as dr. roe pointed out the other night, all va employee needs to do without a doubt is they have to be reminded that they are working for the veteran. not a bureaucracy. as with most things, there are tradeoffs when looking at structural reform, centralization versus decentralization, standardization versus innovative. these discussions have been ongoing for years if not decades. i'd like to think vha is an adaptable learning organization that can make needed transformation. but let me be clear. the only way we're going to truly address the litany of problems is to look at the fundamental change within the department. and rightfully, we're all looking at ways to address the problems as we see today. but i'm hopeful that our ambitious schedule of hearings in the weeks ahead will think anew about how best to provide the quality comprehensive care to our veterans in a timely fashion. and i hope that they challenge us to think anew about how to refashion systems and infrastructure, management and pe

roe, dr. roe, tennessee. >> thank the chairman. but i like to introduce someone before i start, timothy dennis is 19 years of age, is here with us today. this is foster youth shadow day. if he would stand up. he spent six years in foster care in tennessee and he is here as many of his other friends are, with the hill today so let's give him a round of applause. [applause] phil roe speaking. travis, i remember your testimony very well, and i remember you being here and it was powerful than it is powerful now, and thank you for coming back and i'm your neighbor just south of you in east tennessee comes on just down -- were in kentucky are you from? >> i'm from a small town and not county, kentucky, which borders virginia. the closest city to me, people recognize is hazard kentucky spent hazard, i know exactly where you live in. first of all i appreciate your testimony. one of the things that you brought it is extremely important, five years ago, last year we had the va and dod came in and they just build a billion dollars, a built-in

. >> dr. roe, i agree completely. i would like to make a comment regarding the no-show rate. dr. mccaughey has mentioned it and you've mentioned it in a commercial setting how important that is. our experience for 5 1/2 years, we provided services under project hero, which was a contract with v.a. where we provided administrative services. and we set the appointments. we essentially would get the veteran on the line with the doctor's office and do a three-way conference call to set the appointment. and then not only send a letter, but we would follow up within 48 hours before the appointment to remind the veteran of the appointment, plus the directions to the doctor's office. our no-show rate in project hero was less than 5%. >> same as ours. i think you show right there, that's a metric in the private world that you use because, again, your incentives are different in the private sector versus where you have just a v.a. budget that you have this much money to spend at the end of the year and you spend it, you send it back. >> that's exactly right. we were not compensated at all

and to go back to what dr. roe really said, and i think you testified to it, you're setting out a template. the secretary is setting out a template. how low is that bar really? obviously, in my past career, we have performance incentives all the time. we had several tiers of it. we would -- we would have two categories. would be likely to be earned and unlikely to be earned. and it would actually count against the salary cap of that team. it wasn't either all in or all out. there were tiers to it. but i just wanted just -- and i'll end here. and i really don't have a question. i just want to say to -- to be able to have something you're going to set a bar that low, and not be able to really truly measure it, you know, incentives are great. and i don't think anybody here would agree that uniformly across the v.a. that they're being applied equally. and you've said it, too. it's very subjective. the basis of it is getting the facts. and i think we're so far away from that at this point. i really don't even have a que

as dr. roe pointed out the other night, all va employee needs to do without a doubt is they have to be reminded that they are working for the veteran. not a bureaucracy. as with most things, there are tradeoffs when looking at structural reform, centralization versus decentralization, standardization versus innovative. these discussions have been ongoing for years if not decades. i'd like to think vha is an adaptable learning organization that can make needed transformation. but let me be clear. the only way we're going to truly address the litany of problems is to look at the fundamental change within the department. and rightfully, we're all looking at ways to address the problems as we see today. but i'm hopeful that our ambitious schedule of hearings in the weeks ahead will think anew about how best to provide the quality comprehensive care to our veterans in a timely fashion. and i hope that they challenge us to think anew about how to refashion systems and infrastructure, management and pe

the speaker pro tempore: the -- dr. roe. the speaker pro tempore: the gentleman is recognized. mr. roe: i rise in support of h.r. 4810, the veterans access to care act. as a physician, veteran and member of the house veterans affairs committee, words cannot express my outrage over the v.a.'s blatant disregard for the lives of those who serve their country honorably and earned timely access to quality care. i've helped run a hospital and am fully aware of how wait times and performance goals work. when the v.a. set a 14-day goal for scheduling poims it should have become immediately apparent that this was unattainable and could only be realized by cooking the books. even in the private sector a 14-day wait time is quite ambitious this bipartisan legislation offers a simple solution to a deadly problem. the needs of the vast majority of v.a. patients across the country can and will continue to be met through the existing v.a. system. but it's outrageous that veterans could die awaiting care that's readily available in the private sector. so this is a commonsense solution and frankly,

so, i'm going to close my time and i just want to thank you for coming, and i also want to join dr. roe in addressing. i have a constituent here from berlin high school who is joining us in the back of the room, foster, not child but young person, here to learn about congress. mr. fugate, i think you have a bright future and i can just hope and pray that you might choose to address it to resolving the computer issues at the va. so, thank you for joining us. >> thank you. before the panel leaves, i would like to have mr. handle discuss an issue that mr. o'rourke raised relative to the compliance of this committee's website. >> thank you, chairman. to your question, sir, the committee's website does use a reader, and it's called browse loud which is an element of the 508 compliance. so, have you folks at the panel been able to access that? >> could you say the name again please? >> browse aloud. >> i have not used it. >> then we'll get with you after this and you can make sure it does address your needs. >> can i make a comment on that? >> please. >> there are standard screen reading soft

dr. roe brought this up. mr. o rourke and i brought it up with several others. this is the time to think fundamental change. this is the time to think big. i found it interesting that you focused, dr. clancy, on the triage, which of course needs to be done with these veterans right now. and called what we were talking about a second order question. i would argue that you had addressed that earlier, we would have never had phoenix. we would have never had those things. i'm going to ask you, are both of you clinically credentialed. >> i'm not currently -- not clinically credentialed at this time. i certainly have been for the last -- >> can you see patients? >> i cannot see patients, no. >> dr. clancy? >> i haven't. i haven't for a number of years. i've actually looked into what would be required. >> but you're both doctors? >> yes. >> and we don't have enough doctors. so i'm going to say what vietnam veterans of america made this suggestion to you. the question was that you haven't contracted them. this is what they said you needed to do to fix this in phoenix. a

but i'm with dr. roe. but feel something has not been given to me. that may be totally false, but the impression was there. >> i have no doubt this committee will get that report. i just don't have responsibility for it. but i have no count. >> the person who is responsible. we might have to bring them in. what's the job of the congressional liaison. to?do we talk are you there for us to talk to or should we skip over you and directly to general counselman. in a , congressman, subpoena, that's the matter. we work with the committee and the staffs. that without a subpoena. >> every day. >> dr. win strop, you're recognized for five minutes. veteran and physician, i have serious concerns like this committee. patients o many cancel? >> they were cancelled in an effort to reschedule them more timely, first of all. >> to have them seen sooner? >> cancelled to be seen sooner. >> and rescheduled sooner. new patients or some follow-up? historically in phoenix, as i understand it, the management miss helman had used he model where they did not employ the wait