One of the largest, most important health care systems in the country has plans in the works for a huge revamp, including shutting down many of its big, aging hospitals or slashing services there, shifting to smaller clinics, and refocusing its caregiving to parts of the country where its patients live.
Taxpayers will want to pay attention to these plans because they will pay tens of billions of dollars for them — likely with gratitude. That’s because this reimagined system provides care to millions of current and past U.S. service personnel and their families and is best known as the VA, aka the Department of Veterans Affairs, the Washington Post reported.
The Biden Administration has launched the VA on potentially decades of changes in the way it provides the nation’s sacred commitment to those who have fought with honor for their country and earned the right to quality care for what can be considerable, long-term health needs.
Congress, recognizing how the nation’s overall health systems have changed and the high demands on the VA, approved several years ago a seismic change in federal treatment services for veterans and their loved ones, opening the door from them increasingly to see private providers outside agency systems.
In turn, the VA and Secretary Denis McDonough got a deadline for lawmakers to make big changes to the agency’s health system, much of it showing its age and declining in optimal approaches to supporting patients and their needs, the Washington Post reported:
“The restructuring McDonough proposed … is driven by changing reality for veterans… The Department of Veterans Affairs spends billions of dollars a year to maintain crumbling facilities that impede doctors from giving veterans the best possible care, and its hospitals increasingly are located in the wrong places. Almost 70% of VA’s health-care facilities were built more than 50 years ago, and the buildings have a median age of 60 years — compared with 8½ years for private-sector hospitals. According to the agency’s budget submission to Congress for fiscal 2022, the health system needs $61.6 billion worth of construction today. ‘These facilities were not designed to meet modern health care standards, which limits VA’s agility and ability to meet evolving veteran care needs, and basic environment of care expectations…’
“The population of veterans is declining in the Northeast and parts of the Midwest, and growing in the South and Southwest, changes largely driven by the aging of those who fought during the Vietnam era and the increasing loss of those from the Korean War and the World War II generations. Even though the number of veterans is projected to decline in coming years, they will need more outpatient and long-term support, such as nursing home care — and they need more extensive mental health resources than VA offers. By 2029 and continuing for a decade, the veteran population will include more women than ever and will become more racially diverse and younger. VA projects that veterans will continue to live more in rural areas compared with the rest of the population and have a higher prevalence of chronic health conditions. All of these shifts ‘will have significant effects on health care planning efforts,’ [a VA] report said. For example, female veterans, whose numbers are expected to grow by 32.5% by 2029 to more than 1 million, need access to gynecological care, mammography, and specialized behavioral health services.”
The VA secretary, his staff, and consulting experts hope to provide lawmakers with hard evidence to justify changes in care and with the system’s existing 171 hospitals and 1,112 outpatient clinics — with the unenviable likelihood that, as with prospective moves or closures affecting military bases, the reconfiguring of veteran health care will create political heat.
Rural lawmakers are wary already about not only seeing popular facilities shut or reduce services but also whether the private sector can pick up the difference, as might more readily occur in cities, the newspaper reported.
Still, the VA has much catching up to do with private hospital and health systems, many of which have tried to better serve patients and their care by keeping them out (as inpatients) from big, expensive buildings and getting more treatment (as outpatients) in scattered, smaller clinics. Private health systems also have gone away from the idea that every one of their hospitals must be giant and offer comprehensive care, including with costly, intensive, specialized treatments and equipment. These, too, are broken up and select hospitals in systems provide specialty care with intensive resources.
As always, the success of a VA revamp will be determined by the details. Is it a poor forecast of future performance that the agency is under fire for a big mess with a major overhaul under way of veterans’ digital health records? It is clear the VA will need tough oversight by broad-minded administrators and lawmakers who are less focused on political point scoring and more on the safety, quality, efficiency, accessibility, accountability, and excellence of the care provided to the 9 million-plus veterans and their loved ones by an agency with a budget of $260 billion annually.
In my practice, I see not only the harms that patients suffer while seeking medical services, but also the damage that can be inflicted on them and their loved ones by abuse or negligence in when getting care at a hospital or clinic run by the Department of Defense or the Department of Veterans Affairs.
Congress and the courts have made changes but military personnel, especially those on active duty, may face different legal challenges when they make claims of medical malpractice and seek justice in the civil system. They may want to consult with counsel, such as myself and my colleagues, with experience in these specialized cases.
As for the overall VA reconfiguration, we’ll all need to watch closely how this effort goes. We will breathe a huge sigh of relief that isn’t occurring in the shambolic, sketchy, and crony-crazy fashion that the last administration took toward the VA. Still, we have much work to do to ensure that those who have made major sacrifices in defense of their country get the outstanding medical services they have earned and deserve.
