By Sandra Basu
WASHINGTON—Draft congressional legislation is calling for a commission to make recommendations regarding VA’s infrastructure. Even supporters admit the “deck is stacked against” it.
In introducing the bill, which potentially could lead to the closing of some VA facilities, Rep. Phil Roe, MD, (R-TN), chairman of the House Committee Chairman on Veterans’ Affairs, called it “bold, transformative and controversial.”
“Moving forward with it will require a significant amount of political courage and, let’s face it, members of Congress are not known for that,” Roe said.
Ranking Member Rep. Tim Walz (D-MN) said legislators are aware “this is an opportunity,” and reiterated that the issue needs to be addressed.
“We are working side by side on this, but it is a journey, and it is going to be a tough one,” Walz said of the bill.
The draft bill would establish an 11-member paid commission that would consider recommendations made by VA for closure, modernization and realignment.
The bill calls for the commission to hold public hearings on VA’s recommendations and then send a report of its findings, conclusions, and recommendations to President Donald Trump. If he signs off, the recommendations would go to Congress and, if approved there, VA would be required to implement them
“Should Congress disagree with the commission’s recommendations, we would have 45 days to issue a joint resolution of disapproval,” Roe explained.
The bill requires VA to perform an assessment of its facilities, taking into factors including “access to care, the capacity of the local healthcare market, input from local veterans and stakeholders, and potential costs and savings.”
The criteria would be published in the Federal Register, subject to a 30-day public comment period,” Roe said.
Return of BRAC?
The idea for a commission to look at VA facilities is not new. In recent years both the Commission on Care and the Independent Assessment of the Healthcare Delivery Systems and Management Processes of the Department of Veterans Affairs report, have suggested that VA should consider establishing a board or commission similar to the Defense Base Realignment and Closure Commission (BRAC) to address policy issues such as hospital closures.
VA Secretary David J. Shulkin, MD, also has been telling lawmakers that there is a need to dispose of VA facilities that are currently underused. He announced earlier this year that VA had identified 430 individual vacant buildings that it plans to demolish or set for reuse. In addition and the agency’s plan to review another 784 nonvacant but underutilized buildings to determine if additional efficiencies can be identified to be reinvested in veterans’ services.
Shulkin has said VA will work with Congress to develop a modernization plan to allow the agency to use its “buildings in a better way” and to “stop supporting vacant buildings and underutilized buildings.”
Still, VHA Assistant Deputy Under Secretary for Health for Policy and Planning Regan L Crump told lawmakers during the hearing that VA “is not yet clear” on the need for a commission but does seek “legislative flexibility” to support a thorough assessment.
“The draft bill includes many thoughtful features that could serve as useful benchmarks for the market analysis which is what we will use to gather focused, localized and objective data for decision-making,” Crump said, adding that VA would defer to Congress on a potential commission structure and process.
Regarding details of the draft bill, Crump said VA would “be pleased to follow up with the committee to provide more in-depth comments and technical assistance.”
Meanwhile, veterans’ service organizations also weighed in on the issue.
“The American Legion is rarely a fan of congressionally-appointed committees, and this is no different,” American Legion Louis J. Celli Jr., director, Veterans Affairs and Rehabilitation Division for The American Legion. “Fundamentally, we oppose establishing a committee to oversee this process, but if establishing a committee or commission becomes the necessary concession to moving forward, I cannot stress strongly enough that the American Legion will absolutely not support a commission whereby congressionally charted VSOs … are not empowered to have collective veto power over what could turn into a runaway committee.”
Paralyzed Veterans of America Associate Executive Director of Government Relations Carl Blake said that his organization recognizes the need to review facilities as a “necessary evil.”
“We don’t oppose what you are trying to do, [but] we would like to see some refinements to this legislation,” he said.
Among the changes would be more time allotted for VA’s assessment, Blake said, noting that a year was not enough.
Joy Ilem, deputy national legislative director for Disabled American Veterans (DAV) recommended that rather than a “comprehensive, all-or-nothing, one-time infrastructure review process, VA needs to have the authority and flexibility to make decisions through an iterative process as demand for care and market conditions continue to evolve over time.”
“Specifically, we recommend that facility recommendations by the secretary be done in phases, with the first phase consisting of buildings and properties that are currently unused or significantly underused,” she explained in written testimony.
A facility-specific survey found that 138 of 140 VA facilities reported shortages of medical officers, with psychiatry and primary care positions being the most frequently listed.
When Terrence O’Neil, MD, retired as chief of nephrology at the James H. Quillen VAMC in Johnson City in December 2016, he left in his wake decades of work treating kidney disease—nearly 35 years in the Air Force and DoD, plus 11 more at VA.