Wednesday, October 14, 2009

Secretary Shinseki Oct 2009 State of the VA testimony to Congress

WASHINGTON, Oct. 14 /PRNewswire-USNewswire/ -- Today, Secretary of Veterans
Affairs Eric K. Shinseki delivered his "State of VA" testimony to Congress.
Here is Secretary Shinseki's written statement.

OCTOBER 14, 2009

Chairman Filner, Ranking Member Buyer, Distinguished Members of the Committee:

Thank you for this opportunity to report on the state of the Department of
Veterans Affairs (VA). We appreciate the long-standing support of this
committee and its unwavering commitment to Veterans -- demonstrated, yet
again, through your support of advanced appropriations legislation for VA.
Let me also express my thanks to the Committee and the President for a
remarkable 2010 Budget that provides an extraordinary opportunity to begin
transforming the Department. We deeply appreciate your confidence and the
confidence of the President in building on the 2008 and 2009 Congressional
enhancements to VA's budgets in those years. We are determined to provide a
return on those investments.

I would also like to acknowledge the presence of representatives from a number
of our Veterans' Service Organizations. They are our partners in assuring
that we have met our obligation to the men and women who have safeguarded our
way of life. We always welcome their advice on how we might do things better.

Mr. Chairman, this past February, you held a similar hearing on the state of
the Department, which allowed me to benefit from the insights and advice of
Members of this Committee early in my tenure as Secretary. In turn, I was
also able to offer early assessments of VA's mission and some principles that
I felt might help me quickly communicate my intent and direction for the
Department. I have learned a lot in the last 8 1/2 months from some truly
impressive people at VA; from Veterans, individually and collectively; from
the VSOs; from Members of this and other Committees, and from a host of other
key stakeholders, who share both the Department's interests and my personal
passion for making VA the provider of choice in the years ahead. My current
vectors for this Department remain guided by those principles that I mentioned
in testimony in February. As I continue working to craft a shared Vision for
the Department, one that will be enduring, we remain guided by our
determination to be People-Centric -- Veterans and the workforce count in this
Department, Results-driven -- we will not be graded on our promises, but by
our accomplishments, and Forward-looking -- we strive to be the model for
governance in the 21st Century.

This testimony comprises a nine-month progress report on the state of our

We have been busy putting into place the foundation for our pursuit of the
President's two goals for this Department: transform VA into a 21st Century
organization, and ensure that we provide timely access to benefits and high
quality care to our Veterans over their lifetimes, from the day they first
take their oaths of allegiance until the day they are laid to rest.

Every day 298,000 people come to work to serve Veterans. Some do it through
direct contact with Veteran clients; others do so indirectly. But, we all
share one mission -- to care for our Nation's Veterans, wherever they live, by
providing them the highest quality benefits and services possible. We work
each and every day to do this faster, better, and more equitably for as many
of our Nation's 23.4 million Veterans who choose us as their provider of
services and benefits. Today, that number is roughly 7.8 million Veterans.

Veterans put themselves at risk to assure our safety as a people and the
preservation of our way of life. Not all of them are combat Veterans, but all
of them were prepared to be. VA's mission is to care for those who need us
because of the physical and mental hardships they endured on our behalf, the
cruel misfortunes that often accompany difficult operational missions, and the
reality of what risk taking really means to people in the operational

The health care, services, and benefits we provide are in great demand -- a
demand which grows each year. More than four million new Veterans have been
added to our health care rolls since 2001. Some of our youngest Veterans are
dealing with the effects of post traumatic stress disorder (PTSD), traumatic
brain injury (TBI), and other polytrauma injuries. We will provide them the
care they deserve, even as we continue to improve the quality of care we
deliver to Veterans of all previous generations -- World War II, Korea,
Vietnam, Grenada, Panama, Somalia, Desert Storm, and a host of smaller
operational deployments. The President's decision to relax income thresholds
established in 2003, which froze Priority Group 8 enrollments, has enabled
many more Veterans to access the excellent health care available through our
Veterans Health Administration (VHA). It has increased VA's workload, but we
are prepared to accommodate up to 500,000 enrollees, who are being phased in
over the next four years. While the Post 9/11 GI Bill offers serving military
and our newest Veterans expanded educational opportunities, it has challenged
the Veterans Benefits Administration's (VBA's) paper-bound processes. We are
moving aggressively to transform VBA from paper to electrons, even as the
entire organization picks up the pace of producing more, better, and faster
decisions both in disability claims and educational benefits. Finally, the
honor of providing final resting places for our Veterans remains a source of
immense professional pride for the National Cemeteries Administration (NCA),
and indeed the rest of VA. NCA consistently meets the demographic standards
associated with Veteran burials and exceeds expectations with regard to care
and compassion for heroes' families. NCA interred approximately 107,000
Veterans in the past year in our 130 national cemeteries. Five new national
cemeteries have been opened, and sixteen cemetery projects have been funded
for expansion in the past year to address our requirements in this area.

Our Veterans have earned and deserve our respect and appreciation for their
sacrifices and the sacrifices of their families. We at VA are privileged to
have the mission of demonstrating the thanks of a grateful Nation. We are
obliged to fulfill these responsibilities quickly, fully, and fairly --
especially given the current economic climate. All of us, at VA, accept these
increases to an already demanding workload, and we will meet our
responsibilities at a high standard. Doing so will offer VA as a genuine
provider of choice for those Veterans who, today, choose to go elsewhere for
insurance, health care, education loans, home loans, and counseling. To
achieve this kind of standing with Veterans, we must make entitlements much
easier to understand and then far more simple to access.

Each day, dedicated, compassionate professionals at VA do the extraordinary to
meet the needs of Veterans across a broad spectrum of programs and services.

Among them:
-- VA is second only to the Department of Education in providing
educational benefits of $9 billion annually.
-- VA is the Nation's eighth largest life insurance enterprise with $1.1
trillion in coverage, 7.2 million clients, and a 96 percent customer
satisfaction rating.
-- VA guarantees nearly 1.3 million individual home loans with an unpaid
balance of $175 billion. Our VA foreclosure rate is the lowest among
all categories of mortgage loans.
-- VA is the largest, integrated health care provider in the country,
7.9 million Veterans enrolled in our medical services system.
-- VA developed and distributed enterprise-wide, VistA, the most
comprehensive electronic health record (EHR) in the country, linking
153 medical centers to their 774 Community Based Outpatient Clinics
(CBOCs), 232 Veterans Centers, as well as outreach and mobile clinics.
-- VA received an "Among the Best" ranking for its mail order
pharmaceutical program, ranking with Kaiser Permanente Pharmacy and
Prescriptions Solutions, in a J.D. Power and Associates survey of
pharmacy customers.
-- A VA employee, Dr. Janet Kemp, received the "2009 Federal Employee of
the Year" award from the Partnership for Public Service three weeks
Under Dr. Kemp's leadership, VA created the Veterans National Suicide
Prevention Hotline to help Veterans in crisis. The Hotline has
over 185,000 calls -- an average of 375 per day -- and interrupted
5,200 potential suicides.
-- VA has staffed a Survivors' Assistance Office to advocate for Veteran
and service member families. As the "Voice of Survivors," its purpose
is to create and modify programs and services to better serve
-- VA's OIT (Office of Information Technology) office and VBA
with the White House to create a program soliciting original ideas
VA employees and participating VSOs, ranging from improving process
cycle times for benefits to increasing Veteran-satisfaction with the
claims process. Close to 4,000 process-improvement ideas have been
-- VA operates the country's largest national cemetery system with 130

-- VA senior executives are accountable and responsible when these
succeed and when they fall short. As of September 2009, VA maintained
one of the lowest executive to employee ratios (approximately 312
executives to approximately 298,400 employees). I have seen their
dedication to serving Veterans.

I am proud of our people and our accomplishments, but there have been
challenges, missed opportunities, and gaps in providing the quality of care
and services Veterans expect and deserve. We will continue to look for and
find our failures and disappointments; we will be open and candid with
Veterans, the Congress, and other stakeholders when we fall short; and we will
correct those problems, take the right lessons from them, and improve the
process to achieve the best outcomes. In recent months, we have discussed
with the Committee lapses in quality control and safety regarding endoscopes
and other reusable equipment, erroneous notifications of ALS diagnoses, and
expensive IT initiatives that were not meeting program thresholds.

Near term challenges have been riveting. Since enactment, the new Post 9/11
GI Bill has been our top priority for successful implementation by August 3,
2009. These completely new benefits, requiring tools different from the ones
available to us, resulted in massive Information Technology (IT) planning
efforts on short timelines. Delays and setbacks required VA to exercise
emergency procedures two weeks ago to issue checks to Veterans to cover their
expenses early in program execution. Uncertainty and great stress caused by
these delays were addressed through these emergency procedures, which remain
in effect. We will mature our information technology tools to assure timely
delivery of checks in the future.

We must work short-term and long-term strategies to reduce the backlog of
disability claims, even as they increase in number and complexity. In July,
we closed out a VA-record 92,000 claims in a single month -- and received
another 91,200 new ones. We are consolidating and investing in those IT
solutions integral to our ability to perform our mission while looking hard at
those that have not met program expectations -- behind schedule or over
budget. In July, we paused 45 IT projects, which failed to meet these
parameters. These projects are under review to determine whether they will be
resumed or terminated. We know this is of intense concern and interest to
Members of this Committee, and we appreciate your continued support and

In working these near-term demands, we are simultaneously addressing, in 2010
and the years beyond, improvements to programs and new initiatives critical to
Veterans -- reducing homelessness, enhancing rural health care, better serving
our growing population of women Veterans, and refreshing tired, and in a
number of cases unsafe, infrastructure.

To embrace these priorities, we have put in place a strategic management
process to focus our stated goals and sharpen accountability. We are close to
releasing a Department of Veterans Affairs Strategic Plan, in which I look
forward to outlining for you the strategic goals that will drive our decisions
over the next five years, and potentially longer.

I've now engaged in eight months of study, collaboration, and review of as
many aspects of VA's operations with as many of our clients, employees, and
stakeholders, as the Deputy Secretary and I could manage. I've visited VA
facilities -- large and small, urban and rural, complex and simple -- all
across the country. I've spoken with leaders, staffs, and Veterans. I also
invited each of our 21 Veterans Integrated System Network (VISNs) directors to
share with me, in dedicated 4-hour briefings, their requirements; their
priorities; their measurements for performance, quality, and safety; and their
need for resources -- people, money, and time. I've also received multiple
briefings from VBA leadership on the extent and complexity of the benefits we
provide to Veterans. This has been time well-invested -- invaluable.

The Veterans I've met in my travels have been uplifting. Many struggle with
conditions inevitable with old age; others live with uncertain consequences
from exposures to environmental threats and chemicals; still others have
recently returned from Afghanistan and Iraq bearing the fresh wounds of war --
visible and invisible.

Out of my discussions with Veterans, three concerns keep coming through --
access, the backlog, and homeless Veterans.

Access: Of the 23.4 million Veterans in this country, roughly eight million
are enrolled in VA for health care. 5.5 million unique beneficiaries have
used our medical facilities. We want to ensure that any Veteran who can
benefit from VA services knows the range of services available to them. VA
will continue reaching out to all Veterans to explain our benefits, services,
and the quality of our health care system. A major initiative which will
expand access is the President's decision to relax the income thresholds
established in 2003, which prohibited new Priority Group 8 enrollments. We
expect up to half-million new Priority Group 8 enrollees in the next four

Another initiative to expand and improve access is the evolution of our health
care delivery system. About a decade ago, VA decided to move toward the
system of care being provided in the private sector by turning its focus to
outpatient care and prevention. As a result, VA's 153 medical centers are the
flagships of our Nation-wide integrated health care enterprise, and the
Department also provides care through a system of 774 Community Based
Outpatient Clinics (CBOCs), 232 Vet Centers, outreach and mobile clinics, and
when necessary, contracted specialized health care locally. This fundamental
change in delivery of care, means organizing our services to meet the needs of
the Veteran rather than the needs of the staff -- Veteran-centric care.

Our next major leap in health care delivery will be to connect flagship
medical centers to distant community-based outpatient clinics and their even
more distant mobile counterparts via an information technology backbone that
places specialized health care professionals in direct contact with patients
via telehealth and telemedicine connections. Today, we are even connecting
medical centers to the homes of the chronically ill to provide better
monitoring and the prevention of avoidable, acute, episodes. This means that
Veterans drive less to receive routine health care and actually have better
day-to-day access. It also means higher quality and more convenient care,
especially for Veterans challenged by long distances; and, prevention will
mean healthier lives.

While this new, evolving VA model of health care is less about facilities and
more about the patient, it is also more economically efficient and a better
use of available resources. Health Care Centers that provide outpatient care,
including surgery and advanced diagnostic testing, have lower construction
costs compared to traditional hospitals. They better serve communities, and
are more cost effective, than small, traditional hospitals with low numbers of
Veterans receiving inpatient care. To provide emergency and inpatient care
when needed, VA forms alliances and relationships with local civilian
facilities for that care. Outreach clinics also allow us to provide health
care services in communities with smaller numbers of Veterans. These part
time clinics are situated in leased space, and provide in-person care closer
to the Veterans' homes.

Critical to improving Veterans' access to health care is our campaign to
inform and educate them about how VA delivers care. Using social media web
sites, including MyHealtheVet and Second Life, we are making contact with
Veterans, including our OEF/OIF veterans, who did not respond to traditional
outreach -- lectures, pamphlets, and telephone calls.

All of these initiatives to improve access are conducted with assessments of
patient privacy issues. Privacy is important for all Veterans, but we
especially want women Veterans to know that the VA will provide their care in
a safe, secure and private environment that is designed to meet their needs.
While approximately 8 percent of Veterans are women, only about 5.5 percent of
VA patients are women. My intent is to create an environment of care that
will attract more of them to the VA as their first choice for care.

The disability claims backlog: Reduction of the time it takes for a Veteran
to have a claim fairly adjudicated is a central goal for VA. The total number
of claims in our inventory today is around 400,000, and backlogged claims that
have been in the system for longer than 125 days total roughly 149,000 cases.
Regardless of how we parse the numbers, there is a backlog; it is too big, and
Veterans are waiting too long for decisions.

In April, President Obama charged Defense Secretary Gates and me with building
a fully interoperable electronic records system that will provide each member
of our armed forces a Virtual Lifetime Electronic Record (VLER) that will
track them from the day they put on the uniform, through their time as
Veterans, until the day they are laid to rest.

VA is a recognized leader in the development and use of electronic health
records. So is the Department of Defense. Our work with DoD is already
having an impact on the way we are able to provide quality health care to our
Veterans. To date, VA has received from DoD two and one-half million
deployment-related health assessments on more than one million individuals,
and we are able to share between Departments critical health information on
more than three million patients. Although our work is far from finished, our
achievements here will go beyond Veterans and our Service Members to help the
Nation as a whole, as have many of VA's historic medical innovations.

We are working with the President's Chief Performance Officer, Chief
Technology Officer, and Chief Information Officer, to harness the powers of
innovation and technology. In collaboration with our own IT leadership, we
intend to revolutionize our claims process -- faster processing, higher
quality decisions, no lost records, fewer errors. I am personally committed
to reducing the processing times of disability claims. We have work to do
here. But we understand what must be done, and we are putting the right
people to work on it.

Homelessness: Veterans lead the Nation in homelessness, depression, substance
abuse, and suicides. We now estimate that 131,000 Veterans live on the
streets of this wealthiest and most powerful Nation in the world, down from
195,000 six years ago. Some of those homeless are here in Washington, D.C. --
men and women, young and old, fully functioning and disabled, from every war
generation, even the current operations in Iraq and Afghanistan. We will
invest $3.2 billion next year to prevent and reduce homelessness among
Veterans -- $2.7 billion on medical services and $500 million on specific
homeless housing programs. With 85 percent of homelessness funding going to
health care, it means that homelessness is a significant health care issue,
heavily burdened with depression and substance abuse. We think we have the
right partners, the right plans, and the right programs in place on safe
housing. We'll monitor and adjust the balance as required to continue
increasing our gains in eliminating Veteran homelessness. We are moving in
the right direction to remove this blot on our consciences, but we have more
work to do.

Effectively addressing homelessness requires breaking the downward spiral that
leads Veterans into homelessness. We must continue to improve treatment for
substance abuse, depression, TBI and PTSD; better educational and vocational
options, much better employment opportunities; and more opportunities for safe
and hospitable housing. Early intervention and prevention of homelessness
among Veterans is critical. We have to do it all; we can't afford any missed

The psychological consequences of combat affect every generation of Veterans.
VA now employs 18,000 mental health professionals to address their mental
health needs. We know if we diagnose and treat, people usually get better.
If we don't, they won't -- and sometimes their problems become debilitating.
We understand the stigma issue, but we are not going to be dissuaded. We are
not giving up on any of our Veterans with mental health challenges, and
definitely not the homeless.

We have approximately 500 partners in nearly every major town and city across
the country helping us get homeless Veterans off the streets. With 20,000
HUD-VASH vouchers from the Department of Housing and Urban Development, and
our $500 million to invest in 2010 to cover safe housing and rehabilitation
for Veterans we have been able to coax off the streets, we are going to
continue reducing the number of homeless Veterans next year, and each year
thereafter, for the next five years.

I know that this committee and the President are committed to helping VA end
homelessness among Veterans. We are going to do everything we can to end
homelessness among Veterans over the next five years. No one, who has served
this Nation, as we have, should ever find themselves living without care --
and without hope. I know that there are never any absolutes in life, but
unless we set an ambitious target, we would not be giving this our very best
efforts in education, jobs, mental health, substance abuse, and housing.

Education: The President kicked off our post 9/11 new GI Bill program on 3
August, 2009. 267,000 Veterans have applied and been found eligible to
participate in this benefits program this year, and we project that as many as
150,000 more may apply next year. The first time we did this, in 1944 during
World War II, our country ended up being richer by 450,000 trained engineers,
240,000 accountants, 238,000 teachers, 91,000 scientists, 67,000 doctors,
22,000 dentists, and a million other college-educated Veterans. They went on
to provide the leadership that catapulted our economy to worlds largest and
our Nation to leader of the free world and victor in the cold war.

Slow processing of enrollment certificates by VA and slower than anticipated
submission of enrollment documents by some educational institutions delayed
issuance of checks to schools and Veterans. On 2 October, VA began an
emergency disbursement of monies nationally, working with the Treasury
Department to provide almost $70 million in advance payments to more than
25,000 Veterans in the first two days of the program. These payments continue
as a way to bridge the gap until the Veterans' routine, monthly payments
begin. We will do whatever it takes to get checks into the hands of Veterans
for their education, and we will improve the delivery system to eliminate the
barriers to effective distribution of benefits in future years.

Jobs: This summer, I addressed over 1,700 Veteran small business owners at
the 5th Annual Small Business Symposium on 21 July. I reminded them that
Veterans hire Veterans because they know what they're getting. Customers and
partners value their skills, knowledge, and attributes and are eager to work
with them. Just last fall, in a survey conducted by the Society for Human
Resource Management, over 90 percent of employers said they valued Veterans'
skills, in particular, their strong sense of responsibility and teamwork.

VA puts Veterans first in our contracting awards because we recognize the
on-time, on-budget, quality solutions they bring to our contracting needs. In
fiscal year 2008, our unique "Veterans First" buying program resulted in VA's
spending more than $2 billion on Veteran-owned small businesses. That
represented 15 percent of our procurement dollars, up five percent from the
previous year. $1.6 billion of that amount was invested in service-disabled,
Veteran-owned businesses.

At VA, our experience is that Veteran-owned small businesses have a high
likelihood for creating new jobs, developing new products and services, and
building prosperity. Increasing opportunities for Veteran-owned small
businesses is an effective way to help address many needs during this economic

So, education, jobs, health care, and housing: We have work to do here; but
we have momentum, and we know where we are headed. We are positively engaged
with the Departments of Housing and Urban Development, Labor, Health and Human
Services, Education, and the Small Business Administration to work our
collaborative issues.

A transformed VA will be a high-performing 21st century department, a
different organization from the one that exists today. Beyond the next five
years, we're looking for new ways of thinking and acting. We are asking why,
40 years after Agent Orange was last used in Vietnam, this Secretary had to
adjudicate claims for service-connected disabilities that have now been
determined presumptive. And why, 20 years after Desert Storm, we are still
debating the debilitating effects of whatever causes Gulf War Illness. If we
do not stay attuned to the health needs of our returning veterans, 20 or 40
years from now, some future Secretary could be adjudicating presumptive
disabilities from our ongoing conflicts. We must do better, and we will.

VA's mission is inextricably linked to the missions of the Departments of
Defense (DoD) and Health and Human Services (HHS) -- and closely linked to the
Departments of Housing and Urban Development, Education, Labor, and the Small
Business Administration. We are not an independent operator. We administer
the Servicemen's Group Life Insurance program and are prepared to deliver
benefits for any of the 2.25 million men and women of all Services and
Components, who are insured through it. And, together with DoD, we operate
two of the Nation's largest health care systems -- one for health care to meet
operational commitments and one to deal with the long term health care effects
of those operations. As a result, we are a participant with HHS in
discussions of how to best deliver health care. VA's budget requirements are
largely determined by the operational missions performed by the courageous men
and women in the DoD and the entitlements and benefits which accrue to them
for taking those risks. Additionally, VA is uniquely positioned to help with
ideas and a model for providing more Americans with better, more
cost-effective health care, something VA has long pursued on behalf of

Largely hidden from public view is an enormous VA effort to improve management
infrastructure and implement a Departmental model of management that insures
significant improvement in human resources, IT, acquisition, financial and
facilities management. This effort is critical to strengthening both our
performance and accountability mechanisms across VA.

In all our missions, VA seeks to become more transparent by providing Veterans
and stakeholders more information about our performance than ever before. We
want Veterans to have the information they need to make informed decisions.
We will be sharing more data about the quality of VA health care than ever
before. Using our own web sites, we are displaying information on quality
including Health Effectiveness Data and Information Set (HEDIS) scores, wait
times, and Joint Commission results.

Another element of transparency is disclosure when mistakes are made. We have
aggressively disclosed problems with the reprocessing of endoscopes and with
brachytherapy at several sites. These issues were found by our own staff and
then publicly disclosed. In each of these cases, we notified Congress, the
media, VSOs, and the patients. While this process is at times painful, it is
the right thing to do for Veterans and the Nation and will ultimately result
in greater trust and better quality.

Our mission is to serve Veterans by increasing their access to VA benefits and
services, to provide them the highest quality of health care available, and to
control costs to the best of our ability. Our efforts will remain focused on
transforming VA into a 21st Century organization--People-centric,
Results-driven, and Forward-looking, and further refinement of our strategic
plan to achieve our commitments and provide metrics for holding ourselves
accountable. We are applying business principles that make us more efficient
and effective at every opportunity.

However, transforming VA and the current pace of military operations have
required new levels of resources. The care of Veterans, like the sacrifices
they make on behalf of the Nation, endure for many years after conflicts are
resolved. This investment in our Veterans will, over time, provide increasing
returns for them, for the Nation, and for VA. Providing Veterans the care and
benefits they have earned is a test of our character.

SOURCE U.S. Department of Veterans Affairs
October 14th Secretary Shinseki's testimony to Congress

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