We have a golden opportunity to restore and reform VA hospitals

In December, Secretary of Veterans Affairs Denis McDonough was interviewed by the Washington Post on improving veterans’ access to healthcare. At the center of that complex issue are the bricks and mortar of Veteran’s Affairs’ (VA) medical networks — 171 inpatient facilities and 1,112 outpatient clinics that employ the majority of VA civil servants and care for approximately 7 million active customers. 

McDonough commented on the multi-year effort, required by law and begun during the Trump administration, to assess those facilities — many built over 50 years ago on a far different, inpatient-focused model of healthcare delivery than is the norm today. He said the agency was “taking a hard look” at physical infrastructure to meet Congressional requirements for the new Asset and Infrastructure Review Commission.

What McDonough didn’t mention was the status of the Asset and Infrastructure Review (AIR) Commission: an anticipated panel of nine White House vetted, Senate-confirmed appointees required by the VA MISSION Act of 2018. The commission, which has drawn awkward comparisons to a VA Base Realignment and Closure program (VABRAC), was expected to be ready in 2021 but was sidelined by a slow pace of nominees submitted to the White House, a process finally completed last fall. The White House’s inability to send their nominees to the Senate before work concluded in December may have been due to administrative delays or political considerations. At the time, all eyes were on efforts to pass the Build Back Better plan, which reportedly contained several billion dollars for VA’s healthcare infrastructure.   

Meanwhile, last year McDonough was briefed on the results of 96 voluminous healthcare “market assessments” that will form the basis of the commission’s inquiries in a VA report due Jan. 31. These confidential assessments, shared with congressional committees last summer, examine the entire VA medical system and are expected to quantify its capacity and capability to serve a changing population of veteran customers from the Korean conflict to the post 9-11 era. 

Until late last week, the secretary of veterans affairs was expected to issue the report on time — albeit to a still-unnamed commission — and outline his vision for reshaping VA’s national healthcare system. With that date looming, the VA has abruptly announced the report will be delayed six weeks because COVID is disrupting work. Some may see this as a way for VA and the White House to play catch up, while others may wonder if it’s a sign all isn’t entirely well with the assessments and there’s trepidation around how to frame the report for departmental and public consumption. 

Presuming VA stays on its new timeline and the secretary’s March report aligns with the assessments, it will have significant implications for the anticipated AIR Commission. Some consequential questions are:  

• How can VA efficiently repurpose or shed outmoded and unused parts of its sprawling, post-World War Two campuses? 

• How will VA recruit and retain adequate staffing levels in a post-pandemic, health worker constrained environment? 

• Should VA explore joint ventures with private hospitals and community clinics to maximize outreach in underserved areas? 

• What are the limits of telehealth technology and how does VA balance access to remote connectivity with demand for in-person care?   

Those questions and others will inform the way states and localities gauge a future where VA’s “footprint” in healthcare ecosystems may look different than it does today. McDonough shared last month while visiting a VA facility in Texas that trends in population shifts of veterans could warrant resource reallocation from states in the north to those in the south. Those trends reflect data for the U.S. population’s overall migration and have been amplified during the COVID-19 pandemic, but such a seemingly sensible discussion of resources will soon become a political tightrope to walk.  

Veterans possess intrinsic societal, economic and political value in our communities. The coming discussions on VA’s infrastructure and veterans’ health needs are ones that politicians and policy experts shouldn’t shy away from or make into a zero-sum game. Rather, it should energize growing attention in Congress, state capitols and the veteran community about how the largest healthcare system in the nation must continue to evolve to meet the needs of veterans under its care today and how it could be realigned and modernized to better serve a more diverse and changing population of American patriots in the years to come.    

Brooks D. Tucker served as the chief of staff and the assistant secretary of Congressional and Legislative Affairs in the Department of Veterans Affairs during the Trump administration. He is a Marine Corps veteran and a consultant with the Spectrum Group, a strategic advisory and government relations firm.