Archives for August 2014

Secretary McDonald Announces the Start of a National Recruitment Effort to Bring Needed Medical Professionals to VA

Secretary McDonald Announces the Start of a National Recruitment Effort to Bring Needed Medical Professionals to VA

August 29, 2014

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August 29, 2014                         

Secretary McDonald Announces the Start of a National Recruitment Effort to Bring Needed Medical Professionals to VA
Recruitment of Additional Medical Providers Will Increase Access to Care

WASHINGTON – Speaking to a crowd of medical students, residents and faculty at Duke University’s School of Medicine, Secretary of Veterans Affairs Robert A. McDonald today launched a recruiting initiative aimed at bringing the best and brightest health professionals to the Department of Veterans Affairs (VA) which will ultimately expand access to care for Veterans.

“At VA, we have the most inspiring mission and the greatest clients of any healthcare system in the world. That’s exactly the message I’m going to share as I speak with health care professionals and students about the value of serving at VA,” said Secretary McDonald. “We have taken action to get Veterans off of wait lists and into clinics in the short-term, but in the long-term, in order to provide timely access to care, we need to build capacity by hiring more clinicians. We need the best doctors and nurses serving Veterans, and that is why I will be out recruiting, leveraging the existing relationships and affiliations VA has with many academic institutions, and talking directly to medical professionals about joining us to fulfill our exceptional mission of caring for those who ‘shall have borne the battle.’”

 VA is taking multiple steps to expand capacity at our facilities, to provide Veterans the timely care they have earned and deserve.  In addition to Secretary McDonald’s direct messages to clinicians and clinicians-in-training, these steps include:

  • Collaborating on a new nursing academic partnership (VA Nursing Academic Partnerships or VANAP) focused on psychiatric and mental health care to build stronger, mutually beneficial relationships between nursing schools and VA facilities.

  • Partnering with the Department of Defense Health Affairs, Army, Navy, and Air Force to improve recruitment of recently or soon to be discharged health care professionals. VHA is already taking advantage of known separations of military health care workers.

  • Expanding of a pilot program to bring combat medics and corpsmen in to VA facilities as clinicians

  • Improving the credentialing process for VA and DoD health care providers which will involve sharing credentials to speed up the process.

  • Expanding of the loan repayment program, as included in the recently passed Veterans Access, Choice and Accountability Act

  • Considering options to revise pay tables to offer more competitive salaries for VA providers, in comparison to their academic and private practice colleagues. 

 These actions build on existing recruitment tools, including partnerships between local facilities and academic institutions, loan repayment programs, and scholarship programs.

 “In order to recruit and retain the highest quality medical professionals, VA needs to be competitive with other healthcare systems, and ultimately that is how we provide the best care to our Veteran patients,” said Interim Under Secretary for Health Carolyn M. Clancy.

 To learn more about how to work in VA health care and serve our Nation’s Veterans, please visit:

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VA Releases New Version of the GI Bill® Comparison Tool

VA Releases New Version of the GI Bill® Comparison Tool

August 28, 2014

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Online Resource Provides Student Veterans with Key Education and Benefits Information

WASHINGTON, D.C. – The Department of Veterans Affairs (VA) today launched an improved version of the GI Bill® Comparison Tool, which was first launched in February 2014.  The GI Bill Comparison Tool is designed to make it easier for Veterans, Servicemembers, and dependents to estimate their GI Bill education benefits and learn more about VA’s approved college, university, and other education and training programs across the country.  It also provides key information about college affordability and value so beneficiaries can choose the best education program to meet their needs.

In the past 6 months, nearly 350,000 people have accessed the tool on VA’s GI Bill website.  The top schools searched by users include: American Public University, Harvard, University of Texas at Austin, Arizona State University, and University of Washington. 

“We are excited to see how Veterans respond to the wealth of information now available on the updated GI Bill Comparison Tool” said Under Secretary for Benefits Allison A. Hickey. “We’re grateful for the chance to work with our partners at the departments of Defense and Education (ED) to ensure beneficiaries are informed education consumers.”

The updated version of the GI Bill Comparison Tool has new functionality, including a more robust GI Bill benefits calculator and additional information pertinent to the Veteran population (e.g., identifies schools with student Veteran groups, VetSuccess on Campus program, and those that have agreed to the 8 Keys to Success). The GI Bill calculator provides a personalized estimate of Post-9/11 GI Bill tuition and fee, housing allowance, and book stipend benefits that would potentially be paid to the student.  The calculator prepopulates the tuition and fee estimates from the ED’s Integrated Postsecondary Education Data System (IPEDS). The Veteran indicator section now contains new information on schools’ student Veterans groups, VetSuccess on Campus program and Yellow Ribbon agreement status.  

The GI Bill Comparison Tool is one item in a series of resources VA has launched in response to the President’s Executive Order 13607, signed April 27, 2012, which directs agencies to implement and promote “Principles of Excellence” for educational institutions that interact with Veterans, Servicemembers and their families; and to ensure beneficiaries have the information they need to make informed choices about VA education benefits and approved programs. As students return to school this fall, VA is committed to providing the support and information they need to succeed.

Since April 2012, VA has deployed the GI Bill Comparison Tool, the GI Bill Feedback System, and offered a free academic-readiness tool online.  In addition, VA, the Department of Education and Department of Defense have agreed to new Veteran-specific outcome measures and signed a memorandum of understanding to exchange information, which will ensure greater compliance from schools receiving military and Federal education benefits. VA successfully trademarked GI Bill to prevent its fraudulent use for recruiting purposes and to protect this publicly-owned intellectual property.

The Post-9/11 GI Bill is a comprehensive education benefit created by Congress in 2008.  Veterans and Servicemembers who have served on active duty for 90 or more days since Sept. 10, 2001 are eligible for the benefit. The Veterans Benefits Administration, which administers the Post-9/11 GI Bill program, has distributed more than $43 billion in the form of tuition and other education-related payments to more than one million Veterans, Servicemembers, and their families; and to the universities, colleges, and trade schools they attend.  The GI Bill Comparison Tool can be found at:



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IAVA Praises President’s Executive Action Supporting Veterans

IAVA Praises President’s Executive Action Supporting Veterans

CONTACT: Gretchen Andersen (212) 982-9699 or

IAVA Praises President’s Executive Action Supporting Veterans  

A good step, but much more action is needed for true reform

New York, NY (August 26, 2014) – Today at the American Legion’s 96th Convention in Charlotte, N.C., in his first major policy speech on veterans care since the VA scandal began in April, President Obama announced executive action to improve care and support for veterans. Iraq and Afghanistan Veterans of America (IAVA), the largest organization representing post-9/11 veterans and their families, today praised the Administration for taking steps to restore the trust in VA, provide additional support to our community and reverse the suicide trend among veterans. The executive action was created in consultation with IAVA and includes new initiatives on raising awareness for suicide prevention, mental health research, pilot programs on peer support and more. 

IAVA released the following statement on the President’s announcement from CEO and Founder Paul Rieckhoff:

“IAVA applauds the White House for taking this executive action,” said Rieckhoff. “These initiatives touch on many of the most urgent issues facing our community. These are, however, small steps on the very long road to fully supporting our community and reestablishing trust in the VA. Announcements and promises are easy, and we’ve been here many times before. As we saw after the President’s executive order in 2012, effective implementation of these actions and real change will be the hard part. These steps must be supplemented by congressional action, community support outside of Washington and a clear national strategy for veteran’s care—in particular, a real strategy to combat veteran suicide. This summer, IAVA members had their trust in the VA and the President completely shattered. After a tumultuous season of scandal, our members expect the Administration to consistently lead for veterans. Supporting our community can’t be just a one-off event or speech filled with more promises. Our veterans need a sustained, focused effort with measurable outcomes that span the rest of the Obama Presidency. With this Executive Order, President Obama is starting respond to the scope of the challenges we face in the wake of the VA scandal and more than a decade of war.  But, our community needs and deserves much more.”

Rieckhoff added, “We’re extremely disappointed President Obama did not explicitly announce his support for the Clay Hunt SAV Act (H.R 5059). Lives are on the line. We are losing 22 veterans to suicide each day. Although this executive action is helpful, it is not the final remedy. We need the President to lead the entire nation in an effort to battle veteran suicide. We encourage the President to engage with IAVA leaders across the country this coming September during National Suicide Prevention Month to construct a concrete strategy that will really combat veteran suicide.”

According to IAVA’s 2014 Member Survey, a majority of respondents think the President (54 percent) and Congress (69 percent) are doing a poor job of improving the lives of Iraq and Afghanistan veterans. Sixty-eight percent of VA mental health users reported challenges scheduling an appointment. Forty-seven percent of respondents know at least one Iraq or Afghanistan veteran who has attempted suicide, while 40 percent of respondents know someone who has died by suicide, up three points from 2013. A staggering 31 percent of respondents have thought about taking their own life since joining the military, a one percent increase from 2013. 

Combating veteran suicide is IAVA’s top priority in 2014. In March during Storm the Hill, the organization’s premiere advocacy week in Washington, IAVA launched the “We’ve Got Your Back: IAVA’s Campaign to Combat Suicide.” The historic, yearlong effort comprises three goals: 1) passing the Clay Hunt SAV Act, 2) getting President Obama to take Executive Action and 3) connecting one-million post-9/11 veterans with transitional resources. IAVA members continue to call on President Obama to issue and Executive Order specifically focused on veteran suicide and reflective of IAVA’s Six Principles of Excellence for Combating Suicide (AC5) presented to the White House in March. 

Iraq and Afghanistan Veterans of America ( is the nation’s leading nonprofit organization representing veterans of Iraq and Afghanistan and has more than 270,000 Member Veterans and civilian supporters nationwide. Celebrating its tenth anniversary of dedicated service, IAVA has consistently received the highest rating – four-stars – from Charity Navigator, America’s largest charity evaluator.


Seeking New Coping Tools for Veterans with TBI

A woman shows a man a plan written on a large paper pad

Occupational therapist Annemarie Rossi works with Veteran Lonny Ellison during a cognitive training session at the San Francisco VA Medical Center. Photo by Roy Kaltschmidt

One of the most effective tools to manage a mild traumatic brain injury (mTBI), is a smartphone calendar app, say VA researchers. Considered the signature injury of the Iraq and Afghanistan wars, mTBI can result in memory loss, mood disturbances and other potentially disabling symptoms. For some, the injury can prove life-altering.

“With mild TBI, one of the most common symptoms is problems with prospective memory—remembering to do things,” explains Dr. Elizabeth Twamley, a neuropsychologist with the VA San Diego Healthcare System. “We want people to remember to take their medication and buy cards for their wife’s birthday and do all the important things they need to get back to work and school.”

In previous conflicts, mTBI did not play much of a role, so little research has been done on the topic. Now, with between 10 and 20 percent of Iraq and Afghanistan Veteran having sustained at least one mTBI, VA researchers nationwide are hunting for viable treatment options. In addition to pharmacological and other medical therapies being studied, researchers are learning how to use various cognitive rehabilitation strategies to best effect.

Twelve-week program addresses problem-solving and more

“When the service members started coming back with TBI, we began to look for literature on how to treat them and there wasn’t really any evidence-based research,” says Twamley, also with the University of California, San Diego. “It became clear we needed to do something.”

Twamley developed Cognitive Symptom Management and Rehabilitation Therapy (CogSMART) to do just that. Over 12 weeks, Veterans going through CogSMART learn strategies to help with fatigue, sleep problems, headaches, stress, improving attention, memory and problem-solving.

Twamley’s team recently published the results of a CogSMART pilot study involving 50 Veterans. The study showed significant improvements in some areas.

Twamley compares the system to using a cane to support a weak leg. “By working around impairments, we can take advantage of an individual’s strengths … and use different ways and possibly different brain areas to perform cognitively-demanding tasks.”

One of the key tools in CogSMART is smartphone calendars. “They’re the strategies successful people use every day,” says Twamley. “There’s no stigma associated with using your smartphone calendar to remember things. I use mine.” Another smartphone feature that comes in handy is the alarm.

An example of the non-phone strategies included in the program is using acronyms to remember things.

 There’s no stigma associated with using your smartphone calendar to remember things. 

Online cognitive programs: Do they work?

Dr. Amy Jak, also a neuropsychologist with the San Diego VA, directs the site’s TBI cognitive rehabilitation clinic. She adapted a version of CogSMART for the patients in her clinic and, like Twamley, she speaks fondly of smartphones. “Smartphones do a lot of good things, particularly with our younger Veterans who have already embraced the technology.”

Jak also led a review of the scientific literature on publically available computer-based cognitive training programs. “We looked at all the things you see in the news—the Lumosity type of program,” says Jak of the $300-million-per-year online cognitive enhancement industry. “Veterans were coming in saying they heard about something on the Internet and wanted to know if it was any good.”

The programs generally feature game-like tasks that are practiced for up to about 100 minutes per day, three to five days per week, for up to 12 weeks.
Jak and colleagues concluded that “the good news is that there weren’t a lot of negative side effects. They don’t hurt you.” The not-so-good news? “Some of them may work, but mainly they work on the task you’re doing.” In other words, intensive use of a computer-based cognitive game may help you get better at that specific task, but doesn’t necessarily generalize out to everyday life.

Drawing on ancient mindfulness techniques

Meanwhile, other VA teams are exploring other ways to help Veterans cope with mTBI. A team at the San Francisco VA Medical Center, for example, has been testing a cognitive rehab program called GOALS, for Goal-Oriented Attentional Self-Regulation. It teaches participants how to focus on goal-relevant information and hold it in mind while managing distractions and then to apply those skills in managing their own real-life goals.

Neurologist Dr. Anthony Chen describes one of the GOALS strategies, called Stop-Relax–Refocus: “Stop, relax, refocus on the goal to be accomplished and when your mind wanders practice redirecting your attention back to the central goal. This is inspired by mindfulness training that’s been taught for thousands of years. The difference is that we have put a rehabilitation twist to it. This is not traditional meditation, but goal-oriented applied mindfulness.”

The various approaches share a common goal: to help Veterans improve their quality of life. The researchers all agree progress is possible. With the right combination of treatment and management strategies, Veterans are finding they can accomplish more than they previously thought possible — going to college, for example, or embarking on new careers.
Tamley said, “We’re excited about using these cognitive strategies to help Veterans reenter the community and to better themselves.”

Two types of cognitive rehab

There are two broad categories of cognitive rehabilitation:

Restorative approaches aim to restore cognitive abilities through drills and practice, or through other therapies. New brain cells and networks may be created in the process, thanks to brain plasticity.
Compensatory approaches teach patients strategies to work around their deficits—such as using smartphone apps—so they can function better.

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August 26, 2014

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WASHINGTON – The U.S. Department of Housing and Urban Development (HUD), U.S. Department of Veterans Affairs (VA), and U.S. Interagency Council on Homelessness (USICH) today released a new national estimate of veteran homelessness in the United States. Data collected during the annual Point-in-Time Count conducted in January 2014 shows there were 49,933 homeless veterans in America, a decline of 33 percent (or 24,837 people) since 2010. This includes a nearly 40 percent drop in the number of veterans sleeping on the street.

HUD, VA, USICH, and local partners have used evidenced-based practices like Housing First and federal resources like HUD-VASH (the HUD-Veterans Affairs Supportive Housing voucher program) to get veterans off the street and into stable housing as quickly as possible. Since 2008, the HUD-VASH program has served a total of 74,019 veterans.

“We have an obligation to ensure that every veteran has a place to call home,” said U.S. Department of Housing and Urban Development Secretary Julián Castro. “In just a few years, we have made incredible progress reducing homelessness among veterans, but we have more work to do. HUD will continue collaborating with our federal and local partners to ensure that all of the men and women who have served our country have a stable home and an opportunity to succeed.”

“The Department of Veterans Affairs and our federal and local partners should be proud of the gains made reducing Veterans’ homelessness,” said Secretary of Veterans Affairs Robert McDonald, “but so long as there remains a Veteran living on our streets, we have more work to do.”

“As a nation, we have proven that homelessness is a problem we can solve,” said U.S. Interagency Council on Homelessness Executive Director Laura Green Zeilinger. “Communities all across the country are meeting this costly tragedy with urgency and a focus on helping all veterans and their families achieve safe and stable housing.”

To accelerate progress on meeting the goal of ending veteran homelessness by 2015, First Lady Michelle Obama launched the Administration’s “Mayors Challenge to End Veteran Homelessness” in spring 2014. So far, more than 210 mayors, county, and state officials have committed to ending homelessness among veterans in their communities.

The federal government has provided significant new resources to help communities pursue the goal of ending homelessness among veterans. Communities that target these resources strategically are making significant progress and can end veteran homelessness in their communities in 2015. These strategies include: 

  • Using a Housing First approach, which removes barriers to help veterans obtain permanent housing as quickly as possible, without unnecessary prerequisites;

  • Prioritizing the most vulnerable veterans—especially those experiencing chronic homelessness—for permanent supportive housing opportunities, including those created through the HUD-VASH program;

  • Coordinating outreach efforts to identify and engage every veteran experiencing homelessness and focus outreach efforts on achieving housing outcomes;

  • Targeting rapid rehousing interventions, including those made possible through the Department of Veterans Affairs’ Supportive Services for Veteran Families program, toward veterans who need shorter-term rental subsidies and services in order to be reintegrated back into our communities;

  • Leveraging other housing and services resources that can help veterans who are ineligible for some of the VA’s programs get into stable housing;

  • Increasing early detection and access to preventive services so at-risk veterans remain stably housed;

  • Closely monitoring progress toward the goal, including the success of programs achieving permanent housing outcomes; and

  • Aligning local goals and strategies with Opening Doors: Federal Strategic Plan to Prevent and End Homelessness.

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VA Outlines Actions Taken to Improve Access to Care, Implement Recommendations from the Office of Inspector General

VA Outlines Actions Taken to Improve Access to Care, Implement Recommendations from the Office of Inspector General

August 26, 2014

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FOR IMMEDIATE RELEASE                                

August 26, 2014

VA Outlines Actions Taken to Improve Access to Care,

Implement Recommendations from the Office of Inspector General

 WASHINGTON – The Department of Veterans Affairs (VA) Office of Inspector General (OIG) today released the final report of its review of systemic issues with patient scheduling and access issues at the Phoenix VA Health Care System (PVAHCS). VA concurred with the recommendations in the final report and, in many cases, has already implemented action plans and made improvements that respond to the OIG’s recommendations.

 “We sincerely apologize to all Veterans who experienced unacceptable delays in receiving care,” said VA Secretary Robert A. McDonald.   “We will continue to listen to Veterans, our VA employees, and Veterans Service Organizations to improve access to quality care in Phoenix and across the country and we will work hard to rebuild trust with Veterans and the American public.

 The final report updates the information previously provided by the OIG in its Interim Report and contains final results from the review of the PVAHCS. VA outlined key action plans that expand access to care, improve staffing for primary care, and accountability measures in response to the final OIG report.

 In response to recommendations in the May 2014 OIG Interim Report, the following improvements were initiated in Phoenix and across the VA system:

 As of August 15, the Veterans Health Administration has reached out to over 266,000 Veterans to get them off wait lists and into clinics.

  • As a result of the Accelerating Access to Care Initiative, approximately 200,000 new VA appointments nationwide were scheduled for Veterans between May 15 and June 15, 2014.

  • Nearly 912,000 total referrals to non-VA care providers have been made in the last two months.  That is, over 190,000 more referrals to non-VA care providers than the same period in 2013 (721,000).

  • As of August 15, VA has decreased the number of Veterans on the Electronic Wait List (EWL) 57 percent.

  • Reduced the New Enrollee Appointment Report (NEAR) from its peak of 63,869 on June 1, 2014 to 1,717 as of August 15, 2014

  • VA has reached out to more than 5,000 Veterans in Phoenix to coordinate the acceleration of their care including all Veterans in Phoenix identified as being on unofficial lists or the facility Electronic Wait List (EWL).

  • Since May 15, VA has scheduled 2,300 appointments at the Phoenix VA Health Care System and made 2,713 referrals for appointments to community providers through non-VA care.

 “Even before the OIG’s interim report, VA had taken actions to address the issue of patient scheduling and access, working in close concert with Veteran Service Organizations,” said Interim Under Secretary for Health Carolyn Clancy. “We’ve initiated development of a more robust process for continuously measuring patient satisfaction at each site, and will expand our patient satisfaction survey capabilities in the coming year, to capture more Veteran experience data through telephone, social media, and on-line means.” 

 Additional actions include: 

  • Began updating the antiquated appointment scheduling system beginning with near-term enhancements to the existing system and ending with the acquisition of a comprehensive, state-of-the-art, “commercial off-the-shelf” scheduling system.

  • Directed that every Medical Center Director conduct regular in-person visits to all of their clinics, to include interacting with scheduling staff to ensure all scheduling practices are appropriate. Veterans’ Integrated Systems Network (VISN) Directors conducted similar visits. So far, 2,450 visits have been conducted nationwide.

  • Removed the 14-day access measure from all individual employee performance plans to eliminate any motive for inappropriate scheduling practices or behaviors. In the course of completing this task, over 13,000 performance plans were amended.

  • Added primary care to the services available to Veterans through VA’s Patient-Centered Community Care (PC3) contracts, a key and evolving part of the non-VA medical care program. 

  • Established an interdisciplinary accountability review team to ensure leadership accountability for improprieties related to patient scheduling and access to care, whistleblower retaliation, and related matters that impact public trust in VA.

 On August 8, Secretary McDonald announced in Phoenix that every VA medical center will undergo an independent review of scheduling and access practices beginning this fall by the Joint Commission, the nation’s oldest and largest standards-setting and accrediting body in health care. On August 5, McDonald directed all VA health care and benefits facilities to hold town-hall events by the end of September to improve communication with, and hear directly from, Veterans nationwide.

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Secretary Robert A. McDonald’s Remarks for the American Legion’s 96th Annual Convention, Charlotte, NC

Secretary Robert A. McDonald’s Remarks for the American Legion’s 96th Annual Convention, Charlotte, NC

August 26, 2014

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August 26, 2014         


Secretary Robert A. McDonald’s Remarks (as prepared) for the American Legion’s 96th Annual Convention, Charlotte, NC

Dan Dellinger, American Legion National President, thanks for that kind introduction—and thank you all for your warm welcome.  

Let me first recognize your national leadership: Dan Wheeler, Adjutant; Peter Gaytan, Executive Director; your National Vice Commanders, Paul Dillard, Southeast; Robert Newman, Central; William Rakestraw, Northeast;  Wayne Satrom, Midwest; and, Douglas  Wooddell, Western Region; your Auxiliary President, Peggy Thomas; and, Kris Huntzinger, Commander, Sons Of The American Legion.

Let me also recognize those in attendance from a broad range of national and international organizations: The Royal British Legion; the Army, Navy & Air Force Veterans in Canada Association; The Royal Canadian Legion; The Republic of China Veterans Affairs Commission; The Korean Veterans Association; The National Society of the Sons of the American Revolution; Student Veterans of America; and, the National American Legion Press Association.

Finally, all the members of the Legion family present today; VA colleagues, distinguished guests, ladies and gentlemen.

Good afternoon, everyone. It’s a pleasure to be with you here today in Charlotte, and a true privilege to hear President Obama’s remarks earlier. I deeply appreciate his trust and confidence in providing me the opportunity to serve at VA.

President Obama’s presence here at your convention, his steady support of VA over the past six-and-a-half years, and the leadership he has demonstrated in driving greater support and opportunities for Veterans are all evidence of his strong, unwavering support of Veterans.  

Once again, he has taken the lead in calling for elimination of the claims backlog, the ending of Veterans’ homelessness, better and more substantial mental healthcare and support, encouraging companies to seek Veteran employees, increasing educational opportunities, and recruiting medical professionals to better serve our Nation’s Veterans.

There is no stronger advocate for Veterans than President Obama. 

First, let me thank the Legion for your staunch support—for almost a full century now—of our Nation’s Veterans. Your counsel is important to me; I welcome your advice on how to reinforce the time-honored covenant between America and her Veterans.

The VA owes its existence, in part, to the Legion.  You lobbied for the creation of the Veterans Bureau in 1921. You fought long and hard to see that Bureau become, first, an Administration in 1930, and, then, a Cabinet-level department in 1989.

Your accomplishments on behalf of Veterans are legendary:

  • Harry Colmery, a past National Commander, wrote the first draft of the G.I. Bill of Rights—a year before Congress passed the G.I. Bill and two years before the first wave of WW II Veterans returned home; 

  • You led the effort to pass the post-9­­­/11 G.I. Bill;

  • Thousands of your volunteers donate millions of hours through the VA Voluntary Service Program;

  • Your Veterans Affairs & Rehabilitation Commission provides assistance to Veterans and families to make sure they receive the benefits they deserve;

  • And, myriad other Legion programs well serve this Nation’s Veterans of all generations. 

So, your devotion to Veterans isn’t lost on me, and I want to assure you your contributions to VA reform discussions have been of great help.

That sort of ongoing give-and-take will be vital as we take steps to right the wrongs that have occurred, and reposition the Department for the years ahead.

There’s no question that this is a critical moment for VA. We have a lot of work to do to resolve the challenges we’re facing. Before my confirmation hearing, I spoke with VSO leaders and met with many members of Congress. 

Again and again, I was asked: “Why do you want to be Secretary of Veterans Affairs?”

Here’s what I told them—and I believe this very strongly. There’s no higher calling in life than serving Veterans. I see leadership of VA as an opportunity to improve the lives of men and women I care deeply about.

It’s more than professional—it’s personal: 

  • My wife, Diane, and I both come from military families. Diane’s father was a tail gunner in a B-24 during World War II.  He was shot down over Europe and survived the hardships of being a prisoner of war.

  • My father served in the Army Air Corps after World War II and was in the occupation forces in Japan.

  • Both our fathers were educated through the original GI Bill.

  • Diane’s uncle was a 101st Airborne Division Screaming Eagle in Vietnam. Exposed to Agent Orange, he still receives care from VA.

  • And right now my nephew, a pilot in the Air Force, is flying missions in the Middle East.

I graduated from the United States Military Academy in 1975 along with Sloan Gibson, VA’s Deputy Secretary—a great leader and a good friend of mine for many years. 

My education at West Point—and then, service as an Airborne Ranger in the 82nd Airborne Division—instilled in me a lifelong sense of duty to country. 

Four decades later, the words of the West Point Cadet Prayer still guide me—“Choose the harder right instead of the easier wrong.

Subsequently, 33-years of experience at the Procter & Gamble Company taught me a great deal about a mission-driven corporation … about strong company values … about good management practices and goal-oriented leadership. 

I believe that I can use many of those “lessons learned” to help change and move VA forward. 

Unlike, P&G, VA may not be concerned about quarterly profit and loss statements or shareholder value, but it does have a bottom line—Veterans. 

VA is in the important “business” of making a positive difference in their lives. I’m here to promise you that VA will get beyond its present difficulties and be the stronger for it. Two reasons: Mission and Values

First, VA has a great mission. It doesn’t matter whether you’re a GS-1 or a senior executive—everyone wants to have a clear purpose for coming to work every day. 

There are few clearer or more inspiring missions than caring for those “who shall have borne the battle” for our Nation.

Even with just a few weeks on the job, there’s no doubt in my mind that the vast majority of VA employees—many of them Veterans themselves—come to work with a strong passion and an even stronger sense of purpose.  They take great pride in what they do, and who they do it for.   

And from what I’ve seen and heard, I can’t overstate their enthusiasm for being part of the solution to our current problems. Overwhelmingly, their dedication to Veterans is 100%. 

Second, VA has strong, institutional values—those mission-critical ideals and attitudes that profoundly influence day-to-day behavior and performance: Integrity, Commitment, Advocacy, Respect, and Excellence.  Taken together—I-CARE. 

On my first day as Secretary, I asked all VA employees to join me in reaffirming our commitment to these core values.  And I’ve directed VA leaders to do the same with the people who work for them. 

As we tackle VA’s specific problems, our values help cultivate a climate where everyone understands what the right thing is—and then does it. 

Said another way, VA’s way of doing business must conform to how we expect employees to treat Veterans … and how we expect employees to treat one another. 

Those expectations extend to how people behave on-the-job—as well as how they behave when they think no one is looking. 

It’s clear that somewhere along the line, some people’s behavior was at odds with VA’s mission and core values. 

The result was seen in the stark difference between receiving care at, say, one of our highest performing locations, like the medical center not far from here in Columbia, S.C.—and until recently, at Phoenix.  

That said, though, I don’t think we can lose sight of the fact that it was at Phoenix, and elsewhere, that employees had the moral courage to do the right thing … take a stand … and make their voices heard about what they saw happening.

Those employees are examples of I-CARE at its best.

I just mentioned Columbia a moment ago.  I think it’s important to note that last year, The Joint Commission—which accredits and certifies health care organizations—named the William Jennings Bryan Dorn Medical Center there … and 31 other VA hospitals … as “Top Performers” in its annual review of patient care. 

This recognition goes back to my earlier comment that the vast majority of VA employees are 100% committed to Veterans and to the highest standards in care. 

At Columbia, and at VA facilities across the country, Veterans always come first.  I don’t think we should overlook that fact.       

At Procter & Gamble, the most important metric for its more than 120,000 employees is customer satisfaction. It’s the most important metric for any organization, public or private.

For VA, that means Veterans’ satisfaction.  Our Strategic Plan says it plainly:  “VA is a customer-service organization. We serve Veterans.” And it’s by how well we serve them that Veterans ultimately decide our value as an organization. 

The truth of the matter is that we’ve failed in a number of ways.  We need to do better.  Much better.

Right now, it’s up to the Department to reaffirm its worth and regain Veterans’ trust.  Over the past months, we’ve been forced to take a hard look at ourselves through their eyes, and through their experiences—good, bad, and indifferent. 

I think one of the lessons learned is that, if we are to be truly Veteran-focused, we need to continuously measure our performance—not just when things go wrong, but also when things go right.  It’s a 24-hour, 7-day-a-week, 365 days-a-year job.   And that’s what we intend to do. 

From here on out, we want Veterans to know that when they walk through VA’s doors, employees are “all in” when it comes to meeting our mission … “living” our values … and keeping Veterans first and foremost in all that they do. 

Without that, there can be no trust. 

Right now, we’re listening hard to what Veterans, employees, Congress, VSOs, and other stakeholders are telling us. 

Based on we’ve heard, we’re in the process of rapidly developing and instituting an array of changes aimed at fixing VA’s problems in the areas of process initiatives, leadership, and resources. Here’s what we’re doing to address these challenges. 

First, process initiatives:

  • We’ve reached out to over 266,000 Veterans to get them off wait lists and into clinics sooner.

  • In just the last two months, we’ve made almost 912,000 referrals for Veterans to receive care in the private sector.

  • The number of people waiting for appointments has declined by 57% since May 15th of this year.

  • Facilities are adding more clinic hours … recruiting to fill physician vacancies … deploying mobile medical units … and using temporary staffing to provide more care to Veterans more quickly

  • We’re updating the existing appointment scheduling system with short-term enhancements … until we replace it with a state-of-the-art, commercial off-the-shelf system.

  • We’re contracting with an outside organization to conduct a comprehensive independent audit of VHA’s scheduling practices. 

  • We’ve directed every medical center and VISN Director to make regular monthly, in-person inspections of their clinics to assess scheduling practices and identify obstacles to timely care. So far, we’ve conducted over 2,300 of these visits.

  • I spoke earlier about the importance of customer satisfaction. Right now, we’re building a more robust system for measuring Veterans’ satisfaction. It will capture real-time, site-specific information on a continuing basis, and incorporate social media and on-line input as well.

  • We’ll also be reaching out to leading healthcare systems to see what they’re doing to track patient access experiences.

  • The 14-day access measure has been removed from all individual employee performance plans to eliminate any motive for inappropriate scheduling practices or behaviors. 

  • VHA is providing direct assistance to facilities that need the most improvement. There’s a large multi-disciplinary team on the ground, right now, in Phoenix, where we’ve taken action on all the recommendations made in the Office of Inspector General’s (OIG) May Interim Report.

  • Until we get our systems up to capacity, we’re expanding the use of private-sector care.  At the same time, we’re better monitoring it closely to ensure Veterans are receiving the quality care they deserve.

Second, leadership challenges. 

Too many VA leaders:

  • Failed to take ownership of the problems facing their facilities and employees.

  • Failed to identify shortfalls in resources and take action to obtain the additional resources they needed. 

  • And they failed to set the standard for honesty and integrity and quash the culture of self-protection and retaliation.

As you would expect, we’ve made a number of leadership changes in the field and at Central Office.

To help address our immediate concerns, I’ve brought in former VA Under Secretary for Health, Dr. Jonathan Perlin, for a short tour of duty as my Senior Advisor, and former VA General Counsel, Leigh Bradley, to help sort through VA’s responsibilities for taking action against those accused of wrongdoing or management negligence.  

Accountability: Since May 1, 2014, we have taken over 30 personnel actions, and investigations are ongoing.     

  • Two members of the Senior Executive Service have resigned or retired.

  • Three more members of the Senior Executive Service have been placed on administrative leave pending the results of investigations. 

  • Over two dozen healthcare personnel have been removed from their positions.

  • And, four more GS-15’s, or below, have been placed on administrative leave.

That said, right now over 100 ongoing investigations at VA facilities are being conducted by the Office of Special Counsel (OSC), an independent Federal agency that investigates whistleblower allegations and complaints of whistleblower retaliation and by VA’s Office of Inspector General—in some cases, jointly investigating with the FBI.

In most cases, we cannot begin our own investigations while third-party investigations are still active. When the investigations are concluded and the findings provided to us, we will take appropriate action. As those outcomes unfold, we will share information to the degree that we can—while abiding by the law, issues of privacy covered by the Privacy Act of 1974, and due process

For cases involving senior executives, the Veterans Access, Choice, and Accountability Act of 2014, that President Obama recently signed into law, streamlines the removal of Senior Executives and the appeals process—intended to allow us to terminate SES leaders’ employment more quickly than we might have previously if misconduct is found.  It does not change any timelines related to front-line employees or lower-level supervisors.

VA has a noble mission, caring for Veterans and their families.  And we have strong, institutional values—mission-critical ideals that must profoundly influence our day-to-day behavior and performance: Integrity, Commitment, Advocacy, Respect, and Excellence.

In performing that mission and guided by those values, we will judge the success of our efforts against a single metric—Veterans’ outcomes. Our Strategic Plan already states, “VA is a customer-service organization. We serve Veterans.” If we fail at serving Veterans, we fail.

So, we are awaiting outcomes from the investigations now ongoing with OSC, OIG, and other parties. In some cases we have already announced personnel actions—Cheyenne, WY, and Fort Collins, CO are cases in point.  Others will follow.

In addition to leadership accountability issues, we’re also addressing cultural issues and creating a more open VA:

  • We’ve frozen VHA Central Office and VISN Office headquarters hiring and suspended VHA senior executive performance awards for FY 2014.

  • VA’s now posting regular data updates showing progress in improving access to healthcare and making public additional care-quality statistics for every medical center. 

  • Communication is key. Sloan Gibson and I have been making the rounds of VHA medical centers and VBA regional offices to get at the “on-the-ground” truth. Over the past several weeks, I’ve been to our facilities in Phoenix, Las Vegas, Memphis, Reno, and Palo Alto.  Later this week, I’ll be in Durham, North Carolina.  

  • At every location, I’ve met with good people who spoke honestly—from janitorial staff to medical center directors—caring and compassionate employees who want to do right by Veterans. 

I’m listening carefully to Veterans and to our VSO partners, like the Legion, and to our own hard-working employees. I want to know when you and other Veterans are not being served well—and when you are.   

The information, the insights, and the input I hear from employees, from you, and from others will shape and determine the way forward for VA; and, it will constitute the kind of accountability we at VA always want to ensure and that Veterans always deserve.

Last, let me turn to resource issues.  In June, Acting Secretary Gibson made a compelling case to Congress for the additional funds needed to address our immediate needs. The result is found in the Veterans Access, Choice, and Accountability Act of 2014. 

  • The Act allocates $15 billion to VA—$5 billion to hire physicians and other medical staff and improve infrastructure, and $10 billion to fund additional purchased care while we build capacity to meet demand;

  • It authorizes VA to enter into 27 major medical facility leases to give us more space to treat patients;

  • And, as I mentioned earlier, it streamlines the removal of senior executives based on poor performance or misconduct.

What VA needs to do now is institute the operational efficiencies, the cost savings, the productivity improvements, and the service innovations needed to support future budget requests.  

We must show Congress that VA can operate with the same levels of efficiency, customer service, and financial discipline as the best-run companies in America.

What’s ahead? Here are a few areas where I intend to change the status quo.

For one thing, we need to get back to basics and reset the focus on VA’s Strategic Plan—it’s VA’s “Scripture,” so to speak, at the core of all we do.    

 I’ll be reorganizing the Department to efficiently leverage VA’s resources and operate cohesively as One Team, One Dream in delivering the best in care and services to Veterans.

 Part of that includes redesigning or streamlining work processes—In other words, ferreting out the bottle necks in our operations that slow down service and frustrate Veterans. 

 A lot of that change will come from our people in the field—in our hospitals and clinics.  High-performance companies get their best ideas for improvements and innovation from those closest to the customer—VA can too.

We need to do a better job of forecasting.  It’s essential for us to reliably predict future demand for services so we can make good decisions about budgets, about support systems, and about people.

Inadequate forecasting was partly responsible for severe shortages of personnel at some locations.  And so recruiting is Job One right now. I intend to be out-in-front and hands-on in that effort—later this week I’m going to launch our recruiting efforts by speaking to doctors, interns, residents, and students at Duke University’s medical school.

Recruiting isn’t just for HR. 

Here’s how I look at it—on one end of the spectrum is an Air Force Lieutenant about to graduate medical school who tells her father, “I wouldn’t want to work for VA—have you heard all the bad stories about it?” On the other end is Nancy, about to graduate medical school as a neurologist, who told me on the plane back from Memphis, “Practicing medicine at VA is my dream job.” The only difference between hiring a great doctor and being shorthanded is misunderstanding what serving Veterans is about.

Turning to technology—It’s an enabler. And we need to make the most of it, particularly by expanding use of digital technology to free up doctors and nurses for direct care to patients.

On another front, VA-DoD synergy is critical.  I see part of that as working with Secretary Hagel to create an integrated records system.

Like you, I don’t want VA to be known for just “standard” care; I want it known as “THE Standard” in healthcare.  To help do that, I’m establishing a Board of Professionals—comprised of the foremost medical minds in the Nation—to advise me on industry best practices.

Now I know I’ve just laid down an ambitious agenda.  However all this, and more, can be done.    

It can be done with the American Legion’s help and the support of all VSOs.  Close collaboration and ongoing dialogue are priorities—no organization can operate successfully in a vacuum.  Together we can move VA forward with the urgency that the current situation demands with the balanced reforms that will ensure VA is the provider-of-choice for Veterans from Maine to Manila.

Testifying before Congress last month, Sloan Gibson portrayed our situation this way: He said, “We can turn these challenges into the greatest opportunity for improvement in the history of the Department.”

I firmly believe that.  I don’t deny that the challenges ahead are significant.  There’s a lot to do.  And there’s a lot at stake.  But in tough times, I’ve always turned to a favorite saying of mine—“A pessimist sees the difficulty in every opportunity; an optimist sees opportunity in every difficulty.”

Well, I’m an optimist. And a realist.  And a pragmatist.

I’ve no doubt that with the support of President Obama, Congress, VSOs like the Legion, and other stakeholders, we can do what needs to be done to restore confidence in the Department.  

I want to thank all of you for being a long-time, good friend to VA. Thank you for all you’ve done, and continue to do for Veterans and their families.

And thank you for giving me this important opportunity to speak with you this afternoon.  I look forward to working closely with you as we go forward.


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VA Takes Next Step to Modernize Scheduling System

VA Takes Next Step to Modernize Scheduling System

August 25, 2014

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 Announces Request for Proposal for New Scheduling System

The Department of Veterans Affairs (VA) today announced plans to issue a Request for Proposal (RFP) for a new Medical Appointment Scheduling System; the next step in a series of actions VA has taken to replace its antiquated legacy scheduling system.  The new system will improve access to care for Veterans by providing medical schedulers with cutting-edge, management-based scheduling software.  The RFP will be made public by the end of September 2014; eligible vendors will have 30 days to respond from the day of issuance.

“We want this process to be open to all eligible vendors to make sure the Nation’s Veterans have the full benefits the innovative marketplace has to offer,” said VA Secretary Robert McDonald. “When we can put a solid scheduling system in place, this will free up more human resources to focus on direct Veterans’ care. As VA recommits to its mission of caring for Veterans and evaluating our actions through the lens of what serves them best, we know a better scheduling system is necessary to provide them the timely, quality health care that they have earned and deserve.”

VA will issue a draft RFP prior to releasing the full RFP to maximize industry and stakeholder input. The solicitation will require a two-part demonstration of capabilities: a written proposal and a technical demonstration to scheduling staff. VA hopes to award the contract by the end of the calendar year.

“VA chose a full- and open-competitive strategy to acquire a ‘commercial, off-the-shelf’ scheduling system,” said Stephen Warren, VA’s Chief Information Officer. “We want a system that is user-friendly and tailored specifically for our Veterans.”

 Even as VA issues an RFP to replace the existing system, efforts are underway to make the current system easier to use for schedulers and Veterans. Among those enhancements:

  • VA recently awarded a contract to improve the existing scheduling interface, providing schedulers a calendar view of resources instead of the current text-based, multiple-screen view.  This update is scheduled to begin roll out beginning in January 2015.

  • VA is also developing mobile applications to allow Veterans to directly request certain types of primary care and mental health appointments (scheduled to begin deployment December 2014).  Another application under development will give VA schedulers an easier-to-use interface to schedule medical appointments (scheduled to begin deployment December 2014). 

  • VA is also rolling out new clinical video telehealth capabilities in October 2014 to further enhance access to care.

 As part of the current RFP preparation process, VA is working with Veteran Service Organizations (VSO) to incorporate the groups’ feedback on requirements important to Veterans.  VA’s VSO partners are currently reviewing user experience and business process documentation, and VA will continue to consult with VSOs as it works toward publishing its acquisition solicitation. 

VA’s acquisition process will comply with recently established legislative requirements related to the Department’s scheduling software.

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"Family" of Patients Appreciate VA Doctor

A senior man in a swimming pool smiles

“He’s a great doctor. One of the best.”

When I asked Vietnam Army Veteran Rufus how he felt about Dr. Cheng, he paused. For a very long time. Then tears filled his eyes and he whispered, “He saved my life. He’s a great doctor. One of the best. I wouldn’t have another doctor.”

Vietnam Marine Corps Veteran George feels the same way. Also through an emotional whisper, he said, “One more day and I would have been dead except for Dr. Cheng. He’s better than good. You won’t find a better doctor.”

Dr. Jianhua Cheng has been a staff physician in primary care at the Charlie Norwood VA Medical Center in Augusta, Georgia, for 14 years. Although he does not want this story to be about him, it probably will be, in spite of his reminding me a dozen times that he is just part of a great team.

Dr. Cheng quickly points out that “We are here to provide the best medical care for our Veterans for their service to our country. We work together as a team, the doctors, the nurses, staff, social workers, everybody. We just want to do what we can to do our best, second to none. That is our guiding principle.”

Fulfilling His Father’s Dream

A native of Wuhan, China, he received his degree in biochemistry from Oxford University in 1991, fulfilling a family dream. “My father had a dream to be a physician but he did not realize it so I wanted to continue his dream.”

The soft spoken Dr. Cheng explained his philosophy. “When you get in the medical field, you realize it is not just the physical but it is also the soul and the mind. We are human beings, we are not just a body. If you have a bond with the patient, they really appreciate that.”

 But, please. Make this story about the great team here in Augusta. 

And why all the praise and affection from his patients?

“I see all my patients as a family member. I respect them and I treat them like my father and mother wanted to be treated. Sometimes you go to the doctor and you feel uneasy, you feel nervous, even me. I want my patients to feel very comfortable and open, to be able to talk to me, with no hesitation. Then you can really help them.”

Continuing the family tradition, one of his sons is going to be a dentist, graduating from the University of Georgia with honors. “We are very proud.” His other son also wants to pursue a medical career.

Remarkable Work Record

They will have big shoes to fill for Dr. Cheng has not missed one day of work in his entire professional career, including the 14 years at the Augusta VA Medical Center.

I asked him what about those days when you’re exhausted or don’t feel inspired enough to come to work, he quickly pointed out that “There are Veterans who may have to drive for two hours to get here. How could I not be here for them? When I do a job, I want to give 100 percent commitment.”

On an average day, Dr. Cheng will see 10 to 15 patients. “They did a survey of the actual hours physicians work and it was 50 to 60 hours a week when you include all of the paperwork and other follow through tasks we do. I don’t think the public knows this.

“But we do this. We should do this. Because of what our Veterans did for our country.”

“That is my reward.”

When asked about the heart felt testimonials by the Veterans at the beginning of this article, Dr. Cheng also became emotional as he explained the satisfaction he feels when patients send their thanks.

“I had one patient who told me the cardiologist said Dr. Cheng saved his life because he listened. He had told me one small thing, that he was always short of breath and so I ordered the heart work up. They found that he had major blockage and admitted him to the hospital for treatment.

“Later, his family called me to say thank you and to let me know that I had treated their father as family member. That is my reward.”

“But, please. Make this story about the great team here in Augusta, all the other physicians and the nurses and the staff and the compassion we all feel for our Veterans.”

Okay, Dr. Cheng. We’ll do that.

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VA Moves to Streamline Identification of Rural Land Areas

VA Moves to Streamline Identification of Rural Land Areas

August 22, 2014

Printable Version

 Changes Will Improve Service Delivery to Veterans

 WASHINGTON – In order to more accurately identify and serve rural Veterans, the Veterans Health Administration (VHA) is improving the method it uses to define urban, rural and highly rural land areas.

“The Department of Veterans Affairs is committed to providing high quality health care to Veterans when and where they need it, including rural and highly rural areas of the country,” said Secretary Robert McDonald.  “With this change, we will be better able to deliver services to Veterans when and where they need them.”

The current method is being replaced by a more accurate method, modeled on one used by other leading federal agencies. It is anticipated that implementation will begin before October 1, 2014.  The Rural-Urban Commuting Areas (RUCA) system, developed by the departments of Agriculture and Health and Human Services’ Health Resources and Services Administration, has become more accepted because of its sound social science basis and its adaptability for special programs.

“VHA strives to provide high-quality, accessible health care to all enrolled Veterans,” said Interim Under Secretary for Health, Dr. Carolyn Clancy.  “However, we must know where rural Veterans live in order to provide adequate access to care. This requires the best possible definition of ‘rural’ land areas. With this change, VHA will be able to better serve this important Veteran population.”

Improving VHA’s method for identifying urban, rural and highly rural Veterans will result in more accurate identification of rural Veterans, improved reporting of the number and location of rural Veterans and of statistics on their geographic access to sites of care along with improved allocation of resources and improved research on rural Veterans’ needs.

Currently, 3.2 million rural Veterans are enrolled in the VA system, which represents 36 percent of the total enrolled Veteran population.

For a more detailed explanation of the change, visit the VA Office of Rural Health website.


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