but if the v.a.'s leaders keep repeating the failed ways of the past, they will burn through billions of dollars of taxpayer money, only to be left with dysfunctional systems that do nothing to improve services for veterans. today, the ranking member and i laid out the subcommittee's position based on all of the evidence we gathered in the past two years for how the v.a. should be approaching the i.t. modernization. v.a. should not be doing i.t. megaprojects. they just don't work. and they always turn into black holes sucking billions of dollars of the taxpayer's money into the contractor's pocket. put together, fbmt, and the digital g.i. bill are conservatively going to cost the v.a. at least $27 billion more than what they were initially planned. no organization, and that includes the federal government, should be allowed to operate that way. this is just not our opinion. our expert witnesses the pitfalls of buying or developing software without a clear understanding of the organization and its requi

a bipartisan issue and v.a.'s top clinical priority is suicide prevention, yet it does not mandate community care providers to meet the same quality standards as v.a. direct care providers. dav recommends v.a. amend its contracts with these providers and require -- require clinicians to be trained in military culture, suicide prevention, lethal means safety counseling, and trauma-informed care. accessing mental health and substance use disorder care is essential in preventing veteran suicide, and we made recommendations in our testimony to ensure quality services are provided to veterans refer to the community. women veterans are also significant users of community care. they are referred to the community for all maternity care and often times for other basic gender-specific or productive health services. although we want to see fixes to improve access to services in the community we strongly believe that investing in v.a.'s veteran-focused evidence-based care model is likely to produce better health outcomes for

v.a.'s determinations, by the time you're determining competency and looking for a disability benefit for that incompetency, v.a.'s determinations are based on the medical evidence of record and not arbitrary, correct? dr. cohen: medical record does play a role in the process. rep. mcgarvey: they have gone in for treatment. they have indeed incompetent. now they are looking for disability because of the incompetence. the medical record plays a big part of this. >> congressman -- please. chair luttrell: you are not recognized. rep. mcgarvey: i want to reiterate the v.a. did not make of this idea to report beneficiaries deemed mentally incompetent. they are obligated to do so under the gun control act of 1968 and the brady act. what we are talking about today and the kennedy amendment does not change or repeal those laws, is that correct? dr. cohen: the kennedy amendment does not repeal the gun control act. rep. mcgarvey: when we talk about the process, about all the sorts of things, a lot of

we spent many hours in the subcommittee discussing v.a.'s three magic -- megaprojects that are racking up schedule delays. electronic health record modernization has spent nearly $10 billion already and would cost more than 37 billion dollars to implement according to the institute for defense analysis. the true cost across the v.a. is higher than that as it does not include the enormous and additional staffing requirements where the loss in productivity. v.a. and oracle are on the cusp of resuming the rollout but there is no end in sight. after six years, financial management business transformation has only installed a momentum system in a few small corners of the v.a. and its cost estimate has more than doubled to 5.8 billion dollars according to the ida. finally, the digital g.i. bill has missed its original 2024 completion date and its final price tag will likely double as well. not only have these systems gone past schedules and budgets, they are also struggling to live up to the users expectations. however, there are signs that the v.

it is in the v.a.'s five-year development plan, meaning it is a project you have on the books but you do not have funding to do. will you commit today to working with me to get that project started next year as the v.a. plans call for? rep. collins: working with this body to get funding needs for all of our construction is going to be there. one of the issues we have -- our average age of many of our facilities is 60 plus years old. this is beyond when you look at private and public hospitals that average 15 to 20 years. which throws into so many different problems. construction is going to be something an project like that are important but if we just discussed the electronic health care records system, some of our existing facilities are going to have to have major work just to hold the computer systems and others to make that happen. it is something we are going to work towards make sure we get it funded. we are working to get the money for that. sen. banks: i look forward to working with you on that.

but because of v.a.'s budget structures where there are separate accounts, pots of money for medical services and community care, there is almost a perverse incentive for local leaders to cut access to direct care programs like these if veterans can otherwise be cared for in the community as it will free up dollars for other direct care needs. it is a well-known fact that veterans and taxpayers receive far greater bang for the buck by investing in-home, community-based services rather than institutional long-term care. patients and their families are happier and receive higher quality of care in those circumstances. what needs to be done so that local v.a. medical facilities are incentivized to make operational decisions that lead to lower cost in the long run? mr. elnahal: i think a really important question. disinvestment programs like that are exactly what we want to prevent with a 6.6 billion dollar request. we don't want folks to divest from or delay implementation of home-based primary care because b

but because much v.a.'s budget structures, there are separate accounts from medical services and community cara will most a perverse incentive for local leader to cut access to direct care programs like this. if veterans can otherwise be cared for in community it frees up color will do -- dollars for other direct care need, well-known fact that veterans and taxpayers receive greater badge for buck by investing in home and community base services rather than institutional lang homer care. patients and family are happier and receive higher quality care in those circumstances, what needs to be done so local v.a. medical if it ises are incentivizes to lead to lower costs. >> >> a really important. the disinvestment in programs like that is what we want to prevent, with the 6.6 billion dollar request, we don't want folks to divest from or delay implementation of home base primary care, they have identified a population of veterans who benefit from that, and reasons their health would benefit, and for most complex

s and addiction that would allow us to get an indication. build critical evidence on the efficacy of these things. we are working in early-stage with the v.a. who have been absolute pioneers on many problems related to behavioral health given the overlap between veterans and substance use disorders. i also think there is a broader opportunity not just to study these things for critical efficacy, but to think about their application in settings like child welfare, homeless housing. many other settings where we think about the negative consequences of addiction as washing ashore in profound ways. but beyond innovating on treatment efficacy, if you believe we will have to innovate on engagement strategies to improve medication adherence. i will give you guys one example of something we are working on outside of child welfare that has lots of implications and applications to the child welfare setting. here we are thinking about involuntary hospitalizations. just as a bit of background, every state in the country has a law on the books that allow people to be committed to voluntary hospitalization when they are at risk or a danger to themselves

v.a.. cystitis are larger number of female veterans, their having to do that. if you wanted to stay they could. working at both ways isg where e need to be. >> i think the e medical, what sthe best medical treatment is where we need to go. any case of mammograms, you need somebody to reach thousands and thousands of mammograms and if you like take care of a small number of female veterans i wouldn't want to have my mammogram but by some of the only reach 100 mammograms you as most a partner organization like that world hospital or somebody who reads thousands of mammograms so they can better spot any problems. >> exactly. that brings me to come i'm going to jump ahead, goes back to the discussion we had in the office about c box. which made was a good point. i will take a step for the belt which to said though, it's a shopping of skills. for those of us have been to iraq and event afghanistan, we sought trauma emergency care at its finest. if they came to the heroes highway,al 90% made it back home alive. some of them, you are one that didn't come some we didn't but to get back up and i remember time i i sat with young man is with him and prayed with him and he had come