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Restructuring facilities will enhance veterans health care: in a shift from inpatient to outpatient care, VA proposes closing seven hospitals and smaller facilities at estimated savings of $400 million a year
VFW Magazine, Feb, 2004 by Janie Blankenship
IN the changing face of VA health care, seven VA hospitals from Canandaigua, N.Y., to Livermore, Calif., will most likely close their doors. The proposed hospital closures are the result of VA's Capital Assets Realignment for Enhanced Services (CARES) plan.
CARES aims to close, realign and enhance current veterans hospitals and facilities across the nation during the next 20 years. The seven hospitals proposed for closure are: Livermore, Calif.; Waco, Texas; Gulfport, Miss.; Lexington, Ky., Brecksville, Ohio; Pittsburgh and Canandaigua, N.Y.
CARES is designed to provide more outpatient care, which will decrease the number of long-term visits to VA hospitals. It also is a way of addressing veteran population shifts in recent years.
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VA wants to close some of the unneeded or least-used facilities that a General Accounting Office report says costs more than $1 million a day to operate--$400 million a year. The money would then be redirected to places where veterans most need health care.
"We'll either be on the cutting edge of medicine in the 21st century or stay on the trailing edge of the past century," said Anthony Principi, secretary of Veterans Affairs. "We have a responsibility to make changes, much like the private sector has to its systems, and to make sure the extraordinary amount of dollars the American people send us are being spent wisely," he told Air Force magazine.
Furthermore, patients are seeking outpatient care more than inpatient, so there is less need for so many hospitals.
In 1994, VA began shortening or eliminating hospital stays for injuries and illnesses that could be treated at doctors' offices or at clinics.
From 1994 through 1998, a VA study was conducted at VA's Houston Center for Quality Care and Utilization Studies to determine if outpatient care was equally effective. Released last October, the results of the study were astounding to some medical experts like Dr. Eric Schneider of Harvard University's School of Public Health.
"If you'd asked me 10 years ago if you could cut in half the hospital stays in America, I don't think I would have answered yes," he told the New York Times. "Now I can see we can do that."
Studying the medical records of 342,000 veterans, researchers found that hospital stays fell by 50% and outpatient care increased during the years of the study.
"These findings endorse VA's ongoing reorganization to improve health care for veterans;' Principi said. "The restructuring has maintained the quality of care, while allowing us to care for more veterans."
At press time, the CARES Commission was expected to provide Principi with its final recommendations in late January. The VA secretary said he hopes to announce his restructuring plan within a month of accepting the report and to get started this year.
"If I find there are problems, I will send it back" he said. "But once this process is completed, I'll accept it as a national plan, or I will reject it."
Proposal Meets Opposition
In times of change, resistance by opponents is expected. Veterans, employees and communities all will be affected by the proposed realignment. Some veterans assume they will no longer have access to VA health care, employees are concerned about their jobs and communities worry about the economy.
These factors all have been given consideration, said Everett Alvarez, chairman of the CARES Commission. Veterans living in those areas where hospitals may close will still have the same access to health care they did when the facilities were open.
In Waco, for example, inpatient care would be transferred to VA hospitals in nearby Temple and Austin. Outpatient services would be realigned to a newly established clinic in the Waco area. Last year in Waco, some 17,000 patients sought outpatient care and inpatient numbers peaked at only 1,800.
In spite of these statistics, a task force of veterans and business leaders in Waco remain concerned about the 800 employees. But most of those workers will have new jobs at the Olin E. Teague Veterans Center in Temple. Furthermore, about 200 would remain in Waco to staff the new outpatient clinic there.
"All of our employees will have jobs," Liz Crossan, a spokeswoman for the Central Texas VA system, told the Waco Tribune-Herald.
At a Commission hearing in October, Rep. Chet Edwards (D-Texas) spoke out against the closure of the Waco facility: "How do we explain to citizens in a military-oriented district that is sacrificing so much during this time of war that our nation can afford to build new hospitals in Iraq but we cannot afford to keep the Waco VA open?"
Similarly, in Canandaigua protests are evident. Rallies and picketers call on VA to "care for veterans" and "remember the veterans."
The current plan calls for closing this facility and relocating 248 inpatient, mental health and nursing home beds to Syracuse, Buffalo, Albany, Batavia and Bath. A new outpatient clinic would be built in the Finger Lakes region to replace Canandaigua's 171-acre campus.
