The VA released a report March 14 outlining its plans to strengthen and modernize medical infrastructure to meet the changing needs of the veteran population.

Many veterans, caregivers, and family members who heard of the news ahead of the release have been surprised and concerned about the consequences of VA’s plans, and wondered what prompted the recommendations. MOAA has been involved with this process at all stages, from helping draft the law requiring the review to providing feedback on the review itself alongside other veterans service organizations (VSOs). Here’s a look at the process so far:

[REPORT DETAILS: These 17 Medical Centers Would Close Under Proposed VA Realignment]

How We Got Here

The VA and Congress have attempted to assess infrastructure assets and determine facilities and resources needed to deliver health care to veterans for decades. While those assessments never resulted in meaningful changes, the desire and intent has not waned due in part to the growing Veterans Health Administration’s (VHA) budget and costs to run the largest integrated public health system in the country. 

The VA must modernize its infrastructure if it is going to meet the needs of veterans in the coming years and decades. The median age of VHA facilities is nearly 60 years old, per the VA, compared to the median age of 8.5 years for a private sector hospital. Nearly 7 in 10 VA hospitals (69%) are over 50 years old.

Recommendations for modernizing and realigning VHA’s capacity were mandated by Congress in June 2018 when the VA MISSION Act became law. The law required the VA to conduct assessments of its capacity in all its geographic market areas where medical centers and associated clinics are located. The law also requires establishing an independent commission to review VA’s recommendations and offer limited changes to them.

MOAA joined other VSOs and stakeholder groups to work closely with the VA and Congress in drafting the MISSION Act, including provisions related to this new report. At the time, VSOs and other stakeholders were particularly concerned about the ramifications of the Asset and Infrastructural Review (AIR) Commission; many in Congress and veteran groups were seeing evidence of a movement to privatize VHA and move more veterans care into the community.

MOAA has remained steadfast in its goal to protect and preserve VHA’s four foundational clinical, education, research, and emergency preparedness missions while striking the right balance between delivering VA and community care. We have insisted VHA remain the primary coordinator of veterans’ health care, a central tenet of the MISSION Act.

[RELATED: Trump Signs MISSION Act Reforming VA Health Care]

VA’s Approach

According to the VA, the market assessments were driven by asking one question: “What is best for the veterans we serve?” That question teed up the results in the 96 market areas VA reviewed nationwide.

Information was gathered from interviews with leaders at regional and local medical centers, listening sessions with veterans, collaboration sessions with VSOs like MOAA, and extensive reviews of the data at all levels of the VHA and VA.

The VA collected market assessment data from December 2018 through November 2020. The department anticipates its recommendations will answer “what is best for veterans” in the following ways:

• Cement the VA as the primary, world-class provider and coordinator of veterans’ health care for generations to come.
• Allow the VA to build a health care network with the right facilities, in the right places, to provide the right care for all veterans, including underserved and at-risk veteran populations.
• Ensure the VHA infrastructure reflects the needs of 21st-century veterans.
• Strengthen VHA’s role as a leading health care research and training institution in America.
• Allow the VHA to remain in every market, able to deliver timely access to care to every veteran in every corner of the country.

“VA is here to stay,” Secretary of Veterans Affairs Denis McDonough said March 10 in a press conference prior to the report’s full release. “We are not retreating, but strengthening VA to make it more local and closer to veterans.”

McDonough also vowed to be transparent in discussing the recommendations with its partners — employees, veterans, and stakeholders. He has committed to providing updates on the AIR Commission process and ensuring VSOs and veterans be heard as the commission work continues through the year.

[RELATED: MOAA Interview: VA Secretary Denis McDonough on Toxic Exposure, COVID, and More]

He also pledged to feed the commission regular updates on access to care in each market, addressing a concern voiced by members of Congress and stakeholders, and highlighted in a recent Government Accountability Office (GAO) review, which found:

• Gaps in VA’s data, meaning figures did not reflect the impact of the pandemic on health care markets.
• VA’s approach to the market assessments did not include steps to collect information on the quality of its data collected from numerous VA sources, nor to understand any data limitations. Instead, the department relied on local VA offices to validate the quality of data.
• VA’s data didn’t provide a full understanding of the extent to which community care can supplement current and future demands for veterans’ care.

Because of these problems, external stakeholders like the AIR Commission will not have all the relevant information on the quality and limitations used in the market assessments to make informed decisions on VA’s next steps, the GAO report found.

MOAA is encouraged by VA efforts so far to address these issues, but more work needs done to make sure the commission has quality, comprehensive data to reach the best decisions for veterans’ care.

What Do the Recommendations Mean to Veterans?

The entire process from here on out — confirming AIR Commission nominees, learning the commission’s outcomes, and reaching final decisions – could take up to three years.

And while there will be no short-term changes in care and services received by veterans and their families, long-term fallout from the commission could shape how VHA delivers care and what that care will look like.

The full report can be accessed online at this link, with regional details outlined at this link. Some overall figures from the VA recommendations, with the net gain or loss of each facility type: 

Outpatient:

• Health Care Centers (provides ambulatory surgery): +14 facilities
• Outpatient Partnerships: +14 facilities
• Multi-Specialty Community Based Outpatient Clinics: +140 facilities
• Community-Based Outpatient Clinics: -86 facilities
• Other outpatient services clinics: -88 facilities

Inpatient:

• Medical Centers: -3 facilities
• Community Living Centers (nursing homes): +27 facilities
• Residential Rehabilitation Treatment Programs: +12 facilities
• Inpatient Partnerships: +48 facilities

[RELATED: VA Vet Centers Need Longer Hours and More Promotion, MOAA Tells Congress]

The changes would accomplish the following, per VA:

• Improve outpatient primary care, mental health, and specialty care access.
• Increase inpatient mental health care access.
• Expand long-term care capabilities.
• Maintain access to regional services like residential rehabilitation treatment programs, blind rehabilitation, and spinal cord injuries and disorders system of care centers.
• Modernize and optimize facilities (VA and in the community) delivering inpatient medical/surgical services.
• Improve veterans’ access to VA-delivered inpatient medical/surgical services.
  
  

While there are a lot of unknowns and more to be done before the AIR Commission begins its work, one thing is certain: MOAA, our members, and partners must remain engaged to ensure changes in fact result in what is best for veterans.

Stay tuned to The MOAA Newsletter for ongoing updates on the AIR Commission and how you can engage in the process over the coming year.