STATEMENT OF
JEANNETTE CHIRICO-POST, MD
NETWORK DIRECTOR
VA NEW ENGLANDHEALTHCARE SYSTEM
DEPARTMENT OF VETERANS AFFAIRS
BEFORE THE
SUBCOMMITTEE ON HEALTH,
COMMITTEE ON VETERANS' AFFAIRS
U.S.HOUSE OF REPRESENTATIVES

June 7, 2004

Mr. Chairman and members of the Committee,

I appreciate the opportunity to appear before you today to discuss improving health care services to veterans in the State of Connecticut. With me today are Mr. Roger Johnson, Medical Center Director, VA Connecticut Healthcare System, Newington and West Haven, Connecticut and Dr. Fred S. Wright, VA Associate Chief of Staff for Research, West Haven, Connecticut.

Network Perspective

The VA New England Healthcare System (Network 1) is an integrated and comprehensive health care delivery system that provides care in six New England States: Maine, New Hampshire, Vermont, Massachusetts, Rhode Island and Connecticut. Over thirty community based outpatient clinics are strategically located throughout New England to provide increased access to health care services for veterans. Our goal is to provide the right care, at the right time and at the right level required to safely and compassionately meet the unique needs of each veteran.

In Network 1 we are proud of the many accomplishments that demonstrate our commitment to our mission of providing the veterans of New England excellence in health care, education and research. Network 1 has significant, longstanding affiliations with some of the most prominent medical schools in this Country, including Boston University, Brown, Dartmouth, Harvard, Tufts, Yale, Universities of Connecticut, Massachusetts and Vermont Medical Schools.  Research is another strong suit of Network 1.  VA research funding was over $34 million last year, one of the highest among Networks. 

Network 1 has transformed its health care delivery system through a primary care- based service line delivery system that has resulted in outstanding health care achievements.  Service lines enhance the provision of uniform, high quality services throughout the Network by reducing variations in care and by standardizing availability, coordination and outcomes of services. This allows for improved management of patients along a seamless continuum of care.  Our system is organized around five core clinical service lines: Primary Care; Mental Health and Behavioral Sciences; Specialty and Acute Care; Spinal Cord Injury and Disorders; and Geriatrics and Long-Term Care.  Implementing the primary care-based health care delivery system has resulted in improved continuity, improved outcomes, and improved satisfaction while there was an increase in the number of patients served. The transition from a hospital-based system to one that is outpatient-based has facilitated veteran’s access to care, such that 97% of our veterans are now within 30 miles of VA care.

The new emphasis on community-based programs has resulted in an expansion of programs such as community-based outpatient clinics and home-based primary care.  New technologies such as telemedicine and telehealth are also expanding access to care for patients. VA Connecticut was the first in the Network to expand home care using home telehealth technology and care coordination.

All eight VA medical centers are using the computerized patient medical record.  This enhances the safe delivery of care through computerized physician order entry.  This state-of-the-art information technology allows clinicians anywhere in the VA New England Healthcare System to access the electronic medical record for any nationally enrolled patient.  These systems foster communication, coordination, and consultation among physicians throughout New England.  Network 1’s Internet/Intranet sites also facilitate access to information.

In addition, VA now receives medical information on military retirees via the electronic medical record system that VA and the Department of Defense (DoD) are developing.  VA and DoD will be able to share all medical information between departments on all retirees and veterans by 2005.

The VA New England Healthcare System integrates and emphasizes customer feedback to assure that value is added for patients and other stakeholders.  Feedback from patients is one of the most significant measures of quality.  On quality of care measures, Network 1 has demonstrated progressive and consistent improvement in the areas of disease prevention, the management of chronic disease, and use of nationally accepted clinical practice guidelines.

We have achieved success in significantly enhancing access to care by decreasing waits and delays for clinic appointments as a part of the Advanced Clinic Access initiative.  Over the last year, we have decreased our wait list by 83 percent.  We are proud of Network 1’s accomplishments and are aggressively spreading lessons learned to include clinics Network-wide. 

On May 7, 2004, Secretary of Veterans Affairs Anthony J. Principi announced his decision about the National Capital Asset Realignment for Enhanced Services (CARES) Plan. I am pleased that the Secretary’s decision on the CARES Plan will provide even greater access to care for the veterans of New England. The Plan provides the outline for modernizing and expanding health care, and bringing greater quality of care closer to where most New England veterans live. This is particularly important since the average age of our infrastructure in New England is 64 years old. The National CARES Plan includes the following recommendations for New England:

• VISN 1 will undertake a comprehensive study of the feasibility of

consolidating its existing four Boston area medical centers into one state-of-the-art tertiary care facility that will act as a referral center for VA health care for the greater Boston area. The study will consider the best location for existing functions at the West Roxbury, Jamaica Plains, and Brockton campuses of the Boston VA Healthcare System and the Bedford VA medical center.

• Increasing inpatient medicine demand in the VISN will be met by

expansion of inpatient facilities and utilization of existing authority for community contracts where necessary for care. The CARES Plan provides for an expansion of inpatient services at VA Connecticut Healthcare System’s West Haven campus and an expansion of inpatient services in Rhode Island at the Providence VAMC.   A major construction project at Connecticut will include the renovation of medicine, surgery, and nursing units.

• Additionally, the CARES Plan will increase primary care access

across the Network by expanding existing community based outpatient clinics, using existing authority to negotiate new contract care in the communities where needed, expanding telemedicine, and establishing a new CBOC in Cumberland County, Maine.

• The CARES Plan provides for the enhancement of inpatient and

outpatient spinal cord injury services.

• Hartford VA Regional Office will collocate a benefits administration

   office at the Newington VAMC.

Medical Center Perspective

      I am proud of the quality of care demonstrated by the VA Connecticut Health care System. This is exemplified by their performance outcomes, customer satisfaction, and the many Centers of Excellence, including Ambulatory Care, the Eastern Blind Rehabilitation Center, Rehabilitation Research Center, Renal Dialysis, and Seriously Mentally Ill.

      Also, VHA and Network 1 have successfully begun operation of new Community Based Outpatient Clinics in Danbury, New London, Stamford, Waterbury, Windham and Winsted.   Mr. Johnson will provide you with more information on a few of the many successful local initiatives.

Conclusion

Thank you for the opportunity to discuss the achievements and challenges of VHA at the National, Network and local level.  This concludes my opening statement and I, along with my colleagues, will be pleased to answer any questions you or the members of the committee may have.