HILL COUNTRY VETERANS COUNCIL
CARES COMMISSION INPUT FACT SHEET
October 15, 2003

BACKGROUND

In December 2002, The Hon. Anthony J. Principi, Secretary of Veterans Affairs, established the CARES (Capital Assets Realignment for Enhanced Services) Commission to review all assets in the VA Health Care System and recommend to the Secretary as to how these assets may be realigned to provide improved service to veterans.  Each area of interest is to provide input to the Commission.

South Texas Veterans Health Care System (STVHCS) formed a CARES committee to provide input on this area.  Retired Brig. Gen.Walter Schellhase, President of the Hill Country Veterans Council, is a member of this committee.  The STVHCS CARES Committee recommended “all assets remain unchanged at the Kerrville VA Hospital”. 

VISN 17 (the VA region that includes South Texas) formed a CARES Review Team to accept input from all of its stakeholders.  VISN 17 rejected STVHCS’s recommendation and recommended that “all acute-care beds at the Kerrville VA hospital be transitioned to holding beds in conjunction with proposed construction at the Audie Murphy VA hospital”.  VISN’s recommendation includes an $11 million facility at Audie Murphy to accommodate 30 new acute-care beds.

VISN recommendations are included in the Draft National CARES Plan, sent to the National CARES Commission.  The Commission is to provide an objective, independent review of the draft and submit a recommendation to the Secretary for his decision.  The draft national plan is available at www.CAREScommission.va.gov.

The CARES Commission is conducting public hearings and site visits to solicit views from interested parties and obtain public input that will give the Commission a better understanding of the VA health care system before making their recommendation to the Secretary.  There have been two hearings regarding Kerrville and one site visit by the Commission.  Representing the Hill Country Veterans Council, Gen. Schellhase testified at both hearings, opposing VISN recommendations for Kerrville and supporting STVHCS’s recommendation.

The Hill Country Veterans Council further recommends that Kerrville be given 20 additional acute-care beds, that surgical services be restored and that waiting time for appointments and waiting time to see a doctor be improved with addition of more specialists in areas such as urology, orthopedics, podiatry, surgery, audiology and ophthalmology.

FACTS

1.                  Spending $11 million at Audie Murphy to accommodate acute-care patients now cared for in Kerrville is not needed.  Space is available in Kerrville.  Such expenditure would be an injustice to the taxpayer.

2.                  Turning the acute-care beds in Kerrville to holding beds in no way will improve care for veterans – the basic purpose of the CARES process.

3.                  Parking already is a serious problem at Audie Murphy and would become much worse with any type of acute-care bed expansion Audie Murphy.

4.                  The VA is a major employer in the Hill Country and any reduction in service to veterans in this area would have a major and negative impact on the economy.

5.                  No private hospital in the area has the capacity to provide acute-care beds if they were not available at the VA.

6.                  Space is available for the existing 20 acute-care beds and the five intensive-care beds in the existing facility.

7.                  Parking is never a problem in Kerrville.

8.                  The cost per day for an acute-care bed in Kerrville is $870.00 -- is one of the lowest in the nation and far below the cost at Audie Murphy and the average of all VISN 17 hospitals.

9.                  Kerrville has a well-trained and dedicated professional and service staff.

10.              Veterans drive through San Antonio and to Kerrville for treatment when allowed to do so.

11.              The VA sometimes sends acute-care patients to Kerrville because Audie Murphy is full

12.              Often, Kerrville patients needing specialty care cannot be sent to Audie Murphy because acute-care beds are not available.  They must be held in acute-care beds in Kerrville, sent to University Hospital in San Antonio or go to a private hospital at their own expense.

13.              Kerrville has more than 70 acres for expansion; Audie Murphy is landlocked.

14.              Kerrville VA has strong support from the professional community.  When Audie Murphy cannot provide needed specialty care, local professionals have contracted to provide it.

15.              The Hill Country Veterans Council urges the CARES Commission to support expansion of service in Kerrville, not an unneeded $11 million building at Audie Murphy.

16.              To improve veterans health care, it must be accessible, affordable and available.

17.              The VA must reduce waiting time for appointments, reduce waiting time to see a doctor after appointments have been made and provide more accessible specialty care.

SOME ADDITIONAL FACTS

1.      The stagtistics used by VISN 17 to arrive at their decision to transfer the Kerrville VA hospital acute beds to Audie Murphy are rather interesting.  VISN 17 predicts a substantial increase in requirements for primary care in South Texas from a 2001 base line of over 212000 veterans that will require health care to nearly 278,000 in 2012 and then a slight decrease to 256,000 to the year 2022.

  1. Based on a projected veteran increase to the year 2012, VISN 17 selects to move the Kerrville VA hospital acute beds to Audie Murphy.
  2. VISN 17’s study shows that Audie Murphy VA hospital does not have the capacity to accommodate Kerrville’s 20 acute beds and other acute bed requirement due to the opening of more VA clinics in the San Antonio areas.  Therefore, VISN 17 recommends the building of a new acute bed wing at Audie Murphy.
  3. There are no proposed plans for any construction at Audie Murphy at this time.  Therefore, VISN 17 projects that it would take about 4-5 years to get a project approved and another 2 years for construction.  Hence, the new 30 acute beds would come on line in the year 2009 or 2010, only two years before their projected decline in veteran count in the year 2012.
  4. Opening more clinics in the STVHCS will create an additional require for acute beds.  It is a well established fact that each 20 to 40 patients seen in a clinic will refer at least one patient to Audie Murphy for an acute bed.  Many of these patients now come to Kerrville VA hospital is given a choice.
  5. STVHCS has recommended and supported by VISN 17 to remodel the Audie Murphy acute beds suites with 4 beds to 2 bed suites.  This will put an additional requirement for more acute beds.  There is no specifics as to how many acute beds will be eliminated by this remodeling.
  6. Therefore, based on VISN 17’s recommendation Audie Murphy must provide for 20 beds from Kerrville, at least 12 from additional clinics, and 15 to 20 from the remodeling.  Let VISN 17 proposes a construction project for only 30 that will not come on line until 2009 or 2010.

The Hill Country Veterans Council urges that you contact the National CARES Commission in support of maintaining the 20 acute-care and five ICU beds in Kerrville, using the facts above.  Send your comments to:

Mr. Richard E. Larson, Executive Director, CARES Commission, at carescommission@mail.va.gov,

or by mail at Comments: Richard E. Larson, Executive Director, CARES Commission (OOCARES), 810 Vermont Avenue, NW, Washington, DC 20420, or by fax at 202-501-2196 or by phone at 202-501-3015.

This is time-sensitive and urgent.  The CARES Commission will complete its input by Nov. 1, 2003 and submit the complete report to the Secretary by Dec. 1, 2003.  The Secretary will submit his report to Congress on Jan. 1, 2004. 

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