mr. petzel, to be able to go out and recruit and get folks in? because i'm not sure we're there yet. >> thank you, mr. secretary, and thank you, senator. i am aware of the issues at ft. harrison. we have four psychiatric psychiatrists vacancies. in general, we can recruit around the country very successfully for psychiatric social workers, for psychiatric nurse clinicians, and for clinical psychologists. is the m.d. psychiatrist. the most difficult recruitment is the m.d. psychiatrist. this is an issue that all health systems around the country face. we are very competitive, however, in terms of wages, in terms of working conditions and the other kind of things that are appropriate and are needed for recruitment. so it -- i think we're in a position to do the best job we can for recruiting. i don't know what we can add right now to the basket, if you will, of things that we have to offer. it's a matter of identifying the people that want to come to places like helena, which is beautiful, by the way. >> thank you. >> and in an environment where th

petzel for any details. >> thank you, mr. secretary. madam chairman, as a result of the hearing that we had earlier in the year we have now done two things that are, i think, important and on point with regard to your question. one is that we've developed a staffing model. it is the only staffing model that i know that's available about mental health. it's in the beginning stages, but it is giving us some information about what the need might be. but i think more importantly, we're site visiting all 152 of our medical centers to look at the access to mental health services, both the initial appointment and subsequent appointments for, be it for ptsb inpatient program, group program or individual psychotherapy. and what we're finding is that there is, we do meet the criteria for the first appointment in most every instance. we're having some difficulty in some parts of the country making the next appointment in a timely fashion, getting them as you mentioned earlier into the specialty services. this could be the result of three things. o

petzel for any details. >> thank you mr. secretary. madam chairman as a result of the hearing we had earlier this year, we have now done two things that are a think important and on point with regard to your question. one is that we develop a staffing model. it is the only staffing model that i know that is available about mental health. it is in the beginning stages but it is giving us some information about what it might be but more importantly we are siding all 152 of our medical centers to look at the access to some mental health services both in subsequent appointments for ptsd inpatient programs or individual psychotherapy and what we are finding is that there is, we do meet the criteria for the first appointments in most every instance. we are having some difficulty in some parts of the country making the next appointment in a timely fashion, getting them as you mentioned earlier, into the specialty services. this could be the result of three things. one is do we have enough staff out there? here i we give an enough positions in

petzel for any details. >> thank you mr. secretary.hairman, as a result of the hearing we had earlier in the year, we have now done two things that are i think important and on point with regard to your question. one is that we developed a staffing model. it is the only staffing model that i know of that is available about mental health. it's in the beginning stages but it is giving us some information about what the key might be but i think more importantly we are site visiting all 152 of our medical centers to look at the access to mental health services both evangel appointments and subsequent appointments for the impatient -- and patient program or individual psychotherapy. what we are finding is that, we do meet the criteria board the first appointment in most every instance. we are having some difficulty in some parts of the country making the next appointment in a timely fashion, giving them, as you mentioned earlier, into the specialty services. this could be the result of three things. one is, do we have enough staff out there

petzel to provide more detail. >> thank you, mr. secretary. the savings -- let's go through a little bit of what went on in '11. we saved a large amount of money. the gao reviewed that and we're still actually negotiating with them about what they actually found. we indeed can validate the savings that we have claimed from the various operational efficiencies. they do have a legitimate criticism about the way we measured things and the in which we'll be improving. for 2013, as the secretary mentioned we are going to save a large amount of money in dialysis. we have got contracts now or blanket purchase agreement virtually every dialysis centers we will use will save us hundreds of millions of dollars. the medicare rate payment change that occurred with the regulations allowing us to charge -- to collect medicare -- charge medicare rates for both the professional fee and the facility fee is going to save us about $300 million that's absolute money that we would have spent otherwise had we not been able to do that. and in the efficiencies with v

let me turn to there petzel for details. >> thank you, mr. secretary. madam chairman, as a result of the hearing we had earlier in the year, we have now done two things that are, i think, important and on point with regard to your question. we have developed a staffing model. it is the only staffing model available about mental ehealth. it is in the beginning stages, but giving us an idea of the need. we are site visiting all 152 of our medical centers to look at the access to mental health services. both the initial appointment and subsequent appointments for ptsd or individual psycho therapy. what we are finding is there is -- we do meet the criteria for the first appointment in most every instance. we are having some difficulty in some parts of the country making the next appointment in the timely fashion. getting them into the specialty services. this could be the result of three things. one is do we have enough staff out there? have we given enough positions and resources? two, are those positions filled? are they filling those up in a timely fashi

petzel to provide more detail. >> thank you, mr. secretary. senator boozman, the savings -- let's just go through a little bit of what went on in '11. we saved a large amount of money. the gao reviewed that and we're still actually negotiating with them about what they actually found. the essence is going to be that we indeed can validate the savings that we claimed from the various operational efficiencies. they do have a legitimate criticism about the way we measured things and the granularity of the measurement in which we're going to be improving. for 2013, as the secretary mentioned we are going to save a large amount of money in dialysis. we've got contracts now or blanket purchase agreements with virtually every dialysis center that we used that are going to save us hundreds of millions of dollars over what would have expended had we not been able to do that. the medicare rate payment change occurred with the regulations allowing us to charge -- to collect -- charge medicare rates for both medical fee and facility fee is going to save u

petzel for any details. >> thank you, mr. secretary to the madam chairman, as a result of the hearing we had early in the year, we have not done two things that are important and on point with regard to your question. one is that we developed a staffing model. it is the only staffing model that i know is available about mental health. it is and the beginning stages, the it is giving us some information about what the need might be. more importantly, we are side visiting all 152 of our medical centers -- site visiting them at the access to medical services, both the initial appointment and subsequent appointments for pst in-patient program, a group program, or individual psychotherapy. what we're finding is we do meet the criteria for the first appointment in most every instance. we're having some difficulty in some parts of the country making the next appointment in a timely fashion. getting them, as you mentioned earlier, into the specialty services. this could be the result of three things. one is, do we have enough staff o