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

Full text

(1)

Oregon VA Medical Centers

To care for him who

shall have borne the

battle and his widow

and orphan.

(2)

The White House

21 National VISNs: Veterans Integrated Service Networks

DEPARTMENT OF STATE DEPARTMENT OF ENERGY DEPARTMENT OF HEALTH AND HUMAN SERVICES DEPARTMENT OF TREASURY DEPARTMENT OF JUSTICE DEPARTMENT OF TRANSPORT-ATION DEPARTMENT OF VETERANS AFFAIRS DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT DEPARTMENT OF AGRICULTURE DEPARTMENT OF THE INTERIOR DEPARTMENT OF COMMERCE DEPARTMENT OF HOMELAND SECURITY DEPARTMENT OF DEFENSE

Alaska Idaho Oregon Washington

VISN 20 is shown below

VBA

Veterans Benefits Administration

VHA: Veterans Health Administration 156 Medical Centers and over 800 community-based clinics. VHA has facilities in all 50 states!

NCA

National Cemetery Administration

(3)

Our Mission

Honor America’s veterans by providing exceptional health care that improves

their health and well-being.

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 Values

(4)
(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. § 1151

– 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 connected Veterans and non compensable service-connected 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)
(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)
(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

(15)
(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 (ADC) 71 Roseburg 46 (ADC) 70 NH Beds 117 Portland 72 Roseburg 45 RRTP/Dom 507 Portland 36 Roseburg 30 White City 441

(17)

 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.

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(18)

Eliminate Veteran

Homelessness

Design

Veteran-centric

Healthcare Model

Increase Access

to Healthcare

Improve Quality

While Reducing

Cost

Focus on

Mental Health

(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

(22)

Mental Health Activities

• 1200-1500 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

(23)

• 471,383 OEF/OIF/OND Veterans who used VA health care

services in 2011

– 410,103 (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

(26)

Inpatient Quality: CMS Hospital Compare

26

CMS

Hospital

Compare

(27)
(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%

service-connected for tinnitus. She sees her

Portland VA primary care provider for her

annual physical and a mass is discovered in

her breast.

(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.

(33)

Answer

• It depends

– 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-service-condition 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

(37)

Case Study

• Steve is a Veteran who lives in Redmond.

On Saturday, his knee (which he is

service-connected 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)

Answer

• Yes

– 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)

Answer

• It depends

– 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.

(43)

Answer

• No

• 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?

(45)

Transitions of Care

(46)
(47)
(48)

Questions?

• Floss Mambourg, Assistant Director

Floss.mambourg@va.gov

• Rachelle Hershinow, Executive Assistant

Rachelle.hershinow@va.gov

• Megan Davis-Scott, Patient Advocate

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References

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