Atlanta VA Medical Center Access and Wait Times July 2,

VETERANS HEALTH ADMINISTRATION Access and Wait Times 2 Types of Data – Prospective – predicts the average wait time for new and established patients – Retrospective – actual average wait times for a specific month As of June 1, 2014 the following are the Atlanta VAMC’s prospective wait times (number of days): 2 New Pt PC Avg Wait Time Established Pt PC Avg Wait Time New Pt SC Avg Wait Time Established Pt SC Avg Wait Time New Pt MH Avg Wait Time Established Pt MH Avg Wait Time

VETERANS HEALTH ADMINISTRATION Access and Wait Times Retrospective data (number of days) Urgent/emergent cases receive same-day health care 3 New PC Pt Avg Wait Time New SC Pt Avg Wait Time New MH Pt Avg Wait Time April May

VETERANS HEALTH ADMINISTRATION Scope and Complexity Atlanta VA Medical Center is one of the largest and fastest growing in the nation FY13 – provided care for more than 90,000 Veterans – 1.1 million outpatient appointments – 41,000 ER visits FY14 – projecting a 3% growth rate – Projecting 1.5 million outpatient visits 4

VETERANS HEALTH ADMINISTRATION Service Specific Actions to Improve Access Primary Care – New Patients: Increasing capacity for clinics. Saturday clinics from 8 a.m. – 4 p.m. for the Purple Team (located at the main medical center) and there are plans to have Saturday hours at Fort McPherson and Carrollton. Extended hours for appointments. The Gold Team (at the main medical center) and the Decatur Clinic offer appointments from 7:30 a.m. – 5:30 p.m. There are plans to extend these hours to Lawrenceville and Stockbridge clinics. – Established Patients: Can be seen within 2-4 weeks of desired date for routine follow up appointments. Can be seen the same day if the patient desires. Further improved access for established patients by increasing the efficiencies and communication in the clinics, extended hours and the possibility of adding more Patient Aligned Care Teams (PACT). 5

VETERANS HEALTH ADMINISTRATION Service Specific Actions to Improve Access Medical Specialty: – Pulmonary Clinic has expanded clinic hours for Pulmonary Function Tests during the evenings and every other Saturday. Dental: – Eligible Veterans who are not able to be scheduled in a timely manner are being referred to non-VA providers at VA expense. – In the process of hiring four additional dentists. – Opening dental clinics in Oakwood and Fort McPherson this summer. 6

VETERANS HEALTH ADMINISTRATION Service Specific Actions to Improve Access Geriatrics and Extended Care: – Contacting patients to remind them of their appointments and checking to see if they want to be seen earlier, keep their original appointments, cancel their appointments or use fee for service. – Neurology and Physical Medicine & Rehabilitative (PM&R) Services have on-going Saturday clinics for patients. The PM&R Service is scheduled out 90 days for new patients and sending patients to fee for service directly. These are scheduled outpatients who are not emergent. – Traumatic Brain Injury (TBI) Saturday clinic began on June 14, 2014 and is running every Saturday through August and will probably continue into the future. 7

VETERANS HEALTH ADMINISTRATION Service Specific Actions to Improve Access Ophthalmology: – Currently three Community Based Outpatient Clinics (CBOCs) are staffed with Optometry and Ophthalmology (Carrollton, Oakwood and Lawrenceville) services that are available Monday - Friday. – The Eye Clinic will be offering non-VA care at VA expense for Veterans through a new network of providers. – Adding Eye Tele Health clinics to more CBOCs. – Services are available Monday-Friday and every other Saturday. Emergency cases are handled directly from the emergency room 24/7 or as a walk-in during clinic hours. 8

VETERANS HEALTH ADMINISTRATION Service Specific Actions to Improve Access Surgery: – Hiring additional providers in Plastic Surgery, GYN, Orthopedics, Ear, Nose and Throat (ENT) and Urology. These positions are in various stages of hiring. The Plastic Surgery PA will start in July, the ENT physician is pending credentialing and the Urology PA is pending credentialing. – Scheduled appointments for some GYN patients with providers at Fort McPherson to decompress the main campus. Patients that live closer to Fort McPherson are targeted to have their care transferred to this location so that they are closer to home. – Ensuring that all available slots are booked and overbook at a rate equal to the missed opportunity rate. – Hiring 28 additional OR, PACU, Ambulatory Surgery and clinic nurses to increase capacity for surgeries. – Planning to build a ninth OR (hybrid room) to performs specialized vascular procedures. Cardiology will also be able to perform state of the art Trans Aortic Valve Replacement (TAVR) surgeries. – Providing schedulers additional training to ensure that skills and knowledge are current – Daily meetings with the clinic manager and Administrative Officer to ensure that capacity meets demand and that access is optimized. 9

VETERANS HEALTH ADMINISTRATION Enhanced Access - New Sites of Care Downtown Decatur building an outpatient clinic, which will provide Primary Care, Mental Health, Dermatology, Dental, Physical Medicine and Rehabilitation with an Integrated Pain Clinic, a Women's Center of Excellence, a Sleep Disorders Center, Laboratory, Radiology and Prosthetics Construction for additional Primary Care and Mental Health space at the medical center is underway. Awaiting congressional approval for the Cobb County CBOC, which is proposed to be a 64,000-square-foot multi-specialty outpatient clinic Seeking approval for three additional CBOCs in Newton, Pike and Pickens Counties Seeking funding to add additional levels on top of existing parking decks at the medical center to further increase our capacity by another 400 parking spaces. 10

VETERANS HEALTH ADMINISTRATION Advanced Clinic Access (ACA) Strategy 1: Shape the Demand – Work down the backlog – Reduce Demand Strategy 2: Match Supply and Demand – Understand supply and demand – Reduce appointment types – Plan for contingencies Strategy 3: Redesign the System to Increase Supply – Manage the constraint – Optimize the care team – Synchronize patient, provide and information – Predict and anticipate needs at time of appointment – Optimize rooms and equipment 11