# Presentation: 547539

## CARES Planning Initiatives

**VISN 3: VA NY/NJ Veterans Healthcare 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

- 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 3 CARES Planning Initiatives

| Type of 
Planning
Initiative | Long Island Market |  | Metro New York Market |  | New Jersey 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: |  |  |  |  |  |  |
| Castle Point |  |  | Yes | Yes |  |  |
| Capacity PI: |  |  |  |  |  |  |
| Inpt. Medicine | No | No | Yes | Yes | Yes | Yes |
| Inpt. Surgery | No | No | No | No | No | No |
| Inpt. Psychiatry | No | No | Yes | Yes | Yes | Yes |
| 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 3 Overview

- Enrollees
- Projected to decrease by 38% from FY 2001 level to FY 2022
- Planning Initiatives (PIs)
- Access
- No Markets have PIs related to Access
- Inpatient Demand
- One Market has two 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 3 Overview

- Proximity
- Six Acute Care facilities are within the 60-mile standard of facilities within the VISN
- Five 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 three of VHA’s primary High Potential Enhanced Use leasing opportunities and four of the secondary opportunities

- 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: VISN is requested to coordinate planning with VISNs 2 and 4 and with the Chief Consultant, Spinal Cord Injury & Disorders Strategic Health Care group regarding existing SCI beds and potential impact of other CARES PIs.

- SCI: VISN is requested to coordinate planning with VISNs 2 and 4 and with the Chief Consultant, Spinal Cord Injury & Disorders Strategic Health Care group regarding existing SCI beds and potential impact of other CARES PIs.

- 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:

| PI? | Facility Name
 | Second Facility Name | Miles | 
Rationale |
| --- | --- | --- | --- | --- |
| Y | Brooklyn | New York | 11 | The VISN is requested to consider mission changes and/or realignment of acute care facilities within the Metro New York Market.  |
| Y | Bronx | New York | 12 |  |
| N | East Orange | New York | 17 | Although these facility pairs fall within the 60 mile proximity standard, they were not selected for PIs due to differing missions and impact of local transportation patterns (high volume). |
| N | East Orange | Brooklyn | 21 |  |
| N | Bronx | Brooklyn | 22 |  |
| N | East Orange | Lyons | 24 |  |
| N | Bronx | East Orange | 25 |  |
| N | Bronx | Montrose | 31 |  |
| N | Lyons | Brooklyn | 36 |  |

- 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 (Continued):

| PI? | Facility Name
 | Second Facility Name | Miles | 
Rationale |
| --- | --- | --- | --- | --- |
| N | Lyons | New York | 38 | Although these facility pairs fall within the 60 mile proximity standard, they were not selected for PIs due to differing missions and impact of local transportation patterns (high volume). |
| N | Bronx | Northport | 40 |  |
| N | Montrose | New York | 43 |  |
| N | Bronx | Lyons | 46 |  |
| N | Brooklyn | Northport | 49 |  |
| N | Montrose | Brooklyn | 52 |  |
| N | East Orange | Montrose | 55 |  |
| N | East Orange | Northport | 58 |  |

- Revised 03-24-03

## VISN Level IssuesEffective Use of Resources – Proximity

- Tertiary Care Hospitals within 120 miles of each other:

| PI? | Facility Name
 | Second Facility Name | Miles | 
Rationale |
| --- | --- | --- | --- | --- |
| Y | New York | Brooklyn | 11 | The VISN is requested to consider mission changes and/or realignment of tertiary care facilities that fall within the 120 mile proximity standard. |
| Y | Bronx | New York | 12 |  |
| Y | East Orange | New York | 17 |  |
| Y | East Orange | Brooklyn | 21 |  |
| Y | Bronx | Brooklyn | 22 |  |
| Y | Bronx | East Orange | 25 |  |
| N | Bronx | Northport | 40 | Although these facility pairs fall within the 120 mile proximity standard, they were not selected for PIs primarily due to local transportation patterns (high volume). |
| N | New York | Northport | 42 |  |
| N | Brooklyn | Northport | 49 |  |
| N | East Orange | Northport | 58 |  |

- Revised 03-24-03

## VISN Level IssuesEffective Use of Resources – Proximity

- Tertiary Care Hospitals within 120 miles of each other (Continued):

| PI? | Facility Name
 | Second Facility Name | Miles | 
Rationale |
| --- | --- | --- | --- | --- |
| N | Bronx | West Haven (VISN 1) | 64 | Although these facility pairs fall within the 120 mile proximity standard, they were not selected for PIs primarily due to local transportation patterns (high volume). |
| N | New York | West Haven (VISN 1) | 74 |  |
| N | Brooklyn | West Haven (VISN 1) | 85 |  |
| N | East Orange | West Haven (VISN 1) | 89 |  |
| N | Brooklyn | Philadelphia (VISN 4) | 93 |  |
| N | Northport | West Haven (VISN 1) | 95 |  |
| N | East Orange | Philadelphia (VISN 4) | 96 |  |
| N | New York | Philadelphia (VISN 4) | 100 |  |
| N | Bronx | Philadelphia (VISN 4) | 108 |  |

- Revised 03-24-03

## VISN Level IssuesEffective Use of Resources – Space

- Current Vacant Space: **1,001,997** 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:
- Lyons, Northport and St. Albans identified in the top 15 High-Potential Enhanced Use Lease Opportunities for VHA
- Montrose, Castle Point, Brooklyn and Bronx identified on the secondary list of Enhanced Use Lease Opportunities
- VBA: Potential opportunity for VBA/VHA collaboration at Lyons
- NCA: Potential opportunities at Castle Point and Montrose
- DoD:
- Ainsworth Clinic (Ft. Hamilton) and Brooklyn
- Ft. Monmouth and East Orange
- West Point and Montrose

- Revised 03-24-03

## VISN 3 Long Island Market

- Medical Centers:
- Northport, NY

- Description of Market Area:
- The VA Long Island Market was based upon an analysis of referral patterns. The usage patterns are more absolute within the VA Long Island Market than the VA Metro New York Market. **FY 2001 veteran population is estimated at 215,935.**  This market has one medical center, three community clinics and six mental health clinics.

- Revised 03-24-03

## VISN 3 Long Island MarketCARES Planning Initiatives

**Access:**
- No Access Gaps were identified in the Long Island Market.

**70%**

**65%**

- Revised 03-24-03

## VISN 3 Long Island MarketCARES Planning Initiatives

- Revised 03-24-03

## VISN 3 Long Island MarketCARES Non-PI Workload Gaps

- Revised 03-24-03

## VISN 3 Long Island MarketCARES Planning Initiatives

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

- Revised 03-24-03

## VISN 3 Metro New York Market

- Description of Market Area:
- The Metro New York Market was identified based on natural referral patterns, coupled with knowledge of use patterns within the very specific markets and applying data provided.  **FY 2001 veteran population is estimated at 481,670. **

- Medical Centers:
- VA Hudson Valley HCS
- Montrose, NY
- Castle Point, NY
- VA New York Harbor HCS
- New York, NY
- Brooklyn, NY
- St. Albans, NY
- Bronx, NY

- Revised 03-24-03

## VISN 3 Metro New York MarketCARES Planning Initiatives

**Access:**
- No Access Gaps were identified in the Metro New York Market.

**70%**

**65%**

- Revised 03-24-03

## VISN 3 Metro New York MarketCARES Planning Initiatives

- Revised 03-24-03

## VISN 3 Metro New York MarketCARES Non-PI Workload Gaps

- Revised 03-24-03

## VISN 3 Metro New York 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 | VA Hudson Valley HCS: Castle Point
 | 10 | 13 | VA Hudson Valley HCS: Castle Point Division 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. |
| N | VA New York Harbor HCS: St. Albans | 0 | 0 | Although the VA New York Harbor HCS: St. Albans Division is projected to require fewer than 40 acute care beds, this facility fulfills a long term care mission. |

- Revised 03-24-03

## VISN 3 New Jersey Market

- Medical Centers:
- VA New Jersey Health Care System
- East Orange, NJ
- Lyons, NJ

- Description of Market Area:
- The VA New Jersey Healthcare Market was constructed based upon an analysis of referral patterns supporting an **FY 2001 veteran population estimated at 481,496 veterans**. The usage patterns are more absolute within VA New Jersey Healthcare Market than the VA Metro New York healthcare population.

- Revised 03-24-03

## VISN 3 New Jersey MarketCARES Planning Initiatives

**Access:**
- No Access Gaps were identified in the New Jersey Market.

**70%**

**65%**

- Revised 03-24-03

## VISN 3 New Jersey MarketCARES Planning Initiatives

- Revised 03-24-03

## VISN 3 New Jersey MarketCARES Non-PI Workload Gaps

- Revised 03-24-03

## VISN 3 New Jersey MarketCARES Planning Initiatives

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

- Revised 03-24-03