The Department of Veterans Affairs (VA) is set to implement a significant reorganization of its health care management system, marking the largest change since 1995. The overhaul aims to streamline operations by reducing the number of Veterans Integrated Service Networks (VISNs) from 18 to five, with all networks reporting directly to the under secretary for health. This initiative is designed to eliminate redundancies and enhance the consistency of policy making in the Veterans Health Administration (VHA).
In a statement issued on October 23, 2023, VA Secretary Doug Collins emphasized that the current VHA structure has become overly complex, leading to inefficiencies in decision-making and communication. “The current VHA leadership structure is riddled with redundancies that slow decision making, sow confusion and create competing priorities,” Collins remarked. He added that the reorganization would allow policymakers to focus on creating policies while regional leaders concentrate on implementation.
The VA’s plan includes the elimination of the VHA chief operating officer position, with responsibilities being reassigned to the under secretary, the deputy under secretary, or the associate deputy under secretary. Officials assert that these changes will not lead to job losses. Instead, the department aims to reduce the complexity of its bureaucracy, allowing staff to spend more time on patient care and improving access for veterans.
During discussions this week, Rep. Mike Bost, the chairman of the House Veterans Affairs Committee, expressed support for the restructuring. He introduced several legislative proposals, one of which also seeks to reduce the number of VISNs, although his plan suggests a reduction to eight networks rather than the five proposed by the VA. “Change can be a good thing. Veterans and their families gave us a clear mandate last November that business as usual is not cutting it,” Bost stated.
Conversely, Rep. Mark Takano, the committee’s ranking Democrat, criticized the lack of consultation with Congress and veterans service organizations during the planning process. He described the approach as “secretive” and partisan, highlighting that many stakeholders were not informed about the changes until after the plan was publicly announced.
In conjunction with the reorganization, the VA is also modifying its community care program, seeking proposals for contracts to provide medical treatment for veterans outside the VA system. The new agreements could be worth up to $1 trillion over a period of ten years. Under this plan, the number of community care regions would decrease from five to two, although they may be supported by multiple health care networks.
The response from veteran advocacy groups has been cautious as they analyze the extensive proposals. Following a briefing earlier this week, Carl Blake, CEO of Paralyzed Veterans of America, remarked that the proposed changes could address longstanding concerns regarding bureaucratic expansion within the VA. “If it works the way it is intended, it gives us hope that many of these administrative barriers will be knocked down,” Blake noted.
Similarly, the National Commander of Disabled American Veterans, Coleman Nee, expressed support for efforts to enhance VA health care services. He indicated that the organization is eager to learn more details about the planned reorganization and remains committed to collaborating with the VA and Congress to improve care for veterans with service-connected conditions.
A blue-ribbon panel established in 2016 recommended significant changes to the VA’s structure to improve oversight of the VISNs and clarify their roles. The commission’s report pointed out that the responsibilities of medical center directors were not well defined, leading to confusion within the system. Federal watchdogs have echoed these concerns, with a report from the VA’s inspector general highlighting deficiencies in the organizational structure of mental health services.
The VA has announced plans to eliminate 25,000 vacant positions within the VHA, a decision that has raised concerns among some lawmakers about the potential impact on service delivery. The press secretary for the VA, Peter Kasperowicz, stated that these positions primarily consist of roles deemed unnecessary post-pandemic. He assured that no current employees would face layoffs, and the reorganization would not affect overall staffing levels.
The VHA’s structure, created in 1995, aimed to decentralize decision-making authority to better serve local patient populations. Initially designed to have no more than a dozen employees per network, the number has ballooned to over 500 per VISN. The upcoming changes will place greater responsibility on the VA’s Central Office in Washington, D.C., for policy setting, financial management, and oversight, offering clearer operational standards for medical facilities.
While the reorganization is set to unfold over the next two years, beginning in early 2026, the full implications for veteran care and operational effectiveness remain to be seen.
