PILOT PROJECT PROPOSAL EL PASO VA HEALTH CARE SYSTEM

PILOT PROJECT PROPOSAL

EL PASO VA HEALTH CARE SYSTEM

Congressman Beto ORourke

16th Congressional District of Texas

El Paso, Texas

July 16, 2015

1 El Paso VA Pilot Project Proposal 16.July.2015

Outline of Proposal

A. Executive Summary

B. Background 1. Issues and Concerns

2. Resources and Opportunities

C. Actions Planned and Approvals Requested

D. Appendices 1. Summary of Evaluations, El Paso VA Health Care System

2. Community Based Outpatient Center (CBOC) Space Estimates

3. Preliminary Estimates of Costs

4. Paso del Norte Veterans Health Fund

5. One Year Later: El Paso Health Access and Facility Survey Results (2015)

6. Letters of Support


A. Executive Summary

This is a proposal developed by the community of El Paso to improve the availability and quality of

health care for the veterans in our region. Stakeholders include leadership from political, business,

health care and veterans organizations throughout the region. While a full description of the goals and

methods are presented in the full document, here is a brief summary.

Our plan will:

- Ensure that area veterans are seen quickly by the best available provider in the region.

- Develop deeper competencies at the VA for the highest demand injuries, conditions and

disabilities unique to veterans.

- Leverage community providers and facilities to fully complement VA providers and facilities.

- Improve access to care immediately and bring improved facilities and focus to veterans within 24

months.

- Provide the VA with a working model that can be successfully implemented in other parts of the

country saving money, improving access and, most importantly, ensuring better outcomes for

the veterans we serve.

To achieve this:

- The VA will prioritize unique combat and service-connected conditions within the VA by hiring and

retaining the providers necessary and ensuring the quality of facility to deliver this care.


- The VA will prioritize conditions that are common to the general population to community

referral.

- The VA and the El Paso health community will establish a Health Information Exchange system to

ensure seamless, flawless access and delivery of care, regardless of where it is delivered.

- El Paso health organizations and providers (hospitals, clinics, academic health center and the Army

medical center) will ensure superior care delivery for El Paso veterans at prevailing VA rates.

- The VA will develop high-level competency in patient management and navigation.

- Texas Tech University Health Science Center will hire providers to supplement staffing at the VA

and improve access to specialty care by increasing VA resident physician slots within their

graduate medical education programs and appointing dual purpose faculty attending physicians.

- The El Paso community will establish a philanthropic health fund through a third party not-for-

profit organization, through which any interested citizen can direct charitable contributions to

improve the quality of local veteran healthcare (Appendix 4).

In Summary:

Today, one-third of the El Paso VA's budget is spent on referring care to the community. The VA will

continue to provide significant health care services in-house and refer other services to the community,

but will do so in a much more defined, consistent and predictable manner than it does today. It will

develop high-level capabilities in treating those conditions unique to veterans, referring other care to the

community; and it will develop the systems and processes to manage the access and quality of VA

patient care regardless of where it is delivered. The community will fully support this new model of care,


ensuring that the VA can leverage providers, capacity and funding in the community to deliver the best

possible care to our veterans.

B. Background

Issues and Concerns

1. The El Paso Veterans Affairs Health Care System (VAHCS) suffers from a shortage of doctors and other

health professionals, particularly in the area of mental health. As of June 1, 2015, the El Paso VAHCS

ranked second worst in the nation (156 out of 157) for access to mental health services. Mental health

staffing levels have decreased in recent months with fewer personnel on duty than in late 2014. The

El Paso VAHCS currently has a 24% vacancy rate in mental health staffing.

2. The El Paso VAHCS has consistently and historically ranked near the bottom with respect to

measurements of access and patient satisfaction (See Appendix 1). In June 2014, my office conducted a

statistically valid survey of 692 veterans to resolve discrepancies between official VHA reports and

testimonies given by El Paso veterans who had difficulty obtaining an appointment at the VAHCS. The

survey results showed, among other things, that:

a. 36% of veterans attempting to make a mental health appointment were unable to obtain one;

b. Veterans waited 71 days on average to see a mental health provider; and

c. They waited 85 days on average to see a primary health provider.

3. We conducted an updated 2015 survey of veterans to determine what changes, if any, have occurred

over the past year at the El Paso VAHCS. In June 2015, survey data of 1,108 veterans showed a slight

improvement in certain areas, including a decrease in the average number of days to see a mental


66%

34%

2015

Could Schedule

Could NotSchedule63%

37%

2014

Could Schedule

Could NotSchedule

health provider (64 days in 2015) and a decrease in the average number of days to schedule an

appointment for routine care (77 days in 2015). However, issues with overall veteran care in El Paso still

remain:

34% of veterans attempting to make an appointment were still unable to see a mental health

provider at all; and

57% of veterans believe that service in the El Paso VAHCS system is the same or somewhat worse

compared to 2014.

Perhaps because access has traditionally been so problematic in El Paso, our survey found that 82% of veterans

said it is most important to them to receive timely access to care regardless if it is provided at the VA or by a

provider in the community.

El Paso Veterans Unable to Schedule Mental Health Appointment


4. Traumatic Brain Injury (TBI) and Post Traumatic Stress (PTS) are areas of specific concern that deserve

greater attention and resources. According to the Meadows Mental Health Institute, among Operation

Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn veterans, one third have PTS, major

depression, TBI or a combination of these. In El Paso home to the 30,000 soldiers of Fort Bliss, an

installation that has seen significant deployments to these operations and where many of these soldiers

transition to civilian life there has been a substantial increase in the identification of TBI and PTS. We

believe these numbers are significantly underreported due to the high number of veterans who are

unable to receive any mental health care appointment from the VA. The chart below shows the

documented increase in TBI and PTS patients as well as estimates based on reported unmet need:

Fiscal Year

(FY)

TBI Cases PTS Cases EPVAHCS Total TBI/PTS

Cases

Estimated Unreported

TBI/PTS Cases*

Adjusted Total TBI/PTS

(30%>EPVAHCS Cases)*

FY10 46 2,290 2,336 701 3,037

FY11 28 2,296 2,324 697 3,021

FY12 32 2,346 2,378 713 3,091

FY13 22 2,685 2,707 812 3,519

FY14 85 3,163 3,248 974 4,222

FY15 109 3,106 3,215 965 4,180

*In a June 2015 survey of veterans, over 30% stated they could not attain an appointment with a mental health provider. The provided PTS and TBI

numbers are likely understated due to the lack of access to care.


Resources and Opportunities

1. William Beaumont Army Medical Center (WBAMC): Currently located adjacent to the El Paso VA

Outpatient Clinic, WBAMC will be moving to a new 1.13 million square foot facility nine miles from the

current VA in summer 2018. The new pending WBAMC facility will include:

a. A hospital, two clinics, and an administrative facility; and

b. 136 inpatient beds including 10 operating rooms, 20 beds designated for inpatient behavioral

health, and 16 intensive care unit (ICU) beds.

2. Texas Tech University Health Sciences Center El Paso: The Texas Tech University Health Sciences

Center is located on the Medical Center of the Americas campus and consists of three schools:

a. Paul L. Foster School of Medicine;

b. Gayle Greve Hunt School of Nursing; and

c. Regional Graduate School of Biomedical Sciences.

3. El Paso Civilian Hospitals and Doctors: Every organization below, along with its clinical leaders, has

committed to supporting the El Paso VAHCS mission by ensuring capacity for VA referrals and accepting

VA reimbursement rates.

a. Tenet Healthcare: There are presently three Tenet hospitals with a fourth to be built in the near

future. The two largest, Providence Memorial Hospital and Sierra Medical Center each with

approximately 300 general hospital beds, have ample capacity and a wide range of services to

accommodate VA patients;

b. Hospital Corporation of America (HCA): There are two HCA hospitals, including Del Sol Medical

Center, a 300-bed facility, located on the rapidly growing east side of the city. The HCA leaders

have also committed bed capacity and services. In addition, they have offered dedicated floors;


c. University Medical Center (UMC): With 250 adult general hospital beds UMC is the regions Level

1 Trauma Center and the principal teaching hospital for Texas Tech;

d. El Paso Behavioral Health System: This is a 163-bed facility owned by Universal Health Services;

e. Emergence Health Network (EHN): Acts as the County mental health organization. With an

emergency and outpatient focus, EHN works in a complementary manner with private

practitioners and inpatient facilities; and

f. Mentis Neurological Rehabilitation: The only post-acute neurological rehabilitation facility in El

Paso. Mentis currently offers 24-inpatient beds and outpatient services including physical and

occupational therapy, neuro-behavioral intervention, clinical psychology, and neuro-cognitive

retraining to citizens of Texas and New Mexico, including veterans diagnosed with TBI and other

neurological conditions.

4. Medical Center of the Americas (MCA): Established in 2007, the MCA is a 140 acre campus located

directly off Interstate 10 and U.S. Route 54, the two major transportation arteries in the region. It is

centrally located relative to our regions concentration of veterans (see MCA map on page 19). Current

partners located within the MCAs master planned campus include:

a. Texas Tech University Health Sciences Center (TTUHSC) El Paso;

b. University Medical Center, which is a fully accredited general hospital and the principal affiliate of

the TTUHSC and the regions Level 1 Trauma Center;

c. El Paso Psychiatric Center, which is a 75-bed inpatient facility currently operated by the state of

Texas. It is frequently the destination for emergency admissions;

d. Cardwell Collaborative, which is a 60,000 square foot biomedical innovation center under

construction and is scheduled to open in 2016;


e. UMC Outpatient Destination Center will be a 50,000 square foot facility that is expected to begin

construction in 2016. It will include significant diagnostic capabilities and Texas Tech specialists;

f. Other associated medical facilities such as the El Paso Childrens Hospital, the Office of the County

Medical Examiner and Forensic Laboratory, West Texas Regional Poison Center, Texas

Department of Human Services and a City of El Paso fire station with a HAZMAT response team;

and

g. There is space available on the MCA campus that can be dedicated to VA purposes.

5. Paso del Norte Health Foundation (PdNHF): With assets of more than $200 million, PdNHF has been a

driving force in improving the health status of the border region, including the service area of the El

Paso VAHCS. The Foundation organized and currently staffs the Paso del Norte Health Information

Exchange (HIE), which is developing secure sharing of protected medical information for the

improvement of care in the region in conjunction with all major medical providers.

C. Actions Planned and Approvals Requested

We propose to prioritize care within the VA for those conditions unique to military service and not

commonly seen in the general population. Much of the care not related to these core competencies will be

performed in the community by local providers. This structure of care will:

- Ensure access to medical providers in the region that is both timely and predictable for our veterans;

- Develop deeper expertise at the VA for injuries and conditions that are unique to our veteran

population; and


- Expand the pool of eligible medical providers in the region from which veterans can seek care for

non-core competency medical needs.

All care whether performed within the VA or in the community will be centrally managed by the VA,

with care navigators assigned to each veteran to assist with their individual needs and concerns.

Core Competencies:

The VA will commit the resources to fully hire and retain the number and quality of providers required to

ensure that any veteran with service-unique conditions is seen quickly at the VA. The VA will ultimately

construct a center of excellence for delivery of care for Post-Traumatic Stress (PTS) and Traumatic Brain

Injury (TBI). Other core competencies to be prioritized include Military Sexual Trauma (MST),

musculoskeletal injury rehabilitation, and prosthetics secondary to trauma.

1. Mental Health Care Capacity: The VA will hire all currently authorized mental health positions at the El Paso VAHCS and will use community mental health care providers to supplement VA capacity until this goal is met. The El Paso VAHCS will specifically undertake the following steps to meet this goal:

a. Hire: The El Paso VAHCS will hire 14 providers and other mental health employees each quarter, beginning in Q1-2016 until all currently authorized positions are filled (the El Paso VA Mental Health Clinic currently has 28 vacancies). Incentives in the form of sign-on bonuses should be used as necessary to meet the above hiring goals. Eligible, newly hired providers will be awarded up to $20,000 in addition to their normal salaries to promote recruitment and retention;

b. Contract: Contract with new providers and utilize existing relationships as a supplement to and as an extension of current VA staff until fully staffed;

c. Engage in Joint Recruitment: The El Paso VAHCS can partner with Texas Tech University to jointly recruit doctors. The doctors who qualify for clinical faculty appointments will also be contractually


committed to provide care at the VA. Clinical faculty will also have an opportunity to supervise Texas Tech Residents, thereby increasing access to care for veterans particularly in mental health;

d. Provide Medical School Debt Relief: Each newly hired VA staff physician will receive $40,000 a year in medical school debt relief for each year of service at the El Paso VA; and

e. Expand Joint Psychiatry Residency Program: The VA will add a total of six psychiatry residents to better meet the demands of local veterans. These residents will improve access to care and will remain VA physicians for a minimum of three years upon graduation. This service obligation for graduates and continuous backfill of additional residency slots will continue to increase the amount of psychiatrists available to see veterans beginning in Q3-2019 and become fully self-sufficient by Q3-2022 producing a continuous staffing level of six attending psychiatrists and six psychiatry residents.

2. Traumatic Brain Injury (TBI) and Post-Traumatic Stress (PTS): The VA will partner with community medical providers in the short-term to address the immediate PTS and TBI related health needs of veterans until the VA is fully staffed in this area. The VA will retain ownership of treating these conditions as they are primarily associated with military service. This partnership will culminate with the establishment of a VA PTS/TBI Center of Excellence built on the MCA campus, fully staffed with a team capable of providing excellent service to all veterans requiring this care.

Specifically, the VA should hire: a. One brain injury medicine physician (MD/DO) b. One mid-level general provider (either a nurse practitioner or physician assistant) c. One neuropsychologist (a PhD level psychologist who has completed a fellowship in

neuropsychiatry) d. One behavioral psychologist (PhD) e. One part time neurologist (MD/DO) f. One speech physical therapist g. One physical therapy assistant


h. One recreational therapist i. One vocational rehabilitation therapist j. One music or yoga therapist k. One social worker designated to work solely at the TBI/PTS Center of Excellence.

To meet these staffing needs and construct the facility in which all services will be provided, the VA should specifically:

a. Engage in a public-private partnership with MCA to construct the facility. The VA would work with the MCA as the master developer;

b. Execute a long-term lease for the building; c. Contract with new providers in the community and utilize existing relationships to supplement

staffing until all necessary staff are hired to meet demand for TBI and PTS at the Center of Excellence; and

d. The VA will engage in joint recruitment efforts with Texas Tech University and provide incentives to recruit and retain highly skilled specialists.

3. Military Sexual Trauma (MST): The VA will diagnose and treat all mental health conditions secondary to an incident of MST, including PTS, major depression, sleep related conditions such as insomnia, and substance abuse. Secondary physical conditions will be treated through a womens clinic with the option to see a female provider. Veterans will also be assigned a care navigator.

4. Musculoskeletal Injury Rehabilitation: The VA will retain ownership of these conditions as they are a common cause of medical discharge from active duty as well as disability and health related unemployment amongst veterans. VA will partner with existing community providers to conduct major procedures such as surgeries, but will establish comprehensive physical and occupational therapy programs to rehabilitate veterans. The VA will be responsible for the pain management care for veterans who suffer from chronic musculoskeletal conditions. This care will also remain a VA core competency.


5. For prosthetics, traumatic amputations and related conditions the VA will develop these competencies in collaboration with WBAMC. This partnership will provide a seamless transition for veterans being medically discharged from active duty and transitioning into VA healthcare through the Integrated Disability Evaluation System (IDES). For traumatic amputations, the VA will manage all associated care through a veterans primary care doctor, but will also work with specialists at WBAMC.

Non-Core Competencies:

Care for non-core competency conditions will be delivered both at the VA and through community

providers. These conditions will be comprehensively managed by establishing effective partnerships

between VA physicians and their community counterparts. The El Paso VA will be responsible for

implementing three components to manage non-core conditions:

1. Texas Tech Staffing Partnership: Contingent on the VAs commitment to provide staffing needs, funding,

and employment guarantees, this proposal envisions primary care being provided by VA physicians,

some of whom will be jointly recruited and contracted by Texas Tech University Health Sciences Center

(TTUHSC). Through this partnership with the VA, TTUHSC will bolster primary, specialty and mental-

health care so as to increase the number of physicians seeing VA patients and increasing access to

clinical services. Specifically TTUHSC will:

a. Expand Joint Residency Program: TTUHSC will expand the number of family medicine residents

for FY15-FY20 conducting joint rotations at the El Paso VA. Additionally, TTUHSC will partner with

the VA to increase residency positions for additional specialties, including orthopedics and

internal medicine;

b. Increase Access to Clinical Services: TTUHSC will prioritize VA patients for outpatient clinical

services. These services will be performed by TTUHSC physicians at facilities throughout El Paso;

and


c. Engage in Joint Hiring/Shared Services: TTUHSC will engage in joint hiring with the El Paso VA,

focusing on shared services and dual VA clinical and TTUHSC faculty appointments. Specific

specialties to be focused upon include psychiatry, family medicine, orthopedics, gastroenterology

and cardiology.

2. Three New CBOCs: This Proposal envisions adding three new Community Based Outpatient Clinics

(CBOCs) in locations that are in or near the highest concentrations of veterans in El Paso. These will be

co-located with major medical facilities that have the full range of diagnostic and ancillary services

necessary to provide timely services to veterans. In addition to the existing northeast outpatient clinic,

the facilities that these CBOCs will be located at or near include:

a. Tenet and Texas Tech Teaching Hospital (Westside)

b. Sierra Providence East Medical Center Campus (Eastside)

c. Medical Center of the Americas (Central)

d. Existing Facility (Northeast)

As detailed in Appendix 2, the VA CBOC components of these facilities will be approximately 9,000 square

feet and will be identified as VA facilities within existing medical complexes. They will offer services

including primary care, mental healthcare (not related to TBI and PTS), in addition to other healthcare

services deemed essential by the VA that are consistent with the model outlined in this proposal. By leasing

space co-located with major medical complexes, the VA saves money and provides increased access to

specialists and additional clinical services not otherwise readily available.


Excellence in Patient Care and Navigation:

We envision the VA as the primary coordinator of veteran care. This includes the VA maintaining a

comprehensive electronic health record that can be accessed by both community and VA providers. This

record will follow the veteran wherever their care is provided. The VA will develop, or commit to an

existing, two-way record sharing capacity to share this record through an accessible and secure Health

Information Exchange (HIE). Additionally, the VA will recruit a permanent director and hire care navigators

to provide effective customer service to veterans. The VA will also centralize its operations center on the

MCA campus. Critical to ensuring effective patient care management are the below action items:

1. Permanent Director: It will take a talented, dedicated professional to lead improvement and change in

El Paso. Among the operational improvements we envision the new Director making are:

a. Expanding hours of service to see more veterans;

b. Providing emergency care authorizations on a 24/7 basis; and

c. Gaining approval to make the health plan open access with plan design modifications.

2. Health Information Exchange: The VA should be exchanging clinical information with other

organizations and professionals in a rapid, secure electronic manner. The Paso del Norte Health

Information Exchange has formed a consortium with all local hospitals and numerous providers and is

prepared to include the VA in its efforts.

3. Care Navigators: The VA will add a team of care navigators to assist patients with their individual

concerns and needs. These navigators will not serve as case managers, but rather as customer service

representatives tracking a veterans care and identifying patients that require additional assistance.

Specifically, these navigators will be responsible for:

a. Assisting patients with accessing care regardless of where it is delivered.


b. Coordination of a patients electronic health record between VA and non-VA providers; and

c. Being a central point of contact for any veteran whom they are assigned.

4. VA Operations Center on MCA Campus: In order to be closer to the regions major medical providers

and its chief academic medical institution, the El Paso VAHCS will move its central Operations Center to

the MCA campus a 140 acre medical campus located near the intersection of the regions two major

transportation arteries and central to its concentrations of veterans. The VA Operations Center will

house all necessary administrative and executive personnel not directly involved in patient care. A

preliminary estimate is that the central office operational functions can be accommodated in

approximately 16,000 square feet.


Medical Center of the Americas Master Plan


Projected Timetable 2015-2020

General Hiring and Administrative Initiatives 2015-2020

Action Date Notes

Hire El Paso VA Director Q3-2015

VA Evaluates Salary Adjustments and Performance Bonuses Q1-2016 Hiring Bonuses Implemented Until 100% of VA Staffing is Reached

VA Hires 9 Care Navigators to Provide Customer Service Needs of Area Veterans

Q1-2016 + 9 Care Navigators

VA Hires 2 Family Physicians Q1-2016 + 2 Family Physicians

VA Announces Structure of Pilot Project and Increased Access to Care

Q2-2016

VA Hires 1 Family Physician & 1 Womens Health Physician (OBGYN)

Q3-2106 + 1 Family Physician & 1 OBGYN

Begin New Joint VA-TTU Family Medicine Program Q3-2016 + 2 Family Medicine Resident Physicians

Additional Family Medicine Residents Enter Joint VA-TTU Program

Q3-2017 +2 Family Medicine Resident Physicians





VA Hires First Family Medicine Residency Program Graduates Q2-2020 +2 Family Medicine Physicians


Mental Health Hiring Initiatives 2015-2020 Action Date Notes

VA Mental Health Hire-on Bonuses Program Implemented Q4-2015

VA Contracts with 4 New Mental Health Providers in Community Q4-2015 + 4 Community Mental Health Providers


VA Hires 14 New Currently Authorized Mental Health Employees Q1-2016 + 14 New Mental Health Employees

VA Authorizes and Hires 1 Psychiatrist Q1-2016 +1 Psychiatrist


VA Hires 14 New Currently Authorized Mental Health Employees Q2-2016 + 14 New Mental Health Employees

VA Authorizes and Hires 1 Psychiatrist Q3-2106 + 1 Psychiatrist

Expand Joint VA-TTU Psychiatry Residency Program Q3-2016 + 1 Psychiatry Resident


Additional Psychiatry Resident Enters Expanded Joint VA-TTU Psychiatry Residency Program

Q3-2017 + 1 Psychiatry Resident

Additional Psychiatry Residents Enter Expanded Joint VA-TTU Psychiatry Residency Program

Q4-2018 + 2 Psychiatry Residents

All staff for VA TBI/PTS Center of Excellence Hired and On Boarded Q4-2018 +10 Full Time and 1 Part Time Dedicated Positions

Additional Psychiatry Residents Enter Expanded Joint VA-TTU Psychiatry Residency Program

Q3-2019 + 2 Psychiatry Residents

VA Hires First Expanded Psychiatry Residency Program Graduate Q2-2020 + 1 Psychiatrist


Facilities Initiatives 2015-2020

Action Date Notes

Lease Signed for Two New CBOCs Q4-2015 Westside Eastside

Lease Signed for CBOC on MCA Campus Q1-2016 Central

Construction Begins on VA Operations Center on MCA Campus Q3-2016

Construction Begins on TBI/PTS Center of Excellence on MCA Campus

Q3-2016

VA Opens CBOC Q4-2016 Westside

VA Opens CBOC Q1-2017 Eastside

VA Operations Center on MCA Campus Opens Q3-2017

CBOC on MCA Campus Opens Q1-2018 Central

TBI/PTS Center of Excellence Opens Q4-2018

*William Beaumont Army Medical Center moves to new location in Q1-2018


D. Appendices

Appendix 1- Summary of Evaluations, El Paso VA Health Care System

Summary of Evaluations, El Paso VA Health Care System. The El Paso VAHCS has a well-documented record of

poor performance.

a. 2008 Internal VA Performance Survey as reported in the El Paso Times (April 6, 2008): Rated the El

Paso VA Health Care System the worst in the nation for overall access, clinical quality, and patient

satisfaction.

b. 2nd Quarter 2013 VA Office of Analytics and Reporting Strategic Analytics for Improvement and Learning

(SAIL) Report: Ranked the El Paso VA Health Care System in the bottom 4th or 5th quintile for numerous

key metrics, including primary and specialty care wait times, mental health wait times and staff

turnover.

c. June 9, 2014 Internal VA Access Audit: Reported the El Paso VA Health Care System was the worst in the

nation for established mental health care patients; the second worst for new specialty care patients;

and the fourth worst for new mental health patients.

d. December 2, 2014 VA Office of Inspector General Report No. 14-05128-51: Concluded that concerns

expressed by the Office of Congressman Beto ORourke about access to care were substantiated.

e. First Quarter 2015 VA System and VISN Performance Survey: Showed the El Paso VA Health Care System

ranking below the national VA averages in every measured category.

f. June 1, 2015 VA Patient Access Data Audit: The El Paso VA ranked second worst in the nation for mental

health care access.


g. One Year Later: El Paso VA Health Access and Facility Survey (July 2015): Showed serious problems in

veterans obtaining access to primary care and mental health services among other concerns. (Appendix

5).


Appendix 2- Community Based Outpatient Center (CBOC) Space Estimates

Description Number SF/Each Total SF

Medical/Primary Care

Doctor Office 3 140 420

Exam Room 9 100 900

Lab Drawing 1 100 100

Treatment Room 1 120 120

Nurse Alcove 3 100 300

Supply Room 1 120 120

Main Waiting Room 1 250 250

Break Room 1 120 120

Behavioral Health

Doctor Office 2 140 280

Sub Waiting Room 1 200 200

SW/Other Office 2 140 280

Meeting/Teaching

Large Conf Rm 1 220 220

Small Conf Rm 1 140 140

General/Support

Office/Recept 1 250 250

Bus Office 1 180 180

Rest Rooms 3 120 360

Rest Rooms - Staff 2 80 160

Community Based Outpatient Center (CBOC) Space Estimates for One Facility

Other VA Svcs

Navigator Office 2 140 280

Other VA Uses 2,000

Total Net SF 6,680

Total Gross SF @ .75 8,907


Appendix 3- Preliminary Estimates of Costs, Pilot Project


Appendix 4- Paso del Norte Veterans Health Fund

The Paso del Norte Veterans Health Fund is a means through which any interested citizen or organization can

direct charitable contributions to improve the quality of health care and improve the state of health for the

thousands of deserving veterans who are enrolled for services at the El Paso VA Health Care System.

This fund would be analogous in its relationship to the El Paso VAHCS to the USO in its relationship with the

armed forces. The Paso del Norte Foundation is a 501 (c.) (3.) corporation and would manage the fund in its

initial stages. Thus, contributions will be tax deductible for donors.


Appendix 5- One Year Later: El Paso Health Access and Facility Survey Results (2015)

One Year Later: El Paso VA Health Access and Facility Survey

By

Mathew S. McElroy, MPA, MS, AICP

with

The Office of Congressman Beto ORourke

July 17, 2015


Foreword by Congressman Beto ORourke

El Paso VA Health Access and Facility Survey

This is our second annual survey of El Paso veterans to determine the true state of VA healthcare in this region. It is conducted in an

effort to ensure that wemy office, the VA, veterans and the larger publicget the unvarnished truth directly from the people the VA

system is intended to serve.

While we saw small improvements in some areas of service, the overall picture of healthcare access in El Paso remains disappointing

and unacceptable.

77 days, on average, to see a primary or specialty care provider

64 days to see a mental health provider

34% of veterans are not able to get a mental healthcare appointment at all

And, in an indication of how we might begin to address the issues of demand and access,

82% of El Paso veterans said they do not care whether their healthcare is delivered at the VA or within the community, as long as

it is timely.

I am confident that we can improve the access and quality of care in El Paso. By working with the VA, local healthcare providers and

veterans themselves, the community is developing a plan to make

the most of resources in this region and ensure that every veteran

gets timely, quality care. This plan will address the consistent

failure to provide for access to mental health care, a crisis for El

Paso veterans who have come to realize that care delayed has

become care denied.

What makes this community plan to address veterans' access

to care possible is the data provided by veterans that

demonstrates the scope of the problem and hints at the solutions

Thanks to the success and utility of this survey, my colleagues

in Congress have asked how we can replicate this process in

their communities. In response, I authored the Ask Veterans Act

(HR 1319), which requires independent surveys of veterans on

access and quality of VA healthcare throughout the country.

This bill is sponsored by Republican and Democratic members

and we are optimistic that it will see passage. This Congress

and El Paso will help lead the way to an improved, more

accountable VA. - Beto ORourke

- Beto ORourke


that will be necessary to solve it. I am grateful to the El Paso region's veterans for their service, both in uniform and now as we work

together to improve VA healthcare.

As my dad would tell me, "that which is measured tends to improve." We will continue to measure through these surveys and work

with the community and the VA to ensure that the necessary improvements follow.

Sincerely,

- Beto ORourke 16th Congressional District, Texas

El Paso VA Health Access and Facility Survey

This effort focuses on three major issue sets raised regarding healthcare provided at the El Paso VA:

1. A measure of change in quality of service provided by the VA over the last year. This survey replicates the great majority of

the questions used in the June 4, 2014 report. However, a short battery of questions was added that deal specifically with

respondents evaluation of the change in service at the El Paso VA and their ability to take advantage of those changes, such as

the VA Choice program, and a question for female respondents on their preference for the sex of their medical provider;

2. Quality of and access to mental and primary health care. This includes the ability to schedule appointments, the quality of

care provided, and time spent with a provider; and,

3. The adequacy of the current VA facility. This section measures whether veterans would like to see the current facility

expanded. Also included are measures of satisfaction with the current facility, wait times to see a non-mental health care

provider, and overall experience when receiving non mental health care.

In addition, a brief demographics battery containing typical questions on age, years of service, education level, years of separation

from service, and employment status is included.


Veterans' opinions were obtained via survey, with a total of 1,108 responses collected. The results shed light on a number of issues

that warrant attention and comparison against care provided in other regions. These measures should continue to be benchmarked

regularly by a third party to ensure that issues of concern are addressed.

Methodology

The population for this survey was provided by the Office of Texas 16th Congressional District and comprised of a listing of 20,208

veterans within the district, representing a meaningful portion of the entire veteran community in El Paso County. The list of veterans was

matched to phone numbers and email addresses by a third party service provider and the congressional office. Once this was done, a

sample of the full population was selected randomly to participate.

The author and senior staff from the 16th District updated this years survey instrument. Additions were primarily for measuring

change in quality of service over the last year and one question for female veterans as to their preference for the sex of their medical

provider. The original instrument was constructed after an extensive review of existing documents, such as the Inspector Generals report

on the El Paso VA and published healthcare and mental healthcare access studies. The original survey instrument was independently

tested by three different focus groups of local veterans. The panels included patients who had received care at the El Paso VA for several

years and representatives from veterans service organizations that aid veterans in receiving care and helping them navigate the

appointment making and benefits processes.

The surveys were fielded by telephone and email. A total of 1,108 surveys were completed via Survey Monkey (protected for

duplicates, forwarding prohibited) and an automated telephone polling system (Precision Polling). Veterans were contacted first by email

(four waves), then via telephone (three waves) to provide ample opportunity to participate. All survey data collection concluded on June

20, 2015.

It is also important to note that these results reflect the experiences of veterans within the 16th District and that geographic area

differs from the full area served by the El Paso VA. This, in addition to respondents ability to provide exact dates by immediate recall, will


lead to some differences between VA reported statistics and those here. However, the experiences of veterans are a critical triangulation

and evaluation component for measuring improvements in access to care.

- Mathew S. McElroy, MPA, MS, AICP

Key Findings - El Paso VA Health Care Access and Facility Survey

The findings of the current research are provided below, with the newest questions listed first as they are likely of greatest

interest to the reader. The remaining results are shown side by side with the results of the survey conducted in 2014.

The results are very stable from year to year. While the level of change is small in critical areas like wait times, there are slight

improvements in almost all measures of care. For those questions measured in percentages, the improvement is generally under

five points, although day measures such as length of time to see a mental health care provider improved by 7 days (from 71 to

63.85 days).

Compared to a year ago, 33.3 percent of respondents believed that service in the El Paso VA system greatly or somewhat

improved, while 18 percent believed it was much or somewhat worse. 48.8 percent felt service was the same.

56 percent of respondents said the El Paso VA had not adequately explained their ability to participate in the VA Choice program.

81.5 percent of respondents said it was most important to them that they receive timely access to health care regardless if it is

provided at the VA or by a provider in the community. 18.5 percent preferred to get their care at the El Paso VA regardless of wait

times.

66.7 percent of respondents were sent to a provider or doctor outside the VA.

66 percent of respondents were satisfied or very satisfied with the community medical provider they saw.

26.4 percent of respondents were unsatisfied or very unsatisfied with how the VA shared their medical records and other

important information related to their healthcare with other providers or doctors they saw in the community. 38.7 percent were

satisfied or very satisfied.


Side by side comparisons for matching questions year over year are provided in the tables below. Full results are provided in the

Appendix.

Question 2014 2015

Have you attempted to make an appointment for mental healthcare

services at the El Paso VA clinic in the last 24 months?

Yes 36.6 36.9

No 63.4 63.1

Were you able to obtain a mental health appointment?

Yes 63.5 65.6

No 36.5 34.4

Was the mental health appointment for:

An initial visit/appointment 19 17.8

Regular or follow up appointment 76.6 77.5

Unsure 4.4 4.7

At your most recent mental health appointment, did you see:

A counselor (counselor, social worker, psychologist) 58.8 60.5

A psychiatrist 31.1 30


Question 2014 2015

Unsure 10.1 9.5

How many days went by between your request for the appointment and

seeing a mental health care provider? 71 day average 63.85 day average

When you received a mental health appointment, how many times did

the El Paso VA have to cancel or reschedule it? average of 1 average of 1

In the last 24 months, if you attended your VA mental healthcare

appointment, how much time did the provider spend with you? 42 minute average 42 minute average

In your opinion, was the time allotted for your appointment appropriate

to address your mental healthcare needs?

Yes 58.8 60.7

No 27 25.5

Unsure 14.2 13.8

If you received mental healthcare services at the El Paso VA, using a

number between 0 and 10, where 0 is the worst experience possible and

10 is the best experience possible, please rate the quality of mental

healthcare you received. 5.43 average 6.55 average


Question 2014 2015

Have you put off your mental health care because of the difficulty in

obtaining an appointment?

Yes 42.5 40.2

No 49.6 53.4

Unsure 7.9 6.4

Do you believe any untreated mental health issues made it harder to

schedule your appointments?

Yes 32.9 31.6

No 39.6 45.8

Unsure 27.5 22.5

Not including mental health, have you been treated at the Department of

Veterans Affairs health facility in El Paso in the last three years?

Yes 79.5 82.4

No 20.5 17.6

Not including mental health, was your most recent health care visit:

Within the last year 88.7 86.1

Between 1 and 2 years ago 9.2 10.4


Question 2014 2015

Over 2 years ago 2.1 3.5

Not including mental health, was your most recent health care

appointment for:

Primary healthcare services (general medicine, family medicine) 56.1 60.1

Specialty healthcare services (such as cardiology, neurology, sleep clinic,

orthopedics) 37.9 33.2

Urgent care or triage nurse (sick call, walk in triage) 3 4.3

Unsure 3 2.4

Not including regularly scheduled routine care visits, how many days

went by between your request for your most recent non-mental health

appointment and seeing a healthcare provider? 85 day average 77.4 day average

Including mental health, how many times per year on average do you

have a health appointment at the El Paso VA? 9.7 appointments average 7.91 appointments average

Not including mental health, how would you rate your overall level of

satisfaction with the care provided at the VA clinic? 3.1 average 3.1 average

Very unsatisfied 15.3 15.9

Unsatisfied 19.6 20.4

Unsure/Neutral 16.4 18.6


Question 2014 2015

Satisfied 34 32.3

Very satisfied 14.7 12.8

Not including mental health, have you had to travel to a VA healthcare

facility outside of El Paso within the last three years for treatment

because the service was not available locally?

Yes 10.8 12.6

No 86.6 86.7

Unsure 2.6 0.7

Compared to a year ago, in your judgment the service of the El Paso VA

Health Care System:

Has greatly improved N/A 9

Has somewhat improved N/A 24.3

Is more or less the same N/A 48.8

Is somewhat worse N/A 11.1

Is much worse N/A 6.9


Question 2014 2015

Has the El Paso VA sufficiently explained your eligibility and rights to

participate in the VA Choice program?

Yes N/A 31.6

No N/A 56

Unsure N/A 12.4

It is important to me that...

I receive all of my health care at the VA regardless of wait times N/A 18.5

I receive timely access to health care regardless if it is provided at the

VA or by a provider in the community N/A 81.5

Has the VA sent you to see a provider or doctor outside of the VA?

Yes N/A 66.7

No N/A 32.3

Unsure N/A 1

How would you rate your overall level of satisfaction with the community

medical provider you saw?

Very unsatisfied N/A 12.3

Unsatisfied N/A 8


Question 2014 2015

Unsure/Neutral N/A 13.7

Satisfied N/A 41.6

Very satisfied N/A 24.4

How would you rate the VA for sharing your medical records and other

important information related to your healthcare with other providers or

doctors you may have seen in the community?

Very unsatisfied N/A 11.2

Unsatisfied N/A 15.2


Satisfied N/A 31.6

Very satisfied N/A 7.1

Which of the following is most important to you with regard to the

current VA facility in El Paso?

Access to expanded and improved primary care (general medicine,

family medicine) 34.8 37.4


Question 2014 2015

Access to expanded specialty care (such as cardiology, neurology, sleep

clinic, orthopedics) 25.3 29.4

Ability to be admitted to a hospital bed within a VA hospital 7.9 3.6

Access to better mental health care 9.4 9.2

Not having to travel outside of El Paso for medical care 10.3 12.6

Unsure 12.1 7.7

Do you believe the VA facility in El Paso should be expanded?

Yes 88.5 87.1

No 4 4.4

Unsure 7.5 8.5

How would you rate your overall level of satisfaction with the current VA

medical facilities?

Very unsatisfied 16.2 15.1

Unsatisfied 23.1 21

Unsure/Neutral 24.6 30.2

Satisfied 28.6 27.9


Question 2014 2015

Very satisfied 7.5 5.7

What is your gender?

Female 9.4 12.3

Male 90.6 87.7

(If female) How important to you is it to see a female provider or doctor?

Very Important N/A 29.4

Somewhat important N/A 19


Somewhat not important N/A 11.9

Not important N/A 23

What is the highest level of education you have completed?

Less than high school 0.5 0.9

High school diploma/GED 18.9 24.5

Associates degrees 30.8 29.5

4 year degree (Bachelors) 27.5 26.4

Masters degree or higher 22.3 18.7


Question 2014 2015

Do you currently have health insurance aside from the coverage provided

by the VA?

Yes 71.5 70.4

No 25.9 27.4

Unsure 2.5 2.1

Are you currently employed?

Yes 34.3 34.5

No 31.1 31.1

Retired 33.5 33.6

Unsure 1.1 0.7


Appendix 6-Letters of Support

PILOT PROJECT PROPOSAL EL PASO VA HEALTH CARE SYSTEM

Documents

Transcript of PILOT PROJECT PROPOSAL EL PASO VA HEALTH CARE SYSTEM