VA Secretary Press Conference

Denis McDonough (VA Secretary):  –thus the agreements in California and Pennsylvania are two of the earliest tests of 704, so we don’t have specific updates for you on that. The idea we are pursuing in Pennsylvania is not specifically to cancer care, it’s to a whole range of care options for Veterans there. And of course, while cancer is one of the–many, many cancers are among the presump–several of the presumptives under the PACT Act, we enrolled more than 400,000 new Veterans in VHA health care under the PACT Actin the course of the first year. So, we do know that we need greater access to updated infrastructure in facilities across the system. So, the 704 is an example of that. And, importantly, we announced earlier last week a breakthrough for the first–we’ve been trying for many, many years, almost six I’m told, to use increased access for Veterans to the Pensacola Naval Base Medical Task Force where we can, working cooperatively with DoD and the Department of the Navy, increase access for Veterans to that bricks and mortar facility for, in this case, ambulatory care. We are trying to replicate that in other places. We don’t have announcements on those yet, but I hope to have those soon. And we’re building on efforts that are showing promise already in partnership with DoD at Fort Sill in Oklahoma, Tinker Air Base in Oklahoma, and I’ll be going to Fort Campbell in Kentucky later, I think, early next year, where we are opening a new facility on that base. So, the examples that we are pursuing, the agreements that we have in the Bay Area and in Pennsylvania are examples of partnerships with our academic affiliates. We should–we will see more of those, including, I think, most rapidly in VISN 4, where our great leader there, Paul Cruz, has been advocating very aggressively for this. But it’s not just there using 704, it’s also in, for example, as we announced early last week, in Pensacola, Florida and in several other facilities where we are deepening our cooperation with DoD. I hope that’s responsive to the question.

Lucy Bustamante (NBC Philadelphia):  Yes, definitely. Can I ask another question now, Terrence, or would you like me to wait ‘til the very end?

Terrence Hayes (VA Press Secretary):  Can we circle back?

Lucy Bustamante (NBC Philadelphia):  Yes.

Terrence Hayes (VA Press Secretary):  Thank you. Appreciate it, Lucy. Thanks so much. Ellen?

Ellen Milhiser (Congressional Synopsis):  Hello. Yesterday, CDC and NIOSH announced a new national campaign to pay attention to the mental health and burnout issues of healthcare workers. I’m wondering if the VA is actively a part of that campaign and what y’all might be doing to address burnout?

Denis McDonough (VA Secretary):  Yeah, thanks so much. Let me get you an answer if we’re specifically part of that campaign. But I have been very proud of the work that Dr. Elnahal and before him, Dr. Lieberman, really started in our Reboot Task Force. You’ll remember, I think it was early last year that Dr. Mark Upton came down in our monthly press conference and briefed us through the Reboot Task Force numbers–task force strategy and plan. We believe and we believe with confidence that our stronger retention numbers in the course of FY ‘23, which we’ve just–Shereef, Dr. Elnahal’s been Tweeting about this, sharing data out of those with you. We believe that our stronger retention this year is informed, at least in part, by the Reboot Task Force effort. Now, we’ve talked in this room about a whole range of tools that we have used, and we have more tools that we’ll be announcing soon on this because this is a profoundly important issue and I’m really proud of the work that VHA is doing. Let me just say that we talked about FY ‘23 being, as we talked in this room, a year of hiring. We feel quite strongly that it was a successful year of hiring. More than 61,000 employees hired, well eclipsing our goal of just north of 52,000 employees in VHA. And we always made the point that the best hiring strategies begin with proven retention strategies. And our retention strategy was built in large measure, not entirely, but in large measure, on the Reboot Task Force work. So that’s not to say that we’ve completely solved this question of burnout. Our clinicians are awesome, and they have performed at an extraordinarily high level notwithstanding, for the course of the last three years, putting themselves and therefore their families in danger because of exposure to the virus. And that continues to be a challenge for us because not only was the environment difficult, the care that they are offering as a general matter is difficult. And the care in particular for COVID-related illness, given that our Veterans have, on average, more complex health scenarios, was also very difficult. Notwithstanding all that, performance indicators still show that outcomes for Veterans in our system were better.

Ellen Milhiser (Congressional Synopsis):  Thank you.

Terrence Hayes (VA Press Secretary):  Thank you, Ellen. I think we have Orion joining us from the Hill.

Orion Donovan-Smith (The Spokesman Review):  Hi, everybody. Yeah, I’m sorry I couldn’t be there in person, but turns out something actually happened at the capitol today. Mr. Secretary, I just want to get your response from you on some good news. I’ve been talking with clinicians and with folks in the Veterans Experience office about the award, the internal VA award that Mann-Grandstaff won for basically best improvement in inpatient experience over the past fiscal year. Obviously, as you well know, they’ve dealt with some specific challenges there in terms of new EHR and some challenges that all healthcare workers have with the pandemic in recent years. I just want to get your response to that award. I understand that Mann-Grandstaff improved from 101st out of 122 VAMCs to, I think it was 29th, and was awarded for that improvement. I’d just like to get your response.

Denis McDonough (VA Secretary):  Yeah, the clinicians at Mann-Grandstaff are on my mind a lot. I think you just heard DepSec, Orion, say that she’s going to be out there with them next week. They were on my mind this morning when on my run, I heard that were expecting four to six inches of very heavy snow in Spokane. So, as I just answered to Ellen’s question, the context in which our clinicians operate is very difficult, and that’s true for everybody as it relates to the pandemic. In Mann-Grandstaff, the weather, particularly today, is a challenge. And we all know painfully that the EHRM has been a massive challenge. But my comment about the award, Orion, is simply that the data does not lie. And we’ve come in and talked with you at length about the importance of the V-signal. The fact that we’re now applying the V-signal to the Veterans’ Compensation Benefits experience is a really important effort for us over the course of this next fiscal year because we’ve seen the impact that it has on care provision in VHA. And what the data tells us about Mann-Grandstaff is just what you said, which is that the Veteran experience with the care, notwithstanding all of the contextual challenges, some man-made, meaning by us, for them; some natural in terms of the pandemic and the weather, I think speaks for itself. And we’re really proud of those guys. Now, we’ll be making an effort over the course of the next period to get out to the facilities where we are seeing improvement in Veteran experience and where we are experiencing consistent performance on the All Employee Survey, which is an important indicator to us from our employees. So, from our employees to managers across the system and to me about what’s working and what’s not. Performance is up, participation is up in All Employee Survey, up and consistently up in a handful of facilities. And we’ll be going out to thank those employees and making sure that they know that we, like managers at every level, are making good use of that data, learning from it.

Orion Donovan-Smith (The Spokesman Review):  Thank you. Just so I’m not misunderstanding, do you have a visit planned to Spokane in connection to that?

Denis McDonough (VA Secretary):  The only visit we have to announce to Spokane is the one that our awesome Deputy Secretary is undertaking.

Orion Donovan-Smith (The Spokesman Review):  All right, well, with that, a quick question, Deputy Secretary Bradsher, glad to hear you’ll be visiting Spokane and Walla Walla, and the other sites. I understand you don’t want to elaborate too much, but one concern that I’ve heard from clinicians in past visits is that your predecessor didn’t speak with a whole lot of clinicians and focused mostly on leadership. I’m just wondering if you can tell us who you plan to speak with at those facilities?

Tanya J. Bradsher (Deputy Secretary of VA):  So, my goal right now is town halls as well as visiting certain clinics and learning across the board what those challenges they’re seeing and hopefully hearing about some improvements as well. So, I do plan on speaking to clinicians as well as leadership. I will have town halls in all five locations.

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

Tanya J. Bradsher (Deputy Secretary of VA):  Thank you.

Terrence Hayes (VA Press Secretary):  Thanks, Orion. We’ll go to Quil. Good afternoon, Quil.

Quil Lawrence (NPR):  Hey, how are y’all doing?

Terrence Hayes (VA Press Secretary):  Doing well.

Quil Lawrence (NPR):  Thanks so much for holding this. I was just hoping for an update on progress to address the racial disparity in VBA decisions. We spoke about this in the spring, and there was a GAO report over the summer. Can you tell me where you’re at with following those recommendations?

Denis McDonough (VA Secretary):  You bet. Hey, Quil, are you in the Middle East? I heard you’re reporting this morning I think. It sounds like you’re in the region.

Quil Lawrence (NPR):  No, I’m not. I’m still trying to stay out of that game. I was just reporting on some of the—-

Denis McDonough (VA Secretary):  I see. Okay. I just wanted you to know I was impressed by the reporting, and I thought to just inquire about your well-being. That’s obviously very important and a very challenging moment. We don’t have a particular update for you right now, Quil. We will obviously keep coming out every month. When we have something affirmative–definitive to brief, we’ll make sure that we bring it out. We expect that you’ll keep asking about it, but we don’t have a specific update. I do know that our equity assurance plan is at the White House being closely reviewed. You’ll recall that we kind of had a convergence of two lines of effort. One was the demands from the President to make sure that we were quite intentional about equity assurance, coupled with the fact that this was an issue that you all, you know, you, Lucy, others have been asking about, Veterans have been asking about. And of course, this is an issue that’s being played out in the courts as well. So, it was a kind of convergence of those efforts that’s currently over being reviewed by our interagency partners. And when we have more on it, we’ll let you know.

Quil Lawrence (NPR):  Any timeline on that or how long you would expect something like this to take? Ballpark?

Denis McDonough (VA Secretary):  It’s really hard to tell. I’m sorry. I don’t have a timeline. I think we feel the urgency of this for two reasons. One, because it’s Veterans’ lives and it’s been a historic challenge for our VA as we’ve elaborated in this room,. And we want to make sure that Veterans are not deterred or dissuaded from applying for their benefits. And two, we do know that once a month we have to come out and appear before you and Lucy and others and answer these questions, so we feel that urgency. I will say that we are working through our demographic dashboard update, which is meant to be an accounting of how we’re doing under the PACT Act specifically. I’ve argued in this room to date, Quil, that the beneficiaries, the Veterans anticipated to be beneficiaries in the PACT Act represent, particularly in the wars that were fought in Vietnam and then throughout Central Command for the 30 years between 1991 and 2021, I believe, without doing a specific demographic review and I’m not a demographer myself, but I have to believe those are among the most diverse forces to ever have fought by any measure of diversity, to include gender and race. And so, we feel very strongly that we need to perform here going forward, as I’ve said to you before, chalk line forward on PACT Act performance. So, we’ll be updating regularly on PACT Act specific performance there. So, stand by for more updates on that. On the overall question of equity, of how we’ve performed in the past, how we’re performing overall now and into the future is going to be an ongoing piece of work.

Quil Lawrence (NPR):  So, you’re able to, I guess, ‘cause those reports were–I can’t remember what year they went through. But are you able–how are you able to look at what you’re doing right now with decisions that are happening right now? Do you have confidence that there’s any less racial bias in those decisions right now?

Denis McDonough (VA Secretary):  I think I want to let the work speak for itself when we put it out there. So why don’t we get the work out there, and then I’m sure we’ll have an opportunity to discuss and debate it.

Quil Lawrence (NPR):  Okay. I’ll ask you again next month. Thanks.

Terrence Hayes (VA Press Secretary):  Thanks, Quil. Jory?

Jory Heckman (Federal News Network):  Good afternoon. Thank you again for doing this. Mr. Secretary, you mentioned that the FY ‘23 was a record year for VHA hiring and VA hiring in general here. In regards to the PACT Act and all the authorities, the retention and recruitment incentives there. Just wanted to check in and see whether VA is making full use of those PACT Act authorities and if there’s anything specifically that is moving the needle in terms of retention, in terms of that recruitment?

Denis McDonough (VA Secretary):  That’s a really good question, Jory. And I don’t have any concrete data at my fingertips. We are–not only are we employing the V-signal technology and process and procedure to the benefits compensation effort, but we are perfecting and broadening access to what we’re calling the E-signal, the employee signal, to find out what the employee experience is. Because so often that question of Veteran experience, be it in benefits or in healthcare, and the employee experience, the provider experience in VHA, for example, are two sides of the same coin. So that will be one place we get some data. I hope we get–I’ve been looking very closely at the All Employee Survey, so we’re getting some data there. We have been aggressive across the enterprise in the use of existing authorities. So, for example, we have the three R’s; relocation, retention, and re–the third R will come to me. We have effectively used those. We have critical pay position authority, which we’re currently reviewing for use. And then we have the new authority in the PACT Act, which are the critical skills incentives. We report on those regularly in the PACT Act dashboard. I think we use those more than 25,000 times across the enterprise. Those are specific incentives for employees with a skill demonstrated to be in shortage in each–in individual markets. So, we are using those aggressively. We also are continuing to learn from each of these because in particular–and particularly the case with the critical pay positions and the CSIs. Sorry, we have another one, which are called Special Salary Rates, SSRs. We’ve announced those in here, particularly as it relates to technicians–technologists. So, we’re using these aggressively. We’re talking to our employees about the experience with them. Importantly, we’re talking to our managers about how to use them, and we’re constantly auditing how they’re being used. We just had a good briefing with our leadership team last Friday about watch out for us with the use of those incentives. My last point is I think you all are aware of, and we’ve briefed you on our overzealousness in the use of the CSIs in some cases, including with VACO senior executives. And that has been a very difficult experience for our leaders. I’ve apologized personally to them for the way that I have handled those, and that is also part of our learning experience in this. So, I’ve just given you a lot of information. I hope it’s responsive to the question, Jory. I’ll stop there.

Jory Heckman (Federal News Network):  Yeah, just clarifying question on that final piece there. Are you confident that of the scope of those bonuses in question, that $10 million, that that’s the full scope of the bonuses that were, I guess, erroneously paid out? Or is there—-

Denis McDonough (VA Secretary):  You know, I am, but I also–we’re constantly looking at this, and the IG is looking at it. We’ve asked our Office of Management and the Chief Financial Officer to make sure that we’re working this. It’s a big organization with a lot of employees. We want to make sure that we’re investing in them. And so, we’re going to institute these tools with care, and we’re going to constantly watch how we’re doing it and make sure that–we do that for two reasons. One is to make sure that I haven’t screwed up. And two is to make sure that we’re learning the right lessons here. I’ve said this before. This has been a very dynamic period as it relates to management and employment at VA throughout the pandemic. A big push to remote, now a big push to a future of work, deployment of certain billets as remote, others as max telework. Each of those has very profound impact across this enterprise for hiring. We’re trying to make sure that we have our hands around it at each individual turn here, because we want to make sure that the workforce understands how much we need them and value them. And we want to make sure that we’re not creating some kind of perverse incentives somewhere in our various policies.

Jory Heckman (Federal News Network):  All right, thank you.

Terrence Hayes (VA Press Secretary):  Thanks, Jory. Kelsey. Thanks for joining us, Kelsey.

Kelsey Baker (Military.com):  Yes, sir, thank you. Sir, you mentioned at the beginning of the press conference, you referred to Fort Sill, Tinker Air Force Base, and Fort Campbell. It sounds like the VA is expanding healthcare services to Veterans in those areas by partnering with the DoD, as has recently happened in Pensacola. So, I wondered if you could elaborate a little bit more on that. Is there a specific push to cover down on Veterans who might be in more rural locations? And then finally, I think you also mentioned that Pensacola is ambulatory, but they’re providing surgery. So, I just want to confirm on that.

Denis McDonough (VA Secretary):  Yeah, ambulatory surgery. Yeah. So, we are trying to use every authority we have to address what is obviously a challenging infrastructure situation for VA. When, as we’ve talked in this room many times over the course of the last couple of years, when the average age of our healthcare–sorry, the average age of our medical centers, our hospitals is, like, 62 years old. That creates really difficult operating environments for our clinicians, for our VAMC directors, our medical center directors, and our network directors. And so, we’ve been working with our network directors in particular to urge them to use the authorities that we have gotten, like the 704, but then also to work to expand as aggressively as we can in those places that they have identified as opportunities for us. So, I ticked through those couple. Pensacola, Fort Sill, Tinker Air Base, Fort Campbell. We have a series of priority efforts underway in Alaska at JBER. And I’m almost a little sheepish to even brief them from here because it leaves the impression that somehow it’s us. This is not us and VACO. This is our network directors, our medical center directors taking advantage of opportunities where DoD has extra space, and we have providers, to use those providers in their space to provide care for Veterans and for active duty. So, Fort Sill, I was able to visit that–I forget when I was in Oklahoma, but let’s say it was in the second half of–no, sorry, the first half of this year, or let’s just say sometime in the last year I was there. Wade Vlosich, working with local base commanders has made that kind of effort at Fort Sill and Tinker Air Base work by working that out on a local level, taking advantage of excess infrastructure where we have it, putting our providers in there, and getting Vets in there and taking care of active duty and then making sure that we work it all out so that the funding doesn’t create complications. Does that answer the question?

Kelsey Baker (Military.com):  Yeah. Thank you.

Terrence Hayes (VA Press Secretary):  We’ll go back to Lucy. I’ll get back to you in a second, Ellen.

Lucy Bustamante (NBC Philadelphia):  Great. Just a couple of more questions, guys. What I really wanted to circle back to, what Quil brought up, the GAO report was one thing that was looking at the disparities in benefits. We also have a court case coming up November 2nd, the case of Conley Monk, which I know you cannot comment on. And then obviously, the last time that we met, it was about this topic, it was the appointment of Laurine Carson. So, I just wanted to know, what has Carson’s team done in the time that you all announced her presence? What is it that we’re actually waiting on?

Terrence Hayes (VA Press Secretary):  Yeah, again, I think the secretary addressed that earlier, but I’ll give another shot.

Denis McDonough (VA Secretary):  Yeah, I just don’t have any updates for you on it. So, I’ll make sure that when we have some that I come brief them, but I don’t have updates for you right now.

 
Lucy Bustamante (NBC Philadelphia):  Okay. Okay. Let me move on to a couple more topics. State of New Jersey Governor outlawed what the VFW likes to call claim sharks. We also know that it was already illegal in the State of New York to be able to charge a Veteran to file a claim. You all unveiled the website the last time. Any other actions that you all plan to take to be able to stop the practice or support the legislation called the PLUS Act that would allow them to operate given the shortage of people to process claims? If you can tackle that, please.

Terrence Hayes (VA Press Secretary):  Yeah, Lucy, I don’t think we have anything additional to add from the last–I think the press conference before when we had our team members up here kind of explaining detail by detail what we’re doing when it comes to claim sharks and fraud. But again, we can definitely have you sit down with those individuals again and they have that one-on-one discussion with you, but to my knowledge, we haven’t had anything different from what they said when we brought them forth last time.

Lucy Bustamante (NBC Philadelphia):  Okay. And then finally with the COMPACT Act, I wanted to know there’s going to be a rollout, obviously, of the Veterans Response Team at the different VA centers around the country, something that was based out of the Wilmington, Delaware VA here. Just wanted to know how that rollout is going to look as you partner with the different community entities and law enforcement to be able to intervene in the suicide crisis in the Veteran population. How is that rollout going to look?

Denis McDonough (VA Secretary):  Yeah, thanks very much. In terms of the rollout of the Response Teams, I don’t have an update for you on that, Lucy. When we’re ready to roll those out, we’ll make sure that you’re aware of it and that we get to you early on that. One of the things that we’ll be able to do is we’ll be able to draw on the experience that we’ve had since we began implementation of the COMPACT Act earlier this calendar year. And as a reminder to everybody under that act, a Veteran who is experiencing mental health crisis who needs to see a medical professional, can go to any hospital, VA, or otherwise. And by the way, whether they’re enrolled in VA or not, and get that emergency care. And we’ll take care of the cost of that. This is–we’re now, I think, about nine months, I think, into the execution of this. More than 32,000 Vets have availed themselves of this care and I think it’s fair to say that we’re learning from the experience in each of those cases. That will inform the rollout that you’re asking about and will inform our continued execution of this law.

So let me then just take a minute to say to any Veteran or any family member whose Veteran has experienced crisis, a Veteran himself or herself who is in crisis, we are here for you. Please call nine-eight-eight and press one, as a Veteran, and we can get you in touch with a healthcare provider. We can help arrange through the Veteran Crisis Line–nine-eight-eight plus one. We can help arrange for you to see a provider, including in your geography. We want you to not think that you are alone. We are here for you. The COMPACT Act, which you’re asking about, is another avenue for a Veteran to seek care. Whether you are enrolled or not in VA care, it does not matter. If you need to see someone today, you can go to any hospital and we’ll take care of the financing of that. The important part is for you to go get the care that you need.

Lucy Bustamante (NBC Philadelphia):  Mr. Secretary, if you can elaborate on one last question here very quickly, one more on that one. It’s true that you can only have one of those episodes and you have to enroll within 30 days of that episode, right? So that you can have continued care you have to enroll to be able to have continued emergency or care in the future, correct?

Denis McDonough (VA Secretary):  When you’re addressing emergent care under the COMPACT Act, you can get that care whether you are enrolled or not, period. Next paragraph. To have a relationship with VA where we can provide ongoing care, yes, we want you to enroll with us, right? And so that is obviously something that we can do with that Veteran through any number of ways, including through nine-eight-eight and pressing one or dialing 1-800-MYVA-4-1-1.

Lucy Bustamante (NBC Philadelphia):  Has it been around long enough that you would say you think it’s had an impact, a measurable impact on a decrease in the suicide rate? Or is it just too soon?

Denis McDonough (VA Secretary):  Yeah, I don’t know the answer to that question. I think it’s probably too soon but let me ask the team about that. But my guess is it would be too soon.

Lucy Bustamante (NBC Philadelphia):  And very last one here. I met with a few active duty members earlier this morning, and one of the things that they brought up to us to relay to you was what do you need from Congress at this point to make the transition easier from active duty to the VA system better, more seamless? Obviously, the digitization of health records is an ongoing conversation, but just to be able to relay their direct question that they were asking me to bring up to you today.

Denis McDonough (VA Secretary):  Yeah, that’s a great question, and I’m glad they asked it. I’m glad you passed it. We just had a really good hearing on this issue just last week, so we’ll make sure we bundle the back and forth with Congress on that. And I think what you’ll see in there is and you just heard our DepSec also talk about the priority that she places on this in the context of the Joint Executive Commission with DoD, where we’re working very aggressively with them on transition. But I want our Veterans to know, and our transitioning active duty forces to know that it’s not on them to know precisely what’s available to them. I want them to see us rather as a toolbox for them at various times in their life. So, we’ll be reaching them three times through Operation Solid Start during the course of their first year in transition from active duty into Veteran service. We’ll brief them through what’s available to them. And I hope they take advantage to file a claim with us so that we can get them into care right away. Again, I think we want to get away from the idea that somehow the Veteran has to know exactly what VA offers when, and we rather want to get into a relationship with those transitioning service members so that when they need support, they think to call VA. And so that’s our goal for the transition. But we’ll make sure that we get you the back and forth from the hearing, which I think was quite meaty and I think very useful.

Lucy Bustamante (NBC Philadelphia):  All right. Thank you, Mr. Secretary.

Terrence Hayes (VA Press Secretary):  Back to Ellen.

Ellen Milhiser (Congressional Synopsis):  You’re going to talk to the DoD about opening ambulatory care centers or cooperating and collaborating with the DoD. Do you think any of those efforts will enable the VA to close any of the facilities that were identified in the AIR Report, or is that a thought?

Denis McDonough (VA Secretary):  Or is that what? What was that?

Ellen Milhiser (Congressional Synopsis):  A thought. Or have you thought of making the collaborations with DoD fit into the market assessments you had made for the AIR Commission?

Denis McDonough (VA Secretary):  Yeah, I think it’s a really good question. I think without responding to the question about whether I believe it will allow us to close, you heard me say in this room a lot, Ellen, that we wanted to recognize that–we recognize that Congress did not like where the AIR Commission was headed. So, we asked VHA to engage in a very collaborative process at the network director level to ensure that we are collaborating with our Veterans, our Veteran Service Organization partners, our state partners, our academic partners to make sure that the market assessments that formed the basis for the decisions in the AIR Commission from March 2022, that we update that, but that we update that in a very collaborative experience with our Veterans, with our VSO partners, with our state partners importantly, and then with other providers in those markets. I see and I’ve argued in this room that DoD is one of those partners in each of the markets. And so, I’m thrilled that Wade and Teresa Boyd, Skye McDougall, Paul Cruz, are really pushing us as an agency to make use of every available avenue. And they’re doing that because especially somebody like Paul feels the pressure of considerable demand in VISN 4. North Carolina is seeing a lot of growth as a result of the PACT Act, so we have to make sure that we keep up with that growth. So, I’m focused less on closing. I’m focused on precision and clarity around the market assessment, and then I’m focused most particularly on health outcomes, access–starting with access for Veterans and then quality of care and quality of outcomes for Veterans. And so, I think too often these debates devolve quickly into what stays open and what closes. We need every available inch we have of clinical space right now. We’re looking for more inches, feet, square feet of clinical care space. And we’re going to keep doing that because we’ve made a promise to these Vets, right, under the PACT Act, which is we’ll get them into care and we will. I hope that answers the question.

Ellen Milhiser (Congressional Synopsis):  It does. Thank you.

Terrence Hayes (VA Press Secretary):  Thanks, Ellen. Leo.

Leo Shane (Military Times):  Yeah, I have a question for Dr. Cooper, but real quick, going back to the suicide prevention stuff we were just chatting about. It seems to me that we’re overdue for the Suicide–Annual Suicide Report detailing Veterans. Can you say when we’re going to see that? What the issue is at this point?

Denis McDonough (VA Secretary):  Yeah, so I think I referenced this last week, we’re definitely in the window when we typically publish it. I think I mentioned last month, and I know we communicated at Congress and the VSOs in August, that as we were conducting validation of analysis of the suicide prevention data over the course of the summer and in August, that the analytics team identified a concern with the US Veterans eligibility trends and statistics data source. So, this was explored with VA’s Office of Enterprise Integration who investigated and confirmed that some non-Veterans dependent individuals were misclassified as Veterans in that data, which led to some suicides being incorrectly attributed to Veteran suicides when in fact they were non-Veteran suicides. So, we gave a heads up to Congress and VSOs, and I think to you guys that that may lead to a delay, but still within this window that we’re currently in, because traditionally we’ve published it within this August to November timeframe. Ideally we like to publish it during September, Suicide Prevention Month. So, I anticipate it forthwith and surely within that window. Does that answer the question, Leo?

Leo Shane (Military Times):  No, understandable. Dr. Cooper, wanted to ask you about–you spoke a little bit about what you’ve been able to do with the engineering lab and some of the partnership. Not to question our good leadership here, but they talk a lot about the importance of the partnerships and the importance of folks working together. What have you been able to do with University of Pittsburgh and VA that you wouldn’t be able to do individually? Is it just a matter of getting different pieces together or are there advantages to the work you’ve done over the years that come out of that partnership that comes together? Because it seems to me you’re on the front line of this rather than some of the higher up analysts we’re seeing.

Dr. Rory Cooper:  Yeah, I’d like to think I’m on the front line. So, actually there’s actually quite a bit you can do. Universities don’t typically–they don’t have healthcare systems as large as the VA, and so it’s very difficult for them to do large scale national programs, whereas the VA can reach Veterans across the entire country as well as all the territories of the United States and even Veterans living overseas. The VA funds its own internal research program, and the universities typically apply to the National Institute itself, the National Science Foundation, and so it’s a way to use those resources together. And then there’s excellent engineers and scientists and clinicians within the VA oftentimes that have joined appointments with the university as well. And the other advantage is universities have students and they have postdocs. So, it’s a great way to–VA is a great training ground for them, whether it’s in research or in education or in clinical care. And then for VA, it’s a great way to help address the employment problem and recruitment and retention problem by bringing new people in. And it keeps us students, they talk to other people, they take classes, they move around. So, it keeps us fresh and current and bringing new ideas to research as well. And so, it’s a great symbiosis. And universities have access to resources that the VA might not necessarily have as well. And so, in aggregate, you get a much bigger picture by collaborating together and many more opportunities.

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

Terrence Hayes (VA Press Secretary):  Thank you. Eric.

Eric Katz (GovExec):  Hi. Thank you. Two real quick, I think, points of clarification on what was already said. As you are working on these updated market assessments, what is the culmination of that? What are you building toward? What is the result that you expect from that?

Denis McDonough (VA Secretary):  Yeah, well, this is going to be an ongoing thing, right? So, what we expect from those ongoing market assessments is A, where we have authority and existing relationships and money to go ahead and take advantage of new opportunities, we’re going to do it. Pensacola is a perfect example of that. Six years we tried to get it done. Now it’s done, thanks to Skye McDougall, thanks to our awesome clinicians. So, one is when we identify targets of opportunity, we’re going to take those targets of opportunity. Two, we have to ask every year from Congress for infrastructure money, as you know. So, this will inform–these will inform our annual requests, right? And you’ll recall that last year we had an historically very high request that we submitted to Congress. And we think that it’s only appropriate that we are in a position to ensure that those requests are matched against updated assessments of where there’s care that we need to provide and what the infrastructure looks like to provide that care. Third and last, I think what we’re trying to do is to get out of this situation where we’re asking policymakers to make a decision that says we’re closing this facility and in some period of time we’re going to build a new one. And we rather want to be able to show that we are not making policymakers bet on some future promise, but actually have them see the manifestation of the way VA is providing care in new settings so that they don’t have to worry that somehow they’re being misled or that the promises made to them will not be fulfilled. Because nobody wants to leave their Veterans without access to quality care, least of all, us.

Eric Katz (GovExec):  And the other one you mentioned earlier that when you were discussing the retention efforts that there’s more you’ll be rolling out soon. Is that implementation of PACT Act stuff or something else?

Denis McDonough (VA Secretary):  This is something super awesome that I’m not going to tell you about yet.

Eric Katz (GovExec):  Wow. Can’t wait.

Denis McDonough (VA Secretary):  But I’m super psyched about VHA doing it and I think this is going to be really important and I just take advantage one more time of the opportunity to say to our clinicians, you guys are the best. What you do is awesome. We want to keep investing in you. We recognize the context and the pressure–the context within which you operate, the pressure of how you operate, the fact that you have done it now for three years under extreme risk to yourselves and to your families. We really appreciate it and we want to make sure that you’re feeling both our appreciation and, even more importantly, our investments in you.

Eric Katz (GovExec):  All right. Thank you.

Denis McDonough (VA Secretary):  Let me just give you one set of data here before we go to the next question here. Disability backlog numbers today 308,418. That may not be today, that’s probably close of business Friday.

Terrence Hayes (VA Press Secretary):  Exactly, sir.

Denis McDonough (VA Secretary):  So close of business last Friday, 308,418. Total PACT Act Disability Claims received 1,103,860. PACT Act Disability Claims processed 486,622. PACT Act Disability Claims granted 567,724. That’s a grant rate of 77%. More than $2.6 billion of awarded backdated benefits to Veterans and healthcare enrollments since August 10, 2022, 426,880. So, we’ll send you those just because I’ve always promised you we’d give you the numbers. I wanted to make sure I didn’t forget. And plus, Terrence tapes them on here so I don’t forget.

Terrence Hayes (VA Press Secretary):  And you can always go to the fabulous PACT Act dashboard for those numbers. We have some folks who are putting in some real work giving you guys those numbers. So, Jordan.

Jordan McDonald (GovCIO):  Hi. I have a question for the Deputy Secretary. I understand that EHR modernization is going to be a big priority for you into the end of the year, next year. Sort of curious, are there other priorities that you’re looking to tackle as well going into the next year?

Tanya J. Bradsher (Deputy Secretary of VA):  Absolutely. Thank you so much. So, transition working with the Joint Executive Committee and the Department of Defense and Department of Labor is going to be incredibly important as well as also taking a look at untethered Veterans, rural Veterans, women Veterans, minorities, making sure that everyone fully understands the amazing services that VA has. Those are the issues, along with the Secretary going out and doing everything I can to encourage Veterans to join.

Jordan McDonald (GovCIO):  Thank you.

Tanya J. Bradsher (Deputy Secretary of VA):  Thank you.

Terrence Hayes (VA Press Secretary):  Back to you, Lucy.

Lucy Bustamante (NBC Philadelphia):  I promise this is the last one. Wanted to ask you about the testing and the diagnosis of burn pit exposures. Is there a plan to do this in a non-invasive way without having to cut into the lung, biopsy of the lung? Are there any other technologies being applied to be able to make that accurate diagnosis?

Denis McDonough (VA Secretary):  Yeah. Thanks very much. I think in particular, you’re referring to what we call constrictive bronchiolitis, Lucy, and it is obviously one of the issues that we’ve really wrestled with because we know that it is an ailment. We know that it is a condition that Veterans suffer from, but the process by which–the current process by which we confirm it is so invasive, i.e. a lung biopsy, as you’re talking about, as to make that prohibitive. So, while I can’t–for now, here’s what I can say. If you’re a Vet who served in Central Command over the past 30 years and you’ve been diagnosed with constrictive bronchiolitis, your condition is presumptive under the PACT Act, so you should apply today, even though we don’t yet technically have a code for that condition. I know this is a particular issue for many of our Veterans because there’s not an established code, that will not negatively impact you in any way. We will provide you with the benefits that you’ve earned and deserve based on the severity of your condition now and how it impacts your life. We also–so, those are Veterans who have been diagnosed. Veterans who believe they have constrictive bronchiolitis, we also encourage you to file. As with all cases, we will evaluate your condition and do everything we can to get you the benefits you deserve. In the meantime, we’re continuing to work on the testing issue out of our, what we call our home office. And as we’ve published in a proposed rule, we are looking at updating our guidebook for conditions that affect the cardiovascular system of Veterans. And that has been a very informative rulemaking process for us. We’ve gotten many comments. We’re dealing with those comments, and we’ll be updating the rule and we’ll publish that when it’s ready to be published. So, I hope that answers the question on constrictive bronchiolitis. It pains me that we have Veterans with that condition who still are not getting the benefits they deserve. But we ask them to stick with us, to file a claim if they haven’t, and help us get through this issue. Because right now, the severity of and the evasiveness of that test, the test of lung biopsies, is just too invasive. And we just got to get an alternative.

Lucy Bustamante (NBC Philadelphia):  Can you point me in the direction of what you’re looking at? Is it a certain technology that you’re trying to invest in, partner with, anything like that?

Denis McDonough (VA Secretary):  I hope that somebody smarter than me, and there are a lot of those people around here, can answer that question. So let us take that one and see what we can come back to you on.

Lucy Bustamante (NBC Philadelphia):  Okay. Thank you, sir.

Terrence Hayes (VA Press Secretary):  Thank you, Lucy. I believe this concludes the question and answer period. I truly appreciate you. Thank you, Dr. Cooper, for joining us today and your lovely wife as well. Thank you so much for all that you do. Thank you, Madam Deputy Secretary. Boss, of course. We’ll do this again next month everybody. Take care.
 

Denis McDonough (VA Secretary):  Thanks, guys.