▶ 0:22:10All right, good morning everyone. How are you?
▶ 0:22:13Well, thank you so much and uh thank you for the opportunity to uh to join you today. Um the uh subcommittee on technology modernization will come to order. I want to start by thanking our ranking member and uh the host today in your district, ranking member Bazinski for welcoming us to Illinois's 13th district.
▶ 0:22:30I appreciate uh the hospitality and the welcome and everyone and and uh really just uh the uh warmth that I can feel for how you care for veterans and uh how you've welcomed us in the committee here uh today and I really deeply appreciate all of that. Um, I'd also like to thank the University of Illinois and the CHZ Veteran Center for hosting us and for uh all of the staff at the university that helped make this hearing possible. I know many of you went out of your way uh to uh put this together.
▶ 0:22:57And Colonel, I I appreciate uh your uh willingness to to help pull this together and everything that you did. Even though you were volunttoled, I appreciate your willingness to step up and do that. Um, and and I appreciated our conversation earlier really about that transition from military back into civilian life and what the challenges that some of our veterans face whether they're on campus or not and how we can do a better job of of really making that transition easier for our veterans. Uh, I also want to thank Garrett Anderson uh who's here. Where's Garrett? Um, very good.
▶ 0:23:27Garrett, thank you so much for taking me on the tour this morning. really appreciate all of your very very clear um commitment to veterans and making sure that they are welcomed home and and treated with the dignity that they need and uh really transitioned as effectively as possible. So I can tell that you take a great deal of pride in that. We appreciate your your work in that regard. So thank you.
▶ 0:23:48Um the mission of the technology modernization subcommittee is to make sure that VA is buying, using and developing the right information technology in order to deliver the best care and services for our veterans and that's the task that we have on this subcommittee and it plays into why we are here today.
▶ 0:24:06Technology plays a huge role in delivering VA care to rural veterans because VA simply cannot give veterans all the care and services they need at traditional brickandmortar facilities that are often too far for veterans to reach or might not be as convenient to them because of their limitations for travel. This topic is also personal to me. I served 22 years in the United States Army and I'm now building a family in a rural part of Michigan myself. I also represent Michigan State University in my district. So, I do have to say a go green while I'm here.
▶ 0:24:37Um, I know firsthand the frustration that veterans feel when the care they've earned is out of reach simply because of where they live. I actually do not have a VA hospital facility in the district that I represent. So, the 800,000 or so residents of my district and the veterans there have to travel outside of my congressional district if they go to a uh a VA hospital. That's what today is about. Making sure rural veterans aren't left behind. The reality is veterans in rural communities face serious barriers to accessing VA care.
▶ 0:25:07Nearly one-third of VA enrolled veterans live in rural communities. They drive longer distances. They wait longer for appointments, have fewer providers to choose from, and deal with limited broadband and transportation options. However, each community is different and rural veterans do not all have the same experience with the VA. So, I'm glad the ranking member and I were able to take our subcommittee on the road and talk to you all where you live and learn about the specific challenges that you face.
▶ 0:25:35In Washington, we hear a lot of experiences from people, but I think we all benefit from going directly to the source for where things are happening. That's a good reason why we're here One of the most important tools that exists for rural veterans is the community care program. Community care allows veterans, especially those in rural and underserved areas, to see outside providers when brickandmortar VA facilities can't meet their needs. Community care is VA care, and millions of veterans rely on it every single year.
▶ 0:26:04Having used community care personally, I know there is room for I want to ensure every veteran watching this hearing knows that they only need to meet one of the several qu several criteria to qualify for community care. One is if the VA does not offer the service that is needed. Another is if the VA facility is not in the area in which they are located. If the VA cannot schedule an appointment quickly enough or close enough to them.
▶ 0:26:30Or if the if community care is in the veterans best medical interest. Under the leadership of Chairman Mike Bost, chairman of this committee, whose district is not too far south of here, this committee is working hard to ensure that rural veterans are able to make their own choice on whether community care is the right option for them if they are eligible. In addition to community care, VA has many other resources that are important for rural veterans, including telealth, mobile medical units, and much more that we will hear about today.
▶ 0:27:00Technology has a big role to play here, and it's and that is where this subcommittee comes in. There a lot of exciting opportunities for technology to drive better VA care and services in rural communities. A great example is the external provider scheduling system which allows VA staff to see realtime appointment availability and book directly with community providers or within the VA system depending on which is available first and closer to home.
▶ 0:27:25While it is only active at around 50 VA medical uh centers currently, it has empowered staff to schedule up to four times more appointments per day by eliminating delays, confusion, and a honestly a game of telephone that goes back and forth. Another great example is tele medicine. When it comes to mental health, where isolation is a real risk, tools like tele mental health and remote monitoring are essential lifelines for veterans who otherwise might fall through the cracks.
▶ 0:27:52And I want to say I'm very impressed by the services you have here that allow veterans to access those services around other veterans who may have had a shared experience to them. So I think that's another important community aspect of this. But even with these tools, there is room for improvement. Reports from GAO and the VA inspector general have shown that rural health programs lack clear performance goals.
▶ 0:28:15Outreach strategies that are inconsistent at the vision level and community care referrals still take too long, especially in high need areas like mental health and women's care that we're still trying to make strides in. Provider participation in VA cellular networks is also lagging with some rural providers walking away due to red tape, poor communication, or late payments. We can't let bureaucracy or outdated processes get in the way of quality and timely health care.
▶ 0:28:43This subcommittee is committed to ensuring that VA's rural health programs are well-managed, accountable, and truly reaching the veterans they're meant to serve. That means cutting the red tape, improving access to care, and ensuring every veteran understands their options for quality care, and that we leave no veteran behind to figure this out for themselves. It also means ensuring the resources are there to sustain proven services and tools like the external provider scheduling system, teleaalth, transportation services, and others.
▶ 0:29:11My goal is to ensure every program is driven by measurable outcomes that validates better health outcomes, not just good intentions. In fact, we talked about that today earlier. There are so many veteran organizations out there, each with good intentions, sometimes duplicating services, sometimes duplicating intentions. And having a real drive to find out where we can get that done in the best way is really important. The bottom line is this. Geography should never be a barrier to care.
▶ 0:29:39If a veteran qualifies for VA healthcare, it's our job to make sure they can get it without delays, without confusion, without frustration, and without giving up. We hear too many stories about veterans who've simply abandoned the benefits that they've earned because they can't untangle the confusion. I look forward to hearing from you all about how we can accomplish this today.
▶ 0:30:00Before I turn it over to the ranking member, I just want to remind everyone here that this isn't an open forum, but is a oversight uh hearing for members of Congress and the witnesses that are before us today. They will be testifying under oath. So, this isn't a forum for individuals to participate. But I know uh seeing as how we're in the the ranking members district, if you do have questions of your own, I'm sure she's available to uh to work with you on those. And with that, I will uh yield to the ranking member for her opening statement. and thank you again for having us.
▶ 0:30:30Thank you very much, Chairman Barrett, for coming uh to the 13th district. Welcome to Urbana. It's really great to have you here. I appreciate you making that trip. I also want to just echo a sincere thank you to the SHZ Veteran Center and the leadership. I've had the privilege of visiting this center and I know um the important work that you're doing for veterans, student veterans on campus and just want to say it's so special to be here having you host us uh for this field hearing.
▶ 0:30:58So, I want to say a sincere thank you and thank you to the University of Illinois. Um you know, Chairman Barrett's district and mine um are probably very similar. He mentioned Michigan State, so I have to say go Ali. um but very similar in a lot of different ways. And so I think that uh this this forum, this panel is going to be really I think really important to uh to both of us and we'll take all of this information back with us to Washington.
▶ 0:31:26Um so I look forward to a robust conversation about the experiences specifically uh for our rural veterans, gaps in access to care and benefits and resources that are available to bridge them. I want to also welcome our diverse panel of witnesses representing VA leadership, veteran service organizations, county and state programs, and most importantly veterans.
▶ 0:31:50Um, I'm grateful to all of you for being here and I know that many of you traveled long distances uh to participate. Uh, please know that I appreciate those efforts and this conversation wouldn't be as productive without you. So, uh, thank you for the rural veterans in the room. This type of travel is nothing new.
▶ 0:32:09Uh whether it's driving hours to the closest VA medical center or even farther for a compensation and pension exam, rural veterans are unfortunately used to traveling to access the care and benefits they have earned through their service to our nation. I think something the chairman mentioned I share in common. Danville, Illinois is actually outside of my district about 45 minutes from here, but is the closest VA hospital.
▶ 0:32:35So the 13th district is serviced by VA hospitals but just outside of it. This is the biggest reason that I believe that community care though has to remain available to rural veterans. Unfortunately, community care access in rural America is not guaranteed. Due to financial issues and national provider and nursing shortages, rural health care is dying. Changes to Medicaid will only make it worse.
▶ 0:33:01According to the Center for Health Care Quality and Payment Reform, 700 rural hospitals, a third of all rural hospitals in the country are at risk of closing in the near future. Almost half of those are deemed at immediate risk of closing. In fact, Illinois has already lost three community hospitals in recent years and nine more have been deemed at immediate risk. We cannot have a conversation about community care without addressing the fact that it may not be there to take care of our veterans.
▶ 0:33:30I hope to hear from VA regarding its plans to ensure that veterans continue to have access to care. The work that Chairman Barrett and I do on technology modernization on the technology modernization subcommittee seeks to help VA bridge some of these gaps through the use of technology.
▶ 0:33:49VA has long been a pioneer of teleaalth and during the co 19 pandemic the department quickly pivoted to expand teleaalth which allowed many veterans to continue to receive much of their care. Unfortunately teleaalth is only a solution for veterans who have access to sufficient internet and the technical knowledge to use it. It's sad that in 2025, there's still parts of Illinois um and the country that don't have access to broadband internet.
▶ 0:34:18Sadly, it's not just a rural America issue either. Even in places where broadband internet is available, it can't have it can be prohibitively expensive, especially for veterans living on a fixed on a fixed income. I'm looking forward to hearing about our efforts to address the access and cost to make internet available to veterans so that they can access their care and benefits. I hope that we can have a fruitful conversation about these issues and possible solutions.
▶ 0:34:48Thank you again, Mr. Chairman, for being here and I'll yield back.
▶ 0:34:51Thank you, Ranking Member Bazinski. And I will now introduce our witnesses. Um, from the Department of Veteran Affairs, we have Mr. Daniel Zamchek. Right, I said that correctly. the executive director of vision 12 for this region. Thank you for being here. Accompanying Mr. Zamch is Dr. Stacy Williams, the executive director of the uh Elani Elani Healthcare System. Did I say that right?
▶ 0:35:15Ilana. Sorry, my apologies. They even spelled it phonetically for me. So, yeah, I'm an army grunt, so you know, we I was in the artillery. We just got to get close. And um uh Dr. Peter Kaboli, executive director of the Office of Rural Health. Thank you. We also have uh Mr. John Lawson, Army Veteran and Superintendent of the St. Clair County Veterans Assistance Commission. Thank you.
▶ 0:35:41And uh Miss Hillary Reigns from the Illinois Department of Commerce and Economic Opportunity. We met uh back uh in in the coffee room earlier, so thank you. Um and I think you told me you traveled a bit of a distance to get here today, so um appreciate it. Thank you for being here. Uh, finally have uh um Mr. Kim Kchner, an Air Force veteran from uh Gerard, Illinois, and Miss Christina Shower, an Army veteran and co-founder of Tri-State Women Warriors.
▶ 0:36:10So, thank you both for being here as well. Um, at this time, I'll ask the witnesses to please stand and raise your right hand. Do you solemnly swear under penalty of perjury that the testimony you're about to provide is the truth, the whole truth, and nothing but the truth?
▶ 0:36:29Very good. Thank you. And let the record reflect that all witnesses have answered in the affirmative. Mr. Zamch, you are now recognized for five minutes to deliver your opening statement on behalf of EA.
▶ 0:36:39Okay. Well, thank you very much. Um, good morning, Chairman Barrett, Ranking Member Benzinski, and our distinguished guests. Thank you for this opportunity to u discuss VA's efforts to enhance the well-being of our rural veterans, especially within the VA Ilana Healthcare System. As you as you announced, my name is Dan Zamch. I am the network director of Vision 12. Um joining me today um are Dr. Stacy Williams from the Via Ilana Healthcare System and Dr.
▶ 0:37:09Peter Kaboli um from the Office of Rural Health and VHA. I'd like to take uh some time to share some highlights about the work that we're doing within VA uh vision 12 and specifically the VA Ilana healthcare system in providing essential care to our rural veterans. Having been with the VA for over 20 years and serving is as the network director of vision 12 for almost three years. I am deeply committed to our veterans and to our mission.
▶ 0:37:37We strive to ensure that veterans, no matter where they live, receive the top-notch care that they've earned and deserve. I'll start with the health care services provided by the V VA Illana Healthcare System. This system has been a cornerstone within the Danville Danville community for over 125 years uh with a dedicated team of over 1500 health care professionals taking care of uh about 30,000 veterans in the community covering 34 counties in east central Illinois
▶ 0:38:08and west central Indiana. We reach vets in both urban and rural areas. Over two dozen of our sites across vision 12 serve a population where more than half of those veterans are enrolled um from rural areas.
▶ 0:38:25And given that 4.2 million of the 16.5 million US veterans live in rural areas, our services play a crucial role in ensuring these veterans have access to the health care that they've earned and It's also important to note that veterans in rural areas enroll in VHA care at higher rates. That is 65% compared to 47% for their urban I'd like to touch on a few key initiatives that support rural veterans.
▶ 0:38:55Starting with community care, as you mentioned, through the veterans community care program, we ensure timely care closer to home via a network of over 1.4 million nonVA providers.
▶ 0:39:08The network here is vital for delivering hospital care, medical services, and specialty care, especially for those vets that need to travel travel long We've streamlined referrals and improved care coordination to ensure quality and Next, teleaalth, which was also mentioned earlier, and virtual mental health services have truly been a gamecher for our veterans in rural and remote areas.
▶ 0:39:35VA has invested in teleaalth infrastructure enabling veterans to connect with primary care providers and specialists through platforms like VA video connect that we call VVC reducing travel and improving health outcomes. We've also ramped up on virtual mental health services including um therapy, medication management, and crisis intervention all critical for addressing mental health needs of our veterans.
▶ 0:40:02And as a former uh VA psychologist and intern, this is a particular area that's of importance to me is mental health. Lastly, on beneficiary travel, we recognize that getting to appointments can be challenging for our veterans in rural areas. VA's Veterans Transportation Service or VTS provides door-to-door rides for eligible veterans. Our highly rural transportation grants program helps vets to travel to meet VA medical centers.
▶ 0:40:32And the volunteer transportation network backed primarily by the disabled American veterans organization which is a fantastic partner for for us and our veterans offers free rides through volunteers. So that said, Chairman Barrett and Ranking Member Badzinski, I I want to thank you for allowing me and us to share our efforts in assisting our rural veterans. With your backing, VA continues to expand its reach, ensuring more veterans receive the care that they've earned and deserve.
▶ 0:41:02We appreciate your commitment and we look forward to discussing these points further during today's field hearing.
▶ 0:41:10Thank you. And uh the written statement of uh Mr. Zamch will be entered into the hearing record and appreciate your testimony. Um, Mr. Lawson, you are now recognized for five minutes to deliver your opening statement.
▶ 0:41:23Chairman Barrett, Ranking Member Bazinski, and the members of the subcommittee on behalf of the veterans of St. Clair County, thank you for the opportunity uh to provide remarks on challenges faced by veterans in residing in rural America and in our opinion, the best state for veterans, the land of Lincoln, the great state of Illinois. My name is John Lawson. I'm the superintendent of the Veterans Assistance Commission of St. Clair County, Illinois. I'm a VA accredited government veteran service officer through the National Association of County Veteran Service Officers.
▶ 0:41:51I'm also a life member of the Veterans of Foreign Wars Post 1739 in Belleville, Illinois, and currently serving as the VFW State of Illinois Legislative Co-chairman and a life member of the Disabled American Veterans Chapter 24 in Freeberg, Illinois. I lead a small team of five other full-time veteran service officers who are fully invested ensuring our veterans receive the benefits that they have earned and safeguarding them from predatory unacredited claims St.
▶ 0:42:18Clair County is unique in that while we do have a suburban feel and a significant active military presence at Scott Air Force Base, much of our veteran population exists in the small towns that dot rural Illinois. We consider ourselves very fortunate to have our VA community-based outpatient clinic, the Seabbach, in Shiloh, Illinois. and one more forecasted to open in Scott Air Force Base. Even with these two facilities, our population of veterans from St. Clair County and surrounding counties have eclipsed the safe patient load our great care providers at the Seabach.
▶ 0:42:47Many veterans cannot use this facility due to these patient load caps. Coupling this limiting factor is a limited scope of care available at the Seabach that nearly always leads to a veteran being referred to a VA medical uh center for specialty or advanced care needs. Our veterans are served by the St. Louis VAMC that also serves over 110,000 eligible veterans on the Missouri side of the river. Although we understand that full service VAMC on the Illinois side of the St.
▶ 0:43:15Louis metro may not necessarily be in the cars for the nearly 104,000 eligible veterans of the Illinois 12th and 13th Congressional Districts. We do need a much larger footprint and improved service capacity for our veterans by way of a higher level of care facility that is able to accommodate our needs beyond routine physicals and blood draws. At my last count, we had five patient aligned care teams at the St.
▶ 0:43:35Clair County Seabach with the max patient load of 6,000 veterans with two additional patient aligned care teams forecasted for the future Scott Air Force Base uh This combined maximum patient load of 8,400 only represents about 33% of the eligible veteran population of St. Clair County according to the 2023 VAG GADX and roughly 8% of the eligible veterans of the 12th and 13th congressional districts.
▶ 0:44:03The non-forcasted number is even more disappointing at approximately 24% for St. Clair County and 5% for the combined congressional districts without inclusion of the forecasted Scott Air Force Base SEBA. We do believe that HR740, the Veterans Access Act of 2025, will be a good start for Slair County veterans, especially as our Seabach and Shiloh sits directly between two full service hospitals less than two miles to the east or west, much closer than the nearest VAMC in St. Louis, Missouri at 45 minutes to an hour away.
▶ 0:44:34We look forward to the subcommittee's help uh to help our veterans by working with the VA to direct the development of automated approvals of community care applications to reduce the time to approval, reduce travel, reduce the delays in receiving care, and also supporting the local community by veterans utilizing their earned VA compensation where it was intended in that veteran's local community, not in another state. Additionally, we'd like to ensure that the veterans do not receive bills for this care when applicable.
▶ 0:45:02Negotiated reimbursements and payment submission portals for providers should be developed to ensure clarity of responsibility of payment for the provider and patient. Lastly, ensuring our VA electronic health records are two-way accessible to the VA primary care providers and the community care providers is essential in ensuring the best possible outcomes for our veteran patients. In situations involving advanced or specialty care, miscommunication between providers can cause irreparable harm to the veteran.
▶ 0:45:30I wish to emphasize that our support for the Veterans Access Act of 2025 is not to be an indication that we support substitution or privatization for direct VA care for our veterans. To be straightforward, we do not. Our support of this proposal is as a supplemental partnership with the community medical providers to ensure timely access to care and the best possible out health outcomes for our veterans.
▶ 0:45:53It is important to remember that providing resources for care only in the community and not also for VA direct care can lead to a less capable VA which is a detriment to our veteran care. In military terms, community care is a force multiplier when leveraged correctly, not a substitution. Chairman Barrett, Ranking Member Bzinski, this concludes my testimony. I've also submitted written testimony on other pending leg uh legislation matters for your review. I welcome any questions from you or members of the subcommittee.
▶ 0:46:23And with two seconds to spare, we appreciate your uh testimony today. So, did you time that out?
▶ 0:46:29Uh yes, sir, I did. I'm I'm a slow talker from the Ozarks. I'm surprised I got it out that fast.
▶ 0:46:34Well, thank you for your testimony. Thank you for being here. And the uh written statement of Mr. Lawson will be entered into the hearing record. Thank you, Miss Reigns. You're now recognized for five minutes to deliver your opening
▶ 0:46:45Thank you so much, Mr. Chairman, Chairman Barrett, Ranking Member Bazinski, and distinguished guests. Thank you for the opportunity to testify today on behalf of the Illinois Department of Commerce and Economic Opportunity and the Illinois Office of Broadband. I'm here to talk about the critical intersection of teleaalth access for rural veterans and the impact of the digital divide on their health and well-being.
▶ 0:47:07When we talk about the digital divide in 2025, we're talking about a disparity in access to fast, affordable, and robust internet, as well as to the devices, tools, and skills that allow people to connect to critical supports throughout their lives. Vulnerable populations often find themselves on the wrong side of this divide and veterans of course are one of them with only about 67% of Illinois veterans having and using broadband access.
▶ 0:47:37Veterans are often also part of more than one vulnerable population as 56% are over the age of 60 and 26% nationwide over 4 million people live in rural areas. Rural residents have their own challenges where internet connectivity is concerned. The FCC estimates that 28% almost a third of rural residents lack broadband access.
▶ 0:48:0157% of rural locations in Illinois alone are entirely unserved or underserved, receiving internet speeds below the FCC's minimum recommendation of 100 by 20 megabits per second. This recommendation is indeed the bare minimum as it's only often adequate for one user at a time to do every t everyday tasks like video conferencing, streaming, and emailing.
▶ 0:48:27The inability to complete these tasks from home disadvantages rural veterans, especially when trying to access tele medicine resources. The VA obviously provides vital care centers and hospitals across the country. But when we look at veterans who live in rural areas, they live an average of 45 miles. That's an average to be seen in person at a VA center. And as veterans are twice as likely as non-veterans to suffer from two or more chronic health conditions, frequent checkups and appointments are especially important.
▶ 0:48:58Tellahalth resources began to be promoted heavily just before the pandemic to alleviate those challenges with transportation and provider availability, but adoption rates in rural areas suffered because of the lack of broadband access. when considering additional complications such as subscription affordability, device ownership, and varying degrees of digital literacy and skill, especially in the more than half of veterans over 60. The problem is laid out in stark relief.
▶ 0:49:24Illinois has already worked diligently to increase broadband access for rural residents through the Connect Illinois broadband infrastructure grant. Connect Illinois allows internet service providers to build high feed high-speed fiber infrastructure in rural areas that often have low population uh or subscriber density and are isolated from middle mile infrastructure.
▶ 0:49:46As of today, three state and federally funded rounds of this program have connected approximately 7,500 households with 46,000 total more to be connected over the next three years. The fourth round is currently being funded by the federal broadband access equity and deployment act. You might have heard bead uh program and stands to connect over Illinois residents and almost 5 million other households across the country without adequate connectivity.
▶ 0:50:15While the BR bead program program is in progress, there is another program that can fund veterans serving organizations on the ground and help to provide rural res residents with device access, digital skill building, uh one-on-one troubleshooting support and more. That program is the digital equity act.
▶ 0:50:34This program was poised to provide $2.75 billion dollars to states to support programming and subgrants to direct service organizations with veterans being targeted as one of the vulnerable populations most affected by the digital divide. Illinois was to receive more than 23 million to equip households and residents with the skills, resources, and tools needed to use the high-speed internet.
▶ 0:50:59Illinois received over 260 subgrant applications uh throughout the state with the full ask over a 100red million far outstripping the available funds showing the need. Some of the programs proposed were to support telealth and resource access for recently separated women veterans in the rural southwest central region. uh veteran focused digital literacy classes, mobile skilluing hubs, and uh secure community teleaalth rooms.
▶ 0:51:29Unfortunately, the digital equity act and its $2.75 billion of appropriated funding were terminated by executive order, leaving these programs unfunded. Expanding access is the key to health and well-being of rural veterans. Thank you so much and thank you for having us
▶ 0:51:47Thank you for your testimony. Thank you for being here. Um the uh written statement of Miss Reigns will be entered into the hearing record. Mr. uh Kchner, you're now recognized for 5 minutes to deliver your opening statement.
▶ 0:52:00Good morning and thank you everyone for taking the time out of your day to listen to my testimony. My name is Kim Kchner and I'm a proud veteran who served in the United States Air Force Illinois Air National Guard and served in Operation Iraqi Freedom and Operation Enduring Freedom. I'm currently a sergeant with the Mccubin County Sheriff's Department. I'm writing the testimony in regard to the care that I have received at a compensation and pension exam.
▶ 0:52:27I drove over 30 minutes to an exam that the VA scheduled for me with a contract provider. When I arrived, the medical provider informed me that I was not on her schedule and that she couldn't find my medical records. I told her that the VA had called me and asked me to come in at an earlier date due to an opening. She finally found my records but had an attitude through the entire exam which lasted a total of three minutes.
▶ 0:52:56At no time did she conduct a medical exam on me. She only reviewed my medical record. Based on that exam, VA denied my claim. In order to finally get my claim awarded, I had to do a whole another medical exam. This was a massive waste of my time and taxpayers money. I firmly believe that I am not the only veteran this has happened to. And the outsourcing of these exams definitely needs to be looked into.
▶ 0:53:27When a veteran goes for an exam, they should be treated with the utmost respect they deserve, especially for putting their lives on the line for our country. When I walked out of that exam that didn't last approximately 3 minutes, I have never felt so disrespected in my life. It was very frustrating to get treated this way, especially having to drive 30 minutes to the exam due to living in a small town and nowhere close to a VA clinic.
▶ 0:53:55I firmly believe that the VA needs to pay more attention to the care we are receiving from them outsourcing their compensation and pension exams. Thank you everyone and I'm happy to answer any questions that you may have.
▶ 0:54:10Thank you Mr. Kercher and thank you for your service then and your service now. And I uh I've heard from other veterans with similar experiences to yours with that um compensation and pension. Um, so I want to make sure that we correct that and uh and I hope your experience since then has been far better and far more respectful and if not I know the ranking member and I would would be very interested in ensuring that that happens for you going forward.
▶ 0:54:35Um, and uh your uh uh written statement will be entered into the hearing record and again I appreciate your willingness to come and testify today. Um, Miss Shar, you're now recognized for five minutes to deliver your opening statement. Chairman Barrett, Ranking Member Budinski, and members of the subcommittee, thank you for the opportunity to speak today. My name is Christina Shower.
▶ 0:54:59I'm a US Army Iraq War veteran and president of the Tri-State Women Warriors, a nonprofit with a mission to provide connection and advocacy for the unique needs of women, veterans, and service members. Today, I will focus on three key areas of impact for rural veterans. enhanced community outreach, coordinated and purposeful community care utilization, and a strong rural VA presence. Community outreach is vital to ensure veterans understand their benefits, how to access them, and why they matter, especially in isolated rural areas.
▶ 0:55:28The VA's community engagement and partnerships for suicide prevention program has been essential in supporting local coalitions like ours, working to prevent veteran suicide. Our local engagement coordinator has been a behind-the-scenes champion of the tri-state women warriors, which has now served over 100 local women through live events and helped many access VA care for the first time, some for trauma experienced decades ago. These outreach programs serve a vital role in ensuring rural communities stay informed and engaged with the VA.
▶ 0:55:57While many of our members prefer VA care, almost all of us have relied on VA community care at some point due to specialty care needs, wait times, or distance. Despite its necessity, community care is not optimized. Research shows that community care clinicians often report learning about policy and workflow changes only through error notifications and request denials, which is consistent with reports we hear from veterans in our community.
▶ 0:56:20Any policy change that impacts community care partners, such as the compact act, should follow an effective standardized communication process that includes clinical services as well as billing departments to safeguard veteran care and prevent them from receiving medical bills in error. Care continuity is also an ongoing issue. Successful implementation of a comprehensive EHR is paramount to ensure the seamless flow of communication across care teams.
▶ 0:56:46Lack of cultural competency has also been a pain point for community care and unfortunately initiatives to improve this are resource intensive. With 48% of rural hospitals operating at a financial loss in 2023 and the recent passing of HR1, most rural hospitals are strategizing ways to ensure their doors stay open and would struggle to absorb any additional financial strain.
▶ 0:57:08With healthcare vi viability in mind, it's also important to acknowledge that 92 rural hospitals have closed or have been unable to continue providing inpatient services in the last decade. A recent study showed that even in major cities, average weight times across specialties are increasing and nearly 62% of meth mental health provider shortage areas in the United States are rural. Expanding community care without addressing provider shortages could exacerbate current access issues if re VA resources are lost within these communities.
▶ 0:57:37Our local Seabach is a trusted anchor and this committee's greatest focus should be ensuring rural veterans have access to VHA's veteran centered patient care. Research shows rural veterans report higher satisfaction with VA care than community care and that VA facilities often outperform or match nonVA providers in quality and safety. When a permanent physical VA presence is not possible, strategic teleaalth can extend resources and build connections.
▶ 0:58:03Evaluating when face-to-face interactions are most critical to building trust and supplementing with teleaalth can broaden the meaningful uh I'm sorry, evaluating when facetoface interactions are most critical to building trust and supplementing with teleahalth can broaden the meaningful reach of the seabbox. Finally, we must protect the psychological safety of the VA workforce, many of whom are veterans themselves. Successful deployment of a modernized EHR will rely on a heavily on a strong, confident workforce, which is only possible when employees feel valued and supported.
▶ 0:58:32This subcommittee is uniquely positioned to lead in expanding VA access to rural veterans through technology. Community care is vital, but history shows that even well-intended privatization can lead to inequitable services for rural communities as resources naturally shift to more profitable urban areas. As we see this disparity in the broader health care system today, the VA remains a vital equalizer. A balanced, bipartisan approach can strengthen both VA and community care to ensure our most vulnerable veterans are not forgotten.
▶ 0:59:02The VA I returned to in 2004 after my deployment to Iraq as a student on this campus, where I was told by the VA in Danville that my new breathing issues were likely from anxiety, is not the VA we have today. The progress we have made has been intentional and remarkable. Let's continue investing in this transformation and use modern tools to bring care and benefits closer to rural veterans who have earned them. Thank
▶ 0:59:27Thank you, Miss Shower. Appreciate your uh testimony and your written statement will be also entered into the hearing record. And uh we will now proceed to questioning and I'll recognize myself for five minutes and I forgot to advise you ahead of time, but we have a light system here in front of you. Green, yellow, and red, pretty self-explanatory. Yellow is you're getting close and red as you're out of time.
▶ 0:59:46So um uh but we will begin uh um questioning and uh genuinely appreciate each of you that are here today and the uh the um uh uh testimony that you offered today. Um Miss SH where uh when were you you said you were deployed in Iraq 03 04 sometime and uh where were you operating out of there?
▶ 1:00:05Baghdad International Airport.
▶ 1:00:07Okay. And what was your job?
▶ 1:00:08I was a combat medic.
▶ 1:00:09Oh, very good. Well, thank you. Uh I was there a few years after you and and certainly appreciate your uh your service there. So thank you. Thank you.
▶ 1:00:16Um, and uh, Mr. uh, Kurt, did you say you were Army as well?
▶ 1:00:20Uh, no, sir. Air Force.
▶ 1:00:21Air Force. Okay. Yeah. And you were, uh, where were you, uh, deployed when you
▶ 1:00:25in Lake Turkey.
▶ 1:00:26Say again.
▶ 1:00:26Ins Turkey.
▶ 1:00:27Okay. I did a uh, kind of a layover there one time. So, I was in Guantanamo Bay on my way to Afghanistan. So, but it was great because they had a Taco Bell there. So, it was uh, it was good for morale. Um, so yeah. Um and uh Miss Reigns, I wanted to ask you, I know you mentioned a lot of the access to tele medicine and um some of the um extension of broadband. Um the uh you mentioned access to fiber for rural residents and I live in a pretty rural part of Michigan.
▶ 1:00:56In fact, um I'm not joking, my neighbors across the street from me are Amish. um they're not so into the broadband, but um nonetheless, you know, in the community that I live in, uh we have folks like me that need access to to internet and broadband. Do you know the you said you had connected about 7,500 um homes that way? Do you know what the cost for that 7,500 homes was?
▶ 1:01:20Um that 7,500 uh with the 46,000 altogether will be about $350 million. Uh and most of that is I believe all of that has been fiber. Yes. Uh we work with the USDA rural development opportunity fund which is uh in Illinois mostly wireless.
▶ 1:01:45how how many millions again?
▶ 1:01:47350 million about for those were state and federal funds in the first three rounds of the connect Illinois program.
▶ 1:01:53So 350 mil um for how many homes are going to be connected for that? Um it's just over 50,000.
▶ 1:02:02Okay. Um that would be a substantial cost per home with fiber.
▶ 1:02:08Um uh so I and I guess um uh Dr. Kaboli maybe you could help me answer this, but is there any opportunity perhaps where we could just outfit veterans who are teleaalth with a fixed wireless connection? Um I have one of those in my home. It works pretty well actually. Um, and it allows me to use, you know, tell, you know, if I were using teleahalth, I can use Zoom.
▶ 1:02:36My wife works from home and is able to do her her work that way. I feel like for 350 million, we could buy a lot of people a home internet um, you know, uh, fixed wireless provider type of thing and pay 50 bucks a month for them and and not hit 350 million for a great long time.
▶ 1:02:55Either one of you, sorry. Wireless internet is an excellent stop gap. Yes. So in areas in Illinois, especially where I'm from down in Crawford County, Robinson, Illinois, there is no cell signal in a lot of the county. So even if you had a hot spot, you aren't able to access it. Wireless internet is coming, but wireless is uh slower speeds.
▶ 1:03:19It uh is interrupted by any kind of weather, rainstorm or uh thunderstorms, which are very common on the prairie as you know. Yeah.
▶ 1:03:26Um but it is an opportunity to get people uh connected faster.
▶ 1:03:31I actually found I mean I had cable like um copper but it wasn't like it was um wasn't fiber but it was like a a lower speed but it was into the home through the through the um phone line. I don't
▶ 1:03:48I've actually had more reliable service through the Verizon. Not just a little hockey puck hotspot that you would take while you're traveling, but like the fixed plug into the wall kind of service that comes over the air.
▶ 1:04:01And I feel like delivering to those folks you talk about that are the most
▶ 1:04:07I mean, it's going to be a huge expense to run fiber to them. And I almost wonder if we'd be better served putting more of that into some of the more accessible already options available. The wireless tower that provides the Verizon service is served by fiber middle mile infrastructure.
▶ 1:04:23So middle mile infrastructure still needs to go out to provide that wireless
▶ 1:04:28Uh and w uh fiber optic of course is more expensive at the installation. It's also what we call kind of future proof. Uh it's 50 years is uh its serviceable life in the ground and it's still being tested. So it could be even longer than
▶ 1:04:45As speeds increase over time and technology improvement, the cable does not need to be uh upgraded, just the data centers on either side because it carries information at the speed of
▶ 1:04:59Sure. Not to cut you off, I just wanted to get um Dr. Kaboli's uh thoughts really quick before I yield to the ranking member. Um and then we can come back after that. So go ahead.
▶ 1:05:09Yeah, real quickly. Um, I think the other thing to think about is low earth orbit satellite internet. Um, now we looked into this the last couple years to see if we could, Office World Health could provide that service for veterans. Unfortunately, there's no legislative mandate to allow us or authority, okay, to allow us to actually pay for it because you're right, the costs per month would be much less if we could just subsidize it, but we can't.
▶ 1:05:33uh but we do have a pilot uh with uh uh with a company to sort of identify sort of what the challenges are because one of the challenges in rural areas is is actually is the installation uh you know you have to get somebody to come in drive in set up the satellite and all that kind of thing but anyway I'll stop there but I think there's a lot of other options out
▶ 1:05:51Thank you. Thank you.
▶ 1:05:52Just to finish in Illinois and across the country we're using a mix of technologies but of course we're looking towards the future. So that's why we prioritize fiber, but it's definitely going to be a mix of all these things as well as low earth orbit to deliver
▶ 1:06:05Sure. Thank you. I'm going to yield to the ranking member for five minutes uh for her questions.
▶ 1:06:10Thank you uh Mr. Chairman. Um my first kind of set of questions is really just to the panelists from the VA directly. I' I'd love to hear from each of your perspectives just a general question about gaps in care, access to care that you see within the VA um and what those barriers um are that exist in filling those gaps especially especially in our rural communities obviously with the topic today um and then just to ask you in addition what kind of feedback you get
▶ 1:06:40from veterans as it relates to uh these gaps and filling them. Yeah.
▶ 1:06:46Well, thank you, Congresswoman. Um, so I would say there are certainly uh less opportunities for rural veterans, especially the more specialized services that they are. Um, and so throughout Vizen 12, we have a fair amount of rural areas and not only in via Ilana, but in Iron Mountain particularly where it's literally a four and a half hour drive from Sue St. Marie the Seabach to the main campus.
▶ 1:07:16Um I think um uh I think when it comes to primary care and mental health treatment, we've um both virtual and face to face is where we've really been able to close the gap uh more so. Um but um we are continuing to expand our SE box, not only um growing them and doing construction, but also trying to um um create new specialty services there.
▶ 1:07:44Um but but certainly in uh across the board um that's why I think community care, as was stated, is so critical because um we can do a lot in the VA. um we have a lot of opportunities um that we can offer for our vets, but there are some things that we can't. And so having that partnership of community care can really help us. There's a lot of mobile um opportunities that we do too. And I think maybe Dr. Kaboli could talk a bit more about that.
▶ 1:08:19Okay. Um so here at VA Illiana I actually have spent uh over 30 years in health care specifically relating to providing services to individuals in rural areas. So rural health care is a passion for me. At VA Illiana we have actually implemented a screening program um titled ACORN which stands for assessing circumstances and offering resources for needs.
▶ 1:08:47And to speak to some of the testimony that we've already heard, when we've done this screening through our social work team, it really addresses some of the social determinance of health like food, housing, utilities, transportation, education, employment, digital needs, and the like.
▶ 1:09:05We've actually found that 19% of our veterans are positive for digital needs and another 65% positive for so social isolation and Since we are a rural department of veterans affairs hospital, we do have, you know, seabox spread throughout this area, but we certainly recognize the needs of our veterans um to try to remain connected with not only health care,
▶ 1:09:35but with one another.
▶ 1:09:40Um I just want to say to start out though, I'm actually from uh Iowa City, Iowa. I grew up across the river in from Illinois and um southeast Iowa. So, go Hawks. Uh, we have the Big 10 covered here. Uh, but I did wear my Aliite colors today just so I knew where I was. No, I think to answer your question about access and gaps, I think it comes down to sort of kind of like Miss Rain said about you just you you use every possible thing you have. You know, what do we have that we can get veterans access to care? So, it's face-toface care with us,
▶ 1:10:09face to face care in the community, tele medicine, instant messaging, you know, we we have all these things offered out there. And the thing is not every veteran wants tele medicine. Of veterans that have used tele medicine 80% say yes I want this. 20% say you know I tried it it's not for me and pretty much all of us had some form of tele medicine during the pandemic. So we've had experiences with it and really veterans want more tele medicine and but again what do they want?
▶ 1:10:36Let's let's either bring them to care or bring the care to them.
▶ 1:10:39Yeah. Could I ask just one follow question? One thing I've noticed within the district, just within health care in general, just even beyond um providing care to veterans, is we lack the ability to attract specialy specialty care, health care professionals, doctors, nurses um and and so we have a shortage of health care professionals just within our hospital systems. Do you is that reflected as well at the VA in Danville um that you have those shortages or a hard time kind of attracting those professionals?
▶ 1:11:09We have very similar challenges to what are experienced in the private sector and the community care network. Yes.
▶ 1:11:17If I can add to that, I think one of the things that we do have is because we're a national network of providers. We actually don't have a shortage. They have primary care providers. Even though the shortage is everywhere, we just don't have them all in the right places at the right time. And so, like you were talking about pack teams and how many, you know, providers they have, you know, we can supplement that through the clinical resource hub program. So we can supplement primary care, mental health, specialty care.
▶ 1:11:41So a nefologist in Boston who has extra effort to give can provide care in rural Illinois. And that's tellahalth by tellahalth.
▶ 1:11:50Yeah, tellahalth is key to that. Yeah. Okay. I'll I'll go ahead and note back.
▶ 1:11:54Sure. Thank you. Um I'll now recognize myself for five minutes. Um and I know a couple of you I think Mr. Lawson and Miss um Shower, you mentioned the electronic health record um upgrades that are necessary to kind of integrate that community care and VA care together cuz oftentimes veterans will even if they're using community care will also have a a segment of their healthcare through VA and um that's been a major subject of consideration by by our um subcommittee.
▶ 1:12:23I feel like it's taken up 80% of my life these days. Um but uh if you can um give us any of your perspective as to your expectations for that. I know this um you know Cerner has now been acquired by Oracle.
▶ 1:12:38The Vision that that I live in and specifically in Michigan is the next region to receive this update and you know it's frankly not gone well in the places it's it's been rolled out in the past minus the uh exception here in Illinois. Um and curious if you have any thoughts on how that will take place and what your what would be things we ought to look for on this committee to make sure that it is done appropriately.
▶ 1:13:06Yes. When we think about you know those electronic health records even speaking from from the private sector experience uh in my previous life before the superintendency here um the these systems do not talk with one another. So you might have one healthcare facility using um I don't want to endorse any uh uh places here but epic and then one may be on serer those two hospitals might even be owned by the same ownership group but don't communicate with one another with those records because they don't intermix.
▶ 1:13:35So I think what we'd be looking here is you know we look to like software service type of uh mechanisms to where maybe providers might be provided login access something along those lines uh you know to to direct access those records uh from the VA uh on the software rollout from from Oracle and Cerner. We did get an update about that uh last week at the the Knack VSO annual conference.
▶ 1:13:59Um, and when we think about those those records coming in from the active duty component uh of the US armed forces, it is happening. Uh, it seems or appears or we've been told that those bugs have been worked out. Time will tell. Uh, however, we're looking at 18 to 18 months to 24 months of full roll out. U, you know, and Illinois is not among the next states, by the way. Um, we'd like to to see that happen. Um, so that that really kind of covers that active duty component.
▶ 1:14:26But I think what we really need to really focus on is how do we make access for those community care providers either through a software of service platform uh or or some other type of agreement uh with those
▶ 1:14:38So you're saying instead of like sending the file back and forth having an access portal for the community care providers to access your VA record.
▶ 1:14:48And make maybe even some edit privileges to that for the community care work that's being done. very similar how a VSO has VBMS access. I can get in there and I can kind of see what's going on uh with with a case file. Uh I think something very similar to that but with a bit more privilege, you know, from a provider end to to add to and edit.
▶ 1:15:08Sure. Very good. M Miss Sher, I don't know if you have any uh thoughts on that
▶ 1:15:13So my background is nursing um not it and so I want to I want to give that caveat, but um as a clinician, just being able to access the records you need when you need them is especially helpful. Um, and it goes two ways. It's the the VA, EHR, but then also figuring out with the community care, as you mentioned, um, everybody's working on different systems, and so making sure it works with a variety of systems.
▶ 1:15:36Um, another additional thing that just to point out, um, I know up until recently, we did have an EHR change in my organization. Um but when that interoperability is not there um sometimes it does rely on actually making a phone call to the seabach or to the primary care team um which that relies on that seabach being open. So weekends, holidays, nights, you don't always have that ability to access those
▶ 1:16:01Yeah. Um, if this was ever a possibility, I would love to see a a future where um, not only do we ensure that any veteran that's eligible for community care receives the information about what they're eligible for and where they can go, but alternatively, we have a lot of veterans that are not using their VA care. They're using the community on their private insurance. They may not have any awareness. I would love to see some way for some sort of integration that would allow community providers to easily screen and then refer to VA when somebody meets those criteria.
▶ 1:16:31Yeah, I I don't disagree with you. I actually um one of the one of the bills that I introduced was the uh Veterans Community Care Scheduling Improvement Act to allow for that integration with um community care providers within the VA so they could see that matrix of what is available.
▶ 1:16:47And one of the um revisions we made to that bill was a requirement that if if a veteran called for a scheduled appointment, they would be advised of both options available to them so that they would know what is available so that they would then be able to choose between I'm willing to travel a little bit further to get an appointment maybe sooner or I'm going to stay closer for an appointment a little bit later or just that entire decision matrix that they may have.
▶ 1:17:13or maybe they're like a lot of folks in my district who travel to Florida in the wintertime and they spend part of their time there, part of their time in Michigan and having, you know, other options available to them is really uh something that's important. Um, so we're we are working through a lot of this electronic health record, you know, tangled issue right now, but I know Mr.
▶ 1:17:33Lo, and you pointed out in your testimony just that certainty that if you have, for example, a referral for a critical need that it's not getting lost in that in that, you know, gap perhaps before this is fully integrated so that we know if you send a referral for us for a test or a service that it's going to be received on the other end and actioned appropriately in a timely way to make sure that it's not falling through the cracks. So, um, appreciate that and I want to yield to the ranking member for five minutes.
▶ 1:18:01Great. Thank you. Thank you again. Um my next question, Mr. Lawson, actually we could spend probably this entire hearing talking about healthcare, but I do want to talk about um access to benefits. And so I I just was curious if you could speak a little bit to that and what you're hearing uh from your fellow service members just about access to benefits, barriers to that, challenges with it in our more rural communities,
▶ 1:18:26Sure. I I think the the first priority is ensuring that we've got access to accredited veteran service officers for these veterans in rural areas. Um in my office, we are are going through a uh quite a bit of a transformation to make ourselves available to veterans wherever they may be. We even service veterans outside of our county. Uh we've got clients as far away as Ireland um that were able to do remotely, work through the claims process with them.
▶ 1:18:50Um, part of what we do, um, you know, is educating veterans on that, but they have to be into the system first. So, if you've not entered the the VA system, meaning that you've not applied for a VA home loan, if you've not entered VA care, if you've not used education benefits, you're not counted and you're not in the system. We need to make sure that you're enrolled and counted in the system.
▶ 1:19:12one, it gives our um our VA administrative staff and planning staff some better headcount of numbers so we know where to center our care uh and where to look to build facilities or expand out op you know options. Um you know but for us the challenge is is especially as we stand up here in Illinois our veterans assistance commission making sure that we've got an accredited veteran service officer in every county. Uh these c these veteran service officers are free for the veteran to use.
▶ 1:19:40they should use free veteran services officers uh at all times uh and never pay for the service. Uh that is a benefit that they've earned and they should not be charged to access it and that that's that.
▶ 1:19:54Thank you. Yeah, one of the things we've tried to do in my office is host resource center, you know, resource fairs connecting veterans to the VA to services and it's challenging. It's challenging to um we we did it at one of our um community colleges not far from here and we had light attendance. So any observations or kind of suggestions you might have on how we can better connect?
▶ 1:20:19That's one thing we've been wrestling with. We attended one of your uh resource fairs recently as well at the the Legion and in Edwardsville. Um and and we've noticed that as well that the resource fairs the face of the veteran is changing. Uh we have to look at um the demographics of these veterans, how they access care, how they consume information. Uh resource fairs used to work back when the internet didn't exist.
▶ 1:20:43Um now that veteran has more access to information through their handheld computer on their phone uh than they ever will at a resource fair. But there is so much as as uh Congressman Barrett, you know, mentioned, so many groups out there that that are trying to do good things. It's just not a very coordinated effort in my opinion. um that we need to, you know, figure out what that next generation uh of of outreach is. Is it through social media? Is it through other platforms?
▶ 1:21:12It's just it takes money quite honestly uh to commit to those uh types of things. So, we're looking and exploring how do we offer these things uh or these services or or education opportunities uh in a more modern setting to appeal to the OAF OEF generation which uh is ours uh and currently in the most need for care at this point.
▶ 1:21:33I'd love to keep working with you, working with you on that to figure that out for sure.
▶ 1:21:37We'd be happy to.
▶ 1:21:38Thank you. Um Dr. Dr. Williams, I wanted to ask, I know you're um currently the medical center director up in Chicago at the Jesse Brown uh VA MC. Um, and so I was just wondering if you could maybe since we're talking about rural health care, obviously Chicago not being rural, um, if you could kind of just talk to us a little bit about, you know, as you're practicing working up north, kind of the comparison between resources, anything you see different between
▶ 1:22:08what can be offered in a community that's more rural, the challenges or the lesser of the resources that might be down here, or maybe we have adequate, you know, same amount of resources in Chicago. But I was just curious if you could reflect on that.
▶ 1:22:23Um, actually what is very interesting about my time at Chicago is that the Jesse Brown VA actually hosts the clinical resource hub for Vision 12.
▶ 1:22:35Um, and so the some of the rural health care that Dr. Kaboli was mentioning being provided through the clinical resource hub, I see the opposite end of that care. So I see those providers and those specialists in my role as the medical center director at Jesse Brown and then I see my home site VA Iana as a consumer um of those services and that partnership with the clinical resource hub is critical.
▶ 1:23:03um the there are some you know obviously differences between urban and rural health care. And one other noticeable difference is um the kind of the the relationship or affiliations with the educational institutions in the different communities because a larger VA medical center obviously has typically a broader range of services including specialties.
▶ 1:23:30um there's a much tighter relationship with their academic affiliate. Um we do have a great partnership down here at VA with the University of Illinois Urbana Champagne. So we're very fortunate for that, but it's a different relationship than what I see in Chicago.
▶ 1:23:46Yeah. Okay. Thank you. I'll yield back.
▶ 1:23:49Sure. Thank you. And um I uh wanted to um follow up a little bit more um uh Dr. Zamch about the EPS scheduling and and how that has been integrated. I know it's not fully at every facility yet and I'm curious in your vision uh where it's being used and how it's being utilized and if you have any feedback for us as to how that's going uh in its real uh application sense now.
▶ 1:24:15Yes, thanks for that question. Um EPS um I'm well aware of it. um part of um being the governance board um that's been discussed for a number of months um now and so I've been involved in um in those discussions and in uh the roll out um kind of input about the planning. At this point um we don't have any of our um eight facilities in vision 12 that are in the pilot as you had mentioned.
▶ 1:24:43Um however um I think it's a great thing. I think it's a wonderful opportunity to um to provide um more resources and access for our vets and timeliness. I mean, literally, it's moving um appointment scheduling from days or weeks in in some cases to the period of minutes.
▶ 1:25:06So, I'm encouraged about it and um but I do think it's a it's a double-sided coin idea in terms of implementation, right? You really need the local medical center to be, you know, engaged in opening up those clinic slots, but you also need the community partner and a connection like CEO to CEO to open up those grids and then and then kind of get proof of concept so that it can be expanded.
▶ 1:25:32Sure. For uh for those that may be here today unfamiliar, it would basically when you call to schedule an appointment often in community care, um I had this example happen to me. I was had a aiology appointment and they had to first call me and get my availability then call these other providers that were available then call me back and they scheduled it at a time I told them I wasn't available and then they told me well when that happens we just scheduled you for the next appointment if we can't meet your your uh you know timeline that you're available and I'm like
▶ 1:26:02well I'm I'm literally going to be out of the state you know I'm going to be in Washington DC and you scheduled me an appointment in Michigan at the same time and it was a very significant hassle and um so I think having that real time awareness so you're not going through that game of telephone is really critically important.
▶ 1:26:21Um, and so I think you're right though, you need both the VA scheduler as well as the community care provider to opt into that that meshing of uh information so that that scheduling is going to be available for people and then they can know what's close to home, what's available and and what am I willing to travel farther for, what's nearby and timely and everything else. Um uh and I think that's um that's you know an important thing that we've got to kind of pull together basically.
▶ 1:26:52Um and um uh Dr. Kaboli on that piece of it. Have you and and maybe I'm not sure if you have awareness of this. Do you feel like there is that awareness and buyin by potential community care partners when we offer this to them that they have that willingness to
▶ 1:27:10Absolutely. Okay. So, our office has kind of follow has followed the external provider scheduling program for the last three years and and uh you know we've worked for example with the NE Nebraska Rural Health Association because they're really tied into the rural communities and saying we will partner with you to make sure that they're on the grids because like you said if the scheduler has access to both grids at that exact moment in time when they're on the phone with the veteran they can say we can get you into the VA in 32 days or we can get you into this other clinic in 47 days.
▶ 1:27:40which would you rather have or you know and so I think if it if if it works half as well as we hope it does it'll still be good but I think you know uh I think they're up to what four there were 4,000 appointments made last month in June so it's ramping up quickly so I think it'll prove to be mutually beneficial and that's where it'll work
▶ 1:28:01and uh I'm not sure if this is a best question for you or not but the community care partners do you feel um that they feel like they are getting a a I mean everybody always wants a greater reimbursement, but do you feel it at least is a market reimbursement rate that is something that will draw in community care um partnerships? Yes. So, we've gone around and met with community, you know, uh partners and I get I still practice in Iowa and I talk to these other providers all the time and and they're happy with the rates that we provide.
▶ 1:28:31It's just you have to make it easy. the harder you make it, especially, you know, with record exchange. The harder we make it, the it just becomes a hassle. But I think they're really committed to the veterans in their community. And I've never heard anybody in the community ever say, you know what, taking care of veterans is not a priority for us. They always want to care for veterans.
▶ 1:28:49Yeah. And we want to draw in the best that we can by having a reimbursement rate that's reflective of the service that's provided that does that to really strengthen those particularly rural uh community partners that we have. So, so thank you. Um I can yield to the ranking member do you have other questions? Go
▶ 1:29:05I was just going to follow up on teleaalth actually um and maybe ask Dr. Zamchek. Um when you're talking about teleaalth and using it specifically for mental health challenges do you find um that there are still a lot of barriers around stigma related to seeking this care barriers to um you know a veteran coming in in person or utilizing tellaalth. Is tellahalth making it more easily accessible for a veteran that might be trying to get over a stigma about seeking that care?
▶ 1:29:36Well, I think I think first of all VA care and mental health is second to none. I think the plethora of services that we offer and modalities that we offer um mitigates um stigma that historically um was there. I I think it's still there. Um certainly and I think um candidly I think it's part of the disease process to some extent for people to be reluctant um to seek care when they really need it.
▶ 1:30:04And so I think you know we will never stop in terms of that outreach and finding connectivity for for our vets um whether it's uh through VBC or coming to a a local seabach and um using teleaalth or um one of the one of the um programs that we have related to this broadband discussion we've been having is what we call the digital divide program and that's where we we've literally issued VA loaned
▶ 1:30:35um iPads, tablets that have internet connectivity for veterans that are in rural areas who can't afford it
▶ 1:30:43and and then that gives them the ability to connect with their clinician at their kitchen table, right?
▶ 1:30:48And um we've we've distributed thousands of those across the network.
▶ 1:30:52That's great. Yeah, that's great. Can I open the question up to the I know we have a number of veterans obviously on the panel. um specifically around barriers any you know anything you could speak to as far as um barriers that we can help overcome in helping connect veterans to tellaalth services mental health services
▶ 1:31:14so I think um when we think about the teleahalth services I use teleaalth uh tellah health mental health even I'm not even ashamed to admit it um and it was wonderful uh it worked um I'm at work I'm a working adult I'm still in the And I think sometimes there is this misconception that, you know, oh, you can just take off work to go to an appointment. Here in Illinois, we've got legislation pushing forward to to kind of help those veterans take some extra time off uh compensated to go to these appointments uh for service related conditions.
▶ 1:31:43But, um, a lot of this is going to come on educating, especially for for some of our older veterans that are just not quite at the technology level. Maybe some of us are. Um, you know, we're still seeing Vietnam era veterans that are now coming in for the first time for PTSD. Um, it, you know, it breaks your heart to see them, um, dealing with that for so long.
▶ 1:32:10Um, but, uh, we've got to figure out ways to also, as we issue out those iPads and and um, pieces of technology, how do we educate them to use it? Um, you know, one of the things we do in our office is, you know, when they come to see us for claims, do you have va.gov app on your phone? You know, most veterans do have phones at this point, even the older ones. Um, so how do we educate them to use that VA app? They can communicate with their primary care provider on there.
▶ 1:32:36They can retrieve records, uh, letters, medical records, uh, decision notices, they get notices for appointments coming up on their app. It's really a great tool, and we really do love that app. It's just again how do we educate those those veterans on using it? Um you know so making sure that we've got access critical um but also uh education on how to use the tool.
▶ 1:32:58Any other Yeah.
▶ 1:33:00Yeah. So one of the biggest barriers I see is just a lack of awareness of
▶ 1:33:04I think that the V the veterans that are within the VA somehow or have ever been connected to the VA will get some information. Um and you can access so much information on the internet but it's it's almost too much. it's hard to digest. You don't know what's worth going after and not everybody even realizes that it's something that they should pursue. So, um I think again that outreach is so important and going to where the veterans are.
▶ 1:33:29We find a lot of luck meeting women veterans in places like the farmers market, you know, like places just that veterans are versus having a fair where they come to you because if I don't believe we have a lot of veterans that don't even understand that they are a veteran, they don't identify as a veteran. And so that resource fair to them is not for them. Um, and so finding ways to meet the veterans where they are and make sure that you have those conversations about what you are eligible for.
▶ 1:33:57Um, most of our women, that's that's why they have now gotten VA care is because they learned that they could. They didn't even know that it was a possibility
▶ 1:34:06Thank you. I'll go ahead and yield back.
▶ 1:34:08Sure. Thank you. And uh um thank you for that. I think you're right. I think it speaks to a uh thing when I prior to coming to Congress, I was in the state legislature in Michigan and we would always model our outreach and instead of asking are you a veteran? Because you're right, people will self- select out of that definition. um you ask did you ever serve in the military and then you kind of can explore that from there. Um but it's hard to hold a resource fair and advertise it as did you ever serve in the military fair.
▶ 1:34:37So um it's a little bit harder to to package. Um but I think it is part of that going where people are instead of expecting them to come to us. I think there's a lot of um part of this is an inertia thing like you get started, you begin unpacking some of this and then you work through the process and and you know maybe obtain the benefits that you've kind of had on the back burner. Life comes at you. You're transitioning to civilian life. Things are difficult.
▶ 1:35:03It's like being in a batting cage and you're figuring out how to get stood up again and then you think you'll worry about it later and then life comes in and and you have a lot of um other priorities. Even for our our Vietnam generation coming home, they were treated so poorly when they came back that many of them just kind of packed it away and then life took over and then they moved to a different phase of life and those things they had tried to pack away become to kind of percolate back out.
▶ 1:35:30And and I really hope and I think we are making the the stride and effort of making up the the lost ground that we had with that generation because they truly did suffer unnecessarily. And and and I think they I will say I'm grateful that that generation made sure that that our generation was was welcomed back respectfully and and and with the dignity that all veterans deserve. And I think that that each of our Vietnam veterans are owed a a great deal of appreciation for that.
▶ 1:36:00Um Mr. uh Kchner, I wanted to ask you a question. Um since your really tragic experience with that uh provider, have you found or have you gone back into any community care services? What has your experience been like more recently? And can you give us any um insight into how that may or may not have improved and where you think those those improvements ought to
▶ 1:36:24Sure. Um first of all, community care. Excellent. Um every time they call about the appointment, like you said, um we'll get back with you 24 48 hours. It's within 10 minutes they're calling. You know, they're bringing their agame.
▶ 1:36:43Um, where I see that could be a benefit for the veterans and the VA is if I'm going to an aiology appointment, I want my records to be reviewed by an not a heart doctor or a person that's had the training. I don't believe the people that are doing these exams are the right people doing the exams. I think that's where the
▶ 1:37:12you're talking for the compensation and
▶ 1:37:14Okay. Not the community care ongoing medical community care. They're doing everything to get you there. Sure. You know, that's where
▶ 1:37:21community care is on top of their game. I think that's where it's falling apart is whenever community care is done.
▶ 1:37:27That's where it's falling off the board. We'll uh we'll take that that back because I'm not sure sitting here what the qualifications for those uh delegated outsource, you know, compensation and benefit exams, what those what a requirement is for that person to be. I'm sure they they have to be a medical doctor, but I'm not sure in which specialty or what that would uh involve. So, we'll we'll take that back for uh for consideration for some questions to VA about that. Um so, I appreciate your uh your insight there.
▶ 1:37:56And uh Dr. Zamch, one thing I know you talked about outreach with mental health and that being important and I think that is a continuing effort we have to keep working toward. One uh population that we found some success in Michigan was actually reaching out to spouses of veterans as well because oftentimes they are observing the behavioral challenges that veterans may have in a more, you know, intimate setting back home that they're not displaying out in public at their job or they're, you know, taking that hardship back home with them.
▶ 1:38:27And I think that that outreach to the spouses of saying, "Hey, here are some benefits that may be available to your loved one." Um may be that soft encouragement that they need to to, you know, make the decision to come in to to receive the help that they, you know, should have and and it certainly have earned. And I don't know if that's anything you've explored at all or if it's um worthy of uh your consideration or not.
▶ 1:38:49Yes, that's a great point. Um, we know the connectivity with our veterans is often with family members, um, often children. Um, could be a neighbor.
▶ 1:38:58Um, I think as I as I hear this discussion about outreach and connectivity with our veterans, of course, we have teleaalth coordinators. We have people to to talk and to train and to teach our veterans and family members. But um but uh I really think that a multiaceted approach is is what's needed. There can be some of these standardized approaches that we're doing.
▶ 1:39:23But what I've seen in my network is I have very rural and very urban um centers and even some of the hospitals that are very urban have very rural seabox. And so um having uh a group uh h each of the facilities does I think a great job of of even with town hall meetings in reaching out and opening um up our connections. Sometimes it's in person, sometimes it's with Facebook.
▶ 1:39:49Um but um whenever possible, we certainly invite um spouses and family members to be involved in the care so long as it's you know um it's okay from a
▶ 1:39:59sure health information standpoint. Do you know of any way that we've kind of um tried to do the direct outreach to the spouses or or near close family members of veterans um you know with with resources from the VA to encourage them to to try and encourage their veteran loved one to explore their
▶ 1:40:20I'd have to take that back and I'd be happy to follow up with you about any specific program or initiative about that. I think mostly what what we do is it's all-encompassing. So all of the outreach that we do, we we do not turn down if someone is asking about their father or mother or or sibling.
▶ 1:40:38Yeah. I just think it might be a a useful inroad with uh with veterans. It turns out I have a wife and she thinks I'm rather stubborn. So um maybe I'm the only one. I don't know. But um but thank you. Appreciate it.
▶ 1:40:51And uh Ranking Member Bazinski, go
▶ 1:40:53Sure. I just had a final question for Miss Shower. I was wondering if you could speak about specifically women veterans and we've had a lot of conversation obviously focused on rural healthcare but I think that those challenges to access for women um is probably greater. Um but I was wondering if you could speak a little bit to that
▶ 1:41:12Yeah. Uh our women veteran population of course we have a lot of unique needs. Military sexual trauma is probably one of the most prominent. um though not isolated to women veterans, a higher percentage of women veterans. Um what I find in our community is hesitance towards using the VA because of experiences they had 10, 20 years ago, you know, when you dig into it.
▶ 1:41:38Um and so just trying to encourage them that today's VA is different and and you're in a place where you'll be welcomed. And once they try it again, they see and they believe and they socialize it with each other. Um, but I think it's it's getting them in that door. And I think um the social isolation that you're talking about, I love I I want to learn more about that program because that's really uh why our community was created and hearing about the high suicide rates for women veterans.
▶ 1:42:04Um which as a nurse, having been a nurse for 15 years at that point, I was completely unaware of. And um and when we started our group, we had immediate energy behind it and it just keeps growing and it just shows that need for people um and and often it does take asking them two, three, four times to come um but once they come they're like so excited for the next meetup.
▶ 1:42:30So I I do think women have unique needs that have gone a little bit unnoticed and unrecognized for a while. Um, and I'm really happy that today's VA is is seeing that and um and addressing that.
▶ 1:42:44Thank you very much. I'll yield back, Mr. Chairman.
▶ 1:42:48Sure. Thank you. And and appreciate that insight as well. And I think maybe doing some um public service outreach to women to to really ad like having firsthand testimonials of women who've come back and now receive care at the VA to advocate for other women to hey um this isn't you know number one this isn't the military.
▶ 1:43:09Um whatever trauma you may have experienced there is not I I get that this is still the United States government and there is a a you know a hill we have to climb to reestablish trust in many ways. Um, but this is not the same VA that may have been unprepared during those early days of the war on terror and the war in Iraq and coming back home and in a a a lack of of capacity and understanding and, you know, kind of a little bit of a legacy VA that has since transformed and through a lot of work that
▶ 1:43:40was done and paths that were forged by women like yourself and other veterans coming back home and and advocates like many of you here and folks that work uh within the VA. So, we appreciate your your work doing that. Um, I now want to rank to the or yield rather to the ranking member for your uh closing statement.
▶ 1:43:56Yeah, thank you, Mr. Chairman. I just want to say again, thank you for coming to the 13th district. I really appreciate that. Uh, thank you to all the panelists. This was very informative um on the work that we have um ahead of us back in Washington. I really appreciate all of your time um and making the trip here um as the ranking member on um the subcommittee with Chairman Barrett on tech and modernization. It was great to hear some of that conversation and how that's integrated into the rural experience for our veterans.
▶ 1:44:27Um I think we both know we have a long way to go and we're a partner in that work because it is just so critical uh whether it's scheduling or the electronic health record system. uh getting that fully operational within the VA is is something that's critically important and will be to the benefit of the services that the veterans um so welld deserved. So, thank you again for being here to the veterans. Thank you for your service. Um and I'll yield back to the chairman.
▶ 1:44:57Thank you. And uh thank you uh Ranking Member Bazinski for hosting us today and uh for allowing me to see a little bit of a a glimpse of your district and appreciate the uh both similarities and some of the differences between uh communities that we represent and how things are done. And I really can't say enough about how impressed I am by this facility, the outreach that is done and the success stories that you've all had and and the work that's ongoing that you're doing.
▶ 1:45:21and uh kind of like we talked about earlier uh Colonel, allowing veterans to find that next sense of of real purpose and and I appreciate the work that you're doing here uh to to make that happen. And uh and and one thing uh that I think can give us some really focused motivation for this is um there's um statistics around this. Of course, during that that 20-year long span of the war on terror, we had just over 7,000 troops die on the battlefield.
▶ 1:45:51Every single one of them is an absolute tragedy. I have friends that and in and many of us who served have friends that that were lost in that effort. We lost 35,000 more to suicide during the same period of time.
▶ 1:46:05And that really to me speaks about that total the real total human cost of war that we have yet to fully appreciate and we have a lot further to go in that and how we can prevent those each of which are preventable with the right intervention and the right outreach and the right care and treatment. So that is a real mission of what we on this committee are focused on.
▶ 1:46:28And a piece of that is this technology aspect of how we deliver uh benefits to veterans and how we really do a better job of of making sure that they have the adequate access that they've all earned to really head off at the path the next veteran who may be going down that path. And then also looking at veterans who aren't contemplating suicide but still need help for the you know the back injury they sustained or the other service connected conditions they may be facing or dealing with.
▶ 1:46:57What education benefits do they have that are available to them? What you know compensation and benefits are available for that continuation and and all of the other services that VA provides that are really truly important and fall under this rather broad umbrella of the subcommittee and the work that we do. So, I uh I can't tell you how much we appreciate each of you being, you know, really on the ground advocates and with the firsthand knowledge and experience that you have of how we go about that.
▶ 1:47:24Um, you know, Washington DC is is uh an 11-hour drive from here because we we almost had to drive because the weather with the flights yesterday, but um it is a long ways away from here. And it's a long ways away from uh everyday America, but these are the communities that we represent. And I say this in my own district. It's my job to be my district's representative in Washington DC, not Washington's representative back home in my district.
▶ 1:47:54And that should really be a one-way street where we take our voices of our constituents and the folks that we represent and go advocate for them in our nation's capital and not come back here and tell you, well, you know, this is how it this is how it really works. You just got to get on board with it. Um, that's not the role of Congress and that's never going to be what we do on this subcommittee.
▶ 1:48:13So this field hearing today really allows us to gather that insight from all of you here and take this with us back to our nation's capital to really do our best and strive to make the best public policy that we can uh on behalf of our veterans and on behalf of the communities that we represent. So, I thank you again for uh for hosting us today, and we look forward to welcome you uh to Michigan in the future to to do another uh hearing in in in my district.
▶ 1:48:39And uh certainly for those of you that have further insight or or thoughts for us, we welcome your um your uh insight. And if you if you make it to Washington, we'd love to have you uh in our hearing there as well. So, uh thank you again to everyone. Thank you to the the staff, both committee staff on on both sides as well as uh uh the staff for uh arranging all this for those that were here doing uh providing other services for hosting us today. I really do appreciate each and every one of you.
▶ 1:49:05Um with that, I will ask unanimous consent that all members have five legislative days to revise and extend the remarks and include extraneous material. And without objection, it is so ordered and this hearing is