equally high second goal is exceptional veteran experience. we recognize some veterans actually might choose to simply commend for podiatry and skip the rest so we are going to be looking at different options for doing that by way of maximizing efficiency and frankly making the veteran experience very satisfactory. in general we have an incredible opportunity because of the entirety of the department to have an impact on health that no other health care system house. a lot of things affect health besides medical care. its its income comments education whether you have a place to live and so forth in the department has tools through vba and so forth to actually address all of those needs that we take that very seriously. >> the last question i have what are we doing working with the department as veterans transition to make it seamless and the bumps in the road.

i met a veteran who has been out two years and 10% disability but the point is he can't get his paperwork from dod. what are we doing? we have asked this question for years. >> it's a great question. i have to say secretary hagel and i are totally aligned that we want to have a seamless handoff from the department of defense to the va. that's why we have instituted programs like cap while the person is on active duty and allison can talk about that. >> congressman brown some good news to report on this front though it didn't obviously help that particular veteran two years ago we are engaged now in the mandatory program for all of our servicemembers including national guard and reserve for which there are now nearly a million who qualify for benefits that did not previously. another thing that is starting

literally right now is the mandatory separation health assessment. the choice to the veteran told a session is if you are going to make a claim to be a for anything that va will do a complete separation top to bottom before you leave service so we capture everything service-connected on the spot. the next thing i will tell you is we have moved substantially forward with dod on the system where they give complete service treatment and all the parts and pieces we have talked about before that we used to call the gold standard. for while the numbers were really high but they have come down to now about 21% of them are overdue so they are getting better and we are giving them faster and to build while the i.t. connections now such that we simply note in vbms that we have a claim the system tells the dod system we are asking for

the records in the records come back automatically into vbms and are instantly loaded up into our vbms system. that is helps us tantawi. the last thing i will share with you that we have also done is we have reduced substantially those folks waiting in the process are getting much better in our process and i can tell you the benefits district program the backlog has been reduced by a significant amount. there are only five or 10% of those two are now over 125 days. >> thank you. >> thank you very much and i yield back the balance of my time. >> mr. secretary and want to read a text i got from a friend of mine. i had a reason to deal with the v. in jacksonville this morning on a home we finished for a veteran, a guy named max handled my request. i left the conversation warming complete. very good experience. never had that before.

thank you. >> may i get the names i can send a note of recognition? i am serious. >> it was unsolicited and it came in while i was sitting here. >> as you know i have given him my cell phone out nationally and i get 120 contacts today. right now i would say 35% are positive. that's not enough. all of us sitting here at this table wants 100% of those to be positive and we are working on it. >> you betcha and i will be glad to provide you his name. >> mr. chairman you did say jacksonville? >> yeah i did. [laughter] maybe that's why they never had a good experience. [laughter] mr. lamborn. >> thank you mr. chairman and thank you for being here secretary mcdonald. i'm pleased to see you have focused a portion of your budget on construction efforts. can you tell me the status of the southern colorado national

cemetery project family you anticipate they will begin accepting early burials? i'm very concerned that this project stays on track. >> we are as well. we are in the design phase right now and we think that design phase will take about a year or year and a half. ron would elect to provide more detailed? >> congressman lamborn as you know we have made progress significant progress on establishing the cemetery in southern colorado. we acquired the 374 acres at rolling hills branch in el paso county. we do have sufficient funds in the budget right now to complete the design. completed through construction documents the final phase of design. once that is completed we will begin the solicitation phase for construction of phase one.

assuming construction funds are provided in the next budget cycle and that is yet to be determined we would expect the first burials to occur sometime in calendar year 2018. >> i'm disappointed that the timeline seems to be slipping. i will do everything i can to make sure that those funds are in the budget and i will work with other folks to try to achieve that but it sounds like there has been slipping to the right and that is disappointing. >> we are going through a complete review right now our construction management process does you no. sloan gibbs and the deputy secretary is leading that and we have the corps of engineers help. we have got to find a way to shorten these timelines that we face. we will be looking up at an obviously any work we can do to accelerate it we would like to do. >> and i will work with you if

any amendments are necessary or legislative action to give you the authority to make faster progress in the future on the further projects. changing subject secretary mcdonald imagined they were five proposed regions as opposed to 21 visits. i guess that is more efficient. his menu will have fewer personnel doing the same job is before which to me is the hallmark result of more efficiency. >> as i said in my remarks this organization is focused on productivity improvement. i don't feel we can come to you and ask for more money unless we are demonstrating we are saving money at the same time. that is why we have identified the buildings that are empty that cost us money every year. we have nine different geographic maps, each one for different line of business whether it's insurance. >> i have one other question.

it goes to five regions and we haven't yet determined how many we will have but they have to fit those five regions and we have a team of directors looking at that now. everybody is trying to fit into that structure. the point is there will be more efficiency at the middle management level. >> i hope that means fewer people doing the same job which means less budget dollars. >> we are trying to put every budget dollar weakened against the veteran experience making the veteran experience better. >> and lastly a new attempt on this but the transition between dod and va and i have 100,000 veterans in my district and mom is that many dependents and family members and the military compensation and moderate retirement modernization committee has come up with recommendations that there needs to be better transition.

you have mentioned some things who are working on and that's good to hear but what can be done in the future? what could be improved to make that transition better? >> when we met with the committee throughout the work i think they have done excellent work. some of the ideas of allison mentioned are brand-new and before that committee wrote its report, in fact when they gave us the report we mentioned some of these things and they missed the report. the report was already imprinting but this idea of the medical exam before the servicemember leaves the service that's the biggest idea and the problems we have had in the past will be able to resolve with that and also with the way we strengthen the tap program. i think we are getting better but we will continue to look and see if they're of the things we can do. >> thank you so much. >> thank you mr. secretary. it's nice to see you again and

we appreciate you being here. before i asked my general question i'm going to bring up what i always bring up and that is the reno office. we have been without a permanent director for about two years. we are on our second interim. i understand they have asserted to recruit yet but if you move it would be a lot easier to recruit a person to come and take that position. that is my first one. second the hospital built in las vegas was too small by the time was completed because they didn't anticipate the increased usage. we heard deputy secretary sablan say they were going to move some resources to help with the hospital from denver i believe it is aurora. i want to be sure you are not moving resources from a las vegas hospital to fix the problem in aurora so we can follow up with that. and my general question for the last couple of years we have focused on the backlog fixing that problem and also problems

with their hospitals. i would like to see us as we move into the next few years look at other areas of benefits and make to be a more relevant to our 21st century veterans. i appreciate the things you mentioned in your testimony. one is women the second is a lgbt veterans in the third is the issue of medical marijuana. these are all big issues during these times are you talked about how many more women veterans we expect to have but really what we don't know is what we don't know and women veterans task force. >> can get it better handle on performance and the demographics and research analyst who i would like to note the va is making those two positions a priority and if we have your commitment that those would be positions that would be funded and utilized? second i would ask you mr. secretary if you would

commit to whether you think the law needs to be change that prevents the va from giving the lgbt veterans the same benefits that other veterans get. they earned them and they deserve them and they just happen to live in the wrong state. i don't think that's fair and third with medical marijuana as more and more states are legalizing medical marijuana va doctors aren't able to make any kind of recommendations concerning that. i wonder how that be a policy might be moving to address that issue. >> thank you for the questions. first on women i took down the painting in my office that it probably been on the wall since omar bradley was the administrator via an ipod posters. has a picture of a woman in service and each branch of the military. did that on purpose because this is going to be a defining issue for those of us leading the va right now.

you already heard that our buildings are old. we need space to be able to create the women's clinics. we just opened a women's clinic in washington d.c.. i would encourage you to go see it. it's a beautiful clinic but it's different than where the men would want to go and of course the care is different because we have other kinds of care. this is a very important issue for us and we are working hard to identify where we can put women's clinics with women's care. we just got a building from dod in fort mcpherson in georgia where we set up a women's clinic. this is a very big issue for us. we are going to stay after. relative to the lgbt we are following the law. if a couple is married in a given state we will give them benefits. we need a new interpretation in the law. there is an exception to that

great in the national cemetery if we are able because of the legal authority i have two be able to bury partners together when they so choose and in every case we have done that we have looked at the relationship and we have granted that. >> if i may interject i appreciate that but in state cemeteries it still remains a problem as i understand it. >> yes maam, i don't control those. >> but they get funding from the va. >> some of them. on the medical marijuana and let me ask dr. clancy to comment. >> a fair number of our clinicians have veterans who use marijuana medically in boats. they live in areas where this is legally possible. very early days for us to have medical policies but their active discussions going on now and we are trying to learn from what we know about treating differing conditions which by the way are not necessarily

identical with those conditions for which veterans believe they are helpful. i think there is an incredible opportunity for us to learn from some of those experiences that we have to be careful given the variation in legal issues but we would be happy to provide more detail for the record. >> thank you mr. chairman. >> i yield to ms. brown for 30 seconds. >> in the area of medical marijuana we have passed the bill saying that the va doctors cannot administer even at this stage says it's legal and they could be charged with -- so it passed last year on the floor. i didn't vote for it and it was an issue for congress. i think maybe you should introduce a bill but as we speak it is illegal for a va doctor to

administer marijuana. >> that his crew rec's representative brown and i was not clear enough on that point. that said again trying to be responsive to veterans experiences and what they're telling us we are trying to learn from that and understand and anticipate what a different future might look like. >> absolutely. they're all kinds of additional kinds of therapy but as you see now it is illegal for a physician to administer it. am i correct? last year we passed a bill on the floor saying it was illegal for a va physician and i yield back. >> thank you. mr. bilirakis. >> thank you. first of all i want to thank you mr. secretary for taking the position and being so accessible to us and more importantly to our veterans. again you have made a great deal of progress and we want to help

you make more progress of thank you for your corporation we are here for you. first of all i want to talk about, have some questions with regard to police authorizations. first of all i want to thank you for working with me to ensure me to ensure veterans and committee stakeholders in my area in the pasco county lease consolidation located in central florida. to ensure the success of its utilization is important that their opinions on potential locations and what specialty services should be offered were considered. i know you agree. i'm pleased to hear there will be a potential site visit. can you give me an idea when that might be? >> our staffs that this morning actually so i don't know the outcome of that meeting but i think it should be imminent tomorrow or the next day. >> thank you and again is this something we can work with you want to expedite these leases in

general, the leases in general? i'm not talking about the 27 leases from last year. >> as i said sloan gibson or deputy secretary is going to the process to understand how can we speed up our ability to design reconstruct and as we go through that if it looks like there's an opportunity for legislation we will come back to you and ask you for your help. right now we are not ready for that but we are taking a close look at it. >> my next question has to do with the future please authorizations. i understand there is a relationship between va and gsa with goocher lease authorizations not the 27 authorized last year. can you discuss what offers are being considered and that there is enough request in the budget and should the full extent of the least they required? >> i will start and maybe allen can help.

at one time over a year ago now we had a blanket lease authorization which would allow us to enter into from gsa which would allow us to enter into leases easily with their authority. that has been revoked and it requires us to go to gsa for them to study our leases. in some cases at the cost of the least exceeds i think it's $2.85 million than they actually have to take it to a committee which takes even more time. we have been working with them to speed up the process but we are trying to see if there is a totally different way beacon do it. we are applying technology to see if there's a way we can improve the process even more. >> gsa has been working cooperatively with us. we are working on getting those processes right and making sure we all are working under the same standards for scoring so i

think that is progressing well right now. .. a couple of things in follow-up, and follow-up and then i'll be working with the chair. but one is we want to stay in very close touch with your team is in touch with

the rest of our facility, particularly addressing homelessness in west la and then we're suggested to have a follow-up hearing you come back. so we can stay closely engaged. >> this is a team sport. we all need to play together on the same team. veterans being homeless. the largest homeless population in the country. next not evident frustrations. >> we got the land in 1888.

>> i want to go to the opposite of the country tonight talked briefly about the veteran's choice program. make sure that the veterans choice program whatever happens elsewhere, will continue in the state. this is critical for us because we have got folks. they don't they don't travel the distance is that my colleague such particularly of late. can i ask about how the veterans choice act is working in those states? you mentioned briefly about hiring new physicians and medical personnel.

>> i want to make sure that the believes the system of the future of the at work the va an outside care. in the last year we do a 550 million appointments and outside care. this was about a year ago. we are believers in that because that is the way our veterans will you serve the best. it was misinformation. there was there was never his intent to get the choice program were somehow. it was simply asking for recognition that we have seven new line owns a budget , imagine your household, checking account for gasoline a checking

account for groceries. the price of gasoline goes down by half. your hungry but you can't move the money from the gasoline account of the 3rd account. i can't work with veterans and have the flexibility to do that. very hard to achieve customer satisfaction when you have all these restrictions on how you can take care of customers. that was the only.i was making. it's early day. i've had nearly 500000 calls and about 24000 appointments. will let you know. >> we invited over. congressman brown congresswoman miller they

went through our daily -- we're something we call a daily standup. secretary -- deputy secretary gibson leads it and i will let you to come over and watch us to the. i would argue that it like if you confidence in the data and you can see the tram lines. >> thank you. >> mr. secretary, in the budget submission for the office of general counsel congress the conference defending against complex litigation such as the construction projects in orlando and denver the lost

the case on every single.for the hospital in my district. the only way the construction could continue was the contractor demanded that the va construction management personnel be kicked off the project. project. they come in and take over the project. and so i i think this is characteristic of the glossing over the extraordinary problems confronted by your department. mired in bureaucratic incompetence and corruption. there's know substance. there substance. there is no substance. >> am highly offended by your comment. >> i fundamentally believe as unfortunate as it is then

at the end of the day at the end of this president's term that you we will not have made a difference in changing the culture of this organization by virtue of the fact that you continue to gloss over his problems. >> am offended by your comment. been hear six months. you been hear longer than i have. i find it ironic that when i went to la i went to la to solve a lawsuit your busy calling for hearing him him him advise you as to how to the extraordinary problems. what you need to do is focus

on providing the health care benefits and get out of that construction management business. >> each major construction project is hundreds of millions of dollars over budget and years behind schedule. that's a problem. >> we work very closely with the corps of engineers. a good friend and has been helpful. he is told told us he does not want to responsibility. were doing it in denver and we appreciate your help. >> i hope you can make a difference. >> maybe if you want i'll give you my cell phone tonight you can answer some of the calls or go on the

websites and see what the veterans are saying. i run a large company, sir. >> this organization to reflect the value am not sure what. >> i need your help. >> mr. secretary, let me begin by thanking you for your service. of only been in congress a little over two years i really feel that you personally have said a bar for in fact facing the future future so that we bill the better va and do better for the veterans we serve. case in.a few days after so

meeting with. a meeting with the incredible staff that work under mr. danzig we ensure that we had in there to begin with. and ensure that we had someone they're to be transformational. so want to thank you. i also want to thank you for your willingness to work with us to do better. no need to focus on the past $1 billion. we can't do that anymore. we have partners like texas

tech the public hospital toll brothers providers all of whom are desperate to work with us. i would like your commitment that were going to do with the short time that we no that you have with this administration put together a plant so that it is unstoppable. can i have that commitment from you? >> as we talked for their and went to the texas tech site but we want to do in el paso is exactly what we did in los angeles got everyone together will work together to get this done. i look forward to working with texas tech department of the army.

currently our facilities connected the beaumont. >> thank you. i also want to thank you for the presentation you made at the outset. he placed her current problems in context. not all of them some of the them originate the va the commitment in afghanistan and iraq and he in terms to those veterans and 2025. 10,000 servicemembers there expect more us casualties. in a state of perpetual war. funding the assets.

the cost the cost to care for them and their family and their children. i hope are all keeping that in mind. a much larger cost. the component to ss va healthcare process. an independent assessment. let us find implementing the findings and assessments. no know when that's supposed to conclude. >> thank you, representative. required a number of assessments which thankfully we think i'm incredible gift. last week and i spoke to blue ribbon panel they have assembled will take a look

across all of the assessment working very hard to make sure that that happens in a looking at all aspects of the operation. >> dollars in the budget to implement the recommendations? >> we expect that this will be a core part of management. for the recommendations is actionable and relevant. were very much looking forward to those. >> thank you. >> if a man going to go back to something that was touched on briefly last time that's what we actually spend.

that's what i asked him not knowing the of how many rvus per year that the va generates is a common term used both in private sector and in the va. and then with the total cost. but total cost the domain just what the dr. is getting paid. administration, physical plant. it sound like mr. gibson several long way from coming up with that number. how much do we spend on everything to do with healthcare that was generated? i'm curious why we can't come up with a number is a wonder sometimes we really determining committees and more cost-effective to refer out rather than bill that?

is pretty easily defined. the doctor's and paying for the physical plant and staff malpractice and all those other expenditures. we are being realistic if we don't look at the overall picture. >> that's a system we have to develop. where in the process of doing that. the department has had a history of working to a budget that working to a demand or customer focus. congress will provide a budget and that's what apartment we worked for. were actually making some relatively large changes your you can tell but the

process of doing that, that was a big undertaking. >> if we no what the budget is rather health administrators and cost can't that give us something to start with. as the project out i'm looking down the road. i'm here for the same reason you are. we have to come up with those numbers. effectively especially when it comes to dollars. >> that's part of the independent assessment. one of the wild currency of the country are quite familiar with cost per private sector. fixed cost versus variable costs.

that's the.that was in the overall opening statement. if. if i could have been very hard. as secretary mcdonald said what we provided as well as will we send out to community partners so forth in the something like it possibly with a different name. >> i look forward to seeing those types and numbers. that has to be our guide.

>> everyplace is going to have a little bit different demand. i would forward working with you. >> i i was here for three terms anonymous challenges them, as you.out your opening remarks. a lot more services required. i'd like this to give a brief update on the backlog. please be brief. >> absolutely. the backlog is down national.

a toy 5 percent. we have been producing now the claims perspective we started this transformation effort. a quality we have not traded for. it's a big percentage points in is now up at 96 percent. we have not put off nonreading. we need first-time claims that opens the door to more follow-on nonreading opportunity. 1.32 million claims last year and as he saw on the chart the disability level is now on average of

47.7 percent. you have a wider opportunity for many more veterans. since since we last saw you your commitment have you back down 67.3 percent. there doing much better than they were. they also done also done much better on the mail issues we think this whole committee moving let us down. thirty-two days down the eight days. that's a phenomenal saving. >> trust but verify. >> thank you.

following up the challenges you said almost a quote that the va is not ready for legislative help on this issue. i i would like to see if you think public-private partnerships will be beneficial. >> as i said in my remarks strategic partnerships is one of the five points. historically va has not had as many strategic partnerships. one of the 1st things i found we did not accept the help. so they came from the private sector.

secondly, relative secondly relative to construction a lot of changes have been made. probably since the last time you on the community. a lot of times the design was done by architects. the whole design committee reviews it. i would not because there architect streams are very expensive. secondly elected that entire process where we're training, doing a better job training project managers a number of steps are being taken. as the congressman said we are now working with the corps of engineers and then asked them to do a complete review as well as what part

of the process they could help us with. >> on the parochial issue have been temporary structures put up. some of the basic requirements disability accessible bathrooms have not been met. his basic requirements. >> doctor abraham

a record which is open source, free to everyone as well as crowd sourced in terms of the innovation. crowd sourced innovation occurs at a a much more rapid pace than any company can protect there own innovation rate.

their record is open source, source, crowd sourced in terms of innovation. i was at the ama convention talking about the importance of private sector providers using a record so that we can do a really warm handoff working pretty good the warm handoff. >> it's early days. >> is their when they get their and that we get the annotations back in as part of the work we're doing. >> here to for some of the providers were giving the veterans health records that the entire record where the provider only needed the last discharge summary. >> we need something certainly more seamless and more efficient.

>> many that interoperability. >> thank you. >> if i could submit for the record for charts so we have 31 partners, uc davis medical systems. there also is a way of sending the e-mail to that 3rd party provider. we would send the full medical records the va record in the dod record together. modify it so that we can provide that to the third-party providers. they are able to send the url.

>> do you have a timeline. six months, 12 months? >> these documents are what is happening now. using the existing systems. they are about a year away. when have a choice issue with respect to veterans opting in. somebody outside of the system. using the viewer that we deployed last year to add in the capability. >> my 2nd question going back to the efficiency even with that is there a measurement for a provider

on a daily basis that we can access or you can access and get us? chairman miller said it's not anywhere close to being acceptable. acceptable. as a physician i know what one exam room can see. having multiple organ system issues. >> the answer is yes. >> as you get to see last week and the secretary invited anyone who wants to come. it is much more available. understand that some of our providers are also doing research and so forth. all aspects as possible. we post this publicly every two weeks.

>> and punishment to the long-term, but if that physician or that provider is not push himself a little bit he is pushing a little bit more? >> i think the word would be motivating. >> given the issues on access is not a problem. everyone is looking at this data locally and regionally and nationally. >> thank you, mr. chairman. it's really is one of the greatest honors i've experienced in my life. thank you for being here when i look around, some of the most honorable, patriotic command professional people i know.

and i have to say it certainly somewhat subjective, but subjective, but over the last year we have had difficult conversations. they were they were difficult because all of us understood the implications of our actions impacted veterans. but trying to find solutions, and i can say from my experience, and i think it's the one you're hearing your the professionalism and a a willingness to fix this has been greatly gratifying. it feels to me like for the 1st time in a while the department has its feet back under. it's not that we're ever going to stop alley accountability. i accept that and believe your challenges right. we're in this together. we bring up these parochial issues. those are the things that there talking about. i go

back to what you said, this is a unique a unique opportunity. this window we will close. as the nature of politics. we need this is on it. i can tell you from the folks that work out there i just came from a meeting a meeting with the group. the nurses. they want to get this right. them around i care about that. we freeze there pay and tell them the va is not working, they know that's not true. i hear this feedback, from the groups. i just want to go on. i think there is new ideas out there this new model. i want to tie it all together. the 1st thing i worked on was the age a pain management and this comes back again and again mainly because it ties in on so many levels. i think it's timely that yesterday we signed in the

clay handbill one step. i recognize the incredible work that is already being done, but it might be an knew way of looking at this new approach that ties in with why we bring these solutions these are all connected. i agree with you, i've been hear eight years. i own some of that. so what i i ask is when we provided move forward on something, if we figure out a knew model command before we wait for it to run its course we correct and self correct. i know because i for one have bought into your vision of transformation. i want to be that partner and want to make sure i did

pass a peace of legislation that added more your plate and did not improve the care of veterans. >> we are very much in favor we partner with everybody who wants to do it. i have the opportunity with the writer of american sniper the leader and team rubicon and talked about the fact that we are the canary in the coal mine for american medicine. we see things because of the battlefields are veterans go on waiver for the american public. mental health is a big issue any veteran committing suicide is disastrous. the work that you have done gives us more residencies, the ability to pay back student loans. the average medical school student is graduating with about 185,000 and that. the care act, we that.

the care act, we can repay from $60,000.20000. i'm working hard to try to get more residencies for mental health and to get greater throughput. but you no of the 22 veterans who we estimate commit suicide today 17 of them are committed. so one of the things i'm working on what we do have treatments for posttraumatic stress, no how to alleviate it. we just need to get those people connected. >> to all of you unthankful. thank you for working as partners. there are difficult conversations because our veterans are counting on us to have those conversations. >> thank you, mr. chairman. i want to thank you for the

opportunity to have breakfast and share with you the concerns of some of our veterans who because of our geographic and economic isolation don't share and all the benefits they are entitled to. our veterans who make up 10 percent of our entire population have issues that are basic and comparatively small. generally taken for granted. in a nutshell they need a cemetery. we we have no flights. we need access to better health care. the local hospital has no caps can come in a cancer specialist. our veterans must always seek care off island. obama care most of our veterans do not understand always out of merchandise. there's always complaining as to why it is we don't get merchandise and services provided.

medical records to even apply for benefits. mr. sec., what i would like to ask you is the va budget submission has identified an expected increase in claims receipts for fy 2015 at 1.3 million in fy 2016 at 1.4 million. .4 million. these figures represent an increase of 17 and 20 percent respectively over the 1.1 4 million claims received in fy 2014. can you please explain what factors and information you considered in determining the anticipated volumes of claims receipts for these two years? >> absolutely. let me tell

you that the large portion of that is not going to be the brand-new veteran who is now leaving service transition to us but the fact that we have done so many veterans claims and heavy veteran is entitled to come back which is about 67 percent of our workload meeting is the majority of our workload, not the original claim. so as a result you can come back and get another. largely attributed to the increased expectation for supplemental claims. and so that is where the majority of it is. >> thank you. >> if we can i would like to bring our over and sit down with you and go through all the issues we care very much about every veteran. >> that would be great.

>> thank you, mr. chairman. mr. secretary, i want to thank you for your extraordinary lead over the last six months and feel very confident that the letter of the va is being repaired. we certainly believe that we are on a good trajectory for really writing the ship. i really want to thank you for that lead and want to thank you also for today's presentation in the analysis and the presentation because i do think it absolutely demonstrates what the challenges are within the va both in the short and long-term and the fact that all of the challenges that we all must collectively tackle for our veterans. i was very excited to go home this weekend and talk

to my veterans in ventura county and to let them no that an important milestone has occurred here including a new clinic in oxnard for veterans. it was cool it to me that our veterans were underserved when i 1st went into congress. and i think this clinic will indeed right and wrong and that our veterans will be better served. so i just wanted you to speak to that because of why my veterans in ventura county to here from you directly your agreement to the need of this clinic and what the time estimates will be to acquire the lease and build out the facility.

if you could comment on that i would appreciate if. >> first of all i apologize to you for not visiting ventura county when i was in los angeles. that was a relatively a relatively quick trip when i was there for one reason why to get a settlement with the committee to get the homeless veterans of the streets of skidrow. i will counsel ventura county and get together. perhaps this will be a good topic. as deputy sec. gibson goes through and looks at our construction i'm hoping that the kind of time we have seen in the past. we will work together. right now i i don't have any estimates but we will get together with you and work on that. the meat to have meet the needs of veterans. >> very good. did you just described briefly what the process will be in terms of our stakeholders, veterans stakeholders, veterans being included in this process. >> absolutely.

just like of done everywhere else gone by bring together all the stakeholders were members of congress veterans service organizations, mayors because as i said earlier and i really do mean this this is a team sport particularly in the case of homelessness as an example we can do the right thing unless we can have all the dodgers want more willing to rent at that rate crystal have homeless veterans. for me what we did in los angeles will be a prototype of what we hope to do everywhere else call the committee together with the local mayor and work to improve the situation. >> thank you very much.

i think is more progress to be done. this year's tony tony 15. ours is curious. they set an ambitious goal. your predecessor set an ambitious goal in terms of the `. just your comments in terms of meeting that goal. >> we think that goal is doable. one thing that is really clear is we do need more people, even people, even though the productivity is up the inflow is so great command is grown so much. and the repetitive appeals has created a workload issue we had to work mandatory overtime a prescription for disaster. i do have some experience leading large organizations. as a result of that we have got to get what you i find

even further productivity improvements which we're working on by going into the entire digital record has been a big big improvement. one of the nice things about it is we don't have need any more space. we can hire additional people. people working on digital files. >> in fact, congresswoman, i want to thank the entire community. we would not have been able to accomplish this without the support of the committee and every person not. you saw the the growth of the requirement from 2,000. thank you chairman and ranking member for being here long enough to see us through the growth. i want to tell you that there is a savings application to this. working through the agreements on what we do with half million cubic feet of keep peddling no longer

touch. equal attend mount everest and to the empire state buildings, we don't does that anymore. 95% of everything we doing now is in a paperless environment. when we do we have some potential savings in the tune of $30 million in your that we can bring back to you and say this is what the benefit is buy or not needing to house all those cabinets and all those things anymore. we're anymore. we're already realizing the $2.4 million savings is simply shipping costs. >> my time is often i yield back. >> thank you, mr. chairman. appreciate the opportunity. i would like to ask a few questions and then discuss the choice program which is important to me.

my district includes 63 counties and touches for different and create some problems. distance is the main problem email contract from a veteran _-dash 340 miles one way for cardiology. if the va choice program can provide something closer for him then we need to relocate how we implement. the one thing i would like to ask you and there is concern with providers for veterans are looking into taking advantage of that is the fact that it's only temporary. are you and the administration committed to making this a permanent option? >> as you know, we have had an external program. as we look toward a future

where the network is both va care and outside. we're also going to an analysis, given the relatively low rates, but i don't want to assume that is going to continue for our talking about how we can do a better job marketing it and also if we should look at that 40 miles and change the interpretation of it get get cd_something differently so we can make sure the program is robust. >> and your thoughts? >> i'm all for it. i'm all for whatever it takes

we conducted let you know what those options are. i agree with your point of view that distance from a place you can get service seems like a relatively weak measure. but that's what has resulted in the current appropriation. we've got to work with cbo to restore all those opportunities. >> i can follow some of that. but as the crow flies versus as a real person drives, i think that's an interpretation that could be changed. even with the choice program

there's nothing that would prohibit you from using a fee-for-service approach to this exact same situation, which is created many of these problems. >> correct. we have to get the word out that that's possible. >> the word needs to go with folks answering the phone at the v.a. medical center. they are not told that you can get your cardiologist services and -- go to wichita, which is only 157 miles. you can go 340 miles when you could probably get one in his own hometown. the answer should be yes we can. if it's not the choice program, we have the fee-for-service program we should have been using all along. when i'm in a rural area, we have community house will come into my office. we would like to serve those veterans.

we are not able to. we can make a permanent and expand our understanding of the fee-for-service approach that i think we're going to serve veterans better and give them access to the care they deserve. i appreciate your efforts on that and your commitment to make these programs permanent. i think they are critical to make sure the v.a. works long-term. >> i thank you for spanning time with me. i think it can credibly informative. -- spending time with me. all those men and women deserve help right now. that's what i know you're working for. what they don't deserve is a knee-jerk band-aid on a gaping wound fix. i appreciate, as i am sure everyone on the committee does the thoughtful way you were approaching all of these reforms.

i think they're going to serve the brave men and women the protect us in the long run. i just have a couple of quick questions. you mentioned the 22 veterans who commit suicide everyday. i think 17 of them have not accessed any service within the v.a.. we spoke about this briefly yesterday. how we going to reach out to them? >> we have got to eliminate the stigma in this country around mental health care. i'm thinking that this is a fortuitous moment in time, because american sniper, is the largest selling war movie and is started do that. and one of the charlie rose show to talk about this. when congressman o'rourke and i were together in el paso, i will never forget we were looking at a private sector hospital, there was a neon sign at the top of this one building that said

mental health clinic, and there wasn't a car in the parking lot. i turned to him and said of course there's not. it wasn't his hospital, he was in our hospital. of course there's not a car in the parking lot. what we do is take our veterans through the primary care physician into the mental health treatment. as a result of that, the stigma doesn't exist, and they may not even know they are talking to a psychiatrist. we have got to get rid of the stigma. and we have got to reach all the veterans. we have the ability to put on tv a public service campaign that the ad council has worked with us pro bono to get people signed up. i don't feel yet that we are ready for that. that our capacity is so strained that if we were to get a lot more people into the system not for mental health, that we might have issues. third, we have to train the american public. if you see somebody who we think has an issue, we have an acronym called save.

seeing and recognizing that the individual may have an issue. we have a 100 hotline you can call to get that person help. then we go immediately and action. those are some of the things we're doing. it's on everything. the medical exam, when you leave dod is also a big help. but we've got to get our arms around those 17 veterans and care for them. >> i know that there was discussion in terms of the facilities in california that are vulnerable to earthquakes. the v.a. is just outside my district, but i still claim it as my own, obviously. on behalf of the veterans a live district to travel out there superstorm sandy hit my congressional district harder than any other place in the state. i was wondering if part of your construction plan included -- i

mean i understand the focus on earthquakes in places like california. but in similarly fragile invulnerable areas like long island, is there a plan to have some emergency preparedness to prevent any interruption and services. >> when we do structure management, we call it skip. >> you are and excite be the -- and in cyclic media of acronyms. >> we consider seismic and natural disasters is safety. that's a first priority. in the case of sandy, we have a facility near the battery, near battery park in lower manhattan. he was devastated. the entire first floor with water. i visited the facility. we are now building a wall that can help us keep out higher levels of water, should another storm occurred. safety is always number one.

i don't have the specific facts on the facility in long island. but we can get together with you and go through that. >> i appreciate that. thank you mr. secretary. i yield back my time. >> thank you, secretary for being here with your team. i think a lot of the members this morning asked a lot of great questions and touched upon a lot of issues that i wanted to talk about. i want to commend the doctor for bringing up the cost of care. i'm very concerned about that. i wanted to ask a few more questions about when you think you are going to have an idea of what that's going to be, or is this independent review of the v.a. system -- is that going to help look at the number? i know i'm very concerned about it in continuing to implement access to care locally can you just elaborate on that?

>> in addition to the external independent assessments that will be here around august or before then, we are also commissioning some internal work , internal contracts and so forth from some of the leaders in industry, just to figure out how we get to some of the questions that you raised in your recent hearing, when the doctor presented. one of the issues we struggle with in terms of cost is this reliance factor. some veterans use the v.a. for some other needs, but they go outside for others. my uncle recently proudly told me he got his hearing aid. but by and large, given where he lives, does not actually go to v.a. for most of his care. he goes closer to home it. that's part of the issue that we've got to work through as well as this issue of fixed and variable costs. again, i think this is why the secretary raising this issue of fixed costs that are kind of a drag on the budget in terms of getting to the issues of access

and veteran experience are so important. >> i think that's with dr. winthrop was talking about, this cost of these $.5 billion hospital overruns all adds to the cost of taking care of a patient who walks into the clinic. i want to make sure that all of these costs are included in that. we are supporting a bureaucracy -- are we supporting way too much of a bureaucracy for the care we are getting? that's my concern. >> fair question. >> let me ask another question. this is another thing we've talked about. the management of pain within the v.a.. it's been over a year since we talked about this in my subcommittee. this opioid medication and the high doses and the number of prescriptions written and this recent troubling incident with

the iag and toma. what has been going on in the v.a. recently to try to address pain management? is there a better pain management system, is there a referral to pain management specialists? tell me what's happening more recently, and how were we going to put an end to this -- this practice of using opioids on a chronic basis for people with chronic pain? >> one of the things i wanted to say was we take this open we reduce very seriously. and we track it very closely. one of the things i'm most proud of that we do in the v.a. that i don't see as much as in the private sector is we use a lot of alternative approaches, alternative medicines. we use acupuncture, we use yoga, we have used electronic devices that have been shown to be effective amongst some of our veterans. anything we can do to get that veteran off of opioids is

something we want to do. we are developing quite a broad array of tools that we can use that allow us to reduce the opioid use. >> that sounds great, mr. secretary, but i think if you look at the numbers, people who aren't on the alternate treatment versus the opioids you would find there is a lot of people on opioids compared to the number of people that are getting alternate therapies. it's great that you mention those things, but it seems to me that they should be a lot more people having access to pain management specialists that are being treated by their family physician or primary care physician with narcotics. >> incredibly important and serious issue. i think as you know from your prior hearing and we will be happy to brief you in more detail, we actually track opioid use -- each facility has a dashboard.

nationwide, we have seen the trendline go down, which is a good thing. we are also looking at the prescribing patterns of individual physicians to see, to make sure that an overall positive trend that is going down isn't masking some practices that we would consider suboptimal. we are supporting a lot of research in this area as well. some patients, the combination -- >> it's unfortunate that apparently the situation and toma context which you are saying here today. i want to be sure that we maintain a high vigilance on this problem. i'm out of time, but i appreciate your efforts. >> thank you. >> thank you members. mr. brown has one finer question. >> thank you mr. secretary thank you for your service. i have one question. if you notice ago, the congressional order came out, i don't know whether you've seen

the article v.a. health care that high risk i guess they do this every two years. it seemed like they were rehashing it a lot of the stuff that's gone on. i appreciate you going on television, i just think we need to respond. at a town hall meeting, we see about 7 million people year. once they get into the system they are happy with the service. can you speak to the article that is just coming out today and whether or not you would be willing to do an op-ed piece -- i think it's a port in the veterans are not sidetracked. >> i met with the comptroller general, we were talking about whether or not we should put v.a. on the high list. i encouraged him to do so. the reason we did that is because we are a health care

system, and we are going through a large amount of change right now. during a time any organization goes through a large amount of change, we need to make sure that we have the appropriate oversight, the leadership as well as those responsible for it. well i think the v.a. system is absolutely essential to american medicine, we train 70% of u.s. doctors, we have developed innovations that are absolutely critical for american medicine the first liver transplant, the first implantable pacemaker nicotine patch, first time barcode is used to connect patient with medicine. we have to make sure we have a robust v.a.. as we go through this change i'm thankful that you and your oversight role and others will be helping us get through this change and develop this robust system that this country and our veterans need. thank you. >> i want to thank you all for your service.

>> mr. secretary, everyone at the table, thank you for being here today, you are excused. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2014] >> i buy the second panel to the table and welcome mr. carl blay the associate executive director of the government who is going to be testifying to the committee on behalf of the co-authors of the independent budget. accompanying mr. blake is the national legislative director dav. mr. ray kelly, director of national service veterans of

foreign wars, the national legislator director of amvets, we are also went to be having testimony for mystery into plank , legislative director of the american legion. mr. blake, you are recognized for five minutes. >> thank you, mr. chairman and members of the committee. on behalf of the co-authors seated here, i would like to thank you for the opportunity to testify on the fy 16 and 17 budget. i asked that the report of the independent budget be admitted into the official hearing record. >> without objection. >> thank you, mr. chairman. we believe that this is probably the best v.a. budget that we have seen in my many years of being a peer on the hill. that being said, recent media reports of point out that the the a had hundreds of millions of dollars in unspent resources carried over in recent years, we

do not dispute that fact. the v.a. has done a question will job of managing the insufficient resources it has been given in the past. we believe that the access problems and the long waiting list identified over the last year clearly affirm that point. however, we also believe that the v.a. prior to this year has continuously requested insufficient funds to adequately provide health care and veterans services. congress has given the administration virtually everything it has requested yearly, but that certainly does not mean that that he has requested what a truly needs. perhaps the offices of management and budget would have some thing to say about this. this does not mean that the v.a. should not be properly scrutinized for what it spends or does not spend. in fact, we wholeheartedly support this motion. but it should be screwed me in facts, not in rhetoric or parlay formulated assumptions. the independent budget representations represent our natural needs to provide

services across the entire spectrum of programs. they are not clouded by particular agenda were politics. despite the closeness of our recommendations, the ivy has an independent assessment. it is not bloated with the necessary and mistreat of support. i would draw your attention to such clear differences to affirm that point. i recommend asian spokes in the linchpin. medical services, the veterans benefits of administration, the national cemetery administration, and other key areas. a couple of those key areas were originally identified in our policy agenda that we released back in january. those include women's veterans programs, and caregiver support programs. we appreciate the emphasis the committee has put on these two areas. we certainly appreciate the fact the committee held a hearing back in december 2 review the

caregiver support program. it's a high priority for many of our members. those issues are critical issues in this year's independent budget. clearly there are wide range of opinions about how the v.a. manages is capital of restructured. we have no doubt the v.a. construction and contract management has been a disaster. the only people to suffer the consequences of these failures are veterans seeking care. particularly in the denver area. but none of this changes the fact that the v.a. has a huge backlog of valid building projects through various stages from initial planning to near completion. nevertheless we believe the v.a. has not shown the level or degree of commitment and its request for resources to get all of these projects moving in the right direction. or to complete them. we stand with the committee to resolve these v.a. construction management problems, we hope that will be done quickly. lastly we like to comment on couple of points that have been raised. with regards to the question about cost for care, we are

certainly not experts, but i would suggest that in all the briefings i received about the v.a.'s health care enrolling projection model, if one wanted to know how much it cost to do a particular procedure in any region in the united states, that model would produce a number, at least that's what we've been told over the years when we have been briefed on this. i would expect that if the committee wanted to know how much it cost to do a colonoscopy, which came up over and over again, the v.a. can probably produce a number. we appreciate the fact that the v.a. is committed to providing better information with regards to the cost of care. we look forward to having an opportunity to review the information as well. lastly the question about the choice program, which the v.a. brought out into the light of day. i think the independent budget family agrees with the principle that the secretary has laid out that you shouldn't be obligated to spend the money you have been given for one single or purpose. -- one singular purpose. i thought this was the perfect way to describe the need to be

able to shift money around. that being said, i'm not sure that we also agree from taking money from a programmer now that is clearly in an infant stage. i think that program has to be given time to flush itself out and see what actually occurs. three months is certainly not enough time to do a thorough evaluation of utilization of the choice program. until there has been more time to really fully evaluate what will happen, i'm not sure that we fully support what the administration is requesting. with that, mr. chairman, i thank you for the opportunity to testify. i would be happy to answer any questions that you may have. >> good afternoon members of the committee. i would also like to thank senator mcdonald and his staff for their words today. we are very fortunate to sit here and's become behalf american legion for our national commander. with 2.4 million members and 14,000 posts across the country, we make of the backbone of the world's -- of the nation's largest wartime service organization. we focus on getting things right

not just for our members, but for 20 million members beyond that, i was struck by something that secretary mcdonnell said. this is a team sport. we can do it by yourself. i think everyone agrees that the country owes a great service to the veterans, that the country owes a lot of things to the veterans. the country is not just the federal government. the v.a. is a piece of that. i think everyone here this table, everyone here in this room is also a piece of that. we all have to work together on this. i spent two of the last four weekends out of various grassroots events for the american legion and nebraska and kansas, out there with the blue cappers by myself, who were there wanted to go out and go into the v.a. hospitals and help out in whatever way they can. we had over 7000 legionnaires donating almost one million hours of volunteer service to the v.a.. this only works if we are all on the same page, if everyone is on the same page.

braking member brown, you mentioned earlier that you wished hr 216 with the law of the land was an important resource and tool that would help with that. i think we agree very much. i know the legislative hearing earlier, there was a lot of agreement on both sides of the aisle about that. we have to be will to look back and forth and compare these things. i was speaking with a colleague of mine about the v.a. strategic capital investments plan, and whether or not they are putting enough money to these things. the american legion, about four years ago was talking about looking at the v.a.'s construction figures, it was going to take them 60 years to complete the 10 year plan in skip if they went informed those numbers. but trying to compare the figures together when they're still there, you're pulling up a budget from one year, trying to hold a next to another. having it all laid out there where all the stakeholders can participate, i know chairman miller, and that bill was up in the legislative hearing, you spoke about the importance of

the transparency for, and you would see in armed services that we need to have that same kind of transparency with the planning for the v.a. budget so that we can maximize the resources that everyone is putting into this. we have a lot of great organizations, a lot of great veterans who are out there trying to make this a better system. we believe in the v.a. system. we believe the choice part is important, because we have to get access to care for veterans. but we want to make sure that the veterans still have access to the system. is there because secretary donald talked about the demand expanding beyond the v.a.'s capabilities to meet that. we need to make sure that the resources are allocated to meet those demands, but we can't lose sight of the focus that it's the v.a. that we want. the v.a. that we want to be the leader, this pioneering medicine that's the utmost expert in so many conditions. you look at traumatic brain injury, you at post-traumatic stress disorder. you look at a beautician injuries.

there is no reason that the v.a. should not be the world's leading authority on that. and we need to make that happen. and that comes from everybody working together. that comes from everyone being on the same page. the american legion is absolutely devoted to that. we need to be able to look at these pieces. i think of ea's request for an additional 700, 770 full-time employees to work on the backlog is important. i think it's a very good point that they have been given more staff and they were supposed to have been increasing their productivity, but you can't deny the fact that they have been on mandatory overtime for four years. going through for weeks on mandatory overtime says you might have a bit of a problem. knowing through four years of mandatory overtime says you might not have enough people to do that. we don't know exactly how many people we need in every office. that's why we all need to be able to look at these figures on the same page together. i think working together we can do that. i think we are very committed. to being a major partner in that and helping to drive that. we want the system to be the

best system they can be for veterans. i think the committee has been very generous in giving budgets to the v.a. to work with. we just need to keep working everyone on the same page and i think we can couple said. i thank you for having the american legion here to speak on this. you are having all of the veterans to speak on this. i look forward to any of your questions. >> i would like to ask either of you, if you would, count one of the critical components and probably one of the toughest things for the secretary is having is confronted with is going to be closing outdated old substandard or particularly underutilized facilities. it's not easy politically. it's not easy as the secretary has already alluded. i would like to know if you feel like that is an important step. the secretary has to look at. >> i'm going to defer to my colleague.

>> mr. chairman, absolutely. if v.a. is holding property and longer uses or is underutilized they need to find out how to get rid of that property. in the process of figuring out how to get rid of it, they need to have that conversation with the community to ensure those veterans understand that there is still services. there is the fear that my hospital is going away and my services are going away. they need to understand that that will continue to be in the community. it's going to be right size for that community. there is no need to spend three dollars per square foot to maintain a building that is no longer being used just to keep them off bold. >> if i could dovetail onto that -- the thing that the v.a. has been involved in, that committee wants to keep the medical center. i understand if you have an

unutilized building is taking up space. certainly there are regions where it's just not effective. we have to make sure those veterans are included as part of that planning process and they are being listened to. there has been a tremendous amount of frustration in hot springs that the community is adamant and vehemence, and it has been organized and has tried to voice its opinion at every step along the way. we need this facility here. this is serving the veterans in this area. they are very concerned. it's important to be able to open up to some possibilities but let's may sure that we are still serving the veterans. >> any other comments? >> one thing we would caution as they make a determination whether facilities are unutilized or unused that they be innovative also. we talked for years about using this underutilized space for the

homeless veterans issue. one of the challenges of homelessness is having supportive housing that allows them to transition into finding a job and being able to become a productive member of society again. before they choose to close facilities, i would hope that they would think outside the box , some of the areas where these facilities conserver purpose. the doesn't mean that some of these facilities shouldn't just be close, especially fair setting empty and have been setting up different too long. -- setting empty for too long. >> where do you think being ministered of cost and the v.a. could be reduced, and where could those funds be reallocated specifically. we are talking about page three and testimony. -- in your testimony. >> i would suggest from the perspective of the recommendations we have made, we have stuck to the same principle the last couple of years, that we directed most of our recommendations at the medical services line, with about --

where the rubber meets the road. there has been discussion about the general of mis-direction line items. we've also had some conversations with the committee staff about the ministry of cost that exist. we were interested to see the planned to seemingly transition a regional framework of v.a. what we would hate to see is we transition to a five regional alignment where we would go from one region to a different regional alignment. >> the secretary asked mr. kaufman to ask a question to the bso's. since mr. kaufman is no longer here in the room, i last the question on behalf of the secretary. have you seen a difference in the v.a.?

>> the fact that the secretary and his leadership team is still here i think answers that question. i think we all have been impressed about what they have done in the short time they've been here. i would have to say that we appreciate what he is trying to do, and we hope that you work with him to make sure that changes happen. >> we see a difference in spots. they're going to be areas that are slower to change than other areas. we are seeing pockets of improvement. just solving the problems in west l.a., that the land management issue -- something that has been around for years is indication that he's hands-on, he's going to get things done.

>> my time is expired, can i get a yes or no? >> i give a yes. >> a yes. they are starting to own problems too, which is a big change. >> i agree with my colleagues. >> i agree also, there's a difference. i would also say that ms. brown's hr 216 is scheduled to be marked up tomorrow. so we would expect to see that pass very quickly. >> thank you. i would like to associate myself with the remarks of the gentleman from florida. i absolutely think it's a change in v.a., and it's headed in a positive direction. when you talk about v.a., i remember going to l.a. and we had four brand-new unit sitting for over two years that we have built those units -- 400 units

four separate buildings that took vacant for two years because we built him, but the state of california did not have the money to operate it. we've got to make sure that doesn't happen in the future. i'm very pleased he was able to go in and resolve those issues. for the first time, we have forwarding budget and all the other categories. can you give me a response as to how you feel about how this is going to help v.a. move forward? i just want to hear from all three. >> i would say we offered our support for the legislation of the legislator. couple weeks ago. i think mr. plank hit on important point that this would allow for more transparency as they develop their needs going forward. i would also suggest that the

secretary -- when i appreciate seeing is i believe this is the first time i've seen the v.a. take serious this requirement is part of the advanced appropriations process. the last several years this is was passed, one of the chief complaints is been that the congress passes an advanced appropriation as requested by the v.a., next to there's no real adjustment or consideration -- this is the first year at our a substantial analysis review and we estimate for its aid has taken place. we appreciate the fact that this leadership team in particular has seem to have taken this requirement far more seriously than in the past. >> i also want to note i think the forward funding, you're not going to have veterans who are worried about not getting their checks if for some reason there's friction between the congress and they can get a budget passed, i'm not as worried about that immediately. but that's an important

guarantee for them down the road. i also think that planning component that's going along with the legislation is a critical handshake without bill. the ability to plan is critical as we are forward funding things. and to be able to look down the road and see the anticipated results beyond that. i think they are hand-in-hand with each other and very helpful. >> let a mention that when i first came here, we were going through a bright process. of course, we support closing some of the v.a. facilities. but keep in mind, it's down to the right. as long as you don't close any in florida. but that's kind of the mentality of the members of congress. as we work through it, we got to keep in mind it is a team effort. those communities need to have input and involvement as we evolve as to what we want the v.a. to look like. because we are sitting up your saying this is the right thing

this is the best thing for the country, but when we go to some little place in hot springs that community feel that they are going to be disenfranchised. so the question is -- how to we have these other communities and everyone involved in those decisions? don't think the politics doesn't play a part. when the senators weigh in, and some senators say we don't do that. we just interested in what's best for the country. that is not always the case. as i experienced with rack. i want to thank you all for your service, and for your presentation. in closing remarks, 30 seconds. >> i would say this. it's been nice to see that some of the folks in the central offices have been more open to dealing with us on a more regular basis. i've had to briefings on the

model and cost for care since the cost for care hearing which was two weeks ago. prior to that, the last meeting we had with the v.a. employees on the health care model was back in 2009. we are clearly more in tune with the concerns of the committee the concerns we raise, and try to get us more involved in the discussion so we know if they are doing, whether we necessarily wholly supported or not, wave a better idea of where they are going what we're doing. >> i have been over there four times at 8:00 in the morning and i want to get the entire committee over there to review -- like the town hall in the discussion so we have a better feel as to what's going on over there. i think it's very exciting to have the employees involved in what we're doing. it's not some top-down, but the input of the employees. one third of them are veterans. thank you mr. chairman, thank

you for the hearing, yield back the balance of my time. >> as a new congressman, and fortunately for me new member of the committee, i'm very honored to be here. six weeks ago, i was a practicing physician that was privileged to see veterans of my clinic. i'm jumping up and down with joy for this choice program. my question is on these guys levels, are you members, are you getting feedback on the implementation of the choice? is it working, is a fairly seamless? where does it stand from your members perspectives? >> the vfw commission is surveyed through our membership to get feedback. we are doing a two-part survey we cut it off at the beginning of this month. for two months, we found that a good portion of veterans who called for an appointment to v.a., when they interact with

v.a. to get an appointment were not told that they had a choice but now we are in the second phase of the survey. we are finding more those veterans are understanding the have a choice. v.a. employees are being educated to provide that choice. we are seeing that trend of access go up. at the same time, early on, the perception of choice was very positive, or other the experience of choice is very positive. there seems to be a trend now that it's gotten more people in it there's a slight downtick in people's opinion of it. of the care they received. if something we are going to continue to monitor, we will have a report very soon. >> fair enough. >> originally talked to a number of people, one of the biggest early concern, there was a lot of confusion over whether not people were eligible, and a lot of confusion about access.

we get calls from d.c. all the time about this. we've been working i know v.a. has working hard as well to educate better about that. there's a lot to giving the 40 mile straight line, when you're in a rural area where the roads are that accessible, i'm close to a clinic, but it is an offer the services i need. when you are driving 340 miles to get to something. there was a lot of concern about that. as far as whether they want to use the choice program or whether they want to use the v.a., there people who have been very happy with the care they got, they just can get access to it and they were frustrated by that. you want to get back into the v.a. some people were excited of the options of choice. we continue to monitor that. the biggest part we notice early on has been a little bit of confusion about eligibility particularly with that 40 mile circle and how that interacted

with facilities that didn't treat the condition they had. >> i think the playing field is a little and level in trying to evaluate it right now. when you consider that the v.a. doesn't have the capacity to meet all the demand as we see it. in the same, we don't know that the private sector truly has the capacity to meet the demand that might come from the choice program. i think that's a great unknown. i think that we forget that we forget the private health care is a business. they maximize the revenue for their business by not operating in excess capacity. it was santa reason that one people trying that -- it would stand to reason that one people trying to access the facility might have difficulty. when trying to get an appointment here in town, it could be six months. there's challenges. the field is not level in the private sector or the v.a. side. we need to let the program itself even out, for the v.a. to

get it so that -- it's footprint more formally expanded, we can do a more thorough analysis. >> from the dav standpoint, we are getting ready to go out with a survey of our members to see what they are hearing. we are not really hearing complaints. there is some confusion, i get x amount of miles for many travel, but why apply for this, they tell me i'm not that far away. that's of the law was written. early on, our people were more concerned about being forced out of the system, thinking of it was more than 40 miles away or had to wait longer than 30 days, they wouldn't be able to come into the v.a.. that concern them greatly. >> that misinformation has hopefully been dispelled. i think we all envisioned here is that when a veteran needs home repair, i don't mean to minimize bronchitis. he can go to a choice doctor. if you need specialty, he committed -- he has the option

to go to a v.a. facility he wants. want it seamless for the veteran. are we slowly obtaining that goal? >> i think right now, it's a little early. in terms of making analysis about what utilization of the program is, i understand the secretary has stated before that it wasn't so much about what utilization was right now. he was trying to give a warning light that they might need to re-appropriate. for us, it's early to make decisions about that because people are just wanted to get their feet wet. it's something that i know we are, and i know all the other groups of your watching very closely to see how this interacts and how this works. >> i just wanted to get your take. >> thank you, mr. chairman. the secretary of his team are here, and i appreciate you am i just want to make sure that it's noted for the record. if we are going to be successful in this team approach, it's going to take all of us being in

the same room and listening to each other. i thought that was important that you pointed out. i wanted to ask you and any person at the table to respond to this. the secretary also mentioned working collaboratively in terms of how we build and offer medical care beyond this question of the choice act. the example that we talked about last week in a hearing was this hospital in aurora colorado, $6 million, now to 1.1 billion dollars. it was originally supposed to be affiliated with an academic institution, that affiliation is broken. i couldn't help but get the sense that veterans of that area were area -- were assistant that it be flagged solely as a v.a. facility. that might have had cost them confidences. what are your thoughts on the idea of working collaboratively

and involving other non-v.a. institutions in the provision of health care or the development of facilities, organizing how we deliver the health care in a committee like el paso, where i don't know that we need a hospital. don't know we are going to get a $1.1 billion facility. we may have to work collaboratively. we will start with you and then work right down the table. i would love to get your response. >> we have mixed feelings. we have seen other facilities, particularly dod facilities where v.a. and dod have gone in together. sometimes their problems because the troops that are stationed there get deployed. and then the services relate start lacking. i think that some of the facilities up in great lakes have been working fine with a federal v.a.. it just depends on the area. and how it's structured. >> we have to look at every option. we have to look at building

standalone v.a. hospitals. when you look at public private partnerships. when you look at intergovernmental partnerships. we just have to. it has to be right sized, and the services need to be in place for veterans. every avenue, not just with the university hospitals partnerships, but with county hospitals, with city hospitals. i think as they start planning what they are going to replace for their need, if there is need -- if there is room for v.a. at that same campus, and is a co-purchase, co-owned, and services are interoperable, it's a smart move. >> you mentioned city, county, to include private sector. if there's a center that will -- i center of excellence when there's a gap in v.a. care. >> i think it would be unreasonable to think that they shouldn't take advantage of a --

of affiliate opportunities and partnerships of it maximizes opportunities for health care. that being said you mentioned aurora. part of the problem with that over the years is figuring out originally i could member a time when -- remember a time when they had a mix of veteran patients a non-veteran civilian patients. you ran into challenges with something as simple as identification of the two. you got into mark obligated -- more complicated areas. the denver issue is clearly -- i think it's more unique than the problems that existed in las vegas and in new orleans that are still going on, and orlando. the denver project has been going on for 20 plus years now. if nothing else, veterans are being left unsatisfied there because there are many promises that have been made and still no access to health care. that's a clearly underserved

population. >> thank you. it clearly is a country that takes care of veterans, and i've have seen is working in the past with can -- in conjunction with the eight facilities, -- with v.a. facilities. the v.a. has to be the core of that, take care of veterans. there's a reason a lot of veterans like to go to the v.a., it's something that understands them. at the same time, if they are going to be innovative and leading the way, like i was saying, leading authorities on ptsd, etc., that's going to involve partnerships. that will involve finding the best people out there. it's absolutely within their grasp to be able to do that. >> 30 seconds to answer. >> thank you. i would say that while v.a. certainly has many fine doctors and experts, they don't corner the market. there are lots of people in the civilian community who could bring new ideas, research, and

other possibilities. to say that we shouldn't be considering public, private partnerships, i think would be a serious mistake. >> thank you all for your answers and work. >> thank you very much. mr. brown, do have additional comments or questions? >> thank you for presenting the independent budget. we appreciate that. expect questions to the second panel posthearing questions, and to the first panel. there are some issues we were not able to bring up given the time. but mr. secretary, thank you sir for saying -- staying through the entire budget hearing. with that, i request that all members have find legislative days -- five legislative days. this hearing was adjourned. [captions copyright national cable satellite corp. 2015]

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>> washington journal is next. we look at today's news, and take your calls. the house is back this morning at 10:00 eastern. in the afternoon, they work on a package of three tax extending bills for small businesses which expired at the end of last year. watch live house coverage here on c-span. coming up this hour, congressman dana rohrabacher who chairs the foreign affairs subcommittee on emerging threats joins us. he will discuss the president's request for authorization to use military force against isis. then, a congressman will talk about combating isis, the keystone xl will pipeline, and cyber security. later, our bus to her of this wrigley back -- historically

black colleges continues. you can join the conversation on facebook and twitter. and >> when i announced our strategy into december, i said that we are stronger when we work together. today, i submitted a draft resolution to congress to authorize use of force against isis. host: that was president obama at the white house yesterday afternoon after sending a request to congress to fight isis in iraq in syria. that sets the stage for renewed debate