The Department of Veterans Affairs last week convened an internal task force to develop a set of recommendations for fundamental changes at its 171 VA hospitals.
Kenneth Kizer, M.D., the VA's newly installed undersecretary for health, said the task force of 30 VA employees from field hospitals and the agency's headquarters started meeting last week to discuss such changes as giving more authority to hospital managers to determine how best to deliver care to the local veteran community.
Those managerial changes could give the local hospitals more flexibility to expand outpatient care-a trend to which the VA has been slow to shift-or develop community-care networks that could incorporate more private-sector providers.
The task force is expected to deliver a "first cut" of recommendations to Dr. Kizer by the end of the month, and formal recommendations will be completed early next year. He said some of the changes can be accomplished through administrative adjustments, but others may have to be made through legislation.
"We need to identify for Congress those areas where the VA is not up to date with the private sector," Dr. Kizer said in an interview last week. Members of Congress "have no interest in seeing the VA provide backward care," he said.
The task force is considering the managerial changes as possible alternatives to a controversial proposal to break the VA's four regions into 16 Veteran Service Areas, or VSAs.
Dr. Kizer said he is open to any proposal that will allow local managers more flexibility to deliver care more effectively but added that he has a vision of community-based networks-possibly involving more private-sector providers-that will serve veterans.
"I really want to focus on networks of care where hospitals are components," Dr. Kizer said. "I can certainly envision in some areas there may be contract services as the entry point for veterans into the systems, where in other areas that won't be necessary."
The task force won the praise of some veterans groups, which have in the past expressed concerns about funding levels and adequate access to care for veterans.