1. Welcome To care for him who shall have borne the battle and his widow and orphan. Abraham Lincoln Governors Task Force 5 June, 2008 Jack Heims, MSW, FACHE VHA – Oregon Medical Services Portland VAMC Main Campus

2. Our Organization VHA – Oregon Medical Services The Department of Veterans Affairs is comprised of Veterans Benefits Administration – provides compensation and pension, education, life insurance, loan guaranty, & vocational rehabilitation & employment National Cemetery Service – provides burial services to veterans and their spouses Veterans Health Administration – provides medical, surgical, mental health & long term care services to veterans Note: Military hospitals for active duty personnel are part of the Department of Defense, for example - Walter Reed

3. OUR MISSION Honor Americas veterans by providing exceptional health care that improves their health and well-being. OUR VISION To be a patient-centered integrated health care organization for veterans providing excellent health care, research, and education; an organization where people choose to work; an active community partner; and a back-up for National emergencies. VHA Roseburg Facility OUR VALUES Trust, Respect, Excellence, Compassion, Commitment

4. WHO WE ARE VHA – Oregon Medical Services The Veterans Health Administration (VHA) is divided into 22 Veterans Integrated Service Networks (VISN's) The Oregon Facilities are part of VA Northwest Network VISN 20, which is comprised of the largest geographical land mass of any VISN within the Department of Veterans Affairs

5. VHA – Oregon Medical Services Portland VAMC Main Facility PORTLAND VA MEDICAL CENTER 149 inpatient & 72 nursing home beds Referral Center Full Continuum of Care Acute Medicine, Surgery, Psychiatry, Neurology, Rehabilitation, Emergency, Primary, Specialty, Transplant, Ophthalmology, Optometry, Cardiology, Endocrinology, Rheumatology, Geriatrics, Hemodialysis, Endoscopy, Chemotherapy, ENT, Orthopedics, Podiatry, General Surgery, Urology, Dental, Psychology, PTSD, Substance Abuse, Opioid Substitution,, Nuclear Medicine, Imaging, Path & Lab, Audiology, etc. Support VISN 20, Willamette National Cemetery, and two Vet Centers

6. VANCOUVER FACILITY VHA – Oregon Medical Services The Vancouver campus includes a 72-bed Nursing Skilled Care Unit/Comprehensive Rehabilitation Unit, Primary Care Clinic, Mental Health Clinic, Substance Abuse Treatment, Dental, Prosthetics, Community Nursing Home, Home and Community Based Care, Transitional Lodging Unit, Transplant Lodging Unit, Telephone Care, Warehouse, Laundry and VISN 20 Administrative Offices. A Single Room Occupancy Enhanced-Use Lease (EUL) exists on the campus along with the Clark County Center for Community Health (EUL)

7. Roseburg VA Medical Center & Southern Oregon Rehabilitation Center & Clinics VHA – Oregon Medical Services Roseburg VA Medical Center Inpt PTSD, SA Not all Specialties surgical capabilities Primary MH and Primary Care SORCC (White City) Primarily Rehab with 425 Beds Primary MH and Primary Care

8. Additional Medical Care Coverage provided by Community Based Outpatient Clinics VHA – Oregon Medical Services FT Current CBOCs Bandon Bend (expanded) Brookings Eugene (expanded) Klamath Falls Ontario Portland East Salem Warrenton Planned FT or PT Clinics West Portland (12/08) Burns Grants Pass The Dalles (9/08) Lincoln County (FY09) Ore City Area (FY09) Bandon Relocate to North Bend

9. FY07 OREGON VITAL STATISTICS Veterans Served100,157 Veteran Pop.305,387 Outpatient Visits837,410 Budget$427 m Staff3653 Hospital Beds 237 NH Beds127 Dom Beds472 Total Beds836 Portland VA Medical CenterVHA – Oregon Medical Services

10. RESEARCH VHA – Oregon Medical Services 151 Active Research Investigators Research and Education Foundation NW VA Cancer Research Center National Center For Rehabilitative Auditory Research (NCRAR) Mental Illness Research Education & Clinical Center (MIRECC) Parkinsons Disease Research, Education & Clinical Center (PADRECC) Alcohol Research Center MS Center of Excellence NW Hepatitis C Center of Excellence Methamphetamine Research Center Center for the Study of Chronic, Comorbid Mental, and Physical Disorders Agency for Healthcare Research and Quality (AHRG) Decision & Science Center

11. EDUCATION VHA – Oregon Medical Services Primary academic affiliate is Oregon Health & Science University 138 affiliation agreements with 55 educational institutions 133.93 funded house officers in 33 different specialties

12. OREGON VETERAN POPULATION BY COUNTY VHA – Oregon Medical Services

13. EXAMPLE OF ACCESS & GROWTH VHA – Oregon Medical Services

14. OIF/OEF VETERANS VHA – Oregon Medical Services 48% are Active Duty, 52% are Reserve/National Guard 88% are men, 12% are women 65% Army; 12% Air Force; 12% Navy; 12% Marine 34% were deployed multiple times 52%, largest age group, is 20-29 years old 69% of those who filed disability claims received service-connected disability compensation award As of March 2008, Oregon Facilities have enrolled approximately 5000 OIF/OEF veterans

15. OIF/OEF VETERANS VHA – Oregon Medical Services Veterans Tracking Application, March 5, 2008

16. NATIVE AMERICAN PARTNERSHIPS VHA – Oregon Medical Services Continued sponsorship of Camp Chaparral, now in its 14 th year Provision of VA staff to tribal clinics to assist with Post Traumatic Stress Disorder issues, to include training over 200 attendees Development of MOUs in Portland and Walla Walla to provide a mechanism for specialty care referrals and prescription support Provision of technical assistance in the development of electronic medical records at Warm Springs

17. Eligibility, Co-Pays, Fee, CHAMPVA VHA – Oregon Medical Services Eight levels of eligibility (See Handout) Co-Pays depending on priority levels, Income, Special Programs and can be waived in certain circumstances (See Handout) Generally Fee Cards allow, in certain cases, for veterans to access non-VA services in rural parts of the state. These are on decline due to efforts to bring care closer to where veterans live Sometimes we contract (purchase) specialty care in the community when our ability to meet demand outstrips our supply CHAMPVA for spouses and Dependents, Few Oregon providers accept it. (See Handout)

18. OUT OF NETWORK CARE VHA – Oregon Medical Services VA may authorize payment of emergent inpatient care at non- VA facilities only when certain criteria is met. Care must be: For emergent treatment of a service connected disability For emergent treatment for any condition for a veteran rated permanently and totally disabled by VA regional office For female veterans if notified within 72 hours, and A few other conditions

19. OUT OF NETWORK CARE VHA – Oregon Medical Services If neither of these criteria are met, VA may consider inpatient claims for payment if the following is met: Veteran is enrolled in VA healthcare and has received treatment at a VA within the past 24 months VA is notified within 90 days of the admission Veteran has no other insurance Under these conditions, payment is made only until medically stable. Each case is reviewed based on eligibility and medical documentation and can be appealed. If the veteran has other insurance, then VA does not pay

20. SUMMARY Meeting the physical and emotional needs of all our Veterans is a complex undertaking Oregon Facilities have and are continuing to improve access and meet unprecedented growth OEF/OIF Veterans are increasing, bringing New challenges such as TBI VHA – Oregon Medical Services

21. THANK YOU For Your Service to Our Veterans VHA – Oregon Medical Services