Briefing with Secretary of Veterans Affairs David Shulkin

Briefing with Secretary of Veterans Affairs David Shulkin

Male Speaker: Good
morning, everyone. We’re here today with
Secretary of Veterans Affairs, Dr. David
Shulkin, who will give on update on the
state of the VA. And just a reminder that
we’ll be sticking to the topic on hand for
questions afterwards. So, I’ll turn it over now
to Dr. David Shulkin. Secretary Shulkin:
Thank you, Nino. Good morning, everybody. So, a few weeks ago, the
President came over to my offices at VA at his
100-day mark to talk about the recognition of the
progress we’ve had at VA. So, I thought it only
fitting at my 100 days to come to his house to talk
about what’s happening at VA. And as you know, the
President is so committed to fixing issues for
veterans that what he has told me is, is that it is
important that we be open and candid and transparent
about where the problems are; that as a
businessman, the only way to fix the issues in an
organization is if you come out and you talk
about what those problems are. And so, as you know, I’m
a doctor and I like to diagnose things, assess
them and treat them. And so, what you’re going
to hear today is really a candid assessment of where
our problems are in VA, with the focus of a
businessman and the skills of a doctor to be able to
actually help you with that. And as you know, many of
these challenges I’m going to talk about today have
been decades in building and they’ve spanned
multiple administrations. And this is the time for
us to really address these chronic problems that have
affected veterans and, in many ways, have harmed
veterans and their families by not dealing
with these issues. So, I’m going to tackle
these issues heads-on. Just to give you a sense
about what we’re doing today, I’m going to
talk about 13 areas of significant risk for VA. It’s going to take about
25 minutes to get through, so if you need to get up
and stretch, or if you have ADD and you need to
leave, I will not be offended. But I just want to give
you a sense about that. We’ve had 137 different
assessments and studies telling VA what’s wrong
and how to fix it. And what we’ve done in my
first 100 days is to go through these studies —
the Commission on Care, Independent Assessment, as
well as our own internal assessments — to come up
with these 13 areas of risk that I want to share. So, let me
start with them. The very first
area is access. And of course, as you
know, we started with our wait time issue in 2014 —
the real crisis that began recently at VA. So, here’s my
assessment on access. We’ve done a significant
job in improving access to care for clinically urgent
veterans, so people with clinically urgent needs
are now being addressed in a much more efficient way. We’ve developed same-day
services in every one of our 168 medical centers
for primary care and mental health. And in fact, today, over
22 percent of veterans are seen on a same-day basis. What we’ve done recently
is we’ve posted our wait times for every single one
of our medical centers across the country in a
public forum for everybody to see what’s good and
what’s not good in terms of wait times. There is no other health
system in the country that has done anything like
that, and there is no comparison to what the
VA is doing in terms of transparency
and wait times. Yet veterans are waiting
60 days or more for new appointments in primary
care and mental health at 30 of our locations
nationwide. So, we still
have more to do. And while, as I mentioned,
we’ve done well with meeting the urgent needs
of veterans, 10 percent of the time when a provider
wants a follow-up appointment in a specific
time frame, we’re not meeting that provider’s
clinically assessed time for a veteran
to come back. And that’s something
we have to address. Sixteen percent of our
primary care clinics are over 100-percent capacity. When that happens, we
can’t fully meet their needs in terms of
access to care. Ten percent of our
out-patient centers do not offer same-day
services today. Now, we are committing by
the end of this year that all of our out-patient
centers will offer same-day services in
primary care mental health. But today 10 percent
are not meeting that. The second category is
paying providers when veterans go out
into the community. And as you know, our
Choice Program, our community care program,
has provided increased access for millions
of veterans. And we have 500,000
community care providers — doctors and others —
out in the community who participate in
our network. But providers are
increasingly frustrated with the VA’s ability to
get them payments, to the point that some of them are
actually leaving our network. And that’s obviously
working against us. It takes more than 30 days
to process 20 percent of our clean claims at VA,
and that affects about 25,000 providers
across the country. In addition, we have about
$50 million in out-patient bill charges that are
six months or older. As of April this year,
only 65 percent of our claims are handled
electronically. That’s far below what you’d
find in the private sector. And so, we need private
sector help in order to find new solutions to get
that number well above 65 percent, so we can have
faster adjudication of payments to our
community providers. The third area is
community care in general. Though we made a lot of
progress with our Choice Program — because we’ve
had over 70 amendments or modifications to our
original contract — we still have eight separate
programs for paying community care. That just makes it too
complex and it’s confusing veterans and our
employees alike. In terms of the complexity
of this program — it results in VA rejecting
one out of five community care claims — the rules
are so complex, people are so confused, 20 percent of
our claims are rejected. And that’s much higher
that what you’d find in the private sector. And we need Congress to
help us fix those eight separate programs and
put them into a single program. In terms of our Choice
Program, we still, today, only have three Department
of Defense facilities that participate in the
Choice network. And we need to get the
Department of Defense and VA to make all their
facilities and our facilities open to veterans
and to active service members. We certainly have to work
with Congress and our veteran service
organizations to redesign this Choice Program. It will expire essentially
at the end of the year, and we need new
legislation — this Congress — to make sure
that veterans don’t go back to waiting longer
than they need to wait to get care in the community. So, we have to pass
legislation this year. The next area is quality
— quality of care in the VA. We’ve shared with you
our star rating systems. We now publish that on our
websites, and we also now publish quality of care
comparisons between VAs and local community
hospitals. And in that, we’ve
identified 14 of our VAs that have
one-star ratings. That means that their
quality is below the standard in the community. And so that’s not
acceptable to us. We’re deploying teams and
implementing performance plans for each of
those facilities. Veterans shouldn’t have to
accept low-quality care and they deserve
our very best. I think everybody
agrees with that. And when they’re not
getting the best that they can get in the VA, and the
community offers better, that’s what we’re going to
work to do in a revised Choice Plan, is to allow
them to go out into the community if they’re not
getting the very best care. The next area is
disability claims and appeals. We have, currently, over
90,000 disability claims that are taking more than
125 days to process. Our goal is to cut that
in half over the next two years. But 90,000-plus is too
many to be acceptable. Last week, we processed a
claim for disability in three days. That’s called a due
process, called a decision-ready claim. And we’re going to be
introducing decision-ready claims nationwide on
September 1st of 2017. And in addition to that,
we’re going to be going paperless throughout all
of our veterans’ benefit offices by mid-2018. So, we are focused on not
doing claims fast enough now, but we have plans
to get much better. In addition, it’s very
hard for a veteran to get information on where their
claim status is, and we need to make that process
more transparent. In appeals, it takes
almost three years, if you were to file an appeal
today, to get a decision. And it’s going to take
Congress to help us fix that system. I’m grateful that the
House passed appeals legislation last week, and
we need our friends in the Senate to act on appeals
legislation as soon as possible. Information technology. We have 20 of our
facilities that have out-of-date systems
for IT and inventory. And that makes it very,
very difficult for doctors and nurses to get the
supplies that they need to care for veterans. This is what we saw in
the Washington, D.C. VA several weeks ago. We’ve taken immediate
steps to begin to start fixing these inventory
systems, and we’re executing on those plans. Currently, 75 percent of
our IT budget is just maintenance and sustaining
our infrastructure, because our legacy systems are
old and are at risk of failing. And that would cripple
our operations. Our scheduling systems and
our financial systems are outdated, and that
contributes to these excess wait times. Both systems are in the
process of being replaced, but it’s going to take
years to complete that. We have a system called
VALERI, which is the VA Loan Electronic
Reporting Interface. It’s out of date. Without funding for a new
system, VA is going to have to revert to a
paper-based, manual system for electronic loans — or
for loans that are going to reduce the number of
veterans that we serve, from 90,000 per year to
only 12,000 per year. So, we can’t afford to
let that happen, because veterans could be at risk
of foreclosure or even homelessness, and
that’s a risk that we’ve identified. We have to modernize all
of our IT systems to make them commercially viable
and cloud-based solutions to the maximum
extent possible. And I’ve committed to
making a decision on VA’s electronic medical record
in the very near future — definitely before July
of this year was my commitment — that I will
talk about how we are going to move forward with
the new EMR strategy. Capital assets. Our buildings and
our facilities are increasingly fallen
into disrepair. We have a facility
condition assessment report that identified $18
billion would be required to fully remediate our
buildings now, including structural/seismic and
electrical/mechanical improvements that
need to be done. On average, our buildings
are more than 60 years old, with only half
being built since 1920. We have 449 buildings from
the Revolutionary War and the Civil War; of those,
about 96 are vacant. We have another 591
buildings that were built in World War I era,
which 141 are vacant. In all, VA has 400
vacant buildings and 735 under-utilized facilities,
and that costs the taxpayers $25 million a
year just to maintain vacant and under-utilized
facilities. So we need to be
able to act quickly. VA currently has 27
facility leases that we’re waiting for Congress
to authorize. That would provide 2.3
million square feet of needed space for 3.2
million additional clinic visits a year that today
we can’t do because we need authorization
from Congress. We need different types of
strategic partnerships to be able to bring the type
of facilities that we need to veterans, and that
means working with local government, with academic
affiliates, other federal agencies, and private
sector partnerships. We’re going to work with
Congress to develop a modernization plan for our
capital infrastructure through what we call a
National Realignment Strategy that’s going
to allow us to use our buildings in a better way,
stop supporting vacant buildings and
underutilized buildings, all to be a better steward
of taxpayer dollars. Construction. Eleven of our major
construction projects, totaling $1.4 billion, are
on hold because the VA and the U.S. Corps of Engineers
still are trying to work through very difficult processes
and interpretation of the appropriation rules. We’re waiting for
congressional approval on a joint proposal to move
forward, which would allow these projects
to go ahead. The VA’s major
construction and minor construction programs have
large, unobligated balances. We carry at VA $971
million in minor construction in
unobligated balances, and $2.6 billion in
major construction. VA is taking way too long
to make construction awards, and these
obligations are critical for us to meet facility
demands in the future. Accountability. Under current VA law, VA
has to wait at least a month to hold an employee
accountable for misconduct or poor performance. We currently have 1,500
disciplinary actions that are pending, meaning
people that either need to be fired, demoted,
suspended without pay, for violating our core values
— and we’re waiting for each of those actions. Our accountability
processes are clearly broken. We have to wait more
than a month to fire a psychiatrist who was
caught on camera watching pornography using his iPad
while seeing a veteran. The expedited senior
executive removal authority that was given
to us in the Choice Program isn’t working. We weren’t able to
utilize that because of constitutionality issues. Because of the way the
judges review these cases, they can force us to take
terrible managers back who have been fired for
poor performance. We recently saw that in
one of our executives in San Juan. Just last week, we were
forced to take back an employee after they were
convicted no more than three times for DUI and had
served a 60-day jail sentence. Under current law, it takes us
51 days from the date management proposes to suspend, demote,
or remove an employee until the date
that action takes effect. Despite the limitations of
the existing law, we’ve recently removed the
Washington, D.C. medical director from their
position and other employees there as well due
to their failure of leadership. We removed the medical
center director in Shreveport, Louisiana,
and three other senior executives for misconduct
or poor performance. And the President signed
an executive order that created an Office of
Accountability and Whistleblower Protection
that reports directly to me as Secretary. But that isn’t enough. We need new accountability
legislation and we need that now. The House, again, has
passed this and we’re looking forward to the
Senate considering this. But we need that
type of action. Staffing — currently it
takes, on average, 110 days to onboard a nurse in
the VA, and 177 days to onboard a nurse
practitioner. That’s just too long. VA doesn’t have a position
management system, so it’s very difficult for us to
track what jobs are open. And an organization our
size needs that in order to meet the needs of our
veterans and have the right resources for them. We’re going to establish
a fully functioning management manpower office
by December of this year, which is a first step in a
position management system to be established. Low salaries for many of
our healthcare providers and prosthetic
professionals make it difficult to recruit and
retain the best professionals. In 2016, the mean salary
for a biomedical engineer in the country is $85,620. The national average for
biomedical engineers in the VA is $65,677, or 25
percent below the private sector. For mechanical engineers,
the difference between private sector and VA is
$15,000 a year, or 18 percent, where VA is below
the national average. If we can’t compete with
private sector salaries, we’re going to be unable
to retain qualified providers and
support staff. To help with these
shortages, we’re pursuing legislation that would
expand graduate medical education training
opportunities to be able to train more health
professionals to stay in the VA system. And we’re working with
the unified services university — the medical
school of the military — to train more medical
students who then would serve in the VA for
10 years after their education. Bureaucracy. Our central office in VA
has grown too big and is too bureaucratic. We need faster, clearer
decision-making and authority that’s going to
give veterans more control of their services
and care. I’ve directed the VA
Central Office to remain under a hiring freeze as
we consolidate program offices. We have 140
program offices. I’ve directed them to
implement shared services so that they don’t replicate
common corporate services. And that is a result that
I plan to achieve of a 10 percent reduction
in overhead. In addition, we’ve been
reducing burdensome regulations to make
VA more effective. Effective immediately, VA
will stop requiring the use of small-house design
guides for future state home grants. In other words, we’re going
to stop using federal rules. We’re going to allow the
states to use their own requirements to build
veterans homes in the future in the states. That’s going to save
taxpayer dollars while increasing access
to veterans. A few weeks ago, we
announced the VA is removing the more
restrictive guidelines for a mammography for women
and instead adopting the American Cancer Society
mammography guidelines that will allow women
veterans more access to care. We’re restructuring our
caregiver regulations to get services to veterans
and make it less burdensome to get
help from caregivers. Our website is
making it possible for veterans to get better
access to our services. At this time last year,
only 10 percent of benefits applications
were done online. And because of our website consolidating this, we
now have eight times that number online
a year later. Over 200,000 veterans
have applied for health benefits using VA will be soft-launching
the White House Veterans Complaint Hotline
tomorrow, on June 1st. This is something the
President had talked about. We’re going to be testing
that system, starting tomorrow, and fine-tuning
it over the next several months, with the goal of
it being fully operational by August 15th. The soft launch of this,
which is being worked out tomorrow, will be active
— the phone number is (855)948-2311 — and the
full launch of that, as I said, will be August 15th. Fraud, waste, and abuse. Detecting fraud, waste,
and abuse — it’s very important we get resources
to veterans and their families. We’ve been identifying
preventing fraud, waste, and abuse. Already we’ve been able
to prevent $27 million in fraudulent payments and
duplicate payments in fiscal year 2016. However, with centralized
oversight, I know we can do much more than that. That’s why I stood up the
Fraud, Waste, and Abuse Initiative. I recently announced a
Fraud, Waste, and Abuse Prevention and Advisory
Committee and we’re creating that committee
— it’s actually ahead of schedule. We’re going to be
naming co-chairs. I can name today one
of those co-chairs — Shantanu Agrawal, who is
the president and CEO of the National Quality
Foundation, with a heavy background in fraud,
waste, and abuse. We’ll be naming the second
co-chair very soon. Veteran Suicides. And this is the last
of the assessments. Though all of the risks
that I’ve talked about are troubling to me and
require immediate attention, nothing is
more important to me than making sure that we don’t
lose any veterans to suicide. As you know, 20 veterans a
day are dying by suicide. That should be
unacceptable to all of us. This is a national public
health crisis, and it requires solutions that
not only VA will work on but all of government and
other partnerships in the private sector,
nonprofit organizations. I authorized emergency
mental health services for those that were less than
honorably discharged just a few months ago. That is a population of veterans
that is at very high risk for suicide. And that’s just
the beginning. This summer, we’re going
to launch a new initiative called Getting to Zero
to help us end veteran suicide. And again, that’s my
top clinical priority. So, in closing, I just
wanted to reaffirm the President’s strong
commitment to fixing VA and making VA work
better for veterans. That’s a commitment
that I share. I wanted to come out and
to talk about these 13 areas, our assessment of
where the problems are. I want to be held
accountable to fix this. I’m going to need help to
fix it from Congress and from other organizations. But this is our commitment
to finally address these problems that have been
plaguing VA, sometimes for decades. The President, the Vice
President, Congress, veteran services
organizations all share this goal to help
modernize the VA. And that’s why I’m
confident that we can turn VA into the type of
organization that veterans and families deserve, and
all of us want to see. I appreciate
your attention. Thank you very much. The Press: Mr. Secretary,
you spoke of the situation in Puerto Rico, and
there’s a similar situation unfolding with
the VA in Phoenix as well. Does this new legislation
you talked about, does it get rid of this Merit
Systems Protection Board? And will it eliminate the
possibility that somebody like DeWayne Hamlin can
get their job back at least temporarily? Secretary Shulkin: When we
talk about the situation related to Mr. Hamlin,
that decision was made before I was Secretary. I would not have supported
a decision that would have allowed him back. The Merit System
Protection Board indicated that they believed that we
needed to take him back. I would have fought that
through all of the appeals processes that were
available to us. The accountability bill
that we are seeking, that we hope that the Senate
authorizes, still maintains a due process
for employees — something I believe in. But it shortens the
time and it gives more authority to the
Secretary’s decision on why these accountability
actions are being taken so that the courts would be
more deferential — that’s the legal term — to the
Secretary’s opinion. I do believe that would
have changed this situation. The Press: Will you get
anything in time to prevent a similar
occurrence in Phoenix? Secretary Shulkin:
Not until we get this accountability bill
through the Senate. The Press: Is there
anything you can do about that situation? Secretary Shulkin: You’re
talking about with the veteran benefit employees
with Sharon Helman? The Press: Yes. Secretary Shulkin: We are
following the court cases on that. We’re waiting for that
final decision to come out. The Press: Mr. Secretary — Secretary Shulkin: Yes. The Press: Thank you. This is a robust agenda
that you have laid out. Do you have a
specific timeline? And how engaged has the
President been in some of the discussions? Secretary Shulkin: The
President has been extremely engaged. His commitment to being
involved in veteran issues is one of his top
domestic priorities. He has made himself fully
available — both he and the Vice President — to
anything that we need. The White House has been
extremely responsive, and they are impatient and
anxious for us to get on with this. So each of these issues
that I’ve talked about, these 13 issues, have
different timelines associated with them
because some require legislative action
and some are more administrator requirements. The President’s budget
this year, as you know, gave strong support to VA. And that will allow us to
accomplish a great deal of what’s on this list to
modernize the system. The Press: And as you
know, the administration has been dealing with
some controversies. Has that, in any way,
impacted your agenda — your ability to carry
out some of these goals? Secretary Shulkin:
Absolutely it has not. We are completely focused
on what it’s going to take to fix the VA, and there
has not been any lack of responsiveness from the
White House on any of these issues. The Press: Mr. Secretary,
when we look at your list — long list of
priorities, do you have a sense of sort of top
to bottom of these? What’s the most
cost-intensive and how much is it really going
to take in terms of money over 10 years to get
you down this road? Secretary Shulkin: The
budget that was proposed by the President for
fiscal ’18 is a budget that will help us
accomplish this task. I have said that the
problems in VA are not largely going to be solved
through additional money. These are going to be
solved through management practices, focus, and
some legislation changes. But our issues are not
because we’re lacking the financial resources to be
able to accomplish our mission. And so, therefore, I
do believe, with the exception of one area,
that we will not be coming back to Congress or the
administration to ask them for additional money. And that one exception
is to modernize our IT systems. I’ve said that I will make
an announcement as soon as I can before July 1st. That is either going to
look towards outsourcing our current system to
a commercial vendor or picking a system that is a
commercial, off-the-shelf system, and to get VA out
of the software business. And that will require an
initial capital investment that’s not in
fiscal year budget. The Press: Is this the
most expensive thing that you have to do? Secretary Shulkin: Yes. The Press: And
facilities after that? Secretary Shulkin:
Facilities are important. What I’m looking to do in
this National Realignment Strategy is to make sure
that we’re using our current resources
most effectively. That’s why when I’m
spending money on vacant and underutilized
buildings that aren’t helping veterans, I want
to realign that to help invest back into our
facilities that need for capital repairs. The Press: Mr. Secretary,
leaders of the American Legion wrote a rather
impassioned op-ed last week that suggested that a
promising solution to the suicide problem could be
increased medical use of cannabis. You talked about it being
a national health crisis that requires all
of government. Should the Congress
reclassify marijuana from a Schedule I drug to allow
for it to be better used for medical purposes? Secretary Shulkin: Well,
right now, federal law does not prevent us at
VA to look at that as an option for veterans. I believe that everything
that could help veterans should be debated by
Congress and by medical experts, and we will
implement that law. So if there is compelling
evidence that this is helpful, I hope that
people take a look at that and come up with the right
decision, and then we will implement that. The Press: As a physician,
what’s your opinion? Secretary Shulkin: My
opinion is, is that some of the states that have
put in appropriate controls, there may be
some evidence that this is beginning to be helpful. And we’re interested
in looking at that and learning from that. But until the time that
federal law changes, we are not able to be able
to prescribe medical marijuana for conditions
that may be helpful. The Press: Your department
has issued multiple reports saying climate
change threatens the health of veterans and
your staff, and it strains the VA’s abilities to
carry out its mission, and raises the chance of both
healthcare emergencies and vector-borne diseases. So I guess, in the spirit
of the candid assessment that you said you were
doing today, do you continue to see climate
change as a dire threat to your mission? And if so, are you
disappointed that the President is reportedly
pulling out of the Paris climate agreement, or
at least reducing U.S. climate targets? Secretary Shulkin: As the
Secretary of Veteran Affairs, I’m focused on
those environmental issues that impact veterans, and
our studies are focused on usually the chemical and
the environmental impacts that are used on
the battlefield. Those are the ones that I
continue to be focused on. And beyond that, it really
is beyond my scope as Secretary. The Press: You don’t
believe — or you’re sort of repudiating the
multiple reports that have come out of your
department that say climate change in the
broader sense — things like cardiovascular
disease — is a real kind of issue for
your department. That’s not something that
you’re even considering at this point? Secretary Shulkin: Look, I
am focused on the health of our veterans. And, clearly, there’s
a relationship between health and the
environment. What I’m not focused on
is the bigger political issues about United States
policy on other types of reform. I’m focused on the
health of veterans. The Press: You said it’s
going to take $18 billion to repair these
facilities. Do you have plans to
close any of them? Secretary Shulkin: What
we’re doing is, under the National Realignment
Strategy, we’re looking at the best use of our
current resources, because $18 billion is not a
realistic number for us to be able to get to invest
and put all of our facilities up to speed. So we’re looking at using
the current resources that we have, the best
to help veterans. We are making investments. This budget this year
gives us additional dollars. That’s why I’m confident
that this is the right budget for us, because it
allows us to invest and start making significant
progress into that $18 billion. But I don’t believe —
that was our assessment of what the entire inventory,
if we rebuild it up to current standards,
would take. That’s not what
we’re seeking. The Press: So when you
walk away from this, you think that maybe some
should be closed? Secretary Shulkin: We want
to take a look at every facility to make sure it’s
being utilized appropriately. I do not have specific
plans for ay facility closures at this point. The Press: Mr. Secretary,
what is the holdup in filling out your
nominations to the Senate? And do you believe that
the lack of nominations has impacted in any way
the work that you’re trying to do and
described here today? Secretary Shulkin: Well,
one of the things that I’m very fortunate, having
been here in the last administration, is that we’ve
had pretty good continuity. And the people that
are filling our acting positions are people that
I’ve worked with, have great confidence
and trust in. So we haven’t really
missed a beat at VA. We’ve been able
to keep going. Of course, I want all of
our positions filled as quickly as possible. The vetting process that’s
going on is a lengthy process — I know having
gone through it myself — but it’s also really
important to get right. And so while we want to
see it done as quickly as possible, we want to see
it done thoroughly and make sure that we
don’t make mistakes. I do believe that you
will see several other announcements in the
next week or two about positions that we
will be filling. The Press: Mr. Secretary,
two questions. You said the President’s
budget strengthens VA. Two specific questions
about the budget. When it comes
to individual un-employability, IU is
drastically cut in the President’s budget, and
it’s likely never to be made up by compensating
Social Security. Why do you believe that
that’s acceptable and in line with the
administration’s promise to do better by veterans? Secretary Shulkin: Well,
let’s put it — let’s take a look at this
overall budget. This is a 5.5 percent
increase in total budget for veterans. And when it comes
mandatory funding, which is where the IU exists,
we’re seeing a $7 billion increase year-to-year in
mandatory benefits to veterans. So this is a budget that
is providing more care and services to veterans. In doing so, we have
a responsibility to taxpayers and to veterans
to make sure that the resources of our current
programs are being utilized appropriately. So we are going back and
looking at programs and saying, are those
resources — could they be reallocated in different
ways not to withdraw total dollars from veterans, but
could they be revised and reallocated to work
better for veterans? In the case of IU, I think
that what we’ve proposed is not an elimination of
it, but a revision to make the program and resources
that are going currently to some veterans, to help
additional veterans. I understand that there is
a lot of passion on this, and we will have plenty of
time to work with Congress and with our veteran
service organizations to make sure that we’re
getting this right. The Press: I want to ask
you one other question about the budget, but just
to follow up on that, a lot of VSOs consider this
stealing from them, to be changing so fundamentally
the way IU is calculated. What’s your
response to that? Secretary Shulkin: I have
such great admiration and respect for VSOs, and I
understand their passion and I share their
commitment that it is so important that this
country honor its responsibility
to our veterans. That doesn’t mean that you
don’t go back and revisit programs that have been
around for a long time and figure out different ways
to use those resources, as long as they’re directed
to helping veterans and more veterans. Now, I understand there’s
not always going to be agreement. This is Washington, and
we’re always going to get passion over
important topics. And I welcome comments
from our veteran service organizations about how
to do things better. And I know that since we
share the same goal of helping veterans, that
we’ll get to the right answer. The Press: Let me ask you one
other thing, which is about — the budget from
the President focuses on providing care and
purchasing care, less so on infrastructure. You talked a lot about
infrastructure, but you know what I’m talking
about in terms of the VHA and where dollars
tend to go. Are you concerned about
the long-term viability and the potential
preference for privatization or focus on
the Choice Program that’s outlined in the outlays
for this President’s budget? Secretary Shulkin: What I
think the wait time showed us is that VA can’t
do this alone. We have to work with
the private sector. Currently right now, about
one-third of all veterans are getting care
outside of VA. I’m looking to build an
integrated system of the very best of VA and to
strengthen VA and the best of the private sector to
make one system work for veterans. That’s going to be our
new Choice legislation. This is not a
privatization of VA. This is not diluting
the impact of VA. Every day I’m in this
job I am more and more convinced that veterans
and America need a strong VA. It’s essential for
national security. It’s essential to
honor our commitment. I will not allow our
policies to weaken the VA; our policies will
strengthen the VA. But working with the
private sector is the way to do that. The Press: And you don’t
have any concerns about where these
dollars are going? Secretary Shulkin:
What’s that? The Press: You don’t have
any concerns about the long-term effects of where
these dollars are going? Secretary Shulkin: Well,
of course, I have concerns. I look at this every day. But I do believe the
budget and our legislative proposals that we’re going
to work with Congress on on Choice will come up
with the best balance between private
sector and the VA. The Press: You said the
majority of veteran suicides are people who
aren’t under VA care. Why is that? And what is being done to
reach out to those vets? Secretary Shulkin: So of
the 20 veterans a day that are taking their life
through suicide, six are getting their care in the
VA system and 14 aren’t. The reason why those 14
aren’t getting care is really, really important
and a big focus of our research and
understanding. Some of them were other
than honorably discharged. That means that, as you
know, 10 to 15 percent of active service members who
leave the service leave with an
other-than-honorable discharge that leaves
them without benefits. That’s why I made the
decision to offer those veterans emergency
mental health services. Secondly, homeless
veterans — very high risk for suicide, not likely
to have good access to behavioral healthcare. We are — this budget that
the President put forth, additional $600 million
for a total of $1.7 billion to help get
veterans off the street, get them into homes, and
get them the services that they need. Third, the conditions themselves
— depression and traumatic stress — tend to isolate people. They tend to withdraw
because of their condition. And those are the ones
that we worry about the most about, which is
why we say suicide is everybody’s responsibility
— family members, community members. When you see people
withdrawing, that is the time to reach out
and get them help. The veterans crisis line,
which we’ve just staffed up — now answering 99
percent of its calls; 1 percent now only going
into rollover; 95 percent answered in 20 seconds —
is there 24 hours a day if you find a veteran
who is at risk. And finally, let me just
say that this issue will continue to be our top
priority until we figure out all the answers how to
get each of those veterans help. The Press: Thank you. You mentioned that you
identified 14 facilities that were providing lower
care — or lower standard of care than nearby
private sector hospitals. Are those hospitals —
can you identify them? Secretary Shulkin: Yes,
yes, they’re on our website — the 14
one-star facilities. I think you’ve even
published an article about this. And so those are the 14
that we’re talking about. When you’re a one-star
facility, it means that you’re not only the lowest
in the VA compared to other VA hospitals,
but you also are below community standard. And that’s why those are
the important ones to focus on. And in our Choice Program,
you will see, as we go out there, we’re going to be
making sure that veterans have Choice in particular,
where the standard of care is not being met in
the private sector. The Press: Does that mean
that they’ve not been accredited? If they’re one-star
and they’re below the community standard of
care, does that mean they would not be accredited? Secretary Shulkin: No,
all of our hospitals are accredited by the same
national organizations that private
sectors go through. When you talk about below
standards, we’re talking about averages. And so by definition,
there’s always going to be those that are below. VA has set a bar that
is above average, that essentially we want all
VA hospitals, because we believe all veterans
deserve the very best care possible. So it’s not a
minimal standard. All of our hospitals
are accredited. Thank you very
much, everybody. Male Speaker: If you didn’t get
a copy of the packet distributed before the breifing,
it’s available at lower press as well as on our website. Thanks, everyone.

100 thoughts on “Briefing with Secretary of Veterans Affairs David Shulkin

  1. Stick to Topic… MSM idiots we watch What you do, say and How You Act! Impressed with ur Strong Government Not Fake reporters…

  2. You can't meet ever medical issue in mental health with drugs. It has to be a complete program. Peer to peer, doctors and pills.
    Climate change has nothing to do with any VA issue.

  3. DID THAT GUY JUST ASK ABOUT CLIMATE CHANGE????????????Haaaaaaaaaaaaaa ha ha ha ha ha ha haaaaaaaaaaaaaaaaaaa

  4. Is it me, or does common sense mandate SELLING the empty properties? Hmm, isn't there SOMEONE in DC who's in real estate that could make that happen and liquidate assets to gain some capital for the VA? Duh!

  5. I was very Ill for years long after Gulf War 1. I tried to get help. I got pissed on. I was told that no record of war service was found. I am so happy that I am still alive. I have PSTD amoungst other. My poor wife has deylt with me for all these years. Even the Army Doctor I was seeing said that my Congressman has nothing to say; or I can leave now. This system is so screwed!!!! The Germans took better care of me than my own Country!!!!

  6. Part of a Veterans overall "health" is compensation for duty related disabilities. Taking 2 years or more providing them their due compensation is killing them financially! When you have 3 civilian Dr.'s providing "proof" of a disability, that should be a simple, easy, fast claim process. But the VA takes FOREVER and even though back pay is given, the damage has already been done. Stop the feet dragging of the VA and stop credit companies from feeding off Veterans in this scenario! On that note, a Disabled person and/or Veteran should not be punished for having to file bankruptcy for 7-10 years because the VA or SSDI dragged their feet. Veterans and the disabled NEED HELP in this area now!

  7. Why do I have to wait three months to be seen ??? How come I have to jump many many hoops to be seen by you guys ??? Your full of shit and you talk just like them traitors to us veterans !! WHILE EVERYDAY SOME THREE VETERANS COMMIT SUICIDE YOU SIT UP THERE AND TELL US WERE BEING HELPED ???????????????????????????????????

  8. Did this guy just say they have over a hundred abandon, and underutilized buildings but need money for more buildings….? Um did he proof read his little speech here? I'm not hating just saying….

  9. shame on Stan Johnson past director ! shame on Jeff Gering past director ! shame on Robert Smith present director of the San Diego VA Hospital !

  10. oh did I mention ! the San Diego VA hospital in La Jolla California has a b-minus rating !!! Shame ! Shame ! Shame !

  11. Ok – how can anyone "thumbs down" this when it's helping our Veterans?? Much less 16 of them! A pox upon you!! No wonder the VA is such a mess after the last 8 yrs and thank God (and the forgotten working and retired working class) that we now have an amazing President that cares about people – and especially our heroes! MAGA President Trump!

  12. Boy, oh boy, the democrats have really dropped the ball with regard to our veterans. They've been in office for eight years under Obama and he must never have tackled the problem with the VA. Doesn't metter when it all started, but the fact that the VA has outdated equipment, computer systems and operational methods that are archaic. Any of our past presidents should have attended to our veterans needs through the VA. That's shameful for a country to neglect veterans and their care so shamelessly.

  13. where is the hospitality or the compassion or the empathy their need to be more nurses not clerks or janitors or building mantenece people but people to talk to u this is a place where love has something to do with it and a representation on the people being cared for cause in san francisco the patience is mostly black and white but the care givers is mostly asian

  14. Will never satisfy all Veterans. There are plenty who spent 4 years behind a desk or at a mess-grill in Kansas but expect to never have to work again and get four free Percocet a day for perpetuity because their back gets sore if they have to work a job (whose doesn't). I've seen it on a regular basis when at the VA for appointments. A guy missing his leg below the knee from an IED, has a job, comes to VA for PTSD and prosthetics, maybe a new cane; 50% SC disabled but works. Beside him a guy 100% disabled thanks to Unemployabilty for sinus infections, allergies, a finger he broke playing basketball on a base intramural team, knee pain from the same basketball playing, PTSD from a DI yelling at him, etc, etc. Can't work seated from back discomfort, can't work standing due to knee discomfort, only happy at home buzzed on beer and a pain pill, collecting enough disability to pay his bills. I knew a guy, 100% service-connected, unemployable because in Basic he threw a punch at a DI who ducked and blocked the punch, the block caused the guy to fall and he broke his hand. Between PTSD and chronic hand pain, making really good friends with some VSOs, and constant complaining to his Congressman in about 6 years he got his Other Than Honorable Discharge changed to a General Under Honorable Conditions, appealed his rejected disability claim repeatedly until it was enough for Unemployability 100% and then basically retired. Oh, after him and his brother hand built him a home on the family farm. Lucky for him the old VSO had a service buddy who became a Congressman. His brother drives him in to pick-up his pain and PTSD meds monthly, and gets gas and lunch money from VA since he "can't drive"; except apparently to the bars.

  15. Thank you, sir. There was a surplus from taxes this year, just use some of that. Congress seems to be the problem with a lot of the initatives. We the voters will try to fix that in next year's midterms.

  16. I hope this is a sign that press briefings are going to be far more specific, so these rabble can't keep raising bullshit Russia questions every single day

  17. I watched this briefing TWICE!
    I could help but notice the very first questions afterwards
    by the Fake News media… they are pathetic bottom feeders.
    Notice just how many questions were about Veteran's… as opposed
    to protecting failed past legacies and appointee's or empty VA
    property….The MSM disgust me as much as failed comedian
    Kathy Griffin ….Then some hack brings up global warming BS….
    GTFO of here ….media. You are obsolete.

  18. Three noteworthy things here are how empty the press room is, how these journalists asked questions, & how little coverage this will get on a slow news day.


  20. The VA spent 6.8 billion dollars for civilian contractors to perform compensation exams.  veterans now have to travel up 100 miles for an examination when a medical center is only 2 miles away.  great way to spend taxpayers money.

  21. Climate Change ?

    Get fucked, not a direct – direct focus by Dr. Shulkin, you are trying to backdoor a question you should address directly to the president you piece of shit!

  22. C&P Clinics are more concerned about the average days pending for getting an exam scheduled (under 30 days) than taking care of the veteran.  they would rather cancel a request and make the veteran travel 100 miles and get an appointment at day 29 instead of scheduling an appointment for day 32 at their facility..  this is how some clinics are taking care of our veterans.

  23. that fat reporter said that climate change is harming our veterans!!?? where did he get that horseshit??

  24. Disabled USMC vet (served 7 yrs, '72-'79, honorable, S/Sgt.) sand when I came down to NM (Las Cruces) from MN (Mpls. Regional VA Hosp.) I could not get in to see or even get a PCP assigned for over 9 months. In less than 4 years, I filed over 9 complaints with the Patient Advocate to "FIRE" Primary Care Providers (sorry about earlier using PCP) for not providing even the basic primary health care.

    Get the needed laws changed so poor performing doctors, attendants, MSA's and other supportive (NOT) employees discharged!

    Put in your WH Vets hotline. Mail and email out messages to every vet so they know about it.

    Personally, I have talked with other disabled vets, even those back from Afganistan with only one leg who have been fighting the Disability Compensation ratings board for over 3 years.

    Using Choice 30, Choice 40 and Tri-Care all have different rules and they can NOT talk to each other. It takes about 30 days to get proper outside care with all the red tape and no accountability by any one, speaking from experience over the past 3 years. Vets must be informed, with written instructions in plain english, how to proceed thru this nightmare!

  25. Dems need to cooperate with the Reps to help the VA by voting for Trump's budget. If they obstruct this, they are guaranteed to be unemployed after the next election.

    I find these guest speakers at press briefings so helpful, don't you? Now I know more about the VA than the presstitutes who didn't bother showing up.


  27. A very good secretary, doing a good job, and making good decisions. Terrible that the government of the United States has gone downhill and has worse computers than the business world, as well as ability to get things done. We know as citizens, all the government agencies we have to go to are slow, inefficient, make too many mistakes, have brochures for every language but English available, and are falling apart. Who is running these offices? Dumbocrats? Third world country H-1 b visa employees?
    Hope This administration improves as much as possible!!!

  28. Oh, listening further, Im glad to hear they removed some of these people, and said they want accountability legislation. This administration is on the ball and knows what is going on and is working on fixing things. Since the 60's and prior, these things have been a problem, and no one has done anything. Why hasnt the media been complaining about the government offices prior to this administration?
    Oh, yeah, Dumbocrats!

  29. Please train United States citizens for the medical. Many hospitals had brought many nurses from Philippines and Mexico here in the 90's, when many of us United States women and men wanted to be trained.

  30. California senators, democrats are sending out false information that this administration is taking all the caregiver things away, and for disabled. They are trying to rally, the dumbocrats who cant read, to believe them and vote for them next elections.

  31. Thank goodness they are finding all these fraudulent charges!!! There are so many throughout!!! Ever seen California's streets? Where did the funds go for transportations improvement?
    Fraud is rampant across the government agencies and non profits companies.

  32. Thanks for the assessments, and working on improvements, that is terrible that VA has the worst treatment, pay, medical. For some reason employees with government, turn people away and are blindly running , blind rules, and do not want to change. Yeah for trump being able to get things done and improve things. Government in U.S, as rich as they are do not need to be worse than the private sector.

  33. That newscastor wondering how the president has been engaged….Did she watch his campaigns? his speaches? his meetings with organizations and pushing forward with this, and cant she think to give him credit? oh no, i forgot, she is a dumbocrat

  34. Thank goodness, he said they need to improve management!!! He is aware and smart enough to see and know how the government offices are not run well. Dinosaur systems and employee zombies. Get new people in their that are doers, and actually care about the people and country and do their job. Sometimes you wonder if the employees even know how to read the computers and know their job.

  35. Guy is a lying sack of shit. I have been going to the VA for fifteen years.
    There is NO PROGRESS. Things have gotten worse. The VA has been padding their appointments. They won't be late so they won't even schedule you until they have an opening.
    Its taken six months to get a MRI for my back. No pain meds. I'm fed up.
    Try one week to get a doctor to call me back. I had to get my own wheelchair and walker.
    I'm still fucking waiting.

  36. Were the missing labor abuse activists that were abducted at Ivanka's shoe factory murdered? Do you have a China Back Channel or do they have your cell phone number or uh, will you have to use the CIA for…oh yeah Israel, nm. So, if murder isn't now the Trump Brand like Putin does then were those guys Human Trafficked from your factory?

  37. Please don't cut VA DIS to those who are going to hit SSI age…this would result in a cut of $500.00 per month, which would leave me homeless.

  38. As a veteran and the mother of 2 veterans, I pray that you, sir, get all the help you need to complete your mission. God speed.

  39. Draw me a line, please, between 'climate change', and cardiovascular disease. More people die of cold than heat – by a factor of 20.

  40. Whonare your veteransnwas it vitamin iraqu allthe working class that can't afford health care and get turned away from hospital but your president donald has planes mansions boats golf courses resorts but carnt afford to go to healthe care and You shot a king and brake countries why

  41. Is above your pay level or ist it Russia or marines but we have mupti million dollor subs and to bring in the private companyn like the pion or the jet boat in Vietnam

  42. How about starting with a Veterans Administration that accepts guys that were injured working for the department of defense and TO DATE I still am being denied by the VA. They are all full of BULLSHIT! American Lake VA in Washington state is still killing VETERANS! This guy is another LIAR!

  43. Thank you , President Trump ! Perhaps the high rate of Veteran's suicides could be studied in depth, like finding out what they are feeling, what most is bothering or plaguing them, are they realizing that most of the US wars are perpetrated only to make a few rich persons richer???? Are they being totally de-humanized in their terms of service?? Are they being purposely paced on uppers, downers, and a whole raft of drugs??? What the hell is really going on with these suicides ??? Let's find out !! As a psychotherapist, I know that really truly connecting with a person who is feeling totally hopeless and understanding their hopelessness is key. Perhaps, many dealing with Veterans do not have really understanding their thoughts and emotions and feelings of hopeless IS NOT a goal . . . .maybe if working in the government, their paycheck is their motive. I know a ton of really poor or lowly psychiatrist, Psychologists and psychotherapists. Period !

  44. Why not just SHUT DOWN Veteran's Affairs and simply give them vouchers to use the private system? President Trunp should agree with this. That would save a ton of money and give them better care! We can't afford government programs. Government is a big fat DRAIN on the country.

  45. This guy (Secretary) seems to be involved in doing an incredibly great job.. but.. when you talk about destruction don't you know that you can count me out boom boom boom.. and why must we continue the lie of twenty a day when everyone knows with absolute certainty it's closer to one thousand?

  46. Very unfair to remove compensation for 62 year old Vietnam aged vets with service connected injuries and illness haven't been employability for forty years…you will make many of us homeless…and suicidal….think again..this is fubar..why should we be cast aside???

  47. I like this…President Trump should think about having the various heads of his agencies doing these press briefings and have Mr. Spicer et al do maybe once a week or so.

    The Press definitely focuses on the negatives with President Trump, but it's nice hearing the good things he's doing. Even Mick Mulvaney sounds like he knows what he's doing (even though when he says "tax payer" we all know he means the 1%).

    I hope to see more of this…this is good for the President. I don't "like" the President, but I do support him and hope he succeeds.

  48. It's just so nice to have the "politics" out of "governance". Well done Dr. Shulkin. Keep it up!!!

    Thank you,

  49. I was told in January that my claim should be decided in about 210 days and its at D.C. level so yae im part of the 90,000 claims nice to know that i could still take 2yrs


  51. Today I took my 98 years old father a veteran of WWII and a member of the 754th Field Artillery in France, Belgium, Holland, and Germany 1944-1945 to the VA emergency room. His blood pressure was 220/100. After checking in we sat down and waited 4 hours. My Dad was tired, hungry, and irritable after 4 hours. Hell he's 98! I approached the nurses station and asked how much longer it would be. He replied "there are five others a head of him and we take patients based on how sick they are not when they arrived".

    I told him that my Dad was a member of the " Greatest Generation" and that he deserved the greatest health care not what he had to offer. I told him he could take my Dad off the list. That SOB didn't have one word to say. No, sorry for the wait, No sorry for wasting your time, No, I hope your Dad feels better. He just continued typing as we walked away.

  52. I can say this, with the extraordinary lame approach to disability ratings, especially exposure to toxins used in performance of a vets duty we have depended on the IU option. I used a variety of spray chemicals performing corrosion control. Diminished lung capacity. Rating….I get an inhaler, which comes with its own issues. No rating for lung damage. I was exposed to agent orange in Vietnam during 2 tours. Coronary artery disease. Quadruple bypass plus stents. Was aboard ship when the flight deck exploded killing hundreds. We had to pick up the charred remains and bag them after doing the best to match severed limbs. I have some PTSD from that. My total disability is 90%. With 10% IU I receive payment at 100%. Eliminating the IU will amount to about 40% decrease in monthly income. Unsustainable. If the government would be less generous with the funds given to the immigrants and refugees, who receive more per month than a 100% vet, then maybe we could keep IU. I gave 5 years, and now I receive less than the people flying over here and getting the golden goose. Never put 1 red cent into SS but are getting full disability and can claim up to 4 wives and all their kids. I don't understand how I wind up with a less than normal life. Took me 14 years to reach 90%. I worked odd jobs here and there along the path but a plane ride over here and bam…..double what vets receive for giving their youth through draft and here we get it up the ass again. Suicide….very likely, the IU cut would leave me without enough to pay basic bills and modest food. I can't recall the last time I dine out. I guess this is the plan. Cut IU and after thousand commit suicide, some mumbled apology after thousands are gone that perhaps that wasn't a good idea. Mr Secretary……you try to cut it on $1900.00. That's for everything. Somali 5-7k with all the perks. Food, housing monthly allotment. Enjoy your sudden windfall. Why not just invite us to a Jim Jones juice party at a VA picnic???

  53. I'm a veteran.  This guy is just another liar.  I don't agree with cutting Veteran's disability.  I don't think veteran's get enough as it is.  A couple ofyears ago I did a disability exam for a WWII veteran that was going through his 5th exam for the same issue and hadn't been awarded.  I spent hours on my own time reviewing his record to find the "chit".  I found it.  Guess what he finally started receiving disability for that.  He sent me a thank you letter, but I don't do disability exams for the VA anymore….they don't want people who will spend the extra time it takes to comb the medical records to the help the veteran.  They only want people who will do the bare minimum.  That includes most of their employees.

  54. What is a jew doing heading the VA when not a single jew had died in the middle east. He's also worth 19 billion. Just went to Europe on vacation at tax payers expense. Sickning. VA problem is employees don't give a fuck

  55. David Jonathon Shulkin (born July 22, 1959) is the United States Secretary of Veterans Affairs.

    He was nominated by President Donald Trump and unanimously confirmed by the Senate on February 13, 2017.

    Prior to becoming the VA Secretary, Shulkin served as the Under Secretary of Veterans Affairs for Health of the United States Department of Veterans Affairs from 2015 until 2017 in the Obama administration.

  56. Washington and This man make the policies within V.A. There are 8 PRIORITY GROUPS within V.A. NOT all vets are treated the same. Some vets get every medicine and care while others don't. Thats the problem. But you won't hear him discuss this fact or how to change it, the rest is Blah blah blah lies and excuses. Some VETS are charged for care, while others get a free ride.

  57. I got a choice card, they sent me 75 miles away. Because V.A. won't pay doctors on time within 20 miles from me. VA is the problem, they make doctors wait for their money and they WAIT WAIT WAIT. Try dealing with V.A. Albuquerque Nm. Its a horror show.

  58. The same day service he speaks of is just that, they see you then have to refer you to someone 2 1/2 hours away, then they take months to schedule you. Bullshit, more bullshit.

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