1. Naval Branch Health Clinic & VA Outpatient Clinic Key West 2011 VA/DoD Joint Venture Conference Naval Branch Health Clinic Key West & VA Outpatient Clinic Key West

2. Naval Branch Health Clinic & VA Outpatient Clinic Key West 2

3. Naval Branch Health Clinic & VA Outpatient Clinic Key West 3 NAVAL BRANCH HEALTH CLINIC KEY WEST Service provided: Pharmacy Prescription Fill and Dispensing Agreement: Reimbursement for packaging and processing in house is cost plus $8.00 and is cost plus $2.00 for Centralized Mail Order Pharmacy processing. Baseline and Current Status: 2009, 2010, and 2011 Quantitative Results from the Agreement: Revenue generated Qualitative Value of the Agreement: New prescriptions for VA patients are filled at the DoD pharmacy in house providing safe, efficient, and convenient service to our patients. Staff consists of one pharmacist and four technicians.

4. Naval Branch Health Clinic & VA Outpatient Clinic Key West 4

5. Naval Branch Health Clinic & VA Outpatient Clinic Key West 5 NAVAL BRANCH HEALTH CLINIC KEY WEST Service provided: Utilities (includes housekeeping, pest control and biohazard disposal) Agreement: Utilities and housekeeping are reimbursed to the DoD at 10% of total costs for the building. This amount billed is based on the square footage of the building used for the Veteran’s Administration. Baseline and Current Status: 2009, 2010, 2011 Quantitative Results from the Agreement: Revenue generated Qualitative Value of the Agreement: There is no separate system to measure utility usage, or housekeeping, telephone, bio-hazardous waste, and pest control services.

6. Naval Branch Health Clinic & VA Outpatient Clinic Key West 6

7. Naval Branch Health Clinic & VA Outpatient Clinic Key West 7 NAVAL BRANCH HEALTH CLINIC KEY WEST Service provided: Laboratory Services Agreement: NBHC provides phlebotomy, specimen processing, and packaging for transfer. Baseline and Current Status: 2009, 2010, 2011 Quantitative Results from the Agreement: Revenue generated Qualitative Value of the Agreement: NBHC is currently billeted for two laboratory technicians. In house services include: complete CBC with differential, urinalysis, wet prep, KOH, rapid strep, mono, HCG blood and urine, influenza, and hemoccults at 90% of CMAC rate for Miami. A VA courier picks up laboratory tests that cannot be performed at NBHC and transports them to the VA in Miami for processing. In 2011, 45% of 25,182 specimens were VA.

8. Naval Branch Health Clinic & VA Outpatient Clinic Key West 8

9. Naval Branch Health Clinic & VA Outpatient Clinic Key West 9 NAVAL BRANCH HEALTH CLINIC KEY WEST Service provided: Radiology Agreement: NBHC provides X-ray services at 90% of the CMAC rate for Miami. Baseline and Current Status: 2009, 2010, 2011 Quantitative Results from the Agreement: Revenue generated Qualitative Value of the Agreement: NBHC Key West received a digital radiography machine ten months ago improving efficiency and accuracy for the technicians and the radiologists who read the films electronically at Naval Hospital Jacksonville. Approximately 48% of patients seen are VA and an average of 300 x-rays per month are completed. Staff consists of three x-ray technicians.

10. Naval Branch Health Clinic & VA Outpatient Clinic Key West 10

11. Naval Branch Health Clinic & VA Outpatient Clinic Key West 11 VETERAN’S OUTPATIENT CLINIC KEY WEST Service provided: Mental Health Agreement: provided by the VA at the TRICARE allowable amount Baseline and Current Status: An average of five active duty evaluations per month Qualitative Value of the Agreement: Medication management, fitness-for-duty evaluations, and physician exchange with DoD providers.

12. Naval Branch Health Clinic & VA Outpatient Clinic Key West 12 VETERAN’S OUTPATIENT CLINIC KEY WEST Service provided: Physical Therapy Agreement: provided by the VA at the TRICARE allowable amount. Quantitative Results from the Agreement: Limited DoD patients are seen. Qualitative Value of the Agreement: Convenience, familiarity, interdisciplinary approach.

13. Naval Branch Health Clinic & VA Outpatient Clinic Key West 13 Joint Venture Performance Measures PMs USED TO TRACK JV SUCCESS: Annual Revenue Generated: 2010, 2011 (TBD) Access to Care and Missed Opportunities: 2010, 2011 DATA SOURCES USED FOR THE PMs: Reimbursable Amounts to the VA and DoD Rates for Psychiatry OUTCOMES FOR EACH PM LISTED: FY 2010  $1,346,354 - DVAMC - Miami  $ 194,161 - Key West  97% and 12% FY 2011  $TBD DVAMC - Miami  $TBD - Key West  97% and 15%

14. Naval Branch Health Clinic & VA Outpatient Clinic Key West 14 Future Initiatives and/or Proposals NEAR TERM (1-2 YEARS) INITIATIVES Advertise optometry services for comprehensive vision examinations. Propose amending sharing agreement if VA hires additional employees.  Will require additional office space and/or exam rooms. LONG TERM (>2 YEARS) GOALS / INITIATIVES / STRATEGIES Use DoD/VA Joint Venture Key West as a model for future sites. Increase access to care for Physical Therapy.

15. Naval Branch Health Clinic & VA Outpatient Clinic Key West 15 Best Practices – Lessons Learned BEST PRACTICES Emergency Preparedness: Hurricane, Anti-Terrorism, CBRN Life Safety Drills Disruptive Patient Management Training Face to Face Interdisciplinary Team Approach LESSONS LEARNED VA must have CHCS access to order lab tests, x-rays, and pharmaceuticals.

16. Naval Branch Health Clinic & VA Outpatient Clinic Key West 16 Current Issues CURRENT ISSUES Separate standards for Audiology/Spirometry testing Physical Therapy space and resources are limited. AHLTA does not communicate with VA VISTA/CPRS Funding approved funds for building maintenance