so want to thank them for your continued effort. once again, wanted thank you for having this important hearing. with that i yield back the remainder of my time.

>> before we began this morning and want to recognize some participants that are in the audience with us from the american legion boys nation of joined us here today. all -- will you address to fund the debt of gratitude and stepping up as my ranking member has said during the very trying times for the department, and we appreciate you being here. he is accompanied by mr. denny pommel, direct deputy undersecretary for benefits of the department of veterans affairs. assistant director undersecretary for health and administrative operations at the department of veterans affairs. as always, your complete written

so it -- statement, mr. secretary, will be made a part of the hearing record. with that, you are recognized for your opening statements. >> thank you, mr. chairman. i will get straight to business. concerning health care we have serious issues. here is how i see the problems. first of veterans are waiting to long for care. second, scheduling and improprieties were widespread, including deliberate acts to falsify scheduling data. third, and in foreign exists were many staff members are afraid to raise concerns for fear of retaliation is. fourth, metrics became the focal point for some staff instead of focusing on the veterans we are here to serve. fifth, va has failed to hold people accountable for wrongdoing in negligence. last, we lack sufficient resources to meet the current demand for timely, high-quality

health care. as a consequence of these failures the trust of the veterans we serve, the american people, and the elected representatives has eroded. we have to aaron that trust back through decisive action and by greater transparency in dealing with all of your stakeholders. to begin restoring trust we have focused on six key areas. it veterans of witless and in the clinics, says the -- fix systemic scheduling problems. sure that veterans of the focus of all that we do. a culture where leaders insure accountability, transparency as the norm -- hold people accountable for willful misconduct or negligence. establish regular and ongoing disposers of the information and finally quantify the resources needed to consistently deliver timely, high-quality health care

here is where we are doing now. vha has reached out to over 703,000 veterans to get them off of witless and in the clinics to playing a mobile medical units using temporary staffing resources and expanding the use of private sector care. in the last two months between may and may to mid july and we have made over 570,000 referrals for veterans to receive care in the private sector. that is up more than 700,000 to over the comparable time the year ago. each of those referrals will on average results and seven actual apartments and visits. an increase of more than 700,000 of lemons and visits for care in the community last year just associated with the referrals over to once.

the ag is posting a regular twice monthly updates to keep veterans of born about progress we are making and accents. as part of the effort to improve transparency, i recognize, mr. chairman, that we have more work to do in providing complete and timely responses to a special inquiry. we are moving to improve our existing scheduling system and simultaneously pursuing a purchase of a moderate commercial off-the-shelf system. i have directed medical center visit is to conduct monthly and person visits of the clinics andrew lee anytime with care. today over 1500 of these visits have been completed. we are putting in place a comprehensive external audit of scheduling practices and are building a more robust system

for measuring patient satisfaction. i have personally visited 13 to four medical centers in the last six weeks to hear directly from the field how we are getting veterans of witless and the clinics. the 14 day access measure has been removed from over 13,000 individual performance plans. where will fall misconducts, management negligence or whistle blower retaliation and stockyards appropriate personnel actions will be taken. i froze the va central office harry. the ag has dispatched direct assistance to facilities requiring the most improvement including a large team on the ground and phoenix right now. in addition, we have taken action on of the recommendations made in the ig may interim report. senior executive awards have been suspended.

additionally, i have directed a fundamental revision of all medical center and visitor performance objectives to ensure they are aligned with suspicion -- patient outflows. i have repeatedly taken a firm stand on the subject of possible retaliation. in messages to the entire work force and numerous face-to-face meetings with employees and leaders i have made it clear that we will not tolerate retaliation against whistle-blowers. furthermore, i committed that we will achieve compliance. she and i have agreed to streamline the process by which we work together to insure proper was a blower protection. we have also established internal processes to ensure appropriate personnel actions are taken where retaliation has been documented. i have made a number of changes, including naming dr. caroling

clancy and trump undersecretary for health spearheading our immediate efforts to improve veterans access to care. short term assignment as senior adviser to the secretary. comes to us on loan from the hospital corporation of america, for he is the chief medical officer and president of clinical services and is also chairman allied to the american hospital association. emmy's a wealth of knowledge and experience to help the spurs a time until we have a confirmed new undersecretary for health, a position he himself once held. as part of the restructure of the office of medical and specter, we call it aliyah by internally, and dr. jerry cox has been appointed. a career navy medical officer and former assistant inspector general of the navy for radical matters he will have -- you will help insure a strong internal

audit function helping to ensure i standards of care quality and patients' safety. as we complete reviews and investigations we are beginning to initiate personnel actions of those accountable and support is critical work messily bradley has begun a four month assignment as special counsel to the secretary. a former general counsel at va and most recently a senior member of the general counsel tim department of defense or she has a direct response ability for their ethics portfolio. shifting gears, in the area of resources, i believe that the greatest risk of veterans over the intermediate to long-term is that additional resources are provided only to support increased purchases of care in the community and not to materially remedy the shortfall in capacity copied such an outcome would leave va even more poorly positioned to meet future demand.

today va chemicals staff and space capacity are strained. between 2009 and 2013 the number of unique veterans retreat in the has increased by over half a million, and the typical veteran we treat today has on average nine major diagnoses. in just the last three years for the veterans health care facilities have experienced double-digit growth in the number of patients to come through their doors. as an example, at the fao, north carolina va medical center which i visited several weeks ago the number of patients being treated his current 42% in the last three years. this represents a moderate percentage increase in annual expenditures that would address clinical staff, space, and information technology, and

information technology necessary to provide timely high-quality care first. let me briefly address benefits. since arriving at va i have been impressed with the ongoing transformation. i doubt that any major part of the federal government has transformed some much in the past two to three years, and i believe that because of this transformation we are on track to eliminate the disability claims backlog from 2015. having said that, veterans still wait too long to have their fans decided. the quality is still not up to our own standard a portion of our request for additional resources will be provided to ensure accurate and timely claims for veterans. in closing, we understand the seriousness of the problems we face. we own them. we are taking decisive action to begin to resolve them. the president, congress, veterans, the esso, the american

people, and va staff all understand the need for change. we must, all of us, seize this opportunity. we can turn these challenges into the greatest opportunities for improvement to my belief, in the history of the department. furthermore, i think that in as little as two years the conversation can change. va can be the trusted provider for veterans' health care and for benefits. our ability to do that depends on our willingness to seize the opportunity, challenge the status quo, and drive positive change. i deeply respect the important role that congress and the members of this committee play in serving veterans. i am grateful for your long-term support and will work hard to earn the trust. we cannot succeed without the collaboration and support of veteran service organizations. i have conducted some 20 meetings and calls on the last two months with leaders and other stakeholders to solicit

their ideas for improving access and rebuilding trust and look forward to hearing the testimony on the panel that falls. last, i appreciate the hard work and dedication of va employees. the vast majority i continue to believe care deeply about our mission, what to do the right thing and work hard every day to care for veterans. because of their work today, thursday, today hundreds of thousands of veterans will receive great care in facilities all the way from maine to manila. in the midst of this crisis it is all too easy for us to forget that simple fact. mr. chairman, i am prepared to take your questions. >> thank you very much, mr. secretary. it is an honor to have an opportunity to work with you and call you a friend. we have some questions that we're going to ask today. both sides will have some pretty probing questions. i think we appreciate the actions that have been taken at

the department to move veterans of the voiceless and, i think, probably one of the significant questions that is to be as trick now is how many veterans currently are on waiting lists over 30 days for appointments? >> do you want to take the weightless question? >> sure. the electronic wait list numbers about 40,000 nationwide today it down from 57,015th. >> the new enrollee appointment request list, which was another focal point for this overall effort, started at roughly 64,000. it is currently sitting on what is really going to be a permanent level of about 2,000 because there is flow in and out just about every single they. when you look at the number of veterans are awaiting vendor scheduled but waiting longer

than 30 days for their apartments, it's about 640,000 total. we see the number of veterans waiting longer than 90 days as we release information age two weeks. we see that coming down steadily, but not precipitously, not fast enough. >> if we can talk a little bit about the funding request you alluded to in your opening statement, is this a formal request being made, an emergency request, supplemental request? >> what i am trying to do here is articulate the requirement as best as i can. from my perspective is it is a formal request, for funding. >> from the administration. >> that is my understanding. yes, sir. >> is anyone aware of how the supplemental request was made by the white house in regards to the process of the crisis that exists on the border right now?

>> i am not aware of the method by which it was -- >> as supplemental request from the lighthouse. i am trying to figure out because everybody keeps dancing around the work request. even yesterday in undersecretary did here on the hill. i am trying to find out what we -- it is a desire, but ordinarily it would come through the white house. walk me through the how did this come up right now. what was the impetus that began you looking at -- 35 billion on the table. end zone around during the negotiations on a conference committee report you have injected over 17 and half. >> i think as we luncheon to know -- over two months ago we launched into an effort to expellers care for those veterans of our wording the

longest. we undertook simultaneously a process of evaluating the adequate resources and the field in order to the will to meet the standard of consistent high quality health care, timely high-quality health care. as we work through that process using the information systems that we have available to los common we developed an initial set of requirements and begin working with the office of management and budget. as my testimony last week to the senate became closer and closer, nearer and nearer, there was an increase after to try to get that process to closure so that during that testimony as well as this testimony would be able to present that statement of requirement. >> so the memo that you gave to center sanders on the 16th of july says, per your request attached for your information is a summary for additional

resource base through 2017. so was its center sanders request, a combination, yours? >> senator sanders requests the information. the information -- the requirement that is being communicated here and if you will their request is our request. >> you come from a banking background. if somebody came into your bank with three pieces of paper and asked for a million dollars would you give them a million dollars? >> the honest answer there is it probably would depend on who the borrowers, but i understand your point. the committee needs additional information. >> and we have set a goal of trying to wrap up the conference committee by the end of next week before relief so that we can get something to the president for his signature, and we got three pieces of paper to justify a request that centers

and is clearly wants to put into this dough -- making it very, very difficult for us to the will to do our job if all we get our sheets of paper that basically say they are working documents. at some point they have to say, this is the document. you are recognized. >> thanks you very much, mr. chairman. he stated in your statement that va does not have the resources it needs. in your view what led to this lack of resources and when was this on their resources identified? from my third question, what did the department actually a request in their budgets? reason i ask that question is when i first became a member of this committee when i was first elected and the secretaries sitting where you're sitting a.

we asked him, he was defending the president's budget. the question was, can you deliver services for our veterans with iraq and iran and the current -- his response was, if you requested an additional billion dollars and did not receive it but will make do with his budget. he'd been in the french. >> i have come into the department. i formed opinions about what i see and what i here. my general sense is that what we have done historically is managed to a budget number as opposed to managing to requirements, which is what you do in the private sector. i think as a result of that what has happened is we have sort of model their real long and not been able to meet the standard

of care that veterans deserve because we did not manage to requirements. the exercise that we have gone through and, frankly, continued to go through as we work to make sure we're ringing all the productivity we can is really about managing to requirements. i would tell you that process, as i mentioned, in response to the chairman's question, has been underway for about the last two months. i have been in places now for seven weeks. and so we are working through that process. these are not -- in the private sector this would be a routine part of the business. you would be managing to requirements, continuously exercise in productivity tools. and over years you would be building the organizational capacity to ensure that you got the response of resources to be able to meet existing demand.

that is simply not the way the it department has historically been done. i can't answer your question about the specific budget request in relation to what was actually finally approved, but we will take it for the record and did you an answer. >> i appreciate that and your comments : who. that was why some response. i don't care how big of a budget increase you received. are you taking care of the veterans. the outcome is so critical. and over the years through several secretaries i have sat here and listen to i believe they have always operated the department based upon the budgets they had, not what they need to take care of our veterans. hopefully that will change. >> if i may interrupt, sir. i committed to the president,

the employees at va and most importantly to veterans. will not hold back. if i think resources are required, and going to ask peter have told the internal staff, did not ask for 1 penny more than you can justify it. i am not looking for some kind of a blank check, but fire not court to sit here in my meetings with individual employees as they raise issues about the news that they have some resources that the black and come to understand what my job is. my title may be acting secretary , but much of is to create conditions for them to successfully meet the needs of veterans of this her. that's what i am obligated to do. >> i appreciate that. do you think the business operating models that al qaeda currently operates a sustainable and getting to what sherman meant to when you look at the office of level exploded with

management and that the va differently has to be reorganized and a better format to you think the current business model is sustainable in the long term? >> my sense is a their archenemies rose to restructure after from the. ahead i don't like pure proceed with understand an organization as large as this one, you have to have some of the. the challenge is making it work for the people serving veterans day in and day out. there has been concentration. part of that, i would tell you, i think was positively don't as part of taking and consolidating support activities where they can be performed more efficiently and effectively than they can scattered.

that does not mean that we got it exactly right. there is still work to do. >> thank you. >> you're recognized for five minutes. >> thank you thank you for being here today. i want to follow upon something there was brought up earlier. a very important issue that i would like to get more information on. it has to do with where you sit in your statement, we don't have the refined capacity to accurately quantify our staffing requirements. yet in your resource requirement you are requesting over $8 billion for about 10,000 primary and specialty care physicians and other clinical staff. given that you said that the department is unable to quantify its staffing needs, how can the number like that even be a arrived at?

>> of going to let philip address the fundamental question would tell you generally speaking we have got, as i said earlier, we have not been working to solve to requirements . earlier today sent participated in a briefing we delivered about the composition of our ophthalmology specialty. inside that model when you look at the productivity tools that we are rolling out you get a good microcosm of what will ultimately will give us granular the. you will find as we exercise that model there are indications that have enough staff. there are others that may need additional support resources, and additional support staff for space. and then there will be locations where we look and say, we have enough providers. it is storing through that kind

of highly granular process will give us the precise answer. we're working on doing that now. in the meantime as we go live in the field and look at top down requirements, it is clear we do not have the resources we need. the process that we have used. >> the one thing i indicated is, we tried to use a bottom-up approach. we made certain assumptions about improving efficiency over the years and then that gave us the definition of the apartments and cost and the model. we worked with the assumption of that is due mostly purchasing of care and the private sector because of staffing issues and then blended over time and sustain it using internal staff. away the weekend about that was estimating the number of veterans and appointments that would be delivered in a timely

manner and turning at -- >> it sounds like it's a work in progress. so i question how specific you can actually be. a follow-up question is, are there a lot of slots sitting empty did you have not been able to find someone to fill, either doctor or other health care professional? >> i would second yes, there are thousands all across the a.j., roughly 28,000 vacant positions. in some instances they are not all being actively recruited to fill we have been pushing particularly on clinical staff and direct support staff. >> one follow-up question there is, if you have 28000-x open slots and add 10,000 or so more open slots, are you ever going to even be able to fill those

slots under current requirements the current productivity requirements you have, which i understand your testimony is different than the private sector. >> organizations will always have some measure of organic vacancy rates. turnover in staff, but what it allows us to do is raise the floor so that the fully incumbent position number rooms. i think that there will be staff that leave the organization. people leave to retire, move on to other jobs. our vacancy rate is about 10 percent which reflects the turnover rate. just turnovers occur you have a certain vacancy rate. the other thing we are looking at his precision management practices. herring to the requirement which may require in certain cases a fully incumbent staff.

to your point, i think the additional staff allows us to raise the floor. >> i yield back. >> thank you very much. was ms. brown here? you are recognized for five minutes. >> thank you, mr. chairman. i want you to no, i was here before the chairman. [laughter] >> i have been on this committee for 22 years. in fact, when i came jesse brown was a secretary, and his smile was putting veterans first. have been through all of the secretaries. some have left a lot to be desired, and some was -- but the point of the matter is that i am understand that va has changed over time. one time we were serving a certain kind of veteran.

now we have expanded. the conditions are different because of the war. they have come back for different elements. how can you plan for that? because they want their services at the va. want to make sure if the va is there for them. and it is a lot more complicated than we are saying. like you said, they have to an additional things as opposed to at one time it was maybe a lot more simple than it is now. >> we have an actuarial model that we use to forecast. part of that looks at the past practice and forecasts into the future. that is part of it. the other part is to start introducing more bottom-up planning and having our field give us, if you will, the statement of requirements.

this is the number of veterans who think you can surf. i think that and neglected to mention this for the congressman's question, if we improve performance, if we are better at providing high quality and timely care, that his point to affect veterans coming to the va. it will come to us more as they can get care more timely. having the bottom-up planning approach and working with medical center leaders to give us a bottom-up operating plan on what their financial requirement is i sequel also help us adjust for where we are succeeding and when we succeed. >> someone said that we have given the va everything they have requested. i guess institutional memory should be a part of it. in 2007 and 2008 to may was the first time veterans were able to get the budget the requested. you know, that was under president barack obama.

i know i am the only one of the members, but it is important to remember how you got where your he needs to remember that many of us talk the talk but to not walk the walk. so i think that is important for us to remember how we got. and to va, yes, we are having problems, but we're not to the point that we need to destroy the system. and i feel very strongly about that. and i don't want to be the only one saying that that va shouldn't -- i mean, i think we should work with community partners and stakeholders. how do you feel about that? we have teaching hospitals that we should partner with. we could share equipment. i still want to afford to be in charge gorgeous, ma'am. as i travel around -- >> yeah just returned from gainesville corrections, man.

in medical center after medical center i am impressed with the academic affiliation as we have with local partners in the community and the benefit to all the many benefits, the extraordinary care that has allowed to be made available for veterans and the expert clinical staff for we're able to recruit in part because of the strong affiliations, one of our opportunities to continue to pursue. >> take you very much and thank you for your service. >> yes, ma'am. >> you've got 42 seconds. you are recognized. >> thank you very much, mr. cameron. thank you, mr. secretary, for being here today and for your service in this tough time. i agree with your opening statement. i said this in the beginning. one of the problems that va did have was loss of trust. and i think ms. brown brought up

the plight a pretty -- the plan a moment ago that the previous secretary, and said from the beginning of the models should be that we work for the veterans. i think those things, of cultural change will help. one of the things i am just not sure about having more people is going to solve a problem. i came on this committee fun and a half years ago there were quarter of a million people working for the va. the number your testimony is 341,000. that is more people than any city in my district. and just not convinced that getting bigger is going to solve the problem. i think getting better and more efficient will solve the problem. i do not think -- getting larger may make the problem worse. when you see in office go from 800 people to love and thousand, that is mind boggling that that

many more people could be needed when you don't have that many more employees. and i think you are looking internally. i truly believe that. question i have is, as you mentioned accountability, has anyone been held accountable and terminated? >> there were three actions announced dealing with phoenix back about two months ago. there is an additional individual, senior executive manager that has been placed on a leave of absence. >> anybody that does not have a job? >> there is -- >> what we call being fired. >> i understand. i'm also learning the hard way how you do that in the federal government. in so it starts when you create this massive base of information that is documented. i got the end of june the first

results from the ig finally released on one location. 1,000 pages of transcripts of sworn testimony. in the midst of all of that there still was not all the information needed. we had to dispatch additional investigators. we reviewed all of that to multiple e-mail traffic and go through the process of telling hitting authority for proposing an official. have to review all of the information. there are two things going on right now -- >> let me interrupt you. you just made my point. when you were in the private sector did you have to go through a thousand pages? >> no. >> the answer is no, you did not. creating more inefficiencies, more people making this bigger before we turn it down and make it better is not the right direction. very briefly -- i don't have a lot of time left, but we're going to have to try to make some big decisions in the next

week or so that involve a lot of taxpayer money. $17 billion. that is a request. as the chairman pointed out, i asked every time we had a budget hearing, do you have enough money to carry an intermission? the answer each site has been yes. so how do i know this is enough money when i have been told before you have enough money? i voted for every single budget. that is one of the things i will never apologize for, spending money on veterans. i will not do that because we would not have this country the way that it is that i enjoy growing up in if it were not for the veterans of this nation. that is not an issue, but jen not want to take the money that hard-working people, including veterans to go out and pay taxes and not spend it wisely. can you tell me how $17 billion

-- renfro muscle lot of money. >> a lot of money where i am from to. >> how will it be spent? would you be better to take some of that and not look at building a bigger bureaucracy but to veterans who want to -- is a veteran says, would like to go see my doctor outside, let that veteran do that. would that not be cheaper? we have those folks in here week ago today to express the desire to do that and have the capacity to do that. it would not be easier and more efficient. >> one of the points that was made earlier and one of the opening statements was that veterans are pleased with the care you get. >> i agree with of the fact of their pleas to. >> the other thing that has been interesting is, we have been working down these lists. we call veterans of her waiting too long for care and ask if we

want to select it and refer allowed into the community. sometimes it's yes, but more often than not it is no. mr. chairman, one thing i want to tell you. and a sergeant to my office this week. he called a va to cancel his apartment and was on all for two hours. he just walked around his office doing his job. later, when he had a point -- you will have done something because he said he got eight different for all calls from eight different people about his support to funnel point. >> it does not sound very efficient to me. >> i yield back. >> inky. he recognized. >> take you, mr. chairman. secretary, point blank, is there a shortage of doctors and if so, what various? >> i would say the short direct

answer is, yes, there are shortages in primary care and specialty care and mental health >> mental health is a big portion of the shortage there are problems referring people to certain areas of specialty care. what are of the va most successful position recruitment tools? to any stronger tools connect. >> i think we have a number of very strong improvement tools. one of the areas we have done a lot of work is surgery. that program has made significant use of informatics to actually look at practice, process, and identify deficiencies. that program was nationally and is able to support at the regional, national, and local level tracking and trending. >> recruitment, improvement tools. >> i am very sorry, congressman. one of the areas that had come

up before, would we look to have tuition reimbursement and other kinds of the stories provided? i think looking at cost, those are valuable. >> but recruitment, that kind of recruitment, tuition reimbursement presupposes that there is an adequate supply to recruit from. when know that doctors are more likely to stay in practice and the place where they completed a graduate and medical school education. gm east seem like one of the best recruitment tools that the hospitals have. is the va using that effectively >> i think we are. where we find we do not have a strong economic philly it we have challenges. where we have developed a strong academic a filly we have a good pipeline of quality providers who have done work in the va, understand our mission, love our mission, and come to work for us >> would you welcome funding to

expand the va gm the program? nationally ten to 12 percent of graduate member school education with medicaid and medicare checking the other nine years of person. we have been frozen since 96. i have to think that is contrary to a shortage of doctors generally. >> you think this will help address the position shortage if we were able to give more timely care to veterans to increase the number of graduate medical school education slots at the va? >> i think so. >> is my time up? okay. with their current fee basis system, has a lack of interoperable of the between the electronic of record at the va and on va providers been a barrier to providing high-quality, noting of care to our veterans?

>> one of the things that separates us is the requirement that we have, the responsibility to maintain continuity and coordination of care. i think in some of our contract options we have the ability to exchange electronic data. he is the thing. to many of us support the idea of non va access. giving our emerging situation, corporation public and private support that. but our concern about the solution that is the focal point of the funding is this potential lack of continuity. is that part of your plan going for? >> it is a part of it. we're looking at one of our major contracts we have in place today to look further making the

data that we share back-and-forth. today it is not compatible. individual authorization will come and sometimes as paper. in contracts we get a pds, but when the test did the data. many more in carper ability to really make outsources of non va providers more feasible. the ig, and from ig, active ids said in the long run the best efficiencies are going to be to own its own doctors, to keep care within its system. no system whether private or public wants to allosaurs talk of network care. there is usually a huge charge. in a tent the va has the same sort of challenge. in an emergency situation we want to make sure that when we do not sores there is continuity of care. >> as we look at purchase care in the community, we think in

terms of extraordinary geography, technology, and demand. clearly we're in a time of extraordinary demand that we're dealing with as a mix of race care. an extraordinary geography. there will always be communities that we cannot justify building. we will have to provide timely and appropriate access to care. and there will be occasions where highly specialized procedures will not make sense to do in-house. >> we support but we want to set the parameters so irresponsible and does work. >> correct. >> i yield back. >> you are recognized. >> think you for joining us today. in your testimony you said, we will work hard turn your trust the va and your trust being the trust of carter's party your background and mine are very similar. we above sea-level officers and private sector organizations.

now, in those positions, each of us have to report to boards who were responsible in a fiduciary manner for the oversight of the resources of those organizations and so, i am going to lay out the following environment. let's say your of the cfo of an organization of looks like this, performance measures that are not trustworthy, senior executives who manipulate information in order to receive bonuses, past financial inspections including requests for funding that cause spending levels to be higher by billions of dollars. in those funds or repair ramp to of the purposes without letting the board no. then you have a resource management system that according to your own testimony is not accurate. in light of that, what do you think the board reaction will be if you go to incite, i need a whole bunch more money and am only going to give you three

pages to explain in. that is the first part. the second part is, would it have been much more twice to, and sank, we need a small amount and will come back to you and a few months and sure you agree job we did this small amount and then say in light of that unlike to make a larger request because of error on the right track. that is my first question. >> well, i think the sense is that we needed to provide as the conference committee was considering other appropriations are needed to provide our best estimate of the requirements to meet the current demand. >> u-turn those requirements in to request. i don't think that was wise. a think it would have been smarter to come back and say, this is the down payment we need if successful in turning this around and putting veterans health care first we will come

back to you and ask for x, y, and zeke. you asked for the whole enchilada at one time. that cost a lot of us to struggle. now we have other folks trying to latch on. i just don't think it's a good idea. let's give into a little bit more granular information. in the health care model that va uses, the enrollee health care projection model which takes into consideration the number of components, the projected number of enrollees, workload, unit cost of providing services. vesco 11 and 12 estimating resources for about 83 percent of the health care budget estimates. in 2014 expanded the use to develop cost estimates beyond that. over the years they have

identified many problems. and it is of the very coast of the product. so that is an issue. and now the air administration is requesting 17 in half billion dollars. so here are my questions, and of going to run out of time. you can add to the supplemental. was the eh seeped and used to estimate the additional 17 and a half billion dollars needed to clear out the backlog? why did they fail to predict the demand on the system, and is there a way that the model can be adjusted to include reasonable wait times? number three, and most important, should continue to advance va health care funding is clearly the method used to predict the funding needs of far in advance is not working. as i said in earlier testimony, the va overestimated and then

used the funds for the purposes without talking to congress or the board. and so the model goes all over the place. and you're saying it needs over 17 and a half billion. did you use that process? >> indirectly. a used cost, unit cost to derive from the model, but we looked at the appointment wait time and used the data to be had for veterans waiting for care > 30 days. >> the unit cost. >> as correct. >> everything else was starting. >> looking at the data we had at the time. >> to you know what they failed to predict, these estimates in the past? >> i don't know that it did. i would have to go look at the detail. >> the facts say that it did. anyway, get back to us on that. >> thank you very much.

you're recognized for five minutes your recognized. >> excuse me, mr. chairman. well, i think we all agree that the purpose of these hearings end of your proposed reforms to increase service to veterans and their families. services that they have deserved and that the secretary for being here and all that you propose. we have heard of all of the many problems. as they exist generally for veterans, i think the problems are even worse for our analogy bt and women veterans which is are a lot like to address my concerns. i would ask you, and he believes that veterans and their spouses should have equal access to federal benefits through the va regardless of their current state of residence in? >> yes, i do. >> i think you for that answer

and ask you this because last month the va announced that your agency has exhausted all avenues in the wake of the decision of the supreme court in windsor verses the u.s. that struck down , for giving benefits to our o.c. but to veterans. unless congress acts those veterans and their families who live in states that don't recognize their marriages will begin nynex's turned benefits. is that correct? >> yes. >> that is most unfortunate. because of that i recognize that need. after the supreme court decision i introduced h.r. 2529, a simple but i would correct that language problem. we had a hearing on that last march. no one came forward. ahead es those speaking in favor of. no one working against it.

reduce support our efforts to make that change so that all our veterans who have worn the uniform and served equally, serve the united states can have access to those benefits. >> and not familiar with the legislation specifically, but my own policy decisions at the department had been to provide equal benefits to all veterans to the maximum extent permanent dialogue. >> and i think you for that. veterans do, too. i'm sure. as for women, some of the recent reports have highlighted some very disturbing statistics about the low quality of care that of female veterans face. they're less likely to seek out care, often called silent veterans. when they do we have found that that va served 390,000 female vets last year, yet nearly one in four does not have a

permanent gynecologist on staff and if it won at of every to receive medication that could have caused birth defects even though they are at an age where they might want to have children. these are unacceptable statistics and address the question of quality of care. i sent a letter along with 50 colleagues in the house asking that this be addressed. and now you have been busy. i wonder if you could speak to that this morning. >> well, i know you and answer. apologies. i will get you one. we are, quite frankly, playing catch-up. the growth rate in women veterans that are coming to the va for care radically of stress the overall growth rate in the number of veterans coming to va for care. we have not historically been well positioned to provide that care.

we're doing things training for existing providers to buying additional providers as well as -- i know what a big deal if it is every time they're able to cut the new ribbon on elements clinic. so it is a really big deal, but it is catch up. >> i appreciate that and thank you for your answers because sometimes we look at the big picture and forget that there are certain veterans who are, perhaps, being overlooked. what are unproven of services to go for all veterans because they have served and sacrificed. thank you very much. >> thank you very it looks like you are recognized for five minutes. >> thank you, mr. chairman. and thank you, mr. secretary. frankly, your story of coming in

in the interim like this and trying to pick up the pieces of a system that has obviously been under zero lot of stress is admirable. i appreciate what you're doing. have a couple of quick questions that i hope he will be able to help me with. first of all, i just want to address the personal issue the schedule to be increased in size for years and actually the money is apparently in your department and all it needs is your signature. i would like to get your signature on that to make that. my district has been waiting for this war years. the money has been appropriated and is in the budget and really have been trying to get this happen from longtime. >> we will dig into that. >> i have been trying to get this to happen for a long time.

>> when i'm out in the field aren't run into all kinds of instances. >> i appreciate the fact. >> before i leave the room. >> appreciate that you are out there yourself seeing what is happening on the ground. my problem with management is when someone is sitting behind a desk listening to their subordinates tell them how things are, that is when trouble happens. that is what has happened in the past. the question that we properly a, what does the secretary need to do his job? you mentioned how difficult it is to remove people. what would your recommendations be? what powers should this secretary have that he does not have now to make sure the change happens? >> that is not an easy question to answer. i have said repeatedly, will use whatever authority of god and use it to the maximum extent

that i can tell people accountable. there are different proposals out there about granting additional authority to the secretary. if provided, we will use of different recognize that to the extent that those are targeted solely at the department of veterans affairs, that has an impact over time. >> you are explaining a lot but not giving me an answer. what do you need to make this happen better? >> you know, someone asked a question earlier about, is that how it works in the private sector? does look -- was work like we do in the private sector. that ignores a century of -- >> well, let's make a step forward. the number one thing that you would recommend it to make it easier for the secretary to do his job and promote accountability and action? >> i think the flexibility to expedite personnel actions would be a big deal.

>> the me ask another question. we are trying to get the patients of avoiding listen in to the private sector. you know, my experience with the va is it is difficult to make happen because there is so much paper. in this emergency situation making it easier for that veteran to get out in the private sector and make it happens when a. what have you actually done to make this happen? >> that is a question congressman, one of the things they have done is created new tools prevent over talk about them before. it helps us to audit the documentation of the referral. it also allows us to for the first time look at the referral through all of its stages and manage to it will get to look and when it was created, if we

authorized its cover every sat on it too long after authorization, when was a scheduled to while much time passed, when was the care delivered in documentation returned? it is helping. it is not perfect yet. >> what exactly are you doing to get people off the waiting list? tell me how that works. >> specifically phone calls asking if they would like to be seen in the private-sector. if they would and we can coordinate reviews in -- >> not in place of the most part >> not fully, but where it is the will "need. where it is not we are working with veterans. if the new providers to their want to work with a new heart with the provider they're is a scripted process. it is a little bit patter. italy still have a lot of work to do about getting help to look

at the process from a veteran perspective, it's easy to understand, follow through. we have work to do there. >> and plenty had net of you are recognized. excuse me. you're recognized for five minutes. >> thanks you, mr. chairman. thank you for being here today paralyze out on the navajo nation in my district. talking with lots of folks, lots of veterans, many of them in areas with the cellphone coverture broadbent coverage. one of your goals is to expand telemedicine which is a great opportunity for my district. my first question is, in your budget do you have money for expanding broadband infrastructure in those areas where we have veterans who have no access to back. >> i think it is one of the things we have to look at. in the supplemental request we

add additional support for itt include hardware and then with for expanded care, but we need to look at the specific. >> of an up to be part of that conversation as we continue one. it will be so critical to getting the care that they need. one of the question is for the secretary. the inspector general's reports have been very valuable to this committee and trying to unravel the problems and come up with real solutions. no of like to know what you have done, would be a put in place since the interim report from the inspector general in may? >> there were a series of findings and recommendations that were included in the ig may report. most of them have to do with first working the list of 1700 veterans that they had turned up in their process which we have

reached out to every single one of. appointments for a thousand veterans have been scheduled as a result of that particular process. there were recommendations about producing the near report, the new enrollee and upon request report, producing that at the medical center lovell and producing that. that has happened. the new list is down from 64,000 to talk to 100 the last time i looked which would be about the bottom of that. further items. it seems like there were one or two others. >> each one of them became the specific action plan. we have worked on them. we have implemented their recommendations. >> i got it. >> there was also a recommendation, the lists nationwide which obviously we do

produce an published every two weeks. those are really the four or five recommendations that we have vigorously. >> thank you. coriente visit with a doctor. they just veered into a contract with the va for treatment of veterans and a happy and pleased to do that. with that i here back. >> thank you very much. >> this is secretary, thank you for being here today. in no, let me to start, take the assumption that the goal of the va is to see all those eligible for keresan as possible and provide quality care. that should be the assumption. but i find is the motivational factors that i needed to

accomplish that and to achieve it under regular basis to comply with human nature don't already exist. in other awards, the incentives are not necessarily better than what exists in the private sector. and i am curious how you propose in this vast bureaucracy we're dealing with from administrators to physicians and nurses and those that are supposed death about to create an environment where truly seeing the veteran patients is an asset rather than a liability to the system? >> an interesting way to frame the issue. as i mentioned in my opening statement, i continue to believe when i go out to the field in phoenix several years ago visiting with a room full of abuse, that that is clearly our most troubled with what i have

characterized as the failure, mismanagement, chronic under investment. person after person raise their hand and talked about the things they're arguing, the things they had to overcome in order to take care of the veterans. i still find everywhere i go the vast majority of people cared deeply about the veterans we are serving. if we did not have that we would not have anything to reach in and grab hold of. as i tried to take this organization and the direction we need to going to be able to reach in there and grab hold of the fact that they care a critical, critical element of we are doing. with two of you other structural things. i listened to it in my opening statement. i have situations where quality of care at a medical center is

declining and medical center directors are getting top of scores and evaluations. that was what prompted my direction to say we're going to overhaul the standard performance contract for medical center directors and visit directors because we are not going to have a contract rivera result is not aligned with the patient outcomes we are delivering. it will take some of those kinds of structural changes as well to ensure we have people focused airing the lasting would say to this point, so focused on wait times and as we think about how we gauge timeliness of access in the future might think that the centerpiece of that will be a much more robust focus on patient satisfaction. i think that helps us receptor back on the veteran we're serving and not looking and ugly times and the 700 of the mac tricks. >> and those types of responses should be the driving force to whether someone gets a bonus.

>> yes. >> inspected general employment was then us money over the last decade has increased its lead to more layers of administrative access rather than actual care. that really is concern. she. i had a meeting this morning measuring productivity and efficiency which we have done a couple times. think they're going in the right direction, but there are some things missing. what you're able to look at is how much we pay the doctor. there is more that goes. this comes in to what we're asking for money. if you have an old physical plan, you have to take a look at how much you're spending for productivity in a plan that is costing you out of this world. you may be better closing that facility and putting everything in the community in that particular spot. rihanna measuring at.

when you talk about outsourcing, maybe it does not cost more if your physical plant is costing you so much more. those are business decisions. that has got to be the approach. so long going to continue to work with that group and with you. hopefully we can see these types of changes. i appreciate with that i am out of time. >> you're recognized for five minutes. >> thank you, mr. chairman. appreciated. mr. secretary, the way i understand your proposal, predominantly for additional space, additional personnel, professionals, and some money for i t. i certainly agree that in terms of facilities and personnel they're is a need.

as you stated in your testimony, one that has had double-digit increases each year over the last claviers. not much has been done, i will add. i think what i have learned through all of the hearings and we have had, the care for veterans once they get in the system is pretty good. it is accessing the system where we have seen it is truly broken. and when i see the itouch proposal, it concerns me. you did mention of the shelf products you're looking at, off-the-shelf technology. but i really want to no, we have to fix the ax as part of this. don't want to invest more money into a broken system. i want to invest money into new

technologies and innovation and getting the va into the 20 versus three much like the private sector and the tools that they have to access the health care system. if you could just comment on that please. >> first of all, the majority of the i t resources as i've understand the proposal here are associated with the activation of the facilities. it is the ig infrastructure we need. additional clinical staff there are things on their way to really take us into the 21st century. part of it is the purpose of the commercial off-the-shelf scheduling system which is not included. there are other things we were talking earlier about, and dropper ability for purchase care and technology investments that are included.

anything else to have? or check couple of items. private of it is a capital request. we are requesting a certain amount, 12 to 13 million, but we have to help it tap with i t to make it usable and connect that is a part of it. so that is built into it. it is not all just rob development work. it is what you need, to make use of the staff, you need i teach. >> mr. secretary, in terms of offical solutions to was the time friend? where are we looking at? >> there are actually three or four different initiatives on the scheduling for. we have already led a contract to deal with some bofa most challenging aspects of the

current system and they're expecting those to begin to be fielded within the next six to 12 months. the timeline for the purchase of a commercial off-the-shelf system is still, but up in the year based upon that the contractor and a perch we're going to have to pursue. 2016 is probably the best case scenario of that particular system and so that is one of the reasons we're going ahead to make the investments and fixes to the existing systems of the region not wait two years before that improved functionality. >> and quickly in your opening comments talked-about of the bnd improvements there. we also learned in our airings and we had a 2,000 percent increase in the appeals with regards to benefits when you have that together and it gives me pause in terms of believing

in me the improvement. >> i would be glad to there has been this lazar sharp focus on the disability claims backlog. ..

>> i would tell you when i directed zero the medical center's to go out and spend time in each of the clinics people have asked me that does not sound much like a

check and balance but the real motivation behind that was to be on the ground do take ownership including the timeliness. >> from those whistle-blowers. >> but we come behind that with the independent audit comprehensive audit because we need to restore that tressed. >> has anyone lost their job for retaliating? >> no. there are two whistle-blower retaliation referral suggest come from the office of special counsel and tuesday morning investigators will be of the crowd. >> no other ongoing investigations are currently on the way? >> the number is 70. >> the other 68 are ongoing?

>> it is at the office of special counsel i am waiting for the office to provide me the results of their investigation. >> what you doing about it? >> let me describe what we heard from whistle-blowers we get an e-mail once a year then we are faced with retaliation. this is still going on today. >> i can articulate over and over the expectation we will not tolerate that behavior but and toe i have a set of facts to act on i cannot take the action, not the personnel action. nobody is more anxious than i am to have that opportunity. that is why this morning i checked again anything from the office of special counsel? the answer was yes. tuesday morning investigators will be on the

ground. >> following the last meeting i asked for contacts between whistle-blower's that had contacted the chief of staff to the president and i don't believe we have received that information you have access? called mr. baker's that has not been looked into or responded to. these are serious allegation i assume we have a new secretary but to say we will restore the trust but now that is symbiosis' job? >> no. it is my job. i just cannot take action until i have results from the office of special counsel or the zero ig. >> had to issue did need new statements about whistle-blowers? >> yes. >> i yield back. >> you are recognized for five minutes.

>> thank you, mr. chairman and mr. secretary for your hard work i want to recognize a friend, the national president of the american legion here in the room to day visiting us from our district in southern california so think you for being here and your hard work. [applause] recently my office has done an incredible detailed thorough investigation of the issue that faces veterans not only when i started office with a community forum the stakeholder now says research but also interviews but in light of the crisis

we have veterans of pfizer reported that is top notch we conducted surveys in multiple beatings and the virginia administration in. we recently conducted the informal setting but when the approach means the world of a difference to our veterans and approach with the spirit of problem solving of partnerships or solutions of honoring our veterans with the relentless determination to serve and put them above anything else, we found and i will give you information but they tell a story. the vast majority of my

veteran said they waited more than 60 days. of course, they are upset will lead to conduct the survey. with what issues if edney about one-third said at the weekend the concerns raised by secretary a gibson represented here today. even more troubling what could be improved to provide timely care the vast majority again said people who care. we heard that on multiple locations. we also heard there is a culture to believe it is about death.

for one of those veterans centered cultures the veterans administration exist to give care and dignity for those who put their lives at risk. the veterans do not exist to serve the v.a. system it is very important for that sentiment to penetrate every level of the v.a. health care system so my question to you is what is the plan for this system wide cultural change to create a high-performance veteran centered system? >> i think as you look and organizational cultural change, the critical ingredient part of that has

to do with articulating expectations and holding people accountable we are working hard to do the first part we are working hard to do the second part because quite frankly that is where we begin to get real attraction. on the leadership part i a agree completely there is a fundamental shift of culture that has to happen and one of the things that i talk about a lot internally is ownership at all levels not leaders at the top of that all levels taking ownership for issues that are in the way to deliver care to veterans if someone takes an ownership -- leadership for a less than cordial welcome

it could be more fundamental from leader taking ownership to get x-ray machines repaired as everyone into in phoenix but it is about taking ownership to understand my a job as i said is to have those conditions to successfully take care of those. >> that is important that leads to a culture of accountability that we need. however we needed a veteran centered culture so what you being held accountable for? what are the tools you will use to make sure our eyes are not necessarily on the spreadsheet that of the veterans themselves and that can be done with veterans advisory boards, surveys boards, surveys, promotions

to better in satisfaction in a lot of different ways that focuses on all the eyes and accountability everything we do or strive for a and bassist with high-performance answers the question does it benefit the veterans? >> i agree. >> i yield back my time. >> thank you very much. you are now recognized by senate. >> i appreciate you being here with trust and confidence will be honest i have lost a lot of trust and confidence in the virginia. -- v.a. i was confident with the troops that i had as

company commander, and i am not try to have the events of the past cloud my judgment then i decided i would not call congressman and cook i just said biz's paul cook i am on fryer -- viola want an appointment. i could not get past the switchboard. okay? the call the regional office and told them but a parts of me wanted to go to war but parts of me my office does a great job dealing with veterans and i didn't want to endanger other cases on file.

so i said what are you going to do? here is what will happen. i will walk into that v.a. and try to get an appointment and bring when identification card i would not show that them first they will see that i am older than dirt but it will have my social security number and what i want to know is what five questions should have been answered right then and there to go forward with the process? because of i think those questions are working i will spread that there every veteran make sure you have this and you ask these

questions. and sorry it is a long question. m i enrolled? the second question is what kind of care do want? if not i would like to enroll and how do i do that? >> that is just the one question i would like to get an appointment. >> of a bite to see my primary care provider. you should not be asking any other questions. >> suggest two or three? i have a couple of questions

>> them saree what? said they don't know him in advance? >> often times responding to the of what might call. >> i mentioned before about the principle of i agee to manage if there is evidence riding around with the safety pin of? unbelievable but yet when you come in like fact but i

don't know i am kind of excited i still don't understand regularity it is the third time i have heard it in the last today's it dumber reid but i am glad we will start over it again it's about the culture of the military and we can never forget it. i yield back. >>. >> thank you let me begin not only ford being here for the amazing job you have done. you have said transparent

and focused on issues and i believe you have defined it for excellence. but my hope as we have a new secretary for the v.a. you will be a part of the organization at the highest level of the ambitious push to change as a of a culture and so many months and years now. sanders sanded is parochial but it has implications that have situations as of whole. and visiting 13 facilities handle paso was one of them.

to set up a command center over the last one. says showing their reported from june 151 facilities you were absolute dead last the of the worst horror established veterans health care appointments and fourth worst for access to mental health and second worst with specialty care some of the comments talk about problems with the capacity i would love to say i will help you with faithful service veterans hospital by without ask you to make a commitment you cannot follow through or implement but will you work with me to increase capacity

to improve the of access to care for offenders serve facilities? >> absolutely. it has grown almost 20 percent over the last three years and located in a medically underserved market so we have challenges as a relates to use space that we provide organically and some instances to have helped to attract clinicians'. >> if you don't mind i told you on friday attwood call psychologist when i was sworn in there were 19 and a half vacancies now today there are 19 and 1/2 vacancies i have been making recruitments i spoke to

leader of ptsd care but because we are a clinic she will be at gm's 13 but if she were coming to a hospital she would be at 14 i cannot blame her based on what they could serve in the position that they come into an underserved area. it is a mother peace hopes the case for a full-service the a hospital. and with those survivors of service members to transition and choose civilian life we need to do a better job taking care of them when they come back and also provided a potential

solution for us to explore something that dr. rose said to coordinate could thus be a jay become a center for excellence for survivors of ptsd? musculoskeletal injuries like agent orange service members were exposed to in the gulf war and for all other services? i would love to get your thoughts with the chairman's permission since i am close to running out of time. >> the first part of the question should be become a center of excellence we are or should be.

and also that purse exceptional capacity and how that fits into a revised model i don't know if i am ready to give a view but with those areas as i learned from our friends the things that the day has developed specialties are vital in these are great examples. >> as we continue to work together to explore the concept it cannot be everything to all veterans maybe we should focus on centers of excellence. >> you are now recognized for five minutes. >> it is an honor to meet you but i want to take a second to let you know, why

i am stymied with this request of how this started on the committee with 6.2 million hoosiers in the state of indiana and half a million veterans of 6. 2 million people of our state is passionate and they are freedom fighters we embrace the virginia in the state of indiana the fourth largest national old-guard behind california and texas. we're patriots in our state so i am passionate because i believe when our little stage of half a million people answer the call to your promise from this government and i sat here for 18 months on this committee and i still have the original questions i asked because we have never

gotten an answer from that v.a. always wanted to know is what is the status of my state? what is happening? i have gone to several hospital one is not even fully functioning without the icy you if you were a veteran you will be looked at been shipped across the street to a tax -- private facility but taxpayers pay for both of them. two-thirds of beds are empty at another? they have never been called that they showed up on the list that the v.a. have additional questions and the ceo never had no word there have not been any checks. nobody has been fired do whistle-blower's we don't know the status of our state we cannot get the answers to the questions we started with in the question i want

to ask you is when will we know the status of our state? ims those questions from day number one but please don't tell me a it is up to the ig and it is all anonymous? >> on wednesday of next week myself for one or two piers will have made our briefings end then what they provide to year-end the networks themselves. >> that is the second concern. end your itt is a disaster

veterans have had that information coopted and do you have enough money to do what you need to do to protect our veterans and upgrade the systems? we find out from the subsequent hearing at the $17 billion request we have allocated that this city has consistently faithfully allocated what the i t has asked for then we find out the revelation that is on is the most shocking revelations i heard but then we said we're are the billions of dollars? they obviously were not addressing i t when you asked as $70 billion nobody can answer the question whenever requested suspended

that it is a disaster what is the answer to the question of how can may possibly trust you now? when all that money has been accounted for in a revolution under oath we weeder using that to buy software and the taxpayers deserve an answer where did their money go in how can they trust you with $1 billion for upgrades? >> either of you? >> i was listening for a question. >> how can the american people trust you? >> i will be glad to give you the work that the i.t. does at an annual basis to be maintained with the functionality delivered. >> if i could indulge so the information reheard that day

was incorrect? id could not have been possibly correct for us to find out under a hearing we had outdated software when they told me we are compliant and we need more money thank you very much? so that was not true? >> i think he gave you an honest answer. a beginner to station managing to of a bet check and we need a scheduling system it is into our budget >> with all due respect that has been built in four years and we were finding interesting it was used for the allocation requested. >> there was a high the reported bailed the development effort that

occurred back years ago where it invested a substantial amount of money and could not deliver and in the years since starting 2010 when v.a. develop the project management accountability system and we will get you a copy and the progress the functions of natural development, v.a. was the only one. >> i appreciate it. if he is in charge did he get a bonus with deprivation he has provided with lack of evidence? i would like that for the record. >> we actually were going to have an oversight hearing this week it regards to the i.t. that we were not able

to do it because the person responsible is that of the country for a family vacation so we cancel the in the hopes he can attend. you are now recognized. >> i am thankful and grateful this nation produces citizens like yourself. and your commitment is some question best starting i air agree. and what we do possibly will have a decade's long application and it is important why we get it right. i have been advocating this is the strategy that sets that priority. it with that intent and the transition and how that will

work but this nation is committed to you getting this right to provide the resources but they are not mutually exclusive but trying to strike that out i will clarify let's be clear eight at the 10 businesses failed. don't9 take it where you get the information. the government wrote to their right to get into the differences it takes us away from the mission of best practices so i would ask you this, i have the privilege to represent the number one hospital in the nation at the mayo clinic and i understand how it has done this. it has always been in focused on the patient first

the systems analysis has been at the mantra of what they have done. but it starts up with the of leadership but ends with results they have the academy and they're asking basically severity the. >> bedouin talk about sickness if they can come back to answer but what could be done to ensure that of a performance? because then if we give you the money we know. >> interestingly enough we did a review of scheduling

practices inviting folks from of nato and looking and safety practices we invited engineers from the mayo clinic and i did agree they are the model. one of the things we need to look at is a system has the entire health care system not just focusing on a metric here or there but concepts of veteran centric and how do we assess that. looking up productivity work levy breeding flocks from the outside to do purposeful changes to look at the practice if we change it or maximized it with real conditions on the ground.

to deploy and tested to and for though long-term sustainability with the h. j. used to have the academy's that were great and we let that go. we need to build leaders to build them over time and investing in them to succeed >> that corresponds to quality of care and it stems from there it is their private ability you doing here but the core mission needs your vision with the positive lessons and we heard last week there is a great suggestion from indiana that says he looks al the window and sees five hospitals ben knows that they only have 79 capacity on any given day. >> i was in st. louis on tuesday to have the

opportunity to visit our training academy and cited that as the internal best practice we need to meet with b.a. jay because we don't have the kind of talent development and set a long -- succession development that they have. >> it is important but the crisis at the cemeteries and arlington the focus put on that with that turned around is viable with the quality. we can do this but if we miss the opportunity your jealousies -- or ceased to rise to the occasion then shame on all of us. i yield back. >> you are now recognized. >> thank you. i will probably throw out a couple rhetorical questions or some analogies than the one you probably will not

answer but i will throw with out there to see if you would respond is v.a. too big to fail? that is something we have dealt with other sectors in the last decade and i think it is a legitimate question. talking about trust? as the representative said earlier bayou answered with a follow-up and you said said, the personal factor you need a set of facts to act on. that could be done in another process deny we use the analogy after the high school or college days the girlfriend broke up with you and made up the next day you did not ask her to marry you that day.

a legitimate process to been trust over time and to go to that and i love the fact you brought up those managed-care requirements there are seven members on the committee that served with the defense's says a review and most believe the dot does the same thing in tweet the requirement the delay the whole thing up to congress to say at some point we have to prioritize what we will do because there is only so much to go round. when we deal with the crisis and i asked the question question, when we are attacking something like this the claims back off.

dennis said category of claims when you do analysis to say we need this much money to solve the problem but does that go back to everything? was it done by a dual or quarterly basis? will most death benefits or pension and all that kinda stuff. is a possible to move the overlay of what we make definitions to put claims in piles? to you have an idea what that number is and why? >> you have alluded to it with the overall claims and we continue to say we will only ask because i owe for

laid out. >> what is the requirement. >> battle of the fast or a answered on a regular basis period upon the claim aside your benefit side? >> just say claims every single one of them i know them somewhere. what is the number that goes to eliminate? because i know that you talk about modeling but to have that what comes out of those models but is the crisis bigger than we thought it was one year ago.

but can we push this back and say we really have to step back to take a look in realizing it is the bigger problem and we need to dive into said deep. >> as it goes to zaph benefit side, a part of what you are seeing is a regular weekly publication not just the disability bell so. >> the same thing with the wait times you also worked pushing them not to. state -- but we are creating that openness and transparency so people can not an issue and.

i say 641,000 veterans have appointments that are more than 30 days from when they wanted. >> i just want to curtail you i have experienced this in congress as you build trust and say we will do it one step at a time but there is no one on this committee would have a problem for you to talk -- tackle this $10 billion at the time. make sure he kits used to have the set of facts so. >> direct sheikh buys them for early chair this character i wanted to af but

one of the rare bipartisan committees least drive to work together but i want to focus on the issue of the ethics and accountability because my concern we need to do with. >> he will fix the underlying system with integrity and in particular about the scandal that honesty and integrity that

and to act in its so if you could address before we get into additional funding funding, have you intend to restore that level of integrity? . .