# Presentation: 005205

##  CARES Planning Initiatives

**VISN 18: VA Southwest Healthcare Network**

## Presentation Outline

- February 2003 Changes in Planning Initiatives
- Changes in CARES Projections
- VISN Summary
- VISN-Level Issues
- Special Disability Programs
- Effective Use of Resources
- Proximity
- Vacant Space
- VISN/PI Team Identified Issues
- Collaborative Opportunities

- VISN Markets (2)
- 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

## VISN 18 Overview

- Enrollees
- Projected to increase by 0.5% from FY 2001 level to FY 2022
- Planning Initiatives (PIs)
- Access
- 1 Market has 2 PIs related to access in Hospital Care, and Tertiary Care impacting 128,481 enrollees
- Inpatient Demand
- 2 Markets have  4 PIs related to increased inpatient demand
- No Markets have  PIs related to decreased inpatient demand
- Outpatient Demand
- 2 Markets have 5 PIs related to increased outpatient demand
- No Markets have PIs related to decreased outpatient demand
- Small Facility
- 1 facility is projected to require fewer than 40 acute care beds

## VISN 18 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
- Develop plan for research space at Phoenix and Tucson

## 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 18 – Issues Special Disability Programs

**Blind Rehab: ****VISN 18 has **_**not**_** been assigned a Blind Rehabilitation PI**** ****The VISN has received a recommendation to establish a Visual Impairment Services Outpt Program (VISOR)**
**SCI: ****VISN 18 has **_**not**_** received any recommendations to increase SCI acute ****& LTC beds. **

## Outpatient Mental Health

- The forecasting model results in a systematic reduction in forecasted outpatient mental health visits.
-  We are working to understand the dynamics of the model that results in this outcome.
- As a result, negative outpatient Mental Health Planning Initiatives will not be proposed or selected for Market Plan development.

## VISN 18 OVERVIEW

**Collaborative Opportunities**_Enhanced Use_—The team identified potential enhanced use opportunities in Phoenix for medical office building and clinic expansion_VBA_—None_NCA_—Potential columbarium at Prescott
- 	_DOD_—There are potential opportunities at:
**El Paso--William Beaumont Army Medical Center**
**Phoenix--Luke AFB**

## VISN 18 – Issues Special Disability Programs

**Blind Rehab:**** Peak of legally blinded veterans in 2009 at 5,848 (from 5,267 in ’01) & ******** to 5,774 veterans in ‘25.  Consider space planning for blind rehab prgrms (i.e., VISORS, VICTORS, low vision clinics, BROS, & VIST) & restoration of inpt capacity for comprehensive blind rehab ctrs. **
**SCI: ****No issues.**
**Mental Health (SCMI, PTSD, SA): ****consider homeless initiatives. Concern RE comment on Doms in priority 4 – MH Inpt PI.**
**TBI****: ****no specific recommendations.**

## VISN Level IssuesEffective Use of Resources – Proximity

- Acute Care Hospitals with similar missions that are within 60 miles of each other: None in VISN 18
- 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 Level IssuesEffective Use of Resources – Space

- Current Vacant Space: **67,699** 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 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 Level IssuesPI Team Identified Issues

- Listed below are other issues that the VISN will consider when developing the Market Plans:
- 	- Develop plan for research space at Phoenix and Tucson due to recent increases in research funding and start up of human genome project.

## VISN Level IssuesCollaborative Opportunities

- The following collaborative opportunities have been identified for VISN 18  to consider when completing Market Plans:
-  VBA
- None
- NCA
- Potential columbarium at Prescott
- Enhanced-Use possible opportunities for vacant space:
- The team identified potential enhanced use opportunities in Phoenix for medical office building and clinic expansion
- DoD
- There are potential opportunities at El Paso/William Beaumont Army Medical Center, Phoenix/Luke AFB

## VISN 18 Arizona Market

- Medical Center(s):
- Phoenix (Tertiary)
- Tucson (Tertiary)
- Prescott

- Description of Market Area:
- The Arizona Market includes two urban tertiary care VA Health Care Systems located in Phoenix and Tucson, a hospital in Prescott, along with 12 CBOCS. Referrals and travel patterns play a key role in determining this market. The Phoenix and Tucson VAMCs have already reviewed their facilities and removed inefficiencies and duplicate tertiary services. Mountain ranges separating Arizona and New Mexico form a natural barrier that hinders East-West traffic

## VISN 18 Arizona MarketCARES Planning Initiatives

**Access**
- Primary Care: 83% of the veterans residing within the Market are within the Access Guideline
- Hospital Care: 88% of the veterans residing within the Market are within the Access Guideline
- Tertiary Care: 99% of the veterans residing within the Market are within the Access Guideline

**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 18 Arizona 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 18 Arizona 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 | Prescott
 | 28 | 22 | # of projected beds is well below 40 bed standard. Need to evaluate impact on quality. |

## VISN 18 New Mexico-West Texas Market

- Medical Center(s):
- Albuquerque (Tertiary)
- Amarillo
- Big Spring

- Description of Market Area:
- This market includes all of New Mexico and West Texas and is divided into two sub-markets cutting the market into two slices: North and South. Albuquerque VAMC serves as the referral tertiary center for the whole market with two hospitals (Amarillo and Big Spring) in  West Texas, both of which will need less than 40 beds by 2022. West Texas has a major access problem for hospital as well as tertiary care, but population in this region is so dispersed, there is no location which can both solve the access problem or reach a projected demand of 40 beds.

## VISN 18 New Mexico-West Texas MarketCARES Planning Initiatives

**Access**
- Primary Care: 72% of the veterans residing within the Market are within the Access Guideline
**Hospital Care**: 57% of the veterans residing within the Market are within the Access Guideline
**Tertiary Care****:** 54% of the veterans residing within the Market are within the Access Guideline

**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 18 New Mexico-West Texas 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 18 New Mexico-West Texas 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
 |  |  |  |