VA Under Secretary for Health Media Roundtable

USH Media Roundtable, Tuesday, August 15, 2023, 1-2 p.m.

Dr. Shereef Elnahal (Under Secretary for Health):  Good afternoon, everyone. Good to connect as always. Want to call everyone’s attention to a really important deadline that’s coming up vis a vis the PACT Act. As folks have likely been tracking, the deadline for the maximum ability to backdate someone’s benefits for presumptive service-connection related to the PACT Act was Monday at midnight. However, any Veteran who applies for presumptive service-connection related to toxic substances can still get PACT Act benefits. So we don’t want folks thinking that PACT Act has expired. By no means has it expired. Folks just can’t backdate their benefits anymore to August 10th of last year. And I’ll direct anyone with further questions on the ability to backdate perhaps to later dates than August 10 of 2022 to VBA for more specifics, but just wanted to make sure I led with that.

The second deadline to be aware of, which is ahead of us is September 30th for what we call the one-year special enrollment cohort of post-911 Veterans. So, to qualify for this opportunity, a Veteran must have served on active duty in a theater of combat operation somewhere in Central Command in the post-911 era, or served in combat against a hostile force during a period of hostilities after November 11, 1998, and they were discharged or released between September 11, 2001 and October 1 of 2013. That cohort of Veterans was previously eligible to enroll directly into VA Healthcare for a period of five years after their separation. And remember, by definition, for that cohort before the PACT Act, that direct enrollment opportunity expired. So, for the one year period between October 1st of last year and September 30th of this year, they have another opportunity to enroll directly into VA Healthcare. And once someone is enrolled directly into VA Healthcare, that enrollment persists for life. Now, they may be reassessed for priority group later on, but that enrollment is good for the rest of that Veteran’s life. So we want that temporary door to allow as many Veterans who qualify to enter it as possible before September 30th. And the bulk of our outreach efforts on the PACT Act are going to focus on this special one year enrollment cohort of Veterans.

There’s another group of Vets who served in the post-911 era who separated after October 1st of 2013. Those Veterans have a much longer window of being able to enroll in VA Healthcare. But again, for the folks who separated more than ten years ago who were deployed in combat operations, the theater of combat operations, and any of these conflicts, they have that direct opportunity to enroll in VA Healthcare. And I keep saying direct opportunity because service-connection is not required for this enrollment opportunity. So for Veterans who have conditions that the PACT Act deems to be service-connected to exposures, that’s obviously a preferable route because a Veteran may qualify not only for VA Healthcare, but for a higher priority group within VA Healthcare, compensation benefits, and other benefits that VBA can offer. But this window is specifically there for Veterans who don’t necessarily have a service-connected condition related to toxic substances. So we’re trying as many venues as possible to get the word out about this.

And I also want to remind folks that Vietnam era Veterans are also qualified to enroll directly into VA Healthcare. That was as of last year, that the PACT Act opened the door for Veterans deployed to other countries in addition to the Republic of Vietnam. Specifically, if a Vet was enrolled–or if a Vet was deployed to Thailand, at any US or Royal Thai base between 1962 and 1976, they qualify for direct enrollment. They were deployed to Laos between 1965 and 1969, they also qualify. If they deployed to certain provinces in Cambodia between 1969–April 16 through April 30 of 1969, they also qualify. And there are a couple of other areas around the time of the Vietnam War that were added to the PACT Act for a direct VA Healthcare enrollment opportunity. And these Veterans will be assigned to Priority Group Six regardless of the degree of service-connection for any of their conditions. So we’re really focused on making sure, especially that one year enrollment cohort enrolls before September 30th. And your help in getting the word out about this to Veterans across the country would be much appreciated.

Now, I’ll just go into some quick updates on our hiring efforts, as I do every month. We surpassed 400,000 employees for the first time in the VA healthcare system last month. We are now at 400,740 employees. There has never been a period of time in VA history where the healthcare system has had this many employees. That 400,000 threshold is a first. It amounts to a 5.5% workforce growth since October 1st of last year, and it amounts to the figure of 48,585 external hires, which is 93% of our 52,000 external hire goal of this year. So on pace, if we keep up the pace here, we are likely to far surpass 52,000, which was our external hire goal. We’ve already surpassed, to just remind you, the overall total employee on-board growth goal, which was only 3% by September 30th. We’re now at five and a half percent. We may, in fact, double that figure. And specifically, we’ve hired 27,296 employees out of our 30,000 goal for what we call the Big Seven Occupation. These are the front-line employees that are critical in moving the system on behalf of Veterans; physicians, nurses, LPNs, nursing assistants, medical support assistants, in other words, the clerks and the schedulers within clinics, food service workers, and housekeeping aides. So we’re really proud of these hiring results. We’re not stopping, especially until we reach the 52,000 external hire goal for this year. And we’re going to take a close look at our hiring goals for next year on particular types of staff for which we are short. But I’m really proud of all of our network leaders and medical center directors for executing on this. And we’re working as hard as we can not only to bring more folks on board, but to improve the hiring process itself. With that, I’ll pass it back to you, Mark, and to all of you for questions. Thank you.

Mark Ledesma (Director, VHA Communications):  Great. Thank you, sir. So we’re opening up for Q  and A. Our first question comes from David. Go ahead, David, with your question.

David Elfin (cyberFEDS):  Dr. Elnahal, David Elfin with cyberFEDS. Congratulations on hiring success. Two questions. Number one, you said maybe you’ll reevaluate next year’s goals. Could I presume that you’re going to maybe reevaluate those upwards to what you were hoping for? 

Dr. Shereef Elnahal (Under Secretary for Health):  Well, what I want to do is make sure that all of our field operators are focused on the types of staff for which we are still short. So I know for a fact, for example, that housekeeping aides, nursing assistants, and LPNs still remain challenging to hire. The overall labor supply for those really important types of employees has been a challenge. We’re trying to make use as much as possible of all of our PACT Act authorities, recruitment and retention incentives, special salary rates, critical skills incentives to help be much more competitive for those types of jobs. But we remain overall short of our goals in those areas, and there will likely be many other types of jobs that we target our hiring efforts around. So it’s really more around refining the types of folks we want to hire and that’ll factor into our goals for next year.

David Elfin (cyberFEDS):  Okay. And I know this is not a big seven job, but it’s the one my readers care about the most is your HR. And you’ve talked about before hiring the hirers. And I do have the stats from what your staff put out at the one year anniversary, but I wonder what your personal feeling is and how you’re doing on hiring the hirers.

Dr. Shereef Elnahal (Under Secretary for Health): We can’t hire enough of them. I know we’re making some good progress. We have a critical skills incentive in play, which amounts to 25% of the base salary of these professionals. We want as many HR specialists in our system as possible. That will only help reduce times to on-board and hire employees, which is really the main challenge that we’re faced with right now.

David Elfin (cyberFEDS): Thank you very much.

Dr. Shereef Elnahal (Under Secretary for Health):  You’re welcome.

Mark Ledesma (Director, VHA Communications):  Thank you, David. Ellen, you’re up next.

Ellen Milhiser (Congressional Synopsis):   Good morning. With the external hires, when you hire an intern, say in social work or nursing, does that count as an external hire or an internal hire? 

Dr. Shereef Elnahal (Under Secretary for Health):  So when you’re saying, like, somebody’s in a training program, for example, and then we bring them in, that’s a good question. I don’t think trainees are counted as FTE, especially because many of them only spend rotations and temporary periods of time within VA. But I want to make sure I have the facts on that. So I’ll ask Mark to double back with our Workforce Management and Academic Affiliations Team.

Ellen Milhiser (Congressional Synopsis):  And as you reassess your hiring goals and needs are you going to reassess the makeup of your internship and trainee programs?

Dr. Shereef Elnahal (Under Secretary for Health):  Yeah. And the reassessment involves expansion, so we’re looking into ways to expand mental health training opportunities in particular. Everywhere where we have good, effective training programs, whether it’s GME or medical student support, we end up seeing a lot more folks coming on board because they become familiar with the VA and they enjoy working at the VA. It’s an incredible mission. And so we have to remain part of and frankly, become a larger part of the healthcare professional trainee pipeline in the United States.

Ellen Milhiser (Congressional Synopsis):  Thank you.

Mark Ledesma (Director, VHA Communications):  Thank you, Ellen. Orion, you’re up next.

Orion Donovan-Smith (The Spokesman Review):  Hi, guys. Thanks for doing this. Dr. Elnahal, a few months ago, you talked about hiring in the office of Community Care in particular, or offices of Community Care across different VAMCs. Do you have any update on that in terms of progress on goals? 

Dr. Shereef Elnahal (Under Secretary for Health):  Many of the medical support assistants that we’ve hired and, by the way, we’re ahead of schedule for MSAs, which is really heartening, end up populating our Community Care offices because these are a lot of–it’s a lot of administrative work, coordination with Veterans for available appointments in the community, calling community providers, and coordinating that effort. And so a lot of the MSAs fall into OCC, but I can see if we can make that a more granular statistic and give it to you on who’s populating the Community Care offices in the field.

Orion Donovan-Smith (The Spokesman Review):  I’d appreciate that. It’s great seeing those dashboards you guys have put out, and I’d be curious to see that broken down. One other question, and this may be outside of your purview, but in terms of staffing at Vet Centers, is that something VHA has any role in? 

Dr. Shereef Elnahal (Under Secretary for Health):  Yes. So, Mike–Michael Fisher, the Director of the Vet Center Program across the country, reports to me. He has his own HR department that processes packages. We do assist in multiple aspects of the on-boarding process, though. So, for example, drug testing and other parts of the on-boarding process end up happening at the medical centers for the most part, and so it ends up being a collaborative effort with the Vet Center system.

Orion Donovan-Smith (The Spokesman Review): Okay. That’s just sort of for my edification going forward. Thank you.

Dr. Shereef Elnahal (Under Secretary for Health):  Absolutely.

Mark Ledesma (Director, VHA Communications):  Thank you, Orion. Patricia, you’re up next.

Patricia Kime (Military.com):   Yes. Thank you so much for doing this Dr. Elnahal. A couple of questions. You know, surpassing the 400k, how large do you foresee the VHA getting once you’re finishing all the hiring and making sure that you’re keeping up with retirements and attrition? 

Dr. Shereef Elnahal (Under Secretary for Health):  Yeah. So at the beginning of last fiscal year, so around October 1st of ’22, our workforce management team estimated that we would need to hire 52,000 people per year to account for increased demand for care across the Veteran population, but also to account for attrition, retirements, resignations, et cetera. The good news is that we are so far out-pacing both external hires and retention rates this year. And so our teams now are working to see what our revised goals will be based on those trends. But for sure, we will still be on a hiring agenda next fiscal year, given the expected increases in demand that we will see both because of the PACT Act and because the average age of Veterans we serve is going up. And with age, of course, comes comorbidities and incidence of disease that requires clinical care. So, in other words, we’re still focused on hiring. The exact goals for next fiscal year are still underway.

Patricia Kime (Military.com):  So to confirm these goals are fiscal year goals, right?

Dr. Shereef Elnahal (Under Secretary for Health):  Yes.

Patricia Kime (Military.com):  And also, can you sort of discuss the on-boarding time?  Has that been reduced or, like, what is the average current on-boarding time and what are you looking at across this fiscal year with these hiring? 

Dr. Shereef Elnahal (Under Secretary for Health):  We do not have July’s on-boarding times yet. As soon as we do, we’ll communicate those, likely by next roundtable. Just takes some time to process that data. I will say that we were still over 160 days in June for on-boarding. That’s the median on-boarding time–time to fill. And so, obviously way too long. In the beginning of June, we rolled out a standard hiring process for the first time. I spoke about this in a previous media roundtable, and we also mandated the use and opened the use of USA staffing, which is a standard platform that will allow at least some degree of visibility into where packages are in the process. So adding situational awareness to the fingertips of our HR specialists and hiring managers and having a single more streamlined hiring process that every network in the country will implement. Those are the two strategies that we’re undertaking to finally reduce time to fill.

Patricia Kime (Military.com):  Great. Thank you so much, sir.

Dr. Shereef Elnahal (Under Secretary for Health):  My pleasure.

Mark Ledesma (Director, VHA Communications):  Thank you, Patricia. Jory, you’re up next.

Jory Heckman (Federal News Network):  Hi, can everyone hear me? 

Mark Ledesma (Director, VHA Communications):  Yes, we can.

Jory Heckman (Federal News Network):  Okay, great. Thanks for doing this and thanks again for taking the time Dr. Elnahal. I know in one of the previous roundtables you spoke about the PACT Act authorities, the timetable there. I believe the timetable that I have most recent is that VHA is looking to get most of those PACT Act workforce retention and recruitment authorities implemented by this year’s end. Is that still kind of the target there and beyond that, when’s the timeline to have all of those PACT Act authorities implemented and put to good use?

Dr. Shereef Elnahal (Under Secretary for Health):  Yeah. So, the good news is all of the hiring authorities are now available to use. We’ve asked every network in the system to use at least half of them, prove that they’re using at least half of them this fiscal year. And by next fiscal year, they will be required to use all of them. So we’re really serious about not only having these authorities, but using them to the extent that we can to improve hiring. And the good news is every network is on track to meet the goals for this fiscal year. And I’m not hearing about any concerns in using all of them by next fiscal year. So we’re on track on all fronts there.

Jory Heckman (Federal News Network):  Okay, great. And I don’t know if this is a one to one, but you mentioned the deadline for the backdated benefits under the PACT Act. And we saw the VA extend that deadline given some difficulties that some Veterans had applying online. As we look out to that September 30th deadline for the healthcare side of things, you mentioned for Veterans who deployed to a combat zone but never enrolled in VA care, do you foresee any additional steps, any redundancies these guys are putting in that process to make sure that there will be no struggles, no challenges, anything of that nature as we get closer to September 30th? 

Dr. Shereef Elnahal (Under Secretary for Health):  Yeah, I think it’s a fair question. We are, in fact, thinking about that a lot. The hot watch that we’re undertaking now as an agency for what happened both on the website and in the call centers is something that we’re taking to the September 30th special enrollment deadline. The good news is that our capacity for the website on applying for healthcare, at least upfront, seems to be more than enough to account for the estimated denominator of folks who would qualify for the special one year enrollment period. So this is a much smaller cohort of Veterans than all of the Veterans who could benefit from the presumptive service-connections that VBA is determining. So the overall denominator is smaller and our capacity for the website is quite high compared to what we estimate that denominator to be. Nonetheless, we are going to be pressure testing this. We are going to be making sure we take lessons learned from what happened, now, I think it was two weeks ago. No, it was last week–from what happened last week so that we could make sure it doesn’t happen again.

Jory Heckman (Federal News Network):  Okay, great. Thanks so much.

Mark Ledesma (Director, VHA Communications):  Thank you, Jory. Leo, you’re up next.

Leo Shane (Military Times):  Yeah, hi, thanks for doing the call. Had a question for you about the rise in COVID numbers across the VA system. I know there’s been a surge nationwide, but I don’t know if there’s any warnings you guys are going to put out, any new contingencies, any new safety issues?  There’s been quite a spike over the last few weeks.

Dr. Shereef Elnahal (Under Secretary for Health):  Yes. On a percentage basis, the spikes are concerning, and we have all of our operators, but also the team that we have monitoring the pandemic nationally, watching this closely. In particular, we’re watching for bed capacity, in particular ICU capacity. And thankfully we have enough capacity to withstand an even greater increase in cases, but we were operating from such a low baseline against that increase that thankfully we have not seen signs of overwhelm yet across the system. But it’s something we monitor every day and we want to make sure folks are aware that we are in the middle of another wave of COVID-19 with a new variant. So folks need to keep safe, especially when you account for comorbidities and age, may be advisable on a personal basis to wear a mask and certainly advisable to remain up to date on boosters and vaccination.

Leo Shane (Military Times):  How long will it take to convert things if the numbers do keep going up?  I know when we’re talking about the start of the pandemic, it was a whole new thing setting up the special wards and setting up that. If you need to add beds at a particular facilities, is it something that can be done relatively easy at this point and relatively quickly, where you can pivot and just in a matter of days or a couple of weeks, you know, increase that capacity significantly?

Dr. Shereef Elnahal (Under Secretary for Health):  Thankfully, every medical center has a pandemic preparedness plan that accounts for their experiences during the pandemic, which was a much more–much more of an improvisation than a plan during the pandemic. But that spelled out lessons learned to include very specific ways that each medical center can expand bed capacity. And that is now a much, at the ready–much more at the ready plan for medical center leaders to implement. So if we need to add bed capacity, I’m confident we’ll be able to do that wherever we need to.

Leo Shane (Military Times):  Great. Thank you.

Mark Ledesma (Director, VHA Communications): Thank you, Leo. Do we have any other questions from anyone else? Would you like to add anything else, sir? 

Dr. Shereef Elnahal (Under Secretary for Health):  Nope. Thank you so much again.

Mark Ledesma (Director, VHA Communications):   Oh, Orion has another question. Orion, go ahead.

Orion Donovan-Smith (The Spokesman Review):  I’m sorry guys, I was a little bit late getting my hand up there. If you don’t mind, quickly, since we’re a little shorter today, I do look forward to talking with Dr. Evans about the EHRM reset period. I understand that can’t happen until maybe September. So I just want to ask you, Dr. Elnahal, can you give us any update on the progress in that?  Namely, have you established benchmarks criteria for what success means in the reset? 

Dr. Shereef Elnahal (Under Secretary for Health):  The most important criteria for success for me is seeing demonstrable improvements from what our end users say about the usability of the system. So we have multiple ways of doing that, surveying our employees, and we will make use of those ways to get that data. Importantly, I also think it’s important to make sure that we have significant presence at each of the five sites, both in-person and virtually to get faster ticket response times and make sure that the configuration changes we need are happening quickly. Neil and his team have done a great job working with BHA in consolidating essentially the punch list of configuration changes we need, prioritized, of course, by patient safety first and foremost, but then the other functional needs we have and that’ll give a real checklist that every medical center will want to see improved upon once we see those teams on the ground. So Neil will have a lot more specifics for you, I think, on what the reset period will look like and I look forward to working with him on.

Orion Donovan-Smith (The Spokesman Review):  All right. Thank you.

Dr. Shereef Elnahal (Under Secretary for Health):  Thank you.

Mark Ledesma (Director, VHA Communications):   Thank you, Orion. Ellen?

Ellen Milhiser (Congressional Synopsis):  Orion asked my question. Thank you.

Mark Ledesma (Director, VHA Communications):   Thanks, Ellen. Thank you. Would you like to plug the summit?

Dr. Shereef Elnahal (Under Secretary for Health):  Oh, yes. So we have a virtual summit. Do you have the actual date and time? 

Mark Ledesma (Director, VHA Communications):  The date that we’re looking at is the 22nd.

Dr. Shereef Elnahal (Under Secretary for Health):  Okay. So, August 22nd here in DC, we’re doing a summit on virtual reality and extended reality and augmented reality therapies for Veterans. So this is a really exciting area of work that more and more medical centers are undertaking to look at these technologies which inevitably involve a Veteran wearing glasses or goggles that either puts them in an entirely different simulated environment or augments what they see in the world around us for therapeutic reasons. So we’re using this for peer support that can be done on a remote fashion. We’re using it for things like phantom limb pain for Veterans who needed amputations and have lingering pain and a sensation that that limb is still there. That one example involves Veterans wearing goggles and essentially looking at what ends up being a mirror image of their other limb superimposed on their missing limb. And very interestingly, that has therapeutic effects for pain, causes pain relief. And so we’re trying to extend use cases into many other areas. So those are just a couple of examples. This is a summit that’s going to bring folks doing this across our system together with our researchers, and we really look forward to it.

Mark Ledesma (Director, VHA Communications):  So we will be sending out a media advisory for that event, so please be on the lookout and hopefully we see you there.

Dr. Shereef Elnahal (Under Secretary for Health):  Great. Thanks for the reminder on

that.

Mark Ledesma (Director, VHA Communications):  All right. Thank you all for your time and joining us today. And we’ll reach back out for any of the outstanding questions that we weren’t able to address today. Thank you all.

Dr. Shereef Elnahal (Under Secretary for Health):  Thanks, everyone.