CARES Planning Initiatives

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CARES Planning Initiatives

• VISN 17 VA Heart of Texas 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 (4)
• Market Planning Initiatives
• Access
• Inpatient
• Outpatient
• Small Facility Planning Initiative

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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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February 2003 Changes in Planning Initiatives
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VISN 17 Overview

• Enrollees
• Projected to increase by 30,476 (12) from FY
  2001 level to FY 2022
• Planning Initiatives (PIs)
• Access
• 2 Markets have 3 PIs related to access in Primary
  Care and Hospital Care impacting 91,651 enrollees
• Inpatient Demand
• 1 Market has 2 PIs related to increased
  inpatient demand
• Outpatient Demand
• 4 Markets have 10 PIs related to increased
  outpatient demand
• There are no PIs related to decreased outpatient
  demand
• Small Facility
• 1 facility is projected to require fewer than 40
  acute care beds which has not at this point
  closed their acute beds.

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VISN 17 Overview

• Other VISN-Level Issues
• Proximity
• No Acute Care facilities are within the 60-mile
  standard
• No Tertiary Care facilities are within the
  120-mile standard
• VISN/PI Team Identified Issues (OPTIONAL)
• Mental Health services need to be realigned
  throughout the Network.
• Collaborative Opportunities
• 3 Markets indicate the possible opportunity for
  collaborative sharing agreements with DoD.
• There were no collaborative opportunities
  identified for NCA or VBA.

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VISN OverviewNHCU

• Nursing Home Care
• The need for NHCU care remains high over the
  planning period. The NHCU component of VAs LTC
  Planning Model is in process of review to update
  the projections and should be available March
  1st.
• Market Plans shall still consider any space
  and/or capital needs for NHCU care needs.
  (Realignment, renovations, conversion of space,
  etc.)

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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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Outpatient Mental Health

• The forecasting model results in a systematic
  reduction in forecasted outpatient mental health
  visits.
• We are working to understand the dynamics of the
  model that results in this outcome.
• As a result, negative outpatient Mental Health
  Planning Initiatives will not be proposed or
  selected for Market Plan development.

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VISN 17 Issues Special Disability Programs

• Blind Rehab VISN 17 has not received a Blind
  Rehabilitation PI. The VISN has received a
  recommendation to restore its BRC to full
  capacity as part of its overall planning.
• SCI VISN 17 has not received any recommendations
  to increase SCI acute or LTC beds.

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VISN Level IssuesEffective Use of Resources
Proximity

• Acute Care Hospitals with similar missions that
  are within 60 miles of each otherNone in VISN 17
• Tertiary Care Hospitals within 120 miles of each
  otherNone in VISN 17

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VISN Level IssuesEffective Use of Resources
Space

• Current Vacant Space 372,025 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
• Mental Health services need to be realigned
  throughout the Network to maximize use of
  resources and through appropriate referral
  patterns.

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VISN Level IssuesCollaborative Opportunities

• The following collaborative opportunities have
  been identified for VISN 17 to consider when
  completing Market Plans
• VBA
• None
• NCA identification of areas they would like to
  expand
• None
• Enhanced-Use possible opportunities for vacant
  space
• None
• DoD
• Joint Reserve Base Fort Worth OPC
• Fort Hood Temple Medical Center
• Brook Army Medical Center, Wilford Hall, San
  Antonio Medicalo Center

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VISN 17 North Market

• Description of Market Area
• This area is one of four hub and spoke
  configurations in this VISN that reflect referral
  and travel patterns for this region. This market
  includes the 4 county Dallas Ft. Worth Metroplex
  with current market penetration rates well below
  the national average for priority 1-6 veterans. A
  VA staffed multi-specialty CBOC in Ft. Worth as
  well as numerous contract CBOCs scattered
  throughout the market supplement the services of
  Bonham and Dallas VAMCs.

• Medical Center(s)
• Bonham, TX
• Dallas, TX

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VISN 17 North MarketCARES Planning Initiatives

• Access
• Primary Care 71 of the veterans residing within
  the Market are within the Access Guideline
• Hospital Care 88 of the veterans residing
  within the Market are within the Access Guideline
• Tertiary Care 100 of the veterans residing
  within the Market are within the Access Guideline

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 17 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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VISN17 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 17 Central Market

• Description of Market Area
• This area is one of four hub and spoke
  configurations in this VISN that reflect referral
  and travel patterns for this region. This market
  includes the Austin metropolitan area current
  market penetration rates well below the national
  average for priority 1-6 veterans. A VA staffed
  multi-specialty CBOC in Austin as well as several
  VA staffed CBOCs scattered throughout the market
  supplement the services of Temple, WACO and
  Marlin VAMCs.

• Medical Center(s)
• Waco, TX
• Temple, TX
• Marlin, TX

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VISN 17 Central MarketCARES Planning Initiatives

• Access
• Primary Care 63 of the veterans residing within
  the Market are within the Access Guideline
• Hospital Care 60 of the veterans residing
  within the Market are within the Access Guideline
• Tertiary Care 100 of the veterans residing
  within the Market are within the Access Guideline

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 17 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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VISN17 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.None in
  the Central Market

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VISN 17 Southern Market

• Description of Market Area
• This area is one of four hub and spoke
  configurations in this VISN that reflect referral
  and travel patterns for this region. This market
  includes the San Antonio metropolitan area with
  current market penetration rates well below the
  national average for priority 1-6 veterans. A VA
  staffed multi-specialty CBOC in San Antonio as
  well as several contract CBOCs scattered
  throughout the market supplement the services of
  San Antonio and Kerrville VAMCs.

• Medical Center(s)
• San Antonio, TX
• Kerrville, TX

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VISN 17 Southern MarketCARES Planning Initiatives

• Access
• Primary Care 81 of the veterans residing within
  the Market are within the Access Guideline
• Hospital Care 84 of the veterans residing
  within the Market are within the Access Guideline
• Tertiary Care 100 of the veterans residing
  within the Market are within the Access Guideline

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 17 Southern 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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VISN17 Southern MarketCARES Planning Initiatives

• Small Facility Planning Initiative
• The following facilities were projected to have
  less than 40 beds in FY 2012 and/or 2022.None in
  the Southern Market.

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VISN 17 Valley Coastal Bend Market

• Description of Market Area
• This area stretches along the Texas Gulf Coast
  and west to the Rio Grande Valley and Mexican
  border. The Valley is one of the fastest growth
  areas in the country drawing numerous Winter
  Texan veterans who often migrate permanently.
  There are no VA medical centers in this market
  which is 2-5 hours from San Antonio. It is served
  by VA staffed CBOCs in Mc Allen and Corpus
  Christi and several contract CBOCs. There is some
  limited contract specialty and hospital care in
  the Valley..

• Medical Center(s)
• NONE

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VISN 17 Valley Coastal Bend MarketCARES Planning
Initiatives

• Access
• Primary Care 84 of the veterans residing within
  the Market are within the Access Guideline
• Hospital Care 3 of the veterans residing within
  the Market are within the Access Guideline
• Tertiary Care 50 of the veterans residing
  within the Market are within the Access Guideline
  but

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 17 Valley Coastal Bend 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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VISN17 Valley Coastal Bend MarketCARES Planning
Initiatives

• Small Facility Planning Initiative
• The following facilities were projected to have
  less than 40 beds in FY 2012 and/or 2022. None
  in the Valley Coastal Bend Market