tv U.S. House of Representatives Legislative Business CSPAN February 24, 2016 4:00pm-6:01pm EST
veterans have 24-7 access to v.a. systems and nowhere to get accurate -- and know where to get accurate answers whether it's the veteran contact center or the crisis line. veterans visiting primary care facilities have their clinical needs addressed the very same day. veterans calling for veterans 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 performing culture where continuous improvement drives responsive forward-thinking and innovative change. it means training our work force on advanced business techniques. it means responsive performance management systems that resonate with employees and encourage rather than discourage continuous improvement and excellence. it means proper employee
placement, clear performance expectations, continuous feedback and employees equipped with the tools to achieve excellence. it means executive performance ratings and bonuses that reflect actual performance and take into account relevant inputs like veteran outcomes, results of employee surveys, and 360-degree feedback. it means modern automated systems in place of apt kuwaited, cumbersome and -- antiquated and cumbersome processes. we're advancing along these lines and many others. we've launched training last year with 450 senior field leaders. it's not a single event. it's a continuous enterprise-wide process of leaders teaching leaders teaching leaders in order to make lasting change. so fash we've trained more than 5,000 ploles. by the year's end, 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 v.a. teams in new ways with cutting-edge business skills like human-centered design. we're using human-centered design right now to redesign the compensation and pension process because veterans find it confusing and burdensome. we're looking at industry best practices and planning for an a solution for general scheduled employees. we can streamline that process, improve rating accuracy and interdays with o.p.m. all of this -- interface with o.p.m. we need your continued support to achieve it. i appreciate our extensive discussion at the end of january on our my v.a. 12
breakthrough priorities for 2016. the proposed budget continues support of those priorities in the 2017. it provides $65 billion for veterans medical care, $6 -- 6.3% increase over 2016. it provides $66.4 billion in advanced appropriations for the v.a. medical care programs in 2018. that's a 2.2% increase above the 2017 request. it provides 7. billion dollars for mental health -- $7.8 billion for mental health. it funds telehealth access, enhances health program for women veterans and provides an incredibly effective hepatitis c treatment to an expected 35,000 veteran. to help integrate all the my v.a. initiatives across the enterprise provides $2.6 million for the my v.a. program office. to continue training, field
employees on advanced business skills and establishing high customer service standards, it increases funding for our veteran experience office by 47%. and will continue doing all we can to squeeze as much as possible out of every single budget dollar. our pharmacy benefits management program avoided $4.2 billion in unnecessary drug expenditures last year. we saved over a half a billion dollars in travel spending since 2013, exceeding goals of the president's campaign to cut waste. we've reduced employee award spending $150 million and we've reduced s.c.s. bonuses 64% between 2011 and 2015, by rigorously linking awards to performance. since 2011 we've is a saved $16.6 million using more efficient training and meeting methods. we're already save $10 million annually under my v.a. five district structure that we
announced in january of 2015. we saved approximately $5.5 million from 2011 to 2015 by strengthening controls over permanent change of station moves. and now that we've implemented electronics claims process, we'll save millions of dollars each year in paper storage. we're committed to doing everything we can with everything we're given. but many, many important priorities for meaningful change require substantial congressional action. there are more than 100 legislative proposals in the budget, over 40 of them are new this year. and some are absolutely critical just to maintain our current ability to purchase non-v.a. care. it's critical that v.a.'s competitive with private sectors so we can attract top talent. nowhere is that more important than in health care. so among other v.a. -- v.h.a. personnel 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 possible hospital staff who prefer more flexible schedules. we're proposing critical compensation reforms fournettework and hospital directors. like weis, the title 38 s.c.s. proposal we're working on is about being competitive with the private sector in recruiting and in compensation. it's not just about firing people, it's about treating v.a. career executives more like their private sector counterparts. it's the kind of flexibility that attracts top performers in the private sector as well. v.a. needs that flexibility too. we need your help to transform and streamline v.a.'s care in the community systems and programs to best serve veterans. we need your help modernizing and clarifying v.a.'s purchase care authorities to maintain veterans' access to timely community care everywhere in the country. we provided congress with detailed legislation addressing
this challenge more than nine months ago and i've consistently identified it as a top legislative priority. above all, this needs to get done in this congress to ensure that strong foundation for access to community care. art fm funding restrictions are unresponsive -- artificial funding restrictions are unresponsive to veterans' needs so we're proposing a general transfer authority that allows me some spending flexibility to respond to the veterans' emerging needs. the appeals process set by statute is ar cake, unresponsive -- archaic, unresponsive and not serving veterans well. last year the board was still adjudicating an appeal that originated 25 years ago and had been decided more than 27 times. the budget proposal's simplified streamline and fair appeals process so that five years from now veterans have appeals resolved within one year of filing. while requiring short-term staffing increases to to
contend with the 445,000 pending appeals, legislating a simplified appeals process can save more than $139 million annually beginning in 2022. we need congress allege authorization of 18 leases -- congressional authorization of 1 leases in the budget request, as well as authorization of eight major construction projects, including the fiscal year 2016 budget. we need your support for the additional -- for six additional replacement major medical facility leases, two major construction projects, and four cemetery projects in the 2017 budget. and passing special legislation for v.a.'s west los angeles campus will get us positive results for veterans in that community who are most in need. i've outlined a few opportunities for change here. this congress, with today's v.a.'s 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 that we turned the corner. i appreciate the support you've shown veterans, the department and the my v.a. transformation. on behalf of veterans and the v.a. employees serving them every single day, thank you for this opportunity. we look forward to your questions. thank you, mr. chairman. >> your proposal has a unique system which would create a unique pay schedule and disciplinary decision. as i said in my opening remarks, accountability is the single most important thing we must accomplish and my judgment . you detail for the committee the justification for the proposal and how you believe this solves the accountability problem at v.a.
mr. mcdonald: yes, mr. chairman. we run a health care business. we run an organization that if it were a company would be fortune six 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 were afill yad -- that we're affiliated with, like duke medical center, or large health care companies like mayo or cleveland. we believe the best way to treat v.a. employees is as a health care professionals that they are and the title 38 provision would give us that ability. we could pay them more competively. 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 system. separately, we can also recruit and appoint people more quickly because title 38 would give us
direct hiring authority. we believe that moving to title 3 for all employees and v.a. would be a big step forward. make us competitive with the private sector and would improve care for veterans. it would make me the appealing -- the appeal authority. so people would appeal to me. so it would put appellate authority within the department rather than in some external organization. that looks across government. mr. isakson: 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 to msrp? mr. mcdonald: that's correct, sir. mr. isakson: secondly, we talked about the 440,000 pending appeals at the veterans administration. you made a statement in a house
committee meeting the other day that the proposals in here are really a strawman for something like that. do you have specific proposals in terms of that, in this budget proposal that you're offering. mr. mcdonald: yes, sir. we've offered a specific proposal. as we are talking right now, we've been meeting with veterans 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, that we can make even further enhancements to it which could create a greater consensus moving forward. and as we have talked, we expect to have all that done by the end of march so we can get something done with this. mr. isakson: are you moving away from the fully developped claim process? mr. mcdonald: no. we think that's a good step on the way to a totally new appeals process. but it does not fundamentally change the process to the degree that we think it needs changed.
mr. isakson: using the word of the day, which is accountability, i think it's important for our veterans, as accountability in the system, to make sure if they have an appeal it's justified and heard but makes it also so that one don't or two veterans slow it down. one thing i've seen with talk to some at the v.a., there are a handful, i use that as a reference, of appeals that over and over and over again, over a series of years, are still active and pro process. every time one of those takes place, it takes time away from a claim that's recently filed by a veteran who deserves. so i personally am very supportive of us finding a way to give the tools necessary to ensure the veterans get accountability but also have some ability to cut that off so it's not an ongoing process. mr. mcdonald: yes, sir, you're right. as you know, 10% to 11% of veterans appeal the decisions. of those 10% to 11%, it's about
2% of all veterans that win the 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 that 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 have a process in place that eventually would lead to one year for a veteran appeal. mr. isakson: one last comment. in your prepared remarks, you said that 10 of the top 16 leaders in the v.a. are people you've brought. in people from hospitals. is they two of those 10? mr. mcdonald: yes, sir. mr. isakson: if the other eight are doing as good of a job as those two are, i want to
acknowledge them. in the meeting we've been having at the v.a., deal with the accountability issues, they're doing a great job and i appreciate the fact that they've been very responsive to us. thank you very much. mr. mcdonald: as you know, we have an i.g. nominee who we all think very highly of. i think the committee thinks very highly of. we would love that to get passed on the senate floor. mr. isakson: for the record, i'm meeting vidsy with people who i think need to be met with to try to get that to a vote on the floor. we're not there yet but we're making progress. mr. blumenthal: thank you, 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.
e v.a. 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 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. rlier this year the hartford -- they reached out to me because they were informed there were no additional hearing dates. travel board or a teleconference dates for hartford in terms of the appeals process. -- r my inquiry, the b.b.a.
additional teleconference date has been added, which i appreciate. but i think that that experience illustrates the importance of reforming the appeals process, the b.s.o.'s have focused on it, and i assume you agree it should be a priority. mr. mcdonald: yes, sir, absolutely. i also agree on the budget. i would tell you that this is my second budget at the v.a., 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 12 priorities that we have listed for 2016. this is more than just a budget. this is the delivering of outcome for veterans. 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.
mr. blumenthal: focusing for a moment on delivery of services to women veterans. there's a request for a $515.4 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 welcominging -- welcoming and efficient and proficient to meet their needs. i'm still concerned that the culture of the v.a. and the ability to welcome female veterans and provide health care services to them in a sensitive manner may not be keeping pace with the number and the needs of those veterans. could you please tell us how you intend to use the requests funding for women's health care to address frankly the pervasive feeling of many female veterans that the v.a.
remains a male-focused culture and organization? mr. mcdonald: i'm really glad you raised this. this is such an important topic to us. i really think, like, this will be one of the seminole 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 v.a. health care services has doubled from 160,000 to over 447,000 in fiscal year 2015. so this is a major focus for us. we have enhanced care for women, we have designated women's health providers at every site where women access v.a. 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 2,400 providers in women's health to make sure every woman veteran has the opportunity to receive her primary care from a woman's health provider. we have women veteran program managers, maternal care coordinators the eafer -- maternity care coordinators. we provide gynecology care, including maternal care, and -- maternity care, and seven days of newborn care for all veterans either onsite, that's through 130 health care systems, or through care in the community. this is really a very important point to us. and we have to continue to make this transition over time. because as you've said, it's going to continue. mr. blumenthal: thank you very much. my time has expired. i have other questions i may submit for the record but thank you to your team for being here today. thank you. mr. rounds: thank you, mr. chairman.
let me just begin by saying that 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 on -- 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 v.a.'s shift of cost for care to the veterans who have been utilizing the choice program. veterans are paying far more for their care in choice than they paid under v.a. facility care or non-v.a. care. typically as a result of -- as a result of deductible and co-pay calculations that are different than when when they're seen in the private sector. as uconn sol date the care and the community programs, do you
envision veterans continuing to pay more out of pocket to be seen in the private sector? mr. mcdonald: 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. you are right. that 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 costs down of the total choice act. if they use a v.a. service, there's no co-pay. they use a choice act, there is a co-pay. so we do think that change needs to be made. >> the primary difference is the way the choice legislation was written is that in choice, v.a. is the secondary payer. so a veteran has to use the primary insurance and they have to use their co-pays. what we have suggested in our
legislative proposals is to make choice -- is to make v.a. the primary pair and to consolidate all the care in the community. mr. shulkin: that would eliminate this disparity that veterans see today. mr. rounds: we hear that 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 had been outstanding for more than 0 days. what -- 90 days. what specific initiatives are you putting in place to accomplish your 2016 breakthrough priority of getting 85% of claims paid within 30 days? it looks to me like you've got quite a hill to climbment mr. mcdonald: first of all, please give us the name of that provider. we'll 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. the doctor has put that change this place. 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. mr. shulkin: yesterday we delivered to the two t.p.a.'s a proposal for them to sign that would decouple documentation from payment. so we can make faster payments o providers. mr. rounds: i've heard in my state programs have been changed. yesterday we saw a similar story out of cincinnati that contained allegations of services being switched to choice in 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 choice program and in the process eliminating capability to perform those services, when choice is clearly a temporary
program designed to supplement v.a. care and this authorization expires next year? mr. mcdonald: the most important thing in mike making any of these decisions -- in making any of these decisions is what's best for the veteran. nothing else should be a consideration. unfortunately because of the fact that we've had 70 line items of budget where we can't move money from one to the other, you may recall last year 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 v.a. 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 2016 -- 2017 budget proposal is a proposal to give us flexibility on only 2% of our funding so that we can move money between accounts. again, with the idea that we have to get the best care for
the veteran. mr. rounds: thank you. my time is expired. thank you, mr. chairman. mr. tester: thank you, mr. chairman. i want to go back to title 38. could you tell me, mr. secretary, how many medical center directors were eitherer cting or without a position? mr. shulkin: today we have 34 medical centers without a permanent medical center director. i will tell you, being responsible for the health care organization, there's no way i can assure that we're doing the best for veterans with 34 open positions. that includes acting. those are ones we need to fill. mr. tester: can you tell me how long it takes you to recruit and appoint an m.d., for example, right now or a p.a. or a nurse? mr. shulkin: approximately they differ a little bit, but i'm going to say on average six months. mr. tester: ok. now, if we do the changes that you've recommended, how long
would it take to you recruit and appoint? mr. shulkin: 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. so, i think it's going to increase the pool. we have to, one of the secretaries -- secretary's 12 priorities is to streamline the highering -- hiring process. we have to get to where the private sector is. we have to be able to 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 s.c.s. process. i'd like to break it the timeline in half. mr. mcdonald: i think we can do it. mr. tester: you put a number of legislative requests forward. is it accurate to say that veterans' access to care has been impeded by the legal vulnerability associated with getting care outside the federal acquisition
recklations? mr. mcdonald: the complexity of the system, absolutely. mr. tester: i believe we have a bill, maybe not in total what you want, but a bill to get that done. i think that's been out of this committee. is it accurate to say that the v.a.'s efforts to improve the quality and delivery of care have been impeded by the number of director vacancies? mr. mcdonald: yeah, for sure. mr. tester: is it also fair to say that, from a medical personnel standpoint, the appeals process has not been working like it should? mr. mcdonald: we would agree with that. mr. tester: is it also more important to say that you need flexibility in your budget? mr. mcdonald: yes, sir, we do. mr. tester: to move money around. in july of 2014, mr. secretary, you were confirmed by a 97-0 vote. nobody in the senate opposed you. mr. mcdonald: i'm still looking for those three that didn't vote. mr. tester: they were probably out campaigning for president. but at any rate. [laughter]
i would just say this, as a committee, i would be happy to work with the chairman so it's on a bipartisan basis, we need to push the leadership to get these bills to the floor. and hold this man accountable. we can't hold him accountable if his hands are tied. and i really think that it's important dish mean, he came from the private sector, 10 of his 16 folks have come from the private sector. if we want the v.a. to work, we've got to put our trust, if he screws up, gone. but the fact is, i trust you, i believe that you can get this done, and i think we need to give him the tools to get that done. it's going to require the floor action on these bills, with a very limited amount of time for floor action. so, if it will take a letter, phone calls, group meetings with senator mcconnell, i'd be more than happy to join you in that. the only thing i would say, and this may be parochial in nature, but there's an issue with travel pay right now. where the veteran used to get travel pay immediately when they came. now, because of people thinking they were going to try to game
the system, they go to a keys to . now it's a month -- i cans to . now it's a month -- kiosk. now it's a month or loy longer to get their -- or longer to get their travel pay. in a guy want it's to be a crook, they'll be a crook on a kiosk just as well. it's stopping some of our veterans from being able to get the care -- 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 on that, i would appreciate it. mr. mcdonald: we will look into that. that's not an intentional delay. we need to fix that. mr. tester: the last thing i would say it is, and i attribute this a lot to the third party providers and not the v.a., my staff just gave me a chart, you can take a look at it, 53% of the work that we do is veterans work. it used to be 1/3. 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. i think this committee needs to do its job to help you fix it.
and then we need to hold you accountable for that. thank you, mr. chairman. mr. isakson: i appreciate you raising the visibility of the bills that we haven't got through the congress yet. we are working on an omnibus proposal that we hope to, by the end of march, have finished. and acted upon in the house and in the senate. that's an aggressive game plan but we're trying to get all of that done. so your help on, that which i will take as a volunteer to be on my team, we'll make sure we use you to help us do that. it's in a bipartisan way too. mr. tester: i would be more than happy. i think it is important for to us hold the agency accountable. i think it's also to, important for us to listen to the people who are at the head of it and give them the tools they need to be successful and then hold them accountable. we have to hold ourselves accountable. that may be the biggest problem of all. we have to correct that.
mr. moran: mr. chairman, thank you very much. mr. secretary, welcome. thank you for the telephone conversation that we had recently. just a couple of kansas aspects. i was interested in what senator tester had to say about case work. we've 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 issue. let me talk about a couple of items that are kansas-related. the choice act provided for a new cboc in johnson county, kansas. johnson county is the kansas side of the missouri-kansas line in kansas city, 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 g.s.a. and then the time frame is seemingly extraordinarily long,
like five years once the decision is made to begin that lease process. is there something that we can do to help speed this process up? we had the same issue in junction city. junction city is a bedroom community of fort riley. lots and lots of veterans, cboc there is needing to move out of its current facility and they're looking for space which to my knowledge they've not found. but if you would bring me up to date on both of those. and then the broader question is, is there something we can do to help to speed up the process? mr. mcdonald: the process does take too long. we have, i think, is it 16 or 18 leases right now? 16.e waiting -- we're waiting for authorization from you all to move forward onle 18. so -- on. 18. so if you could authorize those, we would really appreciate it. in the case of at least johnson county -- mr. moran: in johnson county it's authorized.
mr. mcdonald: we've worked with g.s.a. to streamline that process. but i'm happy to -- we'll come over and sit down with your staff and go through a streamline timeline of how long it will take. it should not take five years. mr. moran: there are two we could talk about, the one in junction city and the one in johnson county. mr. secretary, let me raise a topic of construction of a new hospital in leavenworth. again, a military community. the strategic capital investment plan lists leavenworth in patient facility as number 13 on the v.a.'s private list. but there were no funds requested in f.y. 2017. what does that mean? what's the value of that 13th ranking and no funding? mr. mcdonald: i think what it demonstrates is, we need more money in construction. most of our priority projects are size mick projects or
projects that -- seismic projects or projects that deal with human safety. as i showed in my written testimony, we have had catastrophes happen because we haven't been seismically ready. 60% of our buildings are over 50 years old. we would love to get down through the total list. but that's going to require a disproportion at amount of capital to do that -- a disproportionate amount of capital to do that. mr. moran: does that speed up the process and help the budgetary constraints? mr. mcdonald: we are. there's actually two different processes. both of which we're 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 that were able to rent from them to house homeless veterans. that's the bill i need passed for los angeles. because i can't do that in los angeles right now and 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 land locked and isolated, what we don't know yet is how will c.b.o. and how will o.m.b. score that? and whether or not, because it is an extended use program, they'll score it as if it were a capital project. so we're looking into that. we should have an answer in march. and we'll be back to you. because if we can do p-3's, it will unlock a lot of capability for v.a. mr. moran: maybe we can have that conversation when we talk about the cboc's as well. i think there's an opportunity for this kind of thing to occur in kansas. my final question is, how does the boc issue affect consolidation choice, community care plan. are cboc's any less valuable,
is there less emphasis as a result of choice? mr. mcdonald: i don't think so. i think it speaks to what we've talked about before which is, had we improved access last year and did the 7 1/2 million more completed health care appointments, that was in large part because we added over two million square feet of new space. so every time you put a building out there, it creates access, advantages that you didn't have before. but what we have to do is we have to be more choice-al. -- choiceful about where we put them, so we make sure we're taking advantage of all of our affiliates like indian health service, medical school affiliates and others, and we're putting those only where they're required. being good stewards of taxpayer money. mr. moran: i appreciate this conversation and look forward to having a future one. mr. mcdonald: me too, sir. mr. brown: welcome, secretary. and all of you. thanks for your public service
to our veterans, to our country, all of you. i want to address the very serious allegations of senator rounds mentioned cincinnati, mismanagement of the v.a. medical center and leadership of visn-10 we've talked with the secretary a number of times for months and months about some of these allegations and issues. nepotism, lack of cleanliness, miss management, staffing shortage -- mismanagement, staffing shortages, fear of whittle blower retaliation. first it's about quality of care, as you have assured us, i know how much you care when you took this job about that. i need your assurances first that while this investigation is going on and the issues and problems are being fixed, that you will ensure 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 v.a. as soon as our schedules permit it for both of us to go together. thank you for that. i want to talk about whistleblower issues for a moment. for than a year whistleblowers, a number of them 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 v.a. employees come forward to voice concerns, regarding improper medical care or other issues, i'm concerned that in too many cases v.a. management is retaliating against them. so i want your commitment for a couple of things, mr. secretary. one, no employee at cincinnati v.a. who did the right thing and advocated -- advocated for our veterans will be retaliated against for their actions. and i want your commitment that if any v.a. employee is retaliated against for speaking up on behalf of veterans and
patients, that you will hold those people accountable. mr. mcdonald: first of all, relative to cincinnati, as you noted, the investigation's ongoing. the cincinnati facility has been a five-star facility historically in v.a. one of our very best. i visited it a couple of times myself over the last two years. so it is an important facility. it has been historically a good facility. we need to dig into this and find out whether or not these allegations are supported. and then take action as quickly as possible to remediate them if they are. relative to whistle blowing, you know, we were the first department certified by the office of special counsel to have done the training on wliftleblowing. we take it very seriously -- whistleblowing. we take it very seriously. 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 sigma.gs like lean six we do not tolerate retaliation and we'll deal with it if we see it and 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. mr. brown: that's what you say. i believe you. mr. mcdonald: that's what i say. i do. mr. brown: that's not what some people, apparently some people in cincinnati that work at the v.a. have done. so i do want that commitment that if proven that people who have retaliated against whistleblowers will be held accountable. mr. mcdonald: they will. anybody who retaliates against a whistleblower will be held accountable. but again, what we're describing here are allegations.
we do the investigation before we commit people. mr. brown: i did not want to convict anybody. i just said if proven, i wanted your commitment. mr. mcdonald: just know that we get a lot of whistleblowers. mr. brown: i understand. i see that. i was a member of the house, i heard it, sometimes it was rack rat, sometimes it wasn't. thank you for. that let me talk briefly -- i want to echo what secretary mcdonald and chairman isakson's i.g.ks on confirming the that's really important. when i wrote to the v.a. about cincinnati unfortunately the letter went to linda halladay, the deputy inspector general, instead of the inspector general. i appreciate your comments and yours on making that happen. let me just close with a bit about staffing directly connected to senator round' comments. the report -- rounds' comments. 61 report recommended full-time equivalents being hired for the cincinnati v.a.
to properly meet the needs of veterans. there are reports that leadership at cincinnati v.a. may actually be abusing it by using as an excuse to cut staff. can you tell me about any of that specific now at this point? or is that something you need to share later once you know more? mr. mcdonald: we immediately sent the office of medical inspection to cincinnati. we do have a preliminary report from them. so we can -- updating you on that now. mr. shulkin: the other thing we did immediately was we removed the management authority from the director, away from the cincinnati v.a., to make sure at there was no ability to influence or to keep people from raising issues. so we want this to be very transparent and we will as soon as we get this final report to review that with you. mr. brown: how long will it take for whatever the number up
to including the number 61, how long will it take to bring in and train new providers? mr. mcdonald: it will depend on the type of providers there. some take longer. mr. shulkin: there will be a spectrum along that line. but, the visn and medical center have been given their budget and do have the ability to hire the most critical positions that they need to hire right now. mr. brown: thank you. mr. isakson: just so it's clear on the record, i consider accountability to apply two ways. employee to supervisor, but supervisor to employee as well. we've got to have accountability on both sides. and that's what we're pushing for so hard. i appreciate your comment on hat. tiltil thank you, mr. chair -- till till thank you, mr. chair -- mr. tillis: thank you, mr.
chair. thank you for being here and the time you've invested, coming to my office. i want to emphasize what you've said that's incredibly important. 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. i'll continue to mention that and stand up for it. ms. council, i want to talk to you for a moment about i.t. it's fantastic to have somebody with your professional experience in the role that you're. in i'm glad to have you there. can you give me an idea of what your instipulates are telling you as you look -- instincts are telling you as you look at this enormous i.t. base, you and i have talked about application portfolio and we could talk in acronyms that most people would think would
be a second language. but 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? ms. council: senator tillis, it's great to talk to you as well. i won't use any acronyms this time. future, k out into the 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 a future is critical. one of the critical areas that
i think that will look very different in the future is how we manage to use data. and how we leverage that data in support of the veteran. we i believe have a prime opportunity, we're putting in a data management function, but putting in something that's 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 and have mobility being used by the veterans in our access and 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 ensuring that we have some capabilities wrapped around our health care, as well as in our benefits
area. mr. tillis: one thing i want to try to get a lot in the last couple of minutes, one thing i'd really like to see from you all over at time to make sense, not do all the things over, is something that we whoa give me some sense that these duplicative or redundant platforms that are used out in the visns or consolidated when they make sense, 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 organizational changes and the systems changes to make a lot of these things that are falling through the cracks, probably the root cause of a lot of the problems we have. so i appreciate the opportunity to maybe get briefed up with you as you've got your legs there and appreciate it. i want to go into a lightning round real quick. because i want to try and stick to my time first. i just want to echo the sentiments here. we need to con firment i.g. and do everything -- confirm the
i.g. and do everything we can. we need somebody in a permanent position. mr. mcdonald, this organization chart seems to me to be an optimized state. it's a per pyramid, looks -- it's a pyramid, looks like you have the right distribution with that really being -- but today it seems to me like it's an oblisk. one thing we haven't talked about here is the organizational change and over time, unless you have a 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? mr. mcdonald: the middle is the most important part. as you well know, of any organization. number one, training. we're training the leadership team, that training is 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 sick sigma, 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 visns tole 18. that's already shown -- visn's to 18. that's already shown. the fact that we have so many open positions is the opportunity to reduce even more. with every open position we really question whether or not we should fill it. we want to reduce spans and layers. we can share that plan with you next time we -- mr. tillis: my time's short, that's why i'm cutting you off. i think seeing a measurable -- instinctively this organization looks like it's heavy in the middle. and with that comes cost and complexity and breakdowns and handoffs. i'd like to see what that transformation looks like over time. both in terms of its structure,
but in terms of the people. to your point, many of them may be so it means you no longer is a need for that position. i think that would be helpful so people understand there is an organizational transformation that's going on. last thing, just to follow up, when a veteran calls for help, let's say it's a distress call for a veteran who may be worried that they're that i thinking about suicide, how are these calls tracked? in other words, if i get reports that a veteran called and was told to call back, how i can track that down and either make sure that person has been trained and hasn't done their job, therefore they should be fired, or that their supervisor hasn't gotten them 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. i'd like your advice on that. either in the committee or afterwards. mr. mcdonald: it's a very complex issue. let me give you a headlined and -- 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 i.g. report, which was written starting on an investigation that started in may of 2014, so before it was confirmed, found that we had a third party that we contracted with that was using voicemail. we 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 a 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 shift the call on -- automatically, rather than having them call back. so this is a work in progress, we're happy to brief you on it. it's taking us longer than we like. but it is one of our goals for this year and we do need the budget to do it. mr. sullivan: thank you, mr. chairman. appreciate the witnesses' focus on these very important issues. mr. secretary, good to see you again. dr. shulkin, wanted to follow
up on a couple of things. i senlt you a letter dated january 4, 2016. this is on the ongoing issue. the 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. veterans who are hounded by collection agencies for unpaid bills that were -- the services were approved by the v.a. and now somehow our veterans are getting sat saddled with that -- saddled with. that the letter had a number of -- actually pages of cases, 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 i think we should nip in the bud, kill. it's outrageous. mr. shulkin: absolutely agree. i heard this directly from you and from veterans when we were together in alaska as well.
so 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 let's us know about that situation, we'll intervene immediately. we've done over 400 interventions in the last three weeks since we put that number up. so we want to know from all your offices, because we want to help. mr. sullivan: is there something legislatively we need to do to fix this? mr. shulkin: no. mr. sullivan: just let them know that if there's that's an issue they should call you guys and you'll take care of it. mr. shulkin: what's happened is because we have had a problem in paying on time, the veteran's been put in the middle. those are the ones we want to stop. right before you came in, we talked about, we now actually have delivered to the t.p.a.'s
yesterday the contract for them to sign that will decouple medical documentation from payment, so we can get much better payments and avoid these situations from happening. mr. sullivan: if you can follow up on the specific ones in the letter, that would be very useful. i wanted to go next to shoot with regard to the appeals process. and i noted that the budget certainly focuses on this, it's an issue that, you know, you know the numbers, but 400,000 veterans have appeals pending as of january, 2016. 80,000 of those are older than five years old. 5,000 of those are older than 10 years old. put forward a bill, s. 2473, very strong bipartisan support on this committee, i won't go through all the elements of it, but we certainly want to work with you. i think my staff's 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? because it does relate of course to the backlog issue and what we don't want to have happen is the backlog then have the appeals become the problem. but we think there's some good things in the bill that 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. mr. mcdonald: we do think the moving forward with the fully developed appeals process makes sense. we are supportive of that. but 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 cite appeal in a year. to do that what we've put together here in this budget is a plan where we add more people now 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 that 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 gum pping up the system for everyone else -- gumming up the system for everyone else. 10% to 11% of veterans appeal. 2% of veterans create about 45% of the appeals. some have appealed 25 taos 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 compensation. and many of them who are appealing are already rated 100% disabled. so you want to get to the point where you can freeze the -- it and cause the person to have to
resubmit rather than having the same person appeal over and over and over again, recognizing that there's no recourse that we have to stop them from doing that. mr. sullivan: we would like to work with you. i appreciate that update. and how you're laying that out more strategically. we'll continue to work with your staff on the s. 2473, which we think is -- it's a pilot program, you may have seen the legislation. we think that it offers a good opportunity. similar to the pilot program that the v.a. is instituting in alaska and for the record, mr. chairman, i'll just ask for -- sub mutt for the record an -- submit for the record an update on where we are on the alaska pilot plan as well. hank you, mr. chair. >> thank you for being here. what is the v.a. currently paying for the cost of hepatitis c treatment? for a regiment of hepatitis c
treatment? mr. mcdonald: less than we were . >> got that. mr. mcdonald: our drug pricing is proprietary. so unfortunately i can't say exactly what it is. it is by far the best on the market. that's why it's senator isakson: $5 ,000 and you are averaging 25% to 30 less. senator cassidy: should be able to treat veterans less if you re paying $35,000 per. secretary mcdonald: that is the idea. we had a five-year plan and with lower costs how do we compress it going forward. senator cassidy: 35,000 to be treated, you hope that's on the upside. secretary mcdonald: 35,000 is in
the budget. we can do many more now. senator cassidy: in the regimen of folks having a new pay scale, government benefits are more generous than private sector benefits and i don't know if that is true for executive compensation? not? >> i would argue that. senator cassidy: i'm talking about retirement benefits. the retirement benefits would be roughly equivalent as well. there is not a tail that is going to come back and bite us greater than we would anticipate? >> no, sir. senator cassidy: when industry decides to downsize, but civil service restricts the ability to release folks when they are no longer needed. it is bad for the veteran. under the new authority if you downsize, we no longer need this
facility, can you immediately release the person without having to go through a complicated process? >> title 38 gives us much more flexibility. senator cassidy: would it be as flexible as the private sector? secretary mcdonald: i'm trying private david, some sectors differ. some people have extended contracts. others are at-will and title 38 is somewhere in between. senator cassidy: you mentioned in your testimony regarding the closing unsustainable facilities and we are actually interested in this and sent a request and we have a request trying to figure out where are these facilities. you attempted to close one in massachusetts, but you ran into environmental issues. but i think i heard you say before, if you have these vacant
facilities and underutilized, what are the top three obstacles in closing them? donald secretary mcdonald: number one would be congressional opposition and congressional opposition borne by maybe perhaps veteran opposition. if you are a veteran and the hospital you go is in a remote area and the hospital only serves five patients a day, it obviously is expensive to serve five patients a day but if you are one of the patients being served, you want it to stay open. senator cassidy: you have 370 facilities that are less than 50% occupied which presumably wouldn't have to be shut down or we are no longer using this wing. those that are fully vacant, what are the obstacles for closing those?
secretary mcdonald: congressional opposition, veteran opposition, some are on the historic buildings. some of our buildings are over 50 years old and we have to come with an atlanta nature use. senator cassidy: let me ask, that could be including boarding umh and putting a fence around? secretary mcdonald: yes yes, sir. senator cassidy: we have money not being used for patient care but not mothball buildings. i would be an advocate of putting a fence around it. and other reasons -- i'm sorry i sbrupetted you. secretary mcdonald: those are the primary reasons. senator cassidy: down from 50% use to closing off a wing, what are the obstacles there? secretary mcdonald: depends on
the building and what it is used for. we do close off wings but they are expensive for us to maintain. honorable shulkin: you have to maintain the pipes and other things. what we normally refer to is the 10 or 11 million square feet that costs us the $26 million a year. in some cases we are being short sighted in not making the upgrades when 60% of our buildings are more than 50 years old, you know we are maintaining systems that are very, very expensive to maintain. that is using technology, we would be able to do a much better job. senator cassidy: when they rebuild a new hospital, they tear it down. you get grandfathered in. it could be more cost effective to cut your losses.
i yield back. senator isakson: senator boozman. mr. boozman: we do appreciate your hard work, i very much appreciate the ability to get in touch with you and you all being very accessible. you mentioned several accomplishments that you have made and that's one of those that people don't think about, the accessibility is important. in going along with that, you also said that the problems couldn't be fixed overnight. could you talk about some of the biggest obstacles that you face in that regard and is there a need for additional legislation to help you in that regard? secretary mcdonald: thank you so much for the question and the time we spent together. to me, job one of any leader is to get the right leadership team
in place and it has taken me to get the 10-16 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 have recommended taking the s.c.s.'s from title 5 to title 38. for me that's job one. we have to get the right leaders n place. mr. boozman: i think we have a situation now where they have overtime more than upheld. secretary mcdonald: batting a thousand. mr. boozman: worked hard and gotten in a situation where you
headed one of the biggest, most respected corporations in america. i think as we visited, i think if the v.a. were a business, it would be the sixth largest in the country. secretary mcdonald: yes, sir. that's correct. mr. boozman: how is it impossible to run an agency where you don't have the ability to discipline people when they need to be disciplined and with that size there are going to be situations where people need to be disciplined and need to be held accountable and how can we help you in that regard and see if we can get this straight. secretary mcdonald: we think the right approach is the proposal we are working on together, the white house and congress ongoing from title 5 to title 38. as i was sharing with the chairman and we talked this when
we were together, we have worked hard to connect performance with outcome. i talked in my testimony about bonuses and rewards are down in the v.a. we have a ranking -- mr. boozman: the old days of handing out a check are over? secretary mcdonald: over. the ranking of our performance by performance level is best in government and fully equal to best in the private sector. 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 10%. and the steps that we're taking are giving people a good knowledge of what they have to accomplish holding them responsible for doing that and making the reward matches that. that is part of the training as
we do the train, it's all about that, accountability and responsibility. changing the s.c.s.'s from title 5 to title 38 would be so important. mr. boozman: you mentioned the vet link program, 3% were dissatisfied, which is a low number. what do we do about the %? how do we follow up on -- secretary mcdonald: we are putting in place a standard veterans' satisfaction measure across the enterprise and this will be the first time ever that v.a. has had this, believe it or not. and we will follow up with the eterans who express a level of dissatisfaction and remediate and we are trying to do that with vet linching and take the comments in and the medical center director has to react to
them and make changes on the spot. mr. boozman: appreciate your service. senator isakson: thank you for ringing up about the accountability. the secretary addressed that and a brought that up. we are in a situation where you have a tool box and has run the agency. i commend you on the things you have done. and getting a new tool box andville accountability as a mechanism that works in the v.a. we have a second panel to come forward and i appreciate your time. second panel, please move forward.
close. that is the infrastructure portion. i'll leave my comments on that. we do have some real concerns about this continued escalated growth in funding on community care. the v.a. introduced its new account when coupled with the choice act, they project to spend $12.2 billion in care in the community. we understand the need to leverage community care as best as possible to expand access. the independent budget framework that we have discussed with the committee staff outlines some of our ideas in that same way much as the v.a.'s new choice plan addresses the issue. however, we are concerned what is the potential for uncontrolled growth in this area. while the congress and the administration seem to be focused on expanding access in the community, i don't think we can emphasize the need to devote
critical resources and focus also on expanding the existing exassity of the v.a., particularly in the areas of specialized services like spinal cord injuries or disease. outsourcing the care in the community, runs the risk of undermining the larger health care system which many veterans particularly those with catastropheic disbilities rely upon. in the v.a.'s budget this year, they project for fiscal year 2016 to spend $1.7 billion in section 802 choice funding. 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 act funding but their budget doesn't square those facts. where will the additional money come from. the remaining balance of the
choice act but that would call into question, how does that impact the $.8 billion that they are projected to spend in fiscal year 2017 in community care. we have concerns about how it will be broken up. last year with the massive budget shortfall, that caused some significant difficulties in trying to manage the funding line. we'll be keeping a close eye on that. with these thoughts in mind, we have concerns about the funding level for fiscal year 2017 that was approved in the advanced appropriations in december of last year. while they recommend prl $72.8 billion for medical care, that appropriation included $66.6 billion. that's a lot of money. the v.a. revised its estimate to
a much higher and much more significant level we believe reflective of the actual need they project to have for 2017. unfortunately, we are setting up a scenario where the very same shortfall problems we experienced last summer may rear its head in 2016 and potentially again in 2017 if this advanced appropriation level is not appropriately addressed. we hope this committee will take a look at that and consider that when you put together your views and estimates. we are concerned about the 2018 advanced appropriation level. when we questioned the v.a. on what we felt was an insufficient level for 2018 along with medical care, they admitted that they don't believe it's going to be sufficient either, which is kind troublesome to us. if you took the historical perspective that that's ok
because it will be corrected. the last two years, congress has adjusted the advanced proceedings in many appropriate ways, the four previous years to that, congress did not adjust by a single dollar, the advanced appropriation for health care. so the track record doesn't lend itself to underestimating now to get it creggetted later. i hope the committee will look at the advanced 2018 appropriation and assure that funding isn't short. i would like to thank you for the opportunity to testify. i would be happy to answer any uestions you may have. mr. varela: good morning. on behalf of us, we thank you for providing us the opportunity to consider our budget and the board of
veterans appeals, the board and simplified appeals process recommendations. for comp. service we recommended n increase of 1,7000 a quifflets. the administration requests 00. believe that 1,000 of the 7,000 requested should be dedicated solely to appeals processing. without adequate resources, pell ants seeking redress will endorse ajudication of their appeals. we have recommended 100s, 300 f. t.e.e. and 300 ft emp e for call centers. d.v.a. must be meeting the needs of veterans, survivors and
dependent eants. second, the rehab. they have recommended a staffing ncrease for f.y. 2017, 158 new ftee's are required, but the administration has not required a staffing increase. this has increased steadily over the past few years to include new applications for entitlement determinations which has increased at roughly the same rate. votion national counselors perform tasks dealing with responsibilities to evaluation systems and veteran success on campus activities. vrc's have one of the most critical roles. they need to ensure they have guidance and resources to lead to more independent and
economically fulfilling lives. they recommended a staffing increase that would support a more client to counselor ratio to devote the appropriate time to ensure they are on a path to success. third, the board. we are please todd see the administration's request for $-- 242 ftee's. we support this request. the additional personnel are needed given the large number of appeals now estimated at 440,000. it's important to note even if the board is provided with this staffing increase and the budget is appropriated on time, the impact would not be realized until 2018. regardless of the time it will take to hire, train and on the part these new hires to the board, they are desperately needed now. and in f.y. 2015, the board
produced 57,000 physicians with 646 ftee's. and if the board were to receive their staffing increase, it could complete 81,000 appeals each year. however, to end the backlog and keep up with incoming appeals, future increases will likely be needed. the proposal regarding a simplified appeals process. we strongly object to closing the record at the point of initial jurisdiction and transferring it and eliminating for a personal hearing. however, they are pleased that they have engaged with us regarding their proposals and we hope to find reasonable and tangible solutions to address the appeals process. i would like to highlight, we
have put several recommendations, such as eliminating the materials standards and enacting fully developed appeals legislation. that passed in the house and introduced here in the senate. we would like to thank the senators for their support. we cannot emphasize enough how important it is to move this legislation forward. it has the potential to provide tangible relief to the appellants and v.a. while it is set up an appeals processing, tempered with due process protections, chairman and members of this committee, thank you for allowing us to testify today and i look forward to your questions. mr. kelley: on behalf of the 1.7 million veterans, thank you for
the opportunity to testify today. as partner of the i.v., we are responsible for capital infrastructure and national administration so i will limit my remarks to those two years. for more than 100 years, the government's solution to provide health care to our veterans is to build, manage and maintain a network of hospitals around the country. many of these facilities need to be replaced or expanded and all need to be maintained. they use the plan to manage and identify v.a.'s current and projected gaps in providing safety. major and minor construction, leasing make up the four corn stones and each work together to ensure veterans have access to their earned health care. while congress and v.a. need to realign the process to allow v.a. to enter into public-
private partnerships to right size v.a.'s footprint, it must fund the projects that are funded today a begin design on those projects that we know they need to fund in the near future. there are 30 major construction projects that are partially funded. to completely fund these projects, v.a. has to invest $30 billion. they need to be put on a clear path towards completion. the next five major projects, two of them are seismic in nature, one is a mental health care clinic and the other a spinal chord center and one is to eliminate access barriers. congress needs to appropriate $1.5 billion for fiscal year 2017 to help close these gaps. 600 minor construction projects
need funding. congress provided additional funding through the choice act and will obligate over $500 million to construction projects over the next two years. these funds are supplemental and not appropriated for minor construction. with that in mind, with they are requesting $749 million for fiscal year 2017. $52 year v.a. is requesting million for leasing needs. while v.a.'s request is adequate, congress needs to authorize these leases and the leases that were brought forward last year. even though nonreoccurring maintainance isn't found, n.r.m. critical to v.a.'s critical infrastructure. they are investing in projects that was funded from the choice
act. but to maintain the status account, it needs to be funded t $1.35 billion. e i.b. requests $ 35 billion baseline for this line item be appropriated so n.r.m. backlog doesn't grow any larger. they asked for and improperly spent for what it needs and recommends that it be refounded at the requested level. v.a. provides construction grants for extended care facilities. they request $200 million for grants and $51 million for cemetery grants. thank you for allowing the v.f.w. to testify before you today. and i look forward to the questions you may have.
>> $money that goes to veterans based on laws for the sole purpose to make them whole. doctors, claims processes, administrative staff, the speaker pro tempore: t. infrastructure and out of that $65 billion will be spent on health care alone. members of this committee, on behalf of the national commander and 10% of all u.s. american veterans, we welcome this opportunity to comment on the department of veterans affairs budget. operatingeizer had an revenue and a staff. meanwhile for the same amount of money, v.a. ran 150 hospitals and 131 national cemeteries.
unlike private v.a. providers are not eligible for overtime pay. when v.a. is conducting its standdown. v.a. will incur very little expense while serving veterans. i'm not sure we can expect the same level from private sector. they have the largest teaching hospitals in the country and maintains emergency backup infrastructure in support of our national defense and national emergencies, millions of compensation claims and cemeteries, processes g.i. bill payments and insurance programs and all while providing health care to millions of veterans in 50 states. this is a massive budget that is broken down and thousands of line items. does v.a. have enough money? they have too much money. all valid questions. but the bottom line is.
someone's got to do it and to date no one has come up with a cheaper solution. and written need portion of my testimony the american legion would like to draw your attention to three areas. consolidation of outside care, ensuring staffing and growing number of appeals. with enactment of the choice act, congress had added one more layer to a and congress for them to fix it by organizing these programs with the single point of entry and streamlined and easy for primary care teams to use, this would not only provide them health care. it is a service-based industry. the most expensive line item is
employee burden. the fastest way to save money is to reduce employee turnover. they have a terrible record of success planning. if they keep their positions filled, they must do a better job. it's rare if it happens at all. this practice leaves little incentive for the deputy to remain loyal and breeds resentment. v.a. has 50% of leadership positions filled by temporary fill-ness. employee turnover is expensive. finally claims. every time a claim goes into the appeals process, it costs money. it will be reduced to a trickle. we address appeals, v.a. has included a request. as submitted.
the american legion does not support that plan. v.a. has been working with the american legion to look at ways they can improve the timeliness and we are excited and encouraged by the progress we have made early on in this discussion and with the openness to get input by treating them as value partners. i will be happy to address any questions you may have.
mr. varela: i have to take that for the record. i don't know that offhand. senator isakson: when we did the act, we made sure to give the states the flexibility to do veterans' training and rehabilitation as a part of that. that is a source of funding and personnel. wouldn't add personnel to the v.a. but service. but i appreciate you checking on that. mr. blake, i'm going to read
this to make sure i get it right, unless i pass out first. your testimony recommends $75 million for a million nunding programs proposed by medical. could you further explain the commendation for dedicated funding. mr. blake: that is a special program that the v.a. is doing, study of all veterans and evaluate the wide variety of issues unique to veterans. our concern is it is a heavy lift. and the v.a. does a good job of extending much of its resources dedicated for the existing medical and prosthetic account. the v.a. is projected to draw $65 million out of its
appropriations request just for m.v.p. and bring the account number back below what was just approved. so we think it would be better served to direct funding for that program for the independent and prosthetic research. senator isakson: thank you for your testimony. this applies to you. if we can form a goal to get this appeals process in terms of v.a.'s claims and appeals, that would be a major move forward. we are at a point now where the committee is prepared to move forward on major legislation to improve some of our problems. let's not let another year go ast and get the v.a. straightened out. senator blumenthal. senator blumenthal: i apologize
i wasn't here earlier, but this is my fourth committee meeting today and the armed services committee where we are assessing the capability of our military force in the south pacific and an issue you feel is as important as well. 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 which is the capacity of the v.a. to deal with women's health care and although we have an all-male panel here or because maybe we have an all-male panel how do you feel the v.a. is doing, judging by what you are doing by members of your organization? >> i'll start. >> the american legion has a
program called a system we are saving. one of the things that we specifically look at is women's health care. female veterans is the fastest growing population of veterans and while v.a. has had a very difficult time standing up women's health care problems, they have come a long way. there are women's clinics. does every hospital have a women's clinic? they do. could they be improved? yes, they can. they are moving in that direction and need to maintain the flexibility and spending to create that and also on that, we need to make sure we continue to keep an eye on child care. there are a lot of women veterans who will forego their medical appointments. they can havegram
child care clinics. we need to make sure those remain funded. senator blumenthal: that point is very, very important and i have heard this repeatedly. we have a new facility, a new clinic in connecticut. it is tremendous improvement. but the issue of child care, the issue of transportation, the issue of taking off from work, which may affect menace well as women, but particularly so for women. i welcome any other comment. >> one of the things i would mention, we can't speak from the perspective of how women are experiencing the v.a. mr. blake: they have advocated additional resources for their programs. the they recommend 90 million in 2017 and 100 million in 2018.
i would offer that while it would be unfair to say there aren't challenges in delivering health care to women veterans, one of the areas we see difficulty that is still out there is meeting the needs of women veterans who have spinal chord injuries. if it's a challenge to deliver care just to women veterans when you add the aspect of complicated services, that adds a whole new element. >> we commissioned a survey and will get the results back when our members are here but just as a recap, women veterans who access v.a. are pleased with it. mr. kelley: they want better access to female providers. 40% are being provided to a
female provider. it goes much further. you mentioned child care. one of the leading causes of the lack of ability to get services and employment services is the lack of child care. it is a hindrance and leading to homelessness and they have no way out. we need to tackle that as a larger issue and women veterans o are over the age of 55 use v.a. at a much lower rate. we need to figure out how to do outreach to let them know that the services at v.a. are there as well. senator blumenthal: mr. kelley, the survey that was done, is that of the v.f.w. members or of women veterans? mr. kelley: we shared it within the community for them to send
out to their membership as well. we have active duty, guard, reserve, veterans from multiple organizations. senator blumenthal: and the number that you mentioned, 40%, that is the number of women veterans who want to see a women health care provider? mr. kelley: keel 40% of those who are seeking health care. 40% of them are being seen by a female provider. by and large all of them want to be seen. senator blumenthal: 40%. in addition to the other challenges that the v.a. has in recruiting female providers, dealing with women's health care issues. mr. kelley: they are doing a great job of training their doctors they have for the
particular needs of women veterans. when asked, would would you prefer to have a female doctor, they want that as well. senator blumenthal: that may be a key to involving more women in seeking health care, the availability of women physicians? r. kelley: that's correct. mr. varela: i would add that the women veterans that we hear from, they say, they don't want better care, they want comparable care and we believe the v.a. is moving in the right direction but more can be done. senator blumenthal: i would like to finish with the chairman's in dullingens. you say that the v.a.'s dollar amount for health care for fiscal 2018 is lower than you
would like to see, is that correct? what is the number that you think it should be? >> mr. blake: recommendations for 2018, our recommendation is about $777 billion. about $64 billion. one of the things i would point out, though and this is a touchy subject, but looking at the community care account alone, $12.2 . looks to spend billion that's through choice and community care account. yet their projection for 2018 reduces that projection by $3 billion. i'm not here for expanding community care, but how can they square that fact? senator blumenthal: thank you very much. i want the record to show that secretary mcdonald and his team are here.
they are 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 afterwards but it is the mark of the expertise and experience and insight that this panel brings to this process that he and his team have stayed. 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. senator isakson: senator boozman. mr. boozman: i echo the ranking member and appreciate your service in so many different ways to your veterans and fellow veterans. we have had your written testimony or heard your spoken testimony. lots of issues today, lots of concerns. if you just take a second and go
through, tell me if you had to summarize the top one or two things that you are really concerned about the budget. that's what we are talking about today. what is at the top of the list. what are your real concerns regarding the numbers that we're seeing on the budget? r. blake: i would say from our concern is clearly what is a projectedes scalted growth in community spending. it doesn't improve access. by and large our numbers don't use the choice programs and don't avail themselves. because they are best served by the system of care in v.a. for all of this work toward expanding community care access, those people and our members
feel like they are being left out in the cold in that discussion. v.a. is committed to making sure there is access for our members in the system of care, but there is more that can be done. mr. boozman: i would like to include capital infrastructure. if you just look at the way it has been put together, in between -- it's around $60 billion in the construction and infrastructure needs that v.a. would need to do under the current model to close that out. that's a tremendous amendment amount we need to look at ways to enter into sharing agreements, to ensure we can reduce some of that backlog on new construction and get out from those older buildings. and i mean as i mentioned in the
first panel, if you are trying to maintain a building that 90 years old, it is much higher than a building that is 10 years old. we need them to give the ability to do those things. and where are we going with construction in the future and align that $60 billion, what can e carve off of that. >> the independent assessment highlighted from leadership, everybody recognizes needs to be fixed immediately. if you have a skeleton crew, you can't serve veterans. if they are not going to be keeping you have a leadership that is unwilling to make decisions which then goes ahead and contributes toll whistleblower retaliation and people dissatisfied.
i heard the secretary and dr. shull kin can talk about reviewing the positions that are needed. they have to do that assessment. if they eliminate those positions, the people that have been pulled from those positions, it's a ripple effect. we have 50% over the v.h.a. lapped scape of leadership that is in a temporary leadership or vacant if those individuals are filling in are just plugging the gaps so the operation can move forward, their positions are now vacant. it's a very difficult situation that needs to be fixed and needs to be fixed immediately. >> if i could comment on my oversight. our concerns lie within the .mount of personnel they have
mr. varela: they should process appeals only. d we need to hire 1,000 -- 1,700 for that program specifically but to people per that hiring. maybe a portion of that so once we get the backlog managed, we may not need all of those people. so within vr nmp e, you take wounded, ill and put them back into the work force, i mean how does the program continue to increase each fiscal year yet their fiscal levels do not. hat is a major concern for us. senator isakson: i want to thank he secretary and thank you you to the v.s.o.'s. [captions copyright national
>> since the start of this campaign, only one network has taken you on "the road to the white house" from the early announcements to the speeches to the candidates visiting diners in iowa and new hampshire and the campaign rallies. after the results in nevada and south carolina, the republican race has narrowed. we are going to stay in south carolina and then we move onto the multi state primaries and caucuses in early and mid-march. this race is getting under way. follow it on the crmp span networks on c-span dorgan c-span radio.
guest: just passed and signed it into law and didn't like it when he did it but he did sign the ball and has a prohibition against any funds to close guantanamo bay. host: can he do it by executive action? guest: whether or not there is a way if he can't do it himself, i think he can direct the military to do so but the military has to follow the law and how that comes down, good question. we don't think he can. but how they respond to it.
he has the ability to interpret it and look around and figure out some way to get around but that doesn't bode well. host: what about his argument that we can put these prisoners the ones that remain in maximum prisons in the united states? guest: he has failed in his argument. republicans and democrats alike said we are going to keep them at guantanamo bay. i have been there and i have seen it. it's a secure facility. it's a case of where it was
designed specifically for the individuals that we do want to rejoin the battle against our forces or allies. it has worked to date. if the president wants to offer alternatives but it should be those that should be declared by congress. we have a law on the books, signed it. he will not be transferring those prisoners. we are trying to figure out the logic that he may try to use. we don't know what it would be. guest host: how do you justify it
>> so there's a cost involved in transferring it. the facilities are set up right there where they are at and we rg are going to have guards. host: congressman rounds, republican from south dakota on president obama's proposal to close gitmo and the latest on the peace deal syria and isis and lots of different things to talk about and big pro opponent of ratcheting of a cyber war. we get to our first phone call. a democrat. caller: caller: good morning, senator rounds. i agree that signing statements are ineffectual and the president should restrain
himself when issuing them. are ie president should restrain himself when issuing them. i also agree that the president should not close guantánamo by eo say as a moderate democrat, the cost savings over time are very clear to me. roughly millions of prisoners going forward with a $250 million cost for 91 prisoners, $2.2 million per year. domestically, weekend house moneypeople without that and it would be astronomical but when you think about the savings over time -- and i didn't hear you mention the cost of the transition, but over time, and they would be there