VA Hospitals: Issues and Challenges for the Future

Front Cover
Stephen P. Backhus
DIANE Publishing, 2000 - Veterans' hospitals - 324 pages
 

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Contents

Evolution of Hospital Care
39
Hospital Care Consumed Increasing Portion of Health Care Expenditures Between 1950 and 1980
42
Supply of and Demand for Hospital Care Have Declined Since 1980
53
Closures Reduced Number of Community but Not VA Hospitals
56
Changes in Medical Technology and Practice Have Decreased Demand for Both Community and VA Hospital Care
57
New Approaches to Treating Psychiatric Patients Have Reduced Institutionalization
61
Issues Concerning the Effects of Changing Medical Technology and Practice on Future Hospital Demand
63
Changes in the Structure of Health Insurance Have Decreased Demand for Care in Community More Than in VA Hospitals
67
Changes in Care Management Have Reduced Admissions and Lengths of Stay
75
Expanded Home Health Care Coverage Has Reduced Lengths of Stay
78
Expansion of Hospice Care Has Reduced Hospital Use by the Terminally III
84
Effects of Recent VA Changes on Future Demand for VA Hospital Care Are Uncertain
85
Additional Factors Likely to Affect Future Demand for VA Hospital Care
88
Medicare Gave Older Veterans Improved Health Care Options
91
Increasing HMO and PPO Enrollment Reduced Veterans Financial Incentives to Use VA Hospitals
93
Many Factors Make Future Demand for VA Hospital Care Uncertain
94
Supply of Hospital Beds Significantly Exceeds Demand in Both the Private Sector and VA
97
Selecting Approaches for Estimating Excess Beds
109
Number of Community Hospital Beds Greatly Exceeds Demand
110
More Than 80 Percent of VA Hospital Beds Could Become Excess
114
Multiple Challenges Face VA Concerning Hospital Closures
118
Changes in How Hospitals Are Managed and in Their Relationships With Other Health Care Providers
127
Hospitals Have Increasingly Joined Networks and Alliances
128
Hospitals Are Expanding Product Lines
133
Hospitals Frequently Contract for Management Expertise
139
Improved Information and Accounting Systems Have Developed
141
VA Must Address Many Issues About How VA Hospitals Are Managed and How They Relate to Other Health Care Providers
145
Work Transformation Leads to More Efficient Use of Personnel Resources
153
Hospitals Are Increasingly Contracting for Patient and Nonpatient Care Services
154
Use of PartTime and Intermittent Employees Can Offer Flexibility
158
Hospitals CrossTrain Employees for Effective Staff Utilization
162
Hospitals Are Creating Nurse Extender and Other Auxiliary Positions
163
Both VA and Community Hospitals Are Implementing PatientCentered Care
167
Many Issues Need to Be Addressed Concerning VAs Work Transformation Efforts
172
Hospitals Reduce Procurement and Inventory Costs Through Changes in Materials Management
174
Implementing JustinTime and Stockless Delivery Systems Reduces Costs
179
Limiting Pharmaceuticals Included in Formularies Can Reduce Pharmacy Costs but Effectiveness May Be Limited
181
Hospitals Use Alternative Strategies for Procuring HighTechnology Equipment
183
Hospitals Share HighTech Equipment
187
Outcome Measures Increasingly Developed to Evaluate Hospitals Physicians and Health Plans
219
Hospitals Increasingly Provide Services in Outpatient Departments
224
Hospitals Are Increasingly Discharging Patients to Other Care Settings
232
Issues VA Needs to Address Concerning Changes in Its Patient Care Monitoring and Delivery
234
Changes in Teaching Hospitals Medical Education Mission
238
Medicare Is the Largest Source of GME Financing
239
Teaching Hospitals Had Increased but Are Now Decreasing the Number of Medical Residents
240
Increased Hiring of Foreign Medical School Graduates
247
Teaching Hospitals Shift Toward Primary Care Residencies
248
Inpatient Training Declining in Importance
250
Teaching Hospitals Offer Deep Discounts to Managed Care Plans
251
VA Faces Issues Concerning the Direction of Its Medical Education Mission
252
Teaching Hospitals Diversify Funding of Medical Research
255
VA Research Funded Mainly Through VA Appropriations
256
Teaching Hospitals Seek Funding From Pharmaceutical and Biomedical Companies
257
VA Is Also Seeking Alternative Research Funding Sources
258
Collaborative Research With Managed Care Plans and Others
260
VA Faces Many Issues in Developing Alternative Research Funding Streams
263
Ownership and Other Changes Shift Hospitals Focus From Uncompensated Care
265
Public Hospitals Provide Disproportionate Share of Uncompensated Care
266
Strategic Goals of Many Nonprofit Hospitals Exclude Serving the Medically Indigent
268
Hospitals Changing Ownership Could Affect Future Provision of Indigent Care
269
VA Restructuring Efforts Create Incentives for VA Facilities Similar to Those of ForProfit Providers
271
Issues VA Will Need to Address Concerning Its Safety Net Mission
273
Conclusions Agency Comments and Our Evaluation
276
VA Comments and Our Evaluation
279
Population Community Hospital Beds and Average Daily Census by State and Census Division
284
Market Penetration of Health Maintenance and Preferred Provider Organizations
288
Estimates of Current Community Hospital Excess Capacity Under the Target Occupancy Rate Approach
292
Estimates of Excess Community Hospital Beds Based on Selected Target of Beds per 1000 Population Based on 1995 Population
296
Estimates of Excess Community Hospital Beds Based on Selected Targets of Beds per 1000 Population for Projected Population in 2010
300
Veteran Users Operating Beds and Average Daily Census by VISN in Fiscal Year 1995
304
Comparison of VA and Community Hospital Utilization by Census Division
308
Estimates of Excess VA Hospital Beds
310
Changes in VA Operating Beds Between Fiscal Years 1995 and 1996
314
Comments From the Department of Veterans Affairs
315
GAO Contacts and Staff Acknowledgments
320
Related GAO Products
324

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Page 284 - New England Middle Atlantic South Atlantic East North Central East South Central West North Central West South Central . ... Mountain Pacific...
Page 31 - ... three basic levels of outpatient care benefits: • comprehensive care, which includes all services needed to treat any medical condition; • service-connected care, which is limited to treating conditions related to a service-connected disability; and • hospital-related care, which provides only the outpatient services needed to (1) prepare for a hospital admission, (2) obviate the need for a hospital admission, or (3) complete treatment begun during a hospital stay. Separate mandatory and...
Page 79 - These restrictions under part A and part B were eliminated by the Omnibus Reconciliation Act of 1980 (ORA) (PL 96499), but little immediate effect on Medicare costs occurred.
Page 48 - A, the claimant can seek reconsideration by the Health Care Financing Administration (HCFA) in the Department of Health and Human Services.
Page 214 - Practice Guideline: An explicit statement of what is known and believed about the benefits, risks, and costs of particular courses of medical action. Intended to assist decisions by practitioners, patients, and others about appropriate health care for specific clinical conditions.
Page 180 - US wholesalers to a manufacturer, accounting for any cash discounts or similar price reductions. Prices paid by the federal government are excluded from this calculation.
Page 141 - DSS— is an executive information system that can provide VHA managers and clinicians with data on patterns of patient care and patient health outcomes, as well as the capability to analyze resource utilization and the cost of providing health care services. VHA...
Page 152 - VA has been phasing in at its facilities a new Decision Support System (DSS) that uses commercially available software to help provide managers data on patterns of care and patient outcomes as well as their resource and cost implications. While DSS has the potential to significantly improve VA'S ability to manage its health care operations, the ultimate usefulness of the system will depend not on the software but on the completeness and accuracy of the data going into the system.
Page 230 - For example, a 1991 VA-funded study of admissions to VA acute medical and surgical bed sections estimated that 43 percent...
Page 130 - Administration's (VHA) natural patient referral patterns, numbers of beneficiaries and facilities needed to support and provide primary, secondary, and tertiary care, and, to a lesser extent, political jurisdictional boundaries such as state borders.

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