ROBERT H. ROSWELL, M. D.
IN NOMINATION FOR
UNDER SECRETARY FOR HEALTH
DEPARTMENT OF VETERANS AFFAIRS
COMMITTEE ON VETERANS' AFFAIRS
UNITED STATES SENATE
March 14, 2002
Mr. Chairman and Members of the Committee:
I am pleased to appear before you today as President Bush's nominee to lead the Veterans Health Administration. For the past twenty years I have devoted my professional life to serving the needs of veterans in a variety of capacities, and I am honored to be considered by you for this position.
Over the past six years, under the visionary and capable leadership of Dr. Ken Kizer and Dr. Thomas Garthwaite, the Veterans Health Administration has undergone a remarkable transformation. Healthcare delivery has been shifted from costly inpatient settings to an outpatient-based primary care delivery model focused on prevention and health maintenance. Quality has risen from questionable to industry leading in many respects; and for the first time in many years we face a burgeoning demand for care that threatens to exceed finite resources within VHA.
I believe that it is important to continue this transformation, safeguarding the quality of care that is at the very heart of the system, while continuing to move the locus of care from the hospital to the outpatient clinic, to the community, and into the homes of veterans. But we must also plan for the future needs of veterans and enhance our ability to respond to a growing demand for VA care.
We must move quickly to assure that the long-term care and end-of-life needs of World War II veterans will be met in ways that provide the care and dignity these veterans have earned, and the functional independence and emotional support they seek. And we must find ways to meet these needs without irrevocably committing our physical infrastructure in a manner ill suited for the needs of those veterans who will come behind them.
I believe we must learn from our experience in treating Vietnam and Gulf War veterans, and recognize that whenever we send men and women into harm's way, there will be healthcare consequences that VA must be prepared to face. Although the exposures our military may face, and the illnesses they will develop may vary, the risk is certain and VA is uniquely situated to respond to their needs.
We must also improve the capture and utilization of all resources available to support the veterans healthcare system. Many of our patients have earned benefits from all three of our country's federal healthcare programs, yet sadly they still face substantial out-of-pocket expense to obtain the care they need. We must improve cost recovery efforts and enhance our business acumen to facilitate our efforts to meet a growing demand for VA care.
Much of VA's remarkable transformation over the last few years is rooted in the network structure put in place in 1996. This reorganization, coupled with the introduction of a performance measurement system, has led to substantial change across what some have characterized as 22 "innovation laboratories". However, others have expressed concerns over the regional variations in programs and services. The time has come to maximize performance and minimize variation across the 21 Veterans Integrated Service Networks within the Veterans Health Administration.
I believe this can be accomplished by the introduction of a comprehensive strategic planning process with involvement of all key stakeholders, careful alignment of the performance measurement system with VA strategic goals, and a cross-cutting management and oversight system for key functional areas across all networks.
Mr. Chairman, if confirmed, I look forward to a continuing and productive dialogue with you and Committee members, as well as other members of Congress as we work to assure a vital and responsive healthcare system for generations of veterans yet to come.