El Paso Joint Venture 2010 VA/DoD Joint Venture Conference El Paso Joint Venture Wm Beaumont Army Medical Center El Paso VA Health Care System

El Paso Joint Venture 2 New Initiatives – Projects Closed IDENTIFY ALL NEW INITIATIVES OVER THE PAST YEAR: 1. Lab Integration: 2. Digital Mammogram Equipment: 3. CMS/SPD Equipment IDENTIFY ANY PROJECTS OR EFFORTS THAT WERE CLOSED OR FAILED IN THE LAST YEAR: 1. JIF – Cardio Thoracic Surgery (Closed) – Successful: Brought CTS into WBAMC and recaptured 60+ cases annually with at least 12 cases being Veterans.

El Paso Joint Venture 3 Joint Venture Performance Measures PMs USED TO TRACK JV SUCCESS: 1. Access availability 2. Workload 3. Timeliness of actions 4. Patient Satisfaction DATA SOURCES USED FOR THE PMs: 1. CHCS 2. AHLTA 3. Work Group reports OUTCOMES FOR EACH PM LISTED: 1. CTS very successful. Open access based solely on need. 2. CTS has meet its annual goals of 12 minimum VAB patients and 60 total patients. FY10: 68 total cases, 17 VABs. 3. Central Materiel Services initiative has been successful in terms of the integration of EPVAHCS staff into WBAMC CMS department. Installation of EPVAHCS purchased CMS equipment is in progress.

El Paso Joint Venture 4 Access to Military Installation Procedures REQUIRED ACCESS PROCESS and POLICIES FOR VA BENEFICIARIES and/or EMPLOYEES TYPE OF VISITOR ID BADGE* PRIOR COORDINATION VA APPOINTMENT DOCUMENTATION / VERIFICATION VISITOR CENTER VA EMPLOYEE DVANO NO VA PATIENT State or VA ID NO NO VA PATIENT ESCORT StateNO NO VA PATIENT VISITOR State NO NO NO * Enter Type of ID Required: ( DoD, DVA, GOVT, State, Post or Base)

El Paso Joint Venture 5 Access to Care and Referral Management ISSUES RELATED TO ACCESS TO CARE & REFERRAL MANAGEMENT: 1. DoD system cannot get CPRS consult directly 2. DVA requirement for PCP initiated consults on most referrals. Causes delays while clinic waits for authorization. 3. EPVA finds delays in WB specialty care consult review cuts into time to meet access standards. 4. WBAMC specialist deployments & WTU access priority affect availability for VA beneficiaries. 5. VA’s inability to view AHLTA encounter info consistently via Remote Data View-VistA Web. RESOLUTIONS TO ISSUES RELATED TO ACCESS TO CARE & REFERRAL MANAGEMENT: 1. WBAMC has provided EPVAHCS ability for a select group to enter consults into CHCS. 2. EPVAHCS provided POC for consult issues. WBAMC monitors their requests and contacts POC. 3. WBAMC developed adhoc CHCS report which allows monitoring of EPVAHCS submitted consults. 4. Special situations/cases are brought to Liaisons who work with clinics directly. 5. Situation was reported to national level IT for both DoD and VA. It is being worked.

El Paso Joint Venture 6 Future Initiatives and/or Proposals NEAR TERM (1-2 YEARS) INITIATIVES: 1. Westside El Paso combined CBOC - Primary Care Clinic 2. Radiology Department Integration 3. Pharmacy Integration 4. DES – Disability Evaluation System (Spring 2011) LONG TERM (>2 YEARS) GOALS / INITIATIVES / STRATEGIES: 1. Integrated / Co-Located Health Care Center

El Paso Joint Venture Mission To improve the quality, efficiency, and effectiveness of the delivery of benefits and services to veterans, service members, military retirees and their families through an enhanced VA and DoD partnership. Vision Statement (adopted 9 Dec 09) “Establish a collaborative system of care for DoD/VA beneficiaries in an integrated medical center under Army command and control and a shared DoD/VA governance structure that achieves seamless delivery of services for beneficiaries, continuity of care, quality care, and cost effectiveness.” Future Joint Venture Federal Campus

El Paso Joint Venture CONOPS signed by Principals on 4 Jan 2010 Governance: –One governance structure –WBAMC Commander exercises command and control (C2) over the integrated Army/VA Medical Center. –EPVAHCS Director exercises complete authority over separate VA outpatient services. –Joint Army/VA representation on medical and leadership committees and on the joint medical staff. Strategic Planning Focus: Will consider the DoD, Army, DVA and VHA strategic priorities, missions, and guidance during program development. CONOPS signed by Principals on 4 Jan 2010 Governance: –One governance structure –WBAMC Commander exercises command and control (C2) over the integrated Army/VA Medical Center. –EPVAHCS Director exercises complete authority over separate VA outpatient services. –Joint Army/VA representation on medical and leadership committees and on the joint medical staff. Strategic Planning Focus: Will consider the DoD, Army, DVA and VHA strategic priorities, missions, and guidance during program development. CONOPS Review

El Paso Joint Venture Daily Operations Framework Objective: combine services where feasible to reduce duplication and increase efficiencies. –Integrate specialty care services as possible, or co- locate with option of integrated administrative support. –Known, current exception: In-Patient Mental Health Care. WBAMC will have a separate AD inpatient unit, staffed and operated by and for the Army. VA will perform cost/benefit analysis to determine if a second inpatient mental health unit is needed. –Staffing and Resources will be consistent with workload between DoD and VA beneficiaries. Daily Operations Framework Objective: combine services where feasible to reduce duplication and increase efficiencies. –Integrate specialty care services as possible, or co- locate with option of integrated administrative support. –Known, current exception: In-Patient Mental Health Care. WBAMC will have a separate AD inpatient unit, staffed and operated by and for the Army. VA will perform cost/benefit analysis to determine if a second inpatient mental health unit is needed. –Staffing and Resources will be consistent with workload between DoD and VA beneficiaries. CONOPS Review

El Paso Joint Venture Emergency Department 3,880 (10%) Outpatient Visits 4,426 Same Day Procedures 191 Inpatient Cases 1,169 (18%) Bed Occupancy Overall: 20% Medicine: 35% Medical ICU: 30% Cardiology: 38% Coronary Care Unit: 46% Surgery: 25% Surgical ICU: 28% As of Jun10 Overall Average Length of Stay is equivalent between VABs and DoD retirees. VA Patient Activity at WBAMC FY10