The Department of Veterans Affairs is planning a massive reorganization of its health care management system, reducing the number of networks that support VA medical centers and realigning policy offices to promote consistency.
In the largest planned overhaul of the Veterans Health Administration framework since 1995, the department will slash the number of Veterans Integrated Service Networks, or VISNs, from 18 to five and require them to report directly to the VA under secretary for health.
The plan calls for eliminating the VHA chief operating officer and placing VHA Central Office staff under the under secretary, the deputy under secretary for health or the associate deputy under secretary.
VA officials said in briefings earlier this week that the changes will reduce VHA’s “complex bureaucracy” while improving communications and consistency in policy making, systems and technology.
“The current VHA leadership structure is riddled with redundancies that slow decision making, sow confusion and create competing priorities,” VA Secretary Doug Collins said in a statement Monday. “Under a reorganized VHA, policymakers will set policy, regional leaders will focus on implementing those policies, and clinical leaders will focus on what they do best: taking great care of veterans.”
In announcing the changes, VA officials stressed that they are not aimed at reducing staff.
According to the department’s briefing documents, the reorganization has been needed for nearly a decade and is an effort to reduce duplication, increase accountability and improve patient service.
According to the VA, officials looked at national health care models and the organization of top health care systems to create the plan.
“Our dedicated staff will benefit from less bureaucracy, clearer direction, and more time to focus on VHA priorities and patient care — enable faster access to care for veterans with fewer handoffs,” according to VA documents.
House Veterans Affairs Committee Chairman Rep. Mike Bost, R-Ill., introduced several pieces of legislation this week addressing the VA’s organizational structure, including one that would reduce the number of VISNs from 18 to eight — three more than the VA is proposing.
On Monday, Bost issued a statement saying he supported Collins’ effort to restructure the agency.
“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 and we must cut through the bureaucracy, remove the red tape, and push VA forward,” Bost said.
Rep. Mark Takano of California, the committee’s ranking Democrat, called for hearings on the proposal, noting that most of Congress and the major veterans service organizations were not consulted or informed of the development process.
“VA has been planning this VHA reorganization effort for the past seven months. During that time, the secretary and other political appointees have avoided gathering input from or informing Congress or veterans service organizations. Instead, they have worked in secret and behind closed doors,” Takano said in a statement to Military Times on Wednesday.
“In launching the plan’s official rollout this month, VA officials took a partisan approach, meeting only with Republican committee members before the plan was announced publicly, and refusing to brief Democratic committee members until the new year. Redesigning the organizational structure of the nation’s largest integrated health care system should not be a secretive, partisan, closed-door process,” he said.
The VA also announced coming changes to its community care program this week, seeking proposals for contracts from companies to provide medical treatment for veterans outside the VA system. The agreements could be worth up to $1 trillion over 10 years.
Under that plan, the number of community care regions would be reduced from five to two. But they may be supported by multiple health care networks. Currently, the program is managed by just two health networks, TriWest Healthcare Alliance and Optum Serve.
VA officials said the new contracts will result in a broader choice for veterans.
Reaction to both announcements has been slow among veteran advocacy groups as they digest the massive proposals. After a VA briefing to veteran service organizations earlier this week, Carl Blake, CEO of Paralyzed Veterans of America, said advocates have been concerned “for years” about the expansion of VA bureaucracy. He said the planned changes — at least for the VHA — sound “promising.”
“Continued growth of the administration has really gotten in the way of health care decisions, policy and decision-making, and so, based on the way this was briefed, if it works the way it is intended, it gives us hope that many of these administrative barriers — and there are many of them across VHA — will be knocked down,” Blake said Tuesday in an interview with Military Times.
Disabled American Veterans National Commander Coleman Nee issued a statement Wednesday saying the organization supports efforts to improve VA health care for veterans with service-connected conditions.
“We look forward to learning more details about the department’s plans to reorganize the Veterans Health Administration and remain committed to working closely with VA, Congress, and other veteran stakeholders to strengthen the high-quality health care our nation’s disabled veterans have earned,” Nee said.
A blue-ribbon panel created in 2016 to study the future of VA health care recommended that the VA redesign its central office to ensure it had proper oversight of the VISNs. It also recommended that the VHA define the roles of the VISNs and ensure that the networks all worked within national standards.
“The role of the Veterans Integrated Service Network is not clear, and the delegated responsibilities of the medical center director are not defined,” wrote members of the Commission on Care in their final report.
Other federal watchdogs have voiced similar concerns. In March, the VA’s own inspector general noted in a report on VA mental health officers that the “VISN organizational structure lacked clearly defined roles and standardized responsibilities and did not ensure accountability.”
VA officials also said this week that the department plans to eliminate 25,000 vacant positions in the Veterans Health Administration, cuts that some say would negatively affect an organization already stretched thin by the loss of 30,000 jobs earlier this year as a result of incentives, early retirements and the firing of probationary hires under orders from President Donald Trump to cut the federal workforce.
VA press secretary Peter Kasperowicz described the vacancies as “mostly COVID-era roles that are no longer necessary” and said most of the positions targeted for elimination have been vacant for more than a year.
“No VA employees are being removed, and this will have zero impact on veteran care,” Kasperowicz said in an email to Military Times.
The VA has not released specifics on the types of jobs that will be eliminated, however, and it has not updated its list of vacant positions, as required by the 2018 Mission Act, since July. That report showed that the department had more than 39,000 vacancies at the time, including 7,413 nursing positions, 231 physician assistant jobs and 2,733 medical doctors.
The VISN structure was created in 1995 to decentralize decision-making authority as part of an effort for local managers to make decisions based on their unique patient populations. VISNs were basically established to serve as the budget and planning units of the systems’ medical centers and clinics.
Originally, VISNs were envisioned to have no more than a dozen employees, but that number increased to more than 500 per VISN.
Under the reorganization, the VA’s Central Office — its headquarters in Washington, D.C. — will be responsible for setting policy, financial management, oversight and compliance.
Operations centers and the VISNs will take direction from the central office to develop operational, quality and performance standards to guide medical facilities.
According to VA, staffing and operations at VA medical centers and clinics will not be affected.
“This initiative is not a reduction in force or an attempt to reduce staffing levels at VHA, and VA does not expect a significant change in overall staff levels once it’s complete,” according to a statement issued by the VA.
Sen. Tammy Duckworth, D-Ill., expressed concern Monday that the cuts will strain the VA workforce and affect appointment wait times.
“Not only is Trump guaranteeing that our VA won’t have the number of staff needed to handle the influx of new claims, but he is also ensuring that our Veterans will wait even longer to get treated — if they can get treatment at all,” Duckworth said in a press release.
The VHA reorganization is expected to take place over the next two years starting in early 2026.
Patricia Kime is a senior writer covering military and veterans health care, medicine and personnel issues.
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