▶ 0:01:26Montgomery county public schools in prince george's county public schools. The full updated list of closings and delays go to our website. >> the cleanup continues here at one dz agency says it has been working around the clock to make sure the district stays online. >> there are wires and machines everywhere.
▶ 0:02:28[please stand by]
▶ 0:16:16Chair Moran: Good afternoon and welcome. Today's hearing is the first of two that will occur over the next month to examine the v.a.'s recent proposals to modernize the v.a. Health care system to better serve veterans in kansas, connecticut, arkansas, washington state, and everywhere else veterans call home. Today specifically we will examine the plan the v.a. Announced last month to restructure the veterans health administration.
▶ 0:16:44Chair Moran: The restructure will impact sustainable effort represents the most significant reorganization of the v.a.'s health care system since the 19 90's. Once fully implemented over the next two years, rise will change how the v.a. Manages and oversees the delivery of health care to veterans across the country. Our goal today is straightforward but serious, to examine how the v.a. Arrived at this plan, are the v.a.
▶ 0:17:09Chair Moran: Will put this plan into place, and how will include the reliability of the health care system and lead to better experiences and outcomes for veterans who rely on it and for the v.a. Staff who work within it. The department describes rise as an effort to reduce bureaucracy and red tape, standardize operations, better align v.a. Resources and needs of v.a. Patients and staff. These are important goals and I commend the secretary and his team for prioritizing them.
▶ 0:17:40Chair Moran: Countless findings from this committee, the v.a.'s office inspector general, government accountability office and others have detailed sufficient -- deficiencies that rise is intended to address. A decade ago for example, a government accountability office noted that recent internal and external reviews of operations identify deficiencies in its organizational structure and recommended changes that would require significant restructuring to address including eliminating and consolidating program offices in
▶ 0:18:11Chair Moran: Reducing bha central office staff. That is from the government accountability office. In testimony last congress inspector general's office noted the v.a.'s current structure quote, did not ensure accountability and lacked clear defined roles and standardized responsibilities which could lead to deficient engagement with facility leaders and inconsistent oversight.
▶ 0:18:34Chair Moran: At the same time while reorganization can sound like a good thing, and often it can be, reorganization carries risks. I look forward to this committee to get a better understanding today of how the v.a. Will mitigate those risks, measure success, and protect continuity of care during this transition. I also look forward to hearing how the v.a.
▶ 0:18:55Chair Moran: Will engage with the veteran patients and their families via health care workers, community providers, organizations and congress about changes moving forward. I have served on the v.a. Committee -- my remarks say eight but I am told it is 11 -- secretaries of veterans affairs. They all made promises to improve -- improve the bureaucracy and implementation of v.a.
▶ 0:19:23Chair Moran: Care and while they have made good faith efforts to do so, we continue to look for long-lasting successful changes and improvements at the department of veterans affairs. I look forward to the secretary collins making the case for why he thinks his plan will finally make lasting changes. I thank secretary collins and the other v.a. Leaders for joining us today to discuss their important work and how we can all work together to make the veterans health administration more worthy of the men and women it serves.
▶ 0:19:51Chair Moran: I yield to the ranking member of senator blumenthal for his opening remarks.
▶ 0:19:56Sen. Blumenthal: Thanks Mr. chairman. Welcome to secretary collins, to your team and to all who are here today and perhaps listening by livestream. I want to begin by taking a moment to honor the memory of alex pretti. As I think all of you know, alex was an intensive care nurse at the minneapolis v.a. Medical center.
▶ 0:20:25Sen. Blumenthal: One of the most demanding jobs at the v.a. Health care system and he was one of the most dedicated of the staff who served our nation's heroes. By all indications he dedicated his life to caring for others, particularly veterans. He wanted to make a difference and he did. As evidenced by the countless coworkers, veterans and families who have come forward with stories about his compassion and his positive impact on their lives.
▶ 0:20:55Sen. Blumenthal: Alex loved his job. He loved his family. He loved his country. That's why he was on the streets of minneapolis last saturday morning. He was protesting and documenting what he saw, what many of us see, as unlawful and unnecessary assault on our communities.
▶ 0:21:19Sen. Blumenthal: And after coming to the aid of someone who was assaulted, a woman who was struck by masked federal agents, he was pepper sprayed, tackled to the ground, beaten, and shot in the back multiple times, while lying unarmed and posing no threat.
▶ 0:21:43Sen. Blumenthal: As we come together today, I hope the memory of alex pretti will inspire us to do better for our veterans, for our country. And their families. Mr. secretary, I appreciate your being here. I regard your appearance as overdue, if I may say so, with all due respect.
▶ 0:22:10Sen. Blumenthal: I respect that there are ways to reduce our bureaucracy at bha, to improve the quality and timeliness of care for veterans, and I think you will find support on both sides of the aisle for that goal. I have concerns about the potentially negative impacts of the reorganization on frontline employees.
▶ 0:22:35Sen. Blumenthal: And how restructuring the nation's largest health care system will be impossible without dedicated, experienced staff. In human resources, I.t., finance, resource management, operations and clinical leadership. I want to know what the implications and the impact for those resources will be as a result of this reorganization and I welcome this conversation. I really welcome your being here.
▶ 0:23:08Sen. Blumenthal: And I will say again, with all due respect, there has been too little conversation and too little responsiveness en route -- on the part of the v.a. For questions that have been asked on both sides of the aisle and request for information that we have made. I hope we are turning over a leaf. And beginning a new chapter.
▶ 0:23:32Sen. Blumenthal: As you may know, I prepared a report on this first year with facts and figures about the results of cuts in workforce, cancellation of contracts, reduction in force, a lot of it remnants of the doge deluge and its impact on the v.a.
▶ 0:23:59Sen. Blumenthal: And so many other functions of government. And if anyone in the v.a. Disagrees with the findings and conclusions of that report, I hope we will be given facts and information. That is the coin of the realm in the congress. That is the way we do our job.
▶ 0:24:29Sen. Blumenthal: And you may recall -- no doubt you do -- that past secretaries of the v.a. On both sides of the aisle have not only provided that kind of information but hosted substantive conversations, for example, with the four corners leadership on a regular basis I have participated in with secretary shulkin and wilkie under the trump administration, as well as
▶ 0:25:00Sen. Blumenthal: Mcdonough in the biden administration. Nearly all of your predecessors have welcomed accountability and made concerted efforts to build constructive relationship with congress, an approach that leads to better outcomes for veterans.
▶ 0:25:24Sen. Blumenthal: And I hope that in turning over this leaf and beginning a new chapter, we can move forward to provide for more responsiveness and more facts forthcoming to our veterans come into the veterans service organizations that so ably advocate for our veterans, and to serve the common goals that we have and that bring us here today. Thank you, Mr. chairman.
▶ 0:25:47Chair Moran: Senator blumenthal, thank you. As I mentioned in my opening, we are joined by secretary collins and his team. Accompanying him are the honorable john bartrum, under secretary health. Mr. mark engelbaum, assistant secretary for human resources and administration. And gregory goins, the acting chief operating officer for the veterans health administration. I appreciate you all being here.
▶ 0:26:16Chair Moran: I am glad that this hearing is taking place. And I'm glad that all members will have the opportunity to have a conversation and a discussion with you and your team, Mr. secretary. And you are now recognized for five minutes, or perhaps as long as you take.
▶ 0:26:31Sec. Collins: Thank you. Good to be with you again. Yes, there is a lot of to having today and continuing that conversation. I hope my tone will be matching that as we go forward to get real answers for the solutions we have been looking for for a long time. I do appreciate that and the other members of the committee as well.
▶ 0:26:56Sec. Collins: I want to express my deepest sympathies to the family and colleagues of alex pretti. The death is currently under investigation. The v.a. Is not involved in that investigation. Neither I nor my fellow panelists are able to give additional details at this time. In this troubling time, I just want to make that very clear to this committee and also the words that you said Mr. ranking member as well, echoing this going through our medical center.
▶ 0:27:28Sec. Collins: Our family -- the family will continue to be in our prayers. The reason I am here today is also what you and the chairman have talked about and that is addressing a lot of things that have been coming up over the years on discussion on how we can reorganize vha to take care of veterans. There has been a lot of misleading and inaccurate descriptions of how we are doing this effort. First off let the state this is not a reduction in force, this is not an effort to diminish direct care for veterans.
▶ 0:27:57Sec. Collins: This is a reorganization designed to eliminate glut and push more resources directly to the field. The chairman made a statement that is so true -- I didn't even have this knowledge when I first got on the job until I got in and started visiting over 30 states and looking at over 70 facilities. We are the largest health care provider in the country but yet we did not act like it.
▶ 0:28:21Sec. Collins: We didn't act like the largest health care provider in the world in many ways because we were trapped internally into our own policies, procedures, things that have been added on, none which added up to taking care of veterans but took care of the v.a. Itself. I think that is where we had to start is asking them. Many of the things we are going to talk about today came from oig reports, gao reports. It came from congress.
▶ 0:28:48Sec. Collins: We went back over testimony over the years and looked at what congress has said about how is the organization balanced. Chairman moran's own comments, also comments from both sides of the aisle on how we can make it better for the veteran itself. We have also listen to bso's taking into their account all throughout the year and looking at them and saying how are you on the front line with your own membership seeing what is happening in our hospitals. This is will you get the information.
▶ 0:29:18Sec. Collins: It is not seeing a coworker report, it is being in the field and talking to the executive directors of these hospitals to say what you actually need and listening to members. When we went and visited together, you see a lot of good stuff when you are there and that fell through is what I have tried to break down. And as you heard me say when I was up there, I say what can you do that you are not doing now? What is stupid -- and I use that term for my own term -- that you do that nobody else does?
▶ 0:29:47Sec. Collins: It is amazing how that broke the walls down. It is amazing how they began to talk about things that needed to be changed. Those are where we come from as we move forward here in looking at where we are. We also looked outside. We looked at other organizations outside the v.a. That are large in scope and health care and say how do you manage this, how do you do the large programs you have that all of your districts have, all of your states have in your public and private health care?
▶ 0:30:15Sec. Collins: What we found was the vha needed organization and reform and that is exactly what we are doing. Here are the goals. -- this is the thing we have to get to pick true lines of authority that allow our hospitals and clinics to do what they are doing and take care of veterans. I want to use an example that you can see in my remarks we sent out.
▶ 0:30:49Sec. Collins: No one many times knew what to do when they had a question because we had policies scattered all over. They had everybody taking apart what I call the camel committee. It was supposed to be a thorough bed but we got a camel out a bit because everybody had a part and nobody talked to each other and at the end of the day the hospitals and clinics were left to figure it out on their own. There is a lot of scary stories about how this is bad or could be bad.
▶ 0:31:14Sec. Collins: What I want today is act on more than two decades of discussion in this committee and in the house on how we can make this better. We have done some really good things this year. You talk about backlog. We have reduced it over 60% from 206 2000 down to 100.
▶ 0:31:33Sec. Collins: The appeals on that are still in line with the increase in actual backlog being taken down to actual appeals within line of what you would expect with the normal increase in decisions made. We have a limited of the backlog. We have open 25 new health care facilities and permanently housing 52,000 homeless veterans. I look forward to a great discussion today. I believe this is generational change.
▶ 0:31:57Sec. Collins: I believe this is something both sides can agree on and find ways to move forward and I look forward to providing any information. As I said earlier I do have folks with me I want to emphasize. With john bartrum, mark engelbaum, hr, and gregory goins , who has been with the department for 13 years. He overlaps everything that has been done. You can tell from his history how this tried to be played out in its beginning.
▶ 0:32:27Sec. Collins: I brought a lot of help because I wanted you to have all the information you need. And with that I yield back.
▶ 0:32:31Chair Moran: Thank you. We will now have a round of questions and I'll begin those questions. First of all, one of the experiences I have had over a long time is I have occasionally been able to get the department of veterans affairs' attention on a particular veteran and his or her problem that needs to be addressed. I have also from time to time be able to encourage and be assured by the v.a.
▶ 0:33:00Chair Moran: That certain policy changes that made no sense to me and two others were being corrected. In both instances, I want to indicate that the end result was not the result I was totally looking for. And so fixing a veteran's problem never meant it fixed anybody else's problem who may have had the same circumstances. So, that's one.
▶ 0:33:27Chair Moran: And policy changes, I discovered the v.a., the secretary and others would tell me, no, we've changed that policy, only to go home to find out that no one in the hospital knew about the change in the policy. Will your reorganization address and solve those kind of problems?
▶ 0:33:47Sec. Collins: I could not have done it better in one minute to describe why we are doing what we are doing. Described it from every member on this panel and not on this panel. It is finding a solution to the individual problem that should solve a policy problem but does not and that is why we have the problem that developed in this over time. I am not going to go back to any prior secretary or prior administration, democrat and republican. There were good intentions all along.
▶ 0:34:16Sec. Collins: When you get an internal growth and you have a department so large that they cannot basically move because of internal frameworks, this is where we get the problems. Mr. chairman, I want to address gregory goins who has been a member almost 14 years working at a hospital level. Greg can talk about how what you just talked about was so difficult when you have policy taken in one place and never applied at the hospital level.
▶ 0:34:44Mr. Goins: Thank you. In my time as a medical center director and now in this role as an operations officer, it is clear there are a lot of silos within our organization that ultimately creates a lot of disconnect both between what is actually drafted in policy and the guidance being given.
▶ 0:35:07Mr. Goins: As a result it is very common in current state of affairs for our frontline -- for a front-line worker to be engaged with a veteran and have a challenge with something that might be written in policy or something given in guidance. And when they try to get clarity on that they might get five or six different answers depending on who they go to between the program officers and medical center. This creates a new element that does not exist currently in medical operations center.
▶ 0:35:35Mr. Goins: That focus is to take policy from the D.C. level and interpret it so that there is one application to the way in which that should be implemented. Nothing pains me more than when I am serving a fellow veteran and I get a call, maybe it is from you or someone on your staff, and I need to address the challenge that individual veteran has. But the pain that I have knowing that this could happen to someone else.
▶ 0:35:59Mr. Goins: This organizational structure change is going to allow us to create continuity from the top all the way to the front line and allow us to flag those type of events proactively so that the communication to the field is consistent, so that we fix those things and escalate them real time.
▶ 0:36:14Chair Moran: Thank you for that answer. One of the aspects of reorganization that you are addressing are the visn's. It took me a long time to learn that the visn was not really supervising the hospitals with direction, or capability, responsibility for doing so. In my early days I assumed the visn was the overall arching leadership when it came to the hospitals within that visn.
▶ 0:36:45Chair Moran: Your rise act indicates that we will reduce the number of visn's from 18 to 5. Visn's, jujst a reduction in and of themselves, is insufficient unless the visn's have purpose and meaning, relevance.
▶ 0:37:12Chair Moran: What problem is the consolidation intended to solve and how will specific roles and responsibilities of the visn's change once rise is implemented and what benchmarks will be v.a. And this committee be able to use to evaluate whether the new visn system is resulting in better outcomes?
▶ 0:37:27Sec. Collins: Just quickly on that, that was part of the problem. There is an article today out of my home state of georgia of dublin v.a. Center in which it showed the inadequacy of the visn system in seeing a problem but not acting on the problem and that was a policy decision in the way this happens. John bartrum is our new undersecretary of health who will be over this.
▶ 0:37:52Sec. Collins: We have taken the five visn's and also added hsa's who can then be more market centered for your rural and urban hospitals, more directed into how they can help those hospitals and give them better direction where the visn is concerned with implementation and management of that. And I want the undersecretary to discuss that.
▶ 0:38:14Mr. Bartrum: Thank you for this opportunity. I really look forward to implementing this change across the department. The scope of the visn directors is too broad and we have to focus that so they are doing the executive level work and the strategy of looking up and with the health service areas. Hsa's, they are looking down at more narrow markets.
▶ 0:38:42Mr. Bartrum: Now they are able to focus on what is going on and help support that hospital director. So that is directly down to the facilities providing that support so that we can assist the hospital director as opposed to add bureaucracy to the process. I realize I am over time. I didn't want to go any longer unless you want me to. Gregory goins can go more in depth as a former visn director as the perils he had to face.
▶ 0:39:10Chair Moran: I was reluctant to ask my question in the manner in which I did because I didn't want you to seem irrelevant.
▶ 0:39:18Mr. Goins: No sir, I did not feel that way at all. In fact, in the last few years I was in that role I look forward to --. As a visn director much of your time is spent trying to compete with multiple responsibilities. That is fine if you are an executive.
▶ 0:39:41Mr. Goins: The issue is with the scope of responsibility being governance and oversight and appropriations come etc. Come every time you spend on that come every day you spend on that is a day of the week you cannot spend in community stakeholder engagement, medical leadership engagement, veterans and their families engagements, and engagements with our local partners like yourselves, legislative partners.
▶ 0:40:07Mr. Goins: What this redesign does is it d's copes the role of the visn director of to focus on the oversight and governance aspects of that role in one place. That is those five visn directors. Then we have these new elements called health service areas and those health service area directors, their sole responsibility is focus on day-to-day interactions with the medical center and the leadership teams along with community stakeholders.
▶ 0:40:34Mr. Goins: It gives them an ability to understand in real-time the challenge is happening in the facility and also work in real time with facility directors.
▶ 0:40:53Mr. Bartrum: This streamlines that. When people talk about bureaucracy, this streamlines bureaucracy. The directors will report directly to me and that allows me to have better access to what is going on in the field and where there are issues. Just like the mock director as well.
▶ 0:41:15Mr. Bartrum: Instead of having this bifurcated system where we go through these different channels , the undersecretary for health will have the five visn directors and the mock director and then two deputies. So we will be a much tighter team to be able to implement future changes.
▶ 0:41:35Chair Moran: Thank you all for your answer. Senator blumenthal. Senator blumenthal asked about five minute rounds. They are from now on. [laughter]
▶ 0:41:50Sen. Blumenthal: I have been there. Thanks, Mr. chairman. Mr. secretary, as you may recall, congress provided an additional $6 billion -- with a b -- in fiscal year 2025 for the v.a. To meet the higher-than-expected cost and demand for v.a. Health care.
▶ 0:42:18Sen. Blumenthal: That funding was supposed to be spent on additional providers, community care utilization, rising costs for prescriptions, and prostatic devices. My understanding is that almost all of that $6 billion was used to cover the cost of the cuts in staff, deferred resignation program, and voluntary early retirement.
▶ 0:42:44Sen. Blumenthal: That included paying out vacation time to employees who were paid to stay home and not work. Can you provide this committee with a full accounting of the $6 billion? Which I think is very important because apparently it was used to push out essential v.a. Health care providers rather than sustaining v.a. Medical operation as we intended.
▶ 0:43:10Sen. Blumenthal: I know you may not be able to do it right here, but I would like an accounting of that $6 billion. Hopefully within the next week.
▶ 0:43:20Sec. Collins: We will look at it and get you the numbers of that. My om is here and we will get to that information. Rest assured, nothing was used to push anyone out in that regard.
▶ 0:43:34Sen. Blumenthal: Well, rather than going into the rhetoric, I want the numbers.
▶ 0:43:39Sec. Collins: You will get the numbers.
▶ 0:43:41Sen. Blumenthal: Talking about numbers, my understanding is more than 40 thousand employees have left the v.a. Since last january. Can you provide this committee with a detailed, updated workforce compilation of data, the number of staff who have left the v.a.
▶ 0:44:05Sen. Blumenthal: Since january 2025, broken down by facility and position, and the list of positions and vacancies each facility plans to cut based on the tasks he set late last year?
▶ 0:44:20Sec. Collins: Number one, that is why mark engelbaum is here from human resources and he will be happy to answer that question. We will get you the information. I want to make -- yes, we will get you the information. It is good not only for the public to hear but also you to hear what the numbers are actually from hr on this.
▶ 0:44:44Sen. Blumenthal: Do you have numbers?
▶ 0:44:46Mr. Engelbaum: Yes, and we will provide you the numbers and positions in detail. We reduce about 30,000 personnel, not 40,000. 40,000 is total losses.
▶ 0:44:59Sen. Blumenthal: I understand. But you have hired people since then. But not necessarily for the same positions. That is why I want the breakdown. We have asked for it repeatedly and we have not received it. I am asking again in this forum -- I should not have to do so, but I welcome your willingness to provide this information. Let me ask you next, because my time is limited to five minutes.
▶ 0:45:30Sen. Blumenthal: The department's annual veteran suicide data report is overdue. Even though it has reportedly been complete since september. Can you confirm your legislative team has issued a non-concur to the report when it was provided by the v.a. Office of mental health and suicide prevention?
▶ 0:45:56Sec. Collins: I have no knowledge of a non-concur. I know the report was being finalized in the fall.
▶ 0:46:02Sen. Blumenthal: It is overdue. Will you provide it?
▶ 0:46:05Sec. Collins: Hopefully it will be out very soon.
▶ 0:46:08Sen. Blumenthal: As you no doubt agree, veteran suicide is a major issue, tragically and unfortunately continuing is a major issue.
▶ 0:46:17Sec. Collins: There is nobody in this room more apparent than that.
▶ 0:46:21Sen. Blumenthal: You owe it to the congress and our veterans that that report is issued. Let me just say on the issue of mental health, wait times have increased. Can you provide to this committee the wait times for mental health care in facilities across the country? I am asking for the details in regard to those, whatever number of facilities there are.
▶ 0:46:51Sec. Collins: I would be happy to appear it I can give you some numbers now but also something I cannot give you when I first appeared for my confirmation hearing was a dashboard that looked at metrics such as that that I can see every facility on a real-time basis.
▶ 0:47:04Sen. Blumenthal: Then you can see the wait times have increased. 50, 60, or 70 days.
▶ 0:47:13Sec. Collins: That is not true. As of january 1 it is 18.8 days. The national average for established patients is 5.8 days. If you need emergency care or you're in a crisis, you have immediate care. That is the actual numbers.
▶ 0:47:29Sen. Blumenthal: Well, that is contrary to the information we have been provided and I would like facility by facility data on the wait time for mental health care. My information is one third of the states have an average wait time exceeding 40 days. Only three states represented on this committee have new patient primary care wait times below the threshold for community care and the wait time for mental health care at many v.a.
▶ 0:47:59Sen. Blumenthal: Facilities is 50, 60, or 70 days. But I welcome the information you are going to provide. I apologize, I am over time.
▶ 0:48:09Chair Moran: I did not notice but will now reinforce the five minute rule was senator boozman.
▶ 0:48:16Sen. Boozman: Thank you. Mr. secretary, we have all heard about the bureaucracy and inefficiencies in the system. And that is certainly not any secret. Throughout your modernization, veteran's abilities to receive care must remain unaffected. What protections are you implementing to ensure continuity of care throughout the v.a. Process?
▶ 0:48:45Sec. Collins: That has been the whole focus as to what we are doing is designed to in theory -- we have seen this as we go along. I can think of ways using best medical interests where we have cut out a layer of bureaucracy and making sure people can get the community care quicker.
▶ 0:49:07Sec. Collins: We have aligned our women's health into where now they don't have to go back to their primary care doctor to get to their normal women's help needs. These are the kinds of things we are working on. I would be happy to let our undersecretary deal with that just a little more.
▶ 0:49:30Mr. Bartrum: You will see the bottom part of this chart which is the medical centers. Not making any organizational change structure in the bottom part. All of the changes are in policy. We are working to get the structure aligned so that the information flow to the facilities and to support the facilities is at the facility level.
▶ 0:49:58Mr. Bartrum: We have policy offices right now that at the policy level do policy implementation and execution. What we need to do is get them out of the execution business and let the facilities to the execution and we just provide them the standardization and right and left boundaries to execute. So that is how we are mitigating the risk relative to the facilities because we are not making significant changes at the facility down level. Everything is up.
▶ 0:50:27Mr. Bartrum: And how do we add additional support to the facilities.
▶ 0:50:33Mr. Goins: My background has always told me the best people to understand the way to improve things other people actually doing the work. The number one priority is to make sure that direct care is not impacted for our veterans and their families. You number one way to make sure that doesn't happen to take input perpetually from the people doing the work in addition to our front line executive leaders. They have been engaged on this change from the beginning.
▶ 0:51:01Mr. Goins: And moving forward, nothing will happen with this reorg without the input and understanding how any changes that we are projecting to make will ultimately impact the reality for the veterans and their families in the facilities. They will be involved every step of the way until we get to the finish line.
▶ 0:51:18Mr. Bartrum: If I could add onto that, the development of this plan was from visn leaders. They worked to develop this plan. This was based on the people are running our organization from the ground up and they got input as they developed it over a nine-month process.
▶ 0:51:40Mr. Bartrum: It is an iterative process and the engaged with outside expertise as well as our own internal consultants we have within vha.
▶ 0:51:52Sen. Boozman: Very good. With senator murray's help and senator collins leading us forward, we are about to wrap up the appropriations cycle, which was really remarkable. Almost immediately we will begin again. Do you currently have the necessary ending sunday to -- necessary funding?
▶ 0:52:18Sec. Collins: Yes we do and we are looking ahead for our fiscal 2026 and we appreciate the numbers given to us. We have had these discussions. We had discussions early on discussing some transfer issues which I think we worked out and I appreciate the appropriation committee's concern and it was taken too hard.
▶ 0:52:41Sec. Collins: We are currently allocated at $50 billion print we are budgeted to that and we believe we will be able to make that and we appreciate the input we got from the four corners on other information as well.
▶ 0:52:55Sen. Boozman: Very quickly I want to mention I had the opportunity to go to fayetteville arkansas the other day to patriot park and we have a lot of challenges we are working through but we always have to remember there is a lot of good things going on in regard to veterans and people just stepping up.
▶ 0:53:18Sen. Boozman: This is a great public-private partnership that has come together that is going to offer very affordable housing for our veterans and should be completed in the next few months. And hopefully we will get you out there, Mr. secretary. Need some of the rest of you to really see a project that we can all be very proud of.
▶ 0:53:38Sec. Collins: Look forward to it.
▶ 0:53:40Chair Moran: Senator murray.
▶ 0:53:42Sen. Murray: Before I begin my questions, people across america are reeling from the horrifying murder of alex pretti by federal agents and as we all know, alex pretti was and I see you nurse at the minneapolis v.a. Medical center. He is remembered by colleagues and friends as a calm presence amid the chaos of the hospital. Someone who cared deeply for the veterans he served.
▶ 0:54:12Sen. Murray: He was remembered as a mentor, a caretaker, and someone who wanted to make a difference in the world. The father of one veteran he cared for until the end described him as the sweetest person you could imagine. Alex pretti spent his last minutes trying to help a woman. She was a bystander being assaulted by federal agents. He was killed by those federal agents months -- moments later.
▶ 0:54:38Sen. Murray: Immediately after he was killed the trump administration began spreading sickening lies about him. They lied about who he was, what he was holding, what he was doing, in the moments before his death. Trump and the miserable folks at the dhs showed right away they didn't care about getting any facts. They told americans not to believe what we all saw and heard with our own eyes and ears. We all saw an american shot and killed by federal agents in broad daylight. Mr.
▶ 0:55:07Sen. Murray: Secretary, your initial response to a v.a. Nurse being killed by federal agents was to blame it on minnesota officials. You didn't say a word about who alex pretti was or the incredible work that he did for veterans. You mentioned him today, but still did not refer to that. That is certainly a choice. Words cannot describe how outraged I am and how outraged we all should be at the killing of alex pretti, who simply did not have to die.
▶ 0:55:39Sen. Murray: And in this administration's rush to spread lies about american citizens whose only crime was peacefully exercising their first amendment rights. Joining ice or border patrol doesn't give you a license to murder. I want to reiterate you all of you that there must be an independent investigation and real accountability here. This cannot continue and I hope that we agree on that basic point in republicans join us to work with us to make that happen. Mr.
▶ 0:56:07Sen. Murray: Secretary, I wanted to ask you today, it is my understanding that minneapolis v.a. Employees have not been granted personal leave to mourn their colic because they are subject to mandatory overtime due to staffing shortages. Are you allowing any of the employees to get personal help, to take any time off, or to offer them your support as they go through a very trying time of losing a very close colleague?
▶ 0:56:34Sec. Collins: Yes, we are providing all we can to those workers and I will have gregory goins discuss that.
▶ 0:56:42Mr. Goins: Not only do we have conversations the day this actually occurred, it has also happened every day since it has occurred. All the resources we offer our federal employees when times like this occur, these tragedies occur, they are offered employee assistance programs, offered whole health assistance programs, also offered things through community partners if necessary.
▶ 0:57:07Mr. Goins: If anyone comes forward to want to take leave because of a close coworker, we always have empathy in allowing that. The very first contact made in that medical center was with icu coworkers. And if I can just add, they just had a memorial service for alex pretti yesterday at noon were over 300 employees attended and were able to memorialize and remember him.
▶ 0:57:29Sen. Murray: It is important your words to those employees personally, be taken care of. I want to move to a really important discussion as well. Because in late december not long ago the trump administration quietly implemented a near-total abortion ban at the v.a.
▶ 0:57:50Sen. Murray: V.a.'s final rule prevents the more than 460,000 women veterans of reproductive age, over half of whom live in states with abortion bans, from receiving abortion care at the v.a. Now. V.a. Providers are not even allowed to discuss abortion as an option with veteran patients. Secretary collins, a simple question. If a veteran has been raped, is she able to get abortion care at the v.a. Under the current policy, yes or no?
▶ 0:58:16Sec. Collins: You know that the v.a. Was up until 2022 not doing any abortions at all. This was a decision by the previous administration to bend the law, go back over generations of democrat and republican administrations.
▶ 0:58:34Sen. Murray: A simple question. A simple question. If you are raped, can you get an abortion?
▶ 0:58:42Sec. Collins: There are no abortions to be done. That has been very clear.
▶ 0:58:49Sen. Murray: My time is up. I just want everyone to know the under this v.a. Final rule, no exceptions for rape or incest. I find that outrageous.
▶ 0:59:00Sec. Collins: I wanted to be known to everyone listening that until 2022 when secretary mcdonough changed what was a high president law of this country there were no abortions of any kind for any excuse or any reason.
▶ 0:59:14Sen. Murray: And he rightfully corrected that to make sure that if someone was raped or a victim of incest they would get health care.
▶ 0:59:23Sec. Collins: We see that differently.
▶ 0:59:25Chair Moran: Senator tuberville.
▶ 0:59:28Sen. Tuberville: I'm grateful that our veterans are finally being put first in this reorganization plan. Mr. secretary, I want to talk about this graph behind me. The red is the growth of employees since 2019 and the below shows the -- the blue shows the number of patients over the same time.
▶ 0:59:57Sen. Tuberville: Between those five years there was a 14% increase in the vha employees but only a 6% increase in patient encounters. Mr. secretary, my colleagues across the aisle are saying rightsizing the v.a. Hurts veterans with this graph does not support that. To me it looks like we are over hired and you are simply rebalancing the books to put more money towards our veterans. Is this correct?
▶ 1:00:22Sec. Collins: You are correct. And I think one of the things we have looked at in this whole organization is for example, I have a sheet here listing out a hospital that had a 33 percent fte growth while only 14% patient encounter growth. We had a 24% growth in fte and negative six in patient encounters. This is what we have seen. Mr. engelbaum can explain that a little further.
▶ 1:00:50Mr. Engelbaum: Thank you. This is exactly what I said as I initially came on. I have always believed and firmly believe the v.a. Has provided wonderful medical care. What we have not done is done that in a cost-effective manner that has actually done more effectively. The idea that throwing more employees at something actually increases our effectiveness and is counter to what reality is.
▶ 1:01:15Mr. Engelbaum: You have more bureaucracy, more overhead that leads to slowing down and removes folks from supporting our veterans. We have been committed from the outset to do that, to bring that back into balance, and that is what we have done them. We have stated from the outset, looked at our reductions but that is always tied to veteran care. We are committed to veteran care and to reducing bureaucracy and making sure we enforce that as our standard, not just the number of people employed.
▶ 1:01:47Sen. Tuberville: Can we get --.
▶ 1:01:51Sec. Collins: Gregory goins has actually experienced this.
▶ 1:01:55Mr. Goins: One, we don't have a direct connection between workload and a number of resource of resources the assigned generally as an enterprise. That creates a tremendous imbalance where we offer people resources in the facilities and it ends up becoming a wish list that is not directly connected to the actual demand the veterans and their families have in that system.
▶ 1:02:16Mr. Goins: The reason that is so important on an enterprise level is when we open a new clinic or an hcc like in fredericksburg, virginia, and we need to add a lot of resources because of the new organic location to serve a growing veteran population, we don't have the ability to look at them and say here are the resources. I have to look at a network director and say you have a new clinic coming on board, figure out where to get the resources.
▶ 1:02:43Mr. Goins: Because we factually have not looked at the places where we are losing veterans and try to right size the workforce to match the demand. So what we saw at the beginning of covid is a massive ramp up in resources because we didn't know what the demand was going to be and I understand that. Same thing happened in the private sector. We did the same thing in anticipation of an increased demand. Frankly, that did not fully realize. We saw more reliance would not a full workload increase like what we might expect.
▶ 1:03:13Mr. Goins: What happened in the private sector post-covid is they went and laid off workers. And I am happy we don't do that. However but we have got to do is understand our organization cannot withstand over time and be sustained with a 14% increase of personnel to support a 6% increase in workload over that same period. It's unsustainable and not right for the taxpayers.
▶ 1:03:35Sen. Tuberville: I have two questions that I'm going to put into one but they are very different, because you will cut me off if I don't ask them at the same time. One, my state of alabama, 42% community care. Where does this fit in in your reorganization? Because we have to have it. And two, we need more domestic-made drugs in the v.a. And we have people who can do it. But let's start treating our veterans with domestic-made drugs.
▶ 1:04:05Sec. Collins: Community care is a huge part and most everybody that has been in congress voted for this and it is the law that we have to make community care available. It is a balance we are seeing in our different states. Remember, I have to make sure when anybody complains about a weight time for community care, that is the doctors in the community causing that, not me. But community care is important.
▶ 1:04:31Sec. Collins: The new contract we have is going to help us with third-party administrators going forward as we look at this. So I think that will address your needs and concerns. And making sure this administration in particular has looked at our supply chains so that we can have more american-made products so we are not caught behind.
▶ 1:04:52Sen. Tuberville: I have complaints about community care hospitals and the v.a.'s communicating. They have to communicating better. They are holding back mri's and things like that.
▶ 1:05:07Sec. Collins: We will be happy to talk about the reasons on that.
▶ 1:05:13Mr. Goins: Can I add a comment? The very nature of that is meant to directly address that. We have someone that is directly engaged with community stakeholders to include those community partners to make sure that stuff is corrected real time instead of waiting after the fact and being reactive.
▶ 1:05:33Chair Moran: Senator hirono.
▶ 1:05:44Sen. Hirono: I want to follow on abortion services. It was determined the v.a. Had the authority to provide abortion services in the cape of -- case of rape and incest. So the fact you are providing such services is an ideologically-based decision, not one required by the law. And yes, we all acknowledge the v.a. Is the largest health care system.
▶ 1:06:14Sen. Hirono: And when we started with this regime, you came and testified, we acknowledge that. But it is in the midst of thousands of v.a. Employees being fired with little to no notice. And thousands more taking the early whatever the doge fork in the road process was. You are obligated at the v.a. To pay for all these people not working.
▶ 1:06:41Sen. Hirono: In the midst of what could be described as chaos at the v.a., while all of this is still going on and questions about even more people, maybe 85,000 more people you are contemplating firing or letting go, you come to us with an entire reorganization of the v.a. It is hard to take it seriously, frankly.
▶ 1:07:03Sen. Hirono: You testified just now that there is currently an investigation being undertaken regarding the murder of alex pretti. Who is this investigation being conducted by?
▶ 1:07:21Sec. Collins: I am with the v.a., you have to discuss dhs and others on that.
▶ 1:07:27Sen. Hirono: Because neither homeland security no more fbi director has indicated they are about to undertake an investigation into what happened to Mr. pretti. The kind of independent investigation that I would say the majority of people in this country are calling for. Since you don't know anything about it, how about expressing may your personal opinion? Do you think such an independent investigation should occur with regard to one of your employees?
▶ 1:07:55Sec. Collins: I agree with the president who said it was going to be investigated and will continue to be.
▶ 1:08:01Sen. Hirono: You know what? His definition of investigation is not the kind of independent investigation we are calling for. This regime is implementing a lot of the items that are in project 2025. When I look at project 2025, what it says about the v.a. Is, quote, to resend all departmental clinical policy directives that are contrary to the principles of conservative governance.
▶ 1:08:31Sen. Hirono: Now, with this reorganization plan, which this is the first time I am being presented with any of this information, are you following project 2025 and you want to have a top down organization that will follow the principles of conservative governance, whatever that means? Are you following that language from project 2025?
▶ 1:08:52Sec. Collins: No. As I said in my confirmation hearing, I am not even read it. By the way, we are in 2026. I am not sure why we are looking backwards.
▶ 1:09:03Sen. Hirono: Because the president is following and implementing a lot of what is in project 2025, including eliminating support for public schools. I find it hard to get that what you are doing is not following what is in project 2025, which is a very ideologically-driven directive on how the v.a. Should be run.
▶ 1:09:31Sen. Hirono: It seems to me that when I look at your reorg plan, what I can make of it is a really top down organization. In fact, when I visited the v.a. In hawaii, he had to go and get approval from you, totally top down. And I was not given permission to visit my own v.a. Person until practically the day the visit was scheduled. Is that how it is going to be? That is a rhetorical question.
▶ 1:10:00Sec. Collins: It is mature -- it is not rhetorical to me.
▶ 1:10:05Sen. Hirono: Excuse me. It all sounds good, you are trying to save money and all that.
▶ 1:10:12Sec. Collins: No, I am trying to help veterans.
▶ 1:10:15Sen. Hirono: That is good to know. How are veterans supposed to be helped if there is going to be a top dorn -- top-down reorganization where your hospital directors will not have the right to hire people? You have a pause or whatever it is.
▶ 1:10:31Sec. Collins: This shows to be unfortunately that all the information given to your staff and others has not filtered up enough. If you claim this reorganization is a top-down approach, I am not sure what kind of charts I can show you that this actually puts the benefits back at the executive director level in the hospitals. This puts our front line we have had it --.
▶ 1:10:54Sen. Hirono: Actually, Mr. secretary, you know what the top down and giving more flexibility to the local hospitals so that they can really care plans -- that is what they were originally intended. Now you are bringing it to a very centralized five. It is hard for me to understand.
▶ 1:11:23Sec. Collins: This is a great conversation but you are missing the point. Gregory goins has stated the visn directors were not in a position to do the management level diagnosis that needs to happen. Now we are having management level at five where they can do management levels at the divisions where they have health service areas who are able to talk to your hospitals in hawaii and other places.
▶ 1:11:46Sec. Collins: If you look at this plan I would welcome any disagreement except for one and that is a fundamental wrong statement that this is a fundamental top-down plan.
▶ 1:11:55Sen. Hirono: You can say all that you want but it is in how it will be implemented. To come up with this whole reorganization plan at a time when there is chaos in this regime, it is hard for me to kind of site, oh -- say, oh well, this is a great thing you're doing.
▶ 1:12:18Chair Moran: Senator cramer.
▶ 1:12:21Sec. Collins: It is amazing to me that we have lowered wait times. It is amazing to me that through this process we have made it easier for our veterans to get care. If that is chaos, maybe we are in the right direction.
▶ 1:12:34Sen. Cramer: Thank you very much. I would not normally do this, but something I did in my previous life was I taught mba students management theory and application. And the notion that top-down flexibility, those two terms don't even go together. What it looks to me like is you have flattened the organization. And so I want to get specifically to what you just brought up.
▶ 1:13:04Sen. Cramer: Because frankly, I am pretty sure a bureaucrat made a mistake. Because there is no way you could have made the agency so efficient that you could come into this mess with 264,000 backlogs and turn that into 105,000 in one year. So please enlighten me as to how that actually happened or who made the mistake.
▶ 1:13:26Sec. Collins: There is no mistake, that is true. And it was put forth by someone who came to us and said we can do better. For those on the committee, you know this. 125 days is our standard for a backlog claim. It has to be 125 days before it even goes on the backlog. Think about that for a minute. This has grown up exponentially over time.
▶ 1:13:51Sec. Collins: When I first came in last year at 264,000, there were over one million claims in the pipeline. That is now closer to 600,000 to 550,000. We've been able to not only reduce the backlog but we have taken the total number as well. Now, there have been some false rumors thrown out that quality is suffering and other things. The truth of the matter is when you have that much more cases being actually adjudicated, there will be people who appealed adjudication.
▶ 1:14:22Sec. Collins: Not everyone will get 100% what they want. So what they have happened is, I think a 3% difference in the number of appeals on the lower number being decided as to the higher number being decided. So this is done by great v.a. Employees that the v.a. Solved the employees saw the issue, they wanted it measured, and they got it done.
▶ 1:14:44Sen. Cramer: I know if I am critically ill, waiting 125 days to see a doctor is not an enhancement in quality of care.
▶ 1:14:54Sec. Collins: This is the benefits to get there. This is one that everybody looks at to start with.
▶ 1:15:00Sen. Cramer: But it amounts to the same thing. If you have the uncertainty, the anxiety of not knowing whether you are getting your benefits and you wait 125 days, that adds to the problem, not the solution.
▶ 1:15:15Sec. Collins: Can I share something even more, and I want this understanding. This doesn't have to do with the organization but I want the committee to hear this. We have been able to take this number not only down to 100,000, and going even further, but average days to complete a claim was 130 five days last january. That's down to 80 days now.
▶ 1:15:40Sec. Collins: My staff tells me if we can work with the department of war to get the files transferred quicker from dod, we can see legitimately this year a 30 to 35 day turnaround time on disability claim. That's a winner, for veterans.
▶ 1:15:54Sen. Cramer: Love it. I need to ask a couple more questions with my next chart. We have heard a lot of these insinuations about how rightsizing the v.a. Is pushing veterans out to community care. I want to point to this board that we created. It's 25 v.a. Clinics have opened since january 20 of last year.
▶ 1:16:20Sen. Cramer: So once again -- backlogs are down, employee numbers evidently down. And yet there is 25 more v.a. Clinics. Did somebody make a mistake or how did you call this off?
▶ 1:16:35Sec. Collins: Like I said a few moments ago, if this is disorganization and chaos, I want to see more of this. Because we are opening clinics --
▶ 1:16:44Sen. Cramer: I want to point to the blank spot in the middle of the continent called north dakota. There are two new ones, one in williston and one in grand forks. Those two communities are 333 miles apart. And that's just straight across. There is a lot of space between those.
▶ 1:17:07Sen. Cramer: Which gets to my point, the legislation senator sheehy and I have introduced to incorporate critical access hospitals, of which we have 37. I will show you a larger map just of north dakota so you can see where they are. We have all these communities far from a cbac or hospital.
▶ 1:17:32Sen. Cramer: As you know, we like to utilize these critical access hospitals in a more efficient way that provides more care to that veteran.
▶ 1:17:42Sec. Collins: We are on board, I agree, and we are looking forward to partnering with rural hospitals. The undersecretary, this is a passion project for him. Also senator duckworth brought this up a long time ago about co-locating some of these facilities, and I agree completely.
▶ 1:18:03Mr. Bartrum: I appreciate the conversation we had the other day on this. I have been confirmed now for a couple of weeks. I have asked the people what restrictions there are for us to do some of the leases with them, the community access hospitals. I believe it is a double win because it helps support the facility itself and it helps support our veterans where they are.
▶ 1:18:30Mr. Bartrum: Partnering with them to be part of our critical care network, because even as we do this reorganization, the clinical care, the contracts is still part of the a.j.. Inside vha you have to manage the clinical care hospitals, the contract for community care. We are working on that. I am actually going to ohio this weekend to open another facility, and we have another 20 scheduled for this year if I have got the number right.
▶ 1:19:01Sen. Cramer: I'm just glad we could reduce our backlog at the senate of confirmations for you as well.
▶ 1:19:07Chair Moran: Senator hassan.
▶ 1:19:10Sen. Hassan: Thank you for this hearing and thank you, Mr. secretary, for being here and for your testimony. As many others have done, I would like to reflect on the fact that alex pretti, a nurse who worked at the ba and cared for veterans in icu, was killed this weekend by masked federal agents in an escalation of unacceptable behavior by this administration.
▶ 1:19:40Sen. Hassan: We urgently need oversight and reform over ice's behavior, because what is happening now in minnesota and across the country is making us less safe, and it needs to stop right now. I hope my colleagues on the other side will work with us to keep the government funded and protect basic american freedoms. Mr. secretary, you mentioned an investigation.
▶ 1:20:06Sen. Hassan: When there are officer-involved shooting's in any other law enforcement agency in this country, the officers are put on administrative leave and an outside agency does the investigation. Those things need to happen. The roving patrols need to get out of minnesota while they mourn these debts and the investigation is pending. Now, to the business of today.
▶ 1:20:31Sen. Hassan: I'm going to ask a question I asked aba official who came before this committee in december, and I'm hoping you will have more information then he did. Last may president trump signed an executive order that required you to direct a feasibility study to create an action plan regarding bringing a full-service va hospital. The action plan was due to the president last november.
▶ 1:20:58Sen. Hassan: My new hampshire colleagues and I asked you to make that action plan publicly available by december 1 so my constituents could review and give input. When will this action plan be made available for granite staters? To look at and provide feedback?
▶ 1:21:12Sec. Collins: There is no one more anxious to get that. At this point we are still putting it together. That is the undersecretary's role. There was some setback that did delay this action. I'm hoping to get it to you as soon as possible.
▶ 1:21:29Sen. Hassan: That would be good because it is way overdue.
▶ 1:21:31Sec. Collins: I understand.
▶ 1:21:34Sen. Hassan: It was good to have you up there, but the need is there. You and I have previously discussed staffing at the v.a. And the need to make sure our veterans have the best staff and the right number to ensure they get the highest quality of care. It has come to light that the v.a. Is planning to permanently eliminate up to 35,000 positions , most of which are currently vacant, including doctor and nurse positions.
▶ 1:22:04Sen. Hassan: Doctors and nurses are not overhead. They are doctors and nurses. This is in addition to the nearly 30,000 employees that v.a. Lost last year. In an article discussing this plan, one v.a. Nurse was quoted saying we are going to continue to do more with less, continue to be overworked.
▶ 1:22:24Sen. Hassan: I'm concerned these staffing cuts could leave the department in a position where it might not be able to care for veterans moving forward, especially as more pack act veterans come forward to receive care. Senator tuberville start raised more questions -- to prevail's chart raised more questions than it answered. What has the v.a. Done to ensure the elimination of these positions will not affect veteran health care now or in the future?
▶ 1:22:51Sec. Collins: That's why my hr person is here and greg owens will explain this to you.
▶ 1:22:57Mr. Goins: I want to make sure we don't conflate personnel and authorizations for positions. Mr.goins mentioned, for years we have a process. You have been asking us for years to produce a document to provide position numbers, structure, how we are organized. The v.a. Has not done that.
▶ 1:23:21Sen. Hassan: I'm running out of time and have one more question. I'm just trying to understand the process.
▶ 1:23:26Mr. Engelbaum: We have a very detailed process. We put this in the hands of the vha. We determined the requirements. They are identifying what they need. We are removing empty billets that have been created at a low level that have been on the books for years that have no funding, no authorization from you to fund, that are just sitting there masquerading as --
▶ 1:23:51Sen. Hassan: I will follow-up with you on that. I will also say when there is a lot of uncertainty and announcements of layoffs and cancellations of contracts, it doesn't make people eager to work at the v.a..
▶ 1:24:03Mr. Engelbaum: That's correct and if --
▶ 1:24:05Sen. Hassan: I only have a few seconds left and I have to get to this next question because it is relevant. As part of the changes, I understand you are looking at placing caps on the number of employees each visit can hire
▶ 1:24:18Mr. Engelbaum: That was something confirmed -- can hire. That was confirmed during committee discussions for this hearing. I'm concerned these caps will affect the number of employees who can be hired for new or expanded v.a. Facilities, like a new hospital in new hampshire. Mr. secretary, will you commit to hiring new staff to support the expanded care and services that will be available for granite staters when this full-service hospital comes online?
▶ 1:24:45Sec. Collins: I will be happy to let greg answer that because he has experience with what you are talking about.
▶ 1:24:51Mr. Goins: This goes back to when senator tuberville put up the chart. We have never had a strategic approach to enterprise, research allocation to do what. You are asking for the reason we have asked our operators in the field to evaluate people on board and number of vacancies, whether in recruitment or not --
▶ 1:25:12Sen. Hassan: Yes or no, caps? I have managed large organizations too. You analyze from the bottom up, you don't put arbitrary caps from the top down.
▶ 1:25:23Mr. Goins: You also do an affordability. Any business in the free world, you can't just keep adding resources --
▶ 1:25:31Sen. Hassan: We are not a business, this is for the people who gave us our freedom and they deserve every investment we can give them. I am proud to work with my colleagues on both sides but we need to put our money where our mouths are.
▶ 1:25:44Mr. Goins: You are correct. My time in afghanistan and both my brothers being deployed says the same on my end. When you have a new hospital that comes into new hampshire as an enterprise, and we don't have a strategy to look at your people to say here is the resources to run it, you are robbing peter to pay paul.
▶ 1:26:04Sen. Hassan: The strategy is fine. Arbitrary caps, which were described to our staff, are not. >> if I can address the caps, when we talked about it -- I know this is in the weeds, but we had to start creating that. How do you create your structure? We asked what the requirements were for vha. They came back and said we need 1000 people, an example.
▶ 1:26:34Sen. Hassan: This is an requirement. If I set my requirement at 1000, I can't put 1000 positions on the books because I am going to have a lapse. What we did is we took their requirement, say 1000,. We inflated that by 9%. That cap was set at the requested authorization.
▶ 1:27:02Sen. Hassan: Thank you for the clarification. I will follow-up with you, because what's really important -- and I will take you at your word -- is we have the services and care for veterans that we need. You guys got off to a start where you announced a huge number of layoffs, a huge number of cancellations, and we couldn't get any information about any process behind it.
▶ 1:27:30Sen. Hassan: You are at a trust deficit right now.
▶ 1:27:34Chair Moran: Mr. secretary and your team, I want to begin by thanking you on the focus you are bringing to our veterans. In particular I appreciate the shortening of wait times for access to health care. In my state you have brought the backlog, which got really high during the biting years, down to -- the biden years, down to a much more workable level.
▶ 1:28:03Chair Moran: I know you have been putting work into that, you and your team. Thank you for that. I know you are trying to deliver better care. You are doing that with genuine heart for our veterans, as a veteran yourself and still serving. I want to thank you and your team. It's not easy work. This is the biggest bureaucracy in D.C. and a lot of people are trying to reform it.
▶ 1:28:26Chair Moran: I want to start, as you are working through the restructuring on the health care side, and I know it's a big undertaking, but the one issue I want to make sure your team continues to focus on is community care. That is deeply important to alaska. As you know, alaska has direct access to community care because of a provision I included in the 2018 mission act.
▶ 1:28:56Chair Moran: A lot of the v.a., if they are not v.a. Officials in alaska, they don't get that. They don't remember that. The provision applies to states without a full-service va hospital. That's alaska, new hampshire, I believe now hawaii. I'm not sure the status of hawaii. That's just in the law. During the biden administration there was an internal memo which tied bonuses to being inside the v.a. System.
▶ 1:29:29Chair Moran: I have no objections to veterans receiving care within the v.a. System one that works. As you know, in my state it doesn't always work. The veteran can get community care period, end of story. How are you making sure as you are doing the reforms that you are still focused on community care?
▶ 1:29:52Chair Moran: Because it's really important and the last administration tried to put their thumb on the scale, even though the law said veterans get to go to the community because we don't have a full-service hospital. We have more veterans per capita in the country of alaska.
▶ 1:30:09Sec. Collins: The community care aspect will be enhanced by looking at the needs of individual hospitals. If you go to new york city, you have four or five within a few square miles in an urban area, which has a different need than alaska, which has no hospital but a lot of community care. This will give us a more hands-on approach to looking at how each of these systems operate.
▶ 1:30:38Sec. Collins: Our new community care contract is being led in a way that's going to enhance our ability to expand our third-party network. -- a little bit of that as well.
▶ 1:30:54Mr. Bartrum: There is no plans to change anything relative to the community structure. As the undersecretary, both community care and direct care fall under my purview on behalf of the secretary. That will happen even after we go forward. The community care contract will still be ran by us.
▶ 1:31:16Mr. Bartrum: One of the things I want to point out is, as you know, you have been actively involved in the decision the secretary made last may in the best medical interest. The best medical interest of allowing to go into the community is the best medical interest of their doctor, which is outside the flexibility alaska has. That has increased by 66% because of the decision.
▶ 1:31:42Chair Moran: Good because that's what we want, better care for veterans, no matter how you get it. Mr. secretary, you know I have skepticism's of visn's realignments. The last one completely overturned the system in alaska. It was a nightmare. That wasn't you guys, it was a long time ago. I have spoken many times about the unique challenges.
▶ 1:32:09Chair Moran: I still want to pitch to you and your team -- we are working closely and I appreciate the outreach with my staff, but to look at alaska as a separate visit -- visn. I know this is something you haven't agreed to yet.
▶ 1:32:27Chair Moran: That and on the hsa issue, we are told if you are not a separate visn, because you have unique challenges -- we have had challenges when there has been the isn reform before. Collapsed the system in 2015 and 2016 in my state. At minimum there would be an hsa committed to alaska. Then we heard from your staff may be the hsa will be combined with hawaii.
▶ 1:32:55Chair Moran: No offense to hawaii, but we don't need to be combined with hawaii. I don't think even senator hirono would like that idea. I am still pushing for some structure that gives my state the ability to have you guys look at the unique challenges. Because whenever we are put in with lower 48 communities, it's so different up there because mistakes get made. The system collapsed in my state.
▶ 1:33:27Chair Moran: Thousands of veterans were not served. Can I get your commitment to continue to work on advocating for this? I know you are skeptical but I am not done making my arguments with you.
▶ 1:33:40Sec. Collins: I have learned from my air force career and the navy, I don't go up against marines and not try to find a solution, so we are going to continue to do that.
▶ 1:33:52Chair Moran: I appreciate you coming. You get worked over in this committee and you are taking it. That's part of the oversight role. You do it with class and dignity and your and your team's heart is in the right spot. It's about taking care of veterans, number one. Number two, number three, that's what the v.a. Is all about. I got your commitment to continue making advocacy for my state, that's what I want.
▶ 1:34:25Chair Moran: >> first I want to acknowledge the life of alex pretti. He was a be a nurse -- a v.a. Nurse. For those of us who have used the v.a., we are lucky to have men and women like him who take care of us in very tough times. It is a sad situation that he was murdered.
▶ 1:34:51Chair Moran: Let's remember him for his dedication to his country and to many of us veterans that use services with the help of people like him. Moving into arizona, I worry about my veterans there. There is a new 30,000 square-foot v.a. Medical facility set to open by summer 2027. We talk about overrepresentation of veterans, that's a big community and rural.
▶ 1:35:22Chair Moran: Supposed to provide comprehensive care for local veterans who are used to needing travel. Primary care, women's health, therapy, imaging, and ideology, which is great -- audiology. With the new staffing caps, the facility would not be able to hire new staff. The only option would be to pull from understaffed hospitals. How could you guarantee veterans in yuma will be able to get medical care if these staffing caps are still existing?
▶ 1:35:50Chair Moran: How can I look at my constituents and tell them that this v.a. Doesn't understand you are going to be robbing peter to pay paul and not creating a fully functional system in one place or another.
▶ 1:36:04Sec. Collins: An underlying secondary reason, if you look at your state is why we are doing this for the organization. Mr. goins talked about this and I would like him to explain how we can reallocate assets for those things.
▶ 1:36:21Mr. Goins: I know you are talking about arizona, but I'm going to use a couple other examples. Nashville is one of the fastest growing areas of the company -- the country, along with the whole southeastern sun belt area. The problems in the past is because we have not created a system that aligns resources in the way mark described with the overall demand and needs for those growth areas.
▶ 1:36:50Mr. Goins: We have created pockets where we have far too many and theory resources. We have to make sure those are allocated appropriately so we can reallocate resources in places where veterans are moving. We know that happens to be in that same market. Veterans are a microcosm of society. Our goal is not to take what you saw go out. Based on what mark said, this is based on the overall needs of the system and use that in perpetuity.
▶ 1:37:22Mr. Goins: If we see a higher need in a market like arizona or nashville, the expectation is as an enterprise, we don't ask local markets to have a shortfall.
▶ 1:37:35Sen. Gallego: The question is timeliness then. It's good in theory, but government is not known for making decisions quickly, nor big bureaucracy. We are going to be opening up the v.a. Facility at the same time you are starting this new process. It's going to be an absolute drop of that. Also related to that as of two weeks ago, the average wait time for new v.a.
▶ 1:38:04Sen. Gallego: Agents for mental health appointments was 51 days. I don't have to tell you, when people have problems we need to get them in to see somebody. The national average was around 35 days. What was happening in arizona, we have that 16 day difference growing.
▶ 1:38:30Sen. Gallego: It is going to be extremely dangerous if we can't prevent veteran suicide or other problems.
▶ 1:38:37Mr. Goins: I am not showing -- I think there is a discrepancy between what you are presenting and what was presented earlier from senator blumenthal. I'm not showing the current national average of what you just said.
▶ 1:38:49Sen. Gallego: What is your average, new patients?
▶ 1:38:52Mr. Goins: 18.8 days as of yesterday.
▶ 1:38:54Mr. Goins: And arizona --
▶ 1:38:57Sen. Gallego: And arizona?
▶ 1:38:58Mr. Goins: I don't have that but can get back to you. In almost every market where we have high velocity of growth for veterans, the wait times are more challenging than almost everywhere else in the country.
▶ 1:39:10Sen. Gallego: I understand, but now you have this program where you have caps and are not necessarily going to be able to react in a timely manner when you have this market demand. Unlike business, what you are talking about his potential he of veterans who are on the edge of -- is potentially knives edge of veterans who are the edge of suicide. Dealing with real people, this gets dangerous.
▶ 1:39:37Sec. Collins: I agree, but let me point out the fact we are talking about fd calculations. In phoenix, the number was 24% fte growth over the last five years, 11% contact with patients. In northern arizona, 39% fte growth and only 11% actual contact. Southern arizona, 18 to two.
▶ 1:40:03Sec. Collins: These are showing that we can, and this is why we need this system to move people where we need to so we can handle areas such as --
▶ 1:40:10Sen. Gallego: Ft doesn't necessarily mean people dealing with mental health.
▶ 1:40:15Sec. Collins: Exactly. You just hit why we are doing this.
▶ 1:40:20Sen. Gallego: I'm not sure it's working in a timely manner that's going to bring services to the people as needed.
▶ 1:40:28Sec. Collins: It is somewhat sticky. Private sector they just lay people off, we are not going to do that. Over time we have to do it through attrition. In the meantime we have told our network directors if there is a critical need related to direct clinical care, put your hand in the air and we will make sure you have the resources needed.
▶ 1:40:49Sen. Gallego: I'm going to tell you now, they are going to need that in yuma right away. It's hard to get people to move there. It is a desert, rural. It's going to be difficult to get people to volunteer to move there and I think it's critical you get ahead of that and not wait for the demands.
▶ 1:41:05Chair Moran: Senator sheehy.
▶ 1:41:09Sen. Sheehy: Electronic health records. Go. [laughter] electronic health records management, as I said last year, was an unmitigated disaster. Coming through two administrations, the previous administration gave up, after billions of dollars spent. I promised this committee last year that would be one of the first things I addressed.
▶ 1:41:39Sen. Sheehy: I did exactly what I said I was going to do. I sat down with our people and said, what's the problem? I heard the list everybody had. Then I went to oracle and said, tell me what your problems are. They wanted to blame us and told me what their problems were. A week later I had them in the same room and said let's talk. They begin very friendly until I started telling them what one said about the other. Then I said ok, let's get this together and figure out a plan.
▶ 1:42:09Sen. Sheehy: After two days, we figured out the number one bha had way too much non-standardization in their plan. We started in washington state, which senator murray and I have talked about. They were allowed to design their own systems while the senator at the time was enabling it. We have had over five years of study looking at what happened and went wrong. After that, I said we are going to standardize our process.
▶ 1:42:42Sen. Sheehy: Vha is no longer going to be the sticking block. We are going to get to 90% of what the standard product is we are being offered, the 10% we need to customize would be the only part we did, and we began the process. After the senate confirmed Dr. lawrence to be our deputy, all he basically has done is went to michigan and ohio and alaska and we have indiana. April 1, we go live on the michigan side.
▶ 1:43:11Sen. Sheehy: They have been working for a year or longer on this. We have had consistent reports, consistent metrics and data. Dr. lawrence has personally been to those sites multiple times. For the first time, I can report we have actually begun to put a system in place that will help community care, allow doctors to not only get paid but also send medical records and charts. It will allow us to incite a system to talk to each other, which we can't right now.
▶ 1:43:41Sen. Sheehy: This is the first step, and our hope is after april we get into june and later this summer we have momentum for our next phase of 2027. For the first time there is an honest plan looking forward. If everybody wants to look backwards, I understand. You have every right to be skeptical. But all I can tell you now is, unlike anything in the past, I have set my focus on getting this done because I knew it's where we need to be.
▶ 1:44:10Sen. Sheehy: We put the resources there and this will be done in the right way. I welcome anybody on staff to ask questions, to get Dr. lawrence. I will make them available to anything you need.
▶ 1:44:21Sen. Sheehy: Thank you.
▶ 1:44:23Chair Moran: Thank you. You were quicker than I envisioned. Senator slotkin.
▶ 1:44:31Sen. Slotkin: There is bipartisan concern about the electronic health record modernization. You mentioned michigan. We are set april 1 to be the next state. I'm going to take you up on the offer you just made to have Dr. lawrence brief our bipartisan congressional delegation. I think from both democrats and republicans, we are concerned that we have a little bit of a perfect storm.
▶ 1:45:01Sen. Slotkin: One, you decided to triple the number of locations that are going to go through modernization this year. We feel like in michigan maybe we don't get the attention we need. You are right, washington was a disaster. We have over 1000 vacancies right now at four va hospital's. Some say they have trouble getting waivers to help with this. We have to speed that up. Number three, we have not seen the v.a.
▶ 1:45:30Sen. Slotkin: Implement all the recommendations. If I am wrong about any of that, please agreed to have Dr. lawrence brief our bipartisan delegation. If you are willing to have him come down, we will pepper him with questions.
▶ 1:45:47Sec. Collins: I will set the date. Also, can I say one thing. Oig reports and recommendations were based on a screwed up system that is not in place anymore. Anything that is referencing the oig report is like looking at a 1945 novel --
▶ 1:46:05Sen. Slotkin: That's fine, I just want democrats and republicans from michigan be able to ask questions to the guy who owns the transfer. I want to turn to the topic my colleagues have been talking about, alex pretti, your employee, the icu nurse killed over the weekend by border patrol. You said in your opening statement that you were not able to engage on this topic, but you did engage on this topic.
▶ 1:46:36Sen. Slotkin: It took you 30 hours to put something on twitter about his death. First you put out something about penguins and greenland. Then you put out a statement that said, such tragedies are unfortunately happening in minnesota because state and local officials' refusal to cooperate with the federal government to enforce the law and deport dangerous illegal criminals. Was alex pretti's death the result of the mayor of minneapolis or the governor of minnesota?
▶ 1:47:05Sec. Collins: Alex pretti's death was a tragedy, as I have stated, and I stand by that statement.
▶ 1:47:11Sen. Slotkin: Ok but you put it out under official v.a. Twitter. This wasn't your personal opinion. You said why he died. He was your employee. You know that people who work for the v.a. Can't just kick in. They are properly vetted. We had other cabinet officials call him a domestic terrorist and assassin. Based on your access to the information in the v.a.
▶ 1:47:36Sen. Slotkin: And in front of 460,000 ba employees, was this man a domestic terrorist or assassin?
▶ 1:47:44Sec. Collins: What I have said about this being a tragedy I will continue to say, and I'm not going to make a characterization on something someone else said.
▶ 1:47:53Sen. Slotkin: You said it was the result of local officials blocking their access. You said it, not someone else.
▶ 1:48:00Sec. Collins: I made no characterization about Mr. pretti.
▶ 1:48:05Sen. Slotkin: You said his death was the result of state and local officials refusal to cooperate with the federal government. Not my words, yours. You are prejudicing this investigation, weighing in on what you think happened. I think in front of the employees you should at least be able to say to his family that he is not a domestic terrorist or assassin. People have eyes, they see the video. I think we owe him more than that.
▶ 1:48:36Sen. Slotkin: To say that you can't engage on it, to say that now donald trump has told the cabinet that now it's ok to have an independent investigation, that secretary noem and stephen miller have to walk back what they have said about this poor man in front of his family, now you can admit that you joined them in prejudicing the investigation of your own employee. I understand there was some sort of memorial event yesterday that was held at the v.a.
▶ 1:49:05Sen. Slotkin: In minnesota. Can you say that neither you nor your senior officials tried to stop that memorial from happening?
▶ 1:49:13Sec. Collins: We did not Sen.
▶ 1:49:14Slotkin: There is an email circulating online that says they were told not to have the memorial and that people went ahead anyway. I hope when this email comes out, there is not any of you sitting at this table that had anything to do with the fact that they wouldn't be able to celebrate the life of a man that was killed. >> I have seen the email. That did not originate from my office or anybody sitting at this table.
▶ 1:49:44Slotkin: That came from a leadership official in minneapolis.
▶ 1:49:45Sen. Slotkin: So he just woke up, or man or woman, who employed this man who is dealing with all kinds of fallout and terrible feeling. That person just woke up and decided to say that someone else, the higher ups, told us not to have this memorial? She just made it up?
▶ 1:50:07Mr. Goins: I don't know that she made it up, I can't tell you what her perception of anything was. I can tell you we have been supportive of an appropriate time to have a period for employees to memorialize alex pretti. They did that yesterday with almost 400 people, at noon, which was scheduled.
▶ 1:50:26Sen. Slotkin: You see how it takes a suspension of disbelief to believe that the woman who was the supervisor of this poor man said higher ups told her she couldn't have a memorial. It seems a little hard to believe, but I yield my time. I am done.
▶ 1:50:40Chair Moran: Chair moran: senator banks.
▶ 1:50:44Sen. Banks: Thank you, Mr. secretary, and all of your colleagues for what you do every day to focus on serving veterans. Especially thank, secretary collins. We have had many discussions and your leadership and what you are doing to work with me to move the indianapolis replacement medical center and the hamilton county outpatient center lease forward in indiana.
▶ 1:51:11Sen. Banks: These projects would replace a really old downtown medical center with a new medical center and an outpatient center that's closer to where most veterans in indiana live. Can you talk about how this innovative approach could better benefit veterans in indiana?
▶ 1:51:32Sec. Collins: I would love to. I think this innovative approach , especially when it comes to the two-pronged effect of direct care and community care, which is something I don't do, and this is when I represented georgia. It is something we have to work with our partners on in making sure we get the best care we can. The best solution I can give you on how this can actually work is what we have talked about today.
▶ 1:52:01Sec. Collins: Greg owens was actually on the field. A lot of his input came from what you are talking about. I would like for him to address how this is going to make this integrated care better as we go forward.
▶ 1:52:17Mr. Goins: The overall integration of care model in the new structure really hinges on the hsa relationship. You have a network director who oversees indiana, ohio, kentucky. They have aspects of care in the areas you are talking about, specifically in their wheelhouse. But they are completely pulled away with some of the oversight responsibilities in D.C.
▶ 1:52:44Mr. Goins: The new hsa's' sole function is going to advocate on behalf of indiana veterans.
▶ 1:52:50Sen. Banks: I know y'all can't talk about the president's budget request in advance. Mr. secretary, I do appreciate your team has shared these projects rank high on the priority list. The next thing we need is the outpatient center lease to go into the fy 2025 budget. Is there any obstacle preventing that that you are aware of?
▶ 1:53:14Sec. Collins: When it comes to budgeting, that would be all here. Nothing from our perspective. We have made it clear on our intentions. We defer to this body and others to get that finalized.
▶ 1:53:30Sen. Banks: Turning to your rise initiative, indiana touches four visn's. Most of indiana is in visn 10. Northwest indiana is in 12. Part of southwest indiana is in 15. A lot of veterans in southeast indiana go to facilities in visn nine. So you see the patchwork.
▶ 1:53:59Sen. Banks: How will consolidating the visn's improve coordination of care in indiana?
▶ 1:54:03Sec. Collins: When you look at it from the perspective of crossing lines -- and it goes back to the issue in how you get answers that are consistent across v.a. This is something that -- and I will let the undersecretary and greg handle the rest.
▶ 1:54:26Mr. Bartrum: As somebody who grew up in evansville, I understand where you're coming from. That's why having the larger visn's allows for resources across the larger geographical territory as they focus on the strategy and resources. The hsa's, since they focus on the markets, if we have not identified what the -- are going to be, the markets can be higher. I will pick on the area where I grew up.
▶ 1:54:57Mr. Bartrum: The evansville vanderburgh tri-state area with the henderson, kentucky area, that's a market and that's an area. As the hsa's, they can cross over boundaries as they go out. They are really going to be able to focus on the market aspect of it. Even today, as you know, there is not a policy barrier to prevent somebody going from one visn to another.
▶ 1:55:26Mr. Bartrum: Although I would contend sometimes that's the perception, as senator moran pointed out earlier, that veterans will get those types of messages because of the broken nature of the policy distribution across the system. This will help us focus on that. The visn director in the louisville area of kentucky, you want to chime in?
▶ 1:55:54Mr. Goins: Veterans will continue to have a choice where they want to receive their care. If they are in southern indiana, that might be louisville, and I think you would prefer that as well. What I think is the challenge in the current system is if a veteran in indiana has an issue, you don't know what visn to go to. To what Mr.
▶ 1:56:14Mr. Goins: Bartrum mentioned, indiana right now as seen in that larger visn, an upper midwest group of states. That would have a singular place to go for resolution when a veteran has an issue. I think it's the best of both worlds.
▶ 1:56:35Chair Moran: Senator king.
▶ 1:56:37Sen. King: A couple of questions about the reorganization. Mr. secretary, thank you for being here today. Is this a done deal or is this a work in progress? Is this some draft we have seen or is this completed to be implemented?
▶ 1:56:55Sec. Collins: This is moving forward a completed issue. That's why we have been over the last month discussing with members of congress. There are still some things we need to work out that even our own people are coming back with and saying, we need to change some things. There are smaller changes. The overall structure of how we are going to take this is where we are moving forward.
▶ 1:57:20Sen. King: From a 30,000 foot level, I don't really understand how we are flattening the organization by inserting a new layer. Now we have 18 visn's. They are going to go to five. We have zero hsa's, going to go to 15. We are going to have fewer visn's and this new thing called an hsa.
▶ 1:57:45Sen. King: I don't understand why we can't simply change the structure of the visn's rather than create a whole new level. Seems to me we are reinventing the visn's from where they were 20, 25 years ago.
▶ 1:57:59Sec. Collins: I think the problem is an understanding of what goes back 25 years ago. For those who look at the history of the visn's, at one point they were not going to be bigger than 10 to 15 people. Some now have tens of thousands of people, which was never intended, which was one of the problems based on how you can't get answers. This is one of the key issues for how we make the executive directors not being top-down.
▶ 1:58:30Sec. Collins: This is about the center directors in the clinics being able to get direct answers. That is part of what greg was tasked with and connect without further.
▶ 1:58:43Mr. Goins: If you look at this on a baseline level, you could make an assumption to say this is adding a layer. Ultimately this is a fundamental change in the way we deliver care, the way we provide support for those who deliver care.
▶ 1:58:57Sen. Banks: A fundamental change in the way the organization is structured. You still have v.a. Hospitals, cboc's, community care.
▶ 1:59:06Mr. Goins: It's a fundamental change in the way we provide support to those medical centers. Currently we have one person over a visn, whether it's 18 or reduced to 10, and they have a bifurcated responsibility, one of which focuses on governance and all the administrative things that have to happen through D.C., which still needs to happen. For every day they spend doing that, which is a lot, that's less time you can spend engaged with the facilities.
▶ 1:59:34Sen. Banks: Couldn't you just have a deputy in each visn to not bifurcate that responsibility, instead of creating a new layer of -- I hate to use the word bureaucracy, but that's what it looks like.
▶ 1:59:49Mr. Goins: You could do that, you could do a bifurcation. The problem is they are still polled both directions. The deputy still has to do both aspects of what I am mentioning. We also did market research with for-profit and not-for-profit private sector health entities. We evaluated their organizational structures. This is considered a best practice so you can specialize on the quality and oversight of care delivery as a singular responsibility.
▶ 2:00:16Sen. Banks: I'm skeptical, as you can tell. I commend you for trying to reorganize and improve the delivery of services. Nobody would quibble with that intent. I want to continue this conversation and be assured this is going to have another layer. I just want to be sure those hospitals get what they need. Second question, the saga of the contracts. You know I have been chasing this since last march.
▶ 2:00:48Sen. Banks: I requested it at a hearing on march 6, sent a letter to you, and we have all gone through various iterations. A few days ago on january 22, we got a supposed new list of the canceled contracts. It turned out it was the oldest.
▶ 2:01:10Sen. Banks: The old list is full of obvious mistakes, $79 billion worth of canceled contracts, which is more than the whole contract amount in the v.a.. There is obviously something wrong with that. There are also 79 contracts listed as being canceled which were canceled during prior administrations, some as far back as five years. Could you please clean up this list? I just want to know what's being canceled.
▶ 2:01:39Sen. Banks: This has been a saga now for almost a year. Give us a clean list. I don't understand why this is so complicated. What contracts have been canceled, what did they do, what are the amounts involved? That's a straightforward request , but so far it hasn't been honored.
▶ 2:01:56Sec. Collins: We will work to alleviate your concerns. As we go forward with the contracts. If there is a specific contract, that's also the issue we have.
▶ 2:02:10Sen. Banks: I just want to see a clean, realistic list without these obvious mistakes. One more quick question about the reorganization. There were a number of parts of the structure that mark listed in the new system. Tribal health, women's health, national chaplains service, readjustment counseling, patient advocacy -- they have disappeared from the organizational chart.
▶ 2:02:40Sen. Banks: Can you assure me those functions are still going to be addressed in this new structure?
▶ 2:02:45Sec. Collins: Yes.
▶ 2:02:46Sen. Banks: That's pretty straightforward.
▶ 2:02:49Chair Moran: Senator duckworth.
▶ 2:02:52Sen. Duckworth: Mr. secretary, I'm glad you mentioned my support for co-locating cboc s with v.a. Rural hospitals. I have a bill called the improving access to care for rural veterans act and it would enable v.a. To facilitate partnerships to co-locate cboc's. V.a. -- in an alleged hearing. My staff has been working to set up a meeting with v.a.
▶ 2:03:21Sen. Duckworth: To see about getting to a place where you can support this legislation. Can you send someone to help us with that?
▶ 2:03:30Sec. Collins: Yes. They are listening to me now and will have don bergen, who is in this room, and it will happen.
▶ 2:03:38Sen. Duckworth: Mr. undersecretary, good to see you again. When we met two weeks ago, I requested the white paper outlining the development of the vha reorg plan with corresponding analysis. You promised I would get it when you were confirmed. I still don't have it.
▶ 2:03:56Mr. Bartrum: I will follow up with staff. I know they had a draft last friday so I will see where they are at.
▶ 2:04:02Sen. Duckworth: The mission of staffing data from a nine slide corporate pitch does not change the fact you removed 40,000 v.a. Employees while planning this reorganization. If the intent is to free up resources, the staffing shortages should be at the forefront of every conversation.
▶ 2:04:21Sec. Collins: I appreciate the question and that is a real concern. 40,000 positions were not eliminated to implement rise. I will be happy to let mark engelbaum explain that.
▶ 2:04:35Sen. Duckworth: That's going to be my question. Mr. secretary, I assume you did a detailed impact assessment, that the department did, that you conducted a detailed impact assessment for the plan to mitigate risk to veterans' timely access to health care, right? You did a timely assessment as you are looking at this plan to make sure they communicated the risks.
▶ 2:05:03Mr. Engelbaum: We are integrating frontline leaders and clinicians to integrate those profiles. The people doing the work are the ones. Taking the risk. That will be done prior to any action.
▶ 2:05:14Sen. Duckworth: So you came up with the plan before you mitigated the risks?
▶ 2:05:18Mr. Goins: No, we evaluated appropriate structures. Then we would create a plan. You start with the current state, look to the future state. You create analysis of functions, you do a risk mitigation strategy to execute. We are very much at the infancy stages of the planning. The planning has to be done by the people on the receiving end of this. It's the frontline clinicians that have to drive this. They know the risk.
▶ 2:05:47Mr. Goins: I can't tell them what the risk is.
▶ 2:05:49Sen. Duckworth: Do they have the risk assessment somewhere?
▶ 2:05:52Mr. Goins: The risks are being created right now.
▶ 2:05:54Sen. Duckworth: Will you provide that to the committee?
▶ 2:05:57Mr. Goins: Yes, when the risk assessments are completed as part of the overall planning process, that's reasonable to be able to articulate.
▶ 2:06:04Sen. Duckworth: Along with the mitigation.
▶ 2:06:06Mr. Goins: Of course, we would not execute on something where we have identified a risk without a mitigation.
▶ 2:06:12Sen. Duckworth: It seems strange would come up with an entire plan without mitigating risk. Maybe it's my army training, but when I went to my commander part of the decision matrix was to have the risks and mitigation before I asked him to choose. You are telling me you chose a course of action before you fully identified the risks were came up with mitigation processes for those. It's kind of backwards.
▶ 2:06:35Sec. Collins: Not really. This is not a new discussion. This is a decades-old plan, even when you were at the v.a. The issue is there is more of a risk problem going forward, the risk aversion to keep us from doing what we are doing now, that we are too scared anything will happen.
▶ 2:06:58Sec. Collins: The risk part is we are headed down a path where we would not be able to service veterans first, not do the things veterans needed because of illogical resource allocations, policies and procedures that had been let go for years that serve more of the visn structure than it did the hospitals. I believe you saw this. We just have to get out of the vaco centric model, back to what they are supposed to do in policy.
▶ 2:07:29Sec. Collins: The risk came from doing nothing. My perspective is to tell them after two decades, every congress report, every vaso, this is what we need to change and we have the ability to tweak the system to ensure nothing is being damaged and ensure our veterans are getting the best care.
▶ 2:07:49Sen. Duckworth: Will you provide to this committee, to myself in particular, your list of risks to veterans timely access to health care and how you plan on mitigating them once it's done?
▶ 2:08:03Sec. Collins: We will get you briefed on that.
▶ 2:08:06Sen. Duckworth: Did you have a list of chosen key performance indicators and data collection methods implemented in this plan, and can you provide those to me?
▶ 2:08:16Sec. Collins: I appreciate you bringing it up because this amazed me when I got to the v.a. Did you realize we had no kpis across vha? Let me rephrase, we did, we had almost 500 in which everybody did their own thing and said, I will measure myself against this.
▶ 2:08:37Sec. Collins: One of the first things we did with the help of folks at this table and john for gorilla, we have narrowed that down to 18 kpi metrics that every hospital now uses. Everybody now knows how they are getting measured and that has driven the process helping hospitals no here is what we do well, here is what we do not. If I had my ipad, I could show you every hospital in our system and they could be compared against it.
▶ 2:09:04Sen. Duckworth: Can you follow it up and send it to me tonight?
▶ 2:09:08Sec. Collins: We can pull data and show you what the dashboard looks like. No secretary before me have this capability.
▶ 2:09:16Sen. Duckworth: Along with the data collection methods you are using? Can you do that? I mean, if you have got it, will you send it to us?
▶ 2:09:25Sec. Collins: I can do that.
▶ 2:09:27Sen. Duckworth: I want to say one final thing. Mr. secretary, will you call on stephen miller and the vice president to delete their tweet calling your employee an assassin tried to murder federal agents?
▶ 2:09:40Sec. Collins: I have already stated my sympathies to the family and I have said all I am going to say about it.
▶ 2:09:46Sen. Duckworth: You are sure you are not going to talk to your fellow cabinet secretary and the vice president? Ok.
▶ 2:09:53Chair Moran: Senators, thank you. We had a pretty darn good hearing. We had nearly every member present and asking questions. I think the witnesses gave good answers. They also committed to providing more information. Thank you for the good answers. Thank you for your commitment on information. If you would like to submit a question to my colleagues, please do that as quickly as possible.
▶ 2:10:23Chair Moran: And then today's witnesses -- I should do this differently. Let's do this sentence over again. Senators who would like to submit questions or additional statements to the record for today's witnesses have one week to do so. My colleagues, we have a week to ask additional questions, and I ask our witnesses to respond to those questions for the record in a very timely manner. Timely manner means in our favor, not in yours.
▶ 2:10:54Chair Moran: >> so senator, I don't have the ability to ask questions. This has been good. This is what we need to have. I appreciate my colleagues, I appreciate our vha nba looking at what we can have for the future.
▶ 2:11:10Chair Moran: This is one of the better hearings we have had with the department of veterans affairs in a number of administrations, so thank you very much for that. Before I pound the gavel, senator duckworth asked one too many questions, so senator blumenthal, iou at least some time if you want to ask another question.
▶ 2:11:29Sen. Blumenthal: Thanks, Mr. chairman. I want to reiterate the importance of getting data from you facility by facility on each of these categories on staffing. I also want the data that we have asked for repeatedly on contract cancellation. I don't know whether it's been raised well I have been --
▶ 2:11:57Sec. Collins: Senator king and I had a good conversation about that.
▶ 2:12:01Sen. Blumenthal: I would like that data. I would like to have a commitment that you will meet with us when we invite you to do so on a bipartisan basis.
▶ 2:12:14Sec. Collins: We can definitely arrange those meetings.
▶ 2:12:18Sen. Blumenthal: Thank you, Mr. chairman.
▶ 2:12:21Chair Moran: With that, the hearing is adjourned. [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. Visit ncicap.org]