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PILOT PROJECT PROPOSAL

EL PASO VA HEALTH CARE SYSTEM


Congressman Beto ORourke
16th Congressional District of Texas
El Paso, Texas

July 16, 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.
2.
3.
4.
5.
6.

Summary of Evaluations, El Paso VA Health Care System


Community Based Outpatient Center (CBOC) Space Estimates
Preliminary Estimates of Costs
Paso del Norte Veterans Health Fund
One Year Later: El Paso Health Access and Facility Survey Results (2015)
Letters of Support

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El Paso VA Pilot Project Proposal 16.July.2015

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

- 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-forprofit 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,
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El Paso VA Pilot Project Proposal 16.July.2015

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
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El Paso VA Pilot Project Proposal 16.July.2015

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

2014

2015
Could Schedule

Could Schedule

34%

37%
63%

Could Not
Schedule

66%

Could Not
Schedule

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El Paso VA Pilot Project Proposal 16.July.2015

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

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

(FY)

*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.

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El Paso VA Pilot Project Proposal 16.July.2015

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

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;

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El Paso VA Pilot Project Proposal 16.July.2015

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
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El Paso VA Pilot Project Proposal 16.July.2015

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

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

h.
i.
j.
k.

One recreational therapist


One vocational rehabilitation therapist
One music or yoga therapist
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.
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El Paso VA Pilot Project Proposal 16.July.2015

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

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.

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El Paso VA Pilot Project Proposal 16.July.2015

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

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.

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El Paso VA Pilot Project Proposal 16.July.2015

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El Paso VA Pilot Project Proposal 16.July.2015

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El Paso VA Pilot Project Proposal 16.July.2015

Medical Center of the Americas Master Plan

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El Paso VA Pilot Project Proposal 16.July.2015

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

VA Hires 9 Care Navigators to Provide Customer Service Needs


of Area Veterans
VA Hires 2 Family Physicians

Q1-2016

Hiring Bonuses Implemented Until 100% of VA


Staffing is Reached
+ 9 Care Navigators

Q1-2016

+ 2 Family Physicians

VA Announces Structure of Pilot Project and Increased Access to


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

Q2-2016
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

Additional Family Medicine Residents Enter Joint VA-TTU


Program

Q4-2018

+2 Family Medicine Resident Physicians

Additional Family Medicine Residents Enter Joint VA-TTU


Program

Q3-2019

+2 Family Medicine Resident Physicians

VA Hires First Family Medicine Residency Program Graduates

Q2-2020

+2 Family Medicine Physicians

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El Paso VA Pilot Project Proposal 16.July.2015

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 Contracts with 4 New Mental Health Providers in Community

Q1-2016

+ 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 Contracts with 4 New Mental Health Providers in Community

Q2-2016

+ 4 Community Mental Health Providers

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

VA Contracts with 4 New Mental Health Providers in Community

Q3-2016

+ 4 Community Mental Health Providers

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
All staff for VA TBI/PTS Center of Excellence Hired and On Boarded

Q4-2018

+ 2 Psychiatry Residents

Q4-2018

Additional Psychiatry Residents Enter Expanded Joint VA-TTU


Psychiatry Residency Program

Q3-2019

+10 Full Time and 1 Part Time Dedicated


Positions
+ 2 Psychiatry Residents

VA Hires First Expanded Psychiatry Residency Program Graduate

Q2-2020

+ 1 Psychiatrist

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El Paso VA Pilot Project Proposal 16.July.2015

Facilities Initiatives 2015-2020


Action

Date

Notes

Lease Signed for Two New CBOCs

Q4-2015

Westside
Eastside
Central

Lease Signed for CBOC on MCA Campus

Q1-2016

Construction Begins on VA Operations Center on MCA Campus

Q3-2016

Construction Begins on TBI/PTS Center of Excellence on MCA


Campus
VA Opens CBOC

Q3-2016
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

TBI/PTS Center of Excellence Opens

Q4-2018

Central

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

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El Paso VA Pilot Project Proposal 16.July.2015

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.

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El Paso VA Pilot Project Proposal 16.July.2015

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).

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El Paso VA Pilot Project Proposal 16.July.2015

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


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

Number SF/Each

Total SF

Medical/Primary Care
Doctor Office
Exam Room
Lab Drawing
Treatment Room
Nurse Alcove
Supply Room
Main Waiting Room
Break Room

3
9
1
1
3
1
1
1

140
100
100
120
100
120
250
120

420
900
100
120
300
120
250
120

Behavioral Health
Doctor Office
Sub Waiting Room
SW/Other Office

2
1
2

140
200
140

280
200
280

Meeting/Teaching
Large Conf Rm
Small Conf Rm

1
1

220
140

220
140

General/Support
Office/Recept
Bus Office
Rest Rooms
Rest Rooms - Staff

1
1
3
2

250
180
120
80

250
180
360
160

Other VA Svcs
Navigator Office
Other VA Uses

140

280
2,000

Total Net SF

6,680

Total Gross SF @ .75

8,907

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El Paso VA Pilot Project Proposal 16.July.2015

Appendix 3- Preliminary Estimates of Costs, Pilot Project

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El Paso VA Pilot Project Proposal 16.July.2015

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.

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El Paso VA Pilot Project Proposal 16.July.2015

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


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El Paso VA Pilot Project Proposal 16.July.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

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

demonstrates the scope of the problem and hints at the solutions

El Paso VA Pilot Project Proposal 16.July.2015

- Beto ORourke 29

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.

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El Paso VA Pilot Project Proposal 16.July.2015

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

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El Paso VA Pilot Project Proposal 16.July.2015

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.

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El Paso VA Pilot Project Proposal 16.July.2015

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

Yes 36.6

36.9

No 63.4

63.1

Yes 63.5

65.6

No 36.5

34.4

Have you attempted to make an appointment for mental healthcare


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

Were you able to obtain a mental health appointment?

Was the mental health appointment for:


An initial visit/appointment 19
Regular or follow up appointment 76.6
Unsure 4.4

17.8
77.5
4.7

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


A counselor (counselor, social worker, psychologist) 58.8
A psychiatrist 31.1

60.5
30

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El Paso VA Pilot Project Proposal 16.July.2015

Question

2014
Unsure 10.1

2015
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
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

13.8

6.55 average

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El Paso VA Pilot Project Proposal 16.July.2015

Question

2014

2015

Yes 42.5

40.2

No 49.6

53.4

Have you put off your mental health care because of the difficulty in
obtaining an appointment?

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

Within the last year 88.7

86.1

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

Between 1 and 2 years ago 9.2

10.4
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El Paso VA Pilot Project Proposal 16.July.2015

Question

2014
Over 2 years ago 2.1

2015
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

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

77.4 day average

3.1 average

Very unsatisfied 15.3

15.9

Unsatisfied 19.6

20.4

Unsure/Neutral 16.4

18.6

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El Paso VA Pilot Project Proposal 16.July.2015

Question

2014
Satisfied 34
Very satisfied 14.7

2015
32.3
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

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

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El Paso VA Pilot Project Proposal 16.July.2015

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

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

It is important to me that...

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

How would you rate your overall level of satisfaction with the community
medical provider you saw?
Very unsatisfied N/A
Unsatisfied N/A

12.3
8
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El Paso VA Pilot Project Proposal 16.July.2015

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

Unsure/Neutral N/A

34.9

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

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El Paso VA Pilot Project Proposal 16.July.2015

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


Unsure 12.1

12.6
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
Unsatisfied 23.1

15.1
21

Unsure/Neutral 24.6

30.2

Satisfied 28.6

27.9

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El Paso VA Pilot Project Proposal 16.July.2015

Question

2014
Very satisfied 7.5

2015
5.7

What is your gender?


Female 9.4
Male 90.6

12.3
87.7

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


Very Important N/A
Somewhat important N/A

29.4
19

Unsure/Neutral N/A

16.7

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
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El Paso VA Pilot Project Proposal 16.July.2015

Question

2014

2015

Yes 71.5

70.4

No 25.9

27.4

Do you currently have health insurance aside from the coverage provided
by the VA?

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

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El Paso VA Pilot Project Proposal 16.July.2015

Appendix 6-Letters of Support

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