During a House Veterans' Affairs Committee hearing last week, Rep. Jen Kiggans (R-VA) questioned VA Secretary Doug Collins about upgrading technologies at the department.
00:00Representative Kicken. Mr. Secretary, it's great to see you. Thank you so much for being with us and a special thank you for coming down to Hampton Roads, home to a lot of Navy veterans, a lot of military veterans. So I really appreciate your time, not just visiting my district, but so many. You've been doing such an amazing job and you're starting to sound like a broken record, which I guess is good, but over and over again about how we are not cutting staff and how you're looking out for physicians and nurses and allied health partners. And I think that's important just to repeat that. And we'll try to repeat that.
00:29as well on your behalf. I know that one of the VA's statutory missions is training for health professionals, and that includes nurses. And we have a nursing shortage right now across the board, not just in the VA, but on the civilian sector. So I'm thankful for the VA's investment in educational opportunities, including residency programs and clinical opportunities. And you have 68 nurse residency or clinical programs, including 34 primary care slots, 26 mental health slots, and you've expanded that to
00:59eight geriatric and extended care slots. And as a geriatric nurse practitioner, I'm certainly thankful for that. I think that we have a lot of older veterans. And I know that with the aging of America, just in general, we need to be focused more on providing geriatric specific health care. So thank you for recognizing that. I wanted to offer some comments on behalf of what I consider to be an underutilized resource. It's no secret that sometimes physicians sometimes feel encroached upon when we integrate advanced practice nurses,
01:29but just to present some evidence-based research. I know that patient safety outcomes are identical, regardless of whether, for example, anesthesia is provided by a physician or a CRNA.
01:38There's no secret that we have a shortage of anesthesiologist. So we have nurse anesthetists who are available. And there's a lot of debate about integrating them into VA health care. CRNAs are often the sole anesthesia provider in rural hospitals, ensuring safe obstetric outcomes.
01:56And then we've got 31 facilities in the last VA OIG report that cited a severe shortage of physician anesthesiologists, including my Hampton VA Medical Center.
02:05The Trump administration has consistently supported the removal of barriers for CRNAs and other advanced practice RNs.
02:11During the pandemic, the administration went even further, suspending Medicare supervision requirement for CRNAs to allow them to practice to the full training,
02:19their full training to provide critical care when the nation needed it the most.
02:22At the same time, the VHA put out a memo calling for facilities to remove restrictions on CRNAs.
02:28These recommendations are all supported by the National Academies of Sciences, Engineering, and Medicine.
02:34Calls to remove restrictions on CRNAs are well supported by data.
02:37So I'm just a little bit, I would love some clarification on what your plans are as the new VA secretary to integrate advanced practice nurses, especially.
02:46We have this lack of anesthesiologists. We have a group of people that can provide that care.
02:52So I just would love to hear from you what your plans for integration are.
02:56Thank you, Congressman.
02:57I appreciate it.
02:58And I've enjoyed working with you and also working with, you know, opening facilities.
03:02I think it was really interesting that one of the issues that we had to deal with early on was in actually your district,
03:07in which there was a discussion about opening a facility.
03:10And it was said because of hiring freezes and everything else, it wasn't opening as it should.
03:15But the reality was it was opening just as all the other CBOCs have opened, and that is with a gradual rollout.
03:21So I appreciate your work there.
03:23We're looking at our scope of practice issues on many fronts.
03:27This was a project that was begun a lot before me, a couple of secretaries ago.
03:33We're still continuing to look at that.
03:34As you've heard even today on this, there's a lot of disagreement, especially when it comes to certain areas.
03:39And so we're trying to find what is the best balance, not only for VA, but also for our employees as well.
03:45So we're still looking at that issue, and we'll be getting more input as we go forward.
03:49We'd love to work with you on that.
03:51As one of two nurse practitioners here in Congress, we feel critical health care shortages and gaps where I think our care is valued.
04:01And I know that the VA is always on the forefront of wanting to provide the best patient care.
04:06So just please don't overlook advanced practice nurses and the role that we play.
04:10And then just to switch gears from health care a little bit, I know we've talked a lot about health care and VA medical centers,
04:15but there's a lot of other veteran benefits that you will oversee now, including GI bill benefits and even health care, VA home loans,
04:26what exactly veterans are entitled to.
04:28And I know as a veteran with a veteran family, it's been frustrating sometimes to actually access my benefits and to understand what that looks like.
04:37And you and I spoke at a roundtable briefly just about what that online component looks like.
04:43For example, MillConnect doesn't talk to the VA website, and I feel like there's some technology challenges there.
04:49It creates a lot of frustration on the part of veterans.
04:51And when I share with my veteran friends, you know, how hard is it for you to access your GI bill benefits or to transfer those to your children?
04:59You know, all of us share the same level of frustration.
05:02So with our VA budget that we have, can we or do you have any plans to dedicate a portion of that into upgrading this probably outdated technology?
05:13I think that we, that investment of trying to make it a little more user-friendly, that website piece so veterans can log on in one place,
05:22can see their benefits, can understand, you know, how to transfer their GI bill benefits to their kids,
05:28what even that paper trail looks like.
05:30I got a 15-page letter about my, you know, my son's, it was my husband's GI bill benefit, but transferred to my son,
05:36and that I couldn't really decipher.
05:39And so that was frustrating to me, and I'm sure I'm not alone.
05:42So just would love to hear your plans about that technology upgrade,
05:45and if you could add that to your list of things to do to maybe make that website just a little more user-friendly.
05:53Yes, we're looking at every opportunity we can to streamline our online access, our online portals,
06:00to make it easier to understand.
06:02It goes back to something in your comment just now reminded me that when I actually was able to access my benefit,
06:09when I used it for my, transferred it to my kids, was I didn't even know it existed.
06:14And it came to me when I was there on base one day, and I had another officer who we were just talking about it in general,
06:19and he said, well, you know that you can use that money.
06:22I said, what are you talking about?
06:23Okay, this just shows you that there's an understanding that needs to happen even more as we go forward.
06:28So, yes, anything we can do in that realm, we're going to continue to do.
06:32It's about putting, this is probably as clear as I can say, it's about putting that veteran first and saying,
06:36how can we make that happen for all of our veterans and make it easier?
06:40I've said this early this morning.
06:41I'll say it again, and I may have partially said it here.
06:43When a veteran has to call any one of your offices, and 60% of your caseload is VA caseload,
06:50when they have to call your office, it's a mission fail for us.
06:53It's a mission fail for VA.
06:55It should not be this hard to get benefits that are already earned,
06:59no matter what the bureaucracy says or anything else.
07:01Thank you for that.
07:02All those benefits are important, important health care, but even the education benefits, et cetera, et cetera.
