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tv   Veterans Affairs Secretary Wilkie Testifies on MISSION Act  CSPAN  December 23, 2018 4:16am-7:01am EST

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fourth age," about artificial intelligence and robotics. ron: we are creating technologies that are of the same magnitude and will change human intelligence, robots by which we have human action. it is an interesting question, when you build machines to think and act for us, what is next for us? what do we do? watch "the communicators," one day night at 8:00 p.m. eastern on c-span2. >> at a joint hearing of the house and senate veterans veteransommittees, affairs secretary robert wilkie discussed aiming better access at v.a. providers, reducing wait times at v.a. hospitals, and better health care for
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veterans. this is just under three hours. rep. roe: the committee will come to order. before we begin, i would like to ask unanimous consent that congressman sablan will be able to sit and participate in today's hearings. hearing no objection, so ordered. welcome. and thank you all for joining us today for the joint hearing of the house and senate committees on veterans affairs. this afternoon, we will discuss
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implementation of the john s. mccain, daniel kay akoka, and the samuel r. johnson department of veterans affairs maintaining internal systems and strengthening integrated outside networks act of 2018, better known as the v.a. mission act. the mission act is a truly transformative piece of legislation that will impact virtually every aspect of scare that the v.a. provides. developing it took many months of intense negotiation, and close collaboration between our committees, the trump administration, the department, and numerous veterans service state advocates. we should all be proud of our work on the v.a. mission act and of the benefits our veteran, our nation's veterans will derive from it in years ahead. however, in many ways, the real work has just begun. almost six months ago, the mission act was signed into law. almost six months from now, one of the act's most noteworthy requirements, the creation of a consolidated community care program, will go into effect. today, at the midpoint between enactment and execution, we are here on a bicameral and bipartisan basis to evaluate both the progress the v.a. has made thus far with regard to the implementation of the mission act, and the barriers that may
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exist to full, on time, and on budget implementation in the coming months. seeing the mission act signed into law took the collective effort of all of us working closely together, with one another, and with v.a. senior leaders, with the white house, and with our veterans service organization partners. seeing the mission act implemented appropriately would require no less than the same amount of team work. in 2014, we passed the choice act in response to what can rightfully be categorized as a crisis in access. a recent news article has criticized execution of that program, namely the high cost of administrative fees. while i do not dispute that the cost of this community care expansion were higher than typical government insurance coverage, the choice program represented a transformational first step in how v.a. provides care, where and when it is needed. these contracts were stood up in record time and changes that were made both legislatively and
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contractually over the past three years as a program matured, and i will say this, as a physician, we asked that the v.a. at that point in time to do something no one could do, which is to stand up, stand up a nationwide network, in 90 days. no one could have accomplished that on time. the choice program is not perfect. but it did allow for an undeniable expansion of access and care both internal to the v.a. and in the community for veterans. this is why it is so vitally important that the mission act, which will guide v.a.'s future coordination of care, be executed efficiently and thoughtfully. mr. secretary, thank you for being here today to provide concrete answers to our many questions about the work that the aegts agency has been doing these last six months and the work that lies before you in the next six months and beyond. the importance and the enormity of the task ahead cannot be overstated, but i have faith in you and your team, and i know that considerable support from this administration and this congress is behind you.
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we want you to succeed. i am for you to be as upfront as possible today and every day about the challenges you're facing and the help that you need from us to ensure success for our veterans. i look forward to working together to overcome any barrier that may be in your way. i will now yield to chairman isakson for any opening statement that he may have. chair isakson: chairman roe, thank you very much for your introduction, and thank you for spearheading calling this meeting today to look at the first six months under the mission act. i'm glad we're doing it. and before i make my comments on the mission act, i want to say this. your service, when working you you, has been a privilege. you have done a phenomenal job as chairman in the house. you have helped us in the senate immensely. your goal setting and what you
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focused on has been unbelievable. and with the exception of a few minor things, mainly where we may have dropped the ball, we have carried the ball and made significant changes in the veterans administration that are known for a lasting and long period of time. so i wanted to publicly thank you for your cooperative spirit, your desire to work, it is so great to have a physician at the top of the leadership, in the house, or the senate for that matter, because we make better decisions when people has done this, it is easy for me, i'm a professional patient, you're a professional doctor, and you've done a great job and i appreciate your friendship and what you've done and the leadership of the committee, and john tower deserves a lot of credit. he has done a great job. let me say this. we are prepared in the next two years to do everything we can do to continue the cooperative spirit between republicans and democrats that we've had on the senate side, and to work on fine tuning the action we passed and implementing things that need to be done to help you in the v.a., those who are here for the v.a., get your jobs done. we understand that what is ahead of us is tough. but we have no choice but to see to it that the v.a. is functioning at the highest possible level, so those that have risked their life for our nation and pledged their service to us as soldiers, have the same
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treatment back to them when they're ensuring their health care and those benefits they're promised under the laws of the united states of america. so i look forward to serving you with you and working with you, and i want to tell you how much i appreciate the great job that you've done. i want to tell my senate membership, and our committee members that are here, democrat and republican, we have had the greatest cooperative spirit. we had the mission act passed in committee with only one negative vote. sailed through the floor. you all did a great job on your end. we realized that we dropped the ball with you on one thing. you all got the blue water navy through on a voice vote on the floor or a suspension vote i think on the floor. we failed in the senate in two, one today and one last week, and i have still got to try them up but i still have difficulty with one or two objections, but we will come right back and hit the ground running. the secretary wilkie has done a great job of indicating he wants to work with us and help us where he can. and i'm not going to let that bone, take that bone out of my mouth. this is one bull dog from georgia that will keep that bone in my mouth until we get it done. a lot of us in the house committee have worked on the
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blue water navy issue and we want the same team work as possible. and primarily i want to thank you and thank senator wilkie to for bringing a breath of fresh air in the v.a. he has done a great job. he took over after a problematic and tumultuous time, but he has a good bedside manner, which most good physicians have. we welcome you and your v.a. membership here today. so thank you very much, chairman, and merry christmas to everyone and the awesome audience today. rep. roe: thank you, mr. chairman. and i wish that bull dog of georgia could have done something to those folks in alabama. i wish that can have happened. chair isakson: i can't tell what we want to do with the alabama people in public. but i apologize, i have to slip in on a minute, but i have one more thing to do on our side.
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thank you, mr. chairman. chair roe: thank you, mr. chairman. it has been a privilege to work with the senate this year, too. this term, i should say. the last two years. and i was going to reserve my remarks until the end for you, and i realize you had to leave , but what an incredible year, to work with you and senator tester, and we could have never passed 80 bills in the house and heard so many in the senate, and our staff worked hand in hand behind us to make this possible. it wouldn't have happened. and i think that 29 or 30 pieces of legislation. and just very briefly, a small thing, like a contract, a cable contract, you might have signed, or a contract on an apartment, and then your spouse loses their life, in service to the country, you ought to be able to get out of that contract for a year, and now hopefully you will be able to do that. little things like that, that don't seem like big things but if you're the person on the end of that, they are big things, and i have seen it and witnessed it with my friends who have had
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to deal with this and these are ideas that came from both sides of the aisle, and i want to thank all of my colleagues in the senate and the house for those ideas. i will now yield for any opening remarks. rep. takano: thank you, chairman. i look forward to working with you in the next congress to serve our nation's veterans. thank you, ranking member tester, for also being here. good afternoon, mr. secretary. thank you for taking the time to testify before us today. we will always welcome the opportunity to speak with you about the progress you have made regarding the implementation of the mission act. it has been a little over six months since the mission act was passed, and seven months since you were confirmed as secretary
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of veterans affairs. i commend you on your hard work so far and assure you that as we move into the next congress, you will continue to find a willing partner on this committee, meaning me, and as most, as the most bipartisan committee in this congress, i intend to work with my colleagues on both sides of the aisle, with you, mr. secretary, and with our vso partner, to ensure veterans get the benefits that they have earned. transparency and open communication between the department and congress is key to our oversight efforts and to ensure that our work here is effective. now, we've asked for, and need information from the department, so that we have an understanding of the steps the v.a. must take to achieve the objectives mandated under the mission act, over the next six months. we also need to know more about the reported outsized influence, a group of advisers may have had, on your decisions, as v.a. should not be subject to outside influence, or the whims of individuals or interests who cannot be held accountable, and who did not have veterans'
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interests, veterans' best interests in mind. however, the v.a. should ensure that the voices of veterans expressed through our veterans service organizations are adequately considered when important decisions such as the adoption of the designated access standards are made. the term designated access standard seems a bit wonky. so what i would like to hear from you today is a simple explanation of what those different scenarios wook like in practice. and i think to unpack designated
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access data, for the public, we can simply understand them as the criteria by which the v.a. refers veterans out to private sector doctors, outside the v.a.,, non-v.a., provider, what are those criteria? we began with an arbitrary criteria of 40 miles, living 40 miles outside of a v.a. radius, the radius of a v.a., of a health center, and somebody who has been waiting for more than 30 days. without those arbitrary standards initially, we would have spent large sums of money, diverted large sums of money of the v.a. health care dollars. so it is important that we get these standards right. the truth, we've always, always, at the v.a., , the v.a. has always embraced outside non-ava v.a. medical providers as part of the solution. this is nothing new in terms how we take vare care of our veterans, but we can't do that at the expense of maintaining and adequately growing the internal capacity of the v.a.
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so these access standards, will outline when and where and how veterans will be referred to providers under the act and how much of your budget will be needed to pay for this private sector care, which we know is often more expensive than v.a.'s internal services. so, and we know, based off of multiple studies by the likes of the rand corporation and dartmouth university, vha care is often, is frequently of higher quality than the private sector. so standards that are too liberal for access to private care could easily jeopardize that high quality v.a. care that our most vulnerable veterans rely on as the dollars that support this care will be diverted into private sector care. so we need that right balance. so we need answers to these
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question, and i remain concerned with the department's lack of transparency. for instance, yesterday, we discovered, via the media, not the v.a., that yet another veteran has taken his life at the bay pines v.a. medical facility. this is the fifth suicide since 2013. we should not be first learning about this in the press. we should be notified immediately with facts that will help us act, so that we can prevent other veterans from taking their lives. the gao report requested by ranking member walls demonstrates a lack of leadership and commitment by the department to prevent veteran suicide. this is the department's top clinical priority. when veterans between the ages of 18 and 34 are committing suicide at the highest rate, the department's failure to communicate services, and attempt to reach veterans in this age group, via social media, is shameful.
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the v.a. offers mental health service, but the quote, disabled american veterans, they are useless and actually preventing suicide, if veterans and family members don't know they exist, or are unable to access them. now, it is simply wrong, simply wrong that only $50,000 -- $57,000 in funds congress prioritized to address preventing veteran suicide has been spent, and $6.2 million has been left on the table. now, i'm committed to achieving progress over the next two years, and i hope that you will in fact, make suicide prevention a priority that the department claims it to be, so that we, as congress, can support, not criticize, your efforts. the same offer applies to the implementation of the mission act. now, the implementation of the
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mission act thus far has been rocky. and all too often members, their staff, and veterans feel misled, or misinformed. in the next congress, let's work towards having a productive relationship, an open dialogue, so that we can work together on behalf of the veterans we serve. and i look forward to our discussion today. and hope that it is the beginning of a strong partnership between the department and congress. i yield back, mr. chairman. chair roe: thank you for yielding. now yield to ranking member tester for any opening comments. sen. tester: thank you, chairman. and if tim walsh were here, i would be thanking him too, and congressman takano, thank you very much very, very much. before i get into my written statement, i want to say it has been a pleasure this last congress working with all the other three corners, and i think what's made the relationship work is communication. we have tried not to surprise
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one another. we've tried to keep one another informed on where we want to go, and i just want to give you a prime example of it, when i was walking over here to this hearing just now, one of my staff members that dr. rowe e wants to say something about confirmations. and he is concerned it might embarrass you. that's damn nice of you. i just want to tell you. that and by the way, give them hell in the confirmations , because it is ridiculous that the folks are not confirmed for the office. and the other thing i want to say in a statement is blue water. it was objected to in the senate. i know we have been providing information after information after information on this issue. i'm going to tell you, if we're not willing to take care of our veterans, we shouldn't be making them, and the bottom line is, we've got to get this done. the science is clear. and i would say that i think that maybe the folks in the legislative branch don't realize it, but we're different than the executive branch. and we need to make the call. and if they want to veto the damn bill, then let the executive branch veto it. it in the meantime, we need to take care of our veterans. secretary wilkie, thank you for being here.
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implementation of the mission act is going to fundamentally transform the delivery of the health system to our nation's veterans. for more than a year, we all worked carefully with the white house and the v.a. to negotiate the text of that bill. we were in regular communications with the v.a. on how it would interpret and implement the bill, passing it back and forth for technical assistance, ensuring that we were all on the same page. since that time, i have grown increasingly concerned with the department's planned implementation of the new veterans community care program created in the bill. mr. secretary, the v.a. is moving away from the direction it was headed just six months ago. make no mistake about that. the most dramatic example has to do with the v.a. designating certain types of care as merely automatic eligibility for community care. six months ago, we agreed that if veterans faced excessive wait times or driving times or distance to access certain services at a v.a.'s facility, they should be offered referrals to the community.
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specifically we discussed access standards for services like routine lab work and x-rays. we agreed to give the v.a. the authority to the extent to decide exactly what services or categories of care should make veterans automatically eligible to receive care within the community. now that we've passed the v.a. mission act, v.a. has decided to head in what i believe is a completely different direction. the v.a. now indicates the plans to designate access standards that apply to each and every type of care a veteran might need. this would essentially outsource all segments of v.a. health care to the community based on arbitrary wait times or geographic standards, which were supposed to be moving away from by ending the choice program. and that's despite the fact that several studies, one as recently as last week, have indicated that the quality of care at the v.a. is good or better than the private sector. let me say that one more time, because it is not said enough. as recently as last week, we received yet another study that
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indicated that v.a. care is as good or better than the private sector. to make matters worse, v.a. officials have offered only vague verbal descriptions of the various sets of potential access standards under consideration by you, mr. wilkie. it also concerns me that each time we discussed this issue in the last two months, v.a. officials have given us wildly different estimate estimates of budgetary resources needed to implement these sets of access standards that you're considering. for example, if the department chooses to go with the same access standard used by tri-care prime, we have been told it could cost anywhere from $1 billion for the first year, to more than $20 billion over five years. some of the v.a. estimates indicate that the costs will be less than what we spent on choice but would make a greater percentage of veterans eligible for community care referrals. that doesn't make sense. so we need to know what you're doing, mr. secretary, and how much it is going to cost. no conflicting or vague answers. no fuzzy math. no game, because the stakes are simply too high.
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mr. secretary, not just six months ago, you came before the senate veterans affairs committee, and you said you would oppose attempts to advertise privatize the v.a. health care system. and i believe you. you then.thved i believe you now. and if you don't, you will bring down the whole boat, and you are going to spend more time and money sending veterans in care that is less likely and not as high quality. it is a bad deal for the taxpayers and a bad deal for the veterans, who would ultimately bear the brunt of the services or the benefits of the increased cost of community care. and that will lead it a bad deal for veterans. at some point, you will burn through the funds quicker than
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expected and come to us because vha is running out of money again. veterans will be in limbo when seeking community care as congress sorts out the v.a.'s fiscal issues. i am frustrated because this hearing would have a great opportunity to talk about the great work being done by the v.a. employees across this country every single day and indeed they are. and about how their critical work will be bolstered by additional health care officials. and about how streamlining the various v.a. community care programs in the new community care network will make care more efficient, more timely, and more seamless for veterans. instead, we're here left trying to figure out why the v.a. decided to take things in a different direction, in what i believe congress is intended, and certainly what veterans have advocated for. my suspicion is that it is politics. i hope i'm wrong. because at the end of the day, i really hope that meaningful consultation will take place before final decisions are made. we've got this far by working together and by taking our cues from veterans, and it would be a shame to undermine those efforts and relationships, because of a political agenda.
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i said it before, and i will say it again, i have tremendous faith in you, secretary wilkie, to make sure that the v.a. is run in a way that our veterans deserve. we need to really step up and do it. thank you for being here. chair roe: thank you, gentleman, for yielding. we're joined on our first and only panel of the day by the honorable robert wilkie. robert wilkie secretary of the department of veterans affairs, welcome. secretary wilkie, thanks for being here. the secretary is accompanied by dr. melissa glynn, the assistant secretary of the office of enterprise and the executive in charge of the veterans health administration. thank you for being here. secretary wilkie, you are now recognized.
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sec. wilkie: thank you, mr. chairman. and thank you, chairman isaacson, chairman-elect takano, senator tester, and distinguished members of both committee, i want to thank you to address the opportunities to implement the v.a. act and share you with the governance and management approach instituted over the last 130 days. as you have said, we are on the cusp of the greatest transformative period in the history of v.a., and your leadership led to the passage of that historic legislation. as i testified in front of the senate veterans affairs committee earlier in the year, i am happy to report that the state of the department of affairs is better, and it is better because of the work that these committees, and the attention paid to our department by the president. as secretary, i visited 17 states in 130 days, 23 hospitals from anchorage to orlando, four claims processing centers, and the veterans treatment court in maryland, and i, as senator tester said, am astounded by the commitment of the v.a. work force. it is dedicated. and it is, in my opinion, the finest work force in the federal government. today, i'm honored to have with me two senior v.a. leaders. dr. steven lieberman, the current executive in charge of the veterans health administration, and dr. melissa glynn, the assistant secretary for enterprise integration.
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we are committed to implement can the mission act by june, 2019. and describe how that mission is being fulfilled. we have established a task force representing key offices across the v.a. and guided by experienced program leaders. we now have a battle group of progress reviews to align resources, identify and mitigate risks, and deliver on the promise to transform v.a. health care, that puts veterans at the center of everything that we do. this effort is emblematic of a new government and management structure we have established throughout the department. that is how we were able to identify the technology supported, the g.i. bill implementation was untenable. i made the decision to define a new approach to deliver education and housing benefits to our veterans and their family members. i want to emphasize that we will execute the law as written, and
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every post-9/11 g.i. bill beneficiary will be made whole of their housing benefits based on both sections 107 and 501 of the forever g.i. bill. i made the decisions not only to stabilize the delivery of services, but to improve the current choice programs. the expansion and extension of the tri-west contract ensures access to community care for our veterans. the decision allows the smoother transition to the community care network contracts when awarded. after multiple delays prior to my arrival at v.a., the acquisition process and subsequent awards are back on track. community care regions one through three will be awarded before the end of february, 2019, and region four is expected to be awarded in march. once active, these contracts will support a key pillar of the mission act, by giving veterans
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expanded choice in their health care. as parts of our new community care program, we are addressing the timeliness and accuracy of payments to providers. we are moving away from paper claims and requiring providers to submit electronic claims through our new electronic claim administration and management system that will be deployed next year. through the mission act, we have established a center for innovation, care, and payment, to develop new approaches to testing payment and service delivery methods. the center has developed a charter and is developing criteria for pilot projects to drive health care quality and efficiency. another pillar of the mission act is ground-breaking support for care givers. there are 5.5 million veteran care givers across the country. i had the privilege several weeks ago to address the third annual national convening of military and veteran care givers , jointly sponsored by the elizabeth dole foundation and veterans affairs. the work of senator dole to invest in care givers and their experiences, to strengthen our ability to successfully execute
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an expanded program of comprehensive assistance to family caregivers under the mission act. i would be remiss if i did not thank the foundation of vsos for vso's for their efforts to make sure that this effort was incorporated into the legislation. and i will take the opportunity also to thank in person someone who is familiar to all of you, and who was instrumental, not only in the development of the mission act, in the caregiver program, but someone who has been on point for veterans for many years, and he is retiring, and that's garry augustine of disabled american veterans, and i thank him for being here as well.
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the other most meaningful aspect of this legislation is the series of related projects, products, that ultimately support the work of the asset infrastructure review commission. these include outputs of national market assessment, and our strategic plan and a data-driven asset and infrastructure assessment and recommendation, with input from our veterans, employees, vso's, local communities, and other key stake holders. the v.a. is embracing the opportunity to assess our footprint and develop recommendations for modernization and realignment of the facilities. mr. chairman, i would like to beg your indulgence for a minute, and i'm going to go offscript, and it is partially in response to a series of stories that i read this morning, stories that have particular meaning to so many members of these committees, and that is on the issue of suicide prevention. when i was acting secretary of the department for eight weeks, i declared that suicide prevention is the number one clinical priority of the department. in addition to that, i named a permanent head of our office of
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suicide prevention, dr. keita franklin, who was the head of our efforts at the department of defense when i was the under-secretary. in addition to that, we have developed, with the department of defense, a stream-lined and comprehensive program to begin addressing the issues that impact our veterans and the issue of suicide, beginning from the time that they enlist. our transition assistance program is done in conjunction with secretary mattis, and now, thanks to the work of this committee, we are including other than honorable dischargees, in our education and outreach efforts when it comes to suicide. the tragic aspect of this is that for the 20 american warriors who take their lives on a daily basis, 14 of those warriors are outside of the department of veterans affairs. when i have gone across the country, i have asked governors, i have asked mayors, i have
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asked vso's to help us find those veterans. when i was in alaska recently, i spoke to the alaska federation of natives. 50% of the veterans in the state of alaska, are outside of the v.a. system, and i've asked them to help us find those who might be in danger. suicide prevention is the number one priority of this department when it comes to our clinical efforts to keep our veterans healthy and well. in addition to that, i do want to say that i echo what senator tester said. last week, dartmouth and the annals of internal medicine indicated that the department of veterans affairs health care, medical care, is as good or better as any in the private sector. that is the story i wish to tell. the other part of that story is, and it will come as a confounding statement for some in the press, that a
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conservative republican is here saying that. i am incredibly proud to be part of the work force that i consider to be the finest in the federal government. in my travels, i have seen the dedication of our men and women. 370,000 strong. and it is my pledge to tell the good news stories that they have created on the behalf of our veterans. in addition to that, another story that i am proud of is that the partnership for public service, for the first time in memory, has now included the department of veterans affairs in the top third of all federal departments when it comes to workplace satisfaction, and the pride that our workers have in being part of the v.a. that is a great step forward. without that pride, we will not be able to deliver the kind of customer service that our veterans expect.
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in addition to that, i'm also happy to say that the department of veterans affairs, when "time" issued its list of the 50 most influential health care minds and providers in this country, the department of veterans affairs had researchers on that list. it is a good news story to tell. it is one that i am proud to tell. and i am very happy and humbled to be part of that outstanding work force that on a daily basis helps veterans, remind all of us why we sleep soundly at night. mr. chairman, i thank you for the indulgence, and i look forward to your questions. chair roe: i thank you very much. and just very quickly, since we have a large number of people here, i will be dropping the gavel at five minutes, including myself, appreciate you being here, but i would like to focus
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today on the, on this hearing, on the implementation of the v.a. mission act, specifically the community care part. because that is, that is coming up in six months. and really, it's literally, if we can do three things, i think mr. secretary, and if you can lay out and give me some ease about how i feel about this, one, will we have networks in place? number two, can you schedule an appointment to the doctor in those networks? and number three, will you pay the bills once the veterans have seen them, so they don't get the bills? and i think if we can do those three things and my concern, we have four regions of the country, the various regions have a year, according to the law, to put these networks together. and i know you're sign can the contracts for three, you said hopefully by february, and then region four by march. that's less than 90 days from the time this thing goes live, that last contract, because i remember very well in 2014, the fiasco that occurred there.
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so of those three things, when we go live, are you going to need more time? and quite frankly, if you see it isn't happening, i would rather keep doing exactly what we're doing, and implement it a month later, than have this thing fall on its face and we fold up all of the community care problems that we have into one and it not work. sec. wilkie: yes, sir. obviously the goal is to fulfill those time commitments. i'm going to take a step back, and answer the third part of your question first. and that is the timely payment to our community care givers and particularly our small town doctors across the country. without that, the entire choice system contained in the mission act fails. we have learned valuable lessons from the experience of choice. i do believe that we have the beginnings of a comprehensive
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set of standards, where by we will, we will take to the country, to bring those community care providers into the network. those contracts are ready to go. we do have the lessons learned from, as i said, the problems that we had with choice. right now, and i will go ahead and address an issue that was raised in the media this morning. tri-west is the bridge to the expansion of our program through the community care networks. and i am confident that given the governance structure that we have in place that we will be able to reach, reach those goals. i will also say that if at any time i don't think we can, i will be up here post-haste, to make sure that we inform the congress of that, that contingency. and dr. lieberman wants to say anything about where we are, in terms of the contracts.
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dr. lieberman: so we're really pleased with how our contracting has been going. we've been meeting weekly on this. and as the secretary said, we expect it to be completed on schedule, as he told you. and then we are ready to go with all of the topics that you have brought up. we certainly are implementing a number of things to help with timeliness, including the timeliness of the payments. we are going to be requiring, except in rare circumstances, that the payments be electronic , which speeds up the claims process. we are also going to have an off-the-shelf product that will auto adjudicate the claims and pay them timely. sec. wilkie: and i would note, that's key. the department of veterans affairs, as this committee, these committees have noted on more than one occasion has an i.t. problem. when it comes to claims processing, hands have to touch each claim. what we have done is look to the
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market for off-the-shelf technology that will allow us to automate the claims process. so that individuals are not having to touch each claim, and this will put the department of veterans affairs in line with the most modern health care administrations in the country. chair roe: well, my time is about expired, but this is what i want to have happen. if i'm a patient, and i come to see the doctor, and i need to go see a neurologist or whomever, i'm seeing the v.a. doctor that day, i walk out front, the v.a. doesn't have that specialist in the hospital, i get my appointment schedule, i get it made, i go see the doctor, that information is transmitted back, and the doctor gets paid. that's how the system works. i had surgery two, well, 18 months ago. two weeks after surgery, the bills had been paid by the third party administrator.
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and that's the kind of -- i know it is not going to be that quick -- but that is the kind of efficiency we want. and i hope that we have. and i'm 'not expecting it on june 7, but i am expecting it sometime fairly soon. mr. takano, you're recognized. rep. takano: thank you, mr. chairman. mr. secretary, over the last few months, the committee staff has heard from various stake holder, s, including the v.a., conflicting information regarding the v.a.'s development and/or adoption of what i talked about in my opening statement, designated access standards. we also heard from v.a. staff the president is likely to announce the adoption of a designated access standard model during his state of the union address. however, congress has not yet been made aware of which models are being considered, and the reasoning behind any imminent decisions. would you commit to us today that you are willing to offer each of the four corners, and i would say members of the
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committee, but i mean it should be made available to all of us, a briefing by millman, who is the actuary, prior to the state of the union? and a reasonably before the state of the union. sec. wilkie: mr. takano, what i will promise is that as soon as the president is briefed, i owe him that courtesy, and certainly, he is responsible for the final decision, and once he makes that decision, i will be up here with our team to brief this committee, these committees, for any comments and advice you have, and any corrective actions that you might have. it is absolutely vital. i think i mentioned in my confirmation hearing, i grew up in this institution, i know why article i is the first article, and i will commit to coming up here and when the president does make his decision, and it is still not clear if he is going to announce anything at the state of the union, but i hope to have him briefed and have those decisions made. rep. takano: mr. secretary, i'm
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a little concerned that this decision could be made, you know, the night before he delivers his speech and makes a grand speech about how every veteran is going to be able to see any doctor they want to see. i mean, that's one model. the veteran can see any doctor they want to see. of course, that sounds good, but there is a lot of down sides to that kind of a model. all the more reason why, the vso's, many of them, are complaining that there's a lack of participation, as per what we said in the mission act, that they should be participating in the development of these access standards. and so i'm not really satisfied with the answer. i wish we were able to get better insight as to what models you're considering, what the costs are associated with each of those models, because that has a lot to do with how much money might be diverted from, you know, regular central v.a. care. takano, let me.
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answer the second part of the question first. in terms of engagement with the vso's. i can say that they are a vital part of what we do at the department. in my time as secretary, we have doubled the number of vso engagements that the department had prior to my arrival. the majority of our vso engagements are handled at the undersecretary level, or above. over the last nine weeks, our vso's have experienced briefings from senior leadership in the department that last well over four hours a week. i will also tell you that in my travels across the country, i have made it a point to reach out to veterans organizations, in the rest of the united states. in alaska, i spoke to the largest vfw post i think west of the mississippi. i was just in your area of
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california, spent two hours with veterans leadership in southern california. did the same thing with the indian nations, the native nations in oklahoma. if the veteran is not at the center of the decisions, it won't work. but i will say when it comes to access standards, i have in mind, not only senator tester's state of montana, when it comes to the ability of our veterans to get to services, but also have in mind some of most heavily congested metropolitan areas this country. we have to make it easier for our veterans to get the care that they need. but i will also say, and i will repeat what i said when i testified in the senate in september, my observation, my experience, and senator tester said it earlier today, veterans are happy with the service they
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get at the department of veterans affairs. i have not seen any indication that the majority of our veterans are chomping at the bit to find alternative ways to take care of themselves. the most important part of this is the one that is not quantifiable, and that is the communal nature of veterans care. veterans want to go places where people speak the language and understand the culture. that is what i have experienced in my lifetime around the military, and that has certainly been validated in the travels that i have undertaken in the very short time that i've been the secretary. veterans will always be at the center of any decision that i make. >> appreciate the gentleman yielding. >> i want to thank mr. secretary, and i am sure mr. secretary you are aware of an article published yesterday, outlining the program, that was reported that
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1.9 billion, nearly a quarter of the funds spent on choice, were for admin fees, i've got a huge problem with that. do you have a problem with that? sec. wilkie: absolutely. >> ok, so moving forward, what are you going to do, or what are you doing, when it comes to admin costs from the private providers? sec. wilkie: well, in order to move forward, senator, may i please take a step back? >> quick step. sec. wilkie: this committee addressed the problems with choice with the mission act. the article in question addressed the problems with the system before mission was passed, before i became the secretary. i am cognizant of what went on with choice. you mentioned it, hastily put together, in response to a tragedy in arizona, so it is my
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direction, and i believe because of negotiations that we've been having with potential community care providers, that those administrative costs you will not see at the level that we experienced through choice, because the department, i will admit, was taken advantage of. because of the hasty nature that took place when the program was put in place. >> i will kind of accept that. but a lot of the folks who are delivering the care now under your thumb are close to one quarter in admin costs. close to one quarter. now, i asked my staff to find out where the v.a. was before choice, for admin, but as i recall, it was one of the, not if the cheapest delivery care system in the nation, when it comes to an admin cost. so i would say that. the other thing i would say is this. and congressman tacona talked about this, if access standard models are expanded to the oint, and i don't think it was
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congressional intent for this in fact, i know it wasn't, for unfettered choice, we've got a big problem, because it is going to cost more money. the care isn't going to be good. i talked about my only statement about blue water veteran, you know why we can't get blue water folks covered? money. extrapolate this a little bit. if it costs more to be in the private sector, if admin costs are higher, benefits are going to be cut. and so while you say it is the president's decision, and it is, he's the boss, there better be some good, good information coming from you and the people that know belter that this access standard needs to have some controls around. it would you agree? >> i agree with you. i just want to mention that the administrative costs are not as high as was quoted in that article. the number is less and it has actually been over years, so it is a much lower percentage. we have learned, since choice was first implemented, in a hurry, what we now move towards is itemization of the
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administrative charges, so there is now a range of what the charges are, and to close to the amount that was in the article per individual, but then with the care network, what we're actually have learned more and we are going to go to a new model which will further decrease the administrative costs. >> so are you planning on putting overhead caps on those contracts? sec. wilkie: we are moving towards a standard that is similar to what the community does. >> that's a no? you're not going to put caps on them? sec. wilkie: we certainly can -- >> i'm not advocating for it but what i'm saying somebody has to have the finger on these costs because i tell you, we're talking about billions of dollars. and after the fact, we can't get it back. and those are dollars that should be spent taking care of veterans. is that, so do we have a plan? do we, have because the truth, with the mission act, we passed it with the best of intentions, but it could be a train wreck
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too, and i hate to tell you, but it is kind of in your lap, it is in your lap, so when we're talking about too high admission costs and we're talking about access standard models that were basically unfettered choice, we could end up with a problem where we're actually cutting benefits for our veterans moving forward, and my guess is if you ask any of the vso's, that would not be a good thing. so i want to make sure that's on your radar screen. i got to have one more and i got to get it in and i only have 25 seconds left. you talked about giving information to the vso's. you talked about briefings. are you gathering information back from them? this isn't an information dump on the vso's. you're actually listening to them, and finding out what their concerns are. because i'm telling you, it is critical. it is critical for us. it is critical for you. did you want to answer that, dr. glenn? >> i can do it. >> go ahead. >> absolutely. in fact, many of the people in the audience will be with me tomorrow morning, in my office, discussing what was discussed here, and they will be telling
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me their input. >> so i'm not throwing anybody under the bus here but i'm going to tell you a lot of vso's have talked to me about the communication within the va. it's not where it needs to be. sec. wilkie: senator, let me add one thing to that . >> add that very quickly. sec. wilkie: i'll do it real fast. something has happened in the makeup of our veterans' population. since the fall of saigon half of our veterans are under the age of 65 which means they have different cares and they have different interests. what i have done in my short time is actually opened the apperture at department of veteran affairs to bring in veterans that aren't traditionally part of the system, purple heart, blinded veterans, student veterans. in fact, we have more veterans at the table discussing their issues with us than we have ever had and that mirrors the change
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in the active duty and reserve population that we've seen. so you have my commitment that every veteran who wants to talk will be heard and input be given. >> thank you, gentlemen, for yielding. senator moran, you're recognized. >> thank you very much. mr. secretary, thank you for you nd your team's presence today. i asked my staff to give you the statutory requirements and it turned out to be pages. in the mission act you are asked to develop regulations and the goal of that language was to make certain that congress was informed before the regulations were determined, not a consultation that says this is hat the regulations will be. my understanding is that those consultations that have occurred have progressively gotten better. we still want more specificity and you seem to be headed in
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that direction, but i would encourage you and your team as we get those briefings to give us the details so that we can encourage, comment, suggest in advance of decisions made in the department of veterans affairs and that is an intentional aspect of the language included in the bill. let me see if i can get a couple of things in the four minutes i now have left that are specific. first of all, how you define how the department of veteran affairs defines episodic care is a hugely important issue in regard to how the mission act will be implemented and what kind of care our veterans will receive. can you, mr. secretary, in a specific way, tell me how you will define episodic care? sec. wilkie: i will let the doctor describe that. >> doctor, thank you. >> so -- thank you. so it will depend on what the issue is. certainly, we have the six different criteria that go into it. if it is something where you
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require orthopedic surgery and require physical therapy, we will bundle the care for that whereas if we can't provide it we will provide it outside. >> obviously, in four minutes there's not a way to be terribly specific, but it will be something that we will continue to ask you. i will tell you that my interest n these topics is generated by our casework and what veterans bring to our office and what problems they have under choice. the idea that you have to go back to the va every time to get the laboratory work and the x-ray and that is not an efficient system and one not designed to fail and not be beneficial to the veteran. would you commit that we'll be able to review your definition, mr. secretary of episodic care before the regulatory process. >> let me turn to access
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standard which is have been a topic of conversation by most of y colleagues who have spoken already this morning. here is what i would look for in today's setting. i'd like to have assurance that might be applied to where the veteran links to his or her post office box as has been the case in the past. >> absolutely, and i've said on many occasions and most of my focus have been on the western united states. that is absolutely necessary if we're going to make choice work. it is striking to me that in 2018 we don't understand the scale of the american west and what you've said is absolutely essential if we're going to make access standards work. >> another piece of work that has become a challenge for us is the definition of in the va and that is that in circumstances in which our veterans are trying to access care, the va's response is the care is available within the v abroadly. in my view, the
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question is the care in the va at the facility, the hospital where the veteran lives and our veterans are being asked to travel long distances because the care is available in the va, ut not geographically. >> that is one of the things that we'll fix as a result of the mission act and we will get a system in place that allows the veteran the opportunity to get that care that is most convenient to him and to his family. enator tester is gone and what i use is the 700-mile round trip in montana, kansas, and the distances are almost as great. >> thank you. >> absolutely. thank you, mr. chairman.
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>> senator murray, you're recognized. >> thank you very much, mr. chairman. >> before we get in the main focus of this hearing and my concerns about the caregiver bill, i do want to remember the chaos with the current gi bill. it is unacceptable to leave veterans without a stipend or an incorrect stipend especially when they rely on that to pay for rent or food and it is nacceptable to put veterans' enrollment at risk by failing to get tuition payments and these are basic tests that the va cannot get wrong. you've had more than a year now to implement the changes in the forever gi bill. i've written you two letters and one more than a month ago and one more than three weeks ago looking for answers on how the va will fix these payment problems and how they'll address the short comings with the gi bill comparison tool and especially in light of the recent collapse of eca to explain why the department of education has stopped sharing accreditation information with
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the va. i don't want you to take the time to answer right now. i would like a written response to that and i want you to know we're all very concerned about it, but do i want to ask about the program, according to briefings from the va the epartment has ruled out trying to narrow the eligibility criteria for the caregiver program, but i am still very concerned that there are a number of issues that the va is looking at that i am concerned about including changes to the stipend, restricting veterans based on their type of injury or requiring a minimum disability rating. this seems to be va's still focused on keeping people out of the program instead of making it work better for our veterans and yesterday npr reported on several cases where veterans including a double and triple amputee are downgraded or kicked out of the program completely inappropriately and these are, by the way, not one off va cases and we're hearing it's a
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continuing problem in the va's management of this program and when the va previously downgraded and terminated care givers, the va assured me that they led to those type of actions and it is very clear it is not true and i would like you to immediately reinstate a ban on downgrades and terminations until the va can demonstrate to us that the serious management problems have been corrected and these types of outrageous errors ill not occur again. sec. wilkie: senator, i will say that care givers is especially important to me. i'm the son of a gravely wounded vietnam warrior. >> i appreciate sec. wilkie: i've seen my mother and family take care of my father prior to his passing last week. >> i appreciate that. will you reinstate the ban? sec. wilkie: i will -- i'm not familiar with all the rules but
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will tell you the national public radio story that problem was corrected within 24 to 48 hours. >> those are not isolated cases. we're hearing many of them. sec. wilkie: and those cases, it is my understanding, have been corrected because people were not reading the regulations properly. so my promise to you is i will do everything i can to make sure everybody stays in the program. it is that important to me personally. >> can i have your assurance that no one else will be downgraded or kicked out of the program until you look and make sure that the regulations are being implemented at every level correctly? sec. wilkie: absolutely. i will make that commitment and will brief these committees. >> ok. and also -- i won't have enough time, but i would like you to get me what your guidance to the program office is and your guidance to the field on how this is being implemented so that we can see how you're telling your staff. sec. wilkie: yes.
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>> ok. and i am also very concerned about the implementation of the changes to the caregiver program that is part of the mission act. before the expansion can begin. you have to certify that a new i.t. system is in place and the law requires you to have that system in place by october 1. that was a month and a half ago and this is not a new requirement and gao's initial recommendation to fix the i.t. system was made in september 2014 and the va has assured me that it is working on that issue and i want to know when you will have that i.t. system in place and have the certification as he law requires. sec. wilkie: the goal is october 1. i would -- i would not be telling you the truth if i told you that i was absolutely certain that given the state of va's i.t. system that that day will be met. >> that was month and a half ago. sec. wilkie: yeah. >> the dates passed.
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sec. wilkie: no. it's october 2019. to certify that the i.t. works. are we confusing two dates? >> that's your goal and not the goal given by congress. >> the timeline to certify the new system is ready is october 19. we did miss the october 18 date to put forth -- >> you gave yourself another year. >> well, there were two dates. there are two dates the senator associated with the requirement. the first date which was october of this year was for validating and deploying a new system. we have not deployed the new system, but the certification of that system was prior to expansion. >> can you define the requirements for that system? >> we have defined requirements and we are on user acceptance testing of the system and we are
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working through that and we do not want to deploy a system until it has been thoroughly tested and we feel is capable of serving caregivers and veterans' needs. sec. wilkie: i would say that has been the problem that i identified and talked, discussed with the members of this committee. the gi bill was a classic case of a program imposed on a system that was incapable of handling it. that's why i had to make the decision to go back to the old system on the gi bill. the same applies here. the system was not capable of addressing it. i give you my commitment. i am doing everything i can and so is the department to bring the i.t. system up to modern standards. he g.i. bill, weir talking about a 50-year-old i.t. system, and it's not acceptable, but you have my commitment that we're working with the best minds we
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can find to make va a modern health care administration and benefits. >> i know my time is up. i've been on this committee for more than 20 years and i always hear we're not going to get an i.t. system because there's a problem. every time it changes. every time there are problems. we've got to get this right. people are counting on it. >> i appreciate the gentle lady for yielding back and i've heard that for 10 years. there are a lot of people here. general bergman, i yield to you for five minutes. >> i can yield back right now, but i won't. folks. folks, we'll get to the heart of the matter very quickly. you are designing a system that you will implement for the benefit of the veterans.
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in my district, the first district of michigan, if any system will work in that system it will work anywhere because you have a largely rural district with some small cities so i am hoping or at least optimistic that you have factored that in that whatever system you're designing to get the veterans, caregivers, in this case, into a functional status that you consider the tyranny of distance and the tyranny of weather and all of hat. now in setting up your network, i'm guessing, although there aren't slide, there are certain assumptions you have made and ertain risk assessments that ou would like in those assumptions and we don't need to talk about it here, but if you would give us that list of assumptions and the risks that
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you have put together that would be greatly helpful and i notice in the slides here that i would guess in these meetings, whether they be weekly or bi-monthly if there is a course correction in a meeting or an update that needs to be made, what do you do? i don't see that in the slides. we have i.d.'d it. i'm a pilot. you see a need to change your heading. change your heading, don't wait. >> thank you, congressman. right now our team is engaged in 180-day reviews back at the va in the provisions of the mission act and we are, as you say, identifying risks and identifying as senator murray highlighted, concerns with things like i.t. how do we take different parallel paths towards getting to that october date. so we are bringing that through our executive committee and issuing guidance to the teams and working through resource requirements and working through
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changes in project plans and understanding what our needs are and bringing forward the stake holder engagement protocol so we can continue to uplift this program and make sure we can hit it. >> do you feel it seems like there's a chairman on the subcommittee oversight investigation and is there a sense of urgency? within your folks that are trying to implement. you have good people trying to do the right things. is there is there a sense of -- and this may sound like an xymoron, bureaucratic urgency? sec. wilkie: yes, sir. and that's one of the reasons why a battle rhythm was implemented. i have a military background and not as extensive as yours and the department has never had anything this complicated and we do now and we have timelines to meet just as we would on the
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flight line in my air force flight, so, yes. and i'll point back to what i said earlier to the attitude of those in the department and it's been my experience that we've had incredible support of those in the career leadership because they understand that va can't fail on this one and i'm very happy with that attitude. >> well, number one. thank you for your service and all honorable service is -- it should be respected by all and personally the proudest moment i've had is to lead marines and be mentored by lance corporals who have a 20-year-old view of the world any that's what drives us, but that and the interest of time i will yield back 50 seconds. >> i thank the gentleman for yielding and one thing we can do is to confirm his assistant secretary for i.t. that would be helpful. i now yield to ms. brownlee for five minutes. >> thank you, mr. chairman and
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mr. secretary for being with us today. i wanted to follow up with senator murray's questioning with regard to the caregiver program, and if i could, i heard you make a commitment, but i want to be abundantly clear that you are committing to us today to not modify any of the current eligibility requirements within the caregiver program as it expands. sec. wilkie: i am committing to review every case involving a caregiver who is in distress. i am also committed to making sure that before any decision is made on the future of the program that this committee is involved in it, and as i told senator murray, i will be reporting to her on the path forward. it is important to me personally
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because of my own experiences and we will get this right for the 5.5 million caregivers out there. >> you mentioned earlier in response to some other questions with regards to the importance of the input of vsos and veterans in general. you responded, i think, by expanded t you've that audience of veterans to younger veterans in trying to get a broader representation which i think is good. on the other hand, the leadership of the vsos really lead by consensus within their organization and representing that broad sense, and i, too, have heard from many of the vsos that don't feel in particular of the caregiver expansion that they are or have not been involved to the degree of that i believe that they should be in
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terms of prospect early making right decisions as you move hrough this process. sec. wilkie: well, you have my commitment and they will be involved. they are involved in making sure that we make the right decisions, but i will fall back in what i said earlier. it's important for us as you pointed out, to make sure that we hear from the entire cross section of the nation's veterans. i said in my statement that on the caregiver effort, that would not have been able to come to the finish line without the work of what i call the foundational bsos and that is my recognition that they are central to the entire issue of caregivers because the majority of veterans who were in that category and
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who need that family care at home come from vietnam and some left in the era and the foundational vsos are the ones who represent the community most impacted by the caregiver. can you commit to providing our committee progress reports in terms of the i.t. system for the caregiver so that we can feel as confident as you do in terms of meeting the october 2019 deadline? sec. wilkie: absolutely. >> that would be great. just in terms of broadly, the governance structure that you've set up for assistance in the implementation of the mission program. i think one of my frustrations on the committee, i've served on the committee now for six years is that we have va
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representatives come to testify. they're updating in this case and we'll want obviously, frequent updates on the progress with the implementation of the mission program, but many times they come, they avoid answering the tough questions, the responses usually, we'll take it for the record and we'll get back to you. i have found that i don't get -- i don't get responses. if i do it's months and months later so i just would like, again, to get your commitment that if it's you or others representing you that you will provide us with the best information possible to be informed and prepared for our questions and at the end of the day given -- you've set up a governance structure that i want to hear from you that at the end
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of the day the buck stops with you and that you alone are accountable for the congresswoman, that is right very i am accountable to you in the veterans. , having grown up in this institution, that in the time i have been the secretary and acting secretary, we have seen a 20% increase in terms of the number of roundtable briefings we have given to committees and the committees and staff. we have seen a 50% increase in terms of the number of actual individual congressional engagements with offices across the congress. that is part of the commitment that i made in my confirmation hearing. i will make that better.
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again, having grown up in the institution, i am aware of article one. >> thank you and i yield back. >> mr. banks, you are recognized. >> mr. secretary, the mission act is about making the community care dollars that congress appropriate's makes it and reaches a veteran. our committee has a spirited debate every year about the funding levels but the reality is and you can pick your analogy, it seems we have been pouring money in a leaky bucket or a clogged up pipe. when authorizations get delayed or lost, the veteran does not receive the necessary care in a timely fashion. when providers do not get paid, they drop out of the network in the veteran ends up in collections. by consolidating all of the different legal authorities and programs for community care, the mission act gives the v.a. the
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first chance in years to make the system work. my question is this -- do you agree that the mission act merely makes it possible and the law is only the beginning of a lot of hard work to establish better payment procedures, stronger audits, connect did i.t. systems, improved customer service, and improved communication to veterans and so many other areas? sec. wilkie: absolutely, it is the greatest first step but they cannot stop. >> i appreciate that sentiment. explore one aspect of that hard work. achieving interoperability with community providers and their e priorities of my top and i know it is one of years as well. run cerner.
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what about the other medical practices that have other ehr's. betweenthe linkage community care to attack that problem? sec. wilkie: i confess that i am not an i.t. expert but right now we are testing those standards, those operations in the pacific northwest and alaska. so these systems talk to each other. our first goal is to make sure that the dod and the v.a. talk to each other. the next step is to make sure that we communicate with doctors in the private sector, community care hospitals, as well as private pharmacies and to talk to those systems that are not part of the cerner network. of theone in other areas
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country and i am confident it will be done here. i will say likely that you are right about the interoperability. also, to the issue of privatization, i have argued that the success of the electronic health record system ensures that v.a. will stay at the center of a veteran's health care. it will be the central node no matter what the veteran decides to do. and that is one of the answers when it comes to the issue of privatization. i see that as a veteran myself. i see that when i look at the experiences of people in my family as well. >> i've shape that. when of the other key areas -- i appreciate that. one of the other key areas is processing. contracts, tohe bring to the table a new and improved claims processing
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system. v.a. will still have to pay the company somehow but the idea seems to be to outsource the i.t. system along most of the claim's paying function. can you please comment on the thinking here? and how will it improve the situation? overall, there are many changes. not just the consolidation of the regulations that govern the choice program now. we are implementing electronic claims payment system so we can auto adjudicate claims. we are also changing the way we will pay third-party administrators so they have the funding available to pay their providers. that all has to happen in tandem and is part of the implementation to get to june 6. there are many aspects of this
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and it is not just the consolidation of programs and new regulations. the technical up infrastructure associated with the community care program and there will be changes in how the gdp's are paid as well. lookingave committed to at the fraud, waste, and abuse in that system. mr. secretary, thank you for joining us today. are you aware that the congressional budget office estimated that the mission act would cost around $46.5 billion time of 2019 until 2023. sec. wilkie: yes, sir. no pay for the 40 $6.5 billion. correct? sec. wilkie: correct. >> those would be discretionary
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funds? sec. wilkie: yes. >> they would count against the budget cap? sec. wilkie: probably. that, thatnt over would trigger sequestration. words, for that 46 point $5 billion, in order to avoid sequestration, we will have to find the money within v.a.'s current budget. sec. wilkie: correct. >> are you aware the president has asked that each of his agencies cut their total budget by 5%? did you receive that request? sec. wilkie: yes. >> do you have a plan to do that? sec. wilkie: i have discussed the plan with omb. the president has not approved it. i will wait for his decision. >> will the money for community
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care be cut by 5%? all, forie: first of the choice program, we are fully funded into next year. i will say that in the submission that i made there were no cuts in community care. come from theould rest of the pas budget that does not -- v.a.'s budget that does not involve community care. yes, and as the steward of the taxpayers money, i am going to make sure we are as efficient and lean as possible. >> the noncommunity care edge it will be cut twice. buyhe 5% requirement and whatever needs to be spent on community care? sec. wilkie: we do not know where it is going to be cut. i have made proposals. >> you have made a proposal.
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and you are not sharing with us any of the details of that proposal? sec. wilkie: because i not had that conversation with the president. >> does it involve cutting personnel? sec. wilkie: it makes efficiency's in the system. >> does it involve fewer personnel to her three years from today --two or three years from today? sec. wilkie: i cannot say that. in the last fiscal year, we have hired 11,000 more employees. we have been hiring at a steady rate. to providingommit us before the end of this year and itemization of the things you propose to be cut with that 5% requirement? sec. wilkie: i commit to discussing with the committee at the earliest possible date the thesions that are made by people responsible for those
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decisions. again, i owe the president the courtesy of having him make the decision and then come to the congress and you are the ultimate arbiter of the budget. i can tell you from my experience what usually happens when a budget comes to congress. i cannot think of the last time one was passed as a came over from the white house. that is the practical nature of the business. >> do you know when you will find out from omb or the president? sec. wilkie: i certainly hope in the next few weeks. >> we do have your commitment, once you receive word from them, to brief us on your proposed cuts? sec. wilkie: once the president has given the all clear and you know the dance that goes on with usually,t process, coming into the finish line sometime in february. i will be as transparent as i can be within the strictures of
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the system as it has existed all the way back to 1974. >> we would like to see an itemized proposal that you have given to the white house as to what should be cut and we would like to see that at the earliest possible date. sec. wilkie: absolutely. >> just to clarify because it does get wonky. the fact that you would cut 5% does not necessarily mean it would come out of the v.a.'s budget. i would refer to the graph right here. these are the number of employees right here mr. lamb that have been hired. i have been here for 10 years and the da has had -- and the v.a. has had an average of employees leaving at about 5000 a year and they have averaged hiring 31,000 during that time. , goingthe budget caps
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back to the sequestration think the last budget was $206 billion. it has over double in the last 10 years and we found that money in other caps. sec. wilkie: one other comment. ahead of my out skis. i come from the department of defense. department the other in the federal government whose needs, it its mission is unique. you have served in one of the two departments. as the chairman has said, our budget has been going up. it is at record levels. president tohe continue his robust support for
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this department as he has for the department of defense. we are different. said, the chairman has that has been reflected in the increase of our budget and the thisity which administration has placed on both the department of veterans affairs and the department of defense. >> thank you. you are recognized. thank chairman isaacson, chairman row, and ranking members tester and -- who is not here for holding this meeting. i want to thank secretary wilkie and their panel for their testimony. i would also like to thank the v.a. for working directly with my staff in keeping me informed on the status of community care network contracts in the u.s. territories. the pacific territories including my home of american samoa face unique challenges
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thanks to their relative isolation both physically and economically from the rest of the united states. one size fits all measures simply do not work for the territories. and special care must be taken to ensure that the unique health care needs of pacific veterans are considered. to that end, i am glad the v.a. is considering the uniqueness of the territories in handling their ccn contracts separately. the v.a. staff briefed my office on ccn contracts just last month and i would like to take the opportunity to touch on the topic again. could you go over how the unique challenges faced by the pacific territories will affect the timeline for the ccn contracts and your ability to comply with the mission act requirements? but i also get your commitment to work with congress so implementation of the mission , the contracts, and any
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future related legislation will be in line with the needs of the territories? to put it another way, could you help us help you provide for our pacific veterans? timeliness is a factor but we also want to make sure that we get it right. sec. wilkie: i just returned from hawaii and i made a commitment to one of your counterparts, the governor of the northern mariana's that i will be visiting american samoa, guam, and the northern mariana's. it is important to me. i have made a commitment in the continental united states to reach out to the native peoples of this country. the same applies to the american citizens in the pacific. no group serves in the military at a greater rate than the men and women of the pacific islands
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or the native peoples of the continental united states. the unique nature of the challenge is 4.5 million square miles that we have to take care of in the pacific. my commitment is that that special categorization of the community care network for the islands in the pacific will address the unique needs. we will make sure, particularly through the implementation of additional telehealth services, our robust visits from it major medical center in hawaii to the pacific islands, that we always take care that the islands are recognized for the special needs that they have. and yout wanted to add are probably also briefed on this that we want to look at how
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tri-care has succeeded in these areas. lessons learned from them. we have to get it right. we will continue to work until we get it right. >> thank you, mr. chairman, i yield back. >> thank you, mr. chairman and i want to thank chairman row and chairman rise -- and chairman isaacson for their efforts on the blue water navy veterans. this is an incredibly important issue. these are folks that served decades ago and we owe them. we are not managing these budgets appropriately. they will not be will to get the care they deserved. it, say that if you bought -- if you break it, you bought it. we have to find the will and the means to do right by them. i think our colleagues in the senate for their enduring efforts to get this passed.
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and something about the care for all caregivers. this is an area where we have made commitments, we know it is a preference of our veterans, and we need to find a way to honor those commitments. and that brings me to today's hearing. the utter importance of managing these budgets appropriately. we have made promises to people that we will get them care where they wanted and how they wanted and in order to do that we have to manage the budgets. will you have sufficient funds in the 802 account given what we know right now? given closeout costs, and claims that you still need to finish. just wanting to make sure that
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we make that transition to mission but we cannot let go of what we currently have. >> let me assure you that overall we are monitoring on a very close basis the expenditures of -- the expenditures related to 802 and we believe we will have funding available through the end of the fiscal year and have taken into account all closeout costs and what we believe from a claims perspective in those projections. dr. glenn.u, and if it turns out not to be correct, please do let us know. sec. wilkie: and i would add to that that you are correct. this is the wave of the future for medicine, for v.a. care particularly, even though the majority are from the vietnam , theyor the new veteran demand service at home. they expect service at home.
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and the trends in medical care in this country as you have rightly pointed to that people get better when they are at home. and you have my commitment to do everything i can to make sure that this is fully funded and it reaches every veteran that we can touch. and thank you are again secretary for being with us here today. i wanted to review again from the very beginning what timeline we are to expect right now with the awarding of the contracts for regions 1, 2, 3, and four. could you go over that again because they are a little different from what we had in the briefing? the end of is for february and number four is for the end of march. >> we will want to be looking at that time frame again. and i would like to return for a moment to the discussion we had
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on the number one clinical priority and that is on military suicide prevention. and it is in part that connection between the handoff rom dod to the v.a. that is something we need to do a much better job on. those of us on the summit committee believe a check back in after six months from returning would be helpful to make sure that people are in the system. number one. number two, i have to push back as my colleagues have -- if we know for younger veterans that they are using social media and they are not already involved in the system of the v.a., why have we not touched the money allocated for you to do that outreach? this is a group not in the system. they need different ways to be connected. how we have done so little to use those funds
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that we have allocated. we used $1.5 million of that -- overall, we have used $12.2 million we spent last year in outrage and we have done a number of different efforts. in the nielsen top 10 we were for public service announcements. we did 22,000 outreach events last year. reachedide coordinators 2.2 million individuals. we also had the "the there" ere" campaignbe thr with tom hanks. actually been very active in this year, i am making sure that we are spending the funding 100% and so im reviewing the budget monthly. we have obligated all of the dollars. we have plans to reach out
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including social media this year. sec. wilkie: i would also say that i was responsible as the undersecretary of defense for personal readiness for instituting the training and the awareness on the part of pentagon commands on the challenges and the threats to our servicemen and women regarding suicide. we instituted the transition assistance program to include those markers indicating that there is a potential for a very tragic event. is committed to that. i am committed to being part of that. we also, thanks to these committees, are treating those who have other than honorable discharges and making sure that they had that transition assistance and that we join with the department to try to catch
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this before it becomes tragic. >> thank you and i yield back. >> sen. boozman: you are recognized. sen. boozman: thank you, mr. chairman. secretary wilkie we appreciate you being care. i have had the opportunity to serve on the house or senate v.a. committee since coming to congress and over the years, i have seen them go repeatedly through pains of implementing new programs. this congress we passed significant legislation that will bring fundamental transformation to the v.a. fails know, when the v.a. to properly implement programs, these committees become the backstop to assure that resources are searched to mitigate impact to the greatest degree possible. during a staff briefing about how the v.a. is going to fix its
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implementation, the forever g.i. bill monthly housing payments, the v.a. was unprepared to answer basic oversight questions about how much funding has been spent on failed attempts or efforts to react to the problem and what lessons the v.a. had learned from the situation that it can take forward to other implementation efforts in the and that are underway at the current time. these are not hard-hitting questions. these are the basics. more to the topic of this briefing, we had a briefing with your staff to get an update on where the department is with determining access standards. a key factor that will have an impact on our v.a. funding levels. when i hear that one set of information is provided to authorizing staff and another offered to procreating staff and different information is offered in briefings to all
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committee staffers, that is a problem. and i agree with you totally that the v.a. is filled with totally wonderful people but when your staff comes over without their act together, with no semblance of transparency, that reflects on v.a. leadership which you have wrecked control over. -- direct control over. it works better when we can trust each other and work together and we have no other choice. for fiscal year 19, the congress appropriated $5.2 billion for the veterans choice fund. can you tell us what the current burn rate is for immunity care and the choice programs -- community care and the choice programs? >> i don't remember the exact number, we can get it for you. different gotten two ones. aroundderstand it is
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460. we will get back to you with the exact number. -- youare serving kurt are saying that current estimates the funding is sufficient. if it is not, and times have come up in the past when it was not, how does the eight at -- v.a. intendw does to address the shortfall? sec. wilkie: one of the things that we saw with the choice act was that many fewer veterans decided to take advantage of it then was originally projected after what happened in phoenix. forhose veterans eligible 100% care outside of the v.a., less than 1% took advantage of that. that number of veterans is in the 3000 or 4000.
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every trend i have seen indicates we are well-positioned to take care of choice funding for the rest of this year. the v.a. develops regulations that would govern things like rights and access standards for the mission act. any decisions would have significant budget implications. those do. we understand v.a. continues to explore multiple options including tri-care standards a medicare it vantage. what is the estimated budgetary impact of the range of options? when will you be prepared to let the committee know how much mission act and community care to cost annually? sec. wilkie: i expect to be up your as soon as the president approves the recommendations i give him. standardsf the excess -- access standards, i precede them to be a hybrid of several of those programs that you just
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discussed. -- and that we will come to a conclusion based on the combination of those standards and what is best for veterans. but i will be a p or as soon as the president approves the access standards. >> thank you. ui mr. chairman. -- thank you, mr. chairman. let me get unanimous consent to put into the record a recent article that appeared in pro-publica. >> without objection. senator sanders: several private companies have been paid nearly $2 billion for overhead
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including profit to provide health care to veterans, that is about 24% of the companies' total program expenses. we have enormous administrative costs in private care for veterans. at a time when i hope we can agree that the function of the the eight is to provide the highest quality care to all veterans in a cost-effective way. my own going concern in this article demonstrates that is that we are in the process of dismembering the v.a., taking resources away from it and putting them into the private sector. many oflt will be that our veterans will not get the quality care that they deserve. secret,etary, it is no by the way, thank you very much for being here. it is no secret that i opposed the mission act. there are parts of the law that
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i support like expanding the caregiver support program and increasing loan repayment through the education net reduction program however, i remain very concerned that as written and without needed funding, this law puts us in a situation where we are focusing -- forcing the v.a. to pay for private sector care at the expense of its own infrastructure and staff. and i remain very concerned about the level of understaffing at the ea that can -- at the v.a. that continues to exist. i fear this is nothing short of a study march to the private sector. when people talk about the , theyization of the v.a. think that the secretary will come forward and say that the v.a. is privatized. it will not happen that way but peace by piece until over -- piece until over
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time it will be privatized. no one disagrees that veterans should be able to seek private care in cases where the v.a. cannot provide the specialized care that they require or when wait times for appointments are too long or when veterans might have to travel long distances. no disagreement. the v.a. has done that for decades. to my mind, the way to reduce weight times -- wait times is not to direct resources outside of the v.a. which the mission act does. should be focused on recruiting and retaining the best health care professionals in our country to take care of those that put their lives on the line to defend us. veteransrastructure so can benefit from the best health care facilities and the v.a. should be focused on figuring out the budget it needs to
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-- for the the vet demands of our veteran patients. mr. secretary, let me start off by asking you a simple question. , the veterans organizations to my mind do a very good job in understanding where the veterans are, the problems that they see when they interface with the the a -- with the vi.a. to my mind, the law says that you are to consult with the vso's but that does not mean a one-way discussion. it does not mean simply that you tell them what is going on it means that you are listening to them. let me ask you this, mr. secretary, can you tell me a way asn as precise
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you can, how you have solicited and how from the vso's that feedback has been incorporated into the regulations currently being written on quality and access standards? sec. wilkie: in the little less than four months that i have been the secretary, i have ooubled the number of vs engagements. i have also opened the aperture on the engagements by including groups that represent the new breed of veterans. even some that represent veterans going back to vietnam that have not been included like the blinded veterans, purple heart veterans. i am meeting tomorrow with many of the people who are in the audience today. it is absolutely essential. i have served, i have a long line of family service, without talking to the veterans and when i say talking to the veterans,
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when i am out in the country, in the great nations of the planes --i do meetains them. senator sanders: i appreciate that and i know you are trying to do that but meeting with them and talking to them is not the same as listening to them. may i have your commitment that you will incorporate their ideas and concert -- concerns into the work that you do? sec. wilkie: mr. chairman, may i -- i agree with senator sanders about privatization. and i agree with him about understaffing the v.a. but i do need to make it clear that we do not exist in a vacuum. the united states, as you have pointed out in many floor
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debates that i heard when i worked at this institution, is suffering from a shortage of mental health professionals, of women's health professionals, of primary care and in turn nests. we are competing for the -- and in turternists. we are competing for those. i now have the opportunity to impress -- to offer more impressive packages to bring those health care providers into the vi.a. we are doing our level best because you are right, we are short on those. i will also say and when it comes to privatization, you and i discussed this in your office several months ago prior to my confirmation, i believe this strongly and i have said it across the country. i do not believe that veterans privatizedv.a. to be
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and i will to you why. it is not anecdotal but emotional. veterans want to be where people understand their culture and speak their language. i am from that world. i understand it. and i agree with you that my job right now is to ensure that those veterans who need that care outside of the the a and we .a. and we do not have it, that they get that. encourage support and a bill that i have to allow doctors that have been trained here to stay here. thank you, mr. chairman and mr. chairman and mr. secretary, thank you for your service. if a veteran does not get good care, to the doctors still get paid over there? sec. wilkie: they get paid
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because they are on a federal scale. >> the federal government will pay them whether they serve the veterans are not? will the administrators get a paycheck whether or not the veterans are receiving good quality care and service? sec. wilkie: i can give you an example of how i acted on that. just historically, will they get paid for the outcome of the patient? sec. wilkie: before the accountability act was passed, before the mission act was passed, the secretary of the department of veterans affairs was under the same strictures that every cabinet leader was under. that there was a laborious process involved in removing federal workers who did not perform. that does not exist anymore. the onene year -- well year that i have been in and out removed.a., we have 5000 employees including the director of one of our largest
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medical centers. i did that because the work was not getting done, veterans were not getting treated, and i felt that the powers that the congress had given us needed to be exercised. and i intend to exercise those powers whenever i see a problem because veterans are first. the institution is not. >> and i hope that you continue to do that. that will be the only way that you will stay relevant and prevent the voters -- the veterans from voting with their feet. let us not be so arrogant that we think we can build a mousetrap from the federal government in washington that will satisfy the customer. even other -- either you deliver good service and they are satisfied or they are not and if they are not, they will decide whether it is privatized or not or a hybrid. in the private sector, if they do not like the customer, the
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private providers, they do not have a business. that is the incentive you are competing with. and that is why i am for choice. the is why i am forgiving veterans the freedom to choose to opt out of a system that may not be working for them. maybe a union controlled monopolistic democracy is not the best way to provide service to our heroes. i don't know. where it is working, great. why it iss not, i get not because it is a very different animal altogether. ok. it was good to meet you the other night, by the way and your wife. sec. wilkie: good to meet you too, sir. >> i'm really not an angry guy i just get fired up about this. our people choosing to go to community care at a greater rate today then they did a year ago? sec. wilkie: they are not choosing that when omar bradley
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ran the v.a. from 1945 until 1947. it has been about the same level, 30%, 35% historically. i think we are even seeing dr. lieberman, a slight dip in the use of community care. >> fewer veterans are choosing to go outside of the via a today -- v.a. today than they did a year or two ago. sec. wilkie: a small percent. >> i assume you measure the overall quality that the veterans are getting. >> within the vha? yes, sir. >> do you compare the quality and service metrics and community care with the quality
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of care and service at the vha? sec. wilkie: absolutely. >> how do they compare, mr. secretary? comparable? better? sec. wilkie: dartmouth released its most recent study a week or so ago in the annals of internal medicine and their conclusion was that care at the department of veterans affairs is as good or better than any care in the rest of the country. that includes community care. we are being judged by comparison -- >> that is good. good to hear. last question. i represent a big swath of role west texas. rural west texas. and i yield back. ac. wilkie: i have talked
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lot, congressman, about the scale of the american west. i sometimes joke that the loneliest sign in america is on interstate 10 in houston which says el paso, 910 miles. access doing is offering our veterans particularly in rural america the opportunity to alleviate a burden on themselves and their families by giving them the option to seek care closer to home if they have to embark on a 300, 400, 500 mile round-trip journey to get to a v.a. center. as i have said many times, it is incredible in 2018i saw this in hawaii last week, we do not understand the scale of the west or the scale of the pacific. walter'sin greg
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district in oregon a year ago and his district has more square miles than the state of tennessee has. our challenge in this committee was to devise a mission act or program that was good for rural america and urban america and that is hard to do. 405 in loson the angeles, you may be quicker to somewhere else if you are stuck on there to get an appointment if you don't live 10 miles from somewhere. it is a real challenge to do this and to get it right where you provide care. i think the v.a. is moving in the right direction. mr. o'rourke, you are recognized. >> thank you, mr. chairman. secretary, in answer to senator tester's question about administrative costs totaling around 24% and then that number
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was disputed but in response you said we were taken advantage of. could you clarify by whom the v.a. was taken advantage of? sec. wilkie: i meant in a generic way that the choice act and i think there is agreement from the leadership of both committees that the choice act was rushed. unreal,ere given such unnatural timelines to implement a program in a 370,000 person department. >> there was no actor or outside contractor that took advantage of you? sec. wilkie: we were forced to take advantage of what we could implement to get a law by the timeline which has now been rectified by the mission act. of" i said "taken advantage and i was not there.
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i was happily in the department of defense. v.a.derstanding was that had to move as rapidly as possible and there was not time for reflection that you would usually have in an issue like this. >> the articles about the recent released gao report about unspent suicide prevention outreach dollars -- $6.2 million allocated as of september. $50,000 spent. use it just there is perhaps another $1 million or 1.5 million dollars spent on top of the $6.2 million. you said you will exhaust that at the end of the year. you said you got 100,000 hits on the website. another thing the gao said which is perhaps more alarming is that you have not established targets for the efficacy of the outreach effort. hits to the website. you not know what it means or if it matters. how do you know how you are
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doing on what you have established as your number one clinical priority, suicide reduction? which i'm grateful that it is a priority. how are you doing against the priority? sec. wilkie: let me talk about the national situation we face. first of all, i was responsible for the department of defense and -- end of this. >> i don't want to hear anecdotes. sec. wilkie: 14 of the 20 veterans who die by their own hands every day are outside of v.a. we spent $12.2 million on that outreach just in the time that i have been in charge, just a few months. i have to go beyond what that gao report says. talked with governor brown and others. i am busy.
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>> if it is your priority, what is your goal? i am not blaming you for where you are. sec. wilkie: the goal is to do our best to make sure that we have done everything possible -- >> we will never be able to judge you. sec. wilkie: the majority of those warriors who take their own lives, from my father's warrior generation. that means these are problems 50 years in the making. i am not going to tell you that i can wave a magic wand and correct problems that began when lyndon johnson was president. i'm doing my best through the outreach that we have and the resources that start with the department of defense -- we never had a transition program or an awareness program on suicide until the last year or
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so at the department of defense. that is where it has to start so we make sure that the mistakes 1960 nine,in 1968, and 1970 are not replicated now. that is not anecdote but historical. >> but if you do not measure it, you will not be able to improve it. do you agree with the gao's finding? if you agree with that, what are you doing to correct the finding? >> we concur that we did not have robust enough metrics. we are in the process of developing more robust once. >> when will you have them? >> later this year. >> this year? >> may 19. sec. wilkie: that is the number -- 2019. sec. wilkie: that is the number one clinical priority.
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i can promise you that we will expend everything we can to try to correct this and address this great national tragedy. i think mr. or works question was if you do not know where you are going, you may end up somewhere else. i think that is what you are asking. thank you, mr. chairman. v.a.ecretary, i think the has always had the authority to reach out to community providers. prior to the choice act. i am trying to remember the name of the program? p3 program? one complaint i have heard is that every separate agreement is negotiated independently. so, being in colorado, we
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have potential for providers drop out because of the length of the negotiations. and the complexities of them. one question they always raised to me is why do we not simply use medicare rates as reimbursement so we are not renegotiating every new agreement from scratch. we are moving away from right now with the tri-west and in the future, with the community care agreements and the mission act. right now, tri-west has stood up and in denver, colorado, and in the first week, they are getting medicare rates and in the first week they have entered 2700 consults and scheduled 500 patients. they have been able to create the network at the facilities have been struggling to do on their own.
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be that is what is going to part of the community care network says we roll them out. >> how are we doing in terms of efficiency on telemedicine? rural raised about america, certainly rural colorado, it is a struggle. oftentimes, for care, they have medical the v.a. center, the regional medical center which is down in aurora, a four-hour drive. i know they are reimbursed for the mileage for that but are we doing better in terms of telemedicine? >> we are investing through support of the congress in increasing bandwidth at many of our c bok locations. we are also doing the anywhere-anywhere system.
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we can provide telehealth into the home. we are also working on partnerships two different entities where they will give us a private room in a more rural area and a veteran can go there and have their appointment in a location closer to their home. >> there was legislation passed that i authored and i think was included in a larger bill that requires an independent study as to those veterans who died, or committed suicide who were under v.a. care. go andective of it is to look into what prescriptions they had at the time of their death. i do have a concern that we are overprescribing some of our veterans in mental health. sec. wilkie: let me talk about video pure issue which is part of that continuum.
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and also to congressman rourke's -- o well-founded concerned about the suicide program, i will say we are not divorced from national problems. we are one part of that which is why in the answer to your question i will say, in this case, the v.a. has taken the lead in creating alternative therapies, alternative prescriptions for those with great pain. the one factor about v.a. care that is not shared in the private sector is that we help people who come from a dangerous profession. who aftere my father 30 years of jumping out of airplanes needed two new knees, hips, and had led in his
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body from vietnam. we have been able to reduce the amount of opioid prescriptions i-40 1% in the last two years. in addition, we are on the cutting edge of alternative therapies. occupational their piece. tai chi. -- that is part of the answer. to those veterans that are suffering from pain and subsequent issues like mental health. >> ms. custer, you are recognized. congresswoman custer: i do appreciate the progress being made on the opioid epidemic and i hope we can spread the new alternative pain management buttegies within the v.a.
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also frankly within the private sector as well. i just want to revisit briefly this issue because i think my constituents and those across the country were so shocked and concerned to read today about this issue that your department had only spent 1% of the $6 million for suicide prevention. we have had more testimony on that today. you say you are doing your best. but what i'm concerned about is that that cannot be true when we have so many leadership thencies at key posts in v.a. related to these programs. what are you going to do about getting the right people in the right place? and i want to give you one chance to revisit mr. o'rourke's question because we cannot respond in our oversight
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function to the concept of doing your best. if we do not know what your goals are. you talk about the majority -- sec. wilkie: the vacancy that you talked about at the head of the suicide prevention office was immediately filled by me by making permanent -- >> does that person have the staff they need? sec. wilkie: yes, and also the expertise of having been the leader of the department of defense suicide prevention. ?> there are other vacancies >> we are building a larger office underneath this individual. >> does that program have
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functional capacity at all of the -- around the country as well? -- i also want to let you know that we really are focusing in a new way on the high risk veteran populations and outside.ha there was an executive order on working with transitional veterans. we have been working on that since 2017 but this week and the rest of the month we are mailing out letters to the over 500,000 other than honorable to encourage them to come to us to see whether they are eligible for care in mental health. we are also looking at the reserve and the guard who have never served. they have recently been
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identified more at risk populations. outreaches to them on their weekends when they are doing drills. we are reaching out to leadership in those areas. another risk we recently identified is that if a veteran came to an emergency room in the prior three months and had just --ittle bit of suicide suicidal thoughts, we did research and found that if we made a suicide safety plan with them where if they are having suicidal thoughts, what are they going to do? call a loved one? listen to music? it has been shown to reduce suicides by 50%. we have implemented this rapidly at all of our facilities across the country. >> the research is important.
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i had another question. whole us -- issue under the mission acts. i will leave it at this. new hampshire is one of the rare states without a full-service va hospital and we are all trying to find this balance of care at the v.a. and if that is not possible, care within the community but i would use new hampshire is a cautionary tale. manchester, we had a problem where the level of care dropped below what is necessary for a robust v.a. going forward. i think that was the point that senator sanders was making and i think it is instructive as we move forward. sec. wilkie: i would add that i complete -- that i agree with you completely about suicide. v.a. as and out of the
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acting and then had to go back to dod and await confirmation. in my first week, i laid down the first pass on the suicide issue. importantothing more and there is nothing more tragic . you have my commitment that as long as i'm privileged to be part of the v.a. team, that will continue to be the case. one quick second. i have been in congress for six years. fifth v.a. secretary in those six years. i appreciate your personal commitment. i have heard that five times. and veterans are dying every single day. we will hold you to the tomitment and we will want know the metrics. i appreciate the innovative solutions and will look forward to continuing discussion. thank you.
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>> secretary i'm glad to know you were in hawaii and obviously -- [indiscernible] ok, this one is working. could you add to my time? are you listening? >> we froze the clock. >> thank you very much. i am glad you were in hawaii and you spoke to the governor but did you let the congressional delegation know you were going to be in hawaii? sec. wilkie: i think i mentioned it to you the last time we spoke that i would be in hawaii in december. >> not to beat you over the head
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but i think it would be good for you to have your team alert the congressional delegation. sec. wilkie: and we do. >> so we can maximize our ability to work with you and support you. sec. wilkie: i will go back to what you and i discussed last time. i made two commitments. one to go to hawaii and one come if you are not there, i have to go back because i'm going to samoa and guam. i want to go there while you are there. years, not, over the only have we had many are ongoing there challenges with i.t., homelessness, suicide, construction delays, and access to care. asked if there is a sense of urgency at the v.a. but i ask you if you have a sense of urgency? sec. wilkie: absolutely. >> what are your top priorities? , i. wilkie: top priorities
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mentioned the first clinical priority, suicide prevention. my top priority is to create with the assistance of these committees and modern 21st-century health care administration that keeps veterans at the center of their health care. this committee has already laid down the template for that. and it is my duty to carry that out. >> i think i'm looking for something a lot more measurable. asked howe, you were can we verify if you are reaching your goal regarding suicide prevention? said hisv.a. secretary goal was to end homelessness. those are the kinds of specific priorities i am asking you to articulate if you have them. sec. wilkie: i will tell you that i am not going to come to this committee and tell you that
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i will end homelessness. and i am not going to come to this committee and say i am going to eliminate suicide amongst veterans. you your topg priorities for the v.a.? decreasing suicides. increasing -- decreasing homelessness. sec. wilkie: i just mentioned them. modern, 21st century administration for the v.a. which means modern i.t., the best medical care possible. >> when you say something like "best medical care possible" how do you come up with a verifiable metric? sec. wilkie: we have the standards. we have the metrics which we share with this committee. we compare what we provide with health care across the country. i have referenced the latest comparison that dartmouth is
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done. it says our care is as good or better than any in the country. prioritiesave those -- it would be good for us to hold people accountable and that there be transparency and accountability and i would want to apply that you. if you have those priorities and they are listed and how you are going -- whether you have verifiable met -- metrics to enable us to realize if you have obtained those priorities, that would be great. about theuestion family caregiver, the comprehensive assistance for family caregivers. an important program for a lot of veterans. i'm glad we expanded it. i have received a note from a caregiver in hawaii this week and she wrote -- i just received
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the devastating news that we are no longer eligible for the caregiver program. i did not even receive a phone call, or if -- or a follow up. how are you communicating with the 5500 family caregivers as to what is happening? officelkie: if your could share with us that individual so we can follow up -- >> certainly. usthe mission act is giving the way forward. to make sure that we are implementing the same matter what country -- state you are in across the country. we propose to move away from the reassessment and move more towards wellness checks to make sure the caregiver has what they
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need. we have regular ways that we communicate with the caregivers. , we have ane calls phone line where they can call him. we have not yet made our decision on how we are rolling out. right now, it is in the federal register. you are right, 5.5 million family caregivers. that is a lot of people to stay in touch with. sec. wilkie: absolutely. >> senator blumenthal, you are recognized. >> thank you, mr. chairman for having this hearing and thank you to the secretary and your colleagues. i want to thank my house
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colleagues for passing the blue water navy bill unanimously. --ant to say how difficult disappointed and ashamed i am that the senate failed to do the same. aen though as recently as couple of hours ago, i was on the floor of the senate asking for unanimous consent from my thatagues to move ahead so bill would become law. jobhe v.a. were doing its in supporting this bill, it would have overcome the , aosition of a small number handful of my colleagues come up locking it now. i'm going to ask you to commit, as i have before, in hearings that you will help us pass that blue water navy bill. sec. wilkie: i committed to the chairman and to senator tester that i would do everything i could to help your committee.
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before but done that unfortunately that support has not been translated into active advocacy with my colleagues. i hope you will do better during the next session. i want to follow up on a number byquestions asked congressman over work about metrics. you cannot do better unless you measure what you are doing. see, when of the chief criticisms in the gao report has been the lack of metrics and measurement. i would sit that -- i would suggest you respectfully that two good ones would be if the rate of suicide is coming down which it is not. and whether the gao is using all of the resources at its disposal to bring it down. which it is not. would you agree? i agree -- sec. wilkie: i agreed with the
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state of affairs at the v.a. that the gao laid out. >> you would agree that the reason you failed at the v.a. to spend more than a fraction of the money given to you by the theted states congress is " reason they did not spend the remaining funds on suicide prevention" was because the approval of this plan was delayed due to changes in leadership and organizational realignment of the suicide prevention program. more specifically to say on 17 that it was a lack of leadership available to make decisions about the suicide prevention campaign and on page 17, by not assigning keys
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leadership responsibilities and clear lines of reporting, the vha's ability to oversee the suicide prevention activities. you and i discussed in your office when i was the acting secretary that the first thing i did when he became active which is sort of being in limbo but i did anyway. was to start moving on the suicide prevention issue. -- can you commit that the v.a. will spend every congressted by the
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allocated by us to a suicide prevention in the coming fiscal year? absolutely and i will probably ask for more or allocate more because of the national tragedy. >> how much more? sec. wilkie: i don't know. , i haveast few weeks been on the phone or in person with jerry brown and other governors discussing the way a head. become -- ahad comprehensive nationwide response to veterans suicides. i need the cooperation of the governors. i have put in train the development of the metrics that you have talked about so we have in place a program to go and attack this problem. that is the best answer that i can give you. that i moved on it as soon as i
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moved into v.a. >> you have to forgive me and maybe us that we have seen this movie before. said, we my colleagues have seen a slew of secretaries who have made commitments and ,romises and i think we are speaking for myself, expressing the frustration and in patients that is well-founded in fact because of the turnover in leadership from the top through the middle ranks and with all due respect, dr. lieberman is an example. he followed others who had been in that position for small links of time. cannot demand accountability if there is a constant itdership overturning which then becomes a failure to spend the money allocated to suicide prevention. sec. wilkie: i agree with your
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observation about suicide. inchoate in 2017 that is why i permanently appointed the dod leader in suicide prevention, the person with the most expertise in this matter available to the government. and that we are increasing the size of that operation. i agree with your criticisms. >> my time has expired. >> thank you, senator blumenthal. first of all, thank you to all for being here. i would like to yield to next year's chairman for closing comments. >> thank you, mr. chairman. mr. secretary, i do look forward to hearing as soon as possible about there designated access standards. you told me in your response to me that you still need to await the president's choices.
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but i hope that you will to us beforeking that time because i see no bso's -- the vso' s and the congress cannot participate with you. not to bedards were developed alone between you, mr. secretary, and the president. and i do not want to see expectations unnecessarily raised at the state of the union speech and congress being in a position to have to try and pull those expectations back. i would like to in the time between now and then and the third week of january, i would like to see your department work more closely with the bso's and
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congress in developing these access standards. so much is at stake. we need to do some trust building among the stakeholders, congress in your department. -- i want to reiterate what senator blumenthal has said. the frustration of congress being able to hold the v.a. accountable when we have seen changeover. some of it is on the senate for not confirming people in a timely manner but, nevertheless, it has been very disappointing to see in the last two years and administration that has not been able to put into place stable i.t.rship and i see the failure with regard to the v.a. eight payments. payments.
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the issue with social media and adequate marketing being done to inform veterans about suicide prevention hotlines. all leading back to the same fundamental problem which is, the unstable leadership at the top. change. got to i would like nothing more than to see you succeed and for you to serve out a tenure which allows you to implement changes. way --o appreciate the or the sentiment that you expressed when you quoted the dartmouth study recently. -- further back the grand the rand study and how you understand how well the v.a. does deliver health care. the main problem is access. 41,000 vacancies.
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i would like to work with you, mr. secretary on not slow so applications aren't knowledged, people are quickly made offers, and we also take a look at what we need to do to develop the health care of the working service in this country. not everything needs to be resolved with a four year degree or a medical degree. mr. secretary come in the spirit of that, i intend to work with you to turn around the situation. sir -- iie: i.t. why, tonk you sir, and i intend work closely with both committees. my respect for this institution
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knows no bounds and the beauty as you said at the beginning is that this is a bipartisan effort. i like to think of this department as bipartisan like the department of defense and you have my commitment to do everything we can to make sure that the lives of our veterans are better. of all, thank you mr. secretary and your team for being here today. i want to thank our staffs. ofpassed a major ease legislation that would not have happened without the staffs. and john and ray, thank you for your leadership in the senate. we worked closely with our colleagues on both sides of the aisle. and i personally, just as a point of personal privity -- just as a point of personal -- i iso went to think -- thank,
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look around this room and i see a lot of veterans. details ofout the this. you had tremendous input and it would not be the bill it is today without your input. the v.a. and mission act -- the v.a. mission act was to take a piece of legislation and make it applicable to world america and -- rural america and urban america. the one thing that was to happen is that every veteran got the best medical care possible. i was a position that provided v.a. utside of the ba -- i have also been a doctor in the army. i think i understand the system fairly well and i want to get three things out before we leave. on june 6, we are made to go.
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if not, would you be willing to come back at the end of march and give us one more, could be a combined meeting, or however but informal to lead the members know that we are ready to go live on the sixth of june or thereabouts. and make appointments at the v.a. for our veterans in a timely fashion. can we pervade -- can we pay our providers. these are good doctors that want to serve. i would like to see those three things happen. and there will be other hearings on the caregiver bill and the asset review. we will do that. i would encourage my senate colleagues, we have a couple of people, your i.t. position. a staffg woman as member on our committee right now is an incredible young woman who came here without any
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education, served in the u.s. navy, has gotten a rn degree and now a doctorate degree and has done investigations of v.a.'s all over the country and he could be -- and she could be in that position doing her job. we need to get that done and she needs to be confirmed sooner rather than later. that is a point of frustration for me. on the mental health side, and we held aarted hearing. i said if we are doing spending $8 million a year or $9 million a year and we have not moved the needle at all, why do we not reevaluate and change what we are doing.
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there are plans out there including in new jersey. the first four days that he was there. he instituted a plan called we should doddy that across the country. evaluate what works and what does not. i was at candidate or. we have a great call center there. i said -- are we changing anything? are the numbers still the same? that is where the metrics are so important. -- they willng continue to work on this as this is a tragedy beyond incalculable. i have spent hours in the operating room operating on a cancer and then treating the
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patient afterwards -- this is one life. if you lord the rate by as much as 55% by doing something simple in the emergency room, why did we do that? -- to senator her own no --in medicine now, quality metrics are fairly standard. look at what medicare uses. v a -- v.a. does the same thing. it always irritates me when my doctor asks me if i can stand up. measurable ande the v.a. does an outstanding job and i want to finish by saying this -- if what i care about my
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in johnson city, tennessee. and i have traveled from long island to los angeles to puerto rico in the last year. vast00% but avs -- a majority of people like the care they get from a suv. it is very customer friendly. and iterans that believe believe they are getting great care. i want to see every veteran gets that care. i know in your heart that you are committed for that. i thank you all for being here today and i thank you as a point of personal privilege and if there are no further questions, i ask -- he could not be with us but i will be submitting questions on
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his behalf. >> are you going to visit northern marianas also? members have five legislative days to submit their remarks. so ordered. the hearing is adjourned.
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>> today on c-span, "washington journal" is next with your phone calls. on newsmakers, senators chuck grassley and james and talk and homeland security secretary kirstjen nielsen testify before the house judiciary committee. in about an hour, we will talk to administration education secretary bill bennett.
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then crystal fleming, the author of how to be less stupid about race. later, new york magazine's washington correspondent olivia nuzzi joins us to talk about funding for border security and staffing changes in the white house. host: good morning. a live view of our nations capital with the christmas tree on this day before christmas eve. day two of a partial government shutdown, affecting an estimated 800,000 government workers. the house and senate return tomorrow in what will be pro forma sessions. by all accounts, this session will continue until thursday evening. this is the third time this year congress and the white house have forced a shutdown. this

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