54 New Clinics Will Broaden Veterans' Access to Care

Washington, D.C. -- The Department of Veterans Affairs (VA) is establishing 54 new community-based outpatient clinics around the country -- another major step forward in its efforts to make its services more accessible and to make VA care more patient-friendly.
"Today's announcement underscores VA's commitment to providing modern care in the most appropriate medical setting through a vigorous program of outpatient clinic development," VA Under Secretary for Health Dr. Kenneth W. Kizer said.

"Our momentum in activating more than 90 such clinics over the last two years, coupled with 54 new ambulatory care facilities, is nothing less than dramatic," Kizer said. "We are enabling VA clinicians to work efficiently and effectively to bring the highest standard of care to more hard-to-reach populations than ever before."

The clinics, which are in addition to 39 new clinics announced in June, bring to 532 the total number of VA outpatient clinics around the country now in operation or in the process of being activated -- including 163 located at VA medical centers. This is part of a general expansion of VA outpatient services through a re-engineering of the VA medical system to make high-quality health care available closer to veterans' homes. The new VA health-care system emphasizes customer service, decentralized management and a primary care structure in which the veteran generally sees the same medical provider or treatment team on each visit.

"The new clinics will be offering a broad range of general medical services such as management of diabetes, hypertension or coronary artery disease, pharmacy services or preventive care, such as vision or cholesterol screening," Kizer said.

The largest medical system in the nation, VA has restructured into 22 veterans integrated service networks (VISNs), giving VISN directors responsibility for assurance that local veteran health-care needs are being met. As part of its transformation, VA has closed more than 22,000 acute care hospital beds since 1994 -- with a corresponding decrease of 250,000 inpatient admissions per year -- while over the same period, outpatient visits have risen by 7.3 million, for a total of more than 33.3 million clinic visits in 1997. Today's clinic announcement is the fruition of a grassroots planning effort by VISNs in partnership with local veterans, labor organizations, and Congressional interests to find the best balance of service delivery mechanisms.

In their proposals for approval of new clinics, VISNs were required to submit business plans weighing the value of new "access point" strategies against alternative costs or cost-avoidance. Examples of cost-avoidance are the dollars to be saved by decreased reimbursement for beneficiary travel or the increased cost associated with providing general medical services in a tertiary hospital setting.

Some VISNs are proposing the new clinics be located in existing space in the community to be leased by VA, while others may provide services through a contract with an existing community service provider such as a private group practice.

The expansion of community-based outpatient clinics over the last two years has in part been made possible by savings in other areas. For example, management has been consolidated at 42 VA medical centers that were merged into 20 integrated facilities.