VA Secretary press conference April 25, 2024

Terrence Hayes (VA Press Secretary):  Good afternoon, ladies and gentlemen, and thank you again for joining us for the secretary’s press conference. I know we have some new faces online, so to those who are in attendance for the very first time online, just use the ‘raise your hand’ function and my team will be monitoring that and they’ll be able to acknowledge you. And then I’ll call upon you at the appropriate time when it’s the Q and A portion. But with that, we’ll go ahead and jump in. I know we got a lot to cover, so I’ll go ahead and introduce VA Secretary Denis McDonough. Mr. Secretary.

Denis McDonough (VA Secretary):  Terrence, thank you very much. Thank you, everybody. It’s great to see you. Thanks for joining us today. Before we turn to the expansion of VA’s Close To Me Cancer Care program, part of the Biden Cancer Moonshot, I’ll take just a couple of minutes to bring you up to date on the impact of the cybersecurity breach at Change Healthcare, which we refer to as CHC, that we learned about in February. First, we want Veterans to know that VA is fully open–fully open for business, and we’re not aware of any adverse impacts on Vets’ care or health outcomes because of the breach. Second, the incident initially impacted a good number of our IT functions, community care payment processes among them. We’ve now restored many of those capabilities and we’re working to get 100% of them up and going. Third, most urgently, we’re focused on protecting Veteran data. While there’s no confirmation yet that Veteran data was leaked because of this incident, CHC announced this week that, “A substantial portion of the people in America” could have had some protected health information leaked. We’re pushing CHC for more information. In fact, we have been pushing CHC for more information for weeks. If we do learn that Veterans’ personal information has been compromised, we’ll move quickly to mitigate the impact and provide full support to Veterans affected. But to be clear, we’re not waiting for that confirmation to communicate with Veterans about the issue. Yesterday, we published an article on our VA blog, news.va.gov. And we sent an email to over 15 million Veterans and their families to make sure they know about the tools and resources they can use to protect themselves from fraud. That included information about the two years of free credit monitoring and identity theft protection that CHC is offering to those impacted. It included the fraud protection resources that we’ve made available to Veterans, which can be found at VA.gov/vsafe. VA.gov/vsafe. And it included a link to identity theft resources on the FTC website. So, we’ll keep monitoring this issue closely and providing updates when they’re available. And as the scope of the breach develops, we’re committed to full transparency with you, with Congress, whom we’ve been keeping routinely up to date, VSO partners, and most importantly with Veterans every step of the way.

With that, it is my privilege to introduce great VA public servants. One has been in this room with me before, and he also ran me into the ground on a run that we took this morning on the United States Capitol Mall. That’s Dr. Michael Kelley, and we’re also going to be joined by chief nurse Andrea Stone. They’re going to talk with you about VA’s Close To Me cancer program, a program that we’re expanding that builds on VA and the Biden-Harris administration’s work to provide the very best care for Vets with cancer. Dr. Kelley is chief of hematology and oncology at the Durham VA and a professor of medicine at our academic affiliate, Duke University. And a very, if I hadn’t said this, already, accomplished runner. And Andrea is our associate chief nurse for specialty care at the Minneapolis VA healthcare system, which happens to be in the greatest state of the union, which we’ve already established that, beyond any reasonable doubt. That’s Minnesota. So, Andrea, Mike, the floor is yours.

Dr. Michael Kelley (Executive Director for Oncology):  All right. Thank you, Mr. Secretary. It was a pleasure to run with you this morning, and I think we would have to debate who ran whom into the ground, but I’m honored to be here to speak to the media and the attendees, both here with us in the room and online. As the secretary said, I’m Michael Kelley, and I have the honor of serving Veterans as an oncologist at the Durham VA and through my role as the executive director for VA’s national oncology program. VA sees about 55,000 Veterans diagnosed with cancer every year, and we provide cancer care across the continuum of prevention, early detection, diagnosis, treatment, palliative care, and surveillance. Navigating a cancer diagnosis and treatment can be one of the most challenging experiences any Veteran could face. Through VA’s precision oncology approaches and services, we work hard to make sure that the right treatment is reaching the Veteran at the right time. Veterans trust us to be a partner with them on the cancer care journey, and the PACT Act has expanded the cancer types of eligibility for presumptive service-connection status, which provides us the opportunity to do that work with even more Veterans. I’m pleased to announce today that our oncology services are expanding to reach Veterans more effectively across the nation through VA’s efforts in oncology with the Biden Cancer Moonshot and our mission to provide accessible, personalized, and high quality healthcare no matter where a Veteran may need it. Through this program, called Close To Me Cancer Care, VA will bring new cancer care services to 9000 additional Veterans per year at up to 30 new locations with access to critical components of the cancer care continuum, namely diagnosis, treatments, and surveillance. These new services are in addition to existing cancer care services and cancer prevention and screening that are already available at these locations. Further, this service has and will continue to enable significant cost savings for VA. Due to VA’s ability to negotiate drug costs, we pay, on average, a third less for oncology drugs within the VA compared to the same drugs that are provided through community care. We’ve already saved approximately $1.9 million in medication costs at the initial pilot sites alone. We know that VA provides the best care for Veterans, and innovative programs like this allow us to leverage our resources better to meet the Veterans’ needs, which are really at the heart of this effort. By reducing the need for lengthy and inconvenient travel to distant VA facilities, Veterans and their caregivers have more time and energy to go about their daily lives and focus on healing. But what truly will demonstrate why this program is so important is hearing about the Veterans’ experiences. And to that end, I am honored to pass the conversation to my colleague Andrea Stone, a registered nurse and associate chief nurse for specialty care at the Minneapolis VA Healthcare System, where she has served for nearly 34 years. She’s one of the champions of our efforts to expand access to cancer care closer to where Veterans live. Her experience in nursing and VA has been critical to making this new service a success, and she’ll tell you more about how our efforts to expand access positively impact the Veterans she cares for every day. Andrea.

Andrea Stone, LPN (Associate Chief Nurse for Specialty Care – Minneapolis VA Healthcare System):  Thank you, Dr. Kelley. I’m so happy to share with you just how much the Close To Me Cancer Care program has positively impacted Veterans in the Minneapolis VA Healthcare System. It’s always been a straightforward mission to make it easier for Veterans to get the care they need and to decrease their travel burden. It started with some simple activities, like being able to access ports for maintenance and blood draws, provide injectable medications, and see how a Veteran might be doing closer to home. Our team travels to 16 community based outpatient clinics in Minnesota and Western Wisconsin. These clinics are from 40 minutes to four hours from the Minneapolis main facility. Now we are able to routinely provide comprehensive care for Veterans who are seeking their cancer care at the VA. Some of these Veterans never even need to come to the main facility and are receiving their provider visits virtually. Other Veterans are able to receive their infusion care closer to home and have the remote nurse travel out to their community based clinic. I want to share a story of one of the many Veterans who’s been positively impacted by this expanded access. He’s a decorated Army Veteran and participated in three conflicts during his service. As a public servant in a small town outside of Duluth, Minnesota, it was very important to him to use the VA while continuing to serve his community. He had a reoccurrence of his multiple myeloma following a stem cell transplant and needed twice weekly chemo treatments and lab draws. However, this used to mean spending two days a week in Minneapolis for treatments, traveling almost three hours each way. Understandably, this is a considerable burden on his time and through the VA’s Close To Me Cancer Care, he was able to come to Minneapolis one day of the week for a provider visit, labs, and treatment, and we were able to bring his second day of treatment to him so he could continue his duties and his role as a public servant. This expansion is incredible, not just because of the cancer care it will provide, but because of the infrastructure the program is building. Thank you. I want to pass it back to Mr. Hayes and focus on the Veterans we have here in clinic today.

Terrence Hayes (VA Press Secretary):  Thank you Andrea, for joining us. We truly are appreciative. We’ll go ahead and open the floor up to questions. Leo.

Leo Shane (Military Times):  Thank you for doing this. Two separate questions. First, on the cancer initiative here, how does that work with the staffers? Is there an increase in people you need for that, or obviously they’re not assigned to the region for a long period of time, but I’m not sure if that incurs extra costs with overtime or travel or things of that sort?

Dr. Michael Kelley (Executive Director for Oncology):  There are additional staffing concerns. We have done the infusions alone with two nurses, and now we’re adding the provider to be able to do the diagnosing and the treatment planning. That expands it to about four positions per site. And those are envisioned to be permanent positions. So not temporary and it’s not overtime.

Leo Shane (Military Times):  Okay. So, they are permanent–these people who will be providing that care in perpetuity there?

Dr. Michael Kelley (Executive Director for Oncology):  That’s correct. That’s my understanding.

Leo Shane (Military Times):  Okay. Great. And Mr. Secretary, question for you about the Supreme Court decision we had last week regarding the GI bill, education benefits, and some of the using both the Montgomery GI Bill and post 9/11 GI Bill. There’s a lot of confusion from folks as to what this is going to mean in the future. I know VA said they are looking into it, but is there a timeframe where you think you’re going to be able to tell folks what benefits they can access and when they might be able to use some of these new benefits if they’re able to?

Denis McDonough (VA Secretary):  Yeah. So, I don’t have a timeframe for you yet, Leo. We are digging into the opinion and making sure that we understand precisely what it means. What we know we will do is enthusiastically ensure that Veterans can access all the benefits that they have earned. And so, we obviously want to do that in a very clear, systematic way. So, we were talking through this with VBA now, lawyers kind of parsing through the opinion. And again, what we know is that we will ensure that every Veteran gets access to those benefits that they’ve earned. And obviously, this is an expansion of that access, and we’re going to be ready to do that. I just can’t give you a specific timeline on that, but we’re working with all due haste.

Leo Shane (Military Times):  Can you give a general time? We are looking at the possibility of classes this fall? There may be some folks who can just–would use that extra money to extend their program. Do you think that–

Denis McDonough (VA Secretary):  Well, what I’d say is that we’re also getting outreach from Veterans. And so, we’re–those Veterans who have that kind of urgent attention on this matter, we’re in touch with them. And if you’re not in touch with us yet, as Veterans, we urge them to be at 1-800-MYVA-411. And as we’re then able to work this through, we’ll work it through with the Veterans directly.

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

Denis McDonough (VA Secretary):  Thank you.

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

Lucy Bustamante (NBC Philadelphia):   Hi, Terrence. Thank you, Secretary McDonough. Thank you all for doing this. A couple of questions from a couple of reporters here at NBC. We’ll start off with the announcement that you will now be offering benefits to those discharged with less than honorable status. Do you know how many will be impacted by this change?

Denis McDonough (VA Secretary):  We don’t, but I’ll just refresh what I’ve said in this room over the last several months, which is the announcement today is obviously the work of about three plus years of looking at how we handle characters of discharge. So, reviewing discharge statuses of Veterans who receive other than honorable discharge. We, as a matter of course have been doing that. We announced that in 2021–the year 2021, at the direction of the White House to make sure that we are working through with dispatch the characterization of discharges especially for Veterans who are discharged for questions about their orientation. I think we’ve gone from doing about 4000 such characterization of discharge reviews in a year to up to 12,000 to 13,000. The new rules, I think, will allow us to do that even more quickly, allowing us to conclude more discharge reviews. And the thing I want to underscore to Veterans is that we want to try to–we want to be in a position to upgrade you for purposes of receiving benefits at VA, and we’re going to exercise every possibility we have in this new rule. So, we’re excited about it. But again, I want our Veterans to hear, we want to be in a position to upgrade your discharge for VA purposes. So please be in touch with us and let us work that through with you. Lucy, in terms of, you know, I could give you a collection of numbers about Veterans impacted by this for different reasons, but why don’t we get one big number for you and we’ll make sure that Terrence gets that back to you and to others. Some of that will be in the regulatory impact analysis that was published–well, that will be published tomorrow with the rule. So, you’ll see some of that there.

Lucy Bustamante (NBC Philadelphia):  If I could ask you just one more question about that. Obviously, there are many reasons that someone could be discharged with that status. If you can talk about some of the behaviors of misconduct or anything that would have led to that. And obviously, we have the number of 12,000. But is there anything you can say about who may qualify under that discharge status? And then another question after that, sir.

Denis McDonough (VA Secretary):  Sure. Right. So, the rules that we–that became available for public inspection today, and that will be published in the Federal Register tomorrow, cover Veterans who received an other than honorable discharge, not Veterans who were honorably discharged, and not Veterans who are dishonorably discharged, but rather those who receive by virtue of some kind of arrangement with their command, an other than honorable discharge. So, look, there’s any number of alleged offenses that may have led to that. And so, you know, our job is to not pre-judge those, but our job is to try to–and this is what we’ve done in the rule, to try to put out for the public to understand, and most importantly for Veterans to understand, the kinds of bases in those four cases, the four bars over and above the statutory bars, that would limit our ability to upgrade a discharge for VA purposes. So again, what I want Veterans to know is we want to be in a position to provide you access to earned VA benefits and to earned VA care. And so come see us, contact us. Let’s work this through with you and you’ll get a full peek at this tomorrow in the Federal Register.

Lucy Bustamante (NBC Philadelphia):  Mr. Secretary, if I could ask you about PFAS and the president’s declaration this last week, finally declaring–the EPA declaring a minimum of parts per trillion of PFAS allowed in the water, and then also the remediation that’s getting ready to happen on a much larger scale through a few water remediation companies that the DoD has contracted, also maybe BRAC. We know that the CDC is doing a large three year now toxin study on seven different sites around the country on places that have high levels of PFAS. Willow Grove, Pennsylvania being one of them in our market here. At what point will the VA let the Veterans know who have been based at one of these bases that we know have had PFAS exposures, that they are eligible for benefits? Or are they going to have to wait until these health conditions are named presumptive in order to get their care paid for and provided?

Denis McDonough (VA Secretary):  Yeah, thanks so much for the question. What I’d say is that the studies that you reference, and obviously the attention from the Environmental Protection Agency and obviously by the president on this issue, impacts a great deal on our ability to establish a presumptive service-connection. But you asked, what are we going to tell Veterans? And let me just tell Veterans very clearly, while there is not currently a presumption of service-connection for PFAS, a presumption is not at all required to receive VA benefits. So, we encourage every Veteran who is concerned that their military service may have impacted their health and/or be associated with a medical condition that they’re currently suffering from, to please submit a claim and let us do that work before there’s a presumption of service-connection. So again, what I tell the Veterans, including those in your area, Lucy, in Pennsylvania, is if you believe your health has been impacted and you’re suffering from a condition that is a result of your service, please file that claim with us and let us go to work on that.

Lucy Bustamante (NBC Philadelphia):  One more, sir. I know that the VA website states that you don’t recommend blood work being done as a way to determine PFAS exposure, but that’s the way that the CDC has run their study is by measuring the ng/mL in the blood PFAS exposure. One Veteran we interviewed had 384 ng/mL in their blood and worked at Willow Grove for 20 years. Is he gonna have to wait? Are these Veterans that make that connection and call you, will they have to wait a long time? Can you give me a timeframe as to how long it will take for them to be able to be covered?

Denis McDonough (VA Secretary):  Yeah. Well, thanks so much. So, what I would say is today there are 323,081 claims in backlog. That’s 31,923 fewer claims than last month’s press conference, and it’s 100,000 fewer claims in backlog than its most recent peak, which was on January 4, 2024. And so, we will continue to comm–and we’re processing claims, on average, at about 17 days faster this year than last. We’re still at, on average–again, averages are helpful, but not overly helpful in this scenario. But averages are high 150s in numbers of days to complete a claim. And by the way, if we need to seek additional information to get the yes for a Veteran, we will do that. We’re not gonna try to shorten the wait with a premature no. So, again, I’d urge those Veterans to go ahead and file a claim with us and let us go to work on this issue for them.

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

Terrence Hayes (VA Press Secretary):  Thanks, Lucy. And don’t forget, Lucy, also, because of the PACT Act in Section 103, not sure if this gentleman falls into that, but they may be eligible for care. And to those Veterans, we encourage them to seek enrollment in VA healthcare so we can take care of them. Next question, Patricia.

Patricia Kime (Military.com):  Thank you for doing this. Mr. Secretary, a question about–I don’t want to get ahead of the letter that Senator Elizabeth Warren wrote you about disability exams, C&P exams, but I am curious, we’ve heard from Veterans that the C&P exams are kind of cursory at best and at worst, the contractors have strung out appointments across multiple appointments because it’s our understanding that they actually get paid by the appointment, which is an inconvenience to the Veteran. So, I guess I’m trying to figure out what is going to be your response to Senator Warren? And are you looking into the contractors and these exams?

Denis McDonough (VA Secretary):  Yeah. Thanks so much. I will reassure you and through you, Senator Warren, that we won’t give our response to her, to you. So, nevertheless, this is an issue that we’ve been focused on. I’ve talked about it with you guys in here about quality. Josh, I think, talked about this with you guys in some of his monthly press conferences. We are tracking quality very closely, and we’re going to make sure that we hold contractors accountable to their commitments on quality. And I can say that last year, we did have, I think, 15% more completed C&P exams than we’ve ever had. That’s positive, but only positive if it also is correlated with high quality reviews and so we’re going to stay on top of this. We’ll make sure that we report that out to you and to Senator Warren and to our Veterans, so that they have confidence that these contractors are held accountable to the service that we’re paying them to provide, and that the Veterans get the benefits that they’ve earned.

Patricia Kime (Military.com):  Okay. And just one follow-up to Leo’s question. There seems to be some dispute as to how many Veterans may actually be affected by the Supreme Court ruling in favor of Mr. Rudisill. I think his attorney said 1.7 million Veterans. What are the numbers you’re looking at?

Denis McDonough (VA Secretary):  Again, I don’t want to put out any numbers prematurely because I’ve been reading your all’s reporting and I see a lot of numbers in there, including numbers attributed to us. So, when we have those numbers, we’ll get them to you. I don’t want to put another number out there right now. One. Two, though I also just want to say to Veterans, we really want you to get your benefits. And so, if you have questions about this, please be in touch with us. And as we, you know, each of the estimates I think are meaningful, but they’re meaningful for planning purposes principally. What we want to ensure is that every Veteran who wants access to the earned benefits, to his or to her earned benefits, gets them. And our commitment is to those Veterans to ensure that they will.

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

Denis McDonough (VA Secretary):  Thank you.

Terrence Hayes (VA Press Secretary):  We’ll go to David.

David Elfin (cyberFEDS):  Afternoon, Mr. Secretary. Within the last month, you guys put out information about the Veteran experience being enhanced by the employee experience, they kind of go hand in hand, and you talked about the reboot and things to combat burnout. But I wonder on the more positive side, are there things that–’cause the reboot is kind of combating bad things that are happening to employees. What on the positive side can you say about the employee experience that you guys are trying to enhance to help ultimately the Veteran experience?

Denis McDonough (VA Secretary):  That’s really interesting. I’m going to take a swat at this, but I think I might just ask Dr. Kelley to talk about that from his and maybe Andrea Stone to talk about this from their perspective. I’ll tell you what we see right now. We see what we call quit rates at historic lows. We see retention up. We’ve asked ourselves why is that? We have some data to suggest that the use of the CSI and other pay authorities, including–you know, the CSI is new, obviously in the PACT Act. Other pay authorities like relocation and retention bonuses are not new. We’ve had those for some time, but we’ve been more aggressive and more strategic about their use. So, we have some evidence that those are working. We have anecdotal evidence that providers, this is now on the VHA side, are coming back after, I think, really hard years for us in 2021 and 2022, for example, when the travel nurse companies were having a lot of success and hiring away talent with big hiring bonuses. But we have some evidence to suggest that some of those nurses are returning, and they’re returning because of our nurse to patient ratios. So, our practices. Now, I want to just hasten to say right now that we have not completely fixed our nurse staffing issue, although we’re up 10,000 over a year ago, and we feel quite good about those. And I’m not saying that our patient ratios are perfect in every facility. They are not. But our policies are clear, right. And our trends toward more patient centered care, which, as you just suggested in your question, is the flip side of the Veteran experience, is the employee experience in that regard. And so, the stress that comes with an individual nurse covering multiple beds in an ICU, for example, in the community is not matched in the VA system, where our patient ratios suggest that it’s a much different experience. So those are two things, I’d say. How we use the talent we have and then how we’re paying for the talent that we have. Mindful of that, of course, always our biggest draw is the mission, and we seek to be then to draw–we’re so on the upside on mission, we seek to draw even or at least competitive on things like salary. And these new authorities have allowed us to do that. But I don’t know. I think it’d probably be more interesting to hear from Michael or from Andrea on that–Mike or Andrea on that.

Dr. Michael Kelley (Executive Director for Oncology):  Yeah. So, I guess I have a much narrower view of VA because I have oncology every day all the time. So, I think from my perspective, there’s the mission, and I think that is a huge draw. We’re all focused on that mission and the quality of the experience that the Veterans are feeling and the quality of care that we’re delivering. And I think from a personal experience, I told the secretary this morning that I have the best job in the world. So that’s that. But I think from the–if we can’t deliver good care because our people are burned out, that’s the problem. I think that’s what you’re saying. You don’t have enough people. You’re too stressed, too thin. And we are intentional about ensuring that when we are assigning duties and managing people, that we do so in a way which maximizes the experience for Veterans. And that means not overextending the staff. Overextended staff are not going to be happy. We do a lot of telehealth now in oncology, and I think that is just one more additional draw for staff and physicians in particular to come to the VA. It is a health system that you can practice in that is comprehensive. It has comprehensive services. And I think when the applicant is looking for jobs in different environments and they understand the type of medicine that you can practice in the VA system, it’s a huge draw in addition to the mission. So that, I think is something which distinguishes us from maybe other health environments in that we’re not just doing one part of the care, we’re taking care of the entire patient. And for many healthcare providers of all ilks, that is a huge draw to be able to say, I’m helping patients, not only with my area, but I have someone else to help with the other patient’s needs that–the social work needs, the nutrition needs, all of these other ancillary services. We started a new cancer genetics service, best in class in the whole country, have been able to reduce the wait times from months to less than a few weeks now. And that’s because we’re able to work together as a team and to work to each other’s strengths. And yet as a team, as an enterprise, we are comprehensive and just the highest quality. So, I think VA is the best place to work. And I think many people who look at us carefully in terms of the quality that we deliver, objectively studied and scientific studies comparing what we do to everyone else in the country, VA does as well or better in many of those studies. And that is a huge attraction for many individuals who are looking for a great place to work.

David Elfin (cyberFEDS):  Sorry, Dr. Kelley, have you noticed any change over the last couple of years? I mean, are employees happier in your facility?

Dr. Michael Kelley (Executive Director for Oncology):  That’s a great question. We don’t actually measure happiness, but we do have an all employee survey where we ask a lot of questions that are sort of like happiness. And I would say that there really, in my little area of the world, it’s very stable, because I think we’ve been very effective in terms of what’s important for our employees. And are they happier? I think that getting by the pandemic, I think people are happier because we’re able to be together physically, at least part of the time. So that has been one aspect of care. But when we look at oncology care in terms of what we’ve done as a system, I think there’s a tremendous amount of enthusiasm because of where we’ve brought the quality of care so close to Veterans, and we’re going even further. So, I think from that perspective, there’s a lot of, not only happiness, but just mission enthusiasm to be able to say, yes, this is what cancer care should look like for everyone, and I want to be a part of this. So, yes.

David Elfin (cyberFEDS):  Secretary McDonough, I did have one somewhat related follow-up.

Denis McDonough (VA Secretary):  Yeah, sure. Let me just see–let’s just see if Andrea has something to add there. If for no other reason than I get to hear. You and I don’t have an accent, Andrea, but everybody else here does. But anything that you would add to David’s question?

Andrea Stone, LPN (Associate Chief Nurse for Specialty Care – Minneapolis VA Healthcare System):  I would just add that the mission is what keeps people here. It is so clear from the housekeeper to the physicians, to the leader of the facilities, there is no other place that you can work where we are unified in what we’re doing. And I’ve been here 34 years, and I would work no other place.
 

Denis McDonough (VA Secretary):  Awesome.

David Elfin (cyberFEDS):  Congressman Franklin from Tennessee put in a bill about VA personal responsibility act or something like–basically related to discipline. I wondered if you had talked to him, if you had any reaction to the bill, or are you disappointed that that bill was filed? Just didn’t know if you had any feeling on it.

Denis McDonough (VA Secretary):  I have talked to him, had a great conversation with him on the phone. You know, he’s on both the authorizing committee in the House and in the appropriate subcommittee in the House. I talked to him before the authorizers hearing. We had a great conversation. I did not talk to him about this bill, and I’ve not seen that bill. And by the way, I then had a good exchange with him in the hearing in the subcommittee on the appropriations subcommittee. He’s a Veteran himself, obviously, in a very Veteran rich district as well. So, what he thinks and what he experiences is really important to us. I haven’t seen the bill, and I will go look at it, and I’m sure Patty’s got thoughts on it and her team. But I would just say one thing here on accountability, discipline generally, my view is that I really want to get us to a position where we’re managing this big, highly effective, but not flawless workforce, and a lot of the statutory changes in the last several years have actually had us before administrative bodies, before the MSPB, before even federal court, rather than managing our workforce. And we’re really serious about managing here. And I just want to shout out a couple of our VISN directors for their very effective management, including of difficult situations. You know, I have two in particular in mind at the moment, David Walker in VISN 7 and Sunaina Giebel-Kumar in VISN 19, who have confronted very difficult challenges and have turned square into them to address those. And so that’s what we’re focused on. And we’ll obviously work with Congress as they consider new alternatives. But we really just want to make sure that we are able to manage in a transparent, professional way this workforce not find ourselves again arguing before the MSPB and the National Labor Relations Board and, you know, federal–the federal courts. We got enough work as it is.

David Elfin (cyberFEDS):  Thank you all.

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

Chris Arnold (NPR):  Hey, Terrence, thanks. Quil’s on vacation, so you guys are stuck with me. Just a quick question about the VASP rollout, as you might imagine, but basically, how’s it going? Is it operational? And do you guys think you’re going to reach everybody and help everybody who needs the help by the end of May when the foreclosure moratorium, for lack of a better word, runs out?

Denis McDonough (VA Secretary):  Yeah. Obviously one of our major priorities is keeping our Vets in their homes. That’s why Josh announced that we’re taking the steps to launch the VA Servicing Purchase Program, or VASP. It allows VA to purchase defaulted VA loans from mortgage servicers, modify those loans, and then place them in the VA owned portfolio for direct loans. This will allow us to modify loans to meet the needs of Veterans experiencing the severe financial hardship that you and Quil have done such a good job reporting on and helping VA borrowers who are experiencing severe financial challenges and are ineligible for other foreclosure support programs. So, I know many of you met with Josh to discuss this earlier this month. I refer back to what he had to say on this in terms of the status of the program, which we feel quite good about. And I just say one other thing, which is we are aggressively reaching out to affected Veterans. And that’s why we’ve wanted to roll this out as kind of transparently and as prudently but quickly so that we can ensure that we reach every Veteran before summer so we can make sure that we can address this. But this is one of the really great reasons I love having our monthly press conferences. Oftentimes, our best conduit to reaching Veterans impacted is through you all. And I have to believe that a lot of Veterans impacted by this set of challenges in the mortgage market are getting a lot of reporting from you, Chris. So, we hope that you’ll communicate to them that we do want to be in touch with them. And if there are Veterans who are still wrestling with loan challenges, that they contact us at 877-827-3702.

Chris Arnold (NPR):  I don’t know if you can answer this or not, but if it looks like you’re not reaching all 40,000 people or whatever that number is, as we get well into March, are you considering pushing back the date on the–on the foreclosure stop?

Denis McDonough (VA Secretary):  Well, if we’re not reaching Vets, then somebody’s ass is going to get chewed by me, right. So that’s the first thing, right. So, I’m watching this really closely. We’re watching this really closely. Congress is watching this really closely. And it turns out you and Quil are watching it really closely too. So, we’re going to stay on top of this.
 

Chris Arnold (NPR):  Okay. Thanks.

Terrence Hayes (VA Press Secretary):  Thanks Chris. Orion.

Orion Donovan-Smith (The Spokesman Review):  Thank you, Terrence. Mr. Secretary, I want to ask you about some of the sort of staffing stuff. There’s been some questions about VA’s overall staffing picture going forward, but as usual, I want to focus on the Oracle health EHR sites. Just to be clear, are those five or now six sites exempt from any requirements or directives that would result in an overall reduction in FTE in staffing from their current level?

Denis McDonough (VA Secretary):  That’s a fair question. Let me get–before I give you an. I’ve never thought about that question that way. So let me get you an answer.

Orion Donovan-Smith (The Spokesman Review):  Okay. There’s been some attention to that, of course, in Spokane, specifically in the past year, about a year ago, and ultimately the VISN 20 director flew to Spokane and made the–

Denis McDonough (VA Secretary):  Ultimately there’s been no reductions. Isn’t that what you’re about to say?

Orion Donovan-Smith (The Spokesman Review):  Orion Donovan-Smith (The Spokesman Review):  Well, that was the statement from Dr. Boyd at the time.

Denis McDonough (VA Secretary):  But the lived experience has been?

Orion Donovan-Smith (The Spokesman Review):  I’m told that there’s some question now about reductions given some of the communication from VACO in the past.

Denis McDonough (VA Secretary):  To date, so far this year, going back to, you know, you and I had this conversation a lot. There’s been no reductions to date, is that right? There is some questions going forward, you’re saying?

Orion Donovan-Smith (The Spokesman Review):  That’s my understanding.

Denis McDonough (VA Secretary):  Yeah, but the lived experience to date has been no reductions, isn’t that correct?

Orion Donovan-Smith (The Spokesman Review):  I don’t know of any specific reductions. Yeah, that’s fair to say. Okay. Thank you. Related to that, have there been–I think this is an easy one, but has there been an increase in staffing at the level FHCC around the go-live of the–

Denis McDonough (VA Secretary):  Yeah, there was–there–and I can get you the numbers on this, I think. I’ve not seen specific numbers, but there was an augmentation at–so an increase, at Lovell, and that began to be drawn down, I want to say now two weeks ago, maybe three weeks ago, but I want to not give you false precision so we can get you that specific experience in Lovell and whether we’re back to pre go-live levels there is the other question we’ll get you an answer on.

Orion Donovan-Smith (The Spokesman Review):  I’ll follow up with Terrence on that. I appreciate it. A little bit related to that, you said in your house testimony, I think it was a couple weeks ago now that it’s hard to run–I’m paraphrasing, but hard to run what’s both a direct care medical system, hospital system, and functionally an insurance company.

Denis McDonough (VA Secretary):  Right.

Orion Donovan-Smith (The Spokesman Review):  Obviously, VAs, we know that the portion of VA spending dedicated to community care has grown since the Choice Act and the Mission Act. Are the marching orders that Congress has given your department sustainable in the long run?

Denis McDonough (VA Secretary):  I mean, I think this is the issue we’re working through in the course of the last three years. And look, let’s take a step back and just look at, as I’ve said in this room, and I want to say one more time, Mission Act, followed quickly by the largest public health pandemic in the last hundred years in the United States, and by the way, globally, followed by the PACT Act. Each of those very significant moves impacting in a very significant way the statutory basis on which we provide care and kind of revolutionizing the way VA and the rest of the healthcare system in the United States functions, especially, as Dr. Kelley just said, with the provision of so much telehealth. So, we’ve worked through all of those things. And as we come out of those big changes and execute our mission, informed by those big changes, I think it is reasonable for us to stop and ask that question. So that’s what we’re going through right now, which is–and, you know, I’ve talked about this with you guys in this room. We’ve been looking at this question really since I arrived here, and we’re not at a point to draw any conclusions here yet, but I think it’s, you know, what do they say? The unexamined life is not worth living. But we can’t–we want to be intentional about the system that Veterans are relying on, and we want to make sure that we’re taking into consideration first and foremost, their needs and their lived experience. Two, we’re taking into consideration these monumental changes so that we, you know, Andrea has worked here for 34 years. What a blessing for VA, right. I want to make sure–I’m not going to work here for 34 years, right. I want to make sure that I pass on a VA that’s well-grounded and sustainable and able to continue doing exactly what Michael Kelley said, or Mike Kelley said, which is provide world class care for those Veterans without regard to all these other crazy things that the private sector has to deal with. So, I hope that’s responsive to the question. You asked a yes or no question. I’m not answering yes or no. I’m saying that we’re looking at that question, and I think Congress would expect us to do that. The OMB director and the president surely expect us to do that. Most importantly, Veterans expect us to do that, and that’s what we’re doing.

Orion Donovan-Smith (The Spokesman Review):  I appreciate the nuance. It’s more than the yes, no question. Dr. Kelley, I wonder if I can ask you something while you’re here. It’s nice to meet you. As you probably picked up on, I’m the guy from Spokane who asked about the EHR stuff. So, I hope you don’t mind me asking you that. [inaudible] Yeah. So, I understand that oncologists, both military and VA facilities, have raised some concerns about the Oracle health EHR with respect to chemotherapy and lacking, or it has lacked or continues to lack, I’m not sure, some of the safety features that are present in the Legacy EHR. I wonder if you’re aware of that. And if so, have those issues been resolved to your satisfaction?

Dr. Michael Kelley (Executive Director for Oncology):  All right, so thanks for that question. So, first of all, the EHR is a tool, and medicine is now a very important tool, but it’s still just a tool. And as my mentor from Minnesota told me, a good workman does not blame his tools. So, we still provide great care, even if the tool is not quite honed. And even our own homegrown CPRS system is not perfect. It has limitations. So, I think what I understand from talking to my DoD colleagues is they have fully implemented oncology, Cerner, Oracle, whatever name we’re giving it now and throughout their entire system, and they are pretty much up to speed on providing that care in a way which is approaching the efficiency that they expect it to be able to get to. We talk to the DoD on a regular basis. I’ve spent a lot of time on VA’s design and implementation of the oncology package from Cerner. It works pretty well in Columbus. FHCC has also launched, as you know, and that went off without a peep. I think I heard one minor tweak that they wanted us to make or consider making, and so they seem to be going quite nicely. Spokane was not a oncology practice when Cerner came to them, and I think they, you know, they hired the oncologist the day–the week before they went live in Cerner, and that, I think, created a situation which everyone would agree was not ideal. And so now, a few years later, it’s time to get them going. I’m actually flying out there in a week or so to spend a few days, and we’re going to go through it side by side to make it work, and I’m confident that it can be done. There is complexity to cancer care, and it’s not just the chemotherapy ordering. The chemotherapy ordering, I think, works fine. It’s not perfect in terms of the first usage. You do have to be cognizant of every aspect of the order to make sure that what is actually the final product reaching the patient is exactly what the physician intended. You do have to be open to that because there are a lot of different controls and connections that have to be made appropriately. I’m not going to go into the technical terms, but probably have you talk to the oncology Oracle team for VA. But the ability to be able to treat patients there requires additional services, medical services, not necessarily Cerner services that are not necessarily available on-site. So, the complexity demands great care coordination, and that is not a tradition that they have at that site. So that I think, to me, is more important. And again, this doesn’t have anything to do with the tools. It has to do with how do you communicate with services that are being purchased outside the VA that are an essential component of many patients in cancer care–PET scans, radiation oncology, surgical specialties, interventional radiology, and many other services that aren’t available at Spokane that you have to coordinate care with. We do this at other VA medical centers, but they have a tradition of doing that, and they’ve worked out all the processes to do that. So, to me, it’s not the tool per se. It is the entire package. The tool is part of it. And I’m confident that we can provide comprehensive care to most Veterans with a cancer diagnosis at Spokane, but we have to get it going now.

Orion Donovan-Smith (The Spokesman Review):  You say most Veterans in Spokane. Would those others be referred to the communities?

Dr. Michael Kelley (Executive Director for Oncology):  So, there are some types of cancer diagnoses and patients that we cannot care for in the VA, and that’s true at every VA. So, we only do stem cell transplants at two medical centers. So many of those patients end up going to the community instead of those two medical centers. There’s some advanced technologies that are out there. CAR-T cells, which is a cellular therapy only available at one VA, bispecific antibodies, which are CAR-T like maybe, if you want to–I don’t know what your background is, but they are immune therapies that are able to have some of the advantages of CAR-T cells without quite the same level of toxicity. Those are coming out in more and more diagnoses, but those we think we can do at many more medical centers. But I wouldn’t do that at Spokane right now.

Orion Donovan-Smith (The Spokesman Review):  I see. Well, my background is definitely not oncology.

Dr. Michael Kelley (Executive Director for Oncology):  I can talk to you more about that.

Orion Donovan-Smith (The Spokesman Review):  I appreciate the detail. Just one last follow-up on that, and I’ll let you go. You mentioned that the launch at Lovell FHCC went off without a hitch. Is that to say that there were–there’s no effect on oncology there as it’s been practiced, or just no errors or patient safety reports?

Dr. Michael Kelley (Executive Director for Oncology):  My understanding is the former is that they have really not missed a beat. Now, I don’t know all the ins and outs of it, but my role is not to actually be involved in that actual launch. But I’m one of the members of a group that helps design the oncology product. So, we provide the subject matter expertise, we don’t actually make the changes in the EHR system, but there’s this oncology workgroup within the ambulatory counsel. So, if you are familiar with the VA structures for this, there’s these counsels, and there’s the oncology group within that. So, we’ve–I think since 2017, we’ve been working to design this with the DoD now, right. So, we designed the oncology product in sync with the DoD. There’s a group called the FOG, the federal oncology group, or something like that–workgroup, I think it is. So, what we’ve designed in VA is almost identical to what DoD has. So, the power plans, which are these chemotherapy regimens that indicate which medications you give in which order, and what doses for how long you infuse them, et cetera, and what other ancillary medications you give to prevent side effects, we’ve designed those together. And so, if they work in DoD, if they don’t work in VA, it’s not because the power plans are defective or designed improperly, it’s because the connections to the rest of the Cerner system haven’t been connected quite for that particular site. And that is something that you have to pay attention to as you activate each new site. But it’s not the power plans themselves and it’s not that you can’t make the system work for you, it’s that you have to work at it in order for it to be effective. And part of it is also just learning the keystrokes. I can do CPRS with my eyes closed because I’ve been doing it for decades, but I can’t do Cerner with my eyes closed. I have to have them wide open and I have to look at every icon on their screen because they have a lot of icons on their screens but the people who are used to it, they just breeze right through it. So, it’s going to take some time for us to learn that, you know, the muscle memory to be able to use the system efficiently.

Orion Donovan-Smith (The Spokesman Review):  All right, I really appreciate the chance of talking. Thank you.

Denis McDonough (VA Secretary):  Wait a minute. Did you see what happened there? He’s like, before I let you go, you don’t get to let him go. That’s my job, man.

Terrence Hayes (VA Press Secretary):  Jory.

Jory Heckman (Federal News Network):  Good afternoon. Thanks for doing this. I wanted to follow up with some consistency reviews that I understand are happening for some VA positions. And I understand that at the direction of the Office of Personnel Management, VA is looking at a handful of positions, industrial hygienists, boilerplate operators, some other folks in there. But I understand the universe of folks is about 4000. Terrence, I know you’ve answered some of my questions about this and the timeline we’re looking at is at the end of May. You guys are going to have that to OPM, but I wanted to follow up and learn a little bit more what are you guys communicating to VA employees about this? In what ways they might potentially be impacted and kind of some next steps?

Denis McDonough (VA Secretary):  Yeah, I think it’s like a great question and I appreciate you asking it, but I think probably the better way to ensure accuracy is not for me to answer it. Why don’t we set up a separate briefing with Tracy and Assistant Secretary of Law? I know we’ve been talking with our labor partners on it too, so if you’re okay with it. I’m not trying to duck it. I just am not confident that I’d be–

Jory Heckman (Federal News Network):  Excellent. Changing gears, I want to circle back to, I believe it was last week the White House had a ceremony working with DoD and the State Department expanding domestic employees teleworking overseas. Obviously that is a program that DoD and the State Department have had for a while, but just considering VA and having some potential overlap there, does VA have a DETO program and if not, are there plans to expand this under the memo that we saw?

Denis McDonough (VA Secretary):  So, do we have a program to allow telework from overseas?

Jory Heckman (Federal News Network):  Yeah. Yeah.

Denis McDonough (VA Secretary):  So, we don’t currently. But coincidentally, I just heard from a VA provider whose spouse just got PCSd to Europe. That provider really wants to continue to provide care at VA. So, we’re looking at that. I think you all have seen our announcement last month about our commitment to active duty spouses. I think this is going back to Chairman Mason was a very high priority for VA to hire military spouses. That’s continued to be a high priority for us, including because of our chief of staff and her personal experience as having worked overseas–teleworked overseas at DoD, and her own experience as a military spouse. So, we’re looking at the question. We don’t–our review on this is relatively new, so we’ll keep you updated on it. But look, when we got an employee who wants to stick with us, we want to figure out a way to do that. Of course, we have to do that consistent with our future of work policies and plans. And so, as we develop this, we’ll make sure that we keep you in the loop. Lastly, as it relates to last week’s announcement, there was not a VA component of that announcement. So, I think that’s specifically a state DoD thing. But we have a lot of Veterans who are currently deployed overseas as state department employees, as DoD employees, and we are also looking at innovative arrangements to get them, for example, access to C&P exams overseas and access to tele-mental health from overseas. So, as we make progress on that, we’ll let you know, too.

Jory Heckman (Federal News Network):  Okay. And then just following up real quick, your opening remarks about, or, I guess, your responses to David’s questions about how the CSI and some other incentives that they’ve really been driving up their intention, that people are staying, and they’re satisfied with the job. I believe, at least for some portion of the SSRs, that there’s a deadline, and then that expires in 2027. I know that’s some ways away, but as far as opportunities to re-authorize that or re-up that, are you guys looking at that? [crosstalk] or was that an option that you guys are able to–

Denis McDonough (VA Secretary):  No. Yeah. No, no, definitely. We’re looking at it. You know, many of these authorities do expire in 2027, because we got them in the PACT Act as a five year test. And this is one of the things I’ve said to you guys is really important to me, is one. First and foremost, I’m focused on how do we keep our awesome providers, our awesome workforce, because that’s what’s in the Veterans best interest. Secondly, I’m also mindful of the fact that we alone among the federal agencies have these tools. So how we do the–how we use them will impact whether other agencies get them and will impact whether we get them extended. And so that’s why we’re trying to do this as prudently as we can, notwithstanding the overwhelming interest in trying to invest in our workforce to keep Veteran satisfaction at that kind of high level that we’re seeing. So that’s why we’ve done like a hard look at CSI performance in the field, right. And we’ve seen those–I’ve seen versions of those numbers. And at the right period, you know, when that’s completed, we’ll make sure that we release that data to the hill and to VSOs and to you guys so you can get a window into how we use that. And one of the reasons we wanted to do these reviews is we are approaching, you know, we think that we got to make a next set of decisions on some of these tools. On some of these tools sometime in May is what we’re looking at. So, I’m sure we’ll keep you up to date as we roll that out. I hope that’s responsive, Jory.

Jory Heckman (Federal News Network):  It is. Yeah. Thank you.

Terrence Hayes (VA Press Secretary):  We’ll go to Ellen. How are you, Ellen?

Ellen Milhiser (Congressional Synopsis):  Hi.

Terrence Hayes (VA Press Secretary):  Thanks for joining. I know earlier you weren’t sure if you’re going to be able to join, but glad to see you today.

Ellen Milhiser (Congressional Synopsis):  Well, I’m still in the hospital hallway, but anyway, just a really fast question. The Closer To Me program, do you have any idea what parts of the country those additional clinics will be in and the additional personnel for those, how does that fit in with the reduction in the VHAs healthcare workforce?

Dr. Michael Kelley (Executive Director for Oncology):  Yeah, so thanks for those questions. I’m sorry that my answers won’t be quite as clear as your question. So, for the first part of it, where geographically will these be located? Those are still being worked out with the sites. There have been very advanced discussions with several sites, but they’re not quite finalized, so we’re not quite announcing that yet, but we will publish those soon, we hope. The majority of patients that we think are located in areas that would be best served are in areas that have a little more rurality to them, as you might guess. But there’s also a number of other geographic considerations and just the local geographic issues about transportation. So that’s not an answer for your clear question. I apologize for that, but we’ll get it to you.

And then the second part of your question is how does this comply with the no hiring staff? So, there is a discussion about how this will work that is, again, also quite advanced in terms of its discussions. There is a rationale for improving quality, improving access, and reducing costs, as I mentioned. So those are sort of like the triple win for everyone involved. And so that’s a very strong argument. And we think that what will happen is that there will be some waiver of the requirement around the FTE ceiling that has been used to try to control costs going forward. That has not been established, so I don’t want to say that too loudly. And so, we’ll get back to you on that as well. But everyone understands that this is the right thing to do for Veterans. And I think that how we get to that in terms of those staff, that is not my area. So, I can’t tell you exactly how that’s going to happen.

Denis McDonough (VA Secretary):  I can add to that. So, Ellen, thanks for joining. And I’m sorry you’re in a hospital hallway. So, as we’ve said all along that we’re going to continue strategic hiring, right. And so obviously, mental health–we routinely cite mental health as a high priority strategic need for VA. I shared the story of my recent testimony of a recent conversation with Wendell Jones, who’s the VISN director down in 17, and with his conversation with Dr. Julie Flynn, who’s the VA medical center director in San Antonio, and a recent decision she made to hire two GI experts. She’d been searching for them for three years. And so that’s an example of strategic hiring that we’re going to make sure that we’re in a position to do even as we wrestle with the real implications and the real tradeoffs of the budget cap and the budget agreement. You know, and that’s why–that’s why we go through this exercise every year of preparing the budget, submitting the budget, making it public, making sure you see our homework and you can follow along with us as we make these decisions and these tradeoffs. And so, we’ll continue to do that here, including on decisions like these around closer to me. Does that answer the question?

Ellen Milhiser (Congressional Synopsis):  It absolutely did. And just one real fast follow-up. When deciding the new clinics to go to with the Closer To Me program, is there a goal of how many patients will be receiving care at each location? And what happens if the number of patients drop and you go from treating 30 patients to 20? Do you just stop the services at that point?

Dr. Michael Kelley (Executive Director for Oncology):  Yeah. So, it’s a great question. So, we have looked at every medical center in the country and did an analysis of how many patients we could serve and then, of course, what the associated cost savings would be and the cost to invest in that particular area. So, we’ve done that modeling across the entire country and we’re working with those that are at the highest level of return in terms of impact on Veterans. So, the number of Veterans served. Our estimate right now is 300 patients per medical center. So not necessarily at one of their clinics, but at some maybe collection between one and maybe four or five. And you heard from Andrea that in Minneapolis their number is even larger than that. So that will be about 300 per site, and that’s 30 sites, that’s 9000 Veterans. The financial payback comes way below 300, well below 100 even, to staff the clinic and the operations that are going on for the infusions. When we add in the other staff to provide the visit and the provider role, to be able to do the diagnosis and treatment planning and write the orders, it’s higher than that, but it’s still significantly below 300. So, we think that even if that original projection of 300 Veterans doesn’t prove out to be exactly correct, that it will still be feasible to do that. So, we don’t know how low we can go. I think that’s a great question is where is the breakpoint? Because there is a breakpoint at some place where it doesn’t make sense and we actually looked it up from the bottom as well as we have identified some sites where we don’t think this is a good model to use because there just aren’t enough geographically concentrated Veterans to be able to do it even in really service-oriented model like we’re proposing. But I hope that answers your question that we don’t think we’re going to back away once we get this up and going.

Ellen Milhiser (Congressional Synopsis):  Thank you very much.

Terrence Hayes (VA Press Secretary):  Caron. Good afternoon.

Caron Lenoir-Kelly (NBC Universal):  Hello. Good afternoon. So good to see you.

Terrence Hayes (VA Press Secretary):  Good to see you.

Caron Lenoir-Kelly (NBC Universal):  So, I have a question about with the expansion of so many–so much care in the VA system and so many new Veterans that are coming into the VA system, are there any plans or changes to the level of service they receive or to peer support? I know a lot of things are going towards telehealth as well, but will there be an expansion in peer support?

Denis McDonough (VA Secretary):  Yeah. Thanks so much. I mean, you know, I was just in VISN–nice to see you. I was just in VISN 12 yesterday. And it’s really exciting to hear from their outreach team that they’ve had a net increase of about 10% additional unique patients in the VISN 12 system. That’s Illinois and parts of Wisconsin and the upper peninsula of Michigan. And so, you’re right that there is growth. And we announced, obviously, you know, 400,000 additional enrollees last year, which is a 30% increase over the year prior. And we saw increases in new, unique Veterans in all 50 states. So, we have pared that in our kind of in our budget development and in our discussions with you all in this room, and then our discussions with Congress, with our increased focus on access. We briefed out those access sprints, of course, and we think that we’re in a really good position to meet the needs of those new Veterans. And I said this in testimony in both authorizing and appropriations committees in the House, that we are not asking for a second bite for our FY ‘25 numbers, but because of this aggressive outreach, 550 outreach events this year, if because of that–in the remainder of this year, by the way–if because of that we get so many new Veterans that we need a second bite, then we’ll ask for it. We won’t be shy. So, period. Next paragraph.

Peer support is something that we have, over the course of the last couple of years, increased reliance on. We have about 1900 peer support specialists now in VA, and those are overwhelmingly in and around mental health support and substance use disorder support. And so that number has been growing because of a need for support and substance use disorder and mental health, but also because of the well-established impact of that programming in that model, which is, in a large measure–it’s based on a lot of different things, but in a large measure based on the mentor-mentee relationship associated with Alcoholics Anonymous. And I’ve said to you all that I’m very familiar with that methodology and that practice. And it’s overwhelming success, not 100% success, of course, but overwhelming success over the course of many years. And so, I guess what I’m trying to say, Caron, is I would slightly disaggregate the two questions, meaning, yes, you’re going to see more peer support specialists at VA, because we think that’s a proven model that augments our other mental health services. And it may, in fact, be that we accelerate it even more if we end up seeing even more additional unique enrollees. But that’s not currently in the cards. We’re just investing in that methodology and those people because it’s awesome and proven. And when you meet these guys, as you and I did with a couple of them in Philadelphia a couple weeks ago, you see why it’s so awesome. These are guys who have fought through recovery themselves, Veterans looking out for their brothers and sisters in arms, and it’s awesome. In fact, I say all the time, there’s nothing more awesome than watching Veterans helping Veterans and the peer support specialists do that.

Caron Lenoir-Kelly (NBC Universal):  Another question I have is I’m wondering if there’s any specific outreach to women or for women who may have experienced miscarriage and infertility and maybe have not connected the dots to toxic exposure. Is there any specific outreach to women who have lived through those experiences?

Denis McDonough (VA Secretary):  So super–super good question. So I was just in Chicago, Illinois yesterday. It’s a great city. It’s not as awesome as Minneapolis, but I was there for a women Veterans resource fair, and I also did a roundtable with women Veterans and women Veteran VA staff members, and it was excellent. The resource fair included opportunities for women Veterans to talk with our gender specific care teams. And so, I cite that as an example of outreach to women Veterans about reproductive health issues. Period. Next paragraph. But you’re asking specifically about outreach around miscarriages. I can double check this, but I don’t know that we would have that kind of data about a Veteran’s experience if she weren’t already in our care. What we are trying to do is to say to women Veterans, we do offer the full suite of care for women Veterans, and most importantly, as Dr. Kelley said, we coordinate that care. So, we provide pre-delivery care coordination, maternal care coordination, and post-delivery now for a year care coordination in VA. So, we want to make sure that all of our women Veterans know about that, whatever their personal experiences are.

Caron Lenoir-Kelly (NBC Universal):  I have a quick follow up for the oncologist, if I could. What do you think would be the best way to quickly connect Veterans to conditions that are related to PFAS?

Dr. Michael Kelley (Executive Director for Oncology):  Great question, but it’s probably not for me because I think that’s a benefits question. So, I will defer to the secretary.

Denis McDonough (VA Secretary):  Yeah, I just say what I said to Lucy, Caron, which is, please be in touch with us. If you’re a Veteran in that catchment area there in Pennsylvania that Lucy was referencing, please call us and you can do that at 1-800-MYVA-411 and we’ll get you connected to the claims filing process and then we’ll get into that. Okay.

Caron Lenoir-Kelly (NBC Universal):  Thank you.

Terrence Hayes (VA Press Secretary):  Eric.

Eric Katz (GovExec):  Thank you for taking the question. I wanted to follow up with the response the secretary gave to Orion. If I understood correctly, you were saying that you were engaging in a review of the sustainability of the Mission Act and community care. I’m wondering, what are the possible outcomes of that review? If the review comes back that you’re–that it’s not sustainable, what do you do? What’s the next step?

Denis McDonough (VA Secretary):  Yeah, well, I want to not, like, give you the impression that we have a team that’s got the pencil sharpened and we’re looking at sustainability. Every year we develop our budget for the next year. Part of the budget development process is looking at what we’re experiencing and how we’re caring for our Veterans. And I’ve been saying to you guys since I arrived here that community care has been growing at an average of about 15% a year. We also explained to you guys that at the second half of last fiscal year, we saw a significant increase in use of referrals to community care. But the review isn’t on the Mission Act. As we develop our FY ‘25 budget, as we prepare the FY ‘26 budget, we’re looking at these overall sets of questions to ensure that we have the staffing and the care provision, including infrastructure, in place to fulfill not just the Mission Act, but the Mission Act, plus the way healthcare is now provided post-pandemic, plus the number of new Veterans that we’re getting in response to PACT Act. Let me give you an example. There’s now 17% more Veterans. I think that’s the number–17% more Veterans with 100% service-connection as a result of the PACT Act. What does that mean? Well, that means a lot of things, but here’s two things that it means for sure. Increased access for dental for Veterans. Because how do you get dental in VA? If you have a specific service-connection to your dental health and/or if you’re 100% service-connected. So, we now have a lot more Vets who qualify for dental care, right. So, if there’s going to be a lot of places where that will mean increased referrals for dental care into the community. So, we have to make a decision about that. Do we want to, and are we in a position to invest in more dental chairs and more dental hygienists and technicians and dentists, to meet that increased demand? Or would we make a decision to refer that out as more of a matter of practice? Right. Secondly, the 17% increase in 100% service-connection means greater access, ultimately, to long term care, right. Which is a big challenge for us right now, which happens to be a big challenge for the entire American healthcare system as we continue into the silver tsunami, as we’re referring to it, right. So those are two very interesting questions for us to resolve as we plan for our budget and as we think, okay, as we do two things, we either purchase the care for the Veteran in the community, or we ensure that we have all the capacity in-house to provide that care in-house. That gets more and more difficult when more and more Veterans are referred into the community and referred in the community, for example, as I’ve now testified a couple times, because in VISN 7, 70% of Veterans are referral qualified from the first instance because they live so far from a VA facility. Incidentally, they live equally far from private sector facilities. So, when we refer them into the community, are we doing them a service or are we just leaving the impression with them, as many get the impression, that we’re urging them to go to the community rather than staying with us? So those are questions that we’re wrestling with. Does that make sense to you? So, now are we going to prejudge the answer to those questions? No. But we’re going to discuss these as we do all questions around here, very candidly, you know, and, you know, we’ll have multiple inputs to that process. Congress and its views is obviously one of those. And you heard some of that in the House last week. I anticipate hearing more from the Senate next week. And then obviously OMB has views on that and the president has views on that, as does the domestic policy counsel in the White House. Important context for this whole discussion is the debate that I think each of you is reporting on. But I’ve heard a lot of reporting from Chris and Quil, which is what’s happening in the Tricare system at DoD, right. That’s lived experience where DHA moved a lot of care into the community. I think there’s some frustration among beneficiaries at the moment that there’s not sufficient care in the community where they’re need it. And as a result, there’s also some frustration that there’s not as much care in the direct care system over there as beneficiaries might like. That’s also informing our review now–or our ongoing efforts to make sure we’re budgeting in a sustainable way for the Veterans who are coming into VA.

Eric Katz (GovExec):  All right, thanks. I’ll forego my follow-ups.

Denis McDonough (VA Secretary):  Great. Thank you. Did you see that judiciousness, you guys?

Terrence Hayes (VA Press Secretary):  That was pretty awesome. I think this concludes today’s press conference. I don’t want to hold–

Denis McDonough (VA Secretary):  Can I just make one point?
 

Terrence Hayes (VA Press Secretary):  Okay.

Denis McDonough (VA Secretary):  Okay. So, I hope you guys recognize one thing, which is, I think it’s awesome that Andrea and Michael come join us and that our practitioners come join us every month. It’s really awesome. Michael only agreed to come up here if he could still see his patients, which he did this morning, telehealth, which is pretty awesome. Andrea is still working, but I was also sitting here thinking, here’s Mike answering questions on Cerner oncology, which isn’t what we asked him to come up here to do, but I gotta say, I think that was pretty awesome, right. And I hope you guys know how much we appreciate the seriousness with which you engage our providers. And I hope you also recognize that, you know, we do this because we want you to see how awesome these guys are, you know. And by the way, you know, it was Terrence’s bright idea to have these guys up here. If we knew that Orion was going to press him about oncology, we’d have said, no, you’re not coming, man. I’m just kidding. I think it’s a really cool thing. So, I really appreciate that. But I appreciate you guys doing it too. So, we’ll keep doing it until somebody screws it up. Thanks.

Terrence Hayes (VA Press Secretary): Appreciate y’all. See you next month.