The Department of Veterans Affairs will recommend closing at least three medical centers and 174 outpatient health clinics and building roughly 255 new health care facilities and nursing homes to improve veterans’ medical services, according to briefings given by the department the week of March 8 and leaked planning documents.
The documents, first obtained by Military Times, show the VA will recommend increasing its overall number of health facilities by 78.
But the expansion also includes increasing partnerships with private hospitals to provide approved care for veterans without access to a VA medical center.
While details of the recommendations have yet to be made public -- they are expected to be published March 14 in the Federal Register -- VA officials have been on the offensive in the past week, briefing veterans service organizations, unions and employees on the recommendations, part of an ongoing review of VA real estate and infrastructure.
VA Secretary Denis McDonough said Thursday the recommendations would improve overall access and quality of care and were designed to meet "the needs of 21st century veterans, not the needs and challenges of veterans in a health care system built years ago."
"[They] will importantly strengthen our leading role as health care researchers in America and as the leading health care training institution in America," McDonough said during an event with the Rand Epstein Family Veterans Policy Research Institute.
"This is investment and investment again, not a retreat," McDonough said.
The recommendations would place nearly 150,000 more veterans closer to primary care and improve access to mental health services and specialty care, putting nearly 200,000 more veterans within a 30-minute drive of mental health services and 370,000 veterans within 60 minutes of specialty care, according to the documents.
But they also will recommend closing a medical center in the "northeast," replaced by new community outpatient clinics, a new nursing home and a partnership that places VA providers in a community hospital for inpatient care so "vets could get care in a modern high-quality setting rather than a VA hospital that only services five or six patients a day," McDonough said.
The Chillicothe Gazette reported Tuesday that the Chillicothe VA Medical Center in Ohio is listed among those recommended for closure.
McDonough added that the VA also will recommend eliminating some services at the Hot Springs VA Medical Center in South Dakota -- a move it has proposed since at least 2015 -- but would expand specialty care at the facility.
Among the additions, he said that the VA will recommend building a new medical center in the Southwest, where demand is on the rise from younger veterans, as well as female and minority veterans.
"Health care has evolved, so VA needs to overhaul and, in fact, lead the evolution," McDonough said.
The recommendations are part of an Asset and Infrastructure Review, or AIR, required by Congress in 2018. A commission -- several members of which were nominated Wednesday by President Joe Biden -- will review the VA's proposals and develop final recommendations in the next year.
The review has been likened to the Defense Department's base realignment and closure process -- an audit to determine whether facilities and programs are needed in areas to continue providing value.
McDonough bristled at the comparison on Thursday, saying the DoD's BRAC process was designed to "reduce the DoD's footprint" while the AIR is meant to ensure that the VA stays "in every market in the country."
"What this is is a modernization effort to upgrade the effectiveness of our facilities by moving away from aged and dated facilities," he said, noting that one of the VA’s clinics has a tree growing in it and the VA hospital in Chicago lacks reliable heat in the winter.
The recommendations also call for increasing the number of stand-alone nursing homes from two to 29 and residential rehabilitation treatment programs from 10 to 22.
The VA would build 14 additional outpatient health care centers and create 140 additional outpatient clinics that provide specialty care, while reducing the number of community-based outpatient clinics by 86.
And it also would shutter 88 other outpatient services clinics. Which clinics will close, however, will not likely be known until the Federal Register issues a preview of the recommendations, possibly as early as Friday.
Despite the lack of detail provided by the VA, unions and lawmakers are already pushing back on the proposals, saying the changes would displace employees and hurt communities and care.
American Federation of Government Employees National President Everett Kelley said Tuesday that the proposals would force veterans to rely on "uncoordinated, private, for-profit care" where they would experience long wait times and not have access to care geared toward veterans' needs.
"AFGE members, many of whom are veterans themselves, are outraged by and strongly oppose plans to dismantle large segments of the VA health care system, including medical centers and inpatient facilities for surgery, emergency medical care, mental health, and substance abuse treatment," Kelley said in a press release.
And lawmakers already are gearing up to protect facilities in their areas. Senate Veterans Affairs Committee Chairman Sen. Jon Tester, D-Mont., issued a statement March 3 calling any reduction in services in his state a "non-starter."
"I'll be working to ensure this multi-year process protects Montana veterans, particularly those in rural areas, and ensures timely access to their earned health care."
Sen. John Thune, R-S.D., said the VA was "wrong, period" to consider downgrading the Hot Springs VA.
"I'm frustrated, and I'm angry," Thune said in a press statement. "This is a massive mistake, and I will do everything within my power to show the administration, by working with the Asset and Infrastructure Review Commission, why it would be in everyone's best interest, especially South Dakota's veterans', to immediately change course."
– Patricia Kime can be reached at Patricia.Kime@Monster.com. Follow her on Twitter @patriciakime.