Testimony
of Thomas
L. Garthwaite, MD
Under
Secretary for Health Department
of Veterans Affairs
Before
the
Subcommittee
on Health
Committee
on Veterans’ Affairs U.
S. House of Representatives
April
3, 2001
Mr.
Chairman and members of the Subcommittee, I am pleased to be here
today to discuss the progress, challenges, and future direction of
health care in the Department of Veterans Affairs (VA). Since
1995, we have dramatically transformed the VA health care system.
We have moved from an inpatient model of care characterized by
limited facilities often far from patients’ homes to an outpatient
model with more than 350 additional sites of care.
While we still provide comprehensive specialty care, we now
also emphasize the coordination of care through the universal
assignment of primary care providers and teams.
We emphasize disease prevention and early intervention,
allowing veterans to avoid illnesses and complications and allowing us
to avoid the added costs of their treatment.
As a result of these strategies, VA today is able to provide
higher quality care to more that 500,000 additional veterans with
25,000 fewer employees than it did just six years ago.
Moreover, since 1997, VHA has reduced the cost per patient by
24 percent. The
key goal that underlies VA’s transformation and continues to drive
our strategies for the future is a quest for health care value.
We have defined value as quality divided by cost.
While we do not yet have a perfect system to measure either
quality or cost, we have made significant progress in measuring both.
We have defined and developed measures across four domains of
quality (technical quality, access, patient satisfaction, and
functional status) and continue to improve our measurement of cost.
The quality and cost measures are directly translated into our
value framework and the “six for 2006” goals. Before
I detail our progress and current strategies toward the “six for
2006,” I would like to comment on some of the overarching themes and
strategies that pertain to most or all of the 2006 goals.
The following issues are important areas of concentration for
us and will directly impact our success in achieving our key goals.
They are workforce development, information technology,
performance measurement, quality and capacity in our special emphasis
programs, enhancement of our academic missions of teaching and
research, the Veterans Health Initiative, rationalization and
modernization of our facilities (CARES), distribution of funding
(VERA), and continuous self assessment using the Baldrige process. Workforce
Development.
VA’s health care workforce is the key to achieving all of our
goals. We must recruit, retain, and develop the best staff if we are
to continue to improve. Recently,
we have noted shortages of nurses and pharmacists in some parts of the
country and the projected shortages in these and other professions are
alarming. Increasingly,
we have difficulty matching private sector pay levels in such critical
areas as physician specialists and computer experts.
We also must continuously invest in the education of our
workforce to allow them to keep pace with changing patient needs and
rapid changes in health care technology.
Last year, I established a taskforce to recommend a
comprehensive set of actions to address these and other workforce
issues. The recommendations of this taskforce are currently under
review. Information
technology. Information
technology is at the heart of most changes in VHA. We use technology to process clinical and administrative
information, to automate previously manual processes, to deliver care
across distances, to train staff, and to conduct research. Examples of the use of technology include the computerized
patient record, a cost accounting and analysis system (DSS),
consolidated mail out pharmacy (CMOP), simulated patient training in
surgery and anesthesia, gamma-knife radiation therapy, advanced neuro-imaging,
bar-coding to aid in the accuracy of medication administration, tele-health,
and many others. Two
key principles in the development of our computerized medical record
are that it is owned by the veteran and that it must be compatible
with emerging and established standards such that a veteran can take
his/her electronic record to or bring it from any other health care
service provider. If a
veteran chooses VA to maintain the health record, we must preserve its
integrity and security and use it only for the benefit of the veteran
or society – and only with his/her permission.
We call our initiative for a veteran-controlled health data
repository and associated functionalities "HealtheVet." Performance
measurement.
The performance measurement system used in VA has played a key
role in the transformation of the system and will continue to be a key
strategy in the continued evolution of the system.
Each year, approximately twenty key measures are selected for
emphasis and become the significant component of a performance
contract between network directors or chief officers and the Under
Secretary for Health. Some
of the detailed results are presented below.
The power of the system is derived from the focus on defining
the most important goals for the year, the development of measures to
chart progress toward those goals, the open feedback about the
progress (or lack of progress) toward those goals and the necessity
that administrators must team with front line staff to make the
outcomes for patients change. Quality
and capacity in special emphasis programs.
Since 1996, we have moved from inpatient care to outpatient
models in medicine, surgery, and mental health.
The numbers of patients seen with serious mental illness, for
homelessness, or suffering with PTSD have increased.
The number of patients with substance abuse treated has
decreased, especially between FY 1999 and FY 2000.
We are working to understand the reasons for this drop and to
assure access to substance abuse programs in our clinics as well as in
our larger facilities. To
this end, I plan to establish a National Mental Health Improvement
Program (NMHIP). This
program will be modeled after a number of well-established VA
data-driven improvement programs, such as the Continuous Improvement
in Cardiac Surgery Program (CICSP), the National Surgical Quality
Improvement Program (NSQIP), the VA Diabetes Program, the Pharmacy
Benefits Management Program (PBM), and the Spinal Cord
Injury/Dysfunction National Program. This new program will use
validated data collection, expert analysis, and active intervention by
an oversight team to continuously improve the access, outcomes, and
function of patients in need of our mental health programs.
These programs include those for patients who are Seriously
Chronically Mentally Ill, or who suffer from Post Traumatic Stress
Disorder, Substance Abuse, or Homelessness. This program will draw upon existing resources in our Health
Services Research and Development Service (HSR&D) including
existing initiatives in our Quality Enhancement Research Initiative (QUERI)
and our Mental Health Strategic Health Care Group (MHSHG) including
the Northeast Program Evaluation Center (NEPEC). The
number of patients treated for spinal cord injury and dysfunction,
blind rehabilitation, and traumatic brain injury has increased over
the 1996 baseline. Fortunately,
the number of patients needing amputation has decreased due to our
aggressive management of vascular disease and diabetes. Academic
missions.
The academic missions of research and health professions
education are part of our “six for 2006” goal to “build healthy
communities.” However, they are also a critical strategy to deliver high
quality and efficient care. These
missions allow us to attract the very best and brightest clinical
staff and enable us to be early adopters of new advances in medical
knowledge and practice. We
must challenge our academic staff to turn their creative talent loose
on the development of new care delivery models that can simultaneously
address quality, convenience, research, and education.
We will engage them in that quest. Veterans
Health Initiative.
The Veterans Health
Initiative was established in September 1999 to recognize the
connection between certain health effects and military service,
prepare health care providers to better serve veteran patients, and to
provide a data base for further study.
The development for this initiative began with the Military
Service History project, which involved a pocket card for medical
residents. This card
details the important components of a military service history,
summarizes some of the health risks associated with various periods of
service, addresses more generic health issues of concern to all
veterans, and specifies Web sites containing references relevant to
the issues. The
components of the initiative will be a provider education program
leading to certification in veterans’ health; a comprehensive
military history that will be coded in a registry and be available for
education, outcomes analysis, and research; a database for any veteran
to register his military history and to automatically receive updated
and relevant information on issues of concern to him/her (only as
requested); and a Web site where any veteran or health care provider
can access the latest scientific evidence on the health effects of
military service. Aligning
capital assets to veterans’ needs. CARES (Capital Asset Realignment for Enhanced Services) will
affect every network in VHA. We
have embarked on a significant new planning process with the goal of
enhancing health care services to veterans by realigning capital
assets. The CARES process starts with the objective assessment of
veterans’ current and future health care needs within each network
and proceeds with the identification of service delivery options to
meet those needs and the strategic realignment of capital assets and
related resources to better serve the needs of veterans.
Through CARES, networks will develop plans for enhanced
services that are based upon objective criteria and analysis,
cost-effectiveness and may include capital asset restructuring.
These plans will take into account future directions in health
care delivery, demographic projections, physical plant capacity,
community health care capacity and workforce requirements.
Network capital asset realignment proposals will be evaluated
and ranked by VHA using a structured decision methodology.
All savings generated through implementation of CARES will be
reinvested in meeting veterans’ health care needs. Resource
allocation.
To date, no ideal system to allocate resources in health care
has been devised. Fee for
service plans lead to overuse of procedures and high costs while
managed care plans are criticized for restriction of choice of
provider and of access to specialty care.
VA uses a risk adjusted, capitated model called VERA (Veterans
Equitable Resource Allocation) to allocate resources among VHA’s 22
networks. Distribution
within each network is based on a set of principles, but in the
absence of an ideal system, we have not mandated a single method for
all networks. Ideally,
VERA would be simple, fair, and promote quality of care.
We do not believe that any models have been able to drive
quality, therefore, we keep the allocation system simple and work hard
to measure the quality of care provided. VERA
has undergone extensive scrutiny since VHA implemented it in 1997.
The effectiveness of VERA has been assessed by
PricewaterhouseCoopers and by two GAO reviews.
All three studies viewed VERA in positive terms.
PricewaterhouseCoopers reported that VERA, which allocates
resources based on objective measures of need, is ahead of other
budget allocation systems, which typically depend on historical
allocations with periodic adjustments. We
reviewed the recommendations from PricewaterhouseCoopers and GAO and
implemented many of them. For
FY 2001, the following VERA policy changes or refinements were
approved for the network budget allocations: ·
VERA Basic
and Complex patient classes and criteria were developed for hepatitis
C patients. ·
The Complex
Care projection methodology was adjusted to delete the veteran
population factor in favor of historical utilization. ·
Research
support funds were passed through VERA directly to each VA medical
center. ·
VHA changed
the workload factor for computing the labor index that weights Basic
and Complex Care workload consistent with recent costs. ·
The
three-year phase-in of Non-Recurring Maintenance (NRM) based fully on
patient care workload and the cost of construction was completed. We
are currently examining several additional areas of possible
refinements to VERA for implementation in FY 2002 or later, but no
conclusions have been made yet. These
areas include patient classifications, priority 7 veterans and market
share, the cost impact of treating patients above age 75, the existing
geographic price adjustment formula to include contracted salary rates
and energy expenditures, and the use of risk adjustment models to
account for differences in age and disease burden in the population
served. We remain
committed to the evaluation of all reasonable explanations for
variance in the model. Baldrige
and the future.
VHA will apply for the President’s Quality Award in the fall
of 2001 and for the Malcolm Baldrige National Quality Award in May of
2002. We do not undertake
these processes for the awards themselves, although we aim to win.
Rather, we seek the experience, the outside feedback, and the
development of skills in critical self-assessment. We have been struck by the economic success of previous award
winners and by their achievements in service quality. We believe that we can identify gaps in our systems and can
improve the integration of all we do.
The Baldrige criteria will provide a structured and integrated
framework for many of the processes we perform today.
In the end, sober self-assessment is a skill that should
benefit any organization. Within
the last year we have updated VHA’s strategic framework to reflect
six organizational goals that closely match our six domains of health
care value. I
will now review our progress and plans for achieving these goals,
which are known as the “six for 2006.” Put
Quality First until First in Quality.
A major force in the transformation of the VA health care
system was the implementation of the Performance Measurement System.
This system was initiated to meet challenges of improving
health care quality, patient satisfaction, and economic efficiencies.
The foundation of the Performance Measurement System is broad,
statistically reliable, ongoing measurement of performance objectives.
As a result of this system, VHA is increasingly able to measure
and report on quality. Moreover,
the ability to measure allows us to identify areas for improvement. VHA’s
quality is not merely good -- in many areas it surpasses government
targets and private sector performance.
VHA’s record regarding post-operative morbidity and mortality
is as good as or better than that found in any published study of
non-VA surgical programs. Our
immunization rates for pneumococcal pneumonia and for influenza far
exceed the goals established for the U.S. population.
Our breast and cervical cancer screening rates are also well
above the national average performance in these areas.
VA patients receive life-saving aspirin and beta-blocker
administration after heart attacks 96 percent of the time, whereas
Medicare patients receive this therapy in only 68 percent of cases. VHA
recognized that the use of evidence-based, clinical practice
guidelines would have an appreciable impact on patient care and
initiated development of National Clinical Practice Guidelines in
1995. Guidelines were
established for many high volume, high risk diseases.
A joint effort between VA and DoD has led to the development of
more than a dozen clinical practice guidelines intended to assure
quality and continuity of care. VHA’s
strides in quality and its leadership in health care quality
management were specifically cited at the recent Institute of Medicine
briefing accompanying the publication of their report, “Crossing the
Quality Chasm.” To
further our efforts in quality improvement, we will continue to use
and update our extensive quality and performance measurement tools.
For example, the expanded Prevention Index and the Chronic
Disease Care Index, which now encompasses the clinical practice
guidelines, were recently revised on the basis of the current medical
literature and expert opinion. In
1998, VA launched the Quality Enhancement Research Initiative (QUERI). The
QUERI mission is to translate research discoveries and innovations
into better patient care and systems improvements.
It is founded on the principle that practice needs determine
the research agenda, and research results determine interventions that
improve the quality of patient care.
The Institute of Medicine, in its report “Crossing the
Quality Chasm,” specifically noted QUERI as a model for translating
the best research evidence into the best patient care. VHA
has also been recognized as a leader in efforts to prevent health care
errors and improve patient safety.
Improved patient safety requires reporting systems to identify
and understand adverse events and close calls and the design and
deployment of systems that reduce such vulnerabilities.
VHA has introduced a mandatory reporting system for adverse
events and close calls that is coupled with rigorous root cause
analysis. This system has
been operational for over a year and has resulted in a 900-fold
increase in close calls reported.
Close call analysis is the preferable way to learn of system
vulnerabilities, because they can be identified without patient
injury. VA
also believes that health care will discover additional
vulnerabilities by instituting a separate, voluntary, and anonymous
reporting system. To that
end, VA formed an agreement with NASA to develop a Patient Safety
Reporting System (PSRS) patterned after one that has been used
successfully in aviation. The
system’s guiding principles are voluntary participation,
confidentiality protection, and non-punitive reporting.
It is designed to be a complementary external system to our
current internal reporting system.
VA’s National Center for Patient Safety and NASA have been
working on the design and development of this system.
Pilot testing will begin this year with the entire system on
line by the beginning of FY2002. The
discovery of system weaknesses must be followed by system redesign. Examples of system improvements include: national
implementation of Bar Code Medication Administration (BCMA) that
improves the accuracy of medication administration, extensive
deployment of computerized order entry that eliminates handwriting and
other common errors, the removal of bulk medications from nursing
wards to minimize mixing errors, and working through an interactive
fix of a design flaw in a temporary transvenous pacemaker with the
manufacturer. Provide
Easy Access to Medical Knowledge, Expertise, and Care.
Traditionally, access to care has addressed issues of travel
times, waiting times, and insurance.
This goal includes those issues as well as access to knowledge
via the telephone or Internet and access to the knowledge of
specialists where appropriate. As
VA has shifted from an inpatient-focused system to one that is
outpatient-based, we have extended care to 350 additional sites, for a
total of more than 1,300. Approximately,
100 additional community-based outpatient clinics have received
congressional approval and are slated to be phased in over the next
several months. Telephone triage and advice programs have been implemented at
all hospitals, and health education is available on the Internet.
Last year, VA did more than 350,000 consultations via
telemedicine (the patient or a diagnostic image and the provider were
connected via voice and usually video). Telemedicine and home-care teleconsultation initiatives
have also been implemented for spinal cord injury patients.
In 1998 and 1999, the Vet Center program implemented the Vet
Center-Linked Primary Care project.
Telemedicine is used in 20 Vet Centers to promote access to
primary care for high-risk, under-served veterans in locations closer
to their respective communities. Applying
for VA health care has never been easier.
We have eliminated almost three-fourths of the health
care-related forms we once required.
Veterans can now obtain applications for enrollment and medical
care over the Internet. Veterans
may send the forms electronically to the VA health care facilities
they have selected or they can print out the completed forms and mail
them. Eligibility
reform and community clinics have enhanced access but in some areas
demand has preceded recruitment resulting in extended waiting times
for appointments. VHA is committed to providing timely care to the veterans
enrolled in our health care system.
We have recently developed a data system and performance
expectations with regard to waiting times for primary care and
specialist consultation. We
believe that our performance goals for waiting times, commonly known
as “30-30-20,” are industry leading and fully support patient
expectations for timely access to care.
Our strategic goal is to provide 90 percent of new primary care
and specialty care visits within 30 days, and see 90 percent of
patients within 20 minutes of their scheduled appointment time.
Of course, patients with emergencies or urgent needs are seen
as quickly as is medically appropriate.
VHA is now working with the
Institute for Healthcare Improvement (IHI) on a major initiative that
will focus on the rapid spread of the most successful actions underway
within each VISN to achieve the “30-30-20” performance goals.
VHA has already seen system-wide improvements in average clinic
waiting times between the start in April 2000 to December 2000. While
the early progress on waiting times is encouraging, we have more to do
in the broader field of access. We
must eliminate barriers to care which result from such things as
poverty, race, gender, geography, language, age, and bias.
We will evolve strategies to provide care to vulnerable
populations including the homeless, the mentally ill, the aged, and
those infected by the Hepatitis C virus.
We also have developed a body of knowledge about veterans’
health issues that we will make available to any veteran or any health
care provider. VHA
has been faced with access issues in extended and long term care.
VA has expanded programs targeted for the elderly, including
Geriatric Evaluation and Management (GEM) Programs, home-based primary
care initiatives, and pilot programs in long-term care and assisted
living as authorized by the Veterans Millennium Health care and
Benefits Act, Public Law 106-117. Enhance,
Preserve, and Restore Patient Function.
The
restoration of function (rehabilitation) is the cornerstone of VA’s
health care mission. VA
has nationally recognized programs for the rehabilitation of veterans
who are blind, suffering from brain dysfunction, afflicted with spinal
cord injuries, or who are amputees.
Notable progress is being made in the development of outcome
measures that evaluate functional improvements in each of these
special programs. Amputation
rates in VA are lower than age-matched private sector populations and
continue to decrease. Activities
are underway to further integrate all of VA's low vision and blind
programs to improve the continuity of care.
A recent report comparing VA spinal cord care with that in the
U. S. private sector and in Sweden concluded that the totality of VA's
benefits package is unmatched. VA
provided far greater continuity and breadth of care than did the
private sector. Life-long,
integrated, and comprehensive care for spinal cord patients is
provided in VA and Sweden, but not in other venues.
The Traumatic Brain Injury (TBI) Network of Care provides
case-managed, comprehensive, specialized rehabilitation spanning the
period from discharge from the acute surgical treatment unit until
permanent living arrangements can be made.
A significant number of these patients are referred to VA
facilities from the military. Nine
research centers of excellence conduct studies emphasizing wheelchair
design and technology, brain rehabilitation, spinal cord injury and
multiple sclerosis, early detection of hearing loss, orientation
techniques for blind persons, and amputation prevention and joint
replacement. VA
also provides comprehensive mental health services across a continuum
of care, from intensive inpatient mental health units for acutely ill
persons to residential care settings, outpatient clinics, Day
Hospital, and Day Treatment programs.
The number of veterans receiving mental health care in the VA
health care system has steadily increased since 1996.
VHA will continue to monitor care and work with networks to
improve and maintain both the capacity and the quality of care for all
veterans with serious mental illness.
Recent initiatives have been undertaken to increase mental
health treatment in community-based outpatient clinics, increase use
of assistive community treatment for the most seriously mentally ill
veterans, and increased use of opiate substitution clinics in major
urban centers. It is also
worth noting that VA is the only federal agency that provides
substantial hands-on assistance directly to homeless veterans and has
the largest network of homeless assistance programs in the country.
The
primary objective of all special programs is to provide the best
possible care and achieve the maximum independence for patients by
restoring lost function or decreasing the impact of their
disabilities. We will
continue to enhance our programs in rehabilitation, sharpening our
focus on improved functional capacity for veterans who suffer from
spinal cord injury, blindness, amputations, brain dysfunction, and
mental illness. To improve the integration of activities and to assure VA has
adequate capacity to meet the specialized health care needs of
veterans, VHA has created a position in headquarters to serve as the
coordinator for special disability programs and has designated a
clinical coordinator in each VISN to work with individual facilities
and headquarters offices to monitor capacity and maintain specialized
services. Exceed
Patients’ Expectations.
VA
created the National Customer Feedback Center (now the National
Performance Data Feedback Center, or NPDFC) in 1993 to measure and
improve patient satisfaction with care and to allow comparison with
other health care systems. Annual
inpatient and outpatient patient satisfaction surveys based on the
Picker instrument were developed using focus groups of patients and
their families. Patient
service standards were also developed, and specialty surveys, such as
long-term care, have been added over the years.
Beginning in FY 2001, VHA’s new Performance Analysis Center
for Excellence (PACE) will refine and expand the data feedback,
satisfaction surveying, and other objectives accomplished by the NPDFC.
PACE will use clinical literature and VA data to identify new
clinically and operationally important performance improvement
opportunities, aligning activities with the strategic objectives of
VHA’s “6 for 2006.” The
overall customer satisfaction scores from VHA’s inpatient and
outpatient surveys have remained relatively flat for the last several
years, with approximately 65 percent of patients rating VA’s
services as “very good” and “excellent.” However, when we consider the significant structural and
programmatic realignments the VA health care system has undergone in
the last six years, it is gratifying that veterans continue to show a
high level of satisfaction and confidence in VA health care.
Nonetheless, we believe that a more focused approach will have
a strong impact on improving our performance.
Therefore, in FY 2001 VHA will begin to focus on three key
areas of patient satisfaction: patient education, visit coordination,
and pharmacy services. These
are areas in which our surveys indicate that we have the greatest
opportunity and need for improvement.
In addition, we will further focus the system on the patient by
emphasizing the goal of ensuring that veterans participate fully in
decisions affecting their health care and understand those decisions
completely. The
American Customer Satisfaction Index (ACSI) provides an independent
assessment to be used with VA’s own data.
This Index, a cross-industry/government measure of customer
satisfaction released December 22, 2000 asked questions about
veterans’ overall satisfaction with their experiences in a recent
visit to a VA medical center. Overall, VA’s customer satisfaction index was 78 on a
100-point scale, seven points above the customer satisfaction score of
71 given by the general public for all sectors of business, and eight
points above the score for private hospitals.
Customer service, perceived in terms of courtesy and
professionalism, was the highest of VA’s three measurement areas, an
average score of 87. ACSI considers scores above 80 to be “high.”
On questions about patients’ likely return to VA medical
centers and willingness to say positive things about VA, VA scored an
88. We
must also expand our partnerships with federal, state, local, and
private entities to minimize redundancy in programs and services and
to leverage our buying power. Through
multiple partnerships, VA will be in a position to manage its services
in such a way as to enhance the quality and coordination of care
provided to veterans. Build
Healthy Communities.
Veterans can only reach their maximum health potential if they
live in healthy communities and healthy environments.
We will continue our work in detecting emerging pathogens, in
the immunization of large populations, and in the understanding of the
long-term effects of toxic agents on health.
Our research and educational roles will continue to benefit
veterans and non-veterans alike.
Our pioneering work in patient safety has the potential to
improve health care for all. We
will work with community partners to combat homelessness and to
coordinate care for veterans. VA’s
influence on the nation’s health goes well beyond its primary
mission of providing care for veterans.
We will continue our efforts to integrate our research and
educational roles with our rapidly changing care delivery system.
VA’s research program, the recipient of three Nobel Prizes
and a plethora of other awards, concentrates on health care concerns
that are prevalent among veterans.
VA fosters multidisciplinary research, pilot studies, and
research training for teams of investigators unraveling questions
concerning such health issues as cancer, multiple sclerosis, Hepatitis
C, kidney disease, depression, stroke, Alzheimer’s disease, heart
attack, lung disease, bone disease, Parkinson’s disease, diabetes,
gastrointestinal disorders, and wound healing.
VA’s research program also pursues research at the interface
of health care systems, patients, and health care outcomes.
The priorities have expanded to include access to health care,
managed care strategies, the effect of facility integrations, changes
in clinical services organization with line management, and ethnic,
cultural, and gender issues as they relate to health services use.
Many VA research studies have been used within and outside VA
to assess new technologies, explore strategies for improving health
outcomes, and evaluate the cost-effectiveness of services and
therapies. VA’s
research program will continue its decidedly clinical focus as a
unique national asset. To
this end, VA Research intends to lead the nation in multi-site
clinical trials, rehabilitation research and development, and health
services research and development.
The majority of research allocations will continue to be
devoted to health services research and research with potential
clinical applications. Lastly,
VA’s research program, through the high quality of its research
offerings, will attract and retain highly trained clinician
researchers who will continue to enhance the VA’s patient care
mission. VA’s
training mission is accomplished through academic affiliations with
many of the nations’ medical schools and other schools in health
sciences, an important and unique characteristic of the VA health care
system. VA remains the
nation’s largest provider of graduate medical education.
Affiliations with 107 of the nation’s 125 medical schools
provide the context for training that annually affects over one-third
of the nation’s medical resident trainees, including half the
nation’s third and fourth year medical students.
In addition, over 54,000 associated health trainees in nursing,
psychology, pharmacy, and over 40 other disciplines receive part or
all of their clinical training in VA facilities.
We currently fund approximately 9,000 positions in graduate
medical education. As
residents rotate through these positions, they are exposed to the best
evidence-based medical practices in the country. They take this knowledge with them as they complete their
training and begin their careers in the care of veterans and
non-veterans. VA can
claim it has trained, at least in part, more than half of the
nation’s practicing physicians. VA’s
academic affiliations are robust and provide vigorous opportunities
for providing the best approaches for continuous improvement of health
care for veterans while contributing to strengthened academic medical
institutions throughout the country.
We must work hard to keep them healthy.
In providing medical contingency backup for the Department of
Defense, VA supports DoD’s medical system during wartime.
VA also assists the Public Health Service, The Federal
Emergency Management Agency (FEMA) and the National Disaster Medical
System (NDMS) in providing emergency care to victims of natural and
other disasters. Under Presidential Decision Directive 62 (Combating
Terrorism), VA works with the Department of Health and Human Services
to procure stockpiles of antidote and other necessary pharmaceuticals,
and to train medical personnel in NDMS hospitals for responding to the
health consequences of the use of weapons of mass destruction. VA is
uniquely positioned to do this training since it represents a large
portion of the Nation's medical capability and has facilities located
throughout the country. I
cannot stress too much the importance of VA’s role in emergency
preparedness and response, and I will work to ensure that VA remains
able to meets its obligations. Back to Witness List |