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U.S. House of Representatives,
Subcommittee on Oversight and Investigations,
Committee on Veterans' Affairs,
Washington, DC.

    The subcommittee met, pursuant to notice, at 9 a.m., in the Humboldt Field House, 1400 North Sacramento Boulevard, Chicago, IL, Hon. Ray LaHood presiding.
    Also Present: Representatives LaHood, Evans, Gutierrez, and Davis.

    Mr. LAHOOD. The hearing will come to order. Good morning, and welcome, all of you interested citizens and folks who are also going to be testifying.
    My name is Congressman Ray LaHood. And I am sorry that Congressman Terry Everett, the chairman of the subcommittee, is not here. Congressman Everett is from Alabama, and unfortunately he became ill a day or so ago and was not able to come.
    I had intended to come to this meeting and participate in the committee hearing, and I was asked to chair the committee this morning. I am from the central part of the State. Peoria, IL, is my home town, and I represent the 18th District. I am also a member of the full Veterans' Committee.
    So I would like to just make a brief opening statement and then call on Congressman Evans, Congressman Gutierrez, and Congressman Davis for any statement they would like to make, and then we will go to our first panel.
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    It is a pleasure to be here in Chicago. This hearing by the Veterans' Affairs Subcommittee on Oversight and Investigations on the formation of the VA Chicago Health Care System is at the request of our colleagues, Congressman Evans and Congressman Gutierrez.
    They have taken a great deal of interest and promoted this hearing, and we are guests today of Congressman Gutierrez, whose District we are presently in. And Congressman Davis has the adjoining District right next to Congressman Gutierrez.
    I want to welcome the Illinois veterans and other stakeholders in Chicago's integration process who are here today for this long-anticipated hearing.
    I believe that this hearing will add to the committee's knowledge about VA facility consolidation and integration because they are occurring all across the country and more are expected.
    The Subcommittee on Health held a joint hearing with this subcommittee on medical facility integration this past July. The VA in Washington is still refining its guidance to regional network directors on how the integration process should operate.
    And by the way, the term ''facility integration'' means the combining of two or more medical facilities into one functional organization to provide a coordinated continuum of health care to veterans.
    We are working with the VA to improve health care for veterans by improving the way facility integrations are accomplished, and obviously there is a willingness on the part of the VA to improve the process and better address stakeholder concerns.
    It must be recognized that facility integration under the best of circumstances involves difficult issues, and stakeholders have legitimate interests that concern them greatly.
    Several of the Chicago area service organizations will present their views, as well as the Deans of the University of Illinois School of Medicine and Northwestern School of Medicine, VA officials, and a representative of the Service Employees International Union.
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    I would like to recognize now the ranking member of the full Veterans' Committee, Lane Evans, from Rock Island, for whatever statement he would like to make.

    Mr. EVANS. Thank you, Mr. Chairman. I appreciate this opportunity to participate with you, and am pleased that you have come as far as from Peoria to be here with us today. The interests of the two down-staters, myself and Congressman LaHood, I think indicates our strong concerns about the VISN process itself as it is being applied here in Chicago as well as throughout the whole United States.
    As a member of the Illinois delegation, I am concerned about possible changes in VA health care in the Chicago area as a result of integration at West Side and Lakeside. I want to understand how the integration process is going and what veterans are to expect of their health care system in the coming years.
    I hope to hear from all parties concerned about how the Chicago system integration process is going. I also can assure everyone present that veterans have a real champion in the ranking member of our Subcommittee on Health, Congressman Luis Gutierrez, who has been tireless about continuing his commitment to keeping the dialogue between veterans, employees, trainees, and officials of the VA system here in Chicago.
    In fact, at a recent hearing we held in Washington, he offered to buy all of us lunch if we came to join him here in Chicago, and that is why I am here today as well.
    It goes without saying that our colleague, Danny Davis, also has been a real fighter for veterans and particularly here in the Chicago area, and we are pleased he could join us as well.
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    This July we had a hearing in Washington to examine facility integration throughout the whole VA system. We learned that there are a few things about the Chicago integration that make it especially tough, namely, that West Side and Lakeside have similar patient care missions, are similar sizes, are close together, and have active medical school affiliations that are important players in their hospitals. In hindsight, we should have expected this process to be harder than most throughout the country.
    During July's hearing, we ended up talking about the process VA should use to coordinate their integrations and the benefits veterans might gain by integrating some VHA activities and facilities with our current funding environment. Some facilities have saved millions of dollars and retrenched this funding into increasing access to primary care and other care that veterans need.
    Where the advantages to integrating services are less apparent, however, conflicts always seem to follow. I believe that this is the case is Chicago, where specific goals and benefits to various stakeholders have not been identified and the perceived losses to all parties are great.
    The lesson I took away from that hearing is how important communicating this information is and involving those interested in making decisions when they clearly understand their choices. VA managers must offer basic guidance in the goals, directions, and reasons for change proposed, and then assure that veterans and other stakeholders enter into the decision-making process.
    So I am pleased to join my colleagues today, and I think all of you can be assured that we are going to follow this beyond this hearing today. Thank you again, Mr. Chairman, for hosting the hearing.
    Mr. LAHOOD. Let me introduce Congressman Gutierrez for whatever statement he would like to make, and thank him and his staff, and also the Chicago Park District, for making this facility available to us. And I know that Congressman Gutierrez and his staff have worked very hard to arrange for this hearing this morning.
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    Mr. GUTIERREZ. Well, thank you. I want to thank Congressman LaHood for being here with us in Chicago. Thank you for coming up.
    Before I proceed, I also would like to recognize the commitment that Chairman Terry Everett has made to veterans of this country. It is unfortunate that he is ill and not with us, because obviously his commitment is well-established in the Congress of the United States.
    I think that, of course, we had this hearing because Chairman Everett knows from his own experience back in Alabama that VA hospital integrations require congressional oversight, and more importantly, that veterans, and I underscore veterans, and other stakeholders affected by these integrations need to be heard in the process.
    We should all be appreciative of Chairman Everett for convening this important hearing and allowing my friend, Mr. LaHood, Congressman LaHood, to sit in the chair in his place. My good friend, Congressman Lane Evans, also deserves our thanks for making this field hearing a reality. I know of no better advocate for veterans than Lane. He is a tireless worker for veterans and a leader and a mentor for my colleagues and I on the Veterans' Affairs Committee.
    He also has a good memory. I do recall mentioning at our hearing in July that if the committee came to Chicago, I would buy my colleagues lunch. I would like to say, however, that it was not so much a bribe as a promotion of the fine cuisine that we have here in Chicago.
    Representative Davis, Danny, thank you for joining us on the committee today. As both the West Side and the Lakeside hospitals are in your District, your leadership and interest in this issue is both welcome and required for this hearing to achieve its goals.
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    While we are on the subject of goals, allow me to explain very quickly what I believe our goals should be. As you all know, the West Side and Lakeside hospitals are undergoing a very significant transformation that could affect—that will affect—the health care received by more than half a million veterans in Cook County and northern Indiana. The two hospitals have been administratively merged into VA Chicago.
    Thirty-two task forces, examining every aspect of health care and support services provided by these two hospitals, have completed their work by submitting their recommendations to the integration coordination committee.
    While much has been accomplished to forward the integration of these two facilities, many questions remain unanswered at this point. The most important questions, I believe, regard the individual health care needs of our veterans.
    How will these service changes, from the kitchens to the inpatient rooms to the surgical units to outpatient clinics, affect the health care veterans receive? And what will the VA in Chicago look like in 2 months, 2 years, or longer, given these new realities? What can our veterans expect from the new VA?
    Back in Washington we hear quite often from health care experts and VA officials about the future of the VA, and we are always debating budgets and deficits and shortfalls and costs.
    But unless we actually go out and listen to the brave men and women the VA was created to serve and allow these courageous individuals to hear directly from VA officials and other affected parties, we are not really doing our job. We are not really serving the people we represent and the veterans who served in the military on our behalf.
    In my conversations with veterans in my District, I have heard a number of concerns reading the integration process. Many veterans fear that integration will mean longer waits at VA hospitals and service reductions that will force them to travel farther to access the health care they have earned and deserve. Many veterans also do not believe that the integration process has been as fair and open to their concerns as it should be.
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    I am not convinced that veterans have had the complete role in the process that they deserve. Let me, however, underscore I do believe that Dr. Joan Cummings, the director of the Service Network 12, and specifically Dr. Joe Moore, the director of the VA Chicago, and Dr. Christopher Terrence, the chairman of the Integration Coordinating Committee, have worked tirelessly and hard to improve the process to include the participation of veterans and other stakeholders, and they should be commended.
    The affiliated medical schools certainly have begun to work cooperatively to improve their relationship with each other and the VA, and that is an excellent signal in the right direction. However, I remain concerned that the process is not open enough, and look forward today to opening it up somewhat further.
    That is why I am particularly pleased today that we will receive testimony from all. Without the input of all, we cannot judge whether integration is a success or a failure. And we need to hear from veterans. Listening and learning from you is ultimately the chief objective of this hearing.
    I also want to suggest to others in our audience that if you have questions or concerns, you can write them down and have them brought up to me so that I may pose them to different witnesses as time permits. Otherwise, with the approval of the chairman, I will have these questions submitted for the official hearing record and answered at a later date by our witnesses.
    I make unanimous request, Mr. Chairman, that we do that.
    Mr. LAHOOD. Without objection.
    Mr. GUTIERREZ. I want to thank all of the people here today, our local veterans, all of those who work at the VA. You are all very important to us for your interest in this important issue. And lastly, to say the process may not have started out excellently, but the process is improving, and we are here to improve it further today.
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    Thank you so much, Mr. Chairman.
    Mr. LAHOOD. Thank you, Congressman Gutierrez.
    Congressman Davis.

    Mr. DAVIS. Thank you very much, Mr. Chairman.
    Let me first of all express my appreciation to you for taking your time to come down, up in this instance, really, from Peoria, to chair the meeting.
    I would also like to express appreciation to the ranking member of the full committee, Congressman Evans, for the outstanding job that he has done in processing the activities of veterans' affairs in all aspects of veteran life, in all aspects of veteran activity.
    I would certainly want to extend appreciations to Congressman Gutierrez for the role that he has played not only in protecting the rights and interests of veterans, but in terms of establishing this hearing and bringing the subcommittee to Chicago to take a hard look.
    Although I am not a member of the Veterans' Affairs Committee, as Congressman Gutierrez indicated a moment ago, in my Congressional District there are three Veterans' Administration hospitals, Lakeside, West Side, and Hines. I guess we probably have more in the way of veteran resources than you would find in most Congressional Districts throughout the Nation. Therefore, we would obviously have a very keen interest.
    My staff has been intimately involved and we have been intimately involved with the planning process, I guess from the very beginning. And I would like to commend and compliment not only Mr. Moore and Dr. Cummings, but also the medical schools and hospitals as well as other stakeholders, for the process in which they have been engaged now for several months.
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    And while it perhaps started out murky, I think that significant progress has been made to the extent that we are delighted to know that rather than talking about, as people earlier were, the possible closing of one of the facilities, we are now talking about the integration of the facilities into a system that can provide in a most cost-effective way the kind of services that the veterans of our city and region need, should have, and have, in fact, earned.
    So I am pleased to be here. I welcome you all. Thank you so much for coming. And I trust that when we finish, that the veterans throughout the region will be happy, satisfied, and well pleased with the kind of services and the kind of care that is being provided for them. So I thank you, Mr. Chairman.
    Mr. LAHOOD. Thank you, Congressman Davis.
    We will begin with Panel 1, and we will ask each person to take up to 5 minutes to summarize your statement. Your entire statement will be made a part of the record. We have a court reporter here. All testimony, all questions, and all answers will be made a part of the permanent record of this particular hearing.
    We are delighted to welcome Mr. James Balcer, the Director of Veterans for the City of Chicago; Mr. Sol Griffin, Chairman, Minority Veterans Committee, past National Vice Chairman of Montford Point Marines, Mr. Robert Plante, Supervisor, National Service Office, Chicago disabled American Veterans, and Ms. Brenda Woodall, Business Representative of Local 73, Service Employees International Union.
    And I would ask Mr. Balcer, if you would like to go first. And we will proceed in this direction: Each take 5 minutes with whatever statement you want. Your entire statement will be made a part of the record. And then we will ask questions following Ms. Woodall's statement.
    Please proceed.
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    Mr. BALCER. Thank you, Mr. Chairman, Congressman Davis, Congressman LaHood, Congressman Gutierrez, Congressman Evans.
    My name is James Balcer and I am a former Marine, Vietnam veteran, Director of Veterans for the City of Chicago.
    Let me say first that I am honored to give testimony to this subcommittee on Oversight and Investigation.
    I am a member of the Integration Coordination Committee for VA Chicago Health Care System. I have also been a patient at VA West Side since 1970. I have worked closely with VA Lakeside, West Side, North Chicago, Hines, and regional offices at 536 South Clark.
    I have worked with patients and staff for over 8 years. As a member of the Integration Committee, I can say that this committee chaired by Dr. Terrence has been sensitive to the needs and concerns of patients and staff when integration has been needed.
    The first question I have always asked is, how will integration affect the patient? Second, will any staff lose a job or position? As someone who has been a patient, I know how it is to take a long bus ride and stand in line and wait for treatment. I have also been unemployed.
    The Integration Committee has been an open and fair process with vigorous debate and discussion when needed. To the best of my knowledge, there has not been interference from anyone outside the Integration Committee.
    Let me close by saying that yes, integration of Lakeside and West Side is needed. However, the veterans and staff must be considered whenever integration occurs.
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    Mr. LAHOOD. Thank you. Mr. Griffin.

    Mr. GRIFFIN. Distinguished Committee, I am honored to have this opportunity to testify as the chairman of the Minority Veterans Steering Committee and past national president of Montford Point Marines.
    Thank you for this opportunity to testify and speak as chairman of the Minority Veterans Steering Committee about the process of integrating the West Side and Lakeside Veterans Medical——
    Mr. LAHOOD. Mr. Griffin, could you pull your microphone a little closer? Thank you, sir.
    Mr. GRIFFIN. Thank you for this opportunity to testify and speak as chairman of the Minority Veterans Steering Committee about the process of integrating the West Side and Lakeside veterans' medical facilities in Chicago. I am also speaking as a veteran and the past national vice president of Montford Point Marines.
    The Minority Veterans Steering Committee has been very concerned about the fate of the West Side VA Hospital. And you may know, I was actively involved in keeping this hospital open at a time when the VA considered closing this hospital to help reduce operating costs. We are certainly glad that never happened.
    But I must say that we remain concerned that it could happen at some future date. Our concern is partly based on what we see happening so far with the facilities integration process.
    We are concerned that so far we don't see an even-handed approach in the integration process. For example, the person who has been charged with integrating the two facilities is from Lakeside Hospital. Can a person who directs this process and is tied to one hospital really be objective in determining what resources and personnel go to which hospital?
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    With the input of the stakeholder committee, which I serve on, it shouldn't matter who directs the process. But the input of the committee is often watered down or comes too late. For example, the committee has too often been presented with plans that have been approved beforehand by the director.
    We are not provided with sufficient information on the integration process, how services will be integrated, how the changes will affect veterans, how much the changes will cost to implement, how much the hospitals will save, and how the Veterans' Administration will reinvest the savings to benefit veterans.
    These are important questions, and the committee can't provide useful input without this information. In addition, the committee needs to have some clout in the process. Otherwise, we are little more than a rubber stamp for the director. There needs to be a clear definition of the authority of the committee and the director and how the two should work together.
    We are concerned that the director may have more authority than he should in the process. We have heard many complaints and concerns from staff and veterans using West Side Hospital that the director tends to favor the Lakeside facility in making decisions about where services and personnel will remain and where they will be cut.
    We are concerned about this because the West Side Hospital has a stronger record of serving minority veterans that the Lakeside Hospital. The West Side Hospital also was the first to have a women's veterans program.
    What also concerns us is that we have heard from employees at West Side Hospital that are being intimidated or reprimanded about any complaints they have about the process. For example, a worker at the West Side Hospital recently wrote me a letter.
    He said that when he wrote a letter to Senator Durbin, also a member of the stakeholder committee, the letter was sent to his supervisor instead. He felt intimidated by this and was concerned that there was not an open process to listen to the opinions of the staff and the veterans served by the hospital.
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    Several workers have reported that complaints are discouraged. If you speak up, you get fired. Some of them have told us—an employee who is also a veteran told us that he was afraid that if he spoke out about his concerns, he would lose his veterans' benefits. A former employee who left for another job wrote a letter about the integration process and signed it, name withheld for fear of reprisal.
    Recently a Lakeside staffer was chosen as the chief of nursing staff over both hospitals despite the fact that a West Side staffer was preferred by the committee. The staff at West Side feels unable to comment about why the Lakeside staffer was chosen for fear of losing their jobs.
    How can we effectively integrate these facilities if we can't hear from the very people who work at the hospitals and are served by them? How can we hope to get honest input if hospital workers feel intimidated in the process, if their letters and comments are misdirected? Who could freely provide comment in such an environment?
    I recommend to you a pamphlet written by the GAO and presented in testimony on making changes in VA health care. The pamphlet is very interesting because it talks about lessons learned from facility integration. One thing mentioned was the need to provide a detailed integration plan to stakeholders before any implementation begins.
    What happens with our committee is that by the time we hear of any plans, things are already done. There needs to be more genuine input by the committee, and that means nothing should happen until the committee has approved plans.
    Second, there needs to be more objectivity in the decision-making process, more independent judgment that isn't tied to the interests of one hospital over the other.
    Finally, we need to open the process so that those people who work in the hospitals or who are served by them feel free to comment about their feelings on the process of the integration.
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    I am not here on behalf of the Minority Veterans Steering Committee to argue against the cost reductions. We know that cost-cutting is part of reality for the health care of veterans, just like they are part of reality for the private sector.
    But I am here to argue for a more fair and reasonable process, one that takes into account the needs of the veterans. The West Side Veterans' Hospital serves a population that does not have the financial resources to get medical care they desperately need. If the purpose of the facilities integration process is truly to serve the veterans, then let's look at what their needs are.
    Thank you again for this opportunity to voice the opinions of the Minority Veterans Steering Committee and to urge you to make sure that the facilities integration process does not result in the closing of one of these hospitals, or an even distribution of services between the two hospitals. Thank you again.
    Mr. LAHOOD. Thank you, Mr. Griffin.
    Mr. Plante.

    Mr. PLANTE. Mr. Chairman and members of the subcommittee, on behalf of the 25,000 Illinois members of the Disabled American Veterans, I am pleased to present our views concerning the integration and consolidation planing of the Department of Veterans Affairs, VA Chicago Health Care System, Lakeside and West Side Divisions.
    At this time, I would like to take this opportunity to commend Dr. Joan E. Cummings, Network Director, Veterans Integrated Service Network 12, for her concentrated efforts to provide quality health care services for all Chicago area veterans. Her tenacity it overcoming major obstacles to achieve this endeavor is in keeping with the highest traditions of the Veterans Health Administration.
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    We believe in order to continue to provide quality health care services to the Chicago area veteran population, the integration and consolidation of services at Lakeside and West Side divisions are necessary. We also believe it is essential to maintain both facilities to adequately care for this significant veteran population. The following information sets out the services provided at the Lakeside and West Side facilities.
    Lakeside division is a 350-bed facility with 1,200 employees and a $96 million budget and 300 volunteers. It provides both primary and tertiary care to approximately 460,000 veterans in Cook County, Illinois and Lake County, Indiana, provided treatment for 21,746 veterans in the fiscal year 1995, and attended to 6,600 inpatient admissions and 208,000 outpatient visitations.
    The West Side division is a 435-bed facility with 1,570 employees and a $123 million annual budget, providing primary and tertiary care to approximately 411,000 veterans in Cook County, Illinois. It provided treatment to 24,781 veterans in fiscal year 1995 and attended to 8,100 inpatient admissions and 280,000 outpatient visitations.
    It is our understanding that the integration and reorganization efforts of the VHA are to reduce operating costs, improve access to care, enhance and standardize the quality of patient care, and to improve satisfactions of services. In our view, these are attainable goals. We also believe integration and consolidation of service is a practical approach to reaching these goals.
    The formulation of the Management Assistant Council, the Stakeholders Advisory Group, and the veterans advisory council within the VISN provided for stakeholders organizations to become an integral part of the reorganization effort. This allowed for open lines of communication to acquire direct information and present feedback during the process. It also served to suppress the rumors regarding the closure of the West Side division.
    During the initial planning stage of integration, veterans service organizations accepted an invitation to meet with the University of Illinois Medical School, the affiliate at the West Side division, and its consultant to discuss the rumored closure of West Side.
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    A rumor had been leaked to the local media prior to the formulation of the stakeholders advisory group. The VSOs made it clear that their concerns were focused on the continued availability of health care for local area veterans, insuring that no additional burden would be placed on veterans seeking necessary treatment.
    Soon after the media leak, local union representatives from West Side contacted VSOs to express their concerns and ask for support to establish lines of communications. We advised these individuals of our primary concern and offered to forward their concerns to the Management Assistance Council.
    VSOs then met with the General Accounting Office to express their views concerning the physical plant at West Side. The conversation focused on the VSOs' responsibilities to area veterans and the necessity of retaining West Side to serve the veteran population.
    The DAV was and remains concerned by the lack of input from stakeholders initially with the formulation of the Management Assistance Council. We believe that future efforts must include the involvement of stakeholder organizations in the initial design process.
    We believe that in the process of insuring across-the-board stakeholder involvement, the VISN entangled itself in a web of groups, committees, and councils, thereby generating initial confusion and suppressing stakeholder participation. Presenting an overall plan prior to implementation would have enhanced stakeholder participation.
    In the beginning, communication with stakeholders was limited to one or two mediums. Efforts to utilize electronic mail, hot lines, newsletters, and conference calls were none existent. We believe a more comprehensive communication plan would have averted the perceptions of impending closure of the West Side facility.
    We believe it imperative to include stakeholders, affiliates, and the news media in the VHA's effort to communicate its plan and the processes necessary to achieve its objectives of quality health care.
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    In closing, we believe that major hurdles have been overcome and Chicago-area veterans will be the beneficiaries of quality health care services provided by both Lakeside and West Side divisions of the Chicago VA Health Care System.
    Mr. Chairman, thank you for convening this hearing today, and thank you for your efforts on behalf of veterans residing in your Districts and throughout the Nation.
    This concludes my statement. I will BE happy to answer any questions you or the committee members may have.
    Mr. LAHOOD. Thank you, Mr. Plante.
    Ms. Woodall, I am sorry if I mispronounced your name earlier. Please proceed.
    Ms. WOODALL. Okay.
    Mr. LAHOOD. Would you pull that microphone closer to you, please? Thank you.

    Ms. WOODALL. Good morning, Chairman, Congressmen. I come here today representing the members of SEIU Local 73 who work at the Lakeside and West Side facilities. I understand my time to speak is brief, so I would like to address three points regarding the VA hospital consolidation process: the process by which the consolidation of services has taken place thus far, the impact the consolidation has had on the workers of the facility, and the impact of the consolidation on the quality of patient care.
    First, the process. Local 73, I was asked to sit in on meetings on the Integration Committee. I assumed the purpose of my involvement was to inject the concerns of workers into the decision-making process. I was wrong.
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    My voice, and therefore the voice of over 1,300 workers I represented was drowned out by the rest of the committee. I offered a proposal to address our concerns and was told that it would not be included in the final recommendation and to negotiate with the individual hospitals, which, as you know, does not make any sense at all.
    The concerns I raised were not taken seriously, and as a result the consolidation has had an extremely negative effect on hospital personnel and the quality of patient care.
    The impact on the workers, I would like to talk about secondly. The cutbacks on staff have been devastating. We used to have 200 people clean Lakeside/West Side VA. Since the consolidation, the same amount of cleaning has to be done with far less personnel.
    It equates to about one person responsible for cleaning 33,000 square feet, where the national average is 15,000 square feet to be cleaned by one individual. I don't have to tell you what it means in terms of worker injuries and employee morale. And that doesn't even get to the problem the consolidation has caused in terms of providing the best level of patient care possible.
    This leads me to my third and most important concern, how this consolidation has impacted the patients. You can imagine what happens when you cut the cleaning staff. But what happens when you stop replacing administrative personnel and cut LPNs and nurses' aides, the people who provide the most direct patient care?
    Well, the first thing that is affected is the entry point to service delivery. With bare bones administrative staff, the waiting time for patients has increased dramatically, and once they get in, the time that someone can spend caring for them is cut considerably. When staff are forced into a situation where they have to run from bed to bed, nobody wins.
    The staff suffer from injuries and low morale because they are not able to give the best care possible, and patients suffer because they don't get the best care that is needed.
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    Veterans deserve to be treated with dignity. This plan was developed and implemented without input from those who give the care and those who receive the care. Although the process of consolidation has started, I think it would still be worthwhile for management to meet with workers and veterans to assess the damage already done and figure out ways to minimize the negative effects for the future.
    I appreciate the opportunity to raise these concerns, and sincerely hope that what has happened here will serve as a lesson for others in the areas in which to be consolidated in the future. Thank you.
    Mr. LAHOOD. Thank you. We will begin with questioning by Mr. Evans, and we will use the 5-minute rule. And then if we need to have a second round, we can do that.
    Mr. EVANS. Mr. Chairman, I would like to ask all the veterans service organizations whether they have yet seen at this point any cost savings, increased patient access, or quality improvements since this integration process has started.
    Anyone have any comments?
    Mr. PLANTE. We certainly have seen a lot of cost savings based on the reduction of duplicative services at both Lakeside and West Side. And we believe that certainly is essential, you know, to the consolidation process and to achieve continued quality health care at both facilities.
    Mr. EVANS. Anybody else like to——
    Mr. GRIFFIN. I would agree, the same thing.
    Mr. EVANS. Can you pull the microphone closer?
    Mr. GRIFFIN. I would agree, the same as my colleague.
    Mr. EVANS. All right. We came here very happy that things seem to be changing somewhat in terms of the dissemination of information to veterans' groups, yet the Montford Marines feel that they have not—if I am reading you right, sir—been involved in the decisions that are being made. At a point where you are asked to give some input, it has already got so much momentum, quite often, that you have no real input whatsoever.
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    Some other veterans' groups have indicated that they feel there has been better communication, but you haven't seen that at this point?
    Mr. GRIFFIN. Well, we have seen some communication. But I think that my statement basically is based on what we hear from employees and veterans in terms of the—we are not against the process of integration. That is not our issue at all.
    The only thing from the complaints that we get is how that the process is going. In reference to the intimidation and these kind of things, we are very concerned about that because we feel that regardless of how you feel about the process, you should be able to express your views without, you know, any concern of intimidation.
    Now, when we get these complaints, we feel that we should speak about it, and hopefully that this committee, maybe that some of these complaints might not even be true. I don't know. But I think that it would be worth or hopefully that the committee would maybe look at some of these issues and investigate some of these things that we hear.
    Now, we feel that how we got into it, actually, we weren't involved in the initial process. The Montford Point Marines were not. And I think—I have served on Congressman Gutierrez's Veterans' Affairs Committee, and how we got into it, after the press noted that there was a change in the health care system for these hospitals, we were not invited to participate.
    And how we became a part was after that, and I was told that they didn't know anything about us even though we are a national veterans organization, the first blacks in the Marine Corps. And we were quite intimidated with that—that they had talked to all the other groups, in other words, American Legion, VFW, DAV, all of them.
    But our organization is structured to do the same things that these groups do, and we feel that we were not—but since that time, when we got, I guess, maybe we forced our way in, basically, to be heard, we have been.
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    And I sit down—I have made the stakeholder meetings. I don't think I have missed any of them. I have sat with the advisory council. I see a lot of good things in the process. But this one issue that really disturbs me and disturbs the people that I represent is, let's bring it out, find out if these accusations are true, and if they are not true, so be it, and let's continue with the business. But we are concerned with that.
    Mr. EVANS. I thought we were doing pretty good by having two Marines on the first panel, and a sailor as well. That is not bad for representation here today.
    Let me ask you, Mr. Griffin, I don't understand. I was in the Marine Corps, so I understand a lot of the military acronyms, and the VA uses some acronyms. Are you—is your Veterans' Advisory Committee plugged into the Management Assistance Council, the Stakeholders Advisory Group, or the Veterans' Advisory Council?
    Mr. GRIFFIN. Yes. I sit on the stakeholders and the advisory council.
    Mr. EVANS. But you don't feel minority veterans—as chairman of the minority veterans group, that you have gotten the kind of input that you think you should?
    Mr. GRIFFIN. No, sir. I think we have got some of the input. In fact, when this process first started, I was very reluctant. But I have looked at the process and meeting with Dr. Cummings, and I see a lot of things that are happening are good.
    The only thing that sort of still gives me a little concern about is the same thing that I am seeing, is that whenever they make these decisions, who makes the decisions? I don't feel that any decisions should be made by one individual, whoever they are.
    And yes, we are concerned about that. And we feel that we are getting some input by me being a member of the stakeholders committee.
    Mr. EVANS. Brenda, just one question. You referred to increases in patient waiting time. You are not talking about waiting in the clinics and waiting rooms; you are talking about inpatient waiting times for help for the individual patients when they need a procedure to be done or some other test to be carried out for them, somebody that is already in the hospital.
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    Ms. WOODALL. Both.
    Mr. EVANS. Both?
    Ms. WOODALL. With the down—with integration, what is happening is they are being considered to be one service, such as, say, X-ray. And with the moving of staff back and forth sometimes, which occurs, we don't have enough personnel to actually service the veterans.
    So you have increased times for patients to do tests in-house as well as the waiting lines because of the staffing levels administratively even to get in to see a doctor, an RN, or what have you, or even with pharmacy lines have increased.
    Mr. EVANS. All right. Thank you, Mr. Chairman.
    Mr. LAHOOD. Congressman Gutierrez.
    Mr. GUTIERREZ. Thank you, Mr. Chairman. And thank you to all of the members of the panel this morning. Welcome here.
    I guess as I sit here and listen to the testimony, it seems as though for the most part people feel the process is improving, that it is going in the right direction. But we still have some hurdles, some objections that we have heard here this morning, some hurdles, some problems in streamlining this process.
    If I hear you right, the Service Employees Union representing the employees feels that they are one stakeholder in the process, but that they are getting shut out and that they are not being properly heard within the group. Is that a correct——
    Ms. WOODALL. Yes. I would say that is correct. I mean, there are times where we are made aware of certain circumstances. But often the decisions already are made and we are coming in at the back half of it.
    And employees, you know, we are trying to explain what is going on and telling them it is getting better. I think the overall process is improving, but I think the problems came about in the first half where there wasn't that open line of communication so we can give people the support they need in order to be assured that they are going to be employed or that, you know, one hospital is not going to overrun the other hospital.
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    I think the lack of communication from the whole process has been a significant problem.
    Mr. GUTIERREZ. So we started with a very murky, and Congressman Davis described, a muddled process of communication to one that is improving but still leaves something to be desired. Because I—Mr. Balcer, I remember first of all saying to Mr. Balcer and Mr. Griffin, both of whom sit on my Veterans' Advisory Committee and have been such great help to me as a Congressman to understand. I want to thank you and all the other members that are here today. I want to thank both of you.
    Jim, what do you think? I mean, you said earlier you were concerned about the veterans and you were concerned about the employees. From what you have seen, what can we do better?
    Mr. BALCER. I would suggest, and I hear—if there is an issue of the veteran, how will the veteran be treated, and what is the time traveling? That is what my biggest concern is, because I remember to this day having to take a bus from 123rd and Normal to the tail end and spending hours on that bus, and then get in line and wait.
    What I try to look at is, what is the time? How will the patient be affected? What are the employees—I don't want to see anyone lose their job. I don't want to see anyone put on the street. So that is what has always been my concern, and I have always tried to be a voice to those two groups, especially the veterans.
    It is not nice to have to take a bus and then stand in line. And I will admit, yes, that at first there were problems with this process. But now it seems to be smoothing out. It is—and I brought along some information, some documentation, that we were given on each of the integration questions.
    This is what we were given every time we were there. So the committee—the integration, speaking of the integration, was given ample information to go over these questions.
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    Mr. GUTIERREZ. Okay. And then in listening to you, Mr. Griffin, you—I am sorry—you are raising some concerns, legitimately so, that you have heard from different people and from different sources.
    But you have also stated that you think it is going in the right direction. You think people are integrating more into the process and more are being heard. But there are still some people you think and some issues you think that need to be wrestled with and addressed?
    Mr. GRIFFIN. Definitely so. I think the process, like you say, is going well compared to what it was when we started. And I think we all—as a veteran community, we know that we have to accept changes, not only to the process.
    And I think that what I would like to see, you know, I hate to stand before this committee and to present these kinds of statements. Somehow I think that to clear the record in terms of things that I have voiced by opinion on, is I think it should be an even-handed process, is that there should be some sort of investigation to either prove that this is right or this is wrong.
    But as far as the overall integration process, I think that what we see, even if there are some things basically we don't like but we know that we have to accept change because of the economic structure.
    But for the veteran, we are very much concerned, and I would say that maybe if we look at both hospitals we are concerned about. But then when I look at the situation at the West Side, I see the population of the homeless veterans and all these people who have to be served by that institution.
    And I think that one of the biggest problems, maybe, that they have with the statements that I am making is that there is a lack of communication between the director and the staff or the veteran.
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    Mr. GUTIERREZ. I think, Mr. Plante, you put it probably as precise as could be in terms of giving an historical overview. Do you think there is room for improvement in terms of this communication, and if you do, where do you think that room for improvement might exist, given where we started and where we are at today?
    Mr. LAHOOD. Could you use that large microphone, please? Thank you.
    Mr. PLANTE. Again, Congressman, I believe that we need some prior planning. We need to involve all parties concerned, not only the VSOs and the affiliates, but also the news media, and ensure that they know what is going on. The employees, obviously, fall into that stakeholder category.
    And we believe that if everyone would have been involved initially and prior to the formulation of all of the committees and councils and advisory boards, that the communication would have flown—would have flowed much easier, if you will. And being so, the communication problem would have at least brought itself down to a low roar.
    What we saw was an initial conflict, initial panic, and phone calls were just pouring in to all the veterans' service organizations that are located in the regional office.
    And we met to discuss what you should do to try to alleviate that problem. As to stakeholder participation in the initial plan, how are we going to look at this problem? How are we going to approach it? And how are we going to address the concerns that are going to be brought up in the initial processes of consolidation and integration?
    Mr. GUTIERREZ. I think that maybe—and we will discuss this some more, and obviously we will have Mr. Moore and Ms. Cummings come up right after this panel and they will be able to answer some questions—but maybe if we could get some more information from them in terms of where we are going with the employees.
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    How many employees do they see being in the integration, so that we can have a sense of where we are going and work more collectively with the labor unions?
    But I think if you knew where they were going, you could have a better sense of what the future—and you could have a better dialogue and discussion, and therefore ameliorate any issues and problems, and figure out a plan of how you are going to get there so that the employees aren't affected—I am sure there are—you know, people don't have to lose a job. People—there are different ways that you can go about reassessing and reevaluating your personnel and assigning them to different issues.
    And I just want to say that I agree with Mr. Plante. You know, this process started out with so many accusations and so much finger-pointing because the process—I think the VA understands that, and I think they have made—from what I hear from all of you, because all of you agree on one thing, and I think that that is very important, that it is heading in the right direction, that there is more communication and that there are room for improvement in that communication.
    So I think that is light years ahead of where we were at one year ago. And so I am happy that you all came. And I want to just state for the record, Mr. Chairman, that I think we are working in the right direction.
    I am happy that we are going to have Mr. Moore and Joe Cummings come up in the next panel, because I want to say one thing, and that is that I had a wonderful conversation with Mr. Moore.
    And I know while some people still have some reservations because of this Lakeside/West Side thing, I think he has taken a lot of steps to make sure that there is a fair and equitable treatment in terms of his new—he is the new director. And he came from Lakeside, not West Side.
    But I think that given his history and given where he has been at and his commitment to veterans, I am happy to see that those kinds of accusations have not been raised here today, because I think that he is trying to do a very, very good job in integrating everybody and to be fair.
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    And I am sure we will be able to raise to Mr. Moore some things that Mr. Griffin and Ms. Woodall have brought up here today so that we can better flesh this out. That is part of the process. And I look forward to hearing from Mr. Moore and Joan Cummings at the next panel. Thank you very much.
    Mr. LAHOOD. Thank you. Mr. Evans, any further questions?
    Thank you all very much for being here. I believe it was—did you want to say something?
    Mr. BALCER. I just wanted to go on record as saying that I agree with Mr. Griffin. If there is any form of intimidation or retaliation, it should be investigated. It should be ferreted out, and let's get to the bottom of it to find out if it is reality or if it is false. Thank you, sir.
    Mr. LAHOOD. Thank you. Thank you all very much.
    It was suggested that we take Panel 3 next. Is that okay with—I believe that we will take Panel 3 now. Dr. Moss and Dr. Colten, if you could come forward, please.
    Those large microphones are the ones that will amplify your voice. So if you will use those.
    Dr. Gerald Moss is the Dean of the College of Medicine at the University of Illinois at Chicago, and Dr. Harvey Colten is the Dean of the—Vice President for Medical Affairs, Northwestern University Medical School.
    If you would like to take 5 minutes to make a statement, your entire statement will become a part of the record. And then we will ask our members to ask questions. Whoever would like to go first may proceed.
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    Dr. MOSS. Good morning, Mr. Chairman, and distinguished members of the Veterans' Affairs Subcommittee on Oversight and Investigations. My name is Gerald Moss. I am professor of surgery and dean of the College of Medicine at the University of Illinois at Chicago.
    Mr. LAHOOD. Let me just ask you to wait, sir. I wonder if those who are having conversations would step to the outside of the doors so that Dr. Moss may be heard by those who are in the room. Could we close the door back there, please?
    Thank you very much. I am sorry. Would you mind beginning over? Thank you, Dr. Moss. We missed part of your opening statement.
    Dr. MOSS. Good morning, Mr. Chairman, and distinguished members of the Veterans' Affairs Subcommittee on Oversight and Investigations. My name is Gerald Moss. I am professor of surgery and dean of the College of Medicine at the University of Illinois at Chicago.
    I appreciate the opportunity to appear before you this morning and to update you on developments in the relationship of the VA Chicago Health Care System with the UIC College of Medicine.
    First, I want to express my thanks and the appreciation of the university to Mr. Gutierrez, Mr. Davis, Mr. Evans, and Senators Moseley-Braun and Durbin, and to former Member of Congress Cardiss Collins, for their outstanding leadership on this issue.
    I am convinced that their efforts have brought about many constructive developments in this evolving relationship, and have been of enormous value in meeting our joint responsibilities to provide care for veterans that is truly second to none.
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    I am particularly proud to note that the University of Illinois and Northwestern University were the first two universities to establish a direct and formal relationship with the VA Health Care System more than half a century ago.
    All of us in health care are being challenged by enormous changes in the financing and delivery of health care, and many of those same changes are affecting the VA. We fully recognize that the VA must adapt and adjust to those new operational and fiscal realities, and I want to assure you that UIC is committed to working with the VA to make those changes in a way that benefits veterans and optimizes the educational environment of both intuitions.
    As you know, we have been concerned about the proposed changes in the VA system here in Chicago. Many of us have been working over the past year and more to ensure that any decisions to be made were driven by accurate and relevant data, and that all of the affected constituencies were appropriately involved, and that the best interests of veterans and those who care for them were foremost concerns.
    The process to integrate services at Chicago VA, one established through your efforts and those of then-Secretary Jesse Brown approximately one year ago, have worked well. I am pleased to report to you today that the dean of the Northwestern University School of Medicine, Dr. Harvey Colten, and I have worked out an agreement that we are convinced will serve the VA, its patients, and our students well.
    Specifically, we have agreed that we will together propose to the director of VA Chicago, Mr. Joseph Moore, a joint dean's committee made up of members from both medical schools and both divisions of VA Chicago to replace the existing two dean's committees.
    We believe that this joint committee will assist VA Chicago to realize operational efficiencies, to preserve the high quality health care that our veterans deserve, and to maintain the superb educational and research environment afforded by the VA system.
    In addition, UIC is working actively with VISN 12 to help it evaluate health care needs of veterans in this region. This is clearly a work in progress. But there are lessons in the Chicago experience that will be useful in other areas of the country as the VA strives to consolidate its facilities to reduce duplication and overlapping efforts.
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    I believe that a rational process for such consolidations would involve a number of steps I have listed in my written testimony. I would like to summarize those.
    First, the VISN director must identify those areas in which duplication of effort seems likely and where geography might permit service consolidations.
    Second, the stakeholders in existing facilities must be convened and a clear articulation of the problem must be presented. A mutually agreeable process must be established with adequate time to deliberate. Public discussion must occur.
    Third, all the data necessary to make fair, balanced, and equitable decisions must be gathered, and appropriate consultations from a neutral third party is highly, highly desirable.
    Finally, a durable oversight mechanism to insure that all parties are treated fairly should be in place.
    In any undertaking of this complexity, mid-course corrections are inevitable. I would respectfully recommend that this committee consider these criteria carefully, which may well serve to guide VA mergers or consolidations across the United States.
    There is one other area of concern to me and many of my fellow deans. The Veterans' Equitable Resource Allocation, known as VERA, is shifting money from VA systems in the northern tier of States to those in the southern tiers. We are concerned VERA does not take into account the health status of those veterans in the northern States, nor recognize that the majority of training programs, with their attendant higher costs, are located in these States.
    I hope that the committee will objectively evaluate the effects of this new resource allocation system and make corrections if they are found to be necessary.
    Mr. Chairman, I am grateful for your interest and leadership in this extremely important issue. The College of Medicine at the University of Illinois at Chicago, and I as a Navy Vietnam veteran myself, are quite proud of the relationship we have with our affiliated VA Medical Center. I welcome the opportunity to answer any questions you may have. Thank you.
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    [The prepared statement of Dr. Moss appears on p. 37.]

    Mr. LAHOOD. Thank you, Dr. Moss.
    Dr. Colten.

    Dr. COLTEN. Thank you, Mr. Chairman, gentlemen, Mr. Evans, Mr. Gutierrez. I assume Mr. Davis is here.
    I, too, am pleased to have a chance to speak with you this morning. I came into this process relatively late, and it sounds like it was a good time to come in. There were many difficulties early in this process. That is not a surprise. Integration of medical services require enormous amounts of reshifting of thinking, resources, and as well as activities.
    We are involved in a process that medical services are going through throughout this country. And we are leading the way in this process in a complex situation where two academic medical centers have a longstanding relationship with the VA, as you have heard from Dr. Moss.
    The cooperation that is developing between these two institutions, I believe, will not only facilitate the process, but will be sensitive to the stakeholders' concerns that we have heard about today.
    I want to point out to you, as I did in my submitted testimony, that the environment within an academic medical center creates a kind of ''sunshine culture,'' a culture in which the availability of data is wide open, where decisions can be data driven, where the best choice among difficult choices sometimes have to be made, and can be made in the presence of free and open information. That process has been taking place!
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    My experience thus far is that the leadership of the VISN under Dr. Cummings and Dr. Moore as director of Chicago VA, and Dr. Terrence's leadership in the integration committee, has been most commendable. I believe I have never seen anywhere, as fair an effort to take into account the views of widely disparate groups.
    In the last analysis, not everyone will be happy with the solutions. But it seems to me, if the objective is the highest quality care at whatever cost savings we can accomplish, we have achieved the purpose by increasing the value of veterans' affairs and health care to veterans. Value, of course, is a product of quality and cost.
    I believe from what we have heard today that, we must redouble our efforts to be sensitive to the stakeholders even though I believed we were doing a good job.
    I think we have to take seriously what we have heard today; make an honest effort to hear out all the arguments, but then, as has been done so far (and I am impressed with it) make those decisions that seek the ultimate objective. If that objective is served, then I think all the veterans are served; the academic institutions are very supportive of that.
    Dean Moss has indicated one of the several steps that we have taken to streamline the information processing and distribution so that we can avoid errors of communication that occurred in the past; that is, the construction of a single dean's committee.
    I believe that is not enough. We must do more. We must redouble our efforts. We are delighted that you are here to help us in that effort, and we thank you very much for the opportunity to speak with you this morning.
    [The prepared statement of Dr. Colten appears on p. 41.]

    Mr. LAHOOD. Thank you. Congressman Evans.
    Mr. EVANS. Thank you, Mr. Chairman. I think I can speak for the entire Illinois delegation when I say we are so happy that you have come up with this compromise. There was a lot of effort put into it, I am sure, and we think this is definitely a step in the right direction.
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    Let me ask you, though: I have heard that medical programs require a certain number of patients, a so-called critical mass, to operate effectively. Are you always sure that the patient populations using the divisions of the Chicago VA comprise a critical mass? And that would be particularly a concern about surgery.
    Dr. COLTEN. Yes, sir, when one is talking about surgery, in general, I believe that is true. There may be surgical subspecialties where consolidation is appropriate on that basis.
    This is not simply an educational requirement. It is a requirement for skill maintenance. Surgeons who are not doing a sufficient number of procedures will, in fact, have their skills deteriorate to some extent. So these guidelines of service numbers include both quality of care issues as well as educational issues.
    Dr. MOSS. Well, it is confounded in the surgical area by the fact that the surgeons tend to move back and forth between the VA and the university. So while there are ebbs and flows of surgical activity at the VA or the university, they tend to cancel each other out at the other side. So both of us watch those numbers pretty carefully, as do the department heads in those surgical areas.
    And we are concerned about that, for sure, but at the moment I think the numbers are satisfactory.
    Dr. COLTEN. Mr. Evans, if I might add: for example, at the Lakeside division, while there are 147 VA-employed physicians, there are 263 physicians from the Northwestern faculty who contribute their services, but their principal practice is at Northwestern Memorial Hospital. What Dr. Moss says is very well supported by the statistics.
    Mr. EVANS. All right. Thank you, Mr. Chairman.
    Mr. LAHOOD. Congressman Gutierrez.
    Mr. GUTIERREZ. Thank you. Thank you very much, Dr. Moss, Dr. Colten, for being here this morning. I am delighted to have been able to read your testimony and to hear from you this morning.
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    For many members of this committee, and particularly for this member, sometimes it felt like it was a Big Ten game going on out there. And your alumni from each side are calling up and cheering and rooting for one side or the other, and they are all saying that Mr. Moore was an unfair referee and we had to get somebody else out there.
    And so, you know, I am happy, delighted, because, you know, here were the veterans and here were the hospitals, who are very necessary. Both of you are so necessary to their care. People need to understand that independent of your own self-interest as institutions, you benefit the veterans, the men and the women that go to the hospital.
    Sometimes I felt like not saying anything myself since I didn't feel that objective since my dad goes to Lakeside, and I said, maybe something I said might go wrong here. What about when the West Side folks find out my dad goes to Lakeside? You know, it gets real tricky for all of us, and was extremely difficult, I know, for Mr. Moore and for Joan Cummings and for others involved in this process. And I kept saying to myself that I knew that this is exactly what was going to happen.
    I said to myself—number one, I thought, doctors. In my view, who is a doctor? Somebody that I go to to get advice. I mean, I don't go into an office as a Congressman to go and argue the partisan debate with him. I go so that he can tell me how to get better.
    Then I thought, deans. And since now I have been graduated for 25 years and I am not a university student, when I was an university student, I don't know if I held deans in that high regard. But 25 years later, as someone who is about to have his daughter go to the university, obviously I have a whole different take.
    So between dean and doctors, I said—and the university, prestigious institution, University of Illinois, Northwestern, I said, I think they can figure this out, which was exactly my conversation with Mr. Moore when we sat down. I said, you know, I think they are going to figure it out in the end.
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    And I want to commend you and congratulate you. Let us know, because I think Dr. Moss, your point is well taken. It is going to be about resources, about how we nationally apply those resources, those dollars. And they are shifting.
    And you are going to be—both of your institutions, I think, are going to be instrumental, fundamental, in relaying that information to the VA and being a source, an academic source, a credible, objective academic source, so that we can go and make those arguments when people want to say that all the veterans are going to Florida and Arizona and Southern California, and so you can do without this because we are going to shift those; that you can come back and supply that kind of coordinated message, not a message from the U of I and another one from Northwestern, but a coordinated message for our veterans.
    Because in the end, it is more than your institutions. I know that. In the end, it is about men and women that your doctors and your physicians and your medical experts serve, that I know you do everything possible to serve them well.
    So where those resources are at and, you know, some of these waiting periods and some of these problems, you know, are they independent of this consolidation? Because we have a consolidation that is occurring, and then people blame everything on the consolidation without looking at other objective factors, such as what is the Congress doing in terms of allocating resources.
    So, you know, if consolidation came about at a time of many resources, you would probably have a much happier consolidation. But were it to occur, and I don't want people to get blamed wrongfully for things that went wrong. I want—because otherwise you don't get a solution. All you get is scapegoating of the process.
    So I thank you so much for being here. You know, in the beginning there was so much confusion, so much bickering and fighting and turmoil—at least that is the way I remember it—that I am happy that you are here, happy that you are working coordinated, which I knew was going to happen because, you know, you serve the State of Illinois well, you serve the City of Chicago well.
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    I know what kinds of institutions you represent and I know what kind of men and women you represent. So thank you so much for being here.
    Dr. COLTEN. Thank you, sir. We are actually rooting for Chicago VA now, not for single institutions in the Big Ten.
    Dr. MOSS. Let's hope for better luck in the future on our football teams.
    Mr. LAHOOD. Okay. Thank you both very much.
    We are going to take a 5-minute recess and then the next panel will come forward. Thank you both for being here.
    Mr. LAHOOD. We are going to reconvene now, and I ask all of you to take your seats for our final panel.
    Our final panel includes Dr. Joan Cummings, Network Director of Veterans' Integrated Services Network 12, Department of Veterans Affairs; Mr. Joseph Moore, Director of VA Chicago Health Care Systems, Department of Veterans Affairs; and Dr. Christopher Terrence, Chairman, Integration Coordinating Committee, VA Chicago Health Care System, Department of Veterans Affairs.
    We are grateful to all of you for being here, and ask that each of you take up to 5 minutes to make whatever statement you would like. Your entire statement will become a part of the record. And then we will ask questions.
    Whoever would like to go first.
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    Dr. CUMMINGS. Thank you, Chairman LaHood, Congressman Evans, Congressman Gutierrez, and Congressman Davis, I would like to thank you all for this opportunity to discuss the integration of VA Chicago Health Care System at this field hearing.
    I would like to state that the Lakeside/West Side integration is actually one element of a larger network strategy that is aimed at accomplishing five principal goals, and I want to just briefly discuss those and their relevance.
    These goals are applicable to many initiatives across the country, not just in our network. And one is the reduction of costs. And in this VISN, we need to reduce our annual expenditures over the fiscal years 1997, 1998, and 1999 by approximately $57 million.
    With the new methodology for the allocation and procession of the funds for VA, this critical financial target will be achieved by our network, I think, in the framework of how we are doing things. We did manage to recoup the $8 million in fiscal year 1997 with no reduction in service. We anticipate the $40 million reduction in fiscal year 1998 will occur also without reduction in service to veterans, and the remainder will be accomplished in fiscal year 1999.
    Cost of VA health care in Chicago is substantially higher than in the rest of the Nation, and the goal here, really, is not cost reduction for itself, but to bring VISN 12 into alignment with VA health care costs elsewhere.
    A significant part of the problem in this regard is the overutilization of VA inpatient care in the Chicago area. And I want to stress, as we convert ourselves from a hospital system into a health care system, that the costs are going to be reduced by making our programs more efficient, not by diminishing the quality of the amount of care we provide to Chicago area veterans. In fact, we plan to provide better, more accessible care to a larger number of veterans.
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    We have reduced in this VISN over the last 2 years—1,600 acute care beds have been closed. This is with no waiting for admission, no denials of admission, and with occupancy rates across our VISN that still are not optimal. So the overutilization, historic inpatient care, is being accomplished without cuts to veteran service.
    Our second goal is increasing our access. And again, this is not just our VISN goal. This is a nationwide goal for VA, to increase the accessibility of VA health care. I totally concur with Mr. Balcer's comments about travel times and waiting and trying to get from the south side of Chicago to a veterans medical center for care.
    And we have a goal to increase our using population, those underserved Category As. When there are reductions in costs, those savings are being reallocated to increase access. We have been concerned for some time about veterans in the Austin area, where there is very poor access to VA. Hines has, with cooperation with the vets' center, opened a primary care clinic in Oak Park and collocated next door to the vets' center to increase that access.
    We have established a clinic in Woodlawn to attempt to increase access for primary care to veterans on the south side, and recently VA Chicago, which is the parent of that clinic, has expanded the hours of the Woodlawn clinic, again to promote the access.
    So as we create the efficiencies across our system, those savings will be put back into health care. We, as you may well know, have been approved to open a community-based clinic in Chicago Heights, another area within Cook County that has, really, very difficult travel to any of our medical centers and significant numbers of low income veterans.
    So our major goal about redirecting some of these resources will be to increase the access of veterans to care and increase the numbers of veterans that can actually get to us for that care.
    Third major goal for the integration is the modernization of VA health care. There is a need to modernize both the manner in which veterans' health care is provided in Chicago as well as to modernize our facilities. For example, in this VISN we have had significant expenditures into our infrastructure to be able to accommodate the computer age and be able to transfer information from site to site so that veterans' records and their health information is accessible wherever they receive care. And again, given the federal funding realities, this also needs to be accomplished within what budget we have.
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    We are changing from a hospital system, which we had been historically, into a health care system. And the infrastructure that we develop with our computer network will allow the outpatient care, which is going to be given hopefully in multiple areas across this VISN, to be effective and to assure that the veterans' records and medical information is available at each one of those outpatient care sites.
    Our fourth goal is really the optimal utilization of VA capital assets. We have begun looking at elimination of unnecessary duplication or redundancy. We have consolidated some of our administrative services. For example, all of our contracting for this area is done as a single entity, which gives us volume buying for eight facilities as well as efficiencies in the contracting.
    We have increased telemedicine usage to handle areas where scarce medical specialties aren't available. This is one of the areas that VA Chicago is an asset for us in terms of supporting some of the rural health care in our VISN, such as at Iron Mountain, MI, where specialists are not as available, and they will actually get support from VA Chicago without those clinicians and specialists having to travel by the use of telemedicine.
    The fifth goal is to really insure consistently high quality care, and many of the performance measures that we are looking at and collecting data across the VISN are to say that as we undergo these changes, that we give consistently high quality care throughout the network.
    This is being measured by a series of measures, both of our performance measures and in looking at our outcomes, but also by veterans' measures. And I agree with many of the previous panelists that the people we serve need to be included in that.
    We have a Management Assistance Council that had been referred to earlier coming up in November, and I will be giving them information from our veteran satisfaction survey which we just received, and I am very proud to tell you that this VISN has improved satisfaction in every measure on that satisfaction survey with the exception of family education, which we are going to improve this year.
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    This includes access so that the veterans who respond to our satisfaction survey are indicating that the changes we are making are improving the care in areas of access, and courtesy which is rated one of the five highest in the Nation by the veterans in terms of looking across the VISNs at the satisfaction survey.
    These are the kinds of measures that we need to continue to do. I don't have results of the outpatient survey, but we hope to get that in November. It is the kind of information we will be sharing with all the facilities and sites of care to see that they know exactly how the veterans that they serve are perceiving the care that they receive.
    I would also at this point like to take the opportunity to all here, both the committee and to all in the audience, to reaffirm my belief that both the Lakeside and West Side divisions are essential, and that I and the department have no plans to close either division.
    However, if we are going to achieve the five goals that I just discussed—reduce costs, increase access, modernize our health care system, and optimally use our VA capital resource while insuring high quality care—there is a need to change how these facilities provide the care and what specific services they provide.
    I think one of the biggest changes that does cause concern is this move to outpatient care, as we set up outpatient clinics and community-based primary care sites with these two additions serving as the nub of their tertiary care.
    In terms of an update on the integration, the Integration Coordinating Committee met on October 1, 1997. The final reports were given. The committee felt that their work has been completed. Dr. Terrence, the chair of the committee, who has been absolutely invaluable to us in this VISN, thanked all of the members for their work and announced the final meeting of the group, as it had completed its task.
    The Stakeholders Advisory Group met yesterday, on October 15, and again, the members were thanked for their work. That advisory group as a separate group is being disbanded. Most of those individuals are on either the Management Assistance Council or the Veterans' Advisory Council that I have.
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    We will be reviewing the membership of that group to assure that those individuals on that Stakeholders Advisory Group are on one of those other groups to continue their input in the meetings we have, both at the facilities and separate meetings at the VISN office.
    Our Management Assistance Council is quite large. It meets twice a year. Because of that, we have had subcouncils of that set up so there are quarterly subcouncils with the Veterans' Service Organizations and the congressional delegation, both in Illinois and then we repeat them in Wisconsin to assure that folks have access to them, that are held in addition to the Management Assistance Council.
    And we will assure that those individuals were put on those groups in place to continue that input, because I totally concur with many of the remarks that the input of the stakeholders is nothing but beneficial.
    It has improved the quality of the decision-making, I believe, of the integration coordinating committee and through the Veterans' Advisory Council and the MAC that I get, and I think improved the functioning of the VISN as a whole.
    That would conclude my remarks, and I would be happy for any questions, Mr. Chairman.
    [The prepared statement of Dr. Cummings appears on p. 44.]

    Mr. LAHOOD. Thank you very much.

    Mr. MOORE. Thank you. Mr. Chairman, members of the subcommittee, it is very nice to follow your boss. Then you can cut out most of your testimony.
    I want to say that when we embarked on this integration process, we chose Webster's words on faith: ''A firm belief in something for which there is no proof.'' When we embarked upon this journey, my faith in the veterans, in the VA, and in the merits of the task before us assured me that we would accomplish this with success.
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    Well, I point out that many naysayers said it won't work. Well, I am here before you today with my faith intact, and to tell you that it will.
    And I would like to show off some of VA Chicago. I have my two associate directors, my two chiefs of staff, and my 16 department heads of VA Chicago. Please stand.
    Mr. LAHOOD. Welcome to you all. Great to have you all here.
    Welcome, Mr. Moore.
    Mr. MOORE. I think that is a diverse group. No matter what anyone says, I want you to know that they were chosen from equal measure. There are eight from VA Lakeside division and there are eight from VA West Side division. Thank you.
    I am not sure how we could convince the world more that we are here to do the right thing. But I think, in closing with my testimony, and I won't say all of these things because my boss has said it so eloquently, I saw a movie and it said, when there is a sparrow that is hurt in Central Park, I feel it. And so it is about VA Chicago.
    I am pleased to be here, and I will answer any of your questions. And you said my testimony in the whole will be in the record. Thank you.
    [The prepared statement of Mr. Moore appears on p. 56.]

    Mr. LAHOOD. It will. Thank you, Mr. Moore.
    Dr. Terrence, welcome.

    Dr. TERRENCE. Mr. Chairman, other speakers and guests, good morning. Thank you for this opportunity to discuss the Integration Coordinating Committee of the VA Chicago Health Care System.
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    I have one advantage. I am an out-of-towner. I am not from Illinois. I am the chief of staff at the VA New Jersey. I was charged by Dr. Kizer on October 1996 to be the chair of the Integration Coordinating Committee of the VA Chicago Health Care System.
    In his letter of appointment, Dr. Kizer stressed that there were ''no preset determinations. The process should be open and data driven, and that all reports and recommendations reviewed by the VISN director and subsequent review at the Under Secretary of Health level.''
    One of the guiding principles that the Integration Coordinating Committee shared early in the process was the need for maximum involvement of the affiliates, the stakeholders, employees, and other interested individuals.
    As of today, over 300 individuals in the VA Chicago health system have been involved in the ICC process as members of either committees of the ICC or subcommittees or the stakeholders group.
    At the first meeting of the Integration Coordinating Committee, it was decided that we would proceed forming chartered work groups with the support of the medical center director. The groups were given service-specific charges to develop a health system that would maintain the quality or enhance the overall service to the veteran while minimizing the costs inherent in operating two tertiary care hospitals.
    The committee decided to start with the services that were relatively noncontroversial in order to prove that the process was valid and could be accomplished in the context of the VA Chicago Health System. When the group completed its proposal, the proposal was submitted to the Integration Coordinating Committee for its review and subsequent recommendation to the medical center director.
    The proposal was reviewed also by the Stakeholder Advisory Group, by the chairman of the various work groups. The recommendations from the Stakeholders Advisory Group were brought forward to the ICC in order to provide maximal input into the deliberations of the ICC.
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    The various work groups were chaired by various service chiefs, but in some instances, such as surgery, medicine, and psychiatry, the groups were chaired by members of the University of Illinois Medicine faculty or representatives of the Northwestern University Medical School faculty.
    In order to keep the staff up to date at the two divisions, up to date on the process, we used a number of various means. The first was using town hall meetings. We held four town hall meetings at the various sites to discuss the work of the integration coordinating committee.
    There has also been regular updates of the ICC in the Chicago Health Care System newsletter and also the minutes of the—all meetings of the ICC were put on the centralized hospital computer, which meant that all the employees could look them up in the computer and see what the minutes contained.
    By October 1 of 1997, all the work groups have presented their recommendations to the ICC. Most of the recommendations have been forwarded to the medical center director with little changes. A few have been referred back to the services work groups for slight modifications.
    The ICC has approved the goals and mission statement of the VA Chicago Health Care System. In addition, the committee has recommended the replacement of angiography equipment at West Side and the replacement of cardiac cath equipment at the Lakeside division.
    The committee has recommended the integration of the ambulatory care services. The committee has built up a track record of accomplishment which has allowed us to deal with the thorny issues of affiliation interests and placement of bed services.
    In order to facility the process among the bed service work chiefs, Mr. Moore and I met with all the bed service chiefs in the beginning of this fiscal year to discuss with them the ongoing progress.
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    In summary, I believe that the ICC of the VA Chicago Health Care System has worked very diligently in setting up a process and framework for integration of two tertiary care hospitals. That committee would never have been successful without the support of the four medical school deans who were members, the union representatives who contributed greatly, the chair of the stakeholders group, and other veterans service organizations.
    Thank you for this opportunity to present this brief overview of the ICC. Thank you, Mr. Chairman.
    [The prepared statement of Dr. Terrence appears on p. 62.]

    Mr. LAHOOD. Thank you. Congressman Evans.
    Mr. EVANS. Thank you, Mr. Chairman.
    Dr. Cummings, the network facility development plan that you participated in as a director at Hines Hospital and testified before one of our subcommittees in 1994 had a different plan for integration of services. The plan included all of the Chicago-area facilities, not just Lakeside and West Side. The recommendations were quite different from those made by the ICC.
    So I would like to ask you, do you still believe that the network facility development plan still offers a guide post for VISN planning efforts, and if not, explain the reasons for your different view.
    Dr. CUMMINGS. Yes, Congressman Evans. That plan that was done as a pilot was the first time it was attempted to have more than one facility develop a development plan. Prior to that, the VA had always had individual facilities develop this development plan in a vacuum from what was around them.
    And as a pilot, they attempted to do this for the four facilities in the district. That plan actually was never finished, and the plan was never accepted by either the district or the regional director or Central Office.
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    The recommendations and the workbooks we have on that that we did—and I was actually the chair of the district then—as facilities working together, I believe there is only one of the recommendations that was developed and accepted by the VA. So that, really, still was the report of the consultants that were hired to develop that plan.
    That is not to say that that information may not be useful to us in the future, but it was never adopted as a plan for us to go forward. And as a matter of fact, prior to the reorganization of VA, there was an overt motion at our district council that stated that we had not accepted it, and that we would take that information and use that as was needed in any future planing.
    It then subsequently became overtaken by the reorganization into VISNs, and we have not really used any of the recommendations in our planning. Some of the data about the square footage and some of the others have been used in our capital asset planning. But we then began a planning of a much wider area.
    Mr. EVANS. You know, I know a lot of people say that the way the VA ought to be going is to more outpatient clinics. Can you tell us what the process is for determining where outpatient clinics are located?
    Dr. CUMMINGS. Yes. I am very pleased with this outcome; it is how we picked the Chicago Heights and the Woodlawn—what we have done is we have used the existing data. There is a veterans survey, and using that and the census, the U.S. Census, you actually can identify areas that have high Category A populations so that we can better provide for underserved areas.
    And we have used across the VISN that data technique. It identified the Austin area I told you, where less than 40 percent of the Category A veterans use any VA facilities, and yet we know the economics in Austin indicate it should be higher.
    With that data, we identified the Woodlawn area, Chicago Heights. LaSalle/Peru is one that we are working on, which also has very similar demographics. So we have used that and focused on areas where there is underserved need.
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    And in addition, the City of Chicago—and I don't remember exactly where it came from, but they developed some years ago a transportation grid when they were looking at a health care system.
    We have that, and we have superimposed that over some of these demographics to look at access routes. And it has given us the information such as the fact that, really, from Chicago Heights you can't get to any of our VA hospitals without a car.
    So we have used demographics like that to try and locate the community-based clinics.
    Mr. EVANS. The SEIU, the Service Employees International Union, says that industry-wide an employee cleans an average space of about 1,500 square feet, but that right now at the hospitals they have gone through a major reduction in cleaning employees. They used to have 286 people cleaning ten buildings. That is down to 179 employees, so that one person is now responsible for cleaning 33,000 square feet.
    Have you looked at those standards? If you can't tell me today, could you submit that to us for the record? I think it is one indication we can save money by downsizing, but if the quality diminishes, that is a real concern of ours.
    And also, we would be interested in your response to the allegations made that cuts in administrative staff and LPNs and nurses' aides are impacting waiting periods for patients within the clinic or within the hospital already. Do you have any thoughts on these issues?
    Dr. CUMMINGS. Well, yes. My general data—I have general data. Our length of stay at both Lakeside and West Side has continued to drop, increasing that they are accomplishing more in less time, so that we have dropped our bed days of care across the system.
    And Lakeside and West Side have both done this in similar kinds of proportion, almost by 50 percent over the last year, so that the length of stays at each of the facilities—and while I believe there can still be improvements, the efficiencies in terms of getting what needs to be done during an inpatient stay does not seem to have been adversely impacted.
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    The access portion of the veterans survey information also indicates to us that the veterans we serve seem to have increased access. We do routinely monitor waiting times, Congressman Evans.
    I can't tell you that I remember specifically the waiting times for clinics, but it certainly is something that we can send to you afterwards because we look at waiting times for all of our clinics and entry into specialty services. And that is one of our performance measures. And I would be happy to send that.
    Mr. EVANS. If you could submit those, Mr. Chairman, I would like that information made part of the record of the hearing.
    Mr. LAHOOD. Without objection.
    Dr. CUMMINGS. I would be happy to do that.

    (Subsequently, the Department of Veterans Affairs submitted the following information):

Strip offset folio 1 insert here

    Mr. EVANS. Thank you, Mr. Chairman.
    Mr. LAHOOD. Congressman Gutierrez.
    Mr. GUTIERREZ. Well, first of all, Dr. Cummings, let me thank you for making the special effort of being here today. I know you were going to be in Washington, DC, but didn't want to miss this hearing. So I appreciate the effort that you have made to be here and to listen to the veterans of Chicago.
    Dr. Cummings, under the Veterans' Equitable Resource Allocation, VERA, funding structure, our local VA network is scheduled, as you testified, to lose $57 million during the next 3 fiscal years. I am sure that the integration process has taken into account these reductions and savings needed to recoup just the $57 million.
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    I want to know, however, how much savings the integration of West Side/Lakeside will incur for the next 3 fiscal years.
    Dr. CUMMINGS. I can't—the third fiscal year I can't give. I don't know that. But we do know if we restrict, and I think it is important to remember that we have to look at not just the integration but what else are we doing.
    For example, one of the major savings in our VISN is a single laboratory plan for testing of blood samples across the VISN, and that has accounted for about $2 million in savings this last fiscal year and hopefully more.
    So a lot of what we are doing, the reducing of the bed days of care and closure of acute beds that result in cost savings, aren't related to the integration. Those are VISN-wide goals.
    If we were to look at only the integration, in the last fiscal year that we are just finishing, estimated that attributable to integration itself is probably $2 million. And that has to do with the fact that many of the areas, as we begin to combine services and do things more effectively, that does decrease your cost. And we expect that a similar figure, our estimate for this coming fiscal year is in the range of $3 million.
    I must admit that it is very difficult for me to get beyond that to predict the further years since it really depends on what the work—you know, the continued single services, what plans they make. But we would expect probably $3 million in this year.
    Mr. GUTIERREZ. And you also stated that in VISN 12, by the year 2002 you want to see veterans care in Chicago expanded to 28,000 new users. This, of course, would occur as outpatient care is expanded throughout the region, and you have talked about Woodlawn and the West Side and having more settings for people to come and receive care.
    My concern is that under the new funding allocations that we just talked about, 57 million fewer dollars over the next 3 years, that Chicago will lose resources, obviously, and that the savings that you make up from the integration of duplicative service and reduction of waste will first have to be devoted to remedying the new mandated short falls.
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    Is it realistic under this scenario, with resources diminishing and integration fading, first having to pay the short fall, the 57 million bucks, that that can really be expanded, fewer resources, integration, you have got to put the money—because you have $57 million. You are expanding. How do you do that?
    Dr. CUMMINGS. I believe it can be done. And let me use our laboratory service plan as an example of that.
    We ran in this VISN eight separate hospital laboratories that, by and large, did 80 percent of the tests that commonly hospitals did. We no longer do that. As many of you know, laboratory testing is largely automated on huge machines. We analyzed the data and the work load and found out that, really, two of our facilities, the two large ones, Milwaukee and Hines, could handle the vast bulk of our laboratory testing, and that we didn't have to run eight separate full-service labs.
    We looked at some other private sector experiences. The Mayo Clinic hasn't had a lab in its building for years. In Indiana, the same circumstance. That is estimated to save us about $7 million a year just in its initial phase of implementation, and we think we can expand that kind of consolidation of workload to include some merged testing and other various types of testing.
    It has also enhanced our quality in that some tests, things like thyroid function and others, where the volume at any one of the facilities was such that they only ran the test, say, once or twice a week, we now can run them daily.
    So I believe that we need to reengineer how we give the care—one of the work groups in the integration has proposed that there only be one kitchen to serve those two facilities. That is—a lot of the world does that, and there is no reason not to do that. That will save money.
    We have looked at other kinds of mechanisms. I have mentioned our consolidated contracting. So I believe that as we reengineer how we do things and we do things as eight regional entities versus eight separate facilities, there are savings to be made to reinvest in outpatient care.
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    The other major area that I am very pleased with, and unlike some of the other aspects of VERA, it is one where this VISN does well and, really, with the help of your committee as well as Congress itself, is our medical cost recovery.
    We now are able to retain third party insurance payments. This VISN is actually one of the VISNs in the country that is a leader in collecting insurance funding. We appear to have at least a slightly higher rate of of individuals having insurance, and we have done well with collections. We think we can increase those collections.
    That also is another revenue source that we can use to increase our access into the outpatient clinic areas. So I believe it is possible. I think that it will require more reengineering and more looking at what we are doing collectively across the VISN.
    We do have the Chicago Heights clinic. We plan to open that, we would hope, as soon as we finish the leasing things over the next several months and get the space there. As I said, we have already expanded the Woodlawn clinic. We expect to open a clinic in LaSalle/Peru and one in Union Grove, which will probably serve, also, some of the veterans in northern Illinois this coming year.
    So I think it is possible.
    Mr. GUTIERREZ. Mr. Chairman, I would just like to take a moment to recognize Bob White from the Paralyzed Veterans of America, and ask that the record be kept open in order for the Paralyzed Veterans of America's testimony to be included in the hearing record today.
    Mr. LAHOOD. Welcome, Mr. White, and the record will be held open.
    Mr. GUTIERREZ. Thank you so much.
    Mr. LAHOOD. Thank you for being here.
    Mr. GUTIERREZ. And we will include—we will keep the record open until you can submit that. Thank you so much for being here, Mr. White.
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    Dr. Cummings, there is a—the ICC and the SAG group got together and met and ended its formal function. Given some of the things that we have heard here today, and given that all of the process has not been completed, how do we end the process at one end in terms of the—I mean, one of the—and Chairman LaHood, you weren't around for all the beginning of this, but if you had, you would understand more keenly, given the lack of communication at the beginning, which I think we can say we didn't know how to do it any better; it wasn't that we didn't want to do it this way, everybody is delighted with what we got today—and given that we haven't ended it yet, shouldn't we keep a safeguard in there since we started Woodlawn, we started with none, we integrated one, and now everybody has come here to talk about how they are all talking and working together, and then we are going to end without one.
    So how do we get the stakeholders in the end process?
    Dr. CUMMINGS. Yes, Congressman Gutierrez. As a matter of fact, we had a meeting yesterday with the veterans service organizations and some of the congressional staffers. I believe that the input is essential.
    Many of the members of that stakeholders council are either on my Veterans' Advisory Council or on the MAC, and as I mentioned in my testimony just briefly, I am going to take that group and make sure that all of them are on one of those groups.
    I think it is important to put them on that because that is probably where the communication occurs. One of the issues that has come up in the integration is, we talk about things that are VISN initiatives, and yet since they are happening at West Side and Lakeside divisions, as they happen everywhere, somehow they get confused with the integration.
    Yesterday at the meeting that I had with the service organizations, and we are going to do this again with my MAC, we took—as you know, the VA is required to do these business plans and our strategic plans. Ours is due the end of October, beginning of November.
    I took all of the initiatives for that plan and gave them out to our stakeholders at those two meetings, and we will do it at the MAC, to solicit their input. And we discussed our initiatives—reducing the bed days of care, opening the community-based clinics.
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    And I think that getting them in that group, they will have access to wider information and it will be more consistent because it will include things that impact Lakeside and West Side that don't have anything to do with the integration.
    And I certainly agree with the testimony, and we will make sure that the groups who were on that stakeholders have access to those meetings. And they meet quarterly with us here, and are on groups that can continue that input, because if there was anything that we could have done differently on this integration, it would have been start the stakeholders council before the newspapers reported about integration.
    Mr. GUTIERREZ. So I am just—we can meet at another time. Obviously, because I think I know what is going to happen. I think we have got an excellent process going on, but I have pretty keen understanding about how a great process can fall apart at a very critical moment.
    So I will talk to Congressman Danny Davis, because he and I are good—not that Congressman Lane Evans won't hear from the stakeholders, but we are—being such in the vicinity, being from Chicago and having been involved in this process. I don't want it to fall apart at this point.
    So let's try to find ways where we can take the stakeholders who we have integrated into the process and keep them in the process at different levels and maybe have a little flexibility. We will talk about that some more later on.
    And I look forward to having that opportunity to do that with you.
    And I want to—I had a question. Somebody did raise a question, Mr. Chairman. They took me up on providing a question. And that question is to Dr. Cummings.
    What is being done to avoid pushing veterans who need long-term care out of the system? And, in parentheses, in the interest of saving money?
    We have learned of one Vietnam veteran who was discharged from North Chicago and had to fight for readmission, particularly after doctors in the private sector discovered he had cancer. Can we avoid this from recurring in the drive to reintegrate Lakeside and West Side?
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    It is not my question, but if you could answer it as best you can.
    Dr. CUMMINGS. Obviously, I don't know the specifics—we could certainly try and investigate the particular incident.
    But let me just speak about long-term care. West Side and Lakeside—and this is independent of the integration; West Side and Lakeside have no long-term care, and have not in the past. So it is not a piece of the integration.
    We have long-term care sites at five of our VISN facilities. The whole issue of long-term care, particularly nursing home care, in the VA is one that—actually, there is a federal advisory committee the VA has chartered, and I am on it, to look at it, because as you are aware, in eligibility reform, there was no change in nursing home eligibility.
    We have not changed our numbers of long-term care beds in this VISN. We have actually increased them slightly in terms of the domiciliary in North Chicago.
    But the issue of the future needs for long-term care is one that I think needs a lot of looking at and a lot of input. There has been concern across the country. We are looking at ways to continue as efficiently at possible the current long-term care we do, but also to look at the future.
    For example—of all nursing home care that veterans use, VA provides approximately 15 percent of that nursing home care. That figure has been stable for, I believe, 10 or 15 years.
    So the VA is a significant player in nursing home care, as you are obviously aware. Except for VA, the major payers of nursing home care are the individual and public aid.
    So we are a significant player. But there has been no change in that number that we can see. I think that this is a challenge that VA needs to look at, nationally and I think it needs a national policy.
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    The advisory committee is being asked to present to Dr. Kizer and VA recommendations on what should we do with long-term care. And I think we have had one meeting, and I think we are due for another meeting in November to look at that.
    It has a lot of experts in geriatrics and long-term care outside the VA to give advice on this. But I don't think the answer is clear to us on what is the VA's role and how much of a role in the long-term care that individuals need.
    Now, the other long-term care that is not nursing home care, I am very proud of. The VISN has got several task groups looking at expanding home care, making sure that we cover areas—certainly the major urban areas first, and then address how we provide home care in the rural areas.
    And we have a long-term care task force that is looking at both that and at adult day care. So I think in those areas of long-term care that come under eligibility reform, we have groups from across the VISN with representatives to look at that, and to make sure that we give access to those kinds of care to as many veterans as we can.
    Mr. GUTIERREZ. Well, I would like to end by saying to Dr. Cummings and Mr. Moore and Dr. Terrence, thank you so much for your leadership in continuing the ICC and keeping everybody together and working to get everybody's recommendations together.
    And I would say, Dr. Cummings, congratulations. This is a far cry from—we are not past the goal line, but this is a far cry from when we were huddled back in my office. I don't know if you remember that cold day.
    I had an advisory committee meeting. I usually have about 15 veterans, 15 to 20 veterans, at my advisory, and my office was full, if you remember. And Dr. Cummings was sitting there among about maybe 75 veterans.
    I am happy to say I keep in touch with all of them. Once they came, they continue to keep coming back. So it was very positive for me in terms of gathering information. So we are a far cry from there.
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    And I still want to say—I want to leave one last thing for the record, because I think that while Dr. Cummings kind of took some of the slings and the arrows in the beginning because she started out this process and she was in charge of the VISN, much of the focus shifted quickly to Mr. Moore and his new ascendence to coordinating both facilities.
    And I want to say that I am delighted and excited about your presence here today and the work that you have been able to do, and I want to tell you, sometimes in the work with the public and in developing public policy and in working, which you have dedicated your life to the public——
    Mr. MOORE. Your job is safe right now.
    Mr. GUTIERREZ (continuing). It happens. It happens. So thank you very much, Mr. Moore, because I know how personally difficult it must have been at times for you. Thank you for being so steadfast and earnest and dedicated to your work. I know it could not have been easy.
    Thank you all very much for your testimony.
    Mr. LAHOOD. Mr. Evans, any further questions?
    Thanks so much for this panel and for your testimony and your expertise. And I want to also thank, again, Congressman Gutierrez for his efforts in arranging this hearing, the Chicago Park District for the availability of this facility, all the interested citizens who attended, and the interest of our members who testified and were willing to answer questions.
    And as was stated earlier, the record will be kept open and be available for anyone who would like to include anything else.
    And we are adjourned. Thank you all.
    [Whereupon, at 11:05 a.m., the subcommittee was adjourned.]