2006 VADP Annual Report

2006 ANNUAL REPORT
HONORING ALL WHO SERVED

VA Desert Pacific Healthcare Network

Our Services

Prevention and Outpatient Care
We provide a full range of primary, specialty and subspecialty care to outpatients at our medical centers, ambulatory care centers and at community clinics throughout Southern California and Southern Nevada. Skilled primary care teams focus on preventing illness and managing the health of veterans through annual preventive screenings, immunizations and education. Specialized medical, surgical and mental health care is also provided to avoid hospitalization and keep veterans home with their families.

Acute Hospital Care
Hospital care and emergency services are available at medical centers in San Diego, Loma Linda, Long Beach and Los Angeles. In Las Vegas, acute hospitalization is currently provided through a Joint Venture with the Air Force at the Mike O’Callaghan Federal Hospital. Specialty services such as open-heart surgery, neurosurgery and radiation therapy are provided at central sites within the Network. Specialized programs also provide care to veterans with HIV/AIDS, Parkinson’s disease and other conditions.

Mental Health Care
A wide variety of mental health services are provided to veterans suffering from emotional stress and readjustment issues, substance abuse, homelessness, acute and chronic psychiatric illnesses and Post Traumatic Stress Disorder (PTSD). Our behavioral health care teams ensure that those in need receive the best treatment in the most appropriate setting. Patients move through different levels of care according to their changing needs. Partnerships have been established with community agencies to provide homeless services, transitional housing and job assistance. Mental Illness Research, Education and Clinical Centers in the Network also enhance care.

Long Term Care
The primary goal of our long term care program is to keep veterans in their homes or with their families as long as possible by providing a variety of home-based care and rehabilitative services. Home care options include Home Based Primary Care, Tele-home Care, Homemaker Services, Adult Day Care and Respite Care. For veterans needing more services, Nursing Home Care is provide at VA centers in
Loma Linda, Long Beach, San Diego, Los Angeles, Sepulveda and at contract sites in the community. Geriatric Research, Education and Clinical Centers in Los Angeles also enhance the care provided to the aging veteran.

Specialty Care
We specialize in providing care to veterans experiencing problems related to their military service both as recently returned combat veterans or from conflicts in the past. We offer acute and ongoing rehabilitative services at all sites as well as extensive care for veterans with spinal cord injuries at Long Beach and San Diego. We custom fabricate and fit prosthetic limbs and other medical and adaptive devices. Care to former POWs and those exposed to hazards associated with military service is also a high priority.

Our mission is to honor America’s veterans by providing exceptional health care that improves their health and well being.

www.desertpacific.va.gov

Message from Kenneth J. Clark, Network Director
Our mission to honor America’s veterans by providing exceptional health care has been enhanced this year by significant accomplishments in quality, access, cost effectiveness and customer service. Our efforts were supported by a well trained workforce and supportive community.
In the year ahead, our focus will continue to be on improving the quality of our care as demonstrated through national performance measures. Recently, many national publications and news segments such as TIME, NBC Nightly News, CBS News, Washington Post and others have highlighted the accomplishments of the VA health care system that now leads the nation in providing high quality, cost effective care in 12 out of 13 standardized measures of quality.
We have enthusiastically responded to the needs of our newest veterans returning from Iraq and Afghanistan by establishing specially trained case managers and programs at each site that address their unique health care and readjustment needs. Targeted outreach to these veterans and their families makes them aware of the benefits they have earned and eases the transition from military to civilian life. For those coming home with injuries, our Network offers specialized poly-trauma and rehabilitative services as part of the VA’s national seamless transition services.
Enhancement of mental health and home care services will continue to be a priority this year. Mental health services have become a part of all but the smallest community clinics with the expansion of specialized programs at our larger facilities. We continue to increase the numbers of veterans whose care is monitored in the home by VA nurses to keep them healthy and out of the hospital. This technology has also proven beneficial in monitoring new diabetics and other conditions improving provider effectiveness and patient convenience.
We have improved access to care where new patients can obtain appointments to primary care and most specialty clinics in 30 days or less and are seen by their provider within 20 minutes of their appointment time. We also are preparing to expand access by opening new clinics in Santa Maria and South Orange County.
As we expand and improve our care, we moved forward with construction projects including a new medical center in Las Vegas, modifications at the San Diego and Los Angeles Medical Centers to make them safer in the event of an earthquake, and the planning for a new blind rehabilitation unit at Long Beach.
I can’t thank you enough for your continued support throughout the year. We value and encourage your input to help us continue to improve. Don’t hesitate to contact me or your local Medical Center Director with your comments and suggestions.

Kenneth J. Clark, FACHE
Network Director, VA Desert Pacific Healthcare Network

Serving Veterans Throughout Southern California & Southern Nevada
VA Desert Pacific Healthcare Network is one of 21 Healthcare Networks or Veterans Integrated Service Networks (VISNs) operated nationwide by the United States Department of Veterans Affairs (VA). We are comprised of five hospitals and 30 community-based clinics serving 1.2 million veterans residing in the 110,000 square miles that encompass Southern California and Southern Nevada.

Governance and Decision Making
Our organizational structure is modeled after the world-renowned Malcolm Baldrige principles of performance excellence. This structure has assisted in making significant improvements in our performance and has brought us closer to achieving our goal of creating one seamless system of care for veterans in Southern California and Southern Nevada. Under this organization, senior-level leaders provide direct, on-site leadership at one of the Network’s facilities while maintaining full responsibility for key Network program operations. Membership on Network councils and committees is both inter-facility and interdisciplinary to ensure broad representation.
We believe our organization brings improved access to high quality health care services to veterans while assuring our management systems keep pace with the ever-changing health care environment.

Our Facilities

VA Southern Nevada Healthcare System
Serving Veterans in Clark, Lincoln and Nye Counties
P.O. Box 360001
Las Vegas, NV 89036
702-636-3000
www.las-vegas.med.va.gov
Medical Center shared with the Air Force at the Mike O’Callaghan Federal Hospital with outpatient clinics throughout Las Vegas and Community Clinics in Henderson and Pahrump
40,229   Enrolled Veterans
432,229 Outpatient Visits
2,405   Inpatients Treated
929   Full Time Equivalent Employees
Operating Budget: $164 million
Research: 27 active research projects with total funding of $2 million
Major Affiliation: University of Nevada, Reno, School of Medicine
Specialty Services: Gambling Addiction, Smoking Cessation and Post Traumatic Stress Disorder Programs, Homeless Community Clinic

VA Loma Linda Healthcare System
Serving Veterans in San Bernardino and Riverside Counties
11201 Benton Street
Loma Linda, CA 92357
909-825-7084
www.lom.med.va.gov
Medical Center in Loma Linda with Community Clinics in Victorville, Corona, Palm Desert, Upland and Sun City
56,722   Enrolled Veterans
489,959 Outpatient Visits
6,498   Inpatients Treated
1,821 Full Time Equivalent Employees
Operating Budget: $264 million
Research: 143 active research projects with total funding of $2.3 million
Major Affiliation: Loma Linda University Medical School
Specialty Services: Bariatric Surgery, Post Traumatic Stress Disorder, Smoking Cessation and Dialysis Programs

VA Long Beach Healthcare System
Serving Veterans in Orange and
Los Angeles Counties
5901 E. 7th Street
Long Beach, CA 90822
562-826-8000
www.long-beach.med.va.gov
Medical Center in Long Beach with Community Clinics in Santa Ana, Anaheim, Whittier/Santa Fe Springs and Cabrillo
42,084   Enrolled Veterans
459,882 Outpatient Visits
5,329 Inpatients Treated
1,907 Full Time Equivalent Employees
Operating Budget: $250 million
Research: 158 active research projects with total funding of $7million
Major Affiliation: University of California Irvine School of Medicine
Specialty Services: Spinal Cord Injury Care, Mental Illness Research, Education and Clinical Center (MIRECC), Hospice

VA San Diego Healthcare System
Serving Veterans in San Diego and Imperial Counties
3350 La Jolla Village Drive
San Diego, CA 92161
858-552-8585
www.san-diego.med.va.gov
Medical Center in San Diego with Community Clinics in Mission Valley, Escondido, Chula Vista, Vista, and Imperial Valley
55,540   Enrolled Veterans
559,398 Outpatient Visits
6,773 Inpatients Treated
2,079   Full Time Equivalent Employees
Operating Budget: $282 million
Research: 1,022 active research projects with total funding of $61.8 million
Major Affiliation: University of California San Diego School of Medicine
Specialty Services: Mental Illness Research, Education and Clinical Center (MIRECC), Post Traumatic Stress Disorder Center of Excellence, Cardiothoracic Surgery and Alcohol/Drug Addiction Programs

VA Greater Los Angeles Healthcare System
Serving Veterans in Los Angeles, Ventura, Santa Barbara and Kern Counties
11301 Wilshire Boulevard
Los Angeles, CA 90073
310-478-3711
www.gla.med.va.gov
Medical Center in West Los Angeles with Community Clinics in Bakersfield, East Los Angeles, Gardena, Lancaster, Los Angeles, Pasadena, Oxnard, San Luis Obispo, Santa Barbara, Lynwood, and Sepulveda
78,366   Enrolled and Veterans
929,554 Outpatient Visits
7,285   Inpatients Treated
3,774 Full Time Equivalent Employees
Operating Budget: $497 million
Research: 800 active research projects with total funding of $45.3 million
Major Affiliation: University of California Los Angeles David Geffen School of Medicine and University of Southern California School of Medicine.
Specialty Services: Substance Abuse, Homeless, Geriatric, Parkinson’s, Gait Assessment and Falls Prevention Programs, Epilepsy Center, OIF/OEF Poly Trauma Level 2 Care, Mental Illness Research, Education and Clinical Center (MIRECC)

VA in the News
VA Care Is Rated Superior to That in Private Hospitals
Washington Post , January 20, 2006

Health Care Confidential
New York Times Op-Ed Column
January 27, 2006

Veterans' Care Praised, Finally
High marks on a patient survey are the latest sign of improved veterans' health care
THE NATIONAL JOURNAL (DC)
February 11, 2006

VA Hospitals’ Amazing Transformation
MSNBC Nightly News, March, 15, 2006

It’s Not Your Father’s VA
PROCEEDINGS, April 2006

Technology has transformed the VA
Veterans' hospitals used to be a byword for second-rate care or worse. Now, thanks to technology, they're national leaders in efficiency and quality
FORTUNE Magazine, May 11, 2006

VA Receives 2006 Innovations in Government Award
Veterans Health Administration (VHA), named one of seven recipients of the prestigious Innovations in American Government Award presented at Harvard University, July 10, 2006

The Best Medical Care In The U.S.
How Veterans Affairs transformed itself – and what it means for the rest of us
Business Week, July 17, 2006

How VA Hospitals Became The Best
TIME, September 4, 2006

VA: High-Quality Health Care at Low Cost
High-Tech Agency Earns Highest Ratings In U.S., And It's A Boon For Taxpayers, Too
CBS Evening News, December 8, 2006

2006 Our Year In Review
This year our goal was to effectively manage our resources to improve access, develop new programs and enhance quality. Many of our operational indicators remained the same as in 2005 requiring internal adjustments to achieve change. Our full time equivalent employees rose slightly to 10,511 with 777 FTEE physicians and 2,000 professional nurses. Our operating beds stayed the same at 1,905 beds including 917 acute, 639 nursing home, 321 domiciliary and 30 psychiatric residential beds. Our medical research and health professions education continued to be one of the largest in the VA system training 743 medical residents and thousands of nursing and allied health students. Over 700 researchers conducted in excess of 2,100 projects with more than $116 million in total funding. We provided priority care to returning combat veterans from Iraq and Afghanistan. We stood ready to provide back-up clinical support to the Department of Defense and served as a national resource after hurricanes and other natural disasters.
We continued our strong affiliation with some of the finest medical schools in the United States including:
•           University of California, Los Angeles (UCLA)
•           University of Southern California (USC)
•           University of California, San Diego (UCSD)
•           University of California, Irvine (UCI)
•           University of Nevada (UN)
•           Loma Linda University (LLU)

We are home to a number of VA Centers of Excellence including Level 2 Poly- Trauma, Post Traumatic Stress Disorder (PTSD), Geriatric Research and Clinical Care, Patient Safety, Parkinson’s Disease Research and Education Center, Homelessness, Mental Illness Research Education and Clinical Care, Spinal Cord Injury, Cardiac and Neurosurgery, Radiation Therapy, HIV/AIDS, Alzheimer’s Care, Comprehensive Rehabilitation, Renal Dialysis and Epilepsy Care.

CARES
Capital Asset Realignment for Enhanced Services
The results of the national VA CARES or Capital Asset Realignment for Enhanced Services planning initiative for our Network included the development of 10 Major Capital Projects totaling over $900 million. The projects will address gaps in facilities and services identified throughout the Network. In addition, a national contractor has undertaken a study of the land at the West Los Angeles VA Medical Center with stakeholder input gathered through a Local Advisory Panel established for the site.

CARES Planned Major Construction Projects:

Las Vegas – New VA Medical Center and Nursing Home
Long Beach – New Blind Rehabilitation Center and Seismic Corrections
Greater Los Angeles – Seismic Corrections, Replacement Nursing Home and Research Building
San Diego – Seismic Corrections, New Research Building
Loma Linda – New Clinical and Research Additions

We provided priority care to returning combat veterans from Iraq and Afghanistan

Quality - Put Quality First
Accomplishments

Increased mental health programs for veterans needing intensive case management, post traumatic stress disorder and substance abuse care and expanded mental health programs in community clinics.
Focused on quality care by conducting quality surveys tracing patient’s care through the system, presenting quality forums, and implementing best practices.
Implemented the National 100,000 Lives Campaign and other best practices proven to improve clinical care and patient outcomes.
Developed medication guidelines, established performance measures and conducted audits to improve the quality of pharmaceutical care and manage resources.
Piloted a “Tuck-In” Program to provide nursing services 24 hours a day to patients recovering from outpatient surgery.
Implemented a Level 2 Poly Trauma Care Center and provided education to address the specialized care needs of returning combat veterans.
Implemented a safety scorecard which reports on the status of major initiatives.

Heart Tests Exceed National Average 95% of patients with heart failure received the proper test

Outpatients using tobacco is the lowest in the nation.

Our goals for 2007

Enhance services and outreach provided to returning combat veterans by expanding Level 2 and 3 Poly-Trauma care, analyzing the care needs of these veterans and providing staff training on how to meet their unique needs.
Improve quality care by meeting or exceeding national performance measures.
Implement additional mental health initiatives including expanding telemental health in community clinics.
Develop a comprehensive utilization management program that manages hospital bed capacity, reducing the need to obtain care in the community.
Develop computer solutions to clinical problems, expanding web services and information for patients.

Cost Effectiveness
Optimize resources to benefit veterans

Accomplishments

Demonstrated sound financial performance by exceeding all national
performance goals.
Avoided $9.7 million in drug costs through performance measures, monitors and cost avoidance initiatives.
Increased alternative (non-VA) revenue by 5% over 2005
by expanding sharing with state, federal and private sector entities.
Reduced workers’ compensation costs by $570,000.

Drug Costs Below National Average Network drug costs decreased in 2006. A team aggressively manages the network drug formulary to control costs.

Non-VA Revenue Increased Alternative revenue increased due to enhanced contract/sharing with DOD across the Network.

Efficiency Measures Implemented Efficient business practices have allowed us to provide care to more veterans without significant staffing increases.

Our goals for 2007

Improve billing and collection processes to meet or exceed national goals.
Reduce non-VA and contract care, expanding capacity and services.
Improve procedures to capture data that will allow for maximum reimbursement.
Reduce workers’ compensation costs by 5% by expanding job offers and limited duty assignments.
Maximize utilization of operating rooms, manage pharmacy costs, improve the efficiency of hospital bed utilization and implement new technologies.

Access
Provide easy access to care, expertise and knowledge

Accomplishments

Created an infrastructure for implementing Advanced Clinical Access Systems in administrative and patient care areas which have enhanced the delivery of services to veterans and were recognized by receiving four national awards.
Aggressively outreached to minority, underserved and returning combat veterans to educate them on their VA benefits.
Assigned 98% of patients primary care providers to manage their care.
Expanded mental health services at community clinics.
Improved the appointment wait time for new and established patients in most clinics to less than 30 days.
Provided care to patients within 20 minutes of their scheduled appointment times.

New Veteran Access to Appointments New veteran access to key clinics meets or exceeds the national average with the exception of eye care. Implementation of advanced clinical access (ACA) techniques has increased access to care in all areas with improvements ongoing.

Wait to See Provider Better than National Average – 75% of patients were seen by their provider within 20 minutes of their scheduled appointment time exceeding the national VA average. Our goal is to continue to improve this measure.

Missed Appointments Focus for Improvement – This measure reflects clinic appointments that were not appropriately used through patient no-shows, cancellations, or poor administrative practices. The goal is to reduce our missed opportunities to less than 12% in all clinics.

Our goals for 2007

Use system redesign techniques to increase efficiency and expand capacity by reducing clinic missed opportunities or no-shows.
Maximize physician productivity to enhance access.
Reduce wait times for an appointment in the top 10 outpatient clinics.
Open new community clinics in South Orange County and Santa Maria, California.
Implement a state-wide initiative to outreach to incarcerated veterans providing care upon release.

Satisfaction
Exceed veteran, family and employee expectations

Accomplishments

Implemented a pilot program at each facility to survey veterans on their provider’s customer service skills.
Educated 100% of new and 85% of current employees on the service and sacrifice of veterans through the implementation of the Affirming the Commitment program.
Established programs and activities at each facility to improve the emotional support offered inpatients.
Conducted “secret shopping” surveys of facilities to evaluate customer service to returning combat veterans.

Patients satisfied with care – Patients satisfied with the quality of both outpatient and inpatient care is slightly below 2005. Aggressive actions planned for improvement.

Our goals for 2007

Improve veteran satisfaction in all areas through initiatives that will improve communication and service.
Expand the customer service provider survey to include all primary care providers.
Enhance employee commitment to service through expanded training.
Implement Service Recovery tools to correct problems immediately when they occur.
Improve veteran communication at all levels of the organization.

Workforce Development
Enhance a worker-friendly environment
Accomplishments

Increased employee participation in the National All Employee Survey from 51% in 2004 to 74% participation in 2006, the results of which provide valuable data for enhancing employee programs.
Provided extensive leadership training to 46 employees through the Emerging Leaders and Leadership Development Institute Programs.
Enhanced the knowledge of staff with 93% of all employees receiving 40 hours of training with 95% of new supervisors trained.
Implemented the Physician Pay Bill which enhanced our ability to attract and retain high quality clinical staff.
Submitted nominations for over 20 National awards.
Converted all employee mandatory training to E-Learning classes with 96% of employees completing the classes.

On-Line or E-Learning Continued Increase – E-Learning offers the ability to provide training to large numbers of employees without leaving the worksite.

Our goals for 2007

Implement a comprehensive program for recruiting personnel in scarce professions.
Meet national performance measures for employee satisfaction using All Employee Survey Data to enhance programs.
Pilot the CREW - Civility, Respect & Engagement in the Workplace - program in one unit at each facility.
Enhance supervisory training to better equip leaders to address organizational goals and challenges.
Continue programs to develop future VA leaders.

Building Healthy Communities
Optimize the health of the veteran and the VA community and contribute to the health of the Nation

Accomplishments

Enhanced the security of protected information by training 100% of employees and contractors on information security, encrypting all laptop computers, restricting access to information systems and by implementing an investigation and reporting system for security breeches.
Launched new internet sites at each facility that provide enhanced information to veterans.
Developed an award-winning Hazardous Alert/Recall Data Management System which is being implemented VA-wide with significant community interest.
Implemented campaigns to support flu vaccine and hand-washing programs to prevent infections.
Improved resident physician training programs through improved supervision scores, development of a tracking system for time and attendance plus enhanced participation in satisfaction surveys.
Distributed over 30,000 health reference books - Healthwise for Life – to newly enrolled veterans.

Resident Supervision – The documentation of resident physician supervision meets or exceeds the national average in most areas improving the quality of education provided trainees. Supervision in the surgical area has improved over the year and ended the year at 100%.

Our goals for 2007

Enhance systems to protect the security and confidentiality of private information.
Enhance internet services for returning combat veterans.
Implement new energy conservation strategies.
Develop a plan for increasing genomic medicine studies.
Partner with the community to promote health including obesity and diabetes prevention.
Increase sharing agreements with Department of Defense and community partners.

Medical Centers
VA Southern Nevada
Healthcare System
P.O. Box 360001
Las Vegas, NV 89036
702-636-3000

Mike O’Callaghan Federal Hospital
4700 Las Vegas Boulevard North
Las Vegas, NV 89191
702-653-2215

VA Loma Linda Healthcare System
11201 Benton Street
Loma Linda, CA 92357
909-825-7084

VA Long Beach Healthcare System
5901 E. 7th Street
Long Beach, CA 90822
562-826-8000

VA San Diego Healthcare System
3350 La Jolla Village Drive
San Diego, CA 92161
858-552-8585

VA Greater Los Angeles
Healthcare System
11301 Wilshire Boulevard
Los Angeles, CA 90073
310-478-3711

Community Clinics
Anaheim
1801 W. Romneya Drive,
Suite 303
Anaheim, CA 92801
714-780-5400

Antelope Valley
547 W. Lancaster Blvd.
Lancaster, CA 93534
661-729-8655

Bakersfield
1801 Westwind Drive
Bakersfield, CA 93301
661-632-1800

Cabrillo
2001 River Avenue
Long Beach, CA 90806
562-388-8000

Chula Vista
835 3rd Avenue
Chula Vista, CA 91910
619-409-1600

Corona
800 Magnolia Ave #101
Corona, CA 92879
951-817-8820

East Los Angeles
5400 E. Olympic Boulevard #150
City of Commerce, CA 90040
323-725-7557

Escondido
815 East Pennsylvania Avenue
Escondido, CA 92025
760-466-7020

Gardena
1251 Redondo Beach Blvd.,
3rd Floor
Gardena, CA 90247
310-851-4705

Henderson
2920 Green Valley Parkway
Suite 215
Henderson, NV 89014
702-456-3825

Imperial Valley
528 G. Street
Brawley, CA 92227
760-344-9085

Los Angeles
351 E. Temple Street
Los Angeles, CA 90012
213-253-2677

Mission Valley
8810 Rio San Diego Drive
San Diego, CA 92108
619-400-5000

Oxnard
250 W. Citrus Grove Avenue
Suite 150
Oxnard, CA 93030
805-983-6384

Palm Desert
41865 Boardwalk, Suite 103
Palm Desert, CA 92211
760-341-5570

Pahrump
2100 E. Calvada Boulevard
Pahrump, NV 89048
775-727-7535

Pasadena
420 S. Las Tunas Dr.
San Gabriel, CA 91776
626-289-5973

San Luis Obispo
1288 Morro St., Suite 200
San Luis Obispo, CA 93401
805-543-1233

Santa Ana
2740 S. Bristol Street, Suite 110
Santa Ana, CA 92704
714-825-3500

Santa Barbara
4440 Calle Real
Santa Barbara, CA 93110
805-683-1491

Santa Maria
(Opening Winter 07)

Sepulveda
16111 Plummer Street
Sepulveda, CA 91343
818-891-7711

South Los Angeles
3737 E. Martin Luther King Jr. Blvd., Suite 515
Lynwood, CA 90262
310-537-6825

South Orange County
(Spring 07)

Sun City
28125 Bradley Road
Suite 130
Sun City, CA 92586
951-672-1931

Upland
1238 E. Arrow Highway, No. 100
Upland, CA 91786
909-946-5348

Victorville
12138 Industrial Boulevard
Suite 120
Victorville, CA 92392
760-951-2599

Vista
1840 West Drive
Vista, CA 92083
760-643-2000

Whittier/Santa Fe Springs
10210 Orr and Day Road
Santa Fe Springs, CA 90670
562-864-5565

VA Desert Pacific Healthcare Network
5901 E. 7th Street,
Long Beach, CA 90822,
(562)826-5963
www.desertpacific.va.gov