A certain house in my neighborhood has stood vacant for the 25 years I’ve lived there. Occasionally the town tacks a maintenance notice on the front door. Someone hacks at the lawn more or less regularly. Thankfully, a few years ago someone removed the rusted 1970s Sedan de Ville sitting on the driveway. The eccentric owner will neither sell, rent, nor occupy the place. So, his deteriorating “investment” is worth a fraction of what it might have been if he’d at least maintained it properly.
The Veterans Affairs Department is a little like this elusive homeowner. That’s what I concluded after reading the latest Government Accountability Office report detailing VA’s struggles to, as GAO put it, “align facilities with veterans’ needs.” I already knew VA operates 168 full-blown medical centers. One long-ago chief information officer pointed out, each one is a congressional district plum. VA also occupies 1,053 outpatient offices.
Check out my interview with GAO’s Debra Draper, director of health care issues, discussing this, the latest in a long line of reports from GAO and others on VA’s facilities.
Federal Drive with Tom Temin interviews Debra Draper
What made my eyes bug is that VA owns 6,091 buildings and leases another 1,586 for $340 million a year. Together these buildings house more than 30 million square feet. That’s more than four Pentagons or 15 Empire State Buildings. Some serve as nursing homes or other types of residences. The list also includes data centers, gyms, dining halls, theaters, swimming pools, shops, administrative offices, storage units, machine shops, and miscellaneous out buildings on aging campuses. VA has designated 5 million square feet worth of such facilities for disposal, but they’re still on the books.
Many are vacant, or have whole sections closed. In some cases, lights burn brightly 24 hours a day even though no one goes there. Many are so old and deteriorating they lie beyond renovation.
Here’s a surprise: VA’s real property management has been on GAO’s high risk list since 2003. Somehow the misalignment of space and planning, mapped against where veterans live contributes to the problems of access. So VA has a financial and a mission challenge with its vast real estate holdings. No wonder the new secretary, David Shulkin, says he wants to close more than 1,000 facilities.
And it has a managerial headache. GAO reports a set of overlapping planning processes that’ll make your head spin. VA operates the Strategic Capital Investment Planning process. It starts two years before the fiscal year in which a medical center might need to invest. The VA Integrated Planning process started in 2011 but it’s still in the pilot stage. There’s the Enrollee Health Care Projection Model (EHCPM) VA uses to project capacity needs at its locations. Into this planning mix you can toss the Veteran Population Projection Model 2014, or VetPop2014.
What VA and GAO both know is that the vet population will rise until 2024 then start shrinking, aging, and moving to warm places. That means the misalignment of space and veterans will grow worse unless VA’s approach to alignment improves.
Little of this should come as a surprise to VA officials. A report from 2004 called Capital Asset Realignment for Enhanced Services (CARES) from a commission called CARES made all sorts of recommendations. Many went undone as of last year, and anyhow, VA dropped the CARES process eight years ago. The last CARES report stated VA had managed to disposed of 509,247 square feet.
Lots of processes, flow charts, color-patterned maps of veteran populations. Yet it all adds up to chaos. Billions of dollars tied up in underused, vacant and decaying buildings (and structures like “historic” metal water towers) — while at fully utilized centers vets wait weeks or months for appointments. This when VA is looking for budget increases and spending more and more on care delivered by non-VA facilities.
In answering the GAO auditors, VA officials acknowledge limitations on their planning processes, but say they’ve in fact revealed problems VA lacks sufficient capital to address. But they concur with most of the recommendations to improve how VA and its regional networks do facilities planning. What to invest in is one thing, what to tear down is another. At a minimum, VA should sell, unlease or bulldoze the places already on its list.