VA Health Care Facilities: Leveraging Partnerships to Meet Capital Investment Needs

What the GAO found

The Department of Veterans Affairs (VA) provides health care services to approximately 9 million veterans at its 171 medical centers and more than 1,100 outpatient facilities. VA has long faced challenges in meeting its urgent infrastructure demands. Under a pilot partnership program, VA is authorized to accept up to five donations of real property, such as buildings, facility construction or facility improvements, from non-federal entities before the end of 2026. It is also authorized to use certain appropriate funds to assist the Donor Entity in financing, designing, or constructing a facility under its Gift. Through this program, VA has received a donation of real estate – an outpatient care center in Omaha, NE – and a second – an inpatient hospital in Tulsa, OK – is planned. The Omaha project provided lessons learned regarding the effectiveness of this approach, such as the use of an electronic design review process, that could benefit future AV construction projects. We have identified several relevant considerations in seeking supplemental grant partnerships, such as challenges related to restrictions on eligible projects and the large grant required.

Completion of Department of Veterans Affairs (VA) Ambulatory Care Center in Omaha, NE, and handover of planned inpatient facility in Tulsa, OK

In 2010, VA and the Department of Defense (DOD) integrated two medical facilities in North Chicago, IL into the Captain James A. Lovell Federal Health Care Center as part of a 5-year demonstration project. The Lovell Center aimed to create a national model of joint health care delivery. There were also plans to inform decision makers about the effectiveness of this model of care if replicated in other VA and DOD sites. However, the departments determined that evaluations of the Lovell Center integration did not reveal that shared facilities offered advantages over a “joint venture” approach. In a joint venture, departments share space but manage their operations separately. In part because of the challenges of converting Lovell Center into a joint venture, in 2016 VA and DOD jointly recommended that Lovell Center continue to be operated as an integrated facility with periodic reviews and implementation recommended improvements.

Why GAO Did This Study

VA administers one of the largest health care systems in the country. VA estimates that completing all of its priority infrastructure projects would cost approximately $63 billion to $76 billion as of fiscal year 2021. GAO reported that VA has faced instances of cost overruns and delays in construction of certain facilities. VA has leveraged partnerships to meet its capital needs, including a grantmaking partnership with the private sector (known as CHIP-IN) and an integrated health care facility with the DOD.

This statement discusses (1) the VA Donation Partnership Pilot Program, identified efficiencies, and relevant considerations for seeking additional donation partnerships, and (2) the integration of VA and DOD of their care facilities. health in North Chicago, IL and agency observations on integration. This statement is based on previous work by the GAO.