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 from 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 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 don't have access to the information that we're seeking and so it seems to me that we're creating 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 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 week pli. 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 sometimes happens or more than sometimes a delay until the i.t. budget gets released. so that now it can catch up to him and then in a case last year i think the budget cr lasted until april.

so pretty significant period. we're a bit off stride here and i'm trying to figure out how we can get this together. and link up the authorities you provide along with the budget to do his budget and get him the tools that allow him to see patients. there's no separation between medical i.t. and medicine today. it's all one treatment discussion. >> well, i just want to let us -- let us know how we can help you be more effective in the i.t. area and i think the charge murray and ranking members will help on this too. i think it's really important in this day and age. and just -- >> can i just follow up very quickly. madam chair, i'll just add here, what has happened last year the i.t. budget is now released in april. and it's big number because it's

all i.t. well really in it you have the paperless system that goes with secretary hickey's operation. and you have medical i.t. that goes with dr. petzel's. i'm just trying to be clear here. a piece that i'm concerned about is the medical i.t. so we link decision to do things for veterans in the medical sense along with the, you know, the tools to be able to do that. what happened last year sometimes happened, this large i.t. budget gets, you know, identified in april. we can now go forward. and the assessment is made, well, they can't possibly spend that before the end of the year. so we lose $300 million in a

detrimental process. and at a time when we really needed to marry the two things up. he can now not deliver what we have already approved a year before and we're delaying that. so i think there's a mech -- >> timing issue? >> yeah. i think there's a mechanism here, getting stride on both ideas and i'd be happy to work with you on it. >> thank you. i want to thank everybody for being here today. i'd get into the rural cemetery thing, but we'll propose those questions in writing. thank you very much. >> thank you. senator moran? >> madam chairman, thank you very much. mr. secretary, in 2008, congres pad -- passed the rural access act. and i was involved in it in my days in house. the program is now referred to as project arch. access received closer to home. and that legislation set certain criteria that if a veteran lived a certain number of miles from an outpatient clinic or v.a. hospital, they'd provide those

services locally. using a local physician, local hospital. my legislation was broad in its initial form, it was narrowed by congress to create pilot local. and the vision that kansas in as one of those pilots. i have express complaint to the va before, it doesn't use a vision as a pilot project, it chose a community. we have taken legislation and created a pilot program and created a pilot program within a pilot program and we now have a pilot program in kansas and we have yet to hear the success it's made. but we want to get the department to expand this pilot so that you can take more than

one community, what happens in pratt, kansas, which is less than an hour from wichita, is significantly different from what happens in atwood, kansas is five hours away. so while i'm certainly pleased a pilot program is ongoing, i'm not certain -- in fact i'm completely uncertain, i said it differently, i'm completely certain the va has not chosen widely as it ha has narrowed al the same topic of sea box, and i understand the doctor's testimony about the inability to retain professionals, but it's becoming clear to me that we have that problem of not being

able to keep the provisions, the availability of a physician has become very limited and we have many cbots now that no physician is generally present. we have certainly offered our vision that we do everything as a part of the senate now, to provide similar personnel. and it's the same one i hear from visiting folks in kansas, it's not really a resource issue, we can pay significant amounts of money to attract medical professionals, but we're struggling just like everyone else to attract those

professionals. in some fashion, that current be a final answer, just because everybody else has struggled to take care of patients, we cannot allow the va to have the same -- i don't mean to be critical in that sense. it has to be something more than, well, everybody's experiencing this problem, there has to be a solution. >> i would say, senator, we in the rural areas particularly are challenged because of the availability, i think dr. petsell said that and our tools are really reaching out to -- and we want highly qualified, we want talent. and our tools are what we're able to compensate, what we're able to recognize good people doing outstanding work and

retaining through bonuses, the high quality ones, so our tools are limited. but we owe you the best efforts we can to go after that talent and the biggest challenges are in the rural communities and we have to circle our wagons here. >> i appreciate your sentence that you owe us that, we also owe our veterans that, but let me tell you i owe you every -- i'm not being asked to do something to solve the problem. what i'm asking for is tell us what we can do to provide the assistance so that when we have a hearing six months from now or we're back here next year talking about the budget, the answer to whether or not there's a doctor at a seboc, or that we're meeting the mental health

needs in every community, it's not every provider, every rural county in the state is having that we are, help us solve this problem. >> do you want to respond really quickly? >> thank you, senator moran. the md issue first. you're absolutely right, that we all have this difficulty in certain rural parts of the country. i would say that if you look at our md situation across the whole system, we don't have a recruitment problem. it's very important that we focus on this as rural america, we kneed to expand our tuition reimbursement program to be d able to provide them with a

secondary school. to do something like the military does, with their uniformed services medicine, pay for their education, with an obligation to follow, to work with us in different parts of the country. >> i just put a little finer point on what dr. pentsell said, if we went rural areas, and found a highly talented individual, and targeted that individual and got them through the college and the medical process, they would be going home so we would not be facing the retention bonuses and you would have provided somebody for the long-term, that's part of the discussion here. >> i appreciate your thoughts and please consider me an alli.

>> i also want to echo the same comments that senator moran and i like some of these ideas you just mentioned. i know that in one of our hospitals in alaska, they actually give a bonus to individuals, up to $10,000 to recruit retain nurses. for the staff that you went up to alaska, i think it was last week or the week before, chairman murray for sending staff also. it's important to come up to alaska to understand what rural is all about. it makes a difference to the people there, but it also, i think opens the eyes to a lot of folks how we have to deliver health care in the most remote, rural areas of this country. so thank you for that

commitment. i know we have had some conversations, secretary, in regard to the idea in the alaska eros card and the idea of trying to weave through this access issue in parts of the country that have limited access to veteran's care. in alaska specifically, we talk about the roadless areas, 80% of the areas in alaska have no roads. i read your testimony about the internet connect, and get the mobile van out there. there's no mobile van out there. the only way to get it is in the air. we have thought about how to create this access and i just want to check in with you on kind of an update of that. i know we have talked about the quality of care through indian health services, that's superior

to so much of the care that's given across the country. it's high quality care. tell me where you think we are at this point, because the veterans all they want to do is to go to a physician rite across the street. the quality of care is equal, or in some cases better than the va specialties. >> i think you'll recall that we have put in a policy that would allow veterans from alaska to go locally and reduce the amount of veterans having to travel to the lower 48. there's a