I 

113TH CONGRESS 

2D SESSION H. R. 5007 

To assess staffing shortages at medical facilities of the Department of 

Veterans Affairs, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 26, 2014 

Mr. RUIZ introduced the following bill; which was referred to the Committee 

on Veterans’ Affairs 

A BILL 

To assess staffing shortages at medical facilities of the 

Department of Veterans Affairs, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Restoring Account5 ability in Veterans Access to Health Care Act’’. 

6 SEC. 2. TREATMENT OF STAFFING SHORTAGE AND REPORT 

7 ON STAFFING OF MEDICAL FACILITIES OF 

8 THE DEPARTMENT OF VETERANS AFFAIRS. 

9 (a) STAFFING SHORTAGE.— 


tjames@gpo.gov on DSK5VPTVN1PROD with BILLS
2 

•HR 5007 IH

1 (1) IN GENERAL.—Not later than 180 days 

2 after the date of the enactment of this Act, and an3 nually thereafter, the Inspector General of the De4 partment of Veterans Affairs shall determine, and 

5 publish in the Federal Register, the five occupations 

6 of health care providers of the Department of Vet7 erans Affairs for which there is the largest staffing 

8 shortage throughout the Department. 

9 (2) RECRUITMENT AND APPOINTMENT.—Not10 withstanding sections 3304 and 3309 through 3318 

11 of title 5, United States Code, the Secretary of Vet12 erans Affairs, based upon a determination by the In13 spector General under paragraph (1) that there is a 

14 staffing shortage throughout the Department with 

15 respect to a particular occupation of health care pro16 vider, may recruit and directly appoint highly quali17 fied health care providers to a position to serve as 

18 a health care provider in that particular occupation 

19 for the Department. 

20 (b) REPORTS.— 

21 (1) IN GENERAL.—Not later than 180 days 

22 after the date of the enactment of this Act, and not 

23 later than December 31 of each even numbered year 

24 thereafter until 2024, the Secretary of Veterans Af25 fairs shall submit to the Committee on Veterans’ AfVerDate Mar 15 2010 05:57 Jul 03, 2014 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H5007.IH H5007

tjames@gpo.gov on DSK5VPTVN1PROD with BILLS
3 

•HR 5007 IH

1 fairs of the Senate and the Committee on Veterans’ 

2 Affairs of the House of Representatives a report as3 sessing the staffing of each medical facility of the 

4 Department of Veterans Affairs. 

5 (2) ELEMENTS.—Each report submitted under 

6 paragraph (1) shall include the following: 

7 (A) The results of a system-wide assess8 ment of all medical facilities of the Department 

9 to ensure the following: 

10 (i) Appropriate staffing levels for 

11 health care providers to meet the goals of 

12 the Secretary for timely access to care for 

13 veterans. 

14 (ii) Appropriate staffing levels for 

15 support personnel, including clerks. 

16 (iii) Appropriate sizes for clinical pan17 els. 

18 (iv) Appropriate numbers of full-time 

19 staff, or full-time equivalent, dedicated to 

20 direct care of patients. 

21 (v) The appropriate physician to pa22 tient ratio (including for both primary and 

23 specialty care), as compared to such ratio 

24 as it exists on the date of the report. 


tjames@gpo.gov on DSK5VPTVN1PROD with BILLS
4 

•HR 5007 IH

1 (vi) Appropriate physical plant space 

2 to meet the capacity needs of the Depart3 ment in that area. 

4 (vii) Such other factors as the Sec5 retary considers necessary. 

6 (B) An explanation of the measurable pro7 ductivity standards used to establish the levels 

8 in the assessment described in subparagraph 

9 (A). 

10 (C) A plan for addressing any issues iden11 tified in the assessment described in subpara12 graph (A), including a timeline for addressing 

13 such issues. 

14 (D) A list of the current wait times and 

15 workload levels for the following clinics in each 

16 medical facility: 

17 (i) Mental health. 

18 (ii) Primary care. 

19 (iii) Gastroenterology. 

20 (iv) Women’s health. 

21 (v) Specialty care. 

22 (vi) Ophthalmology. 

23 (vii) Such other clinics as the Sec24 retary considers appropriate. 


tjames@gpo.gov on DSK5VPTVN1PROD with BILLS
5 

•HR 5007 IH

1 (E) A description of the results of the de2 termination of the Secretary under paragraph 

3 (1) of subsection (a) and a plan to use direct 

4 appointment authority under paragraph (2) of 

5 such subsection to fill staffing shortages, in6 cluding recommendations for improving the 

7 speed at which the credentialing and privileging 

8 process can be conducted. 

9 (F) The current staffing models of the De10 partment for the following clinics, including rec11 ommendations for changes to such models: 

12 (i) Mental health. 

13 (ii) Primary care. 

14 (iii) Gastroenterology. 

15 (iv) Women’s health. 

16 (v) Specialty care. 

17 (vi) Ophthalmology. 

18 (vii) Such other clinics as the Sec19 retary considers appropriate. 

20 (G) A detailed analysis of succession plan21 ning at medical facilities of the Department, in22 cluding the following: 

23 (i) The number of positions in medical 

24 facilities throughout the Department that 

25 are not filled by a permanent employee. 


tjames@gpo.gov on DSK5VPTVN1PROD with BILLS
6 

•HR 5007 IH

1 (ii) The length of time each such posi2 tion described in clause (i) remained va3 cant or filled by a temporary or acting em4 ployee. 

5 (iii) A description of any barriers to 

6 filling the positions described in clause (i). 

7 (iv) A plan for filling any positions 

8 that are vacant or filled by a temporary or 

9 acting employee for more than 180 days. 

10 (v) A plan for handling emergency cir11 cumstances, such administrative leave or 

12 sudden medical leave for senior officials. 

13 (H) The number of health care providers 

14 who have been removed from their position or 

15 have retired, by provider type, during the two16 year period preceding the submittal of the re17 port. 

18 (I) Of the health care providers specified in 

19 subparagraph (G) that have been removed from 

20 their position, the following: 

21 (i) The number of such health care 

22 providers who were reassigned to another 

23 position in the Department. 

24 (ii) The number of such health care 

25 providers who left the Department. 


tjames@gpo.gov on DSK5VPTVN1PROD with BILLS
7 

•HR 5007 IH

1 SEC. 3. CLINIC MANAGEMENT TRAINING PROGRAM OF THE 

2 DEPARTMENT OF VETERANS AFFAIRS. 

3 (a) IN GENERAL.—Not later than 180 days after the 

4 date of the enactment of this Act, the Secretary of Vet5 erans Affairs shall implement a clinic management train6 ing program to provide in-person, standardized education 

7 on health care management to all managers of, and health 

8 care providers at, medical facilities of the Department of 

9 Veterans Affairs. 

10 (b) ELEMENTS.—The clinic management training 

11 program required by subsection (a) shall include the fol12 lowing: 

13 (1) Training on how to manage the schedules of 

14 health care providers of the Department and train15 ing on customer service and veteran-centered care, 

16 including proper planning procedures for vacation, 

17 leave, and graduate medical education training 

18 schedules. 

19 (2) Training on the appropriate number of ap20 pointments that a health care provider should con21 duct on a daily basis, based on specialty. 

22 (3) Training on how to determine whether there 

23 are enough available appointment slots to manage 

24 demand for different appointment types and mecha25 nisms for alerting management of insufficient slots. 


tjames@gpo.gov on DSK5VPTVN1PROD with BILLS
8 

•HR 5007 IH

1 (4) Training on how scheduling systems will be 

2 monitored and how schedulers will be held account3 able for accurate data. 

4 (5) Training on how to properly use data to 

5 meet the demand for health care, including the fol6 lowing: 

7 (A) Training on determining the next 

8 available appointment for each health care pro9 vider at the medical facility. 

10 (B) Training on determining the number 

11 of health care providers needed to meet demand 

12 for health care at the medical facility. 

13 (C) Training on determining the number 

14 of exam rooms needed to meet demand for such 

15 health care in an efficient manner. 

16 (6) Training on how to properly use the ap17 pointment scheduling system of the Department, in18 cluding any new scheduling system implemented by 

19 the Department. 

20 (7) Training on how to optimize the use of 

21 technology, including the following: 

22 (A) Telemedicine. 

23 (B) Electronic mail. 

24 (C) Text messaging. 


tjames@gpo.gov on DSK5VPTVN1PROD with BILLS
9 

•HR 5007 IH

1 (D) Such other technologies as specified by 

2 the Secretary. 

3 (8) Training on how to properly use physical 

4 plant space at medical facilities of the Department 

5 to ensure efficient flow and privacy for patients and 

6 staff. 

Æ 


tjames@gpo.gov on DSK5VPTVN1PROD with BILLS