ARES

1
Department of Veterans AffairsVeterans Health
Administration
C
Capital Asset Realignment for Enhanced Services
ARES
VSO Planning Initiatives Briefing November 21,
2002
2
Outline of Presentation

• CARES Enrollment Utilization Projections
• Planning Initiative Identification Process
• Planning Initiative Results
• Market Area Examples

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Fiscal Year Enrollment Forecasts by Priority
Groups
Enrollment (in millions)
4
Fiscal Year Market Share Forecasts by Priority
Groups
Market Share
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170 E. Southern, V16
136 East Southern, V16
157 Washington, V5
150 Far North, V1
-17 Northern, V9
-63 Puerto Rico, V8
-70 Central Illinois, V11
-65 South Valley, V21
6
Nursing Home Policy

• Large NHC demand in VA LTC model - add 17,000
  beds system-wide by 2022
• Review model
• Decision to not have Nursing Home PIs
• However, Market Plans can
• Convert acute beds
• Rebuild
• Renovations
• Use vacant space

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256 Valley-Coastal Bend, V17
192 Valley-Coastal Bend, V17
136 Long Island, V3
-9, Western, V2
-40 wyoming, V19
-69 Finger Lakes, V2
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Outpatient Mental Health

• The demand model projects a number of markets
  with reductions in forecasted outpatient mental
  health visits.
• NCPO is working to understand the dynamics of the
  model that contributed to this result.
• As such, decision was made to not include
  outpatient mental health, negative workload GAPS,
  as Planning Initiatives

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Domiciliary Policy

• Forecasting model results in the redistribution
  of DOM beds from existing DOMs to other areas
  without DOMs.
• Since this occurred without a policy review, it
  is inappropriate to select DOM PIs from these
  forecasts.
• However, DOMs may 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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Planning Initiative Selection Process
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Goal of PI Review Process

• To identify PIs that will improve the capacity
  to provide high quality accessible services to
  veterans through the allocation of capital
  resources and eliminating vacant space.

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Participants

• DOD, Navy, Army, Air Force
• NCA
• VBA
• Special Populations TBI Blind Rehab SCI
• Mental Health
• VISN Reps, Clinicians, VSSC, NCPO

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Teams

• Planning Initiative Selection Teams (10)
• Multi Disciplinary Teams
• NCPO/VSSC Leadership
• VA Representatives from each Impacted VISN
• Clinicians
• VA Representatives from Outside Impacted VISNs
• All teams used same Process Thresholds
• Teams apply Criteria, Judgment Rationale to the
  Process
• NCPO Review Standardization Team Reviewed
  Output
• Special Disability Groups - Review Team

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Selecting Access Gaps

• Primary Care
• Less than 70 of enrollees within 30 minutes and
• At least 11,000 enrollees are outside 30 minutes
  driving time from Primary Care
• Acute Inpatient Care
• Less than 65 within 60 minutes driving time and
• At least 12,000 enrollees are outside
  60 Minutes drive time from nearest
  hospital

15
Selecting Access Gaps

• Tertiary Hospital Care
• Less than 65 of enrollees are within 4 Hours
  driving time and
• At least 12,000 enrollees are outside 4 Hours
  Driving Time of a Tertiary Hospital

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Selection Thresholds

• Demand Gaps
• Note (No negative gaps addressed by PI Teams for
  outpatient mental health)
• Significance Gap or 25
• Volume
• Inpatient 20 beds
• Outpatient 26,000 PC and Geriatric
  30,000 Specialty visits
  16,000 Mental Health
• Proximity of acute and tertiary 60 and 120
  miles
• Small Facility Planning Initiatives -
• Must have forecast 40 beds or less in both 2012
  and 2022

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Selection Thresholds Demand Gaps Number 3 or 4
( per VISN)

• Strong trend Meet 25 and absolute volume gaps
  in 2012 and 2022 and are same trend forecast
• Moderate trend Meets criteria in one year but
  not the other Team choice
• Peaks at 2012 but decrease in 2022 Team choice
• High volumes but below 25

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Planning Initiative Selection Process

• Collaborative Issues
• EU
• VBA
• NCA
• DOD

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Results from the Planning Initiative Review
Process
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Collaborations

• EUSE 18 Opportunities
• NCA 12 Opportunities
• VBA 13 Opportunities
• DoD 59 Opportunities (included all VISNs)

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Number Of Access Planning Initiatives

• 15 of the 20 VISNs have Access PIs
• There were 33 Hospitals in 15 VISNs with Access
  Gaps
• There were 29 Primary Care Access Gaps in the 15
  VISNs

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Number of Demand Planning Initiatives CARES
Categories
23
FY2022 Projected Gaps in Beds for Inpatient CARES
Categories
24
FY2022 Projected Gaps in Clinic Stops for
Outpatient CARES Categories
25
Small Facilities Planning Initiative Beds 2012
and 2022(20 identified)
BEDS FY12 FY22
BEDS FY12 FY22

• Castle Point 14 10
• Wilmington 39 30
• Altoona 18 13
• Butler 9 7
• Erie 13 9
• Beckley 15 11

• Ft Wayne 14 11
• Saginaw 21 16
• Poplar Bluff 15 11
• Muskogee 36 27
• Kerrville 15 11
• Prescott 25 18

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Small Facilities Planning Initiative (contd)
BEDS FY12 FY22
BEDS FY12 FY22

• Des Moines 32 21
• Knoxville 28 30
• St. Cloud 33 24
• Hot Springs 32 23

• Big Spring 31 31
• Cheyenne 15 12
• Grand Junc. 22 16
• Sioux Falls 40 28

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Proximity Planning Groups

• WestRox/BrocktonProvidence
• Brooklyn/NYBronx/NY/BrklynE.Orange/NY/BrkBronx/
  Brooklyn
• Highland Dr. UD/Aspinwall
• Phila/Wilminton

• Balt/Wash DC
• Augusta/Columbia
• Columbia/Charlstn
• Tampa/BayPines
• Miami/WPB?
• Nashville/Murf
• Lex/Louis/Cincin

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Proximity Planning Groups

• Louisville/Cincin/ Indianapolis
• Cincinnati/Dayton
• Detroit/Ann Arbor
• KsCity/Leavnworh
• Gulfcoast HCS Biloxi/Gulfport

• Palo Alto/San Fran
• Long Bch/LosAng
• Loma Linda/LosAng
• Loma Lind/SanDieg
• Long Bch/San Dieg

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Special Disability Populations

• SDP Team at PI Selection Process
• Reviewed all PIs and made comments sent to
  specific VISNs
• Developed advisory comments on including SDP in
  Market Plans for all VISNs
• Working with CARES model and alternative models
  to develop PIs for mid January for VISNs

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Special Disability Populations

• Mental Health group working with NCPO and
  contractor on CARES model
• Long run is improving CARES model for next CARES
  or Strategic Planning Cycle
• Concerned over use of CARES data outside of CARES
  process (advisory information and memo to VISNs)

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CARES Planning forSpecial Disability Programs

• The unique nature of VAs Special Disability
  Programs (SDPs) creates challenges in applying
  the CARES planning model to them.
• SDP leaders are active participants in the CARES
  Planning Initiative (PI) Selection process.
• PIs developed with the SDP representatives will
  be incorporated into the Market Plans as soon as
  available.
• Legislative mandates for capacity will be
  maintained and enhanced (whenever there is data
  to support increased demand).

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Special Disability Forecasting - Caveats

• VAs Special Disability Programs (SDPs) provide
  services for which there are no comparable
  private sector benchmarks.
• For some programs, current constraints on
  utilization may affect the predicted future
  demand.
• The CARES model is designed for macro-level
  planning and is not ideally suited to planning
  for small program needs.
• Thus, modifications of the projection models will
  be developed and caution is urged in using CARES
  projections for these programs.
• General comments follow for each SDP.

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VISN-Level General IssuesSpecial Disability
Programs

• Blind Rehab Consider space planning for outpat
  blind rehab programs (i.e., VISORS, VICTORS, low
  vision clinics, BROS, VIST) restoration of
  inpat capacity for comprehensive blind rehab
  centers.
• SCI Maintenance of acute care capacity at SCI
  Ctr. sites. Specific issues for VISNs 3, 16, 19,
  21-23.

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VISN-Level General IssuesSpecial Disability
Programs

• Dom/Homelessness Nationally, 44?(1996-2001) in
  homeless veterans treated in VA Domiciliary Care
  for Homeless Veterans (DCHV) and other VA
  Specialized Programs. Consider involvement of
  community service providers, EUL, VA Grt/per
  diem, and other federal funding (e.g., HUD).
  Outcome studies document successful outcomes 59
  housed and 54 are employed at discharge.
• Dom/General Existing or planned State Veteran
  Home Domiciliaries should be taken into account
  in PIs. Forecasting methodology is based upon
  national average use rates, which increased beds
  for VISNs with low use currently and decreased
  beds for VISN with large numbers of beds model
  assumptions projections should be re-examined.

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VISN-Level General IssuesSpecial Disability
Programs

• Traumatic Brain Injury (TBI) If excess space,
  consider continuum of service delivery models to
  address the unique environmental needs of TBI
  pts. E.g., coma care, comprehensive inpatient
  rehab, post-acute care (such as outpatient, home
  care, voc rehab), community re-entry
  (transitional living), alternative long term care
  (LTC) settings (such as assisted living),
  specialized LTC (such as persistent vegetative)
  and respite care. Primary consideration should
  be given to
• Transitional Living for TBI
• Community Re-entry
• Independent Living
• Long Term Care Alternate Living Settings for TBI
• Neurobehavioral Care
• Assisted Living

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VISN-Level General IssuesSpecial Disability
Programs

• Mental Health (SCMI, PTSD, SA)
• Primary Care/CBOCs Primary care PI's should
  include MH services in space planning.
• SCMI Mental health leadership at both national
  and local levels should be included in efforts to
  address potential reductions in capacity. MH pt
  population ? 4/yr (FY96-FY00) 6 in FY01.
  Forecasting models will be refined to address
  questions raised by current projections.
• PTSD population has increased 58 ? (FY96-01).
  A PTSD demand model to maintain current capacity
  and accommodate future growth will be developed.
• Substance Abuse (SA) an marked decline in the
  availability of SA services will be addressed
  through the revised MH demand model.

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Summary and Conclusions

• Planning Initiative Identification Process has
  been completed.
• Next Steps
• Market Plan Development by VISN level with
  assistance of VSSC and National CARES Office
• Participation of VSOs in VISN Planning
• USH Review of DRAFT National CARES Plan
• CARES Commission Review and Public Comment
• Secretarys review and decision