The Department of Veterans Affairs is looking to close three medical centers and reshape its real-estate footprint across the country, as part of a long-awaited plan mandated by Congress.

The VA on Monday expects to release its recommendations for the Asset and Infrastructure Review (AIR) Commission, which is mandated under the 2018 MISSION Act.

VA Secretary Denis McDonough previewed the recommendations Thursday at a virtual event hosted by the RAND Epstein Family Veterans Policy Research Institute, saying the plan calls for a net reduction of three VA hospitals, bringing the total number of inpatient medical facilities from 171 to 168.

However, McDonough said the plans will improve the overall level of care veterans receive, and would help modernize the agency to reflect broader trends in health care.

“Across the board with these recommendations, we’re embracing the idea that health care has evolved. VA needs to evolve and in fact, lead the evolution. That means building facilities designed with veterans and VA employees in mind,” he said.

The plan also calls for new VA construction across the country.

Military Times, which on Wednesday first wrote about the plan’s details ahead of its public release, reported the VA recommends closing 170 of its outpatient health facilities across the country, but also proposes constructing 255 new health care facilities and community living facilities.

McDonough said the recommendations would bring primary health care closer to nearly 150,000 veterans, and make outpatient specialty care more readily available to nearly 375,000 veterans.

“VA is here to stay. This is an investment in VA, not a retreat. It’s a doubling down, a strengthening of our ability to deliver world-class health care. It’s true, there will be changes in markets, but we are staying in every market,” McDonough said.

While the AIR Commission process has drawn comparisons to the Base Realignment and Closure (BRAC) process that that Defense Department went through in the mid-2000s, McDonough dismissed that comparison.

“BRAC was designed to close facilities and to reduce the DoD footprint. This is designed to maintain VA as the premier health care provider in every market in the country,” he said. “What this is, is a modernization effort to upgrade the effectiveness of our facilities by moving from aged, dated facilities into facilities that reflect the needs of our 21st-century vets,” he said.

American Federation of Government Employees President Everett Kelley said in a statement Tuesday that the VA’s plans would “dismantle large segments of the VA health care system.”

“Closing VA facilities will force veterans to rely on uncoordinated, private, for-profit care, where they will suffer from long wait times and be without the unique expertise and integrated services that only the VA provide,” Kelley said.

McDonough said evolving health care practices mean the VA doesn’t need as many inpatient beds as it did 50 years ago, or even a decade ago.

For example, a hip replacement in the 1990s, he said, left most patients in the hospital “for weeks,” while the average hospital stay for the same procedure is now less than 24 hours.

The VA, as part of this plan, is also looking to focus more of its infrastructure in geographic areas that have a higher demand for its services.

McDonough said, for example, the agency is looking to build a new VA Medical Center in the Southeast U.S. because the veteran population in one local market is expected to grow by 25%, while demand for long-term care is expected to increase by 87%.

In the Northeast, however, McDonough said the veteran population in one market has decreased for decades and is expected to drop an additional 18% over the next decade.

The VA, in response, plans to close a VA medical center in the area, but plans to replace it with new facilities, including a community living center and community-based outpatient clinic (CBOC).

McDonough said the VA is also partnering with a community hospital in the area to embed VA clinicians onsite, “so vets can get care in a modern, high-quality setting, rather than a VA hospital that only serves five or six patients a day,”

“When all of that new infrastructure is in place, and the need for the old medical center is gone, we’ll recommend closing it, so we can focus on investing in the new facilities rather than pour limited dollars into a facility that opened just after World War I,” McDonough said.

The VA is also standing up new facilities based on projected demand for specific issues, like veterans struggling with homelessness and substance abuse.

The agency is also looking to improve its level of care for women veterans and upgrade infrastructure to support a surge in demand for telehealth services.

McDonough said the VA “didn’t just consider demand as we made these decisions.”

The VA’s market research, for example, shows a decreased demand for its services in the Southeast and Midwest, and suggested the agency should consider closing sites there.

However, McDonough said the VA wouldn’t close some facilities in those areas, because they serve historically underserved minority and rural veteran populations.

“If we reduce our presence in those markets, there wouldn’t be enough good options in the community. Instead of downsizing those markets, we’re doubling down on it, because that’s the only way to guarantee that vets who live there get the care they need,” he said.

While the AIR Commission process is moving forward, McDonough said the VA is scrutinizing the market research that served as the basis for its recommendations.

The market research started in 2019, but doesn’t account for shifts in demand that happened during the COVID-19 pandemic.

McDonough said a VA “red team” and the Government Accountability Office both determined that the market research data was too old, and needs further review.

“One thing we’ll be doing, conterminous with the commission meeting this year, is updating that information and feeding it into the commission to make sure that we have the best pandemic-informed data — what to expect market by market,” he said.

An independent panel of experts will review the VA’s recommendations, just soon as nominees move through the Senate confirmation process.

President Joe Biden announced Wednesday that he expects to nominate eight members to the AIR Commission. The nominations require Senate confirmation.

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