CHARLEEN R. SZABO, FACHE
ACTING NETWORK DIRECTOR
VA STARS & STRIPES HEALTHCARE NETWORK,
VETERANS HEALTH ADMINISTRATION
DEPARTMENT OF VETERANS AFFAIRS
BEFORE THE
COMMITTEE ON VETERANS AFFAIRS
UNITED STATESSENATE

March 16, 2004

Mr. Chairman and Members of the Committee:   

            I am pleased to appear before the Committee to discuss VISN 4’s ongoing efforts with regard to CARES.

            The CARES process has involved one of the most comprehensive evaluations of the VA health care system ever conducted.  It is a data-driven planning process designed to project future demand for health care services in 2012 and 2022, compare them against the current supply, and identify the capital requirements and the asset realignments VA needs to improve access, quality, and the cost effectiveness of the VA health care system.

            My testimony will be in two parts – the first part will addressPittsburgh, and the second and final part will discuss Butler.

The VA Pittsburgh Healthcare System consists of three divisions, University Drive , Highland Drive and the H. John Heinz III Progressive Care Center.   All three are located in the metropolitan Pittsburgh area within seven miles of one another.  VA Pittsburgh also operates Community Based Outpatient Clinics in the Washington , Westmoreland, and Beaver Counties in Pennsylvania , and a fourth in St. Clairsville , Ohio .  Under the draft national CARES plan, a fifth clinic is proposed for Fayette County in southwestern PA, where veterans currently drive over an hour for VA care. 

As part of the VA Stars & Stripes Healthcare Network, VA Pittsburgh serves as the tertiary hub for the other western VISN 4 facilities, providing specialty care for patients from the VA medical centers in Altoona , Butler , and Erie , Pennsylvania and Clarksburg , West Virginia .  The VA Pittsburgh is also a provider of many educational training programs for tomorrow’s physicians, social workers, nurses and other health care providers. 

With an annual operating budget approaching $300 million, VA Pittsburgh treats over 52,000 veterans per year.  While the average daily census has been around 550 over the last 3 years, outpatient visits have increased to over 430,000.  Service enhancements made in recent months include the addition of bariatric surgery and renal transplantation, along with the establishment of an independent liver transplant program.  Oxygen capacity was added to more nursing home units and additional cardiac telemetry beds were added in acute care to meet the growing demand for higher acuity services.  Other programs were expanded to support veterans in the community including mental health intensive case management, homemaker and home health aide services, and opioid substitution.  When clinic wait times became lengthy, providers were added to primary and many specialty clinics.  These clinics can now schedule veterans within 30 days.  Numerous renovations have been made including the operating rooms, laboratory, specialty clinics, an inpatient psychiatry unit and renal dialysis.  With these improvements, reported veteran satisfaction with care has increased from 59% to over 70% in the last four years.

The plan proposed under CARES calls for substantial construction of new space in Pittsburgh and subsequent consolidation of the current services at Highland Drive to the University Drive and Heinz divisions of the VA Pittsburgh Healthcare System. In order to operate two VA health care facilities in Pittsburgh that will accommodate all current services, a sizeable construction project at the remaining two divisions is necessary.  This construction must include the proposed parking garage at University Drive, where traffic tie-ups are a recurring issue.  I have been assured that Highland Drive will continue to operate until the new space needed is funded and built.  This new construction will provide veterans with state-of-the-art facilities and improve the access to and quality of services now provided by the VA Pittsburgh Healthcare System.  Both University Drive and Heinz are readily accessible to downtown Pittsburgh and major roads and are served by public transportation.   Beyond the construction currently planned, the Heinz site can support growth if additional long-term care capacity is indicated in the future.  Under the proposal, the Highland Drive campus will be evaluated for alternative uses to benefit veterans such as enhanced use leasing for an assisted living facility, with any revenues generated being used for further care enhancements in Pittsburgh. 

All of the excellent behavioral care and other services provided at the Highland Drive division will continue there until the consolidation and will move into new space following the construction. This will take several years to complete once approved and funded.  These services include:

• Acute Inpatient Psychiatric Care
• Outpatient Individual and Group Therapy
• Post Traumatic Stress Treatment
• Psychosocial Residential Rehabilitation Treatment Programs
• Intensive Case Management
• Substance Abuse Treatment
• Domiciliary Care; and
• Services to the Homeless

Care will be improved through co-location of behavioral health care with other tertiary services.  Patient safety and care outcomes will improve as veterans no longer require transport across town when they become medically ill.  As aesthetically pleasing facilities, which meet modern privacy standards, are provided veteran satisfaction will continue to improve.  The environment can positively impact care outcomes, as patient comfort and confidence increases.  Researchers currently situated at Highland Drive will be located adjacent to the affiliate university.  The time saved in travel between the two locations will improve their efficiency.  It is also expected to draw additional nationally recognized clinician-researchers, increase research proposals and funding and generate greater interest in VA Pittsburgh as a behavioral health-training site.

And now, turning to the VA Medical Center in Butler, I am pleased to provide these comments:

The VA medical center in Butler, Pennsylvania provides primary medical care, extended care, and behavioral health services to more than 18,000 veterans residing in a five-county area.  The medical center is located on an 88-acre campus in Butler Township.  Four community-based outpatient clinics have been opened in Mercer, Lawrence, Armstrong, and Clarion counties.  A fifth clinic is being planned in Venango County, and will be jointly operated by staff from the VA medical centers in Butler and Erie.

A majority of veterans requiring outpatient sub-specialty care, as well as secondary and tertiary care, are referred to the VA Pittsburgh Healthcare System, which is located about 35 miles from Butler, PA.  Approximately 80 veterans per year are referred to community hospitals, with Butler Memorial Hospital being the most frequently used hospital.  Each year the VA medical center purchases approximately $1 million worth of services from Butler Memorial in the form of inpatient care, emergency room visits, and imaging services.  A sharing agreement has been in effect since 1998 for a VA purchased CT scanner that is installed and operated at Butler Memorial for both veterans and community residents.  Several physicians on staff at Butler Memorial are consultants at the VA medical center.

The medical center has been very successful in partnering with similar community organizations that have been located in underutilized space on the VA campus and provide expanded services for veterans.  One of these partnerships is the Deshon Place, a transitional housing program in a renovated, underutilized building on the VAMC campus.  Catholic Charities, the Housing Authority, and the VA medical center joined to create this program through a grant which now provides about 50% of its services to veterans.

Another significant project is the recently approved enhanced use lease with Butler County which will construct a 16-bed interim mental health facility on 1.3 acres of the VA campus.  Again, veterans will receive free services that are currently not available in Butler County.

The draft national CARES plan endorses continued exploration of potential enhanced use proposals for the VA medical center.  It specifically cites an enhanced use opportunity with Butler Memorial to expand specialty care on the VA campus.  Since the draft plan has been published, discussions on an enhanced use lease have been expanded to include the construction of  Butler Memorial’s replacement hospital, an ambulatory surgical center, cancer center, and medical office building on 30 acres of the VA campus.  A concept paper to pursue this enhanced use lease potential has been submitted to VACO for review and approval.

The draft national CARES plan also calls for the closure of the VA medical center’s seven acute medicine beds.  Nursing home care and outpatient services are recommended to continue operation.

The potential enhanced use proposal with Butler Memorial for its replacement hospital is an innovative project that will enhance services to veterans in the Butler area; replace old buildings with modern and efficient health care facilities; and make use of underutilized space.  It can accommodate the closure of the seven acute beds with no inconvenience to veterans since they would be treated in Butler Memorial’s acute beds on the same campus.  In conclusion, this proposal has the potential to forge a new type of affiliation between non-urban VA medical centers and community hospitals, which will result in more comprehensive and accessible care for veterans in the communities where they live.

In summary, this plan provides for continued delivery of excellent health care to veterans and potential savings in building maintenance that will support the VA Pittsburgh Healthcare System and VAMC Butler in expanding and enhancing the services provided to our nation’s veterans.