Over the past two federal fiscal years, the number of annual inpatient admissions to U.S. Department of Veterans Affairs hospitals dropped by more than 100,000, according to figures released last week by Kenneth Kizer, M.D., VA undersecretary for health.
The figures are the first tangible results of the VA's ongoing overhaul of its massive healthcare system. Specifically, admissions dropped to 837,275 in fiscal 1996, which ended Sept. 30, from 940,043 in fiscal 1994.
Over the same period, the VA shaved 5,200 beds from its total in-use bed complement of about 53,000, in an effort to increase emphasis on outpatient care, Kizer said.
The bed closings have mirrored a drop in inpatient utilization. Bed-days per 1,000 VA patients have dropped 28.3%, to 2,525 from 3,522. About 2.9 million veterans are frequent users of VA healthcare facilities and are considered to be "unique" VA patients.
Outpatient clinic visits rose 4%, and ambulatory surgeries grew 33% between fiscal 1995 and 1996.
For the past two years, the VA has attempted to restructure its functions to parallel private-sector trends.
It has decentralized the day-to-day healthcare management functions of its $17 billion, 751-facility system into 22 integrated healthcare networks and sought to shift more care to outpatient settings.
While the restructuring has occurred largely without backlash among patients, it has made an impact among workers. When headquarters reductions are counted, the VA healthcare system has reduced its staff by 2.9%, from 240,260 to 233,416.
Meanwhile, VA officials are seeking to restructure the largely salary-oriented compensation for the system's 14,204 physicians and 862 dentists to include some type of performance bonus system.
But the restructuring also could yield dividends for private-sector providers.
A law President Clinton recently signed includes provisions that expand the VA's ability to buy services from private-sector providers or sell services to private providers.
The VA is developing regulations that will govern private-sector contracting activities.