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Food and Drug Administration Safety and Innovation Act--Motion to Proceed--Continued

Floor Speech

Location: Washington, DC


Mr. BURR. Mr. President, I think I can say I was blessed to be here right before the tribute to Katie that our colleagues from Iowa gave. What an inspiring life of a young lady. Although cut short, her impact is felt by many.


I rise today to speak on a bill that I introduced last week, S. 3084, the Veterans Integrated Service Network Reorganization Act of 2012. This legislation would significantly reorganize the structure of the Department of Veterans Affairs, or VA, Veterans Integrated Service Networks, or VISNs, to make these networks more efficient and to allow resources to be moved to direct patient care.

The veterans' health care system in our country was originally established to treat combat-related injuries and to assist in the recovery of veterans with service-connected disabilities. Since its start, the scope of the Veterans Health Administration, or VHA, has expanded and now treats all veterans enrolled in the health care system through hundreds of medical facilities located around the country. Prior to 1995, VHA was organized into four regional offices. These regional offices simply channeled information between the medical centers and the VA's Washington, DC, headquarters office. Since the regional offices' duties were to pass on information to the facilities, they had little ability to exercise independence in implementing policies based on the needs of the veterans in their region.

In March 1995, based upon the recommendations of former Under Secretary of Health, Dr. Kenneth Kizer, VHA underwent a significant reorganization of its Washington, DC, and regional offices. Basically, the VHA health care system was divided up into 22 geographic areas--now 21--with each region having its own headquarters with a limited management structure to support the medical facilities in that region. The goal of the reorganization was to improve access to, quality and the efficiency of care to veterans through a patients-first focus. This structure would improve care by empowering VISNs with the independence to decide how to best provide for the veterans in their region. This change also would have made the most of spending for patient care by suggesting that VISN management be located on a VA medical center campus.

The aim was to provide a better organized system that would have oversight management responsibilities of the medical facilities through a new structure called the Veterans Integrated Service Network. This new system intended to offer a clearer picture of what the duties were of both the VHA central office in Washington, DC, and the VISN headquarters offices. Going forward, VHA central office's responsibilities included changes to VA policies and medical procedures and monitoring the facilities' performance in providing care. Each VISN headquarters' primary function was to be the basic budgetary management and planning unit for its network of medical facilities. Because the scope of their tasks was limited, it was expected that a VISN headquarters could be operated with 7 to 10 full-time employees, for a total of 220 staff for all VISN headquarters nationally. Any additional expertise needed was to be called up from the medical centers on an informal basis.

I believe VHA has significantly strayed from the initial concept behind the 1995 reorganization. While some growth and an increase in VISN management staff over 17 years is expected, the growth and duplication of duties we have seen at VISN headquarters offices and medical facilities quite simply is troubling. Examples of such duplication are coordinators for homeless veterans, OIF OEF OND veterans, women veterans who are present at both the medical facilities and the VISN headquarters.

This duplication has not only redirected spending away from medical centers, it has caused a bloating of the numbers of staff across the 21 VISN headquarters. VISN headquarters have grown well beyond the 220 staff proposed by the 1995 reorganization to a total of 1,340 staff for the 21 VISNs headquarters today--an increase from 220 to 1,340 employees today. These staff are performing functions that have little to do with budget, management, and oversight, let alone direct health care for our veterans. It appears that VHA has allowed VISN headquarters staff to increase without the necessary oversight or an assessment of the impact on the original purpose for VISN. Also left unchecked are the changes in the veterans' population and how veterans have moved between States to determine if there is a need to adjust the VISN boundaries to best serve the veterans seeking care.

This bill--my bill--would bring about a much-needed change to the VISN structure. It would, No. 1, consolidate the boundaries of 9 VISNs; No. 2, move some jobs back to the VHA central office; No. 3, reduce the number of employees to 65 per VISN headquarters; and No. 4, require VHA to review the VISN staff and structure every 3 years. What a novel suggestion, that we would actually review the progress we make.

My colleagues may find it a bit odd that we could reduce the staff of VISN headquarters while also increasing the size of the veterans' population and facilities from some VISN headquarters, but because we are reducing the tasks that the VISN headquarters perform while transferring several jobs to new Regional Support Centers--or RSCs--VISN headquarters staff would be more productive in carrying out the simple budget, management, and planning duties that they were originally tasked with in the 1995 original reorganization.

While the consolidation of VISNs would result in the closure of nine VISN headquarters, no staff would lose their job as a result of this legislation. Staff whose jobs would be eliminated because of the consolidation would have a chance to be transferred to other positions within the VA. Staff who perform the oversight functions that would be moved to the newly created RSCs would be given the opportunity to continue that work at the RSC. This legislation also returns the idea that VISN headquarters should be located on VA campuses by directing that VISN headquarters, if possible, be located on a VA medical center campus. Relocating to vacant space on the VA medical center campus hopefully would reduce the cost to the VA in the long run but, more importantly, it would bring the headquarters staff closer to the facilities they oversee.

I realize this would be an enormous change in the way VHA does business, and yet I believe this can be accomplished without any changes to how VA provides treatment and care to our Nation's veterans. In fact, I believe it will improve how VA cares for veterans by increasing the resources directly available for patient care.

It is important that VA not lose sight of its primary mission, as stated by Abraham Lincoln: `` ..... to care for him who shall have borne the battle'' and, to that end, VA should redirect spending away from bureaucrats and back to the direct care of veterans.

I believe the VISN Reorganization Act of 2012 would provide a more efficient and effective health care system to our veterans, and I hope my colleagues will see it in that light and support this effort at reorganization that is way past due.

I thank the Chair, and I note the absence of a quorum.


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