# Presentation: 658683

##  CARES Planning Initiatives

**VISN 11 – Veterans In Partnership **

## Presentation Outline

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

- Changes in CARES Projections
- VISN Overview
- VISN-Level Issues
- Special Disability Programs
- Effective Use of Resources
- Proximity
- Vacant Space
- Collaborative Opportunities

## 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

## February 2003 Changes in Planning Initiatives

| Type of 
Planning
Initiative | Central Illinois Market |  | Indiana    Market |  | Michigan     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: |  |  |  |  |  |  |
| Ft. Wayne |  |  | Yes | Yes |  |  |
| Saginaw |  |  |  |  | Yes | Yes |
| Capacity PI: |  |  |  |  |  |  |
| Inpt. Medicine |  |  |  |  | Yes | Yes |
| Inpt. Surgery |  |  |  |  |  |  |
| Inpt. Psychiatry | Yes |  | Yes |  |  |  |
| Outpt. Primary Care | Yes |  | Yes | Yes | Yes | Yes |
| Outpt. Specialty Care | Yes | Yes | Yes | Yes | Yes | Yes |
| Outpt. Mental Health |  |  |  |  |  |  |

- Indicates New Planning Initiative.

- Indicates Original Planning Initiative.

## VISN 11 Overview

- Enrollees
- Projected to increase by 1% from FY 2001 level to FY 2022
- Planning Initiatives (PIs)
- Access
- 2 Markets have PIs related to access in Primary Care
- 1 Market has a PI related to access in Acute/Hospital Care
- Inpatient Demand
- 1 Market has a PI related to increased inpatient demand
- No Market has a PI related to decreased inpatient demand
- Outpatient Demand
- 3 Markets have a total of 5 PIs related to increased outpatient demand
- No Market has a PI related to decreased outpatient demand
- Small Facility
- 3 facilities are projected to require fewer than 40 acute care beds

## Other VISN-Level Issues
Proximity
2 Tertiary Care facilities are within the 60-mile standard
3 VISN 11 Tertiary Care facilities are within the 120-mile standard
Collaborative Opportunities
VBA and NCA

- Proximity
- 2 Tertiary Care facilities are within the 60-mile standard
- 3 VISN 11 Tertiary Care facilities are within the 120-mile standard
- Collaborative Opportunities
- VBA and NCA

- VISN 11 Overview

## VISN 11 Overview NHCU

- Nursing Home Care:
- The need for NHCU care remains high over the planning period.  However, the NHCU component of VA’s 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.  (Realignment, renovations, conversion of space, etc.)

## 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).

## VISN 11 – Issues Special Disability Programs

**Blind Rehab**** **
- Peak of legally blinded veterans in 2006 at 9,156  (from 8,606 in ’01) &  to 7,363 veterans in ‘25. Consider space planning for blind rehab programs (i.e., VISORS, VICTORS, low vision clinics, BROS, & VIST).** **
**SCI**
- No recommendations.** **

## VISN 11 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 |
| --- | --- | --- | --- | --- |
| No | Detroit, MI | Ann Arbor, MI | 46 | Projected workload for FY12/22 justifies both facilities.  Potential to share specialty services should be encouraged |

| PI | Facility Name | Second Facility Name | Miles | Rationale |
| --- | --- | --- | --- | --- |
| No | Indianapolis, IN | Louisville, KY | 117 | VAMC Indianapolis is at capacity for tertiary care services - only referral center for Central Illinois and Indiana Markets. Significant construction/staffing required to meet other inter-VISN market(s) workload. |
| No | Indianapolis, IN | Cincinnati, OH | 108 |  |
| No | Indianapolis, IN | Dayton, OH | 107 |  |
| Yes | Detroit, MI | Ann Arbor, MI | 46 | Potential to share specialty services |

## VISN 11 Level IssuesEffective Use of Resources – Space

- Current Vacant Space: 884,615 gsf (3 Historic sites)
- 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.

## VISN 11 Level IssuesCollaborative Opportunities

- The following collaborative opportunities have been identified for VISN 11  to consider when completing Market Plans:
-  VBA
- Indianapolis & Detroit were identified as co-location sites
-  NCA identification of areas they would like to expand:
- Marion, IN
- Enhanced-Use possible opportunities for vacant space:
- No VISN facilities were identified in the list of 20 major EU opportunities.
- This VISN, however, has identified several facilities for potential EU development.

## The following collaborative opportunities have been identified for VISN 11  to consider when completing Market Plans:
DoD
Three geographically separated small clinics operated by DoD of a size too small for VA collaboration
Multi-VISN TriCare Contract in process

- DoD
- Three geographically separated small clinics operated by DoD of a size too small for VA collaboration
- Multi-VISN TriCare Contract in process

- VISN 11 Level IssuesCollaborative Opportunities

## Medical Centers:
Illiana (Danville), IL

- This rural market currently serves 37,325 VHA enrollees and that level of participation is projected to decrease to 33,664 by 2012. The Central Illinois market has been a traditional one with the Illiana HCS as the hub since the 1890’s.  This hub has been reinforced with the recent addition of 5 CBOCs. Tertiary care is referred to the Indianapolis VAMC.

- Medical Centers:
- Illiana (Danville), IL

- VISN 11 Central Illinois Market

## VISN 11 Central Illinois Market

**70%**

**65%**

- This represents the Travel Time Guideline.

- VISN 11 Central Illinois Market

- Access
- Primary Care: 54% of the veterans residing within the Market are within the Access Standard
- Hospital Care: 36% 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

- *NOTES:  Significant Gaps are determined by first applying the percentage threshold and then a volume criteria.

## VISN 11 Central Illinois MarketCARES 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).

## VISN 11 Central Illinois MarketCARES Non-PI Workload Gaps

- *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).

## VISN 11 Central Illinois MarketCARES Planning Initiatives

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

## Medical Centers:
Indianapolis, IN (Tertiary Care)
Fort Wayne, IN
Marion, IN

- Indianapolis, IN (Tertiary Care)
- Fort Wayne, IN
- Marion, IN

- VISN 11 Indiana Market

- Description of Market Area:
- This rural/urban market currently serves 79,877 VHA enrollees and that level of participation is projected to decrease to 88,563 by 2012. The Indiana market is well established with the Marion Division, NIHCS beginning in the 1890’s, the Indianapolis VAMC in the early 1930’s and the Ft. Wayne Division, NIHCS in the early 1950’s. Four CBOCs provide primary care, while the three Indiana facilities provide a broad array of primary-tertiary and extended levels of care.

## VISN 11 Indiana Market

**70%**

**65%**

- This represents the Travel Time Guideline.

**Access**
- Primary Care: 63% of the veterans residing within the Market are within the Access Standard
- Hospital Care: 66% 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

- *NOTES:  Significant Gaps are determined by first applying the percentage threshold and then a volume criteria.

## VISN 11 Indiana MarketCARES 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).

## VISN 11 Indiana MarketCARES Non-PI Workload Gaps

- *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).

## VISN 11 Indiana MarketCARES Planning Initiatives

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

| PI | Facility Name | FY2012 (Beds) | FY2022 (Beds) | Rationale |
| --- | --- | --- | --- | --- |
| Y | Ft. Wayne, IN | 14 | 11 | Community Care available if contracting an option? Distance for other VA services a 2 hour drive for patients. |
| N | Marion, IN | 46 | 31 | Long Term Psych Mission |

## Medical Centers:
Detroit, MI (Tertiary Care)
Ann Arbor, MI (Tertiary Care)
Battle Creek, MI
Saginaw, MI

- Detroit, MI (Tertiary Care)
- Ann Arbor, MI (Tertiary Care)
- Battle Creek, MI
- Saginaw, MI

- VISN 11 Michigan Market

- Description of Market Area:
- This rural/urban market currently serves some 131,810 VHA enrollees and that level of participation is projected to increase to 153,641 by 2012. The Lower Michigan market is well defined with established referral patterns to the VAMCs located in Ann Arbor, Battle Creek, Detroit, and Saginaw. Eleven CBOCs serve the lower Michigan and Northwest Ohio area.

## VISN 11 Michigan MarketCARES Planning Initiatives

**70%**

**65%**

- This represents the Travel Time Guideline.

**Access**
- Primary Care: 71% of the veterans residing within the Market are within the Access Standard
- Hospital Care: 72% of the veterans residing within the Market are within the Access Standard
- Tertiary Care: 96% of the veterans residing within the Market are within the Access Standard

- *NOTES:  Significant Gaps are determined by first applying the percentage threshold and then a volume criteria.

## VISN 11 Michigan MarketCARES 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).

## VISN 11 Michigan MarketCARES Non-PI Workload Gaps

- *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).

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

- The following facilities were projected to have less than 40 beds in FY 2012 and/or 2022.

| PI | Facility Name | FY2012 (Beds) | FY2022 (Beds) | Rationale |
| --- | --- | --- | --- | --- |
| Y | Saginaw, MI | 21 | 16 | Community care may be available by contract.  Other VA services are 2 hours away at Ann Arbor  or Detroit VAMCs. |

- VISN 11 Michigan MarketCARES Planning Initiatives