Despite stiff criticism from some veterans and lawmakers who would see their local Department of Veterans Affairs (VA) hospitals close, Secretary of Veterans Affairs Anthony Principi says he is "optimistic" a major restructuring of the $26-billion VA healthcare system can begin next year. The goal, said Principi, is to make VA health care more efficient and accessible to more veterans by closing old underused facilities and opening new hospitals and clinics where they are needed most.
Last August, the VA completed what Principi describes as the most comprehensive review ever of his department's health facilities. Called CARES (Capital Assets Realignment for Enhanced Services), the draft report recommended major changes at 13 locations. New hospitals would be built in Las Vegas, Nevada, and Orlando, Florida, new centers for the blind in Biloxi, Mississippi, and Long Beach, California, and new spinal injury centers in Denver, Little Rock, Minneapolis, and either Albany or Syracuse, New York. Seven old hospitals would be closed: in Brecksville, Ohio; Canandaigua, New York; Gulfport, Mississippi; Lexington, Kentucky; Livermore, California; Pittsburgh, Pennsylvania; and Waco, Texas. The VA would open 48 new clinics and close or realign other small facilities throughout the country.
The aim is not to cut VA costs, said Principi 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'll either be on the cutting edge of medicine in the 21st century" through restructuring, he said, or stay "on the trailing edge of the past century. 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."
The final phase of CARES began in August when a 15-member commission, appointed by Principi, began 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.' But once that process is completed, I'll accept it as a national plan or I will reject it." Principi said in the end he would accept or reject all the commission's recommendations. To pick out 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 health care within a month of accepting the commission's report. "I have the authority now" to execute such a plan, Principi said. "I don't perceive Congress blocking me. I may be wrong." Restructuring VA facilities will mean "more healthcare, not less," Principi said, hoping to assure veterans. The VA health care system has 163 hospitals and 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 [each]. Today there may be fewer than 200 patients, and we're maintaining 200 or even 350 acres of land [at each facility]."
Principi noted a recent General Accounting Office report that found the VA spends almost $400 million a year on underused facilities. Redirected, he said, that money "can buy a lot of health care 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, New York, 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 of 1,700. Still, Senator Charles Schumer (D-NY) called the closure plan "a monumental mistake." Even so, reaction overall 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 health care has changed and the demographics of the veterans population have changed."