The congressionally appointed VA Commission on Care has some big suggestions for the future of veterans health care.

Among the commission’s 18 recommendations are proposals to create an alternative personnel system for all employees within the Veterans Health Administration and incorporate more private provider options into VA’s network of care.

Those suggestions are getting mixed reviews from federal unions and organizations.

The American Federation of Government Employees, which represents roughly 230,000 VA employees, blasted the report, calling it a “horrendous, anti-veteran proposal.”

The VA provides more than just health care, AFGE said, and the department provides some services that some private providers cannot.

“This care also includes support systems offered at the VA through financial, educational, housing and employment support,” AFGE National President J. David Cox said in a statement. “Destroying this system in favor of fragmented, for-profit private providers creates dangerous gaps in treatment and missed opportunities to heal veterans suffering from many complex, interrelated conditions and problems.”

The Partnership for Public Service praised the commission for addressing the VA’s challenges in recruiting and retaining new talent. But creating an alternative personnel system for VHA isn’t the solution, it said.

“This could increase the complexity and balkanization of the federal civil service system,” Partnership president and CEO Max Stier said. “VHA and government as a whole require a modern personnel system that attracts new talent, develops strong leaders, recognizes outstanding performance and holds poor performers accountable. The difficulties faced by VHA are not unique among federal agencies.”

VA Secretary Bob McDonald praised some general themes in the commission’s report and said many were in line with his own MyVA transformation priorities. He said he plans to review the commission’s report and give a more detailed response in the coming weeks.

But Congress has the power now to approve some of the suggestions the commission made, and McDonald said the legislative branch needs to act quickly.

“Congress must act on our proposals to consolidate our Community Care programs, modernize and reform the claims appeals process and pass the bipartisan Veterans First Act,” McDonald said in a statement. “The window of opportunity is closing fast, but if Congress acts before leaving town this month, 2016 will be the year the nation turned the corner for veterans.”

At more than 300 pages, the commission has other suggestions that could have major implications for the VHA workforce.

1. A smaller VHA workforce

The report does not go into specifics, but its recommendation that VHA flatten and streamline its organizational structure suggests  the agency’s workforce should be smaller.

To get rid of duplicate offices within the VA and VHA, the commission said the department should “undertake a reduction-in-force in [the Veterans Health Administration Central Office] that facilitates delayering and efficiency in communication and decision making.”

Within the next three months, the commission said VHA human capital management should prepare an initial RIF for the offices it wants to eliminate.

The department should also clarify and define job descriptions for executives at Veterans Integrated Service Networks (VISNs) and at VHA program offices and define how they relate to each other.

2. A VHA chief information officer

The Veterans Health Administration does not currently have its own specific IT director. But the commission suggested it should going forward.

The report recommends the head of the VHA Care System select a VHA-specific chief information officer, a member of the Senior Executive Service who would have a “dotted line to the VA CIO.”

This person would be responsible for developing and implementing VHA’s IT policy and budget. The VHA CIO would also be in charge of procuring and overseeing a commercial off-the-shelf IT system for the health agency, rather than modernize the department’s current approach, the Veterans Health Information Systems and Technology Architecture (VistA).

3. A BRAC-like effort for VA medical centers

The VA should begin a systematic review of all of its medical centers and hospitals, the commission said, citing the 336 vacant buildings and 10.5 million square feet in unused space that are still part of the department’s real estate portfolio.

“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,” the report said.

Better authorities would help VA repurpose underutilized buildings and get rid of space it no longer uses, the commission argues. Previous versions of the report suggested a more aggressive and concrete timeline to close VHA facilities, but the final recommendation lacks one.

4. Better supply chain management

The commission was harsh on VHA’s current approach to supply chain management, calling its organizational structure “chaotic” and its data collection efforts “ineffective.”

The report recommends VHA hire a chief supply chain officer to manage all medical center and VISN products and supplies. This leader would also be in charge of updating VHA acquisition regulations, which the commission said are inconsistent with governmentwide Federal Acquisition Regulation.

The department also has challenges in recruiting and retaining new supply chain management talent, which the report said could be solved under the new VHA personnel system that the commissioners also suggested.

5. A new HR technology policy

VHA human capital management needs such a complete overhaul, that VHA leaders should develop a new transformation plan and submit it to the Office of Management and Budget and Congress, the commission said.

VHA performance management should become its own OMB agency priority goal, the report suggested.

And the department should look to other large health organizations for guidance to develop new performance metrics for VHA employees and executives, the commission said. Those metrics should coincide with the standards other health networks use to measure the success of their medical professionals.

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