Oregon VA Medical Centers. To care for him who shall have borne the battle and his widow and orphan. Abraham Lincoln

Transcription

1 Oregon VA Medical Centers To care for him who shall have borne the battle and his widow and orphan. Abraham Lincoln

2 The White House DEPARTMENT OF STATE DEPARTMENT OF ENERGY DEPARTMENT OF TRANSPORT- ATION DEPARTMENT OF HEALTH AND HUMAN SERVICES DEPARTMENT OF TREASURY DEPARTMENT OF HOMELAND SECURITY DEPARTMENT OF VETERANS AFFAIRS DEPARTMENT OF DEFENSE DEPARTMENT OF AGRICULTURE DEPARTMENT OF THE INTERIOR DEPARTMENT OF COMMERCE DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT DEPARTMENT OF JUSTICE VBA Veterans Benefits Administration VHA: Veterans Health Administration 156 Medical Centers and over 800 communitybased clinics. VHA has facilities in all 50 states! NCA National Cemetery Administration 21 National VISNs: Veterans Integrated Service Networks VISN 20 is shown below Alaska Idaho Oregon Washington

3 Our Vision To be a patient-centered integrated health care organization for veterans providing excellent health care, research, and education; an organization where people choose to work; an active community partner; and a back-up for National emergencies. Our Mission Honor America s veterans by providing exceptional health care that improves their health and well-being. Our Values Integrity, Commitment, Advocacy, Respect, Excellence

4 Who We Serve

5 Eligibility & Enrollment Priority Group 1: Veterans with VA-rated service-connected disabilities 50% Priority Group 2: Veterans with VA-rated service-connected disabilities 30% or 40% disabling Priority Group 3 includes Veterans: Who were former POWs With VA-rated service-connected disabilities 20% or 10% disabling Awarded the MOH, a Purple Heart medal, or special eligibility classification under Title 38, U.S.C Whose discharge was for a disability incurred/aggravated in the line of duty

6 Eligibility & Enrollment Priority Group 4: Veterans receiving aid, attendance, or household VA benefits Veterans catastrophically disabled Priority Group 5: Non service-connected Veterans and non compensable serviceconnected Veterans 0% disabled by VA with annual income below VA national income threshold Veterans who are eligible for Medicaid programs or are receiving VA pension benefits Priority Group 6 includes Veterans who: Served in the Republic of Vietnam or Southwest Asia Are compensable 0% or project 112/SHAD participants Exposed to ionizing radiation during the occupation of Hiroshima and Nagasaki

7 Eligibility & Enrollment Priority Group 7: Veterans with gross annual income above VA national income threshold but below the GMT for their location and who agree to pay copays Priority Group 8 includes Veterans with gross annual income above VA national income threshold and above the GMT for their location and who agree to pay copays and are also: Noncompensable 0% service-connected: subpriority a or b Nonservice-connected: subpriority c or d

8 Oregon s Veteran Population & the Affordable Care Act Approximately 6% of Veterans are currently uninsured Enrolled Veterans are covered by VA as a health marketplace VA is an option for Veterans, based on eligibility criteria

9 Portland VA Medical Center

10 Portland Footprint FY12 Total Unique Patients: 80,528 States: 2 Senators: 4 Congressional Districts: 6 Sites of Care: 11 Veteran Centers: 3 State Veterans Homes: 1 VBA Regional Offices: 2 National Cemeteries: 1

11 Portland Research & Education 151 Active Research Investigators $31.4m Research Program 11 Centers of Excellence Primary academic affiliate is Oregon Health & Science University 214 affiliation agreements with 113 educational institutions

12 Roseburg VA Medical Center

13 Roseburg Footprint Veteran Enrollees: 31,032 States: 2 (OR/CA) Counties: 5 Senators: 4 Congressional Districts: 1 - OR & 1 - CA Sites of Care: 5 Vet Centers: 1 (Eugene) State Veterans Homes: 1 (approved-not yet funded Roseburg) VBA Regional Offices: 0 National Cemeteries: 1

14 Southern Oregon Rehabilitation Center & Clinics

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16 FY12 Vital Statistics for Oregon Veteran Population 327,900 Veterans Served 128,294 Outpatient Visits 1,259,080 Portland 804,921 Roseburg 248,849 White City 205,310 Acute Beds 213 Portland 167 NH Beds 117 Portland 72 Roseburg 45 RRTP/Dom 507 Portland 36 Roseburg 30 White City 441 (ADC) 71 Roseburg 46 (ADC) 70

17 What We Provide Inpatient, Outpatient, Long Term Care Acute medicine, surgery, acute psychiatry, neurology, and rehabilitation medicine. Comprehensive health care through emergency, primary, specialty, quaternary and long term care. Provide a number of Specialties services, including: Ophthalmology/Optometry Cardiology, Endocrinology, Gastroenterology, Hematology Infectious Disease, Pulmonology Geriatrics, Rehabilitation Dental Orthopedics, Podiatry, Urology Women specific services: Gynecology, Psychology, Psychiatry, PTSD, Substance Abuse Nuclear Medicine, Imaging, and Audiology.

18 VA Major Strategic Initiatives Eliminate Veteran Homelessness Focus on Mental Health Increase Access to Healthcare Design Veteran-centric Healthcare Model Improve Quality While Reducing Cost

19 Design Veteran-centric Healthcare Model

20 Eliminate Veteran Homelessness

21 Focus on Mental Health Post Traumatic Stress Disorder Substance Abuse Post Deployment Clinics Family Therapy Neuropsychology Traumatic Brain Injury Polytrauma Recreational/Occupational Therapies

22 Mental Health Activities unique veterans served each year Over 10,000 clinical encounters each year Trainings and outreach events within the VA and in the community to include: Law enforcement agencies Professional conference presentations Community training Local tribal entities.

23 Traumatic Brain Injury 471,383 OEF/OIF/OND Veterans who used VA health care services in ,103 (87%) were men 7.1% had a TBI diagnosis 61,280 (13%) were women 2.5% had a TBI diagnosis

24 Improve Quality While Reducing Cost

25 Clinical Performance Measures Designated as TJC Top Performer on Key Quality Measures ACS, IHF, PN & SC One of three VAs named Top Performer in four measures. Weekly clinical reminder group meeting with PC, MH, Spec. Care, HPDP, CACs, Q&P Monthly performance meeting progress and action plans for all measures below benchmark Joint Commission Annual Report Names 620 Hospitals as Top Performers on Key Quality Measures Report Summarizes Performance of More Than 3,300 U.S. Hospitals September 19, 2012 (OAKBROOK TERRACE, Ill) Improving America s Hospitals: The Joint Commission Annual Report on Quality and Safety 2012 includes 620 hospitals that are leading the way nationally in using evidence-based care processes closely linked to positive patient outcomes. The hospitals identified as attaining and sustaining excellence in accountability performance in 2011 represent approximately 18 percent of Joint Commission-accredited hospitals reporting core measure performance data.

26 CMS Hospital Compare Inpatient Quality: CMS Hospital Compare 26

27 Increase Access to Healthcare

28 Access to Care Primary Care Goal <1% Specialty Care Goal <2% Portland 1.39% 2.20% Roseburg 2.17% 7.46% White City 0.33% 0.21% Goal 7 Day Access Goal > 90% Same Day Access Goal > 66% Portland 72.7% 52.3% Roseburg 81.2% 55.1% White City 95.0% 83.8%

29 VA Purchased Care Approximately 13% of Oregon VA Medical Centers budgets are spent on care purchased by VA from community providers

30 Case Study Sally is a Veteran who 20% serviceconnected for tinnitus. She sees her Portland VA primary care provider for her annual physical and a mass is discovered in her breast. Is she eligible for care outside of the VA?

31 Answer Yes, as the Portland VA does not offer mammography services, VA will purchase Sally s care out at a community hospital or breast imaging center.

32 Case Study John is a Veteran who served in Iraq. He just found out from his primary care provider at the Roseburg VA that he needs a hernia surgery. The soonest the VA can perform the surgery is 2 months. Is John eligible for care outside of the VA?

33 It depends Answer Does Roseburg perform the hernia surgery? Is John s hernia life threatening? Is John service-connected for the condition that caused the hernia? As Roseburg can perform the surgery and it is not life threatening, VA will not purchase John s surgery in the community.

34 Coverage of Enrolled Veterans in Non-VA Facilities Eligible Veterans may receive emergency care for non-va facilities at VA expense when a VA or Federal facility is unable to furnish the needed emergency services or is geographically inaccessible VA may pay for emergency care by a non-va facility without prior VA approval under certain conditions Emergency care must be pre-authorized (this can be done within 72 hours of admission to a non-va facility) Payment cannot be extended beyond the date on which the emergency ended, unless the VA cannot accommodate to transfer the Veteran to a VA facility

35 Coverage of Enrolled Veterans in Non-VA Facilities Inpatient and outpatient care covered at non-va facilities depends on if the Veteran: Has a service-connected disability status Requires treatment for disability or medical condition Receives compensation or pension Requires emergency care while receiving care at a VA facility, Contract Nursing Home, or during authorized VA travel

36 Unauthorized Emergency Care for Service-Connected Veterans The VA may pay for emergency care for service-connected Veterans if treatment is for: The service connected disability or non-servicecondition associated with aggravating the Veteran s service-connected condition A disability that caused the Veteran to be released from active duty Any Permanently or Totally disabled Veteran Any condition of an active participant of the VA Chapter 31 Vocational Rehabilitation program

37 Case Study Steve is a Veteran who lives in Redmond. On Saturday, his knee (which he is serviceconnected for) gave out while he was working in his yard. He goes to the ER in at his local (non-va) hospital, where he is admitted for a few days. Is the VA obligated to pay the local hospital for Steve s care?

38 Yes Answer The ER visit is covered as the VA was geographically inaccessible Steve is service-connected for his knee, which needs treatment While ideally the local hospital would contact the VA regarding Steve s admission within 72 hours, in this situation, that is not required

39 Case Study Jane is a service-connected Veteran who has chest pain in Coos Bay. She is rushed to the local ED at a non-va hospital by ambulance. She is admitted with a chest pain Is the VA obligated to pay for Jane s non-va care?

40 It depends Answer Was the VA notified within 72 hours? The ambulance bill may only be paid if travel eligible In this situation, yes, VA would pay for Jane s care

41 Unauthorized Emergency Care for Non-Service-Connected Veterans The VA may pay for emergency care for a non-service-connected Veteran if all of the following conditions are met: The episode of care cannot be paid as an unauthorized claim Veteran is enrolled in the VHA health care system and received VA care within 24 months prior to the emergency care Veteran is liable to the health care provider of the emergency treatment Veteran is not entitled to care or services under a health plan contract Claim must be filled within 90 days from discharge if the Veteran has no contractual or legal recourse against a third party that would extinguish liability

42 Case Study Pat is a non-service connected Veteran from the first Gulf War. He used to have a VA primary care provider in White City, but has been using his wife s insurance instead to see a community provider for the past 3 years. Pat falls in his bathroom and goes to the local non-va ER. Is Pat eligible for care outside of the VA?

43 No Answer While Pat is eligible for VA care, Pat has not seen his VA primary care provider in 3 years. VA is not obligated to pay for Pat s ER visit.

44 Hospital Transfers Is there an appropriate bed available? Is Veteran enrolled in VA healthcare? Is Veteran medically stable? Is VA liable for payment? Does Veteran want to be transferred?

45 A final story.. Transitions of Care

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48 Questions? Floss Mambourg, Assistant Director Rachelle Hershinow, Executive Assistant Megan Davis-Scott, Patient Advocate