	VA’s Efforts to Align its Facilities Are Affected by Several Factors and Are Impeded by Limitations in Its Capital-planning Processes

		Facility Alignment Is Challenged by Shifting Veterans’ Populations, Evolving Care Standards, Aging Infrastructure, and Limited Stakeholder Involvement

Geographic shifts in the veterans’ population, changes in health care  delivery, an aging infrastructure, and limited stakeholder involvement  affect VA’s efforts to align its services and real property portfolio to meet  the needs of veterans. For example, there has been a shift over time from  inpatient to outpatient care. This shift will likely result in underutilized  space once used for inpatient care. In such instances, it is often difficult  and costly for VA to modernize, renovate, and retrofit these older  facilities. The historic status of some VA facilities adds to the complexity of  converting or disposing of them. 1.) Limitations in VA’s Capital- planning Processes Impede Its Alignment of Facilities SCIP Process

Two of the planning processes VA uses to align its facilities—VA’s  Strategic Capital Investment Planning (SCIP) and the VA Integrated  Planning (VAIP)—have limitations. VA relies on the SCIP process to plan and prioritize capital projects  system-wide, but SCIP’s limitations—including subjective narratives, long  timeframes, and restricted access to information—undermine VA’s ability  to achieve its goals. 2.) As such, VA routinely asks its facility planners to submit their next year’s  planned project narratives before knowing if their project submissions  from the previous year have been funded. If VA does not address known  limitations with the SCIP process, it will not have reasonable assurance  that SCIP can be used to accurately identify the capital necessary to  address VA’s service and infrastructure gaps. VA concurred with the  recommendation to the extent the limitations were within its control. While  VA has taken some actions, the recommendation remains open. However, the VAIP process’s facility master plans assume all  future growth in services will be provided directly through VA facilities. In our April 2017 report, we recommended that VA assess the value of  the VAIP’s facility master plans as a facility-planning tool, and based on  conclusions from the review, to either (1) discontinue the development of  VAIP’s facility master plans or (2) address the limitations of VAIP’s facility  master plans. VA concurred with the recommendation, and in August  2017, VA noted that it has discontinued its VAIP facility master plans  while VA pursues a national realignment strategy, after which it plans to  adjust its future facility master plans to incorporate pertinent information,  including care in the community realignment opportunities. Key Elements and Challenges Affecting DOD and the Commission in BRAC 2005

		Key Elements That DOD Used to Develop Its 2005 BRAC Recommendations That Could Benefit VA Asset and Infrastructure Review

As Congress evaluates proposed legislation for disposing of or realigning  VA property, it may wish to consider seven elements DOD relied on as it  developed its recommendations for the BRAC Commission. Establish goals for the process. Develop criteria for evaluating closures and realignments. Estimate costs and savings to implement closure and  realignment recommendations. 3.) Establish an organizational structure. Key Challenges Affecting DOD and the Commission in BRAC 2005

We identified two key challenges that affected DOD’s implementation of  BRAC 2005 and would need to be addressed for VA to adopt a BRAC- like process for its asset and infrastructure review. Some transformational-type BRAC recommendations required  sustained senior leadership attention and a high level of  coordination among many stakeholders to complete by the  required date. Large number of actions and interdependent recommendations  complicated the implementation process. The executive staff of the Commission  told us that it was more difficult to assess the costs and the amount of  time for the savings to offset the implementation costs since many of  the recommendations contained multiple interdependent actions, all of  which needed to be reviewed. This is a work of the U.S. government and is not subject to copyright protection in the  United States.
Why GAO Did This Study

VA operates one of the largest health care systems in the United States, utilizing more than 6,000 federally owned and 1,500 leased buildings. DOD has repeatedly applied the BRAC process to reduce the amount of unneeded property that it owns and leases and to save billions of dollars that could be applied to higher priority defense needs.
This statement is based on GAO's April 2017 report related to VA facility alignment ( GAO-17-349 ) and numerous GAO reports related to the BRAC process as summarized in a June 2011 testimony ( GAO-11-704T ) and a March 2012 testimony ( GAO-12-513T ). This statement addresses (1) the factors that affect VA's facility alignment and the extent to which VA's capital-planning process facilitates the alignment of facilities with the veterans' population, and (2) the key elements and challenges affecting DOD and the Commission in BRAC 2005. Detailed information on our scope and methodologies for this work can be found in these published products, cited throughout this testimony.

What GAO Found

Geographic shifts in the veterans' population, changes in health care delivery, aging infrastructure, and limited stakeholder involvement affect the Department of Veterans Affairs' (VA) efforts to align its services and real property portfolio to meet the needs of veterans. For example, a shift over time from inpatient to outpatient care will likely result in underutilized space once used for inpatient care. Further, the historic status of some VA facilities adds to the complexity of converting or disposing of them. In such instances, it is often difficult and costly for VA to modernize, renovate, and retrofit these older facilities.
GAO reported that two of the planning processes VA uses to align its facilities—VA's Strategic Capital Investment Planning (SCIP) and the VA Integrated Planning (VAIP)—have limitations that undermine VA's efforts to achieve its goals. Specifically:
VA relies on the SCIP process to plan and prioritize capital projects, but VA routinely asks its facility planners to submit their next year's planned project narratives before knowing if their previous submissions have been funded. The overlapping budget cycle, which is outside of VA's control, combined with other SCIP limitations—including subjective narratives, long time frames, and restricted access to information—make it difficult for VA to rely on SCIP to accurately identify the capital necessary to address its service and infrastructure gaps. VA concurred that it needs to address SCIP limitations that are within its control, as GAO recommended; VA has made some progress in implementing the recommendation has made some progress in implementing the recommendation.\
The VAIP process is estimated to cost $108 million and to produce market-level service delivery plans and facility master plans. However, the VAIP master plans incorrectly assume that all future growth in services will be provided directly through VA facilities without considering alternatives, such as purchasing care from the community. GAO recommended that VA consider discontinuing the VAIP facility master plans pending an assessment of their value as a facility-planning tool. VA agreed with the recommendation and is implementing it while pursuing a national realignment strategy..
Key elements of the Department of Defense's (DOD) 2005 Base Realignment and Closure (BRAC) process could benefit VA's asset and infrastructure review. The key elements included: (1) establishing goals for the process, (2) developing criteria for evaluating closures and realignments, and (3) establishing an organizational structure to develop closure and realignment options. GAO identified key challenges that affected DOD's implementation of BRAC 2005 and the results achieved; these challenges would need to be addressed if VA is to successfully apply the process. These challenges included: (1) large, complex recommendations required sustained senior leadership's attention and a high level of coordination among many stakeholders, and (2) the large number of actions that depend on each other for successful implementation.

What GAO Recommends

In the April 2017 report, GAO made recommendations related to capital planning and stakeholder involvement. VA concurred with the recommendations to the extent that they were within its control and has started making improvements.