Biloxi/Keesler Joint Venture Site

2010 VA/DoD Joint Venture Conference

Brig. Gen. Kory Cornum Commander81 Medical Group Keesler AFB

Mr. Thomas Wisnieski, MPA, FACHEDirectorVA Gulf Coast Veterans Health Care System

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Overlapping Gulf Coast Multi-MarketsProvides Unique Opportunity for VA/DoD

Sharing

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Overview

• New Initiatives – Projects Closed

• Joint Venture Performance Measures

• Metrics

• Access to Military Installation Procedures

• Access to Care and Referral Management

• Future Initiatives and/or Proposals

• Other Joint Activities

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New Initiatives – Projects Closed

IDENTIFY ALL NEW INITIATIVES OVER THE PAST YEAR:

  1. Joint Venture Business Office (Completed renovations January 2010)

2. Radiation Oncology (Re-started March 2010)

3. Sleep Lab Expansion FY2010 JIF (Approved March 2010)

4. MRI Radiologist (Hired April 2010)

5. VA Radiology Workstation Installed at Keesler to View VA Images (Installed April 2010)

IDENTIFY ANY PROJECTS OR EFFORTS THAT WERE CLOSED OR FAILED IN THE LAST YEAR:

1. None

2.

3.

4.

5. 

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Joint Venture Performance Measures

PMs USED TO TRACK JV SUCCESS: 1. Quality – Sustain the Highest Quality of Care

2. Access – Accessible to Patients

3. Cost – Financially Attractive and Mutually Beneficial to Both Entities

DATA SOURCES USED FOR THE PMs:

1. Joint Commission, IG, OMB, GAO, and Quality Performance Measures

2. Clinic Wait Time Data Cube and DoD Clinic Reports

3. Vista FEE File, CMAC Rate Sheets and Business Case Analysis

OUTCOMES FOR EACH PM LISTED:

1. Demonstrated Quality by Various Regulatory Agencies and Quality Indicators

2. Statistical Access Results Used to Identify Trends

3. Measurable Cost Savings

Cost Savings(through August 31, 2010)

Keesler Savings: – FY08 $145K– FY09 $374K– FY10 $616K

Savings Calculated: Private Sector Market Value Less Negotiated Rate with DoD6

KEESLER NAVY - PEN/PC EGLIN TYNDALL

FY08 Paid 569097.409999998 199990.08 70940.32 164368.530000001

FY08 Market Value 714742.790000001 226738.300000001 81359.09 184308.12

FY09 Paid 2044889.72 469047.23 322970.720000002 206862.98

FY09 Market Value 2418396.39999999 536935.209999993 366836.160000001 232552.2

FY10 Paid 1572985.14000001 220229.5 378851.479999998 160576.959999999

FY10 Market Value 2188991.77999998 254093.64 429864.999999999 178864.62

$250,000 $750,000

$1,250,000 $1,750,000 $2,250,000 $2,750,000

Access: VA Encounters at DoD Facilities(through August 31, 2010)

• Counts Based on Paid Billed Services 7

KEESLER NAVY - PEN/PC EGLIN TYNDALL TOTAL

FY08 1351 1287 124 823 3585

FY09 2922 694 1623 839 6078

FY10 3144 162 1489 594 5389

500

1,500

2,500

3,500

4,500

5,500

6,500

FY08FY09FY10

Access: Top 5 VA Encounters at 81 MDG (through August 31, 2010)

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CARDIOLOGY MEDICINE MRI RADIATION ON-COLOGY

SURGERY

FY08 63 385 60 NaN 242

FY09 490 391 566 223 188

FY10 638 196 525 914 66

50

150

250

350

450

550

650

750

850

950

FY08

FY09

FY10

NA

• Counts Based on Paid Billed Services

Access: Centers of Excellence Encounters (through August 31, 2010)

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CARDIOLOGY MRI RADIATION ON-COLOGY

SLEEP LAB

FY09 553 3669 383 841

FY10 (PROJECTED) 674 4319.25 1909.38461538462 902

500

1500

2500

3500

4500

Cost Avoidance

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• Cardiology and MRI: Actual combined VA/DoD savings year to date over life of JIF

• Radiation Oncology: Annual projected VA savings• Sleep Lab: Annual projected VA/DoD combined savings after expansion

CARDIOLOGY MRI RADIATION ON-COLOGY

SLEEP LAB

COST AVOIDANCE (IN THOU-SANDS)

1597 745 168 321

STUDIES 647 1410 2745 1440

$250

$750

$1,250

$1,750

$2,250

$2,750

COST AVOIDANCE (IN THOU-SANDS)

STUDIES

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Access to Military Installation Procedures

REQUIRED ACCESS PROCESS and POLICIES FOR VA BENEFICIARIES and/or EMPLOYEES

TYPE OF VISITORID BADGE*

PRIOR COORDINATION

VA APPOINTMENT DOCUMENTATION / VERIFICATION

VISITOR CENTER

VA EMPLOYEE

DVA , Base

(**DoD)X    

VA PATIENT

DVA , Base

(**DoD)X  X X 

VA PATIENT ESCORT

DVA, State

(**DoD)X X  X

VA PATIENT VISITOR

 DVA, State

(**DoD)  X   X

*Enter Type of ID Required: ( DoD, DVA, GOVT, State, Post or Base)**If Retired Military, may present DoD ID.

Meeting Base Access Challenges

• Coordination Between VA and DoD Facilities

• Appointment Lists are Provided to Base Gate Security and/or Appointment Letters are Provided to the Patients

• Shuttle Between Biloxi and Keesler Campuses

• VA Facilities on DoD Property have Perimeter Fences to Separate VA Enclave– Pensacola Joint Ambulatory Care Center– Eglin CBOC

• Patient Pass-Through Gates– Eglin 96 Medical Group

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Access to Care and Referral Management

ISSUES RELATED TO ACCESS TO CARE & REFERRAL MANAGEMENT:

  1. Disparate Referral Processes for different services – For example, scheduling processes are different for MRI and Cardiovascular Cath Lab.

2. Patient special needs – issues for both staff (medical and administrative) and patients (transportation, escorts, and follow up visits).

3. Measuring the effectiveness of the program – Are we saving each other money?

4. Financial Bottom line – Are we paying the right bill at the right cost at the right time for the right treatment...and capturing workload?

5. Referral process is cumbersome and requires close coordination.

RESOLUTIONS TO ISSUES RELATED TO ACCESS TO CARE & REFERRAL MANAGEMENT:

1. Referral Processes are outlined in agreements to tailor the process to each service.

2. Processes for shuttle service and finding lodging for patients with special needs are being developed.

3. To help measure effectiveness, we are hiring 1.0 Program Analyst to review cost of services, align demand with capacity, and measure the effectiveness of sharing.

4. Joint Venture Business Operations (JVBO) office established to facilitate tracking all aspects of business practices to ensure that sharing is mutually beneficially. Capturing workload has been an issue; we are developing processes to ensure that workload is properly accounted for.

5. We have found that embedding personnel is an effective way to streamline cumbersome processes and encourage coordination. We have also used a Process Action Team (PAT) to identify and resolves access referral issues.

 

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Future Initiatives and/or Proposals

NEAR TERM (1-2 YEARS) INITIATIVES:

  1. Shuttle Service Between Keesler/Biloxi Campuses (mitigates base-access issues)

2. Implement an across-the-board CMAC less 25% discounted reimbursement rate (incentivizes sharing)

3. Provide lodging for Radiation Oncology patients (facilitates treatment for patients who live out of area)

4. Install VA workstations at DoD facilities (allows providers treating Veterans access to their medical records)

5. Infectious Disease (Plans for 3 Keesler Specialists to provide care at Biloxi 2 one-half days a week)

LONG TERM (>2 YEARS) GOALS / INITIATIVES / STRATEGIES:

1. Picture Archiving and Communication Systems (PACS) (National Issue for full connectivity)

2. Separate VA/DoD Electronic Patient Records (National Issue)

3. Dual Credentialing (National Issue)

4. Potential Inpatient Psychiatry Center of Excellence

5. Potential Physical Medicine and Rehabilitation Center of Excellence 

• Maintaining Currency/Competency – Nurse Training/Collaboration– Residency Training Rotations– Keesler Graduate Medical Education Programs

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Additional Information as Desired

Nurse Training/Collaboration

• Simulation Laboratory at Keesler – Joint Biloxi/Keesler Staff Conducted Several 6-hour Lab

Sessions Between June & August 2010 – Trained 21 VA Nurses – 126 Contact Hours

• Nurse Clinical Practice Committee – Meets Monthly – Has Joint Biloxi/Keesler Participation

• Trauma Nurse Care Course– September 2010 at Keesler– 2.0 VA Nurses participated

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Residency Training Rotations Biloxi VA Medical Center

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• Typically, 80 Residents Participate in Residency Training Rotations Annually. Rotation Slots follow:– General Surgery: 5 (2 Keesler and 3 University of South Alabama)– Ophthalmology: 2 (Tulane)– Ear, Nose, & Throat: 2 (Tulane) – Cardiology: 1 (University of South Alabama)– Dermatology: 2 (Tulane) – Internal Medicine: 4 (University of South Alabama)– Extended Care: 1 (Keesler)– Radiology: 1 (University of South Alabama)– Psychiatry: 2 (University of South Alabama)

• Active Duty (Keesler) Specialists who work part-time (on their time) at Biloxi without compensation to maintain their skills: – 2 Ophthalmologists – 1 Plastic Surgeon (Currently Deployed)– 1 Vascular Surgeon (Pending—Expected to start in October)

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Keesler 81 Medical Group Graduate Medical Education

• General Surgery Residency– 1 Intern – 4 Post Graduate Year-2 Residents– 4 Post Graduate Year-3 Residents– 1 Research Resident

• Internal Medicine Residency– 1 Intern – 8 Post Graduate Year-2 Residents – 6 Post Graduate Year-3 Residents

• Dentistry– Advanced Education in General Dentistry (one-year program-2010)—6 Residents.– General Practice Residency (one-year program-2010)—2 Residents– Endodontics (two-year program—2010)—2 Residents

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Backup Slides

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Governance Structure

Executive Management Team• Five co-equal partners:

– VA Gulf Coast Veterans Health Care System (VAGCVHCS) – Keesler 81 Medical Group– Naval Hospital Pensacola– Eglin 96 Medical Group– Tyndall 325 Medical Group

• Sets joint policy

• Coordinates multi-market health care delivery

• Provides strategic direction and operational oversight

Sharing Initiatives Should be…

• Designed to Sustain the Highest Quality

• Mutually Beneficial

• Constructed to Serve Complimentary Missions

• Accessible to Patients

• Financially Attractive

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Inpatient Services: Cardiology, Intensive Care, Medicine, GI, Gynecology, Orthopedics, Plastic Surgery, General Surgery, Urology, Oral Surgery, Inpatient Mental Health

Outpatient Specialty Care: Dental Services, Dermatology/Mohs, Neurology, Radiation Oncology, Women’s Health/Mammography

Other Shared Services & Functions:• Education and Training• Medical Records• Laundry • Magnetic Resonance Imaging (MRI)• Patient Transfer/Referrals• Shared RN Staff Training, Residency

Training, & Quality Management • Sleep Center• Tumor Board Conference

Keesler 81 Medical Group & Biloxi VAMC Sharing Initiatives

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Centers of Excellence(Capitalize on Core Competencies, Eliminate Duplication, and Create Synergy)

Keesler Campus

- Magnetic Resonance Imaging (MRI) • June 2008: Keesler Started Scheduling Veterans

- Joint Cardiovascular Care• November 2008: Keesler Started Scheduling Veterans

- Radiation Oncology• March 2010: Keesler Started Scheduling Veterans

Biloxi Campus- Sleep Laboratory

• November 2007: Joint Clinic Established

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Access to Care/Referral Management

• Access– Referral Process Outlined in Agreements– Biloxi-Keesler Process Action Team (PAT) Identifies and Resolves

Access Issues– 1.0 Program Analyst – Located on Keesler AFB

• Review Cost of Services• Align Demand with Capacity • Measure Effectiveness of Agreements/Services Provided

• Referral Management Staff*– 1.0 Authorization Clerk – Located at Keesler– 1.0 Authorization Clerk – Located at Naval Hospital Pensacola – 1.0 Consult Mgmt/Utilization Review Nurse – Located at Eglin

24*Funded with JIF funds to augment existing specialty care staff

Future Direction

• Separate Picture Archiving and Communication Systems (PACS) (VA Radiology Workstation Installed at Keesler to View VA Images)

• Implementing Standardized Business Practices (Joint Venture Business Office (JVBO) is Being Set-up at Keesler)

• Requirement to Cover Costs

• Capturing Workload (Set-up a process to document VA provider workload when VA providers treat VA patients at DoD facilities)

• Dual Credentialing

• Separate VA/DoD Electronic Patient Records

• Base Access

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