[House Hearing, 115 Congress]
[From the U.S. Government Publishing Office]
DRAFT LEGISLATION, THE ASSET AND INFRASTRUCTURE REVIEW ACT OF 2017, AND
H.R. 2773, TO AUTHORIZE THE SECRETARY OF VETERANS AFFAIRS TO SELL
PERSHING HALL
=======================================================================
HEARING
before the
COMMITTEE ON VETERANS' AFFAIRS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED FIFTEENTH CONGRESS
FIRST SESSION
__________
THURSDAY, OCTOBER 12, 2017
__________
Serial No. 115-34
__________
Printed for the use of the Committee on Veterans' Affairs
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Available via the World Wide Web: http://www.govinfo.gov
_________
U.S. GOVERNMENT PUBLISHING OFFICE
31-342 WASHINGTON : 2019
COMMITTEE ON VETERANS' AFFAIRS
DAVID P. ROE, Tennessee, Chairman
GUS M. BILIRAKIS, Florida, Vice- TIM WALZ, Minnesota, Ranking
Chairman Member
MIKE COFFMAN, Colorado MARK TAKANO, California
BRAD R. WENSTRUP, Ohio JULIA BROWNLEY, California
AMATA COLEMAN RADEWAGEN, American ANN M. KUSTER, New Hampshire
Samoa BETO O'ROURKE, Texas
MIKE BOST, Illinois KATHLEEN RICE, New York
BRUCE POLIQUIN, Maine J. LUIS CORREA, California
NEAL DUNN, Florida KILILI SABLAN, Northern Mariana
JODEY ARRINGTON, Texas Islands
JOHN RUTHERFORD, Florida ELIZABETH ESTY, Connecticut
CLAY HIGGINS, Louisiana SCOTT PETERS, California
JACK BERGMAN, Michigan
JIM BANKS, Indiana
JENNIFFER GONZALEZ-COLON, Puerto
Rico
Jon Towers, Staff Director
Ray Kelley, Democratic Staff Director
Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public
hearing records of the Committee on Veterans' Affairs are also
published in electronic form. The printed hearing record remains the
official version. Because electronic submissions are used to prepare
both printed and electronic versions of the hearing record, the process
of converting between various electronic formats may introduce
unintentional errors or omissions. Such occurrences are inherent in the
current publication process and should diminish as the process is
further refined.
C O N T E N T S
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Thursday, October 12, 2017
Page
Draft Legislation, The Asset And Infrastructure Review Act Of
2017, And H.R. 2773, To Authorize The Secretary Of Veterans
Affairs To Sell Pershing Hall.................................. 1
OPENING STATEMENTS
Honorable David P. Roe, Chairman................................. 1
Honorable Tim Walz, Ranking Member............................... 3
WITNESSES
The Honorable Mike Coffman, U.S. House of Representatives, 6th
District; Colorado............................................. 5
Prepared Statement........................................... 37
Joy J. Ilem, National Legislative Director, Disabled American
Veterans (DAV)................................................. 12
Prepared Statement........................................... 37
Louis J. Celli Jr., Director, Veterans Affairs and Rehabilitation
Division, The American Legion.................................. 13
Prepared Statement........................................... 42
Carl Blake, Associate Executive Director of Government Relations,
Paralyzed Veterans of America (PVA)............................ 15
Prepared Statement........................................... 46
Carlos Fuentes, Director, National Legislative Service, Veterans
of Foreign Wars of the United States (VFW)..................... 17
Prepared Statement........................................... 49
Dave Wise, Director, Physical Infrastructure Team, U.S.
Government Accountability Office (GAO)......................... 18
Prepared Statement........................................... 51
Regan L. Crump MSN, DrPH, Assistant Deputy Under Secretary for
Health for Policy and Planning, Veterans Health Administration,
U.S. Department of Veterans Affairs............................ 20
Prepared Statement........................................... 60
Accompanied by:
James M. Sullivan, Director, Office of Asset Enterprise
Management, U.S. Department of Veterans Affairs
STATEMENTS FOR THE RECORD
Concerned Veterans for America (CVA)............................. 62
DRAFT LEGISLATION, THE ASSET AND INFRASTRUCTURE REVIEW ACT OF 2017, AND
H.R. 2773, TO AUTHORIZE THE SECRETARY OF VETERANS AFFAIRS TO SELL
PERSHING HALL
----------
Thursday, October 12, 2017
Committee on Veterans' Affairs,
U. S. House of Representatives,
Washington, D.C.
The Committee met, pursuant to notice, at 10:30 a.m., in
Room 334, Cannon House Office Building, Hon. David P. Roe,
[Chairman of the Committee] presiding.
Present: Representatives Roe, Bilirakis, Coffman, Wenstrup,
Bost, Poliquin, Dunn, Arrington, Rutherford, Higgins, Bergman,
Banks, Walz, Takano, Brownley, Kuster, O'Rourke, Correa, and
Esty.
OPENING STATEMENT OF DAVID P. ROE, CHAIRMAN
The Chairman. Good morning. The Committee will come to
order.
I want to thank you all for joining us today for this Full
Committee legislative hearing.
Before I continue, I want to tell my friends from
California that hopefully we will have a vote later on today
and send some resources out for the awful fires that are going
on. I experienced those a year ago in Gatlinburg, in Sevier
County, Tennessee, where we lost 2500 homes and 14 lives. It is
astounding what is happening there.
So I just wanted to pass that along to you all that are in
California, if there is any way we can help, we are willing to
help. I have been down that road.
This morning we will be focusing on two pieces of
legislation: the draft Asset and Infrastructure Review, or AIR
Act of 2017; and H.R. 2773, a bill to authorize the sale of
Pershing Hall in Paris, France.
Since Representative Coffman will be speaking shortly on
H.R. 2773, which he sponsors, I will contain my comments to the
draft bill that Ranking Member Walz and I have been working on
together.
Exactly three months ago today, we held a Full Committee
hearing to examine concerns regarding the Department of
Veterans Affairs Capital Asset Program and alignment, or
misalignment, as the case may be, of the VA medical facilities
and the veteran patient population.
I came to that hearing familiar with the numerous
challenges VA was facing with regard to managing an
increasingly unmanageable real estate portfolio. In fact, I was
so aware of those challenges I had already decided that taking
action to address was going to be one of my top priorities as
Chairman, yet that hearing was alarming even to me as VA's own
testimony noted that the majority of VA's facilities have
outlived their useful life cycle.
A couple weeks ago, I traveled to Northport, New York to
meet with staff at the Northport VA Medical Center. The
Northport VA Medical Center is a 90-year-old facility on a
sprawling medical campus that struggles with significant
maintenance issues and costs, despite dozens of mothball
buildings. The condition of that facility has gotten so bad
that some veterans claim they can no longer seek care safely
there; instead, travel from Northport to New York City to visit
the VA facilities there.
After visiting Northport, I went to Canandaigua, New York
to visit the Canandaigua VA Medical Center and the Veterans
Crisis Line, which is housed there. The Canandaigua VA Medical
Center is an 84-year-old facility that sits on a 150-acre
campus in the middle of a residential neighborhood. However,
the majority of veteran patients in Canandaigua's catchment
area seek care to the VA community-based outpatient clinic
about 30 miles away in Rochester, New York. That clinic is
nearly busting at the seams from high utilization, while the
Canandaigua VA Medical Center largely sits empty.
At both Northport and Canandaigua, I saw firsthand the
consequences of outdated and oversized medical campuses that
struggle to maintain current standards of care without
significant back-bending. And we wonder why the VA health care
system has struggled to provide care that meets the highest
access and quality standards, and that is why Ranking Member
Walz and I are working together on this draft of the AIR Act.
This legislation would require the Secretary to develop
criteria to access and recommend changes to VA Medical Centers.
That criteria would be published on the Federal Register,
subject to a 30-day public comment period, and would be
required to take into account a number of factors, including
access to care, the capacity of the local health care market,
input from local veteran and stakeholders, and potential costs
and savings.
The legislation would also establish an 11-member Asset and
Infrastructure Review Commission that would use the criteria
established by the Secretary and the recommendations for action
made by the Secretary to develop a report containing findings
and recommendations for the modernization and realignment of VA
medical facilities.
Should the commission find that any of the Secretary's
recommendations deviate substantially from the Secretary's
criteria and a change is needed, the commission would be
required to publish a notice of proposed change in the Federal
Register and conduct public hearings in the local community on
the proposal of changes?
Once finalized, the commission's report would be
transmitted to the President and, contingent upon his approval,
to the Congress. Should Congress disagree with the commission's
recommendations, we would have 45 days to issue a joint
resolution of disapproval. Absent that, VA would be required to
begin implementing the recommendations.
This draft bill has been circulated with VA and with the
VSOs, and was subject to a Full Committee roundtable in early
September. Since then, I have met individually with many
Members from both sides of the dais to discuss this language
and the intent behind it, and how it aligns with ongoing
efforts to course-correct VA's many care in the community
programs.
That said, this bill is just a draft, and I understand that
there are still a number of concerns and questions about it,
particularly with regard to the timeline, the composition of
commissioners, and the involvement of veterans and advocates. I
appreciate the many thoughtful comments made in the written
statements prepared for today's hearing by our VSO witnesses
and I look forward to incorporate many of their suggested
changes in the coming days.
I intend to also incorporate provisions in this bill prior
to its introduction to increase the threshold of minor
construction projects and expand enhanced use lease authority.
Both of those changes have been discussed by this Committee
before and have been requested by the Administration, and have
the support of the VSOs.
Yet even with those changes, it is an understatement to say
that the deck is stacked against the AIR Act. This bill is
bold, transformative, and controversial. Moving forward with it
will require a significant amount of political courage and,
let's face it, Members are not known specifically for that.
That said, veterans, VSOs, and VA employees and taxpayers alike
deserve more from each of us and to recognize how serious the
problem before us is and to fail to act now to institute a
solution.
As Ranking Member Walz wisely noted at our hearing in July,
``We can no longer kick this can down the road, Coach, because
time is not on our side in this battle.''
And as Representative Rice said, if there is any Committee
in Washington, D.C. that has the political courage to do what
is necessary, it is this one. The AIR Act is necessary.
I will now yield to Ranking Member Walz for any opening
statements that he might have.
OPENING STATEMENT OF TIM WALZ, RANKING MEMBER
Mr. Walz. Well, thank you, Mr. Chairman.
And to our witnesses, thank you all for being here. I do
think, maybe someday looking back, this could be a very pivotal
hearing. I would echo the Chairman's statements; this is bold.
I have not changed my opinion that we need to address this.
I would note that there has been, and I think rightfully
so, some folks commenting on the effectiveness of this
Committee and the Chairman's leadership is no small part of
that. Those who said we have been tackling the easy stuff,
remember how appeals started, remember how accountability
started, remember how Choice and Choice reform started, and
remember the GI Bill statement. Some of us are still friends
after that fight, but it took a lot.
What it shows is, it shows the courage, and this is why the
Members are sitting here, you came here to do this. You came
here to legislate, you came here to have healthy disagreements,
you came here with the confidence that we could try and find
some things together, and this is a starting point.
I would like to note a few things in this. We are working
side-by-side in this, but it is a journey and it is going to be
a tough one. And the witnesses, you are going to come and you
are going to present your testimony. You were there at the
roundtables. We can do this, but it is going to have to be done
in that confidence and that trust that we have done some of
these other things.
So providing the Secretary the authority to support his
needs to assess and ultimately realign VA is one of this
Committee's top priorities. However, I do not think any of us
should forget the highest of priorities within the Committee is
ensuring veterans have access to receive the highest quality
services, health care, and benefits.
No one disagrees with the need to modernize the VA's
infrastructure and build community partners where it makes the
most sense for veterans and taxpayers. I pulled out a statement
I made sitting down on this corner in February of 2007 where I
was calling for a quadrennial defense review to align assets
and needs that it did not understand where we were going. I
remember sitting there saying, we could be sitting here in 10
years in 2017 and still not have an understanding of where we
are going. So I think all of us get that part. I do not think
we are there yet.
As the legislation is written, I think it takes a picture,
a snapshot of VA infrastructure, and to make a decision on
going forward on that is going to have decades-long impact. We
need more than a snapshot; we need to develop a process that VA
can use to continually make decisions on an annual basis to
ensure access gaps are identified and filled early.
I also think, folks, whenever we talk about this, and it is
something we should always be striving for, is the belief that
it is going to be a cost saver. I think the belief is based on
the fact that we hear about the 1,400 vacant buildings or
under-utilized buildings. Most of these are not buildings that
provide care for veterans. By my count, fewer than 20 of the
1,400 buildings scheduled for disposal in fiscal year 2018
provide direct care to veterans, while more than 70 buildings
are old hospital staff residences.
What is missing I think from the conversation so far is the
fact that every single VISN there are significant utilization
gaps in outpatient care space and there is an excess in
inpatient care space. What does that mean? It means we have
empty bed towers at too many facilities, but at the same
veterans are waiting in line to receive modernized outpatient
care. The issue deserves serious attention. I commend the
Chairman and everyone here for their willingness to face this
challenge.
The legislation in its current form has more work to do.
While we stated this is a draft bill and a starting place, we
need to start making changes to the language. Other concerns we
have is the timeline, the fact that the Secretary can deliver
recommendations to the commission before the enactment of a
permanent solution to consolidating community-based care is
implemented.
And most concerning to me, and I say this now, I would say
it in 4 years, I would say it in 8 years, is the power of the
President at the end of the process. If he or she disapproves
of the recommendations, the commission ends without further
action. If he or she approves the recommendations, regardless
of Congress or stakeholders' agreement, by simply not signing
the joint resolution of disapproval the recommendations will
still be enacted.
We agree, status quo is not the answer, but I have deep
reservations about this if we do not have answers to earlier
questions.
Mr. Chairman, I will state it again: your leadership and
guidance continues to move us ahead. Your boldness in stepping
through political land mines to try and solve problems is one
that I admire greatly.
I ask now that we have set the plate, we have brought the
people to the table, we are prepared to now start having that
serious discussion about how do we put that template in place
that allows a tool for VA to move forward, how do we get a
quadrennial defense review or a quadrennial VA review that
starts to move us there, and how is the process still with
these Members in this room having more of the power to be able
to move that forward.
So, Mr. Chairman, I thank you. I look forward to the
testimony of our witnesses and the engagement of all Members.
The Chairman. I thank the gentleman for yielding.
And joining us on our first panel, although testifying from
the dais this morning, is our friend and colleague and fellow
Committee Member, the Honorable Mike Coffman of Colorado.
Mr. Coffman, you are now recognized for 5 minutes.
STATEMENT OF HONORABLE MIKE COFFMAN
Mr. Coffman. Thank you, Mr. Chairman.
I would like to begin by thanking you for including my bill
in today's legislative hearing and thank the witnesses for
their testimony.
Mr. Chairman, I think we can all agree that the VA's sole
mission is to provide services to our Nation's veterans. The
maintenance of a 5-star, 24-room boutique hotel, restaurant,
and club in downtown Paris, France is clearly not included in
that description.
Therefore, in an effort to get the VA out of the overseas
hotel business and focused on its core competencies, I
introduced H.R. 2773, the Sell Excess Luxury Lodging, the SELL
Act, to authorize the sale of this hotel, Pershing Hall.
Pershing Hall is a building originally procured by The
American Legion to serve as a memorial to our ``Doughboys,''
who served in France during World War I. The building was
transferred to the VA in 1991, and in 1998 the VA leased
Pershing Hall for a 99-year period to a French firm that
redeveloped the property as a luxury hotel.
In recognition of the historic aspects of Pershing Hall,
H.R. 2773 requires the preservation of architectural details of
the exterior and interior of the structure, and requires all
property of General Pershing and the American Expeditionary
Forces in France during World War I to be transferred to the
American Battle Monuments Commission.
H.R. 2773 also appropriately requires the transfer of sale
proceeds to the American Battle Monuments Commission for the
maintenance of cemeteries, monuments, and memorials dedicated
to our men and women in uniform.
Mr. Chairman, today you will hear the concern that the fair
market value will not represent the true value of the property
because it is encumbered by the VA's lease agreement.
Unfortunately, the reality is that the VA negotiated a bad
long-term deal that significantly decreased the market value of
the property. Even more reason to get the VA out of the hotel
business.
To address this concern, I plan to amend my legislation to
require a condition of the sale be the appraised value of the
property versus the market value. So that what the market value
is, we have this horribly negotiated, really below-market lease
agreement that in a market value assessment will only reflect
the income of the property, this lease agreement. So it would
be a windfall to the lessee, who would be the only one who
could purchase it, because they would say that they are not
going to--that they want the lease agreement continued and so
to reflect again that lower income that would reflect the
market value of the property.
What we want to do, what I want to do is to change it to
appraised value. An appraised value would not reflect that
lease agreement.
And so there would be under two circumstances that it would
be sold, certainly not guaranteed. One would be that the lessee
realizes that the future appreciation of the value is
significant enough that it is good to lock in the value now,
lock in the appraised value now and go ahead and buy the
property despite this below-market lease agreement, or it would
be another buyer who would negotiate with the lessee to buy out
the lease agreement contingent upon the purchase of the sale of
the, the buyer of the property. Those are the both
circumstances.
And so I think it would be, although I want to get the VA
out of the luxury hotel management business, I think that, you
know, there has to be a fair price to the taxpayers of the
United States.
While Pershing Hall is probably a terrific hotel, it makes
no sense that VA keeps a luxury hotel in Paris on its books.
The VA needs to focus its time and resources on its core
mission, taking care of our Nation's veterans.
Mr. Chairman, thank you for allowing me to testify today on
behalf of this legislation and I yield back the remainder of my
time.
[The prepared statement of Mike Coffman appears in the
Appendix]
The Chairman. I thank the gentleman for yielding.
I just have one very quick question, is that when this was
leased, this 99-year lease signed? And then, I guess, why in
the world would you have signed a 99-year-old lease?
Mr. Coffman. Sir, I think we have the VA here, but I
believe that it was done, let's see, in 1998, as I understand
it correctly, that the lease was signed.
The Chairman. I don't think any of us are going to be
around when the lease is up.
I now yield to Mr. Walz.
Mr. Walz. Well, this one too has always been one when it
comes up, it is kind of hard to wrap your mind around this.
I do note The American Legion's positions on the historic
nature of this, their involvement in it. The importance of the
Pershing artifacts in World War I, especially as we are in the
centennial year of World War I. So I am kind of interested to
hear those reports, but I appreciate the gentleman--look, I
certainly have no idea why we run a hotel and a 99-year lease.
I think it is probably the transition here is what we are
getting after and making sure we get that right.
So I yield back.
The Chairman. I thank the gentleman for yielding.
Mr. Bilirakis, you are recognized.
Mr. Bilirakis. No questions.
The Chairman. Mr. Takano, you are recognized.
Mr. Takano. I am certainly interested as a former high
school teacher, both English and social studies, about the
historical significance of this building. I think World War I
had enormous consequences that we are still feeling today, the
high percentage of nationalism that we are experiencing around
the world was certainly present during World War I, and I am
wary of us erasing physical landmarks of such a consequential
war. And we are 100 years away from it, but I am always mindful
that we have to be constantly reminded about the history and
history that gets forgotten by generations.
So I am interested to hear what The American Legion has to
say about their views on this matter.
I yield back.
The Chairman. I thank the gentleman for yielding.
Mr. Coffman has already spoken. Do you have any--Dr.
Wenstrup?
Mr. Wenstrup. Nothing at this time. I yield back.
The Chairman. Ms. Brownley?
Ms. Brownley yields.
Mr. Bost?
Ms. Kuster?
Ms. Kuster. Thank you, Mr. Chairman.
I just want to speak on behalf of H.R. 2773, a bill to
authorize the sale of Pershing Hall, and join my colleague Mr.
Coffman.
Last year, I accompanied Mr. Coffman to a field hearing in
Aurora, in Colorado, when, as you all know, the construction of
the VA hospital in Aurora led to significant cost overruns,
overruns that were unacceptable to Mr. Coffman and myself and
all Members of the Committee. So at that time I joined Mr.
Coffman in a version of this bill last year.
While the Aurora project no longer needs the funds from the
sale of Pershing Hall, it has become clear to me that the VA
should not be in the business of managing properties like a
luxury hotel in Paris, France. But unfortunately, as Mr.
Coffman has outlined, the current lease demonstrates exactly
why the VA should not be managing properties like hotels,
entering into a 99-year lease with a French hotel company in
exchange for renovations. As a result, if the VA sold this
property today, we would receive a small fraction of the $80
million appraised value of the property.
So consequently, I support Mr. Coffman's proposal to amend
the legislation to include as the appraised value as a
condition of the sale of Pershing Hall and I urge my colleagues
to support his amendment in this legislation.
And I yield back.
The Chairman. I thank the gentlelady for yielding.
Mr. Poliquin, you are recognized.
Mr. Poliquin. We have so many problems now in this
Government and the primary responsibility of the VA is to care
for those that are coming back from the battlefield, we should
not be in the luxury hotel business in Europe.
The Chairman. The gentleman yields back.
Mr. Correa, you are recognized--oh, Mr. O'Rourke, I'm
sorry.
Okay. Dr. Dunn, you are recognized.
Mr. Dunn. Thank you, Mr. Chairman.
I wanted to understand, so I was doing a little math here,
do we have about 70 years left on this lease, is that correct?
About right, that is about right. And is the penalty on that to
pay back the entire 70-year lease if we sell the property?
Mr. Coffman. Well, if you were going to breach the lease
agreement, I am sure what--maybe VA could comment--clearly
there is going to be a penalty as, you know, you would sort of
discount, it would be a discounted rate, but that is why I
think moving to the appraised value.
And so, again, it is probably the lessee that could buy it
if they assume that there is going to be a lot of appreciation
to the hotel and it is best to lock it in now. Or it is going
to be, again, somebody who is going to negotiate a buyout of
that lease agreement and then buy the property to the appraised
value.
The Chairman. The gentleman yields back.
Mr. Correa, you are recognized for 5 minutes.
Mr. Correa. Thank you, Mr. Chairman.
First of all, I want to thank you very much for your
thoughts and prayers regarding our fires in California.
Southern California Fire is probably within a mile or 2 of my
district, some of the evacuation sites are actually in my
district. My friends and neighbors, some of my staffers have
been evacuated from some of those areas. And we do pray for
those that have been affected and we pray that the firefighters
are able to stop these fires as quickly as possible.
In reference to Mr. Coffman's bill, I just want to say I
join you in supporting your bill. We should not be in the
business of managing hotels, but we should be in the business
of managing taxpayer resources, and it sounds like we got
snookered here. It is something that is not unusual and I would
say the VA has to figure out how to manage these assets like
any other professional real estate management company would do.
Our job, on my opinion here, first and foremost, like has
already been said, is to make sure we take care of our moral
obligation to our veterans and that everything we do is for the
benefit of our veterans. A lot of times in this Nation, the
issue becomes resources. Where do you get the money to take
care of our veterans in the proper way? The big expense, real
estate, typically, when it comes to delivering the resources.
As we look at assessing these real estate assets that we have,
taxpayer-owned, let's not look at just today, but look at
tomorrow.
I know we had a study group here, right over there. I
looked at a map and one of those maps showed some of the real
estate being located in the Inland Empire, just east of where
my district is. Under-utilized today, but I will tell you, that
is the fastest growing region in California and probably the
United States. And I guarantee you, in 20 to 30 years, if we
sell those resources today, 20 to 30 years from now, we are
going to be kicking ourselves and saying this is where we need
to put VA resources, VA clinics that take care of our veterans.
So let's have a little bit of vision here and let's be good
stewards of real estate assets that are owned by taxpayers.
If you look at life insurance companies, they invest for
the long term, because when they have to sell is when those
folks die, that means 20 to 30 years out they have got to have
the resources to pay on those life insurance companies. We
should do the same thing, which is we know veterans, we have to
take care of those veterans 20, 30, 40 years out. So let's
start thinking like life insurance companies, real estate
investment management companies do. We are looking at a BRAC-
closure kind of a plan here.
Let me tell you about El Toro Military Base in Orange
County. It broke my heart when we closed it down. The
Government invested $900 million upgrading that base. The next
year, through the BRAC process, we decided to close it down. El
Toro, 5,000 acres in the middle of Orange County, tremendous
value, a great real estate play. Let me tell you, when we
closed it down, we should have thought, again, what is number
one? Taking care of our vets.
Let me tell you what happened recently. The veterans came
together in Orange County and said we want a veteran's cemetery
in Orange County, so we won't have to go so far to visit our
veterans that have made the ultimate sacrifice, deceased
veterans. We fought hard to get 125 acres. The City of Irvine
later on reconsidered and said, you only get 25 acres. Five
thousand to 125 to 25 acres. We finally got them to give us 125
acres for a veteran's cemetery.
The lesson? Once you let go of control of our government
resources, they are no longer under our control.
So, again I would ask, go slow, Mr. Chairman; be
methodical, be very careful, carefully weigh the benefits as to
how these resources can best be used for the benefit of our
veterans. And, finally, the process has to be very transparent.
Let's make sure that our veterans are front and center, that
they are part of the decision-making process.
Mr. Chair, I yield.
The Chairman. I thank the gentleman for yielding. I am a
Methodist, so we do everything very methodical and slow.
[Laughter.]
The Chairman. So, Mr. Higgins, you are recognized for 5
minutes.
Mr. Higgins. Thank you, Mr. Chairman.
I concur that we agree on a bipartisan manner, and with the
cooperative and respectful communications of the VSOs that we
listen very carefully to as we move forward to streamline the
VA and reform the expenditures of the people's Treasury. And to
look carefully at these properties that are under-used, under-
utilized, some of them need to go away.
Regarding the Pershing facility being operated as a hotel,
the term ``appraised value'' is being used. This is a business
being operated as a profitable business and in the sale of any
business the consideration of what is referred to as blue sky
is generally considered to be part of the appraised value. In
other words, not just the physical structure and the assets
therein, but what is the value, how much money has the thing
been making? And blue sky is generally considered for 5 years
as added to the value of the property.
So I would suggest that this also be a part of the formula
as we consider the sale of this property. As reflective of the
sale of any real estate and as some sort of a common, you know,
transaction that takes place every day many, many times across
the country, that the blue sky should be considered as part of
the value of that property.
So that would be my only concern. I concur that we need to
get out of the hotel business and it is probably a good idea to
sell the property, but I would just say that we should squeeze
every dime we can out of that for the betterment of the
veterans that we serve.
And with that, I yield back.
The Chairman. I thank the gentleman for yielding.
Let's see, General Bergman, you are recognized for 5
minutes.
Mr. Bergman. Thank you, Mr. Chairman.
Jim Collins, a great author, talks about the three most
important things any business that is going to become great
needs to do every year: you need to fairly evaluate what it is
that you are doing that you need to keep doing, you need to
evaluate what you are not doing that you need to start doing,
and the biggest challenge to any, any entity is to stop doing
things that no longer add value to your mission, your core
business mission.
So having said that, as we look at the VA and trying to
help them focus their efforts on the veterans, and focus on the
veterans on their future needs, without wasting very valuable
and very limited resources on things that we don't need to be
doing anymore, I wholly support the getting out of the Parisian
hotel, boutique hotel business, because we have limited
resources, limited time, limited everything to do the right
thing for the veterans. So I fully support this.
I yield back.
The Chairman. I thank the gentleman for yielding.
Mr. Banks, you are recognized for 5 minutes.
The gentleman yields.
Mr. Arrington, you are recognized for 5 minutes.
Mr. Arrington. Mr. Chairman, I just make a general
statement that I agree with my colleagues that we need to align
assets and resources according to the core mission of the VA,
and we need to make sure that we are also aligning them with
the demand, where there is need, just like every other
organization. And if we don't do that, then we are not being
good stewards of the taxpayer dollar.
And I commend you for the process; it needs to be
objective, it needs to be fact-based, and we need to remove it
from the politics, the parochial politics of protecting our
single-Member-district-type interest, I think that is not
healthy. This should be American taxpayer and American veteran
first and we drive on this.
So I commend you for your leadership and I wholeheartedly
support Mr. Coffman and his efforts on this regarding the
Pershing hotel. I don't know why we would be in that business.
So, thanks for your hard work and I support you on that.
The Chairman. I thank the gentleman for yielding.
Mr. Coffman, do you have any final comments?
Mr. Coffman. Yes, Mr. Chairman. On this bill to align
demand with our current infrastructure and make those
appropriate changes, I want to thank you for your leadership,
as well as Mr. Walz on this particular issue.
And I will say, when I grew up in Aurora, Colorado, which
is the heart of my district, it was a military town with three
military installations in it. Two were closed, an Army and an
Air Force base in successive BRACs, and as a community member I
have fought that BRAC process as hard as I could. But I can
tell you, the economic development that has occurred since
those closures is greater than what we had received when those
bases were operational relative to the economic impact on our
respective community.
I yield back, Mr. Chairman.
The Chairman. I thank the gentleman for yielding.
And just one final comment before we introduce our next
panel. I think Mr. Takano made some good points about not
forgetting the history and the Legion made some good points
when I read their testimony. So I think we need to be sensitive
and aware of that, that history, I agree. I don't know how it
will all work out yet, but I do think you make good points with
what you said historically about what we are trying to maintain
also and let's not forget what happened in World War I. So I
think I will need to think through it some more.
I want to thank you, Mr. Coffman, for your testimony. And
with no other questions, we will introduce our second panel.
Joining us are Joy Ilem, the National Director for the
Disabled American Veterans. Welcome. Mr. Louis Celli, the
Director of Veterans Affairs and Rehabilitation Division of The
American Legion; Carl Blake, the Associate Executive Director
for Government Relations for Paralyzed Veterans of America.
Welcome. Carlos Fuentes--and I thought we were going to have to
send out a search dog for you this morning when you weren't
there--the Director of the National Legislative Service for the
Veterans of Foreign Wars of the United States. Dave Wise, the
Director of Physical Infrastructure Team for the U.S.
Government Accountability Office. Dr. Regan Crump, the
Assistant Deputy Under Secretary for Health for Policy and
Planning, for Veterans Health Administration of U.S. Department
of Veterans Affairs, who is accompanied by James Sullivan, the
Director of VA's Office of Asset Enterprise Management.
Ms. Ilem, we will begin with you. You are now recognized
for 5 minutes.
STATEMENT OF JOY J. ILEM
Ms. Ilem. Thank you, Chairman Roe. Ranking Member Walz,
Members of the Committee, on behalf of DAV, thank you for the
opportunity to testify today on the draft Asset and
Infrastructure Review legislation under consideration by the
Committee.
For years, DAV, along with our independent budget partners,
has consistently called for resolving VA's many infrastructure
challenges, including aging and outdated medical and research
facilities, consistent under-funding for major and minor
construction and critical maintenance needs, as well as
problematic leasing and sharing authorities.
While we do not believe the BRAC-like model proposed in the
draft bill is the most appropriate way to address VA's capital
infrastructure needs, we do acknowledge the need for a
strategic national plan and a comprehensive infrastructure
review and assessment prior to modernization or realignment of
the Department's medical facilities.
Rapid advancements in medicine and significant changes in
the way health care is delivered today, as well as changes in
veterans' needs and preferences and demographics, require a
more nimble and flexible process that allows VA to make changes
when necessary to ensure the delivery of high-quality health
care and specialized services throughout the system. However,
we do not believe Congress should consider systemic changes to
VA's health care infrastructure in isolation from other
critical factors. Most importantly, without first finalizing
decisions on the reform of the Choice program and development
of regional integrated networks that would combine VA and
community care options for veterans.
The 2016 Commission on Care Report concluded and we concur,
real transformation of the VA health care system will require a
comprehensive and integrated systems approach.
For successful reform of the system, the Department must
also address several other critical, interrelated challenges,
to include modernization of its health care IT system and
electronic health record; improvements in HR policies to fill
staff vacancies more rapidly, steadily increasing demand for
services, and existing challenges to provide veterans
convenient access to care in rural communities; all of which
have significant budgetary implications.
Rather than establishing a BRAC-like, one-time asset review
process, we believe VA would be better served by establishing a
standardized, long-term process that includes local
involvement, periodic ongoing reviews, a realistic plan for
upkeep and maintenance costs, and the authority for the
Department to more easily make changes as demand for care and
market conditions shift over time.
Mr. Chairman, my written statement includes a number of
recommended changes to the bill and I will highlight just a few
that we feel are most critical.
We recommend extension of the overall timeline to ensure a
thorough and effective asset review process can be conducted;
inclusion of provisions for early and more meaningful
stakeholder input to ensure veterans understand any proposed
changes and to build support; that information transmitted to
the Commission, Congress or the President also be made
available to the public; that facility recommendations be
carried out in several phases, first focusing on buildings and
properties that are currently unused or significantly under-
used, then considering market assessments and more
comprehensive alignments only after decisions have been made
regarding Choice reforms.
The market assessments should include options for expanding
VA's internal capacity where appropriate through extended hours
of operation or by increasing staff or space.
We also recommended that no VA facility should be closed
until a replacement facility is opened or an arrangement with
community partners has been secured and established, so that no
enrolled veteran ever loses access to care.
Finally, DAV strongly believes that any commission
established affecting the future of VA health care must first
and foremost represent the veteran users of that system. For
these reasons, we recommend the commission include at least six
members who are current users of the VA health care system and
that three of those members represent congressionally-chartered
membership and resolution-based service organizations.
Mr. Chairman, in closing, DAV is committed to working with
you and the Committee to achieving our shared goals of
improving VA health care services for our Nation's ill and
injured veterans.
That concludes my statement and I am happy to answer any
questions you or the Committee Members may have.
[The prepared statement of Ms. Joy Ilem appears in the
Appendix]
The Chairman. Thank you.
Mr. Celli, you are recognized now for 5 minutes.
STATEMENT OF LOUIS J. CELLI, JR.
Mr. Celli. Well, one thing is absolutely clear, veterans
deserve a 21st century health care system; a sustainable,
reliable, and compassionate system that is able to meet their
needs and one that veterans can be proud of.
Chairman Roe, Ranking Member Walz, and Members of this
distinguished Committee, on behalf of Commander Denise H. Rohan
and the millions of veterans making up the largest Veteran
Service Organization in the Nation, thank you for taking on the
challenge of modernizing VA's aging infrastructure.
Admittedly, this is a complicated process and one that will
require a complete assessment of VA's health care delivery
services and current physical capabilities. And while The
American Legion applauds this Committee for addressing VA's
capital needs, we want to take this opportunity to underscore
what our colleagues, Members of Congress, VA, and our members
recognize, VA will need a complete comprehensive health care
market assessment VISN by VISN before anyone can offer a
responsible assessment or recommendation on the modernizing
VA's assets and infrastructure.
The draft legislation being discussed here today helps get
this conversation started. And you already have our witness
statement for the record, so I will just go over some of the
points that we will need to refine before The American Legion
will be able to fully support this effort.
First, The American Legion is rarely a fan of
congressionally-appointed Committees and this is no different.
As highlighted in our written presentation, fundamentally we
oppose establishing a Committee to oversee this process, but if
establishing a Committee or a commission becomes a necessary
concession to moving forward, I cannot stress strongly enough
that The American Legion will absolutely not support a
commission whereby congressionally-chartered VSOs, the most
accurate representation of voices of millions and millions of
veterans this Committee has access to, are not empowered to
have collective veto power over what could turn into a runaway
committee.
Again, specifics on how that can be achieved are detailed
in the testimony you have in front of you.
Second, the Committee has wrestled with leasing health care
facilities over the past several years and, as the Chairman
points out, there is no better time than now to address this in
this legislation. The legislation will certainly miss the mark
if we fail to fix this leasing issue once and for all.
Third, while addressing the demographics of the commission,
The American Legion feels strongly, as DAV does, that the
commission should be a representation of the current
demographic of the average VA patient today and understand what
the needs are of the VA patient tomorrow will be.
Next, The American Legion sees no reason the commission
should need to financially compensate the volunteer committee
members. The structure of this committee calls for senior level
executives and experts that oversee millions of dollars in
health care infrastructure. If the reward for serving on this
committee isn't serving veterans and the honor of participating
in a congressionally-appointed committee that reports to
Congress and the President of the United States, then perhaps
we should reevaluate the selection process.
In the draft legislation, there is a prohibition against
former employees of VA who are instrumentally involved in the
commission's work. I don't understand why that provision is in
there at all and would like to learn more about how that might
be a threat to the integrity of the process.
I also want to mention that the seats assigned to
congressionally-chartered Veterans Services Organizations need
to forever remain assigned to the organization and not to the
appointee. We have seen in the past how appointees have
undermined this authority by accepting an appointment on a
visionary committee, only to divorce themselves from their
organization in favor of their personal opinions, leaving the
VSO community without a voice in the process. It was shameful
and it was unacceptable.
Finally, with regard to this bill, page 19, line 20(c)
needs to change to ``The Commission will recommend changes to
the Committee on Veterans' Affairs of the House and Senate.''
The American Legion adamantly opposes granting the commission
unilateral authority to change or amend the recommendations of
the Secretary. That simply cannot happen under any
circumstances.
With the remainder of my time, I will address the issue of
Pershing Hall in Paris, France. While many Veterans Service
Organizations may not have a strong opinion one way or the
other regarding Pershing Hall, please understand that this
property has historical value and a deeply personal meaning for
The American Legion.
Nearly 100 years ago, the members of the American
Expeditionary Forces of World War I came together to preserve
the memories and incidents of our associations in the Great
Wars. And as the 100th anniversary of our founding approaches,
The American Legion is still dedicated to that mission.
The American Legion fought for the dedication of the
memorial in Paris, France, in the city where The American
Legion was formed, to recognize the service and sacrifices of
The American Legion Expeditionary Forces and General John
``Jack'' Pershing. We take this very seriously.
At a minimum, we should not be able to sort out what should
immediately happen with this monument today and we look forward
to working with Mr. Coffman to work this out. And I just want
to echo your comments and thank you for recognizing that
selling this at a fire sale is the wrong thing to do.
Thank you.
[The prepared statement of Louis J. Celli appears in the
Appendix]
The Chairman. I thank the gentleman for yielding.
Mr. Blake, you are now recognized for 5 minutes.
STATEMENT OF CARL BLAKE
Mr. Blake. Chairman Roe, Ranking Member Walz, Members of
the Committee, on behalf of Paralyzed Veterans of America, I
would like to thank you for the opportunity to testify today.
PVA has no stated position on the Pershing Hall issue, so I
will limit my comments to the Asset and Infrastructure Review
bill that is being considered by the Committee.
First, Mr. Chairman, I would like to thank you and Ranking
Member Walz for holding the roundtable in September where we
began this discussion. Many of us at this table know that this
discussion actually began before that point and we appreciate
you all taking the time to address this with us.
I would say we recognize this as a necessary evil. The
bottom line is, I don't know anyone who was involved in BRAC, I
served in the military during BRAC, who didn't think BRAC was
in some form evil, and yet it is probably a necessary process.
I will say that I am not sure this bill yet gets us there to
the desired end. With that in mind, we don't oppose what you
are trying to do and we would like to see some refinements to
this legislation.
The Commission on Care recommended a BRAC process for VA.
We stated then, our partners in the Independent Budget, DAV and
VFW also stated then, that we don't believe that that is the
right way forward, but we recognize the need to right-size the
VA's infrastructure.
The Independent Budget has stated over and over again that
that was necessary. I think the Secretary understands that; his
list is pretty comprehensive just in terms of buildings. But I
think there are a few key problems that were identified in the
legislation during the roundtable that cannot be ignored to
make this better.
I think the bill ignores what was identified as the single
biggest problem--or the roundtable identified the single
biggest problem with this bill is it does not give the VA time.
And I know that Congress has a complicated position where time
is not exactly a luxury, but the experts from GAO and from the
Congressional Research Service, and all of the stakeholders in
the room when we had that conversation, clearly stated that DoD
had at least 3 years to prepare its BRAC process, and this bill
would accomplish that with VA in far less time.
And I would argue that the VA system is far more dynamic
and more complex than what DoD had to deal with. All DoD had to
do was say, you live here, you are stationed here, you are
moving, and that is it. That is not the way that is going to
work with VA and the population it serves, and I think that
that cannot be overstated.
So if we are going to go down this road, that has to be
foremost in our mind. Giving the VA the time to actually lay
this out properly is key.
The draft legislation we are discussing right now as it
relates to Choice reform has a market assessment component. And
when we had the roundtable about that draft there was
discussion about the bill providing for, I think, a year for
those market assessments, and most people that were part of
that discussion did not believe a year was really sufficient to
do that level of market assessment. And the market assessments
in that Choice reform bill are probably less complex than what
this BRAC process would require, and yet the draft bill gives
less than a year to complete the market assessment and lay
everything out in the groundwork to run out the BRAC process.
That is clearly something that has to be changed in this draft
bill.
I think my colleague from the DAV said something along the
line of developing the integrated health care network and that
whole plan for community care access before we go down the BRAC
road. I think we could have a reasonable debate over whether we
are putting the cart before the horse or not. Some people would
say, we do this first and then we know what we have to work
with. I think we take the position that we should know what the
VA plans to do in terms of delivering care before we then
decide what its footprint is going to look like.
So I think, because we have sort of divorced Choice reform
and ultimately the plan for community care from this, I think
we are setting up maybe a fatal flaw in the ultimate design of
this.
Lastly, my biggest concern or one of my major concerns is I
was here when CARES, towards the tail end of CARES as I came to
work here in Washington. And for those of us who were here
during that period, CARES did a great disservice to the VA,
primarily because there was a moratorium for all intents and
purposes on all new major and minor construction during the
CARES process. That was a couple-of-years process where nothing
new got done in VA. And I could envision a scenario where that
very same philosophy plays out with this bill and that is not
acceptable.
I think part of the reason we are in this situation, you
mentioned Northport. Now, I can't change the fact that it is 90
years old, that is a fact, but I could also argue that many of
the reasons why some of these places are not modernized is
because all the way back then no money was invested in their
modernization while we decided what the footprint of VA was
going to be under CARES, and now here we are again.
So if we are going to go down the road with BRAC--and this
is BRAC, it doesn't matter whether you say it is or not, this
is BRAC for VA--if we are going to go down this road, we can't
then say we are not going to do anything with VA's construction
until we finish this process, because that is 2 years from now
and that is not acceptable.
Mr. Chairman, again, I would like to thank you for the
opportunity to testify. We would be happy to take any questions
that you have.
[The prepared statement of Carl Blake appears in the
Appendix]
The Chairman. I thank the gentleman for yielding.
Mr. Fuentes, you are recognized for 5 minutes.
STATEMENT OF CARLOS FUENTES
Mr. Fuentes. Chairman Roe, Ranking Member Walz, and Members
of the Committee, on behalf of the men and women of the VFW and
our Auxiliary, thank you for the opportunity to present our
views on legislation pending before the Committee.
The VFW agrees with the intent of H.R. 2773, which would
require VA to sell Pershing Hall in Paris, France. VA should
not be in the hotel business, but selling Pershing Hall should
be more than just simply an effort to no longer own the
building.
The VFW is glad the legislation would preserve the history
of Pershing Hall and the memory of the brave American
servicemembers who fought in World War I. We urge the Committee
to explore the option of transferring the building to the
Army's Armed Forces Recreation Centers who operates hotels
throughout the world before selling the building to a private
entity.
The VFW also agrees with the intent of the Asset and
Infrastructure Review Act of 2017, and has several
recommendations to improve it.
For more than 100 years, the Government's solution to care
for veterans has been to operate a network of VA facilities
throughout the country. Many of these buildings must be
replaced, some of them need to be disposed of, others need to
be expanded, and they all need to be managed.
The VA's Strategic Capital Infrastructure Plan, or SCIP,
identifies VA's current and projected gaps in access,
utilization and safety. In VA's fiscal year 2018 budget
request, the estimated cost of closing all these gaps was 55 to
$67 billion over 10 years.
The VFW agrees that VA has an insurmountable capital
infrastructure problem and a systemic realignment of VA assets
may help in addressing these gaps. However, the VFW has
historically opposed a BRAC-style process for VA medical
facilities, because the population VA serves is very different
than the population served by or stationed in military
installations.
When I was in uniform, the Marine Corps could send me where
they wanted, when they wanted, and I had little to no say about
it. VA, however, does not have the ability to require veterans
to move from one location to the other; it has to adjust to
changes in the veteran population.
The SCIP process includes plans to address unused or
underutilized facilities, but the process for approving,
funding, and implementing the plan is what has led to a $67
billion backlog. That is why the VFW urges the Committee to
identify barriers which delay or impede the SCIP process. If
those issues are not addressed, we will find ourselves in the
same or worse situation in the future.
The lack of input from affected veterans has been the
principal reason previous plans to close or realign VA
facilities have failed. The VFW is pleased this legislation
requires the proposed commission to conduct public hearings and
seek input from veterans impacted by changes, yet it does not
require VA to conduct such hearings when developing its plan,
and the VFW believes VA's plan must include input from local
veterans in order to ensure buy-in.
Past plans to close VA medical facilities have also failed
because it would create access gaps to care for veterans.
In order to avoid repeating those mistakes, the VFW urges
the Committee to require VA to implement proposed solutions
before closing facilities or eliminating space. Simply
purchasing more care from community providers is not an
acceptable option. Veterans tell the VFW that they want VA to
hire more doctors and build more capacity.
Through the Choice Program, we have learned that community
providers are a great force-multiplier for VA, but it is not a
panacea of access or quality. This legislation requires and we
support identifying opportunities to fill access gaps by
purchasing care, but it does not require VA to evaluate how
hiring doctors or building new facilities or leasing space
would correct deficiencies or fill access gaps.
The VFW also believes that revenue generated from leasing
or selling existing facilities must be reinvested into
expanding access to VA care for veterans.
Mr. Chairman, this concludes my remarks. I am happy to
answer any questions you or the Members of the Committee may
have.
[The prepared statement of Carlos Fuentes appears in the
Appendix]
The Chairman. I thank the gentleman for yielding.
Mr. Wise, you are recognized for 5 minutes.
STATEMENT OF DAVE WISE
Mr. Wise. Chairman Roe, Ranking Member Walz, and Members of
the Committee, we are pleased to be here today to discuss our
work related to VA's efforts to align its medical facilities
and services, as well as our work on DoD's BRAC process. My
colleague Brian Lepore, who is GAO's expert on the BRAC
process, is sitting just behind me and will be pleased to
answer any questions on BRAC.
VA is one of the largest health care systems in the United
States, annually providing care to nearly 9 million veterans.
It is also one of the largest property-holding agencies in the
Federal Government.
In 2014, VA reported that its inventory included more than
6,000 owned and 1,500 leased buildings covering approximately
170 million square feet of space. A large number of its
facilities are under-utilized and outdated, creating a variety
of challenges for alignment. Real property management overall,
including VA, has been on GAO's high-risk list since 2003.
Our testimony today is based on our April 2017 report
examining VA's efforts to align its facilities with veterans'
needs and on numerous GAO reports related to the BRAC process
as summarized in June 2011 and March 2012 testimonies. I will
address two key areas today: one, the factors that affect VA
facility alignment with the veteran population, and, two, the
key elements and challenges affecting DoD and the 2005 BRAC
Commission that could be instructive as the Committee considers
the proposed legislation before it today.
As we discussed in our April 2017 report, there are a
number of factors affecting VA's alignment efforts.
First, VA projects a 14-percent decrease in the veteran
population by 2024 and continuing migration to the south and
west. Second, similar to trends in the health care industry
overall, VA's model of care continues to shift away from in-
patient to outpatient settings. Third, VA is increasingly
relying on care provided in the community. Fourth, an aging
infrastructure means that many VA facilities are not well
suited to providing care and it is often too costly to
modernize, renovate, and retrofit older facilities. Fifth, the
historic status of some 3,000 historic properties adds to the
complexity of alignment.
VA has recognized the need to improve planning and
budgeting to modernize its aging infrastructure and better
align facilities with veterans' needs. VA's efforts have
included the Strategic Capital Investment strategies, SCIP
process, and the VA integrated planning process. However, both
have limitations.
VA relies on the SCIP process to plan and prioritize
capital projects, but limitations such as subjective narrative,
long timeframes, and restrictive access to information limit
VA's ability to achieve its goal. VAIP also has limitations. It
is intended to produce market level service plans for each
integrated service network and facility master plans for each
medical facility at a total cost of more than $100 million. A
limitation to this process is assuming that all future growth
in services will be through VA facilities, which is unlikely
given the increasing level of care in the community.
Additionally, VA has faced stakeholder challenges in its
facility alignment actions from various groups.
Finally, VA has not consistently followed best practices to
effectively engage stakeholders in these decisions or evaluated
the effectiveness of its stakeholder communication strategies.
In the April 2017 report, GAO made recommendations related
to capital planning and stakeholder involvement. VA concurred
with the recommendations to the extent they were within its
control and has begun making improvements.
Regarding BRAC, as Congress evaluates the proposed Asset
and Infrastructure Review Act, it may wish to consider seven
elements DoD used in developing recommendations for the BRAC
commission. First, establish goals for the process.
The Secretary of Defense developed three primary goals for
BRAC 2005: Transform the military to be more efficient, promote
enhanced jointness among the military services, and reduce
excess infrastructure and produce savings.
Second, develop criteria for evaluating closures and
realignments.
Third, estimate costs and savings to implement
recommendations. Fourth, establish an organizational structure.
Fifth, establish a common analytical framework. Sixth, develop
oversight mechanisms for accountability. And, seventh, involve
the art of community to better ensure data accuracy.
Finally, we identified two key challenges that affected
DoD's elimination of BRAC 2005 and the results achieved. First,
some transformational type recommendations require sustained
senior leadership attention and a high level of coordination
among many stakeholders. This was especially true of
recommendations where a multitude of organizations had roles to
play.
Second, interdependent recommendations complicated
implementation. The BRAC Commission staff told us it was
difficult to assess costs and savings since many
recommendations remained multiple interdependent actions which
needed to be reviewed. These challenges would need to be
addressed if VA is to successfully apply a BRAC-like system.
Chairman Roe, Ranking Member Walz, and Members of the
Committee, that concludes my statement. Brian and I will be
happy to answer any questions you may have.
[The prepared statement of Dave Wise appears in the
Appendix]
The Chairman. Thank you, Mr. Wise. Dr. Crump, you are
recognized now for 5 minutes.
STATEMENT OF REGAN L. CRUMP
Mr. Crump. Chairman Roe, Ranking Member Walz, and
distinguished Members of the Committee, thank you for the
opportunity to appear before you today. Joining me today is my
colleague, Jim Sullivan, the Executive Director of VA's Office
of Asset and Enterprise Management.
Today we are prepared to discuss the Committee's draft
Asset and Infrastructure Review legislation, as well as VA
efforts already underway to modernize our health care system
and infrastructure. VA will follow up later with views on H.R.
2773 regarding Pershing Hall.
The draft legislative text calls for VA to assess our
health care markets nationwide, and determine ways to optimize
the care and services we provide for veterans, and then submit
recommendations to an appointed commission. The Department very
much appreciates the Committee for its attention and commitment
to the effective use of capital assets and delivering high
quality care to veterans.
The draft bill includes many thoughtful features that could
serve as useful benchmarks for the market analysis, which is
what we will use to gather focused, localized, and objective
data for decision-making. As to the commission's structure and
process, many of those requirements concern actions of Congress
and so we defer to Congress. Regarding details of the draft, we
would be pleased to follow up with the Committee to provide
more in-depth comments and technical assistance.
Now, let me highlight what VA's doing with regard to
building a high performing health care system.
One of Secretary Shulkin's top five priorities is modernize
our systems which includes focusing on system streamlining and
also infrastructure improvements. The Secretary is committed to
modernizing our systems and infrastructure by focusing on
primary care and VA's other foundational services, and the
facilities where such services are delivered.
As the Secretary has emphasized, VA is moving forward with
more efficient and agile management of VA's medical care
facilities to match capabilities with where veterans live. The
goal of our upcoming market assessments is to modernize VA's
health care system using a data-driven approach for matching
local capacity to local demand, and to create a modern, high-
performing, integrated health care network in each market to
better serve veterans.
These networks will be well-connected, comprehensive
coalitions led by experienced VA managers who will coordinate
VA health care services complemented, where appropriate, by
other Federal and private sector providers. We must also
continue leadership in our research health professions training
and emergency preparedness missions.
These assessments are aimed at assessing current and future
veteran demand for care and all the capabilities of local VA
providers, DoD treatment facilities, academic affiliates,
federally qualified health centers, other Federal, state, and
local partners, as well as our telehealth resources. Achieving
high-performing networks may require significant capital
investments, clinical service line adjustments, process
improvements, some targeted divestments, robust care
coordination, and smart use of strategic partnerships.
The plans we pursue will undoubtedly require the continued
support of Congress, VSOs, and other stakeholders to ensure
success. In addition to VA's current authorities, we will
continue to explore ways to leverage and establish additional
capability and efficiencies with other Federal agencies such as
DoD and GSA, as well as private sector partners.
Improved authorities to pursue joint facilities through
construction and leasing actions will provide greater
opportunities for VA to deliver 21st century care and services
to veterans in state-of-the-art facilities nationwide.
VA recently submitted proposed legislation to the
Committee, the draft VA CARE, C-A-R-E Act. That bill includes
proposals to increase the Department's flexibility to meet
veterans' needs such as increasing the major construction and
lease thresholds; streamlining requirements for joint facility
projects; creating VA-DoD pilots for sharing health care
resources without billing one another; and, expanding VA's
enhanced use lease authority.
We must continually adapt to the changing needs of veterans
we are privileged to serve.
Mr. Chairman, Ranking Member, and Members of the Committee,
thank you for the opportunity to testify before the Committee
today. We are glad to answer any questions regarding the draft
bill and our approach to building high performing local health
care systems for veterans.
[The prepared statement of Regan Crump appears in the
Appendix]
The Chairman. Thank you, Dr. Crump. I will yield myself now
5 minutes. And I feel like I am back on the planning commission
where I started my political career, except it is on steroids.
This is a huge undertaking that we are talking about today.
And my recent trip to Northport, and to Canandaigua, and to
Rochester a couple weeks ago really helped shape a little bit
about I think you could make this trip in a lot of different
areas and find out the same thing.
One is that we are now developing--and to look at
Northport, it would take $450 million to invest into that plant
and facility. And I think we have to look at not only how
health care is provided today, but how it is going to be, as
best we can figure it, Dr. Crump, 5, 10, 20, long after we are
gone, that is what we are planning for now. Not for right now,
but we are planning for 10 years, 20 years, 30 years what the
VA is going to look like.
And I can tell you what it is looking like in the various
facilities that I go to is that the inpatient hospital beds are
shrinking, they have dropped dramatically. Sometimes 80, 90
percent in the VA, but the VA's done exactly the right thing.
And I don't know what the VA would do today if it hadn't put
CBOCs out there. I think that is one of the best things they
ever did.
And this trip to Canandaigua and Rochester--and I also went
to Rochester where they were shoveling dirt because of one of
the leases that we approved on doubling the size of the CBOC
where very modern health care, and the one they were in was
just packed that day with patients. And they were at elbow to
elbow, the providers were, and the veterans were. And I talked
to many veterans there, and they love the care that they were
getting at the CBOC.
So getting that in focus is going to be difficult. And I
agree with much of what you all said. The timeline, absolutely,
what the commission looked like, that is all debatable. We can
get that figured out. What we got to figure out, and this will
not be an easy undertaking, if we undertake this to do, but I
think it is necessary to provide the best care for our
veterans. And, right now, it is not--I can't imagine at my own
VA at home, if all those patients who were at those CBOCs that
were driving back on that campus, I can't imagine what it would
look like.
So, Dr. Crump, I am going to start with you and go as
quickly as I can, and then I have got a lot of questions that I
will submit for the record.
Does VA support, in general, the draft bill, and will the
Department be prepared to follow up with the Committee to
provide more in-depth comments and technical assistance on it?
Mr. Crump. First and foremost, we would absolutely be
available to provide additional technical assistance. And with
regard to the bill, we are not yet clear whether or not there
is a need for a commission, but there is definitely a need for
the legislative flexibility to support us in doing a thorough
analysis. And then we will, obviously, need ongoing support
from Members of Congress and also from VSOs to implement those
recommendations from that thorough assessment which is going to
be based on the health care services we need.
The Chairman. Well, I can tell you one of my concerns very
quickly is we had in 2004 when Secretary Principi tried to
realign, Canandaigua was one of them. The only thing that
happened, and Carl pointed out, clearly it was--actually it
harmed the VA, it slowed down the--we absolutely don't want to
do that. Without question, we don't want to do that again where
you stop doing everything you should have been doing as far as
capital projects are concerned. And if that indeed happened,
that was a huge mistake on all of our parts. We don't want to
make that mistake again, we learned that.
Two, once a contract is awarded to begin the local market
capacity assessment, how long do you estimate it will take to
complete assessments in all 96 markets? When will VA be able to
tell us that?
Mr. Crump. There was a recent issue related to the
contract. We did award a contract, there is a court order which
is requiring a 60-day stay. So the earliest that we will know
whether or not we will be able to proceed with the assistance
of the contractor is December.
However, we will be able to start. And what we are
estimating now is that we would do six VISNs at a time, I think
we discussed that during the roundtable. There are about 32
markets in those six VISNs, and to do all of those
simultaneously, mounting a VA team supplemented by contractors,
we are now thinking it will probably be about 6 months for that
group, 6 months for the second group of six VISNs, and then
another 6 months, so probably 18 months.
The Chairman. Eighteen months. That was my next question,
you just answered it, and I appreciate that.
Ms. Ilem, very quickly, and my time is about to expire,
your testimony stated that it would be inappropriate and
counter-productive in trying to reform the delivery of veterans
health care, for the process to be closed, non-transparent, and
inflexible.
But the Act clearly says that the Secretary to propose
criteria, publish it on the Federal register, have a 30 day
open public comment period, would require all information be
used by VA to prepare for facility realignment recommendations
be available to Congress, the commission, and the Government
Accountability Office. Would require veterans and VSOs to be a
part of the AIR commission, and would require that each meeting
of the commission be open to the public, and that all
proceedings, information and deliberation, be open to Congress.
Given that, what aspects of the AIR Act do you think are
closed and not transparent?
Ms. Ilem. I think looking back at the CARES process, one of
the issues that we saw in looking at this legislation that we
feared is that there is not as much stakeholder involvement
right from the beginning that we like to see. The biggest
thing, I think, that, you know, started off on the wrong foot
was not making veterans feel that they were involved in the
process from the beginning.
They felt this was already done, and, yes, we are going to
listen to you, or listen to what you say, we are going to maybe
hold a hearing or have one, but not really being involved in
that process, that decision-making process. Veterans feel this
is their system, they are committed, they want to help provide
what they think is best. And I think if as long as you may--
there is a much better effort to do that right up front, and
that they know what is being talked about and considered, and
that they have that input from the beginning.
From New Orleans, the hospital when we were down there, and
we got to tour it during our national convention, one of the
things during the tour that really struck me, everywhere we
went they said, veterans planned and laid out exactly how they
wanted things in the facility, what was important to them from
the infrastructure, the layout, everything. And you could
really see that, you know, they had pride in--that that was
considered, you know, that had been taken into consideration.
So I would like to see that.
The Chairman. Mr. Walz, you are recognized.
Mr. Walz. Well thank you, Mr. Chairman. I would concur with
Ms. Ilem. I got the opportunity to see that New Orleans
facility too, and just randomly stopped a veteran going through
there and asked him what he thought of the place. He said, ``I
feel like I built it.'' And which was a really, really
interesting comment. It is a fabulous facility, certainly
needed, and I think that process goes a long way.
It is the front-end piece of this I was going to ask all of
you and I think you started to answer it in great testimony. To
think about what should this Committee be doing next? What, to
build that trust? What, to have the partners truly engaged?
Because I do think there is alignment.
We all know this is an opportunity, we have all been
talking about it, but I do think creating those tools that can
be used going forward rather than--I keep coming back to the
snapshot-in-time picture and, you know, if I see that damn gas
station at Fort Snelling again I will personally just go tear
it down and we can move on with this conversation, because that
really doesn't have anything to do with the delivery of this.
There is not an asset there to sell, it is probably not
going to save money. But I got to be honest with you, I don't
really know that for certain, I don't know what the tools are
going to be delivered.
So, Dr. Crump, I am going to come to you. I don't know if
you are at liberty to be able to tell me this. In those three,
kind of, target markets out there in North Carolina, Georgia,
and Washington State, you are developing and doing those
assessments to develop the methodology, are you learning
anything? I mean, is there something there that starts to get
us to where we are trying to go?
Mr. Crump. Yes, sir, we have learned a lot. I mean, the
whole purpose of the pilot was, as you said, to develop a
methodology, which I do believe we now have. We have been able
to outline the steps of that methodology. Some of the things we
did learn was the type of data and the volume of data that
needed to be collected.
We also learned, as has been suggested before, that we need
to involve stakeholders very early on in the process. We have
also learned that we need to pull in a variety of assessments
that had been done in the past, and any ongoing assessments. So
we have learned a lot about that process.
We also learned that where we initially started out with
this being more of a contractor-led, or a consultant-led,
initiative. We also learned early on, or maybe later in the
process, that it really must be owned and led by the network
director and the market leaders for that health care market so
that they own the recommendations and can advance those.
We have also learned that, in many instances, the need to
partner with DoD, with our academic affiliates, there are some
constraints to doing that and so that is why we talk about some
legislative flexibilities. So those are some examples of
lessons learned.
Mr. Walz. Well, and I would like--I think this next part, I
think this is our opportunity to think really big. I think
right now as we are looking at it, we are still pretty narrow
because the quote from DoD's process on BRAC was ``reduce the
amount of unneeded property that it owns or leases.''
Well, when you look into this, that meant building up other
places, being built up, shifting of assets. There is a whole
bunch of moving pieces in this, and I think we have to be
really, really careful, all of us in here, of not seeing this
process on an ideological spectrum of shrinking government
versus big government with small government, this is just-right
size is what we are looking for.
I still am trying to get my mind wrapped around what is
that just-right size. So, Mr. Wise, if I could just ask you.
Your understanding, as our draft stands, is there anything in
here that allows the VA to consider options such as building
new infrastructure or leasing space for facilities that are
more than 100 percent utilized?
Mr. Wise. Mr. Walz, GAO doesn't have a position on this
draft legislation. It is not something we have had an
opportunity to really study or comment on, but, of course, we
are available to do so.
But to the point of your question, I think overall the
question is it is a significant challenge for the Veterans
Administration to be able to get at the points you were talking
about in terms of right-sizing, and they realize that.
And the issue is that if you do implement a BRAC-like
process, there are a number of things that need to be
considered. And some of the testimony we have heard today
alludes to those things. And one of the most important ones, as
Dr. Crump noted, was bringing in stakeholders and being able to
engage in effective communication because this was one of the
key elements that was--has been a real problem with the SCIP
process and, to a lesser extent, with the other efforts to
realign VA facilities.
Mr. Walz. Well, I have got some follow-up, my time is
coming to end here, but I would encourage all. This is the
healthy place we need to be. Carl brought up great points about
we can't move our veterans population around by telling them to
move to Joint Base Lewis-McChord because we are closing
something else, it does not work that way.
But I do think there is an opportunity for us to think
really, really big on this, and the tools necessary, and the
assets, and getting this to--so that we are in a continuous
process of reevaluation with the VA and not chasing our tail
all the time when things get outdated.
I yield back.
The Chairman. I thank the gentleman for yielding. Mr.
Coffman, you are recognize for 5 minutes.
Mr. Coffman. Mr. Chairman, I yield back.
The Chairman. The gentleman yields back. Mr. Takano, you
are recognized.
Mr. Takano. Thank you, Mr. Chairman.
Mr. Wise, in your written testimony you highlighted
significant cost savings DoD experienced following the five
BRAC rounds. The majority's leadership is under the impression
that by mandating VA undertake a similar process, it too could
save hundreds of millions, if not billions of dollars.
Now, based on your understanding of the draft legislation
and the challenges faced by DoD to carry out BRAC rounds, do
you anticipate VA seeing substantial cost savings?
Mr. Wise. Congressman, as I mentioned earlier to Mr. Walz,
we really haven't been able to analyze or study the draft
legislation. But I think what I will do is I will bring Mr.
Lepore in because he could tell you some of the issues that
BRAC faced and how they got to their cost savings.
And I think it remains to be seen as to how VA goes about
this process as to whether or not they will be able to realize
significant cost savings going forward. But let me yield to Mr.
Lepore who can give you some analysis of the BRAC savings and
how they came about.
Mr. Takano. Well, but speaking as--based on the legislation
before us, you really aren't able to say whether or not there
would be cost savings. And you are not saying that there
wouldn't be, but you are not saying that there will be either,
as of this moment.
Mr. Wise. Yeah. At this point we are--I am unable to take
any position regarding this legislation as we just haven't had
an opportunity to analyze it and study it. But I think the
points we made in our testimony, in our written statement,
remain valid that, you know, VA faces significant challenges in
trying to realign its resources. And those are the kind of
things we pointed out that will be need to be done in order for
VA to have any opportunity to realize cost savings going
forward.
Mr. Takano. Well, before you yield, I would like to use my
time, I want to give some of the VSOs a chance to answer a
question I want to ask. I want to ask you a second question,
though, and perhaps the colleague could answer on some other
Member's time. But based on your knowledge of past BRACs, do
you have any sense of how much it might cost the VA to
implement any closure or realignment recommendations?
All right, go ahead.
Mr. Lepore. Congressman, my name is Brian Lepore, I am a
Director of Defense Capabilities and Management in the
Government Accountability Office, I lead the work that we do in
the Base Realignment and Closure, or BRAC process.
It is difficult to directly answer that question, but let
me say this. What we do know from DoD's experience with the
defense base closure and realignment process, with respect to
BRAC 2005, DoD is achieving cost savings.
We have done some analysis, we have reported twice now. DoD
is achieving net annual recurring savings of about $3.8
billion.
Mr. Takano. Okay.
Mr. Lepore. Because BRAC 2005 cost as much as it did, it
turned out to cost $35.1 billion to implement, DoD has not
reached the payback period yet. Next year they will finally
take BRAC 2005 into the black. So right now we are still in the
red in a process that started in 2005.
But if I might, to directly answer your question, we would
need to know the nature of the recommendations that the VA put
forward, and we would need to see the cost and savings analysis
that was the part of that. So that is why it is a little hard
to directly answer that.
Mr. Takano. I understand. So just all the more reason for
us, I think, to proceed very, very, very carefully. Because we
are not really sure, based on the methodology laid out here,
that we could achieve cost savings. And it has taken many, many
years, and you haven't yet, at DoD, hit that payback moment,
right? I mean, you have had to spend money to close, but the
savings has been realized very gradually over time, and we
haven't reached that payback point yet.
Mr. Lepore. Yes, that is correct. The other point I would
make that is related to that is the decisions that DoD made
after the commission had approved the recommendations were
directly related to the cost.
In other words, a couple things happened. In several of the
recommendations DoD omitted costs that were known to be
incurred such as transferring people from one base to another.
Indeed, DoD transferred over 120,000 people in BRAC 2005, none
of those costs were estimated.
Similarly, decisions that were made later on how to outfit
the buildings, places like the National GO Spatial Intelligence
Agency's new campus in Springfield, Virginia, turned out to be
about $726 million more than originally estimated just for some
of the military construction type things. So it has to do with
the decisions that get made in terms of implementing the
recommendations the commission approved.
Mr. Takano. Well, thank you very much. My time is up, and I
do have to move it along. Thank you, sir.
The Chairman. I thank the gentleman for yielding. Dr.
Wenstrup, you are recognized.
Mr. Wenstrup. Thank you, Mr. Chairman. I thank you all for
being here. I appreciate the input that we have received, I
appreciate the concerns that people have, and concerns on the
process. We have concerns on the process as well; we want to
get this right.
And I would recommend, as we move forward, if any of your
groups have members that are practicing physicians or health
care providers, please bring them into your conversations that
you are having. I think that is important to bring them
forward, people that understand the health care business, which
is really what we are faced with today. And, especially ones
that are practicing today, whether it is nurses or doctors. You
know, bring them into the fold as you bring forward your ideas.
I think that would be helpful to us.
You know, I consider this an asset review, you know. And we
want to increase our productivity. And I have seen since I have
been here, you know, VA will come in and say, well, we are
producing more as far as patient care. I said, did you increase
your hours? Yeah. Did you add more doctors? Yes. But did you
actually take a look at how productive you can and can't be in
a clinic, for example. To me, this is part of it.
If we have clinics that have one patient room, that is not
going to be productive. If we have clinics that need a couple
medical assistants to make it flow better, and we are not
looking at that, then we are not increasing our productivity.
That is all a part of what we are trying to do here.
Are we operating at maximum efficiency? And that is really
what it comes down to. It includes your physical structure,
your ancillary support, all those things come into play. And do
you have the physical ability within that facility to create
it? The CBOCs, for example, have been excellent. That is part
of the modernization, that is part of this review, if you will,
to actually look and see how effective they may have been in
providing quality patient care for our veterans.
So it is a review of logistics and review of providing
care, and a review of customer service. And I agree, the
timeline we have may not be right. This is big and this is
challenging, so it may not be right. But it is a matter of
looking at what we have and what we don't have, what we need
and what we don't need. That is really what this is all about.
And it is based, really, on current markets and future
markets. We need to look at that. You are right, Mr. Blake, we
can't move people, that is not the idea here, it is being able
to fill the needs of the people. So that is part of the market
review of what we are after.
And so, you know, when it comes to that, I don't consider
this to be like a BRAC. We are not going to relocate people,
right? So it doesn't fit into that same category, I feel, of
what this Committee and what we should be trying to accomplish.
You mentioned Northport not having modernization. Well,
maybe it wasn't modernized because no one did what we are
talking about doing. Because no one looked at it and said, you
don't have what you need. This is what we are trying to
accomplish here.
So let's work together on really trying to make this about
logistics, customer service, 21st century care, and do it in
providing care in a quality fashion and a timely fashion.
Because we are not out here to snooker anybody, we are out here
to make a positive difference for the future of our VA health
care system.
So I don't really have a question, but I just would like to
keep all those things in mind and understand what is in the
heart and soul of this Committee, as I think it is, as we move
forward. And with that, I yield back.
The Chairman. I thank the gentleman for yielding. Ms.
Brownley, you are recognized for 5 minutes.
Ms. Brownley. Thank you, Mr. Chairman. I wanted to first
just make a very quick comment on Pershing Hall. And, from my
perspective, I think that we really do have to dig deeper
around this issue and we need to really research and dig for
every possible option that is out there that can hold the
Pershing Hall's historical value because I think what Mr.
Takano said and what you said is very, very true.
And I think we need to get the value, I don't think that we
should be in the hotel business, I agree with all of that, but
holding onto a historical facility in some way is really,
really important. And so exploring historical societies, other
avenues where we might get the return that we are looking for
but at the same time holding on, I think, to an important
historic building that is very important to the history of our
country. So I just wanted to make that one statement.
With regard to the other bill that we are discussing. I
think that the reason why we keep referring to it as a BRAC, it
is because the language in the bill that we are currently
looking at right now, understanding that it is a draft
language, mimics a BRAC process. So, therefore, I think we call
it a BRAC process.
I agree with Dr. Westrup that, you know, it should be more
of an asset review and driving for efficiencies. But I think
just because of the nature of the language the way it is
currently written is kind of sending the wrong message, I
think, out there. That people really do feel like this will be
a time-a-year process, and it is an up and down vote.
I do agree with the Ranking Member's opening comments that
we really--I think the better approach is a much more of a
continuous approach to this process, that we do have to adapt
to changing needs, both in veteran migration and changes in
health care delivery altogether. So that we need to be
malleable every year in terms of responding to that.
I think veterans need to be at the table at every part of
the process. We need their voice, that is critically important.
And I just feel like if we start in a continuous process, it
might be less complex in some ways. I sort of envision that
there are probably, in this whole process, some easier
decisions that are pretty kind of black and white about maybe
we don't really need this facility, and it is pretty clear to
everyone who is looking at this information. And incrementally
it is going to get more and more difficult.
So if we are in a continuous mode, I think that we can
right away sort of address some inefficiencies in identifying
those that are more or less the easier ones. So I just wanted
to make that statement. I think that we also are looking in
this bill how to shut down, get rid of, however you want to
quantify it, facilities.
We also have to look at improving the processes for
expanding facilities and leasing facilities. And leasing
facilities has been one of my bugaboos, that it is, it has
taken 2 years to get a new group of leases done, and that we
need to revert back to the old process where, you know, this
Committee really does weigh in by resolution on these new
leases.
So those two things have to kind of--we have to work on
both of those issues, I think, simultaneously.
Right now I think the only question that I have is to the
Chairman of the Committee, and if you could just help allay
some of my concerns, I guess, by just trying to let us know how
you perceive our process in terms of how we will proceed in
terms of really discussing all of these issues and moving
forward with changes, or amendments, or whatever. So, Mr.
Chairman, if you wouldn't mind.
The Chairman. What I will do, since your time has expired,
is I will go ahead and let the other Members, so if they have
somewhere they have to go, and at the end I will address that.
Ms. Brownley. Terrific. Thank you.
The Chairman. Mr. Bost, you are recognized.
Mr. Bost. Thank you, Mr. Chairman.
You know, earlier this week, and I want to thank the
Chairman for doing this, both the Chairman and I held a tele-
town hall meeting where we discussed issues specifically to the
veterans in my districts. During that time we received a call
from one of the veterans who spoke specifically about the
assets that is held by the VHA, and many of my constituents in
the northern part of the district used the VA hospital in Saint
Louis.
However, for some in the Metro area, it is still difficult
to get to Saint Louis. So I guess the question I have is for
you, Dr. Crump or Mr. Sullivan, whichever, is do you believe--
and I think that we have answered it before but I would like to
expand on it--that the proposed legislation could lead to
increased assets of VHA like CBOCs in areas like high veterans
populations such as at Metro East?
Mr. Crump. Well, I can't speak to whether or not the
legislation itself will lead to that, but I can speak to the
shifting demographics of veterans in the modernization of
health care. I mean, it is very clear to us, as has been
shared, that our inpatient care demand is going down like 4 to
10 percent a year, whereas our outpatient demand for care is
going up like 10 to 20 percent per year. So that is why we have
had to add more community-based outpatient clinics, and we will
continue to provide more ambulatory care.
The other thing is, telehealth has given us the ability to
utilize excess capacity in one part of the country to provide
care in another part of the country. And so it is our definite
intent to work through VA improving efficiency, partnering with
DoD, and realigning assets to where the veterans are to deliver
more care using more outpatient services, fewer inpatient
services, but also addressing the increased demand for some
mental health services, and use of ambulatory care and
telehealth services.
Mr. Bost. Yeah. That is what we really want. My other
question here is, basically, to the VSOs. At any time have you
been discussing with the VA, if we go forward with this, what
the communications will be with the veterans in the area where
maybe there is a relocation, maybe there are all of these
things that occur that they would then have an open
communication with the veteran to communicate on how their
services and the way they receive their services might be
changed? Have you had those conversations?
Ms. Ilem. I would just say, we have, I think, brought it up
in terms of this stakeholder engagement and how they would
communicate and having really effective engagement early on in
the local communities, that that is important. But also with
the service organizations so we can help educate, that we can
help explain, and that we can also get them, you know, where
they need to be to have their input considered, and look at the
big picture. So I think we have mentioned it in our discussions
as these draft bills have been considered.
Mr. Celli. So I can tell you from The American Legion's
perspective, we also included that in our written testimony.
You know, there was a portion of the bill that talks about
conducting public hearings at every location where there could
possibly be a reduction in buildings. And, you know, we
questioned the logic of having a public hearing if it is only a
storage facility, or if it is a gas station, or if it is
something that is no longer used. But we absolutely demand and
require, you know, public hearings where health care is going
to be affected. And I think that is going to be a critical
component to this.
Mr. Blake. Mr. Bost, I think it is no secret that veterans
in many local communities don't have any idea what the heck is
going on at their local VA facility, even when they are regular
users. I mean, I think one of our chief complaints that we hear
about is there is no effective communication about major
changes that are going on.
And so now we are going to go down this road with a process
where we are going to hope that VA is going to conduct public
discussion and public interaction with those people in those
local communities. It doesn't really happen effectively now, so
it is serious concern we have if we are going to go down this
road.
Mr. Fuentes. We will make sure that happens, and we will
certainly participate in the process to make sure that, you
know, for the VFW, our members are there or represented. But
the key is that the plan is what veterans want, right? Because
often you can listen to them, you can have a hearing, but then
VA goes a completely different route and that is where you get
the issue. Right?
We are a membership-based organization, and if my members,
VFW members in any particular area aren't happy they are going
to come to us and they are going to say, do what you can to
stop it, and that is exactly what I am charged to do.
Mr. Bost. Okay. My time has expired. I yield back.
The Chairman. General Bergman, you are recognized for 5
minutes.
Mr. Bergman. Thank you, Mr. Chairman. Am I last? I am not
going to say you saved the best for last, you saved the oldest
for last. That is how it works.
You know folks, I have got one simple question, and I am
going to ask each of you to answer it in a couple sentences.
And we are going to start right here with Mr. Sullivan. You
haven't had a chance to talk much today, so this, but simply,
in a couple sentences, I want you to tell us why we are here
today.
Mr. Sullivan. We are here today to look at how we can
realign our services to provide more efficient and more
effective health care services to our veterans. And look at
what are the tools and what are the authorities that we need to
deliver those to where the veterans are, where they want to
have it delivered, and what is the best way to deliver it to
them.
Mr. Bergman. Okay. Mr. Crump.
Mr. Crump. I believe and hope that the reason we are here
today is to figure out how VA, VSOs, and Members of Congress,
and other stakeholders can work together effectively to make
sure that we utilize our assets and resources most effectively
to increase access, improve quality, and also make sure that we
improve satisfaction of the care that veterans receive. They
have earned it, and we need to make sure that together we will
work to make sure that we deliver it.
Ms. Ilem. I would concur that we hope that we are here to
collaborate. To listen to each other, to have a voice, have a
say, be part of the discussion about the future of VA health
care. I think everybody has the same goal in mind: wanting to
improve services, ensure veterans are cared for with timely,
quality health care throughout the country. And this is the
start of the conversation to help foster that.
Mr. Celli. I would agree, and I would agree with Mr.
Sullivan's comments. This is the beginning of the conversation;
it is not the first one, but it is the beginning of the
conversation of how to modernize VA with 21st century health
care for our veterans, and without talking about capital assets
and infrastructure we can't have that conversation. But we also
have to make sure that we know where the services are needed.
So I think that this is a step in the right direction.
Mr. Blake. We are here to ensure veterans get timely
quality health care in the best setting and that includes
making sure VA is properly positioned to deliver that care, or
is able to work with the community to do so.
Mr. Wise. Everybody has been so eloquent, it is hard to
come up with something original. But I think one thing, and a
couple of the Members have, I think, alluded to this, is that
it is important that while there can be a lot of really
positive lessons drawn, or lessons as a whole drawn from BRAC,
I think it is important not to overstate the BRAC- VA
connection because their missions are so different, and the
population is very different. Their needs, and their physical
locations, and everything that goes about them is so different
that it is important that it can be used as a learning tool,
but understand the differences as well as the similarities.
Mr. Lepore. It seems to me we are here to assist you in
developing legislation that gets the best possible care to our
veterans in the most efficient way possible and at the best
possible cost.
Mr. Fuentes. I completely agree. I mean, we are here to get
this right, to make sure that there are no gaps in access to
care, and that veterans and the care that they receive are
improved by the outcomes of whatever this Committee passes and
becomes law.
Mr. Bergman. Okay. Well, thank you, each of you, for
putting in your own words because you heard all the Committee
Members who spoke. We all have our own view and our own words.
And communication is not what is said, it is what is heard.
And, you know, in the military we are big on mission statements
because if you can't write a mission statement concisely, then
your commanders in the field are not going to be able to
execute that mission to the success that they need to for the
positive outcome.
So, number one, I know you are all in the game, and those
of us who played in the congressional football game last night
had a chance to play many different positions, and figure out
that we were sometimes running in different directions, but we
are all headed towards the same end zone.
And I would suggest to you that in the case of, you know,
the why that we are here today, I just wrote up a quick mission
statement, this is my version, and that we are all in this
together because you are here because you are part of this
large team that has a dog in the fight here. We are all in this
together to serve our veterans in a forward-thinking way, which
means we have to shed some of maybe the concepts that we have
used that maybe are not going to work in the future.
So in a forward-thinking way that maximizes veteran
outcomes, and minimizes waste, utilizing limited resources. So
maximize outcomes, minimize waste, limited resources. So as we
work together, this is our opportunity to make the change
necessary for the future.
I see I am over my time, and I yield back, sir.
The Chairman. I thank the gentleman for yielding. And the
mission statement last night of the congressional football team
was to get into the end zone, which they did not accomplish.
Mr. Bergman. No.
The Chairman. So I would point that out.
I thank the panel for being here. Once again, I think it is
we are in the beginning of a process, and I appreciate your
comments, and really appreciate all of you being here and the
time you have put into it so far. But we are going to continue
to explore this because it is that important.
I understand that we have a special guest here today that I
didn't know at the time, and I will yield to my good friend,
Tim Walz, to introduce this guest.
Mr. Walz. Well, thank you, Mr. Chairman. As before my
closing here, as a point of personal privilege, my wife Quinn,
a military spouse and so much more, has my 10-year-old son,
Gus, here. He wanted to believe I really had a job, so he is
here to see it. So, thank you.
The Chairman. And have Gus--there he is.
Mr. Walz. That is Gus. Well, thank you, Chairman. And we
all know organizations have written mission statements and
unwritten mission statements. And as the co-captain of that
football team, the true mission statement was to be walking
today after that football game. So, General Bergman,
congratulations on accomplishing that.
Thank you all for being here. You are partners, friends,
you represent us who are in your organizations. More
importantly, you represent those voices of millions of veterans
and their families who are out there today and can't be here.
And I would say, once again, it is not just lip service, that
this Committee is proving that there is no place on Capitol
Hill or no place, certainly in Federal Government right now,
where the true spirit of working together, building
collaboration, and trying to move things forward for our
veterans is actually happening.
It is one thing to say that, everybody wants to say that,
every Committee says we are super bipartisan. Well, move
things, get things done together, and being bipartisan doesn't
mean agreeing on everything. But it does, as the General, and
the Chairman, and so many others have said, it does having the
common goal. So we know what needs to--we know how this process
works. First and foremost, all the stakeholders must be
included and they must be included early, and they must be
legitimately included with their ideas.
We must then figure out, using evidence-based decision-
making, put together plans. Legislation is over at legislative
counsel right now with folks trying to squirrel this. And then
we need to be pragmatic. Not every four-letter word has four
letters, and the United States Senate is one of those places.
And we all know that we have to deal with those places.
We have to make sure that the Senate is on the same sheet
of music. We need to make sure, before we do anything, we are
moving everyone together in the VA. And as we were just
mentioning up here, that is happening. That is starting to
happen that people are talking and moving that.
So nothing is going to be done that violates those basic
principles. General Bergman laid them out, I think we are all
pretty much in agreement with that. Highest quality care, good
stewards of the taxpayer dollars, and thinking about what is
possible.
But this is the opportunity. I have been saying it, and,
General Bergman, you said you were last, I have been there, so
I know. That was 10 years ago that I was sitting down, it was
on this side, down in the end, saying we needed to have this
idea, we needed to think about this.
I remember all of us saying, those wars have been going on
for 5 years and could go on a couple years longer. That is what
we were saying back in 2007, and that is going to create all
kinds of things moving that we are going to have to think
about.
So I am grateful you all are here. Mr. Chairman, I once
again thank you. There is probably not any more difficult thing
in the realm of dealing with veterans and veterans issues than
this topic, and you have done it.
And to the folks sitting here, your good faith effort to
approach this is so sincerely appreciated because we have to
get this right.
I stick with the statement that I made: time is not on our
side. This is one of those things that must be dealt with, it
cannot be kicked down the road. But amongst that, it must be
done right because we are not going to get another bite at this
thing. This is one of those where I truly believe the time is
probably right to try and do something, and it may take a
little longer than we anticipated, that is fine, but having the
discussion happens now.
So thanks to all the Members, thanks for the work.
And, Mr. Chairman, again, I thank you for your willingness
to not dodge difficult things, for your willingness to put us
in things that maybe challenge us and makes us uncomfortable,
but gets at the heart of what we should do. And I yield back.
The Chairman. I thank the gentleman for yielding and his
kind words. I will answer your question, sort of, Ms. Brownley,
in my closing comments.
Medicine is changing almost at light speed, and I don't
think we have even begun to see the changes that are going to
happen. Dr. Crump mentioned telehealth, precision medicine. We
are going to see things. And, remember, I was on two VA
facilities that penicillin had barely been invented and
discovered when those facilities were opened.
The facility I had at my hometown was there before there
were any antibiotics, penicillin, and a hypertensive anything,
1903. And that facility is still functioning today as an
outstanding VA medical center, four-star, I think, soon to be a
five-star medical center.
As I visited Northport and Canandaigua, I looked at those
facilities and we were mentioning, I think Mr. Takano mentioned
about savings, that is not what this is about. It is about
getting the VA right-sized so it can carry out its mission,
which is to take care of veterans who have served and were
injured, or had conditions that occurred because of their
service to this great country.
And I looked at, when I went in there, there are two
buildings that are historic that the roofs had collapsed, and
it is going to cost $10 million just to destroy those buildings
because they are on the historic registry, even if you can do
it. That is just at one center.
And I asked those folks, I said, look, what do you guys do
really well here? And they have a great PTSD treatment. I said,
that is something that you do and you do well at this campus,
and should--you can inpatient put people--we know that mental
health is a huge need in this country, and 35, 40 years ago we
had 500,000 mental health beds in this country, now we have
less than 50,000. And we see the problem we have now in this
country of mental health, the needs are not being met. We see
those in our veteran population.
So the thing that those injuries that occurred because of
your service, the VA should focus like a laser beam on. And I
looked at the five CBOCs they had along Long Island, which is a
beautiful area, beautiful part of this country if you haven't
visited. I said, those things should be updated and really
enhanced, and we should really be putting those resources so
our veteran doesn't have to drive long distances.
I go to Rochester, and I see Canandaigua, and I think where
are the veterans going? Well, they are going where the VA is
accessible to the most VAs. And that is where you brought up
and you have leasing, which is going to be a huge part of this.
And the average lease, and I have done it many times in my
private practice, is about a 3-year thing too. You
conceptualize what you want to build and you get your contract,
you build it, and you move in. VA, it is 9 years, and people
may have moved by then.
So they have to be more nimble. We have got to give them
the tools to do that, that is part of it. We know that we are
going to vote on our Choice legislation in about 3 weeks. And
we know that not only is Choice important to get that done, but
we are going to implement an EHR change which is going to
change how VA carries out its care at the same time. And that
is going to be a 6 or 7, or 8-year process. This is a multi-
year process.
It could be that gathering--and we are going to need to
know what those networks look like before you can implement the
Choice Program in October of 2018. And those panels will look
different as our health care--just like in my own health
insurance plan, my panel may look different this year than it
did last year. So that will be a continuum of changes that
occur.
And we mentioned, I think, HR was mentioned about staffing
and hiring. The VA has hired more nurses and doctors and other
providers, but it certainly has shortages, and that is where
Choice will help provide those care, where those shortages are
where VA doesn't have those assets in place.
If it were me and I were a VISN director, I would clearly
have a vision about where I want--what I want to do with my
VISN. And there are many of those, as you all know, across the
country. And what are my strengths, what are my weaknesses, and
how can I help amplify my strengths and fill in my weaknesses.
And in thinking about what is care going to look like and
one of the reasons that we brought the asset review in is to do
just that. But we have problems that, politically, and we will
all admit that we are weak when it comes to our districts. I
mean, we have a facility in Hot Springs, South Dakota, it is
really very black and white what should be done and, yet, it
isn't being done. So that is one of the reasons that we did
that.
I think what we need to do--and, first of all, I can't
thank you enough, I have got a lot of information here and a
lot of ideas, I just need time to, as we all do, but I think
that is what we need to do.
And to Mr. Correa when he mentioned, look, I am a guy that
believes when I was a mayor of a city and a planning
commissioner, I don't think you turn over those assets, that
being property, casually.
You bring the local community in, can this be used, and I
will give a perfect example. On our campus at home, at our VA,
we have a pharmacy school. It is basically a public/private
partnership, that we built a pharmacy school with private
donations, it is a state school and it is housed in a rehabbed
building on the VA campus in Johnson City, Tennessee.
So those are the visions that we, as leaders, and as
leaders at the VISN level and at the local community level,
have to have, I think, to make this actually work. So I look
forward to sitting down and continuing to work with all of you
all about how we can get this process done, because I agree
with Mr. Walz, it is absolutely mandatory that we do it to
provide the care we need for our veterans.
And, again, I want to thank you all. And I ask unanimous
consent that all Members have five legislative days to revise
and extend their remarks and include extraneous material.
Without objection, so ordered.
Hearing is adjourned. Thank you.
[Whereupon, at 12:24 p.m., the Committee was adjourned.]
A P P E N D I X
----------
Prepared Statement of The Honorable Mike Coffman
Mr. Chairman, I would like to begin by thanking you for including
my bill in today's legislative hearing and thank the witnesses for
their testimony.
Mr. Chairman, I think we can all agree that the VA's sole mission
is to provide services to our nation's veterans.
The maintenance of a 5-star, 24-room boutique hotel, restaurant,
and club in downtown Paris, France is clearly not included in that
mission.
Therefore, in an effort to get the VA out of the overseas hotel
business and focused on its core competencies, I introduced H.R. 2773,
the Sell Excess Luxury Lodgings (SELL) Act, to authorize the sale of
this hotel - ``Pershing Hall.''
Pershing Hall is a building originally procured by the American
Legion to serve as a memorial to our ``Doughboys,'' who served in
France during World War I. The building was transferred to the VA in
1991, and in 1998, the VA leased Pershing Hall for a 99-year period to
a French firm that redeveloped the property as a luxury hotel.
In recognition of the historic aspects of Pershing Hall, H.R. 2773
requires the preservation of architectural details of the exterior and
interior of the structure, and requires all property of General
Pershing and the American Expeditionary Forces in France during World
War I to be transferred to the American Battle Monuments Commission.
H.R. 2773 also appropriately requires the transfer of sale proceeds
to the American Battle Monuments Commission for the maintenance of
cemeteries, monuments, and memorials dedicated to our men and women in
uniform.
Mr. Chairman, today you will hear the concern that the fair market
value will not represent the true value of the property because it is
encumbered by the VA's lease. Unfortunately, the reality is that the VA
negotiated a bad, long-term deal that significantly decreased the
market value of the property. Even more of a reason to get the VA out
of the hotel business.
To address this concern, I plan to amend my legislation to require
a condition of sale be the appraised value of the property.
While Pershing Hall is probably a terrific hotel, it makes no sense
that the VA keeps a luxury hotel in Paris on its books. The VA needs to
focus its time and resources on its core mission: taking care of our
nation's veterans.
Mr. Chairman, thank you for allowing me to testify today on behalf
of this legislation and I yield back the remainder of my time.
Prepared Statement of Joy J. Ilem
Chairman Roe, Ranking Member Walz and Members of the Committee:
On behalf of DAV (Disabled American Veterans) I am pleased to
present our views on draft legislation, the Asset and Infrastructure
Review Act of 2017, as well as H.R. 2773, regarding the sale of
Pershing Hall. As you know, DAV is a non-profit veterans' service
organization comprised of 1.3 million wartime service-disabled veterans
dedicated to a single purpose: empowering veterans to lead high-quality
lives with respect and dignity. To help fulfill the promises to the men
and women who served, DAV advocates for sufficient resources for the
Department of Veterans Affairs (VA) health care system to include
funding for and adequate staffing levels and well-maintained, modern
infrastructure to deliver timely, comprehensive, high-quality care to
enrolled veterans.
As the Committee and Congress are aware, the last several years
have been tumultuous for the VA health care system-but they have also
resulted in historic opportunities for needed reforms. Following
revelations of the waiting list scandals and access crisis in the
spring of 2014, Congress responded by enacting legislation, the
Veterans Access, Choice and Accountability Act (VACAA), creating the
temporary veterans Choice program, which the Committee is currently
working to revise and reauthorize this year. DAV and other veterans
service organizations (VSOs) supported the temporary Choice program to
rapidly address access issues, while also working towards long-term
reforms and solutions to expand access and improve health care
outcomes.
Together with our partners in The Independent Budget (IB)-Paralyzed
Veterans of America (PVA) and Veterans of Foreign Wars (VFW)-we
developed a Framework for Veterans Health Care Reform in November 2015.
We recommended the development of integrated networks that combine the
best of VA and community providers to ensure continuous and timely
access to care for all enrolled veterans. The IB Framework also
included the following recommendations regarding VA's infrastructure:
``To better align medical care and services with where veterans
need that care, the IB's framework would require VA to reassess all
currently proposed and future major construction projects and find ways
to leverage community resources to identify private capital for public-
private partnerships (P3) as an alternative and more efficient manner
to build and maintain VA health care facilities. This would enable VA
to invest in services the community lacks, while ensuring it continues
to provide specialty care, such as mental health and spinal cord
injury/disease care, in state-of-the-art facilities. Future capital
infrastructure expansion would be based on need and demand capacity
assessments, which would incorporate the availability of local
resources.''
DAV and our IB partners have advocated for years to resolve VA's
many infrastructure challenges, particularly inadequate funding,
inefficient construction programs, ineffective sharing authorities and
inflexible leasing authorities. We have consistently argued that VA
must have the ability to build, buy, lease or share health care
facilities when and where veterans require them, as well as the
flexibility to construct, modernize, realign, consolidate or close
facilities as veterans' needs and preferences change. Most critically,
VA must be provided sufficient funding to maintain, realign and
modernize its health care facilities-yet for more than a decade the
actual appropriations for VA's Major and Minor Construction accounts
has been woefully inadequate.
The first finding of the Independent Assessment mandated by VACAA
was that the root cause of VA's access problems was a ``.misalignment
of demand with available resources both overall and locally.'' leading
to the conclusion that ``.increases in both resources and the
productivity of resources will be necessary to meet increases in demand
for health care.'' in the future. Specifically, the Independent
Assessment found that the, ``. capital requirement for VHA to maintain
facilities and meet projected growth needs over the next decade is two
to three times higher [emphasis added] than anticipated funding levels,
and the gap between capital need and resources could continue to
widen.'' Without change, the estimated gap will be between $26 and $36
billion over the next decade. For fiscal year (FY) 2018, DAV and our IB
partners recommended over $2.5 billion for all VA infrastructure
programs; however, the Administration requested only $990 million.
Unless this trend is reversed, no VA health care or infrastructure
reforms can be successful.
However, it is neither feasible nor advisable to address
infrastructure issues in isolation from the many other factors involved
in reforming the delivery of veterans' health care. As both the
Independent Assessment and the Commission on Care report from June 2016
concluded, real transformation of the VA health care system will
require an ``integrated systems approach.'' They recommended that
reforms necessary in each aspect or domain of VA health care be
integrated into an overall plan that considers how changes to one part
of the system affect the whole system. As such, Congress should not
consider systemic changes to VA's health care infrastructure separately
without first determining how, when and where VA will deliver health
care services to enrolled veterans.
In fact, last week the Committee conducted a roundtable discussion
on draft legislation to authorize a replacement veterans' Choice
program that would create a new model of health care delivery
integrating community providers into VA networks to fill gaps in
access, similar to the IB Framework proposals. The Senate and VA are
also working on similar plans and legislation to reform how VA delivers
care. Those efforts should be merged with efforts to reform VA's
infrastructure in a plan that is cohesive and that overlaps. For
example, the draft infrastructure bill under consideration today calls
for a one-time capacity and market assessment whereas the draft choice
bill calls for annual assessments. Further, decisions about how to
structure integrated networks to achieve the optimal balance between VA
and community providers are both based on and will help determine
necessary changes to VA's existing health care infrastructure. Given
the overarching goals of VA health care reform, it is impossible to
separate how health care is delivered from where it is delivered.
Therefore, DAV recommends that the two draft bills - one to reform VA
infrastructure and the other to revise the choice program - be merged
into a single bill focused on comprehensive reform of the VA health
care system.
Furthermore, to ensure the long-term success of VA health care and
infrastructure reforms, Congress must also address other interrelated
challenges facing the Department. In addition to adequate and timely
resources, VA needs to improve its HR policies to recruit, hire and
retain high-quality personnel, particularly clinicians, as well as
modernize its IT systems, including the new electronic health care
record system. Without adequate resources to sustain these critical
changes and meet all its statutory missions, no legislative reforms
will be fully successful.
Mr. Chairman, while we share your intention of providing VA with
greater control over its infrastructure, there are important changes
and improvements that need to be made to the legislation to achieve
that goal.
As currently drafted, the Asset and Infrastructure Review Act of
2017, has the same framework as the Defense Base Closure and
Realignment Act of 1990, legislation enacted to facilitate the closure
of military installations. Although both involve changes to physical
infrastructure, there are significant differences between the two
departments. For example, the Department of Defense (DOD) has
tremendous flexibility in planning facility locations since military
personnel can be ordered to relocate. By contrast, VA health care
decisions are driven by the needs of local veteran populations and
veterans cannot be compelled to relocate. In a military BRAC (base
realignment and closure), the most affected stakeholders are local
communities who benefit from the level of economic activity generated
by the presence of a military installation. Decisions to close military
bases in some communities often result in a significant negative
economic impact to businesses and workers. When VA closes a medical
facility, the most affected stakeholders are veterans who rely on the
system for some or all their medical care. Decisions about how and
where to deliver medical care should never result in veterans losing
access to care. Additionally, a military BRAC involves national
security issues and classified data, justifying a need for secrecy, but
a VA facility review has no similar justification for limiting the
ability of veterans and the public to have full access to all data and
deliberations.
For these and other reasons, the military BRAC process was designed
to be closed, non-transparent and inflexible to limit the engagement
and influence of public stakeholders. While this approach may be
necessary in the context of closing military bases, both for national
security and political reasons, it would be inappropriate and
counterproductive in trying to reform the delivery of veterans' health
care.
The draft legislation under consideration establishes a very
specific asset and infrastructure review process modeled closely on the
BRAC process. The legislation establishes a multi-tiered approval
procedure that includes the VA Secretary, an independent Commission,
the President and Congress. First, the Secretary would propose both the
criteria to be used for making recommendations to modernize, realign,
consolidate or close VA facilities, and subsequently would propose a
comprehensive list of facility changes. Next, an independent Commission
comprised of 11 individuals appointed by the President, after
consultation with Congress, would review the recommendations using the
criteria previously established. Based on its independent judgement,
and with limited public input, the Commission would either approve and
forward to the President the full list of recommendations, or would
modify, approve and forward a revised list of recommendations. Next,
the President would either approve the full list and forward it to
Congress, or he would disapprove in whole or in part the
recommendations and return them to the Commission. If returned, the
Commission would then reconsider and make revised recommendations to
the President, who would either approve and forward to Congress, or by
direct action or inaction, disapprove the recommendations, which would
end the entire process at that point.
Finally, if recommendations are approved by the President, Congress
would have 45 days to pass a motion of disapproval of the entire list
of facility recommendations, otherwise it would be implemented.
Throughout this multistep review process, there are limited
opportunities for stakeholder and public review and input, and the
entire process would take less than two years.
Mr. Chairman, we have significant concerns about the flexibility
and timing of the asset review process as currently written in the
draft legislation. The legislation requires that there be a single,
comprehensive list of recommendations for all VA facility closings,
realignments, consolidations or modernizations-essentially an all-or-
nothing proposition. While such inflexibility may have been necessary
for extremely difficult and politically sensitive base closure
decisions, it creates more problems than it might resolve for VA health
care infrastructure decision-making. For example, what happens in the
years following the completion of this asset review process if
unexpected veteran migration results in changes in the level of demand
for care in certain communities, or if community partners disengage
from VA partnerships due financial or business reasons? Would VA need
to re-establish another comprehensive asset review process to make
additional facility decisions?
Given the rapidly changing nature of medicine and the unpredictable
market dynamics in the American health care landscape, we believe it is
essential that VA have the flexibility to quickly adjust and respond to
market changes to avoid negatively impacting enrolled veterans. Rather
than a comprehensive, all-or-nothing, one-time infrastructure review
process, VA needs to have the authority and flexibility to make
decisions through an iterative process as demand for care and market
conditions continue to evolve over time. Specifically, we recommend
that facility recommendations by the Secretary be done in phases, with
the first phase consisting of buildings and properties that are
currently unused or significantly underused. The second phase, and all
additional phases, should be conducted following the completion of
capacity and market assessments, which should be conducted every couple
of years, when and where warranted. A phased approach will allow VA to
quickly eliminate unnecessary facilities and their associated costs,
while ensuring a more deliberative, flexible and iterative process that
allows VA's infrastructure to expand or contract as required in each
individual market across the country.
DAV also has significant concerns about the timing and duration of
the various reviews and approvals delineated in the current draft
legislation. As discussed above, decisions regarding infrastructure
should be made after decisions are confirmed regarding how, where and
who will deliver health care in the future, including the development
of new regional integrated networks and decisions about the role of
community care. Therefore, the first stage in the asset review process-
establishing criteria for infrastructure changes-should not begin until
after decisions have been finalized regarding the arrangement of
regional integrated networks and community care. Second, we recommend
that the time allotted to the Secretary for proposing criteria be
extended to no less than six months to allow sufficient time for public
and stakeholder input, including due consideration of that input, with
at least an additional 90 days allotted for public comment and review
before publishing final criteria. Third, we recommend that if the asset
review process results in an adopted set of recommendations for
facility changes, the Secretary be required to certify to Congress that
he has secured the necessary funding, authorities and agreements with
appropriate community partners, before initiating any actions to close,
consolidate or realign existing facilities currently delivering care to
veterans. The Secretary should also be required to certify that no
enrolled veterans will lose access to health care due to the enactment
of these recommendations. In addition, the definition of ``modernize''
should be amended to specifically include the ``construction, purchase,
lease or sharing of facilities.''
Mr. Chairman, DAV is equally concerned about the lack of openness
and transparency in the proposed asset review process. By using the
BRAC statute as the starting point for this draft legislation, the bill
inherited a very closed process regarding information sharing and
deliberations. For example, although the bill requires that meetings of
the Commission be open to the public, the legislation specifies that
``proceedings, information and deliberations'' of the Commission only
be made available, upon request, to a very limited number of members of
relevant committees of the House and Senate. While there may have been
national security reasons for including such limits during a military
BRAC process, there should be no such concerns for VA facility
decisions. Therefore, we recommend that the bill be amended so that
whenever decisions, reports or other information is transmitted or made
available to the Commission, Congress or the President, it should also
be made available to the public at the same time.
Finally, and perhaps most importantly, DAV is concerned about the
lack of stakeholder engagement throughout the entire asset review
process, another adverse consequence of modeling the bill on the BRAC
statute. It is critical that stakeholders who will be most affected by
the outcomes of this asset review process be fully engaged from the
beginning. Not only will this result in a better set of decisions, it
will also help build the support and confidence necessary to enact and
enforce the recommendations and outcomes of the asset review process.
Some may recall that another facility review process from 15 years
earlier-VA CARES (Capital Asset Realignment for Enhanced Services)-was
met with opposition and was largely ineffective in part due to the lack
of early and frequent engagement with local veterans from impacted
communities and national VSOs.
As demonstrated by recent successful reforms related to appeals
modernization, the forever GI Bill and accountability legislation,
engaging stakeholders early and often is essential to successfully
enacting meaningful reforms. Therefore, DAV recommends that the draft
legislation be amended to:
Require the Secretary to consult with VSO stakeholders
before proposing criteria for the asset review process;
Require that veteran preferences for receiving health
care be included among the criteria proposed;
Require the Secretary to consult with VSO stakeholders,
including local veterans in each regional market, during the capacity
and market assessments;
Require that market assessments consider the unique
ability of Federal Health Care to retain a presence in rural areas
where commercial providers may not exist or are at risk of leaving;
Require that market assessments consider how deficiencies
may be filled by expanding VA capacity through extended hours of
operation, increasing personnel or expanding treatment space through
construction, leasing or sharing of health care facilities;
Require the Secretary to consult with VSO stakeholders
before making facility recommendations;
Require the Secretary, as part of the justification for
the facility recommendations, to also include information that:
Details how and where enrolled veterans will receive care
following facility changes;
Identifies the resources and authorities necessary to
achieve the recommended facility changes; and
Identifies any non-VA partners who will provide care to
veterans once facility changes are made, including contingency plans
should VA fail to reach agreement with appropriate partners;
Require the Commission to hold hearings in all regions
where closings, consolidations or realignments are proposed by the
Secretary or the Commission;
Revise the language requiring each public hearing of the
Commission to include ``a veteran'' to instead require ``open public
hearings that allow as many witnesses as possible to testify before the
Commission, with preference provided to current users of VA health care
in that region;'' and
Remove the language requiring witnesses to testify under
oath, a requirement that does not exist for witnesses at most
Congressional hearings.
Finally, DAV believes that any Commission created to review the
future of VA health care facilities must first and foremost represent
the interests of the users of that system. Currently, the draft
legislation would only require that three members of the Commission be
veterans. We recommend that the draft legislation be amended so that
the President is required to ``consult with congressionally-chartered,
membership and resolution-based veterans service organizations
concerning the appointment of three members'' and that the Commission
be required to include ``at least six members who are currently
enrolled in and have used the VA health care system during the
preceding year.''
Mr. Chairman, although we have significant concerns with and
substantial recommended changes to the draft legislation, we share the
overall goal of modernizing, realigning and right-sizing VA's health
care infrastructure so that it can deliver timely, high-quality care to
our nation's ill and injured veterans. We understand that this will
require difficult decisions about facilities in some locations;
however, we are convinced that the only way to succeed in this endeavor
is with a process that is flexible, open, transparent and fully engages
veteran patients and stakeholders. We are committed to working with you
and the Committee to achieve our shared goals of reforming, modernizing
and sustaining the VA health care system so that it can continue to
meet the needs of enrolled veterans far into the future.
H.R. 2773, Authorization of Sale of Pershing Hall
This legislation would amend Section 403 of the Veterans' Benefits
Programs Improvement Act of 1991 by adding at the end a new subsection
to authorize the sale of Pershing Hall in Paris, France. Pershing Hall
was dedicated in 1927 to recognize the service and sacrifice of the
American Expeditionary Forces and the General of the Armies General
John J. Pershing. In 1935 the building was purchased by the United
States government, and in 1991 it was transferred to the Department of
Veterans Affairs (VA). However, since 1998 this building has been
leased out to a French firm that continues to use this property as a
luxury hotel.
This legislation directs that an independent assessment be
conducted to ascertain the property's fair market value and requires
that the purchaser preserve the architectural details of the exterior
and interior of the building. In addition, it directs the Secretary, on
or before the date of sale, to transfer to the American Battle
Monuments Commission any pertinent historical property in the
possession of the Department. The funds received by the Secretary
pursuant to the sale of Pershing Hall would also be transferred to the
American Battle Monuments Commission.
DAV does not have a resolution specific to this issue and has no
formal position on the bill.
Mr. Chairman, that concludes my testimony and I would be happy to
answer any questions that you or Members of the Committee may have.
Prepared Statement of Louis J. Celli Jr.
Chairman Roe, Ranking Member Walz, and distinguished members of the
Committee on Veterans' Affairs; on behalf of National Commander Denise
H. Rohan and The American Legion, the country's largest patriotic
wartime service organization for veterans, comprised of more than 2
million members, and serving every man and woman who has worn the
uniform for this country, we thank you for inviting The American Legion
to testify today and share our position regarding The Department of
Veterans Affairs' (VA) Asset Infrastructure Review.
Draft legislation, the Asset and Infrastructure Review - or AIR - Act
of 2017
VA currently maintains a complex physical infrastructure of
thousands of buildings that deliver coordinated care to more than nine
million enrolled veterans. Over the years, many of the buildings VA
uses to deliver this care have been left to deteriorate in favor of
fiscal savings, leaving veterans with a collection of aged
infrastructures. The VA, Veteran Service Organizations (VSOs),
Congress, and even the Commission on Care have long known that VA needs
to clean up their physical inventory of properties by: discarding some,
rehabilitating others, and rebuilding where demand requires it; and
this rehabilitative process is what needs to happen today.
Since we are addressing infrastructure, capacity, and fiscal
responsibility through this legislative discussion draft, The American
Legion requests that this Committee use this legislation as a vehicle
to expand VA's leasing authority to avoid future funding and
jurisdictional hurdles that VA and Congress have struggled with over
the past four years.
The American Legion appreciates the Committee recognizing their
need to support the Secretary as he works toward streamlining and
organizing the physical property VA is responsible for maintaining. We
also applaud the Committee for ensuring that VSOs are integral in this
process through round table discussions, staff meetings, and this
hearing.
Comparisons have been made between the proposed Asset and
Infrastructure Review process contemplated by this draft legislation
and the Base Closure and Realignment Commission (BRAC) process the
Department of Defense (DoD) has used to realign and close excess bases.
It is important to note that BRAC was established because DoD had
reduced its active duty force from nearly 3.8 million active duty
personnel following Vietnam, to just over 1.3 million in 2000. This is
clearly not the case with VA, and the need to restructure is based on
the need to refurbish and modernize infrastructure so that VA can
provide 21st century medicine to a growing population of veteran
patients at a controlled cost with superior results.
The American Legion fundamentally disagrees with the establishment
of a commission to oversee or assist the Secretary with structural
realignment and generally opposes such a recommendation believing that
the Secretary already has sufficient statutory authority to reorganize
infrastructure, and would only need some minor legislative assistance
from Congress, legislative changes that VA has already shared with this
Committee in the past, and has shared here again today. But if
establishing a Commission is the only way Congress will agree to
financially invest in this effort, then The American Legion would
require the following language be amended as follows;
1. Page 2, line 8 (A) APPOINTMENT - Change from 11 members to 9
members with three of those members appointed from Congressionally
chartered Veteran Service Organizations (VSO). Further, language needs
to be added that directs ``a quorum must consist of all nine members,
and all official votes must be ratified by no less than two-thirds of
the voting members.'' The next acceptable number of Commission members
would be 12, with no less than 4 members appointed from Congressionally
chartered VSOs. Additionally, a VSO seat on this commission must belong
to the VSO, not the individual representing the VSO, and the VSO has
sole authority to replace its representative at any time; any vacation
of the seat shall be refilled by the VSO within 10 business days.
2. Page 3, line 16 (A) veterans, reflecting current veteran
demographics: This needs to be further defined. Reflecting current
demographics of VA healthcare patient population is what The American
Legion would recommend, as this would be the population most affected
by future changes based on this initiative.
3. Page 4, line 12 (E): ``at least three members'' needs to be
increased to ``at least four members'' unless item 1 above is changed
to nine members.
4. Page 4, line 15 (d) Meetings - The Commission shall meet only
during calendar years 2018 and 2019. This should be amended to reflect
2018, 2019, and 2020 as needed. It is widely believed that VA will need
at least 18 months to complete the required healthcare market surveys
before they will be ready to publish the selection criteria as outlined
in section 403.
5. Page 6, line 16 (f) PAY AND TRAVEL EXPENSES - The American
Legion understands that the members to be selected for this Commission
would represent multimillion dollar organizations as well as other
senior executives who should be well capable of serving at the pleasure
of Congress for the sole purpose of volunteering, pride, patriotism,
and the prestige of serving on this important Commission. It is for
this reason The American Legion opposes Committee members being paid or
being enriched in any way as a result of serving on this Commission,
and that includes the Chair as outlined on page 7, line 3 (B). This is
not, however, our position on the fulltime support staff as described
on page 8 line 7 (2) RATE OF PAY.
6. Page 9, line 13 (C): Strike this section unless there is some
prohibition as outlined in the Federal Advisory Committee Act. \1\ If
this Commission were fortunate enough to have an appointee that had
been instrumentally involved in this process as an employee at VA
within 12 months of appointment, The American Legion is at a loss to
understand the logic of how this could possibly present a conflict. On
the other hand, contractors who would be in a positon to benefit
financially from the outcome of the Commission's work should be
excluded.
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\1\ https://www.gsa.gov/policy-regulations/policy/federal-advisory-
committee-management/legislation-and-regulations/the-federal-advisory-
committee-act
7. Page 14, line 1 (H): Remove this clause. The Secretary has no
experience or access to information that would qualify him to make any
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such determination on any other than his own agency.
8. Page 14, line 8 (J): insert ``a reasonable sampling of'' before
``Local''. It would not be feasible for the Commission or the VA to
conduct public field hearings at every proposed location targeted for
infrastructure review, especially if the proposed realignment only
involved a storage or maintenance building. The language should include
mandatory field hearings for any facility that provides direct medical
services for the Department.
9. It needs to be understood that the market analysis as directed
by the clause in page 14, line 22 (i),(ii),(iii),(iv),(v) will take
more time than this bill allows for, which is why The American Legion
recommends extending the dates set forth in this proposed draft to
dates agreed upon by the Department.
10. Page 19, line 20 (C) needs to be changed to: The Commission
``will recommend changes to the Committees of Veterans Affairs of the
House and Senate''. The American Legion adamantly opposes granting the
Commission unilateral authority to change or amend the recommendations
of the Secretary.
11. A clause needs to be added that prohibits land sold or granted
to the VA from being included in any recommendations by this Committee
that would result in violation of a trust, agreement, or deed such as
would be the case with the property located in West Los Angeles,
California.
Without these small but extremely significant changes, The American
Legion WILL NOT support this bill and will aggressively oppose any
efforts to allow this bill to move forward.
Provided these issues can be sufficiently addressed, The American
Legion would be able to support this effort and further supports the
overall theme of what this Committee is trying to do - reorganize,
build capacity, and eliminate waste within The Veterans Health
Administration at the Department of Veterans Affairs.
We particularly appreciate that this effort would be led by the
Secretary of Veterans Affairs, beginning with the establishment of
selection criteria, through the selection of locations, and including
the maintenance of funds responsible for carrying out this much-needed
reform.
We also fully support the provision starting on page 12, line 21
(A) & (D) that calls on the Department to establish a market analysis
for providing healthcare for eligible veterans, and again remind this
Committee that this market analysis will take time to complete,
analyze, and implement, and the only realignment that can possibly be
committed to before this analysis is complete would only involve the
1,100 structures the Secretary has already identified for disposal. All
further restructuring will need to be recommended after the healthcare
market analysis has been completed.
With an appreciation and understanding of these requirements, The
American Legion asks this committee to consider structuring this
project into more than one round of recommendations, allowing VA and
the Commission to fully develop the research necessary to implement
this program properly, while allowing sufficient time for proper
analysis and execution.
The American Legion could support the AIR Act of 2017 with the changes
recommended above.
H.R. 2773
To authorize the Secretary of Veterans Affairs to sell Pershing Hall
Nearly 100 years ago, members of the American Expeditionary Force
in World War I came together to ``preserve the memories and incidents
of our associations [in] the Great War[s]'' \2\ and as the 100th
anniversary of our founding approaches, The American Legion is still
dedicated to that mission. As such, a primary charge of The American
Legion is to ensure the sacrifices of America's military is not
forgotten.
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\2\ https://www.legion.org/preamble
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The American Legion fought for the dedication of a memorial
building in Paris, France, the city where The American Legion was
formed, to recognize the service and sacrifices of the members of the
American Expeditionary Forces and General of the Armies John J.
Pershing. The memorial building was a townhouse in the heart of Paris
that would become known as Pershing Hall. This memorial was sanctioned
by resolution at our 1927 National Convention. Eight years later, in
1935, Congress authorized funds to perpetuate the memorial and transfer
the building to the United States Government under the auspice of The
American Legion. In 1991, the building was transferred to the
Department of Veterans Affairs (VA) with the intent that it would be
used to ``administer, operate, develop, and improve Pershing Hall and
its site in such manner as to the Secretary determines is in the best
interests of the United States, which may include use of Pershing Hall
to meet the need of veterans. To meet such needs, the Secretary may
establish and operate a regional or other office to disseminate
information, respond to inquiries, and otherwise assist veteran and
their families in obtaining veterans' benefits''. \3\ Unfortunately,
the building was not used in this manner, but instead, the VA leased
the building to a boutique hotel on a 99-year long lease.
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\3\ https://www.congress.gov/bill/102nd-congress/house-bill/1047/
text
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Through all these actions, it was the hope and wish of The American
Legion that Pershing Hall retain its original purpose, as a memorial
and focal point to honor the memories and sacrifices of the men who had
fought in World War I, and as a location for veterans in the region to
gain assistance from the VA. Although The American Legion does not
fully agree with this legislation, we do agree with the bill's sponsor,
Representative Coffman, that the VA is not capable of appropriately
maintaining this location while meeting the congressional intent of the
1991 legislation.
Currently, the Pershing Hall building, in the prime Paris
neighborhood of the Champs Elysees, contains a luxury hotel and spa,
where guests can stay for upwards of $450 to $900 a night. The focus
and purpose as a place of remembrance seems gone by the wayside. The
building is available to veterans' organizations three days a year, but
access seems to be difficult to obtain. When The American Legion asked
the government to assume control of the building, it was never imagined
that Pershing Hall would be used for any purpose other than as a
memorial and VA service office in Paris for those who had served in the
First World War and subsequent wars.
This legislation would authorize VA to divest itself of the
property and transfer the monies resulting from the sale to the
American Battle Monuments Commission (ABMC). The legislation would also
provide for the transfer of the artifacts and items associated with the
building to ABMC.
The preservation of these artifacts and the history they represent
is a major concern of The American Legion. The materials deserve to be
kept together for the original purpose, to honor and remember General
Pershing and those who fought in World War I. The American Legion wants
to work with VA or ABMC to ``establish permanent American Legion
custodianship of the Pershing Hall art, artifacts, furnishings,
memorabilia and other items so that they can be interpreted for public
display, and protected from damage or disappearance.'' \4\
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\4\ https://archive.legion.org/handle/123456789/5798
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The American Legion has serious concerns with selling Pershing
Hall. Currently, the building is in a 99-year long lease with a company
that renovated it to become a hotel. The assessed value, according to a
report developed by a French appraisal company, values the building
without the lease at 70 million Euros or 82 million U.S. dollars.
However, with the current lease in place, the value of the building is
appraised at 7 to 8 million Euros. The new owner of the building would
be required to honor the 99-year long lease, which lowers the value
drastically.
American Legion representatives in Paris have learned that the
intent of the hotel owner is to buy the building using ``first rights
of refusal'' at the assessed value of 7 to 8 Euros when the building
becomes available for purchase. The owner then wishes to terminate the
lease once they have ownership of the building. By doing so, they would
automatically own a building worth 82 million dollars. The American
Legion has also heard that the intent is to then sell the building,
with the new value of 82 million dollars, and open a chain of Pershing
Hall hotels around France.
Again, when The American Legion transferred ownership of Pershing
Hall to the Federal government, we never expected this building to be
used in such fashion. We are disheartened that Pershing Hall is not a
military memorial or space for veterans to receive information about VA
benefits but instead a boutique hotel with an owner intent on making
millions of dollars off the Federal government. We are even more
concerned with the blatant disregard to the second or third order
effects of selling this building to a private organization.
The American Legion believes that Pershing Hall should remain in
the ownership of the Federal government. We are displeased as to how VA
decided to use the building but also understand that America, its
people, and the need for memorials and VA assistance will be around in
99 years once the lease is terminated.
If Congress is willing to wait until the lease has ended so that
veterans will have a location to gain assistance, The American Legion
is willing to wait as well. To ensure this historical American building
is protected, we recommend either transferring this building to ABMC or
amending the statute deriving from Public Law No: 102-86 from:
``administer, operate, develop, and improve Pershing Hall and its
site in such manner as to the Secretary determines is in the best
interests of the United States, which may include use of Pershing Hall
to meet the need of veterans. To meet such needs, the Secretary may
establish and operate a regional or other office to disseminate
information, respond to inquiries, and otherwise assist veteran and
their families in obtaining veterans' benefits'', \5\
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\5\ https://www.congress.gov/bill/102nd-congress/house-bill/1047/
text
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to:
``administer, operate, develop, and improve Pershing Hall and its
site in such manner as to the Secretary determines is in the best
interests of the United States, which shall include use of Pershing
Hall to meet the need of veterans. To meet such needs, the Secretary
shall establish and operate a regional or other office to disseminate
information, respond to inquiries, and otherwise assist veteran and
their families in obtaining veterans' benefits''.
We would also recommend adding a clause that protects the building
from sale to a private organization in the future.
The American Legion is grateful to Representative Coffman for his
ongoing work with The American Legion and his continued work on behalf
of veterans, and respects the fact that he is doing what he feels is
right, as a follow up to ensuring the VA medical Center in Aurora
Colorado was sufficiently funded, but we cannot support legislation
that would sell an American monument to a private company, thereby
losing an American historical monument.
We feel that this legislation is a short sighted attempt and a
quick fix to a larger issue within VA, and ultimately by selling the
building, veterans lose. It is disconcerting and troubling that this
site could have drifted so far from its initial intended purpose as a
place of remembrance and history. We look forward to working with
Congress to find the best outcome for this historic building.
Using resolution No. 9, Transfer Custodianshipo of Pershing Hall
Building and Artifacts to the American Battle Monuments Commission,
which supports legislation to transfer custodianship of the Pershing
Hall Building and artifacts from the Department of Veterans Affairs to
the American Battle Monuments Commission (ABMC), and ABMC be directed
to restore, preserve and display all artifacts from Pershing Hall,
including those currently in storage, in a dignified and respectful
manner either in Pershing Hall itself, or in ABMC or other federal
government properties. Because H.R. 2773 goes against this resolution,
we cannot support. \6\
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\6\ The American Legion Resolution No. 9 (2016): Transfer
Custodianshipo of Pershing Hall Building and Artifacts to the American
Battle Monuments Commission
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The American Legion opposes H.R. 2773.
Conclusion
The American Legion looks forward to continuing to work closely
with VA and this Committee on these important issues and we applaud the
Committee for working with VSOs and VA as partners to ensure that The
Department of Veterans Affairs is properly structured to meet the needs
of the 21st century veteran.
As always, The American Legion thanks this Committee for the
opportunity to explain the position of the over 2 million veteran
members of this organization. For additional information regarding this
testimony, please contact Mr. Derek Fronabarger at The American
Legion's Legislative Division at (202) 861-2700 or
[email protected].
Prepared Statement of Carl Blake
Chairman Roe, Ranking Member Walz, and members of the Committee, on
behalf of Paralyzed Veterans of America (PVA) I would like to thank you
for the opportunity to testify on this critical subject. There is no
doubt that the Department of Veterans Affairs (VA) capital
infrastructure footprint needs assessment and realignment to properly
meet the demand for health care across the system. As emphasized in The
Independent Budget Policy Agenda for the 115th Congress released in
January of this year, we believe that VA must make a concerted effort
to right-size its infrastructure, in light of the amount of unused and
underutilized capacity in the system. To that end, we appreciate the
Committee conducting the recent round table to bring all stakeholders
into the discussion about how to proceed with necessary infrastructure
realignment.
It is important to note that the Commission on Care addressed the
need for an asset review process in its final report released in 2016.
In fact the Commission report explicitly stated:
Congress should enact legislation, based on DOD's BRAC model, to
establish a VHA capital asset realignment process to more effectively
align VHA facilities and improve veteran's access to care. Creating a
robust capital asset realignment process is vital because previous
capital divestiture efforts have failed. This process should offer a
level of rigor far beyond what currently exists for repurposing and
selling capital assets. It should require VHA to.conduct locally-based
analyses of capital assets. Information generated would be used to
assist an independent commission, established under the legislation, in
making recommendations regarding realignment and capital asset needs.
The independent commission would conduct a thorough, one-time process,
to include making site visits and holding hearings to inform
recommendations that would constitute a proposed national realignment
plan.The commission would be empowered to implement the recommendations
unless, within a specified timeframe, Congress disapproves the plan on
an up or down vote.
The draft bill presented today suggests that the Committee is
interested in pursuing this recommendation as outlined in the
Commission report. However, we cannot emphasize enough that we are not
convinced that a Base Realignment and Closure (BRAC) modeled concept,
as previously used by the Department of Defense (DOD) is the most
effective way for VA to realign its capital footprint. This is the
position we took on the Commission's recommendation last summer and our
position has not significantly changed since then. That being said, PVA
generally supports the intent of this proposal, assuming the intent is
to right-size the VA and not simply use this opportunity to reduce the
footprint of VA for the purpose of fulfilling a promise for greater
community care access and cutting spending.
If the Committee feels the need to pursue a BRAC process, we
believe it is imperative that you consider the recommendations offered
by the participants in that round table last month as you proceed with
consideration. Unfortunately, this draft bill does not include any
changes to the original discussion draft that reflects the concerns
raised by the Government Accountability Office (GAO), the Congressional
Research Service (CRS), members of the Committee, and veterans' service
organization (VSO) stakeholders who participated in that round table.
The fundamental flaw in this proposal is it ignores the most
important recommendation/point made by the experts from GAO and CRS.
Representatives from GAO specifically outlined the deliberative process
that must occur in order to execute an effective BRAC process. The
steps in that process include:
1. Establishing clear goals that consider funding and alignment and
that reflects the priorities of the Secretary.
2. Developing selection criteria for facilities.
3. Developing a method to effectively estimate costs and savings.
4. Establishing the organizational structure (the Department of
Defense created BRAC teams).
5. Utilizing a common analytical framework.
6. Involving audit teams, to include the IG and GAO, to verify data
accuracy and reliability.
The key recommendation supporting the entire process outlined above
is that VA needs sufficient time to plan the process before executing
it. GAO explained that DOD had fully three years before a BRAC
Commission was empaneled to consider the infrastructure alignment of
DOD. Meanwhile, this bill establishes a process whereby the VA will
complete all of its preparatory work within one year from now and the
Commission will then submit its final recommendations to Congress
within six months following that date (by May 2019), effectively giving
VA and the Commission only 18 months to outline the complete
realignment of the infrastructure footprint of the Veterans Health
Administration (VHA). The draft legislation essentially ignores what
GAO identified as the most critical point to ensure success of this
process-time. In fact, the most important step of this process as
identified by GAO and CRS-establishing goals, setting selection
criteria, and developing the cost methodology-has to be completed by
March 1, 2018, per the provisions of this draft legislation. Based on
the recommendations of GAO, a more reasonable assumption for completion
of that phase would be no sooner than 2019, or as far out as 2020 if
the DOD model is followed. This bill establishes a timeline that almost
certainly will doom VA to failure in this process.
Moreover, this legislation appears to be putting the cart before
the horse. We strongly believe that VA should have the opportunity
develop and put into operation its integrated health care network
before any decisions are made about what the footprint of VA should
look like. It makes no sense for VA to make decisions about what its
infrastructure alignment will be without first understanding what its
capacity to deliver services currently is and how an integrated network
must be designed to enhance that capability. Central to that effort is
the completion of a thorough market assessment before the network can
be fully established and implemented. And yet, this bill presumes that
VA will conduct a complete market assessment of the entire VA health
care system by this time next year. The VA itself emphasized the near
impossibility of that task during the recent round table. GAO and CRS
similarly expressed concerns with that expectation. In fact, the VA
only recently finished three pilot market assessments that took several
months to complete. This bill requires modification to its overall
timeline in order to accommodate more time for market assessment if the
Committee wants to ensure there is a thorough and effective asset
review process. If DOD was given three years to prepare, and the scope
of the VA health care system is much larger than the footprint of DOD
bases when its BRAC was conducted, the Committee must extend
significantly the timeframe established in Section 403 of this proposed
bill.
Additionally, the provisions of this legislation that require the
market assessment are principally focused on how community care can be
better leveraged to expand capacity rather than how the VA itself can
build its own internal capacity. Those provisions only seem to affirm
the notion that community care is the only viable option where lack of
capacity exists. We respectfully disagree with this assertion.
We also have serious concerns that fitting a BRAC model to VA
presumes that the nature of the VA health care system is not
fundamentally different from the DOD base alignment that was considered
during its own BRAC process. This proposal ignores the fact that the
DOD BRAC addressed a static military population and simply consolidated
and moved units to fit its planned infrastructure alignment. It was
relatively easy, though not politically, to simply move military
families to new locations to support the force realignment. This fact
does not apply to the VA health care system and the population it
serves. Decisions to close or downsize a VA medical facility will have
a direct impact on the veteran population being actively served in that
selected community. That was not a real issue with base, and by
extension force, realignment in DOD. This is why the market assessments
will be critical to this process.
We wonder what the impact of initiating a BRAC process will be on
current major and minor construction activities at VA. When VA
initiated its Capital Asset Realignment for Enhanced Services (CARES)
process nearly 15 years ago, the most devastating result of this
process was the moratorium placed on virtually all construction for a
two-year period while the process was conducted. Arguably, the VA's
infrastructure is in the condition it is in now because no new
resources were invested in the system during that time. Additionally,
Congress has compounded that problem every year since that time by
woefully underfunding the major and minor construction requirements of
VA. Many facilities are now in serious decline simply because they were
not upgraded or modernized, and because Congress continues to provide
inadequate funding for VA's infrastructure needs, and now many of those
facilities face the possibility of closure because of that neglect.
With the establishment of an Asset and Infrastructure Review
Account we believe that Congress will simply ignore its responsibility
to provide critically-needed funding for ongoing construction projects
in an effort to wait for the outcome of the Commission. This is an
unacceptable proposition for PVA. Major and minor construction should
not be simply put on hold while this BRAC process plays out.
Reviewing the proposed legislation also begs one other important
question: why is only VHA being considered in this process and not all
of VA, to include facilities of the Veterans Benefits Administration
(VBA) and the National Cemetery Administration (NCA)? The individual
administrations within VA do not operate separately in their own
vacuums. They are interconnected and mutually supporting, particularly
with regards to VHA and VBA. Significant changes to the footprint of
VHA could obviously have an impact on the other organizations.
Moreover, if Congress is serious about doing a thorough asset review,
then perhaps all parts of the VA should be included in that discussion.
We appreciate the fact that the Committee recognized the objections
raised about the original version of this legislation presented earlier
this summer that excluded veterans' service organization involvement in
the Commission and has since added the requirement that at least three
of the members of the Commission must come from congressionally-
chartered VSOs. The perspective that VSOs can bring to this process is
frontline experience with VA facilities. With that in mind, it is
important that we emphasize that PVA is the only congressionally-
chartered VSO with a National Architecture program that is regularly
involved in facility design and development at VA. We are the only
organization that conducts thorough capacity assessments of the VA, in
particular the spinal cord injury/disease (SCI/D) system of care, on an
annual basis. We hope that our experience in dealing directly with VA
in this capacity will be reflected when staffing for the Commission is
considered.
With regards to perceived savings from a BRAC process, it is
important to point out that GAO and CRS both confirmed that DOD did not
achieve near the projected savings from closure and realignment of its
facilities. Moreover, the savings that were generated were not realized
until much later following the process. However, we cannot emphasize
enough that any savings generated by the asset and infrastructure
should be reinvested directly into VA, not sent back to the Treasury
simply for deficit reduction. Savings from this process have the
potential to generate sorely needed resources to strengthen the VA SCI/
D system of care, and other specialized programs. Many existing SCI/D
acute care facilities are generally fatigued and in some cases have
been deemed unsafe by the VA's own facility condition assessment. In
fact, the existing San Diego SCI/D center, one of the highest volume
centers in the entire VA health care system, has been deemed unsafe.
Design and construction projects have been identified to correct these
essential infrastructure issues yet they remain unfunded.
In addition, the number of beds dedicated to SCI/D long term care
on a national level is woefully inadequate. While this BRAC process
will almost assuredly focus on areas that can be targeted for closure-a
fact of the DOD BRAC process-serious consideration must be given as a
part of the process to long term care capacity. While there are some in
VA leadership who would like to get VA out of the business of long term
care, this is not an acceptable proposition for PVA and our members.
The aging SCI/D Veteran population will live longer than past
generations and is overwhelming the VA system forcing veterans to live
in institutional nursing facilities that are not designed to safely
accommodate the special needs of SCI/D veterans. As an example, the VA
has invested in the design of the new Dallas SCI/D long term care
center which now needs construction funding to begin addressing this
pressing need. We wonder what will become of projects such as this
while this BRAC process is executed across the VA. Moreover, we do not
want to see this process be used as a means to reduce VA's long term
care responsibilities.
In the end, quality, accessible health care continues to be the
focus for PVA and our partners in The Independent Budget. In order to
achieve and sustain that goal, large capital investments must be made
where appropriate. We hope that this will be one of the key outcomes of
this asset review process.
Mr. Chairman, I would like to thank you again for the opportunity
to testify. We look forward to working with this Committee, the VA and
our partner stakeholders to ensure that the most thorough and effective
process is carried out in order to best position the VA health care
system for the future needs of veterans.
Prepared Statement of Carlos Fuentes
Chairman Roe, Ranking Member Walz and members of the House
Committee on Veterans' Affairs, on behalf of the women and men of the
Veterans of Foreign Wars of the United States (VFW) and its Auxiliary,
I thank you for the opportunity to testify on legislation pending
before this Committee.
H.R. 2773, to authorize the Secretary of Veterans Affairs to sell
Pershing Hall
Pershing Hall has been owned by the Department of Veterans Affairs
(VA) since 1991 and is leased as a hotel in Paris, France, until 2097.
The VFW agrees that VA should not be in the hotel business, but
disposal of the hotel should be more than simply an effort to no longer
own the building. The VFW is glad to see that this legislation contains
requirements to preserve the history of Pershing Hall and the memory of
the brave American service members who fought in World War I.
The VFW would, however, recommend this Committee consider amending
this draft legislation to include language that would call for a
prospectus that will outline the costs, if any, of breaching the lease
agreement and the loss of annual revenue that the current lease
provides. With this financial data, VA and this Committee can more
clearly see the financial positives and negatives of selling the
property.
The VFW also believes that other options must be explored before
selling Pershing Hall to a private entity. Since it has been turned
into a hotel, the VFW urges this Committee to explore the possibility
of transferring the building to the United States Army's Morale,
Welfare and Recreation Programs Armed Forces Recreation Centers. The
Army's Armed Forces Recreation Centers operate lodging facilities
throughout the world, including Korea and Germany.
Draft Legislation, Asset and Infrastructure Review Act of 2017
This legislation would establish a commission to review and amend
as needed a VA-generated plan to close, modernize, or realign Veterans
Health Administration (VHA) facilities throughout the country. This
legislation is based on the Department of Defense's (DOD) Base
Realignment and Closure (BRAC) and the Commission on Care's
recommendation to ``develop and implement a robust strategy for meeting
and managing VHA's facility and capital-asset needs.'' The VFW agrees
with the intent of this legislation and has recommendations to improve
it.
For more than 100 years, the government's solution to provide
health care for our military veterans has been to build, manage and
maintain a network of hospitals across the nation. This model allows VA
to deliver care at 1,753 facilities, but has left it with more than
5,600 buildings and 34,000 acres, many of which are past their building
lifecycle. Many of these facilities need to be replaced, some need to
be disposed of, others need to be expanded, and all of them need to be
maintained.
The process to manage this network of facilities is the Strategic
Capital Infrastructure Plan (SCIP). SCIP identifies VA's current and
projected gaps in access, utilization, condition and safety. It then
lists them in order based on the gap's priority. In VA's FY 2018 Budget
Submission, the 10-year full implementation plan to close these gaps is
estimated to cost $55-$67 billion. The VFW does not foresee a future
where VA receives such sums to address all of its capital
infrastructure access and safety gaps through its current SCIP process.
We agree that VA has an insurmountable capital infrastructure problem,
and a dramatic realignment of its assets may help in addressing safety
and access gaps to ensure veterans have timely access to the high
quality, veteran-centric, and comprehensive health care they have
earned and deserve.
The VFW has historically opposed a BRAC-style process for VA
medical facilities because the population VA serves is very different
from those stationed at and served by military installations. When I
was in uniform, the Marine Corps could send me where they wanted, when
they wanted, and I had little to no say about it. That is because the
nature of our military's obligations and needs change and DOD must
realign its assets, including personnel, to defend our nation in an
ever-changing security landscape. VA, however, must adapt to the
changes in the veterans population and cannot simply require veterans
to move from one location to another. Rather, it must continuously
adjust capital assets to the changing veteran population. This requires
VA to modify, close, or build facilities to adjust to shifts in demand
on its health care system.
The SCIP process already addresses the issue of unused or
underutilized property, but the process for approving, funding and
implementing the plan is what has led to a $67 billion construction
backlog. That is why the VFW urges this Committee to require VA to
identify barriers in the SCIP process which have led to the backlog and
steps needed to ensure a backlog of access and safety infrastructure
gaps does not occur after a BRAC-style process is completed. If such
barriers and issues are not addressed, the proposed recommendations may
not be implemented. For example, a slow and cumbersome construction
process impacts VA's ability to complete major construction projects on
time and on budget. Another example the VFW has urged this Committee to
correct is the congressional authorization process for major medical
facility leases. It takes too long for Congress to approve VA leases
and veterans are directly impacted by VA's delay in executing such
leases. If these issues are not corrected, we will find ourselves in
the same or worse situation in the future.
The Commission on Care recommended a workaround to the lease issues
that the VFW urges this Committee to consider. It recommended that
Congress waive budgetary rules requiring offsets for a period of time
and expanding the enhanced-use lease authority to allow VA to enter
into needed leases, without accounting for the cost of the entire lease
in the first year. However, suspending this offset requirement for a
few years will leave VA in the same position it finds itself today if
Congress does not find a long-term solution to VA's leasing authority.
VA also needs broader authority to enter into enhanced-use leases
agreements. Public Law 112-154 reduced VA's authority to allow for only
adaptive housing. Returning it to its prior authority will allow VA to
lease more of its unused or underutilized property, while still
contributing to VA's mission. The VFW is pleased this legislation
authorizes VA to use its enhanced-use leases to implement
recommendations, but it does not amend VA's overall authority.
The lack of input and buy-in from affected veterans has been the
principal reason previous plans to close or realign VA facilities have
failed. The VFW is pleased to see this legislation would require the
proposed commission to conduct public hearings and seek input from
veterans who would be impacted by any commission-made changes to VA's
plan. However, this legislation does not require VA to conduct open
hearings at medical facilities it plans to realign or close. VA's plan
must include local veteran input as well. Including impacted veterans
in the process from the beginning ensures more buy-in, if VA takes
their concerns and recommendations into account.
This includes the input from veterans who are eligible or enrolled
in VA, but do not use VA health care. In the VFW's latest health care
survey, we asked veterans who do not use VA to tell us why. Veterans
reported having employer-sponsored insurance, not wanting to take
appointment slots from veterans who need them more, or problems with
access which force them to choose other forms of health care coverage.
VA has testified a number of times that it experiences an increase in
demand when access to care is improved. If the asset review is
successful, VA will improve access to care for veterans in every
community. That is why VA must account for the increase in reliance
from veterans who have other forms of health coverage, but would begin
to use VA because of the increase in access or life changes such as
retirement or employment changes that leave veterans without other
forms of health care coverage.
Furthermore, past realignment strategies or plans to close VA
medical facilities have not failed because of lack of authority.
Veterans in such communities object to closures because the proposed
plans create gaps in access to care or do not meet their needs. In
order to avoid repeating such mistakes, the VFW urges this Committee to
require VA to implement the proposed solutions before eliminating
facilities or space. Doing so would ensure veterans do not experience a
gap in access or continuation of care. Simply purchasing more care from
community care providers is not an acceptable option. For example, VA
and Congress cannot expect veterans to wait 10 years for a new facility
to be built and think VA is able to close the old facility immediately.
Veterans tell the VFW that they want VA to hire more doctors and
build more capacity instead of simply turning to community care to fill
the gaps. Through the Veterans Choice Program, we now know that the
community is a great force multiplier for VA, but it is not a panacea
of access or quality. The VFW is concerned that this legislation
requires VA to identify opportunities to fill access gaps by purchasing
care through community care providers, but does not require VA to
include recommendations to hire more providers, build new facilities,
or lease space to correct deficiencies or fill access gaps. Revenue
generated from leasing or selling facilities must be reinvested back
into expanding access to VA care for veterans.
While the VFW believes that realignment of VA medical facilities
must be a naturally occurring process based on the needs of each local
community, we understand that past grassroots efforts have failed and
that a one-time BRAC-style approach may lead to a better outcome if
done correctly. That is why VFW thanks this Committee for including
congressionally chartered and membership-based veterans service
organizations in the proposed Asset and Infrastructure Review
Commission. It is vital that a commission be representative of the
veterans' community and those who use the VA health care system the
commission is charged with improving. The VFW's health care surveys
indicate veterans who use VA health care want VA to hire more doctors
and improve access, while those who do not use it are more likely to
want to dismantle the system or turn to the private sector rather than
fixing issues. It is important that any commission charged with
recommending vast changes to a system millions of veterans rely on for
their health care has the best interest of veterans in mind--not
political or financial motivations.
The VFW is also pleased to see this legislation requires at least
one commissioner to have experience with capital asset management for
the federal government. Yet, it does not specify whether the
commissioner must have experience with VA's capital infrastructure. It
is vital that at least one commissioner, and preferably more than one,
have experience with the challenges VA faces in addressing its capital
infrastructure needs. The VFW has seen previous congressionally
established commissions lack the subject matter expertise to properly
identify issues that have a direct impact on commission
recommendations. If issues with VA's SCIP process are not identified
and addressed, recommendations regarding the closure, modernization and
realignment of VHA facilities will not be carried out appropriately.
Another lesson learned from previous commissions is that making
far-reaching changes envisioned by this legislation takes time. The VFW
agrees with comments by the Government Accountability Office,
Congressional Research Service and VA at the recent roundtable on this
legislation that the current deadlines set in this legislation do not
provide sufficient time for VA to develop a well-thought-out plan, the
commission to evaluate such plan, nor for VA to implement the final
recommendations. The VFW urges this Committee to expand the timelines
in the legislation to ensure the process is deliberate and implemented
correctly.
Prepared Statement of David J. Wise, Physical Infrastructure Issues
Brian J. Lepore, Director, Defense Capabilities and Management
VA REAL ROPERTY
Realignment May Benefit from Adopting Elements of Defense Base
Realignment and Closure Process, Provided Process Challenges Are
Addressed
Chairman Roe, Ranking Member Walz, and Members of the Committee:
We are pleased to be here today to discuss our work related to the
Department of Veterans Affairs' (VA) efforts to align its medical
facilities and services, as well as our work on the Department of
Defense's (DOD) military Base Realignment and Closure (BRAC) process.
These efforts are both relevant to challenges the federal government
faces in real property management.
VA operates one of the largest health care systems in the United
States, providing care to more than 8.9 million veterans each year. VA
is also one of the largest federal property-holding agencies. In
September 2014, VA's reported inventory included 6,091 federally owned
buildings and 1,586 leased buildings. However, in recent decades, the
veteran population and preferences have shifted. VA has recognized this
shift and the need to modernize its aging infrastructure and align its
real property assets to provide accessible, high-quality, and cost-
effective services to veterans. Aligning VA facilities to improve
veteran access to services integrates two of GAO's high risk areas:
veterans' health care and federal real property. In 2015, GAO placed
veterans' health care on its High Risk List due to persistent
weaknesses and systemic problems with timeliness, cost-effectiveness,
quality, and safety of the care provided to veterans. \1\ In 2003, GAO
placed federal real property management-including management of VA real
property-on its High Risk List due to long-standing challenges, such as
effectively disposing of excess and underutilized federal property. \2\
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\1\ GAO, High-Risk Series: An Update, GAO 15 290 (Washington, D.C.:
February 2015). GAO maintains a high-risk program to focus attention on
government operations that it identifies as high risk due to their
greater vulnerabilities to fraud, waste, abuse, and mismanagement or
the need for transformation to address economy, efficiency, or
effectiveness challenges. See, for example, GAO, VA Health Care:
Actions Needed to Improve Newly Enrolled Veterans' Access to Primary
Care, GAO 16 328 (Washington, D.C.: Mar. 18, 2016) and GAO, VA Mental
Health: Clearer Guidance on Access Policies and Wait-Time Data Needed,
GAO 16 24 (Washington, D.C.: Oct. 28, 2015). See also, for example,
Department of Veterans Affairs, Office of Inspector General, Veterans
Health Administration, Review of Alleged Patient Deaths, Patient Wait
Times, and Scheduling Practices at the Phoenix VA Health Care System,
Report No. 14-02603-267 (Washington, D.C.: Aug. 26, 2014) and VA,
Department of Veterans Affairs Access Audit, System-Wide Review of
Access, Results of Access Audit Conducted May 12, 2014, through June 3,
2014.
\2\ See GAO, High-Risk Series: Federal Real Property, GAO 03 122
(Washington, D.C.: January 2003).
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DOD has repeatedly applied the BRAC process to reduce the amount of
unneeded property that it owns and leases. DOD has undergone five BRAC
rounds since 1988 as a means of reducing excess infrastructure and
realigning bases to meet changing force structure needs. The most
recent BRAC round in 2005 also provided opportunities for furthering
transformation and fostering jointness. As a result of these rounds,
DOD reported that it had reduced its domestic infrastructure and
transferred hundreds of thousands of acres of unneeded property to
other federal and nonfederal entities. DOD data show that the
department generated an estimated $28.9 billion in net savings or cost
avoidances from the prior four BRAC rounds through fiscal year 2003 and
expects to save about $7 billion each year thereafter. Regarding the
2005 BRAC round, we estimated that DOD saved about $15.2 billion from
fiscal years 2006 through 2011 with an annual recurring savings of $3.8
billion beginning in fiscal year 2012. These savings reflect money that
could be applied to other higher priority defense needs as well as
savings from what DOD estimated it would likely have spent to operate
military installations had they remained open.
Our testimony today is based on our April 2017 report examining
VA's efforts to align its facilities with veterans' needs, and on
numerous GAO reports related to the BRAC process as summarized in June
2011 and March 2012 testimonies. \3\ Today's testimony addresses (1)
the factors that affect VA's facility alignment and the extent to which
VA's capital-planning process facilitates the alignment of facilities
with the veterans' population, and (2) the key elements and challenges
affecting DOD and the Commission in BRAC 2005. For our April 2017
report, we reviewed VA's facility-planning documents and data and
interviewed VA officials in headquarters and at seven medical
facilities selected for their geographic location, veteran population,
and past alignment efforts. Additional information on our scope and
methodology is available in our April report. Detailed information on
our scope and methodologies for our BRAC work can be found in the
published products, which are cited throughout this testimony. The work
on which this testimony is based was conducted in accordance with
generally accepted government auditing standards. Those standards
require that we plan and perform the audit to obtain sufficient,
appropriate evidence to provide a reasonable basis for our findings and
conclusions based on our audit objectives. We believe that the evidence
obtained provides a reasonable basis for our findings and conclusions
based on our audit objectives.
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\3\ See GAO, VA Real Property: VA Should Improve Its Efforts to
Align Facilities with Veterans' Needs, GAO 17 349 (Washington, D.C.:
Apr. 5, 2017), Federal Real Property: Proposed Civilian Board Could
Address Disposal of Unneeded Facilities, GAO 11 704T (Washington, D.C.:
June. 9, 2011), and Military Base Realignments and Closures: Key
Factors Contributing to BRAC 2005 Results, GAO 12 513T (Washington,
D.C.: Mar. 8, 2012).
VA's Efforts to Align its Facilities Are Affected by Several Factors
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and Are Impeded by Limitations in Its Capital-planning Processes
Facility Alignment Is Challenged by Shifting Veterans' Populations,
Evolving Care Standards, Aging Infrastructure, and Limited
Stakeholder Involvement
Geographic shifts in the veterans' population, changes in health
care delivery, an aging infrastructure, and limited stakeholder
involvement affect VA's efforts to align its services and real property
portfolio to meet the needs of veterans. For example, there has been a
shift over time from inpatient to outpatient care. This shift will
likely result in underutilized space once used for inpatient care. In
such instances, it is often difficult and costly for VA to modernize,
renovate, and retrofit these older facilities. In June 2017, VA
reported that its facility inventory includes 430 vacant or mostly
vacant buildings that are, on average, more than 60 years old, and an
additional 784 buildings that are underutilized.
The historic status of some VA facilities adds to the complexity of
converting or disposing of them. In 2014, VA reported holding 2,957
historic buildings, structures, or land parcels-the third most in the
federal government after DOD and the Department of the Interior. In
some instances, it may be more expensive to renovate than to demolish
and rebuild outdated facilities. In other cases, however, there may not
be an option to demolish if these buildings are designated as historic.
For example, planning officials at four medical facilities in our
review told us that state historic preservation efforts prevented the
VA from demolishing vacant buildings, even though these buildings
require upkeep costs and pose potential safety hazards. (See fig. 1.)
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Note: Kerrville VA Medical Center, Kerrville, Texas: These pictures
show a dwelling formerly used for medical staff housing that has been
designated as a historic building. The outside of the building shows
broken windows, missing bricks, and gutters that have nearly detached
from the building. On the inside, portions of the ceiling have
collapsed, spraying debris onto the floors and walls.
VA has also encountered challenges to its facility alignment
efforts, in part, because it has not consistently followed best
practices for effectively engaging stakeholders. VA may align its
facilities to meet veterans' needs by expanding or consolidating
facilities or services. Stakeholders-including veterans; local, state,
and federal officials; Veterans Service Organizations; historic
preservation groups; VA staff; and Congress-often view changes as
working against their interests or those of their constituents,
especially when services are eliminated or shifted from one location to
another. We found that VA has not consistently engaged with
stakeholders, and, in some cases, this inconsistency resulted in
adversarial relationships that reduced VA's ability to better align
facilities with the needs of the veteran population.
In our April 2017 report, we recommended that VA improve
stakeholder communication guidance and evaluate its efforts. VA agreed
with our recommendations and outlined a plan to implement them.
Limitations in VA's Capital-planning Processes Impede Its Alignment of
Facilities
Two of the planning processes VA uses to align its facilities-VA's
Strategic Capital Investment Planning (SCIP) and the VA Integrated
Planning (VAIP)-have limitations. \4\
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\4\ Established in 2010, the goal of SCIP is to identify the full
capital needed to address VA's service and infrastructure gaps and to
demonstrate that all project requests are centrally reviewed in an
equitable and consistent way throughout VA, including across market
areas within VA's health care system. Annually, planners at the medical
facilities develop 10-year action plans for their respective
facilities, which include projects to address gaps in service
identified by the SCIP process. Medical facility officials then develop
more detailed business plans for the capital improvement projects that
are expected to take place in the first year of the 10-year action
plan. These projects are validated, scored, and ranked centrally based
on the extent to which they address the annual VA-approved SCIP
criteria using the assigned weights.
Separately, implemented in fiscal year 2011 as a pilot project, the
VAIP process's goal was to identify the best distribution of health
care services for veterans; where the services should be located based
on the veterans' locations and referral patterns; and where VA should
adapt services, facilities, and health care delivery options to better
meet these needs as determined by locations and referral patterns.
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SCIP Process
VA relies on the SCIP process to plan and prioritize capital
projects system-wide, but SCIP's limitations-including subjective
narratives, long timeframes, and restricted access to information-
undermine VA's ability to achieve its goals. For example, the time
between when planning officials at VA medical facilities begin
developing the SCIP narratives and when they are notified that a
project is funded has taken between 17 and 23 months over the past 6
fiscal-year's SCIP submissions. \5\ (See fig. 2.) As such, VA routinely
asks its facility planners to submit their next year's planned project
narratives before knowing if their project submissions from the
previous year have been funded.
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\5\ The scoring of submitted projects includes both narrative
responses that are evaluated (about one-third of the overall score) and
data-driven scoring based on gap closure (the remaining two-thirds of
the overall score).
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
(a) Although planning officials at VA medical facilities obtain
initial information from SCIP about what gaps they need to address,
they do not officially start developing the narratives until they
receive a request from VA to submit a project for SCIP scoring and
approval. Officials from the office that oversees SCIP told us that
facilities usually have access to the tools for submission about a week
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prior to the request date.
(b) Medical facilities officially find out which major (over $10
million) and minor construction (under $10 million) SCIP projects are
approved and will be funded when Congress passes the department's
budget for that fiscal year. Non-recurring maintenance SCIP projects-
repairs and renovations within the existing square footage of a
facility that total more than $25,000-are available for funding on the
first day of the fiscal year for that project's submission because such
projects have advance appropriations.
An official from the office that oversees SCIP told us that the
timing of the budgeting process, which is outside VA's control,
contributes to these delays. While these aspects are outside of VA's
control, VA has chosen to wait about 6 to 10 months to report the
results of the SCIP scoring process to the medical facilities. This
situation makes it difficult for local officials to understand the
likelihood that their projects will receive funding. A VA official said
that for future SCIP cycles, VA plans to release the scoring results
for minor construction and non-recurring maintenance projects to local
officials earlier in the process. At the time of our review, however,
the official did not have a time frame for when VA would do this.
Although VA acknowledges many of these limitations, it has taken little
action in response. Federal standards for internal control state that
agencies should evaluate and determine appropriate corrective action
for identified limitations on a timely basis. \6\ If VA does not
address known limitations with the SCIP process, it will not have
reasonable assurance that SCIP can be used to accurately identify the
capital necessary to address VA's service and infrastructure gaps.
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\6\ See GAO, Standards for Internal Control in the Federal
Government, GAO 14 704G (Washington, D.C.: September 2014).
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In our April 2017 report, we recommended that VA address identified
limitations to the SCIP process, including limitations to scoring and
approval, and access to information. \7\ VA concurred with the
recommendation to the extent the limitations were within its control.
While VA has taken some actions, the recommendation remains open.
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\7\ See GAO 17 349.
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VAIP Process
The VAIP process produces a market-level health services delivery
plan for each Veterans Integrated Service Network (VISN) and a facility
master plan for each medical facility. VA has estimated the entire
process to create plans for VISNs and facilities to cost $108 million
when fully complete. \8\ However, the VAIP process's facility master
plans assume all future growth in services will be provided directly
through VA facilities. This assumption is not accurate given that (1)
VA obligated about $10.1 billion to purchase care from non-VA providers
in fiscal year 2015 and (2) VA can provide care directly through its
medical facilities or purchase health care services from non-VA
providers through both the Non-VA Medical Care Program (referred to as
``care in the community'' by VA) and clinical contracts. \9\ The Office
of Management and Budget's acquisition guidance notes that investments
in major capital assets should be made only if no alternative private
sector source can support the function at a lower cost. \10\
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\8\ VA organizes its system of care into regional networks (VISNs),
which are responsible for coordination and oversight of all
administrative and clinical activities within the VISN's specified
geographic region. As of January 2017, VA officials told us they had
mostly completed the VAIP process in 6 of the 18 VISNs and had plans to
start or complete the remaining VISNs by October 2018.
\9\ VA uses the services of non-VA providers in non-VA facilities
under the following statutory authorities: 38 U.S.C. Sec. Sec. 1703,
1725, 1728, 8111, and 8153. The Non-VA Medical Care Program includes
the Choice Program and Patient-Centered Community Care, among other
programs. The Choice Program was authorized under the Veterans Access,
Choice, and Accountability Act of 2014 (Choice Act), which appropriated
$10 billion for the furnishing of non-VA care when veterans' access to
VA health care does not meet applicable timeliness or travel
requirements. Pub. L. No.113-146, 128 Stat. 1754 (2014). VA may
authorize Choice Program care until such funds are exhausted. Pub. L.
No. 115-26, Sec. 1, 131 Stat. 129 (2017). Patient-Centered Community
Care is a nationwide program where VA may authorize non-VA care when a
VA facility is unable to provide certain specialty care services, such
as cardiology or orthopedics, or under other conditions. To implement
the program, VA utilizes two contractors, Health Net and TriWest, to
establish networks of providers in a number of specialties-including
primary care, inpatient specialty care, and mental health care.
\10\ See Office of Management and Budget, Circular No. A-11:
Preparation, Submission, and Execution of the Budget, July 2016.
---------------------------------------------------------------------------
In our April 2017 report, we recommended that VA assess the value
of the VAIP's facility master plans as a facility-planning tool, and
based on conclusions from the review, to either (1) discontinue the
development of VAIP's facility master plans or (2) address the
limitations of VAIP's facility master plans. \11\ VA concurred with the
recommendation, and in August 2017, VA noted that it has discontinued
its VAIP facility master plans while VA pursues a national realignment
strategy, after which it plans to adjust its future facility master
plans to incorporate pertinent information, including care in the
community realignment opportunities.
---------------------------------------------------------------------------
\11\ See GAO 17 349.
Key Elements and Challenges Affecting DOD and the Commission in BRAC
---------------------------------------------------------------------------
2005
Key Elements That DOD Used to Develop Its 2005 BRAC Recommendations
That Could Benefit VA Asset and Infrastructure Review
As Congress evaluates proposed legislation for disposing of or
realigning VA property, it may wish to consider seven elements DOD
relied on as it developed its recommendations for the BRAC Commission.
\12\
---------------------------------------------------------------------------
\12\ After DOD selected its recommendations, it submitted them to
the BRAC Commission, which performed an independent review and analysis
of DOD's recommendations. The Commission could approve, modify, reject,
or add closure and realignment recommendations.
Establish goals for the process. The Secretary of Defense
emphasized the importance of transforming the military to make it more
efficient as part of the 2005 BRAC round. Other goals for the 2005 BRAC
process included fostering jointness among the four military services,
reducing excess infrastructure, and producing savings. Prior rounds
focused more on reducing excess infrastructure and producing savings.
Develop criteria for evaluating closures and
realignments. DOD proposed selection criteria, which were made
available for public comment via the Federal Register. Ultimately,
Congress enacted the final BRAC selection criteria in law with minor
modification and specified that four selection criteria, known as the
``military value criteria,'' were to be given priority in developing
closure and realignment recommendations. \13\ Further, Congress
required that the Secretary of Defense develop and submit to Congress a
force structure plan that described the estimated size of major
military units needed to address probable threats to national security
for the 20-year period beginning in 2005, along with a comprehensive
inventory of global military installations. \14\ In authorizing the
2005 BRAC round, Congress specified that the Secretary of Defense
publish a list of recommendations for the closure and realignment of
military installations inside the United States based on the
statutorily-required 20-year force structure plan and infrastructure
inventory, and on the final selection criteria.
---------------------------------------------------------------------------
\13\ Section 2832 of the Ronald W. Reagan National Defense
Authorization Act for Fiscal Year 2005, Pub. L. No. 108-375 (2004).
\14\ Section 3001 of the National Defense Authorization Act for
Fiscal Year 2002, Pub. L. No.107-107 (2001), amended the Defense Base
Closure and Realignment Act of 1990, Pub. L. No. 101-510 (1990), to,
among other things, require DOD to develop a 20-year force structure
plan as the basis for its 2005 BRAC analysis to include the probable
end strength levels and major military force units needed to meet the
probable threats identified by the Secretary of Defense.
---------------------------------------------------------------------------
Estimate costs and savings to implement closure and
realignment recommendations. To address the cost and savings criteria,
DOD developed and used the Cost of Base Realignment Actions (COBRA)
model, a quantitative tool that DOD has used since the 1988 BRAC round
to provide consistency in potential cost, savings, and return-on-
investment estimates for closure and realignment options. We found the
COBRA model to be a generally reasonable estimator for comparing
potential costs and savings among alternatives. (See fig. 3.)
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
As with any model, the quality of the output from COBRA was a
direct function of the data DOD included in the model. Also, DOD's
COBRA model relied to a large extent on standard factors and averages
and did not represent budget quality estimates that were developed once
BRAC decisions were made and detailed implementation plans were
developed. Nonetheless, the financial information provided important
input into the selection process as decision makers weighed the
financial implications-along with military value criteria and other
considerations-in arriving at final decisions about the suitability of
various closure and realignment options.
Establish an organizational structure. The Office of the
Secretary of Defense emphasized the need for joint cross-service groups
to analyze common business-oriented functions. For the 2005 BRAC round,
as for the 1993 and 1995 rounds, these joint cross-service groups
performed analyses and developed closure and realignment options in
addition to those developed by the military departments. Our evaluation
of DOD's 1995 BRAC round found that few cross-service recommendations
were made, in part because of the lack of high-level leadership to
encourage consolidations across the departments' functions. In the 1995
BRAC round, the joint cross-service groups submitted options through
the military services for approval, but few were approved. \15\ The
number of approved recommendations that the joint cross-service groups
developed significantly increased in the 2005 BRAC round. This increase
was, in part, because high-level leadership ensured that the options
were approved not by the military departments but rather by a DOD
senior-level group, known as the Infrastructure Steering Group. As
shown in figure 4, the Infrastructure Steering Group was placed
organizationally on par with the military departments.
---------------------------------------------------------------------------
\15\ GAO, Military Bases: Lessons Learned From Prior Base Closure
Rounds, GAO/NSIAD 97 151 (Washington, D.C.: July 25, 1997).
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Establish a common analytical framework. To ensure that
the selection criteria were consistently applied, the Office of the
Secretary of Defense, the military departments, and the seven joint
cross-service groups first performed a capacity analysis of facilities
and functions. Before developing the candidate recommendations, DOD's
capacity analysis relied on data calls to hundreds of locations to
obtain certified data to assess such factors as maximum potential
capacity, current capacity, current usage, and excess capacity. Then,
the military departments and joint cross-service groups performed a
military value analysis for the facilities and functions based on
primary military value criteria, which included a facility's or
function's current and future mission capabilities, physical condition,
ability to accommodate future needs, and cost of operations.
Develop BRAC oversight mechanisms to improve
accountability for implementation. In the 2005 BRAC round, the Office
of the Secretary of Defense for the first time required the military
departments to develop business plans to better inform the Office of
the Secretary of Defense of the status of implementation and financial
details for each of the BRAC 2005 recommendations. These business plans
included: (1) information such as a listing of all actions needed to
implement each recommendation; (2) schedules for personnel relocations
between installations; and (3) updated cost and savings estimates by
DOD based on current information. This approach permitted senior-level
intervention if warranted to ensure completion of the BRAC
recommendations by the statutory completion date.
Involve the audit community to better ensure data
accuracy. The DOD Inspector General and military department audit
agencies played key roles in identifying data limitations, pointing out
needed corrections, and improving the accuracy of the data used in the
process. In their oversight roles, the audit organizations, which had
access to relevant information and officials as the process evolved,
helped to improve the accuracy of the data used in the BRAC process and
thus strengthened the quality and integrity of the data used to develop
closure and realignment recommendations. For example, the auditors
worked to ensure certified information was used for BRAC analysis and
reviewed other facets of the process, including the various internal
control plans, the COBRA model, and other modeling and analytical tools
that were used in the development of recommendations.
Key Challenges Affecting DOD and the Commission in BRAC 2005
We identified two key challenges that affected DOD's implementation
of BRAC 2005 and would need to be addressed for VA to adopt a BRAC-like
process for its asset and infrastructure review.
Some transformational-type BRAC recommendations required
sustained senior leadership attention and a high level of coordination
among many stakeholders to complete by the required date.
Implementation of some transformational BRAC recommendations-especially
those where a multitude of organizations had roles to play to ensure
the achievement of the goals of the recommendation-illustrated the need
to involve key stakeholders and effective planning. For example, the
Defense Logistics Agency committed sustained high-level leadership and
included relevant stakeholders to address implementation challenges
faced with the potential for disruptions to depot operations during
implementation of the BRAC consolidation recommendation. \16\ To
implement the BRAC recommendations, the agency had to develop strategic
agreements with the services that ensured that all stakeholders agreed
on its plans for implementation, and had to address certain human
capital and information technology challenges.
---------------------------------------------------------------------------
\16\ GAO, Military Base Realignments and Closures: DOD Needs to
Update Savings Estimates and Continue to Address Challenges in
Consolidating Supply-Related Functions at Depot Maintenance Locations,
GAO 09 703 (Washington, D.C.: July 9, 2009).
---------------------------------------------------------------------------
Large number of actions and interdependent
recommendations complicated the implementation process. The large
number and variety of BRAC actions presented challenges during
implementation. The BRAC 2005 round had more individual actions (813)
than the four prior rounds combined (387). The executive staff of the
Commission told us that it was more difficult to assess the costs and
the amount of time for the savings to offset the implementation costs
since many of the recommendations contained multiple interdependent
actions, all of which needed to be reviewed. Specifically, many of the
BRAC 2005 recommendations were interdependent and had to be completed
in a sequential fashion within the statutory implementation period. In
cases where interdependent recommendations required multiple
relocations of large numbers of personnel, delays in completing one
BRAC recommendation had a cascading effect on the implementation of
other recommendations. Specifically, DOD had to synchronize the
relocations of over 123,000 people with about $24.7 billion in new
construction or renovation. Commission officials told us that in prior
BRAC rounds each base was handled by a single integrated
recommendation. However, in BRAC 2005, many installations were
simultaneously affected by multiple interconnected BRAC
recommendations. Given the complexity of interdependent
recommendations, the Office of the Secretary of Defense required the
military departments and defense agencies to provide periodic updates
on implementation challenges and progress.
Chairman Roe, Ranking Member Walz, and Members of the Committee,
this concludes our prepared statement. We are happy to answer any
questions related to our work on VA's efforts to align its medical
facilities and services or on DOD's BRAC process.
GAO Contact and Staff Acknowledgments
If you or your staff members have any questions concerning this
testimony, please contact David Wise at (202) 512-2834 or [email protected]
regarding federal real property, or Brian Lepore at (202) 512-4523 or
[email protected] regarding the BRAC process. Contact points for our
Offices of Congressional Relations and Public Affairs may be found on
the last page of this statement. Other individuals who made key
contributions to this testimony include Keith Cunningham, Assistant
Director; Gina Hoffman, Assistant Director; Tracy Barnes; Jeff Mayhew;
Kevin Newak; Richard Powelson; Malika Rice; Jodie Sandel; Eric Schwab;
Amelia M. Weathers; and Crystal Wesco.
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Prepared Statement of Regan L. Crump, MSN, DrPH
Thank you, Chairman Roe, Ranking Member Walz, and Members of the
Committee, for the opportunity to appear today to discuss the
Department of Veterans Affairs' (VA) plans for modernizing our health
care system and infrastructure, and optimizing the care we provide for
Veterans through high-performing integrated networks. The Committee
recently added to today's agenda H.R. 2773, to authorize the Secretary
of Veterans Affairs to sell the property known as Pershing Hall. VA has
not had sufficient time to include views on this bill in this
statement, but will be glad to follow up with the Committee.
The draft legislative text in the Asset, Infrastructure and Review
Act of 2017 calls for VA to assess its health care markets nationwide
and determine ways to optimize its care and services for Veterans, and
then submit its recommendations regarding closure, modernization, or
realignment of its facilities to an appointed Commission. The draft
legislation provides that the Commission may change recommendations
provided by the Secretary prior to submitting its written report of
findings and conclusions to the President. If the President approves
the Commission's final recommendations, they are presented to Congress
to be considered through a resolution and voting process.
The Department appreciates the Committee for its recognition and
commitment to delivering quality care to our Veterans. The draft bill
includes many thoughtful features that could serve as useful benchmarks
for the critical market analysis needed to guide focused, localized and
objective data for decision-making. VA would like to follow up with the
Committee to provide more in-depth comments and technical assistance.
As for the Commission, VA defers to Congress for a process it would
establish for its own consideration of recommendations.
As the Secretary has emphasized, VA is moving forward with more
efficient and agile management of VA's medical care facilities to match
where Veterans live. This is a critical element of VA's modernization.
In concert with the draft legislation, I would like to discuss how VA
is moving forward to improve our services and infrastructure, and
highlight some opportunities that will enhance VA's ability to serve
our Nation's Veterans.
VA Health Care System
VA's mission is distinct from other Federal agencies in that we
operate the Nation's largest integrated health care system, with more
than 1,500 health service delivery sites, including hospitals, clinics,
community-living centers, and residential treatment facilities.
Additionally, VA administers a variety of benefits and other services,
and operates 135 national cemeteries nationwide.
One aspect of VA that distinguishes us from large private-sector
health systems is that the average age of VA-owned buildings is
approaching 60 years.
Managing infrastructure of that age poses complex challenges and
requires a significant amount of resources. It requires a great deal of
internal and external coordination and collaboration to modernize a
system of that nature, while adjusting to constantly changing Veteran
demographics across the country.
VA Capital Infrastructure
One of Secretary Shulkin's top five priorities is ``Modernizing
(VA) Systems'' which includes focusing on infrastructure improvements
and streamlining. In support of this priority, VA identified 430
individual vacant buildings totaling 5.9 million gross square feet that
are geographically dispersed through VA campuses nationwide. On June
20, 2017, the Secretary announced VA's plans to initiate disposal
through demolition, sale or transfer; or reuse actions for these vacant
buildings over the next 24 months. These buildings are not being used
to serve Veterans; and the $7 million in annual capital and operating
expenses currently used to maintain these vacant buildings can be
better utilized to support VA's mission. Since June 2017, we have
repurposed or disposed of 110 buildings, and VA is on track to meet the
goal of initiating disposal or reuse actions for all 430 buildings by
June 2019, which was our original goal. VA will review the
approximately 780 underutilized buildings in VA's inventory to
determine if additional efficiencies can be identified to be reinvested
in Veterans' services.
Modernization and Foundational Services
The Secretary has made a commitment to modernize our systems and
infrastructure by focusing on primary care and VA's other foundational
services and the facilities where such services are delivered. By
foundational, I refer to those services that have been tailored to meet
the needs of the men and women who have served our country, many of
whom have experienced the physical and mental wounds of war. Such
services often cannot be provided in the community with the level of
quality, understanding, and intensity that Veterans receive when these
services are provided by VA. Along with these foundational services, VA
plans to ensure that Veterans continue to have the ability to receive
those services contained in the benefits package available under
applicable law.
Commission on Care
VA agreed with the Commission on Care observation that VA should
determine the optimal mix of health care services to meet Veteran needs
at the market level, before realigning its infrastructure to leverage
non-VA health care resources that are available in local communities to
complement VA care. VA also agreed with the Commission's assessment
that VA would need broader authorities and tools to optimize VA's
capital assets.
Way Forward - Market Area Optimization for High Performing Networks
In response to the Commission on Care, and the Fiscal Year (FY)
2015 Appropriations Bill requiring a National Realignment Strategy, VA
has developed a methodology to objectively assess its health care
demand and service-delivery capacity in each of our health care
system's 96 markets. The methodology is a rigorous, analytic approach
developed and validated through the recent pilots. We believe this
data-driven eight-step methodology is sound and reflects a population-
based approach to improving the health and wellbeing of our enrolled
Veterans.
The goal of future assessments will be to modernize VA's health
care system, using this data-driven approach for matching local
capacity to local demand and to create a modern, high-performing
integrated health care network in each market, to better serve Veterans
now and in the future. The methodology assesses current and future
Veteran demand for medical care, and all the capabilities of local VA
providers, Department of Defense (DoD) treatment facilities, academic
affiliates, Federally Qualified Health Centers, other Federal, State,
and local partners, and telehealth resources. We recently awarded a
contract to secure private-sector experts to support our market-
assessment teams led by Veterans Integrated Service Networks. However,
the contract award is now the subject of ongoing legal action which
delays implementation of market assessments until at least December 1,
2017.
The intended outcome of these assessments, once started, is a plan
for a high- performing health care network in each market. These
networks will be well-connected, comprehensive, coalitions led by
experienced VA managers who will coordinate VA health care services,
complimented where appropriate by DoD treatment facilities, academic
affiliates, Federally Qualified Health Centers, and other suitable
community providers. We will also continue to fulfill our research,
health professional training, and emergency preparedness missions.
Achieving high performing networks may require significant capital
investments, clinical service-line adjustments, process improvements,
some targeted divestments, robust care coordination, and smart use of
strategic partnerships. The plans we pursue will undoubtedly require
the continued support of Congress, Veteran Service Organizations
(VSOs), and other stakeholders to ensure success.
Expanded Strategic Partnerships
In addition to VA's current authorities to manage and reconfigure
its vast real property portfolio, VA will continue to explore ways to
leverage and establish additional capability and efficiencies with
other Federal agencies, such as DoD and the General Services
Administration, as well as capabilities and efficiencies with private-
sector partners. Improved authorities to pursue joint facilities with
DoD, as well as with private-sector, non-profit partners through
construction and leasing actions, will provide greater opportunities
for VA to deliver 21st Century care and services to Veterans in state-
of-the-art facilities, nationwide.
DoD is an extremely important partner for VA because, they already
care for over 2 million Veterans, including Veterans who are military
retirees under the TRICARE program, in addition to all the brave men
and women who will be tomorrow's Veterans. We welcome legislative
flexibilities to work with DoD and other partners in a manner
consistent with the President's interagency management and agency
reform agenda, and encourage enhanced continuity of care, joint
purchasing, and shared capital investments.
Support from Congress
In order to modernize the health care system, continued support
from Congress is needed. As the Secretary stated at his recent FY 2018
budget hearings, VA's budget submission includes proposed legislative
requests that, if enacted, will increase the Department's flexibility
to meet Veteran's needs. VA included proposals to: (1) increase the
threshold for minor construction projects from $10 million to $20
million; (2) modify Title 38 to eliminate impediments to joint facility
projects with DoD and other Federal agencies; and (3) expand VA's
Enhanced Use Lease authority to afford VA improved capabilities to
manage and leverage its real property portfolio. Enactment of these
authorities will be critical to modernizing VA's health care system in
accordance with the demands of younger Veterans and changes needed in
all health care systems across the country. We must remain perpetually
agile, so we can continually adapt to the changing needs of the
Veterans we are privileged to serve.
Conclusion
We welcome and need the support of Congress, VSOs, State and local
departments of Veterans Affairs, other Federal agencies, and the media.
Working together, and with the necessary flexibilities to modernize, we
will be able to achieve the optimal mix of services and infrastructure
needed to provide high-quality care, readily accessible services, and
outstanding benefits for our Nation's Veterans. The Department will
keep the Committee informed as progress is made and as barriers are
encountered.
Mr. Chairman, Ranking Member, and Members of the Committee, this
concludes my statement. Thank you for the opportunity to testify before
the Committee today.
Mr. Sullivan and I are here to learn all that we can, and we are
happy to respond to any questions you may have.
STATEMENT FOR THE RECORD
CONCERNED VETERANS FOR AMERICA (CVA)
Draft Legislation - The Asset and Infrastructure Review Act of 2017
A bill to establish an independent commission to review and re-align
the Department of Veterans Affairs's current infrastructure.
The Department of Veterans Affairs (VA) devotes large amounts of
resources to maintain aging and excess infrastructure across the
country. This had led to funds that could have been spent directly in
support of our veterans being wasted on the upkeep of buildings and
land that should have been sold, downsized, or re-purposed for other
uses long ago. Additionally, the VA's current infrastructure footprint
was designed to serve a veteran population that is much different from
the current one and which will not serve the much smaller and more
dispersed veteran population of the future. It is for these reasons
that VA Secretaries under Presidents Bush, Obama, and Trump have all
stated the need for a comprehensive asset review and re-alignment.
Concerned Veterans for America has long advocated for this type of
legislation and we feel it is essential to ensuring that the VA is best
equipped to serve our veterans now and in the future.
Concerned Veterans for America supports this legislation.
HR 2773 - To authorize the Secretary of Veterans Affairs to sell
Pershing Hall
A bill to authorize the Secretary of Veterans Affairs to sell Pershing
Hall for fair market value
The VA should have the ability to sell Pershing Hall in Paris,
France in order to direct resources to other more critical programs.
Concerned Veterans for America supports this legislation.