VA Health Care:

Support Lacking for Mission Change at Miles City, Montana, Medical Center

HRD-87-13: Published: Feb 13, 1987. Publicly Released: Feb 13, 1987.

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In response to a congressional request, GAO reviewed the Veterans Administration's (VA) proposal to change the Miles City, Montana, medical center from a predominately acute care to a predominately extended care facility, specifically: (1) the justification for the proposed change; (2) whether the change would be in the best interests of area veterans; and (3) how easily VA could implement the change.

GAO found that: (1) although the proposed change would offer increased access to area veterans needing extended care, it would decrease convenient access to care for veterans needing surgery; (2) the costs VA used to justify the mission change were inaccurate and its cost-saving estimates were inconsistent; (3) VA planning projections showed a need to increase rather than eliminate surgical beds; and (4) VA did not compare the relative advantages and disadvantages to area veterans of converting the medical center. GAO also found that: (1) the local community hospital has the capability to handle emergency surgical referrals from the medical center; (2) some VA hospitals would have the capacity to absorb an increased work load of nonemergency surgical patients; (3) increased travel could present certain problems to veterans, even though the medical district has implemented revised procedures designed to minimize these problems; (4) VA travel funding constraints might cause veterans to pay for their travel to other VA hospitals or obtain care from other sources; (5) the medical center has the authority to set up outreach clinics; and (6) although the medical center had not officially closed its inpatient surgical service as of January 21, 1987, it had decreased the number of acute medicine beds, increased the number of intermediate medicine beds, established two outreach clinics, and begun performing more outpatient surgery.

Recommendation for Executive Action

  1. Status: Closed - Implemented

    Comments: A VA task force visited the Miles City, Montana VAMC and reviewed the issues identified in the report.

    Recommendation: The Administrator, Veterans Affairs, should address the cost, planning, and trade-off issues this report raised, as well as the potential quality-of-care issue, before making a final decision on the proposed mission change.

    Agency Affected: Veterans Administration


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