of course, i realize there's a lot of speculation. it's hard for anything to be competitive with gas at the price that it is today, but your thoughts. >> so, as you said, there's not sure about the future but i think it may take some time. that would be the short answer for a number of reasons. first, if you look at the evolution of the cost of the technologies, i mean, they have significantly reduced cost but if you want to have powers that has 200-mile or plus driving range, 50, 60-kilowatt hour of battery, you know, to fuel those cars and then the cost, sales ae 100-dollar per kilowatt hour, multiply by 50, you see what the cost is going to be. so it will remain a significant cost. but it depends on what the break

throughs. it's not impossible but a few years out. it's also highly dependent on the price of gasoline, of course. we did our initial calculations with ranges of anywhere between 1.20 and $1.80 per barrel and we are not there today. because consumer looking for paybacks of three years to buy efficiency vehicle -- >> the current plunge in oil prices is with me making the decision to buy my electrical car. >> the move we improve the efficiency of conventional engines and the more we develop technologies the more we keep oil prices down. it's both actually a winning proposition for the consumer and the country but at the same time it makes the life of an electric-vehicle tougher in the

long-term. >> it's interesting you should say that. a professor -- old professor made the most profound observation about oil prices i have ever heard. oil prices in the future would always be the opposite of what you would expect. if you expect them to be high and act accordingly by conserving and doing more conservation kind of measures, that will produce excess supply. if you think they're going to be low, then they're going to have a contraction of supply and prices will be high. i've always thought that was an interesting observation. >> and which means by the way maybe it's not the market that we have to let evolve naturally. this is why legislation is important because otherwise you get the opposite effect of what you're going to get. >> thank you, senator king.

thank you for the contributions that you have provided to the committee this morning. i think it's been useful. it's always nice to know what is new. i think it is clear that we are moving forward in different spaces. quite honestly the driverless cars are going to take a while to get comfortable, but with advances that there's a level of safety, efficiency all well responding to a range that's affordable is good news for us. with that, i thank you for your contributions this morning. with that, we stand adjourn.

>> years ago today the supreme today on c-span at 6:30 p.m. eastern our landmark cases series looks back at how the case was decided and how it shaped political and legal battles over the decades. among those addressing the crowd, presidential candidate carly fiorina, new hampshire congressman christopher smith and a number of of abortion activist. >> speeches, rallies and meet and greets. we are taking your comments on facebook, twitter, and by phone and as always every campaign we

cover is available on the web at c-span.org. >> more road to the white house coverage on c-span this weekend. live 10:00 a.m. a new hampshire republican party town hall meeting. we will hear from rand paul, jeb bush, john kasich, chris christie, carly fiorina, rick santorum, marco rubio and candy carson, the wife of ben carson. ted cruz holding a campaign rally and iowa congressman steve king. and sunday on newsmakers, new hampshire senator on our state's presidential primary on february 9th. senator is a supporter of hillary clinton. newsmakers sunday on c-span. >> veterans affairs secretary

robert mcdonald testified yesterday and outlined the department's reorganization plan designed to make it easier for veterans to navigate va websites and answered questions about reducing the va's disability backlog, veteran homelessness and modernizing it infrastructure. >> i'm going the call the meeting of the veterans affairs. i would like everybody to pay close attention. we have a storm coming, we have a vote at 10:30 we have a lot of people moving and pieces in place and including some of the witnesses that are here today.

i will make a brief opening statement. i will recognize here in time, if not he can make his statement later in the hearing. we will go to secretary mcdonald who has asked and i have granted no limitation on time. we are going to take the time he needs to make his testimony, which i think is only appropriate given the serious intent of this particular hearing which allows me to thank senator tilles and tester, and i'm glad the secretary has come and agreed to do that. the ranking member has made it so you're luckier you're not going to get cut out after all. [laughter] >> any member of the committee that wants to make a statement can submit it for the record after the hearing is over. we will go directly to the secretary which hopefullyhopefuy can accomplish before the

10:30 vote. i want to thank dale, will you remain for a second and remain standing. i just love to tell officers that. [laughter] >> he's from douglasville, georgia, the county next to my county. he's from the legion post; is that correct? >> that is correct. >> we want to thank you for your continuing service to help us in the va committee. you are the eyes and ears. and then nobody has a better more conscientious constructive view. i appreciate you being here to hear the testimony today. we appreciate your comments. i read some of them already. any additional comments you have

for the record we will be happy to submit. welcome and we are glad to have you here. >> thank you, mr. chairman. >> i want to talk about three things in my opening remark and three things only. i'm interesting in making choice ultimately work for the veteran and for the veterans administration for the taxpayer. we had some issues come up recently and in anticipation of this hearing taking place so i'm going to make them public in my testimony so the secretary can address those. we had a situation in new hampshire in the past couple of weeks where we have lost providers, which i think doctor is aware of and the issue basically gets down to prompt pay. we have got to get a situation in the veterans administration where a physician can reasonably anticipate a prompt payment for services rendered under the choice program or choice won't work. in any hearing the secretary was kind enough to come back in december or november of last year, we learned that some of the nature of the paperwork that's required by the

thirdthird -- third-party administrator has to be set up. the va has to expedite or speed up the prompt payments so doctor and physician in a hospital want to provide that benefit. that's the goal i would like to see us continue to work on and do everything we can to do. we also had the kaki situation in my state of georgia. we continue to find cases where the inspector general finds backlogs. we had boxes of records that were supposed to have been scanned and put in the va system. they were stacked in a corner which was bad for accountability. the point i'm trying to make is it's the little things that get you and not the big things. the big vision in terms of va and secretary is one i'm looking forward to hear from. the little things that fall to the cracks that cause you the

biggest problem. i think all of us on the committee on a daily basis is prompt pay, accessibility to the choice program and accountability and no excuse the dog ate my homework. the secretary has been a great leader in the department since he was sworn in in july, i think. >> yes. >> we want to make every single month count for our veterans and taxpayer and i look forward to cheering the committee as we work hand-in-hand to do that. with that, i'll recognize secretary blumental. >> i'm not sure that i would take that as a complement. frankly your job is much more difficult than ours, we thank you for your dedicated work and

that as well as your colleagues here today. today is an important hearing because the va is at a real milestone turning point with the last stretch of the administration ahead, the opportunity to make fundamental cultural and institutional changes. it's fast disappearing, and so today's hearing is about your vision and the plan to achieve it and it's a tremendous opportunity because there's a lot of work to be done, but it's also a tremendous challenge and i know that you've been working at it very hard and very long. i'm -- i'm focusing on a number of changes that i think are very important, obviously consolidating care in the community, the va has estimated

the annual cost of care through the current veteran's choice program about 6.5 billion with an additional 7 billion in community care, that's about 13.5 billion which seems largely unsustainable at the present rate. so something needs to be done. the the inventory has skyrocketed 240,000. 440,000 claims that are under appeal and need top in some way expedited. i'm a supporter and cosponsor of the veterans appeals assistance and improvement act of 2015 which would change current law to expedite the most delay claims, mainly those over eight year's old. it's hard to believe that some claims are over eight year's

old, if there are, there's no reason that they shouldn't be expedited. finally rob in his report out in 2014 talked about the culture at the va, which has led to person -- personnel problems across the board. changing the culture will impact ability to fill the ha open position which i know has been one of your priority, one of the goals of the department of 2016 is to increase access to health care and reduce the the of time it takes to fill open positions by 30%, that is a critically important goal because 900 vacancies which, i think, is the last number that i saw, means that there are 900 fewer people

to be caring for the veterans. those are some of my concerns and we look forward to hearing from you and, again, thank you for your work at the department. >> you're recognized. the floor is yours. >> thank you, members of the committee, thank you for the importance to discuss transformation of the va, what i call my va. thank you for meeting with us repeatedly to hold our transformation plans. i believe they know that my va is about fulfilling the nation of those who have served and to become the number one customer service agency in the government. we have a lot of work to do to reach that goal but we are making progress. this chart reflects the remendous--

tremendous work done by reducing backlog and almost 90% since 2013. our national cemeteries is already rated number one in the nation by the american satisfaction index. sesi rates companies in the nation and nca came out on top. we need to make it so for all of the va. last year gd power rated our consolidated male patient with the highest customer satisfaction score among the nation's public and private pharmacies, higher than kaiser, wal-mart.

a world-class customer focus veteran center organization. this chart shows our five critical my va objectives. first we want to improve veteran experience. every contact between veterans and va should be predictable, consistent and easy. it begins with respectfully receiving our veteran clients. but it's also a science. we are focusing on human center design, process mapping and working with design companies to make interaction with our clients better. second, we need to improve the employee experience. we can't make things better for veterans without improving the work environment of employees. it's no coincidence that the best private sector organizations are also the best place to work. we must enable employees and leaders by bringing our it

infrastructure into the 21st century. our scheduling system dates to 1985, our financial management system is written in cobal, a language i wrote in 1973. this is unacceptable unacceptabt impedes our efforts to serve veterans. fourth, we need to establish improvement, we will apply strategies and other performance capabilities to help employees and build a cultural of continuous improvement. expanding our partnerships will allow us to extend the reach of services available to families. the my va is a framework for modernizing culture to put the needs and interests of veterans and families first. changes of leadership were also necessary. ten, ten of our tops 6 executives are new since i became secretary.

all of them have substantial business experience. our new leadership teams feels comfortable having honest and sometimes tough discussions to transform va. this team includes a former banking industry, cfo, and the president. former chief executive of jollbb. foods, former chief customer officer for the city of philadelphia which spent ten years at usaa. i'm a former chairman, president and chief executive of the company. retired u.s. army general and former chairman and ceo of ussa is also comprised of a diversed

of leaders and medical professionals and experienced executives. i knew that we needed outside expert advice on business and government transformation so i recruited these leaders well before the independent commission was established to help advise our team on va transformation. we are working with many world-class institutions to capture best ideas and practices as we transform as well we are listening to key holders. va can't do everything itself, over the last year we cultivated meaningful partnerships in employment and in ending homelessness and we are streamlining business with

community care providers such as billing, reimbursement and information sharing. we must operate as part of a community of care. we know the va has significant issues that need to be addressed so we are listening to other's perspectives when investing with people. we are running the second largest department 181-billion dollar fortune six organization should be run. we've narrowed down our near-term focus to 12 breakthrough priorities as shown on this slide. on the left are eight veteran facing priorities, on the right are four va facing priorities. make no mistake, all all 1 are design today improve the delivery of timely care and benefits to veterans. we have many accomplishments in

these areas in 2015 but i'll spent most of my time of what we will accomplish in 2016. these are the stretch object iis that we are committed to. first, improve the veteran experience. in 2015 we named va's first chief veteran experience officer and began staffing that office that will set customer service standards and train employees, we are traiting a national network to leverage nonva assets and we have established 36 communities with 15 more in development. in fact, the ranking member attended event in connecticut where we established one of the first community engagement boards. in in 201 with will establish to enable improvements, 47%, the

baseline data that we've gotten to to 70%, we will also expand network of community engagement boards to over 100. our medical centers will be fully staffed at the front line with well-prepared-customer-orientatd employees. second increase access to health care. last year va improved by 1.2 million and completed over 96 of appointments in october within 30 days of clinically indicated or veterans preferred dates. but the end of this year when veterans call or visit primary care to vha medical center, their clinical needs will be addressed that day. enrolled veterans will get medically necessary care referrals and information from any va medical center.

number three, improved community care. in 2015va issued authorizations resulting in 12 million community-care appointments thanks to the flexibility of the choice act. in 2016, pending legislation that we need, va will begin consolidation streamlining of access to our care in the community network. community care claims will be processed and paid within 30 days, 85% of the time and the claims backlog will be reduced to less than 10% of inventory. number four, deliver a unified veteran's experience. last november va launched the initial vets.gov capability. website that will will place numerous other websites with a single log-.

vets.gov will provide with tops 00 search terms within one click. 100% of content and features and forms from the websites will be redesigned, rewritten in plain language and migrateed to vets.gov. five, modernize contact centers including the veteran's crisis line. last year the crisis line was featured in óscar-winning documentary veterans press one. 490,000 calls initiated the dispatch of emergency services over over 11 times and provided over 81,000 referrals the va suicide convention coordinators. by the end of this year, veterans in crisis promptly answered by an experienced responder at the veteran's

crisis line. all veterans will be able to access 24 hours a day, know where to call and get their questions answered and get prompt service and accurate answers and be treated with kindness. number six, improve the compensation process. many find the cmp exam to be confusing. last year vha and veterans experience team worked to redesign using techniques. by february we will have a baseline metric to measure veteran satisfaction with the cmp process, and by the end of 2016 will complete a national role improvement in veterans' improvement. number seven, appeal process. we have driven down the backlog

from peak of seven hundred thousand. that's the highest for va in a single year. in 2016 subject to successful legislation, we will put in place a simplified appeals process enabling the department to resolve 90% appeals within one year of filing by 2021. number eight, continue progress in reducing veteran homelessness. last year we provided services to more than 365,000 homeless or at-risk veterans and placed 108,000 in housing or preventing them from being homeless. in 2016 we will continue reducing veteran homelessness

and progress toward effective end by assistinging -- assisting 100,000 veterans. number nine, these are the internal facing initiatives, improve employee experience. in 2015 we launched a program called leaders developing leaders which trained over 5,000 leaders. we also trained critical parts in lean and human service design to improve problem solving to deliver responsive customer service and have over 12,000 leaders trained in these leader-principles. all of the employees will have a customer standard in their performance plans. number ten, staff critical positions. in 2015 we hired over over

41,000 employees, 4.7% increase that included over 1,300 physicians and 3,600 nurses. additionally, we filled several critical leadership positions to include the secretary for health, the chief information officer and the chief veteran officer. in 2016 our targets include 95% of the medical positions filled with permanent appointments and 90% of other critical shortages addressed while reducing time to fill vacant position standards by 30%. number 11, transform office technology. in july of of 20, council was confirmed as information officer. she's developed a multiyear plan. including 15% of it are on time

and budget. 100% of it's executive performance goals will be tie today strategy goals and close 100% of cybersecurity witness -- weaknesses. number 12, leverages va scale to drive increase in responsiveness and reduction in operating cost with $150 million plus of cost which we will read redirect to priority veteran programs. those are our 12 action steps for 2016 including the commitment that we've made to get them done.

each priority has a responsible individual and a team that meets every other week with the secretary or deputy secretary. .. special legislation for the west los angeles campus,

overhauling the claims appeal process. i encourage the committee to support other key legislative proposals that will be delivered on february 9. and last, we need your assistance and supporting the cultural change. we need you to have the courage to help make the changes youryou are asking the a to make and that we must make. a legislative support is critical to achieve. on behalf of the vast majority of employees who work hard and do the right thing everyday, thank you for this opportunity. we look forward to working together to solve one of the most important national issues, the capability and determination to make a difference veterans lives, to make the department the best it can be so that any veteran experience with va

is world-class. >> we will open to as many rounds of questions. if sen. tillis,senator tillis, as soon as the vote is called the wind go vote and come back so that we can keep it going. when the bell rings if you will show us your north carolina sprint. do your best carolina panthers run. sec.secretary mcdonald, thank you for your testimony. your 1st saw the specific suggestions i want to talk about two of those to start with. one on the cultural change, you need help to make the cultural change within the va, and we want to help you

make that change. as much as you can coordinate with us on decisions that you made before the proverbial banana hits the fan we would appreciate it. we are in a reactive mode as a body. but from a partnership mode we can do things to help. there are things you might want to do that we don't know about that might get a totally different response if you consulted with us 1st, and i am not saying that you don't. for example, i am assuming when you want to make a breakthrough in terms of subjective legislative action you want to resolve 90 percent of appeals within one year of being filed. >> that is correct and will require legislation. >> and will that allow you to not allow additional information to be submitted at the time after a claim has originally been filed?

>> we would like to work with you on that legislation we think there are steps that can be cut out of the process. we would like to work with you on that legislation, and i pledge that we will work together as partners, and this hearing is evidence that we are doing so today. i appreciate you scheduling this hearing. >> dale is here from the american legion. you will need to be a part of that particular issue. we all want to resolve claims within one year, but the fully developed claim process which i'm not necessarily opposed to we will be a major move forward that would need the vsm support our we would never be able to get it done because it involves reasonable cutoff periods for data to be submitted in a claim to be finally resolved. >> absolutely, and we have

involved with eso's and all of our work. as recently as yesterday morning i had breakfast with the veteran service organization leaders. i am used to the hazing. we look forward to working with him on this. >> ii want to get all of the frogs in the wheelbarrow to begin with, rather than afterwards. as quickly as we can get a representative that is appropriate we can involve members from both sides of the aisle. a change like that will take significant legislative willpower and cooperation, but it is achievable. >> if i may add, only about 11 or 12% of claims are appealed. it is a relatively small percentage of the total, but because veterans continue to add information, many go on for years and years. generally, the people who

are appealing are already getting disability payments from the va. what we have got to do is get a process which is manageable where we can get them adjudicated quickly but where the continuing process does not get in the way of getting these claims resolved quickly. >> and i concur, and i appreciate you making that one of your seven priorities. you have got a new job, one of the ten often of 16. you said you had ten new critical people. >> yes, sir. >> if you can do is get a job we will be all right. he has done an excellent job , as has counsel, which leads me to a suggestion. tell her to get in touch with georgia tech. i told you before the hearing, they are developing an interoperable coordinator translator that will allow

systems to talk to each other. if we can breakthrough that we can end the problem. it is important to be able to do so and i appreciate you having her give me a call. lastly, welastly, we want to be a part of the cultural change. it is important to see to it that we are partners and it. there was an exchange in letters and i no you have a response in the "wall street journal" which is healthy and strengthening our relationship to air our differences and answers to those differences, and i agree with your letter in that you cannot fire your way into success, but if we don't have a recognized system of accountability the people can see is working there will always be someone

to throw up a new story. we need to work on that as much as we can. >> we agree. we have terminated over 2600 employees since i have been secretary. after 33 years in the private sector i know the importance of making sure we get people who violate our values out of the organization. we are doing that consistent with what they have done and with due process. we know it is necessary for cultural change. >> thank you for being with us. >> thank you, mr. chairman. let me begin with your chart which shows a reduction in va disability, but in a sense those claims now have caused an increase in the number of appeals. which demonstrates, in a, in

a sense, that you have reduced the numbers but shifted the problem. that is an oversimplistic way of putting it, but as a lawyer in the federal court or state court, for that matter, if a backlog were cleared simply by moving that great mound of work to the appellate process where appeals languished for years and years and years, it would not be regarded as a success story. and so, the 440,000 appeals that currently are pending is, in my view, unacceptable. >> that is exactly why it is one of our breakthrough objectives. as we said, assuming we can work together on the legislation we are planning to get 90 percent of appeals resolved within one year. >> and just as a

qualification to the point you just made, many veterans are receiving benefits. but they may be nowhere near the amount that they deserve and need. so simply to say they are already getting something does not mean they are getting everything they need and deserve. >> that was a statement of fact, not an attempt to downgrade importance. >> i understand. let me come to the question that you just raised. could you give us the details? i assume that you would support the measure that i mentioned earlier, that senator shaheen, myself, others have supported to expedite is appeals. are there additional authorities you need to get this job done? >> we will have to overhaul the appeals process. it is really that simple. the law was created in the

turn of the last century. and so the basis of it is antiquated technology and many other things that are no longer applicable. we have used our process mapping techniques, process mapped. it requires a change in legislation. >> yes, senator. it will require a change in legislation, and we will need to put more people against the problem in order to tackle it. >> my question is specifically what legislative changes are necessary? >> the legislative changes we are working with, if we can get that in place it will go a long way to

solving the problem. i believe that we can do veterans appeals. we just havewe just have to continue to make sure we are doing it the right way. i have not had aa chance to look at the legislation that has been proposed. that sounds like a great idea to expedite. that is what we did with the backlog. right now there doing it by docket order. please have to make sure that does not inadvertently harm veteran. >> let me make a suggestion. i am just a country lawyer from connecticut. in connecticut and criminal matters because of the backlog of rule was adopted that the failure to prosecute within a set amount of time will result in a dismissal.

the speedy trial rule. and i think that became law in various forms in the federal system as well. don't hold me to details, the deadlines were set on timelines were established, the failure to proceed within that timeframe meant that the government's case in effect would be dismissed. and the burden was on the government to prosecute the matter. so, at some point an appeal that is pending for that amount of time within the government structure or process perhaps should result in the government losing the case. >> i would rather work like the chairman said on coming up with good legislation and also systemic changes to the

way we do our work rather than just setting somewhat arbitrary a year limits. i understand the legislation , but it does not say how. as a business guy, the biggest challenge is always how. i would rather work with you in the chairman to figure out how and make sure we put legislation in place that we need to get it done. >> i'm not advocating arbitrary deadlines. at some point this problem is not alleviated that kind of approach will be necessary to go back to your days in the private sector, if you could not get codecs to the show you are penalized. nobody said we will keep the stores closed until png has its products ready to go.

so there is a burden of proof, so to speak, a burden of going forward, burden of proceeding, burden of fulfilling the government's obligation. what i am suggesting is that the remedies for delay may well be that the veteran receives what his claim is because he is the one who is prejudiced, not the government. delay works in the government's favor because very often the criminal defendant was without bail or with pale that could not be made or under the great burden of charges pending, and these kinds of deadlines were proceeding in civil or criminal context in the judicial world theymay have applicable it here. that is what i am suggesting, and we may not be at that point yet, but we may soon be there.

>> we have identified it as one of our 12 priorities for the year. hopefully 90% of90 percent of appeals will be resolved. >> thank you. >> thank you. >> thank you. actually, i am next in order so i am not taking the chairman's prerogative. a -- 1st i want to thank you for being here, for the time you have spent in my office. we have had several meetings along with senator tester. they have been productive. i have a couple of questions for you. i know that because of the limitations of the room one thing we ought to talk about is as you go forward to members will have the ability to track progress. these are not just pretty pictures and the powerpoint, but they map to initiatives. it was mike that outlined

some of the online access that we will have where we can see red, yellow, green. i think it is important to do that. another thing is to make sure that when we make a request of you, in addition to what you have in this transformation -- we will have day-to-day things we will complain about and do all that we have to as a part of oversight, but you need to make sure that you are direct and we make the request of you that all of a sudden puts something else in the critical path of these things. that is an important part of the back and forth. one question that i have this the discussion and concern we have had expressed to us, and i mentioned this briefly about some of the consolidation of the providers who may have had a point of entry.

i guess non- va providers, concerns in terms of reimbursement. can you give the veterans who may be concerned with that, the providers some sense of why this is better over time and why it is an important part of what you are trying to accomplish? >> thank you again. honing these plans, as you know, we have a dashboard that you can drill down on. on. we share that with you in the office. i would love to provide that to the committee. i just would ask that we work together so that i am not spending more time answering questions of you drilling down on the dashboard then i am solving problems for veterans. if we can come to that kind of arrangement i have no

issue and sharing because that is in essence how you will evaluate us. >> over time it should be rolled up to a level or we are not sweating the details. >> i agree. >> just the 12 priorities. >> yes. >> i am going to ask david to comment, but one of the most important things we can do is develop a network of providers including department of defense, va, indian health service, private sector, so by the end of the year we have a network that we all feel good about where billing is not an issue, paying bills is not an issue and we can move forward on behalf of veterans. they have had providers move out of network. i was recently in massachusetts where we were

having a discussion with an academic affiliate because the hospital did not want to accept medicare rates for veterans. you know, these are the rates we have got to pay. i know david is working hard. >> you are not going to be able to see, this is my redneck power. one thing that i think we need to do is always talk. there is a place for choice long-term. to what extent do increases or decreases based upon the state you are operating in, the nature of the population you are serving, we want to make sure we are communicating that at the end of the day this is not getting the veteran to a point of care that they are comfortable with.

>> senator, we would appreciate a copy of your powerpoint. but i think we are on the same page here, which is that we need providers to want to work with va because veterans need the private community. i have spent my career in the private sector trying to get paid. my sympathies go with the providers for providing a service and having a delay in payment. we recognize that we have a problem. we are going to take dramatic actions over the next couple of weeks in order to improve. the major issue is that we are only getting 40 percent of claims electronically. we should be getting 100.

the reason is we demand that not only we get a bill that all the medical record documentation and paper. there going to have to change that policy and should so that we can pay providers and a faster timeframe. >> the other thing that i hope we see come through our leveraging best practices from similar operations like medicare in terms of the relationship of the providers, on boarding. i hope we are not reinventing the wheel. >> we totally agree. >> senator tester. >> thank you, chairman. thank you for being here. i think it is appropriate, there are four teams that may win the super bowl. who are you rooting for? >> which one are you for? [laughter] >> carolina, for sure. >> you are a great american.

[laughter] thank you all for your work. i appreciate being able to be in on some of the plans that you have been putting forward, and i do mean that. i met yesterday, and there are still plenty of issues to deal with this waras far as the character veterans on the ground. i don't know any of them made it to the floor yet. they are not exactly the gold standard. do you have contingency plans. >> what i wanted to do was take the my va transformation which arguably is a big, multi- your process and boil it down to what we can accomplish by december 31.

what i have given you is what i think we can accomplish. arguably there are good outcomes for veterans, but we will need the legislation. if we don't get that we will have to dial back. >> what are three of the most significant short-term deadlines? >> the 1st is provider agreements. we have long-term care facilities right now refusing to do business with us because they are too small to deal with the federal acquisition rules. that is number one. second, the consolidation of care in the community. you all had a hearing on it. the plan we put forward is a good one. we cannot get to that ideal optimal network providers including private sector providers until we get that rule, that law done because

right now there are many different programs all with different criteria, specifications, and all with different payment schedules which confuses veterans, employees, and it distorts incentives because people want the program that is the most expensive. number three, i would say flexible budget authority. last year i had to come to the house committee begging for money for hepatitis c, this numerical drug because we had money in a separate pot designed for that purpose, but i don't have the authority to move it. it is about caring for veterans. i should have the ability to use the money to care for veterans. >> of those three how many can be done without action from congress? >> the consolidation for care, as soon as we get that

los angeles campus eu well the minute we get the past we can put spades in the ground in west los angeles and start building buildings with private sector partners. >> you can have all the greatest ideas you want different regions can have the best of ideas. you need to be direct with the committee as to what needs to pass. that is all i will tell you. if you cannot do what you are going to do we're just talking to one another and not getting to where we need to be. >> agreed. i said pending legislation purposely for a number of

outcome cited. anyone who wants that information can go back to written testimony, and you can see how legislation is tied. >> and we can connect with you for that, too. i think that it is important we talk about changing to va and providing better service, the part of that is actually getting something done. look, i talked about this yesterday. could you give me any sort of update? you have a lot of leadership positions that were and maybe still are open. give me an update on where we are and what we are doing? >> senator, thank you for the question. the chairman had some comments as well. our biggest challenge is getting the right leadership in place and then getting critical positions felt.

as of last evening we had listed 43,000 recruits for the va health system and are desperately trying to attract top-quality professionals. we have in our medical centers 34 medical center director positions that are open. running a healthcare system without permanent leadership in place is a challenge. one of the legislative authorities we have asked for and one of the ones listed is to give us the flexibility to use title viii funding to recruit medical center directors a network directors which frankly i have had a significant challenge convincing any colleagues from the private sector to look at va as a career. ..

>> >> the number of people is about three-quarters lower than two years ago before the crisis occurred. number two, recruiting i have asked members of congress to recruit with me. we went to the university of montana together. this is very important and the senator has come to talk

to town hall meetings to show our employees we're all together and prospective employees we're all together i have been to over two dozen medical schools in the third point we're leading positions vacant because wheedling to add more people than we need a beer in the process to reduce the levels and become more productive so recently we realigned hour regional medical networks so we went to make sure we're recruiting from positions we want to fill after we eliminated three buildings. >> i appreciate that i don't know what is going on but i have a pretty good idea for montana and the vets love those people but we are burning them out because we don't have the staff and it

is critically important. i will walk hand-in-hand with you with recruitment because they have done a lot and we owe it to them. >> good morning. please consider me an ally when it comes to accomplish what you outline with my v.a. testimony this morning. i of anxious to see a transformation for those who served the country that receive the benefits and a cost benefit whey and quality services and that is what your statements were all about. but what i want to focus on is to take us back to the current circumstance where try to find -- help veterans

we did have a hearing on consolidation of the community-based programs and clearly a understand that value of consolidating that cannot be administered effectively. those that have not yet happened and asking for your help to see that they do. for veterans who were not qualifying for the choice act that he would provide me with a list for those that qualified it is a generous offer but but if you could help me because those who were caught in the process of the third-party vendor and told they don't qualify or because they live within

40 miles. then neither one is true. so the goal is who does qualify so there is an understanding telling a veteran if they can access the choice act? that is the offer that secretary gibson indicated. the conversation occurred about the number of people that have been abandoned that is what they called the abandonment rate. i was originally concerned and by the undersecretary several months ago when choice was new and one of the commons was it is a popular with veterans and they don't want choice. what worries me is i did not want to see the of the a create a circumstance when

it was so appealing the decided they did not want to. i have the clear sense of will be valuable with geography and the demographics. there when the railroads started to reduce the services available. and then they decided they didn't use the rail service because it wasn't any good. and then they say let's get rid of it. but that is not the intention of v.a. i don't have the fear that i did that it seems it is increasing community care. to see people served i want to take care of those who have given up.

that is most common conversation i have and then within 40 miles and more recently i use the choice that they provided me with my home town provider but then they insist that i see a specialist have to go through it all over again and was denied the chance to have radiologists look at my x-rays. and then to discourage the program so that abandonment rate i would be provided at would like to have to see how many are walking away. also secretary gives in and i had a conversation about 10 specific cases and i

appreciate what they said if we don't execute then shame on us. and he offered to take care of those 10 offices -- those cases dealing with joyce and what do we need to do? it ended up in our office as opposed to the v.a. stepping and. maybe this is just a pilot program to see what kind of conversations i have with veterans and how the choice act is failing them. maybe this will be useful as to try to solve the problems systemwide. we want good things to happen at the of v.a. may be

trying to reinvigorate v.a. and change out the quality as we transform into the future. >> then moving on to those three things no question that it is essential for us to have a network of providers to care for veterans. and to have a map of the united states and where the providers are with the dod private sector it would be good to have that discussion with each member of the community to see that capability to put in place. >> i would tell you that

every republican member of this committee we asked for a meeting to describe to us to have a consultation with the full time facility from that would take place in think every republican and member has asked to join us to have a meeting but someone who can tell us with the new definition and i would respond to what you said. >> i have met with caucuses and i am happy to do that. >> the choice act is the way for the v.a. to solve professional and abilities. but it is to help v.a. meet the needs because of the

shortage of professionals. with the challenges you face in recruiting. >> and to see some improvement in nevada thank you for that. and the health clinic finally. you can imagine how many years that has taken and we have a new director in the regional office in nevada that is very helpful. in the state of georgia do you mind is there a problem for them to get that health

care? >>. >> this is the insightful question now is not a problem but we have not yet built the capability to allow that to occur. but they can go anywhere they want and we will serve them. >> recalled this seamless care exactly what we want he should be able to be cared for any facility. we'll have a traveling veteran coordinator so they can ask to speak to them our goal is to major that our systems recognize you that

december 31st, 2016 is the goal. would it matter if they went? >> it doesn't matter just like getting your prescription at cbs. some go to st. george some good las vegas. >> we won the veteran to decide rego and the agnostic. one of the things we have talked about if you have to change your address you have to change it and nine different places.

with that system to populate a form we automatically populate so you don't have to write that information. we don't have that single data backbone today but it is an objective. >> so i can say some time around the end of the year? is that fair? >> yes. it is just more painful than we wanted but we try to make the system support we were asking. >> right now they are restricted to travel the extra 45 minutes as opposed to going to sing ga. like to see that change by of a question relative to the backlog that they don't

trust the data any knowing the state of nevada we were ground zero we are seeing some of improvement can you insure me that is that accurate they claim that they don't trust? >> i imagine it was 2014. >> it is a rosy picture. >> we go through this every day. >> i would disagree on their assessment that they don't trust the data for the backlog. one thing that we have tens of this data and the backlog is accurate still not where we wanted to be but i do believe it is accurate data. then nevada said vfw had their midwinter conference

last saturday and this is one of the concerns they brought up that we paint to give a picture obviously they are on top of the report to say that perhaps the data is not as accurate. >> everytime i get one of those questions or comments i have given no my cellphone number publicly and i encourage people to call me that gives me the incense and the day angelou did you deal with? a lot of this, we have to continue to rebuild trust a lot of this was stressed that was lost in 2014 a lot of those ig reports were some time ago and of already been mediated but i would be happy to get together.

>> mr. chairman thanks for being here we appreciate your hard work. we have to va hospitals and one of the acute problems right now because of the turnover of leadership leadership, people retiring retiring, people not wanting to fight the battle any more or good people taken to other jobs within the system. per right now those key people are acting and don't have the authority. it is very difficult in your the acting head and tough

decisions come up the tendency is to put those aside. how can we resolve that? i'm sure it is arkansas and the whole system. >> we talked about this previously but there are a number of things we can do together. i would encourage when you're in the district with three crew together and go to the medical schools and hospitals and recruit together if that is a positive sign i have been to over two dozen. we have flooded as part of the proposed legislation to allow us to treat medical center directors and many are not doctors or title 38

and as a result are paid significantly less than the private sector that is a very important job like to make that 38 -- title 38 to pay competitively. >> the secretary has identified the key issues. we are trying to attract new professionals for a career because many people are retiring and unfortunately some are leaving the system. if we put out a call to the private sector to come serve your country many ways and one is to join the v.a. system and we had a pretty good response we you're looking at decreasing the hiring time that is one of the initiatives. we appreciate your support of the pay authority and

creating an environment where they feel they to be successful because i think much of that dialogue on the same page and helping to recruit would make a difference. >> switching gears you have a lot of people that want to come forward and have come forward in the past and have a reputation to not get a very good rap. and from the circumstances from what comes up also were you appeal and maybe the majority of the caseload comes from v.a. so that is not a good situation and. talk about what you are trying to do to address the problems with retaliation

into encouraging others in a non ha style environment -- a cost islander meant - - hostile environment. >> we have a program we put together in conjunction with a professor at the university of michigan and it is a program where retrain the leaders in three days. the leadership leadership, whistleblowing, and we want every employee to come forward with criticisms to redesign the systems that is one of the reasons we train our employees. a good customer service organization cannot survive unless it is a great place to work the people have to be trained to do that. refers agency to get

certification on whistle-blowers and we called out whistle-blowers who have helped us and it's something we're working very hard to make sure there is a retaliation for those there receive the appropriate discipline. >> thank you for your testimony today. of one to complement you spending time with you and alaska in phoenix and my office there is a lot of work to do but. >> apologize of my trip to alaska coinciding with your service in the military. >> next time i will be there. but i appreciate you were up there recently things for

limey to hold a hearing up there and you saw that level of frustration and the choice act that ideas from what was working in alaska been implemented it was a fiasco and everybody recognizes that. see you committed to this pilot program in alaska that would be up and running and initially you committed to me in november it is starting to take cold but i would like an update. from a strategic perspective we're able to fix the big issues in alaska it gives a sense of how to fix nationally but if not it will spell trouble which every member of this committee cares about which is fixing the choice program so it is serving veterans.

right now it is still not in my state and i would like an update on the timeline going forward. >> first of all, i do want to thank you and acknowledge you have been a great partner and very clear you expect solutions but working with us all along. you are correct we agreed upon a solution to try the pilot program which can serve as a model for the rest of the country. it was delayed because of federal contract rules. it was tough once you're in a contract to get agreement that we got that done and on january 11 it went live. now we have been vetted staff were there in the

medical center. >> are they temporary hires or permanent? >> mustaf of the v.a. are permanent and the rest are permanent hires but we want to move very quickly to make sure we did not miss the jiri 11 date and now taking this up to a new level with the official contracting approval to have the v.a. staff to care coordination. >> when you anticipate to make that commitment? >> i hesitate to give a specific date dealing with contacting lot but i will get back to you. everybody knows that is the final peace and we do believe talking to senator tester yesterday potentially

it montana doing some more pilots. >> get back to us. i would like specific dates. talking about a shortage of professionals and as you know, we have talked about this it is acute and states don't have medical schools so we have been working on legislation that can help states and other members that would benefit to encourage the of partnership that you talk about new in alaska with a different health organizations in particular the tribal organizations are like your commitment to work with us. we have legislation drafted the beginning a marked up but if your commitment to

work with my team to make sure v.a. is good to go i think he would be but we would like to do that with you soon. >> we agree we worked on that together redeye was in alaska and i think it is a great plan. i could not agree more i am sorry the senator is not here because we're working to set up a medical school in las vegas nevada we have to have more medical schools in the states if we expect doctors to relocate and i thought it was a great program. >> i actually think the critical factor to get somebody to take a job is a residency program that is what we're trying to do and we could use some of the

legislation but we found 1500 spots give bin we only filled 372 of those and the reason is what we learned is v.a. neece ability to help the private hospitals begin a reimbursement and that is a limitation they want to increase training the week to use the lead -- legislative fix. >> i was back home recently and heard the issue providers not getting paid and dropping out that i think is a problem in alaska. for veterans who get commitments to go to

providers and have their medical procedures completed and they are dogged by credit agencies to pay a $30,000 bill. event that is incredibly stressful. i heard about that the last time i went home. but to get that commitment to stop this. you heard that it is outrageous. your call murder them last time. you should never put the veteran in the middle so we

set up a special team to deal with veterans to find themselves in the situation we recognize before you came we have to fix the provider payment issue as well. and 85 percent by the end of the year. >> that would be a breakthrough. >> the first question i raised was exactly the same thing. it is the huge issue we have to address. >> i ask unanimous consent to put my false statement in the record. we have talked about moving the of focus to the individual experience.

that is the right move from focusing enough bureaucracy. and i have gotten complaints those are just a few of the problems i am hearing and it is deeply disconcerting. >> to us as well.

give us the names and dates and individuals involved the only way we can do anything with it. the individual told to call 911 we use that with our training now we have trained thousands we use that episode as exactly what we don't want to do we haven't organization that is rules based in green need principal base. this individual thought there were following the rule book that is the wrong thing to do your training leaders. >> i love your words but how is their accountability? and then tell the person to call 911 because that is

unacceptable. >> if you have a problem call your senator. >> my phone number is on the internet. >> i appreciate that but that message cannot be call your senator. >> we ran an investigation and we have to train people it hasn't been doing enough to spend $100 a person if i did that running procter & gamble i would be fired that is the way to hold people accountable.

>> if you go to the facilities you would get positive feedback. >> that has to get down on the ground and exactly what you talked about in the parking lot the deputy secretary sent a memo to every single employee to talk about how that is not under our principles we're getting that out and the protection act to continue funding waiting for action

to get that passed 11 and there still homeless veterans then those that our homeless now who generally have medical issues and as we committed we will continue to have those homeless veterans declined to we need your help in one of the big ones for the los angeles to build the buildings we need them with legislation and. because this show can medical center is without a permanent director from may of last year or chief of

surgery is now foresaw hospital to cut hours. what we doing to make sure those positions are filled? >> this is one of the key priorities. we need your help we have passed for several things to do that including that title 38 funding to compensate medical center directors. in the year so below market that culture and recruiting

very hard for what it is to serve in v.a. we have spots open that is far too many nodded data don't ask people to come help. >> keep that up by appreciating it. >> thank you, mr. chairman. and with regard to the my v.a. as an integrated plan it looks like you're trying to change the culture is

that the specifics you have 300,000 right now. is a time to look at integrating those areas of excellence? with a community health care services from with the innocent -- and it is states utilized. what is the challenge right now? and then for the rest of those in the u.s. today. and it will have the sheer joy culture change but what we talk about is the irreversible momentum when the administration changes

that they can carry this on because in my opening statement this is the first time the business acumen the fed then brought to bear on the six largest company we will not have another c i o from johnson & johnson and al. had to accomplish culture change? you have to raise standards. with the performance evaluations thought to be rated outstanding when you're rated one of the our worst in government?

that is why we like this training to take the leaders of sight to say here is how you run a performance management system not about everybody getting graded border flavin to identify to train people to provide customer service that is now cascading so we enabled those leaders that is why it is cascading right now to check on your own facility. >> en that goes well beyond 2016. if you're looking long term

it seems that some of the tools might be statutory changes is their layout specifically but. >> yes, sir,. about nine different statutory changes a talk about consolidation in purchase health care in streamlining and title 38 and extended use leasing on the campus and the claims process that we guaranteed 90 percent of appeals would be solved in one year. we lay that out we need to work together and that it is

integrating they can use those health care facilities and know that is the goal but as we tried to establish the facilities with the local facilities as well. >> after building the very best in network and forget the up politics to get the service that they demand

with the optima note -- to have the various affiliate's identified whether those we do business with or the department of defense we partner with all of them to see what specialties are necessary. >> still committed to centers of excellence. >> yes. the goal is to give the veteran the very best care. whatever the answer is and having spent time in a the private sector and to use

that just for a second that is quite a surprise how much of a veteran gets it in the system that isn't available for that is why we believe strongly. we're not trying to dismantle and the va. for those you can find in the private sector. >> in the private sector verses the v.a. you cannot find in the private sector those crisis lines transportation and services that care givers are not available homelessness end

medication support behavioral health integration. where in the private sector? in working with every leading academic center to say we're getting intellectual property this is why the v.a. is unique. >> i know the desire that you have that resonates across west virginia. and by doing that to have

rural west virginia the temporary one is open now and i support to make sure we facilitate it is like turning the titanic but we have to cut through that. nobody believes there is a one veteran that's homeless now with that there is problems that we have to address my had someone bring something to my attention he was complaining about the income based service. pacesetter i put on the uniform. does someone you did not do

quite as well but it makes me feel that i am not expected to get the service because they did too well. that doesn't make sense to me. like you should get a scholarship in school. you guided buy you don't need it so we will not give it to you. and that is a true statement >> i am a veteran went to west point and i cannot be served at the v.a. because i am category a-plus i have too much net worth. >> will we deal with our requirements for says budget so where is the balance?

>> we look at that as a policy guide has blessed them well. and also with that ailment that was cured. but then to make the laws better so that is the prescription drug addiction and. i understand that the services but if you go back in his but the crew -- history chronic pain is something v.a. technology early to say there other ways to treat but that is

when the onslaught of opiates came on to the market that is the case reno the detriment to society the culture of america how we treat chronic pain by imploring that these people do not go to prescriptions first but last. looking at the evidence based equine therapy works acupuncture works some stimulation and technology works yoga works there are so many things we are learning to substitute and we track this every day to make sure we are going down there is a lot of american medicine can learn.

>> but the policy the you could adopt it and did you go for a toothache you get 30 days of talks the content perturb -- boxy content. >> so that is what we want to do. we see their role as a leadership role in the year doing several things as evidence based. because quite frankly there are new technologies and academic detailing. that means teaching them. >> end continued education.

and and maybe less than one week. out of a rotation. i would encourage you we cannot change that going through the process you have success have you not? with alternate care of chronic pain? >> for those who may have mental challenges? we have a leadership role in america this is the big innovation how difficult? that is a very smart corporation. that being said with the

public sector versus the private sector you have to have those top management changes of flexibility how far down in the pecking order do you get to make the changes you need to make? >> it is the difficulty of scale the sixth largest in the country and is a challenge of time i was with the same company 33 years so it takes time but having someone with experience in business. >> i think we gave

legislation and that you could fire people? >> we have enough authority to fire people. >> you can move them around? >> as they said 10 of 16 leaders are new that was 18 months ago so i can change the leadership we can do the things we need to do. but should be treating this like the business that they have business experience? this is a very large business. >> thank you. >> with your focus on opioids and addiction and 72 percent of those physicians that is some place to make a cultural

change valenti think the members and senator tester? >> i appreciate you being there had a few home work assignments to elaborate. it is very important the senator rasta question it would be helpful to match those legislative actions to make it clear as draft legislation that rhonda critical path. -- on the critical path. >> also with a stakeholder

management. >> that they are interested in what you have to say but we have to find with that stakeholder plan looks like. >> we have been doing that. and sending out my team to meet with the of vso. blake to know those under the interco part and we will include that to be in the care that we are providing in the field. >> is someone is excluded let us know. >> also to underscore the point about training because it looks like of big number

go $100 per person you have to emphasize it may look like the big number but with the council of the lake to see the infrastructure or technical decisions you are making in view of the vote and then you have a very good reason. >> you know, our prejudice. >> scheduling systems and private sector has it down. and to extend into the other

areas a&e other capacities. with the gatt capital expenditure going forward to make sure that is articulated with that organizational comparison to see with that organizational model looks like with the bureaucracy that is problematic to push more of those resources so that organizational transformational models to the extent it involves all those things would be helpful and i would like to measure on the basis.

truly the final thing. [laughter] we will communicate to your office there is a potential issue with timing. i have heard things that we will be in touch with your office. >> don't give me a letter. talk to me. >> we will get together very quickly. >> we will reduce middle management that they have had historically. >> i find it hard to believe one needs to be different from the other. >> they should not be.

but you customize when you need to to meet the certain customer need. >> that the vso other representatives of our customers. to have the template of the vso. some of those changes to perfect the customers before the fact rather than after the fact. to make sure all hands are on deck. >> thank you for your testimony and commander we will get you back before the snowstorm hits. we are adjourned. [inaudible conversations]

and what when . .

this is an hour. >> hi, good morning. my name is bruce, i i will be the moderator for our discussion today on form policy and the 2016 primaries. i want i want to welcome all of you who have braved the threat of the storm today to make it