VA Secretary press conference September 26, 2024

Terrence Hayes (VA Press Secretary):  Good morning, ladies and gentlemen and welcome to this month’s press conference. We’re excited. We have a lot of folks joining us today to provide you with a lot of great things that we’re doing across the enterprise. So I won’t speak too much longer, I’ll go ahead and get the Secretary up here and introduce our two guests, and then turn it over to the reporters for questions. So with that, I’ll turn it over to Secretary Denis McDonough.

Denis McDonough (VA Secretary):   Terrence, thanks very much, nice to see everybody. And good morning everybody. Hurricane Helene is a very serious storm, expected to make landfall this evening. We’re making preparations for its impact in four of VA’s regions, which you all know we call our VISNs. Florida, which is VISN 8, Mississippi, Louisiana, and Alabama, which is VISN 16–sorry, the Florida Panhandle in particular, which is VISN 16. Alabama, Georgia, South Carolina, which is VISN 7, and then on up into North Carolina and Virginia, which is VISN 6. VA’s in constant coordination with our federal partners, and we are prepared to support the national response to this storm. Our healthcare teams in Florida and across the Southeast have been reaching out to Veterans with high risk care needs, and to our employees. We’ve closed a number of outpatient clinics ahead of the storm, and we’ll continue to communicate directly with the Veterans and their families in the impacted areas about what they can expect from VA facilities. We’re taking all steps to ensure that patients and employees in our hospitals are safe, accounted for, and that all of our VISNs are currently reporting being well supplied to address the impacts of the storm. Most importantly, all Veterans, family members in the path of the storm should take it very seriously, and I strongly encourage them to heed the advice of their local authorities.

We’ve sent information on VA hurricane disaster resources to 810,000 Veterans in Florida already. We’ll be sending that same information, state by state, to Veterans in the path of the storm. If there is any Veteran or family member not getting the information we’re sharing, and they would like to get it, please call us at 1-800-MY-VA-411. That’s 1-800-698-2411. And you can register to receive this kind of information from us on our distribution list at www.va.gov/vetresources. That’s va.gov/vetresources.

Now, next week marks the end of another record-breaking year for Veterans, families, caregivers, and survivors that we’re privileged to serve here at VA. Today more Veterans are applying for and receiving benefits than ever before. More Veterans are using their VA healthcare than ever before. The most affordable, the best care in America for Veterans, outperforming non-VA care. And most importantly, Veterans are trusting us more. Fundamental to all that is that we’ve been changing VA so access to benefits and care fit into Veterans’ lives.

Today, two great VA public servants will highlight key aspects of this care. First, Dr. Neel Patel, Acting Executive Director of our National Emergency Medicine Office, is going to tell you about the nationwide expansion of VA tele-emergency care that ensures Vets get the care they need when they need it.

Then we’ll hear from Adam Farina. You all know him well as our Assistant Secretary of Public and Intergovernmental Affairs. We know him as Slater’s dad. Adam and his team spearheaded the largest outreach effort in VA history, one of the big reasons that we’re now serving more Veterans than ever before. So with that, let me kick it over to Dr. Patel. Doc?

Dr. Neil Patel (Acting Director of VA’s National Emergency Medicine Office):  All right. Thank you, Mr. Secretary, and good morning, everyone. Today we’re extremely proud to share that Veterans now have an easy, on-demand way to access professional emergency medical advice for their immediate health care needs from the comfort of their homes. Tele-emergency care now means that Veterans can simply pick up the phone, call VA, and we can give them advice on what to do and where to go for care. In a way, tele-emergency care is kind of like bringing emergency care in a device into the Veteran’s home, rather than asking Veterans to always go to an ER. And so now every Veteran can feel like they have a doctor in the family.

Now let me explain a little bit more about how Veterans can receive services through tele-emergency care. It’s actually quite simple. But first, I should mention, if folks feel like they’re having a true life-threatening emergency, by all means, they should go to an emergency room or call 911 right away. But for almost all other immediate health care concerns, Veterans can always call VA HealthConnect clinical contact centers and get connected with a triage nurse. That nurse can rapidly assess the Veteran’s symptoms and recommend the appropriate time and place for care, including determining if tele-emergency care is right for that particular Veteran’s symptoms. And look, if it is, the Veteran’s directly connected to a tele-emergency care provider who can do a video visit, and then together, they can determine the best course of action. And tele-emergency care providers can do things like prescribe medications, set up orders for x-rays or labs at the Veteran’s local VA clinic. And by doing this, we can help Veterans get the care that they need when they need it in a way that’s extremely convenient for them. And so far, thanks to the incredible hard work by staff in our VA medical centers and across our VISNs, tele-emergency care has provided care to over 60,000 Veterans. And what we found–and this part’s key–is that in over 60% of those cases, Veterans can have their immediate health care issue resolved through that tele-emergency care visit, saving Veterans the inconvenience, the expense, and the risk of going to a physical ER when they don’t really need to be there.

And so it really is just that simple. Give us a call, and we’ll get you to the appropriate care. It’s truly about helping Veterans get the right care at the right time from the right place. And being able to do this in a way that’s easy and accessible for Veterans truly is icing on the cake. Now, look, it might seem a little strange that we can treat a medical emergency through a telephone call. And look, like I said before, if folks feel like they’re having a true medical emergency, really important, go to an emergency room or call 911 right away. But look, we’ve all been there, right? We may have a cut, and we don’t know if it needs stitches or not. We might have fallen, and we don’t know if we broke our wrist, or we have a really bad cough that’s making us feel short of breath. For many of these concerns, simply talking with an emergency care provider can help you determine if you need an ER visit right away, or if there’s treatments that we can provide to help you get better right at home. And because you’re talking to a VA healthcare provider, we can look at your record. We can review your medical history and give you care that’s not only convenient, but also personalized to you.

And look, I know this might sound a little abstract here, so let me give you an example from a Veteran who I had the honor of taking care of through tele-emergency care from a couple months ago. So this is a lovely 80-year-old gentleman who called saying that he was feeling lightheaded when getting out of bed. And that morning, he had almost passed out. He also didn’t have a ride, and he said he was more than an hour away from his closest ER. So by talking to him, reviewing his chart, the nurse and I were able to figure out that the dose of his prostate medication was increased about a week ago, and that’s really when his symptoms started. Now understanding that this is a pretty common side effect of that medication, we were able to advise him to hold his next dose, take in plenty of fluids, and then provided him with education about when to take this medication to best avoid those side effects. And then when we checked up on him a couple days later, he was feeling great and was so, so thankful that he didn’t need to figure out how to get to an ER and then spend hours in a crowded waiting room. So look, tele-emergency care is perfect for Veterans who need medical advice right away, but don’t have a condition that needs to be treated in person.

Our providers can evaluate Veterans over a video visit or over a phone call, and then we can decide if that’s something that truly needs an ER visit or if there’s options available to treat the Veteran right at home. And all Veterans need to do to do this is call VA HealthConnect. And on top of being able to speak with the triage nurse and possibly obtain tele-urgent and tele-emergency care services, VA HealthConnect also does other things, like provides Veterans with the ability to schedule and reschedule their appointments, request refills on their medications, and even ask questions about the medications that they’re already on. So again, we’re incredibly proud that Veterans throughout the nation now have access to professional emergency medical advice from the convenience of their homes. And actually, what’s even more awesome is that one of the key innovators of tele-emergency care is himself a Marine Veteran. Mr. Josh Geiger, the Director of Operations for VA’s National Emergency Medicine, was instrumental in spearheading this service to help bridge a gap in a care that he and his fellow Veterans were experiencing. It was truly under Josh’s leadership and persistence, in combination with groundbreaking work by clinicians like Drs. Janine Smith, Gauri Behari, Valerie Seeba, Paul Kim, Matt McKenzie, Reshma Patel, Kim Tranquada, Lisa Zhao, and many, many others, that tele-emergency care is now available for Veterans throughout the country. And knowing that this program emerged from a Veteran trying to increase access to care for his fellow Veterans honestly makes doing this work so much more meaningful to me and to many of my VA clinicians.

So again, anyone who’s interested in learning more about tele-emergency care and the other services that VA HealthConnect can provide can visit va.gov/HealthConnect. Now going forward, we’re going to be working incredibly hard to make this service even more accessible to Veterans, no matter where in the US they live. Because look, every Veteran deserves to feel like they have a medical professional in the family. And now all they have to do is pick up the phone and call us, their VA family.

Thank you so very much.

Adam Farina (Assistant Secretary, Public and Intergovernmental Affairs):  Thank you, Dr. Patel. Great work. It’s great to be with you all today. When the PACT Act became law, VA expanded healthcare and benefits to millions of Veterans nationwide. But it’s one thing to make all of those Veterans eligible, it’s another thing to actually get them in the door. So President Biden and Secretary McDonough gave us a mandate on day one, reach out to every single Veteran and every survivor who is newly eligible for care and benefits and make sure they get what they earned.

Since then, we’ve embarked on the largest outreach campaign in the history of VA. We’ve hosted thousands of events across the country, including at places like the largest motorcycle rally in America, major sporting venues like Yankee Stadium, and even local barbecues that we hosted in the cities and towns where Veterans live. For the first time in VA history, we’ve sent text messages to millions of Veterans who are unaffiliated with VA, encouraging them to come to us for the very first time. We’ve executed a nationwide advertising campaign, ranging from digital media to billboards to TV, informing Veterans not only about what the PACT Act is, but why it matters to them. We’ve even worked with everyone from major pharmacies to Congress to prominent influencers to spread the word. And all of this work has had one core idea, wherever Veterans are, that’s where we want to be.

We want to build a department that fits into Veterans’ lives, rather than asking Veterans to make their lives fit into VA, because we know that Veterans who come to VA are proven to do better, to live healthier lives, and the best way to bring them in is to meet them where they are. Now, as a result of this campaign, we’ve seen record increases in applications across the board. For benefits, more than 4.7 million Veterans have applied since PACT, an all-time record and 38% more than the previous two years. For healthcare, 747,000 Veterans have enrolled since PACT, a 31% increase over the previous period, and the most since 2017. And for memorial affairs, 128,000 Veterans have applied to pre-confirm their eligibility for burial in a VA cemetery since PACT, another all-time record. And while these numbers are important, it’s the stories of these Veterans that remind us all why we’re doing this work.

For example, I recently heard a story of a Veteran down in Texas named Ashton Hamilton, who served in the Air Force from 2008 to 2010 before being medically discharged. She’d never sought any assistance from VA before. In fact, she didn’t even consider herself a Veteran. But this past summer, her stepfather, a Veteran himself, sent her a flyer for one of our barbecue-style events down in Texas. So she decided to drop by. At that event, she not only learned that she was eligible for VA care for the first time, she was able to enroll on the spot. Later that day, she said, this was just what I needed to start using the VA benefits that I didn’t even know I had earned. That’s what those events are all about. That’s what this outreach effort is all about. Finding Veterans like Ashton and getting them in the door and getting them what they’ve earned.

Now, partly as a result of this effort, as the Secretary said, we’re now delivering more care and more benefits to more Veterans than ever before in the history of VA, and we’re going to keep it up. So our message to all Veterans is this. Get what you’ve earned today by visiting us at va.gov/PACT, that’s P-A-C-T, by calling us at 1-800-MY-VA-411, or by coming to one of our events or our facilities near you. There’s no wrong door to come to VA, and when you do, we will do everything in our power to serve you just like you’ve served our country. Thank you so much. And Terrence, I’ll turn it back over to you.

Terrence Hayes (VA Press Secretary):  Thank you, sir. All right. Thank you. We will open the floor up to questions. Leo, good to see you.

Leo Shane (Military Times):  Good to be seen. Thank you. Thank you, Mr. Secretary, for doing this. Question about what Adam was just talking about in terms of the increased benefits and the increased workload that’s come from the PACT Act and the folks coming in. You guys have asked for $12 billion in next year’s budget. It looks like that’s not going to be resolved until December, maybe even later. Is there any concern about that surge and that workload over the next few months here, three months here? Can VA keep up with it, or are we going to start to see some issues with hiring, with being able to process these benefits, with getting folks medical appointments?

Denis McDonough (VA Secretary):   Leo, thanks very much for the question. Let me just, before I answer your question, I want to say two things. One, it’s really, really good to see you. Two, Adam takes that outreach effort so seriously, I just want to call your attention to one thing. He had an opportunity to highlight a very major event we just did at Gillette Stadium in Foxboro, Mass with the Patriots, but he didn’t highlight that. He highlighted an event we did at Yankee Stadium with the Yankees. The dude is a Red Sox nut. So this is how seriously Adam and our team takes the outreach, and I really commend him for his awesome work.

So you’re right that the bill that has now passed both House and Senate, the continuing resolution, did not carry the anomaly for VA. We’re continuing to work with OMB and with Congress on that. We’ll be answering additional questions, I’m sure, from members throughout the course of the rest of this month and into during October, and then we hope when they come back and take up the rest of the year funding for FY’24, which will have to be resolved by December 20th–sorry, FY’25, which will have to be resolved by December 20th, we’re hopeful that we see an anomaly there. In the meantime, we’ll continue to provide world-class care, and we will continue to be very discerning about hiring decisions. That’s one of the issues that will continue to be at the heart of how we manage and execute our budget over the course of this year. Our teams, you know, you’ll recall that when I testified last spring, Congress expressed concern about our staffing levels anticipated in the advanced appropriation. We took those concerns to heart in the context also of the very aggressive outreach that Adam just briefed, and we’ve determined that to continue to provide the kind of care that we want to provide, we should have a different end strength number. So we’re hopeful that Congress will help us get to that outcome when they take up the CR–or sorry, when they take up the full-year funding for VA and other agencies at the end of December. In the meantime, I am, you know, you preface your question with, are there any concerns, and I think I’ve said to you guys in this room, any time you ask me a question, is there any concern, my answer as a nervous, anxious character is going to be, the answer is yes, I always have concerns. I think those concerns are manageable at the moment, and we’re really going to work toward answering any remaining questions between now and December 20th, and then we’re hopeful that we’ll get the investment that we need.

Leo Shane (Military Times):  I’ve been out of practice for a little bit, so I should know better than the ‘Are there any concerns?’ But with that, when you say manageable, you’ve been looking at this increase, and you’ve given us some numbers here since March, seeing more folks coming in and everything, so are you starting to hit any concerns with the workforce numbers where three months from now you really need those folks in place, or is that, raising that end strength more of a longer term by the end of the year we’d like to be?

Denis McDonough (VA Secretary):  I’m really happy to report, and we’ve been talking to Congress about this, and we actually should probably just get you guys these numbers, I’m sure Terrence can get them. In terms of all that increased access that Adam just briefed, we’ve seen at the same time continued strong performance and reduction of wait times, and increased access to care across many of our specialties, across primary care, across mental health, and then across the system. So right now, as I look at the system, it’s performing very well, more care to more Veterans, and doing that with reduced wait times, for example. And ultimately, as I said in my opening comments, with the highest trust scores that we’ve experienced since we started scoring trust. But, you know, we’re asking for the additional funds for a reason. And we’ll continue to answer questions about that, and then I’ll be hopeful that we’ll get this resolved by the end of the year.

Leo Shane (Military Times):  Okay, great. Thank you, and thank you and your staff for kindness over the last few months, I appreciate it.

Denis McDonough (VA Secretary):  Listen, man, we say this all the time to each of you in this room, and those of you on the screen, at least most of you on the screen–I’m just kidding. You guys help us do a really important service, which is explaining to Veterans, their families, caregivers, and survivors what it is they’re right to expect, and we really appreciate it. And when you’re not here, we miss you, so thanks for doing what you do.

Terrence Hayes (VA Press Secretary):  Ellen, good morning.

Ellen Milhiser (Congressional Synopsis):  Good morning. Thank you for taking my question. Thank you for doing this. On the tele-emergency service, how often do they do follow-up visits? Dr. Patel indicated he had done a follow-up visit for that patient. How often does that kind of follow-up happen?

Dr. Neil Patel (Acting Director of VA’s National Emergency Medicine Office):  Yeah, thank you for that question. So, yeah, it is a little bit different than when you go to a physical ER, right? When you walk out, you walk out. With tele-emergency care, we actually have the opportunity–so I mentioned that our docs can sometimes order x-rays or labs, and when Veterans go maybe in a couple days to get those x-rays and labs done, we actually have a system in place where we can do follow-ups on those patients. So I can get you the numbers on how frequently folks need follow-up, but it sort of depends on each Veteran’s particular case. But since it’s kind of virtual, it’s really easy to get them on the horn again and explain the results to them and really kind of do that check-in that every Veteran deserves.

Ellen Milhiser (Congressional Synopsis):  So is follow-up only when labs are ordered? Because you indicated that you followed up to see if he was okay with his change in meds. There was no labs ordered.

Dr. Neil Patel (Acting Director of VA’s National Emergency Medicine Office):  Right, and so there’s some patients we just want to do a double check-in to make sure that they’re okay, and so the doctors have the discretion of adding patients to a follow-up tracker where we can then do a follow-up phone call and check in on patients.

Ellen Milhiser (Congressional Synopsis):  And the doctors who are doing the tele-emergency visits, are they located in the same VISN, or might New York be dealing with California in the middle of the night?

Dr. Neil Patel (Acting Director of VA’s National Emergency Medicine Office):  Yeah, really good question. So for most of our programs, the doctors are based within the regional network, the VISN, that the patient is in. And so they’re seeing, you know, it might not be in the same city, but their doctor’s generally in the same region, and they have access to that Veteran’s medical record.

Ellen Milhiser (Congressional Synopsis):  Okay. One last question, then I promise I’m done. If you’re in the VA system, wouldn’t the VA doctor have access to the medical record regardless of where they’re located?

Dr. Neil Patel (Acting Director of VA’s National Emergency Medicine Office):  Yes, they would. So again, that’s the beauty of this system is that, you know, the docs can be anywhere, and the patients can be anywhere in the US, and we can take care of them because we have access to their records.

Ellen Milhiser (Congressional Synopsis):  Okay, thank you so much.

Dr. Neil Patel (Acting Director of VA’s National Emergency Medicine Office):  Thank you.

Terrence Hayes (VA Press Secretary):  Thanks for the questions, Ellen. We miss you in the room.

Denis McDonough (VA Secretary):  Can I just say something to Ellen? Ellen, I think those are, like, super interesting questions. I do think it’s worth–this issue. So each of the VISNs has a, what do we call them, the regional contact–the clinical contact center. And, you know, there’s going to be, and oftentimes, you know, we’ve talked about that in here. In fact, we had the head of the Boise Clinical Contact Center as a presenter here a couple of years ago, and he kind of oversees the entire clinical contact center program. But over time, we’ve got to resolve an issue, which is, you know, because sometimes there’s going to be a specialist available for telehealth from a different VISN. And that, for budgeting purposes at VA, I’m just responding, giving this expressly to you because you understand, I think, uniquely how the VERA model works and how our funding works. It just introduces a very interesting concept, which is we’re going to be then having–there are instances where we have a provider in one VISN providing care for a Veteran in another VISN. So, how that gets scored for purposes of the next fiscal years or two fiscal years hence budget is a really interesting question. And so I’m sure other systems are dealing with this in some ways, but I think this is a uniquely VA issue on our budget that, you know, it bears watching from, you know, your vantage point over the next couple of years because I think it’s a thing that we’re talking to Congress about, mostly we’re talking to inside VA about in terms of making sure that all of our tools reflect how we give care in 2024, 2025, not how we used to give care and how we used to finance care.

Ellen Milhiser (Congressional Synopsis):  Thank you. Yeah, someday I want to talk to you about billing Medicare too, like the former VA Secretary recommended.

Denis McDonough (VA Secretary):  Yeah, well, we’d be more than happy to talk to you about that, and hopefully you’ll be hearing more about that.

Terrence Hayes (VA Press Secretary):  Thank you, Ellen. We’ll go to Patricia.

Patricia Kime (Military.com):  Thanks for doing this. I appreciate it. Doctor, you just–about the tele-emergency healthcare, you mentioned that it wasn’t perhaps completely nationwide. You said something about like hoping that you will expand it. Can you go into some more details about where exactly it’s available and what are your hopes for expansion if it is available already everywhere?

Dr. Neil Patel (Acting Director of VA’s National Emergency Medicine Office):  Thank you for the question. Yes, I should have been clear. It is available throughout the nation, so it’s available through all 18 of our VISNs. What we want to do is be able to increase the capacity in this coming year so that we can handle more patient calls into the system. Again, we’re going to be assessing Veteran demand for the service, and now that we are able to share the good word that this service is available, we have a job to do with capacity management. So, it is right now available throughout the nation, and the work ahead is really trying to make sure that we meet the capacity and the demand that Veterans show for this service.

Patricia Kime (Military.com):  And if the doctor deems it’s an actual emergency, do they have the capability to dial 911 for the patient?

Dr. Neil Patel (Acting Director of VA’s National Emergency Medicine Office):  Yes, that’s what’s really cool here is that sometimes we do get patients who we assess and we say, look, you really need to go right away. And are–we have–the system that we use is connected into the 911 system, so the patient’s location is verified, and so we know where they are, and we can activate what’s called E911 on their behalf and stay on the phone with them until EMS resources arrive.

Patricia Kime (Military.com):  Thank you so much. Another question about the outreach effort. I don’t know who wants to handle that, but the text messages, can I get some data on how many text messages have gone, how you are getting the phone numbers? And I understand you might be on Afghanistan Veterans at this point. Is this like Afghanistan era, or is it like all Veterans? Who are you really specifically doing the outreach on?

Adam Farina (Assistant Secretary, Public and Intergovernmental Affairs):  Great question. So we have, since March 5th, which is when we expanded access to VA healthcare for all toxic exposed Veterans, been working through the different cohorts of Veterans. And so first we started with Vietnam and Vietnam era Veterans, then we moved to Gulf War Veterans, Iraq Veterans, Afghanistan Veterans, and Gulf War Veterans, Gulf War Veterans before Iraq and Afghanistan. We are right now in the process of finishing up the text message campaign to Afghanistan Veterans and then transitioning to Iraq Veterans very soon. We did a text message campaign. It was kind of our first pilot campaign last year. But the main effort has been since March 5th of this year. And since then we have sent 4 million texts and e-mails to those cohorts of Veterans. And we can’t measure every outcome that comes from that. But we do know that directly from those outreaches, we have had more than–or nearly 50,000 Veterans enrolled in health care, and we’ve driven over 114,000 disability benefit, either full claims or intents to file a full claim. And so we are continuing to move through that list. This is the result of data that we have collected over the years, as well as some data that we have securely purchased, which we manage securely in our systems. And what that has allowed us to do is get the most up-to-date information about Veterans who deployed to those conflicts and served in those places but had not yet come to us for health care or benefits. And those are the folks that we’ve been focused on. So it’s folks who are currently unaffiliated with VA who could most benefit from either submitting a claim or getting their health care from VA. And we’ve been focusing on bringing those people to VA for the very first time.

Patricia Kime (Military.com):  And if they read about this and didn’t get a text message, where should they go to find out more?

Adam Farina (Assistant Secretary, Public and Intergovernmental Affairs):  I would encourage any Veteran to go to va.gov/PACT or call 1-800-MY-VA411, and we will get you all of the help and the support you need. And on va.gov/PACT, it very clearly delineates who is newly eligible for PACT Act and what new benefits are available as a result of this new legislation. And if you submit a claim, you can submit a claim for far more than the PACT Act as well. So you can submit a disability compensation claim there, but you can also learn how to enroll in VA health care.

Patricia Kime (Military.com):  Thank you.

Adam Farina (Assistant Secretary, Public and Intergovernmental Affairs):  Thank you.

Denis McDonough (VA Secretary):  Patricia, can I just follow up on two things that you asked Dr. Patel. During the course of this year, we’ve expanded by VISN, the tele-emergency care. And so what Dr. Patel and what we are announcing today is it is now available in every VISN. And so we’ve been able to kind of develop the concept and test the demand during the course of really this year principally. And so it would be maybe interesting, and I’m sure we could pull this data together, because as I talked about this at the VSO conventions, at that time there was about 45,000 Veterans who had been through it. But you heard Dr. Patel say that we’ve now got more than 60,000 Veterans. So we have experiential data now, meaningfully. Secondly, we were talking with Dr. Lieberman today. One place that this will end up being very, very attractive is for our Native American Veterans in very rural settings. And so I just happen to be meeting with the director of IHS this afternoon, and it’s one of our periodic check-ins. I’ll chat with her about how we begin to explore that. But that’s another example of how we are thinking about this not only as a geographic expansion, but also with a particular target to–I guess it’s still a geographic function, but to Veterans in highly remote areas.

Patricia Kime (Military.com):  You just reminded me of a follow-on. Dr. Patel, you might be able to answer this. Is there a civilian-like model for this, or is this completely novel at VA?

Dr. Neil Patel (Acting Director of VA’s National Emergency Medicine Office):  Yeah. So this is another great question. So there are healthcare systems out there that are doing virtual care options. What we’re doing in the VA is something to this scale, to my knowledge, is unique. And the fact that we get to do it in an integrated healthcare system, I think, is also unique, right? We can take care of the Veterans’ whole health needs as opposed to just kind of the acute issue and then hope that they get care later on. We can help connect them with follow-on care. And so that’s what’s unique and special about the VA tele-emergency care program.

Patricia Kime (Military.com):  Thank you very much.

Terrence Hayes (VA Press Secretary):  Thank you, Patricia. We’ll go to Orion.

Orion Donovan-Smith (The Spokesman Review):  Thank you, Terrence. Mr. Secretary, it’s good to see you. As you know, OIG put out a couple of reports earlier this week dealing with the EHR program. I’m looking forward to talking to Dr. Evans soon, so I’m going to save all my wonky questions about this for him. But I just want to ask you one high-level question. One of those reports, which deals with rural Veterans in both Walla Walla and White City, Oregon. That is, Walla Walla, Washington and White City, Oregon VAMCs, a lot of this is not new, and we’ve talked before about the particular challenges that VA faces in rural settings in terms of staffing and access to care, things like that. But in this report, staff at those two medical centers called attention to the EHR’s impacts on both revenue and staffing there, especially in primary care where they’ve lost staff. We’ve talked before about the budget challenges, the strain on VISN 20’s budget of the EHRM program. I just wonder, in light of this latest report, is there anything VA is doing to make sure that those Veterans at those locations and that in VISN 20 as a whole don’t see any impact to their care?

Denis McDonough (VA Secretary):  Yeah, thanks very much. Obviously, we take the IG reports very seriously, and you’ll have seen in there that we concur with the recommendations that the IG makes. As I’ve said in this room a number of times, and as I’ve said directly to the IG, I think their work makes us better, and I think that’s true in the case of the EHRM.

Secondly, we do know that it’s been the case in VA, as it has been the case in other healthcare systems, that the initial deployments of new EHRs leads to productivity loss. We try to make up for that with staffing enhancements. That then has an impact, as you’ve suggested, on budgeting, VISN by VISN. So, those experiences now enhanced by the lived experience of VISN 20 and VISN 10, those estimates and those planning parameters are updated. The plan envisions that. So, at its heart, I think the plan is built around a concept that the Veteran and their access to care should not suffer. The Veteran, in fact, the whole purpose of the deployment of a new EHR has to be focused on Veteran outcome. That’s the whole purpose of it. That’s a longer way of answering your question. The shorter way is, yes, there are steps in place to make sure that the Veteran and their access to care does not suffer as a result of the deployment of the new system.

Orion Donovan-Smith (The Spokesman Review):  Thank you. And just briefly on the other OIG report that deals with the system’s availability with downtime and degradations. Again, it talks mostly about the period before Oracle’s acquisition of Cerner in 2022, but it does deal with some major incidents since then. Just briefly, what’s your assessment of Oracle’s performance in reducing those, even if there are still–there have still been some technical problems with the system?

Denis McDonough (VA Secretary):  I think the best way for me to answer this question is to say that as we’ve relooked at the contract with our partners in the course of the last couple of years, we have highlighted system reliability as a key measurement, and we’ve ensured that there are ways for us to extract penalties from the contractor when the performance is not what Veterans are right to expect it to be. So I don’t have anything to say beyond that, other than that meaning this is a very valuable measure. It’s a measure that we take very seriously, and it’s a measure that we’ve now built into the contract so that everybody understands that performance is the name of the game because the whole purpose of doing this is to improve Veteran outcomes.

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

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

Jory Heckman (Federal News Network):  Hi. Thanks so much again for doing this. A follow-up to Leo’s question about the workforce and the budget shortfall situation. We’ve heard from Dr. Elnahal a couple of times now briefing us on increasing productivity of clinicians through things like the access sprints, getting more appointments per clinician out there. He’s also said about the need to increase the VA healthcare workforce by about a 5000-employee headcount for, I guess, the next year. Do you get the sense that VA clinicians are maximally productive? I know there’s that balance between that and burnout. Are there future access sprints in the works here? How do you balance those two things going forward?

Denis McDonough (VA Secretary):  Yeah. Let me just answer the question this way. I am super proud of VA providers. They operate in very complex settings. You have an example of Dr. Patel right here. He’s going from here back to overseeing the emergency medicine effort at VA. And he’s not getting productivity points for being in here with us, and anytime you’re with me, that’s to be understood because you’ve got to really invest and make me understand something. So we ask a lot of our providers, and we have asked a lot of our providers, going back to 2019 with the Mission Act, 2020 with the pandemic, 2022 with PACT Act. And our providers have taken on each of those major challenges and succeeded very, very well. And, by the way, throughout that, innovating in the kind of ways that Dr. Patel has just talked about. So part one of the answer is our providers are really good. Our providers are particularly good when we put Veterans at the heart of what we do. And we see that time and time again. And we will continue to demand that of our providers. And that’s not a hard demand because that’s what the providers want to do too.

Three, because of what we anticipate will be increased demand from Veterans and because of the fact we’ve talked about this a lot this course of this year in light of the budget agreement from last year with the introduction of the caps, there’s going to be tougher budget years. So we have to be doubly careful about that. So we have introduced the productivity ratings, and I think our providers have responded very, very well to that.

So I guess the reason I answer the question that way, Jory, is that I want you to understand and I want our providers to understand that we’re looking at productivity because of the intensity of the situation we find ourselves in. And it’s not meant to be a characterization of them or their performance. And as with each of those three major system changes, mission, pandemic, PACT, I have every confidence that our providers are going to step up on this as well. And we’re seeing it, clinics on nights and weekends. I have told you guys already about a radiologist I met down in El Paso. I thought it was pretty early, right? I met him at like 7:30, and he had already been in clinic providing radiology services since like 0600 that morning. And they were out providing radiology services in the evenings. So that’s emblematic of providers throughout the system.

Jory Heckman (Federal News Network):  And just to the second point about Dr. Elnahal’s request for an increase of 5000, I think a headcount increase by 5000, how contingent, and I heard what you said earlier about being very careful with the hiring situation, how contingent is that hiring and that workforce growth on Congress addressing this anomaly, this $12 billion shortfall for next fiscal year?

Denis McDonough (VA Secretary):  Remember the status quo ante, right, is the debate we were having in the spring when Congress was saying, hey, we think that this goal of 383,000 at VHA by the end of FY’25, which was embedded in the FY’25 budget, is too little. So we said, look, we think it works, but if we need more, we’ll come back to talk to you. I said the one thing we will not do is we will not stop the outreach to the Veterans that Adam talked about because this is their care that they’ve earned, and we have to make it available. So if we need more providers to make it available, we’ll let you know, and we’ll ask for more money. Well, we did that. And so inside the $12 billion, we would no longer be going to status quo ante, which is 383,000 end strength. We’d be going closer to something like 403,000, 404,000, right? So now those numbers are going to be constantly updated, right, and especially with the end of the fiscal year, we’ll have some accounting to do over the course of the next several weeks. So we’ll take a hard look at that. So I can’t entirely answer your question about how contingent it is, but that gives you a band, right? Status quo ante would have us go to 383. The additional TEF that we’ve asked for would have us go to 403 or so. That gives you a sense of the range.

Jory Heckman (Federal News Network):  Finally, quick clarification because I know previously this year, much had been made about the VA health care workforce exceeding 400,000, and what you’re saying now is that the head count has gone down somewhat, so we’re no longer at that peak VA health care workforce that we saw earlier this year just through attrition?

Denis McDonough (VA Secretary):  You know what, rather than answer that question because I think you’re asking for a degree of precision that I may not have, and as a result I’ll probably answer incorrectly, let us take that and get that to you guys through Terrence, kind of what numbers have been at different snapshots during the course of the year, right, because remember that I think we ended ‘23 at something like 390,000, which is why we thought we could get to 383. During the course of this year, we continued to add, right, off of the base at the end of 2023–fiscal 2023. So what exactly that was and has been at different intervals, we can get you that, and then you can just draw your own conclusions from that.

Jory Heckman (Federal News Network):  Great. Thank you.

Denis McDonough (VA Secretary):  Good. Thanks, Jory.

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

David Elfin (cyberFEDS):  Morning, Terrence. Mr. Secretary, good morning. Not that I don’t want to speak to Terrence, but–so I’m sure you’re a little relieved because everybody is in the government we’re not having a shutdown, but to the $12 billion and to what Jory and Leo have been talking about, do you think once we’re past the election, maybe there’s a little more wiggle room for Congress?

Denis McDonough (VA Secretary):  Yeah, you know, David, I’m going to let Congress speak for Congress, and I just tell you that, you know, they have questions. We’re answering the questions. They’ve been great partners, obviously, to us. So I’ll let, you know, we’ll keep answering the questions, keep doing the things that we’re doing. Most importantly, we’re going to keep the outreach going and we’re going to keep the focus on access as tight as it has been. And then we’ll resolve the, you know, we’ll work with Congress to resolve the issues then when they come back.

David Elfin (cyberFEDS):  Mr. Secretary, speaking to Congress. Ranking Member Takano put in a bill about Title 38 collective bargaining the other day. He’s always bragging about being the PACT Act guy. I wonder what your reaction was to that bill.

Denis McDonough (VA Secretary):  Haven’t seen the bill, Dave. I think he’s done a version of this bill in the past, but why don’t I get you our position on the bill through Terrence so that I don’t give you the wrong answer because I might be confusing, you know, different bills. But as a general matter, we do believe that collective bargaining is an aspect of a strong workforce. But that particular bill, I’m sure we have a view on it now. I’ll let you know.

David Elfin (cyberFEDS):  That’s great. If Terrence could get that and the other information you just mentioned with Jory today, because I’m sure we’re all on deadline, that’d be awesome. And if you could give, Mr. Secretary, you give Terrence a hug because the Jaguars are not doing well.

Denis McDonough (VA Secretary):  Yeah, I don’t know if you saw that the Vikes are 3-0, but anyway.

David Elfin (cyberFEDS):  No, we did. Yes. Congratulations.

Terrence Hayes (VA Press Secretary):  So now we’ve got reporters tasking me and giving shots at me. So I enjoy that. Jordan.

Jordan McDonald (GovCIO):   Hi. Thanks for doing this. I had a question for Dr. Patel. I’m curious with the tele-emergency care service, if there’s synergy between existing VA programs. I’m specifically thinking of the Uber Health Connect program, which you know is tasked with giving rides to Veterans to get to their appointments. Is there any synergy? Will these programs sort of work together?

Dr. Neil Patel (Acting Director of VA’s National Emergency Medicine Office):  Yeah. Again, thank you for that really great question. So right now, that’s work that we need to do in FY’25 to make those connections. We are aware of that, and that’s a very interesting kind of connection that we want to make. We’re also using this service to support checking in on elderly Veterans who have been discharged from an emergency department who are at home, and we can have paramedicine personnel go out to their home and do a well check on them. If there’s questions, they can actually ring up the tele-emergency care program and so that’s in a pilot phase. So, yeah, there’s a lot I think we can do, and I appreciate the kind of suggestions about these good connections because I think we can make this tool all the more powerful and deliver more value for Veterans.

Jordan McDonald (GovCIO):   Yeah, absolutely. Quick follow-up. Now that the service has been enterprise-wide, where is the demand highest? Is it really for rural Veterans using this? Are they using it in cities, northeast?

Dr. Neil Patel (Acting Director of VA’s National Emergency Medicine Office):  Yeah. You know, I would have to probably get back to you on the actual usage data. The one interesting feature of this program is, you know, you might think it might be younger Veterans who are more attuned to using technology. Not so. The majority of patients using tele-emergency care services are actually over the age of 65. But we can get you data on the kind of geography spread, rural versus urban, offline.

Jordan McDonald (GovCIO):   Great. Thank you.

Denis McDonough (VA Secretary):  Some of that data might be skewed so far because we have not yet been, until now, we have not been national. So the data that you’ll see on geography will reflect–it’s like looking under the lamppost, right? Now that we’ve turned on all the lampposts, we’ll get a better handle on that.

Jordan McDonald (GovCIO):   Thank you.

Terrence Hayes (VA Press Secretary):  I think Dan’s on the call. Over to you, Dan.

Dan Sagalyn (PBS NewsHour):  Thank you, Terrence. Mr. Secretary, I have a couple of questions about the VA’s proposed rule for constrictive bronchiolitis. Can you tell me how personally involved were you in the issuing of that rule that created a new code for constrictive bronchiolitis? Were you briefed on the criteria–for what the criteria would be for the sake of establishing disability benefits?

Denis McDonough (VA Secretary):  Yeah, so, you know, all of our rulemaking is published in the Federal Register under my signature, so I was very involved in it.

Dan Sagalyn (PBS NewsHour):  Okay, so I was looking at the comments earlier today. There were 38 comments. Most of the comments are, you know, praise the VA for establishing a code, but they criticized the VA for the criteria for assessing benefits. The proposed rule, as you know, you know, calls for using pulmonary function tests, maximum oxygen consumption, and metabolic equivalents. So, Mr. Secretary, what do you say to the people who put in comments that say those tests are insensitive and can’t detect that condition?

Denis McDonough (VA Secretary):  I say it’s awesome that they’re using the public comment period to add comments. And, you know, the way this works is when the comment period closes, then we’ll respond to those comments and we’ll use those comments to sharpen the rulemaking. And so what I say to them most profoundly is thank you.

Dan Sagalyn (PBS NewsHour):  Do you have an initial reaction to their comments?

Denis McDonough (VA Secretary):  No, I want to be really careful to be respectful of the process here. Dan, you and I have had an ongoing conversation about this, and the Administrative Procedures Act does lay this out quite clearly of what I can say and when I can say it, and I want to not compromise that because it’s been a long time in coming, and I want to make sure that we get it done right for those Veterans who are suffering with this. I will say that I’m really happy to see that to date the grant rate on Veterans filing on CB is north of 75%. That’s positive, but we want to make sure that we get this in a position to get every Veteran the access and the benefits that they have earned.

Dan Sagalyn (PBS NewsHour):  I’m sorry, when you say north of 75%, explain that. I don’t understand that.

Denis McDonough (VA Secretary):  Veterans who are filing claims on constrictive bronchiolitis are being awarded, I’m told by VBA, at 75% grant rate.

Dan Sagalyn (PBS NewsHour):  So you’re saying 75% of Veterans are getting a benefit or their benefit rating is 75% or more?

Denis McDonough (VA Secretary):  I’m saying that of those who file a claim, I’m told by VBA, and we’ll get you the data, Dan, of Veterans who file a claim for constrictive bronchiolitis, that claim is being awarded in the Veterans’ favor 75% of the time.

Dan Sagalyn (PBS NewsHour):  But you don’t know what the rating is. The rating might be zero, but they’re getting an award.

Denis McDonough (VA Secretary):  You’re understanding my answer, yes. You’re understanding my answer.

Dan Sagalyn (PBS NewsHour):  And just last question and I’ll let you go. So the criticism that using an insensitive test as a metric for rating this condition, what’s your response to that?

Denis McDonough (VA Secretary):  The criticism and the input is going to be something that we will address when we respond to the proposed comments, one. Two, the issue of how one measures–how one diagnoses constrictive bronchiolitis is an issue that we have been wrestling with. And critiques of us are expected and helpful because we aspire to be a Veteran-centered organization. And so, again, the way I respond to those critiques is to say, we hear you. This is really important to figure out how best and most accurately to make this diagnosis. And most importantly, we want the Veterans to get the care and the benefits that they have earned.

Dan Sagalyn (PBS NewsHour):  Okay, thanks.

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

Quil Lawrence (NPR):  Thanks very much. Should let Adam know that our Boston affiliates will be investigating the attendance of a Red Sox nation member at a Yankees event. Just automatically triggered the investigation. Fair warning.

But my question, of course, is about VASP, which is rolling out next week. This week, I was in Oklahoma meeting with a former MP who served in the ‘90s, survived MST, took her decades to sort of claw her way back to a good place, part of which involved a VA home loan. And then, because she had to take care of sick relatives during the pandemic, she took a forbearance and then got a call about a year later, as many other recipients of the VA COVID forbearance did, and said–where lenders basically told her she had no choice but to take a loan modification or pay all of her arrears at once. She took what was a 3% loan and ended up with a 7% loan, raised her payment by 50% on her teacher’s salary, and now she’s on very shaky ground financially. The VASP program, which is coming out next week, as written, does nothing to help her. So she wants to know what are you going to do to help Veterans in her situation who were, as they consider, duped into taking this VA forbearance, which had no on-ramp back onto solvency, and the current fix doesn’t seem to affect them? And do you know how many people are in her situation?

Denis McDonough (VA Secretary):  Yeah. Well, thanks very much for the question, Quil. Since we last talked, we’ve obviously continued our work to ensure that servicers participate in the moratorium on foreclosures and that we are continuing to work the VASP program. You and your teammate have done really important reporting on this, including in this case with this Veteran teacher, loving family member. We are working all that data through. I don’t have an answer on your question about similarly situated Veterans. That is to say, I think what you’re saying is Veterans who refinanced and now find themselves in an unfair loan situation, we can aspire to get you that. But we are very focused on October 1, and if we have any further announcements on the aspects of VASP, we’ll make sure that we make them, and you’ll be among the first to know. But I don’t have any news for you on that right now.

Quil Lawrence (NPR):  Okay. I mean, because this is in the year after the program ended, before we started talking about it, which is about a year ago, there were people like her who didn’t get a chance to take advantage of your moratorium, which you put in place right away.

Denis McDonough (VA Secretary):  I understand. I understand. And what we really want to do is make sure that we’re going to have the program reflect the most Veteran-centered way that we can have it to address this range of questions, Quil. And what I want more than anything, on top of addressing our Veterans’ concerns, is to talk to them directly so we can hear them, so that we’re not doing this by analogy or not doing this by, as good as your reporting is, I would love to talk to those Veterans directly about how we can work with them. In which case, I would ask Veterans to contact us directly at 877-827-3702 and then pressing 4. That’s 877-827-3702, and then exercising option 4, or by visiting us at the VA Home Loans site for additional information. That’s not to say that we don’t value your reporting. We do. And we’ll try to get answers to your specific question here. But we’re also very focused on October 1 and making sure that this is ready to go.

Quil Lawrence (NPR):  Right. I mean, respectfully, I have been asking this question to your staff and to you in press conferences now for months.

Denis McDonough (VA Secretary):  Yes.

Quil Lawrence (NPR):  I don’t get the impression that VA is aware of how many people are in this situation. I mean, we’ve been asking for months, so [crosstalk] I mean, we have a data dump, but we don’t have a way to analyze that data. We’ve also been asking for clarification on that data. I wouldn’t normally call this out in a press conference, but I have been asking by email and text for months.

Denis McDonough (VA Secretary):  Yep. And you’re asking specifically for the numbers of Veterans who are in–have refinanced into loans that are difficult to maintain. Is that correct?

Quil Lawrence (NPR):  Yeah. Essentially, were given an ultimatum, pay everything or take this really devastating modification to the loan that VA gave you. And again, these are people who are being punished because they’re Veterans. If they had had a Freddie or Fannie loan and forbearance, this wouldn’t have happened to them. And I really want to know if VA knows how many people are in this situation. And if you know, I’d like to know how many. And I’d like to know what’s–if there’s anything in the works, because VASP, as you wrote it, is doing nothing for these people. So I understand that that’s going to roll out next week and help the people it helps. But VASP, as you wrote it, very clearly does not help these people.

Denis McDonough (VA Secretary):  Right. So there’s one of your responses to two things. One is you want to know the number of Veterans who have been forced by private lenders into very unfavorable [crosstalk] loan modifications. And it sounds like we gave you some data, but you want more clarification on that. I’ll make sure that Terrence and our team work with you.

Question two is what precisely VASP does for Veterans? And as I say, we’ve talked with you about this, including I’ve talked with you about this, in our monthly pressers, and I know that we’ve had–Josh has talked with you as well, and John Bell and others. We’re fast approaching October 1, and as we have new information to share on that, we’ll share it with you. So one, I want to get to your answer on our best sense of the number of Veterans in that difficult situation. We’ll do that. Number two is, as we approach Tuesday, as we have new information, we’ll share that with you. Three, and most importantly, to our Veterans, we really want to hear from you, and so we urge you to be in touch with us directly, even as we continue to value the reporting, Quil, by you and by your teammate, Chris.

Quil Lawrence (NPR): And Chris happens to be here with some follow-ups when Terrence is ready to call him. Thank you very much for doing this. It’s good to see you all.

Terrence Hayes (VA Press Secretary):  Over to you, Chris.

Chris Arnold (NPR):  All right, great. Can you guys hear me?

Terrence Hayes (VA Press Secretary):  Yes.

Chris Arnold (NPR):  Yeah, and just Quil said almost everything very, very well. Just to underline that, I mean, these are Vets–we’re talking to this Vet, Natalie, is her first name, we were just talking to in Oklahoma, and she really does feel betrayed. She was told to take this help. She was helping a family member die during COVID, and then she had the rug pulled out, and again, we want to know how many people that is. And also, I guess my question is, why does the current VASP architecture of the program not help people like her? Is it a worry about cost? Because if we don’t know, well, maybe it’s just a handful of people, and if it is, it probably wouldn’t cost that much to help them, and they feel like she’s saying, please help us too. She just wants some semblance of what her life was before. She’s worried about having to stop being a teacher. She really can barely afford her mortgage and is going to have to give that up and do something else. Or if it’s a lot of people, we find out, well, that sounds like a really big problem, maybe that should be fixed. And why is it that the current program doesn’t help people who went into this in good faith, got blindsided by a much more costly loan mod? Again, if it was a Fannie and Freddie loan, an FHA loan, there were better options in their loan mods. But VA loans, these folks were punished, like Quil just said, for having a VA loan. There was no option after that PCP program ended.

Terrence Hayes (VA Press Secretary):  Yeah, Chris. [crosstalk] Well, Chris, I think we’ve had you, myself, Mr. Jacobs, and other members of Team VBA have this conversation quite often. We’ve shared with you the data, and we’ll get to hopefully a more precise conversation so you can understand what that data states. But I think from those conversations that we’ve had is that one of the things that was explained by Mr. Jacobs and his team is that various Veterans take mods for various different reasons. So that was one of the issues that was brought up in our earlier conversations. To the Veteran that you talked about earlier, as the boss said, our hearts go out to her and her situation. And what we want and what we encourage her and others who potentially might be in a similar situation is to please give us a call first as early as possible when they may be facing any of these potential challenges so we can hopefully come to a collective solution alongside them so they don’t take these mods like you’re stating today. So, again, that’s what we’re trying to do on the prevention side of the house. But, again, we’ll dig into deeper on the numbers and to ensure that you understand what the numbers are that we’ve provided you and Quil. But, again, I think just reference back to Mr. Jacobs, and he’s going to have another roundtable coming up soon, and, of course, you can float that question back to him. But, again, I think we’ve had those conversations–similar conversations, on the differences in mods and how it’s hard for, I think, VA or VBA, that is, to determine, you know, what was a mod, as you referenced, with this particular Veteran and just say a mod from someone else who may just take a modification or refinance or whatever the case may be. So we can circle back on this, though.

Chris Arnold (NPR):  Well, just to be clear, though, I mean, you know, you could very easily, I would imagine, define someone’s in a forbearance, COVID forbearance with a VA loan. They wound up in a loan mod that was significantly higher cost because the interest rate went from 3 to 7 or something. You know, it’s not complicated. It’s like, well–

Terrence Hayes (VA Press Secretary):  Yeah, again, I mean, we’ve had the conversation over, and as the boss said, he’s tasked me out to circle back, and that’s what I’ll do. I’ll definitely circle back with both of you gentlemen to ensure that we can get clarity on the information that we’ve provided you.

Chris Arnold (NPR):  Okay. Yeah, because like Quil said, it’s been nine months, and just even to get a subject matter expert on the phone to be like, what’s in the database?

Terrence Hayes (VA Press Secretary):  Hold on. I want to make sure, for the record, we have indeed provided you and Quil several opportunities to chat with our team, and we’ll continue to do that transparently as the boss demands of me. So, again, I will circle back with both of you to get the information that you request.

Chris Arnold (NPR):  Okay. Thanks, guys. Appreciate you.

Terrence Hayes (VA Press Secretary):  With that, do we have any other questions? Before we close, I think the boss wants to close out with some great news from our colleagues at Team VBA.

Denis McDonough (VA Secretary):  Yeah, so let me just say about our team at VBA, for the first time in history, VBA has processed more than 11,000 claims in a day. That was Tuesday. The second time they did that was Wednesday. So they turned right around and broke that record. So our teammates are really doing important work delivering earned benefits to Veterans. So I thank them for that. But also recognize that, look, our Veterans are still waiting, so let’s get those claims worked. And just for purposes of completeness, the disability compensation backlog today is 241,075 claims. That’s down about 30,000 since the last time we were together. So we’re continuing to make progress. The most important thing I want to explain here is to Veterans, please file claims. These are your benefits that you have earned. So let’s make sure that we get you those benefits. And the first step in doing that is filing a claim. So thanks a lot, everybody. Appreciate you.

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