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Statement of the Honorable
Christopher H. Smith, Chairman House
Committee on Veterans’ Affairs March
7, 2002 VA/DoD
Health Resources Sharing (H.R. 2667) Chairman
McHugh, Chairman Moran, Ranking Member Snyder, Ranking Member Filner,
I want to thank all of you for working together to make today’s
hearing a reality. It is a pleasure to be with you this morning to share my
views on ways to improve the cooperation and collaboration between the
Departments of Veterans’ Affairs and Defense in fulfilling their
health care obligations, and specifically on the legislation that I
have introduced, H.R. 2667, to further this goal. At
the outset, let me say how much I appreciate the support of Armed
Services Committee Chairman Bob Stump, the former Chairman of the
Veterans’ Affairs Committee, in moving ahead with today’s hearing. His leadership, and your leadership, Mr. Chairman, in working
with our Committee, has been exemplary.
You, Chairman Moran, Mr. Snyder and Mr. Filner are truly
demonstrating the advantages of Committees working together to benefit
the men and women who are serving, have served or will serve our
nation in the armed forces. As
Chairman of the House Committee on Veterans’ Affairs, I have the
privilege of working everyday to improve the quality of life for our
nation’s 25 million veterans and their families.
Given the tight fiscal and budgetary realities that face our
federal government, if we are to continue providing quality health
care for all those who need it, we must make the best use of those
resources that are currently available.
Inefficiencies and duplication not only waste taxpayer dollars,
they shortchange military personnel, retirees, and veterans seeking
health care. This
year, the Departments of Veterans Affairs and Defense will spend
nearly $40 billion combined on health care for current or former
military personnel and their families.
Yet despite this enormous sum, there is still not enough to
meet all of their health care needs.
The federal government must find ways to maximize efficiency
and minimize unnecessary, duplicative services that drain dollars from
their primary purpose – providing timely, quality health care to
present and former service personnel and their families. Mr.
Chairmen, I strongly believe that the federal government must
aggressively seek to increase resource sharing between these two
massive health care systems, whenever and wherever feasible.
Although Congress has made efforts in the past to promote
specific sharing, the results have been modest at best. For
example, we authorized the Mike O’Callaghan Federal Hospital at
Nellis Air Force Base outside Las Vegas.
It is a 96-bed Air Force-managed hospital with 52 VA-dedicated
beds. This facility still
has significant potential to serve as a model for sharing, but the VA
and the Air Force were required to maintain separate budgets,
financial, human resources, patient care records and data management
systems. Combined, their
annual budgets are over $46 million, yet they effectively operate as
two independent federal facilities within the same walls, with
needless duplications of systems management and services, as well as
inefficient use of resources. Despite
being co-located, they maintain separate pharmacies, one for veterans
and the other for Air Force beneficiaries.
Both the VA and the Air Force also maintain separate intensive
care units, surgical operating rooms and support facilities and staff. Such duplication of facilities and services wastes funds that
could be used to improve delivery of health care to both veterans and
military communities. In
Albuquerque, New Mexico there is a VA-Air Force partnership between
the VA Medical center and Kirkland AFB Hospital that provides
admitting privileges to Air Force physicians.
The relationship between the VA and Air Force at these
facilities is a good beginning to sharing. However,
despite their promising sharing relationship, there remain many
untapped areas where new efficiencies could be achieved in
Albuquerque. For example,
the Air Force and VA needlessly maintain separate dental clinics,
central dental laboratory functions and separate supply chains.
Also, the Air Force continues to maintain a management presence
as though it were still operating as an independent hospital facility,
even though most of its activities duplicate those of the VA. Some
facilities that are close neighbors – essentially co-located
facilities – could become joint facilities, thereby almost certainly
reducing administrative costs as well as staffing needs.
With such savings, additional resources could be invested in
patient treatment and technological improvements. For instance, at the
San Diego VA Medical Center, the fiscal year 2001 budget is $202
million, and at the Balboa Naval Medical Center, the fiscal year 2001
budget is over $338 million. Although
these facilities are only a few miles apart, no clinical sharing
occurs between them. Does
anyone doubt that money could be saved by reducing duplication of
services, particularly expensive testing equipment and facilities? For
too many neighboring VA and DoD health facilities, separate management
and operations are the only way they conceive of doing business, even
when another federal medical
facility, also supported by public dollars, may be little more than a
stone’s throw away. I
am convinced that this separateness is the result – at least in part
– of deeply ingrained habits, entrenched organizational cultures and
longstanding turf battles. Perhaps
the most illustrative example of the failure to pursue sharing
agreements that we have seen recently is in Charleston, South
Carolina, home to the Naval Hospital Charleston and the Ralph H.
Johnson VA Medical Center. During
a visit last year by Veterans’ Affairs Committee staff, the Naval
Hospital’s Director, in the course of discussing the issue of
resource sharing, also talked of the difficulty they experienced in
recruiting and retaining pharmacy technicians to meet the demand for
approximately 500 mailout prescriptions every day. What
the Navy did not see is literally right across the street: a VA
Consolidated Mail Outpatient Pharmacy facility, one of eight
nationwide, which produces 52,000 mailout prescriptions daily for
eligible veterans. When
our Committee staff and the Navy personnel met with the director of
the VA facility, he told us that he would have little problem
whatsoever in fulfilling an additional 500 prescriptions, which would
increase the workload by less than 1% of their daily volume. That
was last April. Today,
almost one year later, there has been no change.
The new executive staff at the Naval Hospital seems unaware of
our staff’s visit, or of the possibility of utilizing the VA
pharmaceutical facility. Nothing
has changed. These
are just a couple of the many lost opportunities for resource sharing.
I would commend to your attention a staff report published by
the Committee on Veterans’ Affairs that documents these, and other
examples of VA and DoD facilities that have failed to take advantage
of the benefits that come from sharing health care resources. To
move beyond the status quo, last July, I, along with Veterans’
Affairs Committee Vice Chairman Mike Bilirakis and others, introduced
H.R. 2667, the “Department of Defense – Department of Veterans
Affairs Health Resources Improvement Act of 2001.”
This legislation takes another step towards fulfillment of the
goals set out almost twenty years ago by Public Law 97-174, the
“Veterans’ Administration and Department of Defense Health
Resources Sharing and Emergency Operations Act of 1982”. Our
legislation would establish five health care sharing demonstration
projects in five qualifying sites across the country.
The purpose of the demonstration projects would be to reward
those who are not daunted by current obstacles that prevent sharing
where it is clearly possible. H.R.
2667 would, to the extent feasible, require a unified management
system to be adopted in the five demonstration sites to the extent
feasible. A unified
system would look at ways to eliminate differences between the budget,
health care provider assignment, and medical information systems.
At the present time, the two Departments’ information systems
are still incompatible, and so this legislation would also encourage
greater software compatibility. By
making such systems communicate better, we can better ensure
continuity of care, equality of access, uniform quality of service and
seamless transmission of data. In
addition, the demonstration projects would provide for enhancement of
graduate medical educational programs at the five sites.
This will create a great opportunity for health professions
students by giving them a combined exposure that has not been
available to them before. It would also bring a better awareness and understanding of
differences in the two beneficiary populations for new and experienced
health care professionals alike. Mr.
Chairmen, H.R. 2667 is a realistic framework for taking direct steps
to improve sharing, and I would urge both Subcommittees to consider
moving rapidly on this legislation. As
the war on terrorism continues, and casualties occur, we are reminded
once again of the absolutely vital role that our servicemen and
servicewomen play in defending freedom, and of the gratitude and
obligations that we as a nation owe them.
At this very moment, in the frigid mountains of Afghanistan,
they are making sacrifices on behalf of all Americans; some will make
the ultimate sacrifice for their country. In return, we must fulfill our obligation to provide the best and most efficient health care for them and their families, now, and after they return. I am convinced that this will be enhanced if if we truly begin combining – when and where it is appropriate – the health care resources of the Departments of Veterans Affairs and Defense for the benefit of our soldiers, sailors, airmen and marines – past, present and future. Back to Witness List |