Published by Tom Ichniowski
(Map courtesy U.S. Dept. of Veterans Affairs)
The US Dept. of Veterans Affairs has proposed a wide-ranging blueprint to revamp its sprawling network of hundreds of health care facilities that would increase the number of VA hospitals but shrink the total of one type of outpatient clinic.
The VA Asset and Infrastructure Review recommendations, released on March 14, mark the beginning of a long deliberative process, similar to the US Defense Dept.’s Base Realignment and Closure program, which included five rounds of shutdowns—but also some base expansions—from 1988 to 2005.
The program was mandated in a 2018 statute for VA, which operates 171 medical facilities and more than 1,000 centers for outpatient care, which it says makes it the largest integrated health care system in the U.S.
VA's recommendations for new construction, upgrades, reconfigurations and closures respond to several trends, including more veterans who live in many parts of the South and West and fewer in the northeast and midwest, a VA spokesman said.
The condition of VA facilities is another factor. In the report, VA Secretary Denis McDonough said the proposal would replace “old, outdated, run-down facilities with state-of-the-art facilities designed with veterans and VA employees in mind.”
The median age of facilities is nearly 60 years, compared with a median of 8.5 years for U.S. hospitals in the private sector. About 69% of VA hospitals exceed 50 years, says the report.
A major shift in how health care is provided also drives the recommendations. “Many VA hospitals were built in a time when inpatient care, not outpatient care was predominant—a trend that has since flipped as medical advancements have allowed veterans to recover at home,” McDonough said.
The report adds that “innovation in telehealth has helped bring medical expertise directly into veterans’ homes and other convenient locations, further diminishing reliance on in-person visits.”
If the proposal is carried out as proposed, the net number of VA hospitals would rise to 30, from 16 now. Recommended new hospitals would be in Phoenix; Newport News and Norfolk, Va., and San Antonio, Texas.
The number of “multi-specialty" outpatient clinics would jump by 56%, to 388,from 248. Those clinics provide primary care, as well as mental health and other specialty care services....
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