The US Dept. of Veterans Affairs has proposed a wide-ranging blueprint to revamp its sprawling network of hundreds of health care facilities that would involve many new construction projects and result in a net increase in the number of multi-purpose outpatient clinics but a slight net decrease in the number of VA hospitals.

The VA Asset and Infrastructure Review recommendations, released on March 14, mark the beginning of a long deliberative process, similar to the US Defense Dept.’s Base Realignment and Closure program, which included five rounds of shutdowns—but also some base expansions—from 1988 to 2005.

The program was mandated in a 2018 statute for VA, which operates 171 medical facilities and more than 1,000 centers for outpatient care, which it says makes it the largest integrated health care system in the U.S.

VA's recommendations for new construction, upgrades, reconfigurations and closures respond to several trends, including more veterans who live in many parts of the South and West and fewer in the northeast and midwest, a VA spokesman said.

The condition of VA facilities is another factor. In the report, VA Secretary Denis McDonough said the proposal would replace “old, outdated, run-down facilities with state-of-the-art facilities designed with veterans and VA employees in mind.”

The median age of facilities is nearly 60 years, compared with a median of 8.5 years for U.S. hospitals in the private sector. About 69% of VA hospitals exceed 50 years, says the report.

A major shift in how health care is provided also drives the recommendations. “Many VA hospitals were built in a time when inpatient care, not outpatient care was predominant—a trend that has since flipped as medical advancements have allowed veterans to recover at home,” McDonough said.

The report adds that “innovation in telehealth has helped bring medical expertise directly into veterans’ homes and other convenient locations, further diminishing reliance on in-person visits.”

If the proposal is carried out as proposed, the net number of VA hospitals would dip to 168, from 171 now. It would include constructing some new hospitals, including facilities in Phoenix; Newport News and Norfolk, Va., and San Antonio, Texas.

The number of “multi-specialty" outpatient clinics would jump by 56%, to a net 388, from 248. Those clinics provide primary care, as well as mental health and other specialty care services.

Community living centers also would increase, to a net 29, from just two now.

There would be fewer community outpatient clinics, with the net number set to fall 15%, to 469, from 555. Those facilities provide primary care on site, and mental health care services on site or via telehealth. They may also have pharmacy services.

The US Army Corps of Engineers would be the lead federal agency for VA projects valued at $100 million or more, which would appear to include all of the 14 new hospitals VA is proposing, said Brian Turmail, Associated General Contractors of America vice president for public affairs and strategic initiatives. The entire program "would certainly be in the billions for construction." he said in an email to ENR.

A commission nominated by President Joe Biden will review the VA recommendations, a process that will include public hearings. Former Pennsylvania Congressman Patrick Murphy (D) was nominated on March 9 as panel chair, with seven other members also nominated.

The commission, which can make changes in the VA plan, must submit recommendations to the President by Jan. 31, 2023. The President then will submit to Congress and the commission by Feb. 15, his approval or disapproval of panel recommendations. Congress has 45 days to draw up and act on a resolution disapproving the recommendations. If such a resolution fails to pass, the plan will go forward.

VA then has up to three years to begin to implement the plan. "During the implementation, VA would develop a process for prioritization and funding of projects." He added, "It is too early to know how long it will take to complete the recommendations," the VA spokesman said.

Communities that would lose VA facilities under the proposal are expected to mount campaigns to reverse those recommendations, as will their congressional delegations.

One early signal came from Senate Veterans Affairs Committee Chairman John Tester (D-Mont.), whose state would lose a VA nursing home and two clinics under the VA proposal. "As I’ve said in the past, any effort to kneecap our veterans’ health care is a non-starter for me," he said in a statement. "I will fight tooth and nail against any proposals that blindly look to reduce access to VA care or put our veterans at a disadvantage.”

Story changed on 3/22/2022 to correct errors in some of the net changes in types of facilities resulting from the plan.