mr. takano, ms. brownley of california, kirkpatrick, and mr. walz. the speaker pro tempore: for what purpose does the gentleman from new jersey seek recognition? mr. frelinghuysen: mr. speaker, i ask unanimous consent that all members may have five legislative days to revise and extend their remarks and include extraneous material on h.r. 4870 and that i may include tabular material on the same. the speaker pro tempore: without objection. that motion is adopted. pursuant to house resolution 628 and rule 18, the chair declares the house in the committee of the whole on the state of the union for consideration of h.r. 4870. the chair appoints the gentleman from new york, mr. collins, to preside over the committee of the whole. the chair: the house is in the committee of the whole on the state of the union for the consideration of h.r. 4870, which the clerk will report by title. the clerk: a bill making appropriations for the department of defense for the fiscal year ending september 30, 2015, and for other purposes. the chair: pursuant to the rule, the

mr. takano. >> thank you, mr. chairman. mr. huelskamp, that last question brought up some very better better memories. my first, what am i first committee hearings was about this issue of the medical records not being able to be transferred from dod into vista. and i can barely contain the anger i feel about this situation, and the millions and millions of dollars that have been spent trying to solve the situation, and then to hear in the interim the months between my first hearing and now that there seems to be no way to bridge this fall between the two departments. it's bad enough to see a casualty of war, but it's even worse to see that casualty of war maybe even more tragic -- made even more tragic by this system ago between these two departments. i don't know what to do about this. it is frustrating to be a member of congress and not to be able to say, fix this thing and have it fixed. with that being said i do want to say to mr. fugate and -- isn't mr. kebbel? mr. kebbel, that i'm proud to have started the first deaf cauc

mr. takano, you're recognized for five minutes. >> thank you, mr. chairman. thank you dr. lynch and dr. clancy for appearing before us today. i under from 2008 to 2013 nonva care out patient visits grew from 9 million to 15.3 million, 72% increase. do we have any way of knowing about the comparison between nonva care versus inhouse care, it's efficacy and its cost? >> i don't have the comparative data from those years. in the last fiscal erwe spent $4.8 million on nonva care. i have to get previous data to see how our use of nonva care has increased or has changed as we've seen increasing outpatient requirements. >> it seems to me that if we want to expand access for veterans to nonva health care, it will be extremely important there's a continuity of care and health records can be transferred seamlessly and that's part of what you were talking about, i guess, when you were trying to do a quality check on the pc3 and finding those community providers. what can we do to ensure that this happens? >> i think that is a very good question and it's a challenge. right now our community provide

mr. takano, you're recognized for five minutes. >> thank you, mr. chairman. ms. farrisee, can you tell me how many employees under title 5 -- title 5 is what we're talking about. the title 5 employees who were involved in the bonus system. i know there's title 38. but the title 5 employees are the ones who were in charge of managing and responsible for the scheduling. how many employees received bonuses? >> across the complete v.a. or only ses? >> well, it's the -- well, give me the ses number first. >> actually received -- of the -- about 78% of the ses. but that includes title 5 and title 38. >> okay. >> and there are title 5 and title 38 employees at the medical centers. >> okay. but with regard to the -- the accountability for the gaming of the system, i'm trying to get a handle on how -- how many employees are, sort of, accountable for that. i mean, i'm thinking the title 38 are the providers that -- you know, the medical practitioners that for other reasons are getting pay beyond their base pay, right? >> correct. but that is possible there are some title 3

mr. takano of california. mr. takano: mr. chairman, i rise in support of congressman farr's amendment that would remove the waiver that would exempt schools from providing even a half a cup of fruits and vegetables to their students for lunch. more than 200 education and nutritional organizations oppose this. while it may get difficult to get kids to eat healthier, it may be possible as 90% of schools are already meeting the standards. rodney taylor, the director of food services at riverside school district, which is in my district, sent me letter about the importance of nutrition standards saying, quote, children in our district and many others are enjoying meals that meet the updated school lunch requirements from the usda from proving it is possible to have healthy children and healthy budgets. letting schools opt out of these standards will not help them move forward and will be detrimental to the children they serve, end quote. i thank congressman farr for introducing this amendment and i urge all of my colleagues to su

mr. takano, state of california. >> thank you, mr. chairman. dr. mccarthy, just help me, where is this -- where is your center located? physically? >> the vision center of excellence. i'm going to defer to dr. lawren lawrence. >> dr. mary lawrence. the vision center of excellence has two locations in the national capital region. one our headquarters is at walter reed national military medical center in ba these da and we have an office in crystal city, arlington, virginia, and we also have a small office at madigan army medical center in tacoma, washington. >> and walter reed sunday the aegis of the dod, but this center for visual excellence -- one of them is located at walter reed, is that right? >> yes, sir. this is dr. mccarthy again. the vision center of excellence is a joint effort between dod and va, and of the centers of excellence, dod authorized navy to be involved with this. so it's a partnership between the navy on behalf of dod with va. >> that clears up something. i have been to walter reed and saw the center, and so i thought is that

mr. takano and others, and look at the local vha is a little at the hospital or the clinic, and something other are concerned about provider shortage and what it will take to attract and retain the best talent possible to serve the veterans that we represent. and so i'd like to understand how salaries and incentives are set for the providers that, the doctors, psychiatrists and nurses, nurse practitioners and others are to provide the care to our veterans. >> it is a complex process of calculation on market day so that we can look at what the national pay is, and that is used in calculating what we recommend for me. it's and addition to a base pay. if we're talking but sas, talk about title v. there's no addition to any other base pay. our title 38, physicians and tenses, will receive in addition to the base pay, this market day which must do these calculations to come and then also they can receive a performance pay that has nothing to do with an award of performance but it is a contract and objectives that they must meet in order to receive that performance by. >> and so apart from the

mr. takano. yes, sir. >> so i'm a little confused by interoperability of records. can you help me explain about there is no interoperability? >> well, this is a case where you're both right. the second stage of the so-called meaningful use, this is the series of stepped incentives, right, that cms has put in place, incentivizing private sector providers to adopt electronic health records and the like. not just to buy the stuff but to actually use it in such a way as to improve quality of care. that second stage of meaningful use actually requires the providers be able to share some information with other providers. so you're right that meaningful use is actually a path to getting us to a place where we can share all the information. i think it's fair to say that many providers are finding this challenging. so the doctor is also correct when he says give me a break, because if you're thinking about actually just uploading all information from one to another, that's actually much, much steeper and likely a bit far off, but i think your original assertion that, in fac

takano. >> thank you, mr. chairman. and really to observations, and i want to say, there are probably not a lot of people having these discussions. i don't think there are a lot of people on this committee that really have much faith in a lot of the metrics that we use va wide because i know that we all go through whether it is our health centers or regional offices and are totally confused by any metric they throw at us. and to be able to award performance awards off of those type of metrics are mind-numbing to meet. stickleback to what representative roe said, and i think you testified to it, they are sending back a template, the secretary said the representative wenstrup templates. how low is that are really? obviously in my past career we have performance incentives all the time. we had several tiers of it. we would have two categories, likely to be earned and unlikely to be earned, and it would actually count against the salary cap of that team. it was not either all in war all out. there were tears, but i just wan

mr. chairman. >> thank you, senator. congressman takano. >> good afternoon, co-chair sanders and co-chair miller. thank you for the work you have been doing and also thank the ranking members. it is an honor to serve on this conference committee. in the wake of reports of misconduct within the va learning so many of our veterans aren't receiving the care they need in a timely manner and allegations some veterans died as a result of long wait times and the deaths may have been covered up, i look forward to us all working together to pass a bill that will give us -- that will give our veterans access to the health care they need and deserve. it is clear that any solution must include accountability mshls for va employees, improve vha scheduling practices for appointments and prevent future abuse and provide our veterans with timely access to quality care. it is also clear especially in light of yesterday's allegations about cover-ups at the phoenix va that we need to re-evaluate the culture at the va and take steps to ensure that the departm

mr. chairman. >> thank you, senator. congressman takano. >> good afternoon, co-chair sanders and co-chair miller. thank you for the work you have been doing and also thank the ranking members. it is an honor to serve on this conference committee. in the wake of reports of misconduct within the va learning so many of our veterans aren't receiving the care they need in a timely manner and allegations some veterans died as a result of long wait times and the deaths may have been covered up, i look forward to us all working together to pass a bill that will give us -- that will give our veterans access to the health care they need and deserve. it is clear that any solution must include accountability mshls for va employees, improve vha scheduling practices for appointments and prevent future abuse and provide our veterans with timely access to quality care. it is also clear especially in light of yesterday's allegations about cover-ups at the phoenix va that we need to re-evaluate the culture at the va and take steps to ensure that the departm

mr. chairman. >> thank you, senator. congressman takano. >> good afternoon, co-chair sanders and co-chair miller. thank you for the work you have been doing and also thank the ranking members. it is an honor to serve on this conference committee. in the wake of reports of misconduct within the va learning so many of our veterans aren't receiving the care they need in a timely manner and allegations some veterans died as a result of long wait times and the deaths may have been covered up, i look forward to us all working together to pass a bill that will give us -- that will give our veterans access to the health care they need and deserve. it is clear that any solution must include accountability mshls for va employees, improve vha scheduling practices for appointments and prevent future abuse and provide our veterans with timely access to quality care. it is also clear especially in light of yesterday's allegations about cover-ups at the phoenix va that we need to re-evaluate the culture at the va and take steps to ensure that the departm