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

Birmingham Kiwanis Club
Birmingham, Alabama
May 5, 2015

I’m going to tell you some things about your Birmingham VA Medical Center that I bet you didn’t know.

The Birmingham VA is emerging as one of our lead medical centers in the country. That’s great for the 64,000 Veterans across 24 counties who rely on the Birmingham VA medical center and its outpatient clinics.

In March, nearly 99 percent of completed outpatient appointments were within 30 days of the Veteran’s preferred date. Average wait times? A day-and-a-half for primary care. Two days for mental health care. Six days for specialty care.

I suspect that compares pretty favorably to private-sector experiences. But we still have Veterans waiting too long, so we’re making significant investments in Birmingham to do even better on access: extended hours for primary care, to include a half-day clinic on Saturdays here in Birmingham; mental health hours are extended at the medical center and some outpatient clinics—appointments as early as 7:00 in the morning and as late as 7:00 in the evening; weekend hours are also available.

We’re building two facilities over 50,000 square feet—each. First, a Primary Care clinical annex in Birmingham opening in December will include Primary Care Patient Aligned Care Teams, Women’s Health services, and Ancillary Services. And we’re combining Madison-Decatur and Huntsville outpatient clinics in another 50,000 square foot project scheduled to open in August.

The new Huntsville clinic will provide primary care, optometry, audiology, mental health services and include a CAT-scan and X-ray capacity, some on-site lab services, and a pharmacy.

So, we’re improving access. How are we doing on care quality and patient safety?

We evaluate every VA medical center across the country using a model called Strategic Analytics for Improvement and Learning—S-A-I-L, for short. SAIL is VA’s roadmap for delivering better health care outcomes for Veterans. It assesses care quality, patient safety, patient satisfaction, and access—among 22 other criteria. While most health care industry report cards are updated annually—sometimes telling you today where they were two or three years ago—SAIL is reported quarterly at every facility so medical centers can track and improve performance.

So how’s Birmingham doing?

  • Compared to other VAMC’s, Birmingham VA caregivers are very high performers in ambulatory care sensitive condition hospitalizations.
  • Patients admitted for medical or surgical conditions have shorter hospital stays—which is safer for patients.
  • They are very high performers in mental health care waiting times, mental health experience of care, and they are caring for a very high percentage of those in need.
  • Risk adjusted mortality for heart failure and pneumonia are better than private-sector national averages, and better than the average right here in Birmingham.
  • And patient experience at Birmingham VA is on par with patient experiences in the private sector—nationally, and locally.

Want to know more? Go to to see for yourself. We publish our performance statistics quarterly—many statistics that are common across the health care sector so you can compare and see how your VA is performing in relation to the private sector.

One of the reasons Birmingham does does so well is because of their thriving network of academic affiliations. Birmingham partners with 111 programs from 40 different colleges and universities—stretching from the University of Tennessee to the north, to the University of Georgia to the east, and Ole Miss and Texas Tech to the west.

But our most prominent affiliation, of course, is with the University of Alabama at Birmingham (UAB), and it includes physician residency, dental residency, nursing, and others specialties.

I’ll spotlight our partnership with UAB’s School of Nursing.

This morning, I was at the VA Nursing Academy with Dr. Cynthia Cleveland and Dr. Doreen Harper. They’re doing excellent work. The VA Nursing Academy lets students do most of their residency at Birmingham VA Medical Center. That means students become familiar with VA and, we hope, stay with us. Recall, I mentioned the number of parameters we report in SAIL. Well, nursing turnover is one of those, and that’s an area where Birmingham needs to improve.

The Birmingham VA is one of only four VA facilities offering a Mental Health Nurse Practitioner Program—preparing residents to care not only for general mental health needs, but also the mental health needs characteristic of Veterans, things like Post Traumatic Stress and Military Sexual Trauma.

These are exceptional nursing programs, and others are taking notice. Dr. Deborah Trautman, CEO of the American Association of the Colleges of Nursing, visited Birmingham to see our partnerships in action. She left with what she called “clinical envy.” She wants to take our academic partnership model to the private sector.

So Veterans receive very good care here in Birmingham. We are doing many things right, but there is still room for improvement.

Now, let me shift gears and talk about VA more broadly. Again, some things I bet you didn’t know.

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, themselves—and a budget of $169 billion.

We have 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.
  • VA is the Nation’s 10th largest insurance enterprise, with $1.3 trillion in coverage.
  • Our National Cemetery Administration oversees 130 national cemeteries. For the past decade, the American Customer Satisfaction Index—ACSI—has ranked them the top customer-service organization in the Nation, public or private.

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

With over nine million Veterans enrolled, VA is the largest integrated health care system in America. We complete about 55 million outpatient appointments each year—that’s more than 200,000 each weekday. And that doesn’t include the 16 million appointments for VA care Veterans complete in the community each year.

We administered 273 million lab tests and filled 270 million prescriptions.

Speaking of prescriptions—for the last five years, J.D. Power has 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. Seventy percent of all physicians in America receive at least some training at VA. Each year, VA trains 62,000 medical students and residents, 23,000 nurses, and 33,000 in other health care professions.

VA annually invests $1.8 billion in medical research. Here are a few of the dividends:

  • The electronic medical record and bar-code software to safely administer medicines.
  • Implantable cardiac pacemakers that VA researchers developed and the first successful liver transplants.
  • The nicotine patch and some of the first hypertension medications.
  • We helped license the shingles vaccine, and VA researchers proved an aspirin a day reduces risk in patients with unstable angina.
  • And VA showed the world that patients with total paralysis can use their minds to control robotic arms.

So, it’s not just Veterans who benefit from VA.

More Veterans than ever before are using VA—despite the fact that 81 percent of them have Medicare, Tricare, or private medical insurance. Why?

Because they want to.

In fact, across the country, most Veterans are satisfied with their VA. That’s not just me saying that. Since 2004, ACSI has reported that Veterans receiving VA health care give us higher satisfaction ratings than patients receiving care in private hospitals—inpatient and outpatient. 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. Veterans have a lower risk of dying of heart failure in their VA hospital than in the private-sector. And VA hospitals match or are better than the best private hospitals for patient safety and preventing hospital-acquired infections.

On that topic, let me quote from a 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. . . . [H]ospitals 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. It’s not the Mayo Clinic’s hospitals, nor the Cleveland Clinic’s, nor Kaiser Permanente, nor Sutter, nor Geisinger. . . . all hospital chains known for their quality, but another big name leaves them in the dust: the V.A. . . . VA shows how much faster we could go. . . . VA’s achievement is even more remarkable because its patients are older and sicker than patients in other hospitals.

I could cite other examples of VA leadership in important areas. But we still have much room to improve as long as even one Veteran waits too long for care or benefits. We know that trust has eroded. And 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 back that trust. Our top priority has been accelerating access—getting Veterans off wait lists and into clinics. Staffing impacts access—so we’ve increased medical center staffing by 8,000 over the last year—2,200 more nurses, 1,300 more support staff, and 970 more physicians. From May to March, VA completed 2.4 million more outpatient appointments than a year ago. Last year, 880 thousand appointments were after hours, another enhancement to access.

From May to March, 97 percent of completed appointments were within 30 days of the Veteran’s preferred date—but we know that for the Veteran who needs to be seen sooner, 30 days is unacceptable; 93 percent were completed within 14 days; 88 percent are completed within 7 days; 22 percent are completed on the same day.

We made over 2.8 million authorizations for private-sector care in the last 12 months—a 44 percent increase. And each authorization typically translates into multiple appointments. That’s millions of additional appointments for care in the community. In fact, every month more than 1.4 million appointments are completed in the community.

There’s been a lot of talk about mental health care. We complete 500,000 mental health appointments each month. The average wait time? About 3 days. Now, I know we have Veterans waiting too long for mental health care. But if there is any health care organization in America providing more mental health care, more timely, I’d 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.

We are improving access to care, but we have more work to do.

Where are we going as a department? Last summer I met Dr. Harvey Fineberg. He had just stepped down after 12 years as the 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’s never been an opportunity like this one. But let me put that opportunity—and challenge—in perspective.

Think about what it would take in the private sector to overhaul a massive health care system (not to mention the other 8 lines of business)—transforming business processes, reallocating resources, and implementing organization-wide cultural change. It would be very challenging.

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

With all that, we are nonetheless engaged in an historic, department-wide transformation. We want every Veteran to have a seamless, integrated, and responsive customer service experience, every time.

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

  • Improving the Veteran Experience;
  • Improving the Employee Experience by focusing on our people and culture;
  • Establishing a culture of Continuous Performance Improvement;
  • Achieving Support Service Excellence;
  • Enhancing Strategic Partnerships.

We’re doing everything we can to seize this opportunity.

In closing, let me congratulate the Birmingham community—and say thank you.

Your work ending Veteran homelessness borders on miraculous. The number of unsheltered homeless Veterans in Birmingham has dropped 82 percent since 2011. And by most recent count, there are just 35 unsheltered homeless Veterans here in Birmingham.

But it isn’t a miracle—it’s partnerships.

Our partnerships with organizations like the Salvation Army, The Fire House, Aletheia House, Fellowship House, One Roof, Still Serving Veterans, Steps and Traditions, and Three Hot’s and a Cot, and more have made a difference.

Thirty-five to go.

Let’s end Veteran homelessness here in 2015.

Over the next 5 years, a million Servicemembers will transition to civilian life. We’re working hard to help them with career transition. But as with so much else, we need help.

VA hosts a Veterans Employment Center—a collaborative, web-based, integrated employment tool. I’d like you to visit it:

The Veterans Employment Center brings employers together with transitioning Servicemembers, Veterans, and families seeking jobs. Over 8,300 registered employers have already hired nearly 600,000 Veterans, and Alabama employers are among them: the Montgomery Police Department, Auburn University Facilities Management, Jack Hughston Memorial Hospital and Hughston Clinic, Kord Technologies, among others.

Your business can sign up, too.

Think about what these Veterans bring.

These men and women displayed extraordinary strength and resilience. They sacrificed personally for the greater good. They demonstrated remarkable perseverance in the face of adversity to protect the freedoms we, as Americans, enjoy daily. They worked with others, often very different than themselves, to accomplish great feats. They showed care and compassion for those in need, sometimes at the risk of their own lives. They lived by the core values of Duty, Honor, and Country, and in doing so earn our trust.

At a time when the country faces so many challenges, we have the opportunity to help these men and women and their families become integral parts of our communities.

It is the smart thing to do.

Can we imagine any situation where we don’t need more people who put service before self, who can bridge differences to accomplish great things, who will persevere even in the face of daunting obstacles, and who we can trust implicitly to choose a harder right rather than an easier wrong?

At a time when so many of these men and women are returning home after fourteen years of war and sacrifice, we have the opportunity to show our gratitude by embracing them as they transition to civilian life.

It’s the right thing to do.

While saying “Thank you for your service” is important, we all have more active roles to play. Of course, business leaders can bring talented Veterans into their companies. But we can also welcome these families into our neighborhoods, schools, and churches.

Let’s do everything we can to take good care of them and their families, just like they’ve taken good care of us.

Now, you might find yourself thinking I mounted a defense of VA today.

You’d be mistaken.

You heard me take ownership of our problems. What you also heard—which you rarely hear—is the “rest of the story,” the more complete picture.

Great to be back. Thank you for letting me be here with you.