tv Veterans Affairs Secretary Urges Congress to Redesign Choice Program CSPAN June 1, 2017 2:14pm-2:56pm EDT
>> there was a book take a look at that. they're interesting reading predict -- very interesting reading. journal hasstreet put together a list of some of the president's tweets over the years on climate change predict in november of 2012, mr. trump we did "we cannot destroy the competitiveness of our factories to prepare for nonexistent global warming." in january 2014, he said record-setting freezing temperatures throughout the .ountry and beyond global warming is an expensive carried in the meantime -- expensive hoax.
in the meantime, we will take you to the white house. >> thank you. good morning, everybody. presidents ago, the came over to my offices at the v.a. to talk about the recognition and progress we've had at the v.a. to come tofitting his house to talk about what's happening at v.a. 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 transparent about where the problems are. the only way to fix the issues in our organization is if you come out and talk about with those problems are that's what those problems are heard -- talk
today come over 22% of veterans are seen on the same day. wait times forr every single one of our medical centers across the country in a public forum for everybody to see what is good and what is not good in terms of weight times. system in theer country that has done anything like that. there's no comparison to what the v.a. is doing in terms of transparency and wait times. yet, veterans are waiting 60 for appointments at .0 of our locations nationwide
16% of our primary care clinics are over 100% capacity. in 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. 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, our 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. providers are increasingly frustrated with the va's ability to get them payments to the point that some are leaving the network.
that is obviously working against us. it takes more than 30 days to process 20% of our clean claims at va, and that 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 of this year, only 65% of our 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 our community 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 or modifications to our original contract, we still have eight separate programs for paying community care. that makes it too complex and it is confusing veterans and our 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 so confused, 20% of our claims 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 to 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, to make sure veterans don't go back to waiting longer than they need to wait to get care in the community, so we need to pass legislation this year.
the next area is quality. quality of care in the v.a. we shared with you our star rating systems. we now publish that on our websites. we also now publish quality of care comparisons between v.a. and local community hospitals. and, in that, we have identified 14 of our va's that have one star ratings. that means the quality is below the standard in the community. that's not acceptable to us. we are deploying teams and implementing performance plans for each of those facilities. veterans should not have to accept low quality care. they deserve our very best. i think everybody 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 are going to work to do in a revised choice plan, to allow them to ge into the cash to go out into the community if they are not getting the best care. the next area is disability claims and appeals. we have currently 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. 90,000 plus is too many to be acceptable. last week, we processed a claim for disability in three days. that's a new process called a decision ready claim. we are going to be introducing decision ready claims nationwide on september 1 of 2017. in addition to that, we are going to be 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. it 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 of date systems 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, d.c. v.a. 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. our scheduling and financial systems are outdated. that contributes to the excess weight times. ait times. both systems are in the process of being replaced, but it will take years to complete. we have a system called valeria. the v.a. loan electronic reporting interface. without funding for a new system, v.a. 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. 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 on 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 identified $18 billion would be required to fully remediate our 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 during the 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. v.a. 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 visits per year that today we 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 capital 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 -- steward of taxpayer dollars. construction. 11 of major construction projects totaling $1.4 billion are on hold because the v.a. and the 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. our programs 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. we haverrent v.a. law,
to wait at least a month for holding employees accountable for poor performance. 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 had 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 -- who have 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. under current law, it takes 51 days from the date management proposes to suspend or remove an employee from the day that action takes effect. despite the limitations in the existing law, we have recently removed the washington, d.c. 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 have 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. effective immediately, v.a. will stop requiring the use of small house design guides 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. at this time last year, only 10% of benefits applications were done online. because of our vets.gov website consolidating this, we now have eight times that number online when you later. -- one year later. over 200,000 veterans have applied for health benefits using vets.gov. 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 very important. we have been identifying and 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 very 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 thean 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. does this get rid of the protection board? 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 es that were 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 recurrence in phoenix? sec. shulkin: not until we get this accountability bill through the senate. >> is there anything you can do about that situation? sec. shulkin: you are talking about with the veteran benefit employees? 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? 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. 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 an 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 when i'm 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 and learning from 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. in the spirit of the assessment 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. >> multiple reports have come out of the department saying climate change in the broader sense brings up cardiovascular disease 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 hearing the last administration, is that we have had pretty good continuity. the people filling our active positions are people i have trust in. we have 20 facilities that have of date systems for i.t. and inventory. the people that are filling the active decisions are the people i have worked with and have great confidence in and trust in. i want all of our positions filled as quickly as possible. the vetting process going on is a lengthy process. i know, having gone through it myself. it's also really important to get right. while we want to see it done as quickly as possible, we want to see it done thoroughly and make sure we do not make mistakes.
i believe you will see several other announcements in the next week or two about positions we will be filling. >> two questions. you said the president's budget strengthens v.a. when it comes to individual unemployability, iu is drastically cut and likely never to be made up by compensating social security. why do you believe that is acceptable and in line with the administration's promise to do better by veterans? sec. shulkin: let's take a look at this overall budget. this is a 5.5% increase in total budget for veterans and when it comes to mandatory funding, which is where the iu exists, we are seeing a $7 billion increase in mandatory benefit 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. so, we are going back and looking at programs and saying, could those resources be reallocated in different ways not to withdraw total dollars from veterans? could they be revised and reallocated to work better for veterans? in the case of iu, i think what proposed is not an elimination of it, but a revision to make the program and resources currently going to some veterans -- make sure we are getting this right. >> to follow up on that, a lot -- to be changing so fundamentally the way iu is calculated. what is your response? sec. shulkiun: i have such great admiration and respect for vso's. is so important 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 and more veterans. i understand there is not always going to be agreement. this is washington and we are always going to get passion over important topics. i welcome comments on our -- from our veteran service organizations about how to do things better and i know that since we share the same goal of helping veterans, we will get to the right answer. >> can i ask you one other thing about the budget from the president focuses on providing care and purchasing care less so on infrastructure. you talked a lot about infrastructure, but you know what i am talking about in terms of the vha and where dollars tend to go. are you concerned about the long-term viability and the threat for privatization of
r focus on the choice program outlined in the president's budget? sec. shulkin: i think what the wait time showed us is the v.a. cannot do this alone. we have to work with the private sector. about one third of all veterans are getting care outside of v.a. i am looking to build an integrated service of the oft in v.a. and the strength v.a. and thet of best of the private sector to make one system work for veterans. that will be our new choice legislation. this is not a privatization of the v.a. every day, i'm in this job i am more and more convinced that veterans and americans need a strong v.a. it is 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. working with the private sector is the way to do that. >> you don't have any concerns
about the long-term effects of where these dollars are going? sec. shulkin: of course i have concerns. i look at this every day. i believe the budget and legislative proposals that we will work on congress will, with willrk with congress on come up with the best balance between the private sector and v.a. >> what is being done to reach out to those vets? sec. shulkin: the 20 veterans a day taking their life through suicide, six are getting their system andh the v.a. 14 are not. the reason those 14 are not getting care is a big focus of our research. some of them were other than honorably discharged. 10%-15% of active service members who leave the service leave with an other than honorable discharge and that leaves them without benefits. that is why they made 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 health care. this budget the president put forth, additional $600 million for a total of $1.7 billion to help get veterans off the street, get them into homes, and get them into the services they need. third, the conditions themselves, depression and , tend to stress isolate people. they tend to withdraw because of their condition and those are the ones that we worry the most about, which is why we say suicide is everybody's responsibility. when you see people withdrawing, that is the time to reach out and get them help. the veterans crisis line, which we just staffed up, is now
answering 99% of its calls. 1% now only going into rollover. 95% answered in 20 seconds. it is there 24 hours a day if you find a veteran at risk. finally, let me just say that this issue will continue to be our top priority until we figure out all the answers of how to get each of those veterans help. >> you mentioned that you identified 14 facilities that are providing lower standard care than your private sector hospitals. can you identify those hospitals? sec. shulkin: they are on our website, the 14 one star facilities. i think you even published an article about this. those are 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 hospitals, but also below a community standard and that is why those are the important ones
to focus on. in our choice program, you will see as big about there, we are there.will see us out we are going to be making sure that 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? sec. shulkin: all of our hospitals are accredited by the same national organizations that private sectors go through. when you talk about below standards, we are talking about averages. by definition, there is always going to be those that are below. v.a. has set a bar that is a p.e average essentially, we want all v.a. hospitals because we believe all veterans deserve the best care possible. it is not a minimal standard, all of our hospitals are accredited. thank you very much, everybody. >> iyo