CARES Planning Initiatives

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CARES Planning Initiatives

• VISN 8 VA Sunshine Healthcare Network

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Presentation Outline

• February 2003 Changes in Planning Initiatives
• Changes in CARES Projections
• VISN Summary
• VISN-Level Issues
• Special Disability Programs
• Effective Use of Resources
• Proximity
• Vacant Space
• VISN/PI Team Identified Issues
• Collaborative Opportunities

• VISN Markets (5)
• Market Planning Initiatives
• Access
• Inpatient
• Outpatient
• Small Facility Planning Initiative

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February 2003 Changes in Planning Initiatives
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Changes in CARES Projections

• The Revised CARES Projections Incorporates the
  following
• The Census 2000 into the Veteran Population
  projections and therefore, the Enrollment
  projections
• The new Enrollment Policy Decisions
• Eligibility for new enrollment and
• Increased co-pays

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VISN 8 Summary

• Enrollees
• Projected to decrease by 3 from FY 2001 level to
  FY 2022
• Planning Initiatives (PIs)
• Access
• One Market has a PI related to access in Primary
  Care
• Three Markets have a PI related to Acute Hospital
  Care
• Inpatient Demand
• One Markets have a total of 1 PI related to
  increased inpatient demand
• Two Markets have a total of 3 PIs related to
  decreased inpatient demand
• Outpatient Demand
• Four Markets have a total of 10 PIs related to
  increased outpatient demand
• No Markets have a PI related to decreased
  outpatient demand
• Small Facility
• No facilities are projected to require fewer than
  40 acute care beds

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VISN 8 Summary

• Other VISN-Level Issues
• Proximity
• Two Tertiary Care facilities are within the
  120-mile standard
• VISN/PI Team Identified Issues
• San Juan Major Construction
• Tampa VAMC, Fire Safety and Hazardous Materials
  Issues
• Gainesville Division, Patient Privacy and Life
  Safety Issues
• Pockets of Extreme Lack of Hospital Access in
  Gulf, Central, and North Markets
• Collaborative Opportunities
• VISN 8 has opportunities to collaborate with DOD,
  NCA, and VBA as well as Enhanced Use
  opportunities

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VISN 8 OverviewNHCU

• Nursing Home Care
• The need for NHCU care remains high over the
  planning period. However, the NHCU component of
  VAs LTC Planning Model is in process of review
  to update the projections.
• Market Plans shall still consider any space
  and/or capital needs for NHCU care needs such as
  realignment, renovations and conversion of space.

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Domiciliary Policy

• Domiciliary projections will not be part of this
  CAREs cycle.
• However, DOMs may and should be included in
  Market Plans to reuse vacant space or as a result
  of realignments (especially when homelessness or
  residential rehab is the focus of Dom bed use).

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VISN 8 Issues Special Disability Programs

• Blind RehabPeak of legally blinded veterans in
  2006 at 13,263 (from 12,625 in 01) ? to
  11,794 veterans in 25. Consider space planning
  for blind rehab programs (i.e., VISORS, VICTORS,
  low vision clinics, BROS, VIST) restoration
  of inpt capacity for comprehensive blind rehab
  ctrs.
• SCI No recommendations.
• TBI Distinct and separate space needed for
  CARF-accredited TBI inpatient care at the Tampa
  VA Medical Center (one of 4 national ctrs).

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VISN Level IssuesEffective Use of Resources
Proximity

• Acute Care Hospitals with similar missions that
  are within 60 miles of each other
• Tertiary Care Hospitals within 120 miles of each
  other

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VISN Level IssuesEffective Use of Resources
Space

• Current Vacant Space 39,315 square feet.
• Once the future workload demand data is
  translated into future space needs, any excess
  space that is identified will be added to the
  Vacant Space pool.
• The final Planning Initiative for all VISNs will
  be to reduce this total Vacant Space pool by at
  least 10 beginning in FY2004 and 30 in FY2005.

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VISN Level IssuesPI Team Identified Issues

• Listed below are other issues that the VISN will
  consider when developing the Market Plans
• San Juan Major Construction
• Tampa VAMC, Fire Safety and Hazardous Materials
  Issues
• Gainesville Division, Patient Privacy and Life
  Safety Issues
• Pockets of Extreme Lack of Hospital Access in
  Gulf, Central, and North Markets

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VISN Level IssuesCollaborative Opportunities

• The following collaborative opportunities have
  been identified for VISN 8 to consider when
  completing Market Plans
• VBA
• Jacksonville, FL OPC, Mini Regional Office
• Broward County, FL OPC, Mini Regional Office
• NCA identification of areas they would like to
  expand
• Bay Pines (currently a co-located site)
• Gainesville
• Lake City
• San Juan (potential collocation at Fort
  Buchanan).
• If a new facility is obtained in Gulf South
  sub-market, coordinate obtaining additional
  property with NCA Enhanced-Use possible
  opportunities for vacant space

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VISN Level IssuesCollaborative Opportunities

• DoD
• CBOC co-located with the Navy in Key West
  Florida. Potential for further development
  exists.
• Naval Hospital Jacksonville, McDill AFB in Tampa,
  Patrick AFB in Brevard County.
• San Juan VAMC has started discussions with the
  DoD facilities located on Puerto Rico to pursue
  collaborative sharing initiatives.

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VISN 8 North Market

• Description of Market Area
• This 52 county market area is the largest VISN 8
  market in square miles. It was developed to
  include the more heavily populated counties of
  the Atlantic coastal areas and immediate interior
  counties in Florida and Georgia, the heavily
  populated counties of north central Florida, and
  the more rural counties of the eastern half of
  the panhandle area of Florida and south Georgia.

• Medical Center(s)
• North Florida South Georgia HCS
• Gainesville Division
• Lake City Division

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VISN 8 North MarketCARES Planning Initiatives

• Access
• Primary Care 66 of the veterans are within the
  Access Standard
• Hospital Care 35 of the veterans are within the
  Access Standard
• Tertiary Care 100 of the veterans are within
  the Access Standard

70
65
This represents the Travel Time Guideline.
NOTES Significant Gaps are determined by first
applying the percentage threshold and then a
volume criteria.
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VISN 8 North MarketCARES Planning Initiatives
NOTES Significant Gaps are determined by first
applying a percentage change criteria for each
CARES Category. If the gap meets this threshold,
then it must meet the workload threshold criteria
(beds for inpatient categories and stops for
outpatient categories).
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VISN 8 North MarketCARES Non-PI Workload Gaps
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VISN 8 North MarketCARES Planning Initiatives

• Small Facility Planning Initiative
• The following facilities were projected to have
  less than 40 beds in FY 2012 and/or 2022.

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VISN 8 Atlantic Market

• Description of Market Area
• Location This is the most heavily populated
  market in VISN 8. It is anchored by the Miami
  VAMC in the South Submarket and the WPB VAMC in
  the North. The natural barriers of the
  Everglades, combined with the north/south travel
  patterns on I-95, played a large part in
  determining the of 15 CBOCs..

• Medical Center(s)
• Miami
• West Palm Beach

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VISN 8 Atlantic MarketCARES Planning Initiatives

• Access
• NO Access gaps identified in this Market

70
65
This represents the Travel Time Guideline.
NOTES Significant Gaps are determined by first
applying the percentage threshold and then a
volume criteria.
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VISN 8 Atlantic MarketCARES Planning Initiatives
NOTES Significant Gaps are determined by first
applying a percentage change criteria for each
CARES Category. If the gap meets this threshold,
then it must meet the workload threshold criteria
(beds for inpatient categories and stops for
outpatient categories).
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VISN 8 Atlantic MarketCARES Non-PI Workload Gaps
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VISN 8 Atlantic MarketCARES Planning Initiatives

• Small Facility Planning Initiative
• The following facilities were projected to have
  less than 40 beds in FY 2012 and/or 2022.

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VISN 8 Puerto Rico Market

• Description of Market Area
• This market has the largest market share in the
  VHA of 50. Puerto Rico has no submarkets. It is
  comprised of the islands of Puerto Rico, US
  Virgin Islands of St. Thomas St. Croix, and
  Arecibo. The market has one tertiary Medical
  Center in San Juan and six CBOCs.

• Medical Center(s)
• San Juan

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VISN 8 Puerto Rico MarketCARES Planning
Initiatives

• Access
• CARES was unable to complete an access analysis
  for Puerto Rico. Based on the PI selection
  team's analysis of distance to VA facilities, it
  appears Puerto Rico is within access thresholds.

NOTES Significant Gaps are determined by first
applying the percentage threshold and then a
volume criteria.
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VISN 8 Puerto Rico MarketCARES Planning
Initiatives
NOTES Significant Gaps are determined by first
applying a percentage change criteria for each
CARES Category. If the gap meets this threshold,
then it must meet the workload threshold criteria
(beds for inpatient categories and stops for
outpatient categories).
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VISN 8 Puerto Rico MarketCARES Non-PI Workload
Gaps
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VISN 8 Puerto Rico MarketCARES Planning
Initiatives

• Small Facility Planning Initiative
• The following facilities were projected to have
  less than 40 beds in FY 2012 and/or 2022.

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VISN 8 Gulf Market

• Description of Market Area
• This market is made up of 11 counties extending
  south from its one tertiary Medical Center. It
  has 8 CBOCs. It is characterized by dense
  populations along the coast and sparse
  populations inland.

• Medical Center(s)
• Bay Pines

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VISN 8 Gulf MarketCARES Planning Initiatives

• Access
• Primary Care 85 of the veterans residing within
  the Market are within the Access Standard
• Hospital Care 50 of the veterans are within the
  Access Standard
• Tertiary Care 100 of the veterans are within
  the Access Standard

70
65
This represents the Travel Time Guideline.
NOTES Significant Gaps are determined by first
applying the percentage threshold and then a
volume criteria.
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VISN 8 Gulf MarketCARES Planning Initiatives
NOTES Significant Gaps are determined by first
applying a percentage change criteria for each
CARES Category. If the gap meets this threshold,
then it must meet the workload threshold criteria
(beds for inpatient categories and stops for
outpatient categories).
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VISN 8 Gulf MarketCARES Non-PI Workload Gaps
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VISN 8 Gulf MarketCARES Planning Initiatives

• Small Facility Planning Initiative
• The following facilities were projected to have
  less than 40 beds in FY 2012 and/or 2022.

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VISN 8 Central Market

• Description of Market Area
• This is the second most heavily populated market
  in VISN 8, with all 8 urban counties. The Market
  is served by one tertiary care Medical Center and
  8 CBOCs.

• Medical Center(s)
• Tampa

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VISN 8 Central MarketCARES Planning Initiatives

• Access
• Primary Care 88 of the veterans are within the
  Access Standard
• Hospital Care 45 of the veterans are within the
  Access Standard
• Tertiary Care 100 of the veterans are within
  the Access Standard

70
65
This represents the Travel Time Guideline.
NOTES Significant Gaps are determined by first
applying the percentage threshold and then a
volume criteria.
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VISN 8 Central MarketCARES Planning Initiatives
NOTES Significant Gaps are determined by first
applying a percentage change criteria for each
CARES Category. If the gap meets this threshold,
then it must meet the workload threshold criteria
(beds for inpatient categories and stops for
outpatient categories).
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VISN 8 Central MarketCARES Non-PI Workload Gaps
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VISN 8 Central MarketCARES Planning Initiatives

• Small Facility Planning Initiative
• The following facilities were projected to have
  less than 40 beds in FY 2012 and/or 2022.