between those two terms . David shulkin im not in favor of privatization of the v. A. I am absolutely confident since i have been here now, and they came in with an open mind. I came in from the private sector really not knowing what the best decision was. But when i began to see what is happening in the be a system v. A. System and whether that care would be available in the private sector and i began to practice and see patients in the v. A. , i came to the conclusion that we had to maintain a strong v. A. The care that we deliver cant be and wouldnt be replaced in the private sector. At that doesnt mean that we shouldnt be working closely with the private sector. And i believe the way we should fulfill our commitment to veterans is to keep a strong v. A. But integrated with what the private sector is doing. Or what the v. A. Isnt doing as well. So i am looking to design a single system that is seamless. So veterans can get the best of what the v. A. Offers and what the private sector offers with an integrated approach to care. Reporter in what way is comparing the v. A. Which is Government Run Health Care and a government run was a insurance program. Quasiinsurance program. In what way does comparing that to the private sector, using the metrics the wrong way to look at it . In what way can you import private sector metrics and comparisons to the v. A. . Is it comparing apples to oranges . Is a railway at looking at it through the private sector lens bad for veterans . David shulkin no, it is one of the clear directions you will see under my administration. We will make it so we are doing direct comparisons to the private sector. Because that is how veterans can make the best informed choices for their lives and wellbeing. By understanding what the v. A. Has to offer and where the what the private sector has to offer. V. A. Where the is not doing it as well where the v. A. Is not doing it as well i want veterans , going to the private sector that i also want people to recognize that the v. A. Is doing some extraordinary things better than the private sector. Like the Behavioral Health care and many of the programs dedicated to conditions people suffer when they come back from some of our conflicts. We are making it much easier. In fact, we released yesterday a website that allows veterans to see an easily understand what the wait times are for care because it is a big issue for , us. There is nobody in the private sector that is publishing wait times. So i am encouraging the private sector to adopt our metric so that veterans could actually see what the wait times are in the private sector and the v. A. Reporter with that website, do you have concerns about making that data public . I understand the issue of transparency,but it is the threeyear anniversary of the wait time scandal and at the heart of that was some issues with transparency and issues of artificial deadlines that were being placed on Medical Centers. So does it worry you at all that , you could have a competition Medical Centers where they say hey, we need to push the wait time numbers down, here so fudge it over if there is less pressure on us . David shulkin one thing i have learned in government is that there are no easy decisions. This is a fundamental belief of mine. That by the way the fixed to fix the v. A. Is by making information transparent and understandable. And that is where we are, particularly when it comes to peoples health. You should not be hiding data from people. This is too important for them. So by releasing the data, the most accurate comprehensives we have, we are allowing veterans to ask questions and to understand what is happening. I also fundamentally believe that the way you change organizations is not through internal change. But you drive it through external change. And we have learned this with almost every industry outside of government. Products change. Improvements happen because consumers demand it. So i am relying upon the American Public and among our veterans to say whether what we are doing now is meeting their needs. There are going to be unintended consequences of this. And we are very careful to make sure that we dont have disincentives to reporting accurate information, but we will be learning a lot. This will be a system where we have where well be learning a lot but i releasing this information. I fundamentally believe this is the single most important thing that we will do to fix the system in the foreseeable future. Reporter a quick follow up. You have been involved in this and the last year and a half. Are you confident that the wait time data has integrity now . And that there isnt a way to uniquely it or dr. It like what it like whatoctor happened three years ago . David shulkin i think we have made clear to our leadership that we are not going to tolerate any data manipulation that is essential and is part of what leadership must commit to. The integrity of our data. And now that we are reporting it publicly the way that we are, it takes on even greater importance. The data that we are releasing is average wait time data. So my concern is somebody could look at the website and say there is a fiveday wait and call on the phone. And somebody may say, you could get in in three days or eight days. That is how you get averages. So it wont be everybodys experience. But data we are talking about 58 million appoints a year that we are reporting on. So i do believe that this is the right direction. I do believe that the organization understands that if we are going to regain the confidence and trust of the American Public that this data must be accurate. And it has to have integrity. Host six minutes left. Reporter i want to ask about your past experience and how it relates to the job you have now. You were in charge of the health care arm of the v. A. There are the health care side the benefits side and decide , the side of the runs cemeteries. Coming in with just the vha experience, did you find and are you still finding that the learning curve for dealing with the rest of this Massive Organization is steep for you . And along with that, has the slowness with which the administration has acted in appointing assistants for you , political appointees, has it affected the way you are managing the department . David shulkin well, i think i actually had an advantage in that for me, when i entered government from the private sector, that was my learning curve almost two years ago, trying to understand how things work in government. When i was appointed secretary, that was behind me. So i didnt feel that the learning curve was that steep. Even though i was running the health part of v. A. , i was part of the department. I had exposure and i was part of the decisionmaking for really all of the issues in the department. I havent found the learning curve that steep and i feel i have been able to keep and accelerate the momentum of change happening in the v. A. In terms of getting my Leadership Team getting in place and getting people permanently appointed of course , i wish we could do this faster. We are working hard and we are working well with the white house to make sure we are doing it. But part of the process when you bring in political appointees is as you know is it is important to that them. To make sure that they have the right background and that there will be problems going forward. So we are in that process and i feel very comfortable that we are making Good Progress to getting the right people in place. Reporter is the process move more slowly than you would like and is it affecting the way the v. A. Is running . David shulkin whenever you are in an organization like v. A. Which feels a strong imperative to make improvements and change, of course it is slower then you would like. I and generally impatient and want to see change. Of course, i wish it were faster. But i believe it is on course. I have very good Senior Leaders in place. Many of them are acting in return positions and we are making terrific progress. And i feel very comfortable with where we are today. Reporter a final followup on your experience. As secretary of the department of Veterans Affairs, an organization that is touted as knowing how to deal with specific needs of veterans, what does it mean for you to have not served, to not be a veteran yourself . Do you feel it negatively impacts the way you are able to interact with veterans . Able to understand their unique needs . David shulkin every good leader of an organization that has a mission in service has to make sure that they are listening appropriately and meeting the needs of their veterans. One of the real gifts that i believe i was given was the ability to work with so many of our Veterans Service organizations that have been very, very helpful in making sure that we are listening well and meeting the needs of the veteran. So i believe that the ability to develop the relationships with our Veterans Service organizations and veterans across the country in our state departments of Veterans Affairs as well as other organizations has allowed me to develop the type of relationship that i can honor that commitment. Reporter how do you see yourself as different from your predecessor . You had a close relationship with secretary mcdonnell. As mentioned earlier you are the , only obama holdover here. Do you see this then a Seismic Shift in how the v. A. Is offering, or is an extension and some of the reforms he wanted for the veterans organizations . David shulkin yes. Secretary macdonald was a tremendous leader and really helped our organization in ways that i hope people recognize his terrific contributions. I think the big change is in the administration and the and who the president is. The president right now has made veterans reform and making sure that we fix the problems in the v. A. A top priority. And that really allows me in working with congress and the white house to make sure that these changes are necessary and that had needed to be made for a long time. I think that is the major change. Host a minute left. Closing questions . Reporter do you feel based on that that is secretary mcdonnell was working under President Trump or was working under someone who wasnt president obama we would have seen these reforms moving quicker . In other words was the white , house the problem over the last few years when we hadnt seen some improvements that everyone said they wanted . David shulkin no, im not saying that all. I think at the time with the administration and president obama, they had a plan place them are very committed to that and were successful at that. Knows, theyone entire political environment in washington and through the country has changed. And fortunately, the issue about fixing v. A. Has risen to the top of that. So now i believe with the commitment of the president and the changes we have seen in congress and the continued leadership we have seen it , allows us to finally make changes that have been so difficult for the v. A. Over the last couple of years. Host 30 seconds for a final question. Reporter this is the big budgets. One. The v. A. Is a large organization. Do you expect to see the budget continue to go up over time . Are you going to be asking for more money or at some point will you be happy with the amount you have been allocated . David shulkin the problems in v. A. Are not financial. I dont think these are problems that money fixes. The president s budget this year demonstrate his commitment to honoring what he said about fixing v. A. And it is very important that we get the president s budget. But going forward, i am looking to put in system so that we do not need to go back year after year and ask for doubledigit increases. That we have to fix the problems in the v. A. Without looking for additional growth in the budget year after year. Host secretary shulkin, our guest this week. Thank you very much. Newsmakers is back after our conversation with dr. David shulkin. Lets begin with the end of the conversation. With his emphasis on the fact that we have a new president who campaigned greatly on Veterans Issues and we have a congress that is willing to work with this president. Today, as we are taping this, paul ryan, the speaker of the house has put out a summary memo , three years after the phoenix wait time scandal. Trumpeting some of their compliments they have made. Accomplishments they have made. What is the attitude on capitol hill about more spending and the trouble of getting legislation actually passed through this congress . Reporter there is still a lot of frustration that three years later, a lot of the reforms on accountability and what they wanted havent materialized. Specifically on the budget, there are quite a few lawmakers who feel they have invested a lot of money in v. A. And havent seen returns yet. So in the last few months we have seen a pushback from folks saying look, dumping more money into this isnt going to solve the problems. V. A. May need more resources and funding but we need a fundamental culture change and a Management Change over there, instead of writing blank checks. Reporter one of the important things to look at right now with congress is the new session, the leadership in both the house and the senate on the v. A. Committees, they actually get along with each other. So if you look at the veteran issues on the hill, it is one of the spots where there seems to be bipartisanship working pretty well. Reporter they have managed to pass a handful of small bills and the choice act extension was passed without issue so there is an attitude to work with this and compromise but it is still congress. They can still fight and still stall things. Host we heard that the choice act which is being signed next week is not enough. That he wants more comments of conference of legislation and on an accelerated timetable. How likely is that with the politics on capitol hill . Reporter it is i mean, we have to see the final form of the bill is before we can prognosticate on how it will get weighted down or able to fly through. I suspect by the time that all of the tinkering is done under the hood on that, there will be other political battles that the white house will have faced pushing through certain legislation on the hill and who knows if bipartisanship will last in the committee after a few bruising fights on Broader Health care reform and tax reform. Host in this congress, six months is a long time . Reporter there is the issue that the Choice Program is going to run out of money. Secretary at his word that they can get a comprehensive new Choice Program put together by the fall, but congress is not known for acting quickly, especially the end of the fiscal year. The prospect of that getting passed by the end of the year are pretty tight, pretty difficult. The white house, the secretary and the senate and the house committees all seem to be lined up fairly well on what they would like to see happen. As you said they will still have health care fights, we are facing a possible shutdown. Its not an easy quick bill to get through. We asked the secretary about semantics. All it takes is for some money to really play the choice and privatization and that can gum up the works. There are quite a few questions around the website. What was behind all the uestions you asked . This came up when they rolled out the website earlier. From are concerns not just reporters but from veterans, saying the problem three years ago was not necessarily that had full transparency with these numbers, but manipulated behind the scenes. There are still a lot of concern that whatever data you put out , that this is what is actually going on. Public affairs problem. They still have to regain the trust. Sane the hospital has Customer Satisfaction is a good step read most of the Veterans Service organizations have said that, but they have to believe that what is being said is also true. The veteransago crisis line, the suicide hotline, there was an wasstigation that said it reporting that hold times were acceptable and within the boundaries, so if you call and get on hold, that is not happening. There with was transparency there, but they were sort of fudging the way they were talking about hold times. There were people waiting