VA REAL PROPERTY

VA Should Improve Its 

Efforts to Align 

Facilities with 

Veterans' Needs

Report to Congressional Requesters

April 2017

GAO-17-349

United States Government Accountability Office
United States Government Accountability Office

Highlights of GAO-17-349 a report to 

congressional requesters

April 2017

VA REAL PROPERTY

VA Should Improve Its Efforts to Align Facilities with 

Veterans' Needs

What GAO Found

Geographic shifts in the veteran population, changes in health care delivery, and 

an aging infrastructure affect the Department of Veterans Affairs’ (VA) efforts to 

align its services and real property portfolio to meet the needs of veterans. For 

example, a shift over time from inpatient to outpatient care will likely result in 

underutilized space once used for inpatient care. In such instances, it is often 

difficult and costly for VA to modernize, renovate, and retrofit existing facilities 

given the challenges associated with these older facilities. 

VA relies on the Strategic Capital Investment Planning (SCIP) process to plan 

and prioritize capital projects, but SCIP’s limitations—including subjective 

narratives, long time frames, and restricted access to information—undermine 

VA’s ability to achieve its goals. Although VA acknowledges many of these 

limitations, it has taken little action in response. Federal standards for internal 

control state that agencies should evaluate and determine appropriate corrective 

action for identified limitations on a timely basis. Without doing so, VA lacks 

reasonable assurance that its facility-alignment reflects veterans’ needs.

A separate planning process—VA Integrated Planning (VAIP)—was designed to 

supplement SCIP and to provide planners with a more strategic vision for their 

medical facilities through the creation of facility master plans. However, GAO 

found limitations with this ongoing effort, which VA estimated to cost $108 

million. Specifically, the facility master plans assume that all future growth in 

services will be provided directly through VA facilities without considering 

alternatives, such as purchasing care from the community. However, VA’s use of 

care in the community has increased to an obligated $10.1 billion in fiscal year 

2015. Federal capital-acquisition guidance identifies inefficient spending as a risk 

of not considering other options for delivering services. This consideration is 

particularly relevant as VA’s data project that the number of enrolled veterans will 

begin to fall after 2024. Officials who oversee the VAIP process said that they 

were awaiting further analyses required by recently released VA guidance on the 

proportion of care and types of services to obtain from the community. As a 

result of this and other limitations, some local VA officials said that they make 

little use of the VAIP facility master plans and contract for their own facility 

master plans outside the VAIP process.

Although VA instructs local VA officials to communicate with stakeholders, its 

guidance is not detailed enough to conform to best practices. VA has not 

consistently followed best practices for effectively engaging stakeholders in 

facility consolidation efforts—such as in utilizing two-way communication early in 

the process and using data to demonstrate the rationale for facility alignment 

decisions. GAO found that when stakeholders were not always engaged 

consistently with best practices, VA’s efforts to align facilities with veterans’ 

needs were challenged. Also, VA officials said that they do not monitor or 

evaluate these communications efforts and, therefore, have little assurance that 

the methods used effectively disseminate information to stakeholders. This 

approach runs counter to federal standards for internal control, which instruct 

agencies to monitor and evaluate activities, such as communications methods. View GAO-17-349. For more informationcontact David J. Wise at (202) 512-2834 or 

wised@gao.gov, or Debra A. Draper at (202) 

512-7114 or draperd@gao.gov

Why GAO Did This Study

VA operates one of the largest health 

care systems in the United States, with 

168 VA medical centers and more than 

1,000 outpatient facilities. Many of 

these facilities are underutilized and 

outdated. A previous effort aimed at 

modernizing and better aligning 

facilities was not fully implemented.

GAO was asked to review the current 

alignment of VA medical facilities with 

veterans’ needs. This report examines: 

(1) the factors that affect VA facility 

alignment with veterans’ needs, (2) the

extent to which VA’s capital-planning 

process facilitates the alignment of 

facilities with the veteran population, 

and (3) the extent to which VA has 

followed best practices by integrating 

stakeholders in facility alignment 

decisions. GAO reviewed VA’s facilityplanning documents and data, and 

interviewed VA officials in 

headquarters and at seven medical 

facilities selected for their geographic 

location, population, and past 

alignment efforts. GAO also evaluated 

VA’s actions against federal standards 

for internal control and best practices 

for capital planning. 

What GAO Recommends

GAO made four recommendations, 

including that: VA improve SCIP’s 

scoring and approval process among 

other limitations and discontinue or 

improve the utility of the VAIP facility 

master plans, and improve guidance to

effectively communicate facility 

alignment decisions with stakeholders 

and to evaluate these efforts. VA 

partially concurred with the first 

recommendation and fully concurred 

with the other recommendations. GAO 

believes the recommendations are 

sound, as described in the report. 
Page i GAO-17-349 VA Facility Alignment

Letter 1

Background 7

Facility Alignment Is Affected by Shifts in Veteran Population and 

Care Delivery, and an Aging Infrastructure 16

Limitations in the Capital-Planning Processes Impede VA’s 

Alignment of Facilities with Veterans’ Needs 30

Local Approaches to Stakeholder Involvement Vary due to a Lack 

of VA Guidance 39

Conclusions 43

Recommendations for Executive Action and Our Evaluation 44

Agency Comments 44

Appendix I Buildings Operated by the Veterans Health Administration (VHA) and 

Designated for Disposal, by State 46

Appendix II Comments from the Department of Veterans Affairs 54

Appendix III GAO Contacts and Staff Acknowledgments 61

Table

Table 1: Buildings Operated by the Veterans Health 

Administration (VHA) and Designated for Disposal, by 

State, Fiscal Year 2014 46

Figures

Figure 1: Expected Timing and Process for Evaluating and 

Funding Capital Projects within the Department of 

Veterans Affairs (VA) 12

Figure 2: Overview of the Department of Veterans Affairs 

Integrated Planning (VAIP) Process 13

Figure 3: Projected Changes in Veteran Population in the United 

States, by County, from 2014 to 2024 17

Figure 4: Example of Costs Still Accumulating in a Closed 

Inpatient Wing of a Department of Veterans Affairs’ (VA) 

Medical Center, May 2016 20

Contents
Page ii GAO-17-349 VA Facility Alignment

Figure 5: Example of Outdated Double Occupancy Room at a 

Department of Veterans Affairs’ (VA) Medical Center, 

May 2016 24

Figure 6: Examples of Outdated Building Configurations and 

Structural Barriers at a Department of Veterans Affairs’ 

(VA) Medical Center, July 2016 25

Figure 7: Example of Deteriorating Historic Vacant Buildings at a 

Department of Veterans Affairs’ (VA) Medical Center, 

July 2016 26

Figure 8: Example of a Deteriorating Historic Vacant Building at a 

Department of Veterans Affairs’ (VA) Medical Center, 

September 2016 27

Figure 9: Unused Historic Structure That Faces Challenges to 

Demolition at a Department of Veterans Affairs’ (VA) 

Medical Center, July 2016 28

Figure 10: Occupied, Vacant, and Buildings up for Potential 

Disposal on the Historic Chillicothe, Ohio, Department of 

Veterans Affairs’ (VA) Medical Center Campus, 

December 2016 29

Figure 11: Example of a Non-Clinical Building at a Department of 

Veterans Affairs’ (VA) Medical Center That Has Structural 

Damage, July 2016 32

Figure 12: Overlapping Timelines of the Last 6 Fiscal Years of the 

Strategic Capital Investment Program’s (SCIP) Project 

Submissions and the Number of Submissions 34
Page iii GAO-17-349 VA Facility Alignment

Abbreviations

CARES Capital Asset Realignment for Enhanced

 Services

CBOC community-based outpatient clinic 

Choice Act Veterans Access, Choice, and

 Accountability Act of 2014 

EHCPM Enrollee Health Care Projection Model 

HCPM Health Care Planning Model 

Independent Assessment Independent Assessment of the Health

 Care Delivery Systems and

 Management Processes of the Department

 of Veterans Affairs

OMB Office of Management and Budget

SCIP Strategic Capital Investment Planning

VA Department of Veterans Affairs

VAIP Department of Veterans Affairs Integrated

 Planning

VetPop2014 Veteran Population Projection Model 2014

VHA Veterans Health Administration

VISN Veterans Integrated Service Network

VSO veterans service organization

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Page 1 GAO-17-349 VA Facility Alignment

441 G St. N.W.

Washington, DC 20548

April 5, 2017

The Honorable Johnny Isakson

Chairman

The Honorable Jon Tester

Ranking Member

Committee on Veterans’ Affairs

United States Senate

The Honorable David P. Roe

Chairman

Committee on Veterans’ Affairs

House of Representatives

The Department of Veterans Affairs (VA) operates one of the largest 

health care systems in the United States, encompassing 168 VA medical 

centers and 1,053 outpatient medical facilities that provide care to more 

than 8.9 million veterans each year.1 VA’s total health care budget in 

fiscal year 2015 was nearly $51 billion. VA is also one of the largest 

federal property-holding agencies. As of September 2014, VA reported 

that its inventory included 6,091 owned buildings covering more than 

151.5 million square feet and 1,586 leased buildings covering more than 

16.6 million square feet and costing more than $340.6 million annually in 

rent.

As the veteran population has shifted in recent decades and the demand 

for the VA’s health care services has changed, VA has recognized the 

need to improve planning and budgeting for modernizing its aging 

infrastructure and aligning its real property assets to veterans’ needs and 

to provide accessible, high-quality, and cost-effective access to VA’s 

services.2 Specifically, VA initiated a process known as Capital Asset 

Realignment for Enhanced Services (CARES) to determine the future 

resources needed to provide health care to our nation’s veterans. In 

 

1

Outpatient facilities include community-based outpatient clinics (CBOC) and health care 

centers. CBOCs are located in areas surrounding VA medical centers and provide primary 

care and some specialty care services that do not require a hospital stay. Health care 

centers, including ambulatory care centers, are large multi-specialty outpatient clinics that 

provide surgical services in addition to other health care services. 

2

See GAO, Department of Veterans Affairs: Issues Related to Real Property Realignment 

and Future Health Care Costs, GAO-11-877T (Washington, D.C.: July 27, 2011).

Letter
Page 2 GAO-17-349 VA Facility Alignment

February 2004, the CARES Commission released its report 

recommending substantial changes to existing facilities but relatively few 

facility closures.3 VA officials stated that as of June 2016, the CARES 

recommendations were not fully implemented and that the process was 

halted 8 years ago due to shifting priorities.

The need to align VA facilities in order to improve access to services is 

related to two of GAO’s high risk areas. In 2015, GAO placed veterans’ 

health care on its High Risk List due to persistent weaknesses and 

systemic problems with timeliness, cost-effectiveness, quality, and safety 

of the care provided to veterans.4 In addition, federal real property 

management—including management of VA real property—has also 

been on GAO’s High Risk List since 2003 due to long-standing 

challenges federal agencies face in several areas of real property 

management, including effectively disposing of excess and underutilized 

property.5

You asked us to review issues related to the current alignment of VA’s 

medical facilities as they related to veterans’ needs. In this report, we 

examine:

 

3

See CARES Commission, Capital Asset Realignment for Enhanced Services, a report to 

the Secretary of Veterans Affairs (Washington, D.C.: February 2004). The 16 members of 

the independent CARES commission were appointed in December 2003. The commission 

issued recommendations to the Secretary on the basis of its review of the Draft National 

CARES Plan and related information obtained through public hearings, site visits, public 

meetings, written comments from veterans and other stakeholders, and consultations with 

experts.

4

GAO, High-Risk Series: An Update, GAO-15-290 (Washington, D.C.: February 2015). 

GAO maintains a high-risk program to focus attention on government operations that it 

identifies as high risk due to their greater vulnerabilities to fraud, waste, abuse, and 

mismanagement or the need for transformation to address economy, efficiency, or 

effectiveness challenges. See, for example, GAO, VA Health Care: Actions Needed to 

Improve Newly Enrolled Veterans’ Access to Primary Care, GAO-16-328 (Washington, 

D.C.: Mar. 18, 2016) and GAO, VA Mental Health: Clearer Guidance on Access Policies 

and Wait-Time Data Needed, GAO-16-24 (Washington, D.C.: Oct. 28, 2015). See also, for 

example, Department of Veterans Affairs, Office of Inspector General, Veterans Health 

Administration, Review of Alleged Patient Deaths, Patient Wait Times, and Scheduling 

Practices at the Phoenix VA Health Care System, Report No. 14-02603-267 (Washington, 

D.C.: Aug. 26, 2014) and VA, Department of Veterans Affairs Access Audit, System-Wide 

Review of Access, Results of Access Audit Conducted May 12, 2014, through June 3, 

2014. 

5

See GAO, High-Risk Series: Federal Real Property, GAO-03-122 (Washington, D.C.: 

January 2003). 
Page 3 GAO-17-349 VA Facility Alignment

1. The factors that affect VA’s facility alignment efforts. 

2. The extent to which VA’s capital-planning process facilitates the 

alignment of medical facilities with the veteran population.

3. The extent to which VA has followed best practices by fully integrating 

stakeholders in facility alignment decisions.

To address these objectives, we reviewed relevant laws, regulations, 

policies, and other documents related to VA’s real property management 

including, the 2004 CARES report and VA’s annual budget submissions 

included in the President’s Budget of the United States Government for 

Fiscal Year 2017.

6 We also interviewed officials from VA and VA’s 

Veterans Health Administration (VHA) including from:

• VA’s Central Office—including personnel from the Office of Asset 

Enterprise Management, Office of Construction & Facilities 

Management, and Office of Policy and Planning—and

• VHA’s Central Office, including staff from its Office of Policy and 

Planning.

To obtain local perspectives on these objectives, we interviewed officials 

from a nongeneralizable sample of seven VA medical facilities within five 

different Veterans Integrated Service Networks (VISN) to learn more 

about how VA tries to align facilities with the veteran population, or 

“facility alignment.”7 VA medical facilities were chosen based on a review 

of the CARES recommendations, VA’s veteran population data and 

projections, and geographic and veteran population variability.8 We 

 

6

See CARES Commission, Capital Asset Realignment for Enhanced Services, a report to 

the Secretary of Veterans Affairs (Washington, D.C.: February 2004).

7

VA organizes its system of care into regional networks called VISNs. Each VISN is 

responsible for managing and overseeing VA medical centers within a defined geographic 

area. At the VISN level, we met with the VISN planner and Capital Asset Manager, as well 

as VISN leadership at VISN 2 (New York), VISN 4 (Pennsylvania), VISN 10 (Ohio), and 

VISN 21 (California). In VISN 17 (Texas), we met with the VISN planner and engineering 

staff in lieu of meeting with the Capital Asset Manager.

8

These were (1) the VA New York Harbor Health Care System (Brooklyn VA medical 

center, Manhattan VA medical center, and St. Albans Community Living Center); (2) VA 

Pittsburgh Health Care System (H.J. Heinz Campus and University Drive Campus); (3) 

Chillicothe, Ohio VA medical center; (4) Columbus, Ohio ambulatory care center; (5) the 

Central Texas Veterans Health Care System (Waco VA medical center, Temple VA 

medical center, and the Austin Outpatient Clinic); (6) the South Texas Veterans Health 

Care System (San Antonio VA medical center and Kerrville VA medical center); and (7) 

the VA Palo Alto Health Care System (Palo Alto Campus, Menlo Park Campus, and 

Livermore Campus).
Page 4 GAO-17-349 VA Facility Alignment

conducted interviews (either in-person or via telephone or video 

conference) with officials at both the VISN and facility levels to discuss 

facility alignment resources, tools, and policies. At the facility level, we 

met with groups of individuals responsible for planning and making facility 

alignment decisions at seven VA medical facilities.9 Results from our 

sample cannot be generalizable to all VISNs or VA medical facilities.

To determine the factors that affect the VA’s facility-alignment efforts, we 

analyzed veteran population data from the Veteran Population Projection 

Model 2014 (VetPop2014) and interviewed officials at VA’s Office of 

Policy and Planning who oversee the model regarding veteran population 

projections and trends.10 We also reviewed data in the Enrollee Health 

Care Projection Model (EHCPM)—a VA model for estimating the amount 

of resources VA needs to meet the expected demand for most of the 

health care services it provides—and interviewed officials at VHA’s Office 

of Policy and Planning who oversee the model regarding veteran 

population projections and trends.11 We reviewed these models’ 

methodologies, interviewed relevant officials, and determined that the 

data from both the VetPop2014 and EHCPM were sufficiently reliable for 

our audit objectives. We also interviewed planning officials at each of the 

five VISNs and seven VA medical facilities to obtain further information on 

factors related to making facility alignment decisions. Additionally, we 

reviewed specific sections within the Independent Assessment of the 

Health Care Delivery Systems and Assessment Management Processes 

of the Department of Veterans Affairs (hereafter referred to as the 

 

9

In many areas of the country, several medical centers and clinics may work together to 

offer services to area veterans as a health care system. By sharing services between or 

among medical centers, the aim is for VHA to provide veterans easier access to advanced 

medical care closer to their homes. 

10VetPop2014 is an actuarial projection model —developed by the Office of the Actuary 

under VA’s Office of Policy and Planning— for veteran population projections from fiscal 

year 2014 to 2043. The model provides living veteran counts by key demographic 

characteristics such as age, gender, period of service, and race/ethnicity at various 

geographic levels. 

11The EHCPM was developed in 1998 by VA and Milliman, Inc. It helps supports the 

development of VA’s budget estimate for health care and informs strategic and capital 

planning. 
Page 5 GAO-17-349 VA Facility Alignment

Independent Assessment).12 Specifically, we reviewed its sections on 

demographics, health care capabilities, authorities and mechanisms for 

purchasing care, and facilities, and compared these assessments to our 

findings to determine whether there were similarities.13 We reviewed the 

methodology of each of these assessments and found them to be 

sufficiently reliable for our audit objectives. 

To determine the extent to which VA’s capital-planning process facilitates 

the alignment of medical facilities with the veteran population, we 

reviewed relevant documentation about two processes VA uses to 

facilitate planning for medical facility needs, including construction 

projects. For the Strategic Capital Investment Planning (SCIP) process, 

we reviewed documentation and data on the SCIP process since fiscal 

year 2012 and interviewed officials with the Office of Asset Enterprise 

Management who oversee the process. For the Department of Veterans 

Affairs Integrated Planning (VAIP) process, we reviewed relevant 

documentation since the process’s inception in fiscal year 2011, including 

the guiding principles and examples of plans that resulted from using the 

process, and interviewed officials with the Office of Construction & 

Facilities Management who oversee the process. To obtain further 

information on the usefulness of both of these processes we spoke with 

planning officials at each of the VISNs in our review. We also reviewed 

the findings and recommendations from the Independent Assessment’s

section related to facilities, and compared them to our findings to 

 

12VA was required to contract for an independent assessment of health care services 

furnished in its facilities. Pub. L. No. 113-146, § 201(a)(1), 128 Stat. 1754, 1769 (2014). 

VHA contracted with the Centers for Medicare & Medicaid Services’ Alliance to Modernize 

Healthcare (operated by MITRE Corporation, a private entity) and the Institute of Medicine 

to conduct the assessment. Parts of the evaluation were subcontracted to other 

organizations, including McKinsey & Company and the RAND Corporation. See Centers 

for Medicare & Medicaid Services’ Alliance to Modernize Healthcare, Independent 

Assessment of the Health Care Delivery Systems and Management Processes of the 

Department of Veterans Affairs, (Sept. 1, 2015).

13See RAND Corporation, Independent Assessment of the Health Care Delivery Systems 

and Management Processes of the Department of Veterans Affairs, Assessment A 

(Demographics), (Sept.1, 2015); See RAND Corporation, Independent Assessment of the 

Health Care Delivery Systems and Management Processes of the Department of 

Veterans Affairs, Assessment B (Health Care Capabilities), (Sept.1, 2015); RAND 

Corporation, Independent Assessment of the Health Care Delivery Systems and 

Management Processes of the Department of Veterans Affairs, Assessment C (Authorities 

and Mechanisms for Purchasing Care), (Sept.1, 2015); and McKinsey & Company Inc., 

Independent Assessment of the Health Care Delivery Systems and Management 

Processes of the Department of Veterans Affairs, Assessment K (Facilities), (Sept.1, 

2015). 
Page 6 GAO-17-349 VA Facility Alignment

determine whether there were similarities.14 We also reviewed the 

methodology for this assessment and found it sufficiently reliable for our 

audit objectives. Further, we compared the two processes (SCIP and 

VAIP) to guidance outlined in the Office of Management and Budget’s 

(OMB) Circular No. A-11 and federal standards for internal control.

15

To determine the extent to which VA has followed best practices by fully 

integrating stakeholders in facility alignment decisions, we compared VA 

guidance and local stakeholder communication efforts to GAO-identified 

best practices.16 We interviewed VA officials, VISN and facility officials, 

national veterans’ service organizations (VSO), and local veterans’ 

organizations about their involvement in facility alignment decisions. To 

select national VSOs to interview, we chose organizations based on their 

participation in VA reform and planning efforts, and those that were 

recommended by VA officials or other VSOs as being knowledgeable with 

VA’s efforts to align its medical facilities with the veteran population.17 We 

spoke with national representatives from the American Legion, Disabled 

American Veterans, and Paralyzed Veterans of America. In addition, we 

asked the national VSOs for state and local chapter contacts. We 

reviewed each site’s Health Care Planning Model (HCPM) list of external 

stakeholders and asked VA officials for local external stakeholder 

contacts. We did not always meet with the same stakeholder groups at 

each location.18 We spoke to local chapters of the American Legion, 

Disabled American Veterans, Military Order of the Purple Heart, and 

 

14See McKinsey & Company Inc., Independent Assessment of the Health Care Delivery 

Systems and Management Processes of the Department of Veterans Affairs, Assessment 

K (Facilities), (Sept.1, 2015).

15See OMB, Circular No. A-11: Preparation, Submission, and Execution of the Budget, 

July 2016, GAO, Standards for Internal Control in the Federal Government, 

GAO/AIMD-00-21.3.1 (Washington, DC: November 1999), and GAO, Standards for 

Internal Control in the Federal Government, GAO-14-704G (Washington, D.C.: September 

2014). 

16See GAO, Streamlining Government: Questions to Consider When Evaluating 

Proposals to Consolidate Physical Infrastructure and Management Functions, 

GAO-12-542 (Washington, D.C.: May 23, 2012).

17See RAND Corporation, Veterans Access, Choice, and Accountability Act of 2014 

Section 201: Independent Assessment of the Health Care Delivery Systems and 

Management Processes of the Department of Veterans Affairs, Assessment B (Health 

Care Capabilities), (Sept.1, 2015).

18We did not speak to any local or state stakeholder group associated specifically with 

Livermore, CA as we did not receive any responses after several attempts to contact 

them. 
Page 7 GAO-17-349 VA Facility Alignment

Veterans of Foreign Wars, as well as some county veterans’ service 

officers. 

We conducted this performance audit from January 2016 to April 2017 in 

accordance with generally accepted government auditing standards. 

Those standards require that we plan and perform the audit to obtain 

sufficient, appropriate evidence to provide a reasonable basis for our 

findings and conclusions based on our audit objectives. We believe that 

the evidence obtained provides a reasonable basis for our findings and 

conclusions based on our audit objectives.

The mission of VA is to serve America’s veterans and their dependents. 

All VA programs are administered through three major administrations—

VHA, Veterans Benefits Administration, and the National Cemetery 

Administration.19 VA provides medical services to various veteran 

populations—including an aging veteran population and a growing 

number of younger veterans returning from the military operations in 

Afghanistan and Iraq. In general, veterans must enroll in VA health care 

to receive VA’s medical benefits package—a set of services that includes 

a full range of hospital and outpatient services, prescription drugs, and 

long-term care services provided in veterans’ own homes and in other 

locations in the community. VHA is responsible for overseeing the 

delivery of care to enrolled veterans, as well as the health care 

professionals and support staff that deliver that care. VHA is also 

responsible for managing all VA medical facilities.

VA organizes its system of care into regional networks called VISNs. In 

September 2015, there were 21 VISNs nationwide, but VA is in the 

process of merging VISNs that will result in 18 VISNs when completed.20

 

19The Veterans Benefits Administration provides veterans, their dependents, and 

survivors with benefits and services such as compensation, pensions, fiduciary services, 

educational opportunities, vocational rehabilitation and employment services, and home 

ownership and insurance. The National Cemetery Administration inters eligible service 

members, veterans, and family members in VA national cemeteries and maintains the 

graves and their environs as national shrines; it also provides other burial benefits to 

veterans and their families, such as medallions and markers for headstones that signify 

veterans’ service. 

20This realignment is expected to be completed by the end of fiscal year 2018.

Background

VA’s System of Health 

Care
Page 8 GAO-17-349 VA Facility Alignment

Each VISN is responsible for coordination and oversight of all 

administrative and clinical activities within its specified geographic region. 

Medical services are provided in inpatient/residential medical facilities and 

outpatient medical facilities, including:

Inpatient/residential care medical facilities as of January 2017:

• VA medical centers: A medical facility that provides at least two types 

of care, such as, inpatient, outpatient, residential, or institutional 

extended care. There are 168 VA medical centers.

• Extended care site (community living center): A medical facility that 

provides institutional care, such as nursing home beds, for extended 

periods of time. There are 135 community living centers.

• Residential care site: A medical facility that provides residential care, 

such as a domiciliary, for extended periods of time. There are 48 

domiciliaries.

Outpatient care medical facilities as of October 1, 2016: 

• Community-based outpatient clinics (CBOC): A medical facility that 

provides primary care and mental health services, and in some cases, 

specialty services such as cardiology or neurology, in an outpatient 

setting. There are 737 CBOCs.

• Health care center: A medical facility that provides the same services 

as CBOCs, but also ambulatory surgical procedures that may require 

moderate sedation. There are 22 health care centers.

• Other outpatient service: A medical facility that provides care to 

veterans but is not classified as a CBOC or health care center, such 

as a mobile treatment facility. There are 305 other outpatient services 

sites. 

In order to meet the needs of the veterans it serves, VA is authorized to 

pay for veteran health care services from non-VA providers through both 

the Non-VA Medical Care Program and clinical contracts.21 In fiscal year 

2015, VA obligated about $10.1 billion to purchase care from non-VA 

providers. The Non-VA Medical Care Program, including the Choice 

Program and Patient-Centered Community Care, is referred to as “care in 

the community” by VA, and allows VA to offer care to veterans in non-VA 

 

21VA uses the services of non-VA providers in non-VA facilities under the following 

statutory authorities: 38 U.S.C. §§ 1703, 1725, 1728, 8111, and 8153.
Page 9 GAO-17-349 VA Facility Alignment

facilities, such as physicians’ offices and hospitals in the community, and 

pay for this care using a fee-for-service arrangement.22 Clinical contracts 

are used by VA to bring non-VA providers—such as physicians, 

pharmacists, and nurses—into VA facilities to provide services to 

veterans.

VA works with the VISNs, and medical facilities to manage its real 

property assets through VA’s capital-planning process. The SCIP 

process—established in 2010 to assess and identify long-term capital 

needs—is VA’s main mechanism for planning and prioritizing capitalplanning projects, but is affected by the VA’s budgetary resources, which 

will determine how many projects will be funded. The goal of SCIP is to 

identify the full capital need to address VA’s service and infrastructure 

gaps, and to demonstrate that all project requests are centrally reviewed 

in an equitable and consistent way throughout VA, including across 

market areas within VA’s health care system given competing capital 

needs.23

 

22The Choice Program was authorized under the Veterans Access, Choice, and 

Accountability Act of 2014 (Choice Act), which provided new authorities, funding, and 

other tools to help with the reform of the VA health care system. Pub. L. No.113-146, 128 

Stat. 1754. Through this Act, Congress appropriated $10 billion in additional funds to VA 

to under certain conditions expand its ability to provide non-VA medical care to certain 

veterans, such as veterans who are unable to receive an appointment with a VA provider 

within 30 days of either their preferred or clinically appropriate date, live more than 40 

miles from the nearest VA facility, or experience certain excessive travel burdens. This 

funding is available until expended but only for Choice Program activities, which are only 

authorized through August 7, 2017, or until the funds are exhausted, whichever comes 

first. Patient-Centered Community Care is a nationwide VA program that established two 

nationwide contracts with Health Net and TriWest to establish networks of providers that 

can provide care through the Non-VA Medical Care Program in a number of specialties—

including primary care, inpatient specialty care, and mental health care when VA may 

utilize non-VA medical care when a VA facility is unable to provide certain specialty care 

services, such as cardiology or orthopedics, or under other conditions. 

23Each VISN is divided up into smaller geographic areas called market areas (usually on 

county lines), which consider travel and referral patterns, geographic dispersion of 

enrollees, and locations of medical facilities within the market. Each market area may 

have differing numbers of VA medical centers and other VA medical facilities. As of 

November 2016, VA had designated 98 market areas.

Current Efforts to Align 

Facilities with Veterans’ 

Needs

SCIP Process
Page 10 GAO-17-349 VA Facility Alignment

The SCIP process for that particular fiscal year’s projects begins 

approximately 23 months before the start of the fiscal year with VA 

providing a set of guidelines to the VISNs and medical facilities. SCIP 

uses information from models to identify excesses and deficits in the 

services at the local level—called “gaps” within VA—and justify capital 

investments. For example, SCIP uses data from the EHCPM, a model for 

projecting veteran enrollment, utilization of VA health care, and the 

associated expenditures VA needs to meet the expected demand for 

most of the health care services it provides.24

VA officials at the VISNs and medical facilities play a major role in the 

capital-planning process. Each VISN has a Capital Asset Manager and a 

planner who are responsible for coordination and oversight of facility 

alignment activities, and work with individual facility planners and 

engineering staff. Annually, planners at the medical facilities develop a 

10-year action plan for their respective facilities, which include capital or 

non-capital improvement projects to address gaps in service identified by 

the SCIP process.25 According to VA, these long-range plans allow the 

department to adapt to changes in demographics, and health care and 

benefits delivery, while at the same time incorporating infrastructure 

enhancements. Medical facility officials then develop more detailed 

business plans for the capital improvement projects that are expected to 

take place in the first year of the 10-year action plan. These projects are 

validated, scored, and ranked centrally based on the extent to which they 

address the annual VA-approved SCIP criteria using the assigned 

 

24The EHCPM projects the number of veteran enrollees and their utilization using several 

inputs, including from the VetPop2014 model, which provides living veteran projections by 

key demographic characteristics from fiscal year 2014 to 2043.

25The four types of capital investment programs are major construction, minor 

construction, leasing, and non-recurring maintenance. The major construction program 

funds construction projects estimated to cost more than $10 million. See 38 U.S.C. § 

8104(a)(3)(A). The minor construction program funds construction projects estimated to 

cost $10 million or less. In general, non-recurring maintenance projects are repairs and 

renovations within the existing square footage of a facility that total more than $25,000. 

Non-recurring maintenance projects that are strictly meant to ensure facilities are in good 

working condition are limited to $10 million. However, non-recurring maintenance projects 

may include expansion of new space, but associated costs may not exceed $500,000. 
Page 11 GAO-17-349 VA Facility Alignment

weights.26 (See fig. 1 for VA’s capital decision-making process for 

evaluating and funding capital projects.)

 

26The scoring of submitted projects includes both narrative responses that are evaluated 

(about one-third of the overall score) and data-driven scoring based on gap closure (the 

remaining two-thirds of the overall score). SCIP decision criteria and priority weights are 

developed by the SCIP Board (comprised of nine senior level executives across VA who 

are not on the SCIP Panel) annually to address the various priorities of VA. Each criterion 

is given a scoring unit, scoring methodology, and relative weight which are grouped into 

six high level categories (for the fiscal year 2017 submission): (1) improve safety, 

compliance, and security; (2) fixing what we have; (3) increasing access; (4) right-sizing 

inventory; (5) ensure value of investment; and (6) strategic requirements.
Page 12 GAO-17-349 VA Facility Alignment

Figure 1: Expected Timing and Process for Evaluating and Funding Capital Projects within the Department of Veterans Affairs 

(VA) 

Note: The process dates are expected dates, and not actual dates for each year.

a

Business cases must include detailed cost estimates and explanations of how proposed projects 

align with decision criteria, such as reducing facility condition deficiencies.

b

The SCIP Panel—comprised of nine representatives from across VA—scores all major, minor, 

leases, and non-recurring maintenance business cases against the decision criteria and priority 

weights. Each criterion is given a scoring unit, scoring methodology, and relative weight which are 

grouped into six high-level categories (for the fiscal year 2017 submission): (1) improve safety, 
Page 13 GAO-17-349 VA Facility Alignment

compliance, and security; (2) fixing what we have; (3) increasing access; (4) right-sizing inventory; (5) 

ensure value of investment; and (6) strategic requirements.

c

The SCIP Board develops the decision criteria and priority weights annually—which are departmentapproved—to address the various priorities of VA. The Board is comprised of nine senior level 

executives from across VA who are not on the SCIP Panel.

Another tool available for use by some VISNs and medical facilities is the 

VAIP Process, which was implemented in fiscal year 2011 as a pilot 

project. The goal was to identify the best distribution of health care 

services for veterans, where the services should be located based on the 

veterans’ locations and referral patterns, and where VA should adapt 

services, facilities, and health care delivery options to better meet these 

needs as determined by locations and referral patterns. Data from the 

VAIP Process are designed to drive the VISNs’ and VA medical facilities’ 

operational decisions including costs, challenges, and local preferences, 

but the VAIP Process’s findings can also result in future SCIP projects. 

The VAIP Process produces a market-level health services delivery plan 

for the VISN and a facility master plan for each medical facility within the 

VISN. (See fig. 2 for an overview of the VAIP Process.)

Figure 2: Overview of the Department of Veterans Affairs Integrated Planning (VAIP) 

Process

VAIP Process
Page 14 GAO-17-349 VA Facility Alignment

After completing a pilot of the program, VA officials began formally 

implementing the VAIP Process across VISNs and their medical facilities, 

utilizing multiple contractors. As of January 2017, VA officials told us they 

had mostly completed the VAIP Process in 6 of the 18 VISNs and had 

plans to start or complete the remaining VISNs by October 2018. 

According to officials who oversee the program, the entire cost of the 

VAIP process is expected to be about $108 million.

Over time, VA has recognized the need to modernize its facilities and 

align its real property portfolio to provide accessible, high-quality, and 

cost-effective access to services. In addition, VA has been the subject of 

several assessments focusing on facility alignment, and planning efforts 

to modernize its facilities. In 1999, VA initiated the CARES process to 

assess federally owned buildings and land ownership in response to 

changing veterans’ inpatient and outpatient demand for care. CARES was 

the first comprehensive, long-range assessment of VA’s health care 

capital-asset priorities since 1981 and was designed to assess the 

appropriate function, size, and location of VA facilities. In May 2004, VA 

issued the CARES Decision report to Congress and other stakeholders.27

The decision report listed projects and actions that VA planned to take 

over the next 20 years, as well as the tools and principles that the agency 

planned to use to align its infrastructure and upgrade its facilities. VA 

officials told us that the implementation of CARES recommendations was 

monitored through fiscal year 2010. In July 2011, VA released an 

implementation and monitoring report on seven areas highlighted in the 

CARES report.28 In this report, VA stated that excess space was reduced 

through mechanisms such as the demolition of vacant buildings and the 

realignment of underutilized space. VA also reported that since fiscal year 

2009, 509,247 square feet of space was disposed. VA officials stated that 

as of June 2016, some of the CARES recommendations were not fully 

 

27Department of Veterans Affairs, Office of the Secretary, CARES Decision (Washington, 

D.C.: May 2004).

28Department of Veterans Affairs, Veterans Health Administration, Office of Assistant 

Deputy Under Secretary for Health for Policy and Planning, Implementation Monitoring 

Report on Capital Asset Realignment for Enhanced Services, (Washington, D.C.: Jul 

2011). The seven areas highlighted in this report include CBOCs, veteran rural access 

hospitals, improved access/modernizations, special disability programs, excess property, 

VA/Department of Defense collaboration and sharing, and collaborations between VHA, 

the Veterans Benefits Administration, and the National Cemetery Administration.

Prior Efforts to Align 

Facilities with Veterans’ 

Needs
Page 15 GAO-17-349 VA Facility Alignment

implemented, and the process was essentially replaced when the SCIP 

process was implemented in fiscal year 2012.

In a more recent effort, the Choice Act required VA to contract with a 

private entity to conduct an independent assessment of 12 areas of VA’s 

health care delivery system and management processes, including its 

facilities in 2014.29 Among the 12 areas, an assessment of facilities 

examined VA’s processes for facility planning, funding, maintenance, and 

construction. The Independent Assessment identified four systemic 

findings:

1. A disconnect in the alignment of demand, resources, and authorities.

2. Varying bureaucratic operations and processes.

3. Non-integrated variations in clinical and business data and tools.

4. Leaders are not fully empowered due to a lack of clear authority, 

priorities, and goals.30

The Choice Act also established the Commission on Care to examine 

veterans’ access to VA health care and to examine and report on how 

best to organize VA, locate health resources, and deliver health care to 

veterans during the next 20 years.31 The Commission on Care assessed 

the results of the Independent Assessment as part of its work. The 

Commission on Care’s report included 18 high-level recommendations, 

 

29Pub. L. No. 113-146, § 201, 128 Stat. at 1769. VA commissioned the Centers for 

Medicare & Medicaid Services Alliance to Modernize Healthcare (operated by MITRE 

Corporation, a private entity) and the Institute of Medicine to conduct the assessment. 

Parts of the evaluation were subcontracted to other organizations, including the RAND 

Corporation. The Independent Assessment’s 12 areas were (1) Assessment A: 

Demographics, (2) Assessment B: Health Care Capabilities, (3) Assessment C: Care 

Authorities, (4) Assessment D: Access Standards, (5) Assessment E: WorkflowScheduling, (6) Assessment F: Workflow-Clinical, (7) Assessment G: Staffing/Productivity, 

(8) Assessment H: Health Information Technology, (9) Assessment I: Business 

Processes, (10) Assessment J: Supplies, (11) Assessment K: Facilities, (12) Assessment 

L: Leadership.

30In producing the Independent Assessment, the Mitre Corporation created a panel 

composed of experts from diverse health care and stakeholder backgrounds and engaged 

them in producing the Integrated Report and its findings and recommendations. The report 

provides operational, near-term strategies to improve clinical care for veterans and details 

remedies for root-cause problems that must be addressed both by Congress and the VA 

based on the Independent Assessment findings.

31Pub. L. No. 113-146, § 202, 128 Stat. at 1773. 
Page 16 GAO-17-349 VA Facility Alignment

and was submitted to the President on June 30, 2016.32 For example, the 

one recommendation in the Commission on Care’s report related to 

facility management was for the enactment of legislation, which would 

authorize a process similar to the Base Realignment and Closure process 

to facilitate facility realignment decisions.

33 While VA did not fully agree 

with the specifics of the recommendation, it did agree with the concept of 

a realignment commission to focus solely on VA’s infrastructure needs 

once the mission services were determined.

34

Long-standing factors, such as shifts in the veteran population and the 

delivery of care, as well as an aging infrastructure affect VA’s efforts to 

fully align its real property portfolio with the veteran population.

A decrease and a shift in the veteran population, impact the agency’s 

ability to fully align its real property portfolio with veterans’ needs. For 

example, VA’s VetPop2014 projected a 14 percent decrease in the 

overall veteran population by 2024. It also projected a geographic shift 

with veterans continuing to migrate from the Northeast and Midwest areas 

of the United States to areas in the south and west. Figure 3 shows 

projected percentage population changes through 2024, by county.

 

32Commission on Care, Final Report of the Commission on Care (Washington, D.C.: June 

30, 2016).

33The Base Realignment and Closure is a congressionally authorized process that has 

been used to reorganize the military base structure to more efficiently and effectively 

support U.S. forces and increase operational readiness.

34Department of Veterans Affairs, Review of the Commission on Care (Washington, D.C.: 

Aug. 2, 2016).

Facility Alignment Is 

Affected by Shifts in 

Veteran Population 

and Care Delivery, 

and an Aging 

Infrastructure

Shifts in Veteran 

Population
Page 17 GAO-17-349 VA Facility Alignment

Figure 3: Projected Changes in Veteran Population in the United States, by County, from 2014 to 2024

These shifts in the veteran population—which also mirror general 

population trends—may result in a misalignment of services relative to 

veterans’ needs and insufficient capacity in some locations and excess 

capacity in other locations. As the population continues to shift, VA will 

need to make decisions on how to best address these capacity issues. 

For example, planning officials from three medical facilities said that 

facilities located in areas with a declining veteran population—and thus, 
Page 18 GAO-17-349 VA Facility Alignment

most likely a general population decrease—may experience challenges 

recruiting and retaining certain types of specialty providers.35 In addition, 

a planning official at one medical facility told us that in order for a facility’s 

providers to maintain clinical proficiency, there needs to be sufficient 

patient volume. With such shifts, these areas could experience space that 

is underutilized because of a lack of veteran demand and health care 

providers.

Although there is a projected decrease in the overall veteran population, 

VA’s EHCPM projects that nationally the number of enrolled veterans will 

increase through 2024, after which it will decline.36 However, this trend 

varies by region, and generally mirrors the overall veteran population 

trends with decreases in the northeast and increases in the south.

In addition to a projected enrollment increase in the short term, enrollee 

demographics and acuity levels are also projected to change—which will 

affect the amount and type of health care VA is projected to provide. 

According to VA officials who oversee the EHCPM, the aging of enrolled 

veterans and the increasing prevalence of service-connected disabilities 

(either through these disabilities appearing later in life or through VA 

changing its scope for eligibility) are driving significant increases in 

projected utilization and financial expenditures. For example, Vietnam era 

veterans are expected to account for an increased utilization of long-term 

care services. In addition, these enrollees also tend to have increased 

rates of transition into the higher acuity priority groups for benefits.37

Overall, the number of veterans in these higher acuity priority groups is 

projected to continue to increase and is a key driver of utilization for VA 

 

35We have previously reported on the challenges VA faces in its recruitment and retention 

initiatives, including for example, a reduced pool of nurses with advanced training in 

certain locations. See GAO, VA Health Care: Oversight Improvements Needed for Nurse 

Recruitment and Retention Initiatives, GAO-15-794 (Washington, D.C.: Sept. 30, 2015).

36According to VA officials who oversee the EHCPM, total enrollment will begin to decline 

when enrollee mortality begins to outnumber new enrollment. 

37VA’s medical benefits package for enrollees is based on a set of priority groups to 

ensure health care benefits are readily available to all enrolled veterans. The priority 

groups consist of eight different levels (1 through 8), with priority group 1 typically being 

the most severely disabled (the highest acuity). 
Page 19 GAO-17-349 VA Facility Alignment

health care services, including in-home and community- based services.38

As a result of this projected short-term growth in demand, followed by an 

eventual decline in veteran enrollment, VA must balance the expansion of 

services to meet the near-term demand with the potential excess capacity 

in the long-term.

Shifts in the type of care that VA provides and where its veterans obtain 

that care affect VA’s efforts to align its facilities to meet the changing 

veteran population.

Similar to trends in the health care industry overall, VA’s model of care 

has shifted away from providing care in an inpatient setting, to that of an 

outpatient setting, which VA largely houses in converted inpatient space, 

or in a growing number of CBOCs.39 This reflects, in part, the shift in 

demand from inpatient to outpatient services. According to the 

Independent Assessment, between 2007 and 2014, outpatient visits 

increased 41 percent while inpatient bed days declined 9 percent.40

Further, it reported that inpatient bed days have dropped as much as 21 

percent in some VISNs and, over the next 20 years, are expected to 

decline an additional 50 percent or more. This shift in the utilization of 

inpatient to outpatient services will likely result in underutilized space 

once used for inpatients, as a majority of VA medical facilities were 

originally designed for the delivery of inpatient care. Officials who oversee 

SCIP as well as some of the planners at medical facilities in our review 

told us that they can close portions of facilities that are underutilized. 

However, these planners also told us that the savings are small when 

compared to closing an entire building. For example, a medical facility in 

our review temporarily closed one of its inpatient wings due to decreased 

 

38VA offers adult day care, respite care, and other noninstitutional long-term care services 

as part of the medical benefits package it provides to all enrolled veterans. See 38 U.S.C. 

§ 1710B. VA also provides some services that are not part of its medical benefits 

package, such as nursing home care. The population of veterans to whom VA is required 

to provide nursing home care is more limited than the population to whom VA is required 

to provide other health care services. VA is required by law to provide nursing home care 

to certain veterans needing such care who also have service-connected disabilities, and 

VA also makes nursing home care available to other veterans on a discretionary basis as 

resources permit.

39We have previously reported on VA’s efforts to shift its real property portfolio toward 

more outpatient facilities, such as increases in leased space for CBOCs since the CARES 

Decision in 2004. See GAO-11-197. 

40See McKinsey & Company Inc., Assessment K (Facilities). 

Shifts in Care Delivery

A Shift from Inpatient Care to 

Outpatient Care
Page 20 GAO-17-349 VA Facility Alignment

utilization. Although the unused space was technically closed, the wing 

still had beds and equipment, and used electricity and utilities, including 

lights in the hallways and power to operate computers. (See fig. 4.)

Figure 4: Example of Costs Still Accumulating in a Closed Inpatient Wing of a Department of Veterans Affairs’ (VA) Medical 

Center, May 2016

Note: Brooklyn VA Medical Center, Brooklyn, New York: VA closed one of its inpatient wings of the 

facility in July 2015. The space was not being utilized by patients or staff. However, medical 

equipment was still there and electricity was still in use as can be seen, for example, by the various 

computers turned on in the closed wing.
Page 21 GAO-17-349 VA Facility Alignment

In addition to shifts in the veteran population and the type of care 

provided, changes to VA’s use of care in the community affect facility 

alignment. Although VA has traditionally provided care primarily through 

its own facilities, it has, and does also use its statutory authority to

purchase care from providers in the community. VA’s purchased care 

accounted for a small but growing proportion of VA’s health care budget 

in the past decade.41 For example, in fiscal year 2015, VA obligated about 

$10.1 billion for care in the community for about 1.5 million veterans. 

Three years earlier, in fiscal year 2012, VA spent about $4.5 billion on 

care in the community for about 983,000 veterans. VA officials who 

oversee the EHCPM told us that although under VA’s care in the 

community programs, a portion of health care utilization may potentially 

move from VA facilities to community care, the costs of VA facilities—

costs such as staffing, utilities, transportation, and laundry—do not 

decrease proportionally when this shift occurs. As a result, VA may be 

expanding care in the community while simultaneously operating 

underutilized and vacant space at its medical facilities. According to the 

Independent Assessment, if purchased care continues to increase then 

VA will need to realign resources by reducing its facilities.42

As VA expands its care in the community programs, questions remain 

regarding its impact on facility alignment. Planning officials at two of the 

seven medical facilities in our review told us that there is uncertainty 

surrounding the extent to which care in the community, as it currently 

exists, will continue in the future. These officials added that the 

uncertainty affects capital planning because capital projects are planned 

years in advance. For example, a planning official from one medical 

facility told us that in planning for future renovations to address SCIP 

utilization gaps, officials are hesitant to send entire clinical service lines to 

the community because if the Choice Act and its associated funds are not 

 

41RAND Corporation, Assessment C (Authorities and Mechanisms for Purchasing Care). 

42RAND Corporation, Assessment C (Authorities and Mechanisms for Purchasing Care). 

Use of Care in the Community
Page 22 GAO-17-349 VA Facility Alignment

re-authorized, the facility may be financially responsible for providing that 

service through non-VA providers.43

Aging infrastructure affects facility alignment because many VA facilities 

are no longer well suited to providing care in the current VA system, and 

VA will need to make decisions about how it can adapt to current needs. 

For example, the average VHA building is approximately 60 years old—

five times older than the average building of a not-for-profit hospital. 

Planning officials at five of the seven medical facilities in our review told 

us it is often difficult and costly to modernize, renovate, and retrofit older 

facilities—including converting inpatient facilities into outpatient facilities. 

These challenges have contributed to the presence of vacant and 

underutilized buildings. VA reported in 2016 that its inventory includes 

370 buildings that are vacant or less than 50 percent occupied, and 770 

buildings that are underutilized, requiring it to expend funds designated 

for patient care to maintain more than 11.5 million square feet of 

unneeded or underutilized space costing $26 million annually to operate 

and maintain.44

As veterans continue to use more outpatient care and less inpatient care, 

VA’s need to make decisions about its aging infrastructure and how it can 

adapt it to current needs will continue to grow. Planning officials from two 

VISNs and four medical facilities in our review told us that outdated 

building configurations—such as low ceilings and small distances 

between support columns—could prevent facilities from fully complying 

 

43Pub. L. No.113-146, §§ 101(p)(2) and 802(d), 128 Stat. at 1754, 1763, 1802-1803. The 

Choice Act created a separate account, known as the Veterans Choice Fund, which can 

only be used to pay for VA obligations incurred for the Veterans Choice Program. The use 

of Choice funds for any other program requires legislative action. The Choice Act 

appropriated $10 billion to be deposited in the Veterans Choice Fund. Amounts deposited 

in the Veterans Choice Fund are available until expended and are available for activities 

authorized under the Veterans Choice Program. However, the Veterans Choice Program 

activities are only authorized through August 7, 2017 or until the funds in the Veterans 

Choice Fund are exhausted, whichever occurs first.

44Honorable Robert A. McDonald, Secretary, U.S. Department of Veterans Affairs, U.S. 

Department of Veterans Affairs Budget Request for Fiscal Year 2017, testimony before 

the House Committee on Veterans’ Affairs, 114th Cong., 2nd Sess., February 10, 2016.

Aging Infrastructure
Page 23 GAO-17-349 VA Facility Alignment

with more recent VA health care delivery standards.45 A planning official 

from one medical facility told us it is difficult to reconfigure a facility in 

accordance with these new standards after it is already built, and instead, 

these standards would have to be incorporated in the preliminary design 

phase. We observed at various locations where despite renovations, VA 

was unable to fully reconfigure existing spaces to meet newer care 

standards. See figures 5 and 6 for examples of these challenges to 

current health care delivery standards.

 

45Examples of these more recent standards are specific configurations for VA’s new 

primary care model of care, called Patient Aligned Care Teams, and single occupancy 

rooms (as compared to double- or quadruple-occupancy rooms). Among other things, 

VA’s primary care model established examination room privacy standards, such as space 

standards for women’s health Patient Aligned Care Teams.
Page 24 GAO-17-349 VA Facility Alignment

Figure 5: Example of Outdated Double Occupancy Room at a Department of 

Veterans Affairs’ (VA) Medical Center, May 2016

Note: Manhattan VA Medical Center, New York, New York: In this example patients are housed in a 

double-occupancy room, which decreases their privacy. Current health care delivery standards call 

for single-occupancy rooms.
Page 25 GAO-17-349 VA Facility Alignment

Figure 6: Examples of Outdated Building Configurations and Structural Barriers at a Department of Veterans Affairs’ (VA) 

Medical Center, July 2016

Note: Waco VA Medical Center, Waco, Texas: These pictures are of the main building (which sat 

vacant at the time of our visit) and show the low ceilings and small distances between columns. Such 

conditions are inconsistent with current health care delivery standards.

We previously reported that the historic status of certain VA property can 

add to the complexity of converting or disposing of outdated facilities.46 In 

2014, VA reported having 2,957 historic buildings, structures, or land 

parcels—the third most in the federal government after the Department of 

Defense and the Department of the Interior. In some instances it may be 

more expensive to do renovations then it would be to demolish and 

rebuild. However, the option to demolish may not always be an option 

because of restrictions due to these buildings’ designation as historic.47

 

46See GAO, Federal Real Property: Progress Made in Reducing Unneeded Property, but 

VA Needs Better Information to Make Further Reductions, GAO-08-939 (Washington, 

D.C.: Sept. 10, 2008).

47Under the National Historic Preservation Act, VA, like other federal agencies, is required 

to manage historic properties under its control and to take into account the effects of its 

action on historic preservation. VA consults with the relevant State Historic Preservation 

Office before taking any action, including demolition or construction, on a property that has 

been designated as historic. The Secretary of the Interior is responsible for establishing 

standards for all national preservation programs and advising federal agencies on the 

preservation of historic properties listed or eligible for listing on the National Register of 

Historic Places. 54 U.S.C. §§ 300101 et seq.
Page 26 GAO-17-349 VA Facility Alignment

For example, planning officials at four of the medical facilities told us that 

state historic preservation efforts prevented them from demolishing 

vacant buildings, even though these buildings require upkeep costs and 

pose potential safety hazards. (See figs. 7-9.)

Figure 7: Example of Deteriorating Historic Vacant Buildings at a Department of Veterans Affairs’ (VA) Medical Center, July 

2016

Note: Kerrville VA Medical Center, Kerrville, Texas: These pictures show a former dwelling used for 

medical staff housing that has been designated as a historical building. The outside of the building 

shows broken windows, missing bricks, and gutters that have nearly detached from the building. On 

the inside, portions of the ceiling have collapsed, spraying debris on to the floors and walls.
Page 27 GAO-17-349 VA Facility Alignment

Figure 8: Example of a Deteriorating Historic Vacant Building at a Department of 

Veterans Affairs’ (VA) Medical Center, September 2016

Note: Chillicothe VA Medical Center, Chillicothe, Ohio: This vacant building has been designated as 

historic, but is in poor condition with broken windows and a neglected exterior.
Page 28 GAO-17-349 VA Facility Alignment

Figure 9: Unused Historic Structure That Faces Challenges to Demolition at a 

Department of Veterans Affairs’ (VA) Medical Center, July 2016

Note: Waco VA Medical Center, Waco, Texas: At this facility, planning officials told us that the old 

water tower (brown) is unusable due to deteriorating conditions. Its repair would have been more 

expensive than building a new one (white), but the demolition of the old tower faced significant 

challenges due to its historic status. Because of its visibility; however, officials still paid to have it 

painted.

In addition, some VA medical facilities were built as large medical 

campuses with multiple unattached buildings. This configuration no longer 

meets modern health care delivery standards where services are more 

concentrated in one building or a series of attached buildings. For 

example, three facilities we visited had large campuses that included 

portions of vacant land and buildings designated as historic. Figure 10 

illustrates the historic Chillicothe, Ohio VA medical center campus, which 

has numerous vacant buildings that the medical facility would like to 

dispose of.
Page 29 GAO-17-349 VA Facility Alignment

Figure 10: Occupied, Vacant, and Buildings up for Potential Disposal on the Historic Chillicothe, Ohio, Department of 

Veterans Affairs’ (VA) Medical Center Campus, December 2016
Page 30 GAO-17-349 VA Facility Alignment

SCIP has several limitations in the scoring and approval process, time 

frames, and access to information that can limit its utility to effectively 

facilitate the alignment of facilities with veterans’ needs.

Planning officials at VA medical facilities submit projects annually to 

SCIP, where they are centrally scored against a set of departmentapproved criteria and priority categories. To score high enough to be 

approved for funding, a project’s narrative portion of the evaluation must 

demonstrate how it addresses predetermined VA priorities—this narrative 

portion represents about one-third of a project’s overall score. Planning 

officials at two of the VISNs and three of the medical facilities in our 

review told us that the narrative portion is a limitation of the SCIP’s 

project-scoring and approval process because it relies on facility planning 

officials’ ability to write an accompanying narrative that addresses more of 

the priorities. This introduces subjectivity to the process, where the 

writer’s ability to demonstrate how the project’s narrative addresses more 

of the priorities can affect scoring independent of project merits. This can 

undermine SCIP’s goal of ensuring all project requests are reviewed 

equitably and consistently. The Independent Assessment also found that 

some facilities have learned to place considerable emphasis on the ability 

to write a project’s narrative tailored to perceived high value criteria—

often using both in-house staff and consultants to try and maximize the 

scores.48 For example, planning officials from one medical facility told us 

that they needed a SCIP project to expand a women’s health center but 

did not think that it would score highly. Therefore, they told us they wrote 

the narrative carefully so that it linked back to more priority areas that 

they would not have originally thought of, such as “increasing patient 

privacy,” in order for it to score higher.

 

48McKinsey & Company Inc., Assessment K (Facilities). 

Limitations in the 

Capital-Planning

Processes Impede 

VA’s Alignment of 

Facilities with

Veterans’ Needs

VA’s SCIP Has Limitations

Limitations with SCIP’s Scoring 

and Approval Process
Page 31 GAO-17-349 VA Facility Alignment

In addition, another limitation to SCIP is that it allows facility planners to 

gain credit for closing service gaps by proposing capital projects that they 

have no intention of implementing. Specifically, planners at VA medical 

facilities must demonstrate within SCIP that they plan to address all 

service gaps within the 10-year action plan. However, planners can show 

that they are addressing a gap by including such a project in future or 

‘out’ years of their 10-year plan but then continue to delay the project into 

future years without implementing the project or addressing the service 

gap. Such actions can undermine the department’s goal of using SCIP to 

strategically manage its health care facilities. Although the extent to which 

this is occurring is unclear, facility planners at two of the facilities in our 

review told us that they routinely enter projects for future years that they 

have little or no intention of actually pursuing. For example, planning 

officials from one medical facility told us that in instances where they did 

not agree with the gaps that SCIP identified, they would include 

construction or demolition projects in the later years of their SCIP 

submission. They said they did this because (1) they could include a 

general project description without having to be too specific, and (2) 

demolition projects would most likely not score high enough to obtain

funding. Planning officials from another medical facility told us that they 

continue to promote demolition projects to the out years of their SCIP 

plan as a way of appearing to address an excess space gap in SCIP 

plans without actually implementing the project. 

Even though some facility-level planning officials told us they did not think 

demolition projects would score high enough to get funding, officials who 

oversee SCIP told us it is possible if the projects’ narratives linked back to 

several different priority areas, such as “safety” or “reducing facility 

condition assessment deficiencies.” As a result, they said facilities will 

only submit a demolition project in SCIP if it is part of a demolition-andrebuild type project that links back to more priority areas.49 Figure 11 

shows an example of a non-clinical building on a medical facility campus 

that the facility’s planning officials would like to demolish due to structural 

issues. 

 

49As of September 2014 (the most recent information available), 704 of the 5,639 VHAoperated buildings (about 12 percent) were designated by VA as potential disposal 

candidates, representing about 6.5 million gross square feet (about 4.4 percent of the 

approximately 148.8 million gross square feet in VHA-operated buildings). The list 

consists of only those buildings owned by VA, and does not include leased facilities. (See 

app. I for a complete list of those VHA-operated buildings over 10,000 gross square feet in 

size that VA medical facilities have designated as potential disposal candidates.) 
Page 32 GAO-17-349 VA Facility Alignment

Figure 11: Example of a Non-Clinical Building at a Department of Veterans Affairs’ (VA) Medical Center That Has Structural 

Damage, July 2016

Note: Waco VA Medical Center, Waco, Texas: In this building, the foundation is sinking (about 6 

inches as of July 2016). Planning officials at the medical facility told us that it is too expensive to fix, 

and demolishing the building would not score high enough in SCIP. According to these officials, 

although it cannot be used for patient care, the building, at present, is structurally sound and now 

houses the facility’s engineering staff.

In addition, the SCIP scoring and approval process is limited in that it 

does not have a mechanism in place to correctly sequence projects. 

Specifically, planning officials at three of the seven medical facilities in our 

review told us that the SCIP approval process does not allow for, or 

ensure that projects will be approved in the chronological order they 

determined to be appropriate. For example, planning officials at one of 

the medical facilities said that they have been submitting projects in SCIP 

to try and collocate specialty outpatient clinics that were in separate areas 

of the campus. On several occasions, a project that needed to start after 

a predecessor project was finished was approved and funded first 

because the project addressed a higher priority area. Out of fear that they 

would lose the funding if they waited for the first project to get approved, 

these planning officials told us they changed the planned location of one 

clinic to a less desirable location instead of their initial goal of collocating 

the clinics. According to OMB guidance, improper funding of segments of 
Page 33 GAO-17-349 VA Facility Alignment

a project can lead to poor planning or higher costs.50 VA officials told us 

that this problem could be addressed through better training for facility 

planners, but budget thresholds may also play a role. Specifically, VA 

officials told us, and the Independent Assessment reported that VA facility 

planners often divide a larger project into several smaller projects so that 

they stay under the statutorily-defined threshold for major medical facility 

projects ($10 million)—a threshold that the Independent Assessment

recommended eliminating.

51 

SCIP’s lengthy project-development and approval timeframes can hinder 

capital project planning. Specifically, the time between when planning 

officials at VA medical facilities begin developing the narratives for 

projects that will be scored in SCIP and when they are notified that a 

project is funded has taken between 17 and 23 months over the past 6 

fiscal-year SCIP submissions.52 As such, facility planning officials 

routinely submit their next year’s planned projects before knowing the 

outcomes of those from the previous year. In one instance, for example, 

facility planning officials were required to begin working on the narratives 

for the projects planned for fiscal year 2015 before they learned which 

projects for fiscal years 2013 or 2014 were approved for funding.53 In 

another example, facility planning officials had to wait about 18 months to 

officially learn that VA only funded 2 of the 1,403 projects submitted for 

fiscal year 2017.54 Officials who oversee the program told us that while 

they recognize that this is a concern, some information for unfunded 

projects is automatically loaded into the next year’s SCIP submission, 

reducing rework. Long time frames can also exacerbate SCIP’s inability to

correctly sequence projects in the desired order. For example, under 

current time frames and SCIP guidelines, a facility planner may have to 

 

50See OMB, Circular No. A-11. 

51McKinsey & Company Inc., Assessment K (Facilities). 

52Although planning officials at VA medical facilities obtain initial information from SCIP 

about what gaps they need to address, they typically do not begin developing the 

narratives until they receive a request from VA several months later to submit the projects 

for SCIP scoring and approval.

53Specifically, facility planning officials started working on the narratives for the fiscal year 

2015 SCIP submissions in mid-March 2013, but did not officially learn about which 

projects were approved and funded from fiscal year 2013 and fiscal year 2014 until late 

March 2013 and mid-January 2014, respectively.

54According to VA officials, the only projects that were allowed to start in fiscal year 2017 

were major construction projects with the National Cemetery Administration, due to the 

pending Commission on Care report and recommendations.

Limitations with SCIP Time 

Frames
Page 34 GAO-17-349 VA Facility Alignment

delay submitting subsequent projects in a sequenced group of projects for 

up to 2 years each while planners wait to ensure the predecessor project 

was funded. Figure 12 shows the overlapping timelines of the last 6 fiscalyear SCIP submissions. An official from the office that oversees SCIP told 

us that the timing of the budgeting process that is outside VA’s control 

contributes to these delays. 

Figure 12: Overlapping Timelines of the Last 6 Fiscal Years of the Strategic Capital Investment Program’s (SCIP) Project 

Submissions and the Number of Submissions

a

Although planning officials at VA medical facilities obtain initial information from SCIP about what 

gaps they need to address, they do not officially start developing the narratives until they receive a 

request from VA to submit a project for SCIP scoring and approval. Officials from the office that 

oversees SCIP told us that facilities usually have access to the tools for submission about a week 

prior to the request date.

b

Medical facilities officially find out which major (over $10 million) and minor construction (under $10 

million) SCIP projects are approved and will be funded when Congress passes the department’s 

budget for that fiscal year. Non-recurring maintenance SCIP projects—repairs and renovations within 

the existing square footage of a facility that total more than $25,000—are available for funding on the 

first day of the fiscal year for that project’s submission because they have advance appropriations.

While aspects of the process are outside VA’s control, over the last 6 

fiscal-years’ SCIP submissions, VA has chosen to wait about 6 to 10 
Page 35 GAO-17-349 VA Facility Alignment

months to report the results of the SCIP scoring process to the medical 

facilities. This situation makes it difficult for local officials to understand 

the likelihood that their projects will receive funding. Federal standards for 

internal control note that agencies should ensure that quality 

information—such as information about approved projects—should be 

provided on a timely basis.55 A VA official said that for future SCIP cycles, 

VA plans to release the scoring results for minor construction and nonrecurring maintenance projects to local officials earlier in the process. At 

the time of our review, however, the official did not have a timeframe as to 

when this would be done. 

SCIP has limitations in its ability to provide planners with important 

information they need in the initial steps of planning capital needs. VA 

subdivides each VISN into a number of smaller “market areas.” However, 

SCIP limits facility planners’ access to the projects proposed by other 

markets and VISNs. According to federal standards for internal control, 

agencies should identify quality information and ensure that it is 

accessible.56 Planning officials from four of the medical facilities told us 

that these access limitations to SCIP information make it difficult to obtain 

a comprehensive understanding of their needs for capital-planning 

purposes. For example, planning officials at one of the medical facilities 

told us that as a result of the lack of access to information about nearby 

projects, a VA medical facility in a neighboring VISN had plans for a new 

CBOC near its VISN boundary progress farther than it should have before 

VA officials determined that it would have been too close to an existing 

CBOC just over the VISN boarder.

VA is aware of many of the limitations of the SCIP process—as the 

Independent Assessment found many of the same limitations and made 

recommendations to address them—but has taken little action. 

Specifically, in 2015, the Independent Assessment found that SCIP’s 

scoring and approval processes and time frames, among other things, 

undermined VA’s capital-planning and prioritization process.57 In addition, 

the Independent Assessment made several recommendations to address 

those limitations, including: (1) refining the SCIP processes to simplify 

 

55See GAO-14-704G. 

56See GAO, High-Risk Series: Progress on Many High-Risk Areas, While Substantial 

Efforts Needed on Others, GAO-17-317 (Washington, D.C.: Feb. 15, 2017).

57McKinsey & Company Inc., Assessment K (Facilities). 

Limitations Accessing SCIP 

Information

VA Has Done Little to 

Address Known 

Limitations with the SCIP 

Process
Page 36 GAO-17-349 VA Facility Alignment

scoring methods; (2) strengthening the business case submission 

process; and (3) developing mechanisms to ensure projects met 

promised objectives. Officials who oversee SCIP told us that they were 

aware of, and mostly agreed with the Independent Assessment’s findings 

in the facilities section. In order to address all of the Independent 

Assessment’s recommendations, including most of the same SCIP 

limitations we found, VA created a task force called the Integrated Project 

Team, as we reported in September 2016.58 According to VA officials, the 

task force identified several actions to enhance and restructure the 

department’s infrastructure based on the facility section of the 

Independent Assessment. However, after 6 months of work, the task 

force disbanded before it developed an implementation plan for those 

initiatives. VA officials said that they were instead focused on addressing 

other priorities such as those in the Commission on Care’s report—which 

built upon the Independent Assessment—and proposed legislation that 

could affect VHA operations. However, the Commission on Care did not 

address facility management issues on the level of the Independent 

Assessment’s recommendations.59 Not addressing important, known 

limitations runs counter to federal standards for internal control, which 

note that agencies should evaluate and determine appropriate corrective 

action for identified limitations and deficiencies on a timely basis.60 In 

addition, managing federal real property is on GAO’s High Risk List, and 

our High Risk report notes that agencies should have a corrective action 

plan with steps to implement solutions to recommendations in order to be 

removed from the list.61 Without ensuring that recommendations from 

internal and external reviews are evaluated, decided upon, documented, 

and promptly acted on, VA does not have reasonable assurance that 

 

58See GAO, VA Health Care: Processes to Evaluate, Implement, and Monitor 

Organizational Structure Changes Needed, GAO-16-803 (Washington, D.C.: Sept. 27, 

2016). 

59The Commission on Care report’s “facility and capital assets” recommendation is that 

VA develop and implement a robust strategy for meeting and managing VHA’s facility and 

capital-asset needs. To accomplish this strategy, the report outlines several steps that will 

need to be undertaken, but notes that subsequent legislative action will need to take place 

before they can be addressed. Of the 41 facility-related recommendations within the 

Independent Assessment (Assessment K (Facilities)), not all were within the scope of this 

engagement.

60See GAO-14-704G. 

61See GAO, High-Risk Series: Progress on Many High-Risk Areas, While Substantial 

Efforts Needed on Others, GAO-17-317 (Washington, D.C.: Feb. 15, 2017).
Page 37 GAO-17-349 VA Facility Alignment

SCIP can be used to identify the full capital needs to address VA’s 

service and infrastructure gaps.

VA’s ongoing VAIP Process (estimated by VA officials to cost $108 million 

upon completion) was designed to provide a more strategic vision for 

aligning VA’s medical facilities and services with veterans’ needs. 

However, the facility master-planning process has several limitations, 

including that it assumes that all future growth in services will be provided 

directly through VA facilities without considering alternatives, including the 

status quo and purchasing care from the community. This assumption 

runs counter to VA guidance from November 2016 that notes the need for 

using taxpayer resources wisely by avoiding building facilities that create 

100-year commitments if they could use community capacity. 

Nonetheless, facility master plans produced by the VAIP Process make 

construction recommendations that directly contradict this policy because 

the plans do not adequately consider care in the community, for example:

• To address one medical facility’s master plan would require about 

$762 million to relocate and renovate spaces within a building, acquire 

adjacent land, demolish inadequate buildings, construct a new 

medical tower, and provide seven clinical services that are currently 

provided elsewhere. No analysis was done to determine if these 

services could be better or more cost effectively purchased through 

care in the community.

• Another medical facility’s master plan indicated a need to construct 

five new structures estimated to cost about $100 million to provide 

clinical services that veterans were already obtaining elsewhere. 

Similarly, no cost-benefit analyses were done to consider care in the 

community as an option. This construction was recommended in 

addition to an unrelated major construction upgrade costing in excess 

of $366 million.

Because these plans do not consider that care could be provided in the 

community, if implemented, they increase the risk for spending more than 

necessary to provide the services. OMB’s acquisition guidance notes that 

investments in major capital assets should be made only if no alternative 

private sector source can support the function at a lower cost.62 Longterm costs for capital assets are particularly relevant for VA as its data 

project that the number of enrolled veterans will begin to fall after 2024. 

 

62See OMB, Circular No. A-11.

VAIP Facility Master Plans 

Have Limited Usefulness 

Because They Do Not 

Adequately Consider Care 

in the Community, among 

Other Weaknesses
Page 38 GAO-17-349 VA Facility Alignment

VA officials told us that operations and maintenance represent 85 to 90 

percent of the total life-cycle costs for VA health care facilities. Officials 

who oversee the VAIP Process told us that the facility master plans’ lack 

of analyses regarding care in the community was because they were 

awaiting further guidance from VA on the proportion of care and types of 

services to obtain from the community versus in VA facilities. VA released 

this guidance in November 2016. That guidance requires individual 

analyses at the local level in order to determine the mix of services 

provided in VA facilities versus those in community care, a requirement 

that is not in the facility master-planning process.

We also identified other limitations that limit the utility of the VAIP 

Process: 

• Lack of standardization: According to VA officials, they have mostly 

completed the VAIP Process for 6 of the 18 VISNs, but in part 

because it is conducted by several contractors, VA has not fully 

standardized the process across VISNs. As such, the results are also 

not comparable across VISNs. Officials who oversee the program said 

that they are proposing an enhancement to the Health Service 

Delivery Plan portion of the process that would allow for standardized 

analyses, planning, and reporting. But the proposal was still in its 

early stages, and at the time of our review, there was no timeline for 

completion.

• Lack of accountability for implementing VAIP recommendations: 

Officials who oversee the program told us that there is no requirement 

that the facilities or VISNs implement recommendations based on the 

VAIP Process’s Health Services Delivery Plans or the facility master 

plans—although VA officials said there have been discussions about 

requiring this accountability in the future. As a result, there is no 

accountability for evaluating or responding to the VAIP 

recommendations.

• Incomplete cost estimates: The VAIP Process’s facility master plans 

include estimates for construction and design, but do not include any 

long-term estimates for operating costs. OMB’s Capital Programming 

Guide notes that these life-cycle costs, such as operations and 

maintenance, should be included in a credible life-cycle cost 

estimate.63 As previously noted, VA officials said that operating and 

maintenance cost for VA medical facilities can represent 85 to 90 

 

63See OMB, Supplement to Circular No. A-11: Capital Programming Guide. 
Page 39 GAO-17-349 VA Facility Alignment

percent of total facility costs. According to officials who oversee the 

program, the intent was only to provide costs for completing the 

identified projects.

The limitations of the VAIP Process’s facility master plans reduce its utility 

for the VA’s planning officials to the point where some local officials said 

that they do not use VAIP results and planning officials from five of the 

seven medical facilities in our review told us that they already contract for 

their own facility master plans, separate from VAIP. According to federal 

standards for internal control, agencies should take steps to identify, 

analyze, and respond to risks related to achieving the defined objectives, 

an approach that in this case, could reduce risks to the VAIP facility 

master plans’ success.64 Although officials who oversee the VAIP 

Process told us that the VAIP-produced master plans uniquely 

incorporate the Health Care Service Delivery Plan’s recommendations 

from the first step of the process, and would therefore be different from 

the facilities’ master-planning efforts, the potential for duplication exists as 

separate entities could be undergoing strategic planning for the same 

facility. The magnitude of these limitations and the potential for planning 

duplication raise questions about the need for and utility of the VAIP 

facility master plans as they are currently being developed.

VA does not always include stakeholders in facility alignment decisions 

that affect veterans’ health care. VA may align its facilities to meet 

veterans’ needs by expanding or consolidating facilities or services. 

Stakeholders—including, veterans, local, state, and federal officials, 

VSOs, historic preservation groups, VA staff, and Congress—often view 

changes as working against their interests or those of their constituents, 

when services are eliminated or shifted from one location to another.

 

64See GAO-14-704G. 

Local Approaches to 

Stakeholder 

Involvement Vary due 

to a Lack of VA 

Guidance

VA Has Not Consistently 

Integrated Stakeholders 

into Facility Alignment 

Decisions
Page 40 GAO-17-349 VA Facility Alignment

We have previously identified best practices for stakeholder involvement 

in facility consolidation actions and recommended agencies identify 

relevant stakeholders and develop a two-way communication strategy 

that begins well in advance of any facility changes and addresses 

concerns and conveys through data the rationale and overarching 

benefits behind decisions.65 Failure to effectively engage with 

stakeholders in these ways can undermine or derail facility alignment. 

These best practices suggest that VA leadership should engage both 

external stakeholders, such as veterans groups and local politicians, and 

internal stakeholders, such as VA employees. However, we found that 

two-way communication did not always occur when VA engaged 

stakeholders.

External stakeholders: VA often takes steps to involve external 

stakeholders, but those efforts often fall short of the best practice of 

developing a two-way communication strategy. VA requires VISN 

leadership to hold quarterly town hall meetings with external stakeholders 

to promote ongoing communications.66 Planning officials from each of the 

five VISNs and seven medical facilities in our review told us that they 

meet regularly with external stakeholder groups, usually through quarterly 

town hall meetings or roundtables. However, in speaking with external 

stakeholders, we found that, in large part, these meetings were for VA to 

communicate information, not necessarily to involve stakeholders in the 

decision-making process. For example, a local VA official said that the 

monthly stakeholder meetings were primarily a mechanism for VA officials 

to announce projects after decisions were made. Officials from two local 

veterans’ organizations agreed with this characterization, and 

representatives from one stopped attending the meetings as a result. In 

one of these locations, the breakdown in two-way communication resulted 

in picketing when veterans’ organizations opposed the closure of a 

facility.

We also found that when stakeholders were not always engaged 

consistently with best practices, VA’s facility alignment efforts were 

challenged by external stakeholders. For example, one area that has a 

declining number of veteran enrollees also has three medical facilities 

within 25 miles of each other. According to the CARES report, the veteran 

 

65See GAO-12-542. 

66Department of Veterans Affairs, Community Care, Including Veterans Choice Program 

(VCP), Town Halls, (Washington. D.C.: May 10, 2016).
Page 41 GAO-17-349 VA Facility Alignment

population and enrollment in this area did not justify multiple inpatient 

facilities. Based on the CARES recommendation, VA considered a 

consolidation of services. Officials from a local veterans group told us that 

due to the one-way nature of communication with VA officials, they did 

not fully trust that VA would follow through on plans to replace the 

services following the consolidation and feared this VA property would be 

sold or disposed of and not replaced with a new VA facility. This 

alignment proposal prompted members of Congress and of the city 

council and VSOs to conduct a campaign that resulted in all three 

facilities remaining operational 13 years after the CARES report was 

issued.

We found that local facility alignment efforts in which VA officials better 

followed best practices—building transparency by providing data-driven 

information and utilizing two-way communication strategies—with external 

stakeholders were more successful. For example, planning officials from 

one medical facility—which successfully implemented a CARES 

recommendation to consolidate inpatient beds in a neighboring facility—

told us that they communicated with external stakeholder groups as far in 

advance as they could and presented data to support any proposed 

change. Planning officials from another medical facility were able to close 

an underutilized inpatient wing, a leased CBOC that had experienced 

decreased utilization and increased costs, and relocate a domiciliary from 

one campus to another. During this process, facility officials developed a 

communication plan and held meetings with external stakeholders to 

present their data and explain the reasoning behind the change.

Internal stakeholders: Best practices also include engaging internal 

stakeholders to build consensus for facility alignment actions. Facility 

alignment can mean job loss, relocation, or changes in the way 

employees perform their duties. VA officials told us that employees have 

sometimes challenged the facility alignment process and in some 

instances, affected the outcomes where these best practices were not 

incorporated. Specifically, effective communication with internal 

stakeholders can foster trust and an understanding of the planned 

changes, potentially defusing opposition while strengthening commitment 

to the effort. For example, as part of a consolidation and closure at one 

medical facility, planning officials addressed concerns, as well as 

presented data-driven information that highlighted the benefits and 

rationale to employees. Facility officials developed a communication plan 

and held a meeting with employees to present their data and explain the 

reasoning behind the change. In this meeting, they also addressed 
Page 42 GAO-17-349 VA Facility Alignment

employee concerns by reassuring them that no one was going to lose 

their job.

VA does not provide officials at VISNs and medical facilities with 

guidance that incorporates best practices on fully engaging both internal 

and external stakeholders about facility alignment decisions, or evaluate 

the effectiveness of local stakeholder engagement efforts. VA provides 

guidance on communicating changes to stakeholders, but this guidance 

does not conform to best practices in that it does not provide details about 

how and when to communicate. Without official guidance VA cannot be 

assured that the VISNs and medical facilities are consistently applying 

best practices that integrate stakeholders into the decision-making 

process in a way that better ensures the success of alignment efforts.

Further, existing VA guidance does not instruct VISNs and facilities to 

involve stakeholders throughout the decision-making process. Some of 

the guidance cites required notification procedures, but does not address 

general best-practice strategies for engaging and building consensus with 

stakeholders. For example, in April 2016, VA provided guidance to VISNs 

regarding notification procedures for any changes in clinical services. This 

memorandum includes direction to the VISN for a communication plan 

that includes creating congressional notification, patient notification 

letters, talking points, and a press release 30 days prior to opening a new 

facility. However, VA’s guidance lacks specific directions on timelines, 

data, and the extent to which external stakeholders should be a part of 

the decision-making process. A VA official told us that they do not have 

such guidance because it is implicitly understood that local officials 

should engage stakeholders. However, this outcome is not always 

occurring due, in part, to this lack of specificity in the guidance, we 

described earlier in this report. We found variation both in the ways local 

officials engaged external and internal stakeholders in facility alignment 

efforts and in the results of those efforts.

In addition, VA officials stated that they do not monitor and evaluate their 

communication methods for best practices or for the methods’ 

effectiveness in reaching their intended audiences. This runs counter to 

federal standards for internal control, which note that agencies should 

monitor and evaluate their activities.67 We observed variation in the 

 

67See GAO-14-704G. 

VA Lacks Guidance That 

Incorporates the Best 

Practice of Fully Engaging 

Stakeholders and Does 

Not Evaluate 

Communication Efforts
Page 43 GAO-17-349 VA Facility Alignment

involvement of stakeholders and the impact on facility alignment 

outcomes. As noted earlier, in some cases, we observed one-way 

communication that resulted in adversarial relationships that reduced 

VA’s ability to better align facilities to the needs of the veteran population. 

In other areas, such as with the medical facility that was able to close an 

underutilized inpatient wing, close a leased CBOC, and relocate a 

domiciliary, two-way communication with stakeholders resulted in more 

productive relationships and effective alignment efforts.

Evaluating the effectiveness of stakeholder outreach efforts would help 

VA officials identify and internalize lessons for future activities. However, 

VA lacks a process for evaluating its stakeholder outreach efforts. Without 

guidance that adheres to best practices about fully integrating 

stakeholders and the lack of monitoring and evaluation about this 

process, VA increases its risk that stakeholders are not appropriately 

involved in its facility alignment efforts nor can it determine the 

effectiveness of its efforts, or learn lessons from previous efforts.

The shifts in veteran demographics and demand for health services 

combined with antiquated facilities create an imperative for VA to better 

align its medical facilities and services. However, some of the 

recommendations from VA’s last major alignment effort—CARES—were 

not fully implemented and its current efforts to facilitate realignment—the 

SCIP and VAIP processes—are hindered by key limitations. For example, 

SCIP is unable to ensure that medical facilities are not adding projects in 

out years to address gaps that they do not intend to implement. In 

addition, relying on project narratives for one-third of the project score can 

introduce subjectivity into the process, a process that was intended to 

ensure that all projects are reviewed equitably and consistently. If these 

deficiencies remain, VA’s SCIP process for prioritizing capital projects will 

continue to limit the agency’s ability to effectively facilitate decisions to 

correctly align its medical facilities with veterans’ needs and thereby

deliver the best and most cost-effective health care to the veteran 

population.

The VAIP facility master plans also have significant limitations as a 

planning aid. If their trend toward not analyzing the benefits of utilizing 

medical capacity in the community is continued, the VAIP facility master 

plans’ recommendations could result in spending more than necessary to 

provide the services. The level of potential overspending on VA medical 

centers will become an even more significant issue if the number of 

enrolled veterans begins to decline after the year 2024 as predicted.

Conclusions
Page 44 GAO-17-349 VA Facility Alignment

Finally, because VA has not consistently followed best practices for 

effectively engaging stakeholders, stakeholders may not fully support 

alignment efforts—a situation that poses a risk to success. Also, VA does 

not have a process for monitoring and evaluating its communication 

methods, which runs counter to federal standards for internal control. 

Without this, VA does not know if the local officials are meaningfully or 

effectively engaging internal and external stakeholders in the capital 

alignment decisions that affect them.

To improve VA’s ability to plan for and facilitate the alignment of its 

facilities with veteran needs, we recommend that the Secretary of 

Veterans Affairs direct the appropriate offices and administrations to take 

the following four actions:

1. Address identified limitations to the SCIP process, including limitations 

to scoring and approval, and access to information.

2. Assess the value of VAIP’s facility master plans as a facility-planning 

tool. Based on conclusions from the review, either 1) discontinue the 

development of VAIP’s facility master plans or 2) address the 

limitations of VAIP’s facility master plans.

3. Develop and distribute guidance for VISNs and facilities using best 

practices on how to effectively communicate with stakeholders about 

alignment change.

4. Develop and implement a mechanism to evaluate VISN and facility 

communication efforts with stakeholders to ensure that these 

communication efforts are working as intended and align with 

guidance and best practices. 

We provided a draft of this report to VA for comment. Its written 

comments are reproduced in appendix II.68 VA partially concurred with 

our first recommendation. Specifically, VA said that it generally concurred 

with the recommendation to address limitations in SCIP process, but 

limited its concurrence to addressing the limitations that are within VA’s 

control. We edited our report to indicate that some parts of the process 

are outside VA’s control and focused our findings on those elements for 

which VA does have control. VA fully concurred with the other three 

 

68VA provided two identical letters with comments, with one addressed to Mr. Wise and 

the other to Ms. Draper. We only reproduced one of the letters in appendix II.

Recommendations for 

Executive Action and 

Our Evaluation

Agency Comments
Page 45 GAO-17-349 VA Facility Alignment

recommendations and outlined a plan to implement them. VA also 

provided technical comments, which we incorporated as appropriate.

As agreed with your offices, unless you publicly announce the contents of 

this report earlier, we plan no further distribution until 30 days from the 

report date. At that time, we will send copies of this report to the 

appropriate congressional committees and the Secretary of Veterans 

Affairs. In addition, the report will be available at no charge on the GAO 

website at http://www.gao.gov. 

If you or your staff have any questions regarding this report, please 

contact David J. Wise at (202) 512-2834 or wised@gao.gov, or Debra A. 

Draper at (202) 512-7114 or draperd@gao.gov. Contact points for our 

Offices of Congressional Relations and Public Affairs may be found on 

the last page of this report. GAO staff who made key contributions to this 

report are listed in appendix III.

David J. Wise Debra A. Draper

Director Director

Physical Infrastructure Health Care
Appendix I: Buildings Operated by the 

Veterans Health Administration (VHA) and 

Designated for Disposal, by State

Page 46 GAO-17-349 VA Facility Alignment

Table 1 lists the 168 VHA-operated buildings over 10,000 square feet in 

size that, according to VA, had been designated for potential disposal at 

the end of fiscal year 2014, organized by state and medical center.1

Table 1: Buildings Operated by the Veterans Health Administration (VHA) and Designated for Disposal, by State, Fiscal Year 

2014 

State Location Building function Total gross square feet

AL Tuscaloosa

Building 39 Information technology/Salvation Army 46,924

Building CC Connecting corridors 27,980

Building 145 Community center 15,000

Tuskegee 

Building 68 Administrative offices 52,723

AK - - -

AZ Phoenix 

Building 31 Mental health 28,202

Prescott 

Building 70 Vacant 20,685

AR North Little Rock 

Building 76 Nutrition and food 45,234

Building 26 Engineering shops, state veteran service organization 13,594

Building 37 Human resources 12,628

Building 80 Engineering, shops 10,088

CA Long Beach 

Building 5 Administrative offices 32,030

Building 6 Engineering maintenance shop 12,508

Building 5C Police & engineering building 10,080

Menlo Park 

Building 321 Psychiatric outpatient 42,461

Building 371 Warehouse 29,500

Palo Alto 

Building MVC 100 Administrative offices 34,958

Building 9 Patient lodging 34,000

Building 50 Warehouse 26,200

 

1

The list consists of only those buildings under the custody and control of VA, and does

not include leased facilities. 

Appendix I: Buildings Operated by the 

Veterans Health Administration (VHA) and 

Designated for Disposal, by State
Appendix I: Buildings Operated by the 

Veterans Health Administration (VHA) and 

Designated for Disposal, by State

Page 47 GAO-17-349 VA Facility Alignment

State Location Building function Total gross square feet

Building 42 Engineering shops 15,748

Sacramento

Building 646 Consolidated outpatient surgical specialties 19,000

Sepulveda

Building 23 Therapeutic gym 24,432

West Los Angeles 

Building 525 Distant patient lodging services 15,000

Building 345 Radiation therapy 14,217

Building 337 Research animal house 12,941

Building 44 Engineering shops 12,809

Building 46 Engineering shops 11,034

CO - - -

CT Newington 

Building 2W Business office 18,228

Building 4 Vacant 12,394

DE - - -

FL Gainesville 

Building 30 Fisher House 15,943

Miami

Building 68 Fisher House 13,559

Orlando 

Building 7Nona Central energy plant 41,900

GA Augusta (Uptown)

Building 119 Fisher House 14,024

Dublin 

Building 34 Vacant 30,857

Building 33 Vacant 16,888

Building 42 Vacant 16,649

Building 35 Vacant 14,868

HI - - -

ID Boise 

Building 117 Research 18,061

IL Danville 

Building 14 Medical administrative service 31,772

Building 49 Chapel 16,621

Building 48 Carnegie library (vacant) 14,290

Hines 
Appendix I: Buildings Operated by the 

Veterans Health Administration (VHA) and 

Designated for Disposal, by State

Page 48 GAO-17-349 VA Facility Alignment

State Location Building function Total gross square feet

Building 37 Consolidated mail out pharmacy 280,050

Building 800 Joliet community-based outpatient clinic 60,000

Building 20 Supply depot, garage 56,323

Building 8 Engineering shops, prosthetics, administrative 42,095

Building 48 Laundry 39,546

Building 2 Administrative offices 34,906

Building 13 Mental health outpatient 23,090

Building 16 Administrative offices 22,187

Building 17 Office of Human Resources 20,604

Building 12 Clinical exam space, employee fitness center 18,702

Building 7 Engineering shops 16,998

Building 9 Recreation, voluntary 12,034

North Chicago 

Building 135 Administrative, childcare 69,963

Building 1 Research, logistics 56,358

Building 48 Administrative offices, vacant space 26,496

Building 46 Administrative 19,141

Building 3 Administrative 17,447

Building 5 Leased to crisis center 13,872

Building 32 Engineering shops 10,477

IN Indianapolis 

Building 33 Warehouse, storage 45,105

Building 5 Warehouse, storage 24,073

Building 42 Veteran house 21,708

Building 7 Prosthetics, home based health 16,656

Marion 

Building 79 Warehouse, storage 24,697

Building 17 Nursing education 18,471

Building CC Connecting corridors 13,600

IA - - -

KS Leavenworth 

Building 41 Warehouse, storage 32,744

Building 54 Engineering shop 12,365

Building 28 Engineering shop, storage 10,919

KY Leestown 

Building 28 Chapel, storage, vacant space 49,758

Building 5 Administrative, lab (vacant) 24,003
Appendix I: Buildings Operated by the 

Veterans Health Administration (VHA) and 

Designated for Disposal, by State

Page 49 GAO-17-349 VA Facility Alignment

State Location Building function Total gross square feet

LA - - -

ME Togus 

Building 21 Storage barn 15,518

MD Loch Raven 

Building 7 Research building 15,500

Perry Point 

Building 360 Old laundry facility. new warehouse 40,619

Building 314B Recreation 18,686

Building 11H Administrative offices 11,027

MA Bedford 

Building 19 Laundry, storage 18,135

Building 21 Warehouse 11,164

Brockton 

Building 23 Gym, pool 40,957

Building 25 Administrative offices, storage 21,140

Building 24 Chapel 15,720

Building 61 Administrative offices, computer rooms 13,646

Jamaica Plains 

Building 3A Parking garage addition 75,000

Building 1D Radiation therapy 25,000

Building 2 Patient lodging 21,372

Building 1E Cryogenics research 15,000

MI Battle Creek

Building 6 Recreation, auditorium 20,611

Building 8 Homeless veterans program (vacant) 15,296

Building 1 Main administration 10,484

MN Minneapolis

Building 222 Warehouse (Fort Snelling) 61,969

Building 10 Lodging, Veterans Integrated Service Network support 23,336

Building 224 Storage, general 13,460

MS Biloxi

Building 1 Main hospital 122,400

Building 2 Intermediate care 76,170

Building 19 Mental health and rehabilitation 76,170

Building 14 Blind rehabilitation center 55,600

Building 26 Warehouse 45,500

Building T103 Warehouse 20,000
Appendix I: Buildings Operated by the 

Veterans Health Administration (VHA) and 

Designated for Disposal, by State

Page 50 GAO-17-349 VA Facility Alignment

State Location Building function Total gross square feet

Building 5 Surgical residents 13,200

MO St. Louis (Jefferson 

Barracks) 

Building 23 Shops, prosthetics 21,300

MT - - -

NE - - -

NV Las Vegas

Building 5 Community living center 109,748

Building 2 Energy plant 34,005

NH - - -

NJ - - -

NM Albuquerque

Building 53 Behavioral health care 17,607

NY Bath

Building 92 Recreation 44,770

Building 33 Information systems 12,962

Castle Point

Building 101 Storage 10,000

Lyons

Building 55 Domiciliary (vacant) 79,400

Building 9 Storage, vacant space 44,100

Building 15 Linen distribution, engineering shops 27,500

Building 5 Auditorium, gym, administrative offices 16,661

Building 10 Administrative offices 15,950

Building 11 Administrative offices 15,000

Montrose

Building 5 Kitchen, dining hall 58,511

Building 7 Storage, vacant space 47,261

Building 2 Theater 27,077

Building 16 Engineering administration, shops 25,743

Building 26 Pool, gym 23,842

Building 27 Chapel 10,758

Northport

Building 88 Gym 26,195

Building 37 Vacant 21,468

Building 18 Vacant 20,886

Building 13 Linen services 19,173
Appendix I: Buildings Operated by the 

Veterans Health Administration (VHA) and 

Designated for Disposal, by State

Page 51 GAO-17-349 VA Facility Alignment

State Location Building function Total gross square feet

Building 15 Shops, fire department 16,063

Building 89 Engineering shops (future) 12,349

St. Albans

Building 65 Garage 24,364

NC Asheville

Building 9 Nurses quarters (vacant) 42,619

Salisbury

Building 43 Hospice 18,459

ND - - -

OH Chillicothe

Building 3 Rehab clinics 23,922

Building 247 Gymnasium 17,596

Building 4 Vacant 15,418

Dayton

Building 409 Administrative building 86,160

Building 116 Administrative building (vacant) 11,495

Building 226 Freedom house, education 10,729

OK - - -

OR - - -

PA Coatesville

Building 16 Administration 21,700

Building 11 Research 21,600

Building 15 Laundry 16,300

Building 5 Great Hall, administration 15,300

University Drive

Building 30 Research office building 91,139

SC - - -

SD Black Hills (Fort Meade)

Building T274 Vacant recreation hall 17,706

Building 89 Engineering building 13,051

Building 48 Facility management warehouse 10,986

Building 109 Storage 10,265

TN Murfreesboro

Building 4 Medical media 18,653

Building 90 Storage 13,103

Building CC Connecting corridors 12,700

TX Big Spring
Appendix I: Buildings Operated by the 

Veterans Health Administration (VHA) and 

Designated for Disposal, by State

Page 52 GAO-17-349 VA Facility Alignment

State Location Building function Total gross square feet

Building 22 Community living center 21,500

Building 3 Engineering, emergency management 16,910

San Antonio

Building 671FH Fisher House 13,006

Temple

Building 222 Information technology offices, storage, and server rooms 28,453

Waco

Building 24 Engineering and environmental management offices 10,630

UT - - -

VT - - -

VA Hampton

Building 50 Medical record files and vacant space 23,236

Building 15 Boiler plant 22,251

Building 31 Engineering shop 10,674

Building 48 Chapel 10,290

WA American Lake

Building 4 Domiciliary 24,571

Walla Walla

Building 69 Patient call center, audiology, logistics 48,195

Building 74 Clinical swing space, administrative offices, storage 24,408

WV Huntington

Building 23R Research 35,154

Martinsburg

Building 314 Engineering 18,255

WI Milwaukee

Building 2 Domiciliary, main mess hall (vacant) 133,730

Building 6 Offices 120,150

Building 20 Warehouse 56,208

Building 102 Laundry 31,000

Building 5 Great Lakes Service Center (Dom. Quarters) 28,800

Building 41 Ward Memorial Theater (Vacant) 21,986

Building 1 Offices (Dom. Administration) 17,600

Building 108 Structural & machine shop 10,248

Tomah

Building 40 Maintenance/repair and engineering shops 13,999

WY - - -

Total 168 buildings 4,955,946
Appendix I: Buildings Operated by the 

Veterans Health Administration (VHA) and 

Designated for Disposal, by State

Page 53 GAO-17-349 VA Facility Alignment

Source: GAO analysis of Department of Veterans Affairs (VA) data. | GAO-17-349

Note: Data are as of the end of fiscal year 2014. The list consists of only those buildings under the 

custody and control of VA, and does not include leased facilities.
Appendix II: Comments from the Department 

of Veterans Affairs

Page 54 GAO-17-349 VA Facility Alignment

Appendix II: Comments from the Department 

of Veterans Affairs

See comment 1.

Note: GAO comments 

supplementing those in the 

report text appear at the end 

of this appendix. 
Appendix II: Comments from the Department 

of Veterans Affairs

Page 55 GAO-17-349 VA Facility Alignment
Appendix II: Comments from the Department 

of Veterans Affairs

Page 56 GAO-17-349 VA Facility Alignment

See comment 4.

See comment 3.

See comment 2
Appendix II: Comments from the Department 

of Veterans Affairs

Page 57 GAO-17-349 VA Facility Alignment

See comment 5.
Appendix II: Comments from the Department 

of Veterans Affairs 

Page 58 GAO-17-349 VA Facility Alignment
Appendix II: Comments from the Department 

of Veterans Affairs

Page 59 GAO-17-349 VA Facility Alignment

The following are GAO’s comments on the Department of Veterans 

Affairs letter dated March 22, 2017.

1. VA stated that many of the items noted in the draft report 

mischaracterized the intended outcomes of the SCIP process, such 

as the fact that SCIP was not designed as a mechanism to force 

realignment. We did not intend to characterize the SCIP process’s 

intention as a mechanism to force realignment of VA facilities and 

clarified our report to reflect this approach. 

2. VA stated that many of the items we found that needed to be 

addressed through the SCIP process were outside of the SCIP 

program and that VA had limited ability to influence. We agree and 

have edited the report: to reflect that some elements of the process 

are outside VA’s control and to re-focus on the aspects that VA does 

control. Please see comments 3, 4, and 5 below for our responses. 

Regarding how we characterized the intention of the SCIP process, 

see comment 1.

3. In regard to our finding that the SCIP process does not have a 

mechanism in place for ensuring that future-year projects are 

implemented, VA stated that this was not an intentional limitation 

resulting from the SCIP process, but was instead an outcome 

stemming from VA not having enough capital to meet all of the needs 

identified in the SCIP plan. We agree and clarified the report. 

However, in our review, planners at two medical facilities told us that 

they enter projects for future years that they have little or no intention 

of actually pursuing—which is different than not having enough capital 

to pursue the project. As such, we continue to believe that SCIP has a 

limitation in that it does not have a mechanism in place to prevent 

facility planners from gaining credit for closing service gaps by 

proposing capital projects that they have no intention of ever 

implementing. 

4. In regard to our finding that SCIP’s development and approval 

timeframes can hinder capital planning, VA stated that it agrees that 

the planning process is lengthy, but added that the timeliness of the 

SCIP process is driven by the government-wide budget process, 

which is outside of VA’s control. We agree that there are elements of 

the timeframes that are outside of VA’s control and clarified our report 

to address this situation and focus on what is within VA’s control. 

Specifically, over the last 6 fiscal-year SCIP submissions, VA has 

GAO’s Comments
Appendix II: Comments from the Department 

of Veterans Affairs

Page 60 GAO-17-349 VA Facility Alignment

chosen to wait about 6 to 10 months to report the results of the SCIP 

scoring process to the medical facilities.

5. In regard to our finding that the SCIP process’s scoring and approval 

process relies on facility planning officials’ ability to write an 

accompanying narrative that addresses more of the priorities, VA 

stated that it disagreed that the scoring was highly based on narrative 

and/or subjective information. We clarified our report to note that the 

narrative portion represents about one-third of a project’s overall 

score, but as VA states, it relies on the planners’ ability to articulate 

the business need for the project. GAO continues to believe that that 

relying on planners’ abilities to articulate the business need for a 

project introduces subjectivity to the scoring process.
Appendix III: GAO Contacts and Staff 

Acknowledgments

Page 61 GAO-17-349 VA Facility Alignment

David J. Wise at (202) 512-2834 or wised@gao.gov, or Debra A. Draper 

at (202) 512-7114 or draperd@gao.gov. 

In addition to the contacts named above, Keith Cunningham, Assistant 

Director; Jeff Mayhew, Analyst-in-Charge; Colleen Taylor; Laurie F. 

Thurber; and Michelle Weathers made key contributions to this report. 

Also contributing were Jacquelyn Hamilton, John Mingus, Sara Ann 

Moessbauer, Malika Rice, and Crystal Wesco.

Appendix III: GAO Contacts and Staff 

Acknowledgments

GAO Contacts

Staff 

Acknowledgments

(100531)
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