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Report Calls for Closing VA Hospitals

Two years ago Congress directed the establishment of a Commission on Care to look at the health care services of the Department of Veterans Affairs. The Commission was created in the Veterans Access, Choice, and Accountability Act of 2014 to evaluate access of veterans to health care and strategically examine how to best deliver health care to veterans throughout the VA health care system. The 15 member commission is composed of three appointments each to the President and the bicameral Congressional Leadership.

Recently 7 of the 15 commission members released what they call the “strawman report.” The report called for the closure of all VHA facilities and the transfer of patients to private care. The Proposed Strawman Assessment and Recommendations report asserted that “the current VA health care system is seriously broken, and because of the breadth and depth of the shortfalls, there is no efficient path to repair it.” The report called for immediate closure of “obsolete and underutilized facilities” and the eventual transfer of all VA patients to local providers within the next 2 decades.

TREA is strongly opposed to this proposal.

The official final report of the commission is not due for nearly three months and we will be monitoring this issue closely and fighting to stop any attempt to close VA health care facilities. At the same time, we continue to push for accountability within the VA system and for improvements in access to care that must happen as quickly as possible. There is no question that things need to be fixed in VA health care. But that doesn’t mean we should throw out the baby with the bath water.

We thought it might be helpful to our readers to give you excerpts from an editorial VA Secretary Bob McDonald write in the Baltimore Sun about a year and a half ago. In the editorial he reminded everyone of just what services the VA provides and how it is crucial for veterans and for health care in general.

From the Baltimore Sun: VA is critical to medicine and vets

By Robert A. McDonald
October 24, 2014

During preparation for my confirmation as secretary of Veterans Affairs (VA), I was repeatedly asked, "Why doesn't VA just hand out vouchers allowing veterans to get care wherever they want?" For a department recovering from serious issues involving health care access and scheduling of appointments, that was a legitimate question.

Veterans need VA, and many more Americans benefit from VA.
Almost 9 million veterans are enrolled to receive health care from VA — a unique, fully-integrated health care system, the largest in the nation. The VA stands atop a critical triad of support — three pillars that enable holistic health care for our patients: research, leading to advances in medical care; training that's essential to build and maintain proficiency of care; and delivery of clinical care to help those in need.
VA's accomplishments on all three pillars and contributions to the practice of medicine are as broad, historically significant and profound as they are generally unrecognized.

VA is affiliated with over 1,800 educational institutions providing powerful teaching and research opportunities.. Few understand that VA medical professionals:


  • Pioneered and developed modern electronic medical records;
  • Developed the implantable cardiac pacemaker;
  • Conducted the first successful liver transplants;
  • Created the nicotine patch to help smokers quit;
  • Crafted artificial limbs that move naturally when stimulated by electrical brain impulses;
  • Demonstrated that patients with total paralysis could control robotic arms using only their thoughts — a revolutionary system called "Braingate";
  • Identified genetic risk factors for schizophrenia, Alzheimer's and Werner's syndrome, among others;
  • Applied bar-code software for administering medications to patients — the initiative of a VA nurse;
  • Proved that one aspirin a day reduced by half the rate of death and nonfatal heart attacks in patients with unstable angina;

No single institution trains more doctors or nurses than VA. More than 70 percent of all U.S. doctors have received training at VA. Each year, VA trains, educates and provides practical experience for 62,000 medical students and residents, 23,000 nurses and 33,000 trainees in other health fields — people who go on to provide health care not just to veterans but to most Americans.

Our 150 flagship VA Medical Centers are connected to 819 Community-Based Outpatient Clinics, 300 Vet Centers providing readjustment counseling, 135 Community Living Centers, 104 Residential Rehabilitation Treatment Centers, and to mobile medical clinics, mobile Vet Centers and telehealth programs providing care to the most remote veterans.

And since 2004, the American Customer Satisfaction Index survey has consistently shown that veterans receiving inpatient and outpatient care from VA hospitals and clinics give a higher customer satisfaction score, on average, than patients at private sector hospitals.

Finally, VA is uniquely positioned to contribute to the care of veterans with traumatic brain injury (TBI), prosthetics, PTSD and other mental health conditions, and the treatment of chronic diseases such as diabetes and hepatitis.
Fixing access to VA care is important; we have a plan to do that and are dedicated to implementing it. That process will take time — but it must be done, and we will be successful.

Robert A. McDonald is secretary of Veterans Affairs.

Michelle Flournoy, co-founder and CEO of the Center for a New American Security (CNAS) and formerly the Undersecretary of Defense for Policy earlier in the Obama Administration, along with Dr. Stephen Ondra, the chief medical officer of Health Care Service Corp. and an adjunct senior fellow at the CNAS, wrote an op-ed in Politico last week that took aim at the Department of Defense's relentless push to raise TRICARE fees.

The article pointed out that raising fees will not cure the underlying problems that both DOD and beneficiaries have complained about for decades:

“For too long, efforts to undertake much needed reforms in the DOD health care system have been derailed by focusing almost exclusively on cutting costs by decreasing provider reimbursement and increasing copays from beneficiaries. This approach has not only failed to control health care spending, it has also led to lower satisfaction for DOD beneficiaries, especially our active duty members. Going forward, we need to ensure that our service men and women, military retirees and families, receive the best quality of care available and that unsustainable growth in defense health care costs does not increase risk to the DOD’s core national security mission.

“By adopting value-based health care approaches and benefit designs, DOD can keep faith with those who serve by improving the both the consumer experience and quality of care they receive, while also ensuring that burgeoning health care costs do not undermine the DOD’s ability to provide the best possible equipment and training to those sent into harm’s way to defend us.”

The beginning of the article was filled with talking points that DOD has used for years to justify their proposals to have military retirees and active duty families pay more for their earned benefits. The numbers cited were cherry-picked to show an exponential growth in healthcare costs that DOD has been shouldering for over a decade and a half. However, it goes on to note that there are other ways to control costs, many of them contained within the Affordable Care Act (Obamacare) that have worked to constrain healthcare spending in the private sector: namely, changing over to “fee for outcome” based care instead of “fee for service” care.

“Traditional fee-for-service models reimburse providers according to the total number and kind of patient encounters (e.g., how many tests run or procedures performed), rather than according to the health care outcomes those encounters produce (e.g., how functional the outcome is and how satisfied the patient is with the treatment). Fee-for-service tends to incentivize and drive ever-greater quantity of care instead of increasing the value (outcome quality and patient experience/cost) of that care.”

“To address this problem, many private sector health care providers, including well-known brands such as Blue Cross, Aetna and UnitedHealthcare, have accelerated their integration of value-based care reimbursement. Federal agencies, such as the Centers for Medicare & Medicaid Services are catalyzing this transition.”

TREA is fully supportive of the move towards value-based healthcare. Fee-for-service can result in unnecessary and duplicative medical tests and procedures; doing the right test or the right procedure the right way can cut healthcare expenditures without negatively affecting patient outcomes, which is something everybody should be able to get behind. Hopefully Congress agrees.

TREA will keep you updated on this important topic.


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