[Congressional Record Volume 147, Number 107 (Friday, July 27, 2001)]
[Extensions of Remarks]
[Pages E1457-E1458]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


DEPARTMENT OF DEFENSE--DEPARTMENT OF VETERANS AFFAIRS HEALTH RESOURCES 
                     ACCESS IMPROVEMENT ACT OF 2001

                                 ______
                                 

                       HON. CHRISTOPHER H. SMITH

                             of new jersey

                    in the house of representatives

                         Friday, July 27, 2001

  Mr. SMITH of New Jersey. Mr. Speaker, as Chairman of the Veterans' 
Affairs Committee, I am introducing the ``Department of Defense-
Department of Veterans Affairs Health Resources Access Improvement Act 
of 2001'' on behalf of myself and Mr. Brown of South Carolina, Mr. 
Everett of Alabama, Mr. Simmons of Connecticut, Mr. Gibbons of Nevada, 
Mr. Wamp of Tennessee, Mr. Kirk of Illinois, Mr. Buyer of Indiana, and 
Mr. Bilirakis of Florida.
  America's servicemen and women, their families, and our veterans who 
have served in uniform deserve the best health care we can offer them 
as a Nation. My bill addresses the urgent need for the Departments of 
Defense and Veterans Affairs to improve their programs of health 
resource sharing as originally authorized by Public Law 97-174, the 
``Veterans' Administration and Department of Defense Health Resources 
Sharing and Emergency Operations Act of 1982.'' This authority was 
originally intended to provide opportunities to make it easier for the 
two Departments--whose combined health care budgets this year total 
over $35 billion--to increase the variety and amount of their health 
resource sharing for the benefit of their veteran and military 
beneficiaries, while helping hold down costs in Federal health care for 
the benefit of taxpayers.
  Currently, the Secretaries of each Department have at their 
discretion the option not to share. With this bill, we take a new 
approach: it would make sharing the order of the day. Sharing must be 
an important priority of both Departments, and we should create strong 
incentives for the Secretaries to work together to achieve common ends. 
The bill's proposed findings are indicative of our disappointment with 
the current state of VA-DoD sharing. We believe that neither department 
has taken full advantage of sharing opportunities and that the intended 
results of the 1982 sharing authority have not been achieved. We know 
VA-DoD sharing could be greatly increased, and with this bill we want 
to get sharing moving again.
  Mr. Speaker, this bill seeks to establish a health care facilities 
sharing demonstration project in keeping with the intent of the 
original legislation for VA-DoD sharing. Under the bill, five 
qualifying sites across the country would be selected for participation 
in a demonstration project. The purpose of the demonstration project is 
to identify and measure the advantages of sharing, and work through the 
challenges of the two systems becoming true partners in health care
  This legislation would require a unified management system to be 
adopted in the five demonstration sites to the extent feasible. A 
unified system would incorporate budget and financial management, 
health care provider assignments, and medical information systems 
compatibility. At the present time, the two Departments' information 
systems are incompatible, but this legislation would also create a 
framework for greater software compatibility. By making such systems 
communicate better, we can better ensure continuity of care, equality 
of access, uniform quality of service and seamless transmission of 
data. This is a third important goal of our bill.
  In addition, the demonstration project would provide for enhancement 
of graduate medical educational programs at the five sites for 
physicians in training and other health care providers. This will 
create a unique opportunity for

[[Page E1458]]

health professions students by giving them a combined exposure that has 
not been available to them before. It would also bring a greater 
awareness and understanding of differences in the two beneficiary 
populations for new and experienced health care professionals alike.
  Congress has made efforts in the past to promote specific sharing. At 
best, the results have been modest. For example, we authorized the Mike 
O'Callaghan Federal Hospital at Nellis Air Force Base outside Las 
Vegas. It is a 96-bed Air Force managed hospital with 52 VA-dedicated 
beds. This facility still has significant potential to serve as a model 
for sharing, but the VA and the Air Force made the decision to maintain 
separate budgets, financial, human resources, patient care records and 
data management systems. This facility, spending combined 
appropriations of over $46 million, is really operating as two 
independent federal facilities within the same walls, with needless 
duplications of systems and services and inefficient use of resources.
  Another example is the VA Medical center and Kirkland AFB Hospital in 
Albuquerque, New Mexico. Albuquerque is a VA-Air Force partnership that 
provides admitting privileges to Air Force physicians. The relationship 
between the VA and Air Force at these facilities is an example of a 
good beginning to sharing. What was once a 40-bed Air Force hospital 
occupying VA space has evolved to a contractual relationship today. Now 
the Air Force purchases inpatient care services from the VA, rather 
than operating less efficiently as a separate hospital within the 
confines of the Albuquerque facility.
  While many of the lost opportunities to share observed in Las Vegas 
do not pertain to the situation in Albuquerque, some do. For example, 
the Air Force and VA needlessly maintain separate dental clinics, 
central dental laboratory functions and separate supply chains. Also, 
the Air Force continues to maintain a management presence as though it 
were still operating as an independent facility, even though most of 
its activities duplicate those of VA.
  The Committee has also examined sharing in VA and DoD health care 
facilities in San Diego, CA; Fayetteville, NC; Charleston, SC; and San 
Antonio and El Paso, TX. It appears that substantial benefits could be 
achieved on both sides of the sharing equation if sharing became more 
of a standard operating policy between VA and DoD. Obviously, sharing 
is more likely to occur if one potential partner has something 
perceived to be valuable or useful to offer the other and if the right 
incentives are in place to encourage follow-through on sharing 
arrangements. VA Medical Centers have been successful in fields such as 
rehabilitation, prosthetics, treatment of spinal cord injuries and 
geriatrics, but DoD medical facilities treat a broader base of 
patients, which provides opportunities for the medical staff to broaden 
its experience.
  Some of these facilities that could share or share more are close 
neighbors, and close proximity clearly makes sharing much easier to 
achieve. For some of these essentially co-located facilities, a joint 
facility would almost certainly reduce administrative costs as well as 
staffing needs. With such savings, additional resources would be made 
available for patient treatment and technological improvements. For 
instance, at the San Diego VA Medical Center, the fiscal year 2001 
budget is $202 million, and at the Balboa Naval Medical Center, the 
fiscal year 2001 budget is over $338 million. Although these facilities 
are only a few miles apart, no sharing occurs between them. The most 
recent clinical sharing between VA and the Navy in the San Diego area 
appears to have ended in 1989. It appears that Congress must be more 
vigorous or this deplorable situation will continue.
  For too many neighboring VA and DoD health facilities, separate 
management and operations have become the only way they can conceive of 
doing business, even when another federal medical facility, also 
supported by tax dollars, may be little more than a stone's throw away. 
This separateness is mostly about ingrained habits, organizational 
cultures and protecting turf, and is not about promoting the best 
quality medical treatment for veterans and military patients, extending 
specialty care to more federal beneficiaries, or conserving scarce 
resources and funding.
  Our bill would require, among other things, no later than two years 
after its enactment, the Secretaries of both Departments must submit to 
Congress a prospectus for the construction of a new joint federal 
medical facility. The two Secretaries would jointly select the location 
with two options to consider. They could select a location
  Importantly, Mr. Speaker, this bill would make VA-DoD health sharing 
mandatory. This change in the law would require jointly located 
facilities, beginning with those participating in the demonstration 
project, to actively engage in developing and implementing meaningful 
and sustainable plans for sharing. We understand that DoD and VA health 
facilities do not always operate in the same fashion, and that even a 
small change in policy or procedure can have large consequences. That 
is why in order to fully test the principles of this sharing 
legislation, the Secretaries of DoD and VA would be granted the 
authority to waive certain administrative regulations and policies 
otherwise applicable within their respective Departments. This bill 
includes provisions for close monitoring of any administrative 
regulations and policies that the Secretaries would deem appropriate 
for waiver, and would require them to report to the Committee on 
Veterans' Affairs and the Committee on Armed Services on their use of 
such waiver authority.
  In summary, this bill reflects the Committee's belief that veterans 
and military beneficiaries deserve the best health care a grateful 
Nation can offer. Through the creation of this demonstration project 
and other provisions of this bill, we hope to improve health resource 
sharing by providing stronger incentives for both departments to join 
forces and make VA-DoD sharing a reality.
  When I assumed the Chairmanship of this Committee I promised to do 
what is right for veterans. I am convinced that the Department of 
Defense--Department of Veterans Affairs Health Resources Improvement 
Act of 2001 would be good for veterans and the military community 
alike. I urge my colleagues to come on board and support this bill.

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