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**Network Director Update on VISN 19 Expansion Plan**

**9/5/08**

1.  Mr. Grippen, Network Director **last** provided a briefing on the
    Denver Project to the Under Secretary for Health on **8/28/08** and
    to the Secretary on **8/29/08**. Briefing updates are **generally**
    held on a weekly basis. Local political and veteran feedback, news
    articles and e-mails are shared during these briefings.

2.  Mr. Grippen, Network Director attended VHA's 2008 National Planners
    Conference. Presentations relevant to national and VISN planning
    efforts were attached for additional information. The attachments
    described the health care industry trends in the United States,
    current VHA health care delivery issues, how these effect VHA's
    strategic planning direction and defined VHA strategic planning
    efforts on specific needs of the enrolled population. The
    attachments are entitled:

    i.  VHA Present and Future Trends in Veterans Health

    ii. Bridging the Gap, New Models of Care

    iii. Enrollee Health Care Projection Model: Understanding Enrollment
         and Utilization Projections.

3.  VA is in discussion with the HVAC and SVAC on the Denver Project.

4.  VISN 19 hosted a site visit with staff from the House Veterans
    Affairs Committee to Billings, Montana on 8/19/08 to review
    expansion plans in Montana. Meeting was also attended by
    Congressional staff. Attached is the presentation used for this
    meeting.

5.  VISN 19 & ECHCS hosted a site visit from staff from the House
    Veterans Affairs Committee in Denver on 8/20/08 to review expansion
    plans for Colorado. University of Colorado, University of Colorado
    Hospital and Congressional staff attended the meeting. Attached is
    the presentation used for this meeting.

6.  **VISN 19 & VAMTHCS hosted a site visit with staff from the Senate
    Veterans Affairs Committee in Billings, Montana on 9/2/08 to review
    expansion plans for Montana. Same PPT used for the HVAC was
    presented. This PPT was previously sent to VSOs.**

7.  **VISN 19 & ECHCS hosted a site visit from staff from the Senate
    Veterans Affairs Committee in Denver, Colorado on 9/3/08 to review
    expansion plans for Colorado. Meeting attended by Congressional
    staffers. Same PPT (with a few minor edits) used for the HVAC was
    presented. This PPT was previously sent to VSOs.**

8.  Nationally, the VA has continued to implement the new VA-centric
    delivery model of care. An example of this recently received
    coverage in the news: VA Preparing To Open \"Super Clinic\" In
    Florida.   WEAR-TV Pensacola, FL (8/21, 6:07 p.m. ET) broadcast,
    \"Pensacola is now home to one of the most state-of-the-art veterans
    care facilities in the country. The new joint ambulatory care center
    will open its doors to patients on Monday. The 220,000 square foot\"
    Veterans Affairs \"\'super clinic\' was designed with modern decor,
    new equipment, and more services, all under one roof. The \$45
    million facility replaces three different local VA clinics that will
    close their doors this weekend.\" The \"official ribbon cutting\"
    for the clinic is scheduled to take place \"on September 15th.\"

9.  UPI Building -- purchase of UPI building complete at closing on
    7/29/08.

10. Purchase of the lot adjacent to the UPI building purchased from the
    Fitzsimmons Redevelopment Authority. Closed on 7/29/08.

11. **[Research]{.underline} - VISN CMO & ECHCS MCD meet with CU Chief
    Financial officer on September 3. Internal (CU) Research meeting
    scheduled for September 15^th. ^**

12. VISN 19, ECHCS and UCH staff is discussing space needs in bed tower.
    UCH has an A/E that has looked at this but VA has not hired one.

13. The VA A/E is developing plans for building site demolition and
    initial utility site. A/E "on-site" working on the Phase 2
    Environmental Assessment which is required under the Site Demolition
    and Clearing project.  This involves destructive testing and
    selective sampling.  "Pot holing" around the buildings to be
    demolished has been done to see if they could identify any buried
    hazardous materials.  In addition, the A/E met with agencies to
    discuss the termination of utility services to buildings identified
    for demolition. They are also working on the Scope and Budget
    Validation to establish some basic benchmark figures, set planning
    parameters for volumes and began to review VA square foot numbers.

14. VA A/E working on a master plan for the Ambulatory Care Center and
    preliminary design to go to full design with construction
    architects. The A/E and the Project Team developed and refined new
    assumptions which were presented and approved by the ECHCS Critical
    Decision Committee.  The slide presentation posted to the intra and
    internet sites. Critical Decisions Meeting was held July 31^st^.
    Proposal from architects into Office of Construction & Facilities
    Management to proceed with Master Planning and Room by Room Space
    Plan to begin Mid August. Schematic Design to begin Sept 1, 2008.

15. Network Director and Medical Center Director met with UVC President
    7/10/08 to request recommendation of VSOs to be assigned to work on
    planning committees for the Denver Project. Form developed to
    outline groups that will be working on the Ambulatory Care Center.
    VSO representatives to work with groups to be identified by 7/31/08.

16. ECHCS MCD held meeting with July 24 -Meeting with Critical Decisions
    Group (VSOs/Union) to review services and functions for Ambulatory
    Care Center and for Tower. Chart on planned service delivery shared
    with group. Identification of services is a critical step in
    determining lease cost, recurring charges, space needs, etc. On July
    25, ECHCS MCD held meeting with architects and Executive Leadership
    Committee members to discuss space changes that will be necessary in
    ACC. On July 30, meeting held with architects to discuss issues in
    regard to exam rooms and offices. Overall model needs to be
    developed for layout purposes and utilization of UPI.

    a.  Current Construction estimate for ACC is \$384,546,425 -- Target
        from OCFM is \$388,689,000.

    b.  Current BGSF is 627,960 -- VACO 628,221

> 8/22/08: ECHCS is still reconciling the space differences and
> identifying the most efficient use of UPI. Meeting this week with ELT
> and Joint Venture Team to identify assumptions and talking points for
> user group meetings to begin 9/8.

17. Critical Decisions Meeting Held -- August 7, 2008. Joint Venture
    Team (JVT) to have Executive level briefing of progress into VACO by
    8/8/08. Anticipate approval August 18^th^ from OFCM to proceed with
    Master planning and Room by Room Plan. JVT proposal for Schematic
    Design and Design Development to be forwarded to OFCM within the
    next two weeks. Discussed with VSOs (UVC and PVA rep) the level of
    involvement they desired as ECHCS goes into user group meetings. PVA
    wishes to be included for SCI user group. VSOs request we post the
    schedule of user group meetings with the weekly VISN update (see
    below). PLEASE BE ADVISED THAT THESE MEETINGS ARE OPEN AND YOU ARE
    ENCOURAGED TO ATTEND SHOULDYOU HAVE INTEREST IN PARTICIPATING.

> USER GROUP MEETINGS have been scheduled week of

i.  Sept. 8th -- 12^th^

ii. Oct. 6^th^ -10^th^

iii. Nov. 3^rd^ -- 7^th^

> VSO representatives asked for recommendations for improvement in the
> Critical Decision Meeting and level of satisfaction with their
> involvement. Feedback received that beyond the ACC meeting the VSOs
> continued to be concerned about the lack of information presented and
> shared concerning the hospital tower.
>
> Critical Decisions Meeting -August 21st with VSO, Leadership and Joint
> Venture Team

Reviewed HVAC meetings

Reviewed space allocations compared to old model

Reviewed Next Steps in process

Service Chief Kick Off Meetings held August 26. Topics of discussion:

> a\. National Impact
>
> b\. New Planning Models

c\. Assumptions for Health Care Center

> d\. Dissemination of Departmental Space Plans
>
> e\. Review of next steps in planning/design cycle

**[Denver HCC]{.underline}**

a.  **Consulting firm Jones Lang and LaSalle  completing OMB 300 for
    Denver**

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a.  **Departmental Space planning meetings begin week of September 8**

b.  **September 15 -- leadership meeting to review the Master Planning
    options**

c.  **Week of September 21 -- presentation of 3 options for master plan
    (how different functional areas to be laid out on campus)**

d.  **UPI parking could impact overall design of HCC**

e.  **Demolition plan -- status to checked on next week**

f.  **End of September -- present the preferred Master Plan and options
    to VACO in Washington, D.C.**

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18. JIF Dollars are available for VA/DoD integration efforts- VHA
    (ECHCS) local leadership and Buckley met re: integration. Discussed
    potential Joint Incentive Fund projects and scheduling for Tiger
    Team follow up.

19. Colorado Springs -- Meeting with the broker scheduled for 8/14/08.
    Asked for COS union, VSO and VBA representation for involvement and
    transparency in process. Kick off meeting for the Health Care Center
    (HCC) Super Clinic in Colorado Springs held 8/15/08. Discussion
    centered on the following tasks:

-   Delineation of site for clinic. At this point it seems that
    available properties tend to be located in the NE section of the
    Colorado Spring catchment area.

-   Acreage needed is 10-12 if only the HCC and VBA are to be built.

-   All parking would be surface. 115,000 NUSF with building gross of
    approximately 128,000 BGSF calls for 700+ parking spaces

-   Space plan as driven by Project Eagle office shared with Real
    Property architects (HDR).

-   User group meetings would begin week of 9/21/08. This activity would
    occur parallel to property acquisition, NEPA study, etc.

-   Central Office stressed need to hire a local Resident Engineer to
    facilitate the building of this clinic.

-   OMB 300 must be submitted to meet this year's budget time frame.
    Once the Congressional hearings start in November 2008, no further
    OMB 300 submissions will be considered until the next planning
    cycle. Under the current timeline, we anticipate OMB approval in
    February -- March 2009. Goal is to complete OMB by 8/22/08.
    Prospectus, CEA and OMB 300 submitted 8/28/08.

**[Colorado Springs]{.underline}:**

a.  **OMB 300 completed -- 8/28/08**

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a.  **Broker hired -- delineated area developed, in process of
    advertising for owner/developer**

b.  **PD for local resident Engineer in process -- complete week of 8/2
    and advertise**

c.  **Senator Salazar visited clinic on Sept 4.**

d.  **Space planning for functional areas and departments to begin week
    of September 22**

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20. ECHCS Town Hall Meetings -- conducted throughout week. Two major
    agenda items: Replacement Facility Status and Results of All
    Employee Survey

21. ECHCS VAVS Meeting -- 8/7/08 presented progress on replacement
    facility(ies) to date. A number of dissenting opinions expressed.

22. ND; DND; Director, ECHCS and Director, VARO met with leadership from
    Fort Carson, Air Force Academy and Peterson AFB to discuss meeting
    shared needs in the Colorado Springs area. Primary need for DoD is
    for outpatient specialty care and inpatient acute psychiatric beds.
    Joint Medical Operations visit planned in COS for Sept 2nd and 3rd
    to discuss VA/DoD opportunities. Selected Cardiologist for VA/DoD
    Joint Incentive Funds with Evans, Air Force, and Southern Colorado
    (Colorado Springs and Pueblo). Hope to start in October.

23. **DoD/VA Joint Market Opportunities Work Group Site Visits to
    Colorado springs, CO Multi Market Area were held Wednesday,
    September 3, 2008. JMO WG Attendees included the Director, DoD/VA
    Program Coordination Office; Director, DoD Liaison and Sharing
    Office; Chief, DoD/VA Resource Sharing, HQ USA/SGOS, Air Force; SG
    Rep GPRMC, Army OTSG TRICARE Division Rep.; Associate Director,
    ECHCS; TRIWEST; MTF Commanders or Reps. (Peterson AFB/Air Force
    Academy/Ft. Carson). Meeting included review of previous site visit
    and current developments, lack of need for ECHCS to build inpatient
    MH beds due to limited VA workload in Colorado Springs market area;
    current and proposed sharing agreements between DoD/VA and needs for
    outpatient and MH services between DoD and VA.**

> **After much discussion regarding gaps in the delivery of care, there
> appeared to be consensus to further explore the viability of:**

A.  **Establishing a DoD/VA co-located Outpatient Health Care Center
    (VA-115,000 SF and DoD- 18000+ SF)**

B.  **DoD would share ancillary support services (Lab, Radiology,
    Pharmacy, etc.) with VA.**

C.  **Inpatient MH beds would be provided at Ft. Carson or leased at St.
    Francis Hospital. VA would manage entire DoD/VA MH program with VA
    staff wherever Inpatient MH beds are located.**

D.  **VA Ambulatory Surgery patients who have complications requiring
    admission would be admitted at Ft. Carson or St. Francis vs. back in
    Denver.**

**Next Steps:**

A.  **Establish POCs between DoD and VA for f/u communication.**

B.  **Establish task force to enhance collaboration on further
    developing sharing opportunities above.**

C.  **Present DoD/VA recommendations to JMO WG/JEC for rapid action if
    deemed appropriate.**

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24. Grand Junction, Fort Harrison, Cheyenne received additional funding
    to enhance staffing for hospitalist physician coverage and
    respiratory therapy coverage.  This provides a higher level of ICU
    care, which allows for expanded surgical program.

25. Grand Junction and Cheyenne received additional funding for
    equipment to support surgery.

26. Bids received for expanding Billings CBOC. Deadline for receipt of
    proposals 7/30/08. Technical evaluation completed on 8/20/08.
    Negotiations with top four offerors will commence on 8/22/08. Best
    and final offers will be requested and are due 8/26/08. Notice of
    Award will be issued on 9/2/2008**.** Billings CBOC contract awarded
    8/26/08. Acceptance signed and returned to offeror 8/27/08.
    Finalization of lease documents will occur next week. Project
    remains on track.

27. Fort Harrison Inpatient Mental Health construction project submitted
    to VA Headquarters.

28. Grand Junction and Cheyenne have been funded for construction
    projects to increase surgical capabilities.

29. Senator Salazar and Congressman Perlmutter send letter to Secretary
    Peake expressing concern over the VISN 19 Expansion Plan 7/14/08.
    Secretary Peake responds 7/18/08. Copies of letter sent to VSOs in
    last Network Director's update.

30. Information on Senator Salazar's 7/20/08 press conference, follow up
    news articles, editorials and feedback from VSO e-mails are shared
    with VA Central Office in Washington, D.C.

31. Calls made to key VSOs and Congressional representatives to
    reinforce our willingness to work together, our desire to maintain
    relationships and to ask for feedback on communication efforts.
    Varied responses shared with VISN and ECHCS leadership. Feedback
    will also be included in weekly updates to Secretary.