▶ 0:41:09All right, good morning everyone and um thank you for joining us and thank you um everybody who's here. This is an exciting opportunity to bring Congress back home to my district here in the seventh congressional district and a place that I have a a special point of pride in a an area and a community and a a unit that I trained in in the army for about half of my career.
▶ 0:41:34So over the 22 years that I served, I spent about half of the time in in in uniform serving in this facility and tell it's a beautiful uh a beautiful facility where we have some of the most technologically advanced helicopters in the entire world right behind us and it's something that I'm certainly proud to represent and uh proud to to show off to to many of you today. I want to give a special thanks to my friend the ranking member Nikki Bazinski up here from her district in Illinois. Want to thank you and welcome you to Michigan.
▶ 0:42:02welcome you to my district and uh look forward to our our hearing today. I really enjoyed coming to your district last year and we were talking uh before this about the similarities of kind of communities that we represent and a lot of the overlap of of the types of people, the types of communities, the small towns and areas that we represent. So, it's uh it's great to have you here. So, thank you. And uh without objection, the chair may declare recess at any point.
▶ 0:42:31And uh I also want to give a special thanks to the Michigan Army National Guard for hosting us here in Grand Ledge at the Army Aviation Support Facility and the staff from Michigan's Department of Military and Veteran Affairs that helped make this hearing possible. I want to thank General Rogers, our agitant general, for his uh willingness to open this facility for us today. Uh, and of course I have the privilege of representing this community and it's especially meaningful return to return to the facility where I personally trained and served with so many others um that are here still serving today.
▶ 0:43:01I brought the House Committee on Veteran Affairs Subcommittee on Technology Modernization here because oversight doesn't stop in Washington DC. We represent communities all across America. And I think a lot about how it's my job to be our district's representative in Washington, not Washington's representative back home here in Michigan.
▶ 0:43:23But bringing this committee here today allows both the ranking member and I and folks from Washington to hear about what's happening in communities like ours. It's important for Congress to hear from veterans, providers, and leaders in the community where they live, where they receive care, and where the rubber meets the road with VA systems that are felt every day by real patients.
▶ 0:43:47The mission of this subcommittee is to make sure that VA is leveraging the right technology to deliver the best health care and benefits to veterans, not only in Michigan, but across the country. This means finally transitioning the VA into the 21st century. The modern healthcare landscape demands agility. We can no longer remain anchored to the expensive, inefficient, hospital ccentric care models of the past. But technology alone will not will not make new health care providers appear.
▶ 0:44:16VA must continue to strengthen its community care program to ensure the doctors and providers living in our communities can continue to meet veterans where they live and work. Every decision VA makes should focus on putting veterans first, not bureaucracy. As many of you know, veterans here in greater lance in the greater lancing area are about an hour away from both the Battle Creek and Ann Arbor VA medical centers and further than that from Sagenov.
▶ 0:44:43So that means that in this community here in Grand Ledge, you would have to travel more than an hour to go to a large VA medical center. We have community or we have a um community um outpatient clinic in Lancing that does great work. But if you need to go to one of the uh hospitals, you are more than an hour away from any of them. And that's not unique to this community. If you live in Northern Michigan, you're you're two or even more hours away from a VA hospital in many instances.
▶ 0:45:11For some veterans, this distance makes getting care a burden, especially for the long wait times that can come from a VA hospital in certain instances. This topic is personal to me. When veterans are referred to community care, the scheduling process should be simple, fast, and focused on their health care. But for too long, that has not been the case.
▶ 0:45:30What happens now is a scheduler ends up calling the veteran to book an appointment, gets some of their availability, a process that can stretch quite a long time, and then they call a whole bunch of providers in their catalog of community care partners that they work with, and that ends up delaying care for men and women who've earned it. And I've experienced this myself. I was referred for a very routine aiology appointment last year. I got called by a scheduler. They asked me what my availability was.
▶ 0:46:00I told them over the following few weeks, "Here's when I'm available. Here's when I'm not." I didn't disclose to the scheduleuler that I was a member of Congress and would be traveling to Washington DC three or four days a week. But I did tell her I wasn't going to be in Michigan. And then a couple of days went by and I got a text alerting me to my scheduled appointment in the middle of the week when I was going to be in Washington DC. And I called back and they told me that because they couldn't accommodate my scheduling request, they just booked me for the next available appointment.
▶ 0:46:31And I said, "Well, the next available appointment I'm going to be 600 miles away. So that doesn't really help any of us. And then that takes more time out of their schedule for me to call and reschedu it, for them to go back out and look for the appointment and to finally make something that is very routine finally happen. I'm pleased to see the VA finally taking steps to address these issues and update the technology and systems our veterans rely on. VA has been piloting the technology known as the external provider scheduling system or EPS for short.
▶ 0:47:01This scheduling system eliminates a large portion of the time and labor intensive aspects of community care scheduling by giving VA schedulers direct access to community providers appointment availability. They can see in real time the aiology clinic down the street what their availability is and how they can sync a veteran's availability for an appointment that can be done very easily. Prior to this pilot, VA staff had to pick up the phone again and again, often calling the veteran and the provider multiple times to schedule a simple appointment. getting in between that relationship.
▶ 0:47:32The telephone is an invention of the 19th century. The EPS program is an invention of the 21st century. And it's exactly the type of modern tool that VA should be using to advance access to care in Mid Michigan and nationwide. When service members sign up and when our sons and daughters go to war, they make a commitment to this country with the expectation that we will uphold our promise to them through highquality VA healthcare access when they return home.
▶ 0:47:56when they walk through the doors at a VA hospital or call to receive care in their community, that promise shouldn't fall through. The VA piloting of EPS is one of the many ways VA has begun to fix the problem and uphold that commitment. Through EPS, providers agree to share their scheduling grids with the VA and allow VA schedulers to search and short sort appointments by distance, drive time, and availability in a matter of minutes.
▶ 0:48:21With available community care appointments on one screen, a VA scheduler can book the appointment directly with the provider with just one call to a veteran. This allows them to spend less time scheduling each appointment. It means schedulers can be more efficient and veterans like the ones in this room can get their appointments faster. EPS is now active nationwide in all VA medical centers. And I want to thank Secretary Collins for his work on delivering for our nation's veterans in this way.
▶ 0:48:47There are roughly 24,000 community care providers currently active in EPS and that number will need to keep growing if the program is going to reach its full potential. While provider participation is critical, VA must also ensure that the technology is being utilized across the Despite EPS's strong results, the prior administration repeatedly put roadblocks in front of the program, directly impacting veterans here in Michigan.
▶ 0:49:11In 2024, the Biden administration paused enrollment of community care providers, shut down active EPS sites, and halted nationwide expansion plans, all while citing budget shortfalls that never materialized. The damage went beyond veterans. VA also undermined trust with the community care providers we're trying to recruit to participate in this program, who now are going to think twice before partnering with the VA again. When I first heard about this, I knew we needed to take action to get the program back on track for good.
▶ 0:49:40That's why along with my fellow Midwesterner and ranking member Bazinski introduced the bipartisan HR 3482, the Veteran Community Care Scheduling Improvement Act, this legislation will codify and expand VA's EPS program by authorizing a nationwide electronic scheduling process that allows VA staff to efficiently schedule appointments for veterans right away. This legislation would no would ensure that no matter who is in the White House, veterans are still able to access the quick appointments they've earned.
▶ 0:50:10My common sense bill passed the House last month unanimously, and I'm excited to see it included in the Take Care of America's Veterans Act. This package includes more than 60 other bipartisan bills to modernize, enhance, and reform the delivery of health care and benefits for veterans. And I look forward to President Trump signing this bill into law. This great effort will ensure EPS is not just a pilot or a 4-year program only available in certain communities, but rather a permanent capability for the betterment of veterans.
▶ 0:50:39VA has a real opportunity to improve veterans lives with this technology, and I'm proud to lead the charge on it. At today's hearing, I expect VA to outline the progress made thus far, how integrated scheduling will be fully optimized and its plans to integrate with new electronic health record system that we just rolled out here in Michigan and uh ensure that veterans receive appointments when they need them most. Before I turn it over to Ranking Member Visinski, I want to remind everyone here today that this is a congressional oversight hearing, not an open forum.
▶ 0:51:07Only members of Congress and invited witnesses will be and are recognized to speak. If anyone has specific issues or concerns with the VA, I encourage you to reach out to my district office and we would be happy to assist you with that directly. Thank you. And with that, I yield to Ranking Member Bazinski for her opening
▶ 0:51:24Thank you very much, Chairman Barrett, and thank you again for welcoming me here to Grand Ledge into your district, the seventh district of Michigan. I appreciated you coming to my district. Gosh, I think it's been a little over a year now, maybe. But uh very excited that uh to be here today and and couldn't agree with you more that being here reminds me of home. Very similar districts and fields um from the Midwest. I I suspect that the issues also that face our veterans in both of our districts are very similar, too.
▶ 0:51:54Uh for me, the closest VA facilities um are outside of my district, and many veterans drive long distances to the closest one to receive care. It's a real struggle in particular for our rural veterans. It's for this this reason that I believe that community care is an important part of VA health care, especially in rural America. However, getting a community care appointment from VA continues to be a major pain point.
▶ 0:52:22Uh veterans wait for auler to call them, then they wait while the scheduler calls around to different providers looking for an available slot. The whole process takes far too many phone calls and quite frankly far too much time. It delays veterans care and it needs to be fixed. The external provider scheduling program or EPS is a promising new tool in that effort.
▶ 0:52:47The technology allows VA schedulers to book appointments directly into community care providers scheduling grids, eliminating or at least um reducing a cumbersome phone-based processes. It's a great idea and a good tool. I absolutely support this effort and in fact, as Chairman Barrett mentioned, he and I have wrote a bill to support and improve the EPS program. That being said, we must be cleareyed about the reality of VA's efforts with EPS.
▶ 0:53:18While they may have successfully deployed the technology, the network of community care providers sharing their scheduling grids continues to be insufficient in the number and diversity of specialties to making to make it a meaningful tool. There are well over 1 million community providers and VA has only signed up about 25,000. That's barely 2%.
▶ 0:53:43Additionally, we recently learned that of the providers that have signed up, they have a greater than 30% turnover rate, meaning they're losing providers while almost as fast as they're signing them up. VA prioritized the deployment over recruiting efforts. And now, I suspect there are many facilities with a shiny new tool that is effectively useless.
▶ 0:54:05I wonder what it is costing the taxpayers to maintain a system that is underresourced and Without a critical mass of providers in different specialties, VA schedulers will only be able to use EPS for just some appointments if they're lucky. For the rest of the appointments, the schedulers will continue to rely on multiple phone calls between the veteran and different providers to find an available appointment, book it, and then call to confirm.
▶ 0:54:34This is inefficient and leads to veterans waiting weeks just to schedule an appointment. In 2026, the technology exists. VA brought the te bought the technology. I want to understand why it's not being used to the full effect and how VA intends to get it on track.
▶ 0:54:53Additionally, VA recently began to pilot a capability to begin to pilot a capability in EPS that will allow schedulers to see VA's own appointments as well as community care appointments. This capability that was already available during the earlier EPS pilots, but then was shut off uh was shut down inexplicably. This integrated scheduling tool could ensure veterans have the opportunity to make informed decisions about when and where they receive care.
▶ 0:55:23We keep hearing that when we give the choice veterans will choose VA with integrated scheduling, we're giving them that opportunity. I want to hear more about this pilot, including how they will deter how they will determine the requirements for the new tool, what measures of success they've established, and how they're defining success. Veterans deserve to have the ability to see VA's access alongside community care.
▶ 0:55:50I want them to have the Um, but we have to ensure that the tools are properly developed and also deployed. Um, as I said in the beginning, community care is an important part of VA health care, especially for our rural veterans, but I feel like we need to acknowledge that rural health care is struggling. Almost 200 rural hospitals have closed in the last 20 years, and hundreds more are at risk right now.
▶ 0:56:15We must ensure access to quality health care for everyone, but especially for veterans that we committed to care for. As we look into make as we look to make it easier for veterans to get care in the community, we need to also ensure the longevity of the VA uh both VA and community care need to be fully funded so that no one um does not happen so one does not happen at the expense of the other and that VA will continue to be there to care for our nation's veterans.
▶ 0:56:46It was a part of the contract and it is a part of the cost of war. Uh thank you Mr. Chairman and I'll yield back. Thank you, Ranking Member Bazinski. Uh, I also just want to briefly point out that my mom and dad are here. Um, Pat and Maryanne Barrett, along with three of my four kids. So, appreciate you guys. I guess they didn't actually believe I I was in Congress, so they had to come they had to come see it for themselves. Um, but thank you.
▶ 0:57:13And I will now introduce our witnesses from the Department of Veterans Affairs. We have Mr. Andrew uh Gradesen Gratison, senior adviser to the under secretary for health at the Veteran Health Administration. Thank you. Accompanying Mr. Gratison is Dr. Mark uh Houseman, chief medical officer for veterans integrated service network 10 vision 10en and Mr. Zachary Schwarz, principal deputy assistant secretary for office of information and technology.
▶ 0:57:43And finally, from the Government Accountability Office, we have Miss Carol Harris, the director of IT and cyber security at GAO. Welcome to my district, and thank you all for making the time to be here with us. At this time, we'll ask the witnesses to please stand and raise your right hand. Do you solemnly swear under the penalty of perjury that the testimony you're about to provide is the truth, the whole truth, and nothing but the truth? Thank you. And let the record reflect that all witnesses have answered in the affirmative. Mr. Mr.
▶ 0:58:11Grabson, you are now recognized for 5 minutes to deliver your opening statement on behalf of VA.
▶ 0:58:16Chairman Barrett, Ranking Member Bizinski, uh, thank you for the opportunity to testify on VA's efforts to modernize scheduling and improve community care access. Joining me today is Dr. Mark Houseman, Chief Medical Officer of Vision 10, and Mr. Zachary Schwarz, principal deputy assistant secretary in our office of information and technology. We will update the subcommittee on the external provider scheduling or EPS program and our integrated scheduling pilots underway in Charleston, South Carolina and Atlanta, Georgia.
▶ 0:58:45Veterans, veteran service organizations, and members of this committee have consistently emphasized that scheduling challenges have been one of their most significant pain points for veterans seeking care. Secretary Doug Collins listened to VA's customers, and under his leadership, VA is making it easier and more convenient than ever for those who have worn the uniform to choose the care for which they're eligible that best fits their lifestyle.
▶ 0:59:09EPS is a technology platform that improves the process of scheduling veterans with community care providers by supplying information, allowing VA staff to schedule veterans directly into available community care provider appointment slots through a single user As you're aware, under the Biden administration, veterans faced unnecessary delays in accessing community care due to the decision to pause the implementation plan on EPS.
▶ 0:59:37This slowdown limited veterans ability to quickly and easily schedule appointments with community providers. The EPS program is now directly advancing VA's modernization goals by delivering a more consistent, transparent, and intuitive scheduling experience. The modernized EPS program now delivers the following benefits to veterans and their caregivers.
▶ 1:00:00Improved productivity that enables VA to schedule more than three times as many community care appointments per day compared to what we were doing before. Clear, timely choices that allow appointments to be booked in minutes, not days or weeks. real-time visibility into eligible community care provider appointment availability and increased efficiency that will eliminate many calls, faxes, and emails.
▶ 1:00:27Taken together, these improvements ensure greater consistency of services across VA medical centers Since we last testified before this subcommittee in May 2025, VA has moved from in incremental deployment to nationwide availability of the EPS program platform. Since late 2025, the EPS program has been rolled out across every VA medical center.
▶ 1:00:52As of May 2026, there were over 29,000 community providers and more than 41,000 provider services available under EPS. More than 150,000 appointments have been booked through the platform. In January 2026, VA commenced two integrated scheduling pilots in Charleston, South Carolina and Atlanta, Georgia.
▶ 1:01:17This effort allows viewing both direct care and community care appointments on the same platform. Within three months of the commencement of this pil of these integrated scheduling pilots, VA scheduled over a thousand appointments.
▶ 1:01:32Both sites are also testing new veteran self-scheduling capabilities through EPS that would allow eligible veterans to book their own appointments with VA providers or certain community care providers online through va.gov gov or using our mobile app without calling VA or a provider's office.
▶ 1:01:52While the EPS program has reached na national availability, we recognize its long-term success and value to veterans depend heavily on community provider Not all community providers are familiar with our technology. To increase awareness, VA meets with community care providers and explains the benefits in their clinical operations. And VA's ability to support the coordination of care efforts.
▶ 1:02:16VA leverages data to identify and engage community care providers who specialize in a category of care with a high annual referral volume in geographic areas with limited EPS program coverage. When VA engages with community clinicians and provider organizations to explain the program's benefits, we highlight that there are no fees, no change to their health records or scheduling platforms, and our community care providers retain full control over the appointment grids with secure schedule sharing.
▶ 1:02:45Nebraska's statewide rural transformation initiative is a leading model, having expanded EPS program connectivity across dozens of rural hospitals and clinics. VA is similarly working with thirdparty administrators and providers who have entered into a veterans care agreement to simplify participation and ensure broad understanding across the community care network. In conclusion, I'm pleased to inform this committee that under Secretary Collins leadership, the EPS program is a nationally deployed scheduling capability that is reshaping how veterans access their care.
▶ 1:03:15VA is moving closer to our goal of having a single scheduling solution that allows veterans to book appointments that are best for them, whether at VA or in the community through modern and convenient methods that meet their expectations. VA remains fully committed to ensuring that EPS supports timely, high-quality care and enhances veteran expectations across the entire scheduling journey. Thank you, and I look forward to your
▶ 1:03:37Thank you, Mr. Gratison. The written statement of Miss Gratson will be entered into the hearing record. Miss Harris, you're now recognized for five minutes to deliver your opening statement on behalf of GAO.
▶ 1:03:46Chairman Barrett and Ranking Member Bzinski, I want to thank you for inviting us to testify today on VA's efforts to ensure that veterans have timely access to health care through its scheduling systems. As requested, I'll briefly summarize our prior work on VA's scheduling environment and the related challenges for VA providers, schedulers, and veterans. In FY2023, VHA provided roughly 71 million appointments to veterans.
▶ 1:04:11VHA also provided roughly 47 million appointments with nonVHA providers through the Veterans Community Care Program during that same time period. In doing so, the department uses a patchwork of systems that have been developed in ways that makes scheduling with both VHA and nonVHA providers difficult for veterans and staff. Additionally, VA has experienced IT challenges related to the outdated, inefficient nature of systems and its efforts to modernize its health information system.
▶ 1:04:41VA has dozens of systems and tools that support scheduling appointments, managing referrals, and monitoring weight times. Vista facilities primarily use Vista scheduling, but it may also access at least nine additional systems in the process of scheduling appointments with VA providers. VA operates another five systems used by staff for managing referrals and another eight systems to engage with veterans about medical appointments. So that brings a tally to 22 systems.
▶ 1:05:11Oracle health facilities have another set of scheduling systems, 14 in total, and they use some of the same systems that Vista facilities use as well to schedule those appointments and manage referrals. So adding to that tally, that's a total of 36 systems right Additionally, VA employs tools for monitoring scheduling timeliness, providing estimates of wait times on its public website, and determining a veteran's eligibility based on weight time for community care.
▶ 1:05:41Given this environment, schedulers and veterans are experiencing challenges when making appointments. Facility staff must open multiple applications to schedule a single appointment. And as you said, then they got to get on the phone and make those phone calls. They must also run reports in different systems to identify veteran self-scheduled and self-cancled appointments and appointment requests. Navigating this complexity makes schedulers inefficient or require workarounds that may vary across sites.
▶ 1:06:10And VA has told us they are working to standardize veteran appointment scheduling at Vista and Oracle health sites, but they have not yet determined how the modernized and updated products used for scheduling will interface and be pulled to com and combined with the data into a comprehensive report. So consequently, the result is a labor and resource inensive process for VA staff that has continued to evolve over time.
▶ 1:06:35Our work has shown that less than 40% of facilities scheduled more than half of their community care appointments within VHA's 7-day standard. Further, fewer than 10% of facilities scheduled more than 75% of appointments within the In 2020, we recommended that leadership assess community care staffing and resource needs and develop a plan to address any identified risk to their ability to schedule timely appointments. VA concurred, but the department has yet to fully implement it six years later.
▶ 1:07:06Veterans have also experienced challenges requesting an appointment online, getting confirmation once an appointment is scheduled, and receiving duplicative appointment reminders. VA is working toward having one enterprisewide solution to address these issues, among other things. VA's OIT and VHA have also been collaborating to address its scheduling system challenges. They initiated a project to modernize these systems at Vista facilities which includes several concurrent efforts.
▶ 1:07:35For example, one is intended to allow provider-based scheduling which is the ability to see a provider schedule across multiple modalities. So that's like inperson and teleaalth in a single application. VA is also deploying EPS for VA schedulers to schedule veteran appointments directly online with community care providers and deployments have been in progress since 2024.
▶ 1:07:59In May of last year, we reported that while OIT and VHA had employed some key planning practices for the overall modernization effort, there were still gaps, such as accounting for the full scope of IT work in the project schedule and fully developing a requirements management plan. To this end, we made two recommendations to address these gaps. And moving forward, it will be critical for VA to fully and effectively implement the open recommendations we have related to scheduling, which is six in total.
▶ 1:08:29And doing so will enable VA to provide more quality, timely care for our veterans. And that concludes my statement. I look forward to your
▶ 1:08:39Thank you, Miss Harris. The written statement of Miss Harris will be entered into the record. And uh thank you to all of our witness witnesses. We're going to proceed with questioning. And I now uh recognize myself for 5 minutes for questions. Um, Miss Harris, I know you mentioned 36, I think you said, different systems that all touch on scheduling, whether that's internal to VA or outside in the community.
▶ 1:09:02That's correct.
▶ 1:09:03Uh, you also mentioned the um breakdown of the total number of appointments for veterans. I think that ratio is roughly 40% is done out in the community currently. Is that accurate?
▶ 1:09:14Yes. Um I know we've seen a rise in that since the allowances for veterans to be able to do that more easily. Um many of them take advantage of that and I think that speaks to their interest in going in all likelihood closer to home for a lot of the more you know routine appointments that they may have or something that may not be a um a veteran specific type of condition that would necessitate their specialized care at the VA for example.
▶ 1:09:43Um, with the new introduction of the the intentionally more rapid um, deployment of EHRM, will that cut down on this 36 systems or are we just going to multiply that by layering more systems on top of old ones in the meantime?
▶ 1:10:03I mean the I think I can't fully answer that question because VA has yet to provide a comprehensive view of what that final um scheduling process should be. Um and and again it's like it's I think it's like a Louisis Carol saying like if you don't know where you're going any road will take you there. And so VA has not yet defined what that final destination looks like.
▶ 1:10:28So again, you know, you have um a lack of a fully defined business process for what that standardized scheduling um scheduling workflow looks like and then what are the underpinning IT solutions that that are supposed to support that. EPS could be one of those systems, but it's not the silver bullet.
▶ 1:10:49And the sites that we have told that we've talked to have said, you know, there's promise there, but again, you need to have more community care participation to make it more effective. Um, and we haven't seen how that is going to be integrated with the Oracle Health uh revenue cycle scheduling suite of of applications there, those 14 that I mentioned.
▶ 1:11:09So until we see that comprehensive strategic plan of what that final 2B state looks like, it's it's not it's it's not possible for me to answer your question. Yeah, I don't want to uh speak on behalf of the ranking member, but I think uh we share an interest in the end goal of having veterans be able to pick up the phone or go online, communicate through the VA, and then be given the full portfolio of options available to them.
▶ 1:11:39whether that's inside the VA or outside of the VA could say you can get a VA provider here that's further from home you know next week or maybe if you want a community care provider it'll be in 10 days or two weeks but it'll be closer to home for you and might fit your schedule more adequately or something like that that's the end state that we're trying to get to um and I know that we have simultaneously EPS coming in while we're doing healthcare modernization I think the focus of VA
▶ 1:12:09has been in some ways necessitate necessitated by the urgency of the electronic health record roll out to to put a lot of emphasis around that, but we've got to be able to walk and chew gum at the same time and and certainly having 36 systems does not make that very very ideal. Um, Mr. Gratison for or or from VA any any of those with you on on your side.
▶ 1:12:36Can you speak to what we're doing to bring about more participation by community care partners? Because one of the biggest challenges I see is we can build the best system possible. But if we don't have participation, it's not going to benefit anyone. It's not going to benefit the providers and it's not going to benefit the veterans.
▶ 1:12:54We've got thousands of community care providers in in in this area, but very very very few of them are actually signed up through the EPS system in in the network of VA facilities in in this area.
▶ 1:13:07Thank you for the question, Mr. Chairman, and we agree the long-term success of EPS is contingent on being able to bring more community care providers into EPS. And how are we going about that? We're going about it at all levels from our under secretary of health uh engaging large um community care providers uh at the executive level and being able to bring that business case and also clearing up misconceptions that some of our providers have whether there are costs associated with it whether they
▶ 1:13:37retain full control over their scheduling grids or have to make system upgrades themselves. Once we clear up those misconceptions that there's no cost, no uh electronic health record updates need to be made and they retain full control, we've seen broader adoption. We're also leveraging the relationships that our medical center directors have with their communities and at all levels we're having this engagement to bring more providers on board.
▶ 1:14:05Great. Thank you. Uh Ranking Member Bazinski recognized for five minutes.
▶ 1:14:09Yeah, thank you. Actually, I'll probably pick up where you've left off. I think that's exactly kind of my concern as well, which is this is a great tool, but if we don't have enough um you know, we're estimating I think it's about 2% community providers that are participating. Um it's just not enough adoption and we want to see more adoption. So, I appreciate what you've said about prioritizing that.
▶ 1:14:31Um, I just I'm curious, um, if I could drill down a little bit more, how do you think the VA is defining what a sufficient network would be of community providers for any one given facility?
▶ 1:14:46Thank you for the question. Um, ultimately we want to make sure that our our veterans are able to select the care that's right for them. So I I I can get back to you with a specific number of uh or percentage of community care providers that would be sufficient, but it'll be reflected in a veteran being able to select the care that's right for them.
▶ 1:15:06And we've seen enormous growth in the number of community care providers that are participating in our pilots that are underway in Charleston and Atlanta where we've really spent dedicated effort to grow our network of community care providers deliberately. Um and and those percentages continue to grow and it's reflected in the number of appointments that we've uh successfully booked over the last three months over those pilots.
▶ 1:15:31We've booked more than a thousand appointments which is um more than nationally were booked in January of 2025 before this administration took office. So we're seeing enormous growth. Um but ultimately uh we we want to get as many providers as possible signed up. Could you give a little bit more specificity on what that growth looks like? I think you mentioned North Carolina. Is that what North Carolina was the the state that you've focused in on?
▶ 1:15:58So given that state because that's been a priority like what is the percentage of participation in that state now that you've been there that will have community provider
▶ 1:16:10today in our pilot sites in Charleston, South Carolina, and Atlanta, Georgia. uh we're uh approaching 7% of our community care providers that are currently uh participating and that number continues to grow. Um when this administration took office there were fewer than there was about 3,000 providers nationally that were uh signed on to EPS and and we're over 34,000.
▶ 1:16:35So we've seen a 10x increase in the number of providers that are currently uh enrolled in EPS. But uh but we we want to continue to accelerate that growth.
▶ 1:16:45And and just because we're in Michigan and then I represent Illinois, do you know any of the statistics on the percentage of adoption of community care providers in our states?
▶ 1:16:55I I do. Uh there's a lot of room for growth here. Uh Dr. Houseman can help with some of the specific numbers here in Michigan. Uh but um but this is an area where we want to be able to bring the benefits that our veterans are experiencing at our pilot sites in Atlanta and Charleston. We want to be able to bring those benefits here to uh veterans in Michigan. We want to bring them uh to your veterans in Illinois.
▶ 1:17:20Yeah, in Michigan uh participation is low at the moment. Um but I do want to comment on that. So Michigan is one of the states that when the program was kind of paused
▶ 1:17:29and reset and rescaled, Michigan was kind of put put on pause for a period of time there. Um but what's important is there was actually some groundwork that was laid here in the state of Michigan up to that point. Um and conversations have taken place since then that I think will allow us to get um some key providers um you know ready and preparing to participate sooner than later. Um specifically we've been engaging with Trinity Health and University of Michigan as well as Henry Ford and Ohio Health.
▶ 1:17:56So right there are four larger health systems um that would make a huge impact uh in terms of um um you know volume of care that they provide and of course improving the efficiency and the experience for veterans. Uh last thing I would note is we we do enjoy a very um productive relationship with the Michigan Health and Hospital Association. Um and they are an active partner with us and engaging some serve as an inter intermediary or almost a can help us with making introductions u and highlighting the benefits of this program.
▶ 1:18:26So that's a really important uh relationship that we have that we're going to leverage moving forward.
▶ 1:18:30And when you say it it's very low just to put a finer point like where where are we numbers wise? So for the four facilities in the lower peninsula of Michigan, we have between five and 800 providers uh EPS providers enrolled. Now the majority of them are teleaalth mental health providers that are part of a national practice. So when you look at providers that are actually kind of able to see veterans in person in our region, it's going to be much smaller.
▶ 1:18:59Okay. Um I will um yield back to you. I just ran out of time.
▶ 1:19:04Sure. Sure, that's fine. We'll do another uh we'll do a second round. So, um Dr. Houseman, then um
▶ 1:19:10what about I know you mentioned um some of the larger hospital networks that you've made inroads with, but what about the small community providers, physical therapy, for example, that might be an independent um practice, you know, close to home, something like that you got to do twice a week on your way to work. Um it makes a lot of sense to do that close to home.
▶ 1:19:31What work have we done to do outreach to those smaller, you know, um providers that may not have the robust technology of a major major hospital
▶ 1:19:42Yeah, I would say that's where we've we've made the most concrete gain so far. So, for example, we have uh in Ann Arbor podiatry, Battle Creek in Detroit dermatology, aiology, uh optometry and dermatology and sagen plus mental health. So we um you know as we kind of look at strategically how to grow this program um the large health systems we know take some more time.
▶ 1:20:03They have their own processes and bureaucracy and um and a lot of you know a lot of the key to that is is kind of the relationships that can kind of help open the doors and get the convers conversation started. Um but we find that with the smaller clinics, the podiatry clinics, the chiropractic, acupuncture, etc., optometry, it can be a much faster and direct process. And we particularly um engage those that are doing a good volume of veteran care already um and that are of course doing a good job taking care of veterans.
▶ 1:20:32Okay. Um and then what about our um smaller, you know, independent hospitals, for example? We're going to hear from some on the next panel um that aren't part of a big, you know, conglomerate hospital network that goes from coast to coast in Michigan. I have a couple of those in my own district. Uh what are we doing to not overlook the services they can provide?
▶ 1:20:51Yeah, I mean that's a real opportunity as well. Um so as we, you know, as we approach this challenge of enrolling providers, um we do take a look at data. So, we typically, you know, we we look at providers number one that are doing a good amount of veteran care and that we know do a good job of taking care of veterans. So, you have to start somewhere and that's where we tend to to start. Um, but not not to cut you off, but if they're not currently being looked at for community care, how do we know that they're serving veterans?
▶ 1:21:18I mean, a proportion of the population is veterans that they would naturally serve already, but I guess how is that a threshold if they're not in the system? We know they're providing quality care because they're licensed. They're they're doing it. They're, you know, we can look up their records and compliance, their customer reviews, all of those things. Um, but how do we know how many veterans they're serving
▶ 1:21:40So, yeah, great question. So, we um so for VA paid care, we know exactly how many referrals we send to exactly which providers in the community. That's something we track actively. And as we engage with the uh enterprise EPS team, that's kind of how the conversation is started. um who are the providers that you rely on most? Who which providers do a good job? You know, we know they provide good quality and that's where we start to build out the strategy for
▶ 1:22:04Okay. So, if a a hospital was not currently being referred patients from the VA, it would be much harder for them to initiate that community care
▶ 1:22:14Yeah, I would say if they're not doing VA care, um they're probably not going to be towards the top of our list. That said, if there is an interest, especially in an area that is not well served, um we would be very very happy to engage early.
▶ 1:22:27Okay. Thank you. Uh Mr. Schwarz. Uh, what do you see as I know you're on the the tech side of this
▶ 1:22:35um is I know that in general, this is a broad statement, but um a lot of physicians have complained to me, not in the VA system, just out in general, their frustration with health record referrals, with different health record systems, with, you know, having to manage all of that when they should be spending their time on patient care. If this is viewed as one additional tech thing they got to figure out, yeah,
▶ 1:23:03there might be a resistance to that. How are we able to break down that that barrier for for those that might be a little more old school in their practice? For
▶ 1:23:12their way of thinking, I appreciate the question. What our complete focus is is ease of use. We have to develop the technology that brings the grids in from our external providers to make it as easy as possible. So what our team has developed is a way to grab only the information that we need because I also hear complaints or concerns about privacy and security as well taking other patient information that are not veterans. So we want to make it as easy as possible.
▶ 1:23:37We allow the providers to put the information that they need and only the information that they need in a very easy place for us to use technology to grab that as opposed to building connections or building out new systems. We work with what they have so that there isn't any new setup they have to do or any new setup or configurations they need to buy because that's another concern we have.
▶ 1:23:59Great. Thank you. Uh ranking member Zinski recognized for five minutes.
▶ 1:24:02Thank you, Chairman. Um could I ask Miss Harris just to further elaborate on your testimony? Um because we know the number um the history of GAO's you've had a number of audits of the VHA scheduling uh process. could you just flag concerns that you have in the way EPS has been deployed um over these several years and then currently and then maybe what you'd recommend or what observations you'd be looking for to say hey we're making real progress here.
▶ 1:24:32Sure. So um what we do know is that I think VA has a very good handle on the reasons for why um but their medical centers can't efficiently and effectively schedule these appointments for community care. They've been systematically identifying these reasons over years at this point. Um, but it all points to this is a very labor and resource inensive process.
▶ 1:24:55And I want to make sure we don't have blinders here because EPS is focused on the actual process of scheduling the appointments, but there's also managing the referrals and monitoring the weight times too. So you that's how we need to holistically be looking at scheduling appointments.
▶ 1:25:10And that's also um one of the reasons why providers are reluctant to join EPS because there's also okay once they have the referral they're required to submit medical documentation after the initial visit and the final visit and getting that documentation to back to the VA medical facility is is a very difficult process. Um, so that's sort of the bigger picture here.
▶ 1:25:36And anecdotally, what we have heard is while EPS does, yes, it shows promise, but getting community care providers to sign up has been difficult. And at this time, the onus has been on the facilities. They've received very little help from VHA, at least the sites that we have talked to, um, in in getting that support to to get the the community care providers to sign up.
▶ 1:25:59There's also issues with okay once a community care provider has been signed up the coding of their specialties is also in many time in many cases inaccurate. So they go to they that there's still it still requires a phone call by the scheduler to ensure okay a particular aspect of cardiology is in fact you know accurately you know is accurate on the or on within EPS um as as an example and then also getting as um as Andrew
▶ 1:26:29had said you know specialty care like you know pulmonology, cardiology, oncology getting these specialties and and the and the providers ers that that support those specialties into EPS has also been a challenge as well. So I I just want to make sure it that we focus not just on the act of scheduling appointments, but it's this holistic process and that's part of the reason why providers are reluctant to to participate.
▶ 1:26:56Could I just ask Mr. Gratison, like in those conversations with the providers, helping to demystify the process for them and getting them on board, you know, just responding to what Miss Harris has kind of outlined. How have you been kind of working with these community providers to get some of these specialists more on board? What could you share some more specificity around that recruitment process and how it's
▶ 1:27:19Absolutely. Thank you for the question. and and this is an area where we've been fortunate to be able to partner with GAO to better understand the nature of this issue and to engage our community providers. So part of this uh and I'm pleased to report we now have 75 total active specialties uh that we're able to offer through EPS.
▶ 1:27:40Uh but we want to continue to grow that footprint uh because ultimately our measure of success will be our veterans being able to access the exact service that they need in the mo in the way that's most convenient to them. When it comes to u making sure that that we're able to offer our suite of services, um it's it's it's no different uh than engaging anyone else and being able to dispel any misconceptions here. We want to make EPS as robust as possible.
▶ 1:28:10Uh a unified platform where a veteran can compare direct care appointments and community care appointments. Um and we think that ultimately uh they'll continue to select our care more often than not. Um because we'll put up our weight times against anyone in the community.
▶ 1:28:28Okay. I was just going to ask you one question though, just to interrupt a little bit on the community care piece and to drill down on the scheduling when you're recruiting them. Are they are once a community provider is in the system, do they when we're talking about scheduling have that opportunity to approve or accept um the appointment or what is do they retroactively get to do that?
▶ 1:28:52Well, I I I would um engage my partner from Office of Information and Technology when it comes to approval or disapproval, but uh when when a community care provider makes an appointment available, it's our expectation that we'll be able to fill that slot.
▶ 1:29:07So, they can't reject it. just to confirm, you're asking the rejection by VA saying
▶ 1:29:14by community care, the community care provider. Can they reject the
▶ 1:29:20No. Once once it's made available, it's it's accepted. They can always cancel an appointment if a doctor is sick or something, but no, we expect we expect that the veteran can book that appointment then.
▶ 1:29:30We're going to try and do a uh third round, but we might go expedite it. It's two minutes for third round. Okay. Why don't we do that? Um just to um uh accommodate for the for the next panel. Um uh appreciate the conversation though. I wanted to get a sense um Miss Harris, if you have any thoughts on this.
▶ 1:29:48There's been allegations that there's been a resistance within VA to embrace community care as a um as a um option for veterans by maybe slowing down the implementation or things of that sort. Do you feel that there is a resistance within VA to make community care scheduling as easy as possible or is there a reluctance within the VA to to maybe skew more veterans toward the internal VA care?
▶ 1:30:18Yeah. Well, we made a recommendation to VA and to VHA to take a look at the 7-day calendar standard for scheduling um an appointment for community care. Um and and we and they which they did which they did take a look at. They looked at the standard and they ultimately decided to keep the 7-day standard. And like I said earlier, less than 40% of facilities are able to meet that standard um for for at least half of those appointments.
▶ 1:30:48And so again, I think these facilities are overwhelmed because the process is very labor and resource intensive. I don't I mean through the course of our work I don't we haven't seen any evidence that this is done on purpose but because it is such an a labor and resource inensive thing these these facilities are very overwhelmed and if VA isn't going to adjust the standard then they need to find a way to help these facilities to meet it.
▶ 1:31:16Yeah. And with 36 now layered systems on there, it begins to question, okay, what like at what point are we having too many systems interface with one another causing too much error tendency either between systems on the IT side or whether through the human error of inputting into those systems just
▶ 1:31:36uh crossfilling and everything else. So um thank you. Appreciate it. Ranking member Bazinski. Yeah, I just have one final question and actually if you wouldn't mind, Carol, is it just further elaborating on a question I'd asked earlier around uh what would the GAO need to see to kind of better um I guess a signal that would be sent from the VA that they're actually working to fix some of these issues.
▶ 1:32:02And I'm glad to see that you're working together, but what would be those steps that you would say they're making progress? I mean, the foundational step is for us to see a strategic plan. We need to see how VA intends to stream and standardize their appointment scheduling process from managing the referrals to setting up the appointments to following up and and maintain monitoring those weight times that holistic process and then we need to see the IT architecture that's going to support that that end state.
▶ 1:32:31Um so we need to see okay if it's EPS you know as one of the major tools that they intend to use okay um how that and any other new applications coming online how that is going to support that end state and then also of the existing 36 plus systems that we have what are they going to do to turn them off or if they're going to keep them on how that's going to be integrated with all of the other applications that they have.
▶ 1:32:56So we need to see uh a holistic strategic plan from them because otherwise all of these initiatives EPS you know included if we don't have that end state then the current things they're doing are well-intentioned but they are aimless.
▶ 1:33:12Can I just ask Mr. Gretison is that something the VA would be open to doing is putting together kind of a master plan. I will say having getting the opportunity to serve on this committee, we know there are very large implementation plans. EHRM, EPA, these are all critically important, but it does seem like one bigger vision, um, a bigger master strategy might be helpful to bringing these systems in.
▶ 1:33:35Well, I appreciate the opportunity to address this because we're aware of a number of the open recommendations from GAO's May 2025 report and um look forward to delivering uh comprehensive timeline and plan to the GAO. We expect to be able to deliver that so that we can close that um later this summer.
▶ 1:33:57Great. Thank you. Yield back.
▶ 1:33:59Thank you. Um thank you so much for our first panel. uh appreciate you all coming uh to Grand Ledge, Michigan to the seventh congressional district of Michigan to provide testimony today. We appreciate your uh partnership in that. So, thank you for being here. Um and uh you're now excused and we will wait for just a moment as the second panel comes to the witness table. So, if you're on the second panel, if you can come up, um they will put your name tag out for you as well.
▶ 1:34:30We're gonna do a quick shift change.
▶ 1:34:37Yeah. Thank you.
▶ 1:34:41Yeah. Thank you.
▶ 1:34:45Oh, okay. Yeah.
▶ 1:34:50Oh, yeah. Yeah.
▶ 1:34:52Um, on our second panel, we have Mr. Dr. Jed Hansen, co-chair and founder of the Rural Veterans Health Special Interest Group at the National Rural Health Next, we have Major Michael Reev, director of veteran affairs for Shywasi County. Finally, we have Mr. Ben Frederick, associate vice president of advocacy and government relations for Memorial Healthcare and a former colleague of mine in the Michigan Legislature. So, thank you all three of you for being here today. Uh, I'll ask the witnesses to please stand and raise your right hand.
▶ 1:35:25Do 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? Thank you. And let the record reflect that all witnesses have answered in the affirmative. Thank you all once again for attending today. Mr. Hansen, you're now recognized for five minutes to read your opening statement on behalf of National Rural Health Association. Are you ready to go? Very good. Thank you.
▶ 1:35:50Sorry. There you go. Microphones on.
▶ 1:35:53Chairman Barrett, Ranking Member Bazinski, thank you uh for the invitation to Michigan's 7th district and for the opportunity to testify today. I appreciate your leadership in this committee's continued commitment to improving access to care and services for our nation our nation's veterans and service members. For those of you on this committee that have served, thank My name is Jed Hansen, a co-chair of the National Rural Health Association's Rural Veteran Special Interest Group. I also serve as executive director of the Nebraska Rural Health Association.
▶ 1:36:25Congress expanded veterans ability to receive care through the mission act in From my perspective, EPS represents a promise kept. This committee and Secretary Collins and the current VA administration should be commended for prioritizing modernization of the veteran experience across rural America.
▶ 1:36:44This effort is seen as both a commitment to our veterans and as an investment in our rural communities, hospitals, and While veterans may be eligible for community care, eligibility alone does not create appointments. As we've heard uh from some of our other testifiers today, EPS helps translate eligibility into access by connecting veterans, community providers, and VA schedulers through a more coordinated process to uh ultimately reduce administrative burden, improve scheduling efficiency, and expand access.
▶ 1:37:16The National Royal Health Association's special interest group recently identified expansion of EPS as one of its two policy priorities for 26. Through discussions with rural providers, hospital leaders, veterans, and policy makers across the country, one question continue to emerge. How do we move from early adoption to broad statewide utilization? In my home state, we're attempting to answer that question. Nebraska's goal is simple.
▶ 1:37:42achieve the level of provider participation necessary to make EPS a reliable statewide scheduling tool for veterans, providers, and VA schedulers. To support that goal, the Nebraska Ral Health Association developed a statewide EPS expansion strategy in partnership with the Nebraska Hospital Association. Nebraska DHHS and ultimately our governor's team incorporated that approach into Nebraska's rural health transformation program application creating a strong statewide partnership around this implementation strategy.
▶ 1:38:12The strategy seeks to engage Nebraska's broader rural healthcare network including hospitals, clinics, FQC's, behavioral health providers, dental practices, and more to create that critical mass that you've been talking about needed for network adoption. uh this effort uh this this will uh this will demonstrate how existing federal investment can accelerate The veteran EPS project represents the very best of what RHTP funding can be.
▶ 1:38:42Funding that supports technology, that improves access to essential services for veterans and supports rural workforce. The VA's effort to expand scheduling of compensation and pension examinations through EPS also represents an equally important opportunity. Efforts that are particularly important for transitioning service members who may be unaware of available resources and as they transition into civilian life.
▶ 1:39:07Just as EPS can improve access to health care services, it can also help connect veterans to disability evaluations needed to establish service connected conditions and access their earned benefits. Supporting provider training, onboarding, and outreach is going to be essential. Expanding local capacity alone is not sufficient if veterans remain unaware that these services or examinations are available within their own communities.
▶ 1:39:32Nebraska plans to support regional veteran benefits and resources events that connect veterans, their families, and caregivers, and local health care pro professionals to services, disability benefits resources, and the community support programs that they need. This first-of-a-kind statewide program is designed to raise awareness for all those supporting veterans in rural areas. Taken together, Nebraska's plan reflects a broader lesson. Improving access requires more than technology alone.
▶ 1:39:59It requires technology, provider capacity, and outreach working together to ensure veterans can successfully access both healthcare services and benefits. Our experience with EPS and other statewide healthcare modernization initiatives suggests that technology adoption is most successful when innovative tools are paired with trusted implementation partners.
▶ 1:40:18Trusted state and regional organizations such as the center for uh for rural healthcare here in Michigan or I can in Illinois are great examples of who those partners could be in your own Based on our national discussions in Nebraska's implementation plan, I respectfully offer these three recommendations to the committee. First, continue supporting statewide implementation strategies that achieve broad participation among community providers.
▶ 1:40:45Second, pair technology deployment with provider onboarding, training, and technical assistance and outreach to to ensure successful adoption and utilization of EPS. And third, continue advancing interoperability and care coordination between the VA and community care providers. Scheduling is a vital first step, but future success will increasingly depend on stronger integration of referrals, clinical records, benefits, processes, and care coordination workflows.
▶ 1:41:12EPS is undoubtedly transforming eligible uh technology to access care for veterans, but ult but the ultimate measure of success will be whether veterans actually are able to utilize these Chairman Barrett, Ranking Member Bazinski, thank you again for the opportunity to testify and for your commitment to our nation's veterans and service members. I look forward to your your answering your questions.
▶ 1:41:33Thank you. And uh Mr. Hansen, your written statement will be entered into the hearing record. Uh Major Reeve, you're now recognized for five minutes to deliver your opening statement on behalf of Shyasi County. Thank you for being here.
▶ 1:41:46Chairman, ranking member, and [clears throat] distinguished members of the committee. Thank you for the opportunity to provide testimony regarding the challenges veterans in Shiwasa County, Michigan face when accessing VA healthcare. I serve as the director of veterans affairs for Shyasa County and I'm also a veteran with 27 years of active duty service. Through both my professional role and professional or personal experiences, I have gained firsthand insight into the barriers veterans encountered when seeking care through the Department of Veterans Affairs.
▶ 1:42:15As a rural Michigan county, Shyawasi has a veteran population of approximately 5,000 individuals. Many of the veterans we serve are older adults. As our demographic suggests, the average age is 75 years old. Many of these individuals have disabilities and limited transportation options. As of 2018, we have transported 4,729 veterans to VA appointments at VA facilities or to referred health care providers.
▶ 1:42:44Assessing care often requires travel to these VA facilities, mostly in Sagena and Ann Arbor, which are urban, making reliable appointment scheduling, communication especially important. Of note, it takes our drivers 1 hour 22 minutes to travel 74.5 miles to Ann Arbor or 52 minutes traveling 41.46 miles to Sagena.
▶ 1:43:07We have also transported veterans to Battle Creek, which is 1 hour 37 minutes at 102 miles, and also Detroit, which is 1 hour, 33 minutes, and 87 miles. Veterans frequently experience long wait times for appointments and specialized services. In some cases, they are told the next available appointment is more than a month away, leading some to seek care through the emergency department for more immediate attention.
▶ 1:43:30We've also encountered situations in which appointments at the Sageno or Ann Arbor VA Medical Center are cancelled or rescheduled without timely notification. This can create unnecessary travel and strain limited transportation resources. I've experienced this personally as having driven to Ann Arbor for a medical appointment only to arrive and learn upon arrival that it had been cancelled without prior notice. Excuse [clears throat] me.
▶ 1:43:55Additionally, we have observed situation in which veterans establish successful relationships with their local community care provider only to have their care redirected back to the VA facility when that service or specialty becomes available through the VA system. These transitions uh often disrupt uh continuity of care and create frustration for the veterans who then must adjust to new either new providers or treatment plans.
▶ 1:44:21From both my professional and personal p perspective, improving communication, reducing appointment delays, and supporting continuity of care would significantly enhance veterans access to the healthcare services. The challenges we see in Shyawasa County reflect broader trends affecting veterans throughout Michigan and across the nation. More than 30% of Michigan's veterans live in rural communities where transportation barriers and travel distances comp uh complicate access to care.
▶ 1:44:51Federal oversight agencies and independent researchers have also identified ongoing concerns regarding appointment schedulings, wait times, and coordination within both the VA and community care systems. These findings reinforce what we experience every day at the county level that timely communication again, efficient scheduling, and reliable care coordination are essential to ensuring the veterans receive the health care they have earned through their service.
▶ 1:45:17I appreciate Congressman Tom Barrett's leadership and collaboration on the Veterans Community Care Scheduling Improvement Act, as well as a continued utilization uh and a few tweaks for the external provider scheduling system. These efforts represent meaningful steps toward improving care, coordination, and helping veterans access the health care services they have earned through their time and service to our nation.
▶ 1:45:42Thank you for your attention to this important issue and for your continued commitment and improving the access to America's veterans. I look forward to answering any questions.
▶ 1:45:50Thank you, sir. Thank you again for being here. And the written statement of Major Evil will be entered into the hearing record. And uh Mr. Frederick, you're now recognized for five minutes of your opening statement on behalf of Memorial Healthcare.
▶ 1:46:01Thank you, Chairman Barrett, Ranking Member Bizinski. very much appreciate the invitation to participate in this hearing and offer comments on providing worldclass health care services to our veterans in rural mid Michigan. I have the pleasure of serving as associate vice president of advocacy, government relations, and business development for Memorial Healthcare, which is a midsized independent rural hospital located in AASO, Michigan. We serve patients at our main hospital in Wasau and more than 40 outpatient sites across six counties.
▶ 1:46:29a very wide swath of service delivery rank from the standard inpatient to numerous specialty offerings including neurology, orthopedics, rheumatology, pulmonology, oncology, freestanding uh cancer center, GI, home health. I do that list to speak to the continuum there. The other thing, and Mr. Chairman, I appreciate you mentioning is that it's not just a hospital building. It's a continuum of care and in rural areas there is a predominance of employed providers that are in that primary care space.
▶ 1:46:59So the front door to the health care access system 90 plus percent chance that that primary care family medicine provider is going to be a memorial healthcare employed uh provider. So it's a true continuum of care. We very much align with the mission of this committee as the origins of our hospital were directly inspired by the community's desire to serve the veterans of mid Michigan following World War I. Our original 1921 edifice still stands as an ongoing memorial honoring those veterans and the many who have followed.
▶ 1:47:27In fact, our legal name remains the memorial hospital. And our campus is home to AASO's war memorial honoring those who perished in World War I. Our system CEO sends his best regards to this committee and regrets being unable to address you personally. He himself is a veteran of the United States Marine Corps and many members of our leadership team and 800 members strong workforce are proud veterans of the United States military.
▶ 1:47:50The culture of Memorial has long included recognition of our team members who served and a commitment to providing healthc care to the veterans who live within the communities we serve. One of our most solemn traditions at Memorial is a code honor staff recognition which marks the passing of any inpatient or long-term care resident who served who is at our facility. We flag a patient's veteran status during our intake process to ensure a ready connection as we can with available services.
▶ 1:48:15And we also strive to ensure veterans are aware of their benefits and are enrolled as a participating provider in a community care program and through partnership with our county VA. Thank you, Chairman Barrett, as well for your efforts to ensure that the VA proactively notifies veterans of their options to receive community care through other work that you've done. Previously, veterans had to know and proactively urge uh the the utilization of those local services.
▶ 1:48:39This simple change in how a conversation is even initiated at the VA will drive convenience and cost savings, timely care, and better outcomes to the VA system. But it's also a bit of a warning as to how much work needs to be done in addressing that basic communication or culture so that the veteran is not constantly placed in that self- advocate position of knowing what to ask when and so on. But thank you for that effort. In 2025, we served over 400 individual veterans in our inpatient setting and over 400 in outpatient care.
▶ 1:49:07Hundreds more veterans were served with primary insurance that was outside of uh VA insurance. We are not satisfied with those totals and I'm sure if you talk to other rural hospitals, they'll have similar responses. However, they they they represent a small portion of the estimated veteran population who call Shywasi and rural Mid Michigan home as noted by uh Major Reev. But it does speak to the fact that we have I think a a additional utilization capacity that uh but for the option uh we would absolutely embrace.
▶ 1:49:37As a community hospital in a rural region, our patients already face significant challenges that limited access to essential health care services, the transportation, average age. Our veterans carry the additional burden of wounds, both seen and unseen, which can affect their willingness to seek care and their ability to stay connected to care when facing frustrations or barriers. Independent hospitals offer a true partnership that is community focused.
▶ 1:50:03Our competitive advantage is personalized patient care and that direct connection we establish with each individual and addressing specific The overarching concern I would wish to bring to this committee uh on behalf of our team is simply the degree of self- advocacy we see from veterans who are trying to remain with us as their medical home. There's a big travel distance for us as mentioned by the chairman. But the burden often does follow on fall on the veteran themselves to initiate followup and navigate that system that does not communicate across its own components.
▶ 1:50:31So the aspirations of these efforts are quite exciting to us. We're doing as much listening and learning today as anything. Um but it's not something that we've presently looped in on and we want to make sure that any type of implementation is is in accord with our own personalized standard of care and that patient experience as well. and we thank this committee very much for the attention and the time. Thank you.
▶ 1:50:52Thank you, Mr. Frederick. And uh thank you to all of our panelists. Um um the statement, the written statement, Mr. Frederick will be entered into the hearing record. And uh I will yield myself five minutes uh for questions. Um Major Ree, you uh very um succinctly pointed out the commutable distance for veterans seeking care in a traditional VA facility. uh for whether you're providing that transportation service or whether they're on their own traveling there.
▶ 1:51:22Um you know I think about I I think you referenced those are probably from AASO to these facilities I would imagine. Is that correct?
▶ 1:51:33That is correct.
▶ 1:51:34Yeah. So if you live in Perry or Langburg, you're even further away from say Sagena or Detroit or any of these other facilities that may be, you know, a further drive for you in that instance, making it definitely well over an hour for for a whole number of veterans depending on where they are geographically, even within the county or in other parts of my district in Clinton County, for example, and other areas as well. Um, these are things that I think stack up on people.
▶ 1:52:00Um but then you also pointed out that there is an issue of that um continuity of referral. If you start seeing a provider for a uh maybe a chronic condition that you have and you get referred out to community care and then six months goes by and that referral lapses and then they can get you into a VA facility within the limits of what the community care program allows for the VA to retain and it switches that provider.
▶ 1:52:27And I think for a lot of patients, having that continuity is very important. Having that same provider that you can build a relationship with is very important. And I think for veterans, maybe it's even more important depending on the types of challenges they're facing. Particularly when you look at mental health, for example, that you need to build a relationship with a provider over such a sustained period of time. Have you observed that in the veterans you've spoken to and the ones that you serve through your work?
▶ 1:52:53Uh, thank you for the question. Uh, I have a lot of times we'll see, as you just said, that veteran having that care at their home of record, if you will, and then having to transfer to a new doctor, new care. A lot of times the treatment plan will go back to something that has already taken place, uh, potentially a referral out to some more tests that those tests are already in their records.
▶ 1:53:24Um, there are other times that uh, specifically in my line of work, so I'm going to kind of narrow it down a little bit even further, but as a veteran service officer, we also process claims. And a lot of those claims, as you're fully aware, go towards CMP exams. Those CMP in I'll just use my case in particular. Uh, I had one scheduled clear up in Midland. That's a two-hour drive from AASO.
▶ 1:53:55And for this particular treatment plan, uh I looked at how many other providers were in between my house and Midland. There were 51 other providers. Now, whether or not they were part of the community care network, I can't answer that, but uh the propensity to use those providers was there. Sure.
▶ 1:54:17And if it's not a, you know, hyper specialized type of treatment that's only done by a few providers, it begs the question of why they're not using the full complement of availability that that's that's out there. I mean, certainly they're licensed through the state or or otherwise to prove their adequacy of of doing that kind of treatment. So, it really does beg the question of why they're not being utilized by the VA for that. Um, Mr.
▶ 1:54:43Frederick wanted to ask you through Memorial um what I guess what options do you see or what uh partnership availability do you see with the VA and where are the shortcomings coming from your side of the perspective to open up the pathways for more veterans if they choose to seek services closer to home through the types of services that you provide through Memorial.
▶ 1:55:08I think there's a few uh areas that have been mentioned by my team. I think we've heard a little bit about the conne the connectivity issue and just the communication issue with with other uh insurance coverage. We're able to be more of an advocate alongside the patient to keep them connected with their care, but so often we see in between visits, they're charged with that next connection point and we're kind of waiting to see what the determination is going to be. To your point about the relationship, are they going to be able to maintain that specialist relationship?
▶ 1:55:36Um often times we have concurrent ticking clocks on number of visits and duration of authorization which which uh compounds
▶ 1:55:44I've seen that yeah
▶ 1:55:45which compounds the issue. That's actually the chief reason where we slip into denial situations is actually just that we we miss a a deadline like that. But there's a lot of pressure on that on that um
▶ 1:55:57uh on that veteran. The the other is uh things that would be rather routine like diagnostic uh transfer from the VA uh visit back to that uh community care primary [clears throat] relationship or we stuck with a redundant testing situation or is that veteran now the courier for that information.
▶ 1:56:15So in the technology side uh secure electronic file transfer type of a model comes to mind pretty readily there. Is there a way for us to have some of that bilateral conversation? I think some of this is in very good faith, but it is still kind of a one-way communication and if we could really have that bilateral communication in a number of veins, our care team is eager to serve more and also show what we can do. You've been to our facility and know our capabilities. If it's the veterans choice, we certainly want to serve our
▶ 1:56:42Very good. Thank you, Ranking Member Bazinski, for five minutes.
▶ 1:56:45Thank you, Chairman. Um, I want to really applaud what's happening in Nebraska and the work that you're doing, Dr. Hansen. Um, I'd like to spend a little bit of time on that and and learn from your work. Um, in your testimony, you indicate that the Nebraska Rural Health Association developed a statewide EPS expansion strategy. So, I was wondering if you could spend some time talking about what was included in that strategy, how it went, lessons learned. Would love for you to talk about that.
▶ 1:57:12Yeah, I absolutely love that question. So, thank you for asking it.
▶ 1:57:15Sure. Uh so through uh RHTP we developed a a plan where we could provide funding to each of our rural hospitals uh their associated clinics, our FQHC centers in in rural Nebraska and then roughly 100 independent clinics and and offices. So thinking dental offices, therapy, etc.
▶ 1:57:39Um it's we're uh providing approximately 75,000 per hospital and then 20,000 per independent clinic site uh to um to help um accelerate that adoption. Uh with those dollars, uh those facilities can use that to offset any type of technical expertise that they're needing to be able to make that connection with EPS.
▶ 1:58:04Uh one of the early challenges that we found with uh some of our larger uh tertiary centers was just the the data mapping or the schedule mapping and those decision trees that were needed with with scheduling. Uh we also um are encouraging or will be encouraging uh local providers to to sign up to get training so they can provide CMP exams understanding that um that um is a future strategy of the VA. And then to just uh we know that there's a backlog of that as well.
▶ 1:58:33So to to encourage that. Then the final piece uh I briefly been able to mention was the idea of these regional benefits uh
▶ 1:58:43Um I've had the the the fortune of um a NASVA which is the National Association of State Directors of Veterans Affairs a few of their events. And a couple of years ago, I was um walking the vendor hall and I was amazed at at how many different benefits and and um different services are available for our veterans. I was also equally amazed at how little information is out there and how few know about all those services.
▶ 1:59:12So, we're really looking to uh in Nebraska to connect our hospital teams, our community health professional teams, and then in these regional events, making sure that our veterans know uh about the access that they have, the benefits they have, their caregivers, and then our community teams so that we're really taking that comprehensive look at it. Um the other thing that really can't be dismissed here is that um making sure that our local VAS are are synced up.
▶ 1:59:41um those schedulers have historically taken on a lot of work and it has um I was amazed at hearing how many different um systems are are actually involved on the VA
▶ 1:59:52So we've been working very closely with um the the VA center uh for Nebraska Western Iowa and that leadership team uh to uh to work on communication strategies. Um it's netted even very recently just what that relationship looks like. We had a veteran presented to a critical access hospital. they ended up being moved over into a swing bed um uh um care plan and the local facility was receiving denials.
▶ 2:00:19Because of those deeper deeper relationships that we've developed in Nebraska so that we can serve as that liaison, we able to connect in the VA team so they could work on that strategy so that it didn't have to rely on the veteran to be his um in this case his own advocate uh for um for for service coverage there. That's really that's really impressive. Can I just um drill down a little bit more? How can you tell me how many providers ended up then in Nebraska um actively sharing their grids with the VA through EPS?
▶ 2:00:50Yeah. So, uh currently we have uh we have a a handful of our critical access hospitals and then we do have both major um our tertiary centers are our medical centers in the state sharing. Uh those efforts to date have been focused more on targeted specialty. Um understanding that cardiology was a significant uh challenge in our state. We've also been rapidly expanding u mental health and physical therapy in our state as well.
▶ 2:01:19um through uh through RHTP that that um there are certainly some challenges with the with the roll out and the procurement processes with that uh but the plan is to to effectively connect the entire rural healthcare grid in the state over the next couple of years
▶ 2:01:35and and I'm just curious have you gotten any push back from providers then that have been utilizing EPS since they've gone live? Yeah, the the uh the biggest challenge or the biggest push back and challenges one was that scheduling uh mapping that was needed and looking at some of those decision trees especially for some of the specialty services. Uh and then the other one is is just related to that critical mass that's that's ultimately needed.
▶ 2:02:03um when our VA schedulers aren't used to being able to go out to a system and netting a positive um appointment, uh they're less likely to continue that adoption. And so we um we're understanding that we need that. Any type of technology network needs critical mass and this is one of them. And and we were fortunate enough to be able to to work um to develop a plan and then uh one that our state ultimately adopted.
▶ 2:02:27Great. Thank you. I will yield back.
▶ 2:02:29Thank you. We are going to do a second round of questions, but we'll um go to two minutes uh for the second round if that's okay. Um very good. Um Mr. Frederick, just picking up where we left off when uh time expired, you you mentioned a couple of things that I think are important. One is the testing redundancy or diagnostic redundancy that is done when moving health care back and forth between VA and then outside of the VA.
▶ 2:02:52One of the efforts we've undertaken for modernizing the electronic health record is to more easily share that information both within the VA itself. Believe it or not, different VA facilities are not able to share that information today, but then also outside of the VA so that a uh a VA clinician can share information within a clinician outside of the VA network. So, that's an effort that we're undertaking.
▶ 2:03:15We'd certainly appreciate your feedback along the way as this is implemented uh both locally here in Michigan but also nationwide as well. Um but the other thing you pointed out is when VA refers out for community care often there is both a timeline that that stands for as well as a number of visits that are allotted.
▶ 2:03:34So you could hit your limit on one or the other before, you know, you might go for three visits for a referral before the 90 days that that referral stands for, for example, and then you're forced to kind of renew that referral or ask for additional, which can be, you know, bureaucratic and troublesome and can kind of um affect the patient care outcome.
▶ 2:03:57Can you talk about how that is different generally than a traditional health care model or health insurance reimbursement or another way that a patient may be referred for care? The the biggest difference is this combination of visits to time limitation. Uh typically when you're going through that authorization and you've determined that it's a covered benefit, you're able to proceed. Uh or you have a care plan that speaks to a certain number of engagements in a like a physical therapy setting over a period of time and that's just a known schedule.
▶ 2:04:27So it it is a bit disruptive for our team that does the the uh you know running the traps on this to try to manage both of those timelines and again whether they they've taken it on themselves or not mentally there's that recognition from the veteran themselves where they have to manage that too. The other challenge that we're seeing, and I know Major Reeve actually may be able to speak this as well, is that the frequency visits trends, they're they're worsening. So, the amount of recurrent visits that are allowed for certain purposes have declined in some of these areas.
▶ 2:04:56So, we're seeing some challenges with just being able to get a person through rehab or or effectively in a place where we're hopefully minimizing readmission, frankly.
▶ 2:05:06Sure. Thank you, Major Ree. I can give you a moment and then I got to yield to the ranking member.
▶ 2:05:11Thank you. Uh from what Ben was saying in particular we we have got a veteran that was receiving uh um some care and the number of visits uh I believe was 26 uh for this particular service. Uh the VA came back and said no we're cutting that down to 12.
▶ 2:05:33And then if you take in account the travel time on top of that, uh it's no longer feasible for this individual then to uh take time off of work uh in order to to go to that. In addition, there's another veteran who is on dialysis three times a week, has to travel down to Ann Arbor, has to have somebody with them.
▶ 2:05:55So now there's two people essentially taken out of the fight, if you will, instead of going to memorial care just down the road 10 minutes to receive that care back at home that afternoon instead of making it a whole day as we all want to be aware. Dialysis is one of those things that just take a lot out of both the individual and the family.
▶ 2:06:17Thank you. Appreciate it. Thank you both. Ranking member Bazinski.
▶ 2:06:20Yeah, thank you. And maybe I could just pick up with U. Major Reeve and just say, you know, again, thank you for being here, but thank you for your continued service. What you're saying is something that I hear from veterans in my rural district um pretty consistently. How do we get the VA to do better at communicating travel times? You know, we need to shorten weight periods. Um and so I'm guess I'm I I believe I think the VA needs to do better.
▶ 2:06:45Um, but I'm curious if you have any recommendations on ways that we can make those improvements in those areas.
▶ 2:06:53Thank you for the question.
▶ 2:06:55Uh, coming from a rural county in Michigan, uh, one of the big things I would say is the availability of a veterans record to a third party, if you will. Memorial I'll just use Memorial Healthcare as the example.
▶ 2:07:12Um, not only would if that individual selects through the community care network to receive their treatment closer to home, uh, when that individual files the claim and needs to go to a CMP exam, we can then utilize those same services for that. Another big thing and issue in a lot of the different uh, organizations and I hope I am speaking uh, okay for them are nexus letters.
▶ 2:07:37It's one of the key requirements that the VA requires when filing a claim in order to make that service connection. And without that, you're going to get denied most days of the week. A lot of times VA doctors are uh I don't want to say unwilling, but they're hesitant in doing so. I don't know if it's because well, I'll just leave it at that. I'm not quite sure why. And then that leaves the veteran themselves to find an independent provider to then write that nexus letter.
▶ 2:08:07When if that memorial healthc care was within that community care network, it would be a oneanddone service not only for the continuity of care treatment but then the further service in developing that claim.
▶ 2:08:23Thank you. I'll yield back.
▶ 2:08:25Thank you. And uh thank you to all of you on the second panel. Thank you for being here today. We deeply appreciate your testimony. So, thank you. Uh we are now going to move on to uh closing statements. Uh Ranking Member Bazinski.
▶ 2:08:37Sure. I'll I'll just be very brief and say thank you to all the panelists, both the first panel and the second panel for being here. Uh thank you for your hospitality in Michigan 7th district. Um it's it's an honor to serve on this committee. There's so much work that we have ahead of us on all of these different implementation programs, whether it's EPS, EHRM. These are big undertakings that the VA needs to be continuing to take on and I want to see them be successful. So I appreciate the opportunity to continue to do this work with you, chairman.
▶ 2:09:06So thank you.
▶ 2:09:08Thank you. And uh thank you me ranking member Bazinski for coming to my district today. I really appreciate that. Uh and I also want to thank our friends at the Michigan Army National Guard for allowing us to use this facility. Uh Steve, please thank uh the tag on my behalf. I think he did say we can take the Lakota out for a quick trip afterward. Is that is that true? Okay. It's already out there. Great. Yeah. Well, just I won't put a scratch on it, I promise. Um but uh please uh give him our appreciation as well.
▶ 2:09:36And to everybody here at the uh support facility, thank you for accommodating us today. And thank you to our witnesses for being here and sharing your realworld experience of what's going on both within the VA, from the GAO, and from our local partners and from our rural um uh leaders in this way to tell us how we can make this work because ultimately we share the goal of making this the best we can for the veterans that we serve.
▶ 2:09:59and and this facility that you're in today really serves as an example, I think, of the men and women that we are trying to assist with this. You know, this is deeply rooted in this community. We've seen people leave here on a deployment. Over the 20 year long war on terror, there was only a handful of months that we didn't have some unit from this facility deployed in the fight somewhere or another around the world. And we've seen people leave. we've seen, we've welcomed them back home.
▶ 2:10:30Uh you have soldiers that serve here and then maybe they leave after a number of years that their enlistment lasts for or maybe somebody you know one of my friends who I caught up with today is uh approaching his 38th year in service in the military. So it runs the full spectrum and and communities like this support all the different types of men and women who serve. often we are a little bit further removed from your larger active duty facilities that might have a more robust VA component accompanying them.
▶ 2:10:59So when people come back to a unit like this, they're dispersed across this community generally where they're commuting in from which makes them further away from certain VA facilities which I think then really brings about an urgency around how we are going to accommodate the community care network to best serve them in the area that we need to. So, we have a lot of work ahead of us to the ranking members point. Uh we owe it to our men and women to do that work.
▶ 2:11:25I'm committed to that and uh really appreciate everybody being here today and the work that we're doing here is going to be brought back to Washington DC to implement the best that we can. So, uh I will uh how about we have Hey, Lewis, can you come up here a minute? Do you want to swing the gavvel
▶ 2:11:42All right. So with that, I'll ask unanimous consent that all members have five legislative days to revise and extend their remarks and include extraneous material. And without objection, so order, this hearing is adjourned. Go ahead. All right. Thank you.