At least seven hospitals would close--but other acute care and ambulatory facilities would open--under a wide-ranging plan to reshape aging healthcare infrastructure and continue the emphasis on preventive and ambulatory care at the Department of Veterans Affairs.
VA Secretary Anthony Principi unveiled the proposed changes in a draft of the first national Capital Asset Realignment for Enhanced Services plan, a 20-year assessment of expected demand for Veterans Health Administration services.
The VA calls the plan "a virtual roadmap for veterans' healthcare in the future."
The VA says it is issuing the plan in response to two stinging 1999 reports by the General Accounting Office that criticized the lack of capital investment planning and budgeting at the VA and concerns expressed by various congressional committees. It is the first comprehensive, long-range assessment of capital needs for VA healthcare since 1981.
Principi presented the CARES plan Friday to a 15-member commission that he appointed. The commission represents VA healthcare "stakeholders," including VA employees, academic affiliates, veterans' service organizations, healthcare planners at the Department of Defense and members of Congress.
"The draft national plan's goals are to find savings and reinvest them in doctors, nurses and modern healthcare equipment--resources crucial to direct patient care," says VA Under Secretary for Health Robert Roswell, M.D. "It makes sure the decisions we make today and in the future are in line with the healthcare needs of veterans."
The infrastructure plan says that the VA should set capital requirements for building or modernizing facilities, similar to the certificate of need many states require for healthcare construction. Today, the average VA facility is 50 years old.
Principi, who launched the CARES process a year ago, calls for the closure of VA hospitals in Canandaigua, N.Y.; Brecksville, Ohio; Gulfport, Miss.; Waco, Texas; Livermore, Calif; the Highland Drive facility in Pittsburgh; and the Leestown hospital in Lexington, Ky.
New acute care hospitals would be built in Las Vegas and Orlando, Fla., while half a dozen existing locations would gain some specialty services under the proposal.
The VA also is considering whether to consolidate inpatient care in New York City by transferring Manhattan inpatient services to an existing facility in Brooklyn; ending all inpatient services at Montrose, N.Y.; and moving inpatient surgery from Lake City, Fla., to Gainesville, Fla.
"The forecast decrease in the veteran population, though offset in part by increasing numbers of enrollees and aging of the veteran population, is raising questions regarding the size and distribution of VA facilities and outpatient services," the draft says.
Between 1995 and 2002, the VA cut the number of inpatient beds to 19,000 from 52,000 even as annual patient population grew by 50% to 4.5 million veterans.
The CARES Commission is to review the plan in time for Principi to make final recommendations by the end of 2003 so Congress can have a formal capital improvement proposal from which to craft budgets for fiscal years 2005 and 2006, the VA says.
The VA expects to need nearly $4.7 billion in current dollars over the next 20 years for healthcare-related capital investment, plus $469 million for research, according to the proposal.
It estimates the VHA capital budget at a net $736.3 million for fiscal year 2004, $589.7 million in 2005, $444.2 million in 2006, $343.4 million during fiscal 2007 and $97.3 million for fiscal 2005. The estimates include more than $1.1 billion in projected savings from consolidation and other efficiencies over that five-year period.