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A video screen grab shows Rep. Jeff Miller, R-Fla., speaking during a House hearing on Capitol Hill in Washington on Oct. 1, 2015.

A video screen grab shows Rep. Jeff Miller, R-Fla., speaking during a House hearing on Capitol Hill in Washington on Oct. 1, 2015. (YouTube)

WASHINGTON — The Department of Veterans Affairs should consider scaling back its medical system to focus only on specialized care, an independent auditor told the House on Wednesday.

A review of VA’s scope of care and the creation of a governance board to steer changes, similar to the military’s Base Realignment and Closure Commission, were part of landmark study laid out in testimony to the House Veterans Affairs Committee.

House lawmakers are weighing the $68-million independent study, completed last month, as a blueprint for fixing the troubled agency. It was mandated last summer in the wake of the VA wait-time scandal, but its effect was uncertain — the VA opposed one key measure and said it is already pursing many of the other recommendations in the 4,000-page assessment.

Rep. Jeff Miller, R-Fla., said the study joins 137 past VA assessments that uncovered issues.

“Our veterans cannot afford for us to let this assessment become just number 138 gathering dust on some shelf where nobody else will ever see it,” he said.

The study found many veterans are already depending on outside health care to supplement what they receive in the VA system, which has 167 medical centers across the country, said Brett Giroir, a senior fellow at the Texas Medical Center Health Policy Institute who worked on the study.

On average, the 5.8 million who are VA patients received less than 50 percent of their health care from the system, with the rest coming from private hospitals and clinics, Giroir said.

“These demographic data combined with access challenges suggest reconsideration of whether the VHA should aim to be the comprehensive provider for all Veterans’ health needs — or whether the VHA should evolve into more focused centers providing specialized care, while utilizing non-VHA health care networks for the majority of veterans’ health care needs,” he said in the House testimony.

Giroir said the veterans are “voting with their feet” and sending the message that an integrated system with private care is desirable and effective.

A final decision on scaling back VA services would require deeper studies of medical services in each region in the United States, he said.

Any new strategy should be steered by a governance board, which would insulate the VA from politics and increase accountability, the study found. The new board would reshape geographic service areas including facilities and services, similar to the BRAC process that decommissions old and unneeded military facilities — a process that is deeply unpopular on Capitol Hill and among military communities across the country.

VA Secretary Bob McDonald told lawmakers on Wednesday he does not oppose veterans using private care but cited a recent poll by the Veterans of Foreign Wars that found 82 percent of vets prefer VA health care.

“We are here for them and we want to build capability for the number that come,” he said.

McDonald has been pressing Congress for funding in recent months, saying the agency is struggling to handle surging demand for care as it works to overhaul services.

He said the wait-time scandal that included VA staff manipulating records to hide delays in care was largely due to unmanageably high demand.

Meanwhile, McDonald said he takes issue with the governance board idea and that most of the study’s other recommendations are already part of his ongoing overhaul plans for the VA. The secretary was appointed last summer to solve deep problems in health care and administration, along with a $16.3-billion overhaul bill passed by Congress.

“I appreciate the analysis, I couldn’t do it myself but these things are already underway … progress is being made,” he said.

Rep. Corrine Brown, D-Fla., the ranking member on the Veterans Affairs Committee, said a move toward scaling back the VA’s health care responsibilities could be a step toward privatization.

“There are people out there who would want to completely close the VA and privatize the VA system, which is absolutely unacceptable and not what the veterans want,” Brown said. Twitter: @Travis_Tritten

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