MILITARY UPDATE
VA healthcare poised for restructuring
By Tom Philpott
Despite stiff criticism from some veterans and lawmakers who would see their local VA hospital close, Anthony Principi, secretary of veterans affairs, says he is optimistic that a major restructuring of the $26 billion veterans' healthcare system can begin next year.
The goal, said Principi, is to make VA healthcare more efficient and accessible by closing outdated and underused facilities and opening modern hospitals and clinics where they are needed most.
In August, VA completed what Principi describes as the most comprehensive review ever of department health facilities. The draft report of the review, called CARES (Capital Assets Realignment for Enhanced Services), recommended major changes at 13 locations.
New hospitals would be built in Las Vegas and Orlando, Fla.; new centers for the blind would be built in Biloxi, Miss., and Long Beach, Calif.; and new spinal injury centers would be constructed in Denver, Little Rock, Ark., Minneapolis, and in either Albany or Syracuse, N.Y.
Closings proposed
Seven hospitals would be closed: in Brecksville, Ohio; Canandaigua, N.Y.; Gulfport, Miss.; Lexington, Ky.; Livermore, Calif.; Pittsburgh and Waco, Texas.
VA would open 48 new clinics and close or realign other small facilities throughout the country.
The aim is not to cut VA costs, Principi said in a phone interview, but to realign resources over the next 20 years to reflect veteran population shifts and to embrace advances in medical treatment and technology.
"We have a responsibility to make changes much like the private sector has to its systems, and to make sure the extraordinary amount of dollars the American people send us are being spent wisely," Principi said.
Healthcare, he said, "is not defined by bricks and mortar any more (but) by technology, and doctors and nurses operating in clinics (rather than hospitals) and delivering medicine thousands of miles away via telemedicine and digital radiology. So that's what we're trying to do."
The final phase of the CARES process began in August when a 15-member commission, appointed by Principi, started reviewing the realignment recommendations.
To help in that review, the commission held a series of 40 public hearings in affected communities.
The CARES process began in the Clinton administration. Principi added the commission so that final decisions are viewed as more fair and credible.
Chaired by Everett Alvarez, a former VA deputy administrator and prisoner of war in Vietnam, the commission likely will propose some changes to the VA recommendations when it delivers its report in early December.
"I will review it carefully," said Principi. "If I find there are problems I will send it back (saying) 'I really disagree with these points here. I would like you to reassess them and come back to me.' "
Principi said that in the end, he will accept or reject all of the commission recommendations. To pick on some of them, he said, would politicize the process and "that leads to cynicism and distrust."
He hopes to announce a final plan to restructure VA healthcare within a month of accepting the commission report.
"I have the authority now" to execute such a plan, Principi said. "I don't perceive Congress blocking me. I may be wrong."
'More healthcare'
Restructuring VA facilities will mean "more healthcare, not less," Principi said. The VA healthcare system has 163 hospitals but a total of 5,000 buildings on almost 20,000 acres of land.
"Some facilities we inherited from the Army at the turn of the 20th century," Principi said. "At their peak, these facilities may have had 2,000 patients. Today, there may be fewer than 200 patients and we're maintaining 200 or even 350 acres of land."
Principi noted that a recent General Accounting Office report estimated that the VA spends almost $400 million a year on underused facilities.
Redirected, he said, that money "can buy a lot of healthcare and state-of-the-art ambulatory clinics and sophisticated bed towers and surgical suites, and more digital technology so a doctor on the West Coast can be diagnosing a patient on the East Coast. That's what we're tying to accomplish."
Realignment means making difficult decisions, Principi said.
"I appreciate the sensitivity at the local community [level]."
Veterans and lawmakers from affected areas have attacked the draft recommendations.
One of the last public hearings, in Canandaigua, N.Y., attracted 1,500 protesters who opposed replacing the 70-year-old VA hospital and its 700 employees with an outpatient clinic. The 23-building campus has its own fire department, bowling alley and laundry — but only 200 in-patients, down from a peak 1700.
Still, Sen. Charles Schumer (D-N.Y.) called the closure plan "a monumental mistake."
But overall reaction to CARES, said Principi, has "gone as well as one could hope for, given the gravity and comprehensive nature of this report."
Veterans groups, he said, "are keeping an open mind and have not tried to sabotage this effort in any way. They recognize that healthcare has changed and the demographics of the veterans population have changed."
Questions, comments and suggestions are welcomed. Write to Military Update, P.O. Box 231111, Centreville, VA 20120-1111, or send e-mail to: milupdate@aol.com. Or visit Tom Philpott's Web site.
