The Denver Medical Center project, shown here, suffered from substantial cost increases and delays resulting not only from unforeseen circumstances but also from mismanagement, according to a Government Accountability Office report.
VA photo used in 2018 GAO report.
WASHINGTON — The average age of VA’s healthcare facilities is now more than 50 years old. As those buildings have aged, the cost of maintaining them has risen, and VA has not always been able to keep up. VA’s current maintenance backlog totals $23 billion—a number that has doubled over the past decade.
VA infrastructure needs have been included in the latest budget proposal, and an additional $18 billion is included in the American Jobs Plan (AJP)—President Joe Biden’s proposed trillion-dollar infrastructure bill. According to VA officials, $3 billion of that $18 billion would be used for immediate infrastructure needs, with the rest going to replace aging facilities with new ones.
At the same time, VA is undertaking a comprehensive review of its facilities to determine where new ones are required and which ones might no longer be needed. The question for some members of the House Committee on Veterans’ Affairs has become: Why spend billions on new facilities when the results of that review are two years away?
Legislators are also deeply skeptical of VA’s ability to get medical centers built within a reasonable timeframe. They cited the construction of the Denver VAMC, a project that ballooned in cost, took 14 years to complete and was eventually taken away from VA.
“There’s less demand for large, sprawling campuses and more emphasis for ambulatory and virtual care. This evolving landscape requires VA to rebalance its infrastructure to allow for a blend of these delivery efforts,” Brett Simms, director of VA’s Office of Asset and Enterprise Management, explained at a House VA Committee hearing last month. “The American Jobs Plan is a down payment on modernizing our facilities.”
While everyone on the committee agreed that funding was needed to repair and upgrade VA facilities, some questioned whether VA was in a position to know where funding should be directed.
“Every member of this committee has heard about cramped exam and waiting rooms, collapsing roofs, burst pipes or defective heating and cooling in VA medical centers. Despite record budgets year after year, that has not changed,” declared Rep. Mike Bost (R-IL), ranking Republican on the committee.
Bose said his main concern was the timeline of the Asset and Infrastructure Review (AIR) Commission, created as part of a 2018 bill and meant to establish an objective, data-driven process to realign and modernize VA facilities.
Virtual Listening Sessions
VA is now holding public virtual listening sessions across the country, talking with veterans about their experience receiving care at VA. The feedback will be used to develop recommendations on facility realignment that VA will then submit to the AIR Commission in January 2022. The commission will review those recommendations and submit their own recommendations to Biden in 2023.
“We should prioritize maintenance, since every dollar spent to maintain infrastructure goes a long way when properly managed. If we repair a roof today, it could prevent a structural catastrophe tomorrow,” Bost said. “But any new efforts to fix VA’s infrastructure must be in line with the recommendations made by the AIR Commission.”
Asked how the AJP funding can align with the commission when its recommendations won’t be presented for another two years, Simms said that VA already has a solid understanding of where they will need new or replacement facilities.
“AIR will direct the type of investment. What we’re working on now are the sites,” he explained. “We know enough to know there are sites that will continue to have a significant VA-owned footprint.”
For example, a number of facilities have exhausted their footprint and cannot be expanded. Consequently, VA will have to find real estate for additional development.
“That’s the kind of work we’re looking to do now,” Simms said. “AIR will determine what we build on those sites.”
Committee Chair Rep. Mark Takano (D-CA) questioned VA’s ability to oversee major building projects, using the Denver VAMC project as an example. After more than a decade of delays and a total cost that rose from $328 million to $1.7 billion, Congress took management of the project away from VA in 2015 and gave it to the Army Corps of Engineers.
“What assurances can you give that VA has learned from this?” Takano asked.
According to Simms, the department will be taking design and construction processes perfected by the Army Corps of Engineers and bringing them to VA. That includes standardizing certain aspects of their medical centers.
“Part of it is looking at how we structure our projects, starting from the requirement side of it,” he explained. “We want to design VA facilities that are much more structured and streamlined from the start. An adaptable space that can be used for different kinds of service delivery.”
Simms suggested that a standard, adaptable design will allow VA’s construction partners to get used to the needs of that design and will allow VA to carry over lessons learned from one construction project to the next.
“It’ll be easier and quicker to deliver, instead of starting from scratch,” he declared. “Then once the facility is constructed, that adaptable space can be used for different services.”
Hesitating to improve VA facilities will negatively impact the department’s ability to care for veterans, Simms said, though he could not translate that impact into a budgetary line item.
“We fully believe that infrastructure is a requirement—a direct enabler—of healthcare delivery,” he declared. “There is a direct connection, but it’s really difficult to monetize that.”