tv Secretary Robert Mc Donald Testimony on Fiscal Year 2017 Budget CSPAN February 23, 2016 10:00am-12:01pm EST
bringing you cast of thousands. you've got a lot of support here today. big budget, big support. we're proud to have secretary mcdonald be here today. we were proud to have in order danny, doctor, thanks. ronald waters. laverne counsel. ed murray. we appreciate all of you. with all that support, mr. secretary, i'm sure you're going to do a great job. i'll make my opening statement and then turn to blumenthal then to your testimony. i don't want you to feel compelled by any five-minute light. i want you to say what you've got to say. i understand the average attention span of the united states senator is about nine minutes. after that we all start blinking. speaking for myself. that's self-imposed limitation. thank you very much, mr. secretary, for being here today. we're looking forward to discussing the $182 billion budgetary appropriation.
it would be an 8.9% increase. should it be adopted, medical funding would increase by $3.8 billion or 6.3%. i.t. would be increased by $145 million. i'm very encouraged that you've braced the program to merge the programs. we look forward to that. your testimony also talks a little bit about accountability. in fact, i read the information. accountability as a word is used one time but it's probably most important thing this committee is really interested in doing. you and i had a great meeting at your office last week mr. secretary and i want to acknowledge publicly with the members and thanks blumenthal and murray's staff for the work they're doing. i've stated publicly and i'm doing it again now publicly my goal is to see to it by the end march we have an accountability bill for veterans administration employees that's right for veterans and right for those
employees and we look to the future to see to it if we have problems in the future, that we have a defensible accountability system within the department to correct a wrong and not let it happen again. most of them, in fact, if not at all of them, pre your service, mr. secretary. lack of accountability implementations that's impossible to understand. we want to put that behind us. and build a platform that's good for the employees, good for the management. most importantly, good for the veterans themselves so they know they're getting quality services and quality accountability. it's very important we do that. that's the most important thing we can do. lastly, you talked about the appeals process. i hope you'll address that in your remarks. that's something we talked about many times. have not done. something we rightfully need to do. i'd love to know what you're going to recommend. we're glad you're here today.
appreciate your service to the country. it's time to introduce the ranking member senator blumenthal. >> thanks, mr. chairman. i want to second your remarks about the need for an accountability bill which is i think making progress with very close by partisan cooperation between our staffs and ourselves. i want to thank the secretary and the president for a very robust and profoundly significant budget the va's going through major changes as it looks toward the future. and prepared for an even more challenging future so far as the needs of our veterans are concerned. in areas of not only health care but also jobs and job training and skill preparation and of course homelessness. in connecticut, i am very delighted to say is at the forefront of that effort. in fact, announced just last
week that we have ended homelessness for veterans in connecticut. and of course that's a continuing effort. it's a milestone, not a finish line. we need to continue to provide permanent housing for all of our veterans, not just a temporary or transition form of housing. this budget request focuses fortunately on a number of areas i think are important. breakthrough priorities such as community health care, accountability, the appeals process. i also think that in terms of our medical care, the challenges of post traumatic stress and the research and outreach that needs to be done need to be given priority. i hope this hearing will be an opportunity to hear from you about more of the details of this proposal, but i also think the vision for the future is tremendously important not only
this year but looking beyond this year just as you would at a company like procter & gamble, beyond this quart, beyond this year, to think about what this enterprise is going to look like in five years, in ten years. because now is the time to build for the veterans who will be coming out of the service and they'll be more and more of them over the next few years as we downside our active force. so i thank you for being here and i'm looking forward to hearing from you and from the veterans service organizations that perform such an important and vital role in keeping us informed about veterans needs and making sure that all of us are held accountable. thank you. >> thank you, senator. mr. secretary, it's all yours. >> chairman isakson, members of the committee, thank you for the opportunity to present the president's 2017 budget and 2018
advance appropriations request for the department of veterans affairs. i have a written statement that i ask be submitted for the record, mr. chairman. mr. chairman, the president's proposal is another strong tangible sign of his devotion to veterans and their families. it proposes $182.3 billion for the department and fiscal year 2017 which include $78.7 billion in discretionary funding, a 4.9% increase above the 2016 enacted level largely for health care. it includes $12.2 billion for care in the community and a new medical community care budget account consistent with the va budget and choice improvement act. it includes $103.6 billion in mandatory funding for veterans benefit programs and $103.9 billion in advanced appropriations for our three
major mandatory veterans benefits accounts. it supports va's four agency priority goals and our five my va transformational objectives to modernize va and improve the veteran experience, improve the employee experience, improve internal support services, establish a culture of continuous improvement and expand strategic partnerships. those five transformational objectives are about growing va into the high performance organization veterans deserve and taxpayers expect. i learned over three decades in the private sector procter & gamble what makes a high performance organization. it takes a clear purpose, strong values, enduring principles and technical competence. high performance organizations depend on sound strategies. they thrive with passionate leaders who are willing to take tough decisions and make bold changes to improve. and high performance
organizations require responsive systems and processes designed and managed in a high performing culture. well, va has a clear purpose in our most noble mission to care for those who have born the battle. we have strong core values, integrity, commitment, advocacy, respect and excellent. our strategic plan makes clear we're a customer service organization. we serve veterans. our five my va transformational objectives and our 12 breakthrough priorities for 2016 are about accomplishing that strategy. ten of our top 16 executives are new since i became secretary. they're part of a growing team of talented enthusiastic former business leaders and experienced government and health care professionals. and they're making innovative changes and creating opportunities for even greater progress. we're making the sweeping changes necessary for va to be a
high performing organization and we'll know we're getting there when by design veterans needs shape our systems, our processes and our culture. for example, a responsive health care system for veterans means veterans have 24/7 access to va systems and know where to get accurate answers. whether that's their veteran contact center or the veterans crisis line. veterans calling or visiting primary care facilities and medical centers have their clinical needs addressed the very same day. veterans calling for new mental health appointments receive suicide risk assessments and immediate care if needed. and veterans already engaged in mental health care who need urgent attention speak to a provider the very same day. for employees serving veterans, it means a high her forming culture where continuous improvement drives responsive forward thinking and innovative change. it means training our workforce
on advance business techniques. it means responsive performance management systems that resonate with employees and encourage rather than discourage continuous improvement in excellen excellence. it means proper employee placement. clear performance expectations. continuous feedback and employees equipped with the tools to achieve excellent. it means executive performance ratings and bonuses that reflect actual performance and take into account relative inputs like veteran outcomes, results of employee surveys. it means modern systems in place of antiquated costly paper processes. these are a few characteristics of high her forming systems, processes and culture and we're advancing along these lines in many others. we launched our cascading leaders developing leaders training last year with 450 senior field leaders. it's not a single event.
it's a continuous enterprisewide process of leaders teaching leaders teaching leaders in order to inculcate lasting change. we'll have trained over 12,000 senior leaders empowering teams to dramatically improve care and service delivery to veterans and creating better work environments for employees. private sector leadership experts are developing va teams in new ways with cutting edge business skills like human centered design. we're using human centered design and lean right now to redesign the compensation and pension progress because veterans find it confusing and burdensome. we're looking at industry best practices in planning for an automated performance management solution for general scheduled employees. we can streamline that process, improve accuracy and interface with opm. all of this is focused on moving
va into the ranks of high performing organizations. that goal is in reach. we'll need your continued support to achieve it. i appreciate our extensive discussion at the end of january on our my va 12 breakthrough priorities for 2016. the proposed budget continues support of this priorities into 2017. it provides $65 billion for veterans medical care, 6.3% increase over 2016. it provides $66.4 billion in advanced appropriations for the va medical care programs in 2018. it provides $7.8 billion for mental health, funds veterans in the field and crisis line modernization. enhances health programs for womens veterans and provides an incredibly effective hepatitis c
treatment to an expected 35,000 veterans. to help integrate all the my va initiatives across the enterprises provides $2.6 million for the my va program office. to continue training field employees on advance business skills and establishing high customer service standards, it increases funding for our veteran experience office by 47%. we'll continue doing all we can to squeeze as much as possible out of every single budget dollar. our pharmacy benefits management program afforded $4.2 billion in unnecessary drug expenditures next year. exceeding goals of the president's campaign to cut waste. and we've reducinged bonuses 64% between 2011 and 2015 by rigorously linking awards to performance.
we've saved $16 million using more efficient training and meeting methods. we're already saving $10 million annually. we've saved approximately $5.5 million from 2011 to 2015 by strengthening controls over permanent change of station moves. now that we've implemented electronic claims processing we'll save millions of dollars each year in paper storage. we're committed to doing everything we can with everything we're given. many important priorities for meaningful change require substantial congressional action. there are more than 100 legislators proposals in the budget. over 40 of them are new this year. some are critical just to maintain our current ability to purchase nonva care. it's critical va's competitive with private sectors so we can
attract top talent. nowhere is that more important than in health care. personal authority adjustments, we're proposing flexibility on the maximum 80 hour pay period requirement for certain medical professionals. it will help improve hospital operations and attract the best hospital staff who prefer more flexible schedules. we're proposing critical compensation reforms for network and hospital directors. likewise, the title 38 ses proposal we're working on is about being competitive with the private sector in recruiting. it's not just about finding people. it's about treating va career executives more like their private sector counterparts. va needs that flexibility too. we need your help to transform va's care in the community to
best serve. we need your help modernizing va's purchase care authorities. to maintain veterans access to care everywhere in the country. addressing this challenge more than nine months ago, and i've consistently identified it as a top legislative priority. this needs to get done in this congress to ensure that strong foundation for access to community care. we're proposing a general transfer authority that allows me some measured flexible spending. to respond to the veteran's emerging needs. the process is or canot serving veterans well. the budget proposal's
simplified, streamlined, so that five years from now, veterans have appealed resolved within one year of filing. while requiring short-term staffing increases to contend with the 445,000 pending appeals legislating the appeals process can save more than $139 billion, i'm association million dollars annually beginning in 2022. we need congressional authorization of 18 leases submitted in va's 2015/2016 budget request. as well as authorization of eight major construction projects included in the fiscal year 2016 budget. we need your support for six additional replacement major medical facility leases, two major construction projects and four cemetery projects in the 2017 budget. in passing special legislation for va's west campus will give
us positive results for veterans in the community most in need it i've joust lined a few opportunities for change here. this congress, with today's va leadership, can make these changes and more for all veterans and for veterans in the future. then we can look back on this year as the year we turn the corner. i appreciate the support you've shown veterans, the department and the my va transformation. on behalf of veterans and the va employees serving them every single it day, thank you for th opportunity. we look forward to your questions. thank you, mr. chairman. >> thank you, mr. secretary. we're delighted to have you here today. i'll start the questioning and we'll go republican/democrat after we go to the ranking member, all the way through. your proposal has a unique system for senior executive employment within the veterans administration which would create a unique pay schedule and discipline system around title 38. accountability is the single
most important thing we must accomplish on my judgment within this committee and the va itself. you detail for the committee the justification for the proposal. >> yes, mr. chairman. as you know, we run a health care business. we run an organization that, if it were a company, would be fortune 6 on the fortune 500. we compete with health care professionals from the best health care systems in the country, whether they be medical centers that we're afillated with like duke medical center or whether they be large health care companies like mayo or cleveland. we believe the best way to treat va employees is as a health care professional also they are and the title 38 provision would give us that ability. we can pay them more competitively. right now, our average medical center director is paid, at best, half what they can earn in the private sector and we've
lost several recently, and we're paying them the best we can with the scs system. separately, we can also recruit and appoint people more quickly. because title 38 would give us direct hiring authority. so we believe that moving the title 38 for all ses employees in va would be a big step forward, make us competitive with the private sector and would improve care for veterans. >> in the case of disciplinary action, how does title 38 differ? >> would make me the appealing -- the appeal authority. so people would an peel to me. it would put appellate authority within the department rather than in some external organization that looks across government. >> so in a hypothetical example that's really not so hypothetical, in the pennsylvania case that's just been adjudicated on appeal, that would have been appealed to you
and not msrp? >> that's correct, sir. >> okay. secondly, we talked about the 440,000 pending appeals at the veterans administration. you made a administration in the house committee meeting the other day that the straw man or something like that. do you have specific proposals in this budget proposal you're offering? >> yes, sir, we have offered a specific proposal but also as we are talking right now, we have been meeting with veteran service organizations, members of the committee and other members of congress. and are making progress in getting alignment as to what that proposal should look like. so i suspect while the proposal we've submitted is a good one, we can make even further enhancements to it, which could create a greater consensus moving forward. as we have talked, we expect to have all that done by the end of march so we can get something done with this. >> are you moving away from the
fully developed claim process? >> no, sir, we think the fully developed claim is a good step on the way to a totally new appeals process. but it does not fundamentally change the process to the degree we think it needs changed. >> in using the word of the day with is accountability, i think it's important for our veterans as accountability in the system to make sure if they have an appeal it is justified and heard but makes it also one veteran or a handful of veterans appeals don't cause other veterans to get a slower response on an appeal that otherwise would not be appealed to begin with. from talking with the doctor and some of the others at the va there are a handful, and i use a handful as a reference, of appeals that over and over and over, a series of years, have still been active and in process. every time one of those takes place, it takes time away from a claim that's recently filed. i personally am very supportive of us finding a way to give the
tools to ensure they have accountability but also have some ability to cut that off so it's not an ongoing process. >> 10% to 11% of veterans appeal the decisions. of those 10% to 11%, it's about two percentage points, 2% of all veterans that when they appeal drive multiple appeals and their appeals comprise about 45% of all appeals. so you're right, about 2% of veterans are creating about half of the work. that is an unacceptable situation and one we should resolve to the benefit of all veterans. as we've committed in our 2016 end of year outcomes, we would like by the end of this year to be able to have a process in place that would eventually lead to one year for veteran appeal. >> just one last comment. in your prepared remarks, you said 10 of the 16 top leaders in the va are new hires you've brought in, people from
hospitals, are they 2 of those 10? >> yes. >> if the other 8 of those 10 are doing as good a job as though two are, we're going to be in much better shape at the va. i want to acknowledge the doctor's help in the private meetings, not private, the meetings we've been having at the va. they're doing a great job. i appreciate the fact they've been very responsive to us. on the i.t. situation as well so thank you very much. >> we have an ig nominee who we all think very highly of. we would love that to get passed on the senate floor. >> for the record, i'm meeting individually with the people i think need to be met with to try to see if we can't get that to a vote on the floor. we're not there yet but we're making progress. senator blumenthal. >> thanks, mr. chairman. i want to first just mention the elephant in the room.
which is the potential hurdles and obstacles to approve this budget in the potential gridlock and paralysis in the budget process overall. the va illustrates to me the urgency of putting aside partisan differences, putting aside extraneous issues and proceeding to a budget, regardless of what our colleagues in the house of representatives may think about the budgeting process and regardless of other issues relating to the supreme court or any other kinds of challenges that we face here. and i think that you've come here in good faith to argue for some really urgent priorities that must be met and they are commendably a part of this budget. earlier this year, the hartford, they reached out to me because they were informed there were no
additional hearing dates. travel board or teleconference dates for hartford, remainder of the fiscal year in terms of the appeals process. after my inquiry, the additional teleconference date has been added which i appreciate but i think that that experience illustrates the importance of reforming the appeals process focused on it and i assume you agree it should be a priority. >> absolutely. i also agree on the budget. i would tell you this is my second budget at the va, but i feel better this year than i have ever before about connecting our strategies with the budget, with resources, with the legislation required and with the 6, the 12 priorities we
have listed for 2016. this is more than just a budget. we need this budget in order to do that. but we also need the legislation and the other things we've talked about as a group. >> focusing for the moment on delivery of services to women veterans. there's a request for a 515 million for gender specific health care for women and nearly $5.3 million in total care for women, which recognizes the need to consider the growing female veteran population in our country and provide care that is both welcoming and efficient and proficient to meet their needs. i'm still concerned that the culture of the va and the ability to welcome veterans, female veterans and provide health care services to them in a sensitive and tailored manner may not be keep pace with the number and the needs of those
veterans. could you please tell us how you intend to use the requested funding for women's health care to address frankly the pervasive feeling of many female veterans that the va remains a male focused culture and organization. >> i'm really glad you raised this, senator blumenthal. this is such an important topic to us. i think this will be one of the seminal issues of transformation that we will be held responsible for as people look back years from now. as you know, since 2000, the number of women veterans seeking va health care services has double from 160,000 to over 447,000 in fiscal year 2015. so this is a major focus for us. we have designated women's health providers at every site
where women access va health care. currently 100% of our medical centers and 94% of our community-based outpatient clinics have at least one designated women's health provider. we need to get that to 100%. we've trained over 200,000 providers in we's health to ensure every woman veteran has the opportunity to receive her primary care from a woman's health provider. we have women veteran program managers, maternity care coordinators at every health care facility. we provide guy in logical care. either on site, that's through 130 health care systems, or through care in the community. this is, this is really a very important point to us and we have to continue to make this transition over time. because as you said, it's going to continue.
>> thank you, very much. my time is expired. i have other questions i may submit for the record. but thank you. to your team for being here today. thank you. senator. >> thank you, mr. chairman. let me just begin by saying i have appreciated the bipartisan approach by both the chairman and ranking member blumenthal as we move through the different and challenging issues before us. including the budget itself. i'm optimistic that this committee will work very favorably in moving forward in this particular budget process. i've only been here a year but i've been encouraged by the way this group here has worked on these issues. one of the major challenges that has hampered the choice program has been the va's shift of cost for care for the veterans who have been utilizing the choice program. veterans are paying far more for their care under choice than they traditionally paid under va
facility care or nonva care typically as a result of deductible and co-pay calculations that are different than when they're seen in the private sector. as you consolidate the care and the community programs, do you envision veterans continuing to pay more out of pocket to be seen in the private sector? >> it's a great point. we would like when we consolidate care to go to one payment system, one reimbursement system, so we eliminate the complexity. when the choice act was created, veterans were forced to pay higher co-pays to use the choice act service in order to keep the cost down of the total choice act. if they use a va service, there's no co-pay. we do think that change needs to be made. >> the primary difference is the
way the choice legislation was written is that in choice, va is the secondary payer. a veteran has to use the primary service and they have to use their co-pays. what we have suggested in our legislative proposals is to make choice -- is to make va the primary payer and to consolidate all the care in the community. that would eliminate this disparity that veterans see today. >> we continue to hear timely provider payment under the choice program is a continuing issue. recently i heard from a private sector provider that has over $3.3 million in payments that have been outstanding for more than 90 days. what specific initiatives are you putting in place to accomplish your 2016 break through priority of getting 80% of claim also paid within 30 days? >> first of all, please give us the name of that provider. we'll go back and make sure they
get paid. secondly, the systemic change we need is to follow the best practices in the private sector, which is to pay the provider based on them providing the service. not waiting for the paper documents which has been our past practice. we have another week or so until we actually activate it. but that means providers will get payments virtually as soon as they provide the service. >> yesterday, we delivered to the two tpas a proposal for them to sign that would decouple documentation from payment so we can make faster payments to providers. >> i've heard that in my state, vha has made the conscious decision to shift certain health care services over to the choice program and away from vha facilities. yesterday, we saw a similar story out of cincinnati that contained allegations of services being switched to choice and the community in order to make hospital finances
look better. whether that's the case or not, how do you reconcile shifting services over to the cahoice program? when choice is clearly a temporary program designed to supplement va care and its authorization expires next year? >> the most important thing in making any of these decisions is what's best for the veteran. nothing else should be a consideration. unfortunately, i'm not saying this is happening, because we have to investigate the allegation you describe. unfortunately, because of the fact we have 70 line items of budget where we can't move money from one to the other. you may recall i had to come to this committee and ask for the ability to move money from the choice budget that was for care in the community to the va budget that was for care in the community. same purpose but we had to ask your permission to move that money.
what we've put in our '17 budget proposal is our proposal to give us flexibility on only 2% of our funding so we can move money between accounts, again, with the idea that we got to get the best care for the veteran. >> thank you. my time has expired. thank you, mr. chairman. >> thank you, senator. >> thank you, mr. chairman. i want to go back to title 38. could you tell me, mr. secretary, how many medical center directs were either octob acting or without a position. >> today we have 34 medical centers without a permanent medical center director. cy will tell you being responsible for the health care organization, there's no way i can assure we're doing the best for -- >> does that include acting? >> can you tell me how long it takes to recruit a p.a. or a
nurse? >> approximately -- they differ a little bit but i'm going to say on average six months. >> six months. okay. now, if we do the changes that you've recommended, how long would it take you to recruit and appoint? >> well, i think the change to title 38 is going to help us get more candidates and better candidates. we have many medical centers that frankly have been open for years and years because we don't have candidates. i think it's going to increase the pool. we have to -- one of the secretaries 12 priorities is to streamline the hiring process, because we have to get where the private sector is. match or beat where the private sector is to get the best candidates. >> but the title 38 recruiting and hiring process is more streamlined than the ses process. >> so your hope is to get it down to what kind of a time line? >> i'd like to break it in half. >> okay. >> i think we can do it. >> okay. you put a number of legislative
requests forward. is it veterans access to care has been impeded by the legal outside the federal acquisition regulations? >> when you say legal, the complexity of the system, absolutely, that's correct. >> okay. i believe we have a bill, maybe not in total what you want, but a bill to get that done. is it accurate to say the vavt's efforts to improve the quality and delivery of care have been impeded by a number of vacan vacancies? >> yes. >> is it also fair to say that from a medical personnel standpoint, the appeals process has not been working like it should? >> we would agree with that. >> is it more important to say you need flexibility in your budget? >> yes, sir, we do. >> to move money around. in july 2014, mr. secretary, you
were confirmed by a 97-0 vote. nobody in the senate opposed you. >> i'm still looking for those three who didn't vote. >> they were probably out campaigning for president but at any rate. i would just say as a committee, i would be happy to work with the chairman. we needámz push the leadership to get these bills on the floor and hold this man accountable. we can't hold him accountable if his hands are tied. i really think it's important. it came from the private sector. if we want the va to work, we've got to put our trust. the fact is, i trust you. i believe we can get this done. it's going to require some floor action on these bills with a very limited amount of time for floor action. if it would take a letter, if it would take phone calls. i'd be more than happy to join
that. this may be parochial in nature, but there's an issue with travel pay right now. where the veteran used to get trou travel pay immediately when they came. now, because people thinking they were going to try to game the system, they go to a kiosk. now it's a month or longer to get their travel pay. i'm hearing a lot about this. and i'm not sure that it solves any of the problems with pay going to a kiosk because if a guy wants to be a crook, they'll be a crook on a kiosk. what it's doing is it's stopping some our veterans from being able to get the care timely. it may be hard to believe but a lot of these guys need that travel pay and they need it quick so if we can do something. >> senator, we will look into that. that is not an intentional delay so we need to fix that. >> the last thing i would say, and i attribute this to the third party payers. we've got to get this fixed. my staff just gave me a chart. you can take a look at it. 53% of the work we do is
veterans work. it used to be a third, okay. it's 53% now. that isn't happening because things are going smoothly. i think you guys know that. we need to get it fixed. this committee needs to do its job to help you fix it and then we need to hold you accountable for it. >> in re rens to your comment about meeting with leader mcconnell, for your education, information, i appreciate you raising the bills that we haven't gotten through the congress yet. we're working on a -- if you will, omnibus proposal that we hope to by the end of march have finished and acted upon in the house and the senate. that's aggressive game plan. we're trying to get all that done. so your help on that, which i will take as a volunteering to be on my team. it's in a bipartisan way too. >> i will be more than happy. i think it is important for us to hold the agency accountable. i think it's also important for us to listen to the people at
the head of it and make sure we give them the tools they need to be successful and hold them accountable. >> we've got to hold ourselves accountable. >> that's correct. that may be the biggest problem of all. we have to correct that. >> senator. >> mr. chairman, thank you very much. mr. secretary, welcome. thank you for the telephone conversation we had recently. just a couple of, aspects i was interested in what senator tester had to say about case work. as you and i have talked. that's been a significant fact in our life. more veterans with more questions i guess and concerns. so i appreciate senator tester raising that question. let me talk about a couple of items that are kansas related. the choice act provided for a new cbot in johnson county. our fastest growing part of our
state. and the requirement, as i understand it, is for those proposed medical facility leases to be submitted to gsa. and the time frame is seemingly extraordinary long, like five years, once the decision is made to begin that lease process. is there something we can do to help speed that process up? we have the same issue in junction city. junction city is a bedroom community of fort riley. lots and lots of veterans. cbot there is needing to move out of the current facility and they're looking for space which to my knowledge they have not found. and then the broader question is, is there something we can do to help to speed up the process? >> the process does take too long. we have i think is it 16 or 18 leases right now. we're waiting -- 16. we're waiting for authorization from you all to move forward on. >> 18.
if you could authorize those, we really appreciate it. >> johnson county, that i'm talking about, it's authorized. having been authorized, i'm told it's at least five years before -- >> no. well, it shouldn't be. we have worked with gsa to streamline that process. but i'm happy to -- we'll come over and sit down with your staff and go through a streamline time line of how long it would take. it should not take five years. >> there are two if we can talk about the one in junction city and johnson county. let me raise a topic of construction of a new hospital in leavenworth. again, a military community. the strategic capital investment plan lists leavenworth patient facility on the va's priority list. but there were no funds reque requested in fy '17. what does that mean?
what's the value of that 13th ranking and no funding? >> well, i think what it demonstrates, senator, is we need more money in construction. most of our priority projects are projects that deal with safety. in my written testimony, we have things happen because we haven't been seismically ready. we would love to get down through the total list, but that's going to require disproportionate amount of cash to do that. >> in that circumstance, is the va open to public/private partnerships, local entity that would build the facility and then lease it back? does that speed up the process and help the budgetary constraints? >> we are. there's actually two different processes. both of which were looking at. one is something we already have experience with called extended use leasing. this is a process where, for example, there's a company
called core that built a building on our campus in minlow park that we're able to rent from them to house homeless veterans. that's the bill i need passed for los angeles. i can't do that in los angeles right now. that's where we have the majority of the homeless veterans. there's another process called public/private partnership or p-3 which we're currently exploring to move our san francisco campus, which is landlocked and isolated. what we don't know yet is how will cbo and how will omb score that and whether or not because it is an extended use program, they'll score it as if it were a capital project. we should have an answer in march. we'll be back to you. because if we can do p-3s it will unlock a lot of capability for va. >> maybe we can have that conversation we talk about the cbots as well because i think there's an opportunity for this thing to occur in kansas.
my final question, how does the cbot issue affect the consolidation choice, community care plan? are cbots any less valuable? is there less emphasis as a result of consolidation? >> no, i don't think so. i think what it does, it speaks to something you and i spoke about before, which is when we improved access last year and did the 7.5 million more completed health care appointments, that was in large part because we added over 2 million square feet of new space. so every time you put a building out there, it creates access, advantages you didn't have before. but what we have to do is we have to be more choiceful. i don't mean a pun in that word. but we have to be more choiceful where we put them. so we make sure we're taking advantage of all our affiliates. and we're putting those only
where they're required. being good stewards of taxpayer money. >> i appreciate this conversation, look forward to having future ones. >> me too, sir. >> senator brown. >> thank you, mr. chairman. >> you're welcome, mr. secretary. all of veterans, to our country, all of you. i want to address the very serious allegations of senator rounds mentioned of cincinnati of the mismanagement of medical leadership of vsi 10, you and i have talked a number of times for monlts and months about some of these allegations and issues. nepotism, lack of cleanliness, mismanagement, staffing shortages, fear of whistleblower retaliation. first it's about quality of care as you have assured us and i know how much you care when you took this job about that. i need your assurances first, while this investigation is going on, and the issues and problems are being fixed, that you will insure that veterans receive better quality, good
quality care throughout. i know you believe that i just want your assurances, and at the same time restoring faith in cincinnati that veterans and their families feel compromised and that i'm glad that you've agreed to visit the va as soon as our schedules permitted it for both of us to go together. thank you for that. >> i want to talk about whistleblower issues for a moment. for more than a year, a number of whistleblowers have talked to my cincinnati office, talked to me personally, talked to a number of people in my office and others. the atmosphere is some workers will say toxic. where workers fear they'll be punished for doing their jobs well. i'm concerned that when va employees come forward to voice concerns regarding improper medical care or other issues, i'm concerned that in too many cases va management has retaliated against them. i want your commitment for a couple of things, mr. secretary.
one that no employee at cincinnati va who did the right thing and advocated for our veterans will be retaliated against for their actions. and i want your commitment that if any va employee is retaliated against for speaking up on behalf of veterans, and patients, that you will hold those people accountable. >> first of all, relative to cincinnati, as you noted, senator, the investigation is ongoing. cincinnati facility has been a five-star facility historically in va. one of our very best. i visited it a couple of times myself. over the last two years. so it is, it is an important facility. it is has been historically a good facility. we need to dig into this and find out whether or not these allegations are, are supported. and then take actions as quick as as possible to remediate them, if they are. relative to whistleblowing, you
know we were the first department certified by the office of special counsel, to have done the training on whistleblowing. we take it very seriously. in fact we ask all of our employees to give us negative feedback, as well as positive feedback so we can change. that's why we're training them in things like lean 6 sigma, so they can create change themselves. we do not tolerate retaliation and will deal with it if we see it we just don't tolerate it. we work very closely with the office of special counsel to make sure whistleblowers are protected. that they're given good jobs moving forward. and that people who do retaliation, are held accountable. >> that's what you say and i believe you. >> that's what i say. that's what i do. >> that's not what some people apparently some people in cincinnati, that work at va have done. so i do want that commitment that if proven that people who have retaliated against whistleblowers, will be held
accountable. >> they will. anyone neb though retaliates against a whistleblower will be held accountable. but what we're describing are allegations. let's do the investigation before we commit people -- >> i don't want to convict anybody. i didn't mention names. i said if proven, i just wanted your commitment. >> just know we get a lot of whistleblower -- >> i understand. i see that when i was a member of the house, i heard in in brecksville and wade park, sometimes it was accurate. sometimes it wasn't. i want to echo what chairman mcdonald and isaacson. >> when i wrote to the va about cincinnati, unfortunately the letter went it linda halladay, the deputy inspector general, instead of the inspector general. let me close with a bit about staffing directly connected to
senator rounds' comments. that report recommended the veterans, that required section 301 report on staffing, recommended the 61 full-time equivalents be hired for the cincinnati va to properly meet the needs of veterans. their reports at leadership that cincinnati haven icincinnati va by cutting staff. can you tell me about any of poi? or is that something you need to share later once you know more? >> we immediately sent the offices of medical inspection to cincinnati. we do have a preliminary report from them. so we can, i'm fine with updating you on that now. >> the other thing, senator, that we did immediately was we removed the management authority from the director away from the cincinnati va to make sure there was no ability to influence or to keep people from raising
issues. so we want this to be a very transparent and we will be glad as soon as we get this final report to review that with you. >> how long will it take for these whatever the number. up to, up to, including the number 61, if there's 40 or 60 or 20, how long will it take to bring in and train new providers? >> well, it will depend on the type of providers that are there. obviously physicians and nurses take longer because they're orientation and credentialing period than staff, front-line staff. so there will be a spectrum along that line. but the vizn and the medical center have been given their budget and do the ability to hire the most critical positions they need to hire right now. >> senator brown, just so you're clear on the record, i consider accountability to apply in two ways. employee to supervisor and supervisor to employee as well. we have got to have
accountability on both sides and that's what we're pushing for so hard, so i appreciate your comment on that. senator tillis? >> thank you, mr. chair, thank you all for being here and secretary mcdonald and a lot of the folks at the panel, thank you so much for the time you've invested coming to my office and working with me. i want to emphasize what you've said. that is critically important. that of the breakthrough priorities, there's very clearly instances where congress sits in the critical path. if we don't take action to move forward on these legislative priorities, then it will either impede or prevent completely your ability to achieve the goals you've set out. and i'll continue to mention that and stand up for it. miss counsel i want to talk to you a minute about i.t. it's fantastic to have somebody with your professional experience in the role that you're in. and i'm glad to have you there.
can you give me an idea of what your instincts are telling you as you look at this enormous i.t. base, you and i have talked about application portfolio and we can talk in acronyms most people think would be a language. can you tell me what your gut tells you the i.t. platform looks like five years from now versus today in terms of off-the-shelf solutions, integrated platforms, those sorts of things, that i think are at least according to the secretary and others, are huge enablers to what you all are trying to accomplish? >> yes. senator tillis, it's great to talk to you as well. i won't use any acronyms this time. as we sort of look out into the future, one of the things that's become very clear, not just on intuition, but on fact is that we have a very complex
architecture and a variety of different things in our midst. and so figuring out how to manage those today and move off of them and move into the future is critical. one of the critical areas that i think that will look very different in the future is how we manage and use data and how we leverage the data in support of the veteran. we, i believe have a primary opportunity, we're putting in a data management function. by putting in something that is very different than anyone has seen at this point. that will move us forward to have much more agility. related to our operations. related to what the veteran will need increasing our ability to be much more mobile. to have mobility, being used by the veteran in our access to information as well as our ability to speak and engage with them. and i think also when we look at our infrastructure, having a much more solid supply chain
capability, a financial system that will enable much more visibility into the environment. but also insuring that we have some best of breed capabilities wrapped around our health care as well as in our benefits area. >> one thing i want to try to get a lot in after the last couple of minutes. one thing i would like to see, out of all the things you need to do to transform the i.t. operation, is something that would give me some sense that the duplicative platforms, there are very clear patterns that i can view when i take a look at these transition plans, and i'd like to see that. so that i know that we're making the operational changes and the systems changes to make a lot of these things that are falling through the cracks, the probably the root cause for a lot of the problems that we have, so i appreciate the opportunity to maybe get briefed up with you as you've gotten your leg there is
and appreciate it i want to go into a lightning round real quick, i want to try to stick to my time first. cy want to echo the sentiments here. we need to confirm the ig and do everythingky to get the inspector general there, it's a vital role and we need somebody in that position. >> mr. mcdonald, this organization chart seems to me to be an optimized state. it's a pyramid, it looks like you got the right distribution with you know that really being but today it seems like it's an obelisk. one thing we haven't talked about here is the organizational change and over time you don't, unless you have data here, i'd like to find out what we're doing in the middle to reorganize, and either eliminate those resources or free up the resources to provide care out in the communities. can you give me some idea, we haven't talked much about that track. can you give me some idea of what that looks like? >> the middle is the most important part as you well know
of any organization. training, i talk, we're training the leadership team, that train something now cascading through the organization, 12,000 senior leaders will have been trained. we're training leadership, we're training process mapping. we're training lean 6 sigma, value, mission, all the important things, three days of training. number two is structure, spans and layers, we have to reduce in the number of spans, and reduce the number of layers. we talked about moving from 21 advisens to 18, that has already shown savings. but the if a kt that we have so many open positions is an opportunity to reduce even more. with every open position we question, david and i question and sloan, whether or not we should fill it. we want to reduce spans and we want to reduce layers. we can share that plan with you -- >> just because my time is short that i'm cutting you off. but i think seeing a measurable instinctively this organization
looks like it's heavy in the middle. with that comes cost and complexity and breakdowns and handoffs. i'd like to see where that transformation looks like over time. both in terms of its structure and in terms of its people and to your point. many of them may be open. it means you no longer have a need for that position. i think that would be helpful. so that people understand there's an organizational transformation that's going on. last thing. to follow up. when a veteran calls a calls for help. let's say it's a distress call for a veteran who may be worried that they're thinking about suicide. how are these calls tracked? in other words if i get reports as i have in north carolina recently, when a veteran called and was told to call back. how can i track that down and make sure that that person has been trained, hasn't done their job. therefore they should be fired. or that their supervisor hasn't gotten on the appropriate
training to make sure that that is never an appropriate disposition. if in fact it's happening. what i want to do is at least go in and be proactive, and say maybe i don't have the facts straight based on what i've been reported on the ground but if those facts are right, then i want to go after that person for doing the wrong thing for a vet and i'd like your advice on that either in the committee or afterwards. >> it's a very complex issue. let me give you a headline and we'll come over and talk about our veterans crisis line. as you know, one of our priorities for this year is to fix the outreach to veterans and the veterans crisis line. when all of us came, new people to this organization, what we discovered was the veterans crisis line recent ig report, which was written starting on investigations started may of 2014, so before i was confirmed, found that we had a third-party, that we contracted with that was
using voicemail. well you don't use voicemail for a crisis line. we have put new leaders in place, we hired a person with experience on philadelphia 311. they've come in. we've got new technology in place, new training in place. but we've got to get out of the potential for a veteran being put on hold, having to call different number, we still have some medical centers and we're trying to discover which those are and eradicate them. where if they call the medical center and there's an emergency, it says please call this number. rather than immediately shifting that call. we're trying to identify where those are. and then shift the call automatically rather than having them call back so this is is a work in progress. this is happy to brief you on it it's taking us longer than we'd like. but it is one of our goals for this year and we do need the budget to do it. >> senator sullivan?
>> thank you, mr. chairman and appreciate the witness's focus on these very important issues, mr. secretary. good to see you again dr. shulkin. i wanted to follow up again on a couple of things. i sent awe letter dated january 4th, 2016 on the ongoing issue, a bit of a minor issue in some ways, but it's a huge issue, i think you and i have seen this. we've been talking about it for a while now. but that veterans who are hounded by collection agencies for unpaid bills, the services were approved by the va and now somehow our veterans are getting saddled with that. and the letter had a number of actually, pages of cases that last time we spoke, last time you testified, you mentioned to me to get you those specific examples. i did. can you give me an update on where we are on that? this is something that i think
we should just -- nip in the bud, kill. it's outrageous that we should have patients going through that kind of stress. >> absolutely agree and i heard this directly from you and from veterans when we were together in alaska as well. this is a short-term problem and a little bit longer-term problem. fortunately i think we have solutions for both. the short-term issue, we do not want veterans put in the middle. and so we have established a toll-free number. i wish i had the number memorized, but i will get it to your office. where if a veteran lets us know about that situation, we will intervene immediately. we've done over 400 interventions in the last three weeks since we've put that number up. >> great. >> we want to know from all your offerses because we want to help. >> is there something legislatively we need to do to fix this? >> no. >> just let them know if that's an issue they should call you guys and you'll take care of it. >> what has happened is because we have had a problem in paying
on time, the veteran has been put in the middle. those are the ones we want to stop. so right before you came in, we talked about now we now actually have delivered to the tpas yesterday, the contract for them to sign that will decouple medical documentation from payment. so we can get much better at payments and avoid these situations from happening. >> and if you can follow up on the specific ones in a letter -- >> yes. >> that would be very useful. >> i want to next go to the issue with regard to the appeals process. and mr. secretary, i noted that the budget certainly focuses on this. it's an issue that 400,000 veterans have appeals pending. 80,000 of those are older than five years old. 5,000 of those are older than ten years old. i put forward a bill s-2473,
very strong bipartisan support on this committee. i won't go through all the elements of it we want to work with you, i think you, my staff has been working with your staff. i think you're supportive of the bill. but can you talk a little bit about how we get our arms around this appeals issue. it does relate of course to the backlog issue. what we don't want to have happen is the backlog then have the appeals become the problem. we think there's some good things in the bill, a number of us have co-sponsored. but i'd like your view on that, particularly because you do seem to be focused on it in the budget. >> we do think moving forward with, the fully-developed appeals process makes sense, we are supportive of that we don't think it goes far enough to get to what we think is a breakthrough, one of our 12 breakthrough objectives, which is to be able to decide an appeal in a year. to do that what we put together is a plan where we add more
people in the short-term in order to knock the backlog down as much as we can. but at the same time we redesign the appeal law which is over 80 years old. so we can get to that point later. where we deal with each appeal in a year. and then that will actually save us money. that will save the government money and save taxpayers money. to do that, we're going to have to deal with the fact, as i said earlier. that there's only a small group of veterans that are gumming up the system for everyone else. 10-11% of veterans appeal. 2% of veterans create about 45% of the appeals. some have appealed 25 times. 50 times. the majority of those appealing, the majority are already receiving some form of compensation. maybe the wrong amount, but they're already receiving some form of disability conversation. many of them appealing are
already rated 100% disabled. so you know, you want to get to the point, where you can freeze the form 9 as we call it. and cause the person to have to resubmit. rather than having the same person appeal over and over again. recognizing that there's no recourse that we have to stop them from doing that. >> we would like to work with you. i appreciate the update, how you're laying that out more strategically. we'll continue to work with your staff s-2473, which we think is, it's a pilot program, you may have seen the legislation. we think it offers a good opportunity, similar to the pilot program that the va is instituting in alaska. and for the record, mr. chairman i'll submit for the record, an update on where we are on the alaska pilot plan as well. thank you, mr. chair. >> mr. secretary.
>> i have a kind of smattering of questions all over the place. what is the va currently paying for the cost of hepatitis c treatment for a regimen of hepatitis c treatment? >> less than we were -- >> got that. >> our drug pricing is propri y proprieta proprietary, it's the best on the market. >> we'd be happy to tell you privately. >> okay. i was thinking about it, if 54,000 is what the latest regimen cost lists and you're average 25 to 30% less, it seems like we should be able to treat more veterans for the $1.5 billion that we're giving. if you ballpark you're paying $30,000 per. it seems like we should be treating 50,000 veterans as opposed to 30,000. >> that's the idea. we had a five-year plan. we're now looking at with lower costs, how do we compress that
plan forward and get everyone treated. >> so the 1.5 billion you mentioned and i think 35,000 plan to be created. you hope that's elastic on the upside? >> there's no doubt that's the case. 35,000 is what we submitted in the budget we believe we can do many more now. >> thank you. in the new regimen of folks having a new pay scale, government benefits are typically more generous than private-sector benefits. if you increase, i don't know if that's true for executive compensation. >> i would argue that. >> i'm talking about retirement benefits. i'm talking about -- so the retirement benefits, would be roughly ekwif lenlt quivalent a. >> yes, sir. >> there's not a tail that's going to come back and bite us. >> no. >> when industry decides to downsize, a lot of middle management and top management also goes. but our current civil service restricts the ability to release
folks even when they're no longer needed. great for the individual, terrible for the taxpayer and arguably bad for the veteran. under the new authority if you downsize, if you no longer need this facility for example, can you immediately release the person without having to go through a complicated process? >> title 38 gives us more flexibility to do that. >> but much more flexibility, would it be as flexible as the private secretary center. >> virtually as flexible as the private sector. i'm trying to think, david, some private sector differents. some people extended contracts others are at will. and the title 38 is going to be somewhere in between. >> you mentioned in your testimony regarding closing unsustainable facilities. >> we're actually interested in this. and we sent a poorly worded request and now we have a better-worded request. trying to figure out where are
these facilities. you attempted to close one in massachusetts, but you ran into viral issues, i think i've heard you say it before. but for the record tell me, if you have all of these vacant facilities underutilized what are the three top obstacles in closing them, may i ask? >> number one, would be congressional opposition, and congressional opposition borne by veteran opposition. if you're a veteran and the hospital where you go, is in a remote area, and that hospital only serves five patients a day, it obviously is very expensive to serve to run a hospital serving five patients a day. if you're one of the patients being served, you obviously want it to stay open. >> you mentioned that you have 370 facilities at this, that are less than 50% occupied. which presumably would not have to be completely shut down.
but rather, this wing we're no longer using sort of thing. if those that are fully vacant, what is the obstacle to closing those which are fully vacant? >> again, congressional opposition. >> even for something fully vacant? >> yes, sir. veteran opposition. some are on the historic register of buildings. because remember, 60% of our buildings over a years old. we have to come up with an alternate use for those historic structures, unless there's some way to obviate that -- law. >> that could include boarding up and putting a fence around it i presume? >> yes, sir. >> for the taxpayer, it runs an incredible deficit, we've got $26 million not being used for patient care, which is basically being used to not mothball buildings which should be mothballed. >> yes. >> i would be an advocate for putting a fence around it until something can be done or sold or developed or something. other reasons -- i'm sorry, i interrupted you. >> those are the primary
reasons. >> the downsizing from 50% use to closing off a wing, what is the obstacle there? >> again it depends on the historic structure of the building, what it's used for. we do close off wings in bigger buildings. but they still are very expensive for us to maintain. you still have to maintain the pipes and heating and other types of things. what we normally refer to is the 10 or 11 million square feet that costs us the 25 or $26 million a year. i think in some cases, we are being short sighted in not putting in the capital investments to make the upgrades when 50% of our bill or 60% of our buildings are more than 50 years old. you know that we're maintaining systems that are very, very expensive to maintain. using today's technology. we'd be able to do a much better job by investing money right now.
>> typically they rebuild a new hospital, they tear it down. you get grandfathered in until you break a wall then you have to institute the whole code. i can see why it would be cost effective just to cut your losses. >> senator bozeman? >> thank you, mr. chairman. thank you all for being here we do appreciate your hard work. also i very much appreciate the ability get in touch with you and you all being very accessible. you mentioned several accomplishments that you all have made, rightfully so. that's one of those. people don't think about. the accessibility is really important and the members of congress. in going along with that you also said the systemic problems couldn't be fixed overnight. can you talk a little bit about some of the biggest obstacles that you face in that regard? and is there a need for additional legislation to help
new that regard? >> senator bozeman, thank you so much for the question and thank you for the time we spent together. do me job one of any leader is to get the right leadership team in place. and frankly it's taken me too long to get the 10 of 16 leaders in place since i came on board. i wish the nomination and confirmation process were more quick. and we talked about the i.g. as an example of that. but i will tell you also within the organization getting new leaders in place, is job one. and that's why we've recommended taking scss from title 5 to title 38. we are in the process of revamping the recruiting process as well. but for me, that's job one. we've got to get the right leaders in place. >> the latest decision by the merit systems protection board to overturn disciplinary action, i think we have a situation now
where they've overturned more than they've upheld. >> they're batting 1,000. they've overturned every one. >> which is sad, were you blessed and worked hard, and he headed one of the biggest, most-respected corporations in america. as we visited, you pointed out the va were a business, you would be the sixth largest in the country. >> yes, sir, that's correct. >> can you talk a little bit about how impossible it is to run an efficient entity where you simply don't have the ability to discipline people when they need to be disciplined. with that size, the reality is, that there are going to be situations where people need to be disciplined, need to be held accountable. talk to us about how we can help new that regard, and see if we can get this straight. >> start with the last question. first, we think the right approach is this proposal that we're all working on together --
the white house and congress, in going from title 5 to title 38 for the scs employees. as i was chasharing with the chairman. we have worked hard to connect performance with outcome. talked in my testimony about how bonuses, rewards, are down. in the va. we have a, ranking -- >> so the old days of handing out a check are over. >> over. >> the ranking of our performance by performance level, is i would argue best in government and fully equal to best in the private sector. so for example, the top ranking one, which would be considered the most outstanding in 2012, over 25% of the people were rated that way. today it's around 10%. and the steps that we're
talking, are giving people a good, a good knowledge of what they have to accomplish. holding them responsible for doing that. and making the reward matches that. that's part of the leaders train something it's all about that accountability and responsibility. we think again changing the scss from title 5 to title 38 would be a big help. >> that's so important. >> you mentioned the vet link program. i think about 3% were dissatisfied. that's a low number. what do we do about the 3%? how do we follow up on, we are putting in place, just in general, we're putting in place a standard veteran satisfaction measure across the enterprise. that this will be the first time ever that the va has had this. and we will follow up with all the veterans that demonstrate some level of dissatisfaction by getting their verbatim comments
and acting to remediate what their comments are and that's what we're trying to do with vet link. to make sure we take those comments in and the medical center director has got to react to them and make changes right on the spot. >> thank you for being here. appreciate your service. thank you, mr. chairman. >> thank you for bringing up the part about the accountability. earlier in the hearing, the secretary in his testimony addressed that and i think the fact that you independently brought that up as your first comment, we're in a situation where you've got a tool box that doesn't have all the tools you need in it to run the agency the way you like to and the way it should be. i commend you on the things you have done. let's stick to our goal by the end of march, getting a new tool box and giving you the tools you need to have accountability as a mechanism that works in the va. >> thank you, senator bozeman. thank you mr. secretary. we have a second panel to come forward and we appreciate your time this morning.
secretary staying for the second panel. we have veterans service organizations which are critically important to us on the va committee and we have the american legion in town today i was with them earlier and appreciate their support for the veterans administration and for this committee. we have mr. carl blake, the associate executive director of the government relations, paralyzed veterans of america. paul have a littlea, legislative director of disabled american veterans. ray kely, directsor of national legislative service, veterans of foreign wars and the national director of veterans affairs and a rehabilitation, the american legion. mr. blake, we'll begin with you. >> on behalf of the core authors of the independent budget, i would like to thank you for the opportunity to testify today. you have a copy of our joint statement that we submitted for the record. i will limit my comments primarily to the medical care section of the va's budget and the recommendations of the ib. let me say first that we believe the va's budget is a good one. think in many ways it mirrors
the recommendations the independent budget for this year, when you take into account the amount of money that the va intends to spend. it brings the numbers up pretty close. the one exception would be the infrastructure portion. i'll leave the comments on that to my colleague with the vfw. let me say that we do have some real concerns about this continued escalated growth in funding on community care. this year the va introduced its new medical community account when coupled with the choice act. they project to spend nearly $12.2 million on care in the community this year. it's fair to say we understand the need to leverage community care as best as possible to expand access. the independent budget framework that we've already discussed with the committee staff outlines some of our ideas in the same way. much as the new va's veterans choice plan addresses the issue. however we're concerned about what is the potential for
uncontrolled growth in this area. while the congress and the administration seem to be keenly focused on expanding access in the community, i don't think we can emphasize enough the need to devote critical resources and focus also on expanding the existing capacity and the va and the staffing levels of the va health care system. particularly in the areas of health care services, spinal cord injury or disease. outsourcing the care into the community, while it might seemingly improve access runs the risk of undermining the larger health care system, which many veterans, particularly those with catastrophic disabilities rely upon. one interesting note i would like to point out is in the va's budget this year they project for fiscal year 2016, to spend about 1.7 billion dollars in section 802 choice funding, the community care portion of choice. when we asked them about it during their budget briefing, they admitted that they project to spend 2.3 billion or more in choice act funding.
in community care this year. but their budget doesn't seemingly square those two facts which begs the question, where will the additional money come from? the obvious easy answer would be the remaining balance of the choice act. that would call into question, how does that impact the $4.8 billion in choice funding that they're projected to spend in fiscal year 17 for community care. we have real concerns about how the choice act funding is going to be broken up. certainly last year with the massive budget shortfall. that caused some significant difficulties when figuring out how to manage the choice act funding line. we'll be keeping a close eye on how that impacts care going forward with these thoughts in mind we also have some real concerns about the funding level for fiscal year 2017. that was approved in the advanced appropriation in december of last year. while the i.b. recommends approximately $72.8 billion for medical care for 2017, that
advanced appropriation only included about $66.6 billion. that's a lot of money, no matter how you look at it the fact is that the va revised it's estimate for 2017, necessarily so, we believe, so to a much higher and much more significant level. we believe reflective of what the actual need that they project to have for 2017. unfortunately, we believe that they were setting up a scenario where the very same shortfall problems we experienced last summer may rear their head again in the coming fiscal or in this fiscal year in 2016 and potentially again in 2017. if this advanced appropriation level was not appropriately addressed. we hoped this committee would take a serious look at that and consider that as you put together your views and estimates. lastly we're concerned about the 2018 advanced appropriation level. when we questioned the va on what we felt like was clearly an insufficient level for 2018, for all of medical care. they sort of half-heartedly
admitted they don't believe it's going to be sufficient, either. which is kind of befuddling to us. if you took as historical perspective, that that's okay, because it will be corrected, that's not a fair way to look at this. while the last two years congress has adjusted appropriation in many appropriate ways, the four previous years to that congress and d not adjust by a single dollar the advanced appropriation for health care, particularly in medical services. so the track record doesn't lend itself to underestimating now to get it corrected later. >> i certainly hope that the committee will take a real look at the 2018 advanced appropriation and address it so that fund something not left short when we get to that point two years from now. mr. chairman i would like to thank you for the opportunity to testify. i'd be happy to answer any questions that you may have. >> thank you, mr. blake. mr. varella? >> good morning, chairman isaacson and members of this committee. on behalf of the ibvsos, we thank you for the opportunity to
address our fiscal year 2017 budget representations and those proposed within the va's budget request. today i'll focus my remarks on four areas, compensation, vocational service, voc rehab, the board of veterans appeals, the board and the simplified appeals process recommendations. for comp service we recommended an increase of 1700 full-time employee equivalents, the administration requests authorization for just 400. given the significant backlog and workload affecting appeals, we believe that 1,000 of the 1700 ftee requested by the ibvsos, should be dedicated solely to appeals processing. without add kwat resources apellants seeking redress of their aid determinations will continue to endorse significant delays in the adjudication of their appeals. we have also recommended 100 additional ftee for the fid usually program. 300 ftee for nondisability
rating activities and 300 ftee for call centers. vba must be resourced properly to meet the needs and expectations of veterans, survivors and dependants seeking va benefits and services. second, voc rehab. the ibvsos have recommended a staffing increase for 2017, 158 new ftees are required. but for a second consecutive year, the administration has not requested a staffing level increase. mr. chairman, voc rehab program participation has increased steadily over the past fiscal years to include receipt of new applications for entitlements determinations which has also increased at roughly the same rate. vocational rehabilitation counselors, vrcs, perform myriad tasks ranging from their daysly caseload responsibilities to integrated disability evaluation system and veteran success on campus activities. vrcs have one of the most
critical roles within va. they insure that ill and injured veterans have all the help, guidance and resources they need to overcome their employment obstacles to lead to more independent and economically fulfilling lives. the ibvsos recommended a staffing increase that would support a more appropriate client-to-counselor ratio throughout voc rehab so vrcs can devote the appropriate amount of time to each veteran to insure they're on a path to success. third, the board. we are pleased to see the administration's request for 242 ftees. the ibvsos firmly support this request. the additional personnel are certainly needed, given the exceedingly large inventory of appeals now estimated at roughly 440,000 appeals pending review at various stages in the appeals process. it's important to note that even if the board is provided with the staffing increase and va's budget is appropriated on time. the impact of these new employee was not be fully realized until
sometime in 2018. regardless of the time it will take to hire, train and orriest these new hires to the board, they are desperately needed now. and fy 22017 the board was able to produce 57,000 decisions. this averages out to be 88 decisions per ftee. if the board were to receive their staffing increase, thus increasing their staff size to 922, they could conceivably complete 81,000 appeals each year. however, to end the backlog and keep up with incoming appeals, future staffing increases will likely be needed. lastly, mr. chairman, the proposal regarding a simplified appeals process. the ibvsos strongly object to closing the evidentiary record at the point of initial decision, transferring jurisdiction of an appeal to the board upon receipt of a notice of disagreement and eliminating an apellant's option for a
personal hearing before the board. ite bvsos are pleased that the board has engaged with us regarding propose aals and we hope to find tangible solutions to the process. i would like to highlight we've put forth several recommendations, such as eliminating or amending the new material evidence standard. and enacting fully developed appeals legislation. that passed in the house and with a introduced here in the senate. why would like to thank senators sullivan, casey, heller and tester for their support on this legislation. we cannot emphasize enough how important it is to move fda legislation forward. fda has the potential to provide tangible relief to apellants and veterans. fda while it sped up appeals processing is a voluntarily option tempered with critical due process protections currently afforded to veterans. chairman isaacson and members of this committee thank you for allowing us the opportunity to
testify today and i look forward to your questions. >> thank you. mr. kelly? >> mr. chairman on behalf of the 1.7 million members of the veterans of foreign wars and our auxiliary. thank you for the opportunity to testify today. as partner of the ib, the vfw is responsible primarily for capital infrastructure in the national cemetery administration so i'll limit my remarks to those two areas. for more than 100 years the government's solution to provide health care to our military veterans has been to build, manage and maintain a network of federal hospitals around the country. many of these facilities need to be replaced, others need to be expanded and all of them need to be maintained. va use what is is known as the strategic capital infrastructure plan or skip. to manage or identify va's current projected gaps in building access out illization and safety. major minor construction, leasing and maintenance make up the four cornerstones of the
capital structure and work together to insure veterans have ak stoes their earned health care. while congress and va need to realign scip process to allow the va to enter into public/private partnerships, both publicly and federally to right-size va's footprint it must continue to fund the projects that are partially funded today and begin advanced planning and design on the projects that we know va needs to fund in the near future. currently there are 30 major construction projects that are partially funded. to completely fund these 30 projects, va is going to have to invest more than $3 billion to complete them. these projects need to be put on a clear path to completion. out of the next five major projects on va's priority list, two of them are seismic in nature. two of them are specialty clinics, one is a mental health care clinic. the other is a spinal cord injury center. and one is an in addition to an existing facility to eliminate access barriers. the i.b. recommends that
congress appropriate $1.5 billion for fiscal year 2017. to help close these gaps. >> 600 minor projects need funding. congress provided additional funding through the choice act and va developed a spending plan that will obligate over $500 million to 64 minor construction projects over the next two years. it is important to remember these funds are supplemental and not a replacement for the annual appropriations for minor construction. with that in mind, the i.b. is requesting $749 million for va's minor construction accounts for fiscal year 2017. this year va is requesting $52 million for 2017 leasing needs, while va's request is adequate, congress needs to authorize these leases and the leases that were brought forward last year in their appropriations cycle. even though nonrecurring maintenance is not found in the
construction account, nrm is very critical to the va's capital infrastructure. va is investing more than $800 million in nrm projects funded from the choice act. but to maintain the status quo, va's nrm account needs to be funded at $1.35 billion a year. the administration request is just over $1 billion for fiscal year 2017. the i.b. request that the full $135 billion baseline for appropriations for this line item be appropriated, so nrm backlog does not grow any larger. nca historically asked for and properly spends what it needs and the i.b. requested that the nca be funded at $286 million. va provides construction grants for state extended care facilities and state veterans sem aerts, the the i.b. requests
$51 million for cemetery grants. thank you again for allowing the vsw to testify before you today and i look forward to any questions you or the committee may have. >> thank you, mr. kelly. mr. sully? >> $103 billion in mandatory spending. for the sole purpose of attempting to make veterans whole again. $79 billion in discretionary spending for things like doctors, claims processors, administrative staff, i.t. infrastructure, hospital maintenance and out of that, $65 billion will be spend spent for health care alone. chairman isaacson, blumenthal, members of this committee, on behalf of national commander dale barnett and the 10% of all u.s. american veterans that make up the american legion, we welcome this opportunity to comment on the department of veterans affairs budget. in 2014, kaiser permanente had an operating revenue of $56.4 billion and a staff of 177,000 employees. meanwhile, for about the same. money, va ran 150 hospitals, 819
c box, 319 vet centers and 56 regional offices they do with with a staff of 350,000. that's double kaiser's staff. unlike private-sector physicians, va providers are not eligible for overtime pay. so this weekend when va is conducting its second access standown. va will incur very little additional expense while serving veterans. i'm not sure we can expect the same level of dedication from private-level doctors, ever. by law va facilitates the largest teaching hospital in the country, conducts mandated medical research. maintains emergency back-up infrastructure in support of our national defense and national emergencies, processes millions of compensation claims, the appeals that result if those claims, cemeteries, processes gi payments, insurance programs and all while providing health care to millions of veterans in 50 states and the caribbean. this is a massive budget that's broken down into hundreds of
accounts and thousands of line items. does va have enough money? they have too much money. is it wisely spent? of areas where va can save money? all valid questions. but the bottom line is, someone's got to do it and to date no one's come up with a cheaper solution. in the meantime, the american legion recognizes that va will need sufficient budget authority and flexibility in order to serve our members and the members of the united states of america and there are areas where va can save money. as highlighted in the written portion of my testimony, the american legion would like to draw this committee's attention to three areas. consolidation of outside care. and insuring adequate va standpointing and the growing number of pending appeals. with the enactment of the choice act congress added one more layer to an already complicated system of eligibility and payment structures. the time is now to fix it by organizing all of these programs under one umbrella. with the single point of entry and a logical physician reimbursement system that streamlined and easy for primary
care teams to use this would not only save va money, but it would provide better and faster health care for veterans and patients. va is a service-based industry. as an all-service based industry, the most expensive line item is employee burden. the fastest way to start saving money today is to reduce employee turnover. va has a terrible problem filling vacancies and an even worse record of succession planning. if the va is to successfully keep positions filled. they must do a better job with succession planning. it's rare, if it happens at all that a deputy is promoted to the position of the departing director. that leaves little incentive for the deputy to remain loyal and breeds resentment once of new director is instilled. va has 50% of leadership positions filled by temporary fill-ins or vacant. 50%. employee turnover is expensive and a waste of money when it can be avoided. finally, claims, every time a claim goes into the appeals process it costs monday nixt adjudicate the claim correct lit
first time and the rate of appeals would be reduced to a trickle we address appeals today because va has included a request to revamp the appeals process in their budget submission. as submitted, the american legion does not support this plan. that said, va has been working closely with the american legion and our vso partners to look at ways va can improve the timeliness>!s" quality of the appeals practices and we're excite and encouraged by the progress we've made early on in this discussion and with the openness va has shown in seeking detailed input from vsos by treating them as valued partners. i'll be happy to address any questions you have following my opening statement. but more importantly we look forward to our continued work with you, and your very dedicated professional staff. >> thank you, mr. sully. thanks to all of you for testifying and thanks to your operations for your advocacy. mr. >> mr. varella and mr. sully.
both of you commented about rexg the appeals process -- reforming the appeals process. we can't continue to do what we're doing now. we have a backlog of claims now at will have ham a million. some 25 years old that continue to build up. we need your help to come up with a solution that you support and the va can implement. we all commit to us to work with the secretary to try to make such a recommendation? >> we already have. and we continue to commit to working with the secretary. we've already had several meetings now with debby sloan gibson, we've worked with our vso partners and i'd like to associate myself with the comments of mr. varella and d.a.v. as well. >> your comments were very timely. very appropriate. but being timely means we need to move forward. secretary needs some tools in his tool box he doesn't have and one of them is getting the whole backlog straightened out so
let's work towards a date at the end of march trying to come together on some kind of consolidated agreement. would you work with us on that? >> we agree. >> mr. varella, you commented on the fact that your testimony recommends 158 full-time employees in voc rehab and employment services and once again this year the va has asked for none, is that correct. >> that's correct. >> are you familiar with the workforce innovation and opportunity act? >> yes, i am, mr. chairman. >> are those funds available to the va commissioners in the various states, utilize for vocation and rehabilitation? >> i don't know that offhand. >> i would suggest you check that out. when we did the act, we made sure to give the states the flextibility to do veterans training and rehabilitation as a part of that. that's a source of funding and personnel that could be dedicated.
wouldn't add personnel to the va, but would add the service, to the va's whole quiver. so i would appreciate your checking on that and being sure. >> will do. >> mr. blake, your testimony recommends $75 million in direct funding for million veteran program or mvp, independent or supplemental funds proposed by medical and prosthetic research account. could you explain the recommendation for dead indicate funding for the mvp genetic research program? >> well mr. chairman, that's a special program gee gnomic study that the va is doing. longitudinal study of veterans for research purposes to evaluate the wide variety of issues unique to veterans. i think our concern is, it's a heavy lift to fund that program out to function the way it's intended and the va does a good job of expending much to all of
its resources, already dedicated for the existing medical and prosthetic research account. unfortunately this year i think the va is projecting to draw abouts 65 million out of its appropriations request just for mvp. that would actually bring the medical and prosthetic research account number back below what was just approved in the appropriations bill back in december so we think it would be better served to direct funding for that program independent of the medical and prosthetic research line item. >> well thank you for your testimony and for your organization, i want to repeat what i said at the beginning to mr. varella and mr. sully, mr. kelly and mr. blake that applies to you as well. if we can form a goal to get ate peels process worked out. that would be a major move forward and your organization support of doing that would be critical. we're at a point now where the committee i think is prepared to move forward on major legislation to improve some of our problems. let's not let them know that a year passed by kicking the can
down the road, let's make the reforms necessary to get it straightened out. senator blumenthal? >> thank you for your service, i apologize i wasn't here earlier, but this is my fourth committee meeting today. and one of them was the armed services committee. where we're assessing the capability of our military force in the south pacific. an issue i know you feel is important as well. so thank you to the men and women who serve with you. and thank you for your advocacy here. i want to come back to a topic that i asked the secretary about. which is, the capacity of our va to deal with women's health care. and although we have an all-male panel here, or maybe because we have an all-male panel, i want to ask how you feel the va is
doing, judging by what you're hearing, from members of your organization. >> so if you don't mind, i'll start. the american legion has a program that we call we call a worth saving. we visit va hospitals around the country. one of the things that we specifically look at is women's health care. female veterans, as we all know, the fastest growing population of veterans. and while va has had a very difficult time standing up women's health care programs, lately they've come along way. there are several new clinics spread out across the country. does every one have a women's clinic, they do. could they be improved, yes they can. they need to make sure they maintain the flexibility in spending and the funding to create that. and also on that, we also knead to make sure that we continue to keep an eye on childcare. there are a lot of women
veterave veterans who will forego their appointments because they don't have sufficient health care. va has a program by which they can stand up some childcare clinics within the women's health care clinic center. we need to make sure those remain funded. >> that point about women's childcare is very, very important. i've heard this repeatedly in connecticut. we have a new facilitfacility, clinic in connecticut. it's tremendous improvement. but the issue of childcare, the issue of transportation, the issue of taking off from work which may affect men as well as women, but particularly so for women. i'd welcome any other comments. >> mr. classroomen thblumenthal speak from the perspective of how the women are experiencing the va, we appreciate the new
resources to the tune of $30 million for their programs. we believe more could be done. the ib actually recommends about $90 million in 2017 and an additional $100 million in 2018. i would also offer that while i think it would be unfair to say there aren't still some challenges in developing health care to women veterans, one of the areas where we clearly see difficulty that's out there is meeting with needs of women veterans who have catastrophic disabilities. if it's a challenge to deliver care just to women veterans, when you add on the aspect of complicated services and special louisianaeds services program, that adds a whole new element that i don't think they've thought completely out of the box yet. >> as quick as i can, we just commissioned a survey and got the results back. we're going to be sharing those on capitol hill when the folks are here next week doing storm the hill. just as a recap, women veterans
who actual va are by and large pleased with it. they want better access to women health care providers. only 40% of them are being provided access to a female provider if they ask for it. it goes much further than just health care. you mentioned childcare. one of the loading causes of lack of ability to get the health care services and employment services that va has is the lack of childcare. it's a hindrance, it's leading to homelessness, people sleeping on other people's couches with no way out. we need to tackle that as a larger issue. and women veterans over the age of 55 use va at a much lower rate than the current generation of veterans. we need to figure out how to do outrage to that generation of veterans to let them know that the services at va are there for them as well. >> i welcome your comments, too
p. mr. kelly, the survey that was done, is that of the vfw members or women veterans generally? >> we sent it through the membership data pool and shared it with the community to send out to their membership as well. so we have active duty, guard reserve, veterans from multiple organizations and walks of life. >> and the number that you mentioned, 40%, that is the number of women veterans who want to see a woman health care provider and maybe you could just explain that. >> it's 40% of those who are seeking health care through the women's health care clinics, 40 prs of them are being seen by a female provider. but by and large all of them want to be seen by a female provider. >> but only 40% are now. >> yeah. >> in addition to the other challenges that the va has in
recruiting more professionals, female professionals to deal with women's health care issues. >> right. in va's defense, they're doing a great job of training their doctors that they have for the particular needs of women veterans. but when asked, would you prefer to have a female doctor, by and large they want to have that as well. >> and that may be a key to involving more women in seeking health care through the va system, the availability of women physicians. >> absolutely. >> thank you. thank you senator blumenthal. i would also add that the women veterans that we hear from, they routinely say they don't want better care, they want comparable care. and we do believe that the va is moving in the right direction but more can be done. >> and i'd just like to finish with the, with the chairman's
indulgence. i know mr. blake, you said that the va's dollar amount for health care for fiscal '18 is lower than you would like to see. is that correct? in. >> that is correct. >> what -- sorry. go ahead. >> no, sir, you. >> what is the number that you think it should be? >> the ib recommends for 2018 overall for medical care, our recommendation is about $77 billion for medical services alone. it's about $64 billion. one of the things i would point out, though, just looking -- and this was a touchy subject even for the membership. but looking at the community care account alone, the va projects to spend 12.2 pld in '17 on all community care, through choice and community care account. yet their prosection for 2018 reduces that projection by almost $3 billion. now i'm not here advocating for expanded community care but i'm
not sure how they can square that fact. >> thank you very much. i any that's a very very important insight. i want the record to show that secretary mcdonald and his team are here. they're listening to you. i want to thank them for remaining here. not always the case, as you know, that the head of an agency stays to hear panels afterward. but i think it is a mark of the expertise and experience and insight that this panel brings to this process that he and his team have stayed and so i want to thank all of them for being here. and thank you particularly for, again, your service to our nation in uniform and afterward in the organizations that you serve in now. thank you. >> thank you, senator blumenthal. senator bozeman? >> thank you, mr. chairman. we do appreciate your service in so many different ways to your
country and your fellow veterans. we've had your written testimony, we've heard your spoken testimony. lots of issues today. lots of concerns. if you'd just take a second and go through, tell me, if you had to summarize, you know, the top one or two things that you're really concerned about the budget. that's really what we're talking about today. what's at the top of the list? what are your real, real concerns regarding the numbers that we're seeing on the budget as to where they're going? >> yes, sir. >> mr. blake. >> senator bozeman, from pba's perspective on our concern is clearly what is the projected escalated growth in community care spending. i recognize it's a need the address access but that doesn't improve access for the members. by and large the members don't use the existing choice program, they don't avail themselves of
the community care programs. so for all of this work towards expanding community care access, those people are -- our members, pba's members are maybe feeling left out in the cold in that discussion. they're certainly committed to making sure there's access to our members in the care but there's certainly more to be done. >> very good. >> i'd like to include capital infrastructure. if you just look at the way the skip has been put together, in between -- it's around $60 billion in construction and infrastructure needs that va would need to do under the current model to close that out over the next decade. that's a tremendous amount. we need to look at ways to afford va the opportunity to enter into public/private partnerships, do sharing agreements with other federal
agencies to ensure that we can reduce the backlog on new construction but also get us out from underneath some of the older builds that have maintenance costs that have so yous ray jous because they're so old. if u rear trying to maintain a build that's 90 years old, the maintenance is much more than a building that's ten years old. we need to really clearly look at where are we going with construction in the future. and then try to align that $60 billion, what can we carve off of that. if we have these other opportunities afforded to va in the future. >> very good. >> i think by far recruiting and retention. the independent assessment clearly highlighted some leadership deficiencies within the department of veteran affairs that everybody recognizes needs to be fixed needil immediately. if