The Department of Veterans Affairs needs $17.6 billion in additional funding over the next three years to eliminate long waiting times for veterans' healthcare appointments, the embattled agency's acting chief said on Wednesday.
Acting VA Secretary Sloan Gibson told senators that without additional resources to buy private care and increase internal capacity, "the wait times just get longer" as more veterans return from wars, get older and turn to VA for healthcare.
Gibson told the Senate Veterans Affairs Committee that the $17.6 billion request would only last through the 2017 fiscal year. About $10 billion of the total would be needed to purchase private care for veterans and hire about 10,000 additional clinical staff, including about 1,500 physicians.
But to keep ahead of the rising population of veterans needing VA care, even more money will be needed in the future, Gibson said.
"These funds represent only the current shortfalls in clinical staff, space, information technology and purchased care necessary to provide timely, high-quality care," Gibson said.
The VA has been rocked by scandal in the past three months over systematic cover-ups of months-long waiting times for medical appointments at its clinics and hospitals across the country. In Phoenix, doctors have alleged that some 40 veterans died as their names languished on secret waiting lists while officials misrepresented wait-time data to meet targets for bonus compensation.
The Department of Veterans Affairs has lost the trust of veterans and the American people as a result of widespread treatment delays for people seeking health care and falsified records to cover up those delays, the agency's top official said Wednesday.
Gibson said the VA has created an environment where workers are afraid to raise concerns or offer suggestions for fear of retaliation and has failed to hold employees accountable for wrongdoing or negligence.
The agency also has devoted too many resources to meeting performance metrics — such as prompt scheduling of patient appointments — that were subject to manipulation and may not accurately reflect quality of care, Gibson said.
"As a consequence of all these failures, the trust that is the foundation of all we do — the trust of the veterans we serve and the trust of the American people and their elected representatives —has eroded," Gibson told the Senate Veterans Affairs Committee.
The controversy caused retired Army General Eric Shinseki to resign as VA secretary in late May. President Barack Obama appointed Gibson, a former banker who joined the VA in February, to run the department temporarily.
Obama has since nominated Bob McDonald, the former chief executive of consumer products giant Procter and Gamble Co, to be secretary. McDonald will face the Senate veterans panel next week in a confirmation hearing.
Gibson said he had been working with the White House budget office to develop the funding request.
Both the House and Senate have passed legislation aimed at speeding care to veterans, allowing them to see private doctors for two years at VA expense if forced to endure long waits. But lawmakers are reeling from sticker shock after the Congressional Budget Office pegged the cost at $35 billion over 10 years.
The number Gibson gave to senators was significantly lower and would be more geared to purchasing private care in the near term. Later in the 2014-2017 period, the VA would rely more on expanding its own internal capacity.
He said that VA would likely be more efficient at caring for veterans, who tend to be "older, sicker and poorer" than the general population.
About $6 billion of the $17.6 billion request would cover construction of new clinics and other facilities, which would open up about 8 million new appointment slots per year, Gibson said.
The acting secretary told the Senate panel he is committed to restoring the trust of veterans and the American people through a series of actions, including some that have already begun, including outreach to 160,000 veterans to get them off waiting lists and into clinics.
Gibson also vowed to fix systemic scheduling problems, address cultural issues that have allowed problems at the agency to fester and hold front-line workers and supervisors accountable for willful misconduct or negligence.
He also promised to improve transparency, including regular and ongoing disclosures of information about patient scheduling and care.
Lawmakers generally welcomed Gibson's comments, but said the agency has a long way to go to restore trust.
"What has happened over the course of years is a horrendous blemish on the VA's reputation, and much more work will be needed to repair that damage," said Sen. Richard Burr, R-N.C. "The culture that has developed at VA and the lack of management and accountability is simply reprehensible."
Sen. Patty Murray, D-Wash., also lamented "a corrosive culture" at the VA that she said includes management failures and lack of communication at all levels of the agency.
"VA needs more providers, more space and modern IT systems," Murray said.
Sen. Bernie Sanders, I-Vt., chairman of the Senate veterans panel, said he has been impressed by the response of Gibson and other VA leaders to the current crisis, but added: "The simple reality is that the problems they face are staggering."
VA is the largest integrated health care system in the country, with nearly 9 million enrolled veterans seeking care, including many who suffer from a variety of serious mental and physical health problems.
As of June 15, about 46,000 veterans waited at least 90 days for their first VA medical appointments, the agency said. That's down from 57,000 who waited more than 90 days as of May 15.
An additional 7,000 veterans had never gotten an appointment for VA care, despite seeking one over the past decade, the VA said. That's down from about 64,000 veterans who did not get appointments as of May 15.
More than 630,000 veterans have waited at least 30 days for an appointment, the VA said.
The VA operates the largest U.S. healthcare system, providing healthcare to nearly 9 million U.S. veterans at some 1,700 facilities, including 150 hospitals and 820 outpatient clinics.
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