and any efficiencies you have been able to realize in this area? >> senator, i would tell you that we have been working for several years now on restructuring our acquisition business practices. three years ago acquisition was spread throughout the program. and one comes directly under dr. petzel. that's for all medical acquisition. gloves, masks, aprons. we ought to be able to leverage into the bulk purchase and get a good price on those kind of things. for everything else, we have an office of acquisition logistics and construction. we have a director who heads that office, and everything else governing acquisition is console dated under his review. both offices work -- the work of both offices then come up to my level, to the deputy secretary as part of our monthly oversight review process. >> thank you. thank you very much. senator? >> thank you. mr. secretary, let me if i might visit with you about the national call center. b this is something that i think we had high hopes for. you might have had high hopes for it. but i have to tell you, it's not working well. here's what we're running into. the complaints kind of fall into two separate categories. the first category would be people that call the call center and no one answers. i mean, it just rings and rings and there's no one there. i would tell you in my own senate office my staff has run into this problem, where we can't get a live person on the other end of the line. the second area is you finally get somebody -- a live person to answer the phone, and you get connected with them. and they don't have information. you know, the veteran is -- or we're calling in or somebody is calling in, what's going on with my claim or whatever it is. and you're just not getting a responsive human being on the other end of the line. i'm guessing what it is they just don't have access to the information that we're seeking and so it seems to me that we're creating a -- an expectation of service when really there isn't much service there. i'd like to hear your thoughts or whoever's thoughts on your team about the call center, what's the prospects for that. are these -- are you hearing these problems? and if we're still committed to the call center, what's in place or what will be in place to try to solve the issues that i have raised? >> thank you, senator. i have tested the system myself. sometimes been, you know, pleasantly surprised. other times disappointed. but that's been something i have done for three years now. and then demanded that we go out and fix it. and so we are in the process of putting a fix in place called the veterans relationship management system. if the concerns you're expresses are -- expressing are anything six months, the experience occurred six months ago and older, i would offer that we have made -- we have put this tool in place and changes are occurring weekly. i'll ask secretary hickey to provide some detail. but i, like you, i think when a veteran picks up a phone and calls v.a. there ought to be someone there that answers or if he or she chooses to come in on line that it ought to have information that's useful to them. that's easily discovered so they don't have to run through a series of traps to find what they're looking for. we owe them and that's the first step of any service organization. that's our intent here. so let me call on secretary hickey. >> senator johans, thank you for your question, and i appreciate your question earlier about e benefits. that is part and parcel of our multipronged approach in our capability about being able to converse with that veteran and the time and the method they choose. we have surveyed our veterans and 73% of them want to meet us onion li on line and that's part of that. let me tell you about the two new pieces of functionality that we have measured outcomes from our j.d. powers voice of the veterans survey. the first is virtual hold. that means in a veteran calls us, they can elect the hold option, continue feeding the baby, getting ready for work. doing whatever it is they need to do and it will call them back on queue. 90% of our veterans have elected that option. the second one is our scheduled call back. can i schedule a time that i can wait -- talk to you and you will guarantee to call me back? we have just implemented that one in december. between those two our veterans have -- one million veterans have elected those options. as a result, we have seen clear demonstrated measurable performance. we have a 15% improvement in overall satisfaction on the ability of our veterans to get through. and we have seen a drop call rate reduction of 30%. those are both part and parcel of the new technology and the new ways we're doing and working in our veteran relationship management capability. in terms of another vmr initiative, in terms of they don't have the right information, yesterday, not today, yesterday our call agents would have had to cycle through 13 different databases to get you that veteran or the survivor on the information that we needed. and today, unified desktop puts all 13 databases worth of that critical information you want to know on one screen. making them much more effective and delivering a good outcome. also, built into this is world class call recording, call tracking, data analytics into this package this we're using every single day to improve our service in that environment. >> i'm out of time, but if i could just ask as your -- as these things are being implemented, as we're going down the road here, if periodically you could give us on the committee an update as to the progress you're seeing. because i do think there's real hope with the call center. you know, the veteran at least can get somebody who can answer their question, et cetera. so i'd like to stay abreast of how we're doing. >> i'd be very happy. be very happy to do that. >> thank you very much. senator? >> thank you, madam chairman. i appreciate seeing secretary shinseki and all the folks on the panel today. a special thank you to you, general, for coming to montana last summer where the initiatives are appreciative of that. and you too, bob. thank you very much for being there and listening and hearing. thank you very, very much. i want to talk about what senator kaka talked about. and this isn't an gp area, but an area that's much more difficult. and gp is not easy. that is the need for mental health professionals. we have as you know secretary -- mr. petzel, you were there when we opened up the facility in helena, and we need -- it's a great facility. we don't have staffing at this point in time as far as from the psychiatric standpoint. do you have the adequate amount of flexibility to be able to go out and recruit and it can go to the secretary or to mr. petzel, to be able to go out and recruit and get folks in? because i'm not sure we're there yet. >> thank you, mr. secretary, and thank you, senator. i am aware of the issues at ft. harrison. we have four psychiatric psychiatrists vacancies. in general, we can recruit around the country very successfully for psychiatric social workers, for psychiatric nurse clinics and for clinical psychologists. the most difficult recruitment is the m.d. psychiatrist. this is an issue that all health systems around the country face. we are very competitive, however, in terms of wages, in terms of working conditions and the other kind of things that are appropriate and are needed for recruitment. so it -- i think so we're in a best position to do the recruiting. i don't know what we can add right now to the basket, if you will, of things that we have to offer. it's a matter of identifying the people that want to come to places like helena, which is beautiful, by the way. >> thank you. >> and in an environment where there just aren't that many of them. >> okay. well, i just think that it's been an ongoing problem particularly in rural areas like montana and it's not a problem that i think bodes well for the veteran who has issues that revolve around mental health. quality of life will advance and health costs will go down. advances -- to allow the v.a. to be more efficient and effective, however, it is my understanding that the exclusion of advanced approaches have put us in a bind. it is hard to deliver quality care when you can't make investments in phone services, electronic health records. can you just speak about this issue and how the inclusion of healthcare related i.t. funds and advanced appropriations can improve the quality of health for our veterans? >> thank you, senator. i would begin by saying that congress provided us a very unique mechanism called the advanced appropriation. it's a gift to the v.a. because it gives us an opportunity for continuous budgeting and gives us two looks at the budget. we submit our best estimate as an advanced appropriate eight then we submit the actual budget. we can make adjustments. the advanced appropriation applies primarily solely to health care and so dr. petzel has his continuous budget. everyone else is on annual budgeting. under advanced approaches, we have the budget for medical services. medical compliance and reporting. medical facilities, and what happens is when we have a delay, a cr, the rest of the budget where i.t. resides, he has his authorization to start building facilities and standing them up. then we have to wait as sometimes happens or more than sometimes a delay until the i.t. budget gets released. so that now it can catch up to him and then in a case last year i think the budget cr lasted until april. so pretty significant period. we're a bit off stride here and i'm trying to figure out how we can get this together. and link up the authorities you provide along with the budget to do his budget and get him the tools that allow him to see patients. there's no separation between medical i.t. and medicine today. it's all one treatment discussion. >> well, i just want to let us -- let us know how we can help you be more effective in the i.t. area and i think the charge murray and ranking members will help on this too. i think it's really important in this day and age. and just -- >> can i just follow up very quickly. madam chair, i'll just add here, what has happened last year the i.t. budget is now released in april. and it's big number because it's all i.t. well really in it you have the paperless system that goes with secretary hickey's operation. and you have medical i.t. that goes with dr. petzel's. i'm just trying to be clear here. a piece that i'm concerned about is the medical i.t. so we link decision to do things for veterans in the medical sense along with the, you know, the tools to be able to do that. what happened last year sometimes happened, this large i.t. budget gets, you know, identified in april. we can now go forward. and the assessment is made, well, they can't possibly spend that before the end of the year. so we lose $300 million in a detrimental process. and at a time when we really needed to marry the two things up. he can now not deliver what we have already approved a year before and we're delaying that. so i think there's a mech -- >> timing issue? >> yeah. i think there's a mechanism here, getting stride on both ideas and i'd be happy to work with you on it. >> thank you. i want to thank everybody for getting in here today. i'd get into the rural cemetery thing, but we'll propose those questions in writing. thank you very much. >> thank you. senator moran? >> madam chairman, thank you very much. mr. secretary, in 2008, congress padded the reusch pad -- passed the rural access act. and i was involved in it in my days in house. the program is now referred to as project arch. access received closer to home. and that legislation set certain criteria that in a veteran lived a certain number of miles from an outpatient clinic or v.a. hospital, they'd provide those services locally. my legislation was broad in its initial form, it was narrowed by congress to create pilot programs. and the division that kansas was in is included as one of the pilots. i have expressed my complaint to the v.a. before because when the v.a. implemented the pilot program, it didn't choose a visen as a pilot program, but it chose a community. we have taken legislation and created a pilot program within a pilot program. and we now have a project on going in pratt, kansas, to demonstrate whether or not this idea works. i would -- i would love to hear the report of progress being made, but also use this moment as an opportunity to again encourage the department to expand this pilot so that you can take more than one commun y community. what happens in pratt, kansas, which is less than an hour from wichita is significantly different than what happens in atwood, kansas, which is five hours from wichita. the access to providers is totally different between those kind of communities. while i'm pleased the pilot program is on going, i'm completely uncertain -- let me say that different, i'm completely certain that the v.a. has not chosen wisely as it's narrowed it to a small scope to determine how it works. along the same topic of the c box, we have an on going problem similar to what has been expressed in regard to mental health by senator tester. i understand the doctor's testimony about the inability to attract and retain professionals, but it's becoming clear to me that we have that same problem outside mental health. our ability to retain physicians in c box across rural kansas, it's a huge problem and more and more. and we have physician assistants, that the availability of a physician has become very limited and we have many c box that many times no physician is present. i understand the i.t. as a potential solution. we have offered to -- our vizen to make sure we do everything as a member of the senate to provide the v.a. with the resources to provide the necessary personnel. and my assumption is my answer will be similar to what you told senator tester and the same one i here from the folks in kansas is. it's not really a resource issue. we can pay sufficient amounts of money to attract medical professionals, but we're struggling like everyone else to attract the professionals. i've heard that answer for a long time. you said it again today, dr. petzel. in some fashion that can't be the final answer. just because everyone else is struggling to attract professionals to take care of patients, we can't allow -- i understand the problem, i don't mean to be critical in that sense, but it what -- has to be more than well, everybody is having that problem. >> i would say, senator, we -- in the rural areas in particular are challenged because of the availability. dr. petzel said that. and our tools are really reaching out to -- we want highly qualified. we want talent. and our tools are what we're able to compensate, what we're able to award, recognize and performance of good people doing outstanding work. and retaining through bonuses the high quality ones. so our tools are limited. and -- but we owe you the best efforts we can to go after that talent and the biggest challenge is our end rural communities and we have to circle our wagons here. >> mr. secretary, i appreciate that your sentence that you owe that. we understand we owe the veterans there, but i would tell you that congress, i owe you every tool possible to help you meet that criteria and the complaint or concern i have is that i'm not being asked to do something to solve the problem. so what i'm asking for is tell us what we can do to provide the assistance so that when we have a hearing six months from now or we're back here next year talking about the budget, the answer to whether or not that we're meeting the health needs of veterans is not every healthcare provider, every community, every rural, state is having the same struggle we are. help us help you solve the problem. thank you. >> senator begich? >> you want to respond very quickly? >> i'll try to be quick. thank you, senator moran. m.d. issue first. we have this difficulty in certain parts of the rural country. if you look at the m.d. system, we don't have a recruitment problem. 's very important that we focus on the fact that this is rural area. two things we'd like to do. one is that we need to expand our tuition reimbursement program to be able to provide an incentive for people to go to rural areas by reimbursing them for the tuition from the medical school. the second one was an idea that the secretary had. i don't want to get into the details about it, but to do something like the military does with their uniformed services medical school and that is recruit people, pay for their medical education with an obligation to follow to work with us in particular parts of the country. those are two areas that we are trying to explore. >> thanks, senator. i'd put a finer point on what dr. petzel said. i thought if we went into areas, rural areas, and found a highly talented youngster, great potential, and targeted that individual and got them through the college and the medical process, they'd be going home. and so in the long run, we would not be facing the retention bonuses and this kind of thing. you'd have provided someone for the long term as a solution to that requirement, that community. that's part of the discussion here. >> i appreciate your thoughts and please consider me an ally. we can follow up with the arch question at a later time. >> thank you. >> thank you, senator begich? >> thank you very much. i want to echo the same kind of comments and senator moran, i like some of the things you've said. i know in one of the hospitals in alaska they give a bonus to nurses because of the high capacity need. thank you for offering those ideas. let me also say thank you, mr. secretary, for the two staff that you sent up to alaska. i think it was last week or the week before. and the chairwoman murray, and also it's important to come up to alaska to understand what rural is all about. i know you have been there. thank you for your visit an your team's visit. it makes a difference to the people there. but also i think it opens the eyes to a lot of folks how we have to deliver healthcare in the most remote rural areas of this country. thank you for that commitment. let me if i can, i know we have had some conversation with regards to the ideas of the alaska heroes card and the idea of trying to weave through this access issue in parts of the country that have limited access to veterans care. in alaska specifically. we talk about the roadless areas. those areas of 80% of the communities of alaska do not have access by roads. so when we read -- and i noted your testimony about internet connect. there's no mobile van possible. so i know we have talked in a very positive way about how to create this access. i want to check in with you on kind of update of that. i know we have kind of talked about the quality of care through our indian health services which is in -- superior to so much care that's being given today across the country and it is high quality care. tell me kind of what -- where you think we're at this point. i know we have -- you have been very responsive. i know we have been badgering you and your team on a pretty regular basis because as you have seen the veterans all they want to do is go across the street to the indian health service clinic to get their regular checkups as a choice, not as a requirement. if they choose to go to the v.a. hospital clinic, so be it. but if it's across the street, let's make it happen. because we would argue it's better in certain specialties than the v.a. what's your late on that? >> i think as you and i have discussed, i think you'll recall that we have put in a policy that would allow veterans from alaska to go locally and reduce the amount of veterans having to travel to the lower 48. there's rather robust program underway there. as i describe, we're working with the indian health service that would open a lot of processes for -- especially for alaska native veterans. but in the meantime, based on my visit to alaska, the alaskan native consortium, we have also established discussions with them and trying to ensure that however the ihs mou progresses that we have our -- we're ready to provide help to veterans who are being seen now. >> you feel that's going in the right direction with the travel concerns? >> let me talk to dr. petzel since -- >> in negotiations and discussion. >> thank you, mr. secretary. senator begich, i really do sim -- sympathize with the ruralness of alaska. while we're waiting for the mou to be finished, alaska is one of two places where we are proceeding with tribal interactions and i hesitate to use the word pilot. but to get specific agreements within a tribal unit in alaska. i believe it's the southeast alaskan tribal association and we are progressing in getting some arrangements made. it would be wonderful from my perspective if a veteran could make a choice, and access tribal clinics if indeed that was more convenient and the care was -- if it was successful and that we could work out the reimbursement arrangements. i think that's what we're trying to do in alaska and we have another effort in south dakota. >> and you feel -- the ultimate question, you feel it's moving in the right direction? >> absolutely. >> i have two quick ones. the one is senate bill 914, it authorizing a waiver on telehealth and telemedicine. i know we have about 2 hundred veterans or so, i think a hundred or so are in the program in alaska, i know others across the country, especially in the mental health services, telehealth service, i think it works successfully. we have asked that to be waived through the legislation. the copay. so it increases the capacity of telehealth. can you give me a thought of supportive? i know any time you take dollars away, telehealth is a money saver and the shortage of mental health services this is a potential way to meld the two programs and create a solution. >> neither dr. petzel or i are familiar with this legislation. so if i may -- >> absolutely. >> i'll provide that for the record. >> right. we'll give you some information on that. the last comment if i can, if i can just add to my concern undersecretary hickey, our call was on friday from someone who couldn't get on the 800 number. so it's not old. i