VA hospitals shifting focus to outpatient care
By Randy Southerland, Contributing Writer
Atlanta Business Chronicle
July 26, 2002

ormer military personnel who depend on local Veteran Affairs hospitals for care may face a very different health-care system when a new study is completed.

In June, the VA entered Phase 2 of a national initiative designed to make the $20.3 billion health system more efficient and less costly to the taxpayer. The effort was spurred by a General Accounting Office report that found the system spending more than $1 million a day to maintain outdated facilities in aging buildings.

In response, the VA created the CARES (Capital Assets Realignment for Enhanced Services) program to determine how many veterans are served in each of 1,300 hospitals and clinics in 22 geographic districts.

Data on facility use and patient distribution produced by the 18-month effort will be turned over to an independent commission selected by the Secretary of Veterans Affairs for evaluation. The study may lead to the consolidation or closing of some outmoded facilities and more outpatient clinics.

Modernization initiative
The initiative is part of an effort to modernize the VA's aging health-care system. Built just after World War II, the system's network was geared to inpatient care requiring long hospital stays.

"We've had a major effort and been very successful at moving the VA from this hospital-based system to a primary care, outpatient mode of medical care," said Al Sones, public affairs director for Veterans Integrated Service Network Region 7, which includes hospitals, outpatient clinics and nursing homes in Georgia, Alabama and South Carolina. "This gets the veteran in and out of the medical [center] much faster. It focuses much more on preventive medicine. We have a lot of new high-tech equipment and a lot of new procedures that just don't require hospitalizing veterans like we did in the past."

The number of veterans seeking care — particularly the aging World War II generation — has put increasing strain on local resources. In addition, a migration of retired veterans from the Northeast and Midwest to the sunny South has shifted the service population.

Out of the region's 1.5 million veterans, 362,741 are enrolled in this system, and that number is expected to soon top 400,000 — triple the number six years ago. The system includes eight medical centers and 23 outpatient clinics in the three-state area.

Many of those vets received care at the sprawling 12-story Atlanta VA Medical Center on Clairmont Road in Decatur. Built in 1967 as a 400-bed inpatient facility, the center now has just 173 beds for overnight stays following a two-year, $5.7 million renovation effort. So far this year, 46,106 patients have been treated and released the same day, compared with just 5,217 inpatients.

Despite those numbers, the Atlanta Network is providing services to about 10 percent of its potential market, said Molly Reynolds, public affairs officer at the Atlanta VA Medical Center.

"In Atlanta — just this year — we exceeded the number of outpatient visits from last year," she said.

Preview of program's effects
Atlanta officials don't know yet what CARES will mean for local health care, but they don't believe it will result in any facilities being shut down.

"This is not going to reduce health-care services at all," Sones said. "It's basically going to focus on the care that is being delivered."

Although it is likely to be a year before any decisions are made about reforms, officials already have a preview of what CARES will look like. The first pilot effort was recently completed in Region 12, which includes Chicago, upper Illinois, Wisconsin and upper Michigan.

These three areas were considered individual markets because of the particular way veterans were concentrated.

"In the pilot program, what they found was that up in Wisconsin and upper Michigan areas, there was a need for more outpatient clinics," said Kerri Childers, spokeswoman for the VA's CARES program.

In Chicago, Lakeside, one of the city's three hospitals, was converted to an outpatient facility.

"With the money saved from closing the inpatient beds at Lakeside, we were able to expand and improve the other two major hospitals in the area," she said.

More than 80 percent of the care provided to the 4.5 million veterans who use the system is on an outpatient basis, Childers said.

VA officials contend that, ultimately, the system will be more responsive to the needs of veterans. Clinics will be closer to where patients live and, through an upcoming educational program, they will have a better idea of what kind of care is available to them.

© 2002 American City Business Journals Inc.