Remarks

Honorable Leo S. Mackay, Jr., Ph.D.

Deputy Secretary

Department of Veterans Affairs

Luncheon with the CARES Commission

Crystal City, Virginia

(1516 words)

April 4, 2003

Rabinowitz/3 April 03; 3pm

I am very pleased to be here today to discuss CARES.

But before I begin discussing the business of CARES, I want to first
offer my heart felt thanks and appreciation to each of you for making
the commitment to be a CARES Commissioner \-- and for playing a vital
role in the shaping of VA's future.

I do not overstate the case when I say that the work you do here will
help chart the future of VA's infrastructure and health care mission.

Together, your role as an objective and independent review body is
critical to the drive to bring VA health care into the 21^st^ century.
And it is a drive that is long overdue.

Over the past decade, VA's record of achievement in medical care has
been so dramatic that we are now confronted with unprecedented demand
for our services.

I don't believe it is altogether inaccurate to say that VA may well have
become a victim of its own success.

I say this as we confront medical care accounts that are strained to the
limit ... medical centers and clinics that are stretched to the breaking
point ... and lists of veterans who (as you have heard this week from
our veterans representatives), in some parts of the country, are waiting
months for a routine appointment, and even longer to see a doctor.

At the same time, VA has an infrastructure that is suited for the
practice of yesterday's medicine, in many places it is in need of
renovation. It is often located in places unresponsive to the needs of
tomorrow's veteran population.

If we are to well position ourselves for tomorrow, we must plan and
prepare today ... **That** is what CARES was built to accomplish.

Simply put, CARES is about realigning for **results**. Results measured
by **greater access** to our care ... **enhanced quality** of care for
veterans ... and a ***right-sized*** infrastructure that will serve them
well.

We have better places to invest our money than spending \$1 million
dollars every day just on maintaining and operating unneeded and
outdated buildings.

Not long ago, GAO recommended -- and VA agrees -- that these funds could
be better spent treating more veterans in more locations.

CARES is designed to make better use of those funds and to reinvest them
to meet significant patient-care needs that challenge the system.

Our first challenge is to **adapt** to a shifting health care
environment whose hallmarks are new technologies and new treatment
philosophies ...

Second, to re-tool an operating framework that was designed and built
decades ago under a markedly different concept of medical care ...

And, third, to meet new veteran demands by becoming more accessible.
Demands seen in migrating population concentrations ... and an aging
veterans constituency that exhibits increasingly specialized and
long-term medical needs.

CARES provides a blueprint for addressing these challenges, and its
progress will be measured against the following yardstick of program
performance.

*Is it good for veterans? Does it contribute to improved health care
delivery? Will it effect a practical result? Does it safeguard the
taxpayers' interest?*

As you conduct your review of the CARES model and plan, please keep
these core questions close at hand. If you can answer *"yes"* to these
questions, then we are serving veterans as we should and CARES is
meeting its intended goals.

CARES is not about *bricks and mortar* ... not about reductions in
service ... and, most certainly, not about process for the sake of
reinventing process.

CARES is about **optimizing health care** .... and making sure that
veterans get the most accessible, highest quality care we can give them
with the resources with which we are entrusted.

At its core, CARES is a reasonable and responsible initiative to help us
set the solid base of operations we must have to move into the 21^st^
century and provide veterans with the first class care they deserve.

**[The Commission's Charge]{.underline}**

You, assembled here in this room, are the *stewards* of CARES. You were
chosen for your expertise, your experience, your wisdom, and, most
importantly, your demonstrated dedication to veterans.

The Secretary and I are confident that all of those characteristics will
serve you well. They will act as your guide as you consider, deliberate,
and debate both the information that forms the foundation of the CARES
process and the decisions within the DRAFT plan that will be submitted
to you on the second of June.

You have been entrusted with performing an independent and objective
review of CARES and with the development of a report with a
recommendation to the Secretary.

Your report is meant to assure that the CARES data is reasonable and
void of any major oversight or flaw. That decisions based upon that data
meet CARES goals, and that input from the many stakeholders who care
deeply for veterans is heard and considered.

This review is not expected to be a rubber stamp. In fact, it is a vital
task, and one that all of us at VA are confident you will perform well.

At the same time, it is important to recognize that CARES is not a
panacea for all of the issues that face VA health care. While the
Department has an obligation to develop solutions to all of its
challenges, it cannot do so comprehensively through the CARES process.

**[CARES Concerns]{.underline}**

You have heard concerns raised about how CARES will affect VA's fourth
mission. To these concerns, I assure you that VA is acting to assure its
preparedness. We are in ongoing dialogue with the Department of Defense
and are fully engaged in our responsibilities, along with several other
federal Departments.

Further, the CARES process considers emergency management concerns and
assumes an 85% capacity to allow for a 15% natural surge in the event of
an emergency.

The Department also retains the authority to contract for care in times
of national emergency, and is constantly in the process of improving its
preparedness responsibilities.

The Secretary and I take the Department's fourth mission seriously and
enter the CARES process fully conscious of protecting our ability to
respond effectively.

I will add to that, and state that underused facilities will not provide
an effective response. Of much more urgent concern is the availability
of physicians and nurses who can provide needed care. This factor is
primary on our agenda as we continue to improve our ability to provide
backup and emergency care effectively.

As you are also aware, there have been aspects of care that have been
left out of this CARES plan. Long-term care, domiciliary care, and
outpatient mental health care were all determined to need more work
before reliable forecasts could be made.

I assure you today, that VA is committed to addressing these components
of care in the near term and incorporating them into its strategic
planning process.

The Department begins CARES with an understanding that its complexity
demands a focus on continuous improvement through study and experience.
As this model gets tested over time, it will be improved.

And as the model is improved, it will be modified and used to update
forecasts, validate planned projects, and assure that the best
information available is used to support planning for capital needs.

While the Department is committed to continuous improvement with regard
to its forecasting capability, it cannot wait on perfection. The needs
of veterans, and the health care system designed to support them, are
too great and too immediate to be afforded that luxury.

As you deliberate the Department's work and hear testimony from its
stakeholders, remember CARES overriding goals and the broad outcomes it
is designed to produce:

CARES will restructure for **results...** **improve access** to care ...
provide **enhanced quality** of care for veterans ... and
***right-size*** VA's infrastructure so that it makes better use of its
resources. We will also address the increasing demand for care among VA
enrollees.

By providing a solid, independent review of our process, and assuring it
meets these goals, the CARES Commission will inaugurate this effort and
provide the baseline for planning for the needs of tomorrow's veterans,
today.

**[Conclusion]{.underline}**

Most certainly, veterans would not be well-served if we were to maintain
the status quo ...

That is, an infrastructure designed to care for World War II-era
veterans, at locations where they lived in the distant past.

We cannot leave this issue to the next administration. That certainly
would have been easier than making the tough decisions CARES portends.
But, these critical issues cannot linger any longer.

Successfully initiating the CARES process is critical to assuring an
efficient and effective veterans health care system into the future. To
ignore the problems CARES seeks to resolve will only delay decisions and
pass the problems of today to tomorrow.

This body was assembled to make sure we begin on this path responsibly
and deliberately, steering a straight and steady course for improvement
of a vital national resource.

As you proceed with your work, know that you do so with my full
confidence and support.

And now in the time remaining, I would be happy to take your questions
...