Evaluation of the Lovell Federal Health Care Center Merger Findings, Conclusions, and Recommendations (2012) / Chapter Skim
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to create a national model for joint delivery of health care that is more accessible and less expensive than operating two federal medical centers serving overlapping beneficiaries in the same area. The creation of the Lovell FHCC also permits the VA to continue and even to expand inpatient services in North Chicago -- where the North Chicago Veterans Affairs Medical Center (NCVAMC)
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The Illinois congressional delegation, aware that the Navy was planning to build a replacement hospital, urged the DoD and the VA to combine their services in a state-of-theart federal health care center. Senator Richard Durbin later explained that the aim of the delegation was to keep the North Chicago VA Medical Cen ter open, improve options for medical care for the Navy, improve training options for VA and Navy medical personnel, reduce costs, and improve access to health care for veterans and Department of Defense beneficiaries.
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The 2005 decision to have an integrated federal health care facility also included approval for construction by the Navy of a 201,000-square-foot ambulatory care center (ACC) connected to the VA hospital building and expanded parking facilities and renovation of 45,000 square feet in the hospital building for outpatient clinics.
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It was not practical to integrate the clinical operations of branch clinics on the naval base serving enlisted recruits and students, although they were included as part of the FHCC. The law governing DoD/ VA health care sharing limits it to excess capacity on the part of one department or the other, which limits the number of clinics that can schedule 2 Patrick Sullivan has been the director of the North Chicago Veterans Affairs Medical Center since 2003 and was the associate director for the previous 6 years.
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This is part of the reason the FHCC has separate call centers and primary care clinics for VA and DoD beneficiaries, using the Veterans Health Information Systems and Technology Architecture (VistA) and the Armed Forces Health Longitudinal Technology Application (AHLTA)
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, or using both • Determining how to privilege independent duty hospital corpsmen and hospital corpsmen • Handling adverse events involving military personnel The approach taken to resolve most of these issues and many others involved a three-step process. The first step was for the appropriate task group to draft an executive decision memorandum (EDM)
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versus the National Agency Check with Inquiries -- although VA personnel were allowed a grace period of 1 year to undergo the ANACI investigation. Also, it was impossible to agree on a single computer access card, so military personnel use the DoD common access card and VA personnel use the VA personal identity verification card, each programmed to access the other's system.
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In addition, the legislation only applies to the FHCC as a 5-year demonstration project and cannot be used to establish other federal health care centers. 4 A separate bill was required in 2009 to name the North Chicago Federal Health Care Center after retired Navy Captain James A
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This hinders the Lovell FHCC's ability to efficiently provide safe and seamless care to DoD beneficiaries as they move from place to place within the FHCC. RESULTS The Lovell FHCC is unique among health care joint ventures in having a single command structure.
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of 10 to 15 percent because of the learning curve in using the new interoperability solutions, but interviewees indicated that the loss has been closer to 20 percent and was continuing. CONCLUSIONS The Institute of Medicine was asked to form a committee to evaluate the merger of a Navy MTF and a VAMC in North Chicago into a federal health care center in terms of its benefit to the DoD and the VA compared with maintaining separate VA and DoD facilities.
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They are (compared with operating separate VA and DoD health care centers in the same health care market) : more accessible health care, higher-quality health care (e.g., more preventive services and continuity and coordination of care)
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The lessons learned from the VA/DoD joint ventures reported at the annual joint venture conferences are also summarized in Chapter 5, and short profiles of the individual joint ventures and the lessons learned they have reported are in Appendix C, "Department of Veterans Affairs/ epartment of Defense Joint Ventures: Brief Histories and Lessons D Learned."
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The commanding officer of the RTC, who receives daily reports on recruits being seen at the west campus emergency room or admitted to the hospital, said that the FHCC was performing as well as the Naval Hospital/ Health Clinic Great Lakes had been, for example, in the percentage of recruits unable to go to their next assignment for medical reasons. The president of the affiliated medical school, the Rosalind Franklin University of Medicine and Science, had a positive view of the effect of the Lovell FHCC merger on medical education and training and on research opportunities because the merger has created a larger and more varied clinical staff and patient mix.
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RECOMMENDATION 1. Before establishing additional federal health care centers, the Department of Veterans Affairs and the Department of Defense should agree on a governance plan and common policies and procedures for joint health care delivery functions.
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RECOMMENDATION 2. Additional federal health care centers should not be implemented until an interoperable or joint Department of Defense/Department of Veterans Affairs electronic health record system becomes available.
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Conclusions To a large extent, the criteria should address the juncture at which FHCC lower operating costs or greater effectiveness are shown to outweigh the associated significant implementation costs (i.e., a single organizational structure and integrated administrative and clinical processes) enough for the FHCC structure to be regarded as preferable to a joint venture sharing arrangement and its comparative cost effectiveness.
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Only when firm cri teria based on cost savings and the expectation of enhanced health care service delivery are met should the concept of a future FHCC be considered. Analyze and Promulgate Lessons Learned from the Lovell Federal Health Care Center Experience Findings The leadership of the Lovell FHCC encountered numerous issues that had to be resolved to achieve an integrated organization and uniform policies and procedures.
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Lovell Federal Health Care Center merger experience, including both what and what not to do, and disseminate them through onsite consultation, webinars, technical assistance, and other means to other federal health care center sites considering joint ventures and related collaborative arrangements. Conduct a Comprehensive Evaluation of the Lovell Federal Health Care Center Demonstration Findings The Lovell FHCC has been in operation for less than 2 years and is still implementing parts of the integration plan.
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Lovell Federal Health Care Center merger and future collaborative arrange ments, the Department of Veterans Affairs and the Department of Defense should develop a comprehensive evaluation framework with defined and measurable criteria for assessing performance that take into account local and national contexts, organizational capabilities and readiness, implementation plans, intermediate outcomes, and likely long-term impact. Expand the Knowledge Base on Federal Health Care Collaborations Findings The DoD and the VA have not systematically analyzed the experience of the Lovell FHCC and the lessons that may be learned from it in considering if and where to establish additional integrated health care centers modeled after the Lovell FHCC merger.
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Lovell Federal Health Care Center IT informational brief. Pre sentation by the director of the DoD/VA Interagency Program Office to the Institute of Medicine Committee on Evaluation of the Lovell Federal Health Care Center Merger at its first meeting, Washington, DC, February 25.
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