Dr' Paul K' Carlton, Jr'

1
CARES
Implementation of CARES Central Texas Veterans
Health Care System A Proposal for a Pilot
Dr. Paul K. Carlton, Jr. Lt. Gen, USAF, Ret 9
August 2004
2
Central Texas Veterans Health Care System
3
CARES
Capital Asset Reallocation for Enhanced
Services -brings advanced out patient care to
veterans at home -low cost avenue for surge
capacity
4
Recommendations

• Pilot program at one or two sites
• Get good data on acceptability and cost
• Evaluate at one year intervals to determine
  expand or not

5
CARES plus Homeland Security
Safety Net for Nation - VA and DHS funded pilot
6
Surgical Van

• Off the shelf
• 18 Wheeler
• Medicare approved
• Been used for 9 years

7
Equipment ConceptMobile Medical International
Corp

• - Exists
• Ambulatory Surgical unit
• ICU and PACU unit
• Breast unit
• Telemedicine unit (doubles as CC unit)
• To be designed
• Diabetes unit
• Education and training unit
• Simulation center/virtual reality trainer
• Lab unit

8
Equipment Units

• Ambulatory Surgical Unit
• 1 operating room in routine use
  2 operating rooms in surge use
• 4 ICUs/recovery beds
• Result
• 3 hrs/case average
• 8 cases/day/OR

9
Waco Pilot

• Waco has room to be a hub for 18 wheelers for the
  pilot and beyond
• CARES says bring care to veterans in State
• This mobile concept does that to include
• Ambulatory surgery
• Endoscopic procedures

10
THEN Mass Casualty Event occurs
Surge Capacity Exists
Surge Hospital
Surge Hospital
Surge Hospital
Surge Hospital
Surge Hospital
Surge Hospital
11
No one can afford to have medical equipment
sitting
Van Must Earn Its Keep
HOW?
12
The Thursday Hospital
Monday
Tuesday
Wednesday
Thursday
Friday

• On Monday, facility used as
• VA Clinic already present

13
The Thursday Hospital
Monday
Tuesday
Wednesday
Thursday
Friday

• On Tuesday, facility used as
• Imaging onsite
• VA Clinic already present

14
The Thursday Hospital
Monday
Tuesday
Wednesday
Thursday
Friday

• On Wednesday, facility used as
• VA Clinic already present

15
The Thursday Hospital
Monday
Tuesday
Wednesday
Thursday
Friday

• On Thursday, facility used as
• Operating hospital
• VA Clinic already present

16
The Thursday Hospital
Monday
Tuesday
Wednesday
Thursday
Friday

• On Friday, facility used as
• VA Clinic already present

17
1st Week Hospital - East
Brownwood
Cedar Park
Austin
Waco

• One week on site
• Multiple specialties
• Opens van for ICU care cases

18
1st Week Hospital - West
Palestine
Marlin
Waco
Bryan

• One week on site
• Multiple specialties
• Opens van for ICU care cases

19
1st Week Hospital
All surgical specialties because ICU available
20
Sites

• Thursday Hospital
• Driving distance apart is 2 3 hours
• Full time medical presence

• 1st Week Hospital
• Driving distance longer
• One week on site
• Multiply specialties
• Opens to ICU care

21
Proposal

• Buy or lease 2 vans
• Establish headquarters at Waco for scheduling and
  screening
• Set up cost center to get true estimate of cost
• Coordination with DHS for surge capacity

22
Proposal
Pilot Program - Waco hub of schedule and
maintenance - Central Texas Veterans
recipients of care - Prove concept and show
costs
23
Central Texas Veterans Health Care System
24
Central Texas Veterans Health Care System
25
2 Vans
East Swing West
Swing Palestine
Brownwood Marlin
Cedar Park Waco
Austin Bryan Waco

26
East Swing
Palestine
Monday
Friday
Tuesday
Marlin
Thursday
27
Typical Week - East
Monday Travel to Palestine AM work PM Tuesday
Work AM travel to Bryan PM Wednesday Work
Bryan all day Thursday Travel to Marlin AM
work Marlin PM Friday Work Marlin AM travel to
Waco
28
Typical Week - East
Work 60 Travel 40
29
West Swing
Friday
Brownwood
Thursday
Monday
Cedar Park
Tuesday
30
Typical Week - West
Monday Travel to Brownwood AM work PM Tuesday
Work AM travel to Cedar Park PM Wednesday
Work Cedar Park all day Thursday Travel to
Austin AM work Austin PM Friday Work Austin
AM travel to Waco
31
Typical Week - West
Work 60 Travel 40
32
THEN Mass Casualty Event occurs
Surge Capacity Exists
Surge Hospital
Surge Hospital
Surge Hospital
Surge Hospital
Surge Hospital
Surge Hospital
33
Temple

• Surge in place
• Pull in vans
• Add more OR capability
• Add more ICU capability

34
2 Vans
Temple - extra ORs available when demand not
present east or west
35
Users
Thursday Hospital limited to ambulatory surgery
procedures

• General Surgery
• Orthopedic surgery
• Ear, Nose, Throat
• Ophthalmology
• Urology
• Gastro Enterolgy

36
Flexibility

• North South migration of veterans due to
  weather
• Units could follow veterans North and South

37
Manpower Pool

• Come out of Temple initially
• Zero sum game initially

38
Investment

• Vans lease or buy 2.4 million each with
  equipment
• Cadre of people to run and keep track of expenses
• OM should already be sunk in cost if zero sum
  game

39
Options

• Pilot one site
• Pilot in multiple sites
• Implement system wide
• Let someone else prove concept and not do in VA
  at this time

40
Pilot One Site

• Pros
• Implement CARES
• Good test bed
• Easy to keep track of numbers
• Inexpensive to test

• Cons
• What works in one place may not work in another
  place
• Local opposition for market share

41
Pilot in Multiple Sites

• Pros
• Better education of how it will work in all areas
• Better surge capability immediately

• Cons
• Harder to get accurate numbers from multiple
  sites
• More expensive to do

42
Implement VA Wide

• Pros
• Does CARES right now

• Cons
• Hard to know what it would cost
• No model to follow
• Too much change too rapidly
• Very expensive

43
Say NO

• Pros
• No more money
• No change

• Cons
• Does not implement CARES
• Does not add surge capacity

44
Recommendations

• Pilot program at one or two sites
• Get good data on acceptability and cost
• Evaluate at one year intervals to determine
  expand or not

45
Proposal

• Waco test pilot
• 10M investment to run for two years with 2 vans
  in Central Texas Veterans Health Care System

46
Timeline
Implementation of CARES
?
2004
2004 - 2007
Test
Start
Test ends
47
To obtain a copy of this presentation
www.tamushsc.edu/homeland/
Questions?
Dr Paul K. Carlton, Jr. Lt Gen, USAF, Ret
Director, Homeland
Security The Texas AM University System Health
Science Center