# Presentation: 508548

## CARES Planning Initiatives

**VISN 15: VA Heartland Network**

- Revised 03-24-03

## Presentation Outline

- Changes in CARES Projections
- Changes in VISN 3 CARES Planning Initiatives
- VISN Overview
- VISN-Level Issues
- Nursing Home Care
- Domiciliary Care
- Special Disability Programs
- Effective Use of Resources
- Proximity
- Vacant Space
- Collaborative Opportunities
- PI Team Identified Issues

- VISN Markets (3)
- Market Planning Initiatives
- Access
- Inpatient
- Outpatient
- Small Facility Planning Initiative

- Revised 03-24-03

## Changes in CARES Projections

- The revised CARES projections incorporate the following:
- Census 2000
- Veteran Population
- Enrollment projections
- New Enrollment Policy Decisions
- Eligibility for new enrollment
- Increased co-pays

- Revised 03-24-03

## Changes in VISN 15 CARES Planning Initiatives

| Type of 
Planning
Initiative | East Market |  | Central Market |  | West Market |  |
| --- | --- | --- | --- | --- | --- | --- |
|  | PI in
Nov 2002 | PI in
Feb 2003 | PI in
Nov 2002 | PI in
Feb 2003 | PI in
Nov 2002 | PI in
Feb 2003 |
| Small Facility PI: |  |  |  |  |  |  |
| Poplar Bluff | Yes | Yes |  |  |  |  |
| Capacity PI: |  |  |  |  |  |  |
| Inpt. Medicine | No | No | No | No | No | No |
| Inpt. Surgery | No | No | No | No | No | No |
| Inpt. Psychiatry | No | No | Yes | Yes | No | No |
| Otpt. Primary Care | Yes | Yes | Yes | Yes | Yes | Yes |
| Otpt. Specialty Care | Yes | Yes | Yes | Yes | Yes | Yes |
| Otpt. Mental Health | No | No | No | No | No | No |

- Revised 03-24-03

## VISN 15 Overview

- Enrollees
- Projected to decrease by 12% from FY 2001 level to FY 2022
- Planning Initiatives (PIs)
- Access
- No Markets have PIs related to Access
- Inpatient Demand
- No Market has PIs related to increased inpatient demand
- One Market has two PIs related to decreased inpatient demand
- Outpatient Demand
- Three Markets have a total of six PIs related to increased outpatient demand
- There are no PIs related to decreased outpatient demand
- Small Facility
- One acute care facility is projected to require fewer than 40 acute care beds in FY 2012 and FY 2022

- Revised 03-24-03

## VISN 15 Overview

- Proximity
- Two Acute Care facilities are within the 60-mile standard of facilities within the VISN
- No Tertiary Care facilities are within the 120-mile standard of facilities within/outside the VISN
- Collaborative Opportunities
- Several potentials have been identified in the VISN including one of VHA’s secondary High Potential Enhanced Use leasing opportunities
- PI-Team Identified Issues
- Facility Conditions
- Inter VISN Specialty Care

- Revised 03-24-03

## VISN Level IssuesNursing Home Care

- The need for NHCU care remains high over the planning period. The NHCU component of VA’s 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.)

- Revised 03-24-03

## Domiciliary projections will not be part of this CARES cycle
Domiciliaries should be included in the  Market Plans for reuse of vacant space or as a result of realignments (especially when homelessness or residential rehab is the focus of Dom bed use)

- Domiciliaries should be included in the  Market Plans for reuse of vacant space or as a result of realignments (especially when homelessness or residential rehab is the focus of Dom bed use)

- VISN Level IssuesDomiciliary Care

- Revised 03-24-03

## Blind Rehab : VISN is encouraged to establish a Visual Impairment Services Outpatient Program (VISOR) staffed by Blind Rehabilitation Outpatient Specialists and low vision specialists.  In addition, plan for low vision care clinics at tertiary facilities. 
SCI: No recommendations received from the Spinal Cord Injury and Disorders Strategic Health Care Group.

- SCI: No recommendations received from the Spinal Cord Injury and Disorders Strategic Health Care Group.

- VISN Level IssuesSpecial Disability Programs

- Revised 03-24-03

## VISN Level IssuesEffective 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:

| PI? | Facility Name
 | Second Facility Name | Miles | 
Rationale |
| --- | --- | --- | --- | --- |
| Y | Kansas City, MO. USA | Leavenworth, USA | 38 |  |

| PI? | Facility Name
 | Second Facility Name | Miles | 
Rationale |
| --- | --- | --- | --- | --- |
| N | N/A | N/A | N/A |  |

- Revised 03-24-03

## VISN Level IssuesEffective Use of Resources – Space

- Current Vacant Space: **819,050** 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 PI for all VISNs will be to reduce total Vacant Space by at least 10% in FY2004 and 30% in FY2005.

- Revised 03-24-03

## VISN Level IssuesCollaborative Opportunities

- Enhanced Use:
- St. Louis-John Cochran identified on the secondary list of Enhanced Use Lease Opportunities
- Leavenworth, Kansas: Independent Assisted Living
- VBA:** **Potential opportunity for VBA/VHA collaboration at St Louis-Jefferson Barracks
- NCA: Potential opportunities at St Louis-Jefferson Barracks and Leavenworth
- DoD:
- Scott AFB and St. Louis-John Cochran/Marion
- Fort Leavenworth and Leavenworth
- Fort Riley and Topeka
- Whiteman AFB and Kansas City

- Revised 03-24-03

## VISN Level IssuesPI-Team† Identified Issues

- Facility Conditions:
- Kansas City
- Columbia
- St. Louis-Jefferson Barracks
- Inter VISN specialty care:
- Optimization of specialty care referrals with VISN 16
- Fayetteville, Arkansas and Kansas City
- Poplar Bluff and Little Rock, Arkansas
**†**** ****Identified during the November 2002 PI Conference held in Washington, DC**

- Revised 03-24-03

## VISN 15 East Market

- Medical Centers:
- St. Louis, MO
- John Cochran
- Jefferson Barracks
- Poplar Bluff, MO
- Marion, IL

- Description of Market Area:
- The Eastern Market contains the largest Veteran population of VISN 15 and consists of 30 counties from Missouri, 17 from Kentucky, 8 from Indiana, 39 from Illinois and 5 from Arkansas.  **Estimated Veteran Population in FY 2001 was 486,537.**

- Revised 03-24-03

## VISN 15 Eastern MarketCARES Planning Initiatives

**Access**
- Primary Care: 62% of the veterans residing within the Market are within the Access Standard
- Although Market fell short of Access Standard, number of effected enrollees did not meet threshold of 11,000
- Hospital Care: 75% of the veterans residing within the Market are within the Access Standard
- Tertiary Care: 100% of the veterans residing within the Market are within the Access Standard

**70%**

**65%**

- This represents the Travel Time Guideline.

- Revised 03-24-03

## VISN 15 East MarketCARES Planning Initiatives

- Revised 03-24-03

## VISN 15 East MarketCARES Non-PI Workload Gaps

- Revised 03-24-03

## VISN 15 East MarketCARES Planning Initiatives

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

| PI? | Facility Name
 | FY2012 (Beds) | FY2022 (Beds) | 
Rationale |
| --- | --- | --- | --- | --- |
| Y | Poplar Bluff
 | 15 | 11 | Poplar Bluff is projected to require fewer than 40 acute care beds.  The VISN should review potential quality of care issues for this facility and its parent as well as opportunities for reassigning inpatient workload and/or enhancing volume. |

- Revised 03-24-03

## VISN 15 Central Market

- Description of Market Area:
- The Central Market is the second largest veteran population in VISN 15.  It consists of counties in three states:  Eastern Kansas, Western Missouri and 1 county in Illinois for 105 total counties.  82 are designated as rural, 11 as highly rural, and 12 as urban.  **FY 2001 veteran population is estimated at 401,257. **

- Medical Centers:
- Kansas City, MO
- Eastern Kansas HCS
- Topeka, KS
- Leavenworth, KS
- Columbia, Mo

- Revised 03-24-03

## VISN 15 Central MarketCARES Planning Initiatives

**Access**
- Primary Care: 74% of the veterans residing within the Market are within the Access Standard
- Hospital Care: 79% of the veterans residing within the Market are within the Access Standard
- Tertiary Care: 100% of the veterans residing within the Market are within the Access Standard

**70%**

**65%**

- This represents the Travel Time Guideline.

- Revised 03-24-03

## VISN 15 Central MarketCARES Planning Initiatives

- Revised 03-24-03

## VISN 15 Central MarketCARES Non-PI Workload Gaps

- Revised 03-24-03

## VISN 15 Central MarketCARES Planning Initiatives

**Small Facility Planning Initiative:**
**There were no facilities in the Central Market projected to have less than 40 Acute Care beds in FY 2012 and/or 2022.**

- Revised 03-24-03

## VISN 15 West Market

- Medical Centers:
- Wichita, KS

- Description of Market Area:
- This market consists of 59 rural and highly rural counties in western Kansas.  **The** **FY 2001 veteran population was estimated at 117,446 veterans**.

- Revised 03-24-03

## VISN 15 West MarketCARES Planning Initiatives

**Access**
- Primary Care: 56% of the veterans residing within the Market are within the Access Standard
- Although Market fell short of Access Standard, number of effected enrollees did not meet threshold of 11,000
- Hospital Care: 60% of the veterans residing within the Market are within the Access Standard
- Although Market fell short of Access Standard, number of effected enrollees did not meet threshold of 11,000
- Tertiary Care: 87% of the veterans residing within the Market are within the Access Standard

**70%**

**65%**

- This represents the Travel Time Guideline.

- Revised 03-24-03

## VISN 15 West MarketCARES Planning Initiatives

- Revised 03-24-03

## VISN 15 West MarketCARES Non-PI Workload Gaps

- Revised 03-24-03

## VISN 15 West MarketCARES Planning Initiatives

**Small Facility Planning Initiative:**
**There were no facilities in the West Market projected to have fewer than 40 Acute Care beds in either FY 2012 or 2022**

- Revised 03-24-03