VA to Propose Closing Some Medical Centers and Outpatient Facilities

The Veterans Affairs Department will soon recommend reducing its medical facility footprint by three as part of a review to reshape its health care, and announced on Thursday it will also suggest shuttering dozens of additional outpatient facilities.  

VA Secretary Denis McDonough declined to detail which facilities it is recommending for closure ahead of a full rollout of its report on Monday, but local reports and lawmakers have suggested medical centers in at least southern Ohio, South Dakota and western Massachusetts are on the chopping block. VA currently has 171 medical centers across the country and it suggested bringing that number down to 168. The department did not say how many of the more than 1,100 outpatient facilities it will close, or how many new facilities it plans to build. 

About 150,000 more veterans would gain primary care nearby under VA's plan, McDonough said, as well as 375,000 who would gain nearby access to specialty care and 200,000 additional veterans who would be close to mental health care.

The 2018 VA Mission Act required the department to make recommendations to a new panel, the Asset and Infrastructure Review (AIR) Commission. President Biden just nominated eight of the nine commissioners this week, who must now be confirmed by the Senate. The commission will have a year to review that plan, conduct its own hearings and investigations, make its own proposals and send them to the White House. Biden can then reject the plan or sign off on it and send it to Congress. Similar to previous Base Realignment and Closure efforts at the Defense Department, Congress will have to accept all of the recommendations or none of them. Lawmakers must proactively vote down the proposals to void them, however, as inaction would allow them to take effect. 

Overall, McDonough said at an event hosted by the RAND Epstein Family Veterans Policy Research Institute, VA is not planning to reduce its overall footprint. Instead, he said, the department is doubling down on its commitment to serving veterans where they are. 

“To anyone who is concerned about the process, the VA is here to stay,” McDonough said. “There will be changes in markets but we are staying in every market.”

Where VA is recommending closures, he added, it will shift to outpatient or referrals to private sector care in an effort to modernize the services veterans receive. 

“In the place where there are changes, we will be shifting to new or different infrastructure that accounts for how health care has changed,” McDonough said. Unlike a BRAC, he added, which is designed to force closures, the AIR Commission process is “designed to maintain VA as the premier health care provider in every market in the country.” 

In making its recommendations, VA considered whether a site is meeting VA standards, the potential cost savings from a closure, when those savings would occur, if it would harm VA’s ability to carry out its mission and input from local stakeholders. The department has held listening sessions around the country to solicit feedback from veterans on their current and future needs and since 2018 engaged in market assessments to fully understand what and where services are available through its own facilities, other government centers (such as the Defense Department and Indian Health Services) and in the private sector.

McDonough said he has not yet crunched the numbers on job displacement from the suggested closures, but he anticipates the department will wind up with a net gain in positions if its recommendations are implemented. 

“We will be doing what we’re doing today, which is actively working to maintain the billets and filling new billets,” the secretary said. 

Still, Everett Kelley, president of the American Federation of Government Employees, the union that represents a majority of VA employees, blasted the plan, saying the department was ceding its operations to the private sector at the worst possible time.

“Closing VA facilities will force veterans to rely on uncoordinated, private, for-profit care, where they will suffer from long wait times and be without the unique expertise and integrated services that only the VA provides,” Kelley said. “Closing facilities must be entirely off the table. Our veterans deserve better.” 

McDonough pledged to ensure all potential closures would first wait for new facilities to be built or acquired until the medical centers shutter their doors. He said demand was not the sole driver of decision making, citing markets in the southeast where usage of medical centers is low but communities are otherwise underserved. VA can only guarantee access by expanding services in those markets, he explained. Some medical centers are more than 100 years old, the secretary said, and the department is wasting resources continually repairing them rather than building new, “state-of-the-art” facilities. Those new buildings will also reflect the needs of the new demographic trends among veterans, such as the increase of female and younger patients.

Biden on Wednesday nominated eight of the nine panelists that will sit on the commission, including a former VA official, a former Defense Department assistant secretary, veterans group leaders and a Capitol Hill staffer. Former Rep. Patrick Murphy, D-Penn., who also served as acting Army secretary under President Obama, will chair the commission if confirmed by the Senate. 

Murphy said he was honored by the selection and called the commission a “unique opportunity” to improve VA’s health care system. 

“The needs of our veteran population are shifting, with 70% of our nation’s veterans over age 65, more women are serving than ever before and younger veterans are using VA services in record numbers,” Murphy said. “I’m committed to working with my fellow commission members, the VA and it’s employees,  veteran services organizations, health care industry leaders, and members of Congress to develop a path forward for all of us to modernize the healthcare our veterans have access to.”