fiction books and authors. here are some problems to watch for this weekend. saturday night, charlie argues that president obama who came into office saying he turned back the acceptance of the bush administration has picked up where president bush left off in his book. then at 10:00 p.m. on afterwards, former senate leaders tom daschle and trent lott on their book, crisis point. recommendations for moving america forward. they are intered by j.c. watts of oklahoma. >> just the incredible demand for more and more money is one of the issues that really is exacerbating all of this and make it harder for the leaders to bring people together. first they are not in town testimony secondly they are doing all of this other stuff that doesn't allow them to be

the legislatures they need to be. >> this is how we did things or even look at history. history is littered with dysfunction and challenges. george washington almost had to resign. we want to look forward and say here are some things we think would make a difference. sunday night, journalist cast katherine and her book daughters." she looks at the kind of choices young arab women are making and how they differ from their mothers. >> women are going to university in greater numbers than men all over the region. and especially in the gulf countries, the proportions of women are greater compared to the men. he women will tell you partly considered a socially acceptable

way to delay marriage or to be outside the home in a way that the families will support. >> watch book tv all weekend, every weekend on c-span 2. television for serious readers. affairs t rans secretary robert mcdonald testifying before the affairs committee. this is about two hours. >> i want to call the meeting together to get started. i'm going to expedite our meeting. i would like for everyone to pay close attention to so they we have a storm coming. we're going to start promptly at 10:00. i'll make a brief opening statement. if the ranking member is here in time, i will r-recognize him. if not, he can make his statement later on in the

hearing. senator mcdonald, i have granted no limitation on time. we will let him take the time needs to make his testimony which i think is only appropriate given the serious intent of this particular hearing. it allows me to thank the enators. i'm glad the secretary has agreed to come and do that. the ranking member has made it. you're lucky, you're not getting cut out after all. darn. darn. any member of the committee other than the ranking member and myself who wants to make a statement can submit it for the record after the hearing. i'll make brief statement and then go to senator blumenthal. we'll go to vote and then have unlimited questioning until noon today. i want to thank everybody for being here. dale, would you stand up for a second? remain standing.

i just love to tell officers that. dale is the american lesion national commander. he is from douglasville, georgia. fayetteville legion post. we want to thank you for your service and all of your members for their service to our country and your continuing service to help support us on this v.a. committee. you the eyes and ears that give us the feedback for us to see to it that we hold the veterans administration accountable. nobody has a better more than the e view american legion. i want to thank you for what you have done. appreciate you being here to hear the testimony today. we appreciate your comments. after hearing any additional comment jouse for record, we will be happy to submit. glad to have you here. >> thank you, mr. chairman. >> i want to talk about three things in my opening remark and

three things only. i'm interested in making choice work only for the veteran and the taxpayer. we had some issues come up recently in anticipation of this hearing taking place. i'm going the make them public. we had a situation in new hampshire in the past couple of weeks where we have lost providers which i think the doctor is aware of. the issue basically gets down to pay. we have got to get a situation where a fgs can reasonably anticipate a prompt payment for sferses under the choice program. in my hearing, the secretary was ind enough to come in december or november of last year and we learned the cumbersome nature of the paperwork required by the third party administrators to get an appointment set up has to be worked on between the v.a. and the administrator.

they have to expedite or reasonably speed up the prompt payments so the doctor and the physician in the hospital will provide that benefit. that is a goal i would like to see us continue to work on and do everything we can. we also have the situation in my state of georgia which i think the secretary is familiar with as well as the other members where we continue to find case where is the inspector general finds backlogs in terms of records. we had boxes of records that were supposed to have been scanned and put? the v.a. system. they were up in a corner. bad for veterans and accountability. the point i'm trying to make is it is the little things a get you. not the big things. big vision in terms of the v.a. for the secretary is one i toire and am looking forward hear from. it is the little things a fall through the cracks that cause the biggest problems. prompt pay, accessibility to the choice program, account within

the v.a. a no excuses the dog ate my homework environment but instead a can do environment. the secretary has been a great leader for depts since he was sworn in in july of 2015. we have about 11 months to go under the current administration. we want to make every single month count. we work hand in hand toover come our obstacles and provide better service to the veteran s of america. i recognize ranking member blumenthal. >> i'm not sure that i would take that as a compliment, because, frankly, mr. secretary, your job is a lot more difficult than ours. we thank you for your diligent and dedicated work . that's -- your colleagues who

are were you today. today is an important hearing because the v. sambings at a milestone turningpoint with the last stretch of the administration with the opportunity to make fundamental, and institutional chage changes is fast disappearing. so today's hearing is about your vision and the plan to achieve it. it is a tremendous opportunity because there is a lot of work to be done but it is also a tremendous challenge. i know that you have been working at it very hard and very long. and very long. i am focusing on a number of changes that i think are very important. obviously, consolidating care. the va said the current price of the choice problem plus the care

is about $13.5 billion which seems unsustainable at the present rate so something needs to be done. the inventory of appeals is at 44,000 and that has skyrocketed. 44,000 claims that are under appeal and need to be in some way expedited. i am a supporter and co-sponsor of the veteran's assistance and repeal act of 2016 which changes current law to expedite the most claims that are mainly over eight year old. hard to believe some claims are over eight years old but if they are there is no reason they should not be expedited. and rob neighbors in his report

in 2014 talks about the corrosive culture at the va that has led to personal problems across the board. changing the culture is a big job. and partly will impact the ability to fill dha, open positions which i know has been one of your priorities. one of the goals of the department in 2016 is to increase access to health care and reduce the amount of time it takes to fill open positions by 30%. that is a critically important goal because 900 vacancy, which i think is the last number i saw, means there are 900 fewer people then there should be caring for our veterans. those are among my concerns and we are looking forward to hearing from you.

and again thank you for your work at the department. >> secretary mcdonald you are recognized. the floor is yours. >> thank you. chairman isaacman, ranking member, members of the committee thank you for allowing me to support the transfer of va. what we call my va. my appreciation to tom tillis and john coster for meeting with us. i believe my obligation is to help those who have served and to become the number one custer service agency within the government. we have a lot of work to do to reach that goal but we are making progress. this chart reflects the tremendous work done by the veterans administration in resolving the backlog.

an almost 90% decrease. our national cemetery organization is rated number one by the american customer satisfaction index. they rate all customer service companies in the nation and nca came out on top. we need to make it for all of va. last year the pharmacy received the highest customer service award among private and public pharmacies. so that said let me tell you about our framework to transform all of the va by combining functions, simplifying and making the veterans see the va as their va.

this chart shows the five critical objectives. first, we want to improve the veteran contact experience. it should be predictable, consistent and easy. it begins with respectfully receiving our clients. we are focused on human center design, process mapping, and working with exceptional design firms and companies to make every interaction with our clients better. second, we need to improve the employee experience. we cannot make it better without improving the work environment for employees. it is no coincidence the best private sector places are the best places to work. third, we need to improve internal support services. we must enable employees and leaders by bringing our it infrastructure in the 20th century. our scheduling system is dated to 1985.

this is unacceptable and it impedes our efforts to serve veterans. fourth, we need to establish a culture of continuous improvement. we'll apply lean strategies to help build a culture of continuous improvement. and last enhancing strategic partnerships. expanding our partnerships will allow us to extend the reach of service to veterans and their families. the my va is modernizing the environment to put the needs of the veterans first. 10 of the top 16 executives are new since i became secretary. all have business experience. our tehis team includes the

formal banking president, a former chief executive of jolly be foods and the president of mcdonald's europe. the former customer chief officer for the city of philadelphia, a retired disney expert who sent 2010-2011 at walter reed making the customer experience better. my advisory committee led by chairman joe lobus, a retired navy general and former chairman and ceo of usaa and also diverse business leaders, medical professionals and experienced government professionals. i knew we needed outside advice

on business and leadership. i committed these leaders to help advise our team. we are working to capture ideas and best practices as we transform. we are listening to key sta stakeholders. even those critical of the va. we are forming partnerships. va can't do everything itself. we cultivated relationships end helping homeless and mental health. we are streamlining with community care providers and reassessing billing, information sharing. we must operate as a community of care.

we know the va has significant issueess that need to be addressed. we are listening to other perspectives and investing in our people. we are running the government's second largest department like a fortune six organization should be run. balancing the near term improvements while rebuilding the long-term organizational health. we narrowed down the focus to 12 breakthrough priorities. on the left are eight veteran facing prioritariiepriorities. on the right are four va veteran facing priorities. all are designed to improve timely care to veterans. we have many accomplishs in the area of 2015 but i will focus on what we will accomplish in 2016. these are the stretch objectives

we are committed to. we understand it will be a challenge but are committed to producing results for veterans. first, improve the veteran experience. in 2015, we named va's first chief veteran experience office and began staffing the office that will set customer service standards, spread best practices and train employees. recruiting national network of veteran engagement boards to meet veterans needs. we have established 36 communities with 15 more in development. the ranking member attended the event in connecticut where we established one of the first committee veteran board. we will experience the customer wide experience to increst veterans trust in the va from the 47%, that is the baseline data we have gotten, to 70%.

we will insure the veterans experience office is fully staffed with well prepared customer oriented employees. second, increased access to health care. last year the va increased the number of veteran appointments by 1.2 million and completed appointments within 30 dates of indicated or veteran's preferred dates. enrolled veterans will get necessary care, referrals and information from any va medical center. number three, improve community care. in 2015, va issued authorizations resulting in 12 million community care appointments thanks to the

flexibility of the choice act. in 2016, pending legislation that we need, va will begin cons consolidation to the care and community network. veterans will see a community provider within 30 days of referral. community care claims will be processed and paid within 30 days 85% of the time and the claims backlog will be reduced to less than 10%. number four, deliver a unified veter veteran's experience. we launched the visual vets.gov capability which is a mobile base, cloud based website they will replace many other websites with a single log-in. it will provide veterans, their families, and caregivers with the top one search terms found within one click. and hundred percent of content, features and forums from the

current websites will be redi redine -- redesigned and put in language that is able to be understood. five, modernize contact centers including the veterans crisis line. last year the crisis line in new york was featured in the film crisis hotline; veterans press one. they took calls and provided dispatch 11,000 times and provided 85,000 referrals to va suicide prevention. by all veterans will be able to access contact centers 24 hours a day and receive prompt

service, accurate answers and be treated with kindness. number six, improve the compensation and pension exam process. many veterans find the cmp exam to be confusing. last year, vba, vha and our veteran's experience team worked to redesigned the process using human center design and lean tech networks. by february we will have a baseline measure in place to measure the satisfaction and by the end of 2016 we will complete a rollout of initiatives demonstrating improvement of the experience with the exam. number seven, develop a simplified appeals process. we have driven down the claims from the peak in march of 2013. we transitioned from paper to electronic eliminating five

thousand tons of paper a year. 1.5 million disability and pension claims were decided. in 2016, subject to successful legislation, we will put in place a simplified appeals process enabling the department to resolve 95% of appeals within one year of filing by 2021. number eight, continue progress to improve the veterans homeless problem. we placed almost 108,000 in permanent housing or prevented them from homeless. in 2016, we will continue reducing veteran homelessness and demonstrate progress to an effective end by assisting an additional 100,000 veterans and family members. number nine, these are the

internal facing initiatives. improve the employee experience. in 2015 we launched leaders developing leaders that trained over 5,000 leaders. we trained critical parts of our workforce in lean and human center design to improve and encourage problem solving. in 2016, we will continue improving the employee experience by developing engaged leaders who inspire and empower employees who deliver seamless integrating customer service and have 1200 leaders changes. all of the employees will have a customer service standard in the plans. number ten, staff critical position. we increased 14,000 staff and a 4.7 increase that included over

1300 physicians and 3, 600 nurses. we filled the secretary of health, the chief information officer, and the chief veteran officer roles as well. our targets include 90% of the medical director center filled with permanent employees and 90% of critical positions addressed by reducing time to fill the positions by 30%. number 11, transform the office of information and technology. in july 2014, leverne counsel was confirmed as the new chief officer and developed a plan for world class it organization. our goals include insuring 15% of projects are on time and on budget, a 100% of it's goals

will be tied to strategy goals and close 100% of current cybersecurity weaknesses. and implement it quality and compliance, and finalize congressionally mandated requirements. number 12, transform the supply change. in 2016, we would build a medical surgical supply chain to drive an increase in responsiveness and a reduction in operating cost with $150 million plus of cost avoidance that will be redirected to priority veterans programs. those are the 12 action steps for 2016 including the commitments we have made to get them done. we are rigorously managing each breakthrough priority by implemented the score card, metrics and tracking system.

each team has an individual that meets with the secretary or the deputy secretary. mr. chairman, the va is grateful for your continuing support and appreciate your efforts to pass legislation enabling to high quality veteran's care. we identified a number of legislative items we need your help with in 2016. details are in my written statement but we need insistence with, consolidation with care in the community, flexible budget authority, support for the purchased health care streamlining and modernization act, overhauling the claims appeal process. i also encourage the committee to support other key legislative proposals in the president's 2017 budget that will be delivered on february 9th. and we need your assistance of

supporting the cultural change of my va. we need you have to the courage to help make the changes. your legislative support is critical to achieve irreversible momentum for the my va transformation. on behalf of the va employees who work hard and do the right thing every day thank you for this opportunity. we look forward to solving one of the most important issues and chairing for those who protect our freedom. we had have capability to make the difference in veteran's lives and make every experience with the administration world class. we know we can do this. >> thank you, mr. secretary. appreciate your testimony. when the vote is called, what i will ask is if senator tillis go vote and he come back as

chairman to continue the hearing so we can go all the way through. when the bell ring shows us your north carolina sprint and get back in time for me to vote i would appreciate it. secretary mcdonald, i want to talk about two quotes. one is you need our help to make the cultural change within the va. we want to help you make that change. as much as you can coordinate with us we would appreciate. we are in a reactive mode as a body. we can do nothing but be a critic.

but if we are in a partnership mode we can do a lot to help. there are things you might want to do that we don't know about that might get a different response if you consult with us first. i am not saying you don't. but i know there are big things in here. for example, i am assuming that when you want to make a breakthrough in terms of subject to legislative action being put in place you want to resolve 90% of appeals within one year of being filled. is that correct? >> yes, sir, that is correct. and that would require legislation. m >> is that the legislation that would not allow new information to be submitted after the claim is fully developed? >> we would like to work with you on that. i am sure danny can go into further detail. i pledge we will work together as partners. i think this hearing is great

evidence we are doing that today and i appreciate you scheduling this hearing. >> it is great evidence the commander of the american legion is here. you will need to be a part of that particular issue. we all want to be able to resolve claims within a year but the fully developed claim process, which i am not opposed, but it is a major move forward that would need the support of the vfo or we would never get it done. it involves reasonable cut-off periods for a claim to be finally resolved. is that correct? >> absolutely. we have involved the vso's on all work in fully developed claims as recently as yesterday morning i had breakfast with the veterans service organization leaders. dale graduated from west point a year ahead of me so i am used to

him hazing me. >> i want to get all of the frogs in the wheelbarrow to begin with. as soon as we can get a representative from the legion we can involve members of the committee from both sides of the aisle. a change will take a significant legislative willpower and cooperation but it is achievable if we are working together. >> if i may add only 11-12% of claims are appealed. so it is a relatively small percentage of the total but because veterans continue to add information to the file the claims go on for years and year. the people appealing are generally already getting disability payments from the va. we have to get a process that is manageable where we can get them adjudicated quickly but the continuing process doesn't get

in the way of getting these claims resolved quickly. >> i conquer and appreciate you making it one of the seven priorities. >> that correct? you said you had 10 new critical people? > >> yes amsurg. -- yes, sir. which leads me to a suggestion because i will run out of my first five minutes. touch.r to get in they are developing a translator that will allow non-lung we canning -- if break through that, we can end the problem, where the two systems don't talk to each other. it is very important for us to do that, and i appreciate you giving me a call. >> we will do that.

we want to be a part of the cultural change. it is important to make it, and it is important to see we are partners, but it means we have addressed the tough questions. my last comment is there was an and i knowf letters you got a responsible for the wall street journal," which is healthy and strengthening our relationship, and i agree with your letter in which he say you can't fire your way into success. but i would also agree that if we don't have a recognized system of accountability that people can see is working, they wilre will always he someone that slows down cultural change, so we need to work on that. >> we agree, mr. chairman. as you know, we have terminated over 2600 employees since i've been secretary. after 33 years in the private sector's, i have done many restructures, and i no the

importance of getting people who violate our values out of the organization. we are doing that, consistent with what they have done, and consistent with due process. we know that is necessary with cultural change. >> thank you. senator blumenthal. >> thank you, mr. chairman. chart,begin with your which shows a reduction in va but thoset disability checks, claims have caused an increase in the number of appeals, which demonstrates, in a sense, that you produce some numbers, but simply shifted the problem. that's an oversimplistic way of putting it, but as a lawyer in the federal courts or state courts, if a backlog were cleared simply by moving that

great mound of work to appellate process, where appeals language guish for years, it would not be regarded as a success story. appeals that are is, in mypending view, unacceptable. >> that's exactly why it is one of our objectives. as we've said, assuming we can work together on the legislation, we are planning to get 90% of appeals resolved within one year, and i think we can all sign up for that objective. >> just as a qualification to the point you is, in my view, unacceptable. made, many of those veterans are receiving benefits but they may be nowhere near the amount of benefits of they deserve and need. so simply to say they are

already getting something doesn't mean they are getting everything that they need and deserve. >> that was a statement of fact. there wasn't any intent to downgrade the importance of getting them what they deserve. >> i understand. let a cut to the question that you have just raised. could you give us the details? i assume that you would support the measure that i mentioned earlier, that senator shaheen, myself, and others have supported to expedite those appeals. are there additional authorities you need to get this job done? >> we will have to overhaul the appeal process. it's really that simple. below was created at the turn-of-the-century, the turn of the previous -- well -- >> the turn of the last century. >> i'm sorry, yeah. is so the basis of it antiquated technology and many other things are no longer applicable.

we have used our process mapping techniques i talked about -- we have process mapped. we think there are steps we can take out, but it will require a change in legislation. >> yes, senator. it'll require a change in legislation, and we will have to against theple at problem in order to tackle it. >> and my question is, specifically, what legislative changes are necessary? >> i think a legislative changes that we are working with the veteran service organization to close the record -- if we can get that in place, i think that will go a long way to solving the problem. i really believe, looking at the figures they have shown us, that we can do veterans appeals in one year. we just have to continue to work with them to make sure we are doing it the right way. i haven't had the chance to look at the legislation that has been proposed. that sounds like a great idea,

to expedite -- that is what we do with the backlog, get the oldest ones first. right now they are doing it by docket order. we just have to make sure it doesn't inadvertently harm a veteran. >> let me make a suggestion to you. i'm just a country lawyer from connecticut. in connecticut, in criminal matters, because of the backlog, a rule was adopted that the failure to prosecute within a set amount of time would result in a dismissal. the speedy trial rule. i think that became law in various forms of the federal system as well. in other words -- and don't hold me to the details -- but deadlines were set, timelines were established, the failure to

proceed within that timeframe meant that the government's case andact would be dismissed, the burden was on the government to prosecute the matter. an appeal thatt, is pending for that amount of time within a government , perhaps or process should result in the government losing its case. >> sir, i would rather work like the chairman said, on coming up with good legislation and also systemic changes to the way we do our work rather than just setting a somewhat arbitrary eight year limit. i understand the legislation, i understand eight years, but the legislation doesn't say how you do it. as a business guy, the biggest

challenge is figuring out how do you do it. i would rather work with you and the chairman to figure out how we do it, and make sure we put the legislation in place that we need to get it done. >> and i am not advocating arbitrary deadlines. i am not suggesting that i am supporting the system, that at some point if this problem is not alleviated, that kind of approach is going to be necessary to go back to your days in the private sector. if you could not get products to the shelf, you are penalized. nobody said we are going to keep the stores closed until he and he has his products ready to go on the shelf. there is a burden of proof, so to speak, a burden of going forward, a burden of proceeding, the burden of for selling the government's obligation. i don't want to go on at great length, what i am suggesting is that the remedies for delay may

well be that the veteran receives what his claim is, because he is the one -- the lane works in the government's favor as it did in the criminal context, because very often the criminal defendant was kept without bail, or with bail that couldn't be made, or under the great burden of charges pending. these kinds of deadlines proceeding within a civil or criminal context in the judicial world may have applicability here. that is what i'm suggesting. we may not be at that point yet, but we may soon be there. >> but we have identified as one of our 12 priorities for the year -- let's work together on it. hopefully by the end of the year we will get to a point where 90% of appeals are resolved in the year. >> thank you. >> thank you. the orderi'm next in

so i'm not taking any sort of chairman's prerogative. to -- first, i want to thank you for being here, for the time you spent in my office. we have had several meetings along with senator tester. i think we have been very productive and i like what you laid out. i do have a couple of questions for you. i know that because of the limitations of the room, one thing me up to talk about is as you go forward how members will have the ability to track progress on these initiatives. these aren't just pretty pictures in a powerpoint, but a map to initiatives, and i think it was mike that outline some of the online access we will have where we can see red-yellow-green, particularly on priority projects. another thing that takes importance is to make sure that will make requests of you, in

addition to what you have, but we will have day-to-day things we will complain about, measure in committee meetings, do all we have to do on the part of oversight. but you all need to make sure that you are very direct when we make requests of you that all of a sudden puts something else in the critical path of these things we should be able to watch on your dashboard. that is a very important part of the back and forth. one question that i have is the discussion and some concern we have had expressed to us -- and i mentioned this briefly last week, mr. secretary, about some of the consolidation of the providers who may have had a point of entry in a relationship of choice. you're are trying to do a better job of consolidating that. concerns were heard about in terms of reimbursement. those veterans who may be concerned with that, the whyiders, some sense of

this is better for them over time and why is an important part of what you are trying to accomplish? thank youou, sir, and again to the senators for meeting with us or peter le rep. dashboard that you can drill down on. we share that with you in your office. i would love to be able to provide that to this committee, i just would ask that we work together so that i have not spending more time answering questions of you drilling down on the dashboard than i am solving problems for veterans. if we can come to that kind of arrangement then i have no issue ensuring the dashboard, because that is in essence how you will evaluate us, and these are the commitments we have made. >> i think over time it should be rolled up to a level where we are not sweating the details, but looking at trending -- >> just the 12 -- just the 12 priorities, yeah.

ilative to providers only, think one of the most important things we can do in 2016 is develop a network of providers, including the department of service,va, health private sector, so that by the end of the year we have a network that we all feel good about, where billing is not an issue, where paying bills is not an issue, where we can move forward on behalf of veterans. we have had some providers move out of the network. i was recently in massachusetts, where we were having a discussion with one of our academic affiliates, because the hospital didn't want to accept medicare rates for veterans. well, these are the rates that we have got to pay. we have got to find a way to get to this -- and i know david is working hard --

>> as you respond, you will not be able to see, this is from my redneck powerpoint. one thing i want to do while you were doing your opening statement -- one thing i think we need to do is always talk -- i think there is a place for choice long-term. the question as to what extent in the pyramid -- and this is the provider network, not the v.a. -- to what extent does this increase or decrease based on what you are operating, based on the nature of the veteran population you are serving? we want to make absolutely certain we are communicating that at the end of the day this is about getting a veteran to a point of care they are comfortable with as quickly as possible. 'd senator, we appreciate a copy of your powerpoint. [laughter] >> i think we are on the same page here, which is that we need providers to want to work with the v.a. frankly, veterans need the

private community. we have recognized that this is a partnership. i've spent my career in the private sector trying to get paid most of the time, so my sympathies go with the providers who are providing a service and having a delay in payment. we recognize we have a problem today. we are at 72% payment within 30 days. that is not good enough. we are going to take some dramatic actions in the next couple weeks in order to improve that. the major issue here, frankly, is that we are only getting 40% of our claims electronically. we should be getting 100%. the reason for that is that we demand that not only do we get a bill, the we get all the medical record documentation. we are going to have to change that policy, and we should so that we can pay providers in a faster timeframe. >> thank you. . my time is up. the other thing we hope to see come through are leveraging best

practices from several operations like medicare, in terms of the relationship with the providers, although sorts of things. i hope we are not reinventing the wheel and that you are focused on that. >> we totally agree. >> senator tester. >> thank you, chairman. since you are in that position, i thank you for being here. i think it is appropriate that i asked the secretary of the v.a. -- there are four teams then they win the super bowl. who are you rooting for? [laughter] i think it is more important -- >> thank you. carolina for sure. >> you are a great american. [laughter] >> thank you all for your work. i appreciate you being able to claims thate of the you have been putting forward, and i do mean that. thank you. i met with the doctor yesterday,

and there are still plenty of issues we need to deal with, as far as care of veterans on the ground, and we will continue to pastor until he get to that point. we passed a number of bills out here, and i don't know if any of them made it to the floor. not exactly the gold standard when it comes to efficiency here in congress. do you have contingency plans, if we don't pass some of the bills you need? >> we do. onwill cause us to dial back what our outcomes will be, the what i want to do is take the transformation, which is arguably a big, multiyear process, and boil it down to what we can accomplish by december 31. what i have given you is what i think we can come push by december 31, and i think arguably there are good outcomes for veterans, but we will need legislation we have identified. if we don't get that we will have to dial back. >> if you covered this before i got here, i can go back and read the record, but what are maybe

three of the most significant short-term deadlines? >> the first is provider agreements. we have long-term care facilities right now refusing to do business with us because they are too small to deal with the federal acquisition role. that is number one. i would have to add the consolidation and care in the community -- you will have a hearing on it, i thought it was a good hearing. i think the plan we put forward -- we can't get to that ideal, optimum network of providers, including private sector providers, until we get that rule, that law done. right now, there are many different programs -- seven different programs -- all with different criteria, specifications, and importantly all with different payment schedules, which really confuses veterans and employees. it distorts incentives.

people want the program that is the most expensive. say,r three, i would flexible budget authority. last year i had to come to the house committee, begging for money for care in the community for hepatitis c, this new miracle drug, because we had money in a separate pot that was designed for that purpose, but i don't have the authority to move that money. i think as long as it is about caring for veterans, i should have the ability to use the money. >> of those three short-term deadlines, how many can be dealt with from congress? >> well, the consolidation for care, as soon as we get that, it's -- a fourth, i'm sorry. eul extended use leasing. the minute we get that passed, we can put stakes in the ground

and start building buildings. >> here's the point i'm trying to make, mr. secretary. that is that you can have all the greatest ideas you want, your management can have all the greatest ideas, different regions can have the you of ideas, but i think need to be very, very direct with this committee as to what needs to pass if you're going to meet the needs of the veterans out there. that is all it would tell you. quite frankly, if you can't do it you're going to do, we are just talking. we're not getting to where we need to be. >> senator, in my written istimony and oral testimony, said pending legislation purposely for a number of the outcomes that we cited. anybody who wants that information can go back to the written testimony, and you can see how the legislation is tied to those outcomes. >> and we can also connect up with you for that, too. really,hink it is

really important that we can talk about changing the v.a., talk about providing better service, but part of that talk is getting something done. thank you. look, i talked to the doctor about this yesterday. could you give me any sort of update? you have got a lot of leadership positions that were open and maybe still are. can you update us on where we are at to fill those vacancies? >> i asked david to do that -- and -- thank you for the question. i know the chairman has an comment about this as well. our biggest challenge is getting the right leadership in place and getting critical positions filled. as of last evening, we had listed 43,000 recruits for the v.a. health system, and we are desperately trying to attract top-quality professionals to come in. we have in our medical centers

34 medical center director positions that are open. system a health care without having permanent leadership in place is a challenge. one of the legislative authorities that we have asked for, and is just one of the ones listed in testimony, is to give us the flexibility to use title viii funding to be able to recruit medical center havetors, which frankly i had a significant challenge convincing any of my colleagues in the private sector to look at the v.a. as a career. i desperately need that talent. we are working very hard to hire physicians, very hard to hire nurses, pharmacists, psychologists, other mental health workers, leaders of the system. those are our priorities. i know the secretary in particular is out there every day talking about what a privilege it is to join the v.a., and if anyone knows people who want to join, we try to talk to them on a daily basis. >> i would like to add three

other things. asked in my opening testimony about the congress helping us with this culture of change. that we continue to see negative news articles and other things, the number of people applying for v.a. positions is about three quarters lower than it was two years ago, before the crisis occurred. number two, recruiting. i have asked members of congress to go recruit with me. you and i went to the university of montana together. this is very important. the senator has come to the v.a. to talk at town hall meetings. it is important to show our employees that we are all together, and our prospective employees that we are altogether. i have been to two dozen medical schools and have recruited many people on the spot. the third point is we are

leaving positions vacant because we don't want to add more people than we need. we are in the process of trying to figure out how to reduce the levels and how to become more productive. for example, we recently realigned our visions. we eliminated three of them. we want to make sure we are only recruiting from positions we want to fill rather than all positions that may be vacant. >> i got you, and i appreciate -- i don't know what is going on in north carolina or georgia or connecticut, but i have a pretty good idea of what's going on in montana. for the record, the vets in fort harrison love those people. but they are quick to point out that we are burning them out because we don't have much staff. i think it is critically important -- we have got to do it. it's really important. i'll walk hand-in-hand with you if it comes to recruitment, because these folks have done a lot for us. we go into them. >> senator moran.

>> thank you. welcome. good morning. whene consider me an ally it comes to trying to accomplish the things you outlined in your testimony this morning. am anxious to see a transformation of the department of veterans affairs, and that transformation is to receive the care and benefits they are entitled to in a timely and beneficial way. that's what your statements were all about, and i certainly support that outcome. is takeant to focus on us back to the current circumstance in which i find myself trying to help veterans, and we did have a hearing with undersecretary gibson on consolidation of those community-based programs, and clearly i understand the value of consolidating. created toortime,

many programs that cannot be administered efficiently. secretary gibson committed to me during that hearing to do several things, which haven't yet happened, and i'm asking you for your help to see that they do. had a own volition -- we conversation about veterans who were qualifying for the choice act. collision,at his own was that he would provide me with a list of those veterans who qualify for choice in kansas. i think it is a very generous offer but it hasn't happened. perhaps it was too generous. if you can help me in that regard. because we have those who were caught in the process of calling the third-party vendor and being told they don't qualify, were being told they don't qualify because they live within 40 miles, and then you start digging down and neither one of those things were true. i guess the goal is to try to figure out who does qualify, so that there is an understanding by the person on the end of the phone who is telling a veteran whether he or she can access the

choice act. ad,t was one request we h or an offer that he indicated. also, the conversation occurred about the number of people who have been abandoned. what i asked for was something i think the v.a. calls their abandonment rate. concerned about what was said by the secretary, the undersecretary, several months ago, when choice was new. of the comments in the hearing was that choice is not popular with veterans. they don't want choice. what worries me about that is that i did not want to see the v.a. create a circumstance in which the choice act became so unappealing that veterans decided they didn't want it. wee it a chance to work and will let our veterans decided -- i have a clear sense it will be valuable. part of it is the geography and demographics of the state like mine. one of the things i have asked

for is what that abandonment rate is. just as an analogy -- a long time ago, i was in the state legislature and the railroad started reducing services available to my community, my hometown. overtime, customers decided they didn't use the rail service because it wasn't any good. then the railroad goes to the regulators and says no one uses the rail line, let's get rid of it. i want to make certain that not the intention of the v.a., and i don't have the fear that i had some time ago. it seems to me that the v.a. is more and more embracing community care, and i appreciate that, but when we see these numbers about people served, what i want to make certain is that we are taking care of those who have just given up. that is one of the most common conversations i have had with kansans, that they have tried the choice act, and either they were told they didn't qualify and tried again and were told and 40 miles, and more recently it has been -- i used the choice

act, they provided me with my hometown provider, that when the hometown provider insisted i see a specialist, then i had to go through it all over again, and i was denied the chance to go have the radiologist look at my x-rays. it may work initially and then again fall apart, and and want to make certain we don't discourage veterans from using it because it is not working up front. that abandonment rate, i would like to have that to see how many people are walking away. not really because they want to but because it is not meeting their needs. secretary gibson and i had a conversation about ten specific cases in kansas. his willingness to take those cases on and solve the problems -- i appreciate what he said. he said we are committing to fix it, and if we are not executing, shame on us. and he offered to take care of

the 10 cases that had come in to our office that week dealing with choice. the ultimate outcome was that someone from the v.a. called our caseworkers and said, what do we need to do? office, up back in our as compared to the v.a. stepping in and solving the problem. i highlight that opportunity for the v.a. to see, maybe this is just a pilot program where you can see what kind of conversations i have with veterans and how the choice act is failing them, and maybe these ten examples would be useful to you as you try to solve the problems system wide. we want good things to happen at the v.a. the challenge you will have is as you're trying to reinvigorate the v.a., alter its course, change the quality, day to day veterans are being left behind today. those are problems we have to solve while we transform into the future. >> we will get on those. there's no question by any of

us that care in the community is absolutely essential for us to have a network of providers to care for veterans. in fact, earlier when senator till liss was sitting as charmente i meant to say we have a map of the united states that lays out where we think the veterans live and where we think they are going to live, where the providers are, whether they're d.o.d., v.a., private sector. it would be good to have that discussion with each member of the committee, each member of congress to see the kinds of capability we are trying to put in place. we don't want anybody to be abandoned so we are very much -- >> thank you. i think every republican member of the committee at least on the staff level asked for a meeting with somebody from the v.a. to describe to us to explain and have a consultation on the definition of a full-time physician or facility.

that was to take place. it hasn't. we asked for it and i think every republican member would like to -- have asked to join us to have a meeting with somebody not you necessarily just someone who can tell us how the new definition -- i would respond who wra you just said -- >> i wasn't familiar with that. i would be happy to meet with every member. i've met with caucuses. >> the choice act is a way for the v.a. to solve some of its professional inabilities. one theory was we will take care of veteranses where they live but the other component of why we approved the choice act was to help the v.a. get the meeds because of the shortage of professionals. if we can utilize those it reduces the challenges you face in recruiting. thank you. >> thank you. we've seen some improvements in

the state of nevada. we have a good team out there. not this weekend but next we will have the health clinic final lifment i've been working on this since i was in the house. so you can imagine how many years. i'm glad to see we have a new director in the regional office there in nevada. ery helpful. also a new director. appreciate. if you're a california veteran and in the chairman's state of georgia and you need immediate health care. do you mind is there a problem with them appreciate. f you're going to a v.a. hospital in georgia to get that health care? >> this is a very relevant question. it's not a problem. but today we don't yet have the -- we haven't yet built the capability to allow that to occur. one of our break-through

objectives is by the end of the year a veteran can go anywhere and we will serve them. so that's one of the things we have identified. >> we called hospital in georgia to get it s. it's exactly what we want which is that if you are a veteran you should be able to be cared for at every facility. we do have some challenges to doing that but all but three of our facilities have what's called a traveling veteran coordinator. so a veteran can ask to speak to them and their job is to help facilitate it. our goal is to make sure that we don't need to contact the person that our systems recognize you as a veteran you should be able to get care. >> what's the time lime? >> -- line? >> 2016. >> by the end of the year. >> so would you care if a went to ay in nevada slake? >> it won't matter where they go. just like you get your

prescription. > we're getting some feedback. right on the nevada-utah border. some of them want to go to st. george some want to go to las vegas. >> we want to be agnostic. one of the things we've talked about here which is also critical to this issue is today if you're a veteran and you move and you have to change your address you have to change it in about nine different places. we want to move to one data backbone for all of v.a. if you go on line to populate a form we automatically populate it so you don't have to write the information in. we don't have that today but it's one of our objectives

taking on for this year. >> so i can talk to them to say sometime around the end of the year you would be comfortable with going to either hospital f your choice? >> you should today be able to. it's just going to be more painful than we want it. but we're trying to make the system actually support what you're asking. >> right now some of our veteranses in that particular area are being restricted telling them they have to travel the extra mileage 45 minutes as opposed to going to t. george. >> the question that they have relative to your backlog. they say they don't trust the ata. in the state of nevada we were ground zero. we are seeing some improvement. can you assure me that the inspector general isn't accurate that they claim they

don't trust? >> i imagine it was probably in 2014. i believe the data -- >> say painting a rosy picture. >> we go through that every day. >> i would disagree on their assessment. the one thing we have tons of is data. i can tell you that the data on the backlog is accurate. it's still not where we want it to be and we're going to continue to drive it down. the nevada vfw had their mid winter conference and i had a chance to address them. this is one of the concerns that they brought up. was the fact that they're concerned that we are painting too good of a picture that they are obviously on top of this ig report saying that perhaps the

data isn't as accurate as being reported. back to them and to state. >> i've given out my cell phone number publicly. i was asked for give me the instance, the date, who did you deal with? because a lot of this is just simply that we have got to continue to work to rebuild trust. but a lot of this is the trust that was lost in 2014. a lot of the i.g. reports date to some time ago and have already been remead yate. but i would be happy to get together on that one. > thank you. >> in arkansas we have two hospitals where they work really hard at serving veterans

and do a good job. one of the huge problems we have is that right now because of the turnover in leadership throughout the system, either people retiring that are my age and just not wanting to fight the battle any moffer. -- more. or good people being taken to other jobs that perhaps are a little more important more authority within the bigger system. but it's a huge problem. right now most of the people in key positions are acting people. they simply don't have the authority that they do and they don't. it's just very difficult when you're the acting head versus the other. and when tough decisions come up, the tendency is to put those aside to let somebody else deal with them. how can we resolve that? and i know it's true in arkansas. i'm sure it's true throughout the system. >> we talked a little bit about this previously but i think

there are a number of things we can do together. number one i would encourage that when you're in the district and i will go there with you let's recruit together. let's go to the medical schools. let's go to the hospitals. let's recruit people for the v.a. together. i think it really is a very positive sign when members of congress and v.a. leadership are together. i've been to over two dozen medical schools. i would like to get to more. secondly, we have put in as part of our proposed legislation would treated them as title 38. many of our directors are not doctors. they're not title 38. as a result, they're paid significantly less than the private sector. that's a very important job. it should be title 38 and we would like your help to make it that so we can pay them competitively. >> i think the secretary has identified key issues.

we are trying to attract new professionals into the v.a. to see this as a career because many of our people, senator, are refiring. and unfortunately some people are leaving the system. so we put out a call to the private sector to answer which is to come serve your country and you can serve your country in many ways. one would be to join the v.a. system. and we have had a pretty good response. so we're looking at trying to decrease our hiring time to bring in new people into the system. it's one of our initiatives. we would appreciate your support on the pay authority that the secretary just mentioned. and creating an environment that people feel they can be successful in. that's where i think much of the dialogue today about us being on the same page and you helping us recruit would make a difference. >> switching gears a little bit. you do have a lot of people that want to come forward.

some people that have come forward in the past. and the whistleblowers really in the v.a. system have a reputation of not getting a very good rap. that comes from i think just circumstances the cases that have come up. and then also when you look at the agency that where you appeal to in visiting with them they say that probably the majority of their case load throughout government comes from the v.a. so it's not a good situation. can you talk a little bit about what you're trying to do to address the problems with retaliation? and then again encouraging others in a nonhostile environment to come forward and so h that we can make things better. >> surely. we have trained over 450 people in something we call leaders developing leaders. it's a program we put together

in conjunction with a professor at the university of michigan. and it's a program where we actually train the leaders in three days. we train them in leadership we train them in whistleblowing, we train them in everything we can. the cultural change we want from that is we want every employee at v.a. feeling enabled to come forward with their criticisms. we want our employees to redesign the systems they work on. that's one of the reasons we're training our employees. a good customer service organization can't survive unless it's a great place to work. people have to be trained and able to do that. we were the first agency to get certification from the office of special counsel on whistleblowers. we also have rewarded and called out whistleblowers who have helped us. it's something we're working very, very hard on to make sure there is no retaliation or if there is that those who

retaliate receive the appropriate discipline. >> very good. thank you. >> senator sullivan. >> thank you. i want to zphriment dr. shulingen. mr. secretary i've spent a lot of time with him in the last year. we have a lot of work to do but i think somebody is doing -- >> i apologize it coin siding with your service in the military. >> sometimes you can't always pull it off but we will get you up there next time when i'm there. but i do appreciate the fact that both o have been up there recent lifment we went all over the state. and thanks again for allowing me to hold a hearing up there. and you saw the level of frustration. you saw that the choice act, which in many ways got ideas in the choice act from what was working in alaska came in and when it was implemented in alaska just kind of was a

fiasco. i think everybody recognizes that. so then you committed to this pilot program in alaska that was going to be up and running initially you committed to me in november. we miss that had deadline. not we, you. but starting to take hold. i would just like an update on where we are on that pilot program. mr. secretary from a broader strategic perspective, if we're able to fix the big issues in alaska i think is going to give you a sense of how to fix things nationally. if not in alaska it's going to spell trouble for what every member of this committee cares about. you care about. which is fixing the choice program so it's serving our veterans. right now it's still not in my state and i would like an update just on the time line and how you see that pilot program going forward. >> well, senator. first all i do want to thank you and acknowledge you've been a great partner in this.

you've been very clear with the problems and that you expect solutions but you've been working with us all along. so i thank you for that. you are correct that we agreed upon a solution that we would try this pilot program in alaska. which can serve as a model for the rest of the country. it was delayed. the reason for its delay was actually federal contracting rules. it was very tough for us to once you're in a contract actually get agreement to change the rules. but we finally got that done and as you may be aware january 11 the pilot went live in alaska. we now have actually embedded staff. the staff are in our med exl centers. >> are those temporary hires or are you going to move to permanent hires? i know there's a bit of a confusion on that. >> right. well, the staff in the v.a. are permanent staff. the tpa is commiting to getting permanent hires in there. but we wanted to try west moved

very, very quickly to make sure we didn't miss the january 11 date that our second commitment to you and we are now taking this up to a new level. we have to have again an additional contracting approval. so there is one more approval to get the full pilot in place to have v.a. staff do the care coordination. >> and when do you anticipate being able to make that commitment? what date? >> well, we are pushing -- i hesitate to give you a specific date because it has to do with contracting laws. >> i like dates. >> i will get back to you. but everybody knows that's the final piece to get done and we do believe we are talking to senator tester yesterday about potentially in montana doing a similar pilot. >> ok. >> it would be good to get back to us. i would like the specific dates on that. i wanted to turn to the issue of -- and i know we've been talking about it here today. of shortage of professionals. particularly medical

professionals. and as you know, we've talked about this. it's particularly acute in states that don't have medical schools. so what we have been doing is working on legislation that can help states particularly rural states not medical schools like alaska but i know there are other members on the committee that would benefit that would encourage the partnership that mr. secretary you talked about when you were in alaska with the different health organizations particularly the tribal organizations in alaska. so i want your commitment to work with us. we have legislation drafted up to maybe get it marked up soon. but i would like to get your commitment to work with my team on making sure the v.a.'s good to go with it. i think you would be. but we would like to do that with you soon. >> we agree. we actually worked on that together when i was in alaska with the south central

foundation. >> they've been back and working. >> i think it's a great plan. i couldn't agree with you more. i'm sorry senator he willer is not here because we're working together to set up a medical school? las vegas, nevada. we've got to have more medical schools in these states if we're going to expect doctors to locate in these states. i thought this was a great program. >> if i could just add. i actually think that the critical factor to getting somebody to take a job in the v.a. is having your residency program. so it's your post graduate training that's important in addition to medical schools. that's what we're trying to do with south central. >> and that's what our legislation -- >> and we could use some help with legislation. what we found is there were 1500 new graduate medical education spots given to v.a. through the legislation. we've only filled 372 of those spots. and the reason is what we learned is that v.a. needs the

ability to actually help the private hospitals in paying for these spots. they're over their caps so they get no reimbursement. and that's been the limitation. that the hospitals want to and the foundations want to increase training. we want to increase training. but we could use some legislative fixes. >> thank you. and just if i may one other quick, just a commitment from the leadership here. i was back home recently and once again heard about the issue of providers not getting paid and therefore dropping out, which i think has been a problem in alaska. and then doctor you remember and i've heard about it again which is veterans who get commitments from the v.a. to go to providers and then to have their medical procedures completed don't get paid -- the providers don't pay. and these guys are being dogged by credit agencies to pay 25, 30,000 bills.

and i've heard about it again where our veterans who got permission to move forward on a procedure are the guys getting the credit agencies coming after them. as you know that's incredibly stressful. this is a big deal. i want to get your commitment to work on some ways to stop this. you heard it. it's outrageous. > thank you. you're walmer than the last time you expressed it to me. there is no excuse. we should never put the veteran in this. we are setting up a special team to deal with veterans who find themselves in this situation so they can reach us. we cannot put them in the middle of this. we recognized before you came in we have to fix the provider payment issue as well.

>> we committed to pay within 30 days. that would be a breakthrough. >> thank you. >> i appreciate your raising the question because the first question i raised in my time was exactly the same thing. what's happened in alaska has happened in new hampshire and other places around the country prompt pay is a huge issue that we've got to address if we're going to deliver choice to our veterans. thank you. >> in your time as secretary you've talked about moving v.a. fozzcuss to the individual veterans experience trying to get care and benefits. that's the right move getting the v.a. away from focusing on bureaucracy and procedures. but i'm really concerned that those changes aren't taking hold. over the last year in my home state of washington i have gotten complaints of the seattle v.a. refusing to help a

veteran who was in serious pain with a broken foot get from the e.r. and made him wait for an ambulance. elderly and sick veterans have been made to wait outside in rain and freezing temperatures. a dangerously heart rate was turned away with, we're not taking patients. and shooting pains in his arm had to wait for two months to get an m.r.i. and a year-and-a-half for someone to read the results. those are deeply disconcerting. >> to us as well. give me the names the dates the individuals involved. that's tonl way we can do anything with it. the situation you talked about the individual in the car told to call 911 we have used that in all of our training about our leader developing leader

training. we've now trained thousands of people in the orgsigse. we use that episode as exactly what we don't want to do. we have an organization that's rules based and we need an organization that's principled based. the best run on principles not rules. this individual thought they recall following the rule that's the wrong thing to do. we're training our leaders and going to make a difference. >> i love the words that you say. i do. but how do you have accountability for that? >> get me the dates and names. then i have a discussion. in the case of the person that told the person to call 911, we actually conducted an investigation to find out what disciplinary action we should take against the person who did that because that is unacceptable. >> >> i appreciate that. it's just hard to say to our vets gret ahold of your senator. >> have them call me. >> i will.

>> people call me every day. >> i appreciate that. what i'm saying is that we can't have the message be if you have a problem call your senators they will pass it on. we need to make sure that those people are held accountable at the very basic levels so these don't occur. i agree. as i told you we ran an investigation on that one lady. the other thing we've got to do is train people. v.a. has not been doing enough training. in fact in 2014 we spent $100 a person training. if i did that running the proctor and gamble and company i would be fired. so we are taking people off sige site training them. holding people accountable i agree. but training. >> and that is happening and we're going to see less of it? >> if you go to your facilities and ask the people what they thought about their leader developing leader training, i think you would get positive feedback. >> we will do that. and we will pass on the results to you, too, because it has to make it down on the ground.

>> one example which exactly what you had talked about in seattle with somebody not being helped in the parking lot. the deputy secretary sent a memo to every single employee in the v.a. talking about how that did not honor our principles so we are getting that message out. breakthrough goals is to continue to decrease the number of homeless veterans and families which i applaud. last year the senate passed unanimously my homeless service veterans protections act which whether allow v.a. to fund homeless veterans. sitting in the house waiting for action. how important is it to get that passed? >> it is important. anything we can do to how's homeless veterans we talk about the fact that we've decreased the number of homeless veterans by 36% since 2010.

but there's still 47,000. those homeless now generally have medical issues that we have to care for. drug addiction, mental illness. so as we committed here, we are going to continue to cause the number of homeless veterans to decline. but we need your help to do that. >> we need that legislation passed. >> yes. and one of the big helps we need is the eul legislation for los angeles. we're paralyzed without that legislation. >> i want to ask about filling the vacancies in the health care system because again in my state the medical center has been without a permanent director since may of last ear. the slow hiring is leaving a lot of positions unfilled. it's a critical goal you said. what are we doing to make sure

those positions are filled? >> senator, the chairman and several of your colleagues have also mentioned this. this is not only partner to you. >> i was late. >> this is absolutely one of our key priorities. we put out a call for help. we have asked for any of your help in recruitment. we are trying to identify individuals. we have asked for several things to be able to help do that including giving title 38 authority to us to use funding to compensate medical center directors and network directors. unfortunately we are so below market that has become a barrier to us. the culture in v.a. and all the negative attention that we received has hurt our recruiting. we're working very, very hard to give an accurate picture what it is to serve in v.a. which is a tremendous privilege. it's fantastic institution and leaders i think would be very attracted if they took a look at us. so we're working very hard. we have 33 medical snrt spots

open. that's far too many. i can't tell you there's not a day where i'm not calling people to ask them to come help us. >> ok. we've got to keep it up. thank you very much. i appreciate it. >> senator rounds. >> i want to back a little. i think about the goals and layout you put together with regard to my vanch a as an integrated plan. you've laid this out. it looks to me you're trying to change the culture. first i would like to know initially what your thought is. is it -- what's it going to take to change that culture the specifics of how do you get that message across? you have over 300,000 employees right now. the second part i guess i would have is it time to actually look at integrating the areas of excellence these centers of excellence that you do have

within the v.a. and integrate those within the community health care services that the rest of our citizens in the united states actually utilize today? can we do that? what's the challenge for you right now number one in changing the culture? second can you integrate that into the existing health care that you have out there for the rest of our citizens in the u.s. today? >> center, i think we are changing the culture. i obviously don't think the work is done yet but the plan i laid out will have a huge culture change by the end of the 2016. what we've talked about is creating the irreversible momentum by the end of 2016. so no matter what happens twhen administration changes and the government changes, that the v.a. employees can carry this on. because as i covered in my ominge opening statement and written statement, this is the first time i think that the business acumen and the leaders with business experience have been brought to bear on the sixth largest company in the

country. v.a. if it were a company is the sixth largest company in the company. we're not going to have a cio who has been at johnson and johnson. if we're going to get it done we need to get it done this year. we laid out the steps to do that. how do you accomplish culture change? there are lots of things. number one, you've got to raise standards. our standards have been too low. many of our leaders, when i first looked at their performance evaluations, everybody rated everybody 5 outstanding. how can you be rated outstanding when your employees rate your organization as one of the worst in government? that doesn't make sense. so that's why we created this leaders developing leaders training was to take our leaders off site and say here's the way you run a performance management system. it's not about everybody getting rated wonderfully. it's about identifying what we can do to help train people.

it's about holding people accountable. it's about providing the customer service. that training we gave it to 50 individuals. that's now cascading to the organization. what we did is enabled the leaders of the organization to go train their leaders and their subordinates. that's why i say it's cascading through the organization right now. and you can check on your own facility. >> i'm just thinking. looking at the time line that you laid out for my v.a. plan full implementation goes well beyond 2016. i like the idea that you're looking long term on it. but it's going to get passed not only this administration but into the next administration as well it would seem that some of the tools that you may need might be statutory changes. or they may be additional tools. have you laid out or is there a layout specifically that you need that you've got to do to get to my v.a. in? >> yes, sir. in my written testimony it

lists about 9 different statutory changes that we need. in my oral testimony i talked about consolidation care in the community flexible budget authority purchased health care stream lining modernization act. david talked about title 38 authority for medical center directors. about the leasing on e west laument los angeles campus. overhauling the appeals process. if we can get that done 90% of appeals will be solved in one year. so laid it out. we will work together and partner with you to get that done. we know you can't do it by yourself. we know we can't do it by ourselves. we need to work together. >> i hope one area that we are successful in is actually integrating and getting a system in place campus. that the veterans regardless in rural or urban areas they can use the health care facilities close to

them. not just v.a. but the other as well. i know that's the goal. but i'm wondering if we're working against ourselves when we're talking about trying to establish and build new facilities, modernize existing facilities while at the same time suggesting that we still want these veterans to be able to go to their local facilities as well. do we have two different goals that may be inconsistent with one another? >> i don't think so. i think we're after building the very best network with the veteran at the center of that. i mean, forget all the olitics. we want the veteran to be able to go where they want to go. and we're in the process of building the optimum nem network across the country. earlier i talked about the fact that we have a map of the country where we have the various affiliates identified whether it's the medical schools we do business with, whether it's the indian health service the department of defense. we parted anywhere with all of

these folks in addition to the private sector the try west or healthnet. and we look every day to see what specialties are necessary in what areas to recruit the professionals we need to get that job. >> still committed to the idea of centers of excellence. >> yes. i think the goal as the secretary said is to give the veteran the very best care that can be given in the v.a. and the very best care that frankly can be given in the community. whatever the answer is that's where the veteran should go. but i sort of have a unique perspective on this having spent my time in the private sector now coming to the v.a. now starting into pratiss as a physician in the v.a. this is really quite a surprise to me. how much a veteran gets in the v.a. system that is not available in the private sect ever. that is why we believe strongly in building the things that are

great in the v.a. and investing in those. we're not trying to dismantle the v.a. in this plan. we're trying to do the right thing for the veteran. that's going to mean supporting our centers of excellence programs that you can't find in he private sector. >> when you're in the private you can see we provide peer support. our crisis lines aren't available in most hospitals. transportation services. care givers. homelessness. medication support. behavioral health integration into primary care. clothing allowances. and the fact that we work with

almost every leading academic medical center. there is no health system in the country that can say that. we're getting intellectual property and input from every leading academic medical center to help. so these are just some of the reasons why the v.a. is unique and frankly why we need the v.a. to be strong. >> i know your commitment. i've seen it up close and personal. i know the desire you have and i can tell you it resonated with all the veterans in west virginia. when you came there and done some things to change lets them know you care. by doing that you were able to put a medical center that we needed to go around rural west virginia. we lost one of our sea box if you will. the term prear one has been open now. i support what you're doing. i want to make sure that we facilitate what's needed to make these changes.

i understand. but we have to cut through that. i don't think there's one in this room doesn't believe there should not be one veteran that is homeless. there shouldn't be a veteran without a job. now, with that sometimes there's problems that accentuate that we have to address. income based service. he was led to believe that if he had done better in life he's not afford it had same service. he said i put on the uniform. i would have taken the same bullet that a person who got out didn't do quite as well. i was very lucky but made me feel like now i'm not expected to get the service because i did too well in the private sector. that doesn't make sense. if you do well and exceed in

school you should get a scholarship. but if your mom or dad made this one we are not going to give it to you. so we're not rewarding for accomplishment. >> i went to west point. i cannot be served at the v.a. because i'm in the category 8 plus. i have too much net worth. >> it's basically a fact of life what we're dealing with. >> i think what we deal is with budget.rements versus the question is we wouldn't have enough budget. so the question is where's the balance. >> we have accepted that as a policy. i would say the majority has done extremely well. probably even pay. >> it's frankly it's even worse than that in a sense. we have policies that are

written into law that obviously if an individual gets cured they wouldn't get the disability payment for the ailment that was cured. so it seems like the incentive there is to not be cured. so these are the kind of things if we work together i think we can make the laws better so that so we don't have these. trr big thing i want to talk about is the prescription drug addiction we have. it's a huge issue. it's huge throughout the services i understand that too. i ou go back in history, think chronic pain the v.a. acknowledged early. we said there's other ways to treat. i think that's when this onslaught of open yats came on to the market. if that's the case we know the detriment it has had to society. truly believe that the v.a.

could change the cult tur of america. these service people do not go to prescriptions first but prescriptions last. >> as you and i have talked when we're together, we couldn't agree more. when you look at what the v.a. is doing on an evidence-based equine, acupuncture. some stimulation technology. yoga. there's so many things we're learning that we can use to substitute for these open yoits. and we track this every day. we track how many we're using and david traction it to make sure we're going down. there's a lot that american medicine can learn. >> we need to change code here as far as in the general public. basically the policy that you can adopt can lead to cultural change. so as far as the education that these doctors are not getting in how they're prescribing. you go for a tooth ache you get

30 days of oxycotin r. we changed that. so why can't we take the knowledge we have and train them. >> we see our role as leadership role in the country on this issue. we're doing several things. evidence-based therapy we have protocols that the v.a. has put out. but we have to be open to new innovations because quite frankly there are new technologies coming out that can help. we are doing what's called academic detailing. we have mandated that v.a. doctors get academic detailing. that means teaching them on the right way to use oy open oits. >> continuing education. they get no continuing education. none. and if you ask any of the doctors they get one week in medical school. it's just awful. i would encourage you we're not going to change unless you take the lead on this and do it because going through our process is quite cumbersome to get something passed that makes sense.

but you all have experience and basically success as far as in alternate care of chronic pain? and it's helped with presidentd is also. so those who might have some mental challenges you know you can cure and work on that. >> we have a leadership role. this is a big innovation for us that we can help americans. >> one more thing. if i may. how difficult -- you've come from the private sector at the highest level. with that being said, the difference of management of what you're able to do and the public sector versus the private sector. we know that they don't operate the same. we've got to allow you to have your top management changes and flexibility. how much is protected by the

civil service that you can't even touch? how far down can you get to make the exchanges you need to make? >> i think the difficulty of this challenge of changing the is the difficulty of scale. this is the sixth largest business in the country. t's a challenge of time. because i was with the same company for 33 yeerings. during that time the stock price went from $2.32 to $81 when i retired. so it takes time. but i think that having somebody with experience in business is critically important. change that is you made. we gave because i was with the same leg >> we have enough authority to fire people. >> the top level. >> that's not the most -- as i said in my opening statement, 10 of my 16 top leaders are new since i was secretary.

that's what 18 months ago so we've been able to change the leadership. we've been able to do the things we needed to do. i think the question this raises is should we treat this like a business and should we make sure that somebody who has ever secretary has business experience. because this is a very, very large business. and what is at stake here is eterans lives. >> we've been a leader and helped us. it's also important to point out that 72% of the physicians practicing in america today go through the veterans administration in their training. if there was one place we could make a cultural change that's the place. you could thank you for being with us today. i want to thank the members. >> i appreciate you alin