Shortly after Principi took on the secretary's role, he was stuck in New York traffic one night around 21st Street and 1st Avenue in Manhattan. He looked up at the nearby VA facility: the Manhattan campus of VA New York Harbor Healthcare System and noticed only about 10 windows with lights on, a seemingly paltry amount for an 800-bed hospital.
When he got back to Washington, D.C., he asked his staff how many patients the entire New York City VA system was treating. New York's VA system comprises the Manhattan campus, as well as facilities in the Bronx and Brooklyn. At that time, they had about 2,400 beds.
“My chief of staff came back in and said the night I was in New York, there were 283 patients in all three hospitals combined,” Principi said. “That gives you a sense of the magnitude and cost of maintaining this vast infrastructure when healthcare has dramatically transformed into more primary care and ambulatory care.”
This ultimately led Principi to create the Capital Asset Realignment for Enhanced Services, or CARES, commission. After holding dozens of public hearings and visiting multiple VA facilities, the commission realized the VA's resources needed to adapt to the changing times.
That meant consolidating or closing hospitals that weren't being utilized; building more resources in areas like the Sun Belt, where many older veterans were moving; and investing more in primary-care and outpatient centers.
“It really was to take a comprehensive look at all the infrastructure as we began the transition from a hospital-centric to patient-centric-focused system,” he said of the commission's role and recommendations.
The VA has invested heavily in the outpatient settings during and since Principi's tenure. But given the almost daily reports now emerging of more VA facilities with problems, it would appear the next VA secretary will have much more to do.
Follow Bob Herman on Twitter: @MHbherman