The Department of Veterans Affairs is planning a massive reorganization of its health care management system, reducing the number of networks that support VA medical centers and realigning policy offices to promote consistency. <\/p>\n
In the largest planned overhaul of the Veterans Health Administration framework since 1995, the department will slash the number of Veterans Integrated Service Networks<\/a>, or VISNs, from 18 to five and require them to report directly to the VA under secretary for health. <\/p>\n The plan calls for eliminating the VHA chief operating officer and placing VHA Central Office staff under the under secretary, the deputy under secretary for health or the associate deputy under secretary. <\/p>\n VA officials said in briefings earlier this week that the changes will reduce VHA\u2019s \u201ccomplex bureaucracy\u201d while improving communications and consistency in policy making, systems and technology. <\/p>\n \u201cThe current\u202fVHA\u202fleadership structure is riddled with redundancies that slow decision making, sow confusion and create competing priorities,\u201d VA Secretary Doug Collins said in a statement Monday.\u202f\u201cUnder a reorganized\u202fVHA, policymakers will set policy, regional leaders will focus on implementing those policies, and clinical leaders will focus on what they do best: taking great care of veterans.\u201d <\/p>\n In announcing the changes, VA officials stressed that they are not aimed at reducing staff. <\/p>\n According to the department\u2019s briefing documents, the reorganization has been needed for nearly a decade and is an effort to reduce duplication, increase accountability and improve patient service. <\/p>\n According to the VA, officials looked at national health care models and the organization of top health care systems to create the plan. <\/p>\n \u201cOur dedicated staff will benefit from less bureaucracy, clearer direction, and more time to focus on VHA priorities and patient care \u2014 enable faster access to care for veterans with fewer handoffs,\u201d according to VA documents. <\/p>\n House Veterans Affairs Committee Chairman Rep. Mike Bost, R-Ill., introduced several pieces of legislation this week addressing the VA\u2019s organizational structure, including one that would reduce the number of VISNs from 18 to eight \u2014 three more than the VA is proposing. <\/p>\n On Monday, Bost issued a statement saying he supported Collins\u2019 effort to restructure the agency. <\/p>\n \u201cChange can be a good thing. Veterans and their families gave us a clear mandate last November that business as usual is not cutting it and we must cut through the bureaucracy, remove the red tape, and push VA forward,\u201d Bost said. <\/p>\n Rep. Mark Takano of California, the committee\u2019s ranking Democrat, called for hearings on the proposal, noting that most of Congress and the major veterans service organizations were not consulted or informed of the development process. <\/p>\n \u201cVA has been planning this VHA reorganization effort for the past seven months. During that time, the secretary and other political appointees have avoided gathering input from or informing Congress or veterans service organizations. Instead, they have worked in secret and behind closed doors,\u201d Takano said in a statement to Military Times on Wednesday. <\/p>\n \u201cIn launching the plan\u2019s official rollout this month, VA officials took a partisan approach, meeting only with Republican committee members before the plan was announced publicly, and refusing to brief Democratic committee members until the new year. Redesigning the organizational structure of the nation\u2019s largest integrated health care system should not be a secretive, partisan, closed-door process,\u201d he said. <\/p>\n The VA also announced coming changes to its community care program<\/a> this week, seeking proposals for contracts from companies to provide medical treatment for veterans outside the VA system. The agreements could be worth up to $1 trillion over 10 years. <\/p>\n Under that plan, the number of community care regions would be reduced from five to two. But they may be supported by multiple health care networks. Currently, the program is managed by just two health networks, TriWest Healthcare Alliance and Optum Serve. <\/p>\n VA officials said the new contracts will result in a broader choice for veterans. <\/p>\n Reaction to both announcements has been slow among veteran advocacy groups as they digest the massive proposals. After a VA briefing to veteran service organizations earlier this week, Carl Blake, CEO of Paralyzed Veterans of America, said advocates have been concerned \u201cfor years\u201d about the expansion of VA bureaucracy. He said the planned changes \u2014 at least for the VHA \u2014 sound \u201cpromising.\u201d <\/p>\n \u201cContinued growth of the administration has really gotten in the way of health care decisions, policy and decision-making, and so, based on the way this was briefed, if it works the way it is intended, it gives us hope that many of these administrative barriers \u2014 and there are many of them across VHA \u2014 will be knocked down,\u201d Blake said Tuesday in an interview with Military Times. <\/p>\n Disabled American Veterans National Commander Coleman Nee issued a statement Wednesday saying the organization supports efforts to improve VA health care for veterans with service-connected conditions. <\/p>\n \u201cWe look forward to learning more details about the department\u2019s plans to reorganize the Veterans Health Administration and remain committed to working closely with VA, Congress, and other veteran stakeholders to strengthen the high-quality health care our nation\u2019s disabled veterans have earned,\u201d Nee said. <\/p>\n A blue-ribbon panel created in 2016 to study the future of VA health care recommended that the VA redesign its central office to ensure it had proper oversight of the VISNs. It also recommended that the VHA define the roles of the VISNs and ensure that the networks all worked within national standards. <\/p>\n \u201cThe role of the Veterans Integrated Service Network is not clear, and the delegated responsibilities of the medical center director are not defined,\u201d wrote members of the Commission on Care in their final report<\/a>. <\/p>\n Other federal watchdogs have voiced similar concerns. In March, the VA\u2019s own inspector general noted in a report on VA mental health officers that the \u201cVISN organizational structure lacked clearly defined roles and standardized responsibilities and did not ensure accountability.\u201d <\/b><\/p>\n