Remarks by Deputy Secretary Sloan Gibson - Office of Public and Intergovernmental Affairs
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Office of Public and Intergovernmental Affairs

Remarks by Deputy Secretary Sloan Gibson

United Veterans’ Committee (UVC) Awards Banquet
Denver, Colorado
April 19, 2015

If you hear nothing else I say tonight, hear this—we will complete the Denver project.

There have been unacceptable delays. We made mistakes on this project going back years—producing an unacceptable result for Veterans and taxpayers who deserve better from their VA.

We own those mistakes. I own these mistakes. This will not happen again—not on my watch.

I’ve been to Denver six times since August, and I’ll be back again late next week. If you haven’t seen the project, I hope you saw some of it last evening and this morning in the media.

It may be hard to imagine what that hospital is going to look like. I expect that every time Veterans and their family members arrive to receive care, they will recognize it as a heartfelt “thank you” from the America people.

Today we’ve got a fully designed project—with construction about 50 percent complete—that Kiewit-Turner knows well.

Earlier this month, I met with Kiewit-Turner senior leaders and the Corps of Engineers, as I have every month since December. On that same day, I met with 40 to 50 of the largest sub-contractors to make sure they understood our commitment to this project and what it means for Veterans and their families.

Kiewit-Turner and the rest are committed, proud of the work they’ve done, and anxious to see the first Colorado Veterans walking through its doors.

As you know, we are transitioning day-to-day management of this project to the Corps of Engineers. We have a long history of working with the Corps, and they have extensive experience, especially over the last 15 years, in major hospital construction. We are confident in their ability to manage this project to completion and expect to rely on them to manage VA’s future projects of this scale.

Two weeks ago, we named Greg Giddens our new Executive Director of the Office of Acquisition, Logistics, and Construction. Greg has broad experience in both acquisition and construction with VA, DoD, the Coast Guard, Homeland Security, and with Customs and Border Protection—where he managed a multi-billion-dollar portfolio with over 1000 facilities. OALC, under Greg’s leadership, will report directly to me.

And as I testified to Congress Wednesday, we are committed to doing what’s right for Colorado Veterans. Twenty-two of our great partners—both national and state—are with us here tonight, especially including the United Veterans Committee of Colorado. We are grateful for your support and long advocacy of this project, and I fully expect you will continue to hold our feet to the fire.

I want to talk for a few minutes about your Eastern Colorado Health Care System.

First, to be clear, there are too many Colorado Veterans waiting too long for care. If we look at February’s 46,000 completed appointments, 43,000 of those were within 30 days. In fact, the huge majority were completed within seven days of when the Veteran wanted to be seen.

When you look at February’s average wait times—eight days for primary care, nine days for specialty care, and seven days for mental health care—I suspect that is going to compare pretty favorably to the experience of many in the private sector. But there were still about 3,000 appointments in February that took longer than 30 days.

We have to do better.

How is it we have Veterans waiting too long for care? We have made significant investments in access to care, expanding space and increasing staff in eastern Colorado over the last couple of years. We opened the 32,000 square foot Pueblo Clinic in September 2013. We moved the Lakewood Clinic to the new Golden Clinic facility last February—going from 2,200 square feet to 38,000 square feet. Last September, the 76,000 square foot Colorado Springs Clinic opened.

In calendar year 2014, we hired more than 320 additional staff. On top of that, we improved same day access, added hours on nights and weekends, expanded our excellent collaboration with Department of Defense facilities, and dramatically increased authorizations for care in the community.

How could we still have Veterans waiting too long for care?

The answer: over the last six years, the number of Veterans receiving care at VA in Eastern Colorado has increased 40 percent. We are providing care to 23,000 more Eastern Colorado Veterans today than we did in 2008. That’s many multiples of the average growth across VA.

Even though we’ve been improving access to care for Colorado Veterans for years, clearly we have more work to do.

Why are so many coming to VA—especially when you consider that 81 percent of Veterans receiving care at VA have Medicare, Tricare, or private medical insurance?

We’ve already talked about access. Let’s turn to care quality and patient safety. How are we doing in Eastern Colorado?

We regularly publish extensive care quality and patient safety data on our website. If you review the data, what will you find?

  • One of the lowest risk adjusted mortality rates of any medical center in all of VA.
  • Your VA medical center is also among the lowest in hospitalization for what are called ambulatory care sensitive conditions—a key measure of outpatient primary care quality.
  • They have lower length of stay, lower mortality rates from heart failure or heart attack, and lower hospital acquired infections than the private sector. In fact, last year Denver had no instances of the most serious hospital acquired infections.
  • Readmission rates due to heart failure or pneumonia—other key measures—are better than the private sector.

Are there opportunities for improvement? Of course, just as there are in any large health care system in America. But the fact is, Veterans receive very good care in the Eastern Colorado Health Care System, and it seems that many Veterans agree.

Let’s talk about VA more broadly. I am going to tell you some things that I bet even you didn’t know.

Your VA is the second largest agency in Federal government. Eleven million Veterans are registered, enrolled, or use at least one VA benefit or service. We have more than 340,000 employees—a third of them Veterans—and a budget of $169 billion.

There are nine lines of business.

  • We provided four million Veterans and survivors compensation for disability totaling $58 billion last year and assisted another 100,000 disabled Veterans with vocational rehabilitation and employment benefits.
  • We provide Post 9/11 GI Bill benefits to 1.4 million Veterans and family members.
  • We have the lowest foreclosure rate in the industry on the 2.2 million home loans guaranteed by VA—that’s a $100 billion portfolio.
  • Your VA is the Nation’s 10th largest insurance enterprise, with nearly $1.3 trillion in coverage.
  • And for the past decade, the American Customer Satisfaction Index—the ACSI— has ranked VA’s National Cemetery Administration as the top customer-service organization in the Nation—public or private—in any consumer business.

If VA were in the private sector, it would be a Fortune 10 company. And I haven’t even gotten to health care.

VA’s the largest integrated health care system in America—with over nine million Veterans enrolled.

We complete about 55 million appointments inside VA each year—more than 200,000 each weekday. And that doesn’t include the 18 million appointments Veterans completed for care in the community.

Last year, 880 thousand appointments were after hours, we administered 273 million lab tests, and filled 270 million prescriptions.

Speaking of prescriptions, for the last five years, J.D. Power rated VA’s Mail Order Pharmacy highest in overall customer satisfaction.

VA employs 23,000 doctors, and our 91,000 nurses make us the largest employer of nurses in the country. These professionals deliver everything from primary care to the most complex specialized procedures—like organ transplants and neurosurgery.

Clinicians from the most prestigious medical schools deliver care to Veterans, teach, and conduct research at VA—this includes our great academic partners here, the University of Colorado.

Seventy percent of all U.S. physicians receive part of their training at VA. And each year we train 62,000 medical students and residents, 23,000 nurses, and 33,000 in other health care professions.

VA invests $1.8 billion in research each year, with dividends like the electronic medical record and bar-code software to safely administer medicines, the implantable cardiac pacemakers that VA researchers developed, the first successful liver transplants, the nicotine patch, and some of the first hypertension medications.

VA researchers proved an aspirin a day reduces risk in patients with unstable angina and helped license the shingles vaccine.

And VA researchers showed the world that patients with total paralysis can use their minds to control robotic arms.

So, all America benefits from VA.

We still have lots of room to improve—but most Veterans are satisfied with their VA. That’s not me saying that. Since 2004, the ACSI has reported that Veterans receiving VA health care give VA higher satisfaction ratings than patients receiving care in private hospitals—inpatient and outpatient care.

Last year, the Joint Commission recognized 24 VA medical centers as “top performers.”

VA care compares favorably to and outperforms private-sector counterparts in many categories of patient outcomes. VA exceeds private hospitals in prescribing Beta-Blockers after a heart attack, controlling high blood pressure, and conducting colorectal cancer screening. You have a lower risk of dying of heart failure in a VA hospital than in the private-sector. VA hospitals match or are better than the best private hospitals for patient safety and preventing hospital-acquired infections.

Let me quote from Tina Rosenberg’s January piece in The New York Times: “Hospital-acquired infection is one of the country’s leading causes of death, killing 75,000 people per year—more than car accidents and breast cancer combined. . . . hospitals have only started to take prevention seriously in the last decade, most in the last five years. . . . One hospital group, however, has done more than all others. . . . not the Mayo Clinic’s hospitals, nor the Cleveland Clinic’s, nor Kaiser Permanente, nor Sutter, nor Geisinger . . . . chains known for their quality . . . . another big name leaves them in the dust: the V.A.”

She goes on to say, “The V.A.’s achievement is even more remarkable because its patients are older and sicker than patients in other hospitals.”

I could cite more examples of VA leadership in important areas. But if even one Veteran waits too long for care or benefits, it’s unacceptable.

It erodes trust.

We know we’ve got to earn that trust back—one Veteran at a time. Let me tell you about some of the things we’ve been doing to earn it back.

Our top priority has been accelerating access—getting Veterans off wait lists and into clinics. From May to February, VA completed two million more appointments than a year ago. In February, 97 percent of completed appointments were within 30 days of the Veteran’s preferred date. We know that for the Veteran who needs to be seen right away, 30 days is totally unacceptable.

Since May, 12 million of our 46 million completed appointments were same-day.

We complete 500,000 mental health appointments each month. Average wait time? About 3 days.

Now, we still have Veterans waiting too long for mental health care. We have work to do. But, I expect all of us are generally aware of the mental health care access challenges in the private sector. If there is any health care organization in America providing more mental health care, more timely, I would like to know who it is.

I also don’t know of any other large health care organization that integrates mental health care into primary care teams the way VA does, further improving access.

Staffing impacts access, so we’ve grown our medical center staffing by 8,000 over the last year—2,200 more nurses, 1,300 more support staff, and 970 more physicians.

We made over 2.6 million authorizations for private-sector care in the last 11 months— a 44 percent increase. In fact, every month, more than 1 million appointments are completed in the community—about 20 percent of all appointments.

While I’m on care in the community, let me say something about the Choice Program. It isn’t working.

We’re changing the measurement of distance from straight-line to driving distance—similar to beneficiary travel. The change will be effective with publication of the regulation in the Federal Register targeted for Friday.

Second, we’re working with Congress to find alternatives to the current legislation which determines eligibility based on 40 miles to any VA medical facility, regardless of whether the facility offers the specific care a Veteran needs.

We will work with Congress, with private sector care providers, VSOs, and our own staff to ensure Choice is working as intended and delivering great health care outcomes for Veterans.

Last summer I met Dr. Harvey Fineberg, former president of the Institute of Medicine.

I told him that because of the health care crisis, VA could accomplish more in two-to-three years than we could otherwise have done in two-to-three decades.

Dr. Fineberg immediately corrected me. “No!” he said, “VA can accomplish things now it never could have accomplished!”

He’s right—there has never been an opportunity like this one.

We are committed to nothing less than revolutionary change across VA, so every Veteran has a seamless, integrated, and responsive customer service experience, every time.

But let me put that opportunity and challenge in perspective.

First, consider what it would take to overhaul a massive private-sector health care system—transforming business processes, reallocating resources, and implementing organization-wide cultural change. That would be tough.

Now, think about getting it done in the Federal Government. We have 535 board members—Congress. Sixty-five percent of our workforce is unionized. Hiring is hard; firing is harder. Budget and acquisition processes are incredibly onerous and inflexible. And you’re operating the most transparent health care system in America where everything is publicized, scrutinized, and criticized by powerful and vocal competing interests, often with diverging priorities.

We are engaged in an historic, department-wide transformation, changing VA’s culture, and making you—our Veterans—the center of all we do.

Our overarching strategy is called MyVA, and it focuses on five primary areas:

  • Improve Veterans’ experience, delivering a seamless, integrated, responsive customer-service experience, every time.
  • Improve employees’ experience and empower employees to better serve Veterans.
  • Achieve support services excellence—from human resources to information technology to purchasing and construction.
  • Establish a culture of continuous improvement to identify and correct problems faster and replicate solutions nationwide.
  • And enhance strategic partnerships.

We have much to do.

As I close, there may be some here that think I mounted a “defense” of VA tonight.

You would be mistaken.

You heard me clearly embrace our challenges—the need to improve our construction practices, accelerate access to care, improve care quality and patient safety, and more.

What you also heard, which you rarely hear today, was the “rest of the story.”

What you got tonight was a more complete picture.

Every day, more than 340,000 VA employees who care about the mission, do the right thing, and work hard to serve and care for Veterans are delivering on our promise.

That’s what is at the heart of the rest of the story.

I don’t know of any organization with a greater opportunity or a more inspiring and noble mission. With your support—and the support of the President, Congress, VSOs across the Nation, and other stakeholders—we will succeed.

Because we know who it’s for.

Thank you.