Congress is exploring a dramatic transformation of Department of Veterans Affairs (VA) hospitals that would merge them with Department of Defense (DOD) facilities and treat active duty soldiers and veterans side by side.
Many veterans and lawmakers believe the VA healthcare system is in dire need of complete overhaul. The idea of simply using the VA’s budget to put all veterans on private insurance has been widely touted. Congress has also been quietly exploring a change that would shake up the VA by taking it in the opposite direction of privatization — militarization.
A massive pilot project at Lovell Federal Health Care Center in North Chicago just completed a five-year trial, and the good results are readily apparent. The joint DOD-VA hospital now sees most patients within one day and ranks in the top five of VA hospitals in overall wait times.
This stellar performance comes as veterans have died waiting for care at traditional VA hospitals. Lovell also excels in patient satisfaction ratings and was named a top performer by a nationwide hospital accreditation group.
Drawing from the military’s pipeline of disciplined, highly trained medical personnel, Lovell is spared the severe shortage of doctors facing other VA hospitals. It is run by people who can relate to veterans because they, too, have served or are serving.
Lovell’s capacity for treating women vets has improved because DOD hospitals have long cared for the wives of soldiers while active-duty soldiers benefit from VA’s experience in mental health.
Lovell is now the only place in the country where a Korean War vet and an active duty sailor’s wife giving birth may pass each other in the hallway. If any VA staff member needed a reminder that the elderly they are treating are there because of heroic service, the sight of a uniformed Navy recruit also on his way to a physical exam might drive home the point.
Congress conceived of Lovell as an experiment that would report back after five years, with positive results meaning merging DOD and VA hospitals in other cities would be considered.
This month, one of the advantages of the merger — putting military engineers in charge of building instead of the VA’s beleaguered construction office — has already migrated, with Congress giving all VA construction projects to the Army Corps of Engineers. The VA’s biggest recent construction project, a Colorado hospital, went $1 billion over budget and department officials could not explain why. Even so, the VA’s construction administrator got $30,000 in bonuses.
The DOD and VA have been authorized to share resources since the 1980s and there are nine smaller jointly operated facilities around the country, but none as large as Lovell. When a Navy hospital and VA medical center were both dilapidated, then-Illinois Rep. Mark Kirk urged the building of a combined facility. The DOD and VA agreed to the merger in 2002 and it opened in 2010 after a $130 million construction effort.
It is unclear to what extent the current Congress will embrace the larger vision set into motion years ago. Sen. Johnny Isakson (R-GA), chairman of the Senate Committee on Veterans’ Affairs, refused to say whether he knows about the massive experiment, much less what his opinion on replicating it nationwide it might be.
So far, the merger’s financial savings have been underwhelming and Congress did not seem to press the VA and DOD to do better to realize economies, a major benefit of most mergers. Lovell simply requested a budget equal to those of the two predecessor hospitals combined, and congressional appropriators agreed.
“Cost savings, mainly one-time construction savings, were one of the original considerations in deciding to integrate the two facilities, but FHCC officials told us that they are unable to determine whether these savings were actually realized,” a Government Accountability Office report found.
Some savings have been apparent. The hospital voluntarily returned $12 million with appropriations reduced by that amount for subsequent years. More significantly, it has not needed to tap into extra emergency funding for things like an expensive Hepatitis C medicine, as other VA hospitals have.
Improvements to the level of service are apparent, with the hospital rising in VA’s ranking system.
Veterans navigating traditional VA hospitals have long yearned for care that was the caliber of what they received when they were on active duty.
“We take pretty good care of our active duty … we have a lot more support and resources,” Steve Holt, Lovell’s director, told The Daily Caller News Foundation.
In 2014, Lovell provided medical care to 25,000 vets, 4,000 active duty personnel, 10,000 family members, and 50,000 Navy recruits.
The merger has also impacted the culture of the workforce vets are treated by, with 1,000 active-duty military working alongside 2,000 VA civil servants. Military members are known for strong work ethic and unforgiving standards, which vets say they haven’t always seen with VA staff.
Holt is a veteran and a doctor, which also sets the facility apart; only two out of 60 directors in the VA’s traditional healthcare system fit that description.
“One in three of my staff wear a uniform, and there’s a realization of how they relate when they see those sailors that makes them more loyal, more appreciative and more willing to speak up and say ‘you know if you did it this way, you’d do it better,’” he said.
The military culture has permeated the civilian staff in part because sailors who work at the hospital or are there for treatment go on to work there in a civilian capacity after they leave the military. Better yet, military medics work there after they retire from the armed forces, alleviating a shortage of doctors that is one reason the VA fails to treat patients in a timely manner.
“It is an important source of recruitment,” Holt said.
An operating agreement attempts to navigate the merger of two massive bureaucracies. Lovell’s operating agreement says it is supposed to split top jobs between VA and military personnel, and have a VA person in the top job. Holt became a VA executive after retiring from an Air Force hospital in 2005, and Lovell’s second-in-command is a Navy captain.
Military influence is especially heavy now at Lovell because the VA has failed to assign executives to the hospital, leaving many positions filled in an “acting” capacity by military, a review of personnel shows.
In combining two bureaucracies, administrators had to merge two different sets of policies, and said that they selected the most stringent from each.
Next month, reports assessing Lovell’s five years are due from the DOD, the VA, the Government Accountability Office and an auditor. Administrators will deem it a success and urge continuation.
“They want to continue us, they thought that would be more efficient and effective,” Holt said. “Personally I’d like to see the model done elsewhere.”
They have the backing of Kirk, who is now chairman of the Senate’s VA appropriations subcommittee. “I would like to see the Lovell model become one that we can reproduce across the country in order to combine resources and improve veteran care,” Kirk said.
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