# Presentation: 161831

##  CARES Planning Initiatives

**VISN 1 – VA New England Healthcare System**

## Presentation Outline

- Changes in CARES Projections
- VISN 1 Overview
- VISN-Level Issues
- Special Disability Programs
- Effective Use of Resources
- Proximity
- Vacant Space
- VISN/PI Team Identified Issues
- Collaborative Opportunities
- Nursing Home Care

- VISN Markets (4)
- Market Planning Initiatives
- Access
- Inpatient
- Outpatient
- Small Facility Planning Initiative

## 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 | Far North Market |  | North Market |  | West Market |  | East 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 |
| Small Facility PI: |  |  |  |  |  |  |  |  |
| None |  |  |  |  |  |  |  |  |
| Capacity PI: |  |  |  |  |  |  |  |  |
| Inpt. Medicine | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
| Inpt. Surgery |  |  |  |  |  |  |  |  |
| Inpt. Psychiatry | Yes | No |  |  |  |  | Yes | Yes |
| Outpt. Primary Care | Yes | Yes |  |  | Yes | Yes | Yes | Yes |
| Outpt. Specialty Care | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
| Outpt. Mental Health | Yes | Yes | Yes | Yes |  |  |  |  |

- Indicates New Planning Initiative.

- Indicates Original Planning Initiative.

## VISN 1 Overview

- Enrollees
- Projected to increase by 0% from the FY 2001 level to FY 2012
- Projected to decrease by 17% from FY 2001 level to FY 2022
- Planning Initiatives (PIs)
- Access
- One Market has a PI related to access in Primary Care.
- Two Markets have PIs related to access in Hospital Care.
- Inpatient Demand
- Four Markets have a total of 4 PIs related to increased inpatient demand
- One Market has a PI related to decreased inpatient demand
- Outpatient Demand
- All Four Markets have a total of 9 PIs related to increased outpatient demand
- A significant GAP in Outpatient Specialty Care has been identified in VISN 1
- Small Facility
- No facilities are projected to require fewer than 40 acute care beds

## VISN 1 Overview

- Other VISN-Level Issues
- Proximity
- Four VAMC facilities are within the 60-mile standard (West Roxbury, Brockton, Bedford and Providence.) The integration of the four facilities’ missions will be a Planning Initiative.
- One Tertiary Care facility is within the 120-mile standard of five facilities outside the VISN.
- VISN/PI Team Identified Issues Collaborative Opportunities
- Space/Infrastructure Condition Planning Initiative
- Collaborative Opportunities
- VBA Co-Locations: Newington, CT; Providence, RI; Boston HCS

## VISN 1 Overview

**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 1Special Disability Programs

- Blind Rehabilitation Planning Initiative:
- No Planning Initiative.
- SCI:
- No Planning Initiative.

## 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 | Boston: West Roxbury | Boston: Brockton | 20 | VISN 1 will look at mission integrations with Brockton, West Roxbury and Brockton, as well as Bedford, MA (primarily psychiatry). |
| Y | Boston: West Roxbury | Providence, RI | 42 | Same as above |
| Y | Boston: Brockton | Providence, RI | 34 | Same as above |

## VISN Level IssuesEffective Use of Resources – Space

- Current Vacant Space: **478,300** 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

- _Space/Infrastructure Condition Planning Initiative_:        CARES data show most clinical programs being sustained or expanded.  Facilities in VISN 1 have significant infrastructure needs that need addressing now.  Many systems have problems which prohibit appropriate functioning  within current workload demands. These infrastructure issues need to be addressed prior to consideration of program expansions indicated in the CARES Planning Initiatives.

## VISN Level IssuesCollaborative Opportunities

- The following collaborative opportunities have been identified for VISN 1  to consider when completing Market Plans:
- VBA
- VA Connecticut Health Care System - Newington, CT
- Providence, RI  (Enhanced Use or New Construction)
- VISN 1 would like to look at the co-location of VBA and the Boston HCS
- NCA identification of areas they would like to expand:
- No sites were identified.
- Enhanced-Use possible opportunities for vacant space:
- VISN 1 had no Markets identified on the top 15 list of High-Potential Enhanced Use Lease Opportunities.
- DoD
- None identified at this time.

## VISN 1 Far North Market

- Medical Centers:
- Togus, ME

- Description of Market Area:
- The Far North Market (Maine) has vast land area with little concentration of population. The population is centered around the north-south I-95 Interstate in the eastern part of the state. There is a natural boundary (north-south mountain range) that prevents veterans from easy access to the west (New Hampshire facilities). Maine exists as a single market area.

## VISN 1 Far North MarketCARES Planning Initiatives

**Access**
**Primary Care**: 59% of the veterans residing within the Market are within the Access Guidelines
**Hospital Care**: 52% of the veterans residing within the Market are within the Access Guidelines
- Tertiary Care: 80% of the veterans residing within the Market are within the Access Guidelines

**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 1 Far North Market CARES Planning Initiatives

**Workload Gaps:**

## VISN 1 Far North Market  CARES Non-PI Workload Gaps

**Workload Gaps:**

## VISN 1 Far North 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 1 North Market

- Description of Market Area:
- The North Market (Vermont and New Hampshire) residents and veterans share many characteristics and a cluster of population in southern New Hampshire travels to Boston for business and work.

- Medical Centers:
- White River Junction, VT
- Manchester, NH (Outpatient)

## VISN 1 North MarketCARES Planning Initiatives

**Access**
- Primary Care: 75% of the veterans residing within the Market are within the Access Guidelines
**Hospital Care:** 57% of the veterans residing within the Market are within the Access Guidelines
- Tertiary Care: 98% of the veterans residing within the Market are within the Access Guidelines

**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 1 North Market CARES Planning Initiatives

**Workload Gaps:**

## VISN 1 North Market  CARES Non-PI Workload Gaps

**Workload Gaps:**

## VISN 1 North 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 |
| --- | --- | --- | --- | --- |
| N | Manchester, NH | 0 | 0 | Manchester has been converted to Outpatient and Long-Term Care only.  Acute care is provided by referral to White River Junction, Boston Health Care System or by local contracts. |

## VISN 1 West Market

- Description of Market Area:
- Western Massachusetts and all of Connecticut fall together naturally in to the Western Market because of the historical referral of western Massachusetts veterans for specialty care at VA Connecticut. The sharing of a major north-south highway and international airport makes travel  convenient for those veterans requiring primary care services in our CBOCs located near state borders or specialty services located adjacent to the highway system.

- Medical Centers:
- Connecticut Healthcare System
- West Haven, CT (Tertiary Care)
- Newington, CT (Outpatient)
- Northampton, MA

## VISN 1 West MarketCARES Planning Initiatives

**Access**
- Primary Care: 96% of the veterans residing within the Market are within the Access Guidelines
- Hospital Care: 73% of the veterans residing within the Market are within the Access Guidelines
- Tertiary Care: 100% of the veterans residing within the Market are within the Access Guidelines

**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 1 West Market CARES Planning Initiatives

**Workload Gaps:**

## VISN 1 West Market  CARES Non-PI Workload Gaps

**Workload Gaps:**

## VISN 1 West 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 1 East Market

- Description of Market Area:
- The East Market (Eastern Massachusetts and Rhode Island) is a planning entity with high densities in both general and veteran populations.  There is good availability of public transportation throughout the entire market including hourly bus, hourly commuter trains and major North-South and East-West highways.

- Medical Centers:
- Boston Health Care System
- West Roxbury (Tertiary Care)
- Boston-Jamaica Plains
- Brockton
- Bedford, MA
- Providence, RI

## VISN 1 East MarketCARES Planning Initiatives

**Access**
- Primary Care: 96% of the veterans residing within the Market are within the Access Guidelines
- Hospital Care: 90% of the veterans residing within the Market are within the Access Guidelines
- Tertiary Care: 100% of the veterans residing within the Market are within the Access Guidelines

**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 1 East Market CARES Planning Initiatives

**Workload Gaps:**

## VISN 1 East Market  CARES Non-PI Workload Gaps

**Workload Gaps:**

## VISN 1 East 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 |
| --- | --- | --- | --- | --- |
| N | Boston: Jamaica Plains | 34 | 25 | All acute care beds have been moved to the Boston-West Roxbury campus. |