THE HONORABLE ANTHONY J. PRINCIPI
SECRETARY OF VETERANS AFFAIRS
SUBCOMMITTEE ON HEALTH
COMMITTEE ON VETERANS' AFFAIRS
UNITED STATES HOUSE OF REPRESENTATIVES
July 24, 2004
Mr. Chairman and Members of the Committee:
Thank you for providing the Department of Veterans Affairs (VA) this opportunity to discuss my recent decisions surrounding the Capital Asset Realignment for Enhanced Services (CARES).
As you know, last month I announced my decision on the future of VHA’s capital infrastructure and publicly released my CARES Decision Document, copies of which have been provided to the Committee. It is not my intention today to discuss the details of the entire decision document. Instead, I will focus my discussion on the following issues of particular interest to the Committee:
Before I address those topics, however, I would like to provide a brief background on the CARES process. CARES is a data-driven planning process designed to project future demand for health care services, compare projected demand against current supply, and identify capital requirements and asset realignments VA needs to meet future demand for services, improve the access to and quality of services, and improve the cost effectiveness of VA’s health care system. The CARES process is a comprehensive, system-wide approach to projecting into the future the appropriate function, size and location for VA facilities. CARES was initiated to provide a plan for management of VA’s capital infrastructure into the future that can be improved over time. For that reason, the tools and a process used to develop CARES will be integrated into annual capital and strategic planning cycles, ensuring continued and systematic planning for the capital resources VA needs to provide quality health care to veterans.
On February 12 of this year, the CARES Commission presented its final report to me. Following an intensive review of this report, I issued my “CARES Decision” on May 7, 2004. In that decision, I formally accepted the CARES Commission’s recommendations using the flexibility the Commission provided to minimize the effect of any campus or service realignment on continuity of care to veterans currently receiving services. My Decision and the CARES Commission Report form the blueprint that will effectively guide the Department as it moves forward to enhance and improve health care delivery to veterans by modernizing and more effectively managing its capital infrastructure.
I am pleased to announce that VA has developed a long-term Capital Plan, which will be delivered to members of Congress shortly. With more than 5,500 buildings and approximately 32,000 acres of land nation-wide, it is critical that VA has a systematic and comprehensive framework for managing its portfolio of capital assets. This plan provides that framework and is a sound blueprint for effective management of the Department’s capital investments that will lead to improved resource use and more effective health care and benefits delivery for our Nation’s veterans.
As we strive to meet the many challenges that lay ahead, this plan will act as our guide. I recently announced my decisions on the Capital Asset Realignment for Enhanced Services (CARES) process. CARES is the most comprehensive analysis of VA’s health care infrastructure that has ever been conducted and my decision provides a 20-year blueprint for the critical modernization and realignment of VA’s health care system. Consistent with my decision, the capital plan outlines CARES implementation and identifies priority projects that will improve the environment of care at VA medical facilities and ensure more effective operations by redirecting resources from maintenance of vacant and underused buildings and reinvesting them in veterans’ health care. Implementation of CARES will require substantial investment. While I will assess what amounts should be funded in future budgets, this plan reflects a need for additional investments of approximately $1 billion per year for the next 5 years to modernize VA’s medical infrastructure and enhance veterans’ access to care.
The capital plan also identifies our highest priority needs for new construction and expansion of cemeteries in areas where burial sites will soon be depleted, new benefits administration office facilities, and information technology projects designed to improve customer service and enhance delivery of VA benefits.
As we move forward, VA will continue to improve stewardship of the funds entrusted to us by more effectively managing our capital assets and planning to meet the future needs of America’s veterans and their families. By employing best business practices and maximizing the functional and financial value of our capital assets through well thought-out acquisitions, allocations, operations, and dispositions, VA will continue to ensure that all capital investments are based on sound business principles and -- most importantly -- meet our veterans’ health care, benefits, and burial needs. I am confident that effective implementation of this plan will help us to achieve these important results.
Mr. Chairman, many stakeholders have expressed concerns about how VA intends to address the provision of long-term care within the context of CARES. In order to respond to these concerns, I directed in my Decision that VHA develop a Long-term Care Strategic Plan addressing
I am currently considering various policy options that have been designed to adhere to certain core principles, which include a policy that is clinically sound, is fair for veterans, can be modeled for VISN planning, and is acceptable to Congress. Some of the key elements that I will strongly consider are the extent to which the Long-term Care Strategic Plan:
The Long-term Care Strategic Plan will be designed to improve the veteran’s quality of life by seeking to preserve personal dignity, enhance emotional well being, and provide care in the least restrictive setting possible.
In addition to long-term nursing home care, VA is reviewing its long term-care policy in other key program areas, such as domiciliary and residential rehabilitation programs. VA’s long-term care policies relating to these programs will assure that programs in domiciliary structures are focused on residential rehabilitation and that each patient has a clinical treatment plan. As each program (e.g., mental health, substance abuse, and long-term care) defines its discrete capacity for residential rehabilitation, VA will have a more complete picture of the total capacity requirement for domiciliaries.
Veterans Rural Access Hospital:
VA is also reviewing the “critical access hospital” concept that was initially introduced to help ensure that veterans receive high quality care at VA’s small facilities. Recognizing that some small and rural facilities will be unable to maintain the workload necessary to perform certain surgical procedures or manage some complex illnesses effectively, VA will establish parameters to ensure high quality patient care. A new policy, Veterans Rural Access Hospital (VRAH), is under development and will specifically define the clinical and operational characteristics of small and rural facilities within VA. I have directed that the VRAH policy be completed later this month. In the interim, the missions of small facilities recommended for change will not be altered. Once the new VRAH policy is approved, however, VA will study the scope of services performed at VA’s small and rural facilities using the policy’s criteria and the guidance that will be provided. I anticipate the outcome of this study will be clarification of the type and complexity of surgical procedures that can be safely accomplished in small and rural facilities.