# Presentation: 028000

## VISN 19: Rocky Mountain Network

- CARES Planning Initiatives

## Presentation Outline

- February 2003 Changes in Planning Initiatives
- VISN Overview
- VISN-Level Issues
- Special Disability Programs
- Effective Use of Resources
- Proximity
- Vacant Space
- VISN/PI Team Identified Issues (OPTIONAL)
- Collaborative Opportunities
- Nursing Home Care
- Domiciliary
- Special Disabilities

- VISN Markets (5)
- Market Planning Initiatives
- Access
- Inpatient
- Outpatient
- Small Facility Planning Initiative

## 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

## February 2003 Changes in Planning Initiatives

| Type of 
Planning
Initiative | Eastern Rockies Market |  | Grand Junction Market |  | Montana Market |  | Western Rockies Market |  | Wyoming 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 | PI in Nov 2002 | PI in Feb 2003 | PI in Nov 2002 | PI in Feb 2003 |
| Small Facility PI: |  |  |  |  |  |  |  |  |  |  |
| None |  |  |  |  | No | No | No | No | No | No |
|  Cheyenne
Grand Junction
Fort Harrison | Yes | Yes
 | Yes | Yes
 | Yes (Small Bed Section) |  Yes (Small Bed Section)
 |  |  |  |  |
| Capacity PI: |  |  |  |  |  |  |  |  |  |  |
| Inpt. Medicine | Yes | Yes |  |  |  |  |  |  |  |  |
| Inpt. Surgery |  |  |  |  |  |  |  |  |  |  |
| Inpt. Psychiatry |  |  |  | s | Yes |  |  |  | Yes | Ye |
| Outpt. Primary Care | Yes | Yes |  |  |  |  |  |  | s |  |
| Outpt. Specialty Care | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | s | Yes |
| Outpt. Mental Health |  |  |  |  | Yes | Yes |  |  |  |  |

## VISN 19 Overview

- Enrollees
- Projected to increase by 10 % from FY 2001 level to FY 2022
- Planning Initiatives (PIs)
**Access**
- VISN 19 Markets have 4 PIs related to access in Primary Care,Hospital Care, and Tertiary Care impacting 122,086 enrollees
**Inpatient Demand**
- VISN 19 Markets have a total of 1 PIs related to increased inpatient demand
- VISN 19 Markets have a total of 0 PIs related to decreased inpatient demand
**Outpatient Demand**
- VISN 19 Markets have a total of 7 PIs related to increased outpatient demand
- VISN 19 Markets have a total of 0 PIs related to decreased outpatient demand
**Small Facility**
- 2 facilities are projected to require fewer than 40 acute care beds
- 1 facilities is projected to have low psychiatry and/or surgery beds (PI bed section)

## VISN 19 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 **
- Denver relocation
- Seismic issues
- Realignment
**Collaborative Opportunities**
- NCA
- DoD
- Enhanced Use

## VISN 19 Overview

- Nursing Home Care:
- The need for NHC 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.)

## VISN OverviewNHCU

- 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.)

## 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 19 – Issues Special Disability Programs

**Blind Rehab: **No Planning Initiative
**SCI: **** **While the data could be interpreted as supporting new SCIUs in each VISN without an SCIU, existing referral patterns and availability of beds in neighboring VISNs suggest the addition of four new SCIUs could be supported by the data (VISNs 2, 16, 19, and 23). Develop PI to address.
**Mental Health (SCMI, PTSD, SA): ****Certain aspects of projections were flat lined.   MH service developing alternative projection methodology.**
**Dom/Homelessness: **Postponed until next year** **
**TBI: **Postponed until next year

## VISN 19 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 |
| --- | --- | --- | --- | --- |
|  | None |  |  |  |
|  |  |  |  |  |
|  |  |  |  |  |

| PI? | Facility Name
 | Second Facility Name | Miles | 
Rationale |
| --- | --- | --- | --- | --- |
|  | None |  |  |  |
|  |  |  |  |  |
|  |  |  |  |  |

## VISN 19 IssuesEffective Use of Resources – Space

- Current Vacant Space: 119,357 sf
- 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 19 Issues& PI Team Identified Issues

- Listed below are other issues that the VISN will incorporate when developing the Market Plans:
- Denver and Ft. Harrison need to re-evaluate the overall space scores.
- Denver needs to re-evaluate the need for a free standing facility.
- Seismic issues at outpatient & inpatient buildings at Ft. Harrison need to be addressed.
- VISN 19 needs to develop balanced access across the network for VA Nursing Home Care Beds. (The Western Rockies Market currently has no VA NHC beds)
- VISN 19 needs to develop balanced access across the network for psychiatry beds in 2012/2022.
- VISN 19 needs to address lead paint concerns.

## VISN 19 Level IssuesCollaborative Opportunities

- The following collaborative opportunities have been identified for VISN 19  to consider when completing Market Plans:
-  VBA
- None
-  NCA identification of areas they would like to expand:
- Cheyenne
- Enhanced-Use possible opportunities for vacant space:
- Private Lease Building (Salt Lake)
- VAMC Denver (if Denver relocates)
- DoD
- F.E. Warren AFB-Cheyenne
- US Air Force Academy - Denver
- Ft. Carson (Specialty Care)-Denver
- Malstrom AFB-Montana
- Hill AFB-Ogden

## VISN 19 Eastern Rockies Market

- Medical Centers:
- Denver
- Cheyenne

- Description of Market Area:
- A border created by the Rocky Mountains to the west defines the Eastern Rockies market.  A major VA tertiary medical center resides in Denver.  The service area consists of 2 medical centers and 7 CBOCs.  VA health care services available to veterans include tertiary care, primary care, mental health, inpatient (general medical/surg.) and long term care. The Cheyenne VAMC is located in the Southeastern Wyoming sub-market, which also includes three CBOCs (Sidney, Cheyenne county, Nebraska; Greeley, Weld County, Colorado; Ft. Collins, Larimer County, Colorado).

## VISN 19 Eastern Rockies MarketCARES Planning Initiatives

**Access:**
- Primary Care: 80% of the veterans residing within the Market are within the Access Standard
- Hospital Care: 54% of the veterans residing within the Market are within the Access Standard
- Tertiary Care: 98% of the veterans residing within the Market are within the Access Standard

**70%**

**65%**

- This represents the Travel Time Guideline.

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

## VISN 19 Eastern Rockies 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 19 Eastern Rockies MarketCARES Non-PI Workload Gaps

## VISN 19 Eastern Rockies 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 | Cheyenne | 17 | 14 | Present Acute bed levels fall below the 40 bed criteria.  In 2002 staffed Medicine beds are 8 and surgery beds are 2. Projected 2022 beds do not increase significantly. In addition ICU bed levels need to be evaluated for quality. |

## VISN 19 Grand Junction Market

- Description of Market Area:
- The Grand Junction market area includes western Colorado counties with the center of the veteran population residing in Grand Junction. This market area has one VA and one CBOC, which provide primary care, mental health, inpatient care and long term care. A full range of health care services is available in the Grand Junction community.

- Medical Centers:
- Grand Junctions

## VISN 19 Grand Junction MarketCARES Planning Initiatives

**Access**
- Primary Care: 64% of the veterans residing within the Market are within the Access Standard
- Hospital Care: 70% of the veterans residing within the Market are within the Access Standard
- Tertiary Care: 61% of the veterans residing within the Market are within the

- This represents the Travel Time Guideline.

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

- 70 %

- 65 %

## VISN 19 Grand Junction MarketCARES Planning Initiatives

- *NOTES:  A Significant Gap is determined by first applying a percentage change criteria (+/-25%) for each CARES Categories and if the gap meets this threshold, then it must meet the workload threshold criteria (beds for inpatient categories and stops for outpatient categories).

## VISN 19 Grand Junction MarketCARES Non-PI Workload Gaps

## VISN 19 Grand Junction 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 | Grand Junction 
 | 24 | 18 | Present Acute bed levels fall below the 40 bed criteria.  In 2002 staffed Medicine beds are 8 and surgery beds are 3. Overall 2022 bed levels for medicine, surgery and  psychiatry beds are significantly below the 40 bed criteria.  Review should include ICU bed section.
 |

## VISN 19 Montana Market

- Medical Centers:
- Fort Harrison

- Description of Market Area:
- The Montana market area has a complement of a VA medical center and nine CBOCs. VA health care services include primary care, mental health, inpatient and long term care. The presence of veteran population centers located in Helena/Great Falls in the west and the Billings area in the east provide health care services that cover the large rural service area.

## VISN 19 Montana MarketCARES Planning Initiatives

**Access**
- Primary Care: 62% of the veterans residing within the Market are within the Access Standard
- Hospital Care: 20% of the veterans residing within the Market are within the Access Standard
- Tertiary Care: 2% of the veterans residing within the Market are within the Access Standard

- This represents the Travel Time Guideline.

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

**70%**

**65%**

## VISN 19 Montana 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 19 Montana Market CARES Non-PI Workload Gaps

## 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.**

| 
Facility Name | FY2012 (Beds) | FY2022 (Beds) | 
Rationale |
| --- | --- | --- | --- |
| Fort Harrison (Surgery, ICU & Psychiatry only) | 10
11 | 9
9 | *   In 2002 staffed Psychiatry beds are 5 and surgery beds are 7. Overall 2022 bed levels for  surgery and  psychiatry beds should be evaluated for cost efficiency and quality.  In addition, ICU beds need to be reviewed. |
|  |  |  |  |
|  |  |  |  |
|  |  |  | * This is a small facility planning issue that needs to be reviewed for quality and cost efficiency in surgery, psychiatry, and ICU.  This is an exception to the 40 bed rule. |

- VISN 19 Montana MarketCARES Planning Initiatives

## VISN 19 Western Rockies Market

- Medical Centers:
- Salt Lake

- Description of Market Area:
- The Grand Junction market defines the eastern border of the Western Rockies market area.  The Western Rockies market encompasses most of the state of Utah parts of Colorado, Idaho, Nevada, and Wyoming. The market area includes one major tertiary medical center residing in Salt Lake City offering primary care, mental health and inpatient (med/surg) services.  There are 9 primary care CBOCs spread throughout the market.

## VISN 19 Western Rockies MarketCARES Planning Initiatives

**70%**

**65%**

- This represents the Travel Time Guideline.

**Access**
- Primary Care: 74% of the veterans residing within the Market are within the Access Standard
- Hospital Care: 65% of the veterans residing within the Market are within the Access Standard
- Tertiary Care: 92% of the veterans residing within the Market are within the

## VISN 19 Western Rockies 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 |
| --- | --- | --- | --- | --- |
|  | None |  |  |  |

## VISN 19 Western Rockies MarketCARES Planning Initiatives

- *NOTES:  A Significant Gap is determined by first applying a percentage change criteria (+/-25%) for each CARES Categories and if the gap meets this threshold, then it must meet the workload threshold criteria (beds for inpatient categories and stops for outpatient categories).

## VISN 19 Western Rockies MarketCARES Non-PI Workload Gaps

## VISN 19 Wyoming Market

- Medical Centers:
- Sheridan

- Description of Market Area:
- Sheridan market area provides the greatest challenge in defining a clear market service area.  This service area does not have available VA tertiary services.  Secondary services, primary care, mental health and specialty outpatient care are available through VA staffed services or through contracts, but often require long travel distances.  VAMCs Salt Lake City and Denver serve the southwestern and southeastern areas of Wyoming.  Northern Wyoming has one VA medical center and 4 CBOCs.

- 10,358

## VISN 19 Wyoming MarketCARES Planning Initiatives

**Access**
- Primary Care: 67% of the veterans residing within the Market are within the Access Standard
- Hospital Care: 34% of the veterans residing within the Market are within the Access Standard
- Tertiary Care: 1% of the veterans residing within the Market are within the Access Standard

**70%**

**65%**

- This represents the Travel Time Guideline.

## VISN 19 Wyoming MarketCARES Planning Initiatives

- *NOTES:  A Significant Gap is determined by first applying a percentage change criteria (+/-25%) for each CARES Categories and if the gap meets this threshold, then it must meet the workload threshold criteria (beds for inpatient categories and stops for outpatient categories).

## VISN 19 Wyoming Market CARES Non-PI Workload Gaps

## VISN 19 Wyoming 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 |
| --- | --- | --- | --- | --- |
|  | None |  |  |  |