contaminated equipment. we brought in best practices to my implemented across the system. by all accounts we made a correction. they're is model to try and do this. that being said, as you look around, there are many that have long institutional knowledge. many of them have been coming and talking to us and telling us . incredibly frustrating. the breakdown comes when i have to be honest with you. i have proven myself and trying to get this right. i have seen this as an abstraction and nuisance. i have restitution in my district that was offered to help. perhaps i can get a call. this has gone on and on and on. i am a loss.

they -- their people sitting back behind you. i think your sincerity in the work you have done, certainly i am not going to question it. i am reading, this is from dr. heaney and armstrong. they quoted peter drucker and said the greatest danger in times of turbulence is not the turbulence but to act with yesterday's logic. the question was, where is the big idea. my question is, where is the big idea? if you're right to come and ask for technology money, that is a cursory thing they found. when they pull the testimony of the people on the questions, you are going to be embarrassed and my guess is you will not want to, and as for that money. my question to you is, where is the big idea? where is the vision? >> it is a big idea. it may not sound as such, but it is back to basics.

back to delivering safe, quality health care at timely manner, knowing where we can achieve it and where we cannot. an open engagement from partners, a veteran service organizations were not mentioned enough today, but they are our partners. talk and listen with them. they have good ideas about how to get back to basics, not to listen to veterans to what they want, what they're telling a spirit at work with members. some of those things, when we listen and worker when we started measuring wait times there were too long. i don't have a big idea, sir. our idea is back to basics. can be a great system. as phenomenal employees who are mission-driven. our idea is to get back to basics to deliver veterans care in their system. >> mr. griffin, is that possible as it currently stands with the leaders and structure that are there, in your opinion? >> in my opinion it will take a

fair amount of time. it will not happen overnight. there are number of different areas that need to be addressed. when you are talking about timely quality care one of those is performance standards. i heard dr. road tar previously about people who dg i work in the private sector. maybe a are at hmo and know every day i have to do x number of colonoscopy is everyday. when we get out with you in december of 12, specialty care, we have 33 specialty areas. only two of them a performance. how many of the procedures, then generate the number. >> and i like my colleagues have been questioning all the data, the satisfaction surveys, everything that is coming out.

it is frustrating. i would leave it with this before my time runs out to you, today and this report that comes out and you heard mr. denham and others, when you find those entities that are out there, those locations, you do realize every single veteran that attends those is tonight calling, wondering, asking what happened, was there, what is going on. and we don't have a hard time line when you will come back or an idea where it goes. now instead of creating a transparency and that honesty and the reconciliation on this we have created another layer that is causing a stir among veterans. so i would just encourage you, we have to look at this a different way paribas. >> you are recognized for five minutes. following about, the white house deputy chief of staff visited

the cincinnati medical center in the area where many of my constituents are veterans that go there, and i learned that as a result of the internal audit that they were flagged as requiring further investigations. at this time can you tell me what is happening at the cincinnati medical center that got them flag to and should veterans in my district be apprehensive about the care that they are receiving are the timely fashion in which they received? >> they should not be concerned about the quality of kin -- quality of care they're receiving. there are specifics behind each one. it could be a single concern that came in at the time that we were there. we felt those cases, when needed to make sure we listed that. >> get the details of why that was light. >> i do not know yet, but i won't. we have to move back quicker. we reduce the level of banks to.

we have to do that. >> the problems that we have i come from private practice. veterans seeking care in some ways are a liability to the system or to the administered. they're not a desired customer. we have talked about that. and we really need to have incentives for quality and incentives for proficiency. you know, we need -- private practice, a no-show is a liability, i huge liability. you cannot keep your doors open if you have them. they're needs to be not a reward for this. they're needs to be a reward for coming up with ideas of increasing access to private practice will do. the other thing i am concerned about is the council. obviously sometimes there's a

level of urgency depending upon, as you mentioned, the acuity of the problem. you know, if i am referring a patient for an acute problem and will get on the phone and talk to that person i am referring to to say can you get the man? this is something that we do in private practice. you want to make sure your patient is taken care of. when we have a no-show if it is someone that you have been treating and they do not show up as a practitioner you have a personal responsibility to that patient. you find out why. my feeling is, you move forward. you talk about the big idea. at the administrative level we have to look for someone outside the va. if you spent your whole career and a va system you don't know what you don't know. you don't know these things that make an efficient system. it is not on your radar because you have not had to do it, and

it is changing an entire culture if you're going to get someone with in the same culture we're probably going down a problem. we need people that understand. as you said to me of someone desires to be there, that is a good day. you'll get is to have competition. would you agree with that concept of may be coming from outside the va? >> i am an old consultant by training. for me, time is money. and the availability of the time is billable their is a balance. we don't want to turn into a 15 that appointments are ten men and apartments when no one likes to you. they're must be balance and accountability for time. we talk about resources and the management of resources. time is the most valuable asset in our system. we have to manage that time. we have to extract value, be respectful of the way we do it, but competition, to know that we

can get more plants to more veterans who want to come in our system and are happy with our system, we need to introduce some of those concepts in our thinking. >> the quality of care and the patient's perception. that is always the challenge in private practice, someone needs more time that someone else. maybe you give it and find a way to work within that system and make sure that when they leave there they feel satisfied. my advice at this time, one, i want to your what is going on in cincinnati obviously, but i also would really suggest that we take a look outside of the va system because if that has been your whole life, you don't understand how that it could be. and i think competition is the key. i yield back. >> thank you, doctor. you're recognized for five minutes. >> thank you, mr. chairman. i find myself again tonight -- i

associate myself with the comments of everybody on this committee. the more i learn sitting here in the more backward i am on the things that we heard two weeks ago and the things that we are hearing tonight. primarily on behalf of every american taxpayer, where the heck is the money, the billions of dollars that this congress and previous congresses have allocated to itea grace? what do you tangibly have? we have done this. what does that va tangibly spend money on that is working right now? >> i would have to take that for the record. we have veterans benefit management systems. >> she asked a question and you gave the answer. using 1985 programs.

1985. the ig people sat right here. we ask the nasdaq stock has questions. in fact, i specifically asked them, who is in charge? do you have enough money to purchase what you need to get this system moving. the answer was yes ma'am. we have seen all these budgets, funded everything under the sun. it is baffling. the thing that i lead is interesting, did you not have any idea based upon mr. griffin's comments from 2005. eighteen months and that have heard the ig report after gao report. i know that there is problem. you said you are the business side, the engineering side, to

those reports never make it to you? >> i agree with the report. april of 2013. in response to that report we went back and looked at how we computed the wait times for veterans. if you're not a star systems. podiatry. >> we change the performance measure from using the desired date. we switzer the creativity. give us a much more valid measure. we started measuring veterans who were waiting longer routes of time that's ever tried to change that. >> can you say that today? that is a failure? you guys did it at the intermediary level? >> we did not know at that point in time. >> the two things that i came away with the mother has to be criminal investigation.

one breaking news to the american public. i agree. back nine hoosiers will have the same questions. well, what do i do? i guess i will take that on the record. we will get information when we get it. i have a question. i am sensing that where we are going to end up in one of these grand revelations is that this i tea department, this id system is unbelievably must about. we have asked the question, but we have not been provided truth and it has come to those kinds of things. as you know, only authorized to use one electronic list. according sieur written testimony officials piloting another system stated that revaluating decided not to use this approach. to you know if that is vetted by the whole idea of this?

>> we found that when we spoke with va that they had not done a system-wide check. and this is related to the super care. >> would you identify that -- with the program be legitimate? >> it may not be legitimate. one of the problems, the data does not end up in the consul data that is going to be used as a monetary system. can be problematic. >> could that not also be considered a separate electronic system? the system out there. >> we have seen in the last few months that the business rules for the council, the medical centers that we have been speaking with, they are changing their process these. they start out with something and change their processes. it is confusing, and i think that all of the different ways of the medical center's a using,

you know, tracking those future care consols has not really been vetted with al qaeda -- va. >> i yield back my time. >> you are recognized for five minutes. >> thank you, mr. chair. i guess everything in washington comes full circle. waste, fraud, and abuse, going back through my brain, housing group tonight. a couple of questions. by the way, mr. griffin, unannounced. i am delighted that you went in there. the last time we had a hearing she asked the question about the individuals on the panel that came down to phoenix. i believe it was on a friday. did not work on the weekend. it is any one declaring a state of emergency, let's work weekends, let's work maybe six

to six? if we are going to send a striker teams or -- people are dying on our watch to has this ever occurred to people to, hey, we have to do something about this? >> absolutely. we are encouraging and requiring our staff to work longer clinical hours, nights, weekends you know, we are all -- >> maybe i am missing something feet. encouraging to my am looking for a better action verb. can they go down there? asked. >> we have put folks on the ground. they have been on the ground working fix and the problems on the ground at my direction. they're working hard enough finding ways to improve the practice. we are bringing folks in. they are on the ground. >> let's go back.

you know, in the military we are there, that units, fully combat ready or not combat ready? i have to ask myself, some of the hospitals fully mission capable and some not mission capable. others partially. do we have revaluate that? i am getting the feeling that each hospital does their own thing because the policies are different and open, ambiguous and that was the word that i heard correctly and open to interpretation.

anyone? >> we have some great facilities think we also released today data shows quality, efficiency, and others and provide quantitative comparisons. there are some of lower. >> you hit it on this. what you are talking about, trust and all those things which i think some of us all believe in. but unless you have standardization coming from washington and verification of the outcomes, are we working at cross purposes if it is open to interpretation? >> i think the expression trust but verify. >> absolutely. you are stealing my -- holy cow. >> in our organization we get to 50 medical centers a year for a one week review of specific areas of interest. we go to 100 outpatient clinics

a year and the role of the results and can tell the under secretary of veterans health administration that x percent of your facilities are not measuring up in these two categories. then we would expect there to be corrective action on those. >> i am sure you have whistle-blowers. after i get out of the marine corps and became a college professor high. every student has a thing called rate your professor. you want to find out how good, bad, different your to read that ? i am wondering. i was trying to go through a look at different hospitals, sometimes it's eye opening. sometimes you need that self evaluation. i am looking for a more standardized evaluation process

and how they are completing the mission. i have begin do that we will have bad results in the future. >> if i would respond. combined assessment program where we go to those of the facilities, one of the last documents in the back of those reports is a vh a document called the sale report, and it ranks every hospital on about 100 different report it to outperform its metrics and is published in those reports. the data is corrected and available. someone needs to act upon the ones that are not measuring up. >> can i respond to your -- >> yes. >> yes, just, you know, what we found is great reluctance on the part of va to standardize policies and procedures. that leads to also complications when you're trying to do oversight. i think there are issues there. >> the only thing i wanted to say, this came up this year with

the cost of the military units. they're is a deficiency in training, this report would have those deficiencies that could be corrected. all i am saying is i would hope that that va looked at more standardization. >> a cute. you are recognized for five minutes. >> thank you, mr. chairman. just to confirm, you said there were 69 cases where you are now following up to review possible criminal implications. >> there are 69 separate facilities beyond phoenix that we have sent rapid response teams to as allegations have come into us. >> specifically criminal allegations? >> first of all, they are just allegations. >> short. >> criminal investigators are said to take sworn testimony and try and get to the ground truth. in some instances your only as good as your source. >> i understand. and allegations have to be vetted out. you use the term critical to a

criminal. this is different from the follow-up visits that are required as of the institutions. >> that is correct. >> totally separate. okay. the timing -- and i know it has come up for additional information go weeks or months? >> putting together a plan which we started. i agree we need to make sure that it is quality care and what we have identified is questions a practice integrity. >> congress gets frustrated. the some of the problems in the viejo. he spoke about non va care in

your terms being the veterans joyce. this is one of the issues that i have raised repeatedly now. within the current system the ability to get to non va care sometimes is obstructed by process where a patient has to go to the very same medical staff said they did not needed. has that changed? basis choice, has that changed? >> it is. it will take time. in conjunction with accelerating tariff provided training to roughly 1900 and none of our facility and regional staff. that was over about six days. in addition to that we have delivered training to about 2700 staffer appropriate use of the scheduling package and how they manage no-shows him how to schedule appointments. it's going to take a lot of that. if we have seen delays and not use of non va medical care, it is incumbent upon us and the

network and a facility to ask the question why. >> has there been a change in the same medical staff and initially said no having the sun often not saying yes? >> changes the degree of business that we have the communication of our objective the venture must be offered a choice. >> okay. i think each of you have agreed there is problem within management as opposed to the staff and some of the doctors. currently in some facilities private sector of this systems provide management. different than just seeing a non va physician. is there value in expanding the use of regional health care system providers to provide the management? so i understand from a number of the veterans i speak to, they

want to stay within that va system. the idea of using the voucher program is not something i believe the community would embrace. can we expand the use of private sector health care systems? providing management for facilities, what would your thoughts beyond that? >> in some cases we do do that. with contracts community health patient clinics we do have some partners in the private sector that help us manage and some of our outpatient clinics. >> those are really smaller facilities, right? what about the very large hospitals where peer to peer -- and lead is be honest. there simply cannot be private-sector efficiencies and a large va osbourne currently. is there value in looking at larger facilities? >> sure. we can look at it. the one thing i am telling you.

this is taught me to question everything. >> has there ever been a comparative study performance based upon management from private sector? >> periodically. one thing that i would -- just one moment of concern. a lot of our measure is a revenue-based metric which is to generate revenue. so i would say that, you know, other agencies, medicare and others, have had issues with that. our version of productivity, to have some measure of skepticism in the interpretation of that productivity data is tied to revenue. >> i wanted thank you again. i really do appreciate your candor and will tell you, two weeks ago we were asking for urgency. i think we have heard that from you tonight. the acting secretary has demonstrated that his approach is one of urgency as well. thank you very much. i yield back. >> i ask unanimous consent that the former chairman of the subcommittee of oversight and investigation be allowed to ask

questions. without objection you're recognized for five minutes. >> thank you. thank you to my colleagues for allowing me to participate. some of want to focus on the ideas you as subcommittee chair one of my very first request of that va was to show me the i t architecture for the va. i don't know what your tea -- i t background is, so i do not mean ted be insulting. do you know what and i t architecture is? >> i do. >> do you realize it is now going on for years and we still did not have the i t architecture? you know, i sat with the secretary in his office and gave him an analogy.

an analogy that he is familiar with. as a battlefield commander you would not go into a conflict -- i mean, our young people that we are now trying to take care of and their veteran years when they were serving depended upon leaders to make good, strategic decisions and know what the enemy at out in front of us, know what our capabilities or offset those risks and threats. they have the same expectation now of the va to understand what their needs harbor and with the capabilities are that are required to meet them. that va has hundreds and hundreds of i t systems. you made a statement a little earlier ago. you said, i think, to my colleague, one of the systems you said you would not approve it until it was proven to integrate with auerbach current

system. .. as you are looking and investigating into what the problem is. part of the reforms that the va needs to get to is coming into the 21st century with i.t. not only in terms of systems but in the systematic processes and current state-of-the-art

methodologies for managing those systems. mr. murkowski when are we going to see what the va plans to do with its information architecture? >> sir i will have to take that back. >> i heard that three years ago and i'm not trying to be disrespectful but that's the same old question. it's like a dog race. we come out every two years and we chase the rabbit around the circle and then we put the dogs up and so we ask it again. >> i think we have to ask what do we want. in this case for scheduling we want to be able to abide timely accurate information about one veterans want to be seen in what capacity we have in her system. i would rather buy with the industry has an knows it works. health care industry has something called hl seven which is interface language. most modern systems speak that language so does frankly our old legacy vista system and i would like to add complicated

interfaceinterface s but leverage with the industry can show us. >> i would agree with you because i suggested to the secretary in 2012. he said there are three priorities for laminating the homeless problem reducing the backlog and getting an electronic health record. i would not approve a single new dollar of new i.t. spending until someone in that i.d. to -- i.t. department could show me the current architecture and how these systems fit together and how i.t. spending will affect that and make me -- let me make one more point. talked about the electronic health record in the mid- positive comments. i confess that i don't know where the status is of today but i can tell you at the 2012 we had a joint hearing with secretary shinseki and secretary panetta and they were proudly

saying that we were going to have a single transparent electronic health record for military from start to finish within the next five years. he had been working on it for 10 years. this is not a matter of can do. it's a matter of want to and the department does not want that electronic health record because the i.t. technology to get it is there today if they really wanted to do it. mr. chairman i yield back. thanks for giving me the opportunity. >> thank you very much mr. johnson. members the clock says 1010:00 and we will stand in recess for five minutes.

maybe the assassination of president kennedy and 9/11. its impact on the american that this wash really a response from america to demonstrate the solidarity and cohesiveness of the american

victims.wards these >> read more of our conversation with kenneth feinberg and other from ourinterviews book notes and q and a programs in c-span's sundays at eight, public affairs books, now available for a father's day gift at your favorite book seller. >> a couple of live events to on ouru about today companion network c-span 3 house budgeth the hearing on poverty and federal aid, that's at 10:00 a.m. eastern. at 2:00 p.m. eastern the special inspector general for willnistan reconstruction testify before the house foreign subcommittee on the middle east and north africa. a look at how medicaid applicants are faring under the act.dable care from "washington journal," this is 40 minutes. journal" continues. host: joining us is rebecca

adams, the associate editor of healthbeat. we have the applicants on medicaid, on the waiting list. the question is, how many americans are waiting for medicare coverage and according to your survey, it was 2.9 million americans. of 41 2.19 americans out states. 41 states got back to us with numbers. medicaidse are applicants that are applying for medicaid under the regulations of the affordable care act? guest: this is those people who applied for traditional medicaid, since 1965 and also those who are part of the group that gained coverage because they became newly eligible under the affordable care act. is the biggest reason

behind this waiting list of nearly 3 million people? guest: it boils down to technical problems and a surge in applications, we have higher than usual volume, and where we found this problem is in the states that had technical problems with their websites or relied on healthcare.gov. host: there was another report healthme out from kaiser about the same issue and the headline was medicaid applications pile up in some large states, they say an peopledented number of have gained health-care coverage mostly as a result of the affordable care act and 1.7 million are still waiting for their applications with some stuck in limbo as long as 15 months. i think that your reporter agrees with this, the scope of the problem varies. was aggest share of this

backlog of 900,000 applications and the next biggest pileup is illinois and new york, where they have no backlog at all. seen the states have expansion of medicaid. >> there are 2 problems, one of them is relying on healthcare.gov and other states build their own websites, so they have their own problems and california has the biggest problem with 900,000 people waiting in california. >> do they have their own system? >> people apply to the cover california website, and they send applications to the county that will process this, and in some cases it is many months, that there were clinics and the doctors in california are very concerned because in california, over sixill for people

months old they don't get all of their money and they have seen many places like that. host: i would like to point out some of the colors here, the maps areas with the blue letters, they have federal and state websites and the applications are coming from states offices in just a couple of states. thatotal number of states are expanding their medicaid program is how many? d.c.: 27, including expanding them does that mean that the state takes on extra costs? guest: in the first three years of the program the federal government covers all of the costs. where we see the problem is they have this huge surge of applicants, and they also have issues on the technical side and they might have some administrative costs they were not expecting. host: we will remind our viewers -- and in, republicans

for democrats -- and for independents -- we have set aside a line if you applied for medicaid, you can call -- a state where they are trying to expand medicaid is virginia. virginia,from democrats in the senate, the balanced ship in the chamber -- phil say that state senator puckett is resigning -- mcauliffe trying to expand -- want to expand medicaid? big supporter of bill clinton has wanted to expand that, he says it will

work for 400,000 virginians. house,had trouble in the there are enough republicans in the senate to get it through the senate, even with the defection of the democrat who resigned, but now that the senate is , that causesratic more problems and they need to get this done quickly because there is a budget to pass by july 1. host: does the obama administration have any idea eventually, how many states that will be expanding medicaid and how many people does this mean will eventually take that expanded medicaid coverage? guest: they hope that everyone does because for the first three years, this will be 100% of the eligible people, and even after that that is 90% by 2020. it is very unlikely that all of them will come in during that timeframe, but there is part of a continuing interest among even

republican governors, between several republican governors that say that they want to command this case -- this is about 5 million people affected. does that become a single-payer system? guest: i would not call that a single-payer system because you think about the single-payer system, we have medicare and medicaid, we have sponsored insurance, that we rely on. so even though that medicaid has been growing and there are a growing number of americans affected by that, this is still not the universal single-payer system. host: we have a line set aside for medicaid applicants, that line is -- let's hear from seminole, florida. how are you? i am on social security, and i

stopped working when i was 61 end-stage liver disease, so i am on social security and i have a serious problem paying my bills. medicaid, apply for at least to help me a little bit, and if i got that, that would open the door for me to get food stamps, even if this was only $200 per month. i have not been able to get anything, nothing, because they literally laugh at me. dollars,00 something $1700, this is on my social security check and i am being called to pay bills and i just don't have the money. i have never been in this position before. host: you have not been approved for medicaid? caller: i did not even get that far, don't get me wrong, they

are very nice but they say that, the cutoff is $800 per month for social security. they automatically send this over but in my case they don't send it over, because i make too much money. they work strictly on numbers. so -- host: thank you for your call. guest: florida has not extended medicaid, she is in the position of having too much money to qualify. if you live in a state that has expanded, you can take about $16,000 per year, but in a state like florida, there are eligibility -- eligibility guidelines and sometimes they are very low. averaging $16,000 for an annual income. varies, stately by state texas it is very low.

each state has its own guidelines. host: this is from kaiser family help. they look at the states that have expanded medicaid and the map shows 19 states not moving as you, 27 states mentioned moving forward with medicaid, with expanding their medicaid. back to the issue of the exchanges, and the states that were best prepared for this. in your survey -- surprised to find a state with a lot of volume like colorado, where medicaid increased by 33%, they don't have a backlog. in new york they don't have a backlog. it really is not just how many applicants came in, it is how prepared that you were for this particular issue. do you think that eventually more and more states will rely on the federal s

ite, healthcare.gov to handle the problem? that thereould say are 2 ways to apply for coverage, through healthcare.gov and also directly through the state. in terms of states increasingly relying on healthcare.gov, there are other things that they are exploring along with healthcare.gov. en, tennessee. good morning. caller: good morning. host: make sure that you mute your television. caller: let me get that. i sat here and i watch this generalcause as a contractor, as of right now i am unable to work with some severe back problems, but you talk going up andrease,

stuff and we constantly, people -- illegal immigrants come into our country, i don't care if they are legal and do the right thing, but i am reminded by -- immigrants in this country, i have been in the business for 30 years and have never had a complaint and i have never in my life, have ever spent more than 2 days in the almost 10 houses, that i ever did not have american people, high-quality people and million dollar houses that i have built and obama says that americans don't work. i was on crutches and i would crawl on my knees to go out and build houses but they took this down just like they took down trucking. give us your opinion on health care because we are talking about medicaid. is that what you are on for your

health care? caller: i started talk about that because i fought this problem for seven years. i have a lot of american pride and i don't want to be a welfare rat. i want to work. toill tell you i would like work in congress as a common man. someone who knows what the and, -- el like, there,e will let you go with his issue of being unemployed, the bulk of the 2.9 million people applying for medicaid, is there any sense of how the employment situation affects these people or is this hard to gauge? how much is about money that you make, essentially. host: in your report we cover the 2.9 million people who signed up for coverage, who have not had their applications processed, and in some cases they were sitting in ques since

last fall and there are technological snags with the website, and the surge of applicants -- the trade by the promise to expand health care for the most vulnerable citizens. and this led to low income people think prevented from accessing benefits that they are legally entitled to receive. how is that happening? guest: if you apply for medicaid, you think about the population that we are talking about, they don't have a lot of resources. even as someone who has sponsored coverage, if i had a lapse in my coverage i would not go out and try to get surgery, and medical care. think about the people who are waiting and don't have any guarantees, really, they will just confirm that they are eligible for medicaid, they don't want to incur large health care costs while they are waiting for these applications to be processed.

doingwhat are people about the costs if they get approved for medicaid? retroactivelys be paid for by medicaid? guest: that is a great question and the answer is yes. it goes to the first day of the month that you applied, and you can also get covered for 90 days before that. so there is retroactive coverage. the problem is that people who are applying may not realize that. and they may not know for sure whether or not they will finally be approved. host: i remind our viewers that we have a life for medicaid applicants. for all others, for republicans it is -- democrats, -- and for independents -- flagstaff, arizona. od go to donna, go morning. we will let donna go.

we go to tallahassee, florida. brenda. caller: i am from tallahassee, florida, and i am a senior citizen. i have medicare advantage -- the woman who called in does not get medicaid because she makes too much. but if she has medicare she can apply for medicare advance, for an additional $45 per month, her medicare costs are about 98 or 100, the medicare advantage to capital health plan, is 3500 per month. i would like to let everyone know who signs up for medicaid, anyone who signs up for medicaid is possibly allowing their home to be taken away from them at the end of their life, because that is what the state does, when you are on medicaid the government can actually retain your home to get any value back

to them through your house, which is taken away from your heirs. medicare advantage in the capital health plan is a wonderful alternative, you don't have to go through aarp. you can go to the local office innorthern florida, chp northern florida and i am not sure what it is in south florida. host: good information but on her concern on medicaid, that the government would be able to take your house. would be thehis last resort but is there any truth in what she said about this? i think that is some cases this has been a fear that has been little bit overblown. it is something that people are concerned about and watching the outcome, that is happening and how commonly people are thinking in terms of being concerned about it. she was talking about medicare advantage.

those are the private health plans, that you can sign up for if you are medicare-eligible. like whatthat sounded she was paying, this sounded like a fairly reasonable -- guest: this varies, even within the state. host: annie in houston, texas, independent line. caller: i am in texas and i don't know about all of these things -- the caller from two callers ago, she said she had social security with $1700 and she was trying to get medicaid. i don't think that she wants medicaid, especially not here in texas. medicaid ad to pay back because i had to get on disability early, i did not have

enough social security and i get most of my money from their but i get a very small amount from -- you can't save anything. and -- recently they have been trying to force me into the helath care for -- health care for everyone, calling me two or three times a week. they are calling me two or three times a week and they are not supposed to be calling me, they're putting me on that plan and the original medicare. health care for everyone is about -- is in texas? is this a state plan for taxes? caller: i don't understand you. host: health care for everyone is a state plan? caller: they are trying to get everyone -- social security that

we have had ever since it came through in the 60's. they are trying to force me to you don't want the original social security, that is part of the health plan and the reason that i never want to go on a health plan is because i have had the same doctor for 23 years. you go, that let is a lot of information to take him but what are you hearing? guest: she is being forced to transfer from where you go to any doctor you want to to a managed care group. that is what i gathered. host: on the issue of health care, there is no news here, but the headline from "business insider." they say --

the latter phenomenon is what is known as the woodwork effect, when individuals who are eligible for medicaid became aware of this because of increased outreach and attention to health care, as would be expected with the ample mentation of a major health law, overall. leaving enrollment in the states that have expanded medicaid are led by oregon, west virginia and nevada, three states that saw the medicaid rolls jump about three percent. this seems like a big leap in enrollment. guest: it is. the report from the center for medicare and medicaid services came out last week and it said that looking at the health insurance programs and medicaid, there was an increase in enrollment of 6 million people, it went from 59 million people in the three-month average to 65

million people. >> the people that you talk to in the administration, what they say that this is -- they sort of expected this outcome? this is where they think that we would be when the law was passed? >> in terms of the backlog or enrollment? host: the backlog. expectingy were not all the problems that they saw, there was a reporter with kathleen sebelius and other federal officials and they were showing us what healthcare.gov would look like. and they did not hint that there would be major problems the next day, on september 1 and as people were leaving i pulled the lower-level federal official aside and i said, what about the problem that we are hearing will, that healthcare.gov not be able to transfer applications to the state? that is one reason behind the backlog. byy said, it will be fixed

november. it obviously was not fixed by november and by the end of december, the federal officials were calling to the states saying, prevent about the healthcare.gov applications, go back and start the process all over because the second application will be approved faster than the first application. roxanne in panama city, florida. caller: i was calling in because of my daughter, she is 30 years old and had heart surgery on her because of ave motor vehicle accident. problems -- female problems and needs a hysterectomy. this may wrap around and cause her to become septic -- she has been to the emergency room every -- andtime and cheated

she needed something cheaper than all of these er visits, she applied for medicaid and she has no income at all, she is living with me, and i am disabled. and it is just a mess. i have never seen this so bad in my life, she can get her heart medicine and she can't get anything. i don't make that much money. worst i havehe ever seen it. host: she is in florida so she would have to apply for medicaid through the federal system? guest: yes, she would have to go to the state office or apply through healthcare.gov and florida is one of the states that is not expand eligibility with the income level for adults, who have income that is very low. host: i go to the state

exchange, the headline for olitico pro, -- or for a lesser or not as expensive some, adding more states to healthcare.gov. what are you seeing as the next step? what do you think that most states will wind up doing? rebuilding their own websites or joining healthcare.gov? they are still thinking about what they want to do and

it shows you the magnitude of this issue and what is involved. they have really embraced all of the health care laws, they were gung ho from the beginning and they really wanted to do a good job of this, but they did not, in a lot of ways, because of technical issues. host: the headline in the "wall theet journal" says overhaul of the health site is in the work's. healthcare.gov. what are you hearing about this? guest: they are working hard and they need to rebuild the back door functions of healthcare.gov with how insurance companies are paid and subsidies being swapped and there is a lot of healthcare.gov that still has not been built and they are trying to do that and improve upon the site before november 15, which is when the exchanges in the marketplace opens again for people who are buying insurance.

host: what is the biggest lesson that they learned in the first rollout of healthcare.gov? guest: president obama has said that kathleen sebelius does not shows how and it important that it is to get these technical issues right. this is something that you would think would be simple but it really has caused so many problems in the first year. host: james on the line for caller: hi. i am about away from the previous caller in panama city here in florida. i had a car accident two years ago in atlanta, and i broke my back. i got rods and it. i broke my neck also. metal plates attached to my tailbone. i have been going round and round with medicaid here in florida. i went to the hospital after

obamacare was passed and the attendant told me because my condition is not an emergency, they can charge $300 of the co-pay. when everything gets said and done with social security you might get a little bit of cash. i have been going to the hospital for two years. i have been battling with the state. an immigrant there. they do not even speak english as they have a medicaid card because they have a baby. any type of fast action lawsuit we can file in the state of florida saying it is discriminating against people with genuine health problems. the state says if you are pregnant -- if i was with someone who was pregnant with no

insurance, she would get medicaid and i would get it through her. sounds like james has a pre-existing condition. guest: he is. he also raised the issue of immigrants getting medicaid. people here illegally are not eligible for medicaid. people here who have a green card have to wait five years. [indiscernible] rochester, new york. caller: good morning. my daughter has medicaid and was just given social security disability. she is 31. out, social to find security has about $11,000 a .act a of social security will that affect her medicaid in mentalure yangon total

income will be 960. she can collect medicaid without a problem. did borrow money a while ago when she got and that years ago and paid that. is there a limit for how much you can have in the bank? we are upgradable get taken away because of the back page -- backpay. guest: there is not an asset test anymore for particular categories. i would check directly with medicaid to make sure. from one of our regular c-span viewers, what medical options do people have while they are waiting? are they in insurance limbo? you

mentioned retroactive, but they do not have options while they are waiting. they don't. a lot of people are going to health clinics who help people who have low income and sliding scale fees. we are that a lot. this causes problems for a lot of people. if it turns out you applied and turns out finally you do not get approved, then you have been delayed for getting other kinds of coverage, including coverage through the marketplace. host: fort lauderdale. mark on the independent line. caller: good morning. thank you for c-span. you are getting a lot of calls from florida this morning. my fee because of the fact that our health care system is so totally messed up. you had a woman who called a

while earlier that was denigrating medicating -- medicating. the fact of the matter is in our state you cannot get on medicaid unless you are disabled. this ison i know because i had to go social security of the age of 62 because i lost my job and needed money. because i am so short of funds i was not able to carry insurance. i really cannot come up with through obamacare because the social security income is too high -- too low to qualify. at the same time i am too poor to buy health insurance.

you are in a bit of health-care limbo? caller: i am. i have the county thing, catastrophic man. i am hoping to hang on until i hit 65. that woman earlier when she said she is on it and said she paid for medicaid and advantage, she did not know what she had. medicare is free except for part need a and you might supplement to cover the 20% that medicaid does not cover. those advantage plans are nothing more than private insurance companies will make on people to signing up for them. the have stood up the balls, copayments, monthly fees. the people on medicaid advantage

and say obama is taking away from medicare, they are not telling you right. host: how old are you? caller: i am 62. host: a couple of years until 65 kicks in. caller: i went and got my social security but cannot get medicaid. guest: can i ask a question you go host: i'm sorry, i let him go. guest: i was going to ask about marketplace subsidy. about $11,600. i was a little surprised he was not eligible for a subsidy. too expensivebeen for him. i was curious why they keep

the bailouts. as government-funded. government is not a company. they rely on taxpayer dollars. when they say the government is going to pay for this, they just say you the taxpayer are going to pay for this. i live in georgia. i am 64 years old. i will be 65 and october. i do not qualify for medicaid. i went on obamacare. i cannot afford 400 per month for health care insurance and a $4000 to dockable. i i have to wait -- whenever go to the doctor it cost me $250. i wait until i save up money that i go see the doctor and get

a refill for my prescriptions for high blood pressure. i cannot get insurance. medicaid is not great. it will cost at least $100 per month and then you have to pay a $200 co-pay. that is a whole lot better than what i have now. i will be glad when i do qualify for medicaid -- medicare and will not have to pay so much out-of-pocket. appreciate your input. want to get back to the anticipated cost. some expressed concern the expansion of medicaid happens in the states. initially the federal government would pick up the expansion. down the road state to expand medicaid would have to foot the bill. that, ande status of how are states planning for

that, anticipating that yangon hostt? it is an issue. when the state decides to expand, for the first three years the federal government picks up all the costs of those in the expansion category, people who qualify under the health care law. the federal government will not necessarily pick up the other category you were talking about earlier, people coming out of the woodwork. people who just do not know about it and now signing up because they are hearing about it. they do not get a 100% match, more like 57% match. payment stays with them so the federal government only pays 90% of the cost of those adults with anticipated

expanded coverage. talking to rebecca adams about the expansion of medicaid and other health care issues, but -- veterans health. the cleveland chief out of the running, toby cosgrove announcing he would draw his name for consideration as the secretary of veterans affairs. we want to remind you we will cover the veterans affairs hearing tonight on the v.a.. it on c-span3 and radio. let's hear from boston. henry is a medicaid applicant. go ahead. meet your television or radio and go ahead with your comment. caller: i am calling in regards to the lady that called and mentioned they were trying to force her. the one in texas. i think she was missing the

point because medicaid part a or b, they do not pay everything. they may have been trying to get her to enroll in the supplementary plan. b would bert a and the first prayer. -- payor. keeping track of a lot so we will give her a chance. guest: thank you. what henry is talking about is a medigap plan. these are offered through companies like aarp are touring with united health care and others. this covers the co-pay several of the guests have mentioned. it is true medicaid does not cover everything. they do require deductibles and co-pays. host: one more call. caller: i just want to say i

won't -- i would be dead if i lived in florida. a year ago i was diagnosed with cancer. if i would've taken the program i really would have been dead. michigan is a republican state. there are several republican states that have done that. the senator really pushed for this. it took him a lot of work to get this through. started on april 1 and have enrolled a lot of people are ready. host: what is the deadline in terms of the rollout of the health care law? upst: people can start november 15. medicaid and bromance goes all year long. some people can sign up now if they believe they are eligible

for medicaid. they can go ahead and try to put in applications. cq heassociate editor at i think the only way you justify this program as a special carveout is from the perspective of the nation, a ecognition that 9/11 was along with the american civil war,

pearl harbor, maybe the assass nation of president kennedy, and 9/11. its impact on the american people was such that this was really a response from america to demonstrate the solidarity and cohesiveness of the american people towards these victims. >> read more of our conversation with kenneth feinberg and other featured interviews from our booknotes and q&a programs on c-span's sundays at eight now available for a father's day gift at your favorite book seller.

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testimony from gao, the i.g. and v.a. and tonight we are going to address ongoing issues of systemic wait times, manipulation that occurs throughout the veterans health administration and negatively impacts the veterans that we serve and the health care that they should be provided. v.a. wait time answer scheduling issues have been the subject of numerous investigations by the committee for many years. we have many outstanding requests for information, and have held hearings to address the problems within v.a. that have led to veterans waiting so long for needed care. the v.a.'s office and inspector general has also repeatedly warned the v.a. about its substandard scheduling practices. from as early as 2005 in numerous reports, v.a.oig noted

medical facility dis not have effective waiting list procedures, their outpatient scheduling procedures needed improvement nationwide, their data was often unreliable and they overstated their success regarding patient wait times. in december, of 2012, gao found that v.a.'s reported wait ties remained unreliable. vha's position continued to be implemented inconsistently across v.a., schedulers in fact lacked proper training and vha's appointment scheduling system was outdaded and inefficient. despite these repeated warnings that have come from congress, from the gao and even from v.a.'s own investigative body, issues with patient wait times and scheduling remain a pervasive problem today. last year, this committee requested that gao conduct a separate investigation to

confirm the extent of problems throughout the vha regarding ongoing issues with patient wait times and consult delays. gao will testify as to its findings here tonight. recently the committee received whistle employer complaints regarding the phoenix v.a. health care system that explained how the falth was keeping numerous wait lists to give the impression that its wait times were much shorter than they actually were. one of the secret wait lists at the facility sources found that as many as 40 patients may have died while they were awaiting care. after the committee was able to confirm these allegations we made the issue public during our april 9th, 2014 hearing. at that hearing i asked that the v.a./oig look into those allegations that prompted its investigation. the interim results of that investigation were released on

may 28th of 2014. in that report the oig substantiated a number of problems at the phoenix v.a. but noted how it opened or planned to open investigations into 42 different v.a. medical facilities. the oig found that at phoenix, at least 1700 patients would were waiting for a primary care appointment were not on the electronic wait list. meaning that these veterans may never receive such an appointment. additionally, oig found that the phoenix leadership considerably underestimated new patient wait times which is noted is its metric used to consider bonuses and salary increases for v.a. employees. v.a./oig also stated inappropriate scheduling practices like those found in phoenix are systemic across the veterans health administration. finally we were notified earlier last week that v.a. would

provide the findings of its internal audit of appointment wait times by last fry. they provided us with those findings earlier this afternoon. tonight, i look forward to hearing what v.a. has to say about its audit, how it plans to repair the damage it has caused by tampering with veterans' access to care and with that, i now yield to the ranking member, mr. michamichaud. >> there's nothing greater than those who serve with honorary distinction. we're moving quickly to investigate the shortcomings within the v.a. especially those regarding access to health care. thousand is the time for us to identify the problems so we can move forward and implement changes. that means working together or oversight and legislative

solution. it also means having very frank conversations with veterans about their personal experiences. so we know what we're -- how we can improve the system. over the years, this committee has identified how to fix many of the problems within the v.a. but the v.a. is clearly facing a vice cyst, a crisis that is now being addressed by the media and now increase oversight efforts. in this environment, it is especially important that we are fair in our oversight and measured in our responses. but above all, we must never fall short of doing what we need to ensure that the veterans have access to the health care system that they've earned and deserved. it is important for us to work together to achieve the v.a. we envision. we must work together across the aisle and across the branches of government to fix these problems and ensure that the v.a.'s caring for our veterans. when we work together, this

committee works best. we now -- that the work that we must put forward that we must ensure that the v.a. is receiving the necessary assistance and resources that they need to do what they have to. as i see it, there is critical questions that should be asked by this committee. questions that get to the root causes of the problems. questions related to the broad strategic changes needed at v.a., changes in the leadership climate, encouragement with other agencies like d.o.d. and hhs, increased utilization of the private sector and long-term resource planning. we need to ask the hard question, what should the department look like in the future? these are not easy questions. nor do they have easy simple answers. but today, more than ever, we must ask these questions and come up with these answers. i believe thoughtful measured

sound policy is needed today more than ever. the answers need to be comprehensive, and when necessary, nuanced. for example, when holding leaders accountable, we need to not only focus on senior executive members but also the doctors and nurses who occupy administrative or executive leadership positions. as i mentioned earlier, hr-433 -- 43 the 9 closes a gap in the current package of legislation being considered by the house and the senate. mr. chairman, i've always been proud of the bipartisan nature in which this committee has operated. my hope is that we'll continue that spirit working together to help identify the problems and working towards a solution. no single individual has a monopoly on the answers. and no single individual or institution has all the answers. the work ahead of us will be

hard and it will require all of us to work together in that regard. the veterans service organization, the department, this committee, the senate and the white house. and mr. chairman, i want to thank you once again for your robust advocacy for our veterans and holding all these hearings that we're having for the oversight and it's my hope that when the committee asks for information from the department of veterans affairs that they provide that information in a timely manner so we will not have to issue subpoenas that we need. that's our responsibility and expect the department to help us do our oversight hearing as well so with that, mr. chairman, i yield back the balance of my time. >> i thank you very much for your comments this evening. i would ask that all members would waive their opening statements as customary in the committee and would invite the witnesses to please come to the witness table and as you're coming forward i will introduce

you. tonight we'll hear in dr. debra draper, director of health care for the government accountability office, mr. phillip mikovsky for operations of the department of veterans affair, richard griffin, acting inspector general of the department of veterans affairs, mr. griffin is accompanied by miss linda halliday, assistant inter-specter general for audits and evaluations for the department of veterans affairs. i would ask the witnesses if you would to please stand, raise your right hand. do you solemnly swear under penalty of perjury that the testimony you're about to provide is the truth, the whole truth and nothing but the truth. thank you very much. please be seated. all of your complete written statements will be entered into the hearing record. thank you for being here tonight and dr. draper, you are now recognized for five minutes. >> chairman and ranks

members of the committee i appreciate the opportunity to be here today to discuss the ongoing difficulties the veterans are experiencing in obtaining needed medical care. in 2000 and 2001 we reported problems with wait times and medical appointments scheduling and v.a. medical facilities and 2012 reported them again including the unreliability about patient wait times and inconsistent implementation of policy which impacted the timely delivery of care. we are currently conducting work examining v.a.'s management of outpatient specialty care consults, and again have identified problems that may hinder veterans' timely access to care. across our body of work on access to v.a. health care, several common themes have emerged. these include weak and ambiguous policies and processes which result in significant variation,

confusion and increased risk of undesirable practices at the local level. software system that is do not facilitate good practices and inadequate training, unclear staffing needs and allocation priorities and inadequate oversight which relies largely on facility self-certification without independent verification and the use of unreliable data for monitoring. my comments today focus mainly on preliminary observations from our ongoing work examines v.a.'s management of specialty care consults. we found most of the 1250 consults we reviewed were not managed in accordance with v.a.'s timeliness guidelines, specifically we found one in five consult requests were not triaged within the seven-day guideline. we also found 38% of the consults were completed but not within the 90-day guideline. 19% were completed within 90 days but the provider failed to properly close out the consult

in the electronic system. and the remaining 43% were closed out the veterans being seen. v.a. medical center officials told us increased demand for services, patient no-shows and canceled appointments are among factors that lead to delays and impact their ability to meet v.a.'s 90-daikon sult completion guideline. during the course of our review we identified one consult in which the veteran experienced delays and died prior to obtaining needed care. i want to walk through the time line of events force this case. in september 2013 the veteran was diagnosed with two aneurysms. in october the medical center scheduled the veteran for sur surgery in november but was canceled. in december they approved non-v.a. care and referred him to a local hospital for surgery. in late december, after the veteran followed up with the v.a. medical center it was

discovered that the non-v.a. provider had lost the veterans information which the medical center then resubmitted. in february 2014 the veteran died prior to the planned surgery at the non-v.a. provider. this particular case is insightful for a number of reasons including that while non-v.a. care may expand capacity there are potential pitfalls. for example, non-v.a. care requires prior approval which may delay care. more coordination is needed between the v.a. medical center, the veteran and non-v.a. provider and wait times for non-v.a. cares are not vacced by v.a. findings relative 0 our work include variation in ow head what will centers implemented new rules for specialty consults which limits the usefulness of the data for monitoring and overseeing consult systemwide and overall lack of oversight including no independent

evaluation of their actions. as the demand for health care continues to escalate it is imperative that v.a. address this access to care problems. since 200 athe number of patients served by v.a. has increased nearly 20% and the number of annual outpatient medical appointments has increased approximately 45%. in light of this, the failure to address a v.a. to address its access to care problems will considerably worsen and already untenable situation. mr. chairman, this concludes my opening remarks. i'm happy to answer any questions. >> thank you very much, dr. draper. mr mr. mikovsky, you are prepared to make comments. >> that is correct. >> good evening. no veteran should have to wait unreasonable time for their care. they have earned this care,

american america's veterans deserve better. secretary shinseki and acting secretary gibson say we now know within facilities there are systemic and totally unacceptable lack of integrity. this is a breach of trust. it is irresponsible. it is indefensible and untenable. unacceptable. i apologize to our veterans, their families and their loved ones, members of congress, veteran service organizations, our employees and the american people. after this committee raised the issues in phoenix at the v.a. health care system secretary shinseki directed a nationwide audit. i will be talking about that audit tonight and answering some detailed questions. this audit visited over00 locations involved over 400 of our national and field staff at

the senior executive level, senior manager level and, frankly, line management level. we interviewed over 3, 700 front staff members. we saw this as the opportunity. the opportunity for us to set a reset, to sweep away an established clear-eyed assessment of our actual performance, not our reported performance and to establish a systemwide understanding of the change we needed to realize in our agency. we released our results this morning on all v.a. medical cent centers, most midside cbcs and these results confirm the oig interim report our may 3rd initial release and, frankly, the gao studies. i'm here to answer questions about this audi and other concerns. our audit revealed a number of things, number one, we have

hard-working staff on the front line who work at a high-stress, complicated environment with, quite frankly, completely outdated technology. the most frequent challenges cited by our staff are frankly a lack of appointment slots into which to schedule veterans. they have a difficulty understanding our policies and they rely on an antiquated system that requires numerous work-arounds by well-intentioned staff. i have to admit that, unfortunately, we found that our staff were -- had received instructions to enter a date other than the date of veteran wanted to be seen. we know there's an integrity issue here. among some of our leaders, we can and will address this issue. i want to make a comment about reprisals against employee, acting secretary gibson mentioned this, that it is not tolerated in our system.

we need our staff at all levels, but most importantly at the point of care. we need them to tell us how to improve our system, to be able to deliver care better for veterans and they must feel safe to identify problems and they must feel empowered to find solutions. acting secretary gibson has announced immediate actions. we will expand and create new veteran satisfaction surveys for patient care. we will begin with veterans and their perspectives. we are holding senior leaders accountable. all of our senior leaders in the field over the next 30 days are expected to inspect their practices in their facilities and to be personally accountable for the integrity of those practices. we remove the 14-day scheduling goal from employee performance plans. we are increasing the transparency in the reporting of our data and we will be releasing our access and time limits data bimonthly from here

on out. acting secretary gibson also announced an independent external audit of the scheduling metrics. we are deploying a team to phoenix to fix all aspects not just their scheduling and management practices and formal lyzing a practice for high performing sites in both quality access and integrity to be able to provide guidance and leadership to our staff and facilities at facilities that require support. guidance and l at facilities that require support. we've directed staff to phoenix to hire additional staff to bring in temporary clinical staff, to bring in mobile medical units that are currently on the ground, to increase local contracts, to include for primary care. and we are removing leadership where appropriate. we are going -- we have -- i'm sorry -- suspended all ses performance awards for vha and we are freezing hiring for

staff. so we may focus our hiring efforts on bringing on needed clinical engineering and administrative staff to the field. secretary gibson will travel to a series of v.a. facilities over the next few weeks to meet with families, staff and identify obstacles to quality health care. secretary gibson has said we need to restore trust in the v.a. system and we must restore that one veteran at a time. our dedicated workforce over a third of whom are veterans are engaged. mr. chairman, thank you for your dedication to and your care for our nation's veterans. >> mr. griffin, you are recognized for five minutes. >> chairman miller, ranking member, and members of the committee, thank you for the opportunity to testify tonight, to discuss the interim results of the office of inspector

general's work related to delays in care at the phoenix health care system. i'm accompanied by ms. linda halliday assistant inspector general for audits and evaluation. the issue of manipulation of wait list is not new to v.a. and since 2005, the oig has issued 18 reports that identified at both the national and local level deficiencies in scheduling resulting in lengthy wait times and a negative impact on patient care. we are using our combined expertise in audit, health care inspections, and criminal investigators to conduct a comprehensive review requiring an in-depth examination of many sources of information necessitating access to records and personnel both within and

external to v.a. we are charged with reviewing the merits of many allegations and determining whether sufficient factual evidence exists to hold v.a. or specific individuals accountable on the basis of criminal, civil, or administrative laws and regulations. veterans who utilize the va health care system deserve quality and timely care. therefore, it's necessary that information relied upon to make mission critical management decisions regarding demand for vital health care services must be based on reliable and complete data throughout v.a.'s health care networks. to date, we have ongoing or

scheduled work at 69 v.a. medical facilities and have identified instances of manipulation of v.a. data that distort the legitimate yaes of reported waiting times. when sufficient credible evidence is identified supporting a potential violation of criminal law, we are coordinating our efforts with the department of justice. our work to date has substantiated serious conditions at the phoenix health care system. we identified about 1,400 veterans who did not have a primary care appointment, but were appropriately listed on the phoenix electronic wait list. however, we identified an additional 1,700 veterans who were waiting for a primary care appointment but were not on the electronic wait list.

we reviewed a statistical sample of 226 phoenix appointments for primary care in fiscal year 2013. v.a. national data, which was reported by phoenix, showed these 226 veterans waited on average 24 days for their first primary care appointment and only 43% waited more than 14 days. however, our review showed that those 226 veterans in our sample waited on average 115 days for their first primary care appointment, with approximately 84% waiting more than 14 days. we did not report the results of our ongoing clinical reviews in our interim report as to whether any delay in scheduling a

primary care appointment resulted in a delivery or a delay in diagnosis or treatment, particularly for those veterans who died awaiting care. the assessments needed to draw any conclusions require analysis of v.a. and non-v.a. medical records, death certificates, and autopsy results. we've made requests to appropriate state agencies and have subpoenaed -- subpoenas to obtain non-v.a. medical records. all of these records will require a detailed review by a clinical team. while we make recommendations to the v.a. in our final report, we made four recommendations to the v.a. secretary for immediate implementation ensure veterans receive appropriate care. we will address the sufficiency of v.a.'s implementation of these recommendations in our

final report. our recommendations include taking immediate action to review and provide appropriate health care to the 1,700 veterans identified -- not listed on the waiting list at phoenix, and to take the same action at all facilities in the v.a. system. mr. chairman, this concludes my statement and ms. halliday and i would be pleased to answer my questions. >> thank you very much for your testimony. members, we will all do a round of questions at five minutes apiece, and we will do a second round, i'm sure, after the first round. dr. draper, in your comments, you said that 43% of the consults you reviewed were closed without the veterans being seen. can you give me an explanation as to why the care wasn't provided? >> there are various reasons. one is patient no-shows, canceled appointments and this is canceled either by the patient or the medical center,

and we also found instances of some records we couldn't tell, we looked at it and there was no documentation as to why the consults were closed. >> how does v.a. schedule appointments? is it through a telephone call to the veteran or is it by a letter? >> it's typically through a telephone call with the veteran. the veteran may call us. we may call the veteran. we will notify the veterans on a recall reminder process which does involve a letter, sir. >> that's interesting, because i've heard numerous veterans telling me that they receive letters when their appointments will be and not asking whether they can attend that particular appointment. i'm a little confused. >> circumstance i've heard that as well. that is not appropriate. that increases our rate of no-shows. we need to change that. we need to find out when they

need to be seen and scheduling around their requirement. >> v.a. has consistently stated that the alternate list or secret list in phoenix that was being used to populate electronic wait lists was destroyed immediately after the ewl was populated, so my question is was there any independent verification in fact that every veteran on the alternate wait list was successfully transferred to the ewl or can you provide any documentation or assurance to us that no veteran was left off the alternate wait list? >> i've had a team on the ground, sir, reviewing their practices, and their scheduling processes. i have a report that's only their first draft report. i'll get a final report from them and i'll be able to dig a little bit deeper. at this point in time, i don't have any reason to believe that any veterans were left off the final ewl count, but i will wait for the final report, sir. >> can you tell the committee who at the central office, if

anybody, knew or instructed or coached anybody how to manipulate wait times? >> i do not know if anyone had done that, sir, not in my direct experience. >> so you don't know whether they have or they haven't? >> i certainly hope they have not, sir. that would run counter to our policy. i certainly hope not. >> in a brief in may of 2009, dr. mike davies, the national director of systems redesign indicated there were 49,743 veterans waiting for care as of september 15th of 2008. now more than five years later, v.a.'s audit shows and has been reported in the media that it has risen to 57,000 veterans waiting more than 90 days for their first appointment and an additional 64,000 veterans that appeared to have fallen through the cracks. how can this be? >> the correct use of the

electronic wait list is the number that's 57,000, sir. we use the electronic wait lists if we are unable to schedule a veteran who is receiving their first special care consult within 90 days. the correct use of that is to ensure that we can work a veteran into an appointment sooner. the 57,000 number is a much more conservative number. the known direct clinical care is only 40,000. we have to get eyes on the ewl. we have to manage it. we have to make sure there are front line staff at our medical centers are accurately working that list. getting veterans from waiting for an appointment into an appointment. as for the 64,000 that was the new enrollee appointment are request list. mr. griffin had told us that was one of the recommendations. if we can find that in phoenix, that we should look across the entire country. as we had a team review the new enrollee appointment request list, we identified every single

veteran from the beginning of period of enrollment who may have at one point in time requested an appointment at a given facility where they provided their enrollment data. if we can not verify that they had an appointment, we went ahead and added them to the list so we can begin contacting them tomorrow. >> mr. griffin, one final question before i yeel to the ranking member. have you found evidence of criminal activity in your assessment? >> we have found indications of some supervisors directing similar methodologies to change the times. we have been in discussion with the department of justice concerning those and whether or not in the opinion of the department of justice they rise to the level of criminal prosecution. that is still to be determined in most instances. >> i appreciate you talking with

the department of justice. the committee has written a letter to them also asking they open an investigation. we haven't heard anything from them to date other than the fact that they got our letter, but i appreciate it. >> thank you very much, mr. chairman. dr. draper, in follow-up on the question the chairman asked about the v.a. closed consultants due to no shows, what percentage were no shows versus v.a. canceling? >> well, we look at no shows and cancellations we went through the 150 consults and did a research all consults, the 150 cases that we looked at. to look at the history of the consult request. we found that more than half either had a no show or a cancel appointment. so that's a large percentage of the consults. so it's a big problem for v.a., and what we see is that the policies at the local level vary as to how the local facilities handled no shows and canceled appointments.

>> thank you. gao reports that wait times are generally not tracked for non-v.a. care. why don't you track wait times for non-v.a. care? >> historically, sir, we have not -- congressman, we have two initiatives. both of them in full deployment at this point. the first one is for nonv.a. care coordination. effectively what is occurring now is when we refer a veteran to care in the community, if we cannot provide it, it creates an appointment inside a clinic that allows us to monitor that and watch that appointment. we are now collecting timeliness data on that. we also have a nationwide contract called patient-centered care in the community. that contract has a performance requirement from our two contractors that they both schedule and see veterans within 30 days of the referral from us. we think those two approaches will help us in the long run ensure coordination and

management of non-v.a. care. dr. draper also alluded the requirement to manage the coordination of that care. it's not enough just to refer care into the community. we do need to follow through as well, ensure that the veterans needs are met. that that non-v.a. provider is respectfully working with a veteran, her or his family to get into care. >> gao also reports that there is a consistent problem across the vha with policy and procedures for handling no shows and canceled appointments. i'm aware that v.a. -- that you are working on an update to this scheduling policy. when do you anticipate this revised policy to be released and will it address the no-show consistently throughout the v.a. system and canceled appointments? >> i expect it will, sir. we had a team last week reviewing the existing policy we have today and to determine whether or not we should rescind that policy and replace it with

a clear declarative set of instructions for our schedulers in the front line. we expect to take that action. we will replace that policy with a revised policy that allows us to have much more concrete instructions on how to schedule, specific instructions for what to do for staff if we're scheduling within 90 days, what to do on day 91 to actually offer that specific instruction, and tie that policy to training. a lot of our current policy mixes two concepts. scheduling and practice management and we're going to have to make sure that we have a clear scheduling policy and a clear practice management policy. management of no shows can be handled by contacting veterans, working with veterans to ensure that they are reminded of their appointment, frankly. making sure we talk to veterans and their families when we schedule their appointment. when we do those thing, we can reduce our no-shows. >> can you explain to what

extent exercising non-v.a. care requires additional approvals? jenchts. in some of our medical centers they require approval at the chief of staff level to use non-v.a. medical care. as part of accelerating care, we worked on that in the -- i think the second to last week of may, we worked open the plan may 21st and rolled it out may 22nd and began execution on the 23rd of may. we have released instructions to the field that particularly where we have confidence in our wait time data that the field is required, if they cannot offer that care in the v.a. facility, first they must assess their capacity, increase their capacity by running nighttime clinics, overtime, weekends, if they cannot, then they are instructed to offer non-v.a. care to the veteran and then we ask asked them to tell us what you need to make that work.

to work with a veteran, it is a veteran's choice to get timely care and to make sure we offer it. >> thank you very much. >> mr. lamborn, you are recognized for five minutes. thank you, mr. chairman. i appreciate the work you are doing on this issue. one of the areas that is going to get further review is in colorado springs, colorado, and there are three aanonymous whistle blowers who have come forward and said there are problems with manipulating waiting times and i've talked to the leadership in both denver and colorado springs. they have told me personally that this is not going on, and i believe them, but at the same time we have whistle blowers saying that it is going on. how does the v.a. treat whistle blowers and what i'm getting at

ises there is intimidation taking place? how do we change the culture of intimidation of people are free to step forward? >> part of how we designed this audit was to have direct access to the front line to the senior staff. when our auditors went to the field, they met at the same time with union representation at the field and the facility management. not two separate meetings. one meeting. we did not provide announcement of who we wanted to interview. we provided that when we showed up. so we could have a direct conversation. i will tell you i have read through the open-ended comments of all of the responses that i could, and nothing -- nothing saddened me more than an employee who says i was trying to do it right. i know what is right and i received instruction to do it wrong. that is simply not tolerable. retaliation against whistle blowers is also not tolerable. we cannot condone that.

we require a leadership and cultural shift in our way of managing. >> and i raised this a couple of weeks ago at our last late night hearing, and that is if you can't rely on the data, if you can't rely on the records because secret waiting lists by their nature are meant to conceal the truth from someone who is doing a review, like yourselves, is the alternative to go in and do a case-by-case analysis, talking to every single veteran who tried to get an appointment and doing this on a one by one, even if that takes hundreds of thousands of contacts, how do we get to the bottom of it when the records or the reports are not reliable? >> i believe we have to begin with the end in mind. if what we want to do is to provide veterans with timely

quality health care, let's ask them, how are we doing, how is our care, how is our access, is our access meeting your requirements, is it not, if not, let's fix it. the thing that's terrible about this crisis is this isn't even an output measure, right? it's an activity measure. what happens when we change that activity measure is we can't tell where we're not timely. if we can't tell -- in no cases were we finding front line staff who were delaying care by moving the appointment later in the calendar. they were changing the reference point. when that happens, we don't know where we're late. when we don't know where we're late, we can't identify where we need resources or to realign resources, when we don't know that, our entire system is thrown off. >> i hope we've seen the final days and never again where bonuses or promotions are based

on metrics that can be manipulated. instead of like you mentioned and i've mentioned this before and others have also, outcomes, like patient satisfaction, or good care that can be documented. not metrics that can be manipulated. >> i concur. >> and do either of you other two folks want to comment on that issue? mr. griffin. >> i think it comes down to accountability of the senior leadership out at these facilities. and once someone loses his job or gets criminally charged for doing this, it will no longer be a game and that will be the shot heard around the system. >> thank you. i yield back. >> mr. brown, you are recognized for five minutes. >> thank you, mr. chairman. mr. chairman, thank you for having this