VA Under Secretary for Heath Media Roundtable

Dr. Shereef Elnahal (Under Secretary for Health):  –Updated 2023-2024 vaccine which targets the XBB 1.5 variant of the COVID-19 virus tested pretty effectively against most of the variants that are out there right now. There isn’t a single dominant variant at the moment, but we’re confident and hopeful that this will add an extra layer of protection, especially to our most vulnerable Veterans as we proceed through an additional wave of the COVID-19 pandemic in the US. VA will be one of the first federal agencies to receive the vaccine off of our federal supply schedule really shortly after these approvals came through last week. And of course, as soon as we receive the vaccine at our facilities, we will begin offering them at no cost to VA Veterans and healthcare staff. We also are providing free COVID-19 testing as we always do to eligible Veterans as we proceed through this wave. We strongly recommend that Veterans get the vaccine. This is a vaccine that has proven over and over again to be safe and effective, protects against severe outcomes and death very significantly. And as we are seeing hospitalizations go up across the country, we’re concerned that if folks don’t get this latest booster of the vaccine, they might not benefit from the protection. And so, I just wanted to mention that up front. We will be among the first healthcare systems in the country to begin distributing and administering this vaccine.

With that, I’ll just go quickly into a progress report here on our priorities and I’m very pleased to share good news on our hiring efforts. We have crossed our 52,000 employee hiring goal for the year with time to spare. We’ve hired 54,056 people externally into our system through August of this year, breaking the previous end of year record set in fiscal year ‘22 which was only just over 49,000. We have this month remaining, so we have another two weeks to continue hiring. But that was the last goal that we had set for ourselves in the fiscal year and we exceeded it, so we’re really excited about that. That amounts to a 6.2% growth in our workforce, net growth, to include attrition and to include the impact of people leaving the organization. Again, we have doubled our 3% growth goal, which was the original goal, assuming that we would have similar loss rates of employees as in the immediate preceding years. Our loss rate has significantly dropped, which accounts for the fact that we have doubled our employee onboard growth goal. We’ve also improved retention, as I said, and so the loss rate is currently at 7.2% through August compared to an average of 8.9% and a rate of 10.3% this time last year. We have already also exceeded our big seven occupation hiring goal. Remember, these are the frontline clinicians like physicians, nurses, LPNs, nursing assistants, but also critical support staff like medical support assistants who often take care of scheduling and greeting patients, getting them settled into clinic and whatever side of care they come into. And we’ve also focused on hiring food service workers and housekeeping aides. So, we are now 30,433 hires among the big seven occupations, again exceeding our goal. And so, we’re really proud of our hiring efforts. We need to make sure that we have an end strength that allows us to execute on our other priorities. It’s the most foundational priority we had this year operationally, and we have exceeded all of our goals when it comes to onboarding employees. So, I’m really proud of our networks across the country, our medical centers across the country for getting to these outcomes.

A few updates here on our PACT Act implementation efforts. So, as of September 9th, we have completed 4.5 million toxic exposure screens for enrolled Veterans across the country, far exceeding our goal of 4 million for this fiscal year, with more than 1.9 million Veterans reporting at least one potential exposure. And that accounts for about 42% of the total number of Veterans we are screening. So, we call the care that follows this Exposure Informed Care. It is inherently valuable for clinicians in our system to understand that Veterans have been exposed to one of these toxic substances covered under the PACT Act. That is useful information for any clinician that sees the Veteran. On top of that, every single one of these Veterans who screen positive get a letter from VBA instructing them on exactly how to apply for new benefits under the PACT Act. And so especially if a Veteran has a condition that is now considered presumptively service-connected, that will be a direct way that we might enhance the benefits that Veterans in our system already have, to include the potential to increase their priority group which has implications for cost sharing and beneficiary travel and really just making sure that every Veteran who might benefit from the PACT Act post screening gets that benefit. We’ve enrolled 378,000 new Veterans since August of 2022, when the PACT Act was signed into law, and we’ve increased–which accounts for an increase of more than 61,000 new enrollees over the total enrollment of Veterans up to this point last year. In other words, 378,000 new enrollees; 61,000 new enrollees higher than what we had as of August of last year compared to the beginning of FY ‘22.

We are also focused on the one-year special enrollment period, trying to make every avenue available to us used in good faith to reach out to Veterans who might qualify. Remember that this cohort of Veterans has an expiration date of September 30th of this month where they can directly enroll into healthcare. They are Veterans who, by definition, deployed to a combat zone somewhere in Central Command, never enrolled in VA Healthcare, and left active duty between September 11, 2001 and October 1 of 2013. These Veterans are directly eligible to enroll in VA Healthcare through September 30th, regardless of any determinations around service-connection or disability benefits coming from VBA. And so, for Veterans who may have tried to apply for PACT Act benefits through VBA, otherwise were not granted those benefits, but still qualify under these criteria, they can still directly enroll into VA Healthcare. And remember that that enrollment is good for life. Once you are enrolled in the VA for Healthcare, you will not lose that enrollment status. We estimate that 1.7 million approximately Veterans may be eligible for this special enrollment period. We have about 1.3 million of them currently enrolled from this cohort, and we are trying to maximize the number of Veterans in that delta. So, in other words, about 400,000 Veterans who are not currently enrolled who qualify for this special enrollment. So just want to make sure we use every avenue we can to communicate about this opportunity. And we’ve done that. We’ve sent letters, we’ve sent emails to the approximately 400,000 Veterans in our databases who fit the criteria according to the data that we have. And they can go to VA.gov/PACT and click ‘Apply for Healthcare’ to get the process started. The deadline is midnight on September 30th of this month.

I want to talk a little bit more about preventing Veteran suicide because this is Suicide Prevention Month–September is Suicide Prevention Month, and so we are doing events in medical centers across the country to get the word out using our ‘Don’t Wait, Reach Out’ campaign. The central theme of this campaign is that everybody has a role to play, whether they are a VA employee or a Veteran who’s already in our system and knows another Veteran who is contending with mental health conditions, stress, or otherwise may be in crisis. And we are reaching out to the broader public as well to ask if they know a Veteran, they could check on that Veteran, reach out to that Veteran to ensure that they get the support and the care that they need. In early August, we sent out a campaign toolkit and materials across the VA to include our Public Affairs Staff, Suicide Prevention Coordinators, our VBA Partners, and our National Cemetery Administration Partners as they have been working with us on Suicide Prevention Month awareness. We have a digital toolkit with social media, graphics, messaging available by the public for downloading, so anybody can make use of these free tools that we’re putting out there to make sure that folks know about 988, press one, for example, as an avenue for Veterans in crisis and for Veterans who may qualify for VA Healthcare but are not yet enrolled. We know that there is data showing that when you correct for risk, when a Veteran is enrolled into VA Healthcare, considering all of their risk factors, they are at lower likelihood for suicide because they are under the care of one of our expert clinicians who assist them with that. We also have a lot of programming that connects Veterans to each other and that social fabric, that blanket of support that Veterans have when they’re around other Veterans and they’re engaging meaningfully, and they know that they are supported, could be lifesaving. And so, we have now made over 1000 community coalitions. We announced that a couple of months ago. And we are working on the next round of Fox Grants that we hope to release soon. These are direct funding grants to community-based organizations that help us with the mission around suicide prevention by reaching out to Veterans, connecting them to VA healthcare, and otherwise providing that blanket of support.

We’ve also reached through the Governor’s Challenge, now, 50 states and five territories and over 1500 local community coalitions all working to address Veteran suicide. And we have a public health model for suicide prevention that includes what we call lethal means safety. We have partnerships across the country to help us administer and distribute gun locks to Veterans, caregivers, family members. We know that 75% of Veterans, approximately, who have a serious episode of suicidal ideation complete that suicide within an hour. Of the Veterans who complete suicide, 75% of them complete it within an hour of having suicidal ideation, which is a really pressing statistic that shows all of us that adding minutes to somebody’s timeline by having a gun lock on one of their firearms could very well be lifesaving. It’s a public health intervention that’s very effective. And we have partnerships across different sectors to distribute these gun locks, including with gun manufacturers and gun shops. We are above politics in this organization. We’re taking a bipartisan approach to this because we know that it’s lifesaving for Veterans. And so that is the summary of topics I wanted to discuss and I do look forward to your questions. Thank you.

Mark Ledesma (Director, VHA Communications):  Great. So now we’re opening the floor for Q and As. David, go ahead. You’re the first.

David Elfin (cyberFEDS):  Hello, Dr. Elnahal. How are you, sir?

Dr. Shereef Elnahal (Under Secretary for Health):  David, good to see you.

David Elfin (cyberFEDS):  Good. Just wanted to ask you a couple of hiring questions. Obviously, you got a lot to be proud of. The big seven. What was the goal? That one I’ve lost somewhere in all the numbers–that–what the goal was for the big seven.

Dr. Shereef Elnahal (Under Secretary for Health):  The goal was 30,000 people across seven occupation–again frontline workers. And we’ve exceeded that goal for this year.

David Elfin (cyberFEDS):  And then the other question, which I ask you just about every month is hiring the hirers, which you brought up months ago. You couldn’t have done this without hiring the hirers. Where do you stand on that?

Dr. Shereef Elnahal (Under Secretary for Health):  We’ll get you the latest on how many people we’ve brought on from HR specialist standpoint, for sure. I don’t have that number in front of me, but we have significant progress there as well.

David Elfin (cyberFEDS):  Appreciate it. Thank you, Mark.

Mark Ledesma (Director, VHA Communications):  Thank you, David. Patricia, go ahead.

Patricia Kime (Military.com):  Hi there. Thank you so much for doing this, Dr. Elnahal. Can I ask about the COVID vaccines, you know, with the Federal Emergency all over and everything, I know at some point in time, early on, you were doing COVID vaccines for the caregivers, for the people that are all around Veterans. What is going to be the effort regarding the boosters, this round of boosters, when do you anticipate starting? How will people be able to get them? And will people that are not actually Veterans in the VHA health system be able to get them at VA?

Dr. Shereef Elnahal (Under Secretary for Health):  Yeah, it’s a good question. So, we used to have an authority that expired with the end of the public health emergency through the Save Lives Act. Unfortunately, that authority expired at the end of the public health emergency. So, it’s really everybody who is otherwise eligible for care, plus our employees who we also have the authority to vaccinate.

Patricia Kime (Military.com):  And a follow-up to that, I mean, boosters now seem to be fairly just like a flu vaccine, voluntary. Correct? Do you have a mandate for a flu vaccine among your healthcare employees? And will there be a COVID booster mandate for anybody?

Dr. Shereef Elnahal (Under Secretary for Health):  We have a mandate for being fully vaccinated in the healthcare system. And so, what that means is if somebody is coming online who’s new, that requirement to be vaccinated, it will include assessing whether they’re up to date on it. But for employees who have been fully vaccinated, right now, the mandate does not require them to get a booster. I hope that helps.

Patricia Kime (Military.com):  Yes. I mean, so in the military, US Military, the flu vaccine is required. I am guessing that it is not required for VA employees?

Dr. Shereef Elnahal (Under Secretary for Health):  Flu vaccine is required. So, we have a mandate to be vaccinated every year with the flu vaccine.

Patricia Kime (Military.com):  And are you considering the COVID vaccine to be the–booster to be the same?

Dr. Shereef Elnahal (Under Secretary for Health):  With our mandate, it does not cover a requirement to be updated on your vaccine at this time.

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

Mark Ledesma (Director, VHA Communications):  Thank you, Patricia. Leo, you’re up.

Leo Shane (Military Times):  Yeah. Hi, thanks. Just some more follow-up questions with the COVID vaccine. Are you seeing any issues right now with staffing? I know that’s been an issue in the past with some folks being down and some things. I know the patient cases are out there, but what are you seeing employee-wise and is that impacting anything?

Dr. Shereef Elnahal (Under Secretary for Health):  Thankfully, we have not seen a significant increase in employees unable to work thus far during this wave. But it is something that every medical center is, of course, tracking. And we’ve asked every medical center to report to us nationally as to whether they are considering becoming more intensive on the requirements for things like masking. Right now, we have a national policy for masking that was more relaxed than it was at earlier stages in the pandemic. And so, we have not heard that additional restrictions are in place at this time.

Leo Shane (Military Times):  Okay. And how soon are you expecting those vaccines to start to be administered? I think CDC said they’d be available pretty quickly.

Dr. Shereef Elnahal (Under Secretary for Health):  Yeah, we could get our first vaccine shipments as soon as later this week. And so as soon as we get them, we’re gonna start doing shots in arms.

Leo Shane (Military Times):  Okay. Do Veterans need to call ahead to schedule, or is it going to be something that’s offered as they come in?

Dr. Shereef Elnahal (Under Secretary for Health):  That’ll be a medical center by medical center regimen. We are reaching out to Veterans with an intensive campaign to get vaccinated. It’ll be in sort of the existing clinical experience that they have. In other words, we’re not gonna see as many of the established vaccine clinics as we had earlier in the pandemic, where it was more like an assembly line. But we will have vaccination available in different parts of medical centers. Right now, we already have the flu vaccine available at the entrances of most medical centers and strategic locations within the medical centers. So, all we’re really going to be doing is adding the COVID vaccine to that and offering it in other clinical settings.

Leo Shane (Military Times):  Okay. Great. Thanks.

Mark Ledesma (Director, VHA Communications):  Thank you, Leo. Quil, you’re up next.

Quil Lawrence (NPR):  Hi. Thanks a lot Mark for doing this. [crosstalk]

Bill:  I’m on the phone so I can’t see what’s going on.

Quil Lawrence (NPR):  He can go ahead. Bill, you can go next.

Bill:  I don’t have so much a question as I do a comment. I’d really like to compliment whoever it was that started the Uber Program to get our guys out to the hospitals. That’s been just super successful where I’m at here in Tampa. And even for myself, I’m 100%. And the other day I got up, my battery was gone on my car. They managed to get an Uber out here. I didn’t miss my appointment. It’s forward thinking, and I appreciate it.

Dr. Shereef Elnahal (Under Secretary for Health):  Yeah, thank you so much. And, you know, we’re grateful for our partnership with Uber, for our ride sharing program. And it reminds me that we have a legislative proposal out in Congress to restore the much broader use of ride sharing for things like Veteran homelessness, getting Veterans from place to place to coordinate their vouchers, and otherwise expand the use of that program even further. So, we’ve communicated as much as we can with Congress about the need to reestablish that to the level that it was during the worst of the pandemic. We think that’s a helpful authority for Veterans across the country, and we’re seeking it out.

Bill:  I’ve talked to a couple of our doctors out here, and they’re delighted because people are showing up for appointments. They’re not having the people stay home because they couldn’t get a ride.

Dr. Shereef Elnahal (Under Secretary for Health):  Exactly. It’s a really helpful tool to make sure that we not only schedule the appointments, but Veterans get there and they get the care they need without having to reschedule and otherwise delay their care. So, appreciate you saying that.

Bill:  You’re welcome.

Mark Ledesma (Director, VHA Communications):  Thank you, Bill. Quil, you’re up next.

Quil Lawrence (NPR):  Hey, thanks for doing this, very much. I’m just wondering if you’re tracking any PACT Act scams. If any of that is on your radar, what you’re doing about it. I know there’ve been a lot of interest in Congress in preventing misuse of PACT Act funds.

Dr. Shereef Elnahal (Under Secretary for Health):  The big focus of the agency, most of the focus is out of the Veterans Benefits Administration, as they now have well over a million claims filed. And organizations fraudulently presenting themselves as advocate organizations for Veterans is something that we’re very focused on. Not as much out of the healthcare system, but of course, we assist in disseminating information, making sure Veterans are aware that they can get their claims assisted for free by an accredited claims representative out of a Veteran Service Organization, County Veteran Service Organization, representatives from State Health Departments. All of that–all of those are free options available to them. So, Veterans should know that they don’t have to pay a dime to get help filing their claims.

Quil Lawrence (NPR):  Okay. Would you say VBA would be aware of any specific scams that are going on?

Dr. Shereef Elnahal (Under Secretary for Health):  Yes. Absolutely.

Quil Lawrence (NPR):  Okay. Thanks.

Mark Ledesma (Director, VHA Communications):  Thank you, Quil. Jory, you’re up next.

Jory Heckman (Federal News Network):  Hey, good afternoon. Thanks for doing this, Dr. Elnahal. Once more, I wanted to circle back on the hiring side of things. I imagine that with the hiring goal being double what you guys expected, that retention is playing a big part in all that. And so, just looking in what’s been working well this past fiscal year, are there any trends or anything that’s new in terms of what’s driving the higher retention? Any best practices there that you guys are charting as all of this?

Dr. Shereef Elnahal (Under Secretary for Health):  Well, I’d say a couple of things, Jory. The first is our focus on reducing and hopefully eliminating clinician burnout is hopefully helping here. We now have our reboot initiative, which is how we branded the effort. Part of the daily work that our organizational health council does in supporting every medical center and clinic is making sure we try to minimize burnout. So, I think that’s a component of it. I also think that there is a positive effect, a self-reinforcing effect of the hiring success that we’ve had. Having more end strength means that the workload is distributed more evenly and people are compensated enough to continue the job and do it well. And so that’s why hiring so many positive spillover effects to include job satisfaction and hopefully maintaining our lower-than-normal loss rate.

Jory Heckman (Federal News Network):  All right. And then as far as the time to hire, I know that’s something that’s come up in these monthly check-ins pretty regularly. Do you have any updated data on where we stand with the time to hire, time to fill?

Dr. Shereef Elnahal (Under Secretary for Health):  Candidly, that’s an area where we have not made as much progress as I would like. So, right now, we’re still a little over 160 days in terms of time to fill. There’s a dynamic where we’ve put a record number of people through our process as we’re trying to improve it. So, I think that’s a dynamic here. But this is going to be a particular effort that I ask every leader to focus on in the coming year as we refine our hiring goals, knowing that we’ve made substantial progress in this last year.

Jory Heckman (Federal News Network):  All right, one more, if I may. I wanted to circle back to your keynote a couple of weeks ago with the VA AI Summit and your keynote there. As far as this technology, we’ve seen, I guess, across VA, broader use of AI tools, automation tools. As this develops more and this becomes more widely adopted, what do you see as kind of the key areas of growth in VHA for AI and automation and what are you keeping your eye on as the most promising use-cases?

Dr. Shereef Elnahal (Under Secretary for Health):  Yeah. Thank you for that question. So, we are focused on use-cases that make the daily working experience of our frontline employees easier. And the best way to do that is to eliminate as many of the rote tasks that are in front of them as possible as they try to do their jobs. That means they can spend more time in front of Veterans, which is often why they joined the VA in the first place. They can spend more time doctoring, working to the top of their nursing license, whatever it is. But the things that make jobs difficult and the things that asymmetrically lead to burnout are some of the administrative burden tasks that people have to do behind a computer rather than in front of a Veteran. So, one important set of examples, we’re doing an AI tech sprint through challenge.gov that will happen in the next couple of months that will bring early-stage companies across the country to the table, problem solving with use-cases that allow for clinicians to minimize the time that they have to do burdensome administrative tasks. So, one of those examples is called ambient dictation. Where a clinician is in front of a patient, the machine records the visit and ultimately produces a near perfect clinical note that just needs to be tweaked over a span of minutes rather than 15, 20, 25 minutes, which is current state for clinicians trying to write a note after their visit. And so, you can imagine the spillover effects on helping us reduce burnout but also allowing us to increase productivity and improve Veteran access to care when you have a technology like that. So, we’re not limiting it to ambient dictation. We’re looking at a number of other things that reduce administrative burden, but I think those are the most important use-cases we’re gonna start with.

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

Mark Ledesma (Director, VHA Communications):  Ellen, you’re up next.

Ellen Milhiser (Congressional Synopsis):  Hi. Thanks so much for doing this. What you just talked about was really fascinating, this idea of ambient dictation. But you’re already having troubles with the EHR. How well would you be able to incorporate something new with AI into–it would have to, I would assume, be incorporated into the EHR. So, is this going to complicate getting the EHR rollout to be started?

Dr. Shereef Elnahal (Under Secretary for Health):  You know, that’s a good question, Ellen. I think what we would look for is something that could sit on top of our system, whatever it is, right? And so, we are implementing Cerner Millennium. We are only at five sites with Cerner. The rest of our sites are Vista and CPRS. But we would want a solution that can overlay on top of whatever the EHR is that a clinician is using, which will be a big focus and one of the constraints that will be featured in our tech sprints. We want early-stage companies to innovate, knowing what our current constraints are, and ideally, these tools would be able to overlay and sit on top of whatever the underlying system is. So, I’m not sure that it would necessarily need to be code that is integrated, for example, into Vista. In fact, I don’t think that’s required, but we will see what comes out of this tech sprint.

Ellen Milhiser (Congressional Synopsis):  Thank you.

Mark Ledesma (Director, VHA Communications):  Thank you, Ellen. Do you have any other questions?

Ellen Milhiser (Congressional Synopsis):  I’m good. Thank you.

Mark Ledesma (Director, VHA Communications):  Thank you all. So, unless no one else has questions, we’re going to go ahead and wrap this up. Thank you all for joining us today. David, we’ll get back to you on your question regarding hiring the hirers status. So, my team will get with you on that. Would you like to close out with anything, sir?

Dr. Shereef Elnahal (Under Secretary for Health):  No. Just appreciate the time with all of you every month and we will keep you posted on major developments as they come. Thank you so much. Have a great afternoon.