By Sandra Basu
WASHINGTON—The chairman of the House Committee on Veterans’ Affairs has called for a “top-to-bottom review” of all VHA capital assets.
“Rather than continuing to invest valuable resources on infrastructure that in many cases is long past its prime, we need to take an objective view of all VA medical facilities and smartly plan for where and how we can divest of buildings and property that are no longer needed and more importantly for where and how we can grow to ensure that VA medical facilities remain strong assets in communities across the country,” Chairman Rep. Phil Roe (R-TN) said.
Roe made his comments at a committee hearing last month on VA’s capital assets, noting that “a capital asset review and realignment, free of political influence is critical to ensuring that the VA healthcare system remains strong and sustainable.”
What to do with outdated and unused VA buildings has been a question at the forefront in recent months after VA Secretary David Shulkin announced the agency has identified 430 individual vacant buildings it plans to demolish or set for reuse over the next 24 months.
In addition, the agency plans to review another 784 nonvacant but underutilized buildings to determine whether additional efficiencies can be identified to be reinvested in veterans’ services.
Former VA Secretary Anthony Principi, who testified during the hearing, told the committee that VA is spending “too much money on bricks and mortar, rather than doctors and nurses.”
“If VA does not realign itself, the current decline in the veteran population will make many VA medical centers museums of the past—not the guideposts for the future they should be,” Principi said.
“While the practice of VA medicine has evolved, VA’s medical infrastructure has not kept pace,” he told lawmakers.
He said VA should submit recommendations for realignment or closure to a bipartisan commission created by Congress. That commission would then submit final recommendations to Congress that lawmakers would have to vote on as a package.
Both the Commission on Care and the Independent Assessment of the Healthcare Delivery Systems and Management Processes of the Department of Veterans Affairs report had also suggested that VA consider establishing a board or commission similar to the Defense Base Realignment and Closure Commission (BRAC) to address policy issues such as hospital closures.
Principi reminded lawmakers that the Capital Asset Realignment for Enhanced Services (CARES) had offered recommendations for realignment and allocation of VA’s capital assets in 2004. Unlike DoD’s infrastructure review process known as BRAC, however, with CARES there was no requirement for Congress to adopt or reject the commission’s final recommendations as a package. As a result, most recommendations to close or realign the mission of facilities were rejected, he said.
Principi said the recommendations from a new bipartisan commission should have to be approved or rejected by Congress as an entire package.
“Unlike the DoD process, when you don’t have some teeth behind it, it will fail,” he said.
Lawmakers did not directly comment on Principi’s suggestion about a process similar to BRAC, which forced some lawmakers to cast unpopular votes on the recommendations, but acknowledged the need for addressing VA’s capital assets.
“This will take courage and must transcend politics. If it is not done now, we can no longer kick this can down the road because if we do the ability to deliver that care will be diminished,” said Ranking Member Rep. Tim Walz (D-MN).
Also testifying was Government Accountability Office (GAO) Health Care Team director Debra Draper, who said geographic shifts in the veteran population, changes in healthcare delivery and an aging infrastructure affect VA’s efforts to align its services and real property portfolio to meet the needs of veterans.
“Facility planning officials told us that it is often too difficult and costly to modernize, renovate and retrofit older facilities,” she said.
“Adding to the complexity,” she said, is the historic status of some VA facilities, adding, “In some instances, renovations may be more expensive and demolition, and rebuilding may not be an option, given the historic designation.”
Draper said two of the planning processes VA uses to align its facilities—VA’s Strategic Capital Investment Planning (SCIP) and the VA Integrated Planning (VAIP)—have limitations.
VA director of the Office of Asset Enterprise Management James Sullivan added that, in response to language in the FY 2017 Appropriations Bill requiring a National Realignment Strategy, VA began efforts to conduct objective assessments of the markets within the VA healthcare system.
“Once the market assessments are complete, recommendations may include needed capital investments, divestitures, partnerships, and other approaches to modernizing VA’s infrastructure,” he said.
Meanwhile, American Legion Deputy Director for Healthcare Roscoe Butler told lawmakers that the American Legion is concerned VA has not routinely engaged with veteran service organizations about their plans to address VA’s capital asset needs.
“VA must do a better job in involving VSOs in these discussions,” he said.
Most people looking at a hospital room will see an environment specifically designed to keep human beings alive through even the most traumatic circumstances.
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.