instead of privatization schemes, we should make the va simply make the va better. va provide care and services unmatched in the private sector. there are questions of diverting money from care to profits. there are significant questions of medical privacy as veterans would be shuffled between the va and the private sector. and we know what happened in the last ten years. a dozen years ago, we went to war without paying for it. a dozen years ago when we went to war we failed to scale up veteran services and ensuing decade we have seen because of agent orange, presumpbltive eligibility, hundreds of thousands of more people demanding and earning services from the veterans administration. some of have launched an un -- what i think is an unfair attack on the vast majority of va employees who are dedicated public servants to the nation and the veterans. these employees chose a career serving veterans, many, many of these employees as you know and each of your districts and states are veterans themselves. these employees whether it's a police officer at the dayton va, wh

they must come from within va. but addressing the cultural problems within va won't provide relief for the roughly 100,000 veterans experiencing long waits across the nation today. it is now time for us in partnership with the va to begin to repair the damage that has resulted from systematic failures that have undermined the trust veterans have always placed in the veterans administration. to begin to change the culture at va, there's reforms to pursue to ensure veterans have access to timely, quality health care. now, the start of an effective congress and a conference comes with accurate numbers. and since ranking member michauk mentioned cbo, let me talk numbers for just a minute. va is basically broken down in two sides. the veterans benefit administration and the veterans health administration. last year this congress for this year appropriated $55 billion for vha. veterans health administration. of that $55 billion, most members would be shocked to know that 48% goes to direct patient care. we're talking abo

do you do that at va? i'm get back to this we've been trying this issue since 2005 on measure capacity. actually we started back in the 1980s. my question is, i'm not convinced by what dallas or minneapolis or sioux falls that i would get a strategy answer. >> i think, sir, i can offer that we are developing a strategy as it relates to access and as it relates to scheduling. we have in place a seven step process that we are developing. that will address the issue of accelerating care, that will address the development of demand capacity models. that will develop the policies and directives to drive scheduling and access. that will relook at our performance assessment measures so we can develop the measures and the goals appropriate to drive our system to the appropriate end point which is quality timely care. we are developing the processes to put together program oversight and integrity to recruit people and to train them and to integrate our care processes with the nonva care model when necessary. >> whe

outside of the va. bureaucrats would no longer override veterans' choices. the bill also holds va accountable by making it easier to fire anyone who falsifies or manipulates data and makes it much more transparent by requiring disclosure of medical outcomes. passage of this bill and new leadership at the va are just the first steps. congress cannot just hope the problems will now go away. the reason veterans' care has suffered for so long is that congress has failed to hold the va accountable. in the last four years, the senate veterans affairs committee has held just a handful of hearings touching on veterans' health. this committee's only responsibility is to ensure veterans are being taken care of and it has failed to do its job. the problems at the va have long been documented by government investigators who have warned of false wait times and poor management for years. but some in congress have been far more preoccupied with making new promises rather than fulfilling the promises already made. next

what could the va be doing? it seems to me you're checking in with them periodically and that's about all you're doing, is that correct? >> it's tough for me because i'm very satisfied and happy with the medical professionals in the community that i deal with, that i work with when i go to the va. it's failures in the system and that, that are causing, that bother me. >> what could the va be doing for you now that they are not doing? what would you -- is there something you would like the them to do? it seems you're not having that close of a communication with the va over this, you know, tragedy, your loss of sight. it seems to me that there should be some ongoing help to you to get your life in order as best as it can be. are you getting anything like that from the va now? >> yes. absolutely. i go to mental health meetings regularly. identify been involved with the recreational departments. >> what would you like them to be doing that they are not doing. >> currently they are doing fine by me. it's that they f

do you do that at the va? because i'm getting back to that that we've been trying this issue since 2005 on measuring capacity. actually i went back. we started in the 1980's so i'm not convinced what hatched in dallas or minneapolis or sioux falls that i would get an answer. >> we're are developing a strategy as it relates to access and scheduling. we have in place, a seven-step process that we're developing that will address the issue of accelerating care. that will address the development of demand capacity models. that will dop the policies and directives to drive scheduling and access. that will relook at our performance assessment measures so that we can dop the measures and the goals appropriate to drive our system to the appropriate end point. which is quality, timely care. we are developing the processes to put together program oversight and integrity. to recruit people and to train them. and to integrate our care processes with the nonva care model. when necessary to meet -- >> where does that guidanc

some notable examples include va jobs, e-benefits and va forms. va jobs at 80% critical, e-benefits at 95 critical, and va forms 100% critical. the rating of critical in the analysis states that the listed percentage is the amount of that web site that is completely inoperable. we will hear today in va's testimony that they are making great strides in bringing va systems into compliance with section 508. however, we will also hear from a blinded veteran who must actually navigate these pages himself. he may be inclined to disagree. with that, i now reck these ranking member kirkpatrick for her opening statement. >> thank you, mr. chairman. i'm ranking member ann kirkpatrick there congressional district one in arizona. the hearing topic today is an important one, and i look forward to an in-depth discussion with our witnesses. today we are examining the department of veterans affairs' role in the operation of the vision centers of excellence and section 508 of the rehabilitation act of 1973 compliance. as they relate to proper access and services f

instead of privatization schemes, we should make the va simply make the va better. va provide care and services unmatched in the private sector. there are questions of diverting money from care to profits. there are significant questions of medical privacy as veterans would be shuffled between the va and the private sector. and we know what happened in the last ten years. a dozen years ago, we went to war without paying for it. a dozen years ago when we went to war we failed to scale up veteran services and ensuing decade we have seen because of agent orange, presumpbltive eligibility, hundreds of thousands of more people demanding and earning services from the veterans administration. some of have launched an un -- what i think is an unfair attack on the vast majority of va employees who are dedicated public servants to the nation and the veterans. these employees chose a career serving veterans, many, many of these employees as you know and each of your districts and states are veterans themselves. these employees whether it's a police officer at the dayton va, wh

if you've seen one va, you've seen one va. and there is too much, i guess flexibility, or variability in how services are delivered and how veterans can access services at each of the va facilities. >> when you standardize your practice, you create greater predictability and outcomes. whether it's an attorney, a finance expert, a health care expert, they'd all agree that when you standardize your mode of practice, you create greater predictability and outcomes. i think it's the outcome that ultimately that this panel has to address and not just the process of care measures that we're talking about. the. >> dr. mccoy? >> yes, i'd like you to focus on the falilings of this bill. you'll be compromising with the vote you took in the house to create a final bill. and that final bill that you create has to remove these practical impediments. otherwise you are not passing a bill to give vets access to civilian care. it will be a charade if they have to get a all right from the secretary, and if there has to be a call made to get prio

last night i asked our va witness at the va was capable of innovation. they said yes. we must demand innovation in the va bypassing comprehensive reforms. we can solve the patient access problem stop the deceptive appointment scheduling practices mandate transparency and hold va employee's economy by adopting comprehensive reform. we can empower the va to transform itself into a world-class health care system. my top priority is solving the va access to care crisis. our veterans must receive timely world-class care now and in the future so that we never again face another patient access crisis in the va. we can do this in two ways by solving the va's own access and capacity problems and by expanding access to nonva care. >> where reading is because results are coming in from seven states when voters went when voters went to the polls today including new york where congressman charlie rangel has the democratic primary in the 13th district. >> gregory meeks in the house. apopka and senator bill perkins in the house. [applause] i am not going to keep you from all of what

in particular, va requires talented senior executives to manage the complex set of va facilities and programs. we are competing in tough public and private labor markets for skilled personnel. to remain competitive in recruiting and retaining, we must provide tools such as incentives and rewards that recognize superior performance. however, we also acknowledge that we must do a better job at holding our leaders more accountable. senior leadership must engage plans to include counseling, midyear assessments and documentation. we realize that improvement in ses performance management also serves as a model for the general work force appraisal process. the key is precise implementation and oversight for all performance plans, whether for executives or generally scheduled employees. equally important is that we have good training programs for executives. performance management has many challenges. by its nature, it is very subjective and complex. it is used to identify sup superlative and poor performers and it is the foundation of mentoring. senior executives must understand how to crac

in particular, va requires talented senior executives to manage the complex set of va facilities and programs. we are competing in public and private labor markets for skilled personnel to remain competitive in recruiting and retaining we must rely on tools such as incentives and rewards that recognize superior performance. how much we also acknowledge we must do a better job in holding or employees and leaders accountable. our senior leadership must become more engaged in managing executive performance plans to include counseling, mid-year assess. s and documentation. we realize that improvement in ses performance management also serves as a model for the general schedule work force performance if a appraisal process. the key is stringent and precise implementation and oversight of all performance plans whether for executive or general employee. equally important is training programs for executives. performance management has many challenges. it is very subjective and complex, and used to identify superlative and poor performers and is the foundation of development and mentoring. se

the va, there's no choice. you go to the va. that consumer is not got options. so he hat a built-in consumer, if you will, but very consumer oriented. so he first pulls it apart and rebuilds it, as any good executive might do. because it's sick and it's broken, and you need somebody that is strong and has run an organization with 100 some odd thousand people, p & g, and you need somebody that can put it together -- >> i know -- this is government we're talking about and it's not been granted the sweeping new powers like guys like you have said you want to see given the va. now, their propose -- they're proposed in senate and house measures a long way from the president's desk. what is to stop the new van head to say i'm going too whatever i want ask and you can sue me later. >> that's how hey has to come in, break it up, he has -- humpy dumbty -- humpty dumpty and he has to put it together. >> underproffering divisions he shut them down. >> he has to. he has to. that's the big difference with this president. this president looks at people's loyalty, extinction -

in the 1990s va was criticized. the va innovated with the electronic health record. that has now become a standard for the private-sector. i think we can innovate and i think we have an opportunity here in va to respond to this crisis with an innovative model of staffing, of assessing demand and capacity that can become a standard for the industry as well. >> please do it. i yield back my time. >> if i could just add one thing to what dr. lunch just said. i think all of your questions are critically important and tearing us up as well but right now we're focused 100% on trying to get veterans into the system and using all the tools available at our disposal. there will be time for the why questions and the much tougher analytical questions that all of you are asking about how do we fine tune capacity and demand but right now the number of veterans wait cigarette an emergency and that gets the highest priority. that does not mean anything else is off the radar screen. and i just have to say in response to the innovation question i did have the pleasure and opportunity

i've also gotten the sense that the ides process may not be a top priority to va because va has chosen to place what it seems to be fairly exclusive service on eliminating the backlog of claim toss the detriment of these transitioning service members. so let's begin understanding that if this belief exists at va, it is not okay. these transitioning service members have served in recent years during a decade-plus of wars in iraq and afghanistan with many, with multiple deployments and many with service-connected injuries that prevent their continued military service. here i have correspondence from the past couple of months received from soldiers who are awaiting the start of their postmilitary lives, one soldier frustrated with his inability to pay for the future. to plan for the future. he wrote and i quote: it has been four years since i have shared a christmas with my family. it would mean the world if i could finally spend christmas with them this year. i have gone through the board processes and am currently awaiting ratings. end quote. another reads, quote: i have been awaiting m

times are not tracked for non-va care. why don't you track wait times for non-va care? >> historically, sir, we have not, congressman, we have two initiatives, both in full deployment at this point. the first one is for non-va care coordination. effectively, what is occurring now is when we refer a veteran to care in the community, if we could not proprietary, it creates an appointment inside a clinic. it allows us to monitor that and watch that appointment. we are now collecting time lead datas on that. we have a nation wide contract called patient centered care in the community. >> that contract has a performance requirement from our two contractors that they both schedule and see veterans within 30 days of the referral from us. we think those two approaches will help us in the long run insure coordination and management of non-va care. dr. draper also alluded the requirement to manage the coordination of that care. it's not enough just to refer care into the community. we do need to follow through as well to insure the veterans' needs are met, that that non-va provid

is this the audit from the va? >> yes, it is. >> i notice on the 14th of may, livermore which is in our contract area, was audited. i sent a letter in over a month ago requesting each district is given the information whether it is private briefing or public information. but i think every member of this committee has a right to know what is happening in their own district. is there a reason we don't have that? >> we were competing phase one and two. there are not a lot of respondants or staff. we guaranteed the front line staff animity and we want to preserve that. i would be happy to organize briefings or similar mechanisms. >> so there is no reason we should not receive that information soon? >> no reason. the only concern i have is in our very small clinics where there were a small numbers of folks we interviewed i will preserve them. these were front line staff members and we made that promise to them during the interviews. >> you say some locations were flagged for further review and investigation. for instanc

kaiser, we've said it's one va. veterans should be able to choose which va he goes to. so i don't have the explanation for that. >> if you could, also, for the record, gather that. >> yes. >> the other thing is, why are veterans who cross lines c categorized as new rather than an established patient? >> that, i know they're not supposed to. i looked into it a little while back. i had been at the clinic up in south dakota, and i was walking past a waiting room and there was a gentleman sitting there. and a guy says, guys in suits, they must be from washington, get in here. so i went and talked to them. and their comment was that they love the care they were getting in south dakota, but nobody, retired people tended to go to warmer places in the winter, and their only complaint was they went somewhere else, that they were not recognized. even though they were going to the same place over and over again. i came back and looked into that. there is a process that people are supposed to follow to do that. and apparently we don't have that methodology as clearly as it needs to

of manipulation of va data that distort the legitimacy of va waiting times. when sufficient credible eviden evidence is identified supporting a potential violatiol of criminal law, we are inal coordinating our efforts with the department of justice.arrtmt our work to date has our substantiated serious conditions at the phoenix health care bstat system.at the we identified about 1,400 stem. veterans who did not have a primary care appointment but were appropriately listed on th phoenix electronic wait list. however, we identified an additional 1700 vet raps who were waiting for a primary caree appointment but were not on thet electronic wait list.elec we reviewed a statistical sample of 226 phoenix appointments for primary case in fiscal year 2013. va national data, which was phoi reported by phoenix, showed x, these veterans waited on average 24 hour days for their first primary care appointment and only 43% waited more than 14 we days. however, our review showed that those 226 veterans in our sample waited on average 115 days for their first primary care f a

we are currently conducting work examining va's management of va consults. and have again identified problems that may hinder veterans timely access to care. across our body of work on va health care, several common themes have emerged. these include week and ambiguous policies and processes which result in significant variation, confusion and increased risk of indesirable practices at the local level. software systems that do not facilitate good processes and unclear staffing need and allocation priorities and inadequate oversight which relies largely on facilities self certification without independent verification and the use of unverified data for monitoring. my comments today focus on preliminary observations regarding ongoing work. we found most of the 150 consults we reviewed were not managed in accordance with va's guidelines. specifical wi found that one of five requests were not triaged within the guideline. 19% were completed within fli90 days but the provider failed to properly close out the consult in the relekt ronnic system. in the remaining 4

esto va a ser corner. para la selecciÓn de argelia. >> te decÍa que hizo un gran desgaste en retroceder cuando estÁ defensivamente, fue un recorrido largo para Él. ya subiÓ en busca del cabezazo, el balÓn, aquÍ, cerquita seÑores. mostefa. error de sami khedira que trataba despejar la pelota, no le da, le da en la pierna izquierda. la deja ahÍ. por poquito. alemania ha mejorado. ahora empezÓ a llover. >> sÍ. >> sÍ. el balÓn que pasa, buscando velocidad, por ahÍ estÁ quÉ va a hacer, le pega al arco. en el rebote trate de nuevo. en el fondo bien. quedan tres minutos. mano. >> se ve mÁs entera alemania, luis. lo veo mÁs entero. ahora se le dan mÁs los espacios. como lo decÍa hace un rato. porque argelia va en busca del empate. >> la preparaciÓn que tuvo alemania tambiÉn... se preparÓ en el calor en, en la humedad. varios de los patrocinadores... le fabricaron las instalaciones. >> asÍ es. >> para estar cÓmodos. >> eso tambiÉn ayuda, ¿no? >> sÍ, sí. >> aquÍ estÁ ozil, tiene la pel

if you've seen one va, one va. and it's too much, i guess, flexibility or variability in how services are delivered and how veterans can access services at each of the va facilities. >> when you standardize your practice, you create greater predictability and outcomes, whether it's an attorney, a finance expert, a health care expert, they all agree when you standardize your mode of practice, you predict greater predictability and outcomes. and it's the outcomes this panel needs to address and not just the care measures that we're talking about. >> dr. mccoy. >> i'd like to to focus on the failings of this bill. because pretty soon you're going to be voting on it or compromising with the vote you took in the house to create a final bill. and that final bill that you create has to remove these practical impediments, otherwise you are not passing a bill to give vets access to civilian care. it will be a charade if they have to get a letter from the secretary and if there has to be a call made to get prior approval for

the va facility is closed. the er is now using criteria over what patients they'll accept and those they will turn away based on their facilities. by paying for non-va care in addition to operating half-empty hospitals, va appears to be paying for two systems of care. so do you know how many va hospitals fit this description? >> i don't. >> could you give me that number? i found the fort wayne one pretty quickly. >> i think there are facilities that are struggling. they are older facilities. not always like fort wayne where they're in larger communities. sometimes they're in smaller communities. the population that they support is small and oftentimes it's difficult for them to support an icu. those are difficult decisions, but we need to look at our facilities where they are and we need to ensure that we're using them optimally. >> i guess my follow-up question would be what the ig warned us about, which is, who is looking at those numbers to figure out -- for example, in fort wayne, those numbers for pre-basi

por mi culpa, te me vas. te felicito, ya no vas a llorar. sÉ feliz con alguien mÁs. sÉ que falle, que no logré salvar lo nuestro que ya solo quedan restos de mis manos en tu piel. me equivoquÉ, no supe ser tu amor eterno. no merezco ser tu dueÑo. no aprendÍ a serte fiel. majestad de la sierra antes de que muera por completo, dame la oportunidad. por mi culpa, te me vas. te felicito, ya no vas a llorar. sÉ feliz con alguien mÁs. sÉ que falle, que no logré salvar lo nuestro que ya solo quedan restos de mis manos en tu piel. me equivoquÉ, no supe ser tu amor eterno. no merezco ser tu dueÑo. no aprendÍ a serte fiel. sÉ que falle, que no logré salvar lo nuestro que ya solo quedan restos de mis manos en tu piel. me equivoquÉ, no supe ser tu amor eterno. no merezco ser tu dueÑo. no aprendÍ a serte fiel. [aplausos] >> bravo! nos vemos maÑana. maÑana inicia el mundial. [♪ mÚsica ♪] >> televisa presenta... [♪ mÚsica ♪] despuÉs de la tormenta, puse tu amor a la venta y nuestro fuego se quedÓ en cenizas. pero al pasar los aÑos, los refranes de mi

if you've seen one va, one va. and it's too much, i guess, flexibility or variability in how services are delivered and how veterans can access services at each of the va facilities. >> when you standardize your practice, you create greater predictability and outcomes, whether it's an attorney, a finance expert, a health care expert, they all agree when you standardize your mode of practice, you predict greater predictability and outcomes. and it's the outcomes this panel needs to address and not just the care measures that we're talking about. >> dr. mccoy. >> i'd like to to focus on the failings of this bill. because pretty soon you're going to be voting on it or compromising with the vote you took in the house to create a final bill. and that final bill that you create has to remove these practical impediments, otherwise you are not passing a bill to give vets access to civilian care. it will be a charade if they have to get a letter from the secretary and if there has to be a call made to get prior approval for

the va has done. on the other hand his experience with va health care has often been frustrating. he said it was okay that i share this with you today so i want to use kyle as an example. here's an american hero, by any definition, sometimes we use that word too loosely. this guy is a hero and deserves everything we can do. but like other veterans, kyle sometimes had trouble just making an appointment or had to wait a month to see his doctor only to be referred to another doctor and wait another two months for that appointment. he often felt like a number he said, being passed between doctors who sometimes didn't know his situation or why he needed certain medication. he's relied on the help of a patient advocate but at so many steps along the way, it's just been a lot harder than it should have been. as his advocate said, it shouldn't be this way. so va does many things well, like delivering kyle's educational benefits. and we need all of you to keep doing that important work like reducing the disabi

instead of privatization schemes, we should make the va simply make the va better. va provide care and services unmatched in the private sector. there are questions of diverting money from care to profits. there are significant questions of medical privacy as veterans would be shuffled between the va and the private sector. and we know what happened in the last ten years. a dozen years ago, we went to war without paying for it. a dozen years ago when we went to war we failed to scale up veteran services and ensuing decade we have seen because of agent orange, presumpbltive eligibility, hundreds of thousands of more people demanding and earning services from the veterans administration. some of have launched an un -- what i think is an unfair attack on the vast majority of va employees who are dedicated public servants to the nation and the veterans. these employees chose a career serving veterans, many, many of these employees as you know and each of your districts and states are veterans themselves. these employees whether it's a police officer at the dayton va, wh

in the 1990s va was criticized. the va innovated with the electronic health record. that has now become a standard for the private-sector. i think we can innovate and i think we have an opportunity here in va to respond to this crisis with an innovative model of staffing, of assessing demand and capacity that can become a standard for the industry as well. >> please do it. i yield back my time. >> if i could just add one thing to what dr. lunch just said. i think all of your questions are critically important and tearing us up as well but right now we're focused 100% on trying to get veterans into the system and using all the tools available at our disposal. there will be time for the why questions and the much tougher analytical questions that all of you are asking about how do we fine tune capacity and demand but right now the number of veterans wait cigarette an emergency and that gets the highest priority. that does not mean anything else is off the radar screen. and i just have to say in response to the innovation question i did have the pleasure and opportunity

va. there's nothing to compare it to. so if you really want to fix the va, you have to make it totally transparent, you have to give the management the capability to truly hold itself accountable, and if they do that, we'll live up to the commitment that abraham lincoln promised them. >> thank you. congresswoman brown. >> ranking member for opening for the veterans conference report. i've been on the va committee for 22 years, and let me just say that the va is one of the best systems in the united states of america as far as veterans' health care is concerned. now, i want to start out with that. i sent a letter to my colleagues for their suggestion as to how we can improve the system. but i want to be clear that i am not going to be a part of dismantling the system. yes, the system has problems. but i've been on this committee long enough to know that for the first time in a number of years, we built any va hospitals, 15 years we had built not a single one. in fact, the vietnam veterans,

the va at all? >> there's no reason for us not to treat those who have borne the battle, worn the uniform of this nation. we have the money to be able to do that. and they want to throw out the fact we don't have enough doctors. the doctors in many instances aren't seeing enough patients. they don't see nearly the panel of patients that physicians on the outside of the government system. >> let me bring dr. foote into that. that's been a complaint. you know, some critics are saying well, look this is what happens when you get government health care. there is no incentive since you're on salaries. you're not being paid for service. there is no incentive for doctors in the va system to see as many patients as they do in the private sector. your reaction to that, sir? >> that's variable from facility to facility. i think we all understand, it responds much quicker if the restaurants are overcrowded, somebody is going to build a restaurant to take advantage of that. and so in a capitalist system, you're

and been compares the va -- >> is that insane. you cannot throw money at fraud. this place is broken from the top to the bottom. >> they have not touched on the most important point here, the demographics. we have a lot of soldiers that are getting old and we are flooding the system that is unable to deal with it. >> well, there is -- >> i am not doubting the fraud. >> but then that gives us back to something that others have been talking about, if you don't junk the va as we know it, do you look at privatized alternatives, something to cut the wait list down, because that's the problem people are dying and getting sicker because they have to wait for treatment. >> charlie, there is tremendous fraud in almost every medical endeavor. there is tremendous fraud in procurement during world war ii. there is a lot of fraud in everything. there is a lot of fraud in everything. >> no -- >> with all due respect, many years i have toured the va hospital, and -- >> that means you know everything about the va. >> do you work there? >> we all know people that work somewhere.

va a echar porras. va a jugar andrea. >> todos tienen la oportunidad de ponerse en la boca la manzana y darle la vuelta al pedestal pero para esto, la primera concursante va a ser andrea! y nuestro william valdÉs. muy importante, la roja es de la mujer y la verde entre los hombres. por lo tanto, tienen que estar muy pendientes y dice tiempo! sin las manos,andrea no dio la vuelta. >> sÍ di la vuelta. >> eso es, paul. tremendo al trabajo que estÁn haciendo en estos momentos. william ponte a trabajar. >> muy bien. >> seÑores, ha llegado el momento... eso! muy bien, karlita. quÉ talento tienes. vemnga. esta es tu oportunidad. cuidado que no te vayas a caer igual que le pasÓ a anita. increÍble,me han demostrado que tienen un talento increÍble para utilizar su boca. seÑores, solamente faltan 33 segundos. increÍble lo que estÁ sucediendo. las mujeres estÁn muy adelantadas. es increÍble. y karlita estar en su mar. paul, no te duermas, hermano. ¿quÉ pasa? solamente faltan 15 segundos. avancen. 12.

and it's an example of the good work the va has done. on the other hand his experience with va health care has often been frustrating. he said it was okay that i share this with you today so i just want to use kyle as an example. he is an american hero by any definition. sometimes we use that word too loosely. this guy's a hero. and deserves everything we can do. but like other veterans, kyle sometimes had trouble just making an appointment. or had to wait a month to see his doctor, only to be referred to another doctor and wait another two months for that appointment. he often felt like a number he said being treated amongst doctors. not understanding why he needed certain medications, he has been helped by a patient advocate. but steps along the way it's been harder than it should have been. as his advocate said, it shouldn't be this way. so va does things well, like delivering kyle's educational benefits and we need all of you to keep doing that work, like reducing the disability claims backlog. and building on the good work that's al

todo va a estar bien. >> nada va a estar bien. mi vida no va a ser la misma. >> el fÚtbol no es lo único en la vida.

this guy is what the va needs. they need a businessman to run this like a business and deliver account product in this case, what we're talking about, health care, to the veterans of had country. i think they also needed, and i think the president was smart to do this, they need add outsider who unencouplered by any kind of ties in washington, d.c. or the vfw or anyone else. i think his first order of business will be to can a bunch of people. he's got to lay waste to a lot of the managers and the senior administrators there who got the vha into this mess. >> paul, after general shinseki resigned as va director, did anyone in the white house you in any way, formally, informally, did anyone reach out to you to talk about who might take that job? be. >> no, we got one call from mr. neighbors. this hasn't been an open process where the president reached out to veterans groups. he's reached out to veterans across the country. i think mr. mcdonald will have to get out on the road and have to talk to patients. he's going

some notable examples include va jobs, e benefits and va forms. va jobs at 80% critical e benefits, 95% critical. and va forms 100% critical. the rating of critical in the analysis states that the listed percentage is the amount of that website that is completely inoperatable. we will hear today in va's testimony that they are making great strides in bringing va systems into compliance with section 508. however, we will also hear from a blinded veteran who must actually navigate these pages themselves. he may be inclined to disagree. with that, i now recognize ranking member kirkpatrick for her opening statement. >> thank you, mr. chairman, i'm ranking member ann kirkpatrick from congressional district one in arizona. the hearing topic today is an important one, and i look forward to an indepth discussion with our witnesses. today we are examining the department of veteran's affairs roll in the operation of the vision centers of excellence and section 508 of the rehabilitation act of 1973 compliance as they relate to proper access and services for

to va. we're in the concept phase, identifying the requirements and we think this is going to gain major efficiencies for a modern and efficient system. >> thank you very much. i yield back, mr. chairman. >> with that i recognize the other member from florida. >> no questions, mr. chairman. >> i'm going to ask one follow-up. thank you. this is the kind of question in the mold of colonel cook over here. we hear everything that's going mrs. weaver and mrs. rubens, what isn't going right? what do we need to fix that would make a huge difference in the process? what can we really tackle? what are we going to get out of this hearing as colonel cook over here identified his flaws in front of everyone, that's what we want to know from you. what is the one thing that could change the trajectory of this whole process? >> i think we need to go back and look at our survey. we have a significant number of people participating in the survey. we're getting results that say as of december, 83% were satisfi

la televisiÓn viendo el campeonato que une al mundo a travÉs de 4 aÑos. >> el seÑor edgardo campos, va a minuto tener su corte de cabello, y para ello va a tener que ir al estilista todas la semanas, escribanos a facebook de lo que usted es capaz de hacer. >> lo invito que ponga argentina campeÓn, gracias flabio. >> en brasil se preparan para el evento mÁs esperado del mundo, le muestran las horas previas desde copacabana ♪ la entrada que leen carga de dar la bienvenida, es uno de los animales mÁs consentidos de todos los brasileÑos, lo cuidan como un gran tesoro. >> brasil se ha vestido de verde y amarillo para darle la bienvenida al mundo, los sentimientos estÁn a flor de dile en copacabana. >> dejamos mujeres y familia, para poder venir a ver la selecciÓn. >> estamos muy contentos los chilenos de estar acÁ. >> este paÍs ha cuidado todos los detalles hasta el dÍa de los enamorados, celebrado cada 12 de junio. >> nosotros venimos desde guatemala, de luna de miel, estamos contentos. >> los brasileÑos festejan hoy al amor, es el brasil mundialista un paÍs que estÁ con sus

it is a problem within the va. and what this legislation proposes isop that the va work with the national health service corps, debt forgiveness and scholarships to students at medical school so when they graduate they can get in the va and practice the quality medicine we need there. this bill also in addition to that addresses another issue that has been discussed a lot. i think there's widespread bipartisan support for that, support in the house as well, and that is the authorization of some 27 major medical facility leases. in many instances, these leasess would t improve access to care closer to home. it would increase the availability ohef specialty carr services ivin those locations. addition, these will allow va to decompress overutilized va facilities this is an important issue. i brief there's bipartisan support for it. that is in this legislation. furthermore, madam president, this bill would require the president to create a commission to look at va health care access issues and recommend actions to bol

a ser su mundial, yo creo que messi va a tener su mundial, argentina va a llegar lejos, me parece que es una muy buena selecciÓn, messi para mÍ el mejor jugador del mundo, y creo que la pulga sabe lo que dice jorge, que es verdad, a la hora de la hora va a sacar la mentalidad, la experiencia y el talento, y eso que tiene de adentro, el espÍritu, para jugar bien, porque va a haber muchos argentinos, estÁn pegaditos ahÍ. >> de los otros paÍses de amÉrica latina, chile, colombia, uruguay, costa rica, honduras, ¿alguien les llama la atenciÓn que pueda ser la gran sorpresa...? >> a mÍ me gusta chile. >> ¿sÍ? >> me gusta chile, es una gran selecciÓn. digo, para ellos lamentablemente van contra el bicampeÓn y subcampeÓn del mundo, espaÑa y holanda, pero es una buena selecciÓn. ecuador tiene una buena selecciÓn, aunque ahora lo opusimos en su lugar, y colombia tambiÉn. me parece que de los de conmebol hay varios, pero para mÍ el mejor de ellos va a ser argentina. >> yo hubiera puesto como caballos negros en la competencia tanto a chile como a colombia, pero me parece que e

with regard to capacity last year, the va served 390,000 female vets and yet, a quarter of the va hospitals do not have the a fulltime gynecologist on staff. a quarter. with regard to quality, half of the women veterans received medication through the va health care system that could cause birth defects. despite the fact that many are of child bearing age and the majority were not on contraception. this is much higher than would occur in the private practice. with regarded to care coordination, the vaoig said that 60% of female veterans at community clinics didn't receive the results of their normal breast cancer exam within the required two weeks which is your own policy and even more disturbingly, 45% of those results never made it into the electronic health records data system. i mean, i find this these statistics are as bad if not worse than some of the others that we've been talking about just generally speaking. and they indicate that the issues of access to quality care and proper coordination of care may be even worse for our female veterans than they are for the general population.

¿va? se siente increÍble poder estar aquÍ, tener ese contacto con la gente y obvio, me da mucho mÁs emociÓn porque vengo a apoyar mi telenovela, "hasta el fin del mundo". nunca me habÍa tocado ser la vocera de una carrera. lo mÁs emocionante fue la vuelta que nos dieron. estamos aquÍ grabando escenas del "patotas", el coche que serÁ el encargado de pilotear mi querido salvador, pedro fernÁndez. entonces, me emociona. >> ay, quÉ hermosa. >> quÉ divina. >> besos, marjory. >> quÉ gusto me da que le esté yendo tan bien. >> te queremos mucho. >> me hicieron sentir como una reina. >> corazÓn, ven maÑana. >> ¿a las 4 otra vez? lo voy a pensar. >> ahora nos vamos con mr. paul. >> sÍ. ven, por favor porque te voy a extraÑar. y otro lado, creo presentarles, ellos son veracruzanos, de un estilo Único que los destaca. tienen show musical con mÁs de 30 aÑos de carrera artÍstica. y recibimos a los hermanos pÉrez. ellos son los caracoles! son 4 hermanos. ¿quiÉnes son los cuatro?

¿cÓmo te va? adeante. > > este segmento de "despierta amÉrica" es presentado por claritin, claramente claritin. [♪ mÚsica ♪] ♪ que llueva, se caiga el cielo y truene ♪ ♪ lo Único que quieres es que yo te traiga el weather ♪ ♪ que llueva, se caiga el cielo y truene ♪ ♪ lo Único que quieres es que yo te traiga el weather ♪ >> >> me va muy bien, mi satcha. muy contenta acÁ. sonrÍe y la fuerza estarÁ contigo. bueno, continuamos con tiempo severo para el valle de ohio, la zona de los grandes lagos. vientos de 75 millas por hora con rÁfagas de 85 millas por hora. se va a acumular de 1 a 4 pulgadas. ha habido tornados fuertes. las temperaturas mÁximas, comenzamos con miami con una temperatura mÁxima de 85, washington 88, new york 75, dallas 95, chicago 72, el paso 105 grados, phoenix se lleva la temperatura mÁxima de 107 grados y san francisco 67 grados. yo quiero que la gente me recomienda quÉ puedo desayunar. ya me recomendar chilaquiles. ¿chicas? >> unos huevitos divor

yow, i don't think the va -- most people at the va are intentionally lying but i want to encourage you to have as much open dialogue as possible because with that transparency we can meet our mutual goal of helping veterans. i have a good relationship with isabel duff at the southern nevada va health system and we talk regularly, meet regularly. i would encourage that at all your facilities or areas. second, i would like to join miss brownley in the request for information when you find out where oxnard is. would you also look at laughlin and perump. if you could get that back to me, i'd sure appreciate it. >> absolutely. >> thank you. and then the third question i would like to go back to what the ranking member was talking about, the restructuring or realignment of the system. i know you realigned the headquarters and you said it was an ongoing process to look at the realignment of the areas. just give you an example of how this doesn't seem to make much sense. my district is las vegas, and so the constituents there are part of the desert pacific health care network. now, this ranges