VA reveals plan for restructuring veterans health care system

A draft proposal from the Veterans Affairs Department for overhauling the veterans health care system that includes closing seven medical facilities is drawing mixed reactions from veterans advocacy groups.

The draft Capital Asset Realignment for Enhanced Services (CARES) proposal, released Monday by the department, is a 20-year realignment plan for the aging health care infrastructure system that serves 4.5 million patients at a cost of about $25 billion a year.

Under the proposal, hospitals in Canandaigua, N.Y.; Pittsburgh; Lexington, Ky.; Brecksville, Ohio; Gulfport, Miss.; Livermore, Calif.; and Waco, Texas would close. A 15-member commission will review the proposal and send a recommendation to VA Secretary Anthony Principi at the end of the year. Principi will issue a final decision in early 2004.

Dr. Robert Roswell, undersecretary for health at VA, briefed CARES commission members Thursday on the draft proposal, which also includes opening new hospitals in Las Vegas and Orlando, Fla., as well as adding new spinal cord injury centers in Denver; Minneapolis; Syracuse or Albany, N.Y.; and Little Rock, Ark., and centers for the blind in Biloxi, Miss., and Long Beach, Calif. According to Roswell, the average veterans health care facility is more than 50 years old and the growing number of vacancies in some facilities has drawn criticism from the General Accounting Office. Under the CARES plan, services would be shifted to areas with a higher concentration of veterans.

"We looked at existing facilities, we looked at the existing veteran population and we tried to forecast what the veteran population would need in terms of health care," Roswell said Thursday. "The plan expands veterans health care services."

But some veterans groups are wary of the proposal, which is estimated to cost $4.6 billion over the next 20 years.

"We realize there are some facilities that probably need to be closed down, but the VA needs to build new facilities in their place before they close them down," said Ronald Conley, national commander of the American Legion, which has 3 million members. "Congress is going to have to appropriate the necessary money to build these VA hospitals."

Conley is also concerned that the CARES proposal does not take into consideration current active duty military personnel, who may need veterans health care facility services after the war on terrorism.

"That increase has to be taken into consideration," Conley said. "How is the VA going to handle that patient load?"

While drafting the proposal, VA officials met with veterans groups and other stakeholders in the communities affected by the proposed closings and next week, the commission will begin holding a series of hearings across the country to get feedback on the proposal before sending a recommendation to Principi.

"We've seen examples of local involvement that have made a difference, and we certainly hope that the whole process does listen to the local community to make sure that whatever decisions are made truly do meet the community need there and the veterans in the communities," said David Autry, deputy national director of communications for Disabled American Veterans, a nonprofit organization with more than 1 million members. "There is always some concern that this may be a top-down kind of thing and I certainly think that is a wrong approach."

Autry said some veterans are concerned that VA officials will just close facilities so that "bean counters' numbers add up," rather than taking an expansive look at what services are needed in various communities.

"We want to make sure that whatever realignment and efficiencies the VA comes up with [do] enhance services," Autry said. "Some of these facilities are the major source of income for the local economy and it's a big deal. It needs to be handled properly and we're certainly willing and able to work with the VA."

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