Transcripts For CSPAN3 Lawmakers Press Veterans Affairs Secretary On Addressing Agency Problems 20170511

May 1st of 1961, an Incredible Program for young people. He started with the alliance for progress. And he engaged in the space race. For our complete American History tv schedule, go to cspan. Org. Veterans Affairs Secretary David Shulkin testified recently on his departments operations. He addressed several efforts to better serve veterans who seek and receive care, including full implementation of choice 2. 0, wait time reduction, and improving and modernizing the departments i. T. Systems and Veterans Crisis line. This is two hours and 20 minutes. Good morning. Today were pleased to welcome back a good friend, dr. David shulkin, the new secretary of the department of Veterans Affairs. The last time you appeared before our committee, you were va undersecretary for health, now youve been kicked upstairs in a unanimous vote, that says a lot in this contention environment. I know youve got a great background in the philadelphia area. I just learned you were in morristown, in chairman frelinghuysens district for some time. You certainly bring a lot of experience for the job. Im sure these days the challenges are very daunting for you. We realize this hearing is a little bit unusual. Rather than the typical Budget Hearing we usually have at this time of year, were limited to a discussion of the skinny budget materials that the omb sent to the hill in march. The twopage entry for the advancemeva doesnt give us much to go on but does give us one remarkable bit of news for the va. Apparently the administration is proposing a 4. 4 billion or 6 funding increase for the agency. In addition, there is a 2. 9 billion proposed in new mandatory funding for the va. You must be youre probably the only domestic federal agency not facing any substantial consult. So i suspect im going to need a kevlar vest when talking to my fellow appropriations subcommittee chairman. So when we see your full budget later this month, well be asking some tough questions about the merits of the increases while others are struggling. Despite not having a complete budget, im sure members will find plenty of va topics to ask you about this morning. How you envision va striking a balance between dare acare and visits, making the Electronic Health records work for veterans especially as they see more doctors through choice, your efforts to tackle appointment scheduling programs, how you plan to approach disability claim backlogs and appeals, your plans to decrease veteran suicide and homelessness, your campaign to limit opioid abuse among veterans, plans to access care for rural and female veterans. Thats probably just a start. Theyll think of other things, im sure, the members. Mr. Secretary, well include your full Statement Today in the hearing record and well be pleased to hear your oral statement. But before you begin, ill ask our Ranking Member, ms. Wassermann schultz, if she has any opening comments she wants to make, and after that, the chair of the full committee. Thank you, mr. Chairman. And welcome, mr. Secretary. Its been a pleasure to talk with you over the last few weeks and good to have you in my office yesterday. We do appreciate you being here in your new capacity. I echo the chairmans comments, particularly given that its an awkward situation we find ourselves in. Youre operating on a bigger stage than you were previously, with greater responsibility that comes with the duties of being the secretary of the va. Mr. Chairman, since fiscal year 2008, the va has seen a tremendous 70 increase in pva accounts through the medical accounts, grown to 6464 billion and the overall discretionary accounts have increased. In fy 2018 is no different. The president s skinny budget even requesting 78. 9 billion or a 6 increase from the 2016 enacted level. The 2018 budget also requests legislative authority and 3. 5 billion in mandatory authority to continue the veterans Choice Program. And what is a question that arises is that this would support a program that was initially meant as a stopgap temporary fund. Mr. Secretary, while i am certainly thrilled to have you here today, its unfortunate that we wont be able to discuss the specifics of the va budget request. And the lack of detail makes it extremely challenging for the committee to properly do our job. Moreover, given this 70 increase over the past ten years, its critical that this committee has the opportunity to analyze these numbers and know more as to why the va continues to have mismanagement, wait times, and less than adequate care. It is crucial we understand how these issues are being addressed. Once we fully understand those issues, at what point do we ask if this continued growth is unsustainable. Mr. Secretary, i ask these questions with genuine concern for the future of the va. Obviously our driving concern must be to provide the best care to our veterans. However, we dont control costs and ensure the resources this committee provides are used in an appropriate and efficient fashion. We actually hurt our ability to help veterans and deliver top quality care. It comes to mind while we are providing additional resources, were not seeing what would normally come as the commensurate response from the people who are receiving the services, because of the challenges that the va is having in providing those services efficiently. Top quality care is really our top priority. And we need to make sure that we help you deliver on that mission. With that in mind, mr. Chairman, its imperative we discuss a number of key issues including the Choice Program and the state of the vas Electronic Health records. After creating the Community Care account, which includes 9. 4 billion in advanced fy 18 appropriations, why does the budget request also include 3. 5 billion for the Choice Program . Additionally, where is the va in executing congresss mandate for full interoperability with full dod systems . As we discussed this past monday in my office, mr. Secretary, a solution to this issue is long overdue. Finally, i hope you can address the significant number of vacancies at the department and when these positions are expected to be filled. Currently 11 senate confirmable positions remain vacant including the undersecretary for benefits, the undersecretary for health, the undersecretary for memorial affairs, the general counsel, the assistant secretary for information technology, the assistant secretary for policy and planning, the assistant secretary for management, and the chairman of the board of veterans appeal. By the way, the veterans appeals process is an absolute mess. And so for it to have no chair for as long as that has occurred is really unacceptable. From our discussions, i believe you honestly want to reform and improve the va. It is reflected in the confidence that was placed with you in the unanimous vote for your confirmation in the United States senate. Its our duty i believe to ensure that you have adequate resources to do so and the proper oversight is in place to guard against abuses and mismanagement. As you can see, we have a lot to discuss today. Mr. Chairman, thank you for the opportunity to share my concerns. I yield back. I thank the Ranking Member. The chairman of the full committee, mr. Frelinghuysen of new jersey. Thank you, chairman, and ms. Wassermann schultz. Thank you for the bill last year, thank you for that effort. You were the pace setters. I wish we could have followed your pace, in reality we didnt. I cant think of a more Important Department than the department of Veterans Affairs. Those who serve our country and serve our country right now in dangerous places deserve when they get home to get the best care possible. And i know you from your time in new jersey and wonderful things you did there. For good reason, you were unanimously confirmed by the senate. Theres not a lot of unanimity over there. Im glad if they focused their attention and support for you. Two areas of particular interest to me, i dont want to take time away from your remarks or questions. Continuing the appeals and benefit backlog, its a nightmare. Ive even shared with you some of the three or fouryear waiting periods for people. Obviously evidence has to be collected and verified but in reality its a pretty nightmarish prospect. Certainly the confirmation of your undersecretaries might be helpful in that regard, hopefully that will happen. Whats been of continual interest to me is Electronic Medical records. I think three years ago, thenchairman rogers hosted chuck hagel, secretary of defense, and rick shinseki, one of your predecessors. We received a commitment from former general shinseki that we would have a solution. I know the department of defense, and given the resources theyve been given, is getting up to speed. I do view your systems as sort of the weak link. So i just personally feel that this is something which is enormously important, in a day and age when we have so much information passing back and forth, obviously encrypted and protected, to not have that available to our Health Care Providers is pretty inexcusable. Good luck and god speed, and thank you, mr. Chairman. Ms. Lowey, i would like to recognize you. Thank you very much. And i would like to thank chairman dent and Ranking Member Wassermann Schultz for holding this important hearing. And i welcome secretary shulkin today. We as members of congress, and you as the secretary of Veterans Affairs, have a duty to provide the best care available to our veterans, who have sacrificed and faithfully served our nation. The va faces serious challenges in meeting their health needs. After working four years to reduce the claims backlog, it is once again increasing. And the Choice Program will soon run out of money and is in need of reform. And the va and department of defense are not significantly closer to the interoperability of Electronic Health records than they were years ago. We owe it to all current and former future veterans to tackle these challenges now. And this subcommittee is committed to achieving that goal. I must say, after reading your resume, i am so optimistic, as was referenced before, chairman rogers and i had i think four hearings, right, chairman frelinghuysen . We also met in closed door sessions. We hadnt been able to resolve this. Now, i have my own personal preference as to whos to blame, as we were talking about before. But thats irrelevant now. In looking at your resume, i am so enthusiastic, i know youre going to get this done. In my own district, i worked to secure federal funding for rehab facilities to ensure that veterans can receive a high quality of care. For too many, the va is unable to provide the types of services they require. From women struggling to find care in a Health System that has traditionally served men, to veterans who are turned away from va facilities when they are most in need, the va has a responsibility to serve all veterans who seek the care and treatment they have earned. In light of these challenges, congress awaits the details of the president s fy 18 budget request. The budget framework requests an increase of 6 for the va, but lacks detail, providing just seven bullet points of vague proposals. While you may not be able to speak to details of the Budget Proposal now, i hope you will return after its release so we can fully discuss it. Mr. Secretary, i again thank you for being here today. Thank you for your commitment to improving the lives of veterans. And thank you for assuming the responsibility. I look forward to hearing about all your success sooner rather than later, so we wont, in a bipartisan way, continue to talk about backlogs and the lack of records. So we have confidence in you, and i thank you for appearing here today. Thank you, mrs. Lowey. At this time i would like to recognize secretary shulkin for five minutes. Maybe thats better. Okay. Chairman frelinghuysen, chairman dent, Ranking Member lowey, Ranking Member Wassermann Schultz, and all of you who are here today, i was so impressed with your Opening Statements on so many topics that youve thought about and that you care about and i know are serious issues. And were trying to do things differently at the va, that i have a terrific opening statement, but im willing to, mr. Chairman, to actually forego it and get right into your questions, unless you would prefer me to go through the opening state, because i think we have so many issues and i want to use your team most valuable. Ive submitted it for the record. I would be glad to read through it, read through my oral statement, but ill leave it up to you. You would like to hear it . Good. Okay. I told you, its terrific. The abridged version, about five minutes worth. Ill try to do it quickly, but thank you. Thanks for the opportunity to be here today to talk about the president s 2018 budget. I also want to thank you all for your support of the 2017 budget that really gave us for the first time our full budget from the start of the fiscal year. It really speaks well of the u. S. Congress and really of the American People that despite all these differences, and youve mentioned this several times, that we can come together on this topic to support our nations veterans. I have submitted the full statement for the record. The president s 2018 budget reflects his strong personal commitment to our nations veterans, provides the necessary resources to continue the ongoing modernization of the va system. The budget requests 78. 9 billion in discretionary funding for the va. It provides 4. 6 billion more for medical care, a 7. 1 increase, and 3. 5 billion more in mandatory Budget Authority that was mentioned to continue the veterans Choice Program. More veterans are opting for choice than ever before, five times more in fiscal year 2016 than fiscal year 2015. And choice authorizations are still rising. Weve issued 35 more authorizations in the First Quarter of fiscal year 2017 than in the same quarter of 2016. All told, including both care va facilities and in the community, we project a 6. 6 increase in ambulatory care for 2018 over 2016. I urge you to support and fully fund our 2018 request to enable va to meet increasing demands for va services, to modernize the va systems, and to invest in choice. As you know, i came to va during a time of crisis when it was clear that veterans were not getting the timely access to High Quality Health Care that they deserved. I know the va has made significant progress in delivering care and services to veterans. But i know more has to be done. Last week i had an opportunity to meet two courageous young americans, michael and sarah verado of rhode island. All he wanted to do was become a soldier and he served in the armys 82nd asia borirborne div. They told me when he sought care from the va in 2014, they did not receive the care. We cannot allow ourselves to fail american heroes like the verados. My priorities as secretary are to modernize our systems, focus our resources more efficiently, to improve the timeliness of our services, and Suicide Prevention among veterans. We are already taking bold steps towards achieving each of these priorities. Two weeks ago the president signed the reauthorization of the veterans choice act ensuring veterans can continue to get care from community providers. Just last week, the president ordered the establishment of a Va Accountability Office and were moving as quickly as we can within the limits of the law to remove bad employees. Va has removed Medical Center directors in san juan, sleeves po shrevesport, louisiana, due to misconduct or poor performance. We simply cannot tolerate employees who act counter to our values or put veterans at risk. Since january of this year, weve authorized an estimated 6. 1 million Community Care appointments, 1. 8 million more than last year, a 42 increase. We now have same day services for primary care and Mental Health at all of our Medical Centers across the country. Veterans can now access wait time data for their local va facilities by using the easy online tool where they can see those wait times. No other Health Care System in the country has this type of transparency. Last month we announced a Public Private partnership of ambulatory Care Development center with a donation of roughly 30 million in omaha, nebraska, thanks to mr. Fortenberrys help there. Veterans now have or will have a facility thats being built with far fewer taxpayer dollars than in the past. Finally, the va is saving lives. My top clinical priority is Suicide Prevention. On average, 20 veterans a day die by suicide. A few months ago, the Veterans Crisis line had a rollover rate to a backup center of more than 30 . Today, that rate is less than 1 . In support of our efforts to reduce suicides, weve launched new predictive modelling tools that allow va to provide proactive care and support for veterans who are at the highest risk of suicide and ive recently announced that va will be providing emergency Mental Health care to former Service Members with other than honorable discharges at all of our medical facilities. We know that these veterans are at greater risk for suicide and were now caring for them as well as we can. These are just a few of the efforts that are under way but are already improving the lives of veterans. We need congress to help us realign our capital infrastructure, to dispose of property we dont need and we need congress to fund our legacy systems to keep them from failing and to increase our improvement of electronic records. Were also weighing options for adopting a commercial off the shelf alternative to our legacy systems. Ive scheduled a decision for this in july. If it makes sense to go to the off the shelf route, well need some Additional Support from you as well. We need congress to authorize the overhaul of our broken and failing claims appeals process that many of you have mentioned. Working closely with Veterans Service organizations and other stakeholders, va has drafted legislation to modernize the system. Weve submitted our proposal to the 114th congress, and weve resubmitted it in this current congress. We need congress to act on this. Most of all, we need congress to ensure the continued success of choice for veterans, extending the Choice Program past its august end date was an absolute necessity and thank you for that. But extending the program was just the next step towards the modernization of Community Care that veterans deserve. We charted a course for modernization and are already moving forward. We need your help to keep up with the Choice Programs growth, maintain our momentum and make our Community Care plan a reality for all veterans for generations to come. In closing, let me again express my thanks to the Appropriations Committee and to this subcommittee for the support that youve shown veterans in recent years. Without that support, we could not have expanded choice to a Record Number of veterans while also curing so many veterans of hepatitis c. Youve made that possible. And 77,000 veterans are now free of hepatitis c as a result. Thank you for the opportunity to be here today. I look forward to all the questions that you may have. At this time i would like to recognize the chair of the full committee, mr. Frelinghuysen, if he has any questions. Very briefly. You talked about the leg acy system. The acronym is vista. Now youre looking at an offtheshelf system. Isnt the issue here you have i. T. Systems, different i. T. Systems at every hospital . So where are you in the overall very briefly, where are you in terms of maybe some good news in the mix . Right. Well, we only have 130 different systems, okay . The vista system is something that frankly va should be proud of. It invented it, it was the leader in Electronic Health records. But frankly thats old history and we have to look at keeping up and to modernize the system. Ive said two things, mr. Chairman, in the past. Number one is, va has to get out of the business of becoming a software developer. This is not our core competency. I dont see why it serves veterans. I think were doing this in a way that frankly we cant keep up with. So ive said were going to get out of that business. Were either going to find a commercial company that will take over and support vista or were going to go to an off the shelf product. Thats really what were evaluating for you. We have an rfi out for essentially the commercialization of vista that we would no longer be doing it internally. The second thing ive said is that, and i think it was referenced in several of youre comments, you have asked the department of defense and va to Work Together probably for ten or 15 years, and weve always found ways not to do that. Secretary mattis and i have talked about this. We believe that we need to find ways to Work Together. So when i come out in july, im going to be talking about a process that led to a decision to get us out of the Software Development business and find a way to work closer with the department of defense than we have. Were working rapidly towards that decision. Im committed to that date. Thank you. At this time i would like to recognize mrs. Lowey. Thank you so much, mr. Chairman. There are so many questions. But i must continue this discussion, having been part of this issue of records for the last five, six, seven years. And i gather we have spent 1 1. Billion on this. I dont even know what i want to call it, project, search, int interoperability. What im confused about, its my understanding that the Defense Department has already rolled out the system. It seems to me you make a lot of sense saying, were not going to be in this business anymore, we want an offtheshelf system. However, in order to foster, to ensure theres interoperability, whats wrong with the defense program, and why wouldnt you at least at the outset explore that . Because if you choose another system, and they have their system, whats it going to be, another billion dollars that we could use for Suicide Prevention, for treatment, for all kinds of important things. I have to tell you, as the Ranking Member, chairman frelinghuysen and i go to a lot of committee hearings, but this affects my heart. And when i talk to veterans in the district, and i know the challenges they are facing, and i know that you have all the competence, background to do it, why wouldnt you start, or are you looking at the system the Defense Department has rolled out . Yeah, so first of all, i hear your frustration. Thats probably a good word. Im smiling. So weve had hearings where the anger was palpable. Congress has been very clear on this for years and years. Thats why i believe you and the veterans deserve a clear direction on this, and im committed to doing that. I can tell you were exploring all options. Im sure you understand, this is a highly complex issue. And ive lived through personal Electronic Medical record conversions in hospitals that ive led. These are not easy projects in single hospitals, let alone to talk about the size of the va system. So were taking this very seriously. I can assure you were exploring all those options. We can also, as we get more veterans out into the community, out into the private sector hospitals, we have to be very concerned about interoperability with those partners as well. So if there was an easy solution here, i am sure it would have been made already. Were going to make a decision and were going to move forward with it and were going to need your help in being able to implement that. I just want to say thank you, mr. Chairman. And i want to thank you for assuming the responsibilities that our veterans certainly are looking for and they deserve. And i wish you the best of luck. And i look forward to your coming back sooner rather than later, because i dont want to have another hearing on interoperability. And i want to remind you again, 1. 4 billion has already been spent on trying to get the Defense Department and the va coordinated. So thank you so much again. We look forward to hearing from you as soon as possible. Thank you. Thank you, mrs. Lowey. Mr. Secretary, we understand that youre floating ideas for a system to consolidate the various nonva care programs, including choice. While we realize your proposals are by no means locked down, it sounds like youre contemplating a plan that would allow veterans to seek urgent care outside the va system followed by a discussion with a va care provider about whether the veteran should be seen in the community or by the va. That decision would be based on the results of a local Health Market analysis, identifying the capacity, quality, and cost of various services at the local va. Is the basic premise of this proposal to Keep Services within the va, subject to availability, quality, and capacity, rather than open the doors more broadly to nonva care . Let me try to describe it, mr. Chairman, a little bit differently than that. First of all, i think youre correct that what weve identified coming out of the 2014 wait time crisis in phoenix was that the va i dont believe had the appropriate Management Systems in place. And the way i believe that you run a clinical system is, is that you put your clinical urgency first. So if somebody is waiting for a routine examination, thats normal. But somebody shouldnt be waiting if they have a tumor in their chest or they have blood coming out of parts of their body that they shouldnt have it coming out of. That needs urgent care right away. So we are going to prioritize and make sure veterans arent waiting. Secondly, were trying to build an integrated system of care. That means if you look at this from the veterans perspective, which is really the only perspective we should be looking at this from, you want to take what the va does best for veterans that you cant find as well in the private sector and you want to take what the private sector does best that the va doesnt do as well, and you want to make that an integrated experience for the veterans. Thats what were trying to do. Currently onethird of our care happens outside the va walls, twothirds inside. And were working now to get the proper mix in each of the communities, because it will look different in new york city than it will in arkansas, and trying to figure in that community what is the proper mix of inside va and working with the community. And thats what were hard at work at doing. And i think that this will benefit the veteran the most. And just to kind of follow up on that, what cost governors would you include to keep the costs to a manageable level . I am very sensitive to cost. My belief is, is that one of the reasons why we got into the problems that we did in va is because we were not properly funding the actual demand. And thats why i think its so important that we and you work with us to get what the president has requested for the 2018 budget. Because i think that we need that. But i am not looking for nonsustainable increases year after year the way that we have in the past. And i think as congressman Wassermann Schultz said, thats an unsustainable solution. The problems we have in the va are not primarily financial. These are primarily system issues that we havent kept up with and we havent modernized. So i am looking for an investment this year to help us modernize our systems, the i. T. System will be one example where we need to come back. But im not going to be seeking increases of this type in future years to come. So we do need to put cost mitigation strategies in place. One of the areas were focusing on that ive already announced is fraud, waste and abuse. I think that there are huge opportunities to identify waste and abuse in the Current System. There are not the proper safeguards in place. Well be taking aggressive actions to do that. There are other cost mitigation factors including valuebased purchasing. The private sector has now moved towards this where there are Accountable Care organizations to focus on quality and cost, and where you can purchase care based on the best value, which is cost over quality. We dont have those tools in the va. In fact were restricted from using that. We have to pay a flat medicare fee schedule. Im seeking the same tools the private sector has to control cost and improve quality. If congress were to adopt your ideas, what would that mean for workforce and facility infrastructure needs . In this budget . Yes. We are seeking the budget so that we can hire the Proper Health care professionals. We have now 45,000 clinical openings in the Veterans Health administration, and another 4,000 openings outside of the veterans administration. So for a total of 49,300 employees that were seeking. I think that frankly the crisis that we went through and the lack of good press, so the impact on the morale of the workforce, has really hurt us in recruiting. Of course we had a hiring freeze in place up until april 12th. So we have fallen behind. And in particular, in my Priority Areas like Mental Health, i need 1500 new Mental Health professionals to join the va. So were really prioritizing that right now, and this budget would allow us to get up to that staff. Thank you, secretary she will kin. At this time i would like to recognize Ranking Member ms. Wassermann schultz for five minutes. Thank you, mr. Chairman. First and foremost, i just wanted to suggest that as a number of members have mentioned it, because the secretary is only limited to speaking about the skinny budget, it would be incredibly helpful and important, once we have the president s budget released, to ask him to come back and hold a hearing on the actual full budget request. I would ask both chairs to please consider doing that. Just so we can delve into a little more detail. Thank you. I want to focus on the Choice Program for a moment. You have asked for an additional 3. 5 billion. We talked about it yesterday a little bit. We recently extended, as you mentioned, the Choice Program past the august expiration date. There was 950 million left in the choice account. So in part obviously, rather than letting that funding languish and considering that theres still a need, that made a lot of sense. But we did envision the Choice Program to be a temporary program initially. My understanding, and correct me if im wrong, it was really supposed to be a bridge for the va to transition to the Community Care program until we can get the Community Care program in a place where its able to provide the kind of Timely Services that we needed to. If thats not the case, then can you explain the differences between the two, and youve also proposed choice 2. 0, so we have choice, choice 2. 0, and Community Care. Im not sure how it would ultimately help us realize our goal of efficiency if we have three different programs in the private sector to help make sure we can meet the needs of our veterans. I couldnt agree with you more. Im looking for one program. Three programs doesnt work. We now know having two programs, that didnt work very well. We confused veterans. We had two programs, Community Care and choice. They had different rules. They put veterans at risk in their credit because some paid first dollar and others didnt. And you had to call different numbers to use them. We are proposing a Single Program for Community Care. As far as the intent of congress for three years, look, congress stepped up in a big way after the crisis when basically the country and congress agreed that the Current Situation with veterans waiting for care was unacceptable. Va did exactly what Congress Asked us to do, which is to put in place additional options for veterans to get care in the community. Now were seeing those authorizations and appointments occurring in the community. When i started va a little bit less than two years ago, we had 20 of our care in the community. Today its about 32 . So you can see were expanding those options. I dont think theres any turning back from this. So whether it was intended to be authorized for three years or not, i know thats what the legislation said. I think what weve seen is, veterans need that care. Theyre coming to va to seek that care. And we need to continue to support that. Thats my opinion. So the 3. 5 billion built into the program is very much a needed resource for our veterans. And i understand, given that your goal is one program, are you analyzing which program ultimately would be phased out . Because we have a tendency to, instead of phasing out programs because they have people with a vested interest in them, simply going along to go along rather than rocking the boat. If it had 950 million left, there have been challenges with the Choice Program and confusion and there are still challenges with the Community Care program. In what correction is the va thinking of going and what is the timeline for ultimately phasing out one program and only having one . With almost certainty i can tell you there will not be three programs, because the current Choice Program will run out of money by the end of this calendar year. So that program is going to go away, and should be through december of this year. What we are hoping to do is to work with you so that we can introduce a Community Care funding program. The chairman referred to it as choice 2. 0, which is a program that makes sense for veterans, which is a Single Program that operates under one set of rules for how veterans get care in the community. And that new legislation, which we believe needs to be introduced by late summer, early fall, would end up with a Single Program. So you would eventually envision phasing out Community Care with the advent of choice 2. 0. Yes. Thank you. I yield back. Thank you. At this time i would like to recognize the gentleman from florida, mr. Rooney, for five minutes. Thank you, mr. Chairman. I would like to just sort of continue on the same line, briefly, or just maybe make a statement that our chairman of the full committee as well as ms. Lowey, ms. Wassermann schultz, pretty much everybody up here agrees. Weve been giving you a lot of money. Ive been on this committee with mr. Shinseki, mr. Macdonnell, a businessman. Youre a doctor. We have a lot in common, even though im from florida, i grew up in philadelphia, i have a pittsburgh connection, im rooting for you. But, you know, and you talked about working with general mattis and trying to get this continuity of care. We all talk about on the stump, when we are, you know, down in our districts, that if you put the uniform on and serve this country, were going to take care of you. As you mentioned lincoln, we often reference washington. The country can measure itself by how it treats its veterans. One of the things we say is from the time you enlist to the time you get commissioned to the time you die, you will not be left out in the cold, were going to take care of you. One of the things that people ask me about is, well, where does it fall through the cracks . And we often talk about how even though were giving you all the money that you need, that, you know, the difference between dod and the va is way too big. And whether its, you know, the electronic records or just the fact that you have to basically start all over when you leave the military and you pcs and you get into the veterans, you know, program, whatever it is. I guess my first question to you is, if general mattis has a better idea than you do, will you agree to go to his program just to get this moving . I ask you this for this reason. You could be the best va secretary of all time if you solve this one problem. And i mean, every time we sit up here and talk to people at this table, that we always keep asking the same question. And i know that theres a lot of bureaucracy, i know theres a lot of pride, whatever the problem is. But, you know, we just hope that this, if it means you saying to mattis, youre right, you have a better program, were going to go with your program, will you do it . First of all, thank you for your comments, and i appreciate your perspective on this issue, how important it is. Im only here for one reason, and thats to solve the problems that have plagued va. I wish it was only one it was o by the way. But i agree with you. This is certainly an important problem for us. Anybody whether its secretary mattis or anyone else who has a better idea than i have, im going to take it. The answer to your question is yes. We want to resolve this issue in the best way, and if it means taking somebody elses idea, were going to do that. It would be so good to be able to go home and stand up on the stump and tell these guys i come from a district with a lot of military retirees, to tell them if you put on a uniform, well take care of you. If you need the health or the Mental Health after you serve, its one of the advantages of joining is that you know that youre going to be taken care of when you get out. That would be a huge help to all of us up here who are trying to convince people that fighting for this country has benefits well beyond just the pride of service. One quick thing since im running out of time and this is more specific to my district. Im having my constituent Services Representatives down in florida telling me were getting a lot of people that are moving to florida as they always do from other parts of the country, and theyre going in to get care at our va, and because of whatever breakdown in coverage, they are told that in my district, that they are told to start a new treatment plan or return to the state to where they came from where they were already getting care for whatever problems that they were having. And this is kind of absurd from the standpoint of that weve actually got five or six specific cases where people that live in florida cant get the care that they were getting in their other states so rather than starting over in florida, theyre going back to their state they came from because theyre in that system. There shouldnt be a lapse in coverage but there is. Have you heard about this at all . I havent heard about your specific situations, but i hope your directors are watching this right now. Because what you described is unacceptable. We have one v. A. Systems. Veterans should be able to get care at any v. A. They go into. That is our commitment. I am not at all doubting that it doesnt work all the time. I certainly hear many examples where it does work and people are able to get care that are traveling. They lose their medications, theyre able to get to a v. A. , get the care they need. That is the system that we are thats our expectation of how we manage the system, and i will reclarify that to our field. Thank you, doctor. Good luck. Ing thank you. Mr. Secretary if i could interject on that point. Could you describe the current joint legacy viewer and what it can do to share records for the benefit of some of the members . Yeah. And im sorry that congresswoman left for that. I didnt say this to her, but we did certify interoperatability with the department of defense in april of 2016. That is through the joint legacy viewer. Thats probably where a lot of her 1. 4 billion went to, although, i dont think it was that much. And what this does is this allows any va clinician, any dod clinician to be able to access records from the other system. So it is a read only system. Its being used tens of thousands of times a month by our clinicians in both systems. It does work, and its a lot better than before when we didnt have that ability. Its better care. But it is not the complete intraoperatability that i think all of us would ophope for. Its a read only system at this point. Thank you. Thank you very much. Welcome mr. Secretary. Let me join my colleagues in congratulating you and thanking you for your commit toment to g these problems fixed. Let me go to an area of improving timeliness of service which is third party uncollected billing. The fy, the appropriations act directed the v. A. To submit an annual report identifying the amount of third party Health Billings owed to the v. A. , and the annual amount thats collected. They require including a plan to capture uncollected Third Party Billings. The v. A. Was directed to initiate a Pilot Program and to figure out thousand collect the billings. The difference between billings and collections was 4. 7 billion. And in fy 16 it was 5. 164 billion. That means that billions in uncollected dollars are not available to the v. H. A. To provide vfss to the veterans. What is the status of the Pilot Program and who in the department is responsible for Third Party Billings and collections. And if you could answer that quickly, i want to move to another area. Congressman, ill try to answer this quickly. I think you have identified an area of significant risk for us. That we have opportunity to do this in a much better way than were currently doing it. I think youre correct. We currently correct around 3 . 4 billion a. We will be asking for in our new choice legislation, the ability to do this better. We are right now not allowed to require that veterans give us their other health insurance. So a lot of that gap right there is we dont know their insurance numbers or their Insurance Company in which to collect it from. We are looking at and we have a rhp that will be released in the next couple weeks to be able to see whether the private sector can help us do collections better. And that is part of our pilot work that we are doing. Were actually using another federal agency to help us with these collections, and that does seem promising. I can get you a more detailed answer, because i dont want to take up the time now about the results of the pilot project. Thank you very much. And i look forward to that. Yes. Secretary, your predecessor, mr. Mcdonald, started an initiative known as my v. A. To modernize the v. A. My v. A. Vision was to get a unified experience throughout the country. You intend to modernize the v. A. As well. Can you tell us how your plan differs from mr. Mcdonalds and whether or not you plan to build upon the my v. A. Can you also provide an update of the veteran integrated Service Network realignment. Thats the first part of the question. The other has to do with facility realignment. You mentioned a National Infrastructure realignment strategy, and the last time v. A. Made a major effort to settle infrastructure needs was an asset realignment. Do you envision that the department will embark on a similar effort, and if so, when will we see the invest and devest Capital Assets . Well, theres a lot there, congressman. Ill try do this quickly. The my v. A. Program under secretary mcdonald, no doubt, has the correct intent, which is to design a veteran centric experience and to focus on that experience, and we know that there was significant and good improvement being done in that program. Because we could measure it. What i said to the department is that one of the benefits of me having been in the department under secretary mcdonald is that i already know what was working. And i dont want to stop the progress that was being made. But i also dont believe we are making progress fast enough. So im looking to essentially continue the parts of program that work but i am seeking much broader, bolder trance formation of this department, because i think its needed, and thats why ive set my five prior sis forward. We used to have 21 visions. Were down to 18. Whether 18 is the right number, i think were continuing to take a look at that always. But we are going to change the role and function of the vizzen from what it currently is which is another layer of administrative complexity. Some people may call that red tape, so a much more profound function in managing their local markets. And moving toward this valuebased purchasing concept and making sure that veterans get the best of care in the community and the best in v. A. Care. So were working on that transformation as we are building our Choice Program. The realignment, the cares program, i wasnt here when it was implemented. I know weve closed 1,000 facilities so that there has been progress made in that in the past. But i dont believe ive heard anybody with enthusiasm bringing back the cares model. I think we learned a lot of lessons in that. Whether the brak is a model we should take a look at, were beginning to have decisions with members of congress about their suggestions. We do believe that we have, i know today, 431 vacant buildings, and 735 underutilized buildings, and we want to stop supporting maintenance of buildings we dont need and reinvest it in the buildings that we know have capital needs. Well look forward to working with you on that. Thank you very much, mr. Secretary. Thank you. Mr. Secretary, welcome, and thanks for the breakfast yesterday and the opportunity to engage you in conversation before this hearing. It has been my experience down through the years that organizations, particularly Large Organizations that find themselves in a bit of trouble, sometimes and many times, stem from the fact that they get away from their core comp the ten competencies and they expand into areas where theyre not terribly knowledgeable, capable q and certainly not efficient, and they sometimes serve as kind of a weight, an albatross, if you will, around the neck of the organization, and it causes a lot of other things to be compromised in the process. I suspect that the v. A. Probably fits into this category, and so specifically my question is this. Youve spent some time talking about i. T. Which i am beginning to believe is not a core competency of the v. A. We have had many indications that the construction of property is not in aurora, colorado being the poster child for it, not a core competency. You spoke about collections a moment ago. That would not necessarily be a core kpe ten tcompetency, im g throw this on the table and let you respond. Is it your intent as secretary of v. A. To protect the core competency of the v. A. By outsourcing some of the other things that have served to kind of bog down the system . I think your assessment of whats happening in the v. A. Is probably pretty accurate. I they that we have learned the hard way, and taken too long to make decisions in areas that, frankly, we just dont deserve to be in a business, and i think youve identified a few. My only modification, if you wouldnt mind, on the i. The t. Is i think i. T. Has to be a competency of any organization nowadays. I mean, i cant imagine what we dont want to be doing is being in the software and Product Development business, but managing i. T. System needs to be a kpe the tcompetency of Successful Company today, i believe. I dont know whether outsourcing is the right word. I do believe that if were going to serve veterans, we need to be working with a core group of our employees and staff that functions on our core functions, but when we strayed outside, building buildings, doing Software Development, doing claims and billing, i do think that we should be looking toward private Sector Solutions or at the minimum, private sector, private Public Partnerships where we can get the competencies into the federal government. The last question i have is that one of the problems facing the congress in many previous congresses is the fact that the entitlement programs that we know, the mandatory side of Spending Continues to chew up available revenues in putting a lot of downward pressure on the discretionary piece of the budget, and thats getting worse and not better. I think part of that is because, and this is good news, the people are living longer. They are receiving benefits from those systems for a lot longer period of time than actuarially they were expected to at the time. Do we have a pretty good handle on the number of people that will be entering the v. A. System so that we can right size the funding request to ensure that we meet those needs and not play from a position of weakness by being behind . I only have about 45 seconds left, but can you help me have confidence in knowing that we know whats going to be filling that pipeline, say, over the next generation . We certainly have a handle on the demographics of the v. A. Population. The number is expected to decline. What we cant predict is obviously new conflicts that would happen. Because that can change the picture. What we cant predict is new science that would show that there is additional mandatory coverage that we would need to include as science shows that there is a connection between military service and some of the disabilities, and that work is always ongoing. So i think that we do have actuarial models in both health care, cemeteries, and benefits that we can share some of the parameters were needs, but they are not fully accurate, because of the unknowns that are out there. But i think for what youre asking, we can share that with you. Thank you for your service, and congratulations on your appointment. I yield. Thank you. Thank you. We like to recognize miss leaf. Thank you. Good to see you, mr. Secretary. I, too, want to congratulate you and say im glad youre at the helm of v. A. Thank you for being here. A couple of questions. Ill try to ask them quickly. One is relating to the oakland v. A. Regional office. In yan of 64 they found there was significant delays in processing the claims and the management didnt provide the oversight needed to ensure timely processing in claims. We had about 1248 informal claims. This was before the National Work cue. Now were on the National Work q. Has this helped reduce the claims and streamlining and reforming the benefit claims processing specifically regarding the oakland v. A. Regional office . Thats first question. Second question has to do with what we have briefly discussed as relates to minority veterans. I have looked at your Health Disparities report which is a thorough report, and, of course, it cited the fact that minority veterans were diagnosed with ptsd at rates higher than white veterans. Also in the report you go into some of the recommendations to begin to address not only ptsd in materials of the disparity but all the others, and it says that we need more research and more information. And im wondering, though, as it relates to this report and the recommendations as it specific relates to Health Disparities with minority veterans, where are are we on any of it and are the recommendations being followed up . I cant help but wonder why more research would be needed. We have an office of Minority Health over at hhs. And so im not sure if youre coordinating in terms of Health Disparities with health and Human Services just exactly whats going on. Because this is i think, a very good report, and i know many, many minority veterans who are really struggling with all the issues around health care, especially ptsd. And finally, and ive asked this when we were at the va hospital in terms of the using of minority and women on businesses. The its my understanding you dont dising a gait the data. Id like to find how were going when it relates to African American, and i havent been able to drill down and get that report. The v. A. Is a significant enti the entity that contracts out quite a bit of money. We need to understand what the data is showing. Okay. Well, thank you congresswoman lee. These are all really important issues. On the claims backlog, and what the impact of the National Work flow has been, we do believe that thats been helpful, and we are seeing improvements in productivity. I would like to get back to you for the record, the impact from where you were measuring ate the 1248 in oakland and see where we are today so we can track that progress together, because i think thats important. On the health dispar theties report, i agree with you. I think the work that our National Center is doing has identified significant issues. This, of course, is an example where i think v. A. Is actually leading and addressing issues that are important for all of the american public, and in health care we know that disparities is a very significant issue, particularly in many of our geographies across the country. I think v. A. Is leading in this area, but we still have additional work to do. And we are treating this as a priority issue and looking at the recommendations youve talked about. The research that the report recommended, i think is research on disparities in veterans. V. A. Research has Significant Health Services Research to it, and the difference between the Health Services research and the v. A. And then hhs like in the agency for health care search and quality is our research is specific to veterans. And so we do believe that there are some questions that are important to ask in order to understand what most effective interventions are, but i dont think thats a reason for us not to be implementing the other recommendations. Theres important work to be done, and we focussed on this now. Mr. Secretary, let me comment on this. I know the research is very important. But i know specifically, and when you look at African American americans with ptsd, there are other factors that weigh in and office of Minority Health could let you know the are. It would weigh in to help come up with treatment modalities that make more sense right away. Yeah. I completely agree. The research that we research is only good if you act on it, and there are some things we already know. And i think that this is where we are looking at this in terms of implementing the recommendations that we know need to happen, and the its a way that v. A. Can lead and help the rest of American Health care also implement. Do you have a working group . We do. Id like to work with you. Great. On the small business, i dont know how that data can be categorized. Let me look into that and get back to you on that. Thank you. Thank you. Id like to recognize the gentleman from california. Five minutes. Thank you, chairman. Thank you mr. Secretary. As im sure youre aware in 2002 the v. A. Reinterpreted the language of the agent orange act to apply only to veterans who set foot in the republic of vietnam or served in the inland water ways of vietnam or brown water veterans. Veterans who served on ships or blue water veterans were not included and must prove Service Connection and exposure to agent orange. However, proven exposure to blue water for blue water veterans is nearly impossible due to a lack of recordkeeping and the inability to know the precise location of the die ok sins in the air or water runoff. The v. A. Wants to deny claims for Brown Water Navy veterans despite rates of higher cancer among shipboard veterans. Than those who fought on the ground of the country. This year i introduced legislation to right this wrong. Hr 299, the blue water Navy Veterans act. It has over 270 bipartisan cosponsors. I stand ready to work with my colleagues to pass this bill. The department of Veterans Affairs has the power to right this wrong itself without the help of congress. Have you been made aware of this issue since youve taken over as secretary, and to your knowledge, is the v. A. Working toward a solution on this issue . Thank you for that question. Yes, i have been made pay waawa that issue. I would say 20 of my inbox is on this issue. I hear from a lot of people. What i have done is i have actually sat down and i have met with some of the leaders in this Blue Water Navy movement to understand exactly what they believe the science shows, and what theyre recommendationing comma recommending. John rosy, they have followed up with Additional Information which i really appreciated because im trying to bring myself up to speed on this. The v. A. s position on this has been pretty much the science isnt there. Im not convinced thats the full story. And so i have asked them for Additional Information, and additional recommendations that as you said, if the department of veteran affairs has the ability, and i agree with you, to change some of these and if the evidence suggests thats the right thing to do for veterans, i am going to recommend that. So this is very active. I can the tell you. This week alone ive been reviewing additional studies. I will be certainly willing to engage in further conversation with you, and i am aware of your legislation. Thank you. I appreciate the fact that you acknowledge that there is other science out there. There are some studies out there that especially with the way that they treat the water, clean the water, that says it concentrates the chemicals and makes the situation worse for those serving, and i appreciate you bringing that up. Then, i also understand the air force is conducting a clinical human trials at Tinker Air Force base to investigate transcranial magnetic eresonance therapy on veterans suffering from ptsd and tbi, traumatic brian brain injury. After four weeks of active treatment, the treatment reduced an average pclm store from 66 to 37. The air force concluded that the preliminary results suggest its a promising treatment. Modality to help veterans suffering from ptsd. With this information can you share what the v. A. Is doing to capitalize on this promising new treatment to help ptsd . Im very familiar with the technology, and im very concerned about finding new therapies that help our veterans with ptsd as well as other conditions related to the brain. We do use v. A. Has extensive use already of transcranial magnetic stimulation. Its whether the merk Technology Uses additional value to what were currently uses. Ive visited walter reed recently. Ive talked to them about this. Were looking at the science. I would like to see the results of the air force studies as they were coming aware. Basically if theres evidence and science suggesting that this is helpful and effective and especially a noninvasive technology, we absolutely want to be using it. Today i am not aware of evidence that suggests that mert has advantages in terms of scientific advantages over the transcranial magnetic stimulation that others are using. I have talked to my dod colleagues. With new information out of the air force, id be open to seeing it. Thank you. Thank you. At this time id like to recognize the gentleman from West Virginia for five minutes. Thank you, mr. Chairman. Mr. Secretary thank you for the opportunity to talk about your leadership in advance of this meeting and i applaud your efforts. Let me start off with a word of compliment. I learned yesterday from the discussion with you about your push to provide transparency, quality data. Information about wait times. Our veteran satisfaction, patient satisfaction, and you shared with us the website access to care. Thank you for that plug. Yes. You didnt ask for this, by ill give it to you. But i did look after you made mention, and as i understand it from our discussion, this data has been out there. The its been available but nobody was willing to authorize that the switch get flipped. You did that. Thank you. Im encouraging people to take a look, transparency is good. The other i want to make mention of the most recent executive order relating to the some of the whistle blower and the accountability efforts. I cant tell you the number of times from whether it be a v. A. Employee or others about frustration or concern. Maybe very briefly describe this executive order and what kind of reassurances to those on the ground, at the grass roots feel as though their concerns, their voices are going to be heard about reforming the system and Truly Holding it accountable and Holding People accountable for the need for a good performance. Well, i think its i think that its very important that people understand that we are taking these issues extremely seriously, that any organization that has been in trouble has to look toward its own leadership. And so we want to make sure that the people who are serving in our leadership positions are consistent and fulfilling the values that we owe our veterans. And so when we become aware of issues of poor performance or people that have strayed from the values, we are taking action. I think you see that theres been a large number of those actions taken recently. Because of that, we have established the executive order has asked us to establish the Accountability Office that will report directly to me as the secretary. As part of that, we are putting our whistle blower office in that Accountability Office to make sure that our employees know that if they raise issues to us, and if theyre legitimate issues, the employees have been protected. We do not tolerate retaliation, and thats the way we learn and get better as an organization, by addressing issues brought to our attention. These two concepts of it, adhering to our values and protecting our employees that raise issues, are absolutely essential to our success. One area id like you to have staff look into, we get a number of calls to our office relating to the payment processes of the v. A. You have described an effort to work collaboratively with Academic Health centers, local hospitals that have real connections to the v. A. Make one plus one equal three working together. But one of the challenges that i have heard really starting with the restructuring of the Payment System of the v. A. From june of 2015 and it continues today, ive got an academic Medical Center that really values and appreciates their good working relationship. The problem is the v. A. Doesnt pay in a timely fashion. They have literally hundreds of thousands of dollars in accounts receivable from their standpoint. Over 120 days. I have a local hospital with over 10 million in accounts receivable from the v. A. Over 120 days past due. Im not sure whats going on in the accounts payment and claim processing, but i think weve got some realtimeliness issue, and i hope it will be taken seriously. You have to understand that this is the world i came from, and i do believe if you deliver a service, that you deserve to be paid, and you deserve to be paid timely. Its too hard operating the Health Care Organization and not get paid for the work youre doing. I absolutely believe we have to get better at that, and im not being defensive about this. We are not doing a good enough job in that area. The way that i would suggest that we proceed is when you find a Community Hospital that thinks that they have 10 million we owe, please let us know. When weve dug into these, we owe them money, but its usually not the 10 million. There are rejected claims and duplicate claims, sometimes theyre looking at the charges instead of the fee schedule j but we can put a team on that and get them the money that they deserve and get it to them quickly. Thank you. Thank you mr. Chairman. Mr. Taylor. Thank you, mr. Chairman. And thank you secretary for being here today. And we understand that theres nothing little about the big challenges that you face in your current position. We appreciate you for that. I just have i come from an area that has hampton v. A. The Fastest Growing in womens veteran population. Im in the veteran system myself as well. This is something im very passionate about and im looking forward to working with you to figure out sole judge of the challenges and fix them. Quick question for you. If one of us submits a question for your office, what is your policy in terms of the response . How many days . Yeah. We categorize them into two types of responses. There are some that need urgent responses, and i think that were shooting for that for i know im going to get this wrong because we just shortened the time frame to become more responsive. 14 days was our short one . And then is it 30 days for our longer one . He says i got it right. If theres something really urgent, were going to do it in 14 days. Otherwise 30 days. And i know that that has not been the past experience from v. A. To your offices. This is our new commitment to respond to you in a more reasonable timely way. Thank you. Let me touch on the i have a budge of questions. He me touch on some of the most urgent ones. Suicide is one thats also dear. Identify friend thats committed suicide. We have these issues in our area. One of the things that i did submit to your office i havent received yet is questioning the uniform policy. I understand that the v. A. According to ig is sort of decentralized. Is there a uniform policy currently . With people who are trained to intake folks who come up physically that either exhibit signs of suicide or say theyre suicide, and further more, is there a uniform policy for the crisis hotline which i understand is being manned by call centers. Whats the uniform policy and the training those folks get . I have seen some communication. Are you saying were over 30 days already . Yes, mr. Secretary. Okay. This is how i learn. Thank you. My guess is youll be getting a response pretty soon. But i am aware of the issue that there was concern about a lock of consistency of training between Suicide Prevention coordinators that live in our Medical Centers and veteran crisis line responders who respond either from atlanta or up state new york. They are different professionals. Our Veterans Crisis line responders are licensed Mental Health professionals. They get more clinically intensive trainerings. Our suicide pro vengs does different functions. Many of them came out of different disciplines. Among the two categories, there should be consistency among veteran crisis line responders and Suicide Prevention people. Well get you back a response soon. Also one other thing on suicide. Is there any openness to a potential Public Private things with qualified nonprofits . When i say that, there are a lot of veterans not comfortable with walking up or calling but may not help but may feel more comfortable with a nonprofit that they the typically are manned by a lot of veterans as well, have gotten out and seen this problem firsthand. Is there any openness to a sort of Pilot Program potentially for Public Privates to help with that . Not only an openness. We think its absolutely essential. There is no other way to do this. Of the 20 veterans a day that are taking their life by suicide, 14 of them do not get their care in the v. A. System. Theyre out in the community. Six are within the v. A. System. If we dont reach out and do the partnerships youre talking about and get everybody involved, theres no way we can address this this. We have been outreaching. Were working with the Veterans Network and a lot of our vsos on this. We have Public Service announcements. If you have group, theres a new group just reached out to called headstrong. T the galliant organization. If you have new partnerships youd like us to explore, were open to those. Thank you, mr. Secretary. Ill have followup in the next round, but quick, you mentioned earlier that some underutilized billings of 735 and how many were vacant . 435. Ill hit you on the next round. Thank you. Now mr. Ryan from ohio. Thank you. Good to you again. I think what you are doing in your patient centered care area with tracy gaudette is some of the most exciting stuff going on not just in the v. A. But in government today of really figuring out quality solutions, integrating care, all the rest. I just want to say thank you for throwing your weight behind that. I think its really important, and i think were going to start seeing a lot of savings because of that and healing a lot of vets. I want to say thank you out of the gate. I appreciate the balance youre trying to strike between the v. A. Clinics and the Choice Program. One problem weve become aware of in my office is that despite the Choice Program being authorized and appropriated, we have veterans traveling significant distances to try to get their care. And if a veteran has a clinic within 40 miles but the clinic doesnt offer the services they need, the veteran is being told theyre ineligible for the Choice Program and being referred to the nearest v. A. Clinic with the choices offer. Theres no policy that places a cap on the distance the veteran would have to travel. And in my district which includes veterans in warren, ohio, traveling three to four hours to a round trip weekly, sometimes more than once a week, to receive treatment in cleveland. And i was at my sons little soccer practice, and i had a couple vets at the same time grab me about this issue. The primary care position or primary coordinator of benefits as independent authority to authorize two w no limit accomplished by the v. A. Or they can refer them in the community of care to a local doctor they can elect to refer them to choice. However, it requires a justification that theres an excessive burden on the veteran. And you mentioned in your testimony establishing a priority on transparency, but we cant find a readily issued flier to explain what defines a burden that would make them eligible for choice in this situation. Ive cosponsored legislation with representatives to correct this issue. So my question to you is do you have the authorities you would need to fix the problem . And what can we do quickly, instantly to provide more transparency and enroll our vets in the decisions for their care, and we cant fix it immediately, is there a legislative issue that we need to deal with, and i guess lastly, and more comprehensively, will the choice 2. 0 consolidation with Community Care correct this problem. Lots of questions. In designing a Health Care System, i would not necessarily have picked mileage and wait time as my criteria for how to design the system. I understand why congress did, and frankly, to put a National Program up so quickly, i think it was a very well thought out effort that kocongress had, but now that weve had time to experience this, i believe a Health Care System should have a clinical basis to the way its designed. The it is my intent in working with you to present an alternative to 40 miles in 30 days to eliminate that, and to replace it with something that makes sense from a veterans clinical needs. To look at access and clinical quality as the alternative to geography and wait time. Under the Current System that we have, which is still having to follow the rules that were set by congress 40 miles and 3530 days, we do as you correctly said, have the ability to define the excessive burden. What we found, quite frankly, right after i became secretary, was that we had put out five sort of bullet points about examples of excessive burden. The field had interpreted that as those were the only exceptions they could use. Weve now clarified that. What were trying to do is to get the veterans and their doctor, or their providers to have an interaction about what excessive burden is, and weve now loosened up the requirement so that the field can make reasonable judgments about excessive burden, because some of the examples like the ones youre giving really arent acceptable. Right. Thank you, mr. Chairman. Now the gentleman from nebraska. Secretary, welcome. Are you enjoying the new job . Yes. Apparently you are, and im grateful for your projection of compassion and entrepreneurship. Thank you. I appreciate that. In your opening statement, you also reference the new idea that has emerged that has now been empowered by legislation of a unique Public Private partnership thats going to happen in omaha. I want to unpack that a little bit more for the Committee Just so that everyone understands how potentially transformative this could be. The community wanted to go on the point, community leadership, came to congressional leadership and said weve built housing for veterans. Weve built housing for troops. Could we possibly participate through some charitable entity, and updating and upgrading the hospital there which is in serious need of not only a facelift but serious innovation, modernization. So working with my predecessor, congressman the community has committed about 30 million to build upon the money that was set aside for a new hospital. And were going to move forward. I think its exactly the model of what were talking about in terms of creating the 21st century architecture looking to community resours when available to go not just into looking for Charitable Funds for donations but an integrated service. This new facility will be an add on to the existing hospital, ambulatory care facility. It will be close to the medical schools. The synergy will be seamless or as we say, non the veteran wont know the distinction between the type of care theyre getting. Theyre just getting the best possible care under v. A. Auspices using private sector resources, charitable moneys, because thats the objective. I wanted to spend time unpacking that further and hopefully given the very difficult sad experiences weve had with watching burgeoning cost overruns, the denver hospital being the poster child, that this way of proceeding forward is undoubtedly going to tap into a large pool of good will that exists out there in the country. Among Charitable Organization and leadership in various communities to want to assist you in modernizing, innovating, and creating the types of partnerships that use the best of the private sector but always under v. A. s auspices. So im excited by this. Im sorry to spend so much time on it. If you want to comment on that. I also want to mention 50 miles down the road inling co lincoln question have a traditional campus for a v. A. Clinic. A similar thing is happening. A city agreed to build out veteran housing on the site of the old clinic. Were awaiting the decision as to whats going to happen with the new clinic. If you could give us some update on that process, that would be helpful. Once again, a synergy with existing facilities preserving traditional beautiful architecture in prax imty to the citys own private sector medical resources, again, what i hope is a new chapter of the v. A. Third point, ooiive become awa and a little bit involved with project hero. Youre under secretary has given a memo of understanding to your v. A. Directors that they can partner with this organization using recreational activity, bicycling, primarily to be integrated into v. A. s services. Studies have theres metrics on this already showing improved health care outcome, lower cost, sense of well being, drops in suicide, study comes out of george tourn. I wanted to highlight that. This is a type of Program Consistent with being developed because of compassion and initiative because of the private sector looking to partner with the v. A. , and theres great opportunity here. Thank you. I think just briefly on your three points. The project in omaha, nebraska, is exactly what i think were looking to do in the v. A. Which is do things differently. In case, were going to build a new facility. Its going to be good for veterans. And absolutely good for taxpayers. This is going to leverage the federal dollars in ways that in the past we wouldnt have been able to do before. And if it wasnt for your leadership and support in getting this through, it wouldnt be happening. I think this is a transform thetive model. We have four other sites that you authorized after omaha, nebraska, that we can do. Im hoping other Committee Members are listening, because we have a list of 20 sites that now are eligible for this. I think this should become the way that we build a future modern Health Care System. So thank you for your leadership on that. Secondly on lincoln, absolutely. We are moving forward with the new clinic there. It should be awarded this fall, and through the whole build and design process, even though i pushed really hard, probably the opening date is going to be in early 2020. It takes a while to do this, but that is well underway, and its really toward the top of our list. On your third point about project hero, one of the great things about v. A. Is that it defines health care much broader than just physical illness. It defines it as physical, psychological, social, economic, and an example of using sports and Adaptive Sports to help people get better and have a sense of well being is something that frankly v. A. Taught me a lot about, and this is a great example. And so we are very supportive of this, and other work around the country like this. And thank you for bringing this to our attention. Thank you. At this time ill move into our second round of questioning and ill start. Doctor s hu lkin in the skinny budget we received in march, theres a v. A. Request for 2. 9 billion in new mandatory funding presumably to complete the funding for the Choice Program after the mandatory 10 billion after the program is exhausted in january, i guess. Does this indicate the administrations intent to fund the successor Choice Program out of mandatory funding . Yes. Okay. Next question. Being appropriated i always try to keep my eye on the bottom line of new initiatives. Im aware of at least two proposals. While we support them from a policy perspective, we send out our budget antennas on alert. You announced that you intend to provide emergency Health Services to veterans who have other than honorable discharges. Youve also testified in the senate that youre interested in expanding carrier versus the veterans from before the post 9 11 era. How do you plan to fit these added costs into your budget when youre already struggling to cover expenses for your current v. A. Patients . Chairman, you know, maybe this doesnt fit into the budget. But basically, i dont care. I sat in a session that was organized by members of congress, members of the house where there was a young man who sat right in the capital rotunda who said he had been deployed to afghanistan six types. On his return he found out his wife left him. So he took off across the country to try to find her. He was declared awall and other than honorable. You could see he was suffering from severe mental and emotional disorders, and he went to a v. A. , and he shows up at a v. A. , and says im here because i need help. Im suicidal. And the v. A. Says, im sorry, youre not a veteran. Well, he had served our country six times. Six tours. That is not acceptable. When we say that there are 20 veterans taking their life every day, we know its this group that is among the highest. No one wants to help them. Well, im not just going to sit by. I dont want more money for this. Were going to find a way to help these people, and then connect them in the community resources. And get them help. Because thats the right thing to do. So im taking im going to find the way to do that. Because i think this is thats a very compelling story, and im glad youre taking that initiative. And im sorry, chairman, what was the other question . That was care giver. Sorry. Care givers, yes. The Care Givers Program is really, really important. We were authorized to be able to do that for post 9 11 veterans. And theres been tremendous successes. But we, frankly, didnt get this program right. We have been issuing in some areas up to 90 revocations of care givers that we had authorized. Something is wrong there. So we just issued a national suspension of revoking care giver status. And were now in a pause where were going to look at what are the right policies in order for veterans to get access to care givers. It is our intent to be able to bring this to pre9 11 care givers, because, frankly, the most Vulnerable Group right now are elderly veterans. And the worst situation is when somebody is in their home, and they have to leave their home to go to an institution. One is most veterans dont want that. Most people dont want that. And secondly, its the most expinsi expie expense ivew expensive way to care for elderly people. Were look agent how to use the current money and potentially come up with even better policy than what we have today, and were going to be announcing that in probably the next couple months. Thank you. The v. A. s scheduling system has been of concern to you, i know. We understand youre on a dual track modernize. Piloting a commercial system in a mass as well as upgrading your Current System. It seems like these efforts might lack a unified strategy. Why are you interested in investing in two systems simultaneously, and will the sjing system will tirngthe tign . I agree it makes no sense on the surface. Why would you invest in two different paths . We awarded a commercial off the south product called mass. That is the system that we think meets our solutions, and thats the one were implementing. Were working on the pilot site to create the interfaces. So we can do that. The rollout of that across the system as big as ours is going to take several years. In the meantime, we had developed an internal system, one of the, frankly, last i hope that we ever develop, but this one is developed already with taxpayer dollars. And we did an evaluation in the month of february. We rolled it out to eight sites. Its actually working. The it is much better than what we have right now. So as an intermediate stopgap measure, were rolling it out across the country, because the its already been developed, and it will help in that intermediate period of time until we can get a commercial off the shelf system up. Thank you, secretary. At this time id like to recognize the Ranking Member for the second round for five minutes . Thank you. I want to focus on military quality of life, because at that hearing in march we had an opportunity to meet with the senior commissioned officers. We discussed the marines united scandal which we discussed in my office yesterday. Many of the victims of that really horrific social media site are now veterans. And ive met with a number of them as have many of the women members, and i would like to know what the v. A. Is doing to provide them with the necessary care and support they need, because these are women who have had without their permission, nude photos of themselves posted. Theyve been subject to extreme humiliation. With regard to the militarys sexual trauma system that the v. A. Has, how have you let veterans know that this service is available and what outreach have you had . The v. A. Has an extensive system for treating military sexual trauma. We have worked with the department of defense so that the v. A. Is a place where people can go confidentially and get treatment. Women or men who have suffered military sexual trauma can come into any of our vet centers and there will not be a connection of their medical record back to the department mr. Secretary, i appreciate that. But specifically what kinds of outreach are you doing to not only make sure that victims of Sexual Assault in the military are aware of those services, but also specifically the victims to have the marines united scandal . Right. When we met in your office, you actually suggested that thats something we should be doing. I dont believe that we have done that. I agree with you. Its something we should be doing, and so as a result of our conversation, we are putting together a plan for that specific outreach. So thank you for that suggestion. Okay. Youre welcome. We have female veterans that are committing suicide as a rate of six times that of women civilians. Identifying ways and implementing strategies to address the unique Mental Health needs of women is critically important, and so i would appreciate it if you and your staff would follow up with us on that. Yes. The other question i wanted to touch base on is what i mentioned in my opening remarks. Thats the openings, the significant and serious openings that you have in all of your Senate Confirmed positions, and you mentioned that you were going to be making an adjustment in how you fill those positions. But im actually wondering one, if there are any problems that the administration is facing in identifying candidates for those positions. Are you having trouble filling them . And in particular, i find it troubling that the undersecretary for health, the assistant secretary for information and the Technology Given the Serious Problems weve talked about here today, and the chairman of the board of veterans appeals are all positions that remain empty. What is the timeline for filling those, and do you have candidates that you are considering and are you having trouble filling them . Well, i appreciate your concern about this. Im very impatient, and of course, i want my team in place. We have, obviously, very good career acting professionals that are handling these right now, but i want permanent people in place. The undersecretary and undersecretary for benefits, its mandated that we form commissions to actually search for those positions. The undersecretary for those po. The undersecretary for benefits commission met to go through candidates and are recommending several of them for me to see and then me to recommend to the president. And the undersecretary for the health commission, i just saw the Committee Members appointed this morning. That will be Going Forward in the next probably two weeks as well. For cio, ive met a number of candidates. Were vetting them right now, trying to move forward with an off and at the board of veteran appeals were also trying to vet a candidate, also, so i hope that these processes, having gone through it myself, my own vetting process, 13 months, it takes too long. And were looking to move through this as soon as we possibly can. Thank you mr. Chairman. Ill have one in the third round, so i appreciate it. Yield back. Thank you. At this time id like to recognize the gentleman from florida for five minutes. Mr. Secretary, just twoontd say that your office is watching this hearing and has already got with my office regarding some of the issues that we are discussing with our constituents and want to give a shoutout to mary kay in lake city. If youre watching, i have another issue for you to work on. That is with regard to a lot of my districts very rural. And i do have so many of the coast but a lot of the people that are in my district live in the countryside and one of the issues they complain about with the Choice Program is that theres long wait times, theyre receiving complaints about long wait times for v. A. Appointments, referrals, palts through the Choice Program and the payment and reimbursement process to the providers is difficult probably exacerbated because it is rural, so we you know, obviously, in that situation you have smaller hospitals and clinics and many of the providers that are technically participating in the Choice Program are refusing to accept choice patients because they know that theyll have to wait a long time to get paid themselves. So some providers that dont accept the choice patients will only do so if the veteran agrees to pay for the services up front and that leaves the veterans in that same bind they were in before choice, which was either face the excessive wait times at the v. A. Facility with no option to obtain Immediate Care elsewhere without paying out of pocket first. And obviously, thats not the point. Or thats not what were look to do. So i mean, you as a doctor can probably appreciate what these people that want to take the Choice Health care veterans but they know it will take forever to get reimbursed. I dont know if thats a rational but it sounds like that. The oig has criticized the v. A. s monitoring for oversight of these contracts and reported that these contracts still dont have Performance Measures to ensure that contract ors pay the providers in a time lie manner and the oig made this recommendation january 30th of this year. As you work to expand the Choice Program, how are you implementing the oigs recommendations specifically with regard to timely reimbursemen reimbursements . Well, there is know doubt that this is an area of significant risk for us, that monitoring and making sure that the providers are paid is critical because of the issues that youre saying, the veterans are being put in the middle. I would not recommend the veterans put out money for this, that, as you said, is not the point of it. What we have done is we have done multiple contract modifications. Weve actually advanced money to third party administrators. We shall improving payment cycles through the Choice Program but its not perfect by any means. We have to get better at auditing of these processes as were the recommendations and we are working on doing that. This is a significant area of risk for us. In the reauthorization or the redesign of the Choice Program, what were calling choice 2. 0, we want to eliminate the complexity of this process. The private sector does not have to do the type of adjudication of claims we do. They do electronic claims payments. We just are not able to under this legislation do all the things that frankly we know are best practices. Thats what we want to get right in choice 2. 0. Thank you. Like to recognize the gentleman from ohio, mr. Ryan for five minutes. Thank you mr. Chairman. Nice of you pennsylvania guys to let an ohio guy participate. We were in ohio state last year, thats why. Blind squirrel finds a nut every now and then, mr. Chairman. Mr. Secretary, a couple of quick questions. One, with regard to the Choice Program again, there are a lot of people who want to act ive seen it in the last few years, the dcva atbat and other v. A. S where you have centers of excellence where there are these complementally services that are showing significant success in reducing pain, managing pain, reducing open yarkts which is a huge thing for us to be able to do, providing these alternative approaches. And i just want to make sure as were moving to try to better administer the Choice Program that these evidencebased programs are covered in the Choice Program. So that they can access whether its acupuncture or mindfulnessbased stress reduction. Ive seen things like project welcome home troops where they do a lot of breathing exercises with these veterans that are having transformative effects with their stress. Transendental meditation is another thing they use. You can watch these vets who are on ten or 12 drugs, after going through these nontraditional remedies, they go down on their medication. Thats the tools they need to go out in the world and function and be productive members of our society. I want to make sure that as we move with the Choice Program that these, again, evidencebased programs are covered by the Choice Program. Yes. The those types of services and providers are part of the Choice Program. We are expanding the network so that we have more access to those types of providers. Great. I think thats going to be a big thing not just for the vets but out in society as well. The other issue is were talking about dealing with the appeals process. We had this conversation again yesterday. But the legislation currently is not going to affect the hundreds of thousands, almost 500,000 people who are already caught up in the stagnant appeals process. So i say this not to you, because ive already said it to you, but members of the committee and to the public, i think its important for us to figure out how we can help you start to reduce this backlog, how do we get more appeals judges, maybe out of retirement, to get into this program. Congressman womack and i are already working on some legislation to be able to do that and so if your department can provide us with the metrics that we would need to figure out how many retired appeals judges from the board of appeals do we need to get back in the system, even on a parttime basis to start getting through this backlog and so if you could make yeah. Youd give us that i appreciate that suggestion. 470 do backlogged claims right now, so even after legislation is passed and we fix the process Going Forward, we still have that backlog. I appreciate your offer to work with us and see if theres a way to help with that. We have already worked up some numbers wed be glad to share you with and congressman womack. Great. Mr. Chairman i think thats an important step for us to dig into this 470,000 numbers with the appeals that some of them are 30 years in the making and for every additional piece of evidence or paperwork they had, it just slows up the process, and i think weve got to make a concerted effort congressman womack, i wont steal his term, but he was talking about a surge for judges to help dig through this. Thank you again, mr. Chairman for all your leadership. Gentleman from West Virginia is recognized for five minutes. Thank you mr. Chairman. Mr. Secretary this has been a lot of questions answered today. Appreciate your time. Couple of things on the budget. I know that you mentioned that the demand was not fully funded and i know that youre looking for efficiencies and wavste frad and all that. First i want to applaud you for taking a stand in helping veterans who may have been dishonably discharged and some of that because of effects and stresses they had on their personal lives from war, quite flankly. That being said, even in our own v. A. , we walk through it and we noticed and asked questions and certainly saw that there were folks that were being treated there that may not be eligible via the system currently, so and a couple yashs its in my letter or email i think it is it talks about how there are a couple of areas there. You have these veterans that are honorable. Veterans no no issue but when they need a knee replacement, thats not Service Connected, that they may be getting treatment for twlthere in the v. A. , thats a huge cost with zero reimbursements from medicare or medicaid or private insurer or whatever it may be. If theres an active study for it for now, is 23 you exacerbate that across the whole v. A. System, thats significant dollars. Veterans either knowingly or not knowingly because this is not a politically popular thing to say, but im a veteran and i dont care. If youre not a veteran and shouldnt be treated there, you dont get treated there. That being said we want to take care of people as much as possible but im fearful that in the Political Climate maybe the v. A. Is seeing folks that shouldnt be there, that should be using their own private insurer or whatever they have insurance wise. Has there been any studies looking into that to figure out what that is costing the v. A. Across the whole system . Yeah, we have looked at this. Veterans are classified in eight groups. The first three generally are Service Connected. The next three, so four through six are generally income related, lowincome. Sol when you start getting to seven and eights, those are people that fall outside of that and currently that is frozen. So not all veterans, as youre saying, are eligible for care in the v. A. System. And so we are focussing on those that are Service Connected and lower income, so and i think thats if i may . Yes. Has there been any review, if you will, where that may not be the case . I know were four cornersed on the folks that are supposed to be in the system that need care and everything like that, but has there been any review across the whole spectrum to figure out if, in fact im not saying its fraud necessarily. May be, but in some cases it may not be. They just may not know otherwise. But have we had a report across the system to figure out those inefficiencies and what the costs are for the v. A. . Yeah. We know exactly how many people are in these priority groups. Not the priority groups. Im sorry. Didnt mean to interrupt. But not just the priority groups but v. A. S who are getting treated. Im not aware of any veterans who are getting care there who shouldnt be. If there are, we need to investigate that and stop that. Because we do exec, except in emergency care, Eligibility Criteria sure. When people come in. If theyre not eligible for care we generally are telling them that. Now, maybe youre aware of some situations and id really like to understand that better, because i think youre correct in your assumption that our care needs to be focused on those that are eligible for care, particularly when we have access issues, so id be glad to talk to you more about that. I do just want to mention two things. First of all, our policy is for emergency Mental Health care for other than honorable, not dishonorably discharged. Sorry if i misstoke. Oh. I know there are a lot of wounds that are mental, of course. Absolutely. I applaud you for those efforts. The other thing i want to mention is that your letter of march 29th, we did respond by april 6th. We actually made it 14 days. There is Additional Information that your office wants on the protocols on the Veterans Crisis line, so were providing that to you and certainly want to get you that detail. Thank you. I appreciate it. Thank you, mr. Taylor. At this time i guess well move into a third round of questioning for those who remain, so with that, i thought id just quickly touch on a couple of issues. First, mr. Secretary, we included 50 million in the om bus appropriations bill thats going to be considered in florida, i guess right now, for v. A. Opioid abuse prevention and treatment efforts. We realize that the v. A. Has really come a long way in opened outside management efforts. In wisconsin, in the candy land doctor situation. What are the most effective approaches v. A. s identified that keeps the real injured veterans away from opioid dependency and how are you achieving those goals . First of all, thank you for that Additional Support. I can tell you that it is money well spent. We have seen a 32 reduction in opioid ridiculous in the v. A. Since 2010. We have a lot more work to do, so this is a good investment. Identify say briefly, the v. A. Approach to this and we are leading american medicine in this. I just published an article on this. Is a multifaceted approach. One is veterans need to sign an manufactured consent when they go on opioids. Secondly, we actually monitor the profile of doctors so they can compare themselves to how other doctors are previbing. Third, we mandate participation in the state prescription data monitoring programs. Fourth, we do academic detailing where experts go out and actually educate our clinicians on this. Fifth, we are suggesting strong alternatives to opioids and providing those like complementary or integrated medicine in our facilities. Also like to ask you, too, as it relates to disability claims backlog management issue, you know, we were pleased to learn last year that the v. A. Has reached effective zero on the side of the disability claims backlog. I know some claims are always going to be or exceed the target decline because theyre waitings on the veteran to produce information. But youve brought that down in 2013. We understand the backlog is creeping back up because of your shifting workload priority from initial claims to appeal cases. We know that the burgeoning appeals case load needs to be tackled, but this highlights the management dilemma you face and i think congressman ryan touched on this a bit, but what is your longterm plan to bring a balancing between activity on initial claims and appeals work loads . Thats the main issue i guess i want to hear about today. Well, i dont think we are where we want to be on this, so we have to make continuing progress. Were at 100,000 disability claims over 125 days, and that needs to come down significantly. Were doing a number of changes to our processes. Ones called decision ready claims. That will allow veteran to seek a much quicker resolution to their disability claims and give them a choice when they have all their Information Available to be able to do that. Were still advancing our technologies moving towards a paperless system. We have ten sites that are completely paperless. That moves everything through faster. Were looking at a number of other alternatives to do that, so we do have plans to get this down. And were not seeking additional funds to do that. We see it through process improvements. Thank you. And finally, Jared Kushners White House Office of American Innovation was apparently chosen v. A. As its first target to reshape federal bureaucracy by making it leaner and more effective. Has his office fanned out staff at the v. A. To analyze its operations and make suggestions at this points . Yeah. Were in close contact with mr. Kushners office. They have been extraordinarily generous with their time and what theyve really been doing is trying to bring Industry Partners and industry best practices in to help the v. A. , so i dont think that theyre staffed to come in and do their own assessments, nor do i think thats their intent. Its more to identify solutions that already exist in the private sector and bring hem h them in and modernize our system. Thank you for sharing that. All federal agencies, by the way, have received an executive order to reorganize their organizations by september. The v. A. Would like to get started sooner than that, youve said. What changes do you expect in the way v. A. Is organized and how it operates before the on of the year . Well, we are under way with this right now. I think, although i dont know all the specific solutions, because were still working on it. I think what you should expect is were looking to have a smaller, Central Office function, more stream lined. Were looking to move towards more shared Services Rather than silo eed services in each of ou places. Were looking across federal aegtds to see things that maybe other agencies are doing better or they should be doing than us or vice versa or whether v. A. Should be taking on some of the other things other agencies are doing. Were working with other secretaries on that. Thanks, secretary. That completes my questioning. At this time i recognize the rarnging member for five minutes. Thank you, mr. Chairman. I wanted to ask you about the Veterans Crisis line, because when we went to the d. C. V. A. Hospital, we had a rather confusing conversation with their personnel. That made it effovident that th were a number of serious issues with the decentralized nature of the hot lines, there being a National Hotline as well as a hotline at each hospital. And so the report that came out highlighted how significant the concerns are and within days of the igs report, the v. A. Said that the issue had been fixed. Can you explain how fixed it is . And what does that mean and what youre doing to ensure that our veterans are absolutely able when they are in crisis because of the risk of suicide being so high, are able to get the services that they need . I apologize for the confusion. There is only one centralized Veterans Crisis line. Each of the Medical Centers do not have decentralized crisis lines. What the i. G. Was referring to was the fact that when the v. A. Responders and the Veterans Crisis line received more calls than they could handle, they went to backup centers that were located around the country. Those backup centers are certified samsa backup centers, so theyre trained responders as well, but theyre not v. A. Responders. We did not think that was satisfactory, so several months ago, we hired over 200 new responders, how to get them trained. They came on line in the early part of 2017. We opened up a Second Center in atlanta, georgia, and now because of these new responders in the Second Center thats on line, we are able to handle the calls that are coming in. We have less than a 1 backup center roll overrate at this point. Thats why we came out and said we fixed that problem. We have many days where we have zero role over calls. Probably in the last two months we averaged less than 10 roll over calls on a given day. We are responding to over 2,000 calls a day to veterans in crisis. We typically will send out 60 to 65 emergency responses to save veterans lives. When we were at the v. A. Hospital here, they described a system that was one that was based with their personnel and one that kicked to the National System when it was after hours. Well, every v. A. Has a Mental Health service. We have Sameday Services available so if a veteran calls and is in crisis, they will be seen that day or their issue will be dealt with that day. So that does happen. Every one of our Medical Centers has a Suicide Prevention coordinator, many of them more than one that is there to deal specifically with the followup issues and to address people in crisis on that day. But theres only one National Veteran crisis line, and thats run out of two locations in upstate new york and one in atlanta. Do they all receive the same training . They all well, as i was explaining to the congressman, the Veterans Crisis line responders all receive the same training, because they are licensed Health Care Professionals and the Suicide Prevention coordinators all receive the same training but different training than the Veterans Crisis line responders, because theyre not all credentialed or licensed Mental Health professionals. Ok. And then you mentioned the reorganization and Jared Kushners offices goals. Lu huh. Are those goals ablind yours . Are you waiting for mr. Kushners reorganization recommendations before you begin hiring . No. No. Again, i the american enovation office is not intended to come in and do assessments and give recommendations. Thats the executive order has asked the department to do that. Thats what were doing. Mr. Kushners office is helping us in identifying industry best practices and Strategic Partners that can help us advance these modernization goals. Ok. And just as i run out of time, on the veterans the board of veterans appeals and backlog and the issue of the disability a i sesment backlogs as well, are you aware of online Electronic Technology that exists that previously had contracts with the v. A. That no longer do and that could significantly address some of this backlog . No. Ok. Id like to follow up with your office yes. So that you can be aware of this technology. While i have no preference for any particular contractors, the timeline and story that ive heard about the process that they have gone through leaves me frustrated that we have a massive backlog and a potential avenue to help address it, but no way in for a contractor like them to actually be a part of it. No. Thank you. Id like to hear about that. Thank you. I yield back. Id like to recognize the gentleman from virginia, mr. Taylor. Thank you, mr. Chairman. Just wanted to say before i give my question, youre correct. We have the letter, i have it right here. So maybe i misspoke in terms of getting the answers right. Yes, you responded right. Im glad we responded. Sure. I look forward to working on those with you. You mentioned earlier about 32 of the care being outside the walls of the v. A. , which is a 62 increase in two years. Right. So what is your office doing in terms of looking at inside and figuring out yes, if were looking at and youre asking for the moneys for the choice and to fully fund that in the mandatory in the budget, that trojectorys pretty high, right . What are we looking internally in terms of reducing the budget internally . Are you seeing complete demand exploding . Yeah. I think the reason why weve gotten to the crisis in 2014 is because we were not being honest about what the real demand is. Once we opened up both internal access and community access, we started to see what the real demand is, so i think that were reaching, i believe, hope to be reaching a steady state where were not going to see continued growth in the way that we have in the past, but that we are meeting the Health Care Needs of our veterans and honoring our commitment. Ok. Thank you. And back to the 735 underutilized and 435 vacant buildings that are out there, do you have a rough idea what the cost is that you guys are spending that you dont need to per year on that . Yeah. And in fact, i have a chart that i gave to each of you showing you where these are. But the cost of the 435 buildings right now that are vacant is 6. 7 million a year. Our total cost is approximately 25 million a year for all these buildings. Thank you. And then jumping back and i appreciate that. Thank you. Jumping back to the suicide and you mentioned the two different folks that are trained in suicide. Yes. So its my understanding that like hampton, hampton v. A. , theres a call center that mans the suicide hotline, is that correct . No, no. The suicide hotline is a National Hotline. The you know, during Business Hours the hampton v. A. Would be there to assist veterans in crisis. The National Hotline is run out of our upstate new york office and now in atlanta, they have a second office. So a Contractors Office too said they were the call center for hampton v. A. Le. Im sorry. The v. A. s and in some cases divisions run a call center. They do not run the crisis line. They run regular calls that come in and want to be asked for appointments or get to certain places through our telephone operator. We do run call Centers Across the country. But they are its not we only have one 800 number for our Veterans Crisis line and thats run out of upstate new york and atlanta. So the veterans im trying to understand. Yes. The Veterans Crisis line. But if i call hampton and say im suicidal. Call the hampton v. A. , it will say welcome and if youre having issues related to suicide ideation, they use better words than that, please dial 7. Youll automatically be connected to our national Veterans Crisis line. Ok. Thank you. And i have no further questions. I look forward to working with you. Thanks for your time. Thanks. Mr. Chairman. Yes. Thank you. I just i really think that if were having a hard time understanding how the Veterans Crisis line works, then imagine how veterans must feel. I dont think its clear how it works and what happens from beginning to end every hour of every day. I think im glad that you have an additional, you know, Service Center that has your employees staffing it. But i dont understand the difference between who handles suicide calls on the Veterans Crisis line and other Mental Health calls. I dont understand how it works when youre outside of Business Hours. I am confident that there are different crisis lines that are at local v. A. Hospitals, because we were told that they had people working at the d. C. Veterans hospital that handled that and that only went to the Veterans Crisis line when they werent open. So if you could provide greater clarity i would be great. This wouldnt be the first time that i have learned information that then i would agree with you, i would be confused, too. I think i have an understanding thats clearer but please lets make sure its the correct understanding and i do want this to be clear. There should be no doubt how a veteran gets help when theyre in crisis, and obviously were not communicating that well enough or if theres a system that i dont understand, i appreciate you raising it. Ill get back to you on this. Thank you. Especially because lives at stake. Yes, of course. Thank you very much. Thank the Ranking Member. At this time id like to recognize mr. Fort berg, five minutes. Thank you mr. Chairman and thank you mr. Secretary for listening to me earlier and embracing the transformative ideas, what i believe and you believe are transformative ideas that are kicking off in omaha. In this regard, congressman taylor actually touched on the question and others have as well. But back to the idea of excess irch tore. For instance, the air force is going to come here shortly and tell us they carry 30 excess inventory and while yours is in terms of cost impact much, much lower, nonetheless, thats not a good use of dollars. Now, we can thrower around the word brak. I highly suggest you do not use that term. But what we can do is work with you, i think, constructively, maybe already have this option in law to are for instance, sell excess buildings to the communities surrounding you, look at the types of services which the military is starting to do this is a little more applicable to bases but nonetheless its might apply to you that can be contracted, given over to local communities. Thats like land skaining firefighting security as well. These are the types of ideas that go toward the possibility of not pulling forward things that are no longer applicable in an innovative v. A. Without running into the difficulties of impacting communities adversely when you close something. So dont use the word brak. You automatically set yourself up for controversy. I recommend misc, miscellaneous, maybe work on some acronym like that. I think its consistent with what youre trying to do in terms of upsetting the v. A. Getting the best value for the dollar. Ensuring that old ways of thinking are transformed into new ways to care for veterans while pulling forward excess inventory. That doesnt make dmi sense. Those are some thoughts. I know you covered that when i was out of the room more extensively, so wanted to leave you with a that. The other issue is i think youre going to forward to us a working list of possible changes, one of which you brought up the other day, youre in a catch 22 regarding not being b able to study things that weve mandated you to study because you cant study things. Right. Ideas like that, again, back to the transformative theme, we look forward to receiving those. Yes, thank you. Thank you, mr. Chairman. Seeing no further questions, id like to thank everybody for their partners. Thank you, mr. Shulkin. I can see why you were confirmed nachlgsly. Congratulations again. This hearing stands adjourned. Any further subcommittee hearings will occur after the president s budget submission in late may. Thank you. Hearings ajurnt. Adjourned. This weekend on American History tv, on cspan3, saturday at 6 00 p. M. Eastern, author and historian c. R. Gibbs on the black women who worked as nurses, soldiers and spice for the army during the war. She was the wife of edward bannister, one of the leading artists, armstrong africanamer artists and she was a proud and consistent supporter of the u. S. Colored troops. At 8 00 on lectures in history, the university of washington professor on the 1968 president ial election and events that affected the outcome. Hero after hero is explain, john f. Kennedy, Martin Luther king and now robert f. Kennedy. So kennedys designation, just like kings assassination. Lynne cheney author of the book James Madison discusses president madisons personality. Madison was lucky enough to encounter doctors who told him to exercise. What a modern thing to think. Its often recommended today for people who suffer from epilepsy. This month marks president john f. Kennedys 100th birthday and p Steven Kennedy smith and historian Dowling Las Brinkley reflect on the life and career of the 35th president. He was a decorated combat veteran. He did believe in a strong military. But he had a much broader conception about what american identity really was. He reached out across the aisle. He launched the peace corps in 1961, an Incredible Program for young people. He started with the alliance for progress and he engaged in the space race. For our complete American History tv schedule go to cspan. Org. Saturday, at noon eastern on book tv, military historians discuss their books on world war i at the 2017 speakers symposia. Michael nigh berg and his book the path to war, how the First World War created modern america. Retired colonels books over there america in the great war and the recipient of this years award, david barron and his book waging war. 1776 to isis. Watch the 2017 colby military writers symposium saturday at noon eastern on cspan 2s book tv. Next an advisor to the British Government on its negotiations to leave the European Union talks about the impact of brexit on the future of u. S. Uk trade policy. It was part of a discussion at the Heritage Foundation in washington, d. C. Its an hour and 20 minutes