At the v. A. Have any accountability or any responsibility at all for this happening . If so, how much . Of course we do. As was laid out in the last hearing on the same subject just a few weeks ago, there are many reasons that we are where we are. I think we all share some of the response ability. We have a new program called the Choice Program. We have seven different ways of providing in the community. Im sorry. Did you want to interrupt . My time is limited. You have described with the layout of the land is. Is going to show you what accountability we half. Ok. Do you have any role in this . One of the things you learn is to have no excuses. One of the things that baffles me this case is we are dealing with a Computer System that is over 30 years old call the fms system. It is written in a language i wrote in 1973. We have got to change the Management System of the financial of this enterprise. Our i. T. Budget is about 50 of what a Health Care System i. T. Budget is. We have got to fix that. At the same time, we have got to improve our management of the Financial Systems. Were going to work harder to do that. At the same time, it would help if we had flexibility rather than line items we cannot move around. Every time one of these issues comes up on an almost weekly basis, we year please for more money or more flexibility or some like that, we never get to the bottom of what causes it in the first race. That is what were trying to get to the bottom of. I thought is pretty clear in what caused it. They are giving them too much care. When Congress Passes a law here is my real problem here. You said there is no other option except for an emergency supplemental by congress. He will start closing down operating rooms and hospitals all over this country and with a 60 billion healthcare budget theres no other way for you go around this problem than to tell them they cannot come into the operation room after a certain date . What i taught about was using part of the 10 billion that has been appropriate i congress for care in the community to pay for care in the community. You are appropriated money for care in the community. I yield back. Thank you, mr. Chairman. Thank you, mr. Secretary, for your continued leadership to write the ship. I appreciate it. I do think that stability is part of the solution. It is not the panacea, but it is heart of the solution. Clearly we need to be more enabled to serve veterans and to serve them appropriately and in the way that they deserve it. Closing hospitals is not a choice as far as im concerned. We have an i. T. System that cannot track spending and cannot reconcile a budget in a timely way. I think you have alluded to this in your testimony. I would argue that there has been an increase in demand from our veterans. They also argued that the v. A. Is pushing more resources out the door than they have in the past. That is a good thing. It needs more veterans are being served really. You have mentioned areas that we need to improve upon. You have mentioned i. T. Better management of checks and balances. I think before we move forward in any way shape, or form, we need assurances that these kinds of things will get. Will get next. We cannot hope and pray the next time that we will be at her off. We need assurances that these will be fixed and we will know in a timely way where we are. We will know exactly where we are in terms of money that is spent and what the balances are. Share with us the specifics and when you think these things will be fixed so we dont approach another school year with the same kind of calamity that we are facing today. Thank you. I want to reiterate that we do own these problems. We want to fix these problems. I dont want to give any different kind of impression. The starts of getting the right in place. We have our assistant secretary for the office of information and technology. She was the i. T. Leader. I have been working to recruit her for many months in almost the day i was confirmed. We have got to get the right leaders in lace. I think we have them. We need benchmark operations which we are doing. We have got to replace it. Until we do, have got to take root force effort to make sure we do a better job of keeping track of our budgets and keeping you in warmed of them. One of the issues here was when you passed the choice act, you demanded that we account for care the community and the different ways that we were doing it previously. You asked us to centralize that. Im sure you get in order to keep the chill of that money and make we werent spending it for something else. That exacerbated the situation. We tried brute force to try to keep that accounting will so we could understand what was going on. There is no question we have got to do a at her job. Better job. That is part of the solution. I dont have a lot of confidence having served on this committee for 2. 5 years that the va you have asked us for additional money for an i. T. System yet. I assume that will potentially come. It provides the tools necessary that we would need to be able to have a timely thats timely data. Is there something that you are working ons the city . This is a hype your before us high priority for us. We have got to Work Together to go to one with paper the community and making the i. T. System would be easier. Thank you. I yield back. Thank you, mr. Chairman. Thank you for being here this morning. I think you have a ready sisi history of what was going on here. I thank you for the history of what was going on here. I completely agree with that. What im most concerned about is the fact that you didnt do more about the situation in till two weeks ago . All of a sudden it is like a crisis. From my perspective, i was hoping you have a plan to reform the v. A. And make it all good. I havent really seen you about the reform process going on. Im disappointed with the shortfall. Why didnt we know more about this in advance . What is the story with that . I want to draw your attention to this. This i gave you on june 5. This was about placing the denver facility. At that it was important at the time we publish this to give you a heads up on the work were doing to transform va. If you turn to the back this book, the last 56 pages are all about the transformation of the the a. We sat down those members of congress who are interested and went into the detail. We would love to take you through the details. It includes some of the most outstanding ceos in the country that are helping us. If he is going to the largest transformation in its history. Every member on the committee has 56 pages of what is going on. Were happy to spend more time with you. We would like to be a part of it. We like to have hearings of what were doing to transform in the future. Our first knowledge of it was in the middle of may. At the time we had a meeting with both the senate and house appropriations. We mentioned three issues that are emerging. When was hepatitis c. One was denver. The third was the cost of hearing in a community. At that time it that we could solve the problem by putting more veterans into the Choice Program and therefore not as much on our internal community budget. We also thought we could use unspent money from previous years to do it. We couldnt solve the problem. Anytime you have budget line items where you are inflexible and moving items from one item to another, you have unspent money. When we to be the government of that money is to allow flexibility between accounts. In prior years, the last five years sitting on treasury and as those obligations are expensed the obligations and funds they get you obligated i think for the last years there is about i had another question. I heard there is an issue. It is not what it should be. Could you give me a situation of eight with that . Our collections this year are up significantly. I havent refreshed that figure in my head. I would say it is not 7 higher than we had anticipated. Were working hard to improve collections. A lot our patients who have insurance are at a gap coverage. Explanation of benefits. We are not a medicare provider. We are working hard to collect every penny that we can. Out of time apparently. Thank you. A lot of that money that is left was used quite late to a for the continuation of the denver project, wasnt it . I document the money in the treasury . That money is in the treasury. It is not available to us. We cannot use that money. We thought we could. It is money that essentially becomes the obligated as expenses come in. Sometimes there are new expenses for whatever might have happened in 2014 and that money is used in that year. That was not available to us. We had hoped it would be. I was a staff person who had that cryptic conversation in june. We thought we had a plan. We are a victim of our success. We have gotten many more veterans care. Where did you find that money for denver . The money for the denver project we talk about for this year came from the current year budget and not from the previous years budget. Facebook. That is where you also listed a possible solution of taking that 1 across the board cut. It is not a good idea. Apparently at that time you thought you could. That is correct. There is a lot of gnashing and hair pulling today. We cannot let hospitals close. We have to look for some kind of flexibility. Over the difference between care in the Community Programs that have not been consolidated and choice come it seems to me there is little difference in those aside from contract is and some naming. They are really about. The community. Is that accurate . That means it is not that big of a problem . Yes it your statement is accurate and sensible. In execution, it is incredibly complex. What youll find is that with seven different programs. There are different Payment Methods and different exclusion amounts. I was traveling with a senator who brought in dividers about me about every program we had except for one. I knew the reimbursement rate for that program was higher. Because we have different reimbursement rates, we have different providers encouraging one program over another. With we proposed is to bring all of those together under one program. Make it easier for the veteran and that the a employee. Doesnt that mean that the flexibility that you need from the Choice Program to that consolidated community would it sense . Yes, maam. Lets am trying to help you here. Thats exactly right. There is one very were to point. Our Community Care programs are used to call purchase care. There are a lot of in those programs now that are not covered by choice and will require statutory change to fix that. The longterm care is not covered by choice right now. Can you work with us to look for them . Absolutely. Were working on 13 things that we think need to be changed and have made a commitment to sit down with the staff to make sure that we can address those. One last thing. I notice you are all looking that means veterans and sit at the table drive four hours into los angeles will drive eight or 10 hours to separate cisco . San francisco . This is something we are very concerned about. Thank you. Where are trying to simplify it. We want to make sure it gets that are for veterans and not worse. Thank you. Is there lingers that could combine all of this . Were not yet provided the consolidated language. Thank you. The nonva care money is of a discussion of the department of Veterans Affairs where the choices at the discretion of veterans. Thank you, mr. Chairman. I appreciate the topic of consideration day. This is a difficult discussion for me. I had great hope that we would move forward. The most massive shortfall in the a history. When did you know that we had the shortfall . What i said was around the middle of may. If i understand the items ultimately to percent over the budget amount . We have got it problem. Is that a normal manner . It is not coming to attention a list it is 50 over budget . Your essay tried to resolve the issue as quickly as you can. There is a 10 billion source of funds. What were talking about is i do know that. I would like to know why you lowballed the estimates. New gaming projected theyd be 25 you came in and projected theyd be 25 less. They are actually coming in as 1. 5 dollars over. 1. 5 billion dollars over. Let me give you these figures that you provided. This will 2014, actual spending. He said really need 1. 9 . You are surprised to come in. You will spend more than your spending and 2014 . You come here later and say not only to be cut, we are going to add. That is what i dont understand. [talking over each other] wycoff information as quickly as we could. We are here today. Cracks and would like an explanation of why the project to a reduction in this line item , but now youre saying you want an increase over last year . Im not familiar with information you have. I would be happy to look at it. Here is my concern. You said that you do support va choice. We hear from others in the department that you have many employees were not supportive of choice. Somehow it came in well under budget. What you want the next years budget you decided not do that. You decided to come in and request what we wouldnt do for you earlier. I dont know if they lowballed purposely were created a severe mistake. That is what i dont understand. You are wrong on that. That is what you put in the legit. Budget. We would hope it would offset some of that. Out of the 3 billion that is 80 . That is not the numbers you provided to the committee. One last thing, for everybody here that has never happened. You know that is not true. I want to know for the record how many employees have actually been fired . Is it only to . I think we have seen over the weeks that we have made progress. To our retired. We have got over 100 investigations. Lastly, we saw an announcement that the fbi has indicted someone. These investigations do take time. The good news is that they are coming to fruition. I think over 1300 people have been terminated. We take this very seriously. That is why we night of our 17 members and new Leadership Teams at our Medical Centers. The leadership is changing. I hope we have a change in culture and performance. That is why we had 7 million more appointments this year than last year. Thank you. We do have an outstanding question in regards to the people you say have been terminated. How many were probationary . Are still waiting. We will get you the answers as could the as we can. Unfortunately our systems are selected the Financial Systems. Thank you very much. I appreciate being with us here today. I will try to focus on issues that i think may be causing some confusion in the question of Community Care. They had redefined what has been viewed as nonv. A. Care to include other programs. Community nursing homes. Home health care. I just want to be realistic given the age of demographics. Betsy to 5000 Vietnam Veterans. Just so that we understand Going Forward. Longterm if we are making a commitment to shorten the time frame for waiting to provide reader access and to hire more professionals, i want to understand the exact we but it is, this umbrella of Community Care, and how we expect to meet this need in pay for the need Going Forward. Going forward. So we, under the legislation, were required to centralize all these programs under the chief Business Office and to centralize those fundings. Required by whom . By the choice legislation. So we did that and when we did i mean, we always called them purchased care, really, when i came into it years ago it was pcare. But we were calling it nonv. A. Community care and we said when 20 of our care on a cost basis is out in the community its not nonv. A. Care anymore, it is v. A. Care so we call it v. A. Community care. Were trying to change how we talk about it and the mindset in the organization about what were trying to accomplish so you are correct. That bucket of things includes both outpatient and inpatient care that you normally think of as the purchase care stuff that we do. It also includes our nursing home care, our state home care, home care, camp v. A. Those list of things are this and im happy to get you the detailed list of those and the breakout financially of whats being spent in each of those. Is it the your proposal Going Forward that we would consolidate all of those into one program that we on capitol hill referred to as choice, but it could also be referred to as community . We have all these programs and we also have, as the secretary said, seven different ways of acquiring those services through sharing agreements through contracts, p. C. 3 arch, all these things. I think our proposal and we really want to sit down with the staff and jointly hammer out what a future state might look like. I think that the Choice Program is a good program. I think that if we can figure out how to make that model work across all of these Community Care benefits so that we have a more unified and structured way where we have one billing system, one way to authorize the care one way to get information back, the same kinds of providers that can provide those services, then i think we would be much better off because we could actually explain it not only to other people but to ourselves. And then let me understand when that was consolidated under the choice act to a central, presumably here in washington . Or is it located somewhere else . The c. B. O. , the chief Business Officer is here but we have pieces of that office in atlanta and denver and so when that was consolidated it sounds like there was an inadvertent result in that you no longer had the information that is very regional. I know in our area these are individual decisions and as the secretary mentioned, the reimbursement rates, whether a particular clinic, a particular nursing home, a particular Home Care Program is going to accept this rate, enter into a contract, have we is it fair to say that inadvertent congress wrote it that way, is it fair to say thats created a problem . I think you hit the nail on the head. So i think that these programs typically most of the outpatient care, the bulge of it, the nursing care, state homes, all that stuff was managed locally by a Medical Center, they had a budget