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CARES Planning Initiatives

• VISN 2 VA Healthcare Network, Upstate New York

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Presentation OutlineVISN 2

• Changes in CARES Projections
• VISN Overview
• VISN-Level Issues
• Special Disability Programs
• Effective Use of Resources
• Proximity
• Vacant Space
• Collaborative Opportunities

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

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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

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February 2003 Changes in Planning Initiatives
Indicates New Planning Initiative.
Indicates Original Planning Initiative.
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VISN 2 Overview

• Enrollees
• Projected to decline by 34 from FY 2001 level to
  FY 2022
• Planning Initiatives (PIs)
• Access
• No Markets have PIs related to access in Primary
  Care, Hospital Care, or Tertiary Care
• Inpatient Demand
• 1 Market has a PI related to increased inpatient
  demand
• 1 Market has a PI related to decreased inpatient
  demand
• Outpatient Demand
• 3 Markets have a total of 4 PIs related to
  increased outpatient demand
• No Markets have a PI related to decreased
  outpatient demand
• Small Facility
• No facilities are projected to require fewer than
  40 acute care beds

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VISN 2 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 Identified Issues
• None Identified
• Collaborative Opportunities
• There is a potential expansion of NCA at the
  Batavia site

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VISN 2 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 2 Issues Special Disability Programs

• Blind Rehab
• Peak of legally blinded veterans in 2004 at 3,566
  (from 3,491 in 01) ? to 2,243 veterans in 25.
  Consider space planning for blind rehab programs
  (i.e., VISORS, VICTORS, low vision clinics, BROS,
  VIST).
• SCI
• Coordinate with the Chief Consultant, Spinal Cord
  Injury and Disorders Strategic Health Care Group
  regarding potential of locating new SCI Center in
  VISN 2.

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VISN 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

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VISN Level IssuesEffective Use of Resources
Space

• Current Vacant Space 217,546 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.

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VISN Level IssuesCollaborative Opportunities

• The following collaborative opportunities have
  been identified for VISN 2 to consider when
  completing Market Plans
• VBA
• None
• NCA identification of areas they would like to
  expand
• Expansion possibilities exist at the Batavia site
• Enhanced-Use possible opportunities for vacant
  space
• None
• DoD
• None

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VISN 2 Eastern Market

• Description of Market Area
• The Eastern market surrounds the city of Albany
  and includes four moderately populated counties
  of Albany (23,774), Schenectady (12,861),
  Rensselaer (13,248) and Saratoga (16,582). It
  was constructed based upon an analysis of each
  countys referral patterns to CBOCs and
  inpatient facilities, and the proportional share
  of each countys veterans served.

• Medical Centers
• Albany (Tertiary Care)

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VISN 2 Eastern MarketCARES Planning Initiatives

• Access
• Primary Care 85 of the veterans residing within
  the Market are within the Access Guideline
• Hospital Care 86 of the veterans residing
  within the Market are within the Access Guideline
• Tertiary Care 100 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.
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VISN 2 Eastern 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 2 Eastern MarketCARES Non-PI Workload Gaps
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VISN 2 Eastern 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 2 Central Market

• Description of Market Area
• The Central market includes the city of Syracuse
  and the largely populated county of Onondaga
  (38,726). It was constructed based upon an
  analysis of each countys referral patterns to
  CBOCs and inpatient facilities, and the
  proportional share of each countys veterans
  served.

• Medical Centers
• Syracuse (Tertiary Care)

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VISN 2 Central MarketCARES Planning Initiatives

• Access
• Primary Care 80 of the veterans residing within
  the Market are within the Access Guideline
• Hospital Care 77 of the veterans residing
  within the Market are within the Access Guideline
• Tertiary Care 100 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.
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VISN 2 Central 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 2 Central MarketCARES Non-PI Workload Gaps
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VISN 2 Central 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 2 Finger Lakes/Southern Tier Market

• Description of Market Area
• The finger lake encompasses a highly populated
  Monroe county(55,121) as well as four more
  sparsely populated counties. The southern tier
  consists of 7 counties and contains a
  disproportionately high veteran market share of
  50.3, providing services to area veterans
  through CBOCs and inpatient facilities. Both
  areas contain a significant enrolled veteran
  population.

• Medical Centers
• Bath
• Canandaigua

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VISN 2 Finger Lakes/Southern Tier Market CARES
Planning Initiatives

• Access
• Primary Care 80 of the veterans residing within
  the Market are within the Access Guideline
• Hospital Care 98 of the veterans residing
  within the Market are within the Access Guideline
• Tertiary Care 100 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.
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VISN 2 Finger Lakes/Southern Tier 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 2 Finger Lakes/Southern TierCARES Non-PI
Workload Gaps
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VISN 2 Finger Lakes/Southern Tier 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.

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VISN 2 Western Market

• Description of Market Area
• The Western market includes the city of Buffalo
  and the largely populated county of Erie
  (84,027). It was constructed based upon an
  analysis of each countys referral patterns to
  CBOCs and inpatient facilities, and the
  proportional share of each countys veterans
  served.

• Medical Centers
• Buffalo (Tertiary Care)
• Batavia

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VISN 2 Western MarketCARES Planning Initiatives

• Access
• Primary Care 90 of the veterans residing within
  the Market are within the Access Guideline
• Hospital Care 99 of the veterans residing
  within the Market are within the Access Guideline
• Tertiary Care 100 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.
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VISN 2 Western 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 2 Western MarketCARES Non-PI Workload Gaps
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VISN 2 Western 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.