What’s up with the VA?
Stephen Chensue, M.D. Ph.D.
Chief, Pathology and Laboratory Medicine
VA Ann Arbor Healthcare System
A Little Background
• The origin of the VA dates to the first federal
military veterans hospital (Hand Hospital) in
Pittsburgh in 1778
• VA mission was formalized by Abraham Lincoln in
pledge made to America's Civil War veterans
during his Second Inaugural Address, in 1865
"To care for him who shall have borne the battle
and for his widow and his orphan.“
• 1930 established as Veterans Administration
• Distinct from the Department of Defense system
of hospitals i.e. Walter Reed Hospital etc.
Department of Veteran Affairs
Cabinet level department since 1989
Currently under Secretary Eric Shinseki
2009 Budget $87 billion
Department of Veteran Affairs
Administrative Divisions
VBA
VHA
NCA
Benefits
education,
disability
etc.
Healthcare
physical and
mental
Cemetery
burial
services
Veterans Health Administration
•
•
•
•
Largest integrated healthcare system in nation
171 hub hospitals (many University affiliated)
350 community-based outpatient clinics (CBOCs)
Due to its politically sensitive nature it is subject
to intense scrutiny and oversight
• Healthcare quality and efficacy is based on
defined patient outcome metrics
• A RAND Corporation study in 2004 concluded
that the VHA outperforms all other sectors of
American health care in 294 measures of quality
VHA Electronic Record System
• VHA was first to spearhead nationally
integrated digital patient records known as
CPRS ”computerized patient record system”
• Currently a VA patient can be seen at one or
multiple VA hospitals in the nation and their
complete records are available through web
Veterans Integrated Service Networks
(VISNs)
VISN 11
8 Medical Center Hubs
North Tier
1.
2.
3.
4.
Aleda E. Lutz VA Medical Center (Saginaw, MI)
Battle Creek VA Medical Center (Battle Creek, MI)
John D. Dingell VA Medical Center (Detroit, MI)
VA Ann Arbor Healthcare System (Ann Arbor, MI)
5.
6.
7.
8.
South Tier
Richard L. Roudebush VA Medical Center (Indianapolis, IN)
VA Illiana Health Care System (Danville, IL)
VA Northern Indiana Health Care System - Marion Campus (Marion, IN)
VA Northern Indiana Health Care System-Fort Wayne Campus (Fort Wayne, IN)
+ 22 Community Outpatient Clinics
VA Ann Arbor Healthcare System
Clinical Addition Opened 1999
VA Ann Arbor Healthcare System
POC testing
9K outpt
POC testing
Jackson
CBOC
Flint
CBOC
8K outpt
VA Ann Arbor
Main Laboratory
4 pathologists
45 technical
12 phlebotomists
390K outpt
5.2K inpt
64K outpt
Toledo
CBOC
Toledo Laboratory
3.5 technical
1 phlebotomist
VA Ann Arbor Healthcare Pathology and
Laboratory Medicine Service (PALMS)
• CAP accredited laboratory responsible for
laboratory and point-of- care testing activities at
the Ann Arbor campus as well as Toledo, Flint
and Jackson outpatient clinics.
• Provides all anatomic pathology services for
both Ann Arbor and Battle Creek hubs.
• Provides Veteran Women’s Health services: PAP
and GYN pathology for entire VISN 11 northern
tier
Laboratory Activity
Clinical Pathology
•2,372,295 clinical pathology tests Ann Arbor site FY09
•204,374 clinical pathology tests Toledo site FY09
Clinical Pathology
Clinical Pathology Workload
2500000
2000000
1500000
1000000
500000
0
2002
2003
2004
2005
2006
2007
2008
2009
Anatomic Pathology
Anatomic Pathology Workload
Surgical Pathology
Case Accessions
Number
Acccessions
10000
6000
4000
2000
0
Year
900
800
700
600
500
400
300
200
100
0
Acccessions
12000
8000
Cytology
Case Accessions
Frozen Sections
Year
5000
4500
4000
3500
3000
2500
2000
1500
1000
500
0
Year
No Net Increase in Employees
Programmable Rapid Processors
Ergonomic Grossing Station
Automated
Stainer-Coverslipper
State-of-Art Cryostats
VA Physician Pay Bill 2004
• Implementation 2006
• VA Physician Pay-Three Components
1. Base Pay: set amount based on years of service
2. Market Pay: supplement to match local market
pay rate
3. Performance Pay: optional bonus component
based on achieving designated performance
goals and outcomes
VAAAHS Pathologist Performance Criteria
1. Completion of 7000 RVU annually (MGMA)
2. Surgical Report turn-around-time
3. Non-Gyn Cytology Report turn-around-time
4. Autopsy Report turn-around-time
5. Frozen Section turn-around-time
6. Cancer template usage (report quality)
7. Documented consultation
8. Peer review major discrepancy
9. Random peer review complete concordance
10. Frozen section concordance
11. External review and QA testing rating
12. Lab or hospital improvement initiative
>95% within 48 hrs
>95% within 48 hrs
100% within 30 days
>95% within 20 min or less
100% of cancer resections
100% of external consults
<0.1% discrepant
>90% agreement
>95% of cases
fully satisfactory
one project/yr
Future VA Laboratory Challenges
• Continuing volume increases with aging of
Vietnam era and disabled OIF/OEF veterans
• Aging medical technologist staff
• Compliance with mounting regulatory and
documentation demands
• Demand to provide high cost diagnostic
services vis-à-vis impending budgetary cuts
Go “Shoelace”!
From Florida With Love