VA Secretary Press Conference – January 31, 2023

Terrence Hayes: It’s been a while since I’ve seen many of you. I hope you and your families are doing well. As always, I’ll start today’s press conference with the ground rules. To our press in attendance, once I open the Q&A period, please raise your hand and wait for me to recognize you. Once called upon, please step to the microphone. To those joining us virtually, please remember to remain on mute for the duration of the press conference. During the Q&A, please use the raise-your-hand function, and a member of the team will recognize you. Once called upon, please unmute and turn on your camera. Remember to return to mute immediately following your question. We are excited to have Dr. M. Christopher Saslo, Assistant Under Secretary for Health for Patient Care Services/Chief Nursing, and Dr. Kelly Irving, Michael E. DeBakey, VA Medical Center, Associate Director Patient Care Services, joining us today. These tremendous leaders will discuss our efforts to attract and retain the best nurses in the business at VA and the remarkable achievement of the National Database of Nursing Quality Indicators Award for Outstanding Nursing Quality at DeBakey VAMC. Since there is much to discuss, I’ll step aside and turn the floor over to Secretary McDonough.

Secretary Denis McDonough: Awesome. Terrence, thanks very much, and good morning, everybody. Not used to us doing this in the morning. Thank you for joining us for the first press conference of 2023. We’ve started the year strong, and we’re going to continue building momentum that we had going into the new year. Since President Biden signed the PACT Act into law on August 10, we have received 278,000 PACT Act-related claims. We have been working hard to process those claims since January 1, the first day we were authorized to do so by law. Since January 1, we have processed 39,250 claims, and since January 1, we have granted 33,266 of those claims. So, if you take the total of claims since President Biden took office and directed us in May of 2021 to begin getting Veterans exposed to toxins covered, we have awarded 77,000 toxic exposure claims out of 97,000 filed. Let me just reiterate those numbers real quick, so you have them. Overall, accounting for the steps that we took ourselves in May 2021, we have received 97,000 claims, and we have awarded 77,000 of them. If you take those plus claims filed under the PACT Act, we have received a total of 277,493 claims. With specific PACT Act claims since January 1, we have processed 39,250 of those and awarded in 33,266 cases. As with all we’re doing, we’ll continue to be transparent with you while implementing this new law to build and maintain the trust of Vets who have already waited far too long to get the care and benefits that they’ve earned. We’re committed to ensuring that everyone, Veterans, VSOs, the press, our force multipliers and partners on the hill, that everyone has access to accurate and timely information so that they, meaning each of you, can continue the important work of holding us accountable as we continue to fight like hell for Veterans. For Vets and survivors listening today who may have been exposed to burn pits, to Agent Orange, and to other toxic substances, apply for your benefits related to toxic exposure right now. It’s free. It’s easy to apply by working directly with VA or with one of our great Veteran Service Organizations. Everyone can learn more about this important new benefit and apply at any time by visiting va.gov/pact [Link: www.va.gov/pact] or by calling 1-800-MyVA411. That’s 1-800-698-2411. For Vets already enrolled in VA care, get your toxic exposure [screening] as quickly as possible. More than 1.5 million Vets have already had that screening. Any Vet not enrolled, please get enrolled. On a separate note, we’re watching closely the discussions on the hill about ending the national and public health emergencies. Let me reiterate again that we need action from Congress before these emergencies end to ensure that Veterans receive the same level of access and high-quality care that they deserve. This is especially true of the emergency authority, which allows a Vet, for example, in rural Colorado to receive through a telehealth appointment with a doctor at the Clinical Resource Hub in Boise and to have that appointment renew their prescription. This ability to renew prescriptions over state lines is something we badly need to ensure that we can continue once the national and public health emergencies related to the pandemic expire. We’re working diligently on this matter. We’re grateful for the ongoing coordination with Congress and particularly grateful to the White House as we work to get the tools we need to ensure continuity of care for Vets and their families. Finally, nothing is more critical to our success than the people we hire and retain at VA. I’m smiling because I love the people I get to work with. These people are the people we need to serve Veterans as well as they have served us. That’s evident every day with our Nursing Corps, and I’ve said this before, but I love the nurses. My mom was a nurse. She worked midnights in our emergency room and came home and took care of 10 rugrats and sent us off to school. Our Nursing Corps provide world-class health care to Veterans, so I’m proud to introduce our Chief Nursing Officer, Dr. Chris Saslo, and Dr. Kelly Irving, Head of Nursing at the Michael E. DeBakey VA Medical Center in Houston. Dr. Saslo, our chief nurse for the entire enterprise, will share some of the successes we’ve had in hiring nurses but also be candid about the challenges we face going forward. We’re aggressively hiring nurses across the country. So, if you’re interested in joining our excellent team, please visit vacareers, that’s one word, vacareers.va.gov. That’s vacareers.va.gov. [Link: www.vacareers.va.gov] That should be on the screen for those of you who are watching. Meanwhile, Dr. Irving leads a team of well over 2,200 nursing staff at one of the largest VA medical centers in the country, serving over 133,000 Vets annually.

For the second year in a row, her team received a Press Ganey Award for Outstanding Nursing Quality, one of only seven healthcare organizations in the country to be recognized with this prestigious honor, and that’s every hospital in the country, public and private. This award is a reflection of the tireless dedication, professionalism, and compassion Dr. Irving– And by the way, as soon as you hear her talk, you’ll already feel it, but you’ll see why she’s such an awesome nurse.  –tireless, dedication, professionalism, and compassion Dr. Irving and her team of VA nurses demonstrates every single day while caring for our Vets. With that, we’re going to go remote to hear from Dr.

Saslo, then we’ll hear from Dr. Irving. Chris, over to you.

Dr. M. Christopher Saslo: Yes, sir. It’s an honor to be here today meeting with you, Mr. Secretary and Dr. Kelly Irving. I am so proud of the VA nurses and all that you do to honor and serve our Veterans. VHA’s nursing workforce is one of the largest in the U.S. with more than 113,000 nurses. Almost 14% of VA’s nursing workforce are also Veterans, something to be incredibly proud of. Despite our large numbers, we’re struggling with hiring and retaining nurses. In July of 2022, we saw our registered nursing numbers improve, and by the end of September of 2022, we saw a net gain of over 2,000 nurses. The first quarter of FY23 has resulted in hiring over 3,600 nurses. Our registered nurses saw 2% growth in FY23 in quarter one compared to 2.6% growth in all of FY22. We had an onboard surge event held in November of this past year that resulted in a positive growth of our LPN workforce also, as well as our nursing assistants.

Although I’m happy to see the positive growth for our LPNs and our nursing assistants, we’re still far from where we need to be to meet our hiring goals for the next four years. We’re particularly challenged with hiring our LPNs, nursing assistants, and RNs for our inpatient units and nurses for our Community Living Centers, where some of our most vulnerable Veterans reside. In the next four years, VHA needs to hire, in each year for the next three years, over 10,000 RNs, 1,800 LPNs, and 2,400 nursing assistants in order to meet the current and projected growth and turnover. These numbers do not account for the additional nurses needed to implement the current PACT Act that we are working through. Since the start of the pandemic, VA nurses have completed more than 4,000 Fourth Mission deployments, helping to fill critically needed healthcare positions in communities across the U.S. Last year, VA’s Travel Nurse Corps provided more than 100,000 hours of support to facilities in need, and on average, nearly 70 travel nurses were deployed daily, completing nearly 2,000 functional assessments and more than 4,500 assessments performed, providing much needed relief to our nursing staffs impacted by the nursing shortages, while still providing the timely care that Veterans deserve. While significant focus has been on strengthening the VHA nursing workforce, our second pillar of our nursing workforce strategic plan is to focus on inspiring an industry-leading culture and optimizing nursing practice through pursuit of nursing excellence. VHA currently has 11 Pathway to Excellence designations, three recognitions for the Magnet Program, and 46 facilities that are on the journey towards Magnet or Pathway. These designations recognize improved patient outcomes, the role of nursing and performance improvement and evidence-based care delivery and creation, and demonstrating exemplary professional practice, which are also consistent with the High Reliability Organization principles and practices. It is my honor today to join in the recognition of Dr.

Kelly Irving and her outstanding leadership at the Michael E. DeBakey VA Medical Center, where she led her nursing workforce to provide Veterans excellent nursing care. As we mentioned, this is the second time she and her nursing team have been recognized by Press Ganey by providing that high quality of nursing care. I just want to say thank you once again for the opportunity to recognize all of our nurses in VHA, and for those nurses that are looking to come to work with the best health care ever, I invite you to join us today. Thanks, Mr. Secretary, and I’ll turn it back over to you.

Secretary Denis McDonough: Great. Chris, thanks so much. I recognize that there was a little choppy for everybody, so we’ll make sure that we get you Chris’s remarks as surely as prepared and, to the greatest extent possible, as delivered so you have exactly what he’s just given you. Dr. Irving, over to you.

Dr. Kelly Irving: I would like to say thank you to Secretary McDonough and to Dr. Saslo for your kind words and invitation. Just to tell you a little bit about the Press Ganey NDNQI Award for Outstanding Nursing Excellence, this is a competitive achievement for leading healthcare organizations. This award is presented annually, twice to us. The award applauds hospitals and healthcare systems that elevate the field of nursing and, in turn, improve overall patient care, outcomes, and the experience. For those of us at Houston, it’s key that we continue to monitor our nursing outcomes. Those outcomes include falls, central line infections, catheter-associated infections, ventilator-associated events, and my all-time passion, pressure injuries. As a wound, ostomy, and continence nurse in my previous life, that is a passion. Those Veterans that enter into our facilities without infections, without pressure injuries should leave in the same condition and/or improve. So, we monitor our data, we collect the data, we utilize the spirit of inquiry to ask the questions: Is this the right way to do this?

Is this the best way to do it? Is there an alternative way to get this done? And in doing so, we’ve eliminated the old way of thinking: “We’ve always done it this way.” As a four-time designated Magnet hospital on our fifth journey to excellence, we keep an open mind. We encourage nurses to ask the questions, not just the nurses, but all of our employees to ask the questions. We’re alive and visible in the organization, and that fosters a connection and a commitment to excellence, knowing that you have the resources to provide for our Veterans, those of whom have served this country and have earned the care they so richly deserve. As a daughter of parents who both served this country, that is my mission. My mission is to provide care to those that have fought for us, who have served this country. It is my way of giving back. That is a commitment, and excellence. They say if you find a job that you love to do, then you don’t have to work. I have that job. I love every minute of my job. As I walk through the organization, I can talk to everyone from the parking garage all the way up to the top floor about how great we are in Houston, and not just Houston, throughout the VA because this award demonstrates our ability to collaborate with the best of the best, to have positive outcomes, continue to raise the bar. That is what we do every day, and I have to stop for a minute just to thank my team, of whom, any idea I toss to them, any question, any concern, they find a way to get it done. I know oftentimes they’re tired of me asking them to do things and to step up and to raise the bar and to move forward, but yet they do.

Covid was one of those times for us. I can tell you the nurses in our organization exude compassion and out-of-the-box thinking. We ensured that every Veteran that entered, we could take care of them, and we could take care of them safely while still taking care of each other, even during that most difficult time. We may have lost a few nurses, but I’m here to tell you, they came back. They left for the private sector, and many of them have returned. We were able to compete with the private sector, and that is because we have an environment of inclusion. We have an environment where there is a commitment to taking care of our nation’s heroes. I’m thrilled to share how we actually achieved this award. Houston is an open book. We share with our sister facilities. We share with the Texas Medical Center. We’re surrounded by Magnet hospitals, and we collaborate to see what they’re doing because if they can do it, guess what? We can do it and oftentimes do it better. So, I am here to say this is an award, although Houston achieved it, it is huge for VA, and all of us can achieve the same things. We have the resources. We’re the largest healthcare system, and we are here to take care of our Veterans. We provide the best care; our Veterans need to know that. We welcome them, we want them to come to our organizations, right? Because we’re here for them. It is our way of giving back to them. I am thrilled to share this award with anyone who’s interested, but I have to say our phenomenal nurses in Houston are the reason for the award. They embrace the challenges. They utilize all of the evidence to bring ideas and concepts, and my Medical Center Director, Mr. Francisco Vasquez and our senior leadership team support that. There has rarely been an opportunity where we requested resources, whatever it was, and we did not get it. As a matter of fact, I cannot think of one. And that stems from the top with the leadership throughout VA, throughout our network under Dr. Skye McDougall. And so, from the bottom of my heart and for Houston, I thank all of you for the opportunity to share with you how grateful I am to be a leader of such a phenomenal team in Houston. And we do welcome those nurses to apply to come to Houston. We select the best of the best and many of our bedside nurses have advanced degrees and certifications because that’s what it is that we promote. Thank you for listening.

Secretary Denis McDonough: Dr. Irving, thanks so much. Sorry, Terrence, I’m taking your job.

Terrence Hayes: Yeah, no. As a consumer of VA Health Care, if that doesn’t energize you to come see our facilities, to come see our physicians and clinicians and nurses, I don’t know what will, so thank you, Dr. Irving. I appreciate that. We’ll open it up to questions. Patricia.

Patricia Kime (Military.com): Thank you so much for doing this. I’m Patricia Kime with Military.com. Could you give us an update on the EHR pause/rollout, projections for starting that whole process back up again?

Secretary Denis McDonough: Yeah. I don’t have a specific set of targets for you right now, Patricia. This is obviously something that we’re spending a lot of time on. In fact, Dr. Elnahal and Dr. Adirim are out in the field right now, and I just talked this morning with Deputy Secretary Remy about this. I will say that we’re also working very closely with OMB in this to make sure that the budget in the years going forward reflects our dedication to the program, but also that we’re clear-eyed about the fact that the program has not moved as quickly as was initially planned in the program of record before we arrived. So, we’re working this very closely. I don’t have specific dates to give you right now, but when we have them, we’ll obviously roll that out with you guys to make sure that you understand both what we’ve found, how we’ve improved, both how we govern the program and how we fund the program, and then some of the milestones that we’ll hold ourselves to account on.

Patricia Kime (Military.com): So, if Congress were to seriously consider a bill to kill the program, are you exploring alternatives, at all? Or, what would you have to say in response to something like that?

Secretary Denis McDonough: Yeah, we think that it’s really important to have a modern electronic health record. A modern electronic health record has been proven, in every system where it has been deployed, to improve outcomes. And, by the way, through a very difficult change process, improve quality of life for providers as well. But, we have a particular need here for the health record, a modern electronic health record, because we want to be in a position where we can easily access a service member’s record, going back through all of her years in active duty. Our ability to be able to do that with the OD is extraordinarily important. I know that Congress is writing bills right now, and maybe even some of them have been introduced. I have not heard anyone rebut either of those two notions. In fact, what I hear is broad support among Congress for those two notions. What I also hear is something that I know our clinicians, some of our Vets, many of our Vets, and then Donald and I feel, which is frustration that it’s not rolled out more quickly and efficaciously, but we owe it to our Vets to get them that modern record. We owe it to the American taxpayer, who has been very generous to our Veterans, to do this in a way that’s sustainable over time, and that’s what we intend to do.

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

Terrence Hayes: Orion. I know you’re going to stay on the same train, so…

Secretary Denis McDonough: Does Orion have a question on the EHRM?

Terrence Hayes chuckles

Orion Donovan-Smith (The Spokesman-Review): …Something totally different but thank you for doing this. Mr. Secretary, I think you hinted at this when you mentioned OMB–

Secretary Denis McDonough: Yes.

Orion Donovan-Smith (The Spokesman-Review): –but I want to ask you a question, particularly about the budget impacts of the EHR. So, I reported about a month ago that service chiefs in Spokane last year at a few different points were directed to eliminate vacant positions, effectively, to reduce staff, because of budget problems caused by the new EHR, despite the fact that that system is still causing productivity issues, patient safety risks, things like that. Just recently I heard from Columbus that they’re looking at nearly a 30-million-dollar deficit there. They’ve hired about an extra 100 FTE, I think, staff, for that same reason. So, the question I keep hearing from providers at both of those facilities is, will VA commit to providing ongoing funding for that surge staffing so long as there are productivity impacts or safety impacts from the system?

Secretary Denis McDonough: Thanks so much. I saw your story, as is the case with all of your colleagues. Your reporting is required reading around here, so it’s very helpful to have it. I also appreciate your willingness to be a channel with our workforce. I’ll tell you, and I urge my colleagues as members of an HRO, to ensure the free flow of information in both directions. As our clinicians encounter, and our CFOs, by the way, encounter challenges, I hope they’ll know that they have the support of the Office of the Secretary of Veterans Affairs to be really candid with all levels. In fact, that’s what we owe our Veterans. That’s the second point. The third point is, you just heard what Dr. Saslo said about our hiring requirements, and you also have heard me say, both in public testimony and then in this room, that we need to hire 52,000 clinicians over the next years to make sure that we’re in a position to address all the care needs that we have. Not only do we need to do that, but Congress, in a very generous appropriation, which the President just fought for, has given us not only the authorities to do that, but the money to do that, and we’re bound and determined to do this. We just had our weekly update on this topic with the under secretaries, Donald and I did. So, it brings me to my last point, which is Dr. Fischer was not asked to reduce his FTE. As I said, we want more clinicians, not fewer. We’ll stay on top of this and make sure that everybody is clear about what our expectations are for them, and we’ll work it through, and we’ll also work with the VISN leadership to make sure that they have the resources that they need, both in VISNs 10 and 20, to continue to invest in what you have just seen here, the greatest healthcare providers in the country.

Orion Donovan-Smith (The Spokesman-Review): I appreciate that. Whether or not– well, first let me just ask, do you contest whether or not that director went through Dr. Fischer, the VAMT director that, do you contest that?

Secretary Denis McDonough: I think I just gave you a four-point response, so I’m going to stand by all four of the points.

Orion Donovan-Smith (The Spokesman-Review): I guess my worry there is that–

Secretary Denis McDonough: I have a lot of worries. If we’re going to share all of our worries, we’ll have a long press conference.

Orion Donovan-Smith (The Spokesman-Review): Fair enough. I’ve seen correspondence showing that the service chiefs there actually did reduce staff in Spokane. What employees there want to know is–

Secretary Denis McDonough: As I said, Orion, I read your report closely, and as I said, this is why we do this every month. We think you guys’ reporting is really important. So, I don’t want to get into a kind of a back and forth on the specifics. You heard my four points. You heard what I said to Patricia, which is we’re going to continue to work this issue consistent with getting a modern healthcare record to advance the interest of our Vets. The last thing I’ll just say one more time is we need more clinicians, not fewer, right?

Orion Donovan-Smith (The Spokesman-Review): Absolutely. I want to be sure that my reporting is not inaccurate. So, if it’s–

Secretary Denis McDonough: If you want to talk to Terrence about a line-by-line on your report, we can make sure we do that.

Orion Donovan-Smith (The Spokesman-Review): Okay. Please, Terrence, and anyone else, please let me know if that’s inaccurate. That’s my reporting, and I stand by it at this point. I do want to throw you a little curveball here, something different, not on the EHR, believe it or not. In the Senate, Senator Tester and some of his colleagues just introduced the BUILD for Veterans Act, which aims to give VA sort of a long-term plan, but also long-term funding certainty–

Secretary Denis McDonough: Yes.

Orion Donovan-Smith (The Spokesman-Review): –for infrastructure needs. I don’t expect you to legislate from the podium here, but I’m curious, based on what VA’s current infrastructure budget is, if you see a need to change that and to have that kind of long-term plan.

Secretary Denis McDonough: You know, we’ve been going through a really concerted effort since the very troubled construction process in Aurora, Colorado, to prove to Congress and, most importantly, to prove to Veterans that we can be trusted to invest taxpayer dollars in modern facilities of the types that Veterans are right to expect. I’ve shared with you all my frustrations about Veterans getting care in– You know, I was back at the Hines VA on Christmas morning this year, as I was last year. That’s a facility that was built after World War I, so we need modern facilities. The process we’re going through and the next manifestation of that is the healthcare center we’re building in El Paso, which will build on the progress that we’ve made, for example, in Orlando, where a world-class facility came online early and under budget, and interesting new funding mechanisms in, for example, Omaha and in Oklahoma City, where we’re able to partner with other private funders to bring on modern facilities. We’re doing our part to prove to Congress and to Veterans that we can be trusted with those resources. Commensurate with that, we hope to see an increase in funding available for major construction. It’s kind of a conversation we’re also having with the President.

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

Secretary Denis McDonough: Thanks.

Terrence Hayes: We’ll go to Quil. Good morning, Quil.

Quil Lawrence (NPR): Thank you. I wanted to ask, with the PACT Act numbers and onboarding all of these new claims, how is that going in terms of what you expected? Are you approving as many as you thought you would, or more or less? I know it’s early days, but I’m wondering how it’s all jiving with your projections.

Secretary Denis McDonough: Yeah, I think it’s a great question. Thanks, Quil. I’m sorry, did I cut you off?

Quil Lawrence (NPR): Oh, I’ve got an unrelated follow up, but go ahead, please.

Secretary Denis McDonough: So, the backlog today is about 200,140 some… Let me just see if I have the exact number, and that’s not today, but this, I’m sorry, this is the backlog as of close of business yesterday: 200,171. That’s about 24% below the previous high since we’ve been here. And remember that one of the reasons it went up to about 245,000 in the middle of 2021 is because of some new presumptives that Congress enacted in the FY21 DOD Authorization Act that President Trump signed, so we worked that number down to about 140,000. It’s now going back up, so that’s one way to measure it. The second way to measure it, Quil, is we have mapped out, and I think we’ve briefed you, and we’ve briefed Congress, we’ve briefed Veterans, VSOs, other of our force multipliers, on our projections. Our projections in some cases would see a backlog as high as six or 700,000 at its peak over the course of the next couple of years. Right now, we’re still at or slightly below those projections, our assessments. Meaning, we had anticipated more cases into backlog than are currently into backlog, so that tells me that we’re performing pretty well. A third question about measurement is grant rate. I gave you those numbers at the beginning of PACT Act claims processed since January 1, so that’s 39,250. Of those 33,266 have been granted. That’s a grant rate at about 84, almost 85%, which is higher than the overall grant rate for toxic exposure claims, which would include everything going back to May 2021. That’s, I think, interesting to me, but it’s probably too early to assess whether that is evidence that the grant rate under the law is higher than the grant rate when we just do it of our own authority, but that’ll be another thing that we watch really closely. Then, the last thing that we’re watching really closely, Quil, is whether we have the people to meet this increased demand, and that demand is going to be both claims and that demand is going to be care. So, Chris gave you some data there, and again, we’ll make sure that we have it in writing about how we’re doing on our nurse hiring numbers. We’re about 2.2% already over last year’s number just in the first quarter here, and that was after last year, where we had overall just a 2% growth, right? I think we’re well ahead of where we were last year on hiring nurses, but that’s true that it’s a major challenge for us in terms of nurses, docs, specialists, social workers, across the board. Then, of course, hiring at VBA for claims processors is also something we track really closely. We’ll have more data for claims processors after next week’s VBA enterprise-wide onboarding surge event. I’m going to be traveling. I know Donald’s going to be traveling for that, but we’ll have more data for you on that then. Those are kind of four ways to kind of cut how to assess how we’re doing. I hope that’s responsive to the question.

Quil Lawrence (NPR): Yep. That was my question exactly. I’ll shoot the other one to Terrence, so I’m good. Thanks a lot.

Secretary Denis McDonough: Okay, great.

Terrence Hayes: Thank you, Quil. We’ll go to John.

John Hewitt Jones (FedScoop): Good morning, Mr. Secretary. John Hewitt Jones from FedScoop. Firstly, I wanted to ask, earlier this month, President Biden signed into law legislation requiring the VA to obtain independent auditive cybersecurity programs and IT systems. Could you tell us, sort of, what progress is being made with that, please?

Secretary Denis McDonough: Yeah, we’re familiar with the– Obviously, we talked at length with the President before we signed the act, and so there’s obviously milestones and effective dates in there. We’re making sure that we understand what’s required in that as well as what’s required in the 79 other provisions that were included in the omnibus. Obviously, you can imagine that each of those carries an implementation tail. So, we’re working that through, and we’ll be really candid with Congress and with you all about how we intend to do that. That’s point one. Point two is, we take cybersecurity extraordinarily seriously here, and we have not only a very robust internal process that we require adherence to, but we also have among the best professionals on this issue in the federal government led by Kurt DelBene, our Assistant Secretary for OINT. I’m very proud to see our uptake on things like two-factor authentication, where I think we are among the most effective organizations in the federal government, and we’re constantly talking with our teams about cyber hygiene, about the protection of privacy information, and so forth. On top of that, we have requirements like the FISMA and other statutes that have been acted over time that we’re making sure that we stay on top of those as well. I hope that’s responsive to the question.

John Hewitt Jones (FedScoop): Thank you. One quick follow up, if I may. Just returning briefly to the EHR, I wondered if you might have any further comments on the service degradation last week, any sort of additional root cause analysis that may have occurred to kind of give us more details about what might happen to prevent that from occurring going forward.

Secretary Denis McDonough: Yeah, so, I don’t have that root cause analysis in front of me, and we’ll make sure that we get that and make sure that we’re talking through that with you guys. I do know that one of the challenges we face is, unfortunately, and this is one of the issues that, going back to Patricia’s question, we just have to get our hands around, which is that too often we’re a downstream consumer of this infrastructure. Too often, our concern becomes secondary to, for example, DOD, which manages big parts of the network. This makes implementation of this system harder than it might otherwise be, so some of the degradation last week, I think, was related to degradation elsewhere on the system, which again brings forward this question as to whether our concerns are being addressed as a first-order question or whether they’re somehow derivative of DOD concerns. This is, again, one of the issues that we’re working through in this assess-and-address period to get our hands around.

John Hewitt Jones (FedScoop): Thank you, Secretary.

Terrence Hayes: Ellen. Good morning, Ellen.

Ellen Milhiser (Congressional Synopsis): Good morning. Thank you for making this possible. I’m going to ask a different question than I intended. Secretary McDonough, you’re concerned that the VA is not considered top priority for concerns. There are certain things like the scheduling issue and the prescriptions issue that Oracle Cerner had promised would be fixed by August. Are you saying they’re not fixing these things on the schedule they had promised?

Secretary Denis McDonough: No, I think you may have inferred something I did not imply, Ellen. I wasn’t speaking to specific questions about that and I’m not in a position to give you a specific answer on where we stand on those. We’ll definitely take that and come back to you. I was making a different concern, which is that it’s a joint system, and we just have to make sure that all of our concerns are addressed equally rather than one derivative of the other. It’s a big network. It’s a big system, and this is something we’ve got to get our hands around. I don’t think this is a function of anybody being nefarious or not doing what they said they would do. This is just an issue that we have to, as I’ve said now a couple times, get our hands around.

Ellen Milhiser (Congressional Synopsis): And a follow up on the hiring of nurses. Are you making any special effort to hire nurses from the private sector who were already acquainted with using the Cerner system?

Secretary Denis McDonough: Chris, did you hear that question? Or Kelly, do you know? Do you have an answer to that? Maybe not.

Dr. M. Christopher Saslo: I did. Kelly, I don’t know if you want to take the question?

Dr. Kelly Irving: We are making conscious efforts because the transition would help the nurses that have not become familiar with the system. So, yes, we do have that effort, and it’s active.

Dr. M. Christopher Saslo: And if I could just add on that we are using all of the possible hiring authorities in order to secure that talent whenever we can find them. So, once again, my sincerest push to anyone out there with those skill sets that can help us to be more successful.

Ellen Milhiser (Congressional Synopsis): Thank y’all.

Terrence Hayes: Thank you, Ellen. Leo, good morning.

Leo Shane (Military Times): I appreciate you doing this, Mr. Secretary. One more on the EHR for you. You mentioned you’re having conversations with OMB. Are you anticipating needing more money than expected this year as a result of these delays and concerns? I know that was one of the worries on Capitol Hill, that as the timeline slips, this becomes more costly. In your conversations, are you–

Secretary Denis McDonough: No, I don’t, I mean, this is a priority issue. That is what I’m trying to communicate to you, Leo, is that we are working really aggressively with all of our partners, with Congress, with the President, with OMB, and I just wanted you to know that among the people we’re working out with is OMB. When we have news out of that, we’ll let you know.

Leo Shane (Military Times): Okay, great. I know last week you had a meeting with caregivers. In that meeting, you mentioned that VA is planning on changing the motto. This has been an issue for quite some time. Can you give us an update on where that stands and when we’re going to see that change?

Secretary Denis McDonough: We’re going to change the motto. I don’t have a timeline for you yet, but as soon as I have it, I will let you know.

Leo Shane (Military Times): According to my dear colleague Patricia here, you said at the meeting that it would be sometime this spring. Is that an accurate timeline? Is there…

Secretary Denis McDonough: This is something that’s really important to the fastest growing cohort of our Vets, women Vets. It’s something that’s really important to a fundamental part of our care team, and that’s caregivers. That means it’s really important to me, so we’re going to move with all due haste. Get this done.

Leo Shane (Military Times): Okay. One more, since I can’t get a full answer on that one. On the, on the Covid issues that you mentioned before.

Secretary Denis McDonough: Yes.

Leo Shane (Military Times): You mentioned specifically the prescription issue. Are there other complications and are there any changes that will happen to service in VA hospitals if Congress doesn’t act? Or can you keep implementing the changes you’ve made there?

Secretary Denis McDonough: Yeah, we’ve been scrubbing and scrubbing this really hard since the middle of last year. I think we’ve got a good handle on everything that we need to address. We’re going to kind of dust off those slides and those assessments and give that one more look if there’s other things that we need for care or for any of our programs, caregivers or otherwise. We’ll make sure that we have the authority to do it, and where we don’t have the authority, we’ll figure out where to get it. This one, this question of cross-state-line prescriptions, is something I’ve been raising with Congress since I was at that Clinical Resource Hub in Boise, and that was last summer. We were talking to our clinicians there, and they’re really anxious about what happens to their patients, their Veterans in rural settings. In that instance, I think that’s VISN 19. They’re worried what happens if we’re not in a position to maintain those prescriptions. Consistent with the urgency, I tried to communicate that last year several times. I wanted to recommunicate that today, and we’re a serious bunch here, we’re going to make sure that we’ve considered all the available options. We’re working with the White House on that too, but this is really important. The explosion in access that’s been a byproduct of the explosion in telehealth is something that’s led to a lot of positive outcomes for Vets. I want to make sure we don’t lose those. It would be a real shame if we did.

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

Secretary Denis McDonough: Thank you.

Terrence Hayes: Good morning, Sarah.

Sarah Sybert (Government CIO): Good morning. I’m Sarah Sybert with GovCIO Media & Research. As you’re overhauling the EHR and also, Dr. Irving, you mentioned the importance of data management to deliver effective care, and then on top of that, have these new hiring goals that you’re trying to meet. Is that going to put a strain on nurses that are already in management positions as you try to train new hires to adapt to new systems that you’re implementing at the same time?

Dr. Kelly Irving: No, we have a continual rollout, so the staff is being trained as we speak on those things, so when it’s fully deployed to our facility, I feel strongly we’ll be ready. Cerner is very popular in the community, so we attract those nurses. We compete. We’re in the Texas Medical Center, so resources are available. So, we have those nurses. I don’t think it will pose any challenges as a whole. Certainly, the learning curve. I mean, I’m not that tech savvy, right? I probably would be challenged with some of the updates in Cerner when you’re used to the CPRS system. We’ll have that challenge, but, no, I don’t think it impose any issues for our care delivery.

Sarah Sybert (Government CIO): Great. Thank you. And what does that training process look like? To adopt.

Dr. Kelly Irving: It’s very robust. It’s hours of manual, and there will be didactic training as well, so people will have the opportunity to try it before it’s fully implemented in the organization.

Sarah Sybert (Government CIO): All right. Great. Thank you so much.

Dr. Kelly Irving: You’re welcome.

Terrence Hayes: Ellen, back to you again.

Dr. M. Christopher Saslo’s microphone crackles

Terrence Hayes: I’m sorry, Chris. You had something, Dr. Saslo? I’m sorry.

Dr. M. Christopher Saslo: Yeah. I also wanted to acknowledge the fact that we are also planning to aggressively hire as we roll out across the enterprise. We’ve already identified, through the Office of Nursing Service, additional leadership and education positions, so that we’ll be well equipped to be able to support the field as the Cerner continues to roll out. Thanks.

Terrence Hayes: No, thank you. Did I miss you, Jory? Sorry about that. Come on up.

Jory Heckman (Federal News Network): Good morning. Thanks for doing this. Jory Heckman, Federal News Network. Following up on Leo’s question regarding the Biden administration’s plans to end the national public health emergency and what that might mean down the stream in terms of telehealth. Do you foresee any challenges in the disconnect of bridging where the Veterans live and where the healthcare providers live, and is there some sort of regulatory workaround that VA’s looking at in terms of keeping that continuity of care?

Secretary Denis McDonough: Yeah, thanks very much for the question. The principal concern is this one around prescribing across state lines. Because of the dramatic increase in telehealth, it’s meant that we’ve been able to maintain access to a lot of Vets. I just want to make sure that Congress helps us close that last piece. As we identify additional challenges, we’d surely talk those through with you as we talked them through with Congress and with the rest of the government.

Jory Heckman (Federal News Network): Okay, great, and recently several senators introduced the VA CAREERS Act. It’s part of this continuity of what we saw in the PACT Act and what we saw in the RAISE Act of raising the salary caps for healthcare providers. I think in this case, we’re looking at certain VA doctors, optometrists, dentists, podiatrists. There might be a couple more. I think the significant thing here is that it would raise the cap beyond that $400,000 salary cap.

Secretary Denis McDonough: Yes.

Jory Heckman (Federal News Network): Is that something that VA needs in terms of recruiting these sorts of folks?

Secretary Denis McDonough: We are thrilled to see that they introduced the bill. We’ve been talking with Congress about this for the last year. You’ve seen us testify about this. You’ve seen this in the President’s budget. Let me just give you two examples. One is specialists. We end up with an unintended consequence as a result of the $400,000 cap, whereby we could not hire a specialist, let’s say a radiologist, because we’re not competitive at $400,000, but we could then go contract for some part of a radiologist’s time, and I’ve heard from different VISN leadership that there are VISNs where we’re spending a $1,200,000 to get access to that specialist, even as we could have hired that person for far less, meaning far less than $1,200,000, but obviously more than the $400,000 cap. So, we have to fix that, right? The second is hospital directors, which we call med center directors that are functionally hospital CEOs for our hospitals. You heard Dr. Irving talk about the size of the Houston DeBakey VAMC, which is among the best healthcare centers in the country. We’ve already proven by the way, two years in a row, that it’s got the best nursing staff in the country. And you say, “Who’s counting?” Well, I am, because they’re awesome. It gets to be a challenge to keep those hospital CEOs, right now. Those are two really good examples. Specialists like radiologists, whom we end up getting access to the service, but at maybe 2x what it might otherwise cost, and then hospital CEOs, where these are like hugely effective leaders, who, like Dr. Irving, have kind of worked up from the bedside, taking care of Veterans, then wanting to lead a Veteran-serving organization. At some point they top out and they say, “Wait a minute. It’s not competitive for me and my family.” So, those are two examples of why we need it, and we are thrilled to see Congress having introduced it.

Jory Heckman (Federal News Network): Okay, great. One quick one, if I may. Just following up on that. Dr. Saslo, I think, made it pretty clear there’s a long road ahead in terms of nurse staffing and meeting the goals for the years ahead. In your mind, what do you see as the, the biggest challenges to meeting those goals? Obviously, there are new tools in the toolbox, under the PACT Act, under the RAISE Act, and maybe soon under VA CAREERS, but what do you see as those big bottlenecks that you guys need to address?

Secretary Denis McDonough: I have something to say, but I’m pretty sure you’re going to say something more interesting.

Dr. Kelly Irving: Some of the challenges for us is the time that it takes to onboard individuals. When you’re competing with the private sector, it could take 30 to 45 days, and just because we do a rigorous onboarding process, it does take us longer. So, we have to stay engaged with the applicants. That is one of our challenges. Otherwise, we’re hiring people on a regular basis, so as long as you stay in that communication with them, letting them know, “Hey, we are here. We’re working on this process. This is where we are in the step.” They stay engaged with us.

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

Secretary Denis McDonough: I was going to say the exact same thing, which is, I’m flabbergasted at how long it takes us to onboard these people. Dr. Irving has 2,200 nurses, right? Let’s say we’re at 2x the hiring time for the private sector. I think Dr. Irving just said it’s like 25, 30 days in the private sector. Well, if we are at 2x, we would, in many cases, be half what we are in too many VA facilities. Meaning, there’s 90 to 120 days to onboard VA personnel. That’s too slow, right? I mean, we’re trying to get world-class, and we have world-class, nurses. It’s like being the Vikings general manager and you think that you can onboard somebody in four months. I mean, that’s a disaster. We control that. We should fix that. We’re working with OPM on that. We have some ideas on that. What I announced that I’m going to do next week with the VBA onboarding event, which builds on the success of the VHA onboarding event that both Kelly and Chris talked about from last November is an example of a best practice. Last thing I’ll say, the other thing that really makes me worried is the overall number of nurses in the United States, right? We are increasingly, rightly, reliant on our nurses to really run our facilities, so we need more nurses. They’re the best, you know, and I’m really happy about the RAISE Act. I’m really happy about some of the additional authorities to be able to pay them what they’re worth in this market, and they’re worth every single penny. There’s just no doubt about it.

Jory Heckman (Federal News Network): All right. Thanks again.

Terrence Hayes: Ellen, follow up?

Ellen Milhiser (Congressional Synopsis): Yes, on the toxic exposure claims, what percentage of those are Veterans new to the VA and what percentage are Veterans who already have claims approved with the VA for care and services, and this is just increasing their benefits?

Terrence Hayes: We’ll take that back so we can get that broken down for you, so I’ll get back to you hopefully in the next hour or so.

Ellen Milhiser (Congressional Synopsis): Thanks so much.

Terrence Hayes: Appreciate it. Any additional questions? I see none. Well, Dr. Saslo, Dr. Irving, we truly appreciate you joining us today.

Secretary Denis McDonough: What about me?

Terrence Hayes: Mr. Secretary, as always. As always, Mr. Secretary, we truly appreciate your time here. Ladies and gentlemen, we’ll see you again next month. Thank you. Be safe.

Secretary Denis McDonough: Thanks everybody. Appreciate you.

Dr. Kelly Irving: Thank you.