Summary

On May 14, 2003, as requested, we briefed Congress on our preliminary views on the Capital Asset Realignment for Enhanced Services (CARES) process initiated by the Department of Veterans Affairs (VA). On July 29, 2003, we shared our additional perspectives, which Congressional Staff indicated would be helpful to the Commission as it considers the draft National CARES Plan that VA presented on August 4, 2003. For this reason, we are providing an overview of the approach that we plan to use during our continuing review of CARES.

In summary, our approach for analyzing CARES decisions will focus on a series of fundamental questions regarding whether appropriate alternatives were considered and key impacts of competing alternatives were appropriately evaluated. Our framework examines whether choices about the development of capital asset realignment alternatives ensure consideration of alternatives that potentially provide the greatest payoffs, particularly in comparison to the status quo, that is, maintaining VA's existing real property infrastructure for the delivery of health care. It also examines the impacts of such alternatives, focusing on comparisons of their key costs and benefits in a manner consistent with OMB and CARES guidelines. In our view, the success of CARES depends on ensuring that the best alternatives for meeting veterans' needs within a market are recommended and a transparent public record is developed that sufficiently documents the justification supporting CARES decisions. A complete, fact-based public record can facilitate political consensus by allowing the Congress and other stakeholders to focus their deliberations on tradeoffs among the benefits and costs of alternatives for realigning health care assets and enhancing care.