CARES official: Review is difficult

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In 2003, 16 people were appointed to a federal commission whose feel-good name belied its daunting task.

Members of the Capital Asset Realignment for Enhanced Services, or CARES commission, were chosen by the secretary of the Department of Veterans Affairs to evaluate the VA's medical program _ the largest integrated health-care system in the nation.

Through a systematic review _ including site visits, public hearings and public meetings _ the group's job was to figure out how to best align VA facilities with the moving and changing population of veterans.

The goal was to meet the needs of veterans beyond 2020 while improving efficiency of the system and saving the cash-strapped VA some money. The task included directing resources where they are most needed while preserving the VA's missions and continuing to provide health care to veterans across the country.

Difficult and time-consuming was how one member of the CARES Commission described the process during his visit to Walla Walla.

At a field hearing in town September 2003, CARES commissioner Chad Colley noted that the overhaul is meant to provide the best care possible. But in the shortrun, he said, ``someone's ox may end up in the ditch.''That night, the commission heard 4 hours of testimony from veterans and local officials. Hundreds packed the Jonathan M. Wainwright Memorial Veterans Affairs Medical Center to share their opinions _ mostly against changes to local services.

Walla Walla's hearing was one of 38 conducted across the country as part of the evaluation of VA services.

Colley and other members of the commission were appointed by VA Secretary Anthony Principi to make the final recommendations on how to deliver services.

Their work was expected to be costly. According to the CARES charter, estimated cost of operating the commission is $2.3 million. That includes trips to facilities all over the country.

As part of the process, the CARES commission evaluated the VA's health-care facilities. To ensure consistency in how it looked at each one, the process for evaluating the operations was standardized. Five basic steps were used to gather information on the 21 regional health-care networks, called Veterans Integrated Service Networks.

The commission visited VISN population and market areas, veteran enrollment bases and facilities, among other things.

Members also considered profiles of each VA health-care facility. The profiles covered conditions of buildings and identified vacant or underused space, seismic issues, enhanced-use opportunities, current programs and services offered, employment data, costs, medical school affiliations and research programs.

The research entailed 81 site visits by members of the CARES Commission, the formal hearings and monthly meetings that began February 2003. The work resulted in testimony from 770 witnesses, including 135 members of Congress and seven governors.

Additionally, the commission received more than 212,000 written comments from people testifying around the country.

As part of its recommendation, members of the CARES commission concluded inpatient services at the Jonathan M.

Wainwright Memorial Veterans Affairs Medical Center in Walla Walla should be closed and outpatient services relocated.

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