On Capitol Hill, there are few four-letter words that are quite as unspeakable as “BRAC” these days. Nonetheless, the Department of Veterans Affairs has come to the conclusion that it needs something similar to the Defense process for closing excess bases so that it can offload hundreds of crumbling buildings and bring its medical infrastructure more in line with what it takes to run a modern health system.
In contrast to DoD, VA’s problem is not mainly about a raw overabundance of unused real estate: Indeed, it’s asking for a $493 million increase in 2016 from its previous $1 billion construction budget in order to build new hospitals and clinics. Rather, the department says, too many of its existing facilities are in places where a lot of veterans used to live but don’t anymore, were built in a bygone era of different health care delivery models, or have crumbled so badly that they’re beyond the point of economical use.
Robert McDonald, the VA secretary, told the House Appropriations Committee Wednesday that 900 of the department’s 5,600 facilities are more than 90 years old, and overall, 60 percent its buildings have passed the half century mark.
“VA cannot be a sound steward of the taxpayers’ resources with the asset portfolio we carry. No business would carry such a portfolio, and veterans deserve better,” he said. “It’s time to close VA’s old substandard and underutilized infrastructure. We currently have 336 buildings that are vacant or less than 50 percent unoccupied. That’s 10.5 million square feet of excess space, costing an estimated $24 million annually to maintain. These funds could be used to hire roughly 200 registered nurses for a year, pay for 144,000 primary care visits for veterans, or support 41,900 days of nursing home care for veterans in community living centers.”
As examples of ways in which it’s caring for facilities that have outlived their usefulness, VA pointed to an aging 10-bed hospital that, on a busy day, takes care of five patients at a time but is still required to maintain full-time radiology, lab and pharmacy departments.
The department says examples like that are abundant in its health system, since many of its hospitals were constructed when long-term inpatient care was the norm, and many more veterans are now being cared for in outpatient settings.
Then there’s the case of the tiny quartermaster’s gas station building in Minneapolis.
Built in 1932, it’s been vacant for decades. VA wanted to raze it to make room for transitional housing for homeless veterans, but the state’s historic preservation office deemed it too historic to tear down, so the development remains stalled.
Helen Tierney, VA’s assistant secretary for management and chief financial officer, said a myriad of obstacles to closing old facilities have led the department to the conclusion that it needs a formal process to clear the boards of excess infrastructure rather than tackling the thicket of real estate problems one- by- one.
“Each case tends to be a little bit different. Sometimes that facility is on a complex and we don’t have enough construction money to tear it down,” she said. “And sometimes when we start to do that process, one of the local historical organizations gets involved. We need a framework where everybody is going to agree to close certain facilities. There are also a lot of political concerns when we look to close a facility, so we need something like a BRAC process that would be fair, where a board would evaluate our facilities and Congress would agree with those closures based on their ranking.
The need for an independent commission might be satisfied by the Civilian Property Realignment Act, a BRAC-like arrangement that would apply to all federal agencies. The Obama administration renewed its call for such a process in its 2016 budget proposal.
But additionally, VA says it needs expanded authority from Congress to enter into enhanced-use leases with private industry and nonprofits. As of now, that authority is limited to arrangements that deliver supportive housing for homeless veterans; VA wants to reinstate the leasing authority it once had so that it can maintain ownership of some of its historic buildings while letting them be used for activities that benefit local communities.
Congress scaled back the leasing authorities after lawmakers concluded VA had overstepped its discretion by letting one campus in Los Angeles host a car rental agency and a laundry facility.
“We would like to extend that back to the authority we used to have so we could bring in a broader range of people to use those beautiful historic facilities,” Tierney said.
VA secretary McDonald says in his nine months on the job, he’s concluded that the worsening condition of the department’s facilities isn’t just a budget issue, but also has a strong bearing on VA’s ability to recruit medical staff. As of now, the department is short about 4,000 doctors and 10,000 nurses.
He said he has tried to combat the shortage by elevating VA’s clinicians into higher pay bands, and has visited more than a dozen medical schools in an effort to dispel a negative “aura” about working conditions within VA hospitals.
“But the other barrier we face is our infrastructure,” he said. “We have a veteran population that’s roughly 11 percent female right now and it’s quickly growing to 20 percent. Our buildings were built at a time when you only had bathrooms for one gender, and where you didn’t have space for women’s clinics. We’re in the process of trying to retrofit those, which is why our construction budget is so important.”
Even some of the department’s larger and more recently constructed facilities have not kept pace with modern medical practices, McDonald said.
“One of the problems in Phoenix that didn’t get much publicity was the fact that we only had one clinical room for each doctor,” he said. “The average doctor has three clinical rooms; one where the patient’s getting ready, one where the patient’s being examined, one where the patient’s getting ready to leave. So this is a fundamental issue.”
In congressional hearings thus far, VA has gotten very little pushback from authorizers and appropriators for a BRAC of its own — in stark contrast to the frosty reception the Defense Department has received year-after-year for its infrastructure realignment proposals.
Rep. Jeff Fortenberry (R-Neb.) offered VA some unsolicited advice if it wanted to continue to sell its proposals to the rest of his 534 colleagues:
“Whatever you’re doing, do not call it BRAC,” he said to chuckles in the hearing room. “This is a positive thing. We are trying to make you more efficient and effective, not close stuff in communities.”