AIR Report Alarms Legislators Where Shutdowns Might Occur
If new recommendations come to pass, the Carl Vinson VAMC in Dublin, GA, will be closed, but a new facility would be opened in nearby Macon, GA. VA photo.
WASHINGTON — After months of anticipation and years of research, VA has released its Asset and Infrastructure Report (AIR), laying out recommendations for how VA should evolve its physical footprint in the coming decades.
If followed, these recommendations, released last month, would result in a massive physical transformation of the department—closing many hospitals, building new ones and generating an across-the-department shift in favor of outpatient care over inpatient care.
Aware of the political sensitivity of the topic, VA leaders have been laying the groundwork for months to prepare the way for the report. They have been urging stakeholders to examine the market analysis in the report, so they understand why VA is making those recommendations, as well as reminding them that the current recommendations are not binding but part of a larger process.
“We’ve spent the last several weeks and months communicating about this with VA employees, union partners, state partners, veteran service organizations, Congress and more,” said VA Secretary Denis McDonough upon the report’s release. “I’m continuing to consult with our unions and will do so moving forward, because I appreciate the strong partnership we have with them.”
The VA MISSION Act of 2018 required VA to develop an extensive analysis of its current facilities to determine where it should spend its resources in the future. The same legislation required the creation of the presidentially-appointed AIR Commission, which will review VA’s recommendations before submitting its own to the president in 2023.
As expected, the report examines VA’s aging infrastructure, as well as shifts in the size, geography and diversity of the veteran population. The report also focuses heavily on balancing inpatient versus outpatient care.
“The healthcare environment in which VA operates has changed significantly over the last 50 years since much of the system’s infrastructure was designed and built,” the report states. “Advances in clinical approaches and technologies and changes in payment models have solidified the shift from a higher reliance on inpatient care to the delivery of the same care in outpatient settings.”
Thirteen of VA’s 18 VISNs are projected to experience a decrease in demand for inpatient medical and surgical services by FY2029, and all of the VISNs are expected to experience an increase in demand for outpatient services. Nationally, demand for outpatient services is projected to increase by nearly 50% by 2029.
Consequently, VA has more inpatient infrastructure than it needs, the report concludes. The AIR recommends addressing this imbalance by closing 17 medical centers, though it also recommends building 14 new hospitals and renovating many more.
The hospitals recommended for closure are located in: Castle Point, Brooklyn and Manhattan in New York; Coatesville and Philadelphia in Pennsylvania; Hampton and Salem in Virginia; Fort Meade and Hot Springs in South Dakota; Central Western in Massachusetts; Dublin in Georgia; Chillicothe in Ohio; Fort Wayne in Indiana; Battle Creek in Michigan; Alexandria in Louisiana; Muskogee in Oklahoma; and Palo Alto Livermore in California.
The report recommends building new medical centers in King of Prussia, PA, to off-set the closing of the Philadelphia VAMC; in Camden, NJ, to offset the New York City closures; as well as two hospitals in Virginia—Newport News and Norfolk—and two in Georgia—Macon and Gwinnett County, as well as new facilities in Huntsville, AL; Summerville, SC; Grand Rapids, MI; Rapid City, SD; Anthem, AZ; Everett, WA; and Colorado Springs, CO. Other hospitals would be rebuilt either in place or in nearby locations.
Seven of the facilities recommended for closure are in the Northeast, where VA says the number of veterans has decreased in recent years. Demand for veteran services also are expected to decrease in the Midwest, while rising in the South and Southwest, driven by an aging population moving to warmer climates.
Even in areas where the veteran population is declining, the need for outpatient services along with assisted living and long-term care facilities is expected to rise. VA’s proposals include the addition of new outpatient facilities and community living centers (CLCs), creating overall net increase in most areas of care. The only areas expected to see a net decrease are surgery sites in VA facilities, emergency departments, and primary care.
McDonough has said the AIR Commission is different than DoD’s Base Realignment and Closure (BRAC) process because it wasn’t designed to shrink VA’s footprint but shift it. Still, it could still cause similar head-butting among legislators.
“For far too long, VA’s infrastructure has been crumbling. Veterans in every corner of this country deserve better. That’s why Congress acted decisively and bipartisanly to include AIR in the MISSION Act,” said Rep. Mike Bost (R-IL) ranking Republican on the House VA Committee. “There are many milestones and hard decisions ahead, but retaining the status quo is not an option.”
Legislators, especially in areas where VA has recommended hospital closures, are less enthusiastic.
“It’s entirely unacceptable for VA to entertain closing community-based outpatient clinics in Conway, Somersworth and Portsmouth, especially when you consider that New Hampshire lacks a full-service VA hospital,” declared Rep. Chris Pappas (D-NH), who serves as chair of the House VA Oversight Subcommittee. “VA cannot jeopardize our veterans’ access to care in this manner, and I am calling for them to drop these recommendations.”
VA officials have said that, in the short-term, these changes would not disrupt veterans’ care, or result in the loss of VA staff.
The American Federation of Government Employees (AFGE), the largest VA employee union, has said, however, that the recommendations, if implemented, would “shutter large segments of the VA healthcare system, deny veterans their preferred choice in healthcare providers and force our nation’s heroes into a patchwork of for-profit, private care.”
“As the world teeters on the precipice of war, as our healthcare system finally begins to recover from the incredible stress of a two-year global pandemic, and as we just begin to deal with the aftereffects of ending the decades-long conflict in Afghanistan, now is the worst possible time to consider anything but expansion and improvements to VA facilities,” declared AFGE National President Everett Kelley. “Closing facilities must be entirely off the table. Our veterans deserve better.”