VA changes could lead to hospital closures

Despite stiff criticism from some veterans and lawmakers who would see their local VA hospital close, Secretary of Veterans Affairs Anthony Principi says he is optimistic that a major restructuring of the $26 billion VA health care system can begin next year.

The goal, Principi said, is to make VA health care more efficient and accessible to more veterans by closing outdated and underused facilities and opening new hospitals and clinics where they are needed.

In August, the VA completed what Principi describes as the most comprehensive review ever of department health facilities. The draft report recommended major changes at 13 locations.

New hospitals would be built in Las Vegas and Orlando, Fla.; new centers for the blind in Biloxi, Miss., and Long Beach, Calif.; and new spinal injury centers in Denver; Little Rock, Ark., Minneapolis and either Albany or Syracuse, N.Y.

Seven old hospitals would be closed: in Brecksville, Ohio; Canandaigua, N.Y.; Gulfport, Miss.; Lexington, Ky.; Livermore, Calif.; Pittsburgh and Waco, Texas.

VA would open 48 new clinics and close or realign other small facilities throughout the country.

The aim is not to cut VA costs, Principi said in a phone interview, but to realign resources over the next 20 years to reflect veteran population shifts and embrace advances in medicine and technology.

Health care, he said, "is not defined by bricks and mortar any more but by technology, and doctors and nurses operating in clinics and delivering medicine thousands of miles away via telemedicine and digital radiology."

The final phase of the hospital review process began in August when a 15-member commission appointed by Principi began examining the realignment recommendations. To help in that review, the commission held a series of 40 public hearings in affected communities.

The commission likely will propose some changes to the VA recommendations when it delivers its report in early December.

Principi hopes to announce a final plan to restructure VA health care within a month of accepting the commission report.

Restructuring VA facilities will mean "more health care, not less," Principi said, hoping to assure veterans.

The VA health care system has 163 hospitals and a total of 5,000 buildings on almost 20,000 acres of land. "Some facilities we inherited from the Army at the turn of the 20th century," Principi said. "At their peak, these facilities may have had 2,000 patients. Today, there may be fewer than 200 patients, and we’re maintaining 200 or even 350 acres of land."

Principi noted a recent General Accounting Office estimate that found the VA spends almost $400 million a year on underused facilities. Redirected, he said, that money "can buy a lot of health care and state-of-the-art ambulatory clinics and sophisticated bed towers and surgical suites and more digital technology so a doctor on the West Coast can be diagnosing a patient on the East Coast. That’s what we’re trying to accomplish.

Veterans and lawmakers from affected areas have attacked the draft recommendations. One of the last public hearings, in Canandaigua, N.Y., attracted 1,500 protesters who opposed replacing the 70-year-old VA hospital with an outpatient clinic. The 23-building campus has its own fire department, bowling alley and laundry — but only 200 inpatients, down from a peak of 1,700.

But reaction overall to the reorganization, Principi said, has "gone as well as one could hope for, given the gravity and comprehensive nature of this report."

Veterans groups, he said, "are keeping an open mind and have not tried to sabotage this effort in any way. They recognize that health care has changed and the demographics of the veterans population have changed."

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