about 20,500 mental health professionals. so the interest is there in trying to determine what the requirement is. and we're not hesitant about increasing those numbers. >> okay. thank you very much. senator burr? >> thank you, chairman. since the chair just asked about mental health, let me just ask if my information's correct. in december va polled their facilities and they found that there were 1,500 open mental health positions. is that accurate? >> let me turn to dr. petzel. >> would you repeat that number? >> in december of 2011 the va polled their facilities and found there were 1,500 mental health slots that were unfilled. >> out of 20,500 that's true, yes. >> okay. i just wanted to make sure the information i had was correct. mr. secretary, i want to thank you for something unrelated to this budget hearing.

march 31st in north carolina we will have the first in the country welcome home vietnam vets day. an all-day event. and i want to thank you for the va's cooperation at making sure that the va presence is there to make sure that we are able to catch those who have fallen through the cracks, work with those who have problems, and have a va mobile presence there as we will from d.o.d. and a lot of private sector entities that are working on employment placement. i think this is a very special event that's long overdue and hopefully it will be the first of a total of 50 that are held around this country. and i thank you for the va's participation. i'm going to ask for chart number 1 to go up. earlier i mentioned a mub of performance materics that seem to be heading in the wrong direction when it comes to claims processing. but i want to start by talking about the quality of va's decisions on disability claims.

your goal is to have 98% accuracy. but for the past three years accuracy nationwide has been about 84%. and as of december '011 the accuracy rate at regional offices around the country varied from 94 to 61. mr. secretary, in total how much is va requesting for '013 budget to carry out all of those quality initiatives including the quality review teams at each of the regional offices? >> thanks, senator. let me turn to secretary hickey to answer that. >> senator burr, thank you for your question. and i will say i'm glad you're asking us about -- thank you. senator burr, thank you for your question. i'm glad you're asking about quality because we're very focused on both production and quality. it's not a trade for one and the other. i can't give you the very specifics on each one of those costs, but i can tell you we expect the impact to be significant in our ability to

produce a higher accurate and more consistent response across the board. it's not just the quality review teams. but they are a critical part of this. and for those of you that may not be aware of what those are, we have taken what is nationally recognized even by you all and members of this committee and your staffs, our star accuracy team based out of nashville, tennessee. we have replicated their skill level, their training, and what they do every single day now inside every single regional office across the nation. their responsibility will be not just to check quality at the end of the process or inspect quality at the end but to do a new part of the process that works closely with our employees in a training environment to check different parts in our process where we make most errors and to correct those early. >> at what point on a calendar would you make a determination as to whether those quality initiatives are going to work, and what indicators would you look at to make that decision?

>> so thank you, senator, for your follow-up question. i'll tell you, we've already done that. no initiative that we have in our transformation plan of the 40-plus initiatives in the people category of those things, how we're organized and trained to do our work, in the process environment, how we've adjusted and some of our environments or in our technology solutions have not been tried, tested, measured for impact before we're implementing. so in fact on the quality review team -- >> but at some point you've got to say we're going to look at it and see if this is working. >> we did, sir. absolutely did. and we did it in local pilots, and we just announced this week -- >> so a year from now when we get together for the '014 budget, if the quality is not improved or the timeliness down it will have failed? >> no, sir, i don't expect the quality not to have improved. we have some very significant decisions and initiatives. >> my point is what if it doesn't? >> sir, then we will adjust as

necessary to find the reasons why. we will tackle that hard. but i don't expect that to be the answer. i expect us to see improvement in both quality and production. >> senator, if i might, quality is a function of trained people with the right tools. and we're working on both items right now. >> my question was simple, mr. secretary. at what point will we determine whether what we've implemented is working? >> fair. we'll be happy to provide that. we set a target of ending this issue with backlog in 2015. we begin fielding the automation tool we've been building for two years fourth quarter of this fiscal year. we expect that the tool will be rolled out '13, this budget. and as we do that we expect both speed and quality to go up. >> if i could ask the chair for just one additional question on this round.

and i would call up the second slide. va made this projection last year at the budget hearing. productivity due to the impact of the overall transformation plan, which will rise from 89 annual claims per direct labor in 2012 to 129 in 2015. as you can see from the chart, we talked about productivity last year at 79.5%. this year we're looking at 73.5%. what percentage increase in individual productivity do you expect from the veterans benefit management system? and what percent do you expect from other initiatives that are under way? >> well, i'll turn to secretary hickey for the details. i would say what these charts don't reflect, senator, is that

in the last three years we've taken on some other projects that aren't accounted for here. gi bill. requirement to get that program up and running. and today we have over 600,000 youngsters in college under an automated system that didn't exist in 2009. and i think we all recall that first semester we had to do everything manually and it was not the prettiest processing event. but we did that manually, got 173,000 youngsters in a school and on their path to the future. at the same time we began building this automation tool for the g.i. bill. by april we had the first part of that tool out fielded, and we've added four or five more programs to make it more productive. we'll get better over time. it's hard for me to give you a day and a month when this

quality factor will meet any of our expectations. but we set 2015 as the date in which we would have the backlog solved and the quality at 98%. that's what we're focused on. i'll give you the best way points that we can figure out. but that'll be a product of what we're doing to train our workforce and what we're doing to claim the right tools. we're talking about the right tools now. but in the same time your question about the growth in our human resource investments for the department. we trained nearly 300,000 of our workers, many of whom have never been trained, on their job so they can produce what they expect and that they can leverage these tools when they arrive. >> thank you, senator burr.

i would just like to first start by saying thank you to you and to chairman murray and your leadership and the members of this team -- this committee for an unprecedented level of increases, budget increases that vba has enjoyed in the last three years. i think we need to kind of put that in a little context. that 36% was used to tackle a 48% increase in claims over the same period of time. and that was to support nearly 12 million service members, veterans, their families, and survivors. and that's including a net increase in the last year of half a million new veterans to our rolls that did not exist and are using our benefits and services. so we did also for the second year in a row complete more than a million claims using those resources. that's 16% more claims per year than we've done in hart startedf those things. i will tell you and put frankly on the table, we've put more than $3.3 billion, and i thank

you for celebrating our vietnam veterans, we put more than $3.3 billion into the hands of 117,000 of those vietnam veterans out there in the last year. that had an impact on that line. the impact was there were 260,000 other claims in backlog we did not get to that also had an impact on fte because we put to do those right and we put two times the fte associated with each one of those claims on those very difficult complex 50-year-old claims. in addition, we stood up in the same period of time and put four times the level of fte to our most wounded,in our integrated d evaluation system, to get those folks taken care of right and well the first time. so that also had an impactut in front of us. the positive news about all of that is we are done.

we're down to the tens of ten levels, kind of double-digit levels of the agent orange niemer cases 99.9% done through those 250,000 cases. we are now capable of shifting all those 13 resource centers we had across the nation that were hunkered down doing those niemer agent oranges. tomorrow we're shifting that all back into normal backlog case load that will be focused on our benefits at discharge veterans. it will be focused on our quick start veterans. and it will be focused frankly on our oldest cases we have on the books during the month of march. >> thank you, senator burr. senator akaka. >> thank you, madam chairman. general shinseki, as we know, we often face challenges in treating our veterans who live in many rural and remote areas.

this is especially true of places like alaska and hawaii, where you just can't get into some place business jumping in a car and driving there. i know that you're working on an m.o.u. with the indian health service to find solutions to help provide services to our native american veterans. and i commend you and all you're involved in these efforts. mr. secretary, can i get your commitment to look into possible ways of working with the native hawaiian health care systems and native american veteran systems to provide services for in this case native hawaiian veterans who live in many rural parts of the state of hawaii.

>> senator, you have my assurance that we will do our utmost to provide for any of our veterans, wherever they live. from the most rural and remote areas, the same access and quality. to health care and services as we provide to someone living in a more urban area. there is a challenge with that. but we are not insensitive to that challenge, and we're working hard to provide va-provided services. and where we can't to make arrangements where if quality services exist in those areas making arrangements for veterans to be able to participate in those local opportunities. we are, i think you know, working and have been now for some time on signing an m.o.u.

with the indian health service so that wherever they have facilities and we have vested interest that a veteran -- eligible veteran going to an indian health service facility will be covered by va's payments. and we're in the stages of trying to bring that m.o.u. to conclusion. we intend to do that. and where tribes approach us prior to the signing of that m.o.u. and want to establish tr a tribal nation with va a direct relationship because they have a medical facility and would like us to provide the same coverage, we're willing to do that, but that would be on a case-by-case basis. >> thank you. secretary shinseki, staffing shortages continue to be a problem, although there's been

progre progress. but some clinics are seeing staffing levels below 50%, causing excessive waiting times for veterans that need care. understand this is an issue you've been working on. as you know the number of veterans needing services is growing yearly. it shows that you have been making progress. can you provide an update to the department's progress to address staffing levels? >> mr. secretary, thank you. senator akaka, thank you for the question. the -- we've addressed -- we've talked about mental health earlier and the efforts we're making to try to assess whether there's adequate staffing there. i think you're probably talking about primary care, which is our

largest outpatient clinic operation. we treat 4.2 million veterans in our primary care system, and it accounts for the lion's share ever our budget expenditures. we assessed staffing three years ago when we began to implement what we call the patient aligned care team, or p.a.c.t. program. we found we're now able to bring up the support staffing and physician staffing to reasonable levels associated with the standards around the country. i would like to take off record, offline any information you have about specific places where there's a 50% vacancy rate. i'm not aware of the fact we have this around the country. i would be delighted to meet and talk with your staff and find out where these areas might be so that we can address them

specifically. >> my time has expired. but secretary shinseki, as we face budget constraints, we must all work to improve our efficiencies and redouble efforts to look for ways to get the most for our budgeted resources. my question to you is can you talk about any steps you had taken to improve the acquisition process at va and any efficiencies you've been able to realize in this area? >> senator, i would tell you that we have been working for several years now on restructuring our acquisition business practices. three years ago acquisition was spurred throughout the organization. now it's consolidated in two centers. one comes directly under dr.

petzel and that's for all medical acquisition. gloves, masks, aprons. we ought to be able to leverage that into a bulk purchase and get a good price on those kinds of things. for everything else we have an office of acquisition, logistics, and construction and we have a director who heads that office. and everything else governing acquisition is consolidated under his review. both offices work -- the work of both offices then come up to my level, to the deputy secretary as part of our monthly oversight review process. >> thank you. thank you very much. senator johanns. >> thank you. mr. secretary, let me if i might visit with you about the national call center. this is something that i think we had high hopes for.

you might have had high hopes for. but i have to tell you, it's not working well. here's what we're running into. the complaints kind of fall into two separate categories. the first category would be people that call the call center and no one answers. i mean, it just rings and rings and rings and there's no one there. i will tell you in my own senate office my staff has run into this problem, where we just can't get a live person on the other end of the line. the second area is you finally get somebody, a live person to answer the phone, and you get connected with them, and they don't have information. you know, the veteran is -- or we're calling in or somebody's calling in, what's going on with my claim or whatever it is, and

you're just not getting a responsive human being on the other end of the line. i'm guessing what it is is they just and so it seems to me that we're creating a -- an expectation of service when really there isn't much service there. i'd like to hear your thoughts or whoever's thoughts on your team about the call center, what's the prospects for that. are these -- are you hearing these problems? and if we're still committed to the call center, what's in place or what will be in place to try to solve the issues that i have raised? >> thank you, senator. i have tested the system myself. sometimes been, you know, pleasantly surprised. other times disappointed. but that's been something i have done for three years now.

and then demanded that we go out and fix it. and so we are in the process of putting a fix in place called the veterans relationship management system. if the concerns you're expresses are -- expressing are anything six months, the experience occurred six months ago and older, i would offer that we have made -- we have put this tool in place and changes are occurring weekly. i'll ask secretary hickey to provide some detail. but i, like you, i think when a veteran picks up a phone and calls v.a. there ought to be someone there that answers or if he or she chooses to come in on line that it ought to have information that's useful to them. that's easily discovered so they don't have to run through a series of traps to find what they're looking for.

we owe them and that's the first step of any service organization. that's our intent here. so let me call on secretary hickey. >> senator johans, thank you for your question, and i appreciate your comment earlier about e-benefits. that is part and parcel of our multipronged approach in our capability about being able to converse with that veteran and the time and the method they choose. we have surveyed our veterans and 73% of them want to meet us on line and that's part of that. let me tell you about the two new pieces of functionality that we have measured outcomes from our j.d. powers voice of the veterans survey. the first is virtual hold. that means in a veteran calls us and there's a long witting time, they can elect the hold

option, continue feeding the baby, getting ready for work. do whatever they need to do. it will call them back on cue. 90% of our veterans have elected that option. the second one is our scheduled call back. meaning i can't wait on the phone with you now. but can i schedule a time that i can talk to you and you will guarantee to call me back. we have just implemented that one in december. between those two our veterans have -- one million veterans have elected those options. as a result, we have seen clear demonstrated measurable performance. we have a 15% improvement in overall satisfaction on the ability of our veterans to get through. and we have seen a drop call rate reduction of 30%. those are both part and parcel of the new technology and the new ways we're doing and working in our veteran relationship management capability. in terms of another vrm initiative, in terms of they

don't have the right information, yesterday, not today, yesterday our call agents would have had to cycle through 13 different databases to get you that veteran or the survivor the information you needed. today as we deployed this, unified desktop puts all 13 data bases worth of that critical information you want to know on one screen. making them much more effective and delivering a good outcome. also, built into this is world class call recording, call tracking, data analytics into this package this we're using every single day to improve our service in that environment. >> i'm out of time, but if i could just ask as your -- as these things are being implemented, as we're going down the road here, if periodically you could give us on the committee an update as to the progress you're seeing. because i do think there's real hope with the call center. you know, the veteran at least can get somebody who can answer

their question, et cetera. so i'd like to stay abreast of how we're doing. >> i'd be very happy. be very happy to do that. >> thank you very much. senator? >> thank you, madam chairman. i appreciate seeing secretary shinseki and all the folks on the panel today. a special thank you to you, general, for coming to montana last summer where the initiatives are appreciative of that. and you too, bob. thank you very much for being there and listening and hearing. thank you very, very much. i want to talk about what senator kaka talked about. very quickly. and that is the type of strategies they're using. and this isn't an gp area, but an area that's much more difficult. and gp is not easy. that is the need for mental health professionals. we have as you know secretary -- mr. petzel, you were there when we opened up the facility in

helena, and we need -- it's a great facility. we don't have staffing at this point in time as far as from the psychiatric standpoint. do you have the adequate amount of flexibility to be able to go out and recruit and it can go to the secretary or to mr. petzel, to be able to go out and recruit and get folks in? because i'm not sure we're there yet. >> thank you, mr. secretary, and thank you, senator. i am aware of the issues at ft. harrison. we have four psychiatric psychiatrists vacancies. in general, we can recruit around the country very successfully for psychiatric social workers, for psychiatric nurse clinicians, and for clinical psychologists.

is the m.d. psychiatrist. the most difficult recruitment is the m.d. psychiatrist. this is an issue that all health systems around the country face. we are very competitive, however, in terms of wages, in terms of working conditions and the other kind of things that are appropriate and are needed for recruitment. so it -- i think we're in a position to do the best job we can for recruiting. i don't know what we can add right now to the basket, if you will, of things that we have to offer. it's a matter of identifying the people that want to come to places like helena, which is beautiful, by the way. >> thank you. >> and in an environment where there just aren't that many of them. >> okay. well, i just think that it's been an ongoing problem particularly in rural areas like montana and it's not a problem that i think bodes well for the veteran who has issues that revolve around mental health.

we all know if we have the professional health, quality of life and will advance and health costs will go down. have allowed the v.a. to be more efficient, more effective. however, it is my understanding that the exclusion of health related i.t. funds have put us in a bind. it is hard to deliver quality care when you can't make investments in phone services, that connect the veterans, electronic health records. can you just speak about this issue and how the inclusion of healthcare related i.t. funds and advanced appropriations can improve the quality of health for our veterans? >> thank you, senator. i would begin by saying that congress provided us a very unique mechanism called the advanced appropriation. it's a gift to the v.a. because it gives us an opportunity for

continuous budgeting and budgeting. and gives us two looks at the budget. we submit our best estimate as an advanced appropriation and then we submit the actual budget and can make adjustments. the advanced appropriation applies primarily solely to health care and so dr. petzel has his continuous budget. everyone else is on annual budgeting. under advanced approaches, we have the budget for medical services. medical compliance and reporting. medical facilities, and what happens is when we have a delay, a cr, the rest of the budget where i.t. resides, he has his authorization to start building facilities and standing them up. then we have to wait as