VHA

VISION

2020

Charting a New Direction...

April 2003

DEPARTMENT OF VETERANS AFFAIRS

Veterans Health Administration

FOREWORD

Profound changes have occurred in the Department of Veterans Affairs (VA) health care system and even 

more change is expected as we continue to enhance quality, increase access, improve service satisfaction 

and optimize patient functioning. The Veterans Health Administration's (VHA) transformation has led to 

a coordinated continuum of care and a system characterized by achievement of performance outcomes 

that improve services to veterans. For all 18 key health care indicators, from diabetes care to cancer 

screening and immunizations, we have exceeded the performance of private sector and Medicare 

providers. 

We will continue to develop our national, integrated health care delivery system. The future system will 

require VHA components to function together and in concert with public and private health care facilities 

to meet the health care needs of the enrolled veteran population and to minimize duplication of services. 

As we chart a new direction, this system will continue to promote efficiency, assure high quality care, and 

provide optimal access for the veteran population. We will achieve a level of quality and access that sets 

a national standard of excellence for the health care industry. 

VHA Vision 2020 describes our achievements and discusses the key strategies that will enable us to 

continue to provide comprehensive, first-class health care to the nation’s veterans and achieve our goals 

for research, education and emergency preparedness in the coming years. 

Robert H. Roswell, M.D.

Under Secretary for Health
Department of Veterans Affairs 

Veterans Health Administration

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VHA Vision 2020 iii

CONTENTS

FOREWORD ............................................................................................................. i 

CONTENTS .............................................................................................................. iii

INTRODUCTION ...................................................................................................... v

CHAPTER 1 – CHARTING A NEW DIRECTION

VHA LEADERSHIP: THE NEXT GENERATION .............................................................. 1

TURNING INFORMATION INTO INSIGHT .................................................................... 2

REFOCUSING ON CORE VETERANS ................................................................................ 3

IMPLEMENTING CARES.................................................................................................... 6

CHAPTER 2 – STRATEGIC VISION

FUTURE DIRECTION AND CHALLENGES ........................................................................ 9

ELEMENTS OF VHA’S STRATEGIC VISION...................................................................... 10

VHA’S STRATEGIC PLAN ................................................................................................... 11

CHAPTER 3 – FOCUS ON VETERANS HEALTH CARE

ACCESS ................................................................................................................................. 15

SPECIAL EMPHASIS PROGRAMS (SEP) ............................................................................ 18

GERIATRICS AND LONG TERM CARE ............................................................................. 23

PATIENT SAFETY ................................................................................................................. 25

QUALITY INDICATORS ...................................................................................................... 26

VETERAN SATISFACTION .................................................................................................. 29

AWARDS FOR QUALITY ..................................................................................................... 31

ACCREDITATION ................................................................................................................ 33

RESEARCH ........................................................................................................................... 34

PROFESSIONAL EDUCATION AND TRAINING ............................................................... 36

DISASTER RESPONSE ......................................................................................................... 38

CHAPTER 4 – SERVICE EFFICIENCY AND EXCELLENCE

INFORMATION TECHNOLOGY ........................................................................................ 41

PROCUREMENT .................................................................................................................. 43

COMPETITIVE SOURCING ................................................................................................ 44

WORKFORCE PLANNING .................................................................................................. 45 

GLOSSARY OF ACRONYMS................................................................................................ 49
Department of Veterans Affairs 

Veterans Health Administration

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VHA Vision 2020 v

INTRODUCTION

The Department of Veterans Affairs (VA) has responsibility for providing federal benefits to veterans and 

their dependents. Headed by the Secretary of Veterans Affairs, VA is the second largest of the 15 Cabinet 

Departments and operates nationwide programs of health care, income security benefits, and national 

cemeteries. 

VA directly touches the lives of millions of veterans every day through its three administrations. 

 Veterans Health Administration (VHA), with 162 VA hospitals nationwide, operates the 

largest health care system in the United States. VA medical facilities operate within a Veterans 

Integrated Service Network (VISN), working together to provide efficient, accessible health care 

to veterans. VHA also conducts research and education, and provides emergency medical 

preparedness and disaster response. 

 Veterans Benefits Administration (VBA) provides benefits and services to the veteran 

population through 57 VA regional offices. Some of the benefits and services provided by VBA 

to veterans and their dependents include compensation and pension, education, loan guaranty, and 

insurance.

 National Cemetery Administration (NCA) provides burial benefits to veterans and eligible 

dependents. The delivery of these benefits involves managing 120 National Cemeteries 

nationwide, administering the State Cemetery Grants Program that complements the National 

Cemeteries network, providing grave markers worldwide, and Presidential Memorial Certificates 

to next of kin of deceased veterans.

Perhaps the most visible of all VA benefits and 

services is health care. From 54 hospitals in 1930, 

VA's health care system has grown to 162 

hospitals, with at least one in each of the 48 

contiguous states, Puerto Rico and the District of 

Columbia. During the last five years, VHA has put 

its health care facilities under 21 networks, which 

provide more medical services to more veterans 

and family members than at any time during VA's 

long history. 

The Under Secretary for Health in VA heads the 

VHA and is responsible for managing the nation's 

largest integrated health care system. With a 

medical care budget of more than $28 billion, VHA employs more than 180,000 health care professionals 

Veterans Health Administration Veterans Health Administration

21 Veterans Integrated Service Networks 21 Veterans Integrated Service Networks

I J 2002

 

 

N ANUARY

WERE INTEGRATED AND

RENAMED

VISN 13 14

VISN 23

S AND
Department of Veterans Affairs 

Veterans Health Administration

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at 162 hospitals, more than 850 community and facility-based clinics, 137 nursing homes, 43 

domiciliaries, 206 readjustment counseling centers, and various other facilities throughout the country. 

VHA health care facilities provide a broad spectrum of medical, surgical and rehabilitative care. In 

addition to its medical care mission, the veterans health care system is the nation's largest provider of 

graduate medical education and a major contributor to medical and scientific research. 

Who We Are 

Office Of Under Secretary for Health 
VHA Vision 2020 vii

Who We Serve 

Beginning with our Nation’s struggle for freedom more than two centuries ago, approximately 42 million 

men and women have served our country during wartime. Of the 25.6 million living veterans, most (75 

percent) served during a war or an official period of hostility. 

Veteran Population by Period of Service

3.6 3.7

6.5

4.8

8.3

0

2

4

6

8

10

Peacetime Gulf War

Era

Korean

Conflict

World

War II

Vietnam

Era

Period of Service

Millions

Over 6.2 million enrolled veterans look to VHA for health care services and more than 4.3 million 

veterans received care in FY 2002. 

Source: VetPop 2001 
Department of Veterans Affairs

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VHA Vision 2020 1

CHAPTER 1

CHARTING A NEW DIRECTION

 VHA LEADERSHIP: THE NEXT GENERATION

 TURNING INFORMATION INTO INSIGHT

 REFOCUSING ON CORE VETERANS

 IMPLEMENTING CARES

VHA LEADERSHIP: THE NEXT GENERATION

In May 2002, the Under Secretary for Health reorganized Veterans Health Administration (VHA) 

headquarters. Under this reorganization, there is increased centralization and alignment, greater 

uniformity, increased interaction with other federal agencies, particularly the Department of Health and 

Human Services (HHS), and centralization of all business functions. The reorganization created three 

Deputy Under Secretary positions to oversee Health, Health Policy Coordination, and Operations and 

Management. Previously, VHA had only one Deputy Under Secretary overseeing all of VHA. 

To enhance our ability to identify best practices and make our system a more uniform 

national health care system for veterans, we will be restructuring the function of VHA’s 

National Leadership Board, with focus on corporate performance across the VISNs. 

Robert H. Roswell, MD, Under Secretary for Health 

In July 2002, following recommendations by a task force charged to examine VHA’s governance 

structure, the Under Secretary for Health implemented a new system to improve VHA’s management and 

leadership functions. The task force recommended reconfiguration of the existing National Leadership 

Board (NLB). This Board now serves in an advisory capacity to its Chair, the Under Secretary for Health, 

having an active and extensive role in determining VHA policy, strategy, and oversight of organizational 

performance. The NLB also serves as a forum to share responsibility for VHA governance, coordinates 

and oversees the activities of VHA, ensures alignment with VA priorities and goals, develops and 

disseminates information both internal and external to VHA, and facilitates the inclusion of diverse views 

of organizational components within VHA. 

The NLB is comprised of key leaders within VHA, including all Network Directors, all Chief Officers, 

and other senior leaders designated by the Under Secretary for Health. In addition, several senior leaders 

within VA are non-voting members of the NLB, including six Assistant Secretaries, General Counsel, and 

the Under Secretaries for the National Cemetery Administration and Veterans Benefits Administration.
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The NLB consists of an Executive Committee and six functional committees (Strategic Planning, Health 

Systems, Finance, Informatics and Data Management, Communications, and Human Resources). The 

Executive Committee provides leadership to the VHA governance process and operation of the NLB by 

ensuring effective process management, determining the NLB agenda, assessing NLB performance, 

instituting improvements, and enhancing the focus and efficiency of the NLB. The remaining six 

committees each have functional areas of responsibility including: 

 Recommending and formulating policy, strategic direction and planning; 

 Identifying legislative proposals and initiatives; 

 Providing organizational performance oversight; 

 Ensuring effective deployment and communication of policies, plans, and strategies; 

 Identifying the educational and developmental needs of committee and/or Board members; 

 Developing performance and quality measures for functional areas of responsibility; 

 Ensuring that all four VA missions are appropriately considered; and 

 Ensuring alignment of VHA and VA. 

The full NLB and its committees meet monthly to coordinate emerging issues and develop ongoing policy 

and planning initiatives to govern VHA’s extensive health care system.

TURNING INFORMATION INTO INSIGHT

Turning Information Into Insight is the theme of VHA’s efforts to provide decision makers with 

insightful, accurate data to support planning, policy, and budget decisions. The centerpiece of this effort 

was the development of an innovative health care actuarial model to project utilization and associated 

expenditures for the enrolled veteran population. 

VA’s budgeting, policymaking, and capital asset realignment initiative have been 

transformed by the quality of the data provided by the VHA Health Care Demand Model 

and its ability to analyze scenarios and proposed health care policies. 

Anthony J. Principi, Secretary 
VHA Vision 2020 3

The VHA Health Care Demand Model was developed through a public-private partnership, and is 

based on private sector benchmarks that have been risk adjusted for the characteristics of the VHA 

enrollee population and on actual VHA unit costs. The model is also adjusted for the degree of health care 

management in VHA versus the community standard and for veterans’ degree of reliance on VHA versus 

other providers. 

The assumptions and methodologies have been subjected to rigorous review, and the model has been 

enhanced each year by improving the methodology and integrating new data sources and planning 

models. The model was also fine-tuned based on knowledge gained from actual-to-projected analyses. 

The model is readily adaptable to changes in the underlying assumptions. 

The VHA Health Care Demand Model projects veteran enrollment, utilization, and expenditures, 

including detailed projections for approximately 50 health care service categories. These forecasts, along 

with data on health outcomes, access, system capacity, quality, and patient satisfaction, are the foundation 

of VHA’s efforts with Turning Information Into Insight. 

The demand model has revolutionized VHA’s budget, planning, and policy-making processes. In the past, 

VHA budgets (and most federal budgets) were based on historical expenditures that were adjusted for 

inflation and then increased based on proposed new initiatives. Using the demand model, VHA developed 

its FY 2003 and 2004 budgets based on actuarial forecasts of expenditures. This transition from a 

historical to an actuarial model as the basis of budget formulation represents not only a significant 

innovation for VHA, but for the federal government. 

The model has also become integral to planning and policy development. During the development of the 

FY 2003 and FY 2004 budgets, VHA compared the actuarial expenditure projections with expected 

resources and identified significant gaps between veteran demand for VA health care and the resources to 

pay for that care. VHA then used the model to test the impact of proposed policy options, such as 

requiring copayments and limiting enrollment, on expenditures and revenue. Data from the model were 

also used to analyze the impact of these policies on veteran access to care and VHA’s performance 

indicators. The proposed health care policies in VA’s FY 2004 President’s Budget, which are discussed in 

the next section, were developed through this process. 

The model also supports local, regional, and national strategic planning by providing demand projections 

and scenario analyses for VHA’s nationwide capital asset evaluation that is assessing the optimal 

alignment of VHA resources and service sites. 

REFOCUSING ON CORE VETERANS

The recent changes in VA’s health care system have been profound, transforming it to a more efficient, 

effective and accessible system. VA is providing better care to our nation’s veterans, closer to their homes 

and using the latest technology, while continuing to place a strong emphasis on comprehensive specialty 
Department of Veterans Affairs

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care. However, VA has been unable to provide all enrolled veterans with timely access to health care 

services because of the tremendous growth in the number of veterans seeking VA health care. It is also 

clear that continued workload growth of the magnitude seen in recent years would be unsustainable in the 

current federal budget climate. 

When we have veterans who are entitled to care, who aren’t getting the care as quickly 

as we would like to provide it, then my obligation is to do everything I possibly can to 

free up any resources that will help address that issue. 

Robert H. Roswell, MD, Under Secretary for Health 

Therefore, in both the FY 2003 and FY 2004 budgets, VA proposed health care policies to address the 

gap between full demand and anticipated resource availability through a combination of enrollment and 

benefit policy changes and increased collections. In FY 2004, VA’s $27.5 billion budget request, which 

represents an unprecedented 7.7 percent increase over FY 2003’s expected level, also includes health care 

policies designed to balance demand with available resources. 

In FY 2002, Secretary Principi took steps to assure that VA would afford priority access to veterans with 

service-connected disabilities. VA is refocusing attention on its core medical care mission of providing 

needed services to veterans with service-connected disabilities, lower income veterans, and those needing 

specialized care. VA will continue open enrollment for service-connected and low income veterans in 

Priorities 1-7; however, VA has suspended enrollment for Priority 8 veterans who were not enrolled in 

VA prior to or on January 17, 2003. The suspension of Priority 8 enrollment is the first in a series of 

policies designed to better align veteran demand and VA’s health care resources. Although an estimated 

164,000 veterans would be impacted in FY 2003, the continuation of this policy has a profound impact on 

future demand and budget requirements. This policy results in 520,000 fewer enrollees and an $800 

million cost avoidance by FY 2005, growing to 1.1 million fewer enrollees and a $2.8 billion cost 

avoidance by FY 2012 were Priority 8 enrollment suspension to continue. 

This action alone does not address the remaining budget requirements to provide health care for VA’s 

veterans in Priorities 1-7, who are expected to cost, on average, an additional $2.1 billion each year, 

reaching a total annual budget of over $43 billion by FY 2012. In addition, $3.4 billion will be required 

by FY 2012 to support the care for those currently enrolled Priority 8 veterans unaffected by this 

enrollment suspension. Chart 1.1 contains a description of each of the priority groups.
VHA Vision 2020 5

Chart 1.1 VA Health Care Enrollment Priority Groups 

Enrollment Priority 1 

• Veterans with service-connected disabilities rated 50% or more 

disabling 

Enrollment Priority 2

• Veterans with service-connected disabilities rated 30% or 40% 

disabling 

Enrollment Priority 3 

• Veterans who are former POWs 

• Veterans awarded the Purple Heart 

• Veterans whose discharge was for a disability that was incurred or 

aggravated in the line of duty 

• Veterans with service-connected disabilities rated 10% or 20% 

disabling 

• Veterans awarded special eligibility classification under Title 38, 

U.S.C., Section 1151, "benefits for individuals disabled by treatment 

or vocational rehabilitation"

Enrollment Priority 4

• Veterans who are receiving aid and attendance or housebound 

benefits 

• Veterans who have been determined by VA to be catastrophically 

disabled

Enrollment Priority 5

• Non-service-connected veterans and non-compensable serviceconnected veterans rated 0% disabled whose annual income and 

net worth are below the established VA Means Test thresholds 

• Veterans receiving VA pension benefits 

• Veterans eligible for Medicaid benefits

Enrollment Priority 6

• World War I veterans 

• Mexican Border War veterans 

• Veterans solely seeking care for disorders associated with:

 exposure to herbicides while serving in Vietnam; or

 exposure to ionizing radiation during atmospheric testing or 

during the occupation of Hiroshima and Nagasaki; or 

 for disorders associated with service in the Gulf War; 

 for any illness associated with service in combat in a war after 

the Gulf War or during a period of hostility after November 11, 

1998; or 

 Compensable 0% service-connected veterans

Enrollment Priority 7

Veterans with income and/or net worth above the VA Means Test threshold 

and income below the HUD geographic index who agree to pay specified 

co-payments 

• Subpriority a: Non-compensable 0% service-connected veterans 

who were enrolled in the VA Health Care System on a specified date 

and who have remained enrolled since that date 

• Subpriority c: Non-service-connected veterans who were enrolled in 

the VA Health Care System on a specified date and who have 

remained enrolled since that date 

• Subpriority e: Non-compensable 0% service-connected veterans not 

included in Subpriority a above 

• Subpriority g: Non-service-connected veterans not included in 

Subpriority c above

Enrollment Priority 8

Veterans with income and/or net worth above the VA Means Test threshold 

and the HUD geographic index who agree to pay specified copayments 

• Subpriority a: Non-compensable 0% service-connected veterans 

enrolled as of January 16, 2003 and who have remained enrolled 

since that date 

• Subpriority c: Non-service-connected veterans enrolled as of 

January 16, 2003 and who have remained enrolled since that date 

• Subpriority e: Non-compensable 0% service-connected veterans 

applying for enrollment after January 16, 2003 

• Subpriority g: Non-service-connected veterans applying for 

enrollment after January 16, 2003

Additional Information: 

The term service-connected means, with respect to a condition or 

disability that VA has determined that the condition or disability was 

incurred in or aggravated by military service. Some veterans may have 

to agree to pay copayments to be placed in certain priority groups.

Although VA expects to have 7 million veterans enrolled by the end of FY 2003, there are another 17.5 

million veterans who have yet to seek care from VA. There are approximately 6 million veterans age 65 

and over who are not enrolled. These veterans, because of their age, are high consumers of health care 

and are particularly attracted to VA for its pharmaceutical benefits. Suspending the enrollment of Priority 

8 veterans who have higher incomes and are more likely to have insurance and other care choices, allows 

VA to continue efforts towards eliminating waiting lists and longer waiting times to benefit those who 

need VA most. 
Department of Veterans Affairs

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VHA is looking for further management efficiencies and increasing interagency coordination with 

Department of Defense (DoD) and HHS. To that end, VA has reached a landmark agreement with HHS to 

establish a Medicare+Choice (M+C) employer group plan through which VA will provide nonenrolled 

Priority Group 8 veterans aged 65 or older who cannot enroll in VA’s health care system, the option of 

receiving their Medicare benefit through VA. This agreement is fully supported by the White House, the 

Office of Management and Budget (OMB), and the Centers for Medicare and Medicaid Services (CMS). 

The plan calls for VA to contract with an M+C organization to offer a special M+C plan called 

VA+Choice. VA would define the benefits under VA+Choice, and enrollees in VA+Choice would be 

able to receive Medicare benefits through VA facilities and providers. At a minimum, the plan will 

include the benefits required under M+C, including all Medicare Parts A and B services. VA will 

determine any additional benefits it wishes the M+C organization to offer and member cost sharing for 

those benefits. The VA+Choice plan will become effective later in 2003 as details are finalized between 

VA and HHS. 

HHS is happy to join the Department of Veterans Affairs in developing this new option 

for veterans who might otherwise be unable to obtain health care through the VA. This 

is a creative marriage of our federal health programs to serve our veterans efficiently 

and effectively. 

Tommy G. Thompson, Secretary, Department of Health and Human Services 

IMPLEMENTING CARES

VA operates and maintains more than 4,700 buildings and 18,000 acres of land. Some of the buildings 

and land VA owns are not well suited to veterans’ health care needs. The cost to maintain and operate VA 

health care facilities that cannot provide efficient and accessible services diminishes resources that could 

otherwise be used to provide better care in more appropriate settings. VA developed CARES – Capital 

Asset Realignment for Enhanced Services – in response to a March 1999 General Accounting Office 

(GAO) report that concluded VA could significantly reduce the amount of funds necessary to operate and 

maintain its capital infrastructure by developing and implementing market-based plans for restructuring 

assets and apply the savings to health care for veterans. CARES will improve quality as measured by 

access and improve the delivery of health care in a cost-effective manner, while maximizing positive 

opportunities and minimizing any adverse impacts on staffing, communities, and other VA missions. 

Through CARES, VA is realigning and enhancing its health care system to meet veterans’ needs 

effectively and efficiently, now and in the future.
VHA Vision 2020 7

As VA begins the process of making CARES decisions in communities across the country, it 

is important to remember the program’s objectives: more effective use of VA resources to 

provide more care, to more veterans, in places where veterans need that care most. 

Leo S. Mackay, Jr., PhD, Deputy Secretary

The CARES process will strategically address the future infrastructure, i.e., beds, outpatient capacity, and 

other services, to meet the health care needs of veterans including emergency backup needs. VA 

recognizes there is a cost for maintaining readiness and must balance this cost with providing quality and 

timely health care for veterans. Preparing staff and facilities for emergency situations also preserves the 

department’s ability to care for veterans. VA currently has a system in place that develops periodic 

estimates of the number of beds that can be made available to fulfill its Department of Defense (DoD) 

backup requirements. The planning process incorporates network-based data, strategic health care 

planning input, and cooperative participation toward achieving the stated vision and goals of the CARES 

program. In an effort to save federal dollars, this process also seeks to improve the sharing of facilities 

and services between VA and DoD. CARES planning will ensure that enhanced use opportunities are 

addressed in a comprehensive manner and also identify opportunities for converting vacant space into 

alternative uses or disposing of excess assets in the most effective manner. 

The pilot study for CARES was completed in 2001 for Network 12 (Chicago, Wisconsin, and the Upper 

Peninsula of Michigan). VA is now conducting CARES in the remaining 20 Networks. A draft National 

CARES Plan will be published for public comment and evaluated by an independent CARES 

Commission appointed by the Secretary of Veterans Affairs. The independent commission will hold 

hearings and solicit stakeholder comments from Veterans Service Organizations (VSOs), medical school 

affiliates, government entities and local community groups. Options will then be developed based on 

consistent, objective criteria to ensure a cost-effective health care system that best serves America's 

veterans today and into 2022. Following this process, the Commission will forward its recommendations 

to the Secretary, who will make his decision on the National CARES Plan in late 2003. The CARES 

Commission will respond as “Stewards of America’s Resources” to any final stakeholders concerns or 

Congressional inquiries. 

This comprehensive analysis and restructuring of VA health care will change only the way VA delivers 

care – health care services will not be reduced. The goal of CARES is to enhance outpatient and inpatient 

care, as well as special programs such as spinal cord injury, blind rehabilitation and seriously mentally ill, 

and long-term care. Once CARES is completed, VA will have a national plan for directing resources 

where they are most needed; preserving VA’s missions and special services; and, at the same time, 

continuing to provide high quality care to more veterans in more locations. CARES is not a one-time 

process; the initiatives and plans identified will be validated and reassessed to ensure they reflect current 

VA policies. 
Department of Veterans Affairs

Veterans Health Administration

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VHA Vision 2020 9

CHAPTER 2

STRATEGIC VISION

 FUTURE DIRECTION AND CHALLENGES

 ELEMENTS OF VHA’S STRATEGIC VISION

 VHA’S STRATEGIC PLAN

FUTURE DIRECTION AND CHALLENGES

Health care is remaking itself. There are powerful societal, demographic, and industry-wide forces at 

work. In the 20th century, bricks and mortar constituted the basic infrastructure of the health care delivery 

system. The Institute of Medicine’s report, Crossing the Quality Chasm: A New Health System for the 

21st Century (2001), called for fundamental changes in a troubled and ailing health care system. The 

report defined “the quality chasm” as the gap between what scientific evidence has proven is best for the 

patient and the care the patient actually receives. This report called for changes at four levels – patient 

experiences; small practice settings or microsystems that deliver care (e.g., provider groups, 

multidisciplinary teams); health care organizations (e.g., hospitals); and the health care environment (e.g., 

payment policies, legal liability, regulatory processes). These changes require substantial improvements 

built around the core need for health care to be safe, effective, patient-centered, timely, efficient, and 

equitable. 

The changes in the VA health care system have been profound, and the benefits have 

been recognized both inside and outside the Department. We provide better care to our 

nation’s veterans, closer to their homes, and using the latest technology. However, we 

also face significant challenges, which we must meet to assure that our nation 

maintains a comprehensive, integrated health care system for all veterans who choose 

to come to VA for their care. 

Robert H. Roswell, MD, Under Secretary for Health

VA health care is now far more patient-centered and is increasingly the benchmark for health care 

management and delivery. VHA is the benchmark for all 18 clinical performance indicators critical to the 

care of veterans and directly comparable externally. The results of VA’s hard work and culture of quality 

measurement were further validated by the Institute of Medicine’s Leadership by Example (2002) report, 

which praised VA’s use of performance measures to improve quality in clinical disciplines and in 

ambulatory, hospital and long-term care, stating that VA’s integrated health care system is one of the best 

in the nation. 
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Accountability for improvement and achievement is important in VA. Dynamic performance contracts 

between Chief Officers/Network Directors and the Under Secretary for Health are the foundation of VA’s 

quality improvements. These performance contracts provide a basis for focusing and evaluating the work 

of all VHA employees throughout the system. Performance measures have led to consistent application of 

clinical guidelines and have supported improvements in quality and in each of the other strategic goal 

areas.

By the end of 2004, VHA plans to increase its medical work force of 180,000 by more than 800 doctors 

and 2,500 nurses. With a nationwide nursing shortage, an aging workforce and non-competitive wages, 

the recruitment effort will be challenging, but VHA plans to move aggressively. VHA management is 

working on a comprehensive workforce plan, including proposed legislation to improve physicians’ pay 

and benefits that will be submitted to Congress in the spring. The bill would base physician salaries on 

regional market conditions. 

Boosting physician recruitment and enrollment and benefit policy changes will not be enough to eliminate 

the wait list. VHA also is developing a care coordination program to provide home care to more 

patients, which would allow practitioners to manage more patients in settings appropriate to their 

condition and desired by the patient. This new program will eliminate the need for frequent visits by 

patients, as care will be moved to the home and to the workplace, allowing patients to manage care 

themselves. Interactive sessions via the Internet, telephone lines, and telemedicine units will help 

physicians determine whether complications have developed and, if so, arrange for care when needed. 

ELEMENTS OF VHA’S STRATEGIC VISION

In recent years, VHA has emerged as a well-respected, benchmark-setting leader in health care. However, 

we have a professional obligation to not only maintain that excellence but build upon it to address the 

ever-changing challenges to provide the right services to veterans, at the right time, and in the right place. 

To guide those decisions, and to deliver an integrated health care system in the 21st Century, VHA has 

identified a new vision for the future. As VHA focuses on our role in the future of health care, we see an 

organization that will: 

 Be a patient-centered health care system for veterans; 

 Provide comprehensive services to an expanding patient base; 

 Be a fully integrated health care system providing consistent, uniform, and predictable care 

across the nation; 

 Promote a diversified funding base; 

 Serve as a major component of national emergency response; 
VHA Vision 2020 11

 Lead in understanding and providing services that are uniquely related to veterans’ health; 

 Provide continuously improving, cost-effective care through a dedicated, well-qualified 

staff; 

 Be the leader in the use of health information technology; 

 Focus on core service delivery; 

 Coordinate publicly funded health care for the benefit of veterans; 

 Be a leader in expanding the evidence base for health care and translating it into changes in 

delivery; 

 Maintain a prominent role in health care professional education; and 

 Practice effective population health care for enrolled veterans particularly those with 

special needs. 

VHA’S STRATEGIC PLAN

To achieve our strategic vision, VHA’s National Leadership Board (NLB), through the Strategic Planning 

Committee (SPC), developed a comprehensive framework for a new strategic direction. A new VHA 

Strategic Plan outlines the steps we will take and the milestones of this new strategic direction, and 

aligns VHA’s Goals and Objectives with those of the Department of Veterans Affairs. To complete the 

Strategic Plan, I have, along with the Secretary, endorsed a set of 30 specific Strategies to achieve our 

Goals and Objectives that will be the focus of our efforts, resources, and initiatives in the months and 

years ahead (see Chart 2.1). 

During the past few years, VHA has witnessed unprecedented growth in patient demand that has created 

new challenges and the need to operate more efficiently and effectively. As a system, we have responded 

to these challenges in creative and innovative ways which have resulted in improving clinical outcomes 

and access to care, maintaining reasonable wait times in the face of increased patient demand for services, 

enhancing patient satisfaction, and reducing costs. Clearly the road ahead will find us facing new 

challenges in our quest to provide more and better services to a growing number of veterans. The VHA 

Strategic Plan will focus our efforts, creating solutions to these challenges, guiding decision-making, and 

showing us the way to be the provider of choice for America’s veterans and a health system unparalleled 

in the industry in offering outstanding clinical care, research advancements, and educational opportunities 

for health care professionals. 
Department of Veterans Affairs 

Veterans Health Administration

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Chart 2.1 VHA Strategic Plan 2003-2008 

VA STRATEGIC GOALS VHA GOALS VHA OBJECTIVES VHA STRATEGIES 

 1. Restore the capability of 

veterans with disabilities to the 

greatest extent possible and 

improve the quality of their lives 

and that of their families. 

 1. Maximize the physical, mental, and 

social functioning of veterans with 

disabilities and be recognized as a 

leader in the provision of specialized 

health care services. (VA Objective 1.1) 

 1. Maximize the independent 

functioning of veterans in the least 

restrictive setting. 

( 1) Improve and enhance home care 

services and develop an assisted living 

strategy. 

( 2) Promote the use of care 

management to facilitate care in the 

least restrictive and most efficient 

setting. 

 2. Provide coordinated, 

comprehensive, and integrated care to 

promote health and improve patient 

functioning. 

( 3) Reduce variability of health 

outcomes by providing for a more 

consistent delivery of services. 

 2. Ensure a smooth transition 

for veterans from active military 

service to civilian life. 

 2. Ease the reentry of new veterans 

into civilian life by increasing awareness 

of, access to, and use of VA health 

care, benefits and services. (VA 

Objective 2.1)

 3. Optimize the use of health care 

information and technology for the 

benefit of the veteran. 

( 4) Accelerate development of Health 

Data Repository, HealtheVet, and 

telehealth initiatives. 

 3. Honor and serve veterans in 

life and memorialize them in 

death for their sacrifices on 

behalf of the Nation. 

 3. Provide high quality, reliable, 

accessible, timely and efficient health 

care that maximizes the health and 

functional status for all enrolled 

veterans, with special focus on veterans 

with service-connected conditions, 

those unable to defray the cost, and 

those statutorily eligible for care. (VA 

Objective 3.1) 

 4. Increase provider and veterans’ 

knowledge of the impact of military 

service on health. 

( 5) Increase collaboration between 

VBA, VHA, and DoD during the military 

discharge process. 

( 6) Collaborate with DoD to develop a 

complete lifelong health record for 

veterans. 

( 7) Collaborate with VBA to invigorate 

and update the Transitional Assistance 

Program. 

( 8) Intensify efforts to implement 

Veterans' Health Initiative, including fully 

incorporating each veteran's military 

history and potential consequences of 

service into the Computerized Patient 

Record System. 

 5. Continuously improve the quality 

and safety of health care for veterans to 

be the benchmark for health care 

outcomes. 

( 9) Be a leader in the advancement of 

knowledge and practice of quality and 

patient safety initiatives to include: (a) 

the use of preventive medicine practices 

and guidelines for chronic disease 

management; (b) increasing the use of 

validated standardized processes such 

as increasing the use of automated 

systems to reduce the occurrence of 

adverse events; and (c) developing a 

culture of safety where reporting of close 

calls and adverse events results in the 

development and implementation of 

corrective actions that prevent harm to 

patients while under our care. 

 6. Improve patients’ satisfaction with 

their VA health care. 

(10) Implement a "service-recovery" 

program. 

(11) Standardize patient satisfaction 

surveys with real time results. 

 7. Improve access, convenience, and 

timeliness of VA health care services. 

(12) Provide incentives for ongoing, 

continuous healthcare system redesigns 

to streamline work, and to analyze, 

identify, and promulgate improved 

health care practices. 

(13) Collaborate with public and private 

organizations to reduce redundancies 

and fill gaps in services to veterans. 

 8. Create a health care environment 

characterized by patient-centered 

services where individual health care 

decisions are made on the basis of 

current medical knowledge, consistent 

with patients’ informed preferences and 

needs. 

(14) Implement initiatives to support 

shared decision-making and patient 

empowerment. 
VHA Vision 2020 13

VA STRATEGIC GOALS VHA GOALS VHA OBJECTIVES VHA STRATEGIES 

4. Contribute to the public health, 

emergency management, socioeconomic well-being, and history 

of the Nation. 

4. Improve the Nation’s preparedness for 

response to war, terrorism, national 

emergencies, and natural disasters by 

developing plans and taking actions to 

ensure continued service to veterans as 

well as support to national, state, and 

local emergency management and 

homeland security efforts. 

(VA Objective 4.1) 

 9. Prepare to respond to disasters and 

national emergencies. 

(15) Partner with other Federal, state, 

and community agencies to develop a 

national emergency preparedness plan 

that clearly articulates VA’s role and 

capabilities to respond to emergencies. 

(16) Conduct training and emergency 

preparedness drills using standardized 

scenarios consistent with VA's 

Emergency Management Program 

Guidebook. 

5. Advance VA medical research and 

development programs that address 

veterans’ needs, with an emphasis on 

service-connected injuries and illnesses, 

and contribute to the Nation’s knowledge 

of disease and disability. 

(VA Objective 4.2) 

10. Conduct medical research that leads 

to demonstrable improvements in 

veterans health. 

(17) Maintain full research compliance 

and standardized protection of human 

subjects. 

(18) Increase the proportion of research 

funding directed to projects addressing 

veteran-related issues, cooperative 

studies, and translational research. 

6. Sustain partnerships with the 

academic community that enhance the 

quality of care to veterans and provide 

high quality educational experiences for 

health care trainees. (VA Objective 4.3) 

11. Promote excellence and innovation 

in the education of future health care 

professionals. 

(19) Improve the training and awareness 

in military health related issues. 

(20) Provide appropriate support for 

training, education, and resident 

supervision. 

VA ENABLING GOAL VHA ENABLING GOALS VHA ENABLING 

OBJECTIVES 

VHA ENABLING 

STRATEGIES 

Deliver world-class service to 

veterans and their families by 

applying sound business 

principles that result in effective 

management of people, 

communications, technology, and 

governance. 

7. Recruit, develop, and retain a 

competent, committed and diverse 

workforce that provides high quality 

service to veterans and their families. 

(VA Enabling Goal E-1) 

12. Recruit, support, and retain a 

knowledgeable, diverse, engaged, and 

continuously learning workforce. 

(21) Develop a comprehensive and 

coherent workforce development plan 

that incorporates High Performance 

Development Model, succession 

planning, diversity training, and Alternate 

Dispute Resolution orientation. 

(22) Implement pay policies and Human 

Resource practices to facilitate hiring and 

retaining sufficient health care workers to 

meet capacity demands across the full 

continuum of care. 

8. Improve the overall governance and 

performance of VA by applying sound 

business principles, ensuring 

accountability, and enhancing our 

management of resources through 

improved capital asset management; 

acquisition and competitive sourcing; and 

linking strategic planning, budgeting, and 

performance planning. 

(VA Enabling Goal E-4) 

13. Effectively communicate the 

contributions of VA health care, research, 

and education. 

14. Expand Federal, state, local, and 

private partnerships to foster 

improvements in the coordination and 

delivery of health care and other 

services. 

15. Promote cooperation and 

collaboration throughout VA to provide 

seamless service to veterans. 

(23) Implement the VHA communication 

plan. 

(24) Expand VA sharing and 

collaboration with DoD, Indian Health 

Service, and state veterans' 

organizations. 

(25) Expand the Compensation and 

Pension Record Interchange. 

16. Optimize the availability and efficient 

use of resources and services. 

(26) Deploy VHA initiative to increase 

competitive sourcing. 

(27) Fully implement Procurement 

Reform Task Force recommendations. 

17. Increase revenue and efficiency 

through private sector partnerships, 

technology, and improved business 

practices. 

(28) Assess the feasibility of Federal 

imaging, lab, and prescription centers. 

(29) Take full advantage of researchrelated intellectual property opportunities 

18. Develop innovative approaches to the 

design and evaluation of health care 

delivery systems. 

(30) Re-engineer health care processes 

to incorporate technologic advances and 

to address shortages of health care 

professionals. 
Department of Veterans Affairs

Veterans Health Administration

14
VHA Vision 2020 15

CHAPTER 3

FOCUS ON VETERANS HEALTH CARE

 ACCESS

 SPECIAL EMPHASIS PROGRAMS

 GERIATRICS AND LONG TERM CARE

 PATIENT SAFETY

 QUALITY INDICATORS

 VETERAN SATISFACTION

 AWARDS FOR QUALITY

 ACCREDITATION

 RESEARCH

 PROFESSIONAL EDUCATION AND

TRAINING

 DISASTER RESPONSE

ACCESS

Public Law 104-262, the Veterans Health Care Eligibility Reform Act of 1996, effective October 1, 

1998, mandated VA to establish and implement a national enrollment system to manage the delivery of 

health care services to veterans. Enactment of this legislation precipitated serious problems with clinic 

waiting times, delays, and long cycle times. The number of veterans enrolled is a statistic that is both 

frustrating and encouraging. While the increase has strained the health care system, it indicates the 

desirability of VHA’s inexpensive and high-quality care. 

Since 1997, VHA has reduced the cost of care per veteran by 26 percent, not by cutting corners, but by 

delivering care more efficiently and more effectively. VHA has more than 1,300 sites of care and 

provides health care services at locations much closer to where patients live. Eighty-seven percent of 

VHA’s patients now live within 30 minutes of a VHA medical facility. 

The VA health care system is not only focused on the quality of care a veteran receives, but also on 

improving a veteran’s access to care. VHA expects to treat 66 percent more patients in FY 2003 than 

were treated in 1996. This increase, mostly from nonservice-connected veterans, significantly reduced 

VHA’s ability to treat patients in a timely manner, including the highest priority veterans – those with 

service-connected conditions, those with lower incomes and those with special health care needs, such as 

blindness, amputations or spinal cord injuries. FY 2004’s proposed budget for the medical care program, 

together with a comprehensive set of legislative and regulatory proposals, will allow VHA to focus its 

health care assets on providing medical care to those with service-connected disabilities, the indigent and 

those with special health care needs. 
Department of Veterans Affairs 

Veterans Health Administration

16

 Generated by VHA Planning Systems Support Group

 August 2002

 Source: Census 2000 total population by tract; 

 2002 Urban Mobility Report

 2000 major roads

 August, 2002 VHA Service Sites

Travel Time Service Areas with VHA Service Sites

Legend

i VHA Sites as of 8/1/02

Travel Areas in Minutes

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Gulf of Mexico

Atlantic

Ocean

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Ocean

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-130° -120°

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Central Meridian: -96

1st Std Parallel: 20

2nd Std Parallel: 60

Latitude of Origin: 40

Albers Projection

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Chart 3.1 

 SOURCE: PSSG website http://vaww.pssg.med.va.gov/

We expect to treat 4.8 million patients in fiscal year 2004, while continuing to reduce the 

time veterans must wait to see a doctor. Our goal is to have veterans wait no more than 

30 days for a non-emergency, primary care visit. 

Anthony J. Principi, Secretary

As of January 2003, approximately 200,000 veterans were on waiting lists. These numbers are not static. 

As new enrollees join the list, enrollees come off of the waiting list to become new patients in the system. 

VHA is fostering multiple efforts to reduce waiting times. 

 Developing the Advanced Clinic Access (ACA) initiative in collaboration with the Institute for 

Healthcare Improvement: The core of ACA is a training program that provides strategies and 

change concepts to assist clinic staff in making their processes more efficient to reduce wait 

times, improve access, and decrease costs. 

 Developing a national Waiting Times Web Site and computerized wait list and scheduling 

package: This effort enhances measurement of wait times for every patient seeking access to 

VHA services and improves scheduling, efficiency and effectiveness. 

 Developing monitors to identify the percent of active patients assigned to primary care providers 

and the percent of primary care provider capacity that is utilized by active patients. 
VHA Vision 2020 17

 Suspending new enrollment for Priority Group 8 veterans. Effective January 17, 2003, new 

enrollments were suspended in VA’s health care system for veterans in Priority Group 8, those 

who are not being compensated for a military-related disability, and whose incomes are above 

HUD low-income levels. The decision will affect approximately 164,000 Priority Group 8 

veterans projected to enroll in FY 2003; the 1.4 million Group 8 veterans enrolled prior to 

January 17 will continue to receive VA health care. 

 Recruiting additional primary care and specialty provider staff to keep pace with the current 

demand for care and assure VHA’s ability to meet the comprehensive needs of veterans. 

VHA continues to place a strong emphasis on comprehensive specialty care for which it has long been 

highly respected within the medical community, while now also emphasizing coordination of care 

through the universal assignment of primary care providers. With this transformation to a primary care 

delivery model, and by employing new models of care coordination and delivery, veterans have gained 

access to an integrated health care system, focused on addressing their needs before hospitalization 

becomes necessary. 

Historically, health care in this nation has been managed from the perspective and needs of the provider. 

As a hospital system, VHA waited until veterans required hospital care. Even now, appointments are 

scheduled based on the provider’s best guess as to when the patient will need to be seen and when an 

appointment might be available, rather than based on when the patient actually requires care. VHA is not 

alone; this is the approach taken by most health care systems today. However, VHA believes that better 

health care management strategies are now possible. 

VHA is identifying new ways to partner with patients to more effectively manage health and disease 

processes continuously, 24 hours a day, 365 days a year. VHA needs to be able to see the patient “just in 

time” when a complication or need starts to develop. This shift constitutes a fundamental change in how 

VHA views health care and this approach will have a groundbreaking impact on both primary care and 

long-term care. While the impact on primary care and the management of many chronic conditions will 

be substantial, the impact on long-term care will be even more profound, especially as the VHA system 

will experience a significant increase in veterans over 85 years of age by 2010 (1.02 million in 2000, 2.65 

million in 2010). 

VA’s health care system is growing and changing at a very rapid pace to provide the best 

possible care to our Nation’s veterans. 

Laura J. Miller, Deputy Under Secretary for Health for Operations and Management 
Department of Veterans Affairs 

Veterans Health Administration

18

To oversee many of the initiatives needed to implement a patient-centered model for primary and longterm care, the Under Secretary for Health has created a Care Coordination Office. While the 

responsibilities of this office have not been formalized, it will foster the use of technology in care 

coordination and will guide the development and implementation of policies and initiatives in chronic 

disease management and long term care. 

SPECIAL EMPHASIS PROGRAMS

VHA seeks to maximize the ability of the special veteran population to become full and productive 

members of society. To this end, VHA has developed world-class facilities, staffed by world-class 

doctors, nurses, and other allied health care professionals who are devoted to treating our Nation’s 

veterans. 

 

Today’s VA health care system supports a number of clinical and administrative initiatives that have been 

designated as Special Emphasis Programs (SEPs). Typically, SEPs are clinical services that address 

illnesses specific to the service-connected veteran population, constitute areas of special VA expertise, or 

are unique programs that address the psychosocial needs of certain identified veterans. 

Public Law 104-262, the Veterans Health Care Eligibility Reform Act of 1996, effective October 1, 1998, 

mandated that the VHA ensure capacity for veterans with spinal cord injuries and diseases, blinded 

veterans, veterans with amputations, and veterans with chronic disabling mental illnesses. The law also 

requires the publication of data in an annual report (the “Capacity Report”) to Congress demonstrating 

VA’s compliance with the provisions of this mandate. 

This section presents a brief overview of selected SEPs and a few highlights of accomplishments. 

SEP OVERVIEWS

Homeless Veterans Programs 

Nearly 25% of the homeless population are veterans. Many more veterans who live in poverty are at risk 

of becoming homeless. VHA provides substantial hands-on assistance and maintains the largest network 

of homeless assistance programs in the country. VHA’s specialized homeless veterans treatment 

programs strive to offer a continuum of services that include: aggressive outreach to those veterans living 

on streets and in shelters, who otherwise would not seek assistance; clinical assessment and referral to 

needed medical treatment for physical and psychiatric disorders, including substance abuse; long-term 

sheltered transitional assistance, case management, and rehabilitation; employment assistance and linkage 

with available income supports; and supported permanent housing. 
VHA Vision 2020 19

 Approximately 75% of veterans in a Domiciliary Care for Homeless Veterans Program or 

Community-based Contract Residential Care Program were discharged to an independent or a 

secured institutional living arrangement. 

 In FY 2003, more than 7,000 transitional and permanent beds will be available for veterans who 

are homeless. 

 During the past year, more than 20,000 homeless and at-risk veterans received medical care from 

VHA, and more than 19,000 veterans received transitional and supported housing, directly or in 

partnerships with grant and per diem or contract residential care providers. 

 On January 27, 2003, the Department of Housing and Urban Development (HUD), HHS and VA 

announced a $35 million program to provide permanent housing, health care and other supportive 

services to those experiencing chronic or long-term homelessness. 

For more information visit homeless programs online at http://vaww.va.gov/homeless or 

http://www.va.gov/homeless. 

Seriously Mentally Ill (SMI) 

VHA has committed itself to expanding state-of-the-art treatments of serious mental illness, using the 

Assertive Community Treatment (ACT) model. VHA now operates one of the nation’s largest networks 

of ACT-like programs, called Mental Health Intensive Case Management (MHICM). Another aspect of 

VHA’s care for the seriously mentally ill is a commitment to using state-of-the-art medications. This 

results in improved clinical outcomes, decreased incidence of side effects and increased compliance with 

prescribed medications. 

 In FY 2002, VHA provided support to more than 293,000 veterans who are severely mentally ill. 

 Approximately 20% of those veterans were hospitalized during the past year and over 80% were 

discharged to a community living situation at the end of their hospitalization. 

For more information visit Seriously Mentally Ill programs online at 

http://vaww.mentalhealth.med.va.gov or http://www.mentalhealth.med.va.gov. 

Readjustment Counseling 

Readjustment counseling is provided through a national system of community-based counseling or Vet 

Centers. The Vet Center program service mission features a holistic mix of direct counseling and multiple 

community-access functions: psychological counseling for veterans exposed to war trauma to include 

post-traumatic stress disorder (PTSD), and/or veterans who were sexually assaulted during military 

service; family counseling when needed for the veteran’s readjustment; community outreach and 

education; and extensive case management and referral activities. The latter activities include a full range 
Department of Veterans Affairs 

Veterans Health Administration

20

of supportive social services designed to improve general levels of post-military social and economic 

functioning for veterans. 

 In FY 2002, VHA provided readjustment counseling services to over 132,000 veterans. 

 In FY 2002, 99% of veterans using Vet Centers reported being satisfied with services including 

readjustment counseling and said they would recommend a Vet Center to other veterans. 

For more information visit Vet Centers online at http://vaww.va.gov/station/VetCenter/index.htm.

Spinal Cord Injury & Disorder (SCI&D) 

The mission of the SCI&D program is to promote the health, independence, quality of life, and 

productivity of individuals with spinal cord injury/disorders. This is accomplished through the efficient 

delivery of acute rehabilitation, medical/surgical care, patient/family education, psychological, social, and 

vocational care, research, and professional training of residents and other professionals in the continuum 

of care for persons with spinal cord injury/disorders. 

 During FY 2002, 98% of the spinal cord injury (SCI) patients were discharged to noninstitutional settings in the community. In FY 2003, VHA plans to meet or exceed this target. 

 Two Centers of Excellence were established to develop new therapies for veterans with SCI. The 

Center at the Bronx VAMC will explore the use of Pharmaceuticals to treat the secondary 

disabilities of spinal cord injury, and the Center at the Miami VAMC will study pain 

management, recovery of motor and sensory function, and other related issues. 

For more information visit SCI&D online at http://vaww.va.gov/health/sci/disorders. 

Traumatic Brain Injury (TBI) 

VA offers a full continuum of TBI rehabilitation through the Defense and Veterans Head Injury Program 

(DVHIP) which was established in 1992 as a collaboration between DoD, VA and the Brain Injury 

Association (BIA) to ensure that military and veteran personnel with brain injuries receive coordinated, 

comprehensive care. VHA offers a range of TBI rehabilitative care services, from acute rehabilitation 

through community re-entry. Each participating medical center has a designated TBI case manager who 

facilitates patient participation in the program and expedites facility transfers and community placement. 

 VHA has four lead Traumatic Brain Injury Centers: Minneapolis, MN; Richmond, VA; Palo Alto, 

CA; and Tampa, FL. These facilities provide leadership as VA and DoD work to provide a 

nationwide system of case-managed TBI care. In addition to the lead Centers, there are 22 other 

VA TBI Network sites. Rehabilitation services at the other network sites vary from acute 

rehabilitation on a general rehabilitation inpatient unit to sub-acute rehabilitation and case 

management to facilitate coordination of care. Some network sites without an inpatient 
VHA Vision 2020 21

rehabilitation bed service have developed programs within the framework of existing resources 

and offer special programming for specific problems. 

For more information visit TBI online at http://vaww.va.gov/health/rehab or 

http://www.va.gov/health/rehab. 

Gulf War Veterans (GWV) 

The GWV program provides strategic direction for clinical, research, education and outreach programs 

for these veterans and ensures that available benefits are provided to eligible claimants. This objective is 

accomplished by working collaboratively with other VA offices; federal, state, and local government 

agencies; and non-profit community and private providers. The ultimate goal is to ensure quality health 

care for Gulf War Veterans. 

We want the best researchers and the best ideas brought to bear on this long-standing 

problem. Research into Gulf War illnesses is an area ripe for important discoveries. 

Leo S. Mackay, Jr., PhD, Deputy Secretary

 The GWV illnesses research portfolio includes 224 federal research projects sponsored by VA, 

DoD, or HHS. The scope of the research portfolio is broad, from small pilot studies to large-scale 

epidemiology studies involving large populations and major research center programs. By the end 

of FY 2001, 124 projects had been completed and 100 projects were still ongoing. Cumulative 

expenditures through FY 2002 were $213 million. The overall emphasis has been the greatest in 

the areas of symptoms and general health status, and brain and nervous system function. 

 In FY 2004, VA plans to make available up to $20 million for research into Gulf War illnesses, 

which is twice the amount spent by VA in any previous year. 

For more information visit Gulf War Veterans online at http://vaww.va.gov/health/environ/persgulf.htm. 

Women Veterans 

The mission of the Center for Women Veterans is to ensure women veterans have access to VA benefits 

and services, ensure that VA health care and benefits programs are responsive to the gender-specific 

needs of women veterans, to perform outreach to improve women veterans’ awareness of VA services, 

benefits and eligibility, and to act as the primary advisor to the Secretary for Veterans Affairs on all 

matters related to programs, issues, and initiatives for and affecting women veterans. The Center’s goals 

were developed to assess women veterans' services within and outside the Department on an ongoing 

basis, to assure that VA policy and planning practices address the needs of women veterans and foster VA 

participation in general federal initiatives focusing on women's issues. 
Department of Veterans Affairs 

Veterans Health Administration

22

 Second only to elderly veterans, women veterans are the fastest growing segment of the veteran 

population. There are approximately 1.4 million women veterans. They comprise 5.5 percent of 

the total veteran population and 5 percent of all veterans who use VA health care services. VA 

estimates that by 2010 women veterans will comprise 10 percent of veterans using VA health 

care services. 

In addition to the Center for Women Veterans, the Women Veterans Health Program Office is located in 

the Office of Public Health and Environmental Hazards to support the Women Veterans Coordinators in 

all VA medical centers. 

For more information visit Women Veterans online at http://vaww.va.gov/womenvet, 

http://vaww.va.gov/wvhp, or http://www.va.gov/womenvet. 

Blind Rehabilitation 

The mission of the Blind Rehabilitation Program is to coordinate a health care service delivery system 

that provides a continuum of care for blinded veterans extending from their home environment to the 

local VHA facility and to the appropriate rehabilitation setting. These services include adjustment to 

blindness counseling, patient and family education, benefits analysis, comprehensive residential inpatient 

training, outpatient rehabilitation services, the provision of assistive technology, and research. 

 Over 17,000 veterans successfully completed VHA’s blind rehabilitation program in FY 2002. As 

a result of their participation, these veterans became more self-sufficient in their daily activities 

and achieved a higher level of independence. 

For more information visit Blind Rehabilitation online at http://vaww.va.gov/blindrehab or 

http://www.va.gov/blindrehab. 

Preservation-Amputation Care & Treatment (PACT) 

VHA’s PACT program was established in 1993 to meet the changing needs of the veteran population, i.e., 

more neuropathic and vascular problems and fewer traumatic amputations. It represents a model of care 

developed to prevent or delay amputation through proactive early identification of patients who are at risk 

of limb loss. The PACT program incorporates interdisciplinary coordination of surgeon, rehabilitation 

physician, nurse, podiatrist, and therapist, as well as the services of social work, ambulatory care, 

medicine and prosthetic/orthotic personnel to track every patient with amputations, or those at risk for 

limb loss, from the day of entry into the VA health care system, through all appropriate care levels, back 

into the community. 

 Issued VHA Directive 2001-030, Preservation-Amputation Care and Treatment (PACT) program 

that placed greater emphasis upon prevention of amputations through improved screening and 

evaluation processes among the diabetic population and others with neuropathic/vascular 

problems and end stage renal disease. 
VHA Vision 2020 23

 84% of diabetic patients screened for foot problems and identified as “at risk” for amputation 

were referred to a foot care specialist. 

For more information visit PACT online at http://vaww.va.gov/health/rehab or 

http://vaww.va.gov/health/rehab. 

Prosthetics & Sensory Aids (PSAS) 

The mission of the PSAS Strategic Healthcare Group is to provide specialized quality patient care by 

furnishing properly prescribed prosthetic equipment, sensory aids and devices in the most economical and 

timely manner in accordance with authorizing laws, regulations and policies. PSAS serves as the 

pharmacy for assistive aids and as case manager for prosthetic equipment needs of the disabled veteran. 

The objectives of PSAS are to restore the capability of disabled veterans to the greatest extent possible, 

improve their quality of life, and to continually assess veterans’ satisfaction with VHA-prescribed 

prosthetic and sensory aids. 

 The Eligibility Reform Act of 1996 dramatically increased the prosthetic workload. In 1996, 

PSAS spent over $304 million to treat patients and by FY 2001 that amount had doubled to 

approximately $635 million. Over one million patients sought PSAS’s services in FY 2002. 

For information visit Prosthetics & Sensory Aids online at 

http://vaww.va.gov/med/clincare/c_prosthetic.cfm. 

GERIATRICS AND LONG TERM CARE

The veteran population is projected to decline from 26.5 to 22.0 million between 2000 and 2010, but over 

the same time period those age 75 and older will increase from 4.5 to 4.7 million and those 85 and older 

will nearly triple from 510,000 to 1.3 million. These most vulnerable of our older veterans, particularly 

those over 85, are especially likely to require long-term care and to need health care of all types. Also of 

importance is the fact that current VA patients are not only older in comparison to the general population, 

but they generally have lower incomes, lack health insurance, and are much more likely to be disabled 

and unable to work. 
Department of Veterans Affairs 

Veterans Health Administration

24

Chart 3.2 

Veteran Population Age 85 and Older

0.18

0.51

1.14 1.03 1.02

1.32

0.0

0.5

1.0

1.5

2.0

1990 2000 2010 2020 2030 2040

Year

Source: 2001 VetPop Adjusted to Census 2000 

The projected peak in the number of elderly veterans during the first decade of this century will occur 

approximately 20 years in advance of that in the general U.S. population. Thus the current demographics 

of the veteran population are one of the major driving forces in the design of the VA health care system. 

The lessons learned from VHA’s experiences in delivering health care to the aging veteran population 

will be of great importance to the entire nation. 

As the VA health care system has redefined itself in recent years as a “health care” system instead of a 

“hospital” system, VHA’s approach to geriatrics and extended care has evolved from an institutionally 

focused model to one that includes a continuum of home and community-based extended care services 

in addition to nursing home care. One of VHA’s strategic objectives in this area is to provide care in 

the least restrictive setting.

In its 1998 report, “VA Long Term Care at the Crossroads,” the Federal Advisory Committee on the 

Future of Long-Term Care in VHA made 20 recommendations on the operation and future of VHA longterm care services. These recommendations served as the foundation for VHA’s national strategy to 

revitalize and reengineer long-term care services. A major recommendation was that VHA expand home 

and community-based care while retaining three nursing home programs (VA, contract community, and 

State Home). VHA is making progress on that strategy. Between 1997 and 2002, the VHA average daily 

census (ADC) in home and community-based care increased from 11,433 to 17,465. VHA has a budget 

performance measure that calls for an ambitious 22 percent increase in the number of veterans receiving 

home and community-based care. VHA plans continued increases to achieve a level of 34,500 ADC in 

home and community-based programs in FY 2006 by expanding both the services VHA provides directly 

and those it purchases from affiliates and community partners. VHA will meet most of the increased need 

for long-term care through home health care, adult day health care, respite, and home-maker/home health 

aide services. 
VHA Vision 2020 25

Nursing home care will become an option of last resort, where it is medically infeasible 

or inadvisable for a veteran to receive care at home or in an assisted living facility. 

Robert H. Roswell, MD, Under Secretary for Health

VHA is exploring computerization and new technologies, such as telemedicine, to expand care of 

veterans in the home and other community settings. This technology can be used to monitor how patients 

feel and whether they are taking their medications properly. Technology can also be used to monitor 

blood pressure, blood glucose levels for diabetics, and weight for patients with heart failure. With 

telehealth support, veterans will be able to stay in their homes or in assisted living facilities with their 

spouses in the towns where they have a support network. By using interactive technology to coordinate 

care and monitor veterans in the home environment, VHA can significantly reduce hospitalizations, 

emergency room visits and prescription drug requirements, while providing veterans with a more 

rewarding quality of life and greater functional independence. 

VHA’s plans for long-term care include an integrated care management system that incorporates all of the 

patient’s clinical care needs; more care in home and community-based settings, when appropriate to the 

needs of the veteran; emphasis on research and educational initiatives that will improve delivery of 

services and outcomes for VHA’s elderly veteran patients; and development of new models of care for 

diseases and conditions that are prevalent among elderly veterans. 

For more information visit Long Term Care online at http://vaww.va.gov/med/clincare/c_geriatric.cfm. 

PATIENT SAFETY

VA’s National Center for Patient Safety (NCPS) was created in 1998 to take the lead in integrating 

patient safety efforts and innovations, and to develop and nurture a culture of safety throughout VHA. 

NCPS’s primary goal is nationwide reduction and prevention of harm to patients caused by adverse 

events consequent to medical care. NCPS also directs four applied research centers known as Patient 

Safety Centers of Inquiry (PSCI), that are charged to develop practical solutions to eliminate, reduce, or 

prevent selected classes of patient safety adverse actions. 
Department of Veterans Affairs 

Veterans Health Administration

26

HIGHLIGHTS

 VHA has an internal reporting system for adverse events and close calls that is coupled with 

rigorous root cause analysis. The rest of the medical community now looks to VHA for 

innovations in reducing medical adverse events. Australia, Japan, Denmark, the United Kingdom, 

and other countries have adopted strategies and parts of the VHA patient safety program. In 

addition, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) patient 

safety goals have been significantly influenced by the work of VHA. 

 VA has established a program with NASA to create a voluntary external patient safety reporting 

system for health care adverse events and close calls in VA health care facilities. The system’s 

guiding principles are voluntary participation, confidentiality protection, and non-punitive 

reporting. 

 VHA is recognized as a national leader in the application of information management technology 

through its development and widespread use of an electronic medical record system and Bar Code 

Medication Administration program. 

 VHA was the recipient of two of the first annual John E. Eisenberg Awards in Patient Safety 

Awards. See Section titled Awards for Quality. 

For more information visit NCPS online at http://vaww.ncps.med.va.gov.

QUALITY INDICATORS

VA is a national leader in developing quality measurements to provide the best health 

care for our veterans. Both health care and veteran satisfaction have improved as a 

result of our quality improvements. 

Anthony J. Principi, Secretary 

VA’s health care system is one of the most effective and successful health care systems in the Nation. 

VHA’s performance now surpasses many government targets for health care quality as well as measured 

private sector performance. VHA is the benchmark for all 18 clinical performance indicators critical to 

the care of veterans, and directly comparable externally. This includes use of beta-blockers after a heart 

attack, breast and cervical cancer screening, cholesterol screening, immunizations, tobacco use screening 

and counseling, and multiple aspects of diabetes care. 
VHA Vision 2020 27

Table 3.1 VA’s PERFORMANCE COMPARED TO NON VA 

Footnotes describe adjustments made to match indicator measures as closely as possible with Non-VA benchmarks. 

CLINICAL PERFORMANCE INDICATOR VA Base 

(FY) 

VA 

2001 

VA 

2002 

MA/MC1

Best 

Reported 

Advised smokers to quit at least once in past year 33% (Q4-96) 93% NA2 NA 66% NCQA (2001)

Beta blocker on discharge after heart attack NA 94% 97% 83% / 89% 94% MMCP (2001)

Breast cancer screening 68% (Q4-96) 80% 80% 55% / 74% 75% MMCP (2001)

Cervical cancer screening 64% (Q4-96) 89% 89% 60% / NA 80% NCQA (2001)

Cholesterol screening in all patients NA 88% 91% 44% / 71% 73% BRFSS (3) (2001)

Cholesterol measured after heart attack4 NA 89% 92% NA 77% NCQA (2001)

LDL Cholesterol less than 130 after heart attack5 NA 71% 74% NA 59% NCQA (2001)

Colorectal cancer screening 34% (Q4-96) 60% 64% NA 44% BRFSS (3) (1999)

Diabetes: HgbA1c done past year 59% (Q4-95) 93% 94% 68% / 82% 86% MMCP (2001)

Diabetes: Poor control6 (lower number is better) NA 20% 17% 55% / 33% 37% NCQA (2001)

Diabetes: Cholesterol (LDLC) measured NA 91% 94% NA 87% MMCP (2001)

Diabetes: Cholesterol (LDLC) controlled (<130) NA 68% 70% NA 50% NCQA (2001)

Diabetes: Eye Exam 44% (Q4-95) 66% 72% 43% / 63% 69% MMCP (2001)

Diabetes: Renal Exam NA 72% 78% 38% / 45% 46% NCQA (2001)

Hypertension: BP < 140/90 most recent visit 46% (Q4 00) 52% 55% 45% / 47% 54% NCQA (2001)

Immunizations: influenza, patients 65 and older7 27% (Q4-96) 73% 74% 72%8 / NA9 65% BRFSS (3) (2001)

Immunizations: pneumococcal, patients 65 and 

older10 26% (Q4-96) 85% 87% 65%11 / NA12 60% BRFSS (3) (2001)

Mental Health follow-up within 30 days of inpatient 

discharge 72% (Q4-98) 84% 81% 55% / 59% 73% NCQA (2001)

SOURCE: Office of Quality and Performance 

1

 MA = Medicaid, MC = Medicare 2000-2001. 

2

 VA scores for counseled at least 3X per year (FY02 69%), NCQA scores at least once per year. VA not calculated for 02 for once per year. 3

 BRFSS scores are median; VA scores are average. 4

 VA evaluates cholesterol q 2 yr ongoing (FY01 if ever an AMI; FY02 if AMI in past 5 years); NCQA evaluates 1st year after myocardial 

infarction (heart attack) only. 

5

 see #4. 

6

 Diabetes: poor control defined by VA > 9.5; NCQA > 9.5 values for most recent HgbA1c. 7

 This VA number matches NCQA methodology to exclude high-risk patients less than 65. VHA Network Directors performance measure 

includes high risk patients and patients 65 or older (FY02 68%). 8

 Medicare sample using BRFSS methodology, median for all noninstitutionalized persons > 65 (including managed care). 9

 Medicaid only reports childhood and adolescent rates. 

10 This VA number matches NCQA methodology to exclude high-risk patients less than 65. VHA Network Directors performance measure 

includes high risk patients and patients 65 or older (FY01 79%, FY02 81%). 11 Medicare sample using BRFSS methodology, median for all noninstitutionalized persons > 65 (including managed care). 12 Medicaid only reports childhood and adolescent rates. 
Department of Veterans Affairs 

Veterans Health Administration

28

These improvements don’t just look good on paper; they save lives, reduce hospitalizations, preserve 

function, lower costs, and improve patient quality of life. VHA is essentially identical to the best private 

sector health care performance on the last two indicators. VHA’s performance measurement program 

creates a framework for accountability, specifying the improvement VHA will achieve, not simply 

recording where VHA has been. The recent Institute of Medicine study entitled Leadership By Example 

(2002) praised VHA’s approach to translating the best scientific evidence of research into increasingly 

effective patient care. According to the study, “VHA’s integrated health care information system, 

including its framework for using performance measures to improve quality, is considered one of the best 

in the nation.” 

The recent Institute of Medicine study entitled Leadership By Example (2002) can be viewed online at 

http://www.iom.edu. 

The U.S. can no longer practice 20th century medicine. Government needs to lead the 

metamorphosis to 21st century patient-centered quality health care through better use of 

health information technology. Consistent, publicly reported quality measurement is 

essential to improve health care delivery and patient satisfaction. 

Frances M. Murphy, MD, MPH, Deputy Under Secretary for Health Policy Coordination 

HIGHLIGHTS

 During 2002, VHA received national recognition for its delivery of high-quality health care from 

the Institute of Medicine in its report Leadership by Example (2002).

 VHA will continue to use clinical practice guidelines to help ensure high-quality health care, as 

they are directly linked with improved health outcomes. VHA will employ this approach most 

extensively in the management of chronic disease and disease prevention. 

 VHA is also leading by example by providing a Web “portal” for patients to better manage their 

health and health records. Though still in development, VHA’s “My HealtheVet” will create an 

Internet environment to allow patients to find information to answer health questions, alert 

clinicians to problems, and review their health records. In the future, patients will be able to 

reorder medications and even schedule appointments online.

For more information visit Quality and Performance online at http://vaww.oqp.med.va.gov/default.htm or 

http://www.oqp.med.va.gov. 
VHA Vision 2020 29

VETERAN SATISFACTION

Presidential Executive Order 12862 was issued in September 1993 requiring agencies to publish customer 

service standards, survey their respective customers and use customer feedback information to manage 

the agency. Veteran patient satisfaction surveys are designed to promote health care quality assessment 

and improve strategies that address patients’ needs and concerns as defined by patients. In 1995, VHA 

began surveying its patients using a standardized instrument modeled from the Picker Institute, a nonprofit health care surveying group, which had been a leader in assessing non-VA patient experiences with 

health care. VHA’s Performance Analysis Center for Excellence (PACE) of the Office of Quality and 

Performance (OQP) is the analytical, methodological, and reporting staff for Veteran Satisfaction 

Surveys. 

The veteran satisfaction surveys are aimed at capturing patient perceptions of care based on the following 

Veteran Service Standards (VSS): 

 Access 

 Patient Preferences 

 Coordination of Care (visit and overall) 

 Continuity 

 Education 

 Courtesy 

 Emotional Support 

 Transition 

 Physical Comfort 

 Involvement of Family and Friends 

 Pharmacy 

 Specialist Care 

VHA, inclusive of 21 VISNs, individual VAMCs, and Community Based Outpatient Clinics (CBOCs) 

rely on the analyses, interpretations, and delivery of these survey data for making administrative and 

clinical decisions for improving the quality of care delivered to veterans. As a result of the survey 

process, VHA has been able to consistently deliver understandable, applicable, impartial and comparable 

data and information based on sound scientific practices regarding patient perspectives towards the care 

received in the VA health care system. The information provided by the surveys drives process 

improvement at all levels of the organization (i.e., National, VISN, VAMC, and CBOC) including the 

development of VHA’s strategic plan. The survey instrument, methods, and analyses are standardized 

across the country and over time. This allows a valid comparison to be made for each VISN’s satisfaction 

score to the National VHA satisfaction scores on each of the VSS. These practices also provide the 

mechanisms for yearly trend analyses, which are critical for measuring improvement. 

PACE currently administers the veterans’ satisfaction surveys. Surveys are sent to patients who have 

received care in a variety of settings including inpatient, outpatient, and home-based primary care, and 

certain special emphasis programs. Veteran satisfaction will continue to be benchmarked to other large 

organizations. A new inpatient and outpatient survey, the Survey of Healthcare Experiences of Patients 

(SHEP) incorporates a new sample methodology and was put into operation in the second quarter of FY 

2002. The inpatient survey is conducted semi-annually and the outpatient surveys are conducted 

quarterly. All surveys are administered by mail to a sample of veterans meeting qualifying criteria. PACE 
Department of Veterans Affairs 

Veterans Health Administration

30

is responsible for designing the survey instrument, drawing the sample, performing the analysis, and 

reporting results. 

HIGHLIGHTS

 Results of the FY 2002 SHEP surveys show substantial improvement in overall quality ratings for 

both inpatient and outpatient care. For inpatients, preliminary analyses suggest a 5-point increase 

was seen nationally. Significant increases above the 2001 average of 64 percent were observed in 

19 out of 21 VISNs. Eleven VISNs met or exceeded the Exceptional goal for the year (70 

percent). In the outpatient setting, a 10-point gain in satisfaction was observed nationally. 

Fourteen of 21 VISNs met or exceeded the Exceptional goal (72 percent) while another three 

VISNs met or exceeded the Fully Satisfactory goal (70 percent). 

 Although these results are impressive, the very size of the improvements described suggest that 

part of the increase in satisfaction may be due to changes from the old satisfaction survey formats 

to the expanded content and altered formats of the SHEP. VISN-level outpatient results show 

modest, but significant improvements for 6 of 11 VSS in courtesy, emotional support, overall 

coordination, specialist care, and Pharmacy Service (both at the facility and by mail). A 

significant 3-point decline in continuity was also noted in FY 2002. Further analyses and the 

increased availability of SHEP data owing to more frequent sampling and roll-up should allow 

VHA to better describe the drivers of patient satisfaction in future reports. 

 The VSS representing visit coordination relates to the communication of test results, follow-up 

and referral appointments, and whether the patient was given information on who to contact for 

information after the patient’s visit. Despite the challenges presented in this measure, 

improvement was noted between FY 2000 and FY 2002 in 17 of 22 VISNs on this standard, 

illustrating the commitment by VHA to address and improve patient education/information. The 

gains in the education/information VSS continued in FY 2002. 

 VHA scored 82 (on a scale of 100) on the externally conducted American Customer Satisfaction 

Index for hospitalized patients. This is significantly above the mean private sector health care 

score of 68. Loyalty and customer service scores were even higher at 91 and 90 and exceeded 

scores in health and other sectors. 

While transforming VA health care to a more efficient, effective, and accessible system, 

VA has become an industry leader in customer satisfaction, as is shown by its consistent 

benchmark-level scores on the American Customer Satisfaction Index (ACSI), an 

econometric measure of government and private sector satisfaction. 

Robert H. Roswell, MD, Under Secretary for Health 
VHA Vision 2020 31

PACE conducts national satisfaction surveys that allow VHA to better understand and meet patient 

expectations. The surveys have been updated this year to target the dimensions of care that concern 

veterans the most, as well as patient reported information on functional status and healthy behaviors. 

Results of this new survey are available on a quarterly basis. 

For more information or to review survey results visit veteran satisfaction online at 

http://vaww.oqp.med.va.gov/oqp_services/veterans_satisfaction/vss.asp.

AWARDS FOR QUALITY

In VHA, we hold ourselves accountable for improvement and achievement. VHA’s 

improved quality, even transformation, over the last several years has been framed by 

aggressive performance contracts between Chief Officers/Network Directors and the 

Under Secretary for Health. These contracts provide a basis for focusing and evaluating 

the work of leaders, managers, clinicians, and all staff throughout the system. 

Performance measures have led to consistent application of the best scientific evidence 

in the form of clinical guidelines and have supported improvements in quality and in 

each of our other strategic goal areas including access, satisfaction, patient functional 

status, cost effectiveness and community health. 

Jonathan B. Perlin, MD, PhD, MSHA, FACP, Deputy Under Secretary for Health 

The following are a few noteworthy awards VHA received during the past 2 years. 

 VHA’s medical center in Grand Junction, Colorado, won the President’s Quality Award 

Trophy – the highest award for management given to federal employees and agencies. This 

award, which is based on the same criteria that is used for the national Malcolm Baldridge 

Award, recognizes outstanding performance in quality management and customer satisfaction.

 In June 2002, VetPro, VHA’s electronic credentialing program and its federal partner, the 

Federal Credentialing Program, received an e-Gov Trailblazer Award for innovation in the use of 

electronic tools in government. 

 VHA is a leader in patient safety and quality and has adopted patient safety procedures in all its 

health care facilities. To avoid errors in transcription, VHA implemented an electronic patient 

record to ensure that patients are provided the right prescription, in the right dose, at the right 

time. In 2001, Harvard University presented VHA’s patient safety program with the prestigious 

Innovations in American Government Award.
Department of Veterans Affairs 

Veterans Health Administration

32

 Five VHA facilities were among the winners of the Robert W. Carey Awards for Excellence. 

These annual awards recognize VA organizations that have excelled in quality achievement and 

that serve as models against which other organizations can assess their efforts, effectiveness and 

performance in delivering service and satisfying customers. One of the winners of the Category 

Award was the Research and Development/Cooperative Studies Program, Clinical Research 

Pharmacy Coordinating Center in Albuquerque, NM. This center provides pharmaceutical 

support service for large intramural and extramural multi-center clinical trials inside and outside 

the United States. Another recipient of the Category Award was the VA Medical and Regional 

Office Center in Honolulu. Excellence in health care quality allowed the Center to achieve a 

perfect score of 100 in its Joint Commission accreditation, placing it in the top 2 percent of the 

Nation. 

 Two VA health care systems recently received Quality Achievement Awards, the Loma Linda 

Healthcare System and the Northern Arizona VA Health Care System. Additionally, the VA 

Medical and Regional Office Center at White River Junction in Vermont was recognized with an 

Achievement Award for providing efficient “one-stop shopping” for veterans and other 

beneficiaries. 

 The American Pharmaceutical Association (APhA) Foundation, and the Health Care Quality 

Alliance (HCQA), a coalition dedicated to assuring quality is the core value of the nation’s health 

care agenda, have awarded VA the 2002 Pinnacle Award in the Institutional category for 

implementing the Bar Code Medication Administration System. The Pinnacle Awards recognize 

an individual, a group of individuals, or a health care organization for a significant scientific 

contribution and/or exemplary leadership in the improvement of quality in the medication use 

process. 

 The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the National 

Forum give the Eisenberg Awards for Healthcare Quality and Reporting. The VHA National 

Center for Patient Safety in Ann Arbor, Michigan, was a co-winner in the category of System 

Innovation for leadership in developing and implementing a systems approach to error reduction 

within VHA’s hospitals. In the category of Advocacy, the Lexington, Kentucky VA Medical 

Center was singled out for its national leadership in openly and voluntarily disclosing health care 

errors to harmed individuals and/or their families. 

For more information visit Quality Awards online at 

http://vaww.oqp.med.va.gov/oqp_services/quality_awards/quality_awards.asp. 
VHA Vision 2020 33

ACCREDITATION

An accreditation program ensures that accepted standards of health care operation are met. VHA’s 

Accreditation Program is comprised primarily of health care organization accreditation by the Joint 

Commission on Accreditation of Healthcare Organizations (JCAHO) and rehabilitation program 

accreditation by the Rehabilitation Accreditation Commission. 

JCAHO hospital accreditation is nationally recognized as a symbol of quality and is considered one of 

VHA’s major external quality reviews. JCAHO hospital accreditation confers recognition that health care 

organizations meet certain standards of quality and safety, and also confers deemed compliance with 

quality standards of payers, both public (e.g., Medicare) and commercial. Accreditation scores provide an 

important comparison with non-VA health care organizations regarding performance in meeting a wide 

range of standards. All VHA health care facilities are accredited. The average hospital score in 2001 for 

the 59 VAMC’s surveyed was 92.7 as compared to the national average of 91.4. 

Chart 3.3 

VA/Non-VA Average Grid Scores for JCAHO Hospital 

Accreditation Program

93

91 87

91

94

92 90 90

94

88

90

92 91 91

92 92

70

80

90

100

1994 1995 1996 1997 1998 1999 2000 2001

Year

Percentage

VA Non-VA

 Source: Accreditation, Office of Quality and Performance 

In addition, VHA’s Consolidated Mail Outpatient Pharmacies (CMOP), which dispense in excess of 65 

million prescriptions a year to VHA facilities, were accredited by JCAHO for the first time in 1999 and 

all were resurveyed in November 2002. All seven were fully accredited with six of the seven CMOP’s 

achieving Accreditation with Commendation. Also, beginning in FY 2002, VHA’s Opiod Treatment 

Programs (OTPs) began to undergo JCAHO accreditation review. 
Department of Veterans Affairs 

Veterans Health Administration

34

Since 1996, VHA rehabilitation programs have been accredited by the Rehabilitation Accreditation 

Commission. VHA’s commitment to provide specialized treatment and quality rehabilitation care to 

veterans with a disability is supported through a system-wide, long-term venture with the Rehabilitation 

Accreditation Commission to achieve national accreditation for all appropriate rehabilitation programs. 

Standards published by the Rehabilitation Accreditation Commission are consumer-focused, field-driven, 

and state-of-the-art national standards for rehabilitation. 

For more information visit accreditation online at 

http://vaww.oqp.med.va.gov/oqp_services/accreditation/accreditation.asp. 

RESEARCH

Today’s VA Research; Leading Tomorrow’s Health Care 

VHA’s research program is specifically directed toward ensuring that the best science based information 

is used to improve health care, and that our research portfolio increasingly focuses on the clinical and 

health services research that specifically addresses the needs of veterans. 

VHA is widely recognized as a leader in such research areas as aging, women’s health, 

AIDS, post-traumatic stress disorder, and other mental health issues. 

Robert H. Roswell, MD, Under Secretary for Health

Research is a never-ending quest for new knowledge, with each answer revealing a new set of questions. 

VHA’s Office of Research and Development (ORD), pursues this quest by supporting one of VA’s 

central missions — providing its veteran patients with the most effective and efficient health care 

possible. 

ORD oversees VHA’s research in biomedicine, rehabilitation, health services and clinical trials, more 

specifically, pursuing programs’ goals, including supporting the highest quality research, education and 

patient care, translating research results into improved patient care; and capitalizing on the value of the 

nation’s largest health care system with more than 1,300 sites as a resource for research.

ORD organizes its program around 17 areas of high priority for veterans: acute and traumatic injury; 

aging; military and environmental exposures; mental illness; special populations (high-risk or 

underserved); sensory disorders and loss; health services/outcomes research; substance abuse; emerging 

pathogens/bioterrorism; cancer; heart diseases; lung disorders; kidney diseases; diabetes and major 

complications; digestive diseases; infectious diseases; and other chronic diseases. 
VHA Vision 2020 35

Research is not limited to the laboratory. In VHA, you will find researchers caring for patients in medical 

centers and clinics. ORD’s scientists link VHA and the larger scientific and medical communities through 

VHA’s relationships with the nation’s medical schools and other government agencies, such as the 

National Institutes of Health. VHA collaborates with organizations that share interests, including the 

Juvenile Diabetes Foundation, the American Diabetes Association, the National Parkinson Foundation, 

and the National Stroke Association. 

VHA research is embarking on many exciting new endeavors. More than ever, research is the connection 

between patient care and improved outcomes. VHA takes great pride in the research that keeps VHA at 

the forefront of modern medicine and health care. 

Health Services Research and Development Service (HSR&D) works to identify and evaluate 

innovative strategies that lead to accessible, high quality, cost-effective care for veterans and the nation. 

HSR&D is an intramural research program that funds eligible VHA clinicians and investigators to address 

VHA health care priorities such as: patient outcomes, quality of care, access to care, cost and costeffectiveness, alternative organizational and delivery models, and development of new research methods 

and measurement tools. A high priority for HSR&D is putting research findings to work. One way this is 

accomplished is through the broad dissemination of findings to targeted groups of policy makers, decision 

makers, and practicing VHA clinicians. The goal is to ensure that innovations are adopted into clinical 

practice and result in improvements in health care for veterans. 

Medical Research Service (MRS) focuses fundamental research on disorders of significance to the 

veteran population. As the biomedical arm of the ORD, MRS funds and administers research on the 

etiology, pathogenesis, diagnosis, and treatment of virtually the full range of diseases and disorders 

affecting veterans. The primary goals of MRS are: to support meritorious fundamental research relevant 

to veterans' health care needs; to develop and enhance an intramural research environment that promotes 

success; to recruit and retain productive clinician and non-clinician scientists; and to train the next 

generation of VHA scientists. 

Cooperative Studies Program (CSP) aims to conduct clinical research on health issues that are vital 

to our nation's veterans; define research results that establish new standards of care and improve veterans' 

health; improve the efficiency of the VA health care system; and improve the health of the population as a 

whole. With this mission in mind, the CSP organizes research involving multiple medical centers within 

VHA and reaps greater benefits than can be achieved from a single site study. 

Rehabilitation Research and Development (Rehab R&D) Service is an intramural program for 

improving the quality of life of impaired and disabled veterans. Rehab R&D is dedicated to the wellbeing of America's veterans through a full spectrum of research: from approved rehabilitation research 

projects, through evaluation and technology transfer to final clinical application. The veterans served not 

only help define research goals, but also participate in research efforts, and often test the outcomes and 

ultimate usefulness of research results in their daily lives. 
Department of Veterans Affairs 

Veterans Health Administration

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HIGHLIGHTS

 ORD oversees a program funded by more than $1.2 billion from VA and other sources. 

 Investigators at more than 110 VA medical centers are conducting more than 14,000 active 

research projects designed to enhance the health care VHA provides for veterans. 

 Published Impacts 2002, which summarizes a number of studies that demonstrate VHA’s 

commitment to making a difference in veterans’ health care. The highlighted studies are 

organized into categories of importance to the veteran population, such as aging, chronic diseases, 

health systems (e.g., health care delivery, organization, quality and outcomes), mental illness, 

sensory disorder and loss, substance abuse, and special populations (e.g., women, ethnic and 

cultural groups). 

For detailed information regarding research activities visit Research Services online at 

http://vaww.va.gov/resdev/. 

PROFESSIONAL EDUCATION AND TRAINING

VHA conducts the largest coordinated education and training effort for health care professionals in the 

nation. The Office of Academic Affiliations (OAA) has a substantial impact on the current and future 

health workforce of the VA health care system and the nation. 

VHA’s partnership with 107 medical schools and 1,200 other colleges and universities offering health 

professional training programs ensures that VHA brings state-of-the-art thinking to patient care. 

Conversely, as VHA improves technologies such as computerization, advances accountability through 

measurement, and develops delivery models that better address patient needs, VHA improves health care 

for the country, as a significant percent of all health professionals and 70 percent of physicians experience 

some portion of their training in VHA. 

VHA is much more than a network of medical facilities for sick and disabled veterans. In fact, every

citizen who seeks medical care, veteran and non-veteran alike, benefits from VA care and its statutory 

charge to train health care professionals for VHA and the nation. Indeed, VHA is the cornerstone of 

medical education in America as evidenced by the following facts. 

 More than 76,000 health care professionals receive part of their clinical training in VHA facilities 

each year. 

 Many nurses, psychologists, social workers, podiatrists, dentists, pharmacists, optometrists, 

physicians and other health care trainees, receive much of their education in the care of patients at 

VHA facilities. 
VHA Vision 2020 37

 More than 40 health care disciplines are represented annually in the 5,000-plus clinical 

educational programs involving VHA facilities and VA staff. 

 VA is the second largest financial supporter of education for medical professionals, after 

Medicare. 

 As academic medical centers are under increasing financial pressures to reduce education for 

health care professional training, VHA maintained existing programs that train for VA and the 

nation. 

 Programs initiated at VHA have led to the development of new medical specialties such as 

geriatrics, which focuses on care of the elderly. 

 VHA-based training in addiction psychiatry, pain management, and spinal cord injury medicine 

are addressing the needs of the nation as well as the needs of our veterans. 

 VHA is developing new programs using teams of health care providers specializing in services to 

veterans, such as palliative care teams that provide care to patients at the end-of-life. 

 VHA trains health care professionals in the total care of the patient, because VA health care 

provides total care to eligible veterans.

 More than 80% of current trainees highly value their VHA educational experience, and if given 

the opportunity, would choose to train in VA again. 

 VHA is a valued partner in American medical education, and has “partnership” agreements with 

107 of the nation’s medical schools. 

VHA’s medical education mission is an essential feature of the VA health care system that is critical to 

providing high quality health care for veterans. Over a half-century ago in 1946, a “radical” strategy was 

proposed to achieve quality in health care: an academic partnership between the Veterans 

Administration—later to become the Department of Veterans Affairs—and academic medicine. This 

partnership has grown into the most comprehensive academic health system partnership in history. As the 

nation’s health care system continues to evolve, VHA will continue to be on the leading edge with 

innovative programs benefiting all Americans. 

For more information visit Academic Affiliations online at http://vaww.va.gov/oaa/ or 

http://www.va.gov/oaa/. 
Department of Veterans Affairs 

Veterans Health Administration

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DISASTER RESPONSE

VHA has three well-known missions: medical care, education, and research. It also has a lesser-known 

mission: contingency support in emergencies. This function has grown over time from that of providing 

back-up support to the DoD in times of war and other national emergencies to a comprehensive 

emergency management program using an all-hazards approach emphasizing mitigation, preparedness, 

response, and recovery. This approach has stood many tests in times of disaster, most recently following 

the events of September 11, 2001. 

VHA’s fourth mission includes: 

 VA contingencies; 

 DoD contingencies; 

 Support of the National Disaster Medical System (NDMS); 

 Support of the Federal Response Plan; 

 Response to radiologic emergencies; 

 Provision for Continuity of Government (COG); and 

 Continuity of Operations (COOP). 

Under the COG and COOP plans, VA maintains five sites, including the Crisis Response Center in VA 

Central Office. Following September 11, VHA operations were successfully relocated to Site B for a brief 

period of time. 

Many people carry out the actual work of managing emergencies locally and nationally. However, the 

backbone of VHA’s emergency management is the Emergency Management Strategic Healthcare Group 

(EMSHG), an out-based central office group with 34 Area Emergency Managers (AEMs) located across 

the country. Three District Managers supervise the AEMs. They have worked closely with the VHA 

Center for Engineering and Occupational Safety and Health to produce an Emergency Management 

Program Guidebook. This will assist VAMCs and CBOCs to develop a Comprehensive Emergency 

Management Program. VHA has deployed personnel and supplies as requested to all major disasters 

declared by the President, such as Hurricanes Andrew and Floyd and the Houston floods. Over 1,000 VA 

employees have participated in disaster relief efforts. In addition, VA has provided significant on-site 

support for high-risk events such as the Olympic Games, the Papal Visit, and the Inauguration. 
VHA Vision 2020 39

In 2002, the Secretary created a new office within VA, the Office of Policy, Planning, and 

Preparedness (PPP), which assumed overall responsibility for VA emergency preparedness. The new 

PPP organization enhances VA's readiness and ability to support the Nation's response to the war on 

terrorism. PPP was created to establish a department-level focus, augment continuity of operations, 

emergency preparedness, readiness and security, and enhance strong partnerships with other agencies. As 

a result of this decision, VA offers continued services to veterans, a national infrastructure of resources, 

participation in homeland security, and 24/7 staffing at the five VA Readiness Operations Centers 

(ROCs). The collaboration between VHA’s EMSHG and PPP makes VA "A Force Multiplier in 

Homeland Security" in terms of VA skilled personnel and strategically located facilities. 

HIGHLIGHTS

 VA is one of four partners in the National Disaster Medical System and provides support to the 

Federal Response Plan. VA will support DoD and other agencies to address casualties coming off 

the battlefield overseas, and civilian casualties at home. VA’s efforts will be coordinated with the 

new Department of Homeland Security, DoD, HHS, and other government agencies. 

 After the terrorist attacks on September 11, 2001, VA Central Office ensured continuity of 

operations nationwide. Veterans Integrated Service Networks (VISNs), headquartered in the 

Bronx and Baltimore, activated command centers. In the aftermath of the attack, VA deployed 

critical care burn nurses to the Cornell Medical Center Burn Unit in New York City, and the 

Washington Hospital Center Burn Unit, in Washington, DC. In New York City, VA deployed 

staff and shared inventory with other emergency health care facilities to bring supplies to 

emergency workers and the National Guard. VA was also part of a coordinated effort to deliver 

emergency pharmaceuticals and medical supplies to New York City for the rescue operations. 

EMSHG Area Emergency Managers deployed to New York City to assist with response and 

recovery efforts. 

 Staff from VA’s National Center for PTSD assisted DoD in its relief efforts at the Pentagon after 

September 11. Education was provided for counselors as well as debriefing and psycho-educational 

support for relief staff, including Red Cross personnel and DoD Casualty Assistance Officers. 

Special procedures ensured that life insurance beneficiaries were paid within 48 hours after 

receiving a claim. 

 A plan was developed to procure personal protective and decontamination equipment to protect 

the medical staff and others at risk of chemical, biological, or radiological exposure so that VHA 

could continue to treat veterans at a VHA facility in the event of a catastrophic incident. 

 VA experts have collaborated with HHS in defining a proposed VHA role in a smallpox 

vaccination program and have supported HHS in forming the USA Freedom Corps Medical 

Reserve Corps cadre of volunteer health care professionals to provide medical care in case of an 

attack. 
Department of Veterans Affairs 

Veterans Health Administration

40

 In FY 2003, VA is seeking ways to enhance the preparation and handling of emergency situations 

while continuing to maintain its fundamental mission of servicing veterans and their families. To 

this end, VA is conducting a systematic evaluation of its Comprehensive Emergency 

Management (CEM) program that will address mitigation, preparedness, response, and recovery. 

For more information visit EMSHG online at http://vaww.va.gov/emshg/ or http://www.va.gov/emshg. 
VHA Vision 2020 41

CHAPTER 4

SERVICE EFFICIENCY AND EXCELLENCE

 INFORMATION TECHNOLOGY

 PROCUREMENT

 COMPETITIVE SOURCING

 WORKFORCE PLANNING

INFORMATION TECHNOLOGY

VA is committed to reforming the way its information technology (IT) business is conducted. VA has 

developed a One-VA enterprise strategy, embarked on a nationwide telecommunications modernization 

program, and laid a solid foundation for a Departmental cyber security program. 

 

In FY 2004, the Department will continue to implement the One-VA Enterprise Architecture and 

integrate this effort into key Departmental processes such as capital planning, budgeting, and project 

management oversight. The goal is to use this architecture to develop the common infrastructure and 

systems development environment necessary to build and support systems that allow a comprehensive 

approach to expanded electronic government. These new systems will allow for integrated, 

comprehensive, consistent, veteran-centric, and universally available electronic access to all veteran 

services and information. The foundational systems under development are: telecommunications 

infrastructure, cyber security infrastructure, and corporate and regional data processing with continuity of 

operations (COOP). Successfully completing these system initiatives will allow VA to expand electronic 

government services. 

VA’s Enterprise Architecture is a business line-oriented approach that seeks to understand and capture the 

major business processes that are required to provide America’s veterans with the benefits they have 

earned in a consistent, timely, efficient, comprehensive, well-managed, and cost effective environment. 

The Enterprise Architecture will allow for a single, shared database for all veteran information. It will 

also allow for a common interface for each user category for a consistent look and feel and for a customer 

application profile that requires an end user to provide necessary information once. Lastly, it will ensure a 

standardized, One-VA approach to electronic government across the spectrum of government to citizen, 

government to government, government to business, and internal government efficiencies.
Department of Veterans Affairs 

Veterans Health Administration

42

Information technology is at the heart of most changes in VA health care. We use 

technology to more readily and accurately process clinical and administrative 

information, to automate processes that were done manually, to deliver care across 

distances, to train staff and to improve quality and reduce errors. 

Robert H. Roswell, MD, Under Secretary for Health 

VA’s Computerized Patient Record System is acknowledged in the Institute of Medicine’s Leadership 

By Example (2002), as second to none for supporting clinicians in providing quality health care. VA is 

also leading by example by providing a Web “portal” for patients to better manage their health and health 

records. Though still in development, VA’s “My HealtheVet” will create an Internet environment where 

veterans, family, and clinicians may come together to optimize veterans’ health care. Early national 

phases of My HealtheVet will provide powerful health education information and health self-assessment 

tools. In the future, veterans will be able to reorder medications, view appointments and review their 

health records online. This computerized patient record system builds upon the Veterans Health 

Information Systems and Technology Architecture (VistA) to be patient/data centric; to use the best 

modern technology; to move to an enterprise-wide approach; to standardize health data and 

communications; to substantially enhance the health systems supporting veterans care; and to secure 

health systems and veterans health information. 

The FY 2004 budget includes funds to continue to move VHA toward My HealtheVet, the ideal health 

information system. Major projects under My HealtheVet include building a Health Data Repository that 

will provide a longitudinal healthcare record, a replacement scheduling system, an enrollment system, 

implementation of VistA imaging at all health care facilities, and purchase of a Patient Financial Services 

System. Also included are funds to support the Federal Health Information System that provides VA 

health care practitioners access to Department of Defense health records. VHA also collaborates with the 

Indian Health Service on collaborative health information systems and State Veterans Homes who are 

interested in acquiring and implementing VistA in their long term care facilities. 

In the field of telemedicine, VHA is ahead of other medical providers. VHA has a natural advantage in 

this area because of its network of facilities nationwide, its experience with chronic disease, and its need 

to develop creative alternatives to managing its financial resources. VHA conducts as many as 300,000 

telemedicine cases each year in 31 clinical specialties. The projects range from home care administered 

with the aid of telemedicine technology, to remotely evaluating x-rays. VHA will remain a leader in this 

field. 
VHA Vision 2020 43

PROCUREMENT

With annual spending of about $6 billion, VA is the second largest purchaser of goods and services in the 

federal government after DoD, yet ranks sixth in procurement overhead costs. Procurement initiatives 

begun in 2002 will extend the VA’s buying power for its health care system even more. The reforms 

include standardizing the purchase of items used throughout the system, pursuing more opportunities for 

joint purchasing with DoD and advocating the government-wide use of Universal Product Numbers to 

improve inventory management. 

In addition, VA continues to implement aggressive strategies to leverage purchasing power, standardize 

equipment and supplies, ensure that any provider working part-time for VA supplies services for every 

hour paid by VA, and maintain other management costs at or below 2003 levels. VA will also achieve 

efficiencies at the local level. 

In the past year, top leadership in VA and DoD created a Joint Executive Council that developed an 

overarching shared vision for the future and began to implement changes. Two priorities are jointly 

underway which will greatly enhance the seamless delivery of services to veterans – the information 

technology efforts on enrollment systems and electronic patient records. Many impressive collaborations 

have been made in other areas such as shared facilities and equipment, coordinated human resources, 

procurement, and other common business practices and training. VA has shown significant progress and 

expects continued results as the delivery systems become coordinated. 

[VA and DoD] have made unprecedented progress in sharing and coordinating 

medical care resources. 

Robert H. Roswell, MD, Under Secretary for Health

VA and DoD have made substantial progress in increasing joint procurement activities. The foundation 

for this progress was established in December 1999 when VA and DoD signed a Memorandum of 

Agreement (MOA) to combine their purchasing power and eliminate redundancies. As of July 1, 2002, 

there were 63 joint VA/DoD contracts and four blanket purchase agreements (BPA) for pharmaceuticals. 

The cost avoidance resulting from these contracts and BPAs was approximately $350 million in 2001 and 

over $100 million in 2002. VA and DoD are converting DoD’s Distribution and Purchasing Agreements 

to the Federal Supply Schedule for medical/surgical products. In addition, the electronic interface for 

VHA’s Consolidated Mail Out Pharmacy (CMOPs) has been completed and is compliant with the Health 

Insurance Portability and Accountability Act and cyber security requirements. Initial prescription 

processing began in August 2002. Facilities and CMOPs filled 105.5 million prescriptions in FY 02. 
Department of Veterans Affairs 

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COMPETITIVE SOURCING

VA has more than 1,300 sites of care and provides health care services at locations much closer to where 

veterans live. Eighty-seven percent of VA’s patient population now lives within 30 minutes of a VA 

medical facility. VA is providing care to nearly 48 percent more veterans than it did in 1997. At the same 

time, VHA has reduced the cost of care per veteran by delivering care more efficiently and more 

effectively. Towards this end, VA is implementing management initiatives that will produce an 

unprecedented offset to the overall cost of the projected growth in workload and utilization. VA has 

undertaken a rigorous competitive sourcing plan to determine whether commercial activities should be 

performed in-house using government facilities and personnel, or with private procurement processes. 

We remain firmly committed to managing our medical care resources with increasing 

efficiency each year. 

Anthony J. Principi, Secretary

Competitive sourcing asks managers to make very hard management choices -- choices that affect real 

jobs held by very dedicated and loyal career civil servants. A key element to the success of any private 

sector company is the regular evaluation of whether necessary services should be provided in-house by 

company employees or by another company, the ultimate "make or buy" decision. This initiative strives 

to focus the federal government on its mission -- delivering high quality services to our citizens at the 

lowest cost. 

Over each of the last five years, VA as a whole has steadily increased its contractual services spending 

while decreasing the number of full-time employees. In addition, VA’s 2001 FAIR Act inventory 

identified approximately 85% of VA’s workforce as being engaged in commercial activities. The Deputy 

Secretary charged VA’s Office of Policy and Planning with establishing and coordinating a working 

group to develop a more streamlined competitive sourcing process for VA. The work group developed a 

three-tiered streamlined process, with more focus on cost-benefit analysis and less focus on solicitation to 

make the management decision about whether to contract out or retain the work in-house. The Office of 

Management and Budget approved this process in April 2002 for use throughout VA. The following 

reflects an overview of the process. 

 Tier 1 competitive sourcing process focuses on cost-benefit analysis for the day-to-day make or 

buy decisions at the local level for 10 or fewer FTE;

 Tier 2 focuses on a more detailed and rigorous but internal cost analysis using market research for 

competitive sourcing for 11 or more FTE; and
VHA Vision 2020 45

 Tier 3 requires a formal A-76 study based on the premise that a federal agency must rely on a 

formal procurement process in order to make a decision about whether to contract out an activity 

or conduct it in-house.

VA has completed and circulated for implementation throughout the Department a Directive on 

Competitive Sourcing. For 2002, VHA, which represents about 97% of VA’s total commercial activities, 

conducted 1,626 cost comparison studies. These studies covered 4,061 FTE positions and resulted in 

3,189 being contracted out and 872 being retained in-house. VHA has increased the amount of contract 

services to $2.6 billion – a 32% increase over the last five years. VHA’s total contract service 

expenditures equate to approximately 43,000 full-time employees. One of the key factors contributing to 

VHA achievements in competitive sourcing is the transformation of the health care delivery approach, 

moving increasingly from inpatient to outpatient care and toward the use of Community Based Outpatient 

Clinics (CBOCs) to improve access for veterans. For each CBOC opened, VA determines whether it is 

more cost effective to operate the facility with VA employees. Out of 609 operating CBOCs, 146 are 

staffed with contract personnel. 

The Department will compete 52,000 jobs over the next five years (such as laundry, food and sanitation 

services), with an estimated cost savings of approximately $3 billion. To that end, VHA began reviewing 

all laundries in CY 2003. In addition, a Work Group was tasked in January 2003 to identify other 

functions for review; educate the Field on the competitive sourcing process; improve reporting of local 

and national existing contracts which would include credit for work in progress such as CMOPs, CBOCs, 

Scarce Medical, MCCF, etc.; and improve reporting of local day-to-day sourcing decisions. 

WORKFORCE PLANNING

Throughout the last decade, VHA has experienced a dramatic transition. This remarkable transformation 

from a hospital system to a health care system created a new model with a culture that requires a new kind 

of employee. Concurrent with the organizational changes came a dramatic shift in the VHA workforce 

profile. By 2005, 98% of VHA’s Senior Executives, 80% of VHA’s Chiefs of Staff, and 75% of VHA’s 

Nurse Executives will be eligible to retire. Exacerbating the problem is the tight labor market and the 

inability of the federal government to keep pace with private sector salaries and incentives. 
Department of Veterans Affairs 

Veterans Health Administration

46

Chart 4.1 VHA Employees by Age – 2001

Source: VACO Management Support 

To work down the waiting lists, and to continue to provide the quality and safety our 

veterans deserve, and to provide care with the efficiency that the budgetary 

environment demands, VHA needs to recruit and retain appropriate health care 

professionals. 

Robert H. Roswell, MD, Under Secretary for Health

National nursing leaders and health care organizations are projecting a shortage of registered nurses that 

will be unlike any experienced in the past. The current and future numbers of professional, registered 

nurses may be insufficient to meet the national health care needs. At the same time, changes in health care 

delivery will require larger numbers of well-educated nurses who perform increasingly complex functions 

in hospitals and the community. VA expects to face increasing challenges in maintaining its nursing 

workforce and must remain competitive in pay and workforce innovations. 

2001

VHA EMPLOYEES - BY AGE

Age

15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 55 57 59 61 63 65 67 69 71 73 75 77 79 81 83 85 87 89 91 93 95 97

10000

9500

9000

8500

8000

7500

7000

6500

6000

5500

5000

4500

4000

3500

3000

2500

2000

1500

1000

500

0

Average Age 

46.3
VHA Vision 2020 47

VA is also facing a critical situation in which its compensation system for physicians and dentists is 

unresponsive to the demands of the current market. The effect of noncompetitive pay and benefits is seen 

in dramatic increases in VA’s scarce-specialty, fee-basis, and contractual expenditures. In addition, the 

short supply of some clinical sub-specialties in the medical community is causing rapid increases in 

salaries, benefits, and prerequisites. VA’s special pay authorities have not been revised since 1991. VA’s 

current pay authorities are stretched to the maximum, and the Department can no longer offer competitive 

salaries for these medical sub-specialists. More importantly, the current statutory compensation structure 

does not offer a way for VA to link physician and dentist compensation to quantitative and qualitative 

outcomes. 

The development of a comprehensive succession plan was fundamental to VHA’s continued ability to 

provide quality care for the nation’s veterans. Recognizing this, VHA charged a succession planning 

committee in 2000 with developing a comprehensive strategy to meet this challenge. The committee used 

the following definition: VHA Succession Planning encompasses all processes and activities needed to 

ensure that our current and future missions are supported by the highest quality work force. The 

committee benchmarked best practices, assessed VHA’s workforce, analyzed drivers of employee 

satisfaction, and examined statutes, regulations and policies. The final report approved by the Under 

Secretary for Health and published in January 2002 included more than 100 action items. 

A Deployment Committee was established to address and track the categories identified in the report, i.e., 

workforce planning, leadership development, technical skills development, supervisory development, 

employee satisfaction, and legislative and policy initiatives. VHA has been working diligently in each of 

these areas. Some of the accomplishments to date include development and implementation of a 

succession planning Web site, workforce analysis and planning included in VHA’s Strategic Planning 

Process for FY 2002, a workforce performance measure included in FY 2003 performance agreements, 

Web-based workforce/diversity planning and analysis tools, an Executive Career Field (ECF) Candidate 

Development Program, Technical Development Programs that focus on VA-specific disciplines, 

increased use of available Human Resource authorities (e.g., Relocation Bonuses & Retention Pay), and 

legislative and human resource policy changes. Other projects underway include revising the performance 

appraisal and recognition system, employee satisfaction and organizational development programs, 

redesign of employee surveys, supervisor training and new employee orientation. All of these projects are 

designed to meet the dynamic changes occurring in VHA. 

VHA is also developing a comprehensive workforce improvement proposal that would enhance VHA’s 

ability to recruit high-quality specialists thereby improving access; increase the attractiveness of full-time 

VA positions thereby reducing the need for contract/part-time physicians; enhance the ability to 

financially reward performance and expertise to further VHA goals thereby improving care; improve 

balance in financial relationships between VA and affiliates; and enhance the ability to pay for actual 

services needed (24 hour coverage, intermittent service). VHA expects to submit this proposal by late 

spring of 2003. The new opportunities this proposal can provide include a focus on emerging veteranspecific health care needs; an enhanced tertiary capacity with less fragmented care; a facilitation of 

sharing with DoD because of increased medical expertise and training opportunities; and increased 
Department of Veterans Affairs 

Veterans Health Administration

48

research opportunities. This proposal will be vital to VHA’s ability to recruit the additional providers 

needed to increase our capacity, eliminate waiting lists, and refocus on VHA’s core mission of 

comprehensive care for service connected, low income, and special needs veterans. 

For more information visit VHA Succession Planning online at http://vaww.va.gov/succession/. 
VHA Vision 2020 49

GLOSSARY OF ACRONYMS

ACA.................Advanced Clinic Access 

ACSI ................American Customer Satisfaction Index 

ACT .................Assertive Community Treatment 

ADC.................Average Daily Census 

AEM.................Area Emergency Managers 

APhA ...............American Pharmaceutical Association 

BIA...................Brain Injury Association 

BPA..................Blanket Purchase Agreements 

BRFSS .............Behavioral Risk Factor Surveillance System 

CARES.............Capital Asset Realignment for Enhanced Services 

CBOC...............Community Based Outpatient Clinic 

CEM.................Comprehensive Emergency Management 

CMOP ..............Consolidated Mail Out Pharmacy 

CMS.................Centers for Medicare and Medicaid Services 

COG.................Continuity of Government 

COOP...............Continuity of Operations 

CSP ..................Cooperative Studies Program 

CY....................Calendar Year 

DoD..................Department of Defense 

DVHIP .............Defense and Veterans Head Injury Program 

ECF ..................Executive Career Field 

EMSHG ...........Emergency Management Strategic Healthcare Group 

FTE ..................Full Time Employee 

FY ....................Fiscal Year 

GAO.................General Accounting Office 

GWV................Gulf War Veterans 

HCQA ..............Health Care Quality Alliance 

HHS .................Department of Health and Human Services 

HSR&D............Health Services Research and Development Service 

HUD.................Department of Housing and Urban Development 
Department of Veterans Affairs 

Veterans Health Administration

50

IOM..................Institute of Medicine 

IT......................Information Technology 

JCAHO.............Joint Commission on Accreditation of Healthcare Organizations 

MOA ................Memorandum of Agreement 

MCCF ..............Medical Care Cost Fund 

MHICM ...........Mental Health Intensive Case Management 

MMCP .............Medicare Managed Care Plan 

MRS.................Medical Research Service 

NASA...............National Aeronautics and Space Administration 

NCA.................National Cemetery Administration 

NCPS ...............National Center for Patient Safety 

NCQA ..............National Committee for Quality Assurance 

NDMS..............National Disaster Medical System 

NLB .................National Leadership Board 

OAA.................Office of Academic Affiliations 

OMB ................Office of Management and Budget 

OQP .................Office of Quality and Performance 

ORD.................Office of Research and Development 

OTP..................Opiod Treatment Programs 

PACE ...............Performance Analysis Center for Excellence 

PACT ...............Preservation-Amputation Care and Treatment 

POW.................Prisoner of War 

PPP...................Office of Policy, Planning and Preparedness 

PSAS................Prosthetics & Sensory Aids 

PSCI.................Patient Safety Centers of Inquiry 

PSSG................Planning Systems Support Group 

PTSD................Post-Traumatic Stress Disorder 

Rehab R&D......Rehabilitation Research and Development 

ROC .................Readiness Operations Centers 

SCI ...................Spinal Cord Injury 

SCI&D .............Spinal Cord Injury & Disorder 

SEP...................Special Emphasis Program 

SHEP................Survey of Healthcare Experiences of Patients 

SMI ..................Seriously Mentally Ill 

SPC ..................Strategic Planning Committee 
VHA Vision 2020 51

TBI...................Traumatic Brain Injury 

VA....................Department of Veterans Affairs 

VACO ..............VA Central Office 

VAMC .............VA Medical Center 

VBA.................Veterans Benefits Administration 

VHA.................Veterans Health Administration 

VISN ................Veterans Integrated Service Network 

VISTA..............Veterans Health Information Systems & Technology Architecture 

VSO .................Veteran Service Organization 

VSS ..................Veteran Service Standards 

VSSC ...............VISN Support Service Center
Veterans Health Administration

Office of Policy and Planning (105)

810 Vermont Avenue, NW

Washington, DC 20420

http://vaww.va.gov/vhaopp/report01/vision/vision2020.pdf

http://www.va.gov/vhareorg/vision2020.pdf