2015-may-june

Healthcare Journal of new orleans

MAY / JUN 2015

in culinary skills and find employment in the

community or somewhere else. If you are

going to live in New Orleans you ought to

know how to cook, right?

Do you experience the same access chal-

lenges that other systems have?

We are in a little bit of a unique situation.

Everywhere else in theVAthe challenge with

access sits in a hospital setting with com-

munity clinics. So you are talking about the

capacity in that hospital, the capacity in the

clinics, andwhether that systemneeds to go

outside of the VA to get additional capacity

to see patients in amore timelymanner.And

so that coordination of the care is performed

by a group of providers that workwithin that

hospital setting andwithin the clinics. In our

case, we’re almost like that except there’s no

hospital.We don’t have the benefit of a large

pool of specialty care providers that can help

us coordinate that care. We right now out-

source roughly about $85 million worth of

non-VA care that we buy in the community

to keep our veterans in the community.And

our clinics, with assistance of some staff on

the specialty care side, coordinate that care.

And that’s the bulk of our challenge. How

do we find enough capacity in the commu-

nity to be able to have our veterans seen in

a timely manner? For the most part we do

a fantastic job.

We’ve been consistently improving our

wait times, which is something I look at

every day.We get a daily report, mymorning

report, from each one of our clinics. Every-

one dials in and we go through the stats,

we go through the numbers, make sure we

are getting the results that we want. And of

course we are up against capacity issues just

like everybody else in that sense. So we are

looking for ways to expand our footprint in

those clinics, opportunities for additional

space, and we are taking advantage of the

recent funding with the Choice Act that is

going to give us additional FTEs. So we are

hiring that staff. And where we can we are

bringing on staff that we will eventually need

at the hospital, so they can part of the access

answer. I think probably the unique chal-

lenge for us is that we are more dependent

thanmost onwhat’s available in the commu-

nity.The community has been very support-

ive.We have great partnerships withTulane,

LSU, Ochsner, Our Lady of the Lake, Baton

Rouge General, throughout the region. It’s

not been challenging in that sense.

Is there enough mental health capacity?

No. In the short time that I’ve been here

I’ve probably noticed that more than any-

thing. It seems like every other week we’re

in diversion for mental health beds across

the state. I think that’s an area where we are

going to want to come up with additional

solutions.

So as far as the timeline where are you

now?

Based on what we know right now we

know that we’re not going to be able to see

a patient in the newhospital until the end of

2016.There are a number of entities that have

to come together for us to be able to have an

environment where we could see patients.

The vertical timeline explanation is that we

have a contractor that has to complete their

work in their sequence. We have a number

of technology components that have to be

implemented, some within the VAand some

withVApartners.Thenwe have our own ver-

tical on the hiring and doing the activation

pieces. At least two of those three vertical

columns I don’t have direct line authority

over. I have to rely on collaborative rela-

tionships and cooperation. On my end we

are pedaling as fast as we can with that goal

in mind.

Why would a veteran choose the VA over

another community hospital? How are you

going towin those patients back from the com-

munity hospitals they have been using for the

last ten years?

The eligibility piece of the VA is fairly

complex.We have 22million veterans in the

United States; about 9million are enrolled in

theVAand roughly about 7.5million actually

use the VA.That’s that 66,000 number in the

case of our region, the 23 parishes we serve.

Not all veterans are eligible for VA care and

for themost part, veterans that present have

three additional non-mental health diagno-

ses and one additional mental health diag-

nosis. They tend to be poor and tend to be

on the lower end of the education scale. In

many instances these would be Americans

that would be uninsured or underinsured.

There’s an appetite for those patients in the

private sector, especially with the modifica-

tions of theAffordable CareAct. The reason