STATEN ISLAND, NY – The US Department of Veteran Affairs (VA) recently released recommendations to “modernize and realign” its Veterans Integrated Services Network (VISN), proposing changes that would dramatically shift how and where veterans in New York City receive medical care. .

The extensive proposed plans for VISN 02, also known as Metro New York Market, include closing the VA medical centers in Brooklyn and Manhattan, as well as aligning Staten Island’s VA Multi-Service Community-Based Outpatient Clinic with the New Jersey market. VISN 02 includes the five boroughs of New York City and several counties north.

But what does the VA’s plan to “reset the market” mean for day-to-day health care services for veterans? The department’s “Recommendations to the Asset and Infrastructure Review Commission” report detail the following changes:

Inpatient services available at affiliate facilities. Rather than replace the Manhattan and Brooklyn VA medical centers, the VA will utilize its partnerships with “academic affiliates” to provide inpatient medical and surgical services. Some of the VA’s academic affiliates in VISN 02 include New York University, Mount Sinai, New York Medical College, SUNY Health Science Center, New York-Presbyterian and the Hospital for Special Surgery.

Outpatient services in new Community Based Outpatient Clinics (CBOC). The VA will establish two new CBOCs – creating a new one in Brooklyn and relocating Harlem’s current CBOC to a new site in the vicinity of Harlem.

New Brooklyn CBOC in Central Brooklyn. According to the VA, a majority of Brooklyn veterans enrolled in VA health care reside in Central and Eastern Brooklyn. Rather than establish the CBOC where the medical center is in Fort Hamilton, the new CBOC would be located closer to the majority of members in the borough in Central Brooklyn.

Aligning the Staten Island clinic with the New Jersey Market. With the Manhattan and Brooklyn VA medical centers closed, the next closest medical center or VA hospital for Staten Island veterans would be in New Jersey. The VA’s resolve is to align Staten Island with the New Jersey Market instead of care within the five boroughs.

Staten Island veterans to access inpatient services in East Orange. Under the proposed changes Staten Island veterans would have to go to the East Orange VA medical center in Essex County for emergency and urgent care, as well as surgical services.

Mental health services in SI clinic to expand. Among the recommendations is the expansion of the Staten Island multi-service CBOC’s mental health services. The AIR report does not specify which services would be added or expanded.

Brooklyn Residential Rehabilitation Treatment Program (RRTP) to move to Queens. Another drastic change would be to move Brooklyn’s RRTP, which is housed in the medical center in Fort Hamilton, and consolidate it under the St. Alban’s medical center’s program. This would mean the program is moved approximately 20 miles away.

Pictured, a “Future Market Map” depicts proposed changes to the Veteran Integrated Services Network (VISN) 02 – Metro New York Market – including closing the Brooklyn and Manhattan Veteran Affairs Medical Centers (VAMC), establishing partnerships with community affiliates and new Community- Based Outpatient Clinics (CBOC). Changes also include realigning the Staten Island Multi-service CBOC under the New Jersey Market. (Screenshot from Dept. of Veteran Affairs’ “Va Recommendations to the Assett and Infrastructure Review Commission” report, released March 2022)

HOW SOON WOULD REALIGNMENT OCCUR IF APPROVED?

In their report, the VA emphasizes that all realignment plans and “strategic collaborations” at new and affiliate facilities – such as New York University – would be set in place before the medical centers in Brooklyn and Manhattan are closed.

They also note that closing the medical centers is “contingent on the outcome of the proposed strategic collaboration” – if the VA is not able to supplement inpatient and outpatient services elsewhere, the existing Manhattan VAMC, for example, would remain open.

It could be years before the VA’s drastic market “reset” actually goes into effect. All VA proposals must be approved by the AIR Commission, the president and Congress.

According to Government Executive, the commission will have a year to review the recommendations before forwarding the report to President Joe Biden.

Biden can submit additional recommendations before submitting them to Congress. If he does submit them, Congress can approve the recommendations as a whole by inaction or reject them as a whole by passing a joint resolution of disapproval.

If approved, the VA says it must implement the recommendations within three years, for which the timing will vary with different markets.

In short, there are numerous and significant hurdles between the recommendations and their implementation.

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