VISN 19: Rocky Mountain Network

1
CARES Planning Initiatives

• VISN 19 Rocky Mountain Network

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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

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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

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February 2003 Changes in Planning Initiatives
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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)

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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

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VISN 19 Overview

• Nursing Home Care
• The need for NHC care remains high over the
  planning period. However, the NHCU component of
  VAs 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.)

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VISN OverviewNHCU

• Nursing Home Care
• The need for NHCU care remains high over the
  planning period. The NHCU component of VAs 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.)

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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).

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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

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VISN 19 Level IssuesEffective 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

12
VISN 19 IssuesEffective 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.

13
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.

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VISN 19 Level IssuesCollaborative 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

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VISN 19 Eastern Rockies Market

• 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).

• Medical Centers
• Denver
• Cheyenne

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VISN 19 Eastern Rockies MarketCARES 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.
17
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).
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VISN 19 Eastern Rockies MarketCARES Non-PI
Workload Gaps
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VISN 19 Eastern Rockies MarketCARES Planning
Initiatives

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

20
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

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VISN 19 Grand Junction MarketCARES 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

70
65
This represents the Travel Time Guideline.
NOTES Significant Gaps are determined by first
applying the percentage threshold and then a
volume criteria.
22
VISN 19 Grand Junction MarketCARES 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).
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VISN 19 Grand Junction MarketCARES Non-PI
Workload Gaps
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VISN 19 Grand Junction MarketCARES Planning
Initiatives

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

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VISN 19 Montana Market

• 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.

• Medical Centers
• Fort Harrison

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VISN 19 Montana MarketCARES 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

70
65
This represents the Travel Time Guideline.
NOTES Significant Gaps are determined by first
applying the percentage threshold and then a
volume criteria.
27
VISN 19 Montana MarketCARES 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).
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VISN 19 Montana Market CARES Non-PI Workload Gaps
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VISN 19 Montana MarketCARES Planning Initiatives

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

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VISN 19 Western Rockies Market

• 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.

• Medical Centers
• Salt Lake

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VISN 19 Western Rockies MarketCARES Planning
Initiatives

• 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

70
65
This represents the Travel Time Guideline.
32
VISN 19 Western Rockies MarketCARES Planning
Initiatives

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

33
VISN 19 Western Rockies MarketCARES 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).
34
VISN 19 Western Rockies MarketCARES Non-PI
Workload Gaps
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VISN 19 Wyoming Market

• 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.

• Medical Centers
• Sheridan

10,358
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VISN 19 Wyoming MarketCARES 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.
37
VISN 19 Wyoming MarketCARES 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).
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VISN 19 Wyoming Market CARES Non-PI Workload Gaps
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VISN 19 Wyoming MarketCARES Planning Initiatives

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