Strategic Goal: Provide One VA world-class service to veterans and their families through the effective management of people, technology, processes, and financial resources. VA will operate as a veteran-focused organization that provides high quality, accessible, and timely information and service through the development and maintenance of a high-performing workforce, the application of state-of-the-art technologies, the continuous improvement of processes, and the effective allocation of dollars.

Objective: Improve VA’s overall governance and operational management, and access to benefits and services to meet or exceed the expectations of veterans and their families, while ensuring full compliance with applicable laws, regulations, and financial commitments.

Performance Goal: Maintain the 16 percent reduction in average cost per patient (FY 1997 baseline = $5,458).

Means and Strategies

As part of a three-ply approach to becoming more efficient, in FY 1998 and FY 1999, VA achieved its performance targets to reduce the average cost (obligations) per patient. Therefore, prior to developing the FY 2002 Performance Plan, we will reevaluate the appropriateness of maintaining this as one of the Department’s key measures.

The primary strategy for bringing about reductions in the cost per patient is reengineering the health care system by shifting health care resources and patient treatment modalities from inpatient care to outpatient care. This shift impacts physical plants, clinical staff needs, and almost all aspects of the health care delivery system. Hospital utilization is minimized whenever therapeutically possible, and inpatient services are being converted to outpatient services and extended into the community.

Consolidation and integration are undertaken to eliminate redundancy, improve economies of scale, and bring service levels and/or workload up to minimum levels to assure cost effectiveness and clinical quality. Restructuring addresses consolidation, integration, right sizing of facilities, and realignment of services and programs within facilities. VA has witnessed a significant decrease in the number of operating beds nationwide as a result of these activities and plans to continue decreasing operating beds in the future.

VA collaborates with the Department of Health and Human Services (HHS) to develop non-VA benchmarks for bed days of care, which are obtained from a Health Care Financing Administration (HCFA) database. VA is able to obtain data on ambulatory procedures from the National Center for Health Statistics. VA collaborates with DoD on enhancing VA’s Parametric Automated Cost Engineering System (VA PACES), on partnering on real property assets, and on acquisition and collocation of VA facilities with excess property available through the closure of military bases. VA also participates in joint design and construction projects with the Department of Agriculture, Indian Health Service, Public Health Service, National Park Service, and Merchant Marine Academy.

Other crosscutting activities include providing laundry services to State Veterans Homes and Job Corps Programs, collaborating with the General Services Administration (GSA) in a government-wide real property information Sharing program on utilization of government-owned and government controlled real property in the Northeastern area of the United States, and acquiring leasehold interests in real property for clinical and administrative purposes within various regions across the United States. VA also participates with a private sector panel to identify enhanced-use lease initiatives at various VA medical centers for the purpose of obtaining lower cost utilities and energy services thus making more resources available for direct patient care.

GAO has identified as a major management challenge whether VA’s health care infrastructure meets veterans’ needs. For example, they note the need for consolidation of hospital assets in the Chicago, Illinois, area. VA has developed a plan for more efficiently meeting the health care needs of veterans in the Chicago area and has other plans in place to ensure the health care infrastructure will ensure veterans’ needs are met.

The source of the data for this goal is the Automated Allotment Control System (AACS). AACS allocations (includes the prorated share of national specific programs) are compared against the total number of unique patients. A VISN-specific report is produced annually. There is no independent validation of this information.

(For additional information on this performance goal, refer to Medical Programs, Volume 2, Chapter 2.)