[House Report 114-811]
[From the U.S. Government Publishing Office]
114th Congress } { Report
HOUSE OF REPRESENTATIVES
2d Session } { 114-811
======================================================================
DEPARTMENT OF VETERANS AFFAIRS EMERGENCY MEDICAL STAFFING RECRUITMENT
AND RETENTION ACT
_______
November 14, 2016.--Committed to the Committee of the Whole House on
the State of the Union and ordered to be printed
_______
Mr. Miller of Florida, from the Committee on Veterans' Affairs,
submitted the following
R E P O R T
[To accompany H.R. 4150]
[Including cost estimate of the Congressional Budget Office]
The Committee on Veterans' Affairs, to whom was referred
the bill (H.R. 4150) to amend title 38, United States Code, to
allow the Secretary of Veterans Affairs to modify the hours of
employment of physicians and physician assistants employed on a
full-time basis by the Department of Veterans Affairs, having
considered the same, report favorably thereon with an amendment
and recommend that the bill as amended do pass.
CONTENTS
Page
Amendment........................................................ 2
Purpose and Summary.............................................. 2
Background and Need for Legislation.............................. 2
Hearings......................................................... 3
Subcommittee Consideration....................................... 4
Committee Consideration.......................................... 4
Committee Votes.................................................. 4
Committee Oversight Findings..................................... 5
Statement of General Performance Goals and Objectives............ 5
New Budget Authority, Entitlement Authority, and Tax Expenditures 5
Earmarks and Tax and Tariff Benefits............................. 5
Committee Cost Estimate.......................................... 5
Congressional Budget Office Estimate............................. 5
Federal Mandates Statement....................................... 6
Advisory Committee Statement..................................... 6
Constitutional Authority Statement............................... 6
Applicability to Legislative Branch.............................. 6
Statement on Duplication of Federal Programs..................... 7
Disclosure of Directed Rulemaking................................ 7
Section-by-Section Analysis of the Legislation................... 7
Changes in Existing Law Made by the Bill as Reported............. 7
Amendment
The amendment is as follows:
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Department of Veterans Affairs
Emergency Medical Staffing Recruitment and Retention Act''.
SEC. 2. MODIFICATION OF HOURS OF EMPLOYMENT FOR PHYSICIANS AND
PHYSICIAN ASSISTANTS EMPLOYED BY THE DEPARTMENT OF
VETERANS AFFAIRS.
Section 7423(a) of title 38, United States Code, is amended--
(1) by striking ``(a) The hours'' and inserting ``(a)(1)
Except as provided in paragraph (2), the hours''; and
(2) by adding at the end the following new paragraph:
``(2) The Secretary may modify the hours of employment for a
physician or physician assistant appointed in the Administration under
any provision of this chapter on a full-time basis to be more than or
less than 80 hours in a biweekly pay period if the total hours of
employment for such employee in a calendar year does not exceed 2,080
hours. No physician or physician assistant may accrue overtime by
reason of modified hours of employment authorized under this
paragraph.''.
Purpose and Summary
H.R. 4150, the ``Department of Veterans Affairs Emergency
Medical Staffing Recruitment and Retention Act,'' was
introduced by Representative Raul Ruiz of California on
December 1, 2016. H.R. 4150, as amended, would (1) authorize
the Department of Veterans Affairs (VA) to modify the hours of
employment for a full-time VA physician or physician assistant
(PA) to be more than or less than 80 hours in a biweekly pay
period if the total of such employee's hours of employment in a
calendar year does not exceed 2,080 hours and (2) stipulate
that no physician or PA may accrue overtime as a result of
modified hours of employment pursuant to this authority.
Background and Need for Legislation
According to the 2016 report from the Association of
American Medical Colleges, the United States is facing a coming
physician shortfall as ``[p]hysician demand continues to grow
faster than supply leading to a projected total physician
shortfall of between 61,700 and 94,700 physicians by 2025.''\1\
The Veterans Health Administration (VHA) is not immune to the
expected provider shortage. On March 16, 2016, VA officials
testified before the Subcommittee on Health that VHA had 43,000
current vacancies, nearly 4,000 of which are physician
vacancies.\2\ VHA's ability to effectively manage these
vacancies is hampered by continued struggles to recruit and
retain quality health care providers and make efficient use of
the existing VHA workforce. Accordingly, in the final report of
the Commission on Care, which was issued in June 2016, the
Commissioners noted that VHA employs ``policies that fail to
optimize the talents and efficiency of all health professionals
[and] detract from the effectiveness of VHA health care,'' and
that ``robust structured programs to recruit, retain, develop,
and advance high potential staff are essential.''\3\
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\1\The Complexities of Physician Supply and Demand: Projections
from 2014 to 2025. https://www.aamc.org/download/458082/data/
2016_complexities_of_supply_and_demand_projections.pdf.
\2\Subcommittee on Health and Subcommittee on Economic Opportunity
Joint Legislative Hearing on draft legislation to improve the authority
of the Secretary of Veterans Affairs to hire and retain physicians and
other employees of the Department of Veterans Affairs, March 16, 2016.
https://veterans.house.gov/hearings/legislative-hearing-draft-
legislation-improve-authority-secretary-veterans-affairs-hire-0.
\3\Commission on Care Final Report. https://
commissiononcare.sites.usa.gov/files/2016/07/Commission-on-Care_Final-
Report_063016_FOR-WEB.pdf.
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Currently, VHA's ability to maximize its providers' time is
hampered by a rigid, 40-hour work week pay schedule that is at
odds with private sector industry standards. Typically,
emergency department providers work flexible schedules to
accommodate the variant, irregular hours that their work
demands. As the University of California, San Francisco School
of Medicine explains, ``EM [emergency medicine] physicians
should expect to work a mix of day, evening, night, weekend,
and holiday shifts,'' where ``every shift is different,'' and
``work shifts range from 6-12 hours plus time to sign-out and
finish clinical tasks.''\4\ However, VHA's standing 80-hour pay
period does not provide emergency room providers sufficient
flexibility to work fluid hours similar to their private sector
counterparts, putting VA emergency room staffing practices at
odds with industry standards. In VA's fiscal year 2017 budget
submission, the Department issued a legislative proposal--which
this bill is based on--that would address this issue. According
to the Department, this would, ``allow VA to arrange flexible
physician and physician assistant work schedules to allow for
the staffing and full implementation of a hospitalist physician
system and to accommodate the unusual work schedule
requirements for Emergency Medicine (EM) Physicians.''\5\
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\4\Career Information: Emergency Medicine. http://meded.ucsf.edu/
ume/career-information-emergency-medicine.
\5\Full Committee Legislative Hearing on H.R. 3216, H.R. 4150, H.R.
4764, H.R. 5047, H.R. 5083, H.R. 5162, H.R. 5166, H.R. 5392, H.R. 5407,
H.R. 5416, H.R.5420, and H.R. 5428, June 23, 2016. https://
veterans.house.gov/hearings/legislative-hearing-hr-3216-hr-4150-hr-
4764-hr-5047-hr-5083-hr-5162-hr-5166-hr-5392-hr-5407.
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The Committee is dedicated to ensuring timely access to
quality care for veteran patients. Providing appropriate tools
to enhance the recruitment and retention of a high quality VA
workforce is essential to achieving that priority. As such,
Section 2 of the bill would allow VA to determine a physician
or physician assistant's full-time status based on the hours
they are expected to work in a year--2,080--rather than the
hours they work during a bi-weekly pay period--80. Section 2 of
the bill would also stipulate that no physician or PA may
accrue overtime by reason of the modified work hours authorized
in this legislation unless the hours worked exceed the normal
scheduled hours. The Committee believes this change will enable
VHA to maximize the Department's current workforce and,
therefore, increase access to care for veteran patients.
Hearings
On June 23, 2016, the Full Committee held a legislative
hearing on various bills introduced in the 114th Congress,
including H.R. 4150. The following witnesses testified:
The Honorable Doug Lamborn of Colorado, U.S. House of
Representatives; the Honorable Dina Titus of Nevada,
U.S. House of Representatives; the Honorable Raul Ruiz
of California, U.S. House of Representatives; the
Honorable Beto O'Rourke of Texas, U.S. House of
Representatives; the Honorable Ron DeSantis of Florida,
U.S. House of Representatives; the Honorable Ted Yoho
of Florida, U.S. House of Representatives; the
Honorable Jody Hice of Georgia, U.S. House of
Representatives; the Honorable Dan Newhouse of
Washington, U.S. House of Representatives; the
Honorable David Young of Iowa, U.S. House of
Representatives; the Honorable Sloan Gibson, Deputy
Secretary, U.S. Department of Veterans Affairs,
accompanied by Laura Eskenazi, the Executive in Charge
and Vice Chairman of the Board of Veterans Appeals,
David McLenachen, the Deputy Under Secretary for
Disability Assistance for the Veterans Benefits
Administration, and Dr. Maureen McCarthy, the Assistant
Deputy Under Secretary for Health Patient Care Services
for the Veterans Health Administration; Raymond Kelley,
Director, National Legislative Service, Veterans of
Foreign Wars of the United States; Paul Varela, the
Assistant National Legislative Director, Disabled
American Veterans; Carl Blake, Associate Executive
Director of Government Relations, Paralyzed Veterans of
America; Louis J. Celli, Jr., Director, National
Veterans Affairs and Rehabilitation Division, The
American Legion; and, Rick Weidman, Executive Director
for Policy and Government Affairs, Vietnam Veterans of
America.
Statements for the record were submitted by:
American Battle Monuments Commission; AMVETS; Court
of Appeals for Veterans Claims; Iraq and Afghanistan
Veterans of America; Military Officers Association of
America; Military Veterans Advocacy, Inc.; National
Organization of Veterans Advocates; National Veterans
Legal Services Program; P.A.W.S. Foundation; Stetson
University College of Law's Veterans Law Institute;
and, U.S. Department of Labor.
There were no Subcommittee hearings held on H.R. 4150, as
amended.
Subcommittee Consideration
There was no Subcommittee markup of H.R. 4150, as amended.
Committee Consideration
On September 21, 2016, the Full Committee met in open
markup session, a quorum being present, and ordered H.R. 4150,
as amended, favorably reported to the House of Representatives
by voice vote. During consideration of the bill, the following
amendment in the nature of a substitute was considered and
agreed to by voice vote:
An Amendment in the Nature of a Substitute to H.R.
4150 offered by Representative Raul Ruiz of California.
Committee Votes
In compliance with clause 3(b) of rule XIII of the Rules of
the House of Representatives, there were no recorded votes
taken on amendments or in connection with ordering H.R. 4150,
as amended, reported to the House. A motion by Representative
Mark Takano of California to report H.R. 4150, as amended,
favorably to the House of Representatives was agreed to by
voice vote.
Committee Oversight Findings
In compliance with clause 3(c)(1) of rule XIII and clause
(2)(b)(1) of rule X of the Rules of the House of
Representatives, the Committee's oversight findings and
recommendations are reflected in the descriptive portions of
this report.
Statement of General Performance Goals and Objectives
In accordance with clause 3(c)(4) of rule XIII of the Rules
of the House of Representatives, the Committee's performance
goals and objectives are to modify hours of employment for
certain VHA employees in order to increase access to care for
veteran patients.
New Budget Authority, Entitlement Authority, and Tax Expenditures
In compliance with clause 3(c)(2) of rule XIII of the Rules
of the House of Representatives, the Committee adopts as its
own the estimate of new budget authority, entitlement
authority, or tax expenditures or revenues contained in the
cost estimate prepared by the Director of the Congressional
Budget Office pursuant to section 402 of the Congressional
Budget Act of 1974.
Earmarks and Tax and Tariff Benefits
H.R. 4150, as amended, does not contain any Congressional
earmarks, limited tax benefits, or limited tariff benefits as
defined in clause 9 of rule XXI of the Rules of the House of
Representatives.
Committee Cost Estimate
The Committee adopts as its own the cost estimate on H.R.
4150, as amended, prepared by the Director of the Congressional
Budget Office pursuant to section 402 of the Congressional
Budget Act of 1974.
Congressional Budget Office Cost Estimate
Pursuant to clause 3(c)(3) of rule XIII of the Rules of the
House of Representatives, the following is the cost estimate
for H.R. 4150, as amended, provided by the Congressional Budget
Office pursuant to section 402 of the Congressional Budget Act
of 1974:
U.S. Congress,
Congressional Budget Office,
Washington, DC, October 12, 2016.
Hon. Jeff Miller,
Chairman, Committee on Veterans' Affairs,
House of Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for H.R. 4150, the
Department of Veterans Affairs Emergency Medical Staffing
Recruitment and Retention Act.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Ann E.
Futrell.
Sincerely,
Keith Hall.
Enclosure.
H.R. 4150--Department of Veterans Affairs Emergency Medical Staffing
Recruitment and Retention Act
H.R. 4150 would allow the Department of Veterans Affairs
(VA) to offer alternative work schedules (above or below 80
hours on a biweekly basis) to physicians or physician
assistants (PAs) who work for VA on a full-time basis, provided
that the total work hours in a calendar year do not exceed
2,080. Physicians and PAs would not be eligible for overtime
pay for the hours worked in accordance with an alternative work
schedule. VA reports that implementing this bill would not
affect the amount of compensation paid to those employees.
CBO estimates that implementing this bill would cost less
than $500,000 over the 2017-2021 period to prepare the
necessary regulations; that spending would be subject to the
availability of appropriated funds.
Enacting the legislation would not affect direct spending
or revenues; therefore, pay-as-you-go procedures do not apply.
CBO estimates that enacting H.R. 4150 would not increase
net direct spending or on-budget deficits in any of the four
consecutive 10-year periods beginning in 2027.
H.R. 4150 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act would
not affect the budgets of state, local, or tribal governments.
The CBO staff contact for this estimate is Ann E. Futrell.
The estimate was approved by H. Samuel Papenfuss, Deputy
Assistant Director for Budget Analysis.
Federal Mandates Statement
The Committee adopts as its own the estimate of Federal
mandates regarding H.R. 4150, as amended, prepared by the
Director of the Congressional Budget Office pursuant to section
423 of the Unfunded Mandates Reform Act.
Advisory Committee Statement
No advisory committees within the meaning of section 5(b)
of the Federal Advisory Committee Act would be created by H.R.
4150, as amended.
Statement of Constitutional Authority
Pursuant to Article I, section 8 of the United States
Constitution, H.R. 4150, as amended, is authorized by Congress'
power to ``provide for the common Defense and general Welfare
of the United States.''
Applicability to Legislative Branch
The Committee finds that H.R. 4150, as amended, does not
relate to the terms and conditions of employment or access to
public services or accommodations within the meaning of section
102(b)(3) of the Congressional Accountability Act.
Statement on Duplication of Federal Programs
Pursuant to section 3(g) of H. Res. 5, 114th Cong. (2015),
the Committee finds that no provision of H.R. 4150, as amended,
establishes or reauthorizes a program of the Federal Government
known to be duplicative of another Federal program, a program
that was included in any report from the Government
Accountability Office to Congress pursuant to section 21 of
Public Law 111-139, or a program related to a program
identified in the most recent Catalog of Federal Domestic
Assistance.
Disclosure of Directed Rulemaking
Pursuant to section 3(i) of H. Res. 5, 114th Cong. (2015),
the Committee estimates that H.R. 4150, as amended, contains no
directed rule making that would require the Secretary to
prescribe regulations.
Section-by-Section Analysis of the Legislation
Section 1. Short title
Section 1 of the bill would provide the short title for
H.R. 4150, as amended, as the ``Department of Veterans Affairs
Emergency Medical Staffing Recruitment and Retention Act.''
Section 2. Modification of hours of employment for physicians and
physician assistants employed by the Department of Veterans
Affairs
Section 2 of the bill would amend section 7423(a) of title
38 U.S.C. by striking ``(a) the hours'' and inserting ``(a)(1)
Except as provided in paragraph (2), the hours'' and adding at
the end a paragraph authorizing VA to modify the hours of
employment for a full-time physician or physician assistant to
be more or less than eighty hours in a biweekly pay period, so
long as that employee's total hours do not exceed 2,080 in a
single calendar year and stipulate that no physician or
physician assistant may accrue overtime due to modified hours
of employment authorized under this paragraph.
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italic, existing law in which no change is
proposed is shown in roman):
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italics, and existing law in which no
change is proposed is shown in roman):
TITLE 38, UNITED STATES CODE
* * * * * * *
PART V--BOARDS, ADMINISTRATIONS, AND SERVICES
* * * * * * *
CHAPTER 74--VETERANS HEALTH ADMINISTRATION - PERSONNEL
* * * * * * *
SUBCHAPTER II--COLLECTIVE BARGAINING AND PERSONNEL ADMINISTRATION
* * * * * * *
Sec. 7423. Personnel administration: full-time employees
[(a) The hours] (a)(1) Except as provided in paragraph (2),
the hours of employment in carrying out responsibilities under
this title of any employee who is appointed in the
Administration under any provision of this chapter on a full-
time basis in a position listed in section 7421(b) of this
title (other than an intern or resident appointed pursuant to
section 7406 of this title) and who accepts responsibilities
for carrying out professional services for remuneration other
than those assigned under this title shall consist of not less
than 80 hours in a biweekly pay period (as that term is used in
section 5504 of title 5).
(2) The Secretary may modify the hours of employment for a
physician or physician assistant appointed in the
Administration under any provision of this chapter on a full-
time basis to be more than or less than 80 hours in a biweekly
pay period if the total hours of employment for such employee
in a calendar year does not exceed 2,080 hours. No physician or
physician assistant may accrue overtime by reason of modified
hours of employment authorized under this paragraph.
(b) A person covered by subsection (a) may not do any of the
following:
(1) Teach or provide consultative services at any
affiliated institution if such teaching or consultation
will, because of its nature or duration, conflict with
such person's responsibilities under this title.
(2) Accept payment under any insurance or assistance
program established under title XVIII or XIX of the
Social Security Act or under chapter 55 of title 10 for
professional services rendered by such person while
carrying out such person's responsibilities under this
title.
(3) Accept from any source, with respect to any
travel performed by such person in the course of
carrying out such person's responsibilities under this
title, any payment or per diem for such travel, other
than as provided for in section 4111 of title 5.
(4) Request or permit any individual or organization
to pay, on such person's behalf for insurance insuring
such person against malpractice claims arising in the
course of carrying out such person's responsibilities
under this title or for such person's dues or similar
fees for membership in medical or dental societies or
related professional associations, except where such
payments constitute a part of such person's
remuneration for the performance of professional
responsibilities permitted under this section, other
than those carried out under this title.
(5) Perform, in the course of carrying out such
person's responsibilities under this title,
professional services for the purpose of generating
money for any fund or account which is maintained by an
affiliated institution for the benefit of such
institution, or for such person's personal benefit, or
both.
(c) In the case of any fund or account described in
subsection (b)(5) that was established before September 1,
1973--
(1) the affiliated institution shall submit
semiannually an accounting to the Secretary and to the
Comptroller General of the United States with respect
to such fund or account and shall maintain such fund or
account subject to full public disclosure and audit by
the Secretary and the Comptroller General for a period
of three years or for such longer period as the
Secretary shall prescribe, and
(2) no person in a position specified in paragraph
(1)(B) may receive any cash from amounts deposited in
such fund or account derived from services performed
before that date.
(d) As used in this section:
(1) The term ``affiliated institution'' means a
medical school or other institution of higher learning
with which the Secretary has a contract or agreement as
referred to in section 7313 of this title for the
training or education of health personnel.
(2) The term ``remuneration'' means the receipt of
any amount of monetary benefit from any non-Department
source in payment for carrying out any professional
responsibilities.
(e)(1) The Secretary shall establish a leave transfer program
for the benefit of health-care professionals in positions
listed in section 7401(1) of this title. The Secretary may also
establish a leave bank program for the benefit of such health-
care professionals.
(2) To the maximum extent feasible--
(A) the leave transfer program shall provide the same
or similar requirements and conditions as are provided
for the program established by the Director of the
Office of Personnel Management under subchapter III of
chapter 63 of title 5; and
(B) any leave bank program established pursuant to
paragraph (1) shall be consistent with the requirements
and conditions provided for agency leave bank programs
in subchapter IV of such chapter.
(3) Participation by a health-care professional in the leave
transfer program established pursuant to paragraph (1), and in
any leave bank program established pursuant to such paragraph,
shall be voluntary. The Secretary may not require any health-
care professional to participate in such a program.
(4)(A) The Secretary and the Director of the Office of
Personnel Management may enter into an agreement that permits
health-care professionals referred to in paragraph (1) to
participate in the leave transfer program established by the
Director of the Office of Personnel Management under subchapter
III of chapter 63 of title 5 or in any leave bank program
established for other employees of the Department pursuant to
subchapter IV of chapter 63 of title 5, or both.
(B) Participation of such health-care professionals in a
leave transfer program or a leave bank program pursuant to an
agreement entered into under subparagraph (A) shall be subject
to such requirements and conditions as may be prescribed in
such agreement.
(5) The Secretary is not required to establish a leave
transfer program for any personnel permitted to participate in
a leave transfer program pursuant to an agreement referred to
in paragraph (4).
(f) The Secretary may purchase promotional items of nominal
value for use in the recruitment of individuals for employment
under this chapter. The Secretary shall prescribe guidelines
for the administration of the preceding sentence.
* * * * * * *
[all]