CARES Planning Initiatives VISN 1 VA New England

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 Far North Market Type of Planning Initiative North Market West Market East Market PI in Feb 2003 PI in Nov 2002 Yes Yes üInpt. Psychiatry Yes No Yes üOutpt. Primary Care Yes üOutpt. Specialty Care Yes Yes üOutpt. Mental Health Yes Yes Small Facility PI: üNone Capacity PI: üInpt. Medicine üInpt. Surgery Indicates Original Planning Initiative. Yes Yes Indicates New 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

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 1 st. – 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 Mile s 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 FY 2004 and 30 % in FY 2005.

VISN Level Issues PI Team Identified Issues 1. 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. – Do. D • None identified at this time.

VISN 1 Far North Market 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. – Medical Centers: • Togus, ME

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% Identified as a CARES Planning Initiative. 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:

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 None FY 201 2 (Beds) FY 202 2 (Beds) Rationale

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% Identified as a CARES Planning Initiative. 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:

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? N Facility Name FY 201 2 (Beds) FY 202 2 (Beds) Manchester, NH 0 0 Rationale 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% Identified as a CARES Planning Initiative. 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:

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 None FY 201 2 (Beds) FY 202 2 (Beds) Rationale

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% Identified as a CARES Planning Initiative. 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:

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? N Facility Name FY 201 2 (Beds) FY 202 2 (Beds) Boston: Jamaica Plains 34 25 Rationale All acute care beds have been moved to the Boston-West Roxbury campus.