The Future of VA Health Infrastructure Continues to Evolve

CARES Process Lacks Transparency, Performance Measures

Washington, D.C. – On Tuesday, June 9, the House Veterans’ Affairs Health Subcommittee, led by Chairman Michael Michaud (D-ME), held a hearing to review the future of health infrastructure at the Department of Veterans Affairs (VA). The Subcommittee marked the five-year anniversary of the Capital Asset Realignment for Enhanced Services

(CARES) decision by examining the effectiveness of the capital planning tool for the Veterans Health Administration (VHA).

"When the VA embarked on the CARES process five years ago, the VA’s health infrastructure was thought to be unresponsive to the needs of current and future veterans," said Chairman Michaud. "CARES was intended to eliminate or downsize underused facilities, convert older massive hospitals to more efficient clinics, and build hospitals where they are needed in more populated areas. In essence, CARES was to direct resources in a sensible way to increase access to care for many veterans and to improve the efficiency of health care operations across VA facilities."

CARES was designed to assess VA’s buildings and land ownership in light of expected demand for VA inpatient and outpatient health care services through fiscal year 2022. VA initiated the CARES process in October 2000 to improve its capital asset planning and budgeting to meet the current and future needs of veterans. The CARES process involved a number of steps, including defining market areas, analyzing needs, developing market plans, and integrating the plans into the strategic planning cycle. On May 7, 2004, VA announced its CARES decisions on the alignment of inpatient and outpatient services at locations it identified for potential service duplication, low workload, or limitations in geographic access and published a report on these decisions.

Witnesses discussed their ideas for what the VA of the 21st Century should look like and how these upcoming decisions should be made. There were also discussions of shortcomings in the CARES process and how those should be addressed.

Joe Wilson from The American Legion offered the following testimony regarding the need for increased transparency: "Although the VA had begun implementing CARES decisions, a Government Accountability Office

(GAO) report found implementation was not being centrally tracked or monitored to determine the impact the CARES process has or hasn’t had on the mission… The American Legion maintains that the CARES implementation process must be an open and transparent process that continually and fully informs the Veterans’ Service Organizations of CARES initiatives, criteria, proposals and time frames. This also includes an accurate assessment of the demand for all medical services which gauges how much infrastructure is required to accommodate this nation’s veterans. Through this form of checks and balances, the maintenance of quality stands to uphold the effectiveness of CARES as it pertains to strategic planning and the future of the entire VA system."

Dennis Cullinan of Veterans of Foreign Wars categorizes the CARES decision as a depoliticized and dynamic decision-making process. He explained two problems of funding and speed that hamper the effectiveness of CARES in his testimony. He said, "First is that the very nature of the report required a large infusion of funding for VA’s infrastructure. While a huge number of projects are underway, a number of these are still in the planning and design phase. As such, they are subject to changes, but they have also not received full funding…

This Congress and this Administration must continue to provide full funding to the Major Construction account to reduce this backlog, but also to begin funding future construction priorities. Another difficulty has been the slow pace of construction. Major construction projects are huge undertakings, and in areas — such as New Orleans or Denver — where land acquisition or site planning have presented challenges, construction is slower than we would like. There are, however, many cases where there have been fewer challenges, and when the money was appropriated, construction has moved quickly."

Representatives from VA discussed the ongoing strategic facilities planning process. Donald Orndoff, Director of the Office of Construction and Management at VA, said, "VHA no longer distinguishes between CARES and non-CARES planning as the tools and techniques acquired through CARES have become part of our standard operating procedures for strategic planning within our health care system." VA plans to release an internal oversight report later this month to provide an assessment of the effectiveness of ongoing strategic

planning.

"This Committee is committed to working with VA to transform into a 21st Century organization that is responsive and accessible to each and every veteran that needs health care," commented Bob Filner, Chairman of the House Committee on Veterans’ Affairs. "Change is never easy, but it must be embraced in order to improve. I urge VA to rely on the input and counsel of veterans, interested stakeholders, labor groups, and veteran service organizations to effectively manage VA’s capital assets

for the maximum function for our Nation’s veterans."

Witness List:

Panel 1

* Joseph L. Wilson, Deputy Director, Veterans Affairs and

Rehabilitation Commission, The American Legion

* Carl Blake, National Legislative Director, Paralyzed Veterans of

America

* Dennis Cullinan, Director, National Legislative Service,

Veterans of Foreign Wars of the United States

* Rick Weidman, Executive Director for Policy and Government

Affairs, Vietnam Veterans of America

* Joy J. Ilem, Assistant National Legislative Director, Disabled

American Veterans

Panel 2

* Everett Alvarez, Jr., Chairman, CARES Commission, U.S.

Department of Veterans Affairs

* Mark Goldstein, Director of Physical Infrastructure Issues, U.S.

Government Accountability Office

Panel 3

* Donald H. Orndoff, AIA, Director, Office of Construction and

Management, U.S. Department of Veterans Affairs

Accompanied by:

* Brandi Fate, Director, Office of Capital Asset Management and

Planning Service, Veterans Health Administration, U.S. Department of Veterans Affairs

* James M. Sullivan, Director, Office of Asset Enterprise

Management, U.S. Department of Veterans Affairs

* Lisa Thomas, Ph.D., FACHE, Director, Office of Strategic

Analysis and Planning, Veterans Health Administration, U.S. Department of Veterans Affairs

Prepared testimony and a link to the webcast are available on the internet at this link:

http://veterans.house.gov/hearings/hearing.aspx?newsid=399