Test test. Test. We want it to work like medicare. Help us do that. The choice law has eight different eligibility criteria. We have to determine if theyre Service Connected or not. We have to determine if they have another Health Insurance or not. We want to be able to get to the point where it is actually i only have 30 seconds left. We promise to work with you on that. Could you tell me when Eastern Maine will get 13 million and when maine medical will get 9 million . I dont think its 13 maryland but were meeting with them this week. They think its 134 maryla m we dont. Whatever we agree on we will cut a check and make his day. Is it going to be in three weeks . Three weeks. The weather is clearing up. Its a good time to be in maine. Thank you, member chair. And thanks for organizing this committee hearing. Secretary shulkin, congratulations. I live in california, a lot of new americans where english is their second language. First question to you, the number of latino veterans is rapidly rising. Over the next decade theyll make 15 of all of the veterans. With that many mind, maybe language challenges. How are latino veterans finding and fairing under the Veterans Choice Program . I have not seen a specific study on that issue. Its probably a good thing for our office of minority and diversity to take a look at to make sure that theyre not fairing any worse. Our workforce tends to reflect the makeup of our veterans since more than 40 of our workforce are veterans. We do have a large contingent of Latino Workforce as well. And i hope that we are certainly meeting the needs of all of our veterans. But thats something that i think we would like to work with you on. Mr. Chair, i would like to see, you know, some goals or maybe some data on that area. Yes. A lot of them, again, their families are spanish speaking. Possibly english is their second language as well. I want to make sure that language is not a barrier to them receiving the proper benefits, Veterans Services that theyre entitled to. Second question is an important one. Under existing immigration laws if a legal permanent resident veteran is convicted of a crime, even nonviolent offense or minor infraction, some of them face deportation. These men and women have defended our country with honor, yet their lives continue to be disproportionately affected. So are we doing anything to ensure that these veterans, resident veterans who fall into these categories have access to Health Care Without fearing deportation . That is, that is something that i think that were going to have to work with our general counsel on. I understand the concern. Im not aware of any particular circumstances right now, but we certainly we have a Veterans Court program, we have a veterans justice outreach program. We work very closely with veterans who do get into trouble with the law and we work with judges in particular on those issues. So i would hope that we could work in a way that would i would love to work with you on this issue. Orange county, our district was the first in california to have a Veterans Court. This is a unique issue in the sense that legal permanent residents who violate the law or convicted luose their residency and are being deported. I know a lot of them are concerned about where do they go, what do they access and do they face deportation. Theres a growing group of these veterans south of the border who are now living there because theyve lost their legal permanent residency. I would like to explore this issue with you a bit further. Thank you. Thank you, sir. Thank you, gentleman. Dr. Done, youre recognized for five minutes thank you, mr. Chairman and thank you secretary shulkin and all of you gentlemen for spending your evening with us. Im sure its exciting for you to be here. I thank secretary shulkin for mentioning dr. Tom starzal who passed away this weekend. He was a champion for the veterans and a pioneer in the transplant surgery realm. I was fortunate to study under him many years ago. Just yesterday a veteran i represent provided to my office an account of his experience receiving Specialty Care through the Choice Program and it underscored a number of challenges that weve discussed here, particularly the veteran encountered poor communication between the va and Third Party Administrator and also the va and his choice provider. And it severely delayed his access to care. Automobile though he ultimately did get an appointment with a podiatrist through the Choice Program, the nearest provider was hours away from his home. And he had some difficulty getting his prescribed custom prosthesis and orthotics. Ultimately he did the math on the multiple round trips and the prosthesis was cheaper and the medical care was cheaper out of his pocket. And thats what he did. This letter is amazingly lucid and articulate, polite letter. Ill make it available to the committee. It reads like a Marx Brothers skit. What should this committee keep in mind in regard to the particular needs of the Specialty Care patients like this and how is that different from the primary care referrals. This is sort of a special situation. Yeah. Well, what we are doing to make sure that we get this right is we are doing community by Community Assessments because theres you know, just like real estate, all health care is local. And so there are some areas that have oversupply specialists and some under supply. And it sounds like your constituent lives in an area where there might be a shortage of specialists. On your panel clearly. I know there with specialists near him but for whatever reason theyre not on the panel. Were continuing to grow orb network so if there are available specialists in the area and we have a shortage of them, we are continuing to grow that area. We actually have a slide of this where you can see the progress that were making in provider growth right now. It might not pop up. Oh, there it is. 133 growth. But we need to continue to build out the network and stories like that are impactful. Im glad youre going to make it part of the record and we can look at that. Im also my practice, we were on your Choice Network and i will say that a lot of times the problem was not that the i mean the veterans are there in town, were there in town, we have slot thr them, we can see them. But the problems were authorizations. This system in a number of ways is dysfunctional. The Payment System is also pretty dysfunctional. More basically its important to get them in and get themm taken care of. They had to go back for authorizations again and again. What are we going to do to make the system work a little better . When we started our authorizations were only good for 60 days. We did a contract modification and made it for a year. So as we learn the problems in the program, much like the way that youre describing, we are doing these modifications. Weve had 70 of them since the contract started. So they would come to see me and they wouldnt be able to get xrays. I would see them, prescribe them medicine which they would have to get at the va, they couldnt get the xrays. I couldnt see the xrays. The delays were just atrocious. In addition to lengthening the care, what were doing now is doing bundles. If youre getting your hip replaced, the pt comes with it, the mri comes with it. Were trying to tackle that problem as an episode together so we dont split up and we maintain continuity of care. Thank you. We look forward to working with you. Were excited about the possibility. Mr. Chairman, i yield back. Youre recognized. Thank you everyone. Good morning. From where im from its 11 00 in the morning. I know i have been nodding off a bit but when it takes you 25 hours to get here, you get tired. And because its so far away, mr. Secretary, congratulations, sir, on your appointment, on your confirmation. I truly wish you all of the success in your term in office. You were successful in your previous job running a huge hospital. But the veterans believe that our country has forgotten them. I dont stop anywhere in the country going home or coming back. But i stopped over in hawaii, i met dr. Hastings, i urged him to complete the contract that he was negotiating with one doctor who actually now provides service to a certain number of veterans, the only doctor on the island providing service to veterans. And then we now have one vha employee. But the country, the veterans feel that the department that is tasked with administering Veterans Benefits and services have done little to change their feelings about their being forgotten. Over the years in the last nine month my office has seen increasing complaints from va receives members, their family members that no use of va resources have brought in people who helped with teach iing methods. For people with ptsd i brought in a documentary and tom, who walked the country to learn how to handle his demons. I just had a resource fair a couple of weeks ago and i have never had a more successful fair. We put together all potential resource providers and brought our veterans in. And were very successful. And then all of the sudden comes senior administrator from hawaii and his deputy and they couldnt make it to the fair but now theyre having a one and a half hour town hall, after stopping in guam for the night. So my question is, will you pledge to work with me, please, to improve the quality and access to va services if our veterans . Im from the Northern Islands. Somehow we truly are we truly need your service, sir. Yeah. Id like to come and see you and lets try to figure this out together. Thank you very much. Thank you. That committee is important. Mr. Missal, thats you, sir, right . Yes it is. Inspector general . Yes, sir. In your evaluation of the Choice Program implementation, what have you found to be the experience of veteran patients in the outlying areas or insular areas or territories, some people say in the colonies such as the northern accessing health care in a timely manner under the Choice Program . Well, sir, weve looked at it in a number of different ways. We havent just isolated it in those particular areas you mentioned. But the same issues we found, whether its with vision 6, whether when we looked at it more nationally are going to be the same issues that impact people in those more rural areas, which are the complexity of the programs make it very difficult to administer which increases the time involved. And then one of the other issues that i know weve talked about already is the care coordination, to make sure that when a veteran leaves the va system one of the strengths of the va system, its an integrated system where they can watch very closely the care for the patients. When they leave that system, you have to make sure that the records go out with the patient and you have to make sure they come back in. And weve seen challenges to both of those situations where theyre not going out as quickly and coming back as quickly as they should. Well my question was, so thats the experience you have found in veterans accessing health care in a timely manner or is that an answer that says really that you dont know what youre talking about . I would hold that answer and well come back a little later. Mr. Rutherford, youre recognized for five minute. My time is up. Mr. Secretary. Thank you for your long testimony here tonight. Youve probably heard the old saying that vision without action is just daydreaming and action without vision is chaos. And sometimes i hear from veterans in my district im from florida 4, which is the Northeast Corner of florida. We have a very large veteran population. Sometimes they talk about the chaos of the system. But ive heard a couple of things here tonight that really struck me. One was that your number one concern, and it happens to be mine as well, is veteran suicide. Yes, sir. Im very pleased to hear that. In addition to that, i heard that another vision you have is that the va is going to get out of developing i. T. Software and those kind of things and look for those off the shelf type packages. Those are significant cultural shifts i think within the va. Yes. Could you just give me one or two more yeah. That you have you know, visions that you have about the va and how to yes. What will change the culture . Yeah. The three biggest areas that im focused on are number one, giving veterans additional choice. And you know, i think that ive already explained tonight, this means keeping the va system strong. I happen to believe the way you keep the va system strong is by allowing veterans to decide where they want to get care. Right. And giving them more choice. And i believe thats going to make us a stronger system. I think it goes along with, secondly, what dr. Roe has introduced, which is accountability. For me, account aboability w had that discussion as well. Accountability is not only making sure that if you lose your way and lose your value you shouldnt working in the va but also that the secretary has the tools to recruit and retain the very best in health care. And i do believe we have among the very best Health Care Professionals in the country working at the va today. I want to keep them there. And third is i want the system to be modernized. I believe that veterans deserve the very best this country can offer, modern i. T. Facilities, modern programs and proof professionals and technology. Those three things are what are driving the transformation of the va. Thank you, mr. Secretary. I believe the entire committee looks forward in working with you and making that happen. In light of the hour, mr. Chairman, ill yield back. Thank the gentleman for yielding. Thank you, mr. Chairman, thank you mr. Secretary and all of those staying in the late hours. I this were all extremely ha l heartened to hear about the i. T. This issue about coordinated care, i had one of my round tables yesterday, someone came forward and said a friend of theirs had just gotten a 36,000 hospital bill that went straight to the veteran despite medicare. Medicare extension at that or Bluecross Blueshield and va and the hospital sent him a 36,000 bill. This is someone recovering from surgery, is already qualified, has served this country and is over 65. And that is just shameful and wrong and we absolutely need to have a system where that cant happen. They cannot as a first course of resource send that bill. I heard the same with the er care. The veterans get the er bills. They dont know what to do. Theyre told they have a bill to pay, they panic, they dont pay other bills, they pay the er bill and thats wrong. We need clarification of what the rules are. It should not take 150page manual. It just should not be that hard. On military suicide, were heartened to hear your commitment around that. I found for a lot its people who have not come into the system at all. So you may have the best care available, but if nobody is coming into the system, like my friend beto, i know our Veterans Centers are providing that care for our Vietnam Veterans right now. We need to figure out how to reach out over the last 20 years. Theyre not in the system whatsoever. Were getting those calls in our office. Weve had suicide calls come into the office and had to patch people through and track down their provider. Shouldnt be having to call your member of congress to get help. So we need to Work Together to figure out how to actually bring people in so that theyre not saying, hey, weve got great care but youre never going to see it. One of the issues you did not flag which i would like you to is on women veterans. That needs to be a priority. We are integrating our forces. There have been some unwelcomed news out of the marines in the last couple of days. If you want to talk about the damage that does to our system and ability to attract and retain and attain the brightest, that does real damage. And that underscores the need to have that kind of care. Its a little specialized. And as we look at care outside of the system, those distances become an issue. Mine is one of those districts, im in connecticut but it is rural. Northwest corner of my state looks a lot like vermont or maine. To actually get to a va facility might be 50 or 60 miles but theres a cboc thats 20 miles away. We need to deal with the issue where you may have outpatient thats really close but actually what you need is going to be further. So i would like your feedback on whether we can have choice recognize the difference between a facility thats within the 40 miles and actually what you need. And it may not be that specialized. If youre talking women veterans, it may be more specialized. Well, congresswoman, you have identified so many important issues, i dont even know how to begin to address them all. Let me try to make one point about each one. Putting the veteran in the middle with the bills, absolutely horrible. I am going to tell you what to do. Call 18778778817618. That is a special hotline for veterans who are in the situation where theyll being billed inappropriately and were going to get them out of the credit situation. On the issue of veteran suicide, thank you for your recognition on that. We know va cant do this alone. It has to work with the Community Providers and we are strongly looking for Community Groups and other partnerships who are willing to go into the community and reach people that youre talking about. On the issue of womens veterans, absolutely. Its an oversight not to mention it as one of our key areas, Fastest Growing group of veterans. We have done a lot but we need to do a lot more and its not uniform across all of our facilities, our specialized womens care but were getting there. On the Choice Program, as ive said, if i were designing a program, i would not have picked mileage and wait times as my criteria. I tend to think more clinically about how you meet Health Care Needs of veterans and patients. So thats what we look forward to working with you. If i didnt mention it, we are very supportive of an Extension Program now for choice. But we want to come back and we want to work with you on a redesigned choice 2. 0. Were going to have a veteran name for that too. And we really want to get that done with you by september. That would be our goal to get that done and get a system that makes sense. Thank you. And i see my time has expired. Thank the gentle lady for yeegd. Mr. Higgins, youre recognized for five minutes. Thank you, mr. Chairman. Secretary shulkin, i very much support hr 369, the extension of the Veterans Choice Program. The remaining 1 billion of american treasure certainly needs to be dedicated to American Veterans. In your testimony youve noted that congress should pass legislation to clarify criteria for veterans to receive care closer to home, to facilitate the development of a network of Community Care providers and to better coordinate Veterans Benefits. I would like to bring our conversation completely closer to home, all the way to the home. As you know, many of our most severely wounded veterans prefer to receive their care from their family at home. So im referring to family caregivers. And specifically as we move forward with what youve referred to as choice 2. 0, with an eye towards making a real difference in the lives of American Veterans that are seeking health care and need it, do you believe its in the best interest of American Veterans to expand a program of comprehensive assistance of family caregivers to include pre9 11 vets whereby they can receive their care from those that know them the best, their loved ones. Would you please give us your feedback on that. One of the parts of va that im most proud of is our support for carecaregivers. I think weve demonstrated when we send somebody off for work, were not just sending them off. Theyre sending the entire family. Family needs to be part of the solution when they come back home and our support for care gooifrs is vital. As you mentioned, it was only authorized if veterans post9 11. I do believe it needs to be for all veterans, particularly or older veterans that want to stay at home and maybe they wouldnt have to leave their home into an institution. The cost for that program right now, it would be scored in the about 4 billion. I believe thats not an accurate reflection on the true cost because i believe were going to save money. Save money. By not institutionalizing people. Were beginning to come back with a true reflection of the costs but i am supportive of that. I thank you for your seasons. Very encouraging. God bless you for that, sir. As the lowest Ranking Member of this committee, i had the great honor of asking the last question. I yield my time back, mr. Chairman. Maybe not. Im sorry. Not the lowest ranked. You snuck in on me there, brother. You snuck . On me. Thats my boss, by the way. Thank you gentleman for yield. Mr. Banks you recognized for five minutes. Mr. Secretary, its an honor to have you here today. As a recently deployed post9 11 veteran, im interested in the transition programs. To get to the heart of the veteran suicide rates, what can we do at the outset, the beginning of the process . My personal experience was in germany in the navys warrior transition program, which was a terrific program that in hindsight benefitted me greatly on my return home trip from afghanistan. What lessons have you learned from other branches. I understand the navy has a model program. Can we protect it, model it in the other branches . What can this committee to do support you with t. A. P. Programs as well. First of all, thank you for your service. And id like to work with you because it sounds like you have some experience that maybe we could benefit from. I do believe this transition period and the t. A. P. S. Programs is an area for doing better in. We hear too many stories where people didnt think about the transition in the way that e with would like for them to and find themselves without knowing thou seek help. I was speaking to the president about this last night and one of the things that were going to be doing, secretary mattis and are going to be getting together to figure out how to get our organizations to Work Together in a closer way. With your input i think we would be better prepared for that conversation. I look forward to working with you on that. On another note, we have a number of veterans in indiana where i live who are interested in alternative treatments like hieber baric oxygen, other al tern f alternative treatments. What can we look for . I was in indiana last week visiting the vas there. And toured the va with the governor, governor holcomb. The areas im most concerned about are areas that veterans has a high prolix of wptsd, other conditions, that today we do not have great state of the art treatments in. So im not as worried about meeting pneumococcal pneumonia. We have established a new office called the office of compassi compassionate. So other areas have been an opening to come in and well work with them to explore new ideas. The very first one of these that we looked at and have granted access to is the use of service dogs for veterans who have ptsd or other emotional disorders. And while there isnt, believe it or not, great Science Behind the fact that service dogs help, i think its common sense that service dogs help. We hear it every day from veterans. Now weve started to make them available. So ideas such as what youre talking about, hyper baric is an interesting story, theyve studied it three times and found a negative association. But yet were finding veterans who say theyve been helped by it. We want to continue to look at that. I look forward to working with you. Mr. Chairman, i yield back. Thank you, mr. Banks. We are going to have a round table later in the year. I had several meetings over the recess and just yesterday on trying to bring a lot of the people out in the community who are working with veterans, trying to bring together and coordinate the efforts. Ive met with now three people in the last four days who are doing something here, somebody over here. But lets get everybody, not with the cameras on, but just around the table and find out how we can better coordinate this with the va. Gentleman, youre recognized for five minutes. Thank you, mr. Chairman. And i am last, right . Thank all of you for being here tonight. Just before coming in we had i had a town hall, 2,000 people or so dialed in. About 50 of the questions that came befowere related to vetera. Michigan as a state has a higher per spen taj of veterans. Double perpercentage. We have a lot of folks in our district lets put it this way. They laid it all on the line for our country, now we need to lay it on the line for them. Mr. Missal, did i get that right . Is that how you pronounce it . Thats how you pronounce it. I just wanted to make sure. In your written testimony you discuss how the va accounts for Community Care expenses. The topic is extremely complex. Let me try to state it in lay n laymans terms as i understand it. Im a marine so it will be simple here. The va estimates how much each individual episode of care is going to cost and sets aside funds for that care. That doesnt happen quickly or accurately. When the excess is too high, the excess funds remain set aside and the va has to do an adjustment to put them back in the pot. Correct. Those adjustments dont happen quickly either. The department wants to change this to stop estimating each episode of care and instead do one biggest mate at the beginning of the year. My question is, if we allow va to make this procedural change but they dont get more accurate in their estimates, what are the potential downside consequences that could result . Well theyre pretty significant downside. Accounting for dollars in the community was seen as a material deficiency in the audit that we conducted of the financial statements. So obviously as youre getting into estimating, its very tricky. By doing it at the beginning of the year where youre doing it as more broadly, youre going to have some of the same issues that youre going to have when youre doing it on a casebycase basis. And also, mr. Missal, you mentioned in your testimony that the report released publicly last week that included shortcomings within choice, particularly that most veterans were waiting an average of 84 day to receive care. Your staff informed the committee that it provided va its findings around august of 2016 for agency review. In the seven months from when they were provided to va until the report was released publicly, did the oig make any substantive changes to the findings . And if so, what types of information was changed . We did make some changes. Our process is when we finish a report we do share the draft with va. Its our report. Were going to stand by our findings. But the important thing is we want to make sure we get it right. So we did meet with Senior Leadership at va to talk about it. We wanted to clarify some things. So i would put it more in terms we didnt change our findings we just clarified things to make it absolutely clear exactly what we had looked at, what the methodology we use and any comments from va. Dr. Shulkin who is an undersecretary responded with some comments that are included in our report. Thank you. And in the interest of the lateness of the hour, i yield back, mr. Chairman. Thank the gentleman for yielding. And mr. Missal and mr. Williamson, youre finding out its good to do a town hall with a senator because i dont have to answer any questions, just like when the secretary is here tonight, he answers most of the questions. Ill use my five minutes very quickly and just state some things that weve heard tonight. I think number one we all agree that we need choice extension sooner rather than later. Number two, i think we need the choice consolidation. And what im hearing is, is that reform of the Choice Program im going to ask a specific question. Number three was a breath of fresh air to hear that i think the va is going to quick developing i. T. And be microsoft and apple and let somebody do that. Well absolutely Work Together with you. I think if we can accomplish getting the i. T. Started and those other two things this year, it would have been one of the most successful years in va history. I believe that. I think we can do that. I truly do. Ive laid that out and we know where weve been with the va. We know where we are now. And i think id like to hear dr. Shulkin, you go ahead and tell us your personal vision for transforming the va and how this committee can be of help to you in doing that. Well, first of all, thank you. And having sessions like this where we really do get a chance to share opinions i think is a really important start. Any solution is going to have to be all of us wanting to get this done together. The vision for va is to transform this organization to be a veteran centric organization. Its not rocket science. You have to have the right people caring for veterans. Were fortunate that we have a great workforce but weve all seen examples where there are people that shouldnt be working in va, its been too hard to get them to leave. And our accountability bill is an important step forward in that. I also need the tools like we talked about, and i appreciate your willingness to consider the carrots and the sticks, thats the dual part of accountability, getting the right people in the door and getting the great people to stay in the organization. I think we need to transform the culture in many ways that we learned our lessons in 2014 by having the wrong incentive systems in place, by not having management understand their jobs and by not being transparent enough. I think we need to change our culture that way. I think we do need to put the control of health care back into the hands of veterans so its their choice on where they get health care. Theyre the ones who make the appointments, theyre the ones that essentially say whether were doing a good job or not and we have to do that. And finally the last piece as we talked about several times tonight is modernizing the va system. By the way, theres probably not enough money to completely modernize the system so were going to have to be creative in our solutions. Were going to have to Leverage Existing Technology thats out there in the market. Were going to have to partner with our Community Partners to provide the right types of facilities. It may mean that the va is not going to be build as many brandnew hospitals but working with Community Hospitals to share resources that the department of defense and other federal facilities. Its doing business differently. Its being willing to take some risks that maybe we havent. And thats where i think us doing it together is going to be the right formula for success for veterans in this country. Youre seeing the consolidation on the private side too. Yes. Its going on in this country right now. Its not just the va system. Do you believe the Provider Networks now are robust enough to provide care for veterans in a timely fashion . The Choice Program. I think weve come a long way but i think we have much more to do. Our vision is a network of providers that have made commitments on both the service and the clinical side to caring for americas veterans. And thats what we want to work towards developing. I would suggest, dr. Shulkin, that you and i take the suits off one day and probably go in a va, put our stethoscopes back on and go in an examining room and find out the frustrations. I would say if you were back in the examining room and you had a patient that you felt needed to see a cardiologist, rheumatologist, and how hard weve described tonight that is, and the lengths of time people go months to get an appointment, it would the rest of the hair, the few that are on my head would fall out. And i want you to tell me how you if you were making that appointment, what would you expect to happen. Well first off, you just gave me a soft ball. Im inviting me to join me the next time i go and put on my stethoscope because i see patients in manhattan and in oregon. You can decide where you want to go with me. And dr. Yehia sees patients as well. Were focused in the va in making sure that urgent care is delivered at the right time. Thats why we have same day access right now in every one of our medical centers for Mental Health and primary care. Were focused on getting stat consults down. Right now there are less than 100 that are more than 30 days. Its a functional zero. And were working to make all of our Specialty Care more accessible, but of course we do need to use Community Care to do that. My time has expired. Im going to it is an important we dont get the secretary here that often. Im going to open it up for a second round for one minute and the chairman will be very, very very careful. Mr. Walz. Thank you, mr. Secretary. And your vision is where were all at. I appreciate it. Know were there to give you the tools. Well have our discussions here, family discussions, well deliver you something, Veterans First act that we had. We want to give you accountability. But im glad you mentioned. What i can tell you is we can say were going to remove people fast but without leadership, without hiring, without due process, those are going to be the things that dont give you the tools. Your vision is solid. Weve been followed tonight online by a lot of folks watching. And i can tell you overwhelming the veterans suicide issue resonated. There was a Military Spouse said, im a mother, my sons father served 25 years. My son will not serve because of the suicides. We understand that this is a faith issue. I just appreciate your vision, i appreciate your leadership, i appreciate the chairman being there and the folks sitting behind you, theyve got your back. Theyve been out there and theres a lot of those groups. Lets get this done together. Thank you mr. Walz. Mr. Bilirakis. There have been issues related to veterans care in which the va attributed those failure to poor training. In instances when a va employee was in criminal ak fifties with, patient records or failures that have led to patient harm, is the va oig authorized to investigate . Yes, we are. Under the Inspector General act of 1978 we do have the authority to work with the department of justice and other Law Enforcement to bring criminal charges and we have done that on a number of occasions over the years. Okay. Very good. Thats what i want. We look at it in a number of different ways. We look at the extent of the harm, the number of veterans impacted, the amount of dollars impacted, how long the conduct has been going on. So we look at a variety of different factors and try to prioritize the ones that are of the most serious nature. Thank you very much. I yield back. I thank the gentleman for yielding. M were hearing from the veterans online who want to ask you questions. Many of the questions are about Mental Health care. Mow can we better recruit and trainmen tall Health Providers . I think were working on two things. We need to hire more Mental Health professionals. If people are following us online and theyre interested in working for the va, were interested in talking with them. We need 1,000 more Mental Health providers. Were leveraging the areas of the country where we have a good supply of the Mental Health providers which we call the hubs for telehealth. Were providing those professional to the more rural areas of the country where we dont have the providers. And were working with our Community Providers like orourke mentioned in el paso where there are great places we can work with. I would like to ask more about gmes and how were using those. Him ti my time is up. Thank you again for your service to this country. One question i have, doesnt the va ive read that the va has a certification system for Mental Health professionals within the community, outside the va, where they can be certified to deliver care to our veterans. And i think you mentioned your concern that the average provider outside of the va may not understand the culture of the military and thats a real concern. I wonder if you can explain how this program, this Certification Program works and is it being utilized today to sign up more providers outside the va. Yeah. We are doing outreach to our Community Providers that were working with to make sure that they do have the education and the materials to be able to see veterans. This is part of our concept of the High Performance network to get providers in there who want to and are committed to seeing veterans to provide the type of quality care we believe they deserve. But its a fornmal certification process, is it not . Yes. Can you give some metrics in terms of how that program is going right now . We measure the number providers that take advantage of our Educational Programs and that we have outreach to. So we can get you more information on the number of providers. We need to do more of it. I was just thinking that that is theres a multiplier capability. Yeah. In terms of having resources by virtue of leveraging whats in the community but certifying them or making them go through a process, training process where we know that they meet the requirements. Yeah. For the va. I think we have more work to do on formalizing that program. I think thats the direction that were headed in, though. Okay. Thank you. Time has expired. Youre recognized for one minute. Okay. Gentleman yields. Mr. Rutherford youre recognized. You must be a real man of action because that Mental Health sc service dogs for th mentally ill or veterans who are suffering from ptsd and tbi were told three years ago that there was going to be a study to determine the efficacy of it and then at the end of that three years they were told, well its going to be another three years before that report will be finalized. Youve done it in like 30 days. Thank you. Let me tell you about that study. First of all it will be another three years before we get the Study Results and im not willing to wait buz there are people out there suffering. But when they did the study, like any good study, theres two arms, one that should be with dogs and one without dogs so they can learn. They couldnt find a single veteran who was willing not to take a dog. I think that tells you something right there. So i said, give them all dogs. Thank you very much. I can tell you that is going to be a resounding success back in my hometown. God bless you. Mr. Sablan, youre recogni d recognized. Mr. Missal, let me go back again. I dont mean to be disrespectful in any way. I know youve said youve looked at veterans in other rural areas. Im talking about my area, my district, the Northern Islands. The experience there and the experience in rural areas are not the same. So im asking you to consider looking at the veteran experience in the outlying areas, like my district. You do know where the Northern Islands is in. Yes, i do. Yes, sir. You guys come through guam all the time. Again, mr. Secretary, your director out of hawaii and her assistant are on for an hour and a half today. Its been a while since anyone has been there but they took an hour and a half today. Thank you very much. But i would like to work with you again. Thank you. Thank the gentleman for yielding. Im going to yield my time to dr. Winstrop who i rudely ignored. Just call me skip, mr. Chairman. Im going to go to something about the gme and residency program. As you know, most doctors in america spend some time in a va as part of their training. What are you looking at with that where we can be of help as far as what specialties we may want to engage with further, such as in Mental Health. But also association with academic institutions and making those more robust programs. Programs. Were doubling down on our relationships with academic centers. We think it is one of the best and strongest features of v. A. And it benefits veterans and americans in the way we train our Health Care Professionals. They gave us the additional gme spots. We have taken advantage of those. All have gone to primary care or Mental Health. We believe we could do more. I like to look at ways to get them in the rural part of the country without teaching programs. That would be a big, i believe, addition to helping us in increasing the quality of the environments that our veterans get care in. We like to work with you for ways to expand it. As you know, the country needs more graduate medical education spots. They have expanded the under grad, but not the gme spots. Somehow that formula will not work out if we dont expand the gme spots. Thank you. Thank you for yielding. You are recognized. Secretary shulkin. Im a veteran. My state has the highest density of veterans in my state. 20 of my veterans regularly access the hittiealth care syst. We have seen improvements in the Choice Program. I have confidence it will allow a greater access to health care for all veterans who penetrate that number and help more veterans access to health care that they earned and deserve. I have a high degree of confidence that tomorrow the sunset window will go away and 1 billion will be invested as it should in the lives of our veterans that have earned it. Will you work with the committee and this body to help us develop a furtherance of the Choice Program and continued improvement of it . Please share with us in the remaining three seconds resounding yes. Yes. Thank you, sir. I yield back. General bergman, you are recognized. Secretary shulkin, congratulations. You are now the dog that has caught the rest of us in the same boat. That vehicle has multiple tires and a lot of us have multiple teeth in it right now. I believe it has visibility within the Veterans Administration already. A proposed beta project. The cherry tree in michigan that involves health care and education and jobs and housing. Im looking forward to working with the Veterans Administration to bring project cherry tree to a level where it gets a good look to see what is in the art of the possible because were all in this together. The results we will achieve will only be limited by our desire to achieve them. So thank you very much. I yield back. Thank you. Thank you all. The questions now have ceased. I want to thank the panel. You all have been very, very generous with your time tonight. I think you can see the interest to the number of members who stayed around this long and the folks in the audience who stayed here. It is truly one of the most important things we will have tasked to us and congress men and women to help the v. A. We learned the problems in the last 114th. We pointed out those clearly and had help with gao and ig and clarifying that. I think now is it to solve the problems. I look forward to doing that with you and this entire panel does. They are huge and not easy. I certainly understand that. We mentioned and brought up more tonight. Im optimistic and im certainly optimistic after tonights hearing. We all have the oars in right and all pulling in the same direction. That will get results. Mr. Walz. Mr. Chairman, i asked unanimous consent to submit to the record case study work on choice for mr. Nolan and colleague. That is so ordered. Do you have closing comments . I do not. I echo the chairmans comments. The right people are on the bus and on the right seats. We are here to do what we can do. Thank you, mr. Chairman, for all your work. I ask unanimous consent you have five days to revise and extent remarks. Without objection, so ordered. This hearing is now adjourned. [ gavel drops ] we will continue with our live coverage of the Health Care Coverage markup of the committee. The committee began the work on the markup yesterday at 10 30 and continued through the night. Live cspan coverage. Its showing. I think we all need to take a very deep breath. I think you have done right thing by apologizing for what