▶ 0:09:49committee will come to order and good morning. I want to thank uh you to I want to say thank you to all of our witnesses for being here and when it uh you know when I got home from the Marine Corps VA was a different place was a long time ago too by the way. Um it was slow, it was frustrating and less modern.
▶ 0:10:08Now, we've made progress, a lot of it, because the work the comm this committee, not only in this session, but over the years, has done to make sure that it is moving into the modern world. But I'm not interesting, not interested at all in patting ourselves on the back. There's still too much work to do. Today's hearing will be about making sure veterans have access to the best health care technology available.
▶ 0:10:34No matter where they live, what they've been through or when they serve. We're here to ask a few basic questions. What innovations are working? What's holding them back? And how can we faster? Government delays and red tape should never be the reason a veteran can't get a life-saving can't get life-saving care.
▶ 0:10:57I support efforts to cut waste, eliminate duplication, and streamline the way VA buys new tools and services. And from my seat as chairman, I am focusing on pushing VA into a modern agency, and I know it can be done.
▶ 0:11:15AC acquisition reform isn't flashy, but it And when it comes to bringing new technology into VA, the stakes are too high to let process get in the way. VA has said they want to partner with industry and academic leaders, and good.
▶ 0:11:36But we need to know that what really what that really looks like, who's getting through the door, and how long it's taking. Let's get past buzzwords. Veterans don't need more talking points. They need results. That's what House Republicans and the Trump administration are focused on. Over 30 million American lives with with over 30 million Americans live with diabetes.
▶ 0:12:07The VA, one out of every four patients have it. Heart disease is the number one cause of hospitalization at the VA and it kills twothirds of our veterans who live who diabetes. PTSD makes those things worse. It increases the risk of heart disease. It causes sleep issues and veterans with chronic pain suffer more and longer than the average American.
▶ 0:12:35These are real challenges, but there are real solutions out there. Many of them are sitting in this room today. Still, innovation takes too long. A recent study showed that hospitals struggle to bring new products and tools. Budgets are tight. Training takes time. But I want the VA to be the the exception. Veterans can't afford to wait. That's especially true for rural veterans.
▶ 0:13:04Too many lives um too many live hours away from care. They deserve access to the same devices and services as someone in the big city. That's what the hear that that this hearing is all about. The people here today aren't just developing impressive technology. They're building tools that have have veterans and give veterans more options, more access, more chances to live live healthier lives.
▶ 0:13:34Our job is to make sure the system helps, not hinders that work. We owe that to today's veterans and to the veterans of tomorrow. One day, I suspect more of my grandchildren will be veterans. And I want them to walk into a VA that's not just functional, but forward thinking, fast, innovative, at the front of of of at the front edge of modern medicine.
▶ 0:14:02So, let's keep moving towards that goal. And with that, I want to welcome our witnesses and look forward to your testimony. And I now recognize ranking member Takano for his opening comment. Thank you, Chairman Chairman Boast. I want to be very clear. Veterans deserve to receive gold standard healthcare. Veterans deserve access to the most cutting edge medical innovations.
▶ 0:14:30and veterans deserve a VA that is fully staffed to deliver the worldclass care and benefits they have earned. These are core beliefs that I hold. Achieving these goals depends on Congress meeting the true funding needs of VA. But under Trump and Secretary Collins, VA leaders are being forced to make impossible choices.
▶ 0:14:53cut after cut after cut to personnel, contracts, and veterans care, all in the name of so-called efficiency. These cuts are not making VA more efficient. They are forcing VA to decide between keeping staff on the floor and investing in expensive equipment that may sit idle without enough personnel to operate it. Let me said it again.
▶ 0:15:24The gentleman that before us today to talk about the innovations and the medical equipment that they want to sell VA that there may not be the personnel that's trained and ready to operate that equipment. If the draconian cuts at VA were improving care, VA would be would be here telling us about it. But what we are actually hearing are reports of the opposite.
▶ 0:15:53So on poster number one, this is a prosthetics customer service uh center shut but has its doors shut in Grenville, North Carolina. The VA clinic prosthetics are, you know, the the the artificial limbs that veterans need. That is a VA facility that's been closed in a members district who sits on committee.
▶ 0:16:21Post number two, Doge has canceled a contract for a mobile MRA unit at the Danville VA Medical Center. And then finally, here's a contract for supply chain management support cancelled by Doge.
▶ 0:16:43As we sit here today, instead of sending officials to testify before us, VA leaders two miles away at central office are planning how they're going to cut how they're going to fire over 80,000 additional employees. Unfortunately, due to the financial reality VA currently faces and the uncertainty about the future of VA's workforce, medical center and vision directors have to make either either or decisions routinely.
▶ 0:17:13Either or either or new cutting technologies or fully staffing VA in many cases staffing VA and able to facilitate the operation of these new innovations.
▶ 0:17:29Just a few months ago, we heard from a VA medical center director who told us that he had to put off purchasing new telemetry, a new te telemetry unit and hiring additional staff to operate it because his budget had been eaten away by skyrocketing community care costs. We know for a fact that there is expensive medical equipment sitting idle in VA facilities across the country because it does not have the staff to operate or maintain it. We're talking about medical equipment that already exists at VA.
▶ 0:18:00We are missing a whole side of this conversation today, and that's no accident. The majority deliberately chose not to invite VA to testify, shielding the department from the responsibility and real oversight this committee is supposed to provide. When the minority invited VA to send witnesses, VA declined. I'll say that again. VA declined the minority's invitation to be here today.
▶ 0:18:30The majority decided that we don't need to hear about VA's actual need for these devices, that we don't need to hear how VA will pay for these investments. and they did not care if we heard rather VA has sufficient workforce to supply to provide the manpower and and follow-up maintenance that is necessary with machines and devices like the ones our sell without V here without VA here to provide excuse me without
▶ 0:19:00VA here to provide the other side of the story about the on the ground reality of veterans needs all you're going to hear today is a sales pitch and indeed an expensive one at at VA leaders also deserve to speak uh about uh the the the department's proud history of research and innovation. VA has long been at the forefront of biomedical breakthroughs that have saved millions of lives. Breakthroughs like that corporations like Phillips and Boston Scientific have profited from.
▶ 0:19:30For instance, Dr. William Oldenorf, a VA neurologist at the West LA VA Medical Center, developed the first prototype and held the first patent for a CT scanner in 1963. Philillips now sells CT scanners to VA. Likewise, Boston Scientific would not have been able to develop and sell its pacemakers had it not been for the groundbreaking research of Dr. William Chartik and Mr. William Mr.
▶ 0:19:58the Wilson Great Batch of the Buffalo VA Medical Center in 1960. But if VA is to re remain a leader in medical renovation, we need to invest in its research infrastructure, not outsource that expertise to private companies whose bottom line takes priority. Now, VA should be here. That's exactly why I find the timing and participants of this hearing so strange.
▶ 0:20:23At a time when Secretary Collins is cutting research, slashing staff, eliminating worker protections, and cancelling critical contracts, my colleagues across the aisle are suddenly eager to talk about innovation and the brand new equipment VA needs to buy. How tonedeaf is that?
▶ 0:20:42I don't believe the Trump administration is setting up VA is setting VA up for success in providing basic care for our veterans right now, let alone creating an environment that will lead to groundbreaking innovations. I have to say, if things continue at this rate, the time of VA as an innovative force will be behind us. I'm not willing to see that outcome come to pass. My colleagues across the aisle talk a lot about making hard choices to get our country's finances back in line.
▶ 0:21:12But let's be clear, those hard choices should not mean choosing between veterans care and corporate profits. And right now, VA facilities are being forced to decide whether to keep the staff they need to provide veterans quality care or spend billions on expensive high-tech high-tech equipment sold by for-profit companies whose promises are not to our veterans, but to their shareholders. Bottom lines.
▶ 0:21:35I'm worried that we are not even getting that we're not even getting to be able to fulfill the fundamentals of care and benefits for veterans if Trump and Collins keep arbitrarily cutting staff resources. I want the Veterans VA serves to have it all. Worldclass care, cutting edge in cutting edge innovations, and a fully staffed VA that is prepared to meet their needs today and in the future. But that future is at risk if we continue down this path of arbitrary cuts and misplaced priorities.
▶ 0:22:06We cannot allow VA's mission to be undermined by short-term costcutting or long-term privatization. And with that, Mr. Chairman, I yield back. Thank you, Ranking Member Tano. And it's great to see that jet lag has not affected your ability to deliver messages. Oh, thank you. Glad to see you here this morning. We both got in from Japan yesterday. It's wonderful with where we went and what we did. But we will now turn w to the witnesses uh testimony.
▶ 0:22:36Now testifying before us today, we have Mr. Will Gray uh vice president for marketing, commercial operations and government of at Boston Scientific. Boston Scientific has made advances in the medical device field using stints among other technologies. We also have Dr. John Bloom. He's the chief executive of uh Podrammetics.
▶ 0:22:59And Padromedics has partnered with the VA on programs calling the uh initiative to end diabetic limb loss at VA. We also have Mr. Jeff Dulo uh executive vice president of the chief she chief regional leader of Phillips North America.
▶ 0:23:20Philips North America offers a range of products that among other functions utilize imag um imagining to create uh visual representations of the body's interior. And we also have Dr. uh Pas Rothi um director of the center for sleep uh and uh ne ner neuroscience research at the University of Arizona health science.
▶ 0:23:50Uh the university has invested in sleep apnea research among other areas. Will each of the witness please stand and raise a right hand? Do you solemnly swear that the testimony you're about to provide is the truth, the whole truth, and nothing but the truth? Thank you. You may be seated. Um that let the record reflect the witness all answered in the affirmative. Mr. Gray, you are now recognized to deliver your testimony for five minutes.
▶ 0:24:20And I will explain the the light system here. Red or green, you're going. Yellow, it's coming to a close. And red, you better get her stopped. And I don't want to play rodeo. and throw you out in eight seconds. So there we go. Great. Thank you. Chairman Boston, Ranking Member Tano, and distinguished members of the committee. Thank you for the opportunity to testify today. My name is Will Gray. I'm a proud Marine and have spent the past 25 years at Boston Scientific.
▶ 0:24:50For the past 13 of those years, I've focused on the commercial strategy in the VA and the Department of Defense, ensuring that veterans and military personnel have access to life-saving medical technologies. I also lead our marketing and commercial operations strategy for Boston Scientific for our largest civilian health care systems.
▶ 0:25:09This role gives me a unique perspective on how advanced civilian hospitals provide care in the quadruple aim and that's efficiency, quality, cost, and patient satisfaction. At the same time, I remain personally dedicated to the veteran community, mentoring and advocating for those that have selflessly served our country. Boston Scientific is a leading US global medical technology company headquartered in the Boston area.
▶ 0:25:37We have a strong US presence in me manufacturing and research with thousands of employees in states like Massachusetts, Minnesota, Indiana, Texas, and Georgia. We focus on technologies that address major health needs in the veteran population, pain, heart disease, stroke risk, and neurologic and gastrointestinal disorders. Over 65% of veterans suffer suffer with pain.
▶ 0:26:04To help reduce opioid use and improve quality of life, we offer nonopioid solutions like spinal cord stimulators, which deliver personalized pain relief. For veterans with atrial fibrillation, our Watchman device offers a safe alternative to blood thinners, reducing stroke risk through a minimally invasive procedure, and those patients are five times more at risk than those without atrial fibrillation.
▶ 0:26:29We've also developed Ferrapulse, a pulse field ablation technology that's truly transforming how atrial fibrillation is treated. In less than a year, that therapy has become the dominant type of uh treatment for AIB, for EP ablation, taking over for RF and cryoblation.
▶ 0:26:50For those uh patients and veterans with peripheral artery disease, our technologies help keep arteries open and prevent repeat procedures and potential limb loss. For the heart, we have a agent drugcoated balloon which which was just FDA approved that delivers medication directly to the artery, reducing the chance of blockage for for stance. These innovations have already improved care in civilian hospitals, and all veterans deserve the same access.
▶ 0:27:20The VA has the VA has made meaningful progress in integrating clinician voices into into its procurement system. In 2017, we worked with other companies in this committee alongside representatives Scott Peters and General Jack Bergman to help improve the meds surge prime vendor program. This effort brought clinical expertise into purchasing decisions and created a rolling process for adding new products. I would say the MSPV today is a model for how clinicianled sourcing can work.
▶ 0:27:50And today we're working with this committee to apply those same principles on the prosthetics and sensory aid services or PASS program. Again, ensuring that clinicians are part of the procurement process helps ensure product decisions reflect the needs of veterans. And this is what we do in the civilian side as well. Having physicians and clinicians involved in that process is critical. Despite these successes, challenges remain.
▶ 0:28:14Technology adoption is often delayed due to staffing shortages, budget unpredictability, and inefficient procurement workflows. One example is that pulsefield ablation technology I talked about that that has become the dominant therapy for EP ablation. In the US, we project 61% of EP ablations will occur um uh with pulse field ablation this year, right? 61%. But less than 10% of VA hospitals have access to that therapy. Less than 10%.
▶ 0:28:45To address this, we we recommend the following. A transparent, predictable budget process at the hospital level. That's number one. Number two, hiring and training more procurement staff. Number three, adding two um psych product cycles when you can add products on all national contracts. You have it on the MSPV. We recommend you put it on the PAS as well. and then consider an innovation fasttrack for high impact technologies.
▶ 0:29:10Again, the VA has made commendable progress in modernizing procurement, especially through clinician engagement, but more must be done to ensure veterans receive timely access to the technologies available in commercial hospitals. Boston Scientific is proud to support the VA, this committee, and all those working to improve care for those who served. To this committee, I thank you for your service to our veterans, and I thank you for your time. Thank you, Mr. Gray. Uh, Dr. Bloom, you are recognized for five minutes for your opening statement.
▶ 0:29:41Chairman Bost, Ranking Member Tano, and distinguished members of the committee, thank you for the opportunity to testify today. I'm Dr. Jonathan Bloom, a physician and the proud son of a decorated Vietnam veteran who is sitting behind me today. I co-founded Pometrics over 13 years ago after spending way too many whole days in the operating room doing nothing but amputations for for diabetes. Essentially, Civil War medicine, limbs we could have saved with early intervention.
▶ 0:30:10A staggering one in four veterans have diabetes. Double the rate of non-veterans in our nation. Compromised blood flow into the limb and diminished sensation in the feet, both the result of unchecked diabetes, can result in a diabetic foot ulcer, a a typically silent wound to the bottom of the foot. Veterans and caregivers are often unaware until the wound is o the wound is open, infected, life-threatening, and requires emerent intervention, a lifealtering amputation.
▶ 0:30:41In fact, 85% of lower limb amputations are a result of a diabetic ulcer. Most crazy enough, the five-year mortality after a foot ulcer is 70%, which makes it worse than almost all cancers that we have. Uh and then of course each year the VA estimates that they spend approximately $3.2 billion in direct expenditures just caring for diabetic foot ulcers and more recently 3.5 billion.
▶ 0:31:08I've been working with the VA for over a decade to develop a solution to prevent diabetic foot ulcers. Starting with our very first clinical trial in the VA in 2013. Seven years later in 2020, after years of research and study, we formalized our partnership to develop and deploy a remote temperature monitoring program with the Podometric Smartmat called the VA's initiative to end diabetic limb loss supported in part later on thanks to all of you through the 2020 CARES Act. And here it is real quick here.
▶ 0:31:38You know, basically uh uh from the comfort of a veteran's home, a veteran stands on the smart mat for just 20 seconds a day while they're brushing their teeth or combing their hair. The MAT then scans for temperature changes in the feet which may indicate a developing foot ulcer. The data is then securely trans transmitted for analysis without the need of Wi-Fi or mobile device allowing a clinician to intervene hopefully in time to prevent the complication before it occurs. The impact of this collaboration has been remarkable.
▶ 0:32:07VAled research suggested that clinicians could detect 97% of diabetic foot ulcers on the bottom of the foot over five weeks before they would have otherwise recognized them. VA research presented last year suggested participation of the program resulted in a 37% reduction in one-year mortality. That equates to one veteran life saved for every 23 veteran participants uh who came into the program in just the first year alone.
▶ 0:32:35In March of last year, fewer than 6% of eligible veterans enrolled for 12 months or with that population, the VA reported that it had saved an estimated $100 million over that period, almost $16,000 per veteran participant per year.
▶ 0:32:51If scaled to all 110,000 veterans at the at the highest risk of a new di new diabetic funer, this program could save approximately 1.8 8 billion annually to the VA to US taxpayers and save approximately 5,000 veteran lives in just that first year. Partnering with the VA, we have proven remote temperature monitoring program that the program works, but scaling this technology to every every eligible veteran remains a challenge.
▶ 0:33:16I want to share four observations uh that I've seen over my 10 plus years working with the VA on foot ulcer prevention. One is that rural and low-income veterans still struggle to gain access to the system relative to their counterparts. It's still a challenge. Two, almost all enrollments come from VHA podiatry. Yet only half of atrisisk veterans get their podiatric care at the VA. We must ensure equal access regardless of their geography or circumstance. No veteran should be left behind.
▶ 0:33:45Number three, budgeting silos do affect veteran care. The prosthetics budget pays for the system, but most of the savings goes to medical care. budget must be protected to ensure that we don't save a little spend in one silo at the expense of dramatic savings in another. These budgets do not coordinate as they work together. And then lastly, the workload credit to do to do an amputation is dramatically higher than the workload credit to prevent one.
▶ 0:34:12Until incentives are fixed for this complication, the VA will struggle to deliver care deliver preventive care. And stated hyperbolically, we have all the people we actually need. They're just too busy treating preventable complications. To close, in in most of your districts right now, Pometrics and the VA remote temperature monitoring program are improving our veterans healthcare, but almost 100,000 veterans still need access. Over one and a half billion in loss savings each year.
▶ 0:34:40No veteran should walk into a hospital one day and then leave in a wheelchair or worse, not at all, especially when we have the technology to prevent it. Thank you, and I look forward to your questions. Thank you, M. Bloom. Uh, Mr. Dulo, um, you recognized for five minutes. Chairman of Vast, Ranking Member Tano, and distinguished members of the committee. It's an honor to be before you today. My name is Jeff Dulo.
▶ 0:35:05I have the privilege of serving as the CEO of Phillips North America, leading a dedicated team of 17,000 professionals, many of whom are veterans themselves. Phillips is a global health technology leader, delivering AI enabled solutions in diagnostic imaging such as MRIs or CT scans. non-invasive cardiac procedures and patient monitoring solutions spanning from hospital to home. Our mission is to improve the lives of two and a half billion people per year through meaningful innovation.
▶ 0:35:32And nowhere else are we more focused on this mission than in serving America's warriors. At Phillips, we get to serve heroes and we know that. And we do this by putting our innovation to work specifically for the VA. Some examples, a critically needed MRI in the aftermath of a battlefield trauma, helping clinicians to monitor veterans remotely because we know veterans recover better at home, accelerating precision detection and treatment of cancers, and bringing the highest quality cardiac care to our veterans.
▶ 0:36:02Our mission is clear. Support the best possible care for those who have defended our freedom. And for me, the mission is also a personal one. I am a graduate of the United States Military Academy. I served as an infantry officer and an army ranger. More importantly, I'm a proud father of a soldier. Every morning, my daughter, Emma, dons the uniform of a US Army officer, having answered that same call to serve. At some point, she will rely on the VA for her healthcare.
▶ 0:36:31That's why my work is not work, it's Phillips has been a proud innovator with the VA and a partner for more than 50 years, helping design and deliver innovative solutions to improve care for millions of veterans during that time. In fact, when a veteran walks into a VA medical center today, there's a better than 50% chance they will interact with a Phillips piece of equipment.
▶ 0:36:53Innovation exists today in commercially that will improve veteran patient experience, relieve workload on we know where V stressed VA staff and reduce the overall cost of delivering that care. And in several areas of innovation, we are proud to say the VA has already demonstrated a clear leadership. For example, in 2020, the VA implemented with Philips Help Telecritical care program or TCC, which utilizes a secure digital infrastructure and network to connect all VA intensive care units.
▶ 0:37:23TCC digitally leverages critical care nurses and specialists from other VA locations across the network for real-time support and better monitoring in high acuity settings. The VA has done an incredible job with the TCC program. It's a banner example to any health system and I talk to every health system in the nation. Better patient care, better staff utilization. It just works.
▶ 0:37:46We believe also the VA should expand virtual nursing support by using existing technologies to develop more comprehensive virtual nursing programs for lower acuity settings, which is the vast majority of care like medical surgery units, stroke units, and emergency departments where timely interventions are critical and where staffing continues to be a challenge. The opportunities for virtual care go far beyond nursing. However, the VA handles more than 25 million diagnostic imaging scans annually.
▶ 0:38:16That is a staggering number of scans. Today, the VA radiology departments often operate largely independently, relying on their own resources, their own capacity, and their own expertise. Radiology is a complex Creating a network that connects all VA radiology departments, distributing the remarkable expertise of VA radiologists would allow facilities to share expertise, improve utilization of those radiology teams in the same way it currently does with TCC.
▶ 0:38:45the Philips Radiology Operations Command Center. We call it Rock, not to be uh too cute as an infantryman. We call it Rock. An innovative solution that allows technicians in a central command center format to connect with technologies operating imaging machines in real time across many locations in the network, not just Philips locations. Any any location, any original manufacturer piece of equipment, we can do it across any.
▶ 0:39:11These technicians can remotely deploy pro protocols, conduct, view and fine-tune imaging exams. The approach standardizes image acquisition quality and reducing rescan rates or think of that as veterans revisiting for a scan and ensures more accurate diagnosis with m smoother workflow for clinicians saving time across millions of scans a year.
▶ 0:39:33We also have AI enabled solutions in the scanning process that itself can dramatically reduce scan times for veterans, enabling the same staff to schedule more veterans per day with significantly lower sedation rates. These are just a few of the examples of the opportunities available today. Commercial technology today when they are more needed than ever. Better care for veterans, better experience for VA clinicians, lower cost for taxpayers. Chairman Bost, Ranking Member Dano, thank you very much for holding this hearing today.
▶ 0:40:01Thank you for your unwavering dedication to those who have served our nation and those that defend our freedom and their families. And thank you for asking us to show how we can deliver smarter technology to serve those who protect America. I look forward to answering your questions. Thank you. Thank you Dr. Priy. You are recognized for five minutes. Thank you uh chairman most ranking member uh Mr. Takano and distinguished members of the committee. It's an honor and privilege to uh give my testimony in front of you today. Uh my name is uh Sram Parasa.
▶ 0:40:31I'm a professor of medicine and chief of pulmonary allergy critical care and sleep medicine at the University of Arizona um and in Tucson, Arizona. I previously served in two veterans affairs hospitals, both at the Edward Hines Junior VA hospital in Hines, Illinois, as well as at the Southern Arizona VA Healthcare System in Tucson for a total of 11 years where I served as section chief for pulmonary critical care and sleep medicine and also subsequently as chief of research at the Southern Arizona VA Healthcare System.
▶ 0:40:58Um, I speak to you uh today as um as member or board of director for the VA nonprofit affiliate uh at the u um also known as a southern Arizona VA healthcare system biomedical research education and foundation of southern Arizona. I'm board certified in pulmonary critical care and sleep medicine. I'm here to talk about uh the area of my research expertise which is has a special focus on implementation science in the area of sleep medicine.
▶ 0:41:27The approach of implementation science entails harnessing new biomedical innovations and bringing it to the bedside and clinics to benefit patients and veterans everywhere. And hence I believe that I can speak to the topic at hand which is uh regarding harnessing biomedical innovations in modernizing VA healthcare system uh for the future.
▶ 0:41:49Essentially, a wealth of scientific knowledge is being generated by biomedical research, especially in the area of sleep and circadian science, which has crosscutting benefits to veterans health in every organ system. In order for us to realize the full return on investment to such scientific knowledge and to improve the health of veterans and the nation, especially with the extent to which chronic disease afflicts our people, there's a dire need to disseminate and implement or simply put harness these research findings into day-to-day clinical practice.
▶ 0:42:19It is frequently reported that there's a time lag of 17 years before 15% of research innovation that is developed by research and science that's being brought to day-to-day clinical practice in order to benefit both veterans and civilians. Such harnessing, if you want to call that, has evolved into the science of implementations.
▶ 0:42:40And the veterans healthcare system and affiliated university partnerships are uniquely and well poised uh to thoughtfully harness and implement these wonderful innovations into the real world and benefit veterans everywhere. Implementation science takes into account the healthcare provers's work related burden um in a busy clinic or hospital system and the validity and applicability of the scientific findings to that context.
▶ 0:43:06The ability to get clinics to adopt these practices and maintain them over time is another crucial aspect that needs to be taken into thoughtful consideration. We need to carefully assess the metrics that will measure the process of implementation and return on investment for us to exercise proper financial stewardship. We need to identify barriers for implementing these medical innovations and identify facilitators uh to better assist with such implementation or harnessing efforts.
▶ 0:43:33So essentially we need to perform a shifting of the task from the busy healthcare providers to machines that can work handinhand with them. One such example is in the area of sleep apnnea which is an area of my expertise and sleep apnnea is very common in veterans and is characterized by repetitive obstructions of the upper airway throat and sensations of breathing and low oxygen count.
▶ 0:43:52Both sleep apnnea and insomnia have been associated with heart attacks, strokes, high blood pressure, road traffic accidents, poor outcomes in individuals with traumatic brain injury, PTSD, depression, suicidality, and even death. However, one in four individuals remain undiagnosed with sleep apnea and many with insomnia and the remaining individuals are left undiagnosed.
▶ 0:44:14So we and others have refined machine-braased algorithms that are developed by various researchers including at MIT that embedded into electronic medical records uh within the system of the University of Arizona healthcare system which can identify individuals with high likelihood of sleep apnea and alert healthcare providers to the fact that they have it and enable them in a file manner to play diagnostic tests and enable treatments to be brought to four or treatment of sleep apnnea with CPAP machines and other treatment devices that can help keep the throat open
▶ 0:44:44can reduce motor vehicle accidents, reduce blood pressure, red reduce cardiac deaths and in about um unfortunately only twoirds of people with sleep apnnea during to such treatments and there are not enough providers and caregivers to support this.
▶ 0:45:00So we need a IML based algorithms that need to be developed which we have developed with um funding from the veterans affair health services research and development as well as from picori to help veterans and civilians to be adear to treatment and to derive the full benefits from such treatment. And so there are similar machine-based approaches for behavioral therapies as well.
▶ 0:45:20So in summary, these there are numerous approaches to successfully identify and treat individuals um and with these medical conditions in the sleep space uh with AML approaches and there's now more than ever a need to harness these biomedical innovations to improve the health of veterans using such technology. Thank you. Thank you all. Now time for question. I recognize myself for five minutes.
▶ 0:45:50Um, Mr. Duo, uh, could you tell us about your experience with the acquisition process at the national level and at the facility level as well? Mr. Chairman, thank you for the question.
▶ 0:46:08I think our our general experience is we have a limited number of national level acquisitions that we do typically in the the nature of the business that we're in those budgets typically are held at the vision or below level. So we typically compete for localized uh localized contracts or consolidations at the local level. We see a distinct difference in how we would deliver uh capabilities around software uh and more advanced uh AI capabilities that should be more at the enterprise level.
▶ 0:46:38And I think the budgeting of that would be an area we would want to express or or explore with the VA in more detail to show the total total economic value creation uh of those solutions. All right. Thank you. Um Dr. Gray or Mr. Gray, uh Boston Scientific engages with VA through a number of different contracts. Uh is this a v this variety of contracts appropriate or should we process be Thank you, chairman, for the for the question.
▶ 0:47:08Um, I would say that our contract status at Boston Scientific is very is very good. Um, we have almost all of our products uh throughout all divisions of Boston Scientific on a national contract. As I mentioned before, our the MedSurge prime vendor, I would say, is an excellent contract. One that allows clinician input. It also allows us to um add products twice a year. It's pretty easy for us to get products on. The other one is the PASS, the prosthetics contract I also mentioned.
▶ 0:47:34I would say that one is is more challenging and we're working with this committee on improving that so that again clinician voice two different periods per year where we can add products and that's one of the big challenges when we have an implant or a piece of capital it's very difficult to get it on that contract in a timely manner and that's why we're not able to get some of that technology quickly to the veterans where where they deserve it. Thank you Dr. Bloom. One out of every four veterans suffer from diabetes.
▶ 0:48:00How is your company's work helping prevent long-term complications and reduce hospitalization among this Well, certainly one of the most dreaded complications of diabetes we talked about the diabetic foot ulcer. What isn't as well recognized is that when you have an open wound, you're twice as likely to be hospitalized for heart attack, stroke, CHF exacerbation, COPD exacerbation. It tips the bodies o over to to have a number of very costly complications.
▶ 0:48:30So, if you're able to prevent that fiddles from recurring, you typically can prevent this cascade of of bad outcomes and costs. So, that's what we've been able to do in partnership with the VA is to build a a tech and a program around it to identify those veterans early, get them the care the moment we see an issue, and ultimately show the savings, which I believe the VA last estimated about $16,000 savings per patient per year by being in the program. Dr.
▶ 0:48:58Parthi, veterans with PE post-traumatic stress and chronic pain often face serious sleep uh disorders. How is your work helping veterans treat these Yeah. Um sleep apnea, you know, can actually make PTSD worse and um it can actually cause um traumatic brain injury to not heal as uh quickly as possible.
▶ 0:49:23um some of the technologies with colleagues here at the University of Arizona and elsewhere are using artificial intelligence deep learning uh for developing virtual imagery based diagnostic tests um in order to be able to quickly within 20 minutes diagnose someone with PTSD. It can even be used in the war theater where four hours of a neurosychologist actually doing a cognitive exam is going to be difficult.
▶ 0:49:48So some of these technologies are able to assist um with diagnosing but also with regards to therapies and desensitizing people with PTSD and help improve not just do with medications but also by able to uh be able to deliver cognitive therapy using uh machine-based approaches. Thank you.
▶ 0:50:09And I want to thank all the panelists because you know that's what today's hearing is about is the technology that we're moving forward with each with unique situations where before we would only be a able to start dealing with the problem when the problem and and don't do anything to prevent the problem. Uh so much of this will will save in the long run not only for the veteran health care that we spend but also for the veterans and improvement of their lives. So with that, I'm going to yield my time back and recognize the ranking member, Mr.
▶ 0:50:42Thank you, Mr. Chairman. Well, before we even consider uh investing in new expensive equipment, we need to ask, can VA afford to operate and maintain this technology without sacrificing essential staff and services? In light of this administration's ongoing efforts to slash VA's workforce, VA medical facility leaders are facing hard choices.
▶ 0:51:06Every dollar spent on these devices is a dollar that VA cannot spend on retaining nurses, doctors, and technicians who are essential to delivering care. I want to avoid a situation where uh President Trump and Secretary Collins are imposing on VA leaders the necessity of having to choose so that veterans do not lose out on whether on either the innovation or the staffing side.
▶ 0:51:35But to do that, we need all the information so that we can make sure can we make we can make the case for more funding at VA. Mr. Dulo and Mr. Gray, last week, my staff contacted your companies to request certain information about the products you sell to VA. Your companies both declined to provote to provide this information, claiming it is proprietary. If these innovations are truly cost-effective, why won't your companies provide the the committee with full pricing information?
▶ 0:52:05This committee needs to know more not only about what resources Congress needs to make available to purchase those products, but about your company's respective fiduciary interest in doing business with VA. I'd like to also give you an opportunity to provide this information to the committee. Within the next week, I want to ask, will you provide a a list of all the products you sell to VA? B, the unit price of each product. C, the overall quantity of each of these products you have sold to VA.
▶ 0:52:35And D, the overall number of VA facilities that have purchased your was yeah, Mr. Gray and Mr. Doo, will you will you do that in the next week? So, I I would I would answer your question, ranking member. First of all, thank you for the question and thank you. I know that um that we've worked with you. I was I was in your your office in the past year uh speaking to you. Mr. I don't have much time.
▶ 0:53:04I just need to know whether you'll provide that information with us kindly. What I will do is provide the information that we have and how it got under your national contract. As I mentioned before, we have the vast majority of our products that went through the process of getting it on the contract which very respectfully Mr. Greg, can we just get an answer to whether ABC D you'll provide that information to us? Yeah. Uh that's proprietary information and um I'll get with with my team. It's proprietary information. I thank you uh Mr. Dulo. Mr. Ring member, thank you.
▶ 0:53:33I would suggest that the pricing is uh is very dependent on specific uh contracts that we work across the VA. So, we can provide all of the information uh in in material that we have sold to the VA. Those are those are those are contracts that we we have in place and we would be happy to do that. Thank you. Thank you. So, Mr. Gray, your yours is a no. Yours is yes. We we can provide our contracts and our our contract pricing. Absolutely. So, I'm going to tell you, Congress and the American people are entitled to this information.
▶ 0:54:04These are contracts. Doge is cancelling contracts left and right without even looking into whe on on the board they canled contract for supply chain management support. If we're going to get a handle on how much things cost, we need to know American people should have a right to know what they're buying. And so, um, thank you.
▶ 0:54:27Uh, you know, VA wants once the engine of biomedical innovation in this country, and I'm concerned that we are now outsourcing that role to for-profit companies whose primary goal is maximizing shareholder profits. If we are serious about modernizing VA healthcare, we should be investing in VA's own research and innovation capacity, not handing over billions to corporations. But the new administration is slashing VA's research left and right.
▶ 0:54:55Already VA has indiscriminately fired researchers whose term limited appointments have expired. They have delayed or outright cancelled important clinical trials that v that veterans are relying on as their best last chance for care. And they are driving away some of the country's best and brightest.
▶ 0:55:16Many of whom would be thrilled to contribute to veteran research, but have decided it's simply not worth the long-term If this continues, I'm very concerned that VA that the VA that this VA that laid the groundwork for pacemakers and CT scanners, which your companies are making money on, will be no more. As a nation, we can't afford to lose out on the advancements that VA research has a proven track record of providing.
▶ 0:55:46And I'm disappointed that VA is not here to answer the questions I have about VA's workforce. However, to make sure that Congress can fulfill its oversight obligations, my colleagues and I will be sending a letter to VA demanding answers to many of these questions later today. And I hope VA officials choose to answer this letter. Thank you. And I yield back. Gentleman yields back. Dr. Murphy, you are recognized for five minutes. Thank you, Mr. Chairman.
▶ 0:56:11One of the things that drives me absolutely insane is inaccuracies and untruths that are being spoken sometimes. I'm a surgeon, so I don't tolerate that crap very well. Um, the the last uh administration secretary came in here and by his own admission stated that they had overhired during the VA and that they didn't quite know what to do about it. So why I'm glad that we now have an administration that actually has accountability as their number one goal.
▶ 0:56:40You guys couldn't run companies if you didn't have accountability. You can't do that. And there's no reason that the United States taxpayer should not demand the same thing from its government. Um, you know, the VA in Greenville, which by happens be in my district, and I've actually been in that few years ago during the Arizona scandal where we didn't get patients seen, bought, I think 80 to$und00 million worth of equipment. You know what that equipment turned out to be? Coat hangers. Because guess what?
▶ 0:57:08The VA didn't have the anesthesia set up or couldn't have the anesthesia set up to do. So just pouring money into problems as you guys in any company would know doesn't fix the problem. The other thing I would like to for the record correct the ranking members statement about my VA. The prosthetics department at the VA in Greenville is it remains open during normal business hours Monday through Friday 8:00 a.m. to 4:30 p.m.
▶ 0:57:35to support the needs of veterans um during the in the entire VA Durham VA healthcare attachment. letter for the record. Without objection. Um, thank you all for coming. I use a lot of your products and continue to use them. Um, I I will say that I always had a pinchion for Boston Scientific over Cook, but they're not here to defend themselves. That was a it's a great thing. Um, I'm I'm going to ask some hard questions though because I think that is important.
▶ 0:58:03I look at all the great innovations that you've had, especially the one the left atrial appendage thing. I think that was absolutely brilliant. whoever whoever did that thing to help with clotting disorders. But the real question comes down and I believe this is a fair question because I served on our hospitals administration for three years is cost containment. How do we do that? Because guys, you know, we have seen little last 15 years an absolute explosion in the number of remedies um interventions that can be done now.
▶ 0:58:33Boy, it used to be cardiac surgery was always when I was coming through a heart wide open. Now, there's so much that's being done innovative-wise to keep the patient out, send them out the next day, but I'd like to know what each of you are trying to do for cost containment. This is critical for our nation. It is wonderful to be able to develop these things, but how the hell do we pay for them? And throwing money at problems doesn't solve the problems. So, Mr. Gray, if you guys will give me a 15-second answer, that would be great.
▶ 0:59:01Sir, we uh we definitely focus on on cost. I think the one thing that I have to give a lot of credit to the VA is and the the contracting establishment with the meds surge prime vendor and the PASS it's a very rigorous process it's much more rigorous than uh civilian hospitals so clinical data uh comparison pricing obviously features and benefits that kind of stuff um any other kind of similar type of customer pricing we have to provide that too so from a cost perspective the VA really uh drives it
▶ 0:59:32below Um, a few moments in prevention or having a patient walk less for two weeks has the potential to save an amputation which can cost as much as $100,000. So, I think it's critical. We we would be happy to talk pricing. We're trying to give at least a 4x return on invested capital to the systems we do. Mr. Dilio Doo Congressman, I I'll I'll go back to my radiology operations command center.
▶ 0:59:57we can deploy uh radiology exams into communities closer to where veterans live at a much lower cost than you would in a high care acute cost center. Uh that immediately takes cost out of the exam. I I think AI with what you're doing with your pathology stuff is going to be it's groundbreaking because that's just pattern recognition and that same thing a lot with radiology has moved forward. Sleep apnea, how do you guys save money?
▶ 1:00:18Just diagnosis and treatment of sleep apnnea is one of the most coste effective approaches to changing the paradigm of reducing heart disease and major um cardiovascular events and hospitalizations and deaths. A and this is this actually if people will understand this when you save money and you deliver more efficient care it is better for everybody. Throwing money at problems does not solve them. Being smart about them and efficient about them is how we solve problems.
▶ 1:00:45So, look, I believe in competition and it's good that Cook is around because you guys wouldn't be as good if you were had they not been around. And so, I I think this is very critical that I'm glad that accountability has now come to Washington DC. No one would run a business, as I said before, without it. And this is the way we need to run our government. So, thank you all for coming. Mr. Chairman, I'll yield back. Thank you, Representative Brownley. Five minutes. Uh, thank you, Mr. Chair, and thank you to the panel for being here today.
▶ 1:01:15Um, while I appreciate all of your uh testimonies on how VA can can and should be the worldclass healthcare delivery system, and I appreciate all of your contributions to that end. Uh, but it is important that we point out the actions VA has been taking with the planned reduction in force of about 80,000 employees. That's a fact. the ongoing hiring freeze, that's a fact.
▶ 1:01:45And the haphazard contract cancellations, that too is a fact. And how the Trump administration is hurting VA's ability to fulfill its promise of delivering highquality care to our nation's veterans. It is it is ironic that we are here today talking about biomedical techn technological advances when we are hearing of VA employees who are responsible for ensuring surgical suites, exam rooms and inpatient rooms at VA
▶ 1:02:15medical centers are stocked with the basic medical supplies are being fired. We have already seen how getting rid of supply technicians and inventory management specialists has led VA clinics to do to delay or cancel procedures due to delays in getting critical supplies. We cannot let illogical policies of the Trump administration get in the way of VA delivering the care our veterans deserve.
▶ 1:02:44We must ensure VA has access to state-of-the-art equipment and medical supplies so that VA clinician teams can actually provide the care our veterans need. Uh Mr. Gray, um thank you for being here. I I just wanted to mention that I have witnessed uh your spinal cord treatment uh for pain.
▶ 1:03:09your uh Boston Scientific was in my district at at one point I think maybe 10 years ago or so, but I went there, visited with the team and and saw it in saw what was going on and it it was really um the results are really extraordinary.
▶ 1:03:25And I also appreciate how your testimony acknowledges uh the challenges VA faces when it comes to procurement and and in which you provided recommendations for VA on creating an environment of stability and procurement through budget predictability, investing in procurement professionals to combat staff shortages and modernization.
▶ 1:03:49So, uh, with the current slash and burn environment the Trump administration has created through the this hiring freeze and a plan to cut 80,000 more VA employees. Uh, can you elaborate on how you see these executive actions impacting stability with within the VA and its ability to continue working with companies like Boston Scientific? Thank you, Congresswoman. I I honestly can't answer that question because I don't know what positions are going to be eliminated.
▶ 1:04:17What I do know is exactly what you just said. You echoed my testimony, which is we have to have staff in there to order the product, to pay for the product. We have to have a process to be able to bring new products on. Um, and we need physicians engaged in that process. I that's really really important. I've been thinking about uh an analogy. It's almost like every VA has a an academic medical center affiliated with it, right? So, a lot of times those physicians go between both.
▶ 1:04:46And if you have the great technology in the academic medical center and you don't in the VA, it's almost like if you have a snowstorm in two different houses, use a shovel in one and a snowblower in the other one. You still get the job done, but that clinician is going to going to want to go to the academic medical center where it's more efficient and fast. And so that's my concern. Well, it sounds like you've had a good experience with the procurement process within the VA. Um, do you think it's a perfect one?
▶ 1:05:13I've had a really good one with the med search prime vendor and I we've been challenged with the prosthetics one. So I will say the leadership in the VA has been wonderful to work with. Um in the last 5 years there's been a a real paradigm shift in my opinion and their willingness to reach out to suppliers like Boston Scientific and be partners and collaborate on solutions to bring to bring products in. I've been really impressed with the leadership. You know, thank you for anybody on the panel.
▶ 1:05:42My next question is um as a business uh with VA contracts with the knowledge that your contract could be cut at any moment change how willing you are to continue to work with the VA. Any any one of you can answer. Congresswoman, I'll I'll uh answer it's a good good question. We are here because we're devoted to veterans and I I think it's not a matter of whether we uh want to work with the VA or not or whether it's a more profitable business for us to operate. We do this out of passion. We've been with the VA for 50 years and we need to find creative ways.
▶ 1:06:12We are here to help work with you and the VA to find ways to creatively deliver these innovations to improve the productivity of the staff and drive better patient outcomes, better veteran outcomes into the communities where they live. Great. My time is up. I yield back. Thank you. Uh Representative Barrett, you're recognized for five minutes. Thank you, Mr. Chairman, and uh thank you to the uh panelists. Appreciate you being here. It's Mr. Dulio. Go Army. Thank you. I uh started my uh career in the army as a grunt.
▶ 1:06:41Um attached to an infantry unit as a forward observer and then uh ended up going to flight school as a warrant officer. So I never never did the academy or anything like that. I'm not quite as smart as you are, but appreciate you being here nonetheless. And always appreciate a good uh army uh army infantryman. So thank you. And you wore your army blue t infantry blue tie today. I could tell. And appreciate the the rest of you for joining us as well. Um had a question for uh Dr. Bloom.
▶ 1:07:07um with the issue of um diabetes and the chronic nature of handling that disease and especially the prominence it has within the veteran community. Um I don't think any American can turn their head today without these uh GLP1 advertisements smacking us in the face every time you turn on the TV, open your phone, use anything. Um is that a promising preventative from some of the disease progression with diabetes?
▶ 1:07:35and can you give us any insight as to where that that might lead going forward? Well, I think it's uh the data coming out is is actually quite dramatic. So, the potential for this medic these medications, it could be considerable. I think we still though have some challenges like if you look at the other major blockbusters, ACE inhibitors, ARBs, statin therapy, we're still not seeing these medications and these are pennies to being utilized by the patients who who really need it most. And now we come back to the GLP1s which are often injectables.
▶ 1:08:06So I think we're going to have to still figure out ways to make sure that the patients who need it most can get them because often it's now not necessarily a a ch it's a challenge of access. Can they get those medications and use them? But I think their promise could be considerable. Mhm.
▶ 1:08:19And then um it sounds like from each of you describing the the ounce of prevention versus the p pound of cure and the potency in in reality of which that provides us better patient outcomes, preventing disease progression, finding things um you know more easily and quickly allowing us to treat those conditions that lead to a cost savings as well as a better patient outcome for the people that we are treating. Um I have the uh privilege I I will say Mr.
▶ 1:08:48chairman, not the um not the curse of chairing the subcommittee dealing with this electronic health record update, but the privilege of chairing that subcommittee and we've taken testimony about some of the challenges related to that. But one of the hopes I have is that we can cut down on the um inconsistent nature of maybe duplicating expensive um screenings um expensive um testing that's done and use of equipment.
▶ 1:09:15um appreciate the work that Phillips does in in a lot of this technology that's out there, but these are expensive tests that can be done. Uh do you have any insight into bringing that together to achieve a better cost savings for us around the duplicative cutting out the duplicative nature of some of the testing whether veterans are getting their treatment entirely within the VA or in combination with an outside you know civilian u medical um treatment for example. Maybe to start. Congressman, thank you.
▶ 1:09:45It's a it's a complicated question, but I think if you look at some of the specific technology around so EHR by definition, we work at the software level and at the product level, we work interoperably with any EHR that's out there. That's by definition, we should never have a vendor with the with the VA that isn't interoperable across networks. Now, the challenge specifically with EHR is it is it is it is it connected to uh community care networks as well?
▶ 1:10:10Because today a lot of times that's a flat file and it's not really a fully enriched product for you mean like editable or the data is um usable. It's it's almost like a a a faxed packet that's put into a PDF file. So So today we for radiology exams are what we call um pack systems or u archival and and uh communication systems for images for veterans within the VA.
▶ 1:10:34We Phil Phillips has about 50% of that overall business within the VA with the different V v uh V vista applications but they are highly uh unique unique or customized. So in moving to a standardized central or enterprise level EHR we have the opportunity to integrate all of those different instances into one.
▶ 1:10:52So, we're already in the VA and I think it's it's an opportunity to say, hey, we can save a lot of money by trying instead of doing something new, we just uh integrate the interoperable interoperable nature of our archival retrieval systems already holding millions of uh veteran records. Okay. Thank you. And uh my time's running out, so certainly appreciate each you if you have insight into how this is going. Would appreciate um the opportunity to to hear feedback from you on that um you know, either privately or otherwise. So, thank you again, Mr. Chairman. yield back. Thank you.
▶ 1:11:22Thank you, Representative Sheffley McCormack. You are recognized for 5 minutes. Thank you so much, Chairman Voss, and thank you so much to our witnesses for being here. Um, I'm very disappointed that we do not have anybody here from the VA. The reason being is um working the Congress, I was the CEO of a home healthcare company for 15 years and I'm very well aware of your products and how great your innovation has been especially when it comes to reducing readmission rates where it comes to identifying real time health issues and providing it to the providers but also prevention
▶ 1:11:53and I don't believe that you can't do prevention and treat critical care at the same time but it does take the right structure it takes the right policy and it also takes the right personnel in place to make sure that all of your technologies are successful. Um, none of your technologies are self-sufficient, meaning that they don't work by themselves. They have to go to a health care professional, a clinical care professional. Um, in understanding that, it's important that we have the VA here to actually talk about the systems they have in place, to talk about the policy and the procedures they have in place.
▶ 1:12:23Um, without them being here, there's no substantial certainty that your products can actually help our veterans um, in its sole entirety. And so my question is going to have to be to you guys, which I appreciate you taking these questions.
▶ 1:12:36Um, do you believe in this current environment and the cuts that we see that are going on that the VA has been able to take the proper steps to set up the proper structure, process, and personnel to ensure our veterans get the same care or similar care as our private insurance um patients? That could be for any one of Congresswoman. It's a it's a again a wonderful and complicated question and so I'll I'll take a stab at it from our perspective.
▶ 1:13:05The uh the first thing to think about I I believe I've been doing not just technology deployments at Phillips but for my entire career since since the military it is incredibly complicated and change management and personal change is the biggest uh and and and hardest driver to really overcome to get the full adoption of that capability. At Phillips, for example, when we come to the VA, if we have a new software or application, because we're much more into the workflow of how the VA clinicians operate, not just the box itself or the piece of technology, it's about the workflow.
▶ 1:13:34So, when we do that, we bring our clinical specialists in during deployment, after deployment to try to get the maximum use of the capabilities that we deploy. We also have over 1300 uh education uh platforms either on demand, seminar, or or or uh or on-site or physical trainings that we can deliver during the life cycle of that project. We work that into our contracts with the VA because we also understand there is human turnover. So in every aspect we understand it's hard.
▶ 1:14:00We can't necessarily cover the people that are coming into the VA but we can make sure that we have all the adoption uh training and capability delivery to them during the entire life cycle uh of the product in uh within the VA. So I guess my question um just to make it short would be a yes or a no. Do you believe or are you substantially confident that the VA actually has the process in place to ensure our veterans will get the best outcomes? Without the VA being here, they can't answer. So, I would pose that to you guys. I know it's a difficult I I could not answer for the VA.
▶ 1:14:29Maybe one of you want to, but I I would suggest that we work very hard as part of the process in deployment to work that out with the VA on those specific applications. Now, last session, I was the ranking member for U technology modernization. And after several hearings, it became very clear that the VA did not have the structure in place nor the process or the personnel to ensure that their implementation was successful.
▶ 1:14:51And so that's why I had to come to you because what we're looking at right now is a standard of care that our veterans are actually being denied and they're being denied because the VA is not living up to it. And I just want to, you know, reiterate that we can actually treat our veterans who are in critical situations while simultaneously preventing other disease and preventing and seeing our veterans do better.
▶ 1:15:12More most importantly, we've even seen that when you have these um uh remote monitoring devices in their homes and you have personnel that the entire family has done better. So not just the veterans, the caregiver, their spouses, and the children. So, it's important that we hold the VA to task and that the VA be invited and is present to make sure that we're all living up to our promise to our veterans. And so, my last question would be, do you believe that you actually have the resources?
▶ 1:15:41Once again, I know it's hard for everyone to answer this, but now let's look at the resources for prevention. Do you believe that you have the resources or do you believe that there can be investments into ensuring that we are dealing with I do think many sites, thank you for the question by the way, many sites do still struggle. Do they have enough staffing to be able to do preventative care?
▶ 1:16:08I think a lot of it just comes back to u um even the incentive structure making sure that they can incentivize preventative care because many of them find that it's just it's not as viable. They're going to need to stay on doing the adequate workload that it's going to take to keep them in good standing. So I think there's there's a lot to that making sure they have the staffing but one key piece is just making sure that they're able to protect their time towards the services that they need to do the most. Thank you. I yield back. Representative Han.
▶ 1:16:38Thank you Chairman Bos for convening this important hearing today. Now as many are aware Arizona is emerging as a prominent technology hub especially as states like California implement regulations that hinder American innovation. I have an interest in biomedical innovation and its broader implications and I appreciate the opportunity to engage in this crit critical discussion. Now, currently the procurement process within the VA system places the agency at a significant disadvantage, often delaying access to the latest technological advancements by two years.
▶ 1:17:08This means that by the time the VA acquires a life-saving innovation, private hospitals across the nation have already utilized it for an extended period of time. Furthermore, by the time the VA implements technology that was initiated for purchase two years ago, it is often outdated. Now, in my opinion, the dedicated men and women who served our country deserve better access to cutting edge solutions. And the medical staff at VA deserve better, more modern tools to deliver that care. Now, my first question is to you, Mr.
▶ 1:17:38Dulo, and thank you for your service and thank you for your daughter's continuing that legacy and her service as well. You must be very proud. Now, I noted in your written testimony the section regarding rate or the rapid analysis of threat exposure. Now, this technology piqued my interest particularly given my role in the House Armed Services Committee and your mention of Phillips collaborating with the Department of Defense on rate. Now, could you elaborate for my colleagues on what rate is, how it operates, and its practical um applications? Thank you, Congressman, for the question.
▶ 1:18:07love to talk about this because it's a it's a force protection measure for me and it's about friends that I have that are serving on the front lines in other places in the world that they're using this today. So rate rapid analysis of threat exposure. Basically years ago we started with the defense innovation unit. Uh it takes a commercially available devices like this ring that I have on uh and this watch that I have on that that can record and other devices as well.
▶ 1:18:29They're commercially available that you can extract about 165 biomarkers whether it's heart rate, stress level, sleep level, oxygen level, uh temperature. Uh we've been building algorithms with the DoD for years as a force protection measure to determine when a when an individual might have a a degraded state where this becomes particularly applicable in over years of building thousands of uh servicemen and women's data, we've been able to apply algorithms that allow us to determine whether someone will come down with an infection within uh inside
▶ 1:18:59of 48 hours or outside of 48 hours from actually showing symptoms. So imagine you're on an aircraft carrier and you have an infection that you haven't shown symptoms yet for a day or two. I can actually intervene and quarantine you and keep the force safe and keep the mission going. We would love to see that kind of speed and innovation working with the VA as well because we see applications uh with healthcare providers within the VA.
▶ 1:19:21A critical resource and and a constrained staff to make sure that if they are about to contract an illness that they're not a passing that on potentially to another veteran that comes into a VA center uh or or that we see a degradation that makes them vulnerable in an ill population that we can avoid that and keep them safe and uh and working another day. Very good. So that's a pilot program you say? So we ran a pilot. It's 11,000 participants, men and men and women in the armed forces that are doing this pilot.
▶ 1:19:45Uh even some Navy Academy midshipman I believe much to my dismay and uh and and still uh we find the algorithms are trainable and learnable to new solutions and new uh infections constantly as we're as we're building this pilot. Will it be expanded? We are working we would love to uh continue the discussions with the VA to expand this into uh the VHA system as well. Yes. Very good. and the privacy considerations on that is being taken consideration as well. Correct.
▶ 1:20:12It it is completely it's it's it's commercially available applications but we secure that obviously and and democratize or sterilize the data. So it's it's it's really looking at human condition. It's not looking at any individual or personal applicable data, personal health information. Very good. Now uh Dr. Partha um welcome from Arizona and my alma mater for law school. Now, how has the University of Arizona used artificial intelligence to en enhance patient care?
▶ 1:20:38Yeah, we've been able to embed that into the electronic medical record system. Um, and so that for example for sleep apnea uh we run algorithms that have been developed by researchers at uh MIT to able to identify and alert the clinician, the provider, the nurse or the nurse practitioner at the very busy clinic that their patient may for example have sleep apnnea.
▶ 1:21:01So, and that way they're able to be alerted to the fact that this is essentially a disease that can be diagnosed, treated, and therefore um keep patients out of the hospital and reduce the risk for heart attack, strokes, and so on and so forth. Secondly, we're developing algorithms to help them be more adherent to the treatment because just because there's a medication doesn't mean they're going to order a device therapy doesn't mean they're going to use it.
▶ 1:21:27So this is meant to actually be patientf facing technology that actually gives them um uh psychological cues and advice and tips and tricks for them to be able to use the CPAP device for example for sleep apnea or in a more adherent fashion. So we actually collaborating with researchers um at Harvard to actually develop an algorithm for us to be able to use that to help uh augment the ability for people to be able to use the therapies and improve.
▶ 1:21:58Similarly, there's actually an FDA approved uh technology using algorithms embedded in an app that is helping deliver cognitive behavioral therapy for insomnia uh that can actually help bend the curve on insomnia or address jet lag for active duty to military for them to be able to adjust their SL sleep time before they travel across time zones.
▶ 1:22:19So there are various technological approaches and uh we have being able to embrace some of them and some of them are in development and one particular one that I'd mentioned earlier uh was this Vermona technique that has been developed at the University of Arizona with funding from the department of defense uh that is looking at virtual imagery.
▶ 1:22:36It's almost mimicking a video game of shoot no shoot situations to be able to test the neuroscychological decision making of the individual and it's being tested in a thousand individuals who've been at the war theater in order for us to be able to address whether a 20inut video game can replace 4 hours of a neurocognitive battery. Very good. My time is up. I yield back. Representative Pazenski, you're recognized for five minutes. Thank you, Mr.
▶ 1:23:03chairman and thank you ranking member Takano uh for convening this hearing and thank you to our witnesses for being here today. Um I appreciate the pursuit of innovative technologies that help deliver world worldclass health care to our veterans, a goal I think everyone in this room does share. However, I too am deeply concerned that the Trump administration and Secretary Collins are rapidly dismantling the VA workforce, threatening VA's healthc care operations.
▶ 1:23:32and I've been listening to veterans back home. I hosted an event with Senator Duckworth and our local VFW and American Legion chapters in my district just this last Sunday and we also met with the Tri-State Women Warriors Network just yesterday. I listened to veterans sharing stories of friends who have committed suicide, veterans who rely on the VA every day and asking me about who has been laid off and why.
▶ 1:24:00There are questions like those that I cannot answer because those are questions this administration itself can't answer. When the VA itself is headed to a crisis, why are we having a discussion about biotech?
▶ 1:24:15Without VA present, this hearing is a missed opportunity to look at VA's capacity at the staffing and resources needed to deliver care to improve VA's procurement systems to modernize VA's physical and software infrastructure. Without the VA witness here, we cannot get answers to the administration's recent actions on crucial VA research.
▶ 1:24:40Instead of building on the VA's tradition of innovative research, this administration has set us back by firing researchers and targeting research with quote unquote trigger words such as female, women, and gender. As ranking member Takano noted in his remarks, VA research findings have contributed to not only save that have not only saved lives but also greater profits for companies like Phillips and Boston Scientific.
▶ 1:25:10Innovation is not limited to the Veterans Health Administration. As ranking member of the technology and modernization subcommittee, I'm also deeply concerned that the cuts to the VA Office of Information and Technology staffing and budget will disrupt VA's IT modernization efforts. The VA is still operating with outdated technology to manage its medical equipment inventory.
▶ 1:25:35For example, the automated engineering management system, medical equipment reporting system, a system built back in the 1980s, is not able to support today's interconnected softwarebased technology. It seems tonedeaf to engage in conversations about innovative biomed equipment when the foundations of the VA are crumbling.
▶ 1:25:59When the VA is threatening to cut 80,000 of the missiondriven staff who serve veterans each day. When veterans crisis line operators say Doge has made their job stressful to the point of tears. Being forced to do more with less while remaining steadfast in their mission of serving veterans in crisis. When VA clinical trials have been delayed or cancelled because the staff who managed them were let go.
▶ 1:26:27when VA has canled hundreds of contracts, including IT and management contracts, among others, that will impact cancer care and VA's ability to access toxic exposure and disability ratings. When President Trump's latest executive order attempts to intimidate federal workers out of their unions and attack collective bargaining rights, including for over 425,000 veterans across the government.
▶ 1:26:53To our witnesses here today, I do truly appreciate your work, the work you're doing to improve the care for our veterans, and I wish the VA could have joined you today to be a part of this important discussion. My question is for Mr. Dulo. Do you know how many non-clinical staff members are required to install, inspect, maintain, and repair your products?
▶ 1:27:20Congresswoman, I appreciate the question and I I I actually don't know that. I would be happy to follow up and have a discussion separately both both uh our side and uh and the VA. As I mentioned earlier in a statement, one of the things that we do is we dedicate resources to the VA specifically for adoption and maintenance. Uh and so we look at that in in a geographic context. We have people that show up at VA centers and help with that continuing education, but we also help maintain the equipment.
▶ 1:27:45That would be really wonderful because one of the things I understand the administration has been saying is that these layoffs are not going to are only are going to be held off in um you know for folks that are doctors or nurses, but the non-clinical staff are also very critical um to making sure that the mission of the VA is complete and and conducted uh for our veterans. So I would very much appreciate that. Um thank you. And I think I'm about out of time, so I yield back. Thank you.
▶ 1:28:13Uh, Representative Radwagon, you are recognized for five minutes. Thank you, Chairman Boston and Ranking Member Tano for holding this hearing today. Talofa, and thank you to the witnesses for your testimony. Dr. Partha Sarathy, thank you for that extensive answer earlier on sleep apnea.
▶ 1:28:34Um what are uh the consequences of of some of the consequences of sleep apnea if left untreated and what is sleep apnea therapy nonadherence? Thank you.
▶ 1:28:48Um so sleep apnnea is when individuals have repetitive obstruction of the upper airway and it causes low oxygen count and as a result that reduces the amount of oxygen goes to the heart and the brain and leads to increased risk of strokes, heart attacks, heart failure, motor vehicle accidents also reduces the rate of healing of traumatic brain injury and can also lead to depression and anxiety. And so these are all the consequences of untreated sleep apnnea.
▶ 1:29:18It can also lead to increased amount of hospitalizations and also there's an increase in all cause mortality death due to any cost um if left undiagnosed and untreated. And the problem with adurance is is that the therapies usually involve a CPAP mask that's applied on the nose with pressurized air and people find it difficult for them to wear and get used to.
▶ 1:29:40As a result, variably about twothirds of people only are adherent or in some communities it's only half of the individuals are adherent to the CPAP therapy. And we have shown other researchers have shown that non-adurance to the treatment um can actually lead to increased risk for all of the consequences that I enumerated previously.
▶ 1:30:02So it's very important to have these treatment approaches and now the new GLP-1 drugs which are used for diabetes management has also been shown to be effective in treating sleep apnea and not just devices but again people are not necessarily adherent to uh medications or devices um and as a result we need to do more to use uh these medications and devices as uh uh Erit Coupe uh the surgeon general said you know pills don't work if people don't take them.
▶ 1:30:32And so devices don't work if people don't use them. And so I think that's a very profound but very simple statement. And there that's where we did our research where veterans were actually helping veterans through a peer-to-peer intervention to help promote their importance of using it and to make them realize by talking veteran to veteran about the importance of using these treatments in order to get the full benefit from the therapy that has been delivered to us.
▶ 1:30:58So is VA equipped to monitor patients adherence to sleep apnea therapy? Yes, they are. And um many of these devices have a centralized secure safe harbor system that is um has PHI protected health information in it. Um but it's also help held in a secure manner where these devices in people's homes transponds and sends it through uh the cell phone uh tower information about the usage and non-usage. Thank you doctor.
▶ 1:31:27Uh let's see. So there were a couple of questions earlier about diabetes and uh Dr. Bloom, what are some of the causes of diabetic uh foot ulcers and what are the consequences of diabetic foot ulcers if left untreated? Um thank you Carwoman for the question and by the way we should acknowledge some of the unique challenges I think you've seen you see for the constituency you have.
▶ 1:31:55My understanding is that podiatric care comes from uh the Honolulu VA medical center and that this podiatrist has to come out only once a month to see patients, right? The opportunities to catch problems in between those visits. Uh and so systems that can offer, you know, expand monitoring passively hold I think a lot of promise there. The causes of diabetic foot ulcer, there's a number of them. One is you have diminished blood flow into the limb.
▶ 1:32:22So you can't really bring all the healthy mediators and and healing cells to a wound. You don't have enough oxygen to that tissue. So it's already acting dysfunctional. The the nerves uh get destroyed. So now you can't feel any pain. The gift of pain. You could get injured. Now you don't know that that wound is there. Um because of the high glucose. You can get really bad bugs when they get infections like mukor sudamonus some of the bad staff infections.
▶ 1:32:48It's it's basically a perfect storm to get now an eskeemic wound, low blood flow, uh infected that we now need to see me in the operating room. So, is it faster for VA to monitor a veteran's health by using a pometrics mat at home or by scheduling appointments at the office? The hope is they don't need to come into the office. Yeah. Give them a mat in the home. They can step on it for 20 seconds a day while they're brushing their teeth.
▶ 1:33:12And now our hope is to avoid the need to ever come into the facility in the first Thank you, Mr. Chairman. I yield back. Represent McGarvey. Thank you, Mr. Chairman. And look, I'm excited about today's hearing. I think this is an amazing opportunity, truly an amazing opportunity to ensure that the VA is the leader in innovation so that we're giving the best care to our veterans.
▶ 1:33:36I think about what the Department of Defense looks like with they had the Defense Advanced Research Projects Agency that I think everybody knows stands for DARPA. They incentivized innovation and because of that we have things like GPS, we have the internet. Not only are they helping our soldiers on the battlefield and giving us a technological edge, they are then technologies that all of us can use. What if we did the same thing in VA? What if we actually incentivized innovation?
▶ 1:34:06Think about what the VA is. 9 million patients, the largest patient population by a multiple. 75% of physicians do some of their training at the VA. We have the largest longitudinal data set of any health care system in the country. We get you when you're 18. Sometimes we keep you till the day you die. And what are we doing with this? What today's hearing shows me is not enough. But that's what's exciting because we can do this. We've seen models of this that work. And think about what DARPA did.
▶ 1:34:36Now think about it in the VA context. If we find a cure for traumatic brain injuries, for PTSD, for spinal cord injuries for our veterans, we do it for everybody. But those are service connected in injuries. What happens if the veteran who comes in with diabetes or Parkinson's or heart disease or cancer and we find a cure for that?
▶ 1:34:56I think this is a both and proposition that the balance for this is through partnership where the VA and industry develop solutions collaboratively that ultimately save money, generate revenue and provide better health care for our veterans. So I would love to see this and Dr. Bloom I think your story is a perfect example of the kind of innovation possible at the Veterans Health Administration. In your case, CAR's Act funding made it possible as a highly effective pilot project for monitoring diabetic foot ulcers.
▶ 1:35:27Um, but the VA's traditional acquisition structure doesn't really allow for this kind of innovation, does it? No, sir. Thank you for the the question. You know what I have to acknowledge is that um every so when you're starting your company off and you have a a mission, a vision you want to accomplish, you need to go to the venture capitalist to fund this company. It's a big part of getting it up to speed.
▶ 1:35:52The blame fact is that every VC I went to when I said I was going to go to the VA, um often they would even roll their eyes, I was dead in water. Now the reason why they did that is they actually cited a number of companies that they had funded that commercialized through the VA and they were all dead. Right? So this was no longer a winning proposition for them.
▶ 1:36:13So if you actually could have something like an advanced market commitment that actually say look here's a critical problem the VA is saying that they have and they they would they are eager to buy this type of solution. Go into a venture capitalist with that type of some sort of uh um commitment by the VA. That's that's company changing. That's healthcare changing, right? It's the startups that take this enormous risk. We can put hundreds of millions into a system like government isn't set up to take that kind of risk and even larger companies can't take that. But we can.
▶ 1:36:42But without that funding, we're dead in water. Yeah. And I'm glad you brought that up because last year at the very end of last Congress, I introduced a bill called the Innovate Act, hoping to empower the VA with the authorities it needs uh to conceive of and scale up these type of innovative solutions you're talking about. I plan on reintroducing uh a newer version of that bill this time. The bill is not going to will support not replace the outstanding research and innovations already underway inside the VA. But of course, it's going to do things that like you talked about.
▶ 1:37:13It'll provide VA with two specific authorities that would make these partnerships and pilots possible. The other transaction authority and the advanced market commitment that you talked about. And just uh to break that down, you know that other transaction authorities, a special authority that lets government agencies team up with outside organizations more quickly and flexibly. Uh that's a big help that you just mentioned. And the advanced market commitment, it's like a promise from an agency to buy a product in the future even if it hasn't been created yet.
▶ 1:37:43This encourages companies to invest in developing solutions they might not otherwise pursue. And of course you know this this approach led to the creation of the new Macakco vaccine which has saved over 700,000 lives in developing countries. I think we have to do more. I think we have to do more of this type of work where we're collaborating to help our veterans. And I will say there is government spending and there is government investment and we are investing in these preventative medicines. We are investing in these cures and these innovations. We are not just helping our veterans.
▶ 1:38:12We are helping everyone and I think doing the mission of this committee. Dr. Bloom, I appreciate your testimony. Mr. Chairman, I yield back. Thank you, Dr. Milm. You're recognized for five minutes. Uh, thank you very much, uh, Chairman Bost, for this hearing. I thank our witnesses for being here. Uh, two years ago, I was, uh, asked to chair a, uh, task force for my colleagues on modernization of health care, looking at what we prepare for legislation. And I actually focused that on three things.
▶ 1:38:40um and that was access prevention and affordability through uh artificial intelligence technology wearable devices and I think what you've underscored today is exactly that uh is it possible and I'll ask you all this just very quickly if you can answer uh is technology disruptive and sometimes as we advance whether it's from an agrarian society to the industrial age to the information age are there people who lose jobs and positions Mr.
▶ 1:39:07gray uh just like during the agrarian time there is but they will flex and new jobs will be created. Dr. Bloom um your hope is you're going to be able to avoid the need for a number of clinicians but those can be put to other use. Mr. Dulu I believe technology available today allows clinicians to work at the top of their lensure which will help us scale. Dr. Parasanti I think this is where implementation science needs to be followed where it needs to be phased in rather than be disruptive.
▶ 1:39:31So not not not unusual that as technology advances we will one have more access, two be able to use prevention, three make it more affordable and we may need less people to do certain things such as 80,000 VA employees that were hired during the last four years at uh $126 billion increase in revenue to the VA with level national uh people applying for and receiving care.
▶ 1:39:57So I think that that's a normal process uh as we uh develop and uh and grow and innovate. Uh Dr. Blum um I think uh Representative Ratawagen asked you about the causes of diabetic ulcers. As a doc um I know them, but if you could and I think you mentioned this consequences of diabetic foot ulcers left untreated or poorly treated and you mentioned amputations and the cost of amputations. So could you just reiterate that again?
▶ 1:40:26Well, first per VA national data, we know that the five-y year mortality of just getting the photo ulcers is 70%. That's worse than almost all cancers except for maybe glyopblastoma, pancreatic cancer, a couple of the really big scary ones. So, that already is is very alarming. And of course, if they get infected, they might have to see one of us in the operating room. Now, we're going to lose the limb. And that's now a lifealtering event where they now can't take care of themselves the same way. We see dramatic increases in depression, suicide ideation, u the actual suicide event.
▶ 1:40:56it it is a it's a devastating change in their life. For example, we had one patient where um they just stopped using it. Now, per protocol, we're going to reach out to that patient and try to find out what's happening, remind them to get on the mat, and we had to just leave a voicemail. They called back the next day. Thankfully, they did and he acknowledged that um the pain was too much in his limb. He now wants to take his life, thanked us for the care that he had, and just wanted to let us know that that was going to be the case. And thankfully, we were able to get him the services.
▶ 1:41:23So, it's because of those things that products like yours have recognized significant cost savings as well as quality of life improvement. Significant savings. And now for that veteran, he's still with us just thanks to that that extra touch to the patient. And how was uh your experience engaging with the office of health innovation and learning at the VA? Well, I think that the innovation group um offers like this critical part to that to the industry. And when we were just coming along, we didn't know what we were doing. There's no manual to the MVA.
▶ 1:41:52Try try to come in in any way you can. We started to work with the the um uh it had a different name prior, but oh essentially they were able to figure out okay what is the right model for a company to adapt to the VA. It it's arrogance to presume the VA is going to adapt and bend to us. So we had to build it together. But when we did now it was perfect built for our veteran, perfect built for those VA infrastructures and that's why we're seeing the savings we are. Thank you. And I'm running out of time but Mr.
▶ 1:42:18Dulo, what complimentary steps do remote services offer to connect VA practitioners with rural veterans and may save visits to the hospital or to practitioners? Congresswoman Miller Migs, uh, it's great to finally meet you. Uh, I I I would actually I'll use one example that's uh is is significant in our ability to reach into uh rural communities specifically. We have something called a lumfi, which if you can imagine an ultrasound today in uh an ultrasound can be done on a on an iPad.
▶ 1:42:47They can have a transducer plugged in. I can video in on broadband a a technician or a synographer or a radiologist remotely anywhere. For example, I was in the Calispell Clinic in Montana this summer. They have no imaging equipment there, but yet it's a large enough facility where you could put an iPad in there and beam in somebody from Fort Harrison from three hours away and I can get a a gastro scan, I can get a prostate scan, I can get a liver scan uh with over-the-shoulder coaching and in real-time results.
▶ 1:43:13I can do that anywhere in the c country and we do that in uh private healthcare and have you used artificial intelligence to enhance patient care? Absolutely. I'll just use that. We could talk for a long time on the ability to enhance imaging and speed the process but in that particular case we actually construct the image uh in in AI on the system itself and and render a very precise diagnostic and that's our new new opportunities not just to reach patients but give precise diagnostics Thank you, Representative Ramirez.
▶ 1:43:43You're recognized Prime Minister. Thank you, Chairman from the great state of Illinois. Uh I want to thank uh the chairman, the ranking member for holding today's meeting, and I want to also thank all of the witnesses that are here today. Today's committee hearing is titled harnessing biomed innovation, modernizing VA healthcare for the future. And I want to start by uh putting on the record that I find it difficult to have this conversation, an important one, right, on innovation without having the VA here. That's not your fault.
▶ 1:44:12Uh you can't represent the VA or ask them to be here. But in absence of them being here, it means that we're having this robust conversation about technologies and innovation, how to modernize the VA healthcare without the same agency, the very same agency that would be responsible for these implementations. And so it almost feels like a sales pitch instead of real conversation about how we modernize um the VA in order to provide the highest quality of care for our veterans.
▶ 1:44:41It feels like a calculated attempt, not by you, but you know, in the way that this committee was set up in this hearing to accelerate privatizing the VA while patting the pockets of for-profit companies. all it feels like to carry out a Musk Trump agenda to dismantle the VA under the guise of modernization and efficiency.
▶ 1:45:00Look, the Musk bad boss playbook is manufacture failure through hiring freezes, mass firings and reduction resources, scare and demean the workforce, disregard the clients, publicize every single problem.
▶ 1:45:16All so you can see say see it didn't work all along and then venture capital corporations can swoop in and claim their only solution left to try is theirs and we've all seen how that ends up have we not learned from X formerly Twitter. Just last month Trump turned the White House lawn into a Tesla showroom after announcing that he planned to buy a Tesla himself. See there's a pattern.
▶ 1:45:42use federal power to boost private industry and this time at the expense of our veterans. And look, I do believe that veterans deserve the highest tech and devices possible, but our veterans need state-of-the-art, high techch devices with fully funded, fully staffed VAS that can actually implement these devices and these technologies. Now, how do you do that if you don't have the staff to be able to operate them? Mr.
▶ 1:46:11Dulu, you lead a team of nearly about 17,000 employees. Am I right? Okay. So, if 15% of your workforce, if my math is right, that's about 22,550 employees were cut, could you operate effectively? Yes or no? Congresswoman, uh, that is not a yes or no question, but I would tell you it would be harder. But I would also treat it as a compelling event to find ways to deploy technology to make up or automate things that I don't want people doing anyway.
▶ 1:46:40But if you didn't need those 2550 employees, then why would you hire them? See, given VA's plan reduction of 83,000 employees, how do you expect the VA to implement and sustain new technologies your company's providing? Congresswoman, let me address it from from from my perspective only. I I have no insight into the VA or and they're not here, so they can't answer. But I would say from my perspective, everything that we're doing and we talked to the VA about as well as every other health system in the country, three things are true.
▶ 1:47:10Everyone is seeing an increase in needed to need needed care. So people are getting older. More people are getting older. They need living longer. They need more care. Second thing is cost of care is going up. 17% of GDP in north in the United States is spent essentially around healthcare which is astronomical figure but it means cost for the average American to include veterans goes up. And the third thing is that staffing is going down. People are not entering the medical field at the rate they're leaving. So this is not a VA specific item. It is a national crisis in my opinion.
▶ 1:47:40And so technology companies like Phillips and like the other ones here are trying to find ways to create automation AI enabled solutions to do much faster diagnostics. Thank you Mr. Bulu. I'm low on time so I really appreciate what you just said and I absolutely agree with you. We need that innovation. We understand the challenges that we're living, but given the dramatic staffing reductions on the VA, it's hard for me to believe that the VA will have the capacity necessary to introduce Philips technology and ensure that there's proper maintenance, operation, and the effective use of these systems.
▶ 1:48:09And so, you know, I asked you the questions I did recognizing you can speak on behalf of the VA, but unfortunately there's no one here that can. And I'm asking because they weren't invited to appear before this committee. And so in your opinion, wouldn't these be better questions for the VA leadership who could provide real insight into the workforce capacity, the budget constraints, and the operational readiness to be able to operate these devices?
▶ 1:48:35Uh, Congresswoman, in my opinion, no single entity or or healthcare provider can solve those things in a vacuum. I think it takes partnership and open discussion with partners that bring capability. Thank you, Mr. Dulu. My time is up. I would like to have the VA here to answer these questions. With that, I yield back. Thank you. Before I go to the next speaker, I got want to respond to some things. Let's be clear. There's no no final number of any potential reduction in workforce. None.
▶ 1:49:03What we do know is that unlike the previous administration, Secretary Collins and the VA have been transparent with Congress every step of the way, and I expect to continue moving forward. But this idea that we should start ringing the alarm bell before the plan even exists, that's just more of the same fear, tactics, and political threats. If you want to have a serious conversation about oversight, I'm here for it.
▶ 1:49:29But let's not sit here and pretend this there's a five alarm fire when we're still looking at the blueprint. Veterans deserve the truth. And I just want to stand want to make sure that you understand that's the truth. So, let's get back to the discussion here at hand. And with that, I yield to uh General Burkeman for five minutes. It's interesting to observe life.
▶ 1:49:55I was just sitting here reflecting on 20 years ago being at that witness table in uniform before a military personnel subcommittee hearing. There were seven reserve and guard chiefs and we were pretty underwhelmed by what happened and what was discussed up here. I would uh associate my comments with the chairman. Let's not waste time because veterans never wasted their time because of the fact that we they fought to defend our country.
▶ 1:50:23So, we'll get right to the meat of it right away. And just yeah, I I was in the Marines a few years, but probably most important for for this discussion here was for three decades, I was involved in the operating room equipment business. a lot of it in radiology, some in micro surgery and others. So, I'll kind of put that hat on a little bit here. Um, but uh let's get right to the questions. Mr.
▶ 1:50:47Gray, your testimony states that approximately 61% of all API procedures in civilian hospitals will use post field ablation technology. Yet only roughly 10% of VA hospitals have access to this technology. Could you why? Yes, sir. um you know multiffactorial but really for the past year. So it was this was launched uh by the FDA in March of 24 and there was a huge scramble for the technology.
▶ 1:51:17So it was so transformational I would say because of the budget uncertainty within the medical facilities in the VA not across the VA but each one they weren't sure if they were going to have the budget when it was going to come. Should they not make a purchase because they're not sure if they're going to have the infrastructure in place. It was almost this fog of war type of mentality. So it was almost like stasis going on. So that was a huge part of it. The second one is what I talked about before with the contract.
▶ 1:51:43There is not a today um a process in place to add new products like there is in the med surge prime vendor. So you have to jump through so many steps and if you don't hit every single step and there's not money there, it's just a very very challenging process. And so while we're able to get some other new technology like that agent drugcoded balloon into the med surge prime vendor program quickly the prosthetics contract was just much more challenging and that's the biggest issue.
▶ 1:52:09Again we have it in less than 10 hospitals and physicians are clamoring for it because as you said it's becoming the standard of care for atrial fibrillation in the United States really across the globe. Yeah. Well, it's it's utilizing new technology that's been developed, tested, and getting it into the VA system as as appropriately quickly as possible to provide better outcomes for the veterans. Yes, sir. It's 40% faster and it's safer than the current technology. We have to get it in there.
▶ 1:52:38Well, um, just a little data point. Several of the surgical instruments used today were invented in the 1700s, but that doesn't involve electricity or computer programming. And how important, we'll get back to the point here. How important is the clinical input? Speaking of instrumentation and medical equipment, how important is clinical input in medical in the medical procurement process?
▶ 1:53:02the dis the people who will actually be using that equipment in the O in the radiology lab in wherever it is how important is that clinical input it's critical it's necessary whether it's the VA or it's a commercial civilian hospital physician voice has to be part of the process and when it when they are the process runs smoother for the hospital for the system and for the patients yeah so the point is include the people using it in the decision process um since I serve on both armed services and veterans affairs How
▶ 1:53:32does VA compare to DoD when it comes to the procurement of medical technology, especially when it comes to timelines for implementation? It's a it's a difficult question to answer because it's not an easy question to answer. I would say this, the DoD has u a contract vehicle called the ECAT electronic catalog. That's fantastic. Once you get a product, you submit the right information, it goes live pretty quickly. Almost identical to the meds surge prime vendor uh contract that you worked on in the VA.
▶ 1:54:02So, very similar. But then you also have the pro prosthetics contract in the VA, which needs to catch up to the other two. So, I it's a long answer to say the DoD and the ECAT is as good as the med surge prime vendor in the VA, but the prosthetics contract is much lower and needs to get needs to get up to that level.
▶ 1:54:20So to cap off because I see I got 30 seconds left, it is okay and desirable I would suggest to you within just compare the DoD and and VA to allow them to piggyback off of and and take each other's successes and build on it rather than reinvent the wheel in two different departments. So let's leverage what we have and let's move forward with good processes. And with that, I yield back. Representative Dexter, you're recognized for five minutes.
▶ 1:54:52Thank you, Mr. Chair. Uh, and thank you all for being here. As I understand it, the purpose of today's hearing is to examine how our veterans can access the highquality care that they deserve while ensuring the VA remains a responsible steward of taxpayer dollars. Absolutely an appropriate goal for this committee. Given that goal, I was shocked in preparing for this hearing to learn that the majority had declined to invite anyone from the VA to testify.
▶ 1:55:17As a pulmonary and critical care physician, I was involved in specialty relevant procurement processes. I know very well what a robust procurement process looks like. This isn't it. I'm frankly horrified that we are here having a discussion about important clinical decisions without any clinicians. And no offense to my colleagues, but not a single one of us should be engaged in this. We have procurement processes and if it isn't working optimally, let's focus on fixing it.
▶ 1:55:46That is absolutely the right thing, not go around it. This right here today is how we increase risk for waste, fraud, and abuse. I'm completely unclear on having on how having a series of industry adjacent representatives here today without the insight insight of a procurement discussion advances the goals of using taxpayer dollars wisely.
▶ 1:56:10As someone who served as a VA provider for seven years and as a US Congresswoman, I care deeply about providing our veterans with the best possible care. But that is not what this hearing is about. Instead, we have decided to use, my Republican colleagues have decided to use the incredibly valuable time and resources of this committee to give private industry an opportunity to pitch their products.
▶ 1:56:33At the same time, we are doing extraordinary harm to our systems of medical research and development that has historically been a priority for the VA. I'm just going to use one example, and I mean no disrespect. I just want to go through this for um the purposes of of illustration. So, Mr. Gray, I read your testimony regarding Ferrapulse and in your written testimony prepared for today's hearing.
▶ 1:57:00Is it true that you cited the study entitled quote pulse field or conventional thermal ablation for pro paroxismal atrial fibrillation to substantiate the value of this product? Yes, I believe so. Thank you, Mr. Gray. Is it also true that the study draws its conclusions from a non-inferiority trial? I believe so. Thank you. Finally, did I read correctly that the study was finance financed by Boston Scientific? I think so.
▶ 1:57:28For those listening today, is important to note that this study financed by the company who manufactures the product and which showed only that it is no worse than other treatments on the market is the only evidence that was provided by our witness. And again, this is not the right place to do this. So, I'm not trying to call you out specifically. It's just that it's not the right process. We do not have access to the cost data to be able to compare it to current practice that is not inferior.
▶ 1:57:56And the VA has a procurement process that we are not discussing here and we should be. If that process isn't working as we've heard it is not optimally, then it is our obligation to help it do Although President Trump and the architects of Project 2025 claim to support a veteran centric VA system, it is clear yet again that the rhetoric does not match reality.
▶ 1:58:20Instead, my Republican colleagues seem more interested in furthering corporate interests than truly serving the veterans who fought for our country. Where is the VA today? Where are the clinicians who can talk about the impact of the hiring freeze or the terminations of vet on veteran care or even whether or not they think these are good products to use? And why in the world are we politicians being involved in this procurement process?
▶ 1:58:44Maybe even just a sales pitch that should be evaluated by a rigorous, reliable process, not a partisan body powered by special interest investments. The absurdity of today's hearing is honestly quite stunning. I want to see a VA that fulfills its promise to our veterans and their families. One that is efficient and innovative, expands care to veterans most in need, and focuses on prevention, as many of you do.
▶ 1:59:09However, instead of focusing on that, we have listened to advertisements without hearing from the VA or the clinicians who will use these products, engaging in an in forwardlooking conversation about how to best use taxpayer dollars. That is what this committee should be focused on. that would be living up to our promise to our veterans. That would truly be veteran centric. This hearing is a distraction from the harm being done to veterans across our country.
▶ 1:59:35We need to all be prioritizing their well-being, not corporate interest being discussed here today. I implore my colleagues to do better. And thank you. I yield back, Mr. Chair. Representative Sisammani, you're rep uh recognized for five minutes. Thank you, Mr. Chairman. You know, my my views on healthcare are pretty simple. No matter where a veteran seeks care, they should have the highest quality outcomes and the most efficient ones as well.
▶ 2:00:02I was proud to sponsor legislation that was signed into law to focus on support for at home care services for our veterans and their caregivers. I want all options to be great options. This is what it truly means to have our veterans at the center of our mission in this committee. I also want to before I get into my question specifically thank uh and and highlight a special guest from the University of Arizona my alma mater um Dr.
▶ 2:00:32I have the pronunciation here. So, let me give it a shot and you correct me. Uh, Partha Sarathi. Yeah. Okay. Good. Well, uh, I want to thank you for being here and and who leads a center for sleep research and has treated veterans in my district at the VA. The university is leading the world in this research which impacts other healthc care outcomes. I'm proud to support these partnerships that foster discovery, innovation, and results.
▶ 2:01:00I I have three questions, three separate questions that I would like to get to. So, if if you wouldn't mind, I'll post the question and if um the the three gentlemen can address it and uh and I can and I can go to the next one as well, so we can cover all three areas. Mr. Bloom, I'll start with you if possible. My my district has a very high proportion of seniors with dis with uh diabetes in all of Arizona.
▶ 2:01:22Out of the 1,727 eligible patients, only 63 veterans are being assisted by your company currently. Could you speak to the taxpayer savings that the remote temperature monitoring program in your company uh create? And if this if if this is saving money, what is keeping VHA from ensuring every vulnerable veteran has access? Um, thank you uh Representative Sisman for that question. That's a that's a big one.
▶ 2:01:51I'll try to go efficient so you can get through them all. Um the savings per the VA uh presented to Senate last year is it's about 15 and a half $16,000 savings per patient or per veteran participant per year. That typically comes from avoidance and hospitalizations and outpatient visits. 15 and a half% is that uh 15.5 to 16,000 per patient per year from avoided hospitalizations and outpatient visits. So the savings is actually quite considerable.
▶ 2:02:20Yeah, many of our veterans aren't getting access to it and there are a number of challenges. So, some of the big ones are still just lack of access. We look at our rural veterans or veterans with limited financial resources. They're not able to get to the centers to get enrollment. Um, unfortunately, well, the vast majority of writers are VHA podiatrists, but over half of veterans don't have access to VHA podiatry. So, right there, you're already losing a ton of access to the tech. And then we talked about budgeted silos being a factor.
▶ 2:02:49And of course, I think the incentive structure needs to be addressed. Your something that has proven savings, dramatic outcomes, improvements, including mortality, and yet the workload credit for delivering an amputation is dramatically higher than the workload to prevent it. So that has to be fixed. If we can do that, we can do a lot better. Thank you. Thank you for that. And I know it was very condensed. I I I'll have a follow-up if I have time here at the end. But for now, Mr. Dulo Dil Dilo, right? No, Congressman, you can say anything. No, no, no. I know. Dulo. It's Dulo.
▶ 2:03:20Dulo. Okay, great. Dulo. Um, I have a high also a high number of veterans in my district with lung disease and and respiratory disorders, which remains one of the leading health risk factors for for veterans just overall. However, the the VA has historically struggled with managing these case loads leading to long wait times, which could be very tragic.
▶ 2:03:45How can innovative technology help better serve our veterans and ease administrative burdens on physicians specifically? I'm going to give as quick a thing as I can. This this needs dissertation. So, the PAT act is a an incredible piece of legislation.
▶ 2:03:59It also has unintended consequences of potentially increasing that problem of backlog of scans and uh and diagnostic imaging or assessments of potential veterans at risk due to things that are not detectable and normal cancer or lung cancer CT scans uh like chron uh constrictive bronchilitis DRD and other other symptoms that are common 75% veterans uh with with those exposures have a much higher lung lung cancer rate.
▶ 2:04:24So what we're doing is working with a partner called 40 medical that is FDA approved that we can come in on a simple CT scan for hundreds of dollars at a rate of 20 times faster than you can do a lung biopsy which is a putting a needle in somebody's lung taking it out taking the biopsy into a into a path pathology workflow that is thousands of dollars and I can do it 20 times faster at at a 20th of the cost. So, hundreds versus thousands. And I can I can ex speed diagnostics so I get the right veteran uh with the right care before it's too late.
▶ 2:04:53And we know we have worse outcomes with uh with lung cancer. Thank you. Thank you for that. Um Dr. Parther Parther Orier, I'm out of time on this one. If there's a second round, I'll stick around to ask you a question. But thank you. I yel back, Mr. Chairman. Dr. Uh thank you, Chairman Boston. And um as has been mentioned, we're here to discuss uh technology procurement in the VA.
▶ 2:05:19And um and of course I should say that I'm hopeful always for technology and technological advancement. We do know that we are um in the health care system, hospital system in particular, we are dealing with shortages of uh nursing supply.
▶ 2:05:36And of course, we want to make sure that we're able in spite of of some of the deficiencies we're seeing there in personnel uh that we can fill uh some of that gap uh with technology that will allow us to identify someone as has been mentioned here, might be failing, who needs a higher level of care. we can get them transferred to an ICU or to to a to a step down unit so they can be more carefully monitored by um more expeditiously finding out if they are deteriorating in their healthc care status.
▶ 2:06:06It's very important uh that we do that. Um I think I'm not asking this as a question that many of these things are in the early stages and because I've heard words like I hope it it may um you know save and reduce cost. Um and I and I say I hope and may I say that I hope May will become does and will um in the very near term because it will be better uh for our patients and for the outcomes that we all seek and we want great outcomes obviously for our veterans in the VA system.
▶ 2:06:36I must um uh mention a concern at this point and my comments uh about the many things that we have heard in this uh committee room and outside of this committee room about deferred maintenance and other very important diagnostic uh capabilities and equipment within the VA itself. And so while this um um hearing focusing on technology is very important, it's certainly not without costs.
▶ 2:06:59And there are other and I think you would even agree um more critical um um devices equipment in our VA uh system that um is not there now and should be to achieve the outcomes that we want for our veterans. And I'm certainly concerned that we don't have the VA here now to address some of the concerns we've heard throughout the hearing since I've been sitting here anyway uh about the procurement process.
▶ 2:07:25Um and I will take um uh the chairman's admonition that perhaps we don't know what cuts in the V v. I hope that um if he's suggesting that there'll be less than the 80 to 83,000 we've been hearing repeatedly in the news is not um is not correct and not knowable now. Okay. Um I hope um um that um we will see that that number whatever it turns out to be is far less than the current number.
▶ 2:07:51Uh I believe very strongly that that hospitals and healthcare delivery there's a system involved and that system starts at the at the physical plant or and goes right right through security and the people who deliver food and clean the facility and make sure the equipment in there is maintained right on up the clinicians that are that are involved in providing the care and indeed the people uh that manage the referral process and hears concerns and complaints so that that the hospital itself as a system of providing care can work as well uh as it as it
▶ 2:08:21should. Mr. Gray, you mentioned in your testimony about uh the procurement process and I and I I I hope that we will spend more time I think this Congress anything that happens in these departments from contracting or to procurement I think we have a right to know about it because our responsibility is to get that information delivered and present it to the American people so they uh can assist us and bring accountability for the services that receive through their government with their taxpayer dollars.
▶ 2:08:48I I might add, I shouldn't hesitate to add um you mentioned that the procurement process at DoD or in uh and uh the VA in some respects are similar and work pretty well, but then you cited the prosthetics procurement process and can you put some more clothes on that for me? What's what's going wrong there? Because perhaps if you identify that to us, we can get together and figure out how to get either the resources or help uh the VA either by bringing attention to it.
▶ 2:09:17uh that that process is improved because obviously there are a lot of veterans who come back who need a pro a prostthesis to engage in as normal a life as they can in spite of the injuries they've suffered on behalf of our country. Yes sir. The the great news is we've been working with uh the ranking uh member as well as the chairman on this um because we learned a lot of great lessons from the med surge prime vendor.
▶ 2:09:40When we think about med surge prime vendor um that is more for non-implants so like not pacemakers or defibrillators or knee joints it's more uh contract is for permanent implants so typically higher uh technology higher cost technology and so that's the one that needs help and in terms of what help clinician involvement in the process more staff to ensure that they can order the product. So there's a staffing issue. Go ahead. Staffing issue there. And you mentioned inefficiencies.
▶ 2:10:09Is that also the staffing or the Yes, sir. Yes, sir. Inefficiencies. There's no uh time to add new products like there is in the med surge prime vendor contract. In that contract, you have two windows a year. There is zero in the in the uh prosthetics contract. So, that's one that we we need to open up and add technology to. So, things like Ferrapulse, when you're trying to bring that in, it's like, well, there's there's nothing open. There's no window. You can't add it. And so we're we're asking questions and not getting answers.
▶ 2:10:35And so I think that's the one that really needs to get um you know solved. Thank you. And thank you, Mr. Chairman. Representative Kenny. Thank you, Chairman. Thank you, Ranking Member Tano, uh for this important meeting. Um I just want to join the chorus of my colleagues in uh my disappointment that the VA is not here being represented today. Uh there are four of you. There are five seats. There is an empty chair right there waiting for the VA.
▶ 2:11:03They are not here to answer these questions. And when we're talking about the gaps in the industry work that is being addressed by your technology. Uh and first of all, thank you all for your work. Uh thank you for your commitment to the American people and our servicemen and women.
▶ 2:11:27Um, but when we're talking about the highlights in in in the gaps in in industry, we don't have the VA here. That is a major problem. We can't get to the bottom of the issues without the VA being represented here.
▶ 2:11:42And when the secretary comes out and says we're going to go back to 2019 levels of staff, that incurs a cut of 83,000 plus people to 399,000 workers preacted act pre- pandemic. We know that healthcare has changed in so many different ways.
▶ 2:12:09And so when we're thinking about how the VA will maintain or operate your technologies with drastically fewer engineers and technicians and support staff with 80,000 fewer employees. I find it absurd that they're not here to answer that question.
▶ 2:12:33The VA recently cancelled 900 contracts affecting things like cancer care, supply chain management, prosthetics, critical areas that directly impact veterans. How can we expect the VA to absorb the cost of new technologies when they're actively cutting these services? Again, I don't expect any of you to answer these questions based upon the fact that these are questions for the VA to deal with directly.
▶ 2:13:03You can try and I appreciate the efforts, but again, there is a very specific service that the VA provides to our military heroes that they've earned and deserve. you are there to complement that work.
▶ 2:13:26Without the staff to provide the resources, we are going backwards. Also, as far as maintaining the technologies to have the cuts that are coming forth to our veterans services and not having those individuals in place to take care of the technologies, again, I appreciate the effort, but when we're already talking a shortage
▶ 2:13:56of tens of thousands of workers where in the community that I represent in Buffalo, in Western New York, the Buffalo VA had nurses out on theformational picket line because they were underst staffed.
▶ 2:14:13And we have veterans that are going to the local VA because they love getting the services there because they know that those workers that are there underpaid and overworked are doing their absolute best and pouring their heart and soul into their work because they care about our veterans. So again, I'm appreciative of your efforts. I appreciate your testimony, each and every one of you.
▶ 2:14:43Again, I'm disheartened and disappointed that the VA is not here. And um we'll leave it at that. I yield back. Thank you. Representative Tano, you're recognized for your closing statements. Yes, Mr. Chairman. Thank you. Um before I begin my closing statement, I do want to clear up something. Um, here is a transcript of remarks that Dr.
▶ 2:15:05Murphy made earlier in the committee meeting in which I in response to my claim and I quote myself, "This is a prosthetics customer service center that has closed its door in Grenville, North Carolina. That is a VA facility that has been closed in a members district that sits on this committee." Dr. Murphy when it is questioning time uh came to him uh responded quote I'd like to correct the ranking member's statement about my VA.
▶ 2:15:32The prosthetics department at the VA in Grenville remains open during normal business hours Monday through Friday 8:00 a.m. to 4:30 p.m. to support the needs of vets in the entire Durham VA healthc care catchment. And he submitted um to support his contention that I had given out inaccurate information. He submitted for the record uh a vision response. I want to point out that that very response that Dr.
▶ 2:15:59Murphy submitted for the record, I'll quote from the middle paragraph, uh the prosthetics customer service window at the Granville VA Healthc Care Center, HCC, will remain closed until further notice. That uh document that Dr. Murphy submitted is dated March 18th.
▶ 2:16:21I will point out that this photograph that I had on my uh poster uh uh which actually shows the Grenville uh facility uh being closed and and it reads the Grenville VA ATC prosthetics customer service window is closed at this time. That is timestamped March 21st of of this year. Um I would like to submit resubmit Dr.
▶ 2:16:46Murphy's letter uh with unanimous consent as well as the transcript um uh of our exchange without objection and as well as the photograph without objection. So without question what is accurate information is that the Grenville prosthetic center is We can surmise and I think we can draw conclusions regarding the staffing cuts that have been undertaken at undertaken at VA that that
▶ 2:17:16might have something to do with this closure. Um I think this committee needs to uh needs to hold oversight hearings and and get transparency from VA about this very thing. Now I want to point out also in that document that uh was provided uh to the committee that Dr. Murphy submitted for the record is also an exchange between John Clark and Dr.
▶ 2:17:42Murphy's staff regarding concerns over and this is I quote from John Clark. We have heard from a few constituents in the Jacksonville office uh front desk now is going unmanned at times due to termination of support assistant and clinicians are having uh to either pop out of appointments to help people that walk in or shift their schedule to cover the front desk. Now the chairman has said there's there's no five five alarm uh uh concern here.
▶ 2:18:11I would suggest to the different suggest differently. I as many people know taught English for a number of years uh 24 to be exact and you know there's a famous quote in the uh in Hamlet where uh Queen Gertrude says uh the lady doth protest too much implying that someone is overemphasizing or overacting their emotions or making their sincerity seem doubtful.
▶ 2:18:37Now, the gentleman from North Carolina, I could say, is maybe doing both. Protesting too much uh against my inaccurate supposed inaccurate statements, but I would also say protesting too little about the staffing shortages that are causing him concern and that there should be more more protest about this particular concern by that gentleman.
▶ 2:19:03Um, now I want to also further say in my part of my closing that Secretary Collins has not met with a single Democratic member of the committee in the two months since he's been sworn in. Committee Democrats have sent 22 letters to the secretary and he has only answered three, just barely satisfactory responses to the three. However, very very superficial and scant responses.
▶ 2:19:30The uh secretary appeared on Fox and Friends on March 10th where he confirmed VA plans uh to cut the workforce by 80,000. That is a five uh alarm fire uh about to occur. U that is something the secretary confirmed on Fox and Friends. Well, Mr. Mr.
▶ 2:19:52Chairman, my hope uh when I invited VA to be our witness at this hearing was that there uh that this would be uh that this was a result in a conversation about how we can ensure veterans have access to life-saving technology at a fully staffed VA. Unfortunately, uh the majority chose to help VA continue to avoid any actual oversight of its staffing and procurement issues by not demanding their presence uh at the witness table.
▶ 2:20:16As we saw with regard to procurement uh there was a actual contract uh cancellation with regard to procurement or supply chain management uh assistant. It makes no sense to me why we would be having a hearing about VA's acquisition process without having VA here to talk it there. I can only assume that there there's some hesitancy on VA's part to be able to answer questions from all the members of this committee.
▶ 2:20:44The many questions my colleagues and I have had about this topic today are left unanswered because we have had no one from VA uh to uh to direct them to. So sadly this hearing has turned out exactly to be what I expected, a sales pitch with no bearing in reality. Trump, Musk and Collins are bleeding VA dry and have so far offered very little information to Congress about where, when, and how they're making cuts. Our many letters and requests for information continue to go in unanswered.
▶ 2:21:13Again, I want all veterans I want veterans to have it all. Access to life-saving technology presented here today is very much part of what I want veterans to have and and a VA that is staffed to provide them the health care when they need it and is and is fully staffed to be able to make this technology uh accessible. Uh this hearing today gets us no closer to this goals and until VA starts showing up, these conversations are futile and unproductive. And given Dr.
▶ 2:21:42Murphy's own concern about staffing in his own district. Mr. Chairman, I I I I ask you when we are going to have an oversight hearing on the 80,000 cuts that they are planning to do just two miles from here and they couldn't make it over to this Well, I want to say thank you to the ranking member for bringing up many concerns. We have since received an email. Actually the clinic for the uh there that has been in discussion is open.
▶ 2:22:13The service window was closed. That's it. A service window has a sign in it. The clinic is still open. And so that's important that we know that we know that chairman that clinic is an hour and 40 minutes away from what you're talking about. a service window is I just got the I just got the answer from the vision through a VA through an email that that there's the event the the VA did not close the facility.
▶ 2:22:42It closed a service window. That's exactly what I said and exactly what Dr. Murphy exactly what Dr. Murphy said. He said the clinic is open. He said the clinic is open. I I offered you the the actual quote. So with that being said, there are a few few other things I would like to bring one it was mentioned once again, as I said, we're seeing fear-mongering from other side of the aisle.
▶ 2:23:12VA's decision to terminate 580, this was early on, non-m missionritical D uh duplicative contracts instead it isn't a step backward. It's a long but it's long overdue. These weren't core services being cut. Many of these contracts were for duplicative work like paying a contractor just to produce material for other contractors to execute. That's not modernization.
▶ 2:23:41That's bureaucratic bloat. There's there's be that let's be clear. The nearly 1 billion in recovery funds will now be redirected to what actually matters, veterans health care benefits and cutting edge technology.
▶ 2:24:00This is a this hearing was about the future and I sincerely hope the future uh in the in days ahead my colleagues across the aisle won't immediately turn to the hysteria uh every time a a 24hour news cycle flashes up because trimming the fat is not a crisis. It's sense and veterans deserve better than scare tactics.
▶ 2:24:27they deserve the results and that's what I will continue to lead this committee in. One other issue when we talk about the concern about when is the secretary going to tell us the secretary is going to tell us like every other secretary there there are a number of items raised and rightfully so but I will remind the colleagues that there will be plenty of opportunity to engage with the secretary's questions when we hold our hearing on the details
▶ 2:24:57of the president's budget which always comes up that's when we're going to have the opportunity to do and to criticize. Um, let me tell you that majority staff did work, put the request in, VA chose not to show. That being said, let me tell you that as a member, two wrongs do not make a right, but I still think I need to bring this up.
▶ 2:25:18When we had a situation with the previous administration where two of the lead people had made decisions to give bonuses to the upper echelon executives, when we asked for them to come, they chose not to send them. Instead, the secretary came. So, it is not anything new for whenever we have this happen like this with the VA. I think both sides should work together to make sure the B VA is accountable. There's no doubt.
▶ 2:25:45But understand, remember when we're talking about the cuts, they keep saying the cuts. That was a memo. That was not a plan. That was just a proposal to get the people to the table. Now I've said in this hearing over and these hearings over and over again if someone is cut and feel they were unduly cut then they can contact our offices they can contact your offices to answer to that question and we're glad to do that but also remember one of the key things that that is concerning that one of the key issues if someone has
▶ 2:26:15been let go they can appeal to their immediate supervisors and if your immediate supervisor doesn't think essential I've been in job before and sometimes the immediate supervisors realize, okay, that one's not essential and it's not worth fighting. So, I do want to thank our witnesses for coming here today. We're grateful to hear uh just a few of the many healthc care leaders and we're we've learned a lot, I think, through this hearing.
▶ 2:26:43We've identified challenges healthc care uh innovators face in providing cutting edge quality services and products for veterans through the VA. Together, I believe we can see a day when veterans receive the care they need to regain their strength, mobility, and independence without barriers of access cost. I look forward to working with my colleagues on both sides of the aisle to achieving this goal.
▶ 2:27:09Now, again, I want to thank everybody for being here today and I ask unanimous consent that all members have five legislative days to revise and extend their remarks and will and include extenduous material. Hearing no objection. So ordered. The hearing is now journed.