Remarks by Secretary Robert A. McDonald
National Press Club
November 6, 2015
Since the Civil War, the Y has been a friend to Servicemembers and Veterans. The YMCA’s education scholarships were forerunners of the GI Bill.
Today, I’m pleased to announce that VA and the Y have agreed to continue that legacy by further expanding our partnership. This enhanced agreement makes it easier for local VA facilities and YMCAs to collaborate on helping transitioning Servicemembers and Veterans connect to the resources and opportunities that they need.
Neal Denton, thanks to you and the entire organization for your enduring devotion to Veterans.
The Benevolent and Protective Order of Elks have been friends of Veterans for a long time, too. The Reconstruction Hospital they built in Boston in 1918, and gave to the government, was a forerunner of today’s VA Medical Centers. Last month, the Elks committed $4 million over a four-year period to help end Veteran homelessness. Further, they’re deploying their 800,000 members across the country to help end Veteran homelessness in their own communities.
Paul Helsel, thank you and Elks across this great country for your generosity and loyalty to our Nation’s heroes.
The Y, the Elks . . . these are the kinds of strategic partnerships we are establishing as part of our MyVA transformation, which are making profound differences in the lives of Veterans and their families.
Let me also welcome a great Veteran and VA employee, Patty Andrews. Patty’s representing more than 106,000 VA employees who are Veterans themselves. Ask Patty why she works at VA, and she’ll tell you, “Veterans helping Veterans is nothing short of a dream job.”
Patty—thanks for your example, and your continued service to the Nation at VA.
Let me ask all Veterans here today to stand and be recognized. Thanks to you all for your services and your sacrifices, and those of your families, as well.
Several days ago in Kansas City, I had lunch with Vietnam Veteran Larry Parrish. Larry agreed to let me share his VA experiences with you.
Larry’s a very active man. But over two years, his health deteriorated over a hip problem. He said, “I was 278 pounds. I was walking with a cane. I was in pain. And I was only 61. I was suicidal because of the pain and because nobody seemed to care.”
On the advice of a trusted friend, he turned to VA. Here’s what Larry said about VA’s physical therapy: “They gave me my life back. They turned it around in 24 hours. They were the most comprehensive, most efficient, and the most cordial of any therapists I’ve worked with, public or private.”
When Larry’s VA doctor recommended a hip replacement, Larry chose VA, for two reasons.
First, his private insurance deductible was about $5000, more than he could afford. But more important to him was this: “I wanted to go to the same place because they were so damn good. Every time someone saw me, they’d hug me or pat me on the back and say, ‘Thank you for your service. Welcome home, brother.’”
That’s VA doing it exactly right—the world-class experience Veterans earned and deserve. It’s employees living VA’s I-CARE Values of Integrity, Commitment, Advocacy, Respect, and Excellence.
Those stories are out there in abundance. They’re too rarely reported.
I want to begin by telling you how VA’s improving Veterans’ access to health care and meeting increasing demand with expanded capacity, how we’ve doubled the capacity required to meet last year’s demand by focusing on four pillars: staffing, space, productivity, and VA Community Care.
We have more people serving Veterans. The Veteran Health Administration’s net staff is up over 15,000 (August 2014 to September 30, 2015).
We activated 1.7 million square feet and increased the number of primary care exam rooms in FY2014 so providers can care for more Veterans each day. We added 2.2 million more square feet in FY2015.
In the wake of the access crisis, we aggressively increased access to care. In the 12 months following the crisis, June 2014 to June 2015, we completed 7 million more appointments than during the same period the year prior: 2.5 million of those were at VA; 4.5 million were in the community.
This [past] fiscal year [FY2015], we completed 61.5 million appointments—3.1 million more than last fiscal year [FY2014]: more than 2 million more at VA facilities; a million more in the community. Altogether this year, 2.6 million Veterans were authorized care in the community, a 9 percent increase over authorizations the year before.
Right now, 97 percent of appointments are within 30 days, 92 percent are within 14 days, 87 percent are within seven days, and 23 percent are same day. Specialty care wait-time is six days, primary care is four days, mental healthcare is three days.
Those averages are excellent for most, unless you’re in the tail of the curve, like a Veteran living in a city seeing dramatic Veteran-population growth. So we’re going to take advantage of the scale of VA and its affiliates and partners to have a one day Access Stand Down to make sure every Veteran gets appropriately scheduled for care.
We’ve made significant progress addressing Veteran homelessness. Since 2010, over 230,000 Veterans and family members have been permanently housed, rapidly rehoused, or prevented from falling into homelessness. Altogether across the country, there’s been a 33 percent decline in homeless Veterans.
Backlog claims are down 88 percent to 76,000 from the 611,000 peak in March 2013—historic lows. We completed 1.4 million claims in FY2015—the highest in our history and 67,000 more than last year. Today, Veterans wait about 93 days for claims decisions—that’s 6 months fewer than March 2013, and the lowest this century.
Veterans are noticing.
I met Veteran Keith Toy last week at the D.C. VAMC. Keith’s father served in Vietnam with the First Infantry Division and the 101st Airborne Division, and his grandfather fought Rommel in World War II.
Keith brought up a great point I want to share. He said, “My personal experience with VA has been 95 percent positive . . . both VHA and VBA. But some people aren’t experiencing the same quality of work that I got.”
Keith advised, “What we need to work on is consistency across the board.” Keith pinpointed the reason the MyVA Transformation is shaping a seamless, unified, high quality Veteran customer experience across the entire enterprise, across the country.
MyVA will modernize VA’s culture, processes, and capabilities to put the needs, expectations, and interests of Veterans and beneficiaries first. It’s focused on five main objectives: improving the Veteran’s experience, improving the employee’s experience, achieving support-service excellence, establishing a culture of continuous improvement, and enhancing strategic partnerships.
I've suggested to the Chairmen and Ranking Members of our Senate and House Veterans Affairs Committees that we hold a hearing on the MyVA transformation, rather than continuing the barrage of hearings on mistakes that occurred two years ago.
In the meantime, here are some updates on our progress transforming VA.
We’re realigning VA to facilitate internal coordination and collaboration among business lines—from nine disjointed, disparate organizational boundaries and organizational structures to a single framework. That means down-sizing from 21 service networks to 18 that are aligned in five districts and defined by state boundaries, except in California. The realignment means opportunities for local level integration, and it promotes the consistently effective customer service Keith Toy described. Veterans from Syracuse to Seattle will see one VA.
Our Veterans Experience Office is fielding a VA staff of customer service experts who will help us get to Keith’s vision—every Veteran everywhere getting the same world-class service. They’ll be singularly focused on delivering consistent quality and the highest standards of professionalism and integrity. The North Atlantic office opens at the end of this year. We’re following-up with the Southeast Office in February 2016, the Midwest Office in April, and we’re working details on Continental and Pacific offices. This is about making it easy for Veterans and their families to be VA customers.
We’ve launched the MyVA Community model across the country. This model brings together local Veterans service providers, advocates, and others to improve outcomes for Veterans and their families. MyVA Communities aren’t run by VA. They’re community driven networks chaired by local leaders. I was in Connecticut when we established the first Veterans community board in August. Thirty-seven other communities across the country have adopted the MyVA model.
In 25 cities last May, we kicked-off our Veterans Economic Communities Initiative. Like MyVA Communities, Veteran Economic Communities promote local collaboration and partnership among organizations serving transitioning Servicemembers, Veterans, and families. Because of the success we’ve already seen, we’re doubling down on 25 more Economic Communities early next year.
We are investing in VA employees. And the last Federal Employee Viewpoint Survey results show that employee experiences are improving, trending slightly higher than last year. The best customer experience organizations in the world are also the best places to work. So we’re training leaders in Human-Centered Design, or Design Thinking, and Lean Six Sigma.
Great customer service companies use Human Centered Design to understand what customers want and need, and then design customer experiences to meet those needs. Lean Six Sigma makes these processes effective, efficient, and repeatable. We started training leaders on Lean Six Sigma last month. By December 2016, we intend to have 10 percent of leaders trained.
For Human Centered Design, we’re using a combined top-down and bottom-up approach to train a cadre of leaders and employees. We started in October, and we’re looking to train 5,000 employees over the next year. Improving employees’ experience is inextricably linked to improving Veterans’ experience.
We kicked-off our Leaders-Developing-Leaders cascading training model with 300 senior field leaders last month. We’re equipping leaders to dramatically improve delivery of care and services to Veterans and create a better work environment for our employees. This month we’ll complete initial training for all senior leaders.
So employees are better informed on the broadest spectrum of benefits and services, we’re giving them VA-101 training. 6,000 employees across 60 sites have received VA-101 training, so far. We’ll have 170,000 trained by next December [2016]. VA-101 also helps employees better appreciate the great value they bring to VA.
So, notable progress on healthcare delivery, the claims backlog, Veteran homelessness, MyVA transformation . . . all of that’s to say that we’ve made undeniable and tangible progress.
Every healthcare system has challenges, and VA has its fair share, some of them unique to VA. You’ve read the Independent Assessment of the VA’s Health Care Delivery Systems. You read about stark differences in Veterans’ experiences facility-to-facility; about bureaucratic challenges, leadership and staffing challenges, and failures in access and quality; about cultural challenges employees and leaders experience.
As I testified to the House Committee on Veterans’ Affairs in early October, the Assessment has given us some new ideas and a great deal of information on some known problems. It also confirms our own analysis and indicates we’ve been headed in the right direction for some time now.
But as long as one Veteran doesn’t have the Larry-Parrish-experience, we have work to do. So, let me address some challenges before we open things up for questions.
Access to care has improved. But here’s the inevitability: improved access means more demand. Remember, we completed 7 million more appointments in the year following the crisis than we did the year before. That should have satisfied pent-up demand twice-over. Still, the number of appointments not completed in 30 days has grown from 300,000 to nearly 500,000.
Why? The more Veterans come to us for care, the harder to balance supply and demand—without additional resources. That kind of imbalance predicts failure in any business, public or private. The healthcare industry is no different.
Example? The 2014 access crisis. The access crisis was predominantly a matter of a significant mismatch of supply versus demand. The crisis was exacerbated by greater numbers of Veterans receiving services.
You see, more and more Veterans like Larry Parrish choose VA, and for good reasons. For many, VA healthcare is just more convenient. For others, like Larry, it was quality and cost. The average Medicare reimbursement for a knee replacement is $25,000, with a co-pay of 20 percent. VA saves Veterans $5,000. Veterans don’t pay for hearing aids, and we cover all hearing loss, not just service-connected. VA saves Veterans something in the neighborhood of $4,000.
Veterans notice.
Hiring challenges will persist for the foreseeable future. Private-sector healthcare turnover is around 30 percent. Our turnover rate is about 9 percent—pretty favorable. But we need about 4,300 more physicians and 10,000 more nurses. And we need to fill 41 senior-level vacancies in the field. That growing shortage of qualified candidates is a national problem. For our own part, we’re working closely with the deans of medical schools to increase throughput. We’re asking Congress for more residencies. We’re asking for scholarships and loan reimbursements. And we’re working with universities and state governments to create new medical schools.
One of our most pressing challenges is in the appeals process—delivering timely decisions in the manner Veterans deserve. The process is too complex, too confusing to Veterans, and it’s too lengthy. In 2015, the Board of Veterans' Appeals served over 55,700 Veterans—more than we have in recent memory—and they held over 12,700 hearings.
That’s a lot. But it’s not enough. Simply put, our capacity to serve Veterans with timely final appeals decisions is encumbered by some antiquated laws—they’ve evolved since WWI, and they don’t well-serve today’s Veterans with a modern system. We worked with Veteran Service Organizations to reengineer the process. Now, we’re working with Congress to pass the laws necessary to bring the process into the 21st century.
We still have challenges in Veterans’ experiences in benefit delivery. Last month, I received an urgent e-mail from Vietnam Veteran Mike Hughes. Mike had submitted a correct and fully developed compensation claim through e-Benefits that was incorrectly rejected. Calls to his regional office were unproductive and understandably frustrating. The call center agent at that office couldn’t access the information necessary to answer Mike’s questions and correct the problem on the spot. Even though that’s one Veteran in one encounter, it's not the kind of customer service we aim to provide.
We owe Veterans more. We owe our employees who serve Veterans more. They deserve the tools and training that empower them to give every Veteran a world-class experience.
For benefits call centers, we’re strengthening our customer service model so it’s more Veteran-centric. We’re empowering call center agents to process certain claims at the point-of-call—to take action while the Veteran is on the phone with them. As of this September, we’re processing dependency claims at the point-of-call so agents can, for instance, add a minor child or a spouse to a claim. As we continue to strengthen our service model, call center agents will begin taking more and more actions while the Veteran is on the line.
Other initiatives I’ve described—like Lean Six Sigma, Human Centered Design, Leader-to-Leader training, VA-101, and others—will, over time, help us achieve our customer-service goals for Veterans.
We own all these challenges. We’re working hard to do our part, aggressively tackling issues within our control. In a relatively short period for an enterprise of this size and complexity, we’ve demonstrated the significant capacity for meaningful change.
The Independent Assessment reported that “VHA has the opportunity to achieve a place among the highest performing health care systems in the world.”
And we will. But we know we can’t accomplish all we need to for Veterans without the help of Congress, Veterans Service Organizations, and many other stakeholders.
The Y, the Elks . . . they’re just two members on a great and growing team of some 250,000 partners working with VA—from philanthropic organizations to non-profits to businesses to other federal agencies.
But let me be clear. While those partnerships are important, our most essential partnership is with Congress. Congress holds the keys to many of these doors. Congress legislates the benefits we provide Veterans. And it’s Congress that has to fund the benefits it legislates. Some 25 of the Independent Assessment recommendations require congressional action. So, we literally cannot do it alone, not without the right congressional support.
Here are five specific requirements that will make a significant difference to Veterans. I’ve repeated them during testimony and at every other opportunity. I don’t mind reciting them again:
- We need Congress to fully fund the President’s 2016 budget request.
- We need Congress to give us the flexibility to align resources with Veterans’ demand for care.
- We need Congress to act on the proposal we submitted May 1 to end the uncertainty about aspects of purchased care that are outside the Veterans Choice Program and that complicate provider participation in VA’s other Care in the Community programs.
- We need Congress to address the many statutory issues burdening VA with red tape and bureaucracy.
- Finally, we need Congress to streamline and consolidate all care-in-the-community programs.
The Independent Assessment reiterated this requirement for Veterans. For years, a variety of different authorities and programs have provided community care to Veterans. It’s all very difficult to understand. Veterans don't get it. Providers don’t get it. Employees don't get it.
We sent our plan—the New Veterans Choice Program—to The Hill last Friday. It’s VA’s long-term vision for delivering timely, high-quality community care. Veterans need to see Congress act on it quickly.
This week, I had breakfast with the Chairmen and Ranking Members of our Senate and House Committees. There’s tremendous unanimity to pass these measures, to work together to transform the VA, and to provide more consistent, delightful experiences for Veterans.
Remember Mike Hughes, that Veteran who couldn’t get answers about his claim? A week after he wrote me, he wrote again: “One day after my email to you, I received a call from the Regional Office assuring me that my complaint had been heard and that my claim was, indeed, one that would be handled promptly.”
That’s the response Mike should have gotten to begin with.
We’ll get there. We’re well on our way.
I look forward to your questions.
