 Hi, I'm Joy Elam, DAV National Legislative Director. Dr. Stone, thank you for taking time to participate in this very special forum. I know how busy you are for caring for our nation's veterans and managing the veterans' health care system during the pandemic. As you know, DAV is celebrating an important milestone this year, our 100th anniversary, a century of serving our nation's ill and injured veterans, for which we're very proud. Like most large gatherings, unfortunately, DAV's National Convention was canceled due to ongoing public health crisis. However, given these uncertain times, we thought it was especially important to provide DAV members an update on the status of VA health care services for veterans using the VA health care system and what's ahead. The COVID-19 pandemic has affected every aspect of life in the United States, particularly our nation's health care institutions. In March to keep everyone safe, the VA had to quickly pivot to alternative health care delivery options to care for veteran patients. VHA did an incredible job quickly expanding telehealth services and ensuring enrolled veterans had access to their doctors for routine care, medication refills, and treatment for COVID-19. Dr. Stone, could you please give us an update on how things are going, lessons learned over the last few months, and what options veterans have today for VA care? Well, Joy, first of all, thank you for inviting me to do this. Thank you for the support that you and DAV have shown throughout this in some pretty difficult days as we've worked our way through. Congratulations on the 100th anniversary and what a great organization representing, I think a million of us that are disabled veterans and we appreciate all you do in the role that you've taken and frankly just the collegial nature that you've worked with us through this and as we tried to make things better. You know, we began working with this pandemic back in January. It was actually the end of December when we began talking to our emergency operations people about this new virus that had transmitted from animals to humans. And then in early January when the virus first went human to human is when we stood up our emergency operations center. We have worked hard to make sure that we had appropriate access to health care for our veterans and remember that we do about 300,000 visits a day normally. That dropped to about 100,000 visits a day and remember that those other 200,000 still needed some sort of care and so we've had a tremendous increase in telemedicine. We've had a tremendous increase in telephonic calls and we've been working hard to make sure that everybody has gotten cared for well. I'm very, very pleased that throughout this urgent health care needs have been cared for in the same rapidity just as quickly as we were doing before the pandemic and it's a great testament to the creativity and innovation of the VA workforce as they've gone through this. So today we're back up to around 170,000 visits every day face to face. Our surgery has recovered to about 70% of what it was before. Our ERs are just about as busy as they were before and urgent care out in the community which was a new benefit for us as veterans had dropped off very significantly and that has come back up to about 80% of what it was. Great. Well, I can attest as a veteran who uses the VA health care system VA did not miss a beat right in March. I had no scheduled appointment. I thought it would likely be canceled but no, they reached out. Everything went fine and had a great visit and felt very good that I was able to keep that and not postpone any needed, you know, care. You know, Joy, that's one of our greatest concerns is that we don't want veterans to put off their care and we recognize that there are veterans that feel uncomfortable or have chemotherapy, things like that, that they're uncomfortable going out or coming in and we need to work through with that. You know, there's another area of great concern for us and that is our caregivers. You know, our caregivers have had a tough time going through this and we have almost 20,000 families in which there's a caregiver for one of our disabled veterans and we're working hard to make sure that there's appropriate respite for them, that they have appropriate supplies and that we're sort of watching for every possible complication that might occur in trying to interrupt that. Sure. Well, I know caregivers is a really important issue to DAV and DAV members, so many of them have a caregiver and wanting to make sure they're safe as well. Is telehealth still the best option for veterans who may be at really high risk? Well, I think we can mitigate risk face-to-face but yes, telemedicine or video visits are a way in many, many cases for veterans to be able to get care while not taking the risk of going out of their home or coming into the medical center. We are very pleased though that at every medical center there's a pre-screening that's done and once you get through the pre-screening then we've worked hard to make sure there's appropriate distancing within waiting rooms so people aren't waiting too long that we try to bring every service to the veteran in the treatment room so that people aren't having to move around the facility like we did before the pandemic when people might wait in a waiting room for pharmacy or in a waiting room for laboratory. So we're working hard to make sure that we mitigate that risk but video visits have been very, very popular with veterans and are up very dramatically. The beauty of telemedicine for the VA was that we already did 2 million telemedicine visits a year for our rural veterans or veterans that they just wanted to be seen that way so our ability to expand has been really dramatic. The other thing that's little known is we do a lot of telemedicine in intensive care. There's a shortage around the nation in all hospitals of intensivists that care for critically ill patients and we have multiple telemedicine hubs for intensive care and we've expanded that fairly dramatically during this pandemic. That's great. I think that's a question all veterans have is that if I do get sick is VA going to be able to take care of me? We're going to have enough beds. We know there were a lot of challenges in the community with regard to some states even now that we're experiencing high levels of COVID and I think veterans would like to hear if they get sick can they count on VA? Do they know they're going to have access to the critical care they may need? So we operate about 10,000 med surge beds about 1,500 ICU beds. We reconfigured ourselves and actually grew by over 4,000 beds early in the pandemic. Because of that we were able to offer 1,500 beds to critically ill Americans that were not veterans and I can tell you that as of today we're in very good shape when it comes to bed capacity, ICU capacity. We also purchased a mobile ICU unique in the world and it is now in Oklahoma City and there are 12 veteran patients in that mobile ICU because we knew that Oklahoma was an area that was struggling for hospital beds across the entirety not just VA but the entirety of the system and as such we've been able to decompress the beds in the Oklahoma City and the Muscogee VA hospitals. That also brings up the point that we've been able to take veterans who are infected with COVID out of the state veteran homes run by the states but there's been some pretty high profile outbreaks of COVID and we've been able to bring many of those veterans into our hospitals to care for and to work to save their lives. That's great. We know as you mentioned how hard hit some of the community care centers, living centers were internally VA has the community living centers. How were those veterans affected? We know there was maybe some limited ability for people, visitors and such. Is that still the case right now just to maintain their safety or has that changed? We operate 133 nursing homes. We call them our CLCs, our continuous living center. These have about 8,000 veterans on any given day that are housed there that call that their home. We are very, very pleased with the fact that our infection rates have been dramatically lower than other nursing homes around the nation and the state veterans homes and it is because of the very robust physician staffing as well as very robust nursing staffing that we do. Our patient to nurse ratio is much more like an acute care hospital and because we run it in that manner our ability to do infection control to understand how to put on and take off protective equipment, how to isolate patients and you know very early on in this we thought we could run COVID positive and COVID negative hospitals and CLCs. It is not possible to do that because so many people come in from the outside with COVID not even realizing it and we're able to run COVID positive and COVID negative neighborhoods and in those neighborhoods of a facility we're able to protect people and been very pleased at how well we've done. In fact we've done work in supporting American nursing homes and literally hundreds of nursing homes across 47 states. The most painful thing that I think that we have had to do is to cut off visitors for those veterans and especially those veterans with dementia or cognitive decline really need visits from their families and we had to do that because we had to protect the veteran population and I think if you were talking to the secretary he would tell you that that's one of the most difficult decisions that we made very early on and it was tough for many many families. We've been able to work through through the gracious support of many of the of the great industries that support us with some iPads and things like that we've been able to do electronic visits but there's nothing like having your family with you and it's still been a tough part of what we're doing is the limitation of visits. I think I saw a message from VA coming out that maybe volunteers would be allowed coming back at some point you know their role has been so important and many DAV members are volunteers in the facilities. Do you see that happening in the near future? I do in fact on Wednesday two days ago I was just up in Chicago North Chicago at the Federal Health Center up there that's a combined Navy and VA facility and I was actually surprised to see two volunteers there that were helping do some screening and they're going through the same testing that our employees do that are doing that kind of job but it was great to see volunteers back in the facilities because it's such an important part of connecting our community of veterans together. Our members have really missed being able to do that and they want to help out wherever they can so I know that's a welcome some welcome news for them if a veteran needs a test or feels you know that there might be becoming sick or might be COVID positive and they want to find out just to make sure what's your best advice should they call the VA Medical Center first or do they just need to go in? Yeah they should if they're not sick or think they're in the early stages of sickness they should call their primary care team and their primary care team will help them through the process of being tested or not. I think though that if they're really sick and they're having trouble they need to come into the ER in one of our institutions or go to urgent care and get through that process of being taken care of the faster we get at this the better and helping them through and so what one of my biggest concerns is I don't want people putting off care because of fear of coming in so a phone call first contact your medical center and if there's appropriate time to do that but if you're really sick let's get you into the emergency room where we can work through every one of our emergency room will have a screening outside of the emergency room to make sure the potential COVID positive from the COVID negative patients that's great I think that will be reassuring for veterans and I think VA's also put out and you've talked about they'll probably be a temperature check mask wearing in the facility social distancing even having veterans maybe even notify them from their car when they get to their appointment so they're not having to be in the facility to come in when their appointment is when they're ready to be seen yes all of those things are true and just like you and I are wearing a mask just like you and I are socially distant all of those things will occur in the institution or in the CBOC if they're going into a CBOC all of those things will occur in order to protect us and also be aware that unless you need a assistant to be with you for a visit for whatever reason your visitor or someone who might come with you will wait outside in order to protect everybody in the institution just trying to keep at a minimum people who really need to be there and to keep everyone safe just two last quick questions on the healthcare points how quickly are you getting tests back or does that differ at different locations we have rapid tests for the sickest patients and those will come back within 45 minutes we have another series of tests that come back in five hours and then we have some that come back 24 to 48 hours later but we are still sending out to some states in some visions and those can take two to three days to come back we have just been going over those numbers in fact today I'm going to go over some of our testing numbers we are trying to become completely self-contained for testing but as you know in different areas of the country testing is run a little differently and so but our idea is to get for the sickest patients that we can get testing back as quickly as possible great another issue I just wanted to bring up because I know a lot of veterans this is a really uncertain time and some veterans might be struggling due to the isolation just you know the stress of everything happening with COVID but VA has really emphasized that addressing your mental health is part of addressing your whole health and I know that is an important piece especially during that period what can veterans expect is VA doing any special outreach to veterans to make sure they are continuing if they were had mental health visits that they were doing routinely how about the vet centers are they still seeing veterans what's changed or what's happening there so we've done very significant outreach with the vet centers in fact we put the mobile vet centers on the road into many communities and they've moved around the country and over the last many months they've gone to some of the most hard hit areas to reach out and they've touched over 10,000 veterans as part of that outreach in addition when appointments started being canceled either by patients or by us in mental health one of the taskers that went to all mental health teams was to reach out to their veterans that their appointments were being canceled to make sure that they were okay and intense isolation and the stress of potential job loss is something that we worry about a lot and we know that veteran unemployment was down in the low 3% and has jumped up to almost 10% and has now come back down to 8.8% but that financial stress adds to the social isolation and if there's anything we talk about today that is important this is absolutely the most important if you're struggling call the crisis line call your care team come into one of our ERs or the urgent cares to really talk to us and let us get re-engaged with you so that we know that you're well cared for and we're really very concerned about lots of capacity in our mental health units we've been very careful with protecting people in those units from COVID we've had very few problems and it remains a very robust delivery system for mental health and the vet centers have been an important front line effort for that now in the vet centers are still doing face to face visits if the veteran wants we can also do that as a video visit or a telephone visit great well that's good to hear because I know when we interface with our veterans or members who call DAV we're making sure we always check on our veterans make sure that they know VA is open, ready for business if there are mental health issues make sure that they reach out to me or reach out to VA directly so that's great news last series of questions looking at the upcoming flu season there's been a lot of discussion just in the news that we have a potential for a really difficult period coming up with both the flu season and COVID just still challenges in the country that we're facing in terms of reducing the spread of COVID could you just talk a little bit about what's VA doing to prepare for that what do you see for the months ahead so two respiratory viruses in the community at the same time that are as severe as influenza as well as COVID is just unacceptable and we must do everything we can to protect veterans with immunization last year we had over 4600 admissions 600 admissions to the ICU for the flu if we add that to what we currently have for COVID it'll put us in a very difficult situation and put America's veterans in a difficult situation so we have ordered extra immunization for influenza we will begin distributing that next month for this and we also mandated for the first time that all of our employees receive immunization unless there's a medical or a religious reason that they shouldn't but we must reduce the amount of influenza now there is good news compliance with mass and we as veterans are pretty good at following orders our compliance with mass we think as veterans is higher than some of the rest of the American population isolation or social distancing will help reduce the amount of influenza but more important than that it is getting your flu shot in a timely manner will protect us so we're hopeful we've been working for about 3 months now on the influenza campaign and you'll begin to hear more about it and we'll need your help to reinforce this to make sure we get people in there's lots of places you can get your flu shot from local pharmacies are able to do this throughout our system and our urgent care system that is out in the commercial network is able to do so that's great and I know we'll be happy to help push that message out since VA did go to the community at your local CVS or other pharmacies where you can get the flu shot because a lot of times we always went to the VA and made sure we just stopped they used to have them right there in the atrium so you could quickly get it without doing so I'm sure you're going to provide some instructions with regard to that going forward and we'll start that communication campaign over these next few weeks great the other last thing to ask about was research research is such a cornerstone of the VA healthcare system and we appreciate that it's so better and focused is VA involved in any research projects for treatment of COVID? we are, in fact there's no portion of COVID therapy that we are not involved in research and from development of the vaccine participating in operation warp speed to examining medications and innovative ways to ventilate patients who are struggling with breathing during their COVID infection in fact as you and I are speaking there's more than 80 studies here in the VA that are ongoing we were just recognized in the Swedish literature as being the innovators in how to decide when to put somebody on a breathing tube and a ventilator versus the advantages of not doing that and so I'm really proud of the system and how quickly it's stepped up we've broken down a lot of bureaucracy to get studies going quickly and we're really pleased at the work that's going on great well we expect nothing less from the VA always on the cutting edge I may add Dr. Stone thank you so much for taking the time today to talk to DAV members about these important issues I know that there is a lot of uncertainty for everyone these days but one thing is without question is clear VA doctors, nurses and clinical support staff are working hard every day to care for our nation's veterans often at personal risk to their own health and well-being and I know this pandemic touched you and your family personally and what an incredible responsibility you have for coordinating care for millions of veterans every day so on behalf of DAV more than one million members and our auxiliary we want to thank you and all of VHA employees for your commitment your dedication and your tireless efforts to care for those who served Dr. Stone before we close I want to provide you an opportunity to make any final comments anything that we might have missed that you would like to just share and make sure our members here directly from you well just I'd like your members to recognize what a great partnership there is between your leadership team and our leadership team and how proud we are of that relationship you've heard me talk many times we can't do this alone we need your help and we need the role that you play in helping to inform your members we're humbled to do this work our employees are very very proud to do this and proud of the role that we've taken throughout this unprecedented time in American history well we appreciate that we know again how hard you've worked and what a personal toll it takes to be on call I'm sure 24-7 for these months that have followed and but you've been a tremendous leader we appreciate your cooperation your collaboration with DAV you've been on all the calls trying to keep us informed as much as possible and so we really thank you for that so with that we want to make sure that VA employees stay tuned to view the DAV auxiliary virtual salute that we're going to do in place of our national convention on August 26th at 7pm Eastern Time and that can be viewed at DAV.org slash virtual salute and that will include honoring our awardees for the top VHA, VBA and NCA employees of the year and that's been a tradition and we didn't want to stop that and our leadership made sure that that's going to be a big part of our virtual salute and that we recognize employees in throughout VA that have really done a stellar job they've gone above and beyond and much appreciated by our membership so I hope that your employees will tune in I hope you'll have the time to do that and make sure that you see the recognition and how much we appreciate all you do Thank you Thank you very much