tv Veterans Affairs Secretary Urges Congress to Redesign Choice Program CSPAN May 31, 2017 11:57pm-12:41am EDT
use that political term, owned by a labor union in chicago, and a socialist who bought a station in new york city, they wanted to espouse their opinions. these were immediately dubbed propaganda stations by regulators. when they were renewed, they were told to be careful about expressing opinions. >> sunday night at 8 p.m. eastern on c-span's "q and a." >> veterans affairs secretary shulkinelton -- david held a press briefing today. that are in suicide has become a top priority. from the white house, this is 40 minutes. sec. shulkin: thank you. good morning, everybody. so, a few weeks ago the
president came over to my office is at v.a. at his hundred day mark to talk about our progress. i only thought it fitting in my hundred days to come to his house to talk about what is happening at va. as you know, the president is so committed to fixing issues for veterans that what he has told me is that it is important that we be open and candid and we be open and candid and transparent about where the problems are. that as a businessman, the only way to fix issues as an organization is if you come out and talk about what the issues are. i am a doctor and i like to diagnose things, then treat them. what you're going to hear today is a candid assessment of where the problems are in va, with the focus of a businessman and the skills of a doctor to help you with that. many of the challenges i'm going
to talk about today have been decades in building and a span multiple administrations. this is the time for us to address these chronic problems that have affected veterans and in many ways, have harmed the veterans and their families by not dealing with these issues. i am going to tackle these issues heads on. just to give you a sense of what we're doing today, i'm going to talk about 13 areas of significant risk for va. it is going to take about 25 minutes to get through. so if you need to get up and stretch or you have add and need to leave i will not be offended. i just wanted to give you a sense about that. we have had 137 different assessments and studies telling v.a. what is wrong and how to fix it. what we have done in my first 100 days is to go through these studies, the commission on care, independent assessments, and our own internal assessments, to come up with these 13 areas of
risk that i want to share. that me start. the first area is access. as you know, we started with our wait time issue in 2014. the real crisis that began recently at va. here's my assessment on access. we've done a significant job in improving access to care for clinically urgent veterans. people with clinically urgent needs are now being addressed in a much more efficient way. we have developed same-day services in every one of our 168 medical centers for primary care and mental health. in fact today over 22% of veterans are seen on the same day basis. what we have done recently as we have posted our weekends for every single one of our medical centers across the country in a public forum for everybody to see what's good and what's not good in terms of wait times. there is no other health system
in the country that has done anything like that, and there is no comparison to what the va is doing in terms of transparency and wait times. yet, veterans are waiting 60 days or more for new appointments in primary care mental health at 30 locations nationwide. we still have more to do. while we have done well with meeting urgent needs of veterans, 10% of the time when a provider wants a follow-up appointment in a specific timeframe, we are not meeting timeframe, we are not meeting that provider's clinically assessed time for a veteran to come back. that is something we have to address. 16% of our primary care clinics are over 100% capacity. when that happens, we cannot fully meet their needs in terms of access to care. 10% of our outpatient centers do not offer same-day services today. we are committing by the end of this year that all outpatient centers will offer same-day services in primary care and
mental health. but today, 10% are not meeting that. the second category is paying providers when veterans go out into the community. as you know, our choice program, community care program, has provided increase access for millions of veterans. we have 500,000 community care providers, doctors and others in the community, who participate in our network. but providers are increasingly frustrated with the va's ability to get them payments to the point that some are leaving the network. that is working against us. it takes more than 30 days to process 20% of our clean claims at va, which affects about 25,000 providers across the country. in addition, we have about $50 million in outpatient billed charges that are six months or older. as of april this year, only 65% of claims are handled electronically.
that is far below what you would find in the private sector. we need private sector help to find new solutions to get the number well above 65% so that we can have faster adjudication and payments to providers. the third area is community care in general. though we've made a lot of progress with our choice program, because we've had over 70 amendments to the original contract, we still have eight separate programs for paying community care. that makes it too complex and it is confusing veterans and employees alike. in terms of the complexity of this program, it results in va rejecting one out of five community care claims. the rules are so complex and people are confused that 20% are rejected, much higher than what you would find in the private sector. we need congress to help us fix those eight programs and put them into a single program.
in terms of our choice program, we still today only have three department of defense facilities that participate in the choice network. we need to get the department of defense and va can make all their facilities and our facilities open to veterans and active service members. we certainly have to work with congress and our veterans service organizations to redesign this choice program. it will expire at the end of the year, and we need new legislation. this congress needs to make sure veterans don't go back to waiting longer than they need to wait to get care in the community, so we have to pass legislation this year. the next area is quality. quality of care in the v.a. we share with you our star rating systems. we now published that on our websites. we also now publish quality of care comparisons between v.a. and local community hospitals.
and that, we have identified 14 va's that have one star ratings. that means the quality is below the standard in the community. that's not acceptable to us. andre deploying teams implementing performance plans for those facilities. veterans should not have to accept low quality care. and they deserve our very best. i think everyone agrees with that. when they are not getting the best they can get in the va and the community offers better, that's what we will work to do in a revised choice plan, to allow them to ge into the community if they are not getting the best care. the next is disability claims and appeals. we have over 90,000 disability claims that are taking more than 125 days to process. our goal is to cut that in half over the next two years.
but 90,000 plus is too many to be acceptable. last week we processed a claim for disability in three days. that's called a new process called a decision ready claim. we will be introducing decision ready claims nationwide on september 1 of 2017. in addition to that, we are going paperless throughout all of our veterans benefit offices by mid-2018. we are focused on not doing claims fast enough now, but we have plans to get much better. in addition, it's very hard for a veteran to get information on where their claim status is. we need to make that process more transparent. in appeals, it takes almost three years if you were to file an appeal today to get a decision. that is going to take congress to help us fix that system. i'm grateful the house passed appeals legislation last week. we need friends in the senate to
act on appeals legislation as soon as possible. information technology. we have 20 facilities that have s for i.t. and inventory. and that makes it difficult for doctors and nurses to get the supplies they need to care for veterans. this is what we saw in the washington dc va several weeks ago. we have taken immediate steps to begin to start fixing these inventory systems and we are executing on those plans. currently 75% of the i.t. budget is just maintenance and sustaining infrastructure, because our legacy systems are old and at risk of failing. that would cripple our operations. howard scheduling -- our scheduling and financial systems are outdated. that contributes to the excess weight times. both systems are in the process of being replaced, but it will take years to complete. we have a system called valeria.
the va loan electronic reporting interface. without funding for a new system, va will have to revert to a paper-based manual system for loans that would reduce the number of veterans we serve from 90,000 per year to only 12,000 per year. we can't afford to let that happen. veterans could be at risk of foreclosure or homelessness. for loans that would reduce the that's a risk we have identified. we have to modernize all i.t. systems to make them commercially viable and cloud-based solutions to the maximum extent possible. i'm committed to making a decision in the v.a.'s electronic medical record in the near future, definitely before july this year with my commitment, that i would talk about how we are going to move
forward with the new emr strategy. our buildings and facilities are falling into disrepair. we have a facility condition assessment report that identifies $18 billion would be required to fully remediate buildings now, including structural, seismic, and electrical and mechanical improvements that need to be done. on average, our buildings are more than 60 years old with only have been built since 1920. we have 449 buildings from the revolutionary war and the civil war, of those 96 are vacant. we have another 591 buildings built in world war i era, which 141 are vacant. in all, v.a. has 400 weakened buildings and 735 underutilized facilities, costing taxpayers $25 million a year just to maintain vacant and underutilized facilities. we need to act quickly. va currently has 27 facility
releases that are waiting for congress to authorize. that would revised 2.3 million square feet of needed space for 3.2 million additional clinic that would revised 2.3 millionve can't do because we need authorization from congress. we need different types of strategic partnerships to be able to bring the type of facilities that we need to veterans, and that means working with local government and academic affiliates, other federal agencies, and private sector partnerships. we will work with congress to develop a modernization plan for instruction -- infrastructure through a national realignment strategy that will allow us to use our buildings in a better way to stop supporting vacant buildings and underutilized buildings, all to be a better store of taxpayer construction. dollars. 11 of major construction projects totaling $1.4 billion are on hold because the v.a. and u.s. corps of engineers are
still trying to work through difficult processes and interpretations of the appropriation rules. we are waiting on a congressional approval on a joint proposal to move forward to allow these projects to go ahead. we have large unobligated balances. we carry at v.a. $971 million in minor construction as unobligated balances, and $2.6 billion in major construction. v.a. is taking way too long to make construction awards, and these obligations are critical to meet facility demands in the future. accountability. there are currently a law, the has to wait at least a month for holding employees accountable for poor performance. these obligations are critical to meet facility demands in the future. we have 1500 disciplinary actions pending, meaning people that either need to be fired, demoted, suspended without pay for violating core values, and
we are waiting for each of those actions. our employee accountability processes are clearly broken. we have to wait more than a month to fire a psychiatrist caught on camera watching pornography using his ipad while seeing a veteran. the expedited senior executive removal authority given to us in the choice program isn't working. we were not able to utilize that because of constitutionality issues. because of the way judges review these cases, they could force us to take terrible managers back who has been fired for poor performance. we recently saw that in one of our executives in san juan. just last week, we were forced to take back an employee after they were convicted no more than three times for dui, and served a 60 day jail sentence. working. we were not able to utilize that under current law, it takes 51 days from the date management
suspends or removes an employee from the day that action takes effect. despite the limitations in the existing law, we have recently removed a washington dc medical director from their position and other employees as well due to failure of leadership. we removed the medical director of shreveport, louisiana and three other senior executives for misconduct or poor performance. the president signed an executive order to create an office of accountability and whistleblower protection. that reports directly to me as secretary. that isn't enough. we need new accountability legislation, and we need that now. the house has passed this, and we are looking forward to the senate considering this, but we need that action. staffing. it currently takes on average 110 days to onboard a nurse in the v.a., and 172 onboard nurse practitioner. that is just too long. v.a. doesn't have a position management system. it is very difficult for us to
track what jobs are open. an organization our size needs that to meet the needs of veterans so they have the right resources for them. we will establish a fully functioning management manpower office by december of this year, which is a first step in a position management system to be established. low salaries for many of our health-care providers and prosthetic professionals make it difficult to recruit and retain the best professionals. in 2016, the mean salary for a biomedical engineer in the country is $85,620. the national average for a biomedical engineer in the v.a. is $65,677, or 25% below the private sector. for mechanical engineers, the difference between the private sector and v.a. is $15,000 a year, or 18% were v.a. is below the national average. if we can't compete with private sector salaries, we will be
unable to retain qualified providers and support staff. to help with these shortages, we are pursuing legislation that would expand graduate medical education training opportunities to be able to train more health professionals to stay in the v.a. system, and we are working with the unified services university, the medical school of the military, to train more medical students who would serve in the v.a. 10 years after their education. bureaucracy. our central office in v.a. has grown too big and is too bureaucratic. we need faster clearer decision-making and authority that will give veterans more control of their services and care. i have directed the v.a.'s central office to remain under a hiring freeze as we consolidate program offices. we have 140 program offices. i directed them to implement shared services so they don't replicate common corporate services.
that is a result that i plan to achieve of a 10% reduction in overhead. in addition, we have been reducing burdensome regulations to make v.a. more effective. v.a. will immediately stop requiring the use of small house for future state home grants. we will stop using federal rules. we will allow the states to use their own requirements to build veterans homes in the states. that will save taxpayer dollars while increasing access to veterans. a few weeks ago, we announced the v.a. is removing the more restrictive guidelines for mammography for women, and instead adopting the american cancer center mammography guidelines to allow women veterans more access to care. we are restructuring caregiver regulations to make it more accessible to veterans and less burdensome to caregivers. our website is making it possible for veterans to get better access to services.
year only 10%ast of benefits applications were done online. because of our vets.gov website consolidating this, we now have a times that number, over 200,000 veterans have applied for health benefits using vets.gov. year only 10% v.a. will be soft launching the white house veterans complaint hotline tomorrow on june 1. this is something the president had talked about. we will be testing that system starting tomorrow and fine-tuning it in the next several months with the goal of it being fully operational by august 15. the soft launch, which is being worked out tomorrow, will be active. the phone number is 855-948-2311. the full launch will be august 15. fraud, waste, and abuse. detecting fraud, waste, and
abuse is important. we have been identifying preventing fraud, waste, and abuse. we've been able to prevent $27 million in fraudulent payments and duplicate payments in 2016. however, with centralized oversight, i know we can do much more than that. that's why i stood up to fraud, waste, and abuse initiative. i announced a prevention advisory committee. we are creating that committee. it is ahead of schedule. we are going to be naming cochairs. i can name one of those today. he is the president and ceo of the national quality foundation, with a heavy background in fraud, waste, and abuse. we will be naming the second cochair soon. veteran suicides. this is the last of the assessments. all the risks i had talked about are troubling to me and require immediate attention.
nothing is more important to me than making sure we don't lose any veterans to suicide. as we know, 20 veterans a day are dying by suicide. that should be unacceptable to all of us. this is a national public health crisis. it requires solutions that not only that v.a. will work on, but all of the government organizations and the private sector, and nonprofit organizations. i initiated emergency health services for those honorably discharged just a few months ago. that is a population of veterans at high risk for suicide. that is just the beginning. this summer, we will launch a new initiative called "getting to zero." that is my top clinical priority. in closing, i just want to reaffirm the president's strong commitment to fixing v.a. and making it work better for veterans. that's the commitment i share. i wanted to come out and talk
about these 13 areas. our assessment of where the problems are. i want to be held accountable to fix this. i will need help to fix it from congress and other organizations, but this is our commitment to finally address these problems that have been plaguing v.a., sometimes for decades. the president, the vice president, congress, veterans service organizations, all share this goal to help modernize the v.a. that's why i'm confident that we can turn v.a. into the type of organization that veterans and families deserve and all of us want to see. i appreciate your attention. thank you very much. >> you spoke about the situation in puerto rico. there is a similar situation unfolding in phoenix as well. will this eliminate this protection board and will this
eliminate the possibility that someone like dwayne hamlin can get their job back? sec. shulkin: when we talk about the situation related to mr. hamlin, that decision was made before i was secretary. i would not have supported a decision that would have allowed him back. the merit system protection board indicated they believed we needed to take him back. i would have fought that through all of the appeals process is available to us. the accountability bill that we are seeking still maintains due process for employees, something i believe in, but it shortens the time and gives more authority to the secretary's decision on why these accountability actions are being taken so that the courts would be more deferential to the secretary's opinion. i do believe that would have changed the situation. >> would you get anything in time to prevent a similar occurrence in phoenix? sec. shulkin: not until we get
this accountability bill through the senate. >> the senate. >> is there anything you can do about that situation? sec. shulkin: you are talking about employee benefits? we are following the court cases on that. we are waiting for the final decision to come out. >> this is a robust agenda you have laid out. do you have the timeline? how engaged has the president then in this discussion? sec. shulkin: the president has been extremely engaged. his commitment to being involved in veteran issues is one of the top domestic priorities. he has made himself fully available, both he and the vice president, to anything that we need. the white house has been extremely responsive. they are impatient and anxious for us to get on with this.
each of these issues i have talked about have different timelines associated with them, because some require legislative action, and some are more administrative. the president's budget this year gave strong support to the v.a. that will allow us to accomplish a great deal of what on this list to modernize the system. >> as you know, the administration has been dealing with controversy. has that in any way impacted your agenda, the ability to carry out this? sec. shulkin: absolutely it has not. we are completely focused on what it is going to take to fix the v.a. there has not been any lack of responsiveness from the white house on these issues. >> when we look at your lists, your long list of priorities, do you have a sense of, top to bottom, what is the most cost intensive? how much is it really going to take in terms of money over 10 years to get you down this road? sec. shulkin: the budget that was proposed by the president
for fiscal 2018 is a budget that will help us accomplish this task. i have said that the problems in v.a. are not largely going to be solved through additional money. these are going to be solved through management practices, focus, and legislative changes. but our issues are not because we are lacking the financial resources to be able to accomplish our mission. therefore, i do believe with the exception of one area, that we will not be coming back to congress or the administration to ask for additional money. the it exception is to modernize our i.t. systems. i said i will make an announcement as soon as i can before july 1, that we will look towards outsourcing the current system to a commercial vendor or picking a system that is an
commercial off-the-shelf system, to get v.a. out of the software business. that will require a initial capital investment that is not in our fiscal year budget. >> is this the most expensive thing you would do? and facilities after that? sec. shulkin: facilities are important. what i'm looking to do in the national realignment strategy is to make sure we are using current resources most effectively. that's why am looking at the vacant underutilized buildings that aren't helping veterans, i want to realign that to help invest back into facilities that need capital repairs. >> leaders of the american legion wrote a rather impassioned op ed last week suggesting that a promising solution to the suicide problem could be increased medical use of cannabis. you talked about it being a national health crisis that requires all of government. should the congress reclassify marijuana from schedule one drug to allow it to be used for medical purposes? sec. shulkin: right now, federal law does not prevent us at v.a.
to look at that as an option for veterans. i believe everything that could help veterans should be debated by congress and by medical experts, and we will implement that law. if there is compelling evidence that this is helpful, i hope that people take a look at that and come up with the right decision and we will implement that. >> as a physician, what is your opinion? sec. shulkin: my opinion is that some of the states that have put in appropriate controls, there may be evidence this is beginning to be helpful. we are interested in looking at that. but until time that federal law changes, we are not able to be able to prescribe medical marijuana for conditions that may be helpful. >> your department issued a report saying climate change threatens the health of
veterans, and that your stuff strains the v.a. ability to carry out missions. assessmentit of the you are doing today, do you continue to see climate change as a dire threat to your mission, and if so are you disappointed that the president is reportedly pulling out of the paris agreement? sec. shulkin: as you said, as the secretary of veterans affairs, i'm focused on those environmental issues that impact veterans. our studies are focused on usually the chemical and environmental impacts that are used on the battlefield. those are the ones that i continue to be focused on. beyond that, it really is beyond my scope as secretary. >> you don't believe, or -- multiple reports have come out of the department saying climate change in the broader sense brings up cardiovascular
--ease and is a real issue that's not something you are considering at this point? sec. shulkin: i am focused on the health of our veterans. clearly, there is a relationship between health and the environment. what i'm not focused on is the bigger political issues about united states policy on other types of reform. i'm focused on the health of veterans. >> you said it will take $18 billion to repair these facilities. do you plan to close any of them? sec. shulkin: what we are doing is under a national realignment strategy, we are looking at the best use of current resources, because $18 billion is not a realistic number for us to be able to get to invest and put all of our facilities up to speed. we are looking at using the current resources we have, the best to help veterans. we are making investments. this budget this year gives us additional dollars.
that's why i'm confident this is the right budget for us. it allows us to invest and start making significant progress into that $18 billion. but i don't believe -- that was our assessment of what the entire inventory, if we build it up to current standards, would take. that's not what we are seeking. >> when you walk away from this, you think some should be closed? sec. shulkin: we want to take a look at every facility to make sure it's being utilized appropriately. i do not have specific plans for any facility closures at this point. yes? >> mr. secretary, what is the holdup in filling out your nominations to the senate, and do you believe the lack of nominations has impacted in any way the work you are trying to do that you have described here today? sec. shulkin: one of the things i'm very fortunate, having been >> one of the things i'm very fortunate, having been hearing
the last administration, is that we have had pretty good continuity. that people that are filling active positions are people that i've worked with and have great confidence and trust, in so we have not missed a beat at v.a. i want our positions filled as quickly as possible. the vetting process that's going on is a lengthy process. i know, having gone through it myself. it's also important to get right so while we want to see it done as quickly as possible, we want to see it done thoroughly and make sure we don't make mistakes. i do believe you will see several other announcements in the next week or two about positions to be filled. >> you said the president's budget strengthens the v.a., to specific questions about the budget. when it comes to individual unemployability, iu is drastically cut in the budget and will not be made up because of cuts to social security. why would that be in line with the administration's promise
doing better for veterans? shulkin: let's take a look at the overall budget. this is a 5.5% increase in total budget for veterans. when it comes to mandatory funding, which is where the i u exists, we are seeing a $7 billion increase year-to-year in mandatory benefits to veterans. this is a budget that is providing more care and services to veterans. in doing so, we have a responsibility to taxpayers and to veterans to make sure that the resources of our current programs are being utilized appropriately. we are going back and looking at programs and saying, are those resources, could they be reallocated, in different ways not to withdraw total dollars from veterans, but could they be revised and reallocated to work better for veterans? in the case of iu, i think what we proposed is not an elimination of it, but a
revision to make the program and resources that are going currently to some veteran to help additional veterans. i understand there's a lot of passion on this, and we were plenty of time to work with congress and veterans service organizations to make sure we are doing it right. >> i want to ask another question about the budget, but to follow up, a lot of the if those consider stealing from them to be changing fundamentally the way iu is calculated. what's your response? shulkin: i have such admiration for vso's. i understand their passion and i share their commitment that it's so important that this country honor its responsibility to our veterans. that doesn't mean that you don't go back and revisit programs that have been around for a long time and figure out different ways to use those resources, as long as they are directed to helping veterans.
i understand there's not always going to be agreement. this is washington. we will always get passion on important topics. i welcome comments from veterans service organizations about how to do things better. i know since we share the same goal of helping veterans, we can get to the right answer. >> one other thing, the budget from the president focuses on providing care and purchasing care, less so on infrastructure. you talked about infrastructure, but you know it i'm talking about terms of the vha and where dollars go. are you concerned about the long-term viability and preference for privatization, or focus on the choice program outlined in the president's budget? shulkin: i think the wait time showed us that the the a cannot do it alone. we have to work with the private sector. one third of veterans are getting care outside of the v.a. i'm looking to build an integrated system for the very
best of the v.a. and the best of the private sector to make one system work for veterans. this is not a privatization of v.a. it's not diluting the v.a. i more and more convinced veterans need a strong v.a. it's essential for national security and to honor our commitment. i will not allow our policies to weaken the v.a. our policies will strengthen the v.a., but working with the private sector is the way to do that. >> do you know where that dollars are going? you don't have any concerns about the long-term effects of where the dollars are going? shulkin: of course i have concerns, but i do believe the budget, congress will come up with the best balance between private sector and the v.a. >> you said the majority of veteran suicides are people not
under v.a. care, so what will be done to reach out? shulkin: 20 veterans a day that are taking their lives, six are getting care through the v.a. system and 14 are not. the reason why is important. the big focus of our research and understanding is this. some of them are other then honorably discharged. 10% to 15% of active service who leave the service leave with other than honorable discharge, which leaves them without benefits. that's why i offered the decision to offer those veterans emergency mental health services. secondly, homeless veterans, very high risk for suicide, not likely to have good access to behavioral health care. this budget that the president put forth, additional $600 million for a total $1.7 billion to help get veterans off streets, get them into homes,
and the services they need. third, the conditions themselves, depression and traumatic stress, tend to isolate people. they tend to withdraw because of their position. those are the ones we worried the most about. that's why we say suicide is everybody's responsibility. family members, community members, when you see people withdrawing, that is the time to reach out and get them help. the veterans crisis line, now answering 99% of its calls, 1% only going into rollover, 99% answered in 20 seconds, it is there 24 hours a day if you find a veteran who is at risk. finally, let me just say that this issue will continue to be our top priority until we figure out all the answers how to get each of those veterans help.
>> you mentioned that you identified 14 facilities providing lower care or lower standard care than the private sector. can you identify them? shulkin: yes. they are on our website. the 14 one star facilities. i think you have even published an article about this. those were the 14 we are talking about. when you are a one star facility, it means you are not only the lowest in the v.a. compared to other v.a. hospitals, but you also are below community standards. that's why those are the important ones to focus on. in the choice program, you will see that we are going to be making sure veterans have choice, in particular where the standard of care is not being met in the private sector. >> if they are one star and below the community standard of
care, does that mean they would not be accredited? shulkin: all of our hospitals are accredited at the same national organizations that private sectors go through. when you talk about below standards, we are talking about averages. by definition, there will always be those that are below. v.a. has set a bar that is above average. we want all v.a. hospitals, because we believe all veterans deserve the best care possible. it's not a minimal standard. all hospitals are accredited. thank you very much, everybody. >> if you didn't get a copy of the packet distributed before the briefing, is available with laura as well as the website. thank you, everyone. [captions copyright national cable satellite corp. 2017] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit ncicap.org] tomorrow night, a discussion about the state of congress and how it differs from the founders vision with political scientist
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