VA Secretary Press Conference – April 27, 2023

Terrence Hayes, VA Press Secretary: Good afternoon, ladies and gentlemen. It’s great seeing you all today. Before Secretary McDonough steps to the podium, I wanted to share a couple items with you. First, we continue to process claims and conduct toxic exposure screenings for thousands of Veterans across the country. I am personally encouraging all my fellow Veterans who may have not received a toxic exposure screening since President Biden signed the PACT Act into law to please learn more at va.gov/pact [Link: www.va.gov/pact]. The toxic exposure screening is easy. I did it myself, and it has resulted in follow-up testing at my local VA medical center. My hope is you’ll get your screening as well. Second, we’re almost at the one-million mark for the Million Veteran Program. The Million Veteran Program is a national research program looking at how genes, lifestyle, military experiences, and exposures affect health and wellness for Veterans. Since launching in 2011, more than 950,000 Veterans have joined MVP. As a member of MVP myself, I’m asking Veterans out there who may want to join this effort to visit mvp.va.gov [Link: www.mvp.va.gov]. Okay, that’s all from me for now. I’ll now step aside and turn the floor over to Secretary McDonough.

Secretary Denis McDonough: Terrence, thanks very much. Nice to see everybody. Let me begin by sharing the story of one of the Vets we’re privileged to serve: Van Rich. Van has one of the most unique stories I’ve heard in a while. He served in the Navy, the Navy Reserves, Air Force, and the Air National Guard. Van deployed to Southwest Asia seven times over the course of his 35-year career. 35 years, seven deployments, two different branches, two different reserve components. He was a member of air search and rescue units, saving the lives of his fellow sailors and airmen. While he was doing that for us, Van was being exposed to toxins. Van remembers seeing the ground change colors as different toxins seeped across the topsoil from the burn pits nearby. Because of that toxic exposure, Van developed what are now presumptive conditions covered by the new toxic exposure law, and as a result, his conditions are now service connected. For Van, the retroactive and monthly toxic exposure benefits are what he calls a big step forward financially and, in his words, a blessing. While I appreciate that sentiment, it’s not a blessing. It’s what this country owes Van. It’s what he’s earned and what he so richly deserves for so courageously serving and sacrificing for this country and for all of us. So, that’s what we do here. Let me tell you for a moment about one person who does it. Rochelle Montanona, a rating Veterans service representative in our Seattle Regional Office, having served Vets for nearly 20 years. Her dad fought three tours in Vietnam. Both of her brothers served in the Army. That tradition of service runs in her family. Now too long ago, Rochelle was reviewing a claim from one of her dad’s brothers in arms, a Vet who was stationed in Thailand during the Vietnam War and who kept missing his doctor’s exams, and Rochelle needed that exam to make sure the Vet got the right rating. She emailed him. She called him. No answers, so she started calling numbers on his emergency contact list and finally got an answer. Because she wouldn’t give up on him, the Vet made it to his exam. Because she wouldn’t give up on him, the Vet got the rating he deserved. Because she wouldn’t give up on him, the Vet is now getting the VA care and benefits he earned and so richly deserved, just like Van. Rochelle sees the new law for toxic exposure as a real game changer for these Vets, and she’s right. Now, I’m honored to introduce today’s guest speaker, Josh Jacobs, VA’s newly confirmed Under Secretary for Benefits. Now, I want to draw your attention to one, actually, to three facts. Fact one, VA hasn’t had three concurrently serving, Senate-confirmed under secretaries since May 2014. May 2014. In 2014, the VA budget was 154 billion dollars in discretionary mandatory. In 2023, the VA budget is 309 billion dollars. An increase in that period during which we did not have three concurrently serving, Senate-confirmed under secretaries of 155 billion dollars, or 101 percent. In terms of personnel, in 2014, the budget supported approximately 319,000 people. In 2023, the budget will support approximately 434,000 people, an increase of 115,000 personnel, so it’s critically important that we have confirmed personnel in these jobs, so we really appreciate our partners’ work on Capitol Hill to get Josh into this fight as the Senate-confirmed Under Secretary for Benefits. Josh, over to you, brother.

Under Secretary Josh Jacobs: Thanks, Terrence, and thanks, Secretary McDonough, for your kind words and for placing your trust and confidence in me to serve as Under Secretary for Benefits. Today, I want to spend a few minutes to update everyone in the room on the tremendous work and the progress underway in VBA on behalf of our Veterans, families, caregivers, and survivors. As you know, VBA set a record last year when it completed over 1.7 million claims, which beat the previous year’s record by 12 percent. We’re halfway through the fiscal year, and we’re on track to break that record again this year. We’ve completed 14 percent more claims today than we did at the same point last year. We’ve completed over 8,000 claims in a day 39 different times this year. That’s something we’ve only done six times in the rest of VA’s history, and just last week, we completed over 9,000 claims in a single day, the first time ever in VA’s history. Two weeks ago, we processed our one-millionth benefits claim a month earlier than the record we set last year. Thanks to our aggressive hiring and our planning for workload management, our backlog remains under 27 percent of the total inventory at 213,000 claims as of close of business Saturday. As a result, we’re delivering nearly three billion dollars of benefits to more than six million Veterans, their families, and survivors, and we’re doing everything we can to reach out to more Veterans so that they can get access to the life-changing benefits that they’ve earned. Yesterday, we announced that Veterans have filed over 500,000 claims for toxic exposure-related conditions under the PACT Act. We’ve completed more than 241,000 of these claims as of this week, and we’ve awarded over a billion dollars in earned benefits as a result. Thanks to the PACT Act and our proactive outreach efforts, we’ve received 31 percent more claims this year than we did at the same point last fiscal year. That means more Veterans and their families will receive an extra bit of financial stability. Many will receive it when they may need it most, and some will gain new or increased access to health care or realize their dream of earning a college degree or even purchasing a home with their earned benefits. So, we’re really proud of the role that we play at VBA in helping Veterans, their families, and survivors reach their goals, whether they’re big or they’re small, and we’re on pace to achieve so much more. Our loan guarantee service is nearing the historic milestone of delivering the 28-millionth VA-guaranteed home loan in the coming weeks. Education claims are being processed on faster timelines, and the new technology that we’re rolling out is making enrollments easier than ever. Our insurance service is now the twelfth-largest life insurer in the United States, and we’re continuing to expand after launching the new VALife program. Delivering these benefits and more to our Veterans wouldn’t be possible without our people, so to help meet our increasing demands for VA benefits, we’ve been aggressively expanding our workforce through hiring fairs and through other avenues. Over the last couple of months, VBA held hiring fairs in eight regional offices. We had over 2,800 attendees and almost 1,100 same-day job offers. As a result of this aggressive hiring, our total workforce has now over 28,000 VBA team members. It’s the largest VBA has ever been, and it’s the highest growth rate in over a decade at 15 percent in the last year and a half. This growth is what’s allowing us to deliver more benefits to more Veterans than ever before, and while we continue to focus on increasing production and improving the quality of our claims decisions, we’re also working with the Veterans Experience Office to look at how we can improve the Veteran experience throughout the disability compensation process. So, tomorrow, for the first time ever, we’re sending out customer experience surveys to Veterans who participate in the disability compensation process, and we’re going to work with our VEO partners to turn these key Veteran insights into tangible actions that improve the Veteran experience. Finally, I want to encourage all eligible Veterans and survivors to file PACT Act claims as soon as possible. If you apply for a PACT Act-related benefit on or before August 9, 2023, your benefits may be backdated to August 10, 2022, the date the law was enacted. If you’re not ready to submit a claim by then, don’t worry. You can also submit an intent to file before August 9 and still potentially receive that earliest possible effective date. So, please visit va.gov/pact [Link: www.va.gov/pact] or call 1-800-MyVA411 and press 8 for more information. I’m really looking forward to continuing to serve Veterans in this role and building on the past successes of these past months and years, and with that, I will turn it back to Terrence and open it up to questions.

Terrence Hayes, VA Press Secretary: Thank you, sir. I will take questions. We’ll start off with Leo. He seemed to call your confirmation before we knew.

[Laughter]

Leo Shane (Military Times): Appreciate that. Question for both Mr. Secretary and Mr. Under Secretary. In reference to those surveys, how will that data be used, and what kind of data are you pulling from these folks? Is it just a “three quick questions,” or is it a more comprehensive look at what went there?

Under Secretary Josh Jacobs: We’re working with our VEO partners to deploy what they call the VSignal survey, and we’re looking to capture both qualitative and quantitative data. The survey contains 13 questions. It’s going to ask about their filing experience, organizational and platform support they use, whether they’re doing it online or through paper, the communication touch points, and what level of trust Veterans had throughout that process. The goal here is to take that information and identify both the pain points and the moments that matter so that we can use that information to drive actionable improvements to build trust because we know that VBA and the claims process is often the first point that a Veteran engages with the department, and it can be the difference between whether or not they decide to pursue the additional earned benefits or access health care or not. So, we’re going to take both the qualitative and the quantitative data that these surveys will provide, along with some of the human-centered research that we’ve already completed, and we’re going to take that and drive specific projects to make tangible improvements to the overall process.

Leo Shane (Military Times): And Veterans who are receiving this, will they be getting it through email? Will they be getting through the mail? What should they be looking for in the next few days?

Under Secretary Josh Jacobs: I believe it’s email.

Leo Shane (Military Times): Okay, and then just one other quick question. I believe you said it was a 31 percent increase in the number of claims that you received up to this point this year. The hiring numbers you said, obviously those folks are going to take some time to load on and get through the whole process. Are you concerned about the issue of burnout at this point with the amount of work going in, with the amount that you’re demanding from staff to get through to try and pull down that backlog?

Under Secretary Josh Jacobs: Yeah, so, I’ve been traveling to various regional offices over the last several months, and every single office that I visited, I have been incredibly impressed by the talent, the dedication to the mission, and the ability to deliver outcomes. The last two years, we’ve broken all-time production records in VBA’s history, producing more claims, delivering more benefits to Veterans than ever before, and our employees are increasing productivity. They are delivering more benefits per person than ever before, and they’re doing that while the total amount of claims is increasing, and they’re being asked to process in a very new way. The PACT Act is incredible, but it’s changing the way that we operate as an organization, so I am concerned about ensuring that we take care of our employees because when we take care of our employees, they can take care of Veterans. So, we’re actively looking at ways that we can protect against burnout. We can provide the support that our employees need and make sure that, at the end of the day, the Veterans we care for get the benefits that they’ve earned.

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

Terrence Hayes, VA Press Secretary: Next question. You got a question, John? You can come up, John. I couldn’t see you back there.

John Hewitt Jones (FedScoop): Hi, sir. Sorry. Thanks for taking my question. I’m afraid I would like to ask about the EHR again, the electronic health record, and I have a question, I guess, more on process than anything else. Last week we had the news of the postponement for the future of the rollout of the program, and at the time we heard again from senior leaders at the agency that issues with the system are being solved. There was an outage last week that happened, and we were told that was solved. There’s another outage that actually came to my attention yesterday. Over the last week or so, this also occurred. I guess I really wanted to ask, are you being made aware when these often pretty serious outages are taking place, and are they being reported to Congress?

Secretary Denis McDonough: Yeah. Thanks so much. I didn’t understand the first thing you said that these outages were being “sold,” you said?

John Hewitt Jones (FedScoop): No. We’re being told something.

Secretary Denis McDonough: You’re being told, I see.

John Hewitt Jones (FedScoop): I’m sorry. Yeah. Sometimes VA officials will say, last week, for example, a senior VA official was saying, “This outage has been solved. There’s not a problem,” when, actually, there was another separate outage taking place. I guess I’m really trying to understand what the process is for making sure you and other senior leaders are aware when these medical records aren’t available in these institutions.

Secretary Denis McDonough: Yeah. Great. Thanks so much for the question. I want to be careful to not add a lot to what has been a robust set of briefings in the last week. I think you guys all sat down with Dr. Evans last week. You sat down with Dr. Elnahal earlier this week. I had a couple things to say about this yesterday. Nevertheless, I think you’re asking a very straightforward question. I’d say two things in response to it. As I said to Congress yesterday, we had had seven months with no outages. That’s not to say there had not been degradations, but there had been seven months with no outages, and that’s not to say either that degradations aren’t serious. They are very serious. Nevertheless, despite those seven months of no outages, as I testified yesterday, in the last week, we’ve had two outages, which is the source of great, as I said yesterday, frustration. That’s the first thing. Obviously system reliability is chief among the concerns that Dr. Evans talked with you all about last week and chief among the concerns as to why we chose the reset. Point two, how do we know about what’s happening? Well, we start every day with a morning huddle, and in that huddle is the Assistant Secretary for IT, Mr. DelBene, and Dr. Evans, who is running the program office, so we are given regular updates including warnings about developments that have occurred overnight or even in the day prior. So, that’ll give you a sense of that.

John Hewitt Jones (FedScoop): Thank you, and, sorry, just to clarify, those two outages that you refer to there, there’s one, the Downtime Viewer outage, and then the other outage from the update last weekend. Those are the two you’re referring to there?

Secretary Denis McDonough: Why don’t we take that question? I want to make sure that I don’t confuse the issue, but we had system-wide outage just the day before yesterday, that impacted the entire enclave, as we call it, DOD and VA. We obviously did have problems with a joint viewer, but I want to make sure that I’m not confusing any of these, so I’ll make sure that somebody gets back to you with a specific answer to how you characterize the outages so that I don’t mischaracterize them.

John Hewitt Jones (FedScoop): Thank you, Secretary. One quick question, if I may, not related to the EHR. The VA has been leading on responsible AI in the use of responsible artificial intelligence technologies, often to aid with diagnosis. I wondered if you had any thoughts on some of the AI programs that are currently in place and the VA’s focus on that technology going forward.

Secretary Denis McDonough: I’m really proud of our technologists, and I’m really proud of our entire workforce for taking, on everything we do, a Veteran-centered focus on how we care for Veterans, how we develop the claims process. As Josh just said, we’re rolling out the VSignal in the benefits compensation program tomorrow, which is a fundamentally Veteran-centered choice, and we expect the same of our technologists as we look at technical innovations and technical improvements.

John Hewitt Jones (FedScoop): Thanks, Secretary.

Secretary Denis McDonough: Thank you.

Terrence Hayes, VA Press Secretary: We have a question from Lucy. Good afternoon, Lucy.

Lucy Bustamante (NBCUniversal): Hey, good afternoon, everyone. Thank you so much for taking my questions. I have a couple, if you don’t mind. First of all, welcome, Mr. Jacobs. I just wanted to know if you’re going to be the person that will be heading the equity team, or if you all are waiting to have him in position to start naming the members of that equity team. That is my first question.

Secretary Denis McDonough: Yes, why don’t I take that, Lucy, and then, obviously, if Josh wants to pile on, he can. As I told you last time we talked about this, we are building that team. We’re doing a full scrub of our records and our processes. We don’t yet have an announcement on who those people will be on the team, but we owe responses on that to a lot of important people, starting with the President of the United States and our Veterans and to you, so when we have announcements on that, we’ll let you know for sure.

Lucy Bustamante (NBCUniversal): Okay. A couple more questions for you, sir. I just wanted to know as well, one of our NBC stations has been doing a 20-year investigation into flawed neurological exams at the Tomah VA. One, are you aware of the level of examination that has been offered through the years to these Veterans and that the House Veterans’ Affairs Committee is basically investigating this at this point, and do you have a sense of the extent of these flawed neurological exams in Tomah that have led to the misdiagnosis of traumatic brain injury through the years?

Secretary Denis McDonough: Yeah. Thanks so much. I’m familiar with the reporting because it’s my hometown news-reporting organization, and I’ve been to the Tomah facility. We’re following this issue very closely. I’ve discussed it with the congressman from that area, Mr. Van Orden, with Senator Baldwin, who’s been focused on this very much, and I had an exchange with her yesterday about it. We are very concerned about the C&P exams. We’re looking at the full range of C&P exams as well as care provided in the Tomah facility. I don’t have any broader announcement than that, but am I aware of it? The answer to that is yes. I’m intimately familiar with it, and we’re staying on top of this to ensure that our Veterans get the care that they have earned and that they deserve and that any Veteran who got a C&P exam that is not up to our standard has the right to have a review of that without compensating his effective date or her effective date, meaning they should not have to refile a claim. We’re working this very closely with the congressional delegation, and as we have more news to share on that, we will.

Lucy Bustamante (NBCUniversal): Just one more on that and then one other question, sir. Mr. Secretary, if you could tell me about the procedure in the past, they have said before it would be corrected, and there was reporting done saying essentially what you had just said, “We are aware. We’re going to fix this,” and then years passed, and we were seeing that this was still happening. Is there anything that you can say about how the accountability process will look different to make sure that the doctors that aren’t well-equipped, well-trained, well-certified, appropriately certified, so that they are taken out of the situation when it comes to diagnosing Veterans?

Secretary Denis McDonough: Yeah. Thanks. Obviously, we can’t speak to what had happened before I was here, before Josh was here, before Dr. Elnahal was here, but we take the C&P exam, the compensation and pension exam, very seriously. To his very good credit, Josh Jacobs, whom I call today Under Secretary Jacobs, has insisted on higher quality metrics, incentives, and disincentives for those C&P exams during his time as he’s in the acting role. While I want to be careful not to comment about an ongoing situation, I can say to you that if we had reason to believe somebody was not providing quality care, either in the clinical setting or in C&P exams, we would make sure that they were not carrying those functions out, and I stand by that as a general matter, and I want our Veterans to have the assurance that we will make that so whenever we’re presented with that situation.

Lucy Bustamante (NBCUniversal): And then the final question for you, sir, or Mr. Jacobs, if you want to take it. I understand that it is National Infertility Week, and this is a question that isn’t just for the military families but really for all of the programs and their leaders that are worried about budget cuts that were just announced with the latest announcement of the debt ceiling. One of the things that I understand is going on right now before Congress is the military families fighting for an expansion of coverage for IVF, ART, adoption, third party reproduction. Obviously, as military families, we know it’s even harder to bring a child into this world when your other half is gone all the time, and then just the process of getting that kind of coverage and then services connected, if you can prove that your infertility issues were because of your service and even if it wasn’t, it seems like it’s just lagging much more behind what the civilians get through their health insurance, depending on who your employer is and what the plan is. So, can you just elaborate on the focus on helping military families with this disparity and what is covered for growing their families when their partner is gone so much of the year?

Secretary Denis McDonough: Yeah. Thanks so very much for the question. This is an issue that has been a priority for us since we arrived. In each of his budget submissions, President Biden has tried to change the limitations on VA in the types of services that we can provide families as it relates to infertility services or fertility services. We are going to fight until we get this enacted. I’ve talked at length with many members of Congress for whom this is also a major priority, and I hope that we get there, but your characterization of the situation is accurate, meaning that there are limitations on services that VA can provide, to include to legally married same-sex couples, that we think are not in keeping with our requirements to care for all Veterans. We have sought to have this changed. We will continue to seek to have it changed until we can provide Veterans the full suite of services that they have earned and so richly deserve.

Lucy Bustamante (NBCUniversal): Thank you, sir, and Terrence, last question, I promise you. The numbers that you all just released that Melissa Chan from our organization reported on, the record number of calls to the suicide hotline. As we ramp up to cover Memorial Day and another round of analyzing these numbers, and also Mission Daybreak just awarding to Stop Soldier Suicide, what is the implementation going to look like when people are calling that hotline now, and now that you’ve awarded your Mission Daybreak grant winners, what does it look like on the ground, especially in the Special Ops community that just suffered three in the last two weeks? What do you say to these people?

Secretary Denis McDonough: Thank you very much for the question. Obviously, ending Veteran suicide is our number one clinical priority in VA. The use of the Veterans Crisis Line is a critical tool in that, and, in fact, as you said, Veterans called texted and messaged the hotline 88,092 times in March 2023. That is the most in the history of the hotline. This increase in contacts means that Veterans in crisis are getting the help they need at the moment they need it. It’s really important that our performance statistics on fielding those calls, on making sure that Veterans are not waiting an inordinate period on the line as they make those calls, and then that they are connected to services, especially if they’re in crisis, that day when they call the line. We have continued to perform on those metrics. Even at the highest month that we’ve had, we’ve continued to perform to ensure that Vets get connected to somebody with training and some clinical experts and then get them into care, including that day, if they need it. Now, there is a question around why the number is as high, and I think one of the things that motivates your question, Lucy, and one of the things that was in your colleague’s reporting, was an attribution for why. The fact is there is no one factor that fully explains the increase. Many factors influence increases in calls to the Veterans Crisis Line. There are, however, some clear trends that we’ve identified. First, seasonality. Year over year, we’ve consistently seen increases in contacts in the month of March, including similar spikes in 2020, 2021, and 2022. Seasonal patterns of variation over time occur in other parts of the year as well. So, that’s one. Two, the shortened hotline number to 988. Any Veteran in crisis, please, just dial 988 and then touch 1, and we’ll get you care. Since that, there has been, routinely, more Veterans reaching the Crisis Line. Since the launch of 988 and subsequent advertising and awareness campaigns, there has been a consistent increase in Veterans Crisis Line calls of 12 percent for calls, 36 percent increase for texts, and a 10 percent increase for chat messages across the board. We’ve also been aggressively reaching out to Veterans, including in the Special Ops community that you’ve just talked about, in media, in advertising, and in person to raise awareness for this simplified hotline number. This has resulted in significant increases for VCL volume, just as it has, according to Secretary Becerra and the HHS for the national 988 Suicide and Crisis Lifeline, which fields calls across the country outside the Veterans Crisis Line. Again, there are many reasons that this is happening now, point one. Point two, this increase in calls has not meant any diminution of services, and it has not meant any slowness in responding, which means, three, as a Veteran, if you are in crisis, please contact us at 988, then press 1, and we’ll make sure that we get you into care today. Thanks.

Lucy Bustamante (NBCUniversal): Thank you both.

Terrence Hayes, VA Press Secretary: Ellen.

Ellen Milhiser (Congressional Synopsis): Hello. Thank y’all for doing this. I’m interested in research today. You indicated there are 950,000 Veterans signed up for the MVP already. How many of them have completed their DNA testing and analysis so that they’re fully in the biobank?

Terrence Hayes, VA Press Secretary: Yeah, I can get those specific numbers back to you, so let me follow up with the MVP team, and I’ll get that to you hopefully by the end of the day.

Ellen Milhiser (Congressional Synopsis): Okay. I appreciate it. Okay, the new Gulf War Illness study that y’all are doing with NIH, when will you start enrolling Veterans into that?

Terrence Hayes, VA Press Secretary: Unless you know, that’s probably another one I need to look into, Ellen, so we’ll circle back on that, too.

Ellen Milhiser (Congressional Synopsis): Okay. Thank you.

Terrence Hayes, VA Press Secretary: Thank you, Ellen. [Terrence Hayes chuckles] Jory.

Jory Heckman (Federal News Network): Thanks as always for doing this. VBA question, following up on some remarks from earlier this year, Under Secretary Jacobs. I wanted to keep an eye on the efforts under VBA to automate claims processing. I know that there was an update back in February on that. Just in terms of the claims that are being processed under that, how are things going? Is there a push to widen the scope of claims that are being automated at VBA?

Under Secretary Josh Jacobs: Yeah, thanks very much for the question. I think this is one of the most exciting areas of work going on in VBA at the moment. We talked a lot about the hiring, and we’re continuing to push very hard to hire more new VBA employees, but the promise of the automated decision support technology is that we can help our employees deliver more benefits to more Veterans more equitably and accurately and consistently than ever before. We’re actively working through that and, at eight regional offices, getting direct feedback from frontline employees to test and provide feedback on that. I was just in Montgomery, one of the eight sites that is actively testing our automated decision support tools, and got some really great feedback, got the demo. There are some really fantastic features that are already directly improving the speed to complete certain portions of the claims process, and we’ve seen other ways where there’s additional promise, but we need to change the automation logic, so we’re actively working. There’s, as you would expect, the tension between the need to continue to innovate and expand the aperture of the number of employees who can use this technology while also dealing with the near term immediate needs to produce decisions for Veterans right away. There is robust collaboration underway across the entire organization making sure, as we further deploy this technology, that we’re making appropriate policy, regulatory, or pursuing statutory changes that may be needed, and we’re also working with our employees because we want to make sure, as we provide these tools, that they’re actually going to be adopted and used across the system and not incentivize some sort of workaround. So, a lot of great progress and still plenty more to do.

Jory Heckman (Federal News Network): Going back to the job fairs, the hiring, the effort being there in the workforce. Something we always track, of course, is the time to hire, how quickly people who are interested in the job are able to get in the door and start working at VBA. In terms of the metrics there, are things improving? Are they currently where you’d like them to be? Just an update there would be great.

Under Secretary Josh Jacobs: Yeah, I can get back to you with the specific details and the stats, but I think generally speaking, we’re doing quite well with the 80-day time-to-hire-onboarding process. One of the things that we’ve done, and we’re always looking to shrink that time, is through these hiring fairs, we’ve learned along the way what works and what doesn’t, so we’re continuing to streamline and improve the process and our ability to provide these same-day hires has been absolutely phenomenal. Still pushing very hard to keep shrinking that process, and then the important thing is not only getting these new employees onboarded, but we also need to get them trained. We’re working very hard to align the timing of our hiring actions with the timing of the classes that each of these new employees goes through because we want to make sure we build the skills that are necessary to do this very complex and important work. So, I’m pretty pleased with the level of effort and the outcome so far and continuing to push the team to work even faster and more diligently because everyone understands our ability to do this directly impacts our ability to serve Veterans.

Jory Heckman (Federal News Network): Something we’ve seen across the entire federal workforce now is that right mix of in-person work and virtual work, and, of course, with the healthcare side of VA, that’s not really as much of an option, but with the benefit side of things, I’m just curious, is there still flexibility being offered there in terms of new and current employees? Is telework still an option for them? Just what’s the current state of play there?

Under Secretary Josh Jacobs: Yeah, our VBA employees, for the most part, are complying with OPM requirement of being in the office two days per pay period. I think what we’ve demonstrated as an organization over the last two years is we’ve been able to increase production and increase productivity, notwithstanding the challenges associated with the very quick pivot to this largely virtual operation. I’m confident that the team will continue to produce no matter what happens in the future. The VBA workforce is represented by– more than 55 percent of our employees are Veterans. All of them are Veteran advocates. So, I know no matter what happens, they’re going to do the job.

Jory Heckman (Federal News Network): Okay, and Mr. Secretary, I did want to follow up on your remarks yesterday on Capitol Hill. Regarding the EHR and the budgeting, you said that there’s about 400 million dollars in the FY 2023 budget that just, given the reset and the current reality of things with the EHR, is probably not going to be used this year. Does that money go back to Congress? Are lawmakers able to repurpose that so you guys are able to spend that elsewhere within VA? Just what’s the current situation with that funding?

Secretary Denis McDonough: Yeah. Thanks for the question. I want to just go back on two things that you just talked to Josh about. One is on workforce. Because of the centrality of people to our ability to perform against the numbers that you’ve seen from Josh and that you heard about from Shereef earlier this week, time for hiring, time for onboarding are really important metrics for us, so we’re working through a process here to be very transparent with you all on what that looks like. In the same way that we’re putting out that PACT Act performance dashboard, we’ll be looking to some kind of similar set of regular measurements that we’ll make public for you all to consume. On the future of work, as we’re calling it, I just got to say again, how proud I am of the VA workforce for the performance that they’ve had throughout the pandemic. You saw those numbers from Josh on his charts earlier. I think you’ve seen the numbers that we’ve produced as it relates to Veteran care at VHA and then caring for Veterans through our national cemeteries. We’ve continued to operate at a very high level at VA throughout the pandemic, consistent with a call from OMB recently to see a substantial increase in workforce. In headquarters elements, we are working very closely with our leaders, our supervisors here in the National Capital Region, to make sure that we are meeting and leading on the standards that OMB has called for. I will say though, in the field, as your question envisioned, our personnel VHA, VBA, NCA, are so productive. We are going to make sure that they can continue to operate the way they’re operating now. Now, on the 400 million, what happens with the 400 million will be something that obviously we will work through with Congress. And there are a series of benchmarks laid out in statute including on when we unlock certain parts of the set-aside money for this year. So in that process we’ll work out precisely what happens, but that’s something for us to work out with Congress.

Jory Heckman (Federal News Network): And like you said yesterday for FY 24, that still remains in flux?

Secretary Denis McDonough:  Same thing. We’re going to work that through with Congress, but what we’re going to do – remember what we’re focused on here, is getting it right at the five sites.

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

Secretary Denis McDonough: Thank you.

Terrence Hayes, VA Press Secretary: Over to Quill. Good afternoon, Quill.

Quil Lawrence (NPR): Hey, good afternoon. Nice to see you all. Thanks very much for all of the people you’ve offered up to explain the EHR situation. Mr. Secretary, I just wanted to give you a chance to address a couple of very general issues because this is the first time we’ve had a chance to talk to you about it since the pause was announced. Can you talk directly to the Veterans who live and who get their care at those five sites, plus I guess Northern Chicago, about why they’re continuing on this system which has been frozen because it hasn’t performed well. Some of them tell me they feel like guinea pigs. I just wanted to give you a chance to address that and tell them why it’s safe for them to be getting their care under this current system. I have a couple of follow ups, but I’ll just let you –

Secretary Denis McDonough: Good. Why don’t you gimme ’em all and then I can hit ’em.

Quil Lawrence (NPR): Okay. Yeah. The next logical question is if you’re keeping this system, which has been so frustrating, does it not leave you in a position in negotiating with Cerner where it already seems like vendor lock? If the VA isn’t offering and doesn’t seem to be able to switch back to Vista, or show a clear alternative of what it will do without Cerner, what leverage does that give you? And then the third one really is just do you have an idea about what went wrong or what has gone wrong in a general way? I’m still hearing about Cerner officials who are still learning the very basics of how the VA system works now five years into the contract and two decades into this process. Really just what went wrong, what’s your understanding of what has gone wrong so far? Just very general questions.

Secretary Denis McDonough: Yeah. Thanks so much. So I’ll go like two, three, one, if that’s okay. We’re working through the contract with Oracle Cerner, very little I can say about that. But what’s really important here is as I’ve said for me, since you’re asking me personally, two things are of vital importance, obviously patient safety and patient outcomes and user satisfaction. Those two issues are largely informed, in my experience now over the last two years, by system reliability and by training. So what went wrong is, I think, we have not seen suitable reliability and we’ve not seen the kind of training, again, this is my, this is Denis’s view – I’ve not seen the training that we had come to expect and that I think you’ve reported on and others in the room have reported on. So as we negotiate this contract, we will want to see greater accountability in particular around those two areas. So that goes to the issue of what went wrong and the contract. We’ll keep working the contract and I think we feel like,  so we’ll keep working the contract. To our Veterans in those five sites and to our healthcare providers there, I was recently in Roseburg, Oregon, I was really appreciative of the time that the team made for me quite early one morning to share their experience and to share the things that I can do to be a better partner to them. I say to them that we continue to believe, as all of healthcare does, that there’s real power in healthcare health record modernization. It unleashes, when done effectively, important benefits in terms of patient safety and patient outcomes, which is our number one priority here. And importantly, allowing us to interface with DOD will not only improve patient outcomes, but will improve our ability to resolve benefits questions that much faster. So that’s the promise of the record we intend to implement, in a very Veteran centered way with patient safety and patient outcomes leading our principled implementation of it. We intend to deliver those outcomes.

Quil Lawrence (NPR):  Just briefly, can you tell the Veterans in those sites how you’re plussing up the support, what you’re able to do to make their experience safer and better while they are, I guess, the laboratory for the development of this HR?

Secretary Denis McDonough: We’re working that through with our providers in the facilities and the program offices leading that charge, Quill. So I’m going to leave that to them to do that. But what we’re making clear in the context of this reset is that the most important thing that matters here is making it work in those five sites, driven by the principles of patient safety and improved Veteran patient outcomes. And that’s the way we’re going to pursue this.

Quil Lawrence (NPR):  Thanks a lot.

Terrence Hayes, VA Press Secretary: Orion.

Orion Donovan-Smith (The Spokesman Review): Thank you guys for doing this, as always. First, I just want to take the opportunity since Leo was here to say go Mariners. We haven’t scored yet, but that’s normal, so we’re fine. I appreciate the questions from other reporters on the HR and of course the chance to talk with Dr. Evans and Dr. Elnahal about this so I’m just going to ask but a few particular things, Mr. Secretary. VA told me in a statement that the contract with Oracle Cerner does not allow the company to monetize Veterans health records without the express written permission of VA, so I just have to ask, has VA given that permission?

Secretary Denis McDonough: I’m going to take the questions because over here, I think this is like a bad spot here. Who said? Somebody said what again? Orion Donovan-Smith (The Spokesman Review): I just got in a statement from your press team this morning that I’d asked if Oracle Cerner has monetized, has used the Veteran health records they receive from VA through the EHRM process to make money in any way, to monetize that data? I was told that can only happen with VA’s express written permission. So I just have to ask, to your knowledge, has that permission been given?

Secretary Denis McDonough: To my knowledge, no. But I’ll find out for certain whether it has, and there’s no circumstance under which I would allow that.

Orion Donovan-Smith (The Spokesman Review): Thank you. Have you had any direct communication with Secretary Austin about the shared challenges between, like you say, the federal enclave in terms of these recent outages that affected DOD?

Secretary Denis McDonough: On the most recent outages? I have not, no.

Orion Donovan-Smith (The Spokesman Review): In the past you have generally on the –

Secretary Denis McDonough:  We’ve talked generally about EHR as we talk about a lot of different things, but I have not talked specifically about the most recent challenges.

Orion Donovan-Smith (The Spokesman Review): Thank you. And I just want to ask you a question that Senator Murray asked yesterday. And I know it’s tough to answer. This has been posed a few times, but in terms of productivity, because there’s been a lot of talking about patient safety, about some of the other impacts of the EHT, but productivity has been reduced at the affected facilities. They’re seeing fewer Veterans than they were prior to the new EHR being deployed. And as a result, of course, those Veterans are either deferring care or they’re going to private providers through community care where often they face long delays. So how much longer can those Veterans expect to wait before productivity is restored at those sites?

Secretary Denis McDonough: I guess I want to say two things. One, I want to say the best thing to do is to take my answer from yesterday because I was speaking to the chairman of the appropriations committee.

Orion Donovan-Smith (The Spokesman Review): I just asked cause you didn’t actually answer that part of her question, so I had to repeat it.

Secretary Denis McDonough:  And the second thing I’d say is we’re resolving this as quickly as we possibly can. We’re doing it, as I said, as we do everything around here, in a Veteran centric way to ensure patient safety and best Veteran outcomes. And we continue to work to ensure timely access to world class care.

And we’ll continue to do that. But I think that’s how I’d answer the question.

Orion Donovan-Smith (The Spokesman Review): I’ll leave it there. Thanks.

Secretary Denis McDonough: Thanks.

Terrence Hayes, VA Press Secretary: Rebecca. Good afternoon.

Hello, can you hear me?

Terrence Hayes, VA Press Secretary: Yes, we can hear you Rebecca.

Rebecca Kheel (Military.com): Okay, great. Thanks for doing this. So obviously there’s been a lot of focus this week on how the Republican debt limit and spending cut plan could affect Veterans. And the bill itself, while it has the top line spending cap, does not specifically cut VA. And I understand that the math to get to that cap would be really hard without cutting VA, it is theoretically possible. So do you have a response to the Republicans who have been accusing the administration of fearmongering and lying when it talks about these possible cuts to VA?

Secretary Denis McDonough: I’m not familiar with the last part of your question. So I guess if there’s something for me to say to our Republican colleagues on the hill, I’ll say that to them personally and as I always do, and I keep an open line with them. So I guess I’m a little trepidatious about answering the question when you say, “Hey, what do you think about somebody saying you’re lying?” So let me answer the question analytically, and then if there’s something that I need to say to my colleagues, I’ll obviously reach out to them  as I always do and really appreciate the open and clear and respectful channel we have there. I’ve read the provisions that they’re debating, and it does carve out the Department of Defense expressly so, but does not carve out anybody else. So a fair reading of that would suggest that we, as we prepare for the provision of care into next year, be ready for the full range of options, a full range of outcomes. And that’s what we’re doing and we’re working with OMB to do that. And as with everything else, I’m going to be very transparent with you all about that. And as much as the bill did not choose to do for VA what it chose to do for DOD means we need to prepare ourselves for the outcomes of the type that we’ve been very candid in writing, in testimony and in private conversations with Capitol Hill, as well as with all of you, about what those potential outcomes would be.

Rebecca Kheel (Military.com): So to your mind, it is a very real possibility that these 22% cuts will come to pass, that you’ll not be able to persuade lawmakers to save VA funding, if you will.

Secretary Denis McDonough:  Again, I just want to tell you my position without – I’m not really sure I understand how you’re asking the question, so I want to just tell you my position. I read the bill, and the bill does not carve VA out of the potential cuts. The bill does carve DOD out of the potential cuts. In as much as they chose to do that for DOD, but did not for VA, leads me as a leader of this organization and one who considers himself a prudent leader, to need to prepare for very real cuts. That’s why we’ve stacked these up. That’s why we’ve done the analysis to be sure that members understand that and that we begin to prepare for that.

Rebecca Kheel (Military.com): Alright. Thank you.

Terrence Hayes, VA Press Secretary: Any further questions? Sir, this does it for the month of April. Thank you, Mr. Jacobs for joining us this afternoon.

Secretary Denis McDonough:  I’m sorry, Under Secretary Jacobs.

Terrence Hayes, VA Press Secretary: The Honorable Undersecretary. Mr. Jacobs, thank you, sir for joining us today. It is a pleasure.

Secretary Denis McDonough: Thank you everybody.

Terrence Hayes, VA Press Secretary: Thanks everybody. We’ll see you next month.