The Department of Veterans Affairs has unveiled a plan that calls for closing 17 aging or underused medical centers, while shifting services to more than 30 new or rebuilt hospitals. In some cases, it would rely on private care.
Under the nearly $2 trillion proposal released Monday, the department would lose a net of three medical centers and 174 outpatient health clinics but would gain 255 health care facilities, including new clinics, stand-alone rehabilitation centers and nursing homes.
Medical centers in areas with diminishing veteran populations are among those slated to close, while others would be built in growing urban centers, the West and the South -- areas where veteran populations are growing.
The recommendations, which represent the VA's vision for future health care delivery to more than 12 million veterans in the next 25 to 50 years, are the first step in an asset and infrastructure review required by Congress in 2018.
The infrastructure modernization proposals will be reviewed next by an independent commission, which will provide its own input. The final plan must be approved by Congress before being enacted.
Already, lawmakers are weighing in on the recommendations. Sen. Jon Tester, D-Mont., who chairs the Senate Veterans Affairs Committee, issued a statement Monday noting that a nursing home and two clinics would be closed in his state.
He called any "efforts to kneecap veterans health care ... a non-starter."
"I will fight tooth and nail against any proposals that blindly look to reduce access to VA care or put our veterans at a disadvantage," Tester said.
Illinois Rep. Mike Bost, the ranking Republican on the House Veterans Affairs Committee, said he looks forward to seeing the commission complete its work, adding that "retaining the status quo is not an option."
"For far too long, VA's infrastructure has been slowly crumbling. Veterans in every corner of the country deserve better," Bost said.
VA Secretary Denis McDonough described the current VA medical infrastructure as unable to meet the health needs of today's veterans. Many of its facilities were built in the early to mid-20th century and cannot accommodate modern technology or are inappropriately structured for the population they serve, he said.
"If we implement these recommendations, nearly 150,000 more veterans will have primary care nearby; 200,000 more would have mental health care nearby; nearly 375,000 more vets will have outpatient specialty care nearby; and all the care will be delivered in modern state-of-the-art facilities," McDonough said during an event last week with the Rand Epstein Family Veterans Policy Research Institute.
Under the plan, 17 medical centers in 12 states would close, 18 in 16 states would be completely replaced, and 13 new centers would be built in 11 states.
Of the 17 slated for closure, three are in New York City or its suburbs, including Castle Point, Manhattan and Brooklyn. Two each are in Pennsylvania (Philadelphia and Coatesville), Virginia (Salem and Hampton), and South Dakota (Fort Meade and Hot Springs).
Other medical centers on the proposed closure list include those in:
- Livermore, California
- Dublin, Georgia
- Fort Wayne, Indiana
- Alexandria, Louisiana
- VA Central Western Massachusetts
- Battle Creek, Michigan
- Chillicothe, Ohio
- Muskogee, Oklahoma
Some of these facilities would shift services to nearby civilian hospital networks or become multi-specialty community outpatient clinics, while others would shift their patients to newly built VA medical centers or bolstered existing hospitals nearby.
For example, in South Dakota, the plan calls to build a new, centrally located VA medical center in Rapid City. In Philadelphia, patients would have access to care at new state-of-the-art facilities in King of Prussia or just across the state line in Camden, New Jersey.
New medical centers also would be built at:
- Newport News and Norfolk, Virginia
- Macon and Gwinnett County, Georgia
- Huntsville, Alabama
- Summerville, South Carolina
- Grand Rapids, Michigan
- Everett, Washington
- Colorado Springs, Colorado
- Anthem, Arizona
Another 18 medical centers would be completely rebuilt, either on existing land nearby, as is planned for the VA medical center in Washington, D.C. -- or closer to other major health providers and hospitals in their areas, such as the VA medical center in Buffalo, New York, according to the recommendations.
Those include medical centers in Bedford, Massachusetts; Durham, North Carolina; Tuskegee, Alabama; Hines, Illinois; Shreveport, Louisiana; Reno, Nevada; Beckley, West Virginia; Wilkes- Barre, Pennsylvania; Miami, Florida; Atlanta; Phoenix; Indianapolis; Albany and St. Albans, New York; and Roanoke, Virginia.
According to the recommendations, however, the newly rebuilt facilities may offer different services and care than they currently provide. In Albany, for example, the facility will focus on inpatient mental health, nursing home care and residential rehabilitation treatment programs, and shift inpatient medical and surgical care elsewhere if the department can institute a strategic collaboration with existing civilian facilities.
As part of their deliberations, members of the Asset and Infrastructure Review Commission plan to hold public hearings and meet with those who have a vested interest in the future of VA health care, including veterans service organizations, health care experts and institutions, and those who would be affected by the changes.
While most veterans service organizations had not weighed in on the recommendations as of late Monday, the American Legion released a statement saying it generally doesn't support closing facilities but recognizes that changes must sometimes happen based on population shifts.
"The American Legion will always advocate for every U.S. veteran, but we realize that for VA to properly serve America's veterans, it must from time-to-time optimize, reallocate, and re-invest in some of its decades-old infrastructures," American Legion National Commander Paul E. Dillard said in a statement.
The conservative Concerned Veterans for America, a group that supports broader access for veterans to private health care, issued a statement immediately after the recommendations were released saying it welcomed the proposals
"Today's veteran population is vastly different from what it was even five years ago, let alone decades ago. A rigid system that cannot adapt to the changing and unique needs of the veterans it serves leads to waste, complications and, ultimately, an absence of care," CVA Deputy Director Russ Duerstine said.
Editor's note: This story has been updated to correct when most VA buildings were constructed.
-- Patricia Kime can be reached at Patricia.Kime@Military.com. Follow her on Twitter @patriciakime