WASHINGTON -- Veterans hospitals across the country and the vets they serve will come under intense scrutiny as officials consider where to cut back and where to add new services.
In the end, an unknown number of hospitals are likely to close as the Department of Veterans Affairs shifts its focus to outpatient care and works to bring services closer to people who need them.
Decisions about specific cities and hospitals won't be made for more than a year, but the massive restructuring was being launched Thursday. In some cities, hospitals are likely to be closed or operations scaled back; in others, new services will be added.
"This is not about the closure of facilities. It's about continuing the change in VA health care and changing it for the better," Deputy Secretary of Veterans Affairs Dr. Leo S. Mackay Jr. said in an interview.
Decisions about where to cut and where to add will be made after analyses of demographics and services available at 163 hospitals and more than 1,000 clinics, nursing homes and other health care facilities.
Some of the facilities date back to the early 1900s and cannot be easily renovated. Some hold historical significance, complicating any effort to sell or alter the buildings.
An independent, nine-member commission is to make recommendations to the VA secretary in August 2003. As with recommendations on military base closings, the secretary must accept or reject the plan as a whole -- an attempt to minimize pressure surrounding the closure of sometimes cherished institutions.
"It's one way to get some degree of insulation from the politics," Mackay said.
Reaction from veterans groups was tepid. Some were concerned that the VA may be dismantling an infrastructure that is part of the national homeland security plan. And they worried that some vets would lose access to care.
"While they keep saying they're improving services, they are drastically cutting services," said Bruce Parry, 55, of Veterans for Unification, a Chicago advocacy group.
The national overhaul, recommended by government auditors in 1999, is aimed at shifting dollars away from aging, inefficient facilities in communities where the number of veterans is shrinking in order to provide modern medicine closer to where vets of the future will live.
The 1999 audit by the General Accounting Office, the investigative arm of Congress, predicted that without change, the VA would wind up spending billions of dollars to operate unneeded buildings, with as much as one of every four VA health care dollars devoted to the maintenance and operation of facilities.
But slimming down may be easier said than done. In a pilot program in one region, the VA opted to cut inpatient service from a downtown Chicago hospital and expand services at other facilities. Veterans groups were outraged, and VA officials are pledging to consider their opinions upfront as the market analyses begin across the country.
The GAO suggested that the greatest potential for savings was in 40 cities where there is more than one VA hospital. These hospitals have a significant number of empty beds and compete with one another to serve "rapidly declining veteran populations," auditors said.
VA officials declined to speculate as to which hospitals might close and said their goal is not to cut services but to redeploy them to areas where they are needed more. They emphasized that hospital beds are not needed for the VA's new emphasis on outpatient care, which follows a national shift spurred by better drugs and more outpatient surgeries.
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