VA Health Care:

Inadequate Planning in the Chesapeake Network

HEHS-95-6: Published: Dec 22, 1994. Publicly Released: Dec 22, 1994.

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Stephen P. Backhus
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Pursuant to a congressional request, GAO reviewed the Department of Veterans Affairs' (VA) planned construction of a new nursing home in the Baltimore, Maryland, area, focusing on whether VA used sound planning criteria in: (1) choosing the new nursing home site; and (2) developing its plans to replace the former medical center and nursing home.

GAO found that: (1) VA did not soundly plan its construction projects partly because it failed to provide adequate guidance to its regional offices and medical centers on how to change its facility-by-facility construction process into an integrated network planning process; (2) the VA Eastern Region did not provide an integrated plan to develop the Chesapeake Network into a competitive managed care system as VA envisioned; (3) VA inadequately surveyed the future availability of community nursing home beds, misallocated the availability of state nursing home beds, and did not thoroughly explore the option of renovating excess hospital space in determining the need for a new VA nursing home; (4) VA may have overstated its need to build additional extended-care capacity in the Chesapeake Network; (5) the VA construction plan may not be the best approach to improving veterans' extended-care services in the Chesapeake Network service area; and (6) the proposed site may not be the best location for a new VA nursing home in light of the misallocation of state nursing home beds.

Recommendations for Executive Action

  1. Status: Closed - Not Implemented

    Comments: VA required its Veterans Integrated Service Networks (VISN) to develop 1-, 2-, and 5-year strategic and business plans. These plans were completed in 1996. In addition, action has been taken to integrate management of the Baltimore, Perry Point, and Fort Howard facilities. Several ongoing assignments are assessing the adequacy of the network plans.

    Recommendation: Before requesting funding of any future Chesapeake Network construction projects, such as the Fort Howard replacement hospital and nursing home, the Secretary of Veterans Affairs should provide Congress with a revised plan for meeting the future medical care needs of Chesapeake Network veterans. This plan should include: (1) a thorough assessment of the needs for all types of care throughout the Network, rather than assessments made on a facility-by-facility basis; (2) a thorough assessment of alternatives to new VA construction, including renovation and conversion of unused space at VA facilities; and (3) identification of planned VA construction and renovation projects that the Secretary considers necessary after need has been determined and alternatives explored, prioritized according to need.

    Agency Affected: Department of Veterans Affairs

  2. Status: Closed - Implemented

    Comments: VA required VISNs to develop strategic and business plans. These plans were completed in 1996. The plans do not, however, include the type of facility-by-facility assessments envisioned by the recommendation.

    Recommendation: The Secretary of Veterans Affairs should consider requiring completion of similar plans for all other VA medical care networks.

    Agency Affected: Department of Veterans Affairs

  3. Status: Closed - Implemented

    Comments: With its shift to VISNs, VA has emphasized networkwide planning. In addition, guidance issued to VISNs encourages greater use of contracting when it is cost-effective.

    Recommendation: The Secretary of Veterans Affairs should direct the Undersecretary for Health to revise VA strategic planning guidance to: (1) better support networkwide, rather than facility-based, planning; and (2) improve the methodology for conducting community nursing home surveys.

    Agency Affected: Department of Veterans Affairs


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