1. 377 MDG/NMVAHCS: Joint Venture Review 2010 VA/DoD Joint Venture Conference New Mexico VA Health Care System 377 th Medical Group, Kirtland AFB Albuquerque, NM NMVAHCS Associate Director: Ms. Kaye Green NMVAHCS Joint Venture Director: Ms. Donna Saffioti 377 Medical Group Commander: Col Steven Reese 377 Medical Group Joint Venture Director: Ms. Patricia Ospino

2. 377 MDG/NMVAHCS: Joint Venture Review 2 New Initiatives – Projects Closed IDENTIFY ALL NEW INITIATIVES OVER THE PAST YEAR: 1. ENT referrals are sent directly to VA ENT clinic vs. being sent to VA Managed Care Office. Results: Increase in referrals and increase in timely access to care. 2. NMVAHCS/377 MDG JIF 2010 Project Approved: VA Emergency Department Phase 2 Renovation. $783,262. 3. Development of NMVAHCS/377 MDG Ambulatory Surgery Unit Sharing Agreement (Air Force space renovation cost of $2.5M). 4. Renovation of Joint Decontamination Team operations area. Now primary space to use during real world and exercise contingencies. 5. NMVAHCS/377 MDG JIF 2011 Sleep Study Lab proposal submitted in June 2010, $4.9M. IDENTIFY ANY PROJECTS OR EFFORTS THAT WERE CLOSED OR FAILED IN THE LAST YEAR: 1. Referrals to VA for Ultrasound. All AF patients requiring ultra sounds are now referred to the network. 2. AF Audiology patients referred to the Network for hearing aid fittings.

3. 377 MDG/NMVAHCS: Joint Venture Review 3 NMVAHCS DECON AREA BEFORE AND AFTER SPACE RENOVATION BEFORE RENOVATION: NON-AMBULATORY DECON SHOWER AREA AFTER RENOVATION: NON-AMBULATORY DECON SHOWER AREA

4. 377 MDG/NMVAHCS: Joint Venture Review 4 POST RENOVATION: POST-DECONTAMINATION CLEAN AREA POST RENOVATION: TEAM DRESSING AREA

5. 377 MDG/NMVAHCS: Joint Venture Review 5 Joint Venture Performance Measures PMs USED TO TRACK JV SUCCESS: 1. 377 MDG quarterly expenditures to the NMVAHCS. 2. 377 MDG quarterly encounters at the NMVAHCS. 3. Quarterly Joint Venture Working Group (JVWG). 4. Quarterly Joint Executive Committee (JEC). DATA SOURCES USED FOR THE PMs: 1. 377 MDG Resource Management Office billing received from NMVAHCS for services. 2. 377 MDG Resource Management Office billing received from NMVAHCS for services. 3. JVWG Core Members and Subject Matter Experts. 4. JEC Core Members and JVWG Minutes. OUTCOMES FOR EACH PM LISTED: 1. Helps determine if a need exists for requesting additional funding for Joint Venture Clinical services 2. Identifies specific areas of change in Joint Venture Sharing. 3. Creation of sub working groups and tracking/closing of JVWG minute items. 4. Items referred to JVWG and tracking/closing of JEC minute items. Slides 7 - 10 represent Performance Measures for items 1 & 2

6. 377 MDG/NMVAHCS: Joint Venture Review 6 377 MDG expenditures paid to VA

7. 377 MDG/NMVAHCS: Joint Venture Review 7 Data includes Inpatient admissions, Outpatient visits, Lab tests, Imaging studies, Ed Visits not resulting in Admission and ASU procedures. 377 MDG encounters at the NMVAHCS

8. 377 MDG/NMVAHCS: Joint Venture Review 8 FY 2010 MEDICAL GROUP CLINICAL ENCOUNTERS AT THE NMVAHCS

9. 377 MDG/NMVAHCS: Joint Venture Review 9 FY2010 MDG Laboratory and Imaging studies performed at the VA

10. 377 MDG/NMVAHCS: Joint Venture Review 10 Access to Military Installation Procedures REQUIRED ACCESS PROCESS and POLICIES FOR VA BENEFICIARIES and/or EMPLOYEES TYPE OF VISITOR ID BADGE* PRIOR COORDINATION VA APPOINTMENT DOCUMENTATION / VERIFICATION VISITOR CENTER VA EMPLOYEE DVAY N Y VA PATIENT N/A N N N VA PATIENT ESCORT N/AN N N VA PATIENT VISITOR N/A N N N * Enter Type of ID Required: ( DoD, DVA, GOVT, State, Post or Base)

11. 377 MDG/NMVAHCS: Joint Venture Review 11 Access to Care and Referral Management ISSUES RELATED TO ACCESS TO CARE & REFERRAL MANAGEMENT: 1. VA has limited excess capacity for 377 MDG patients. 2. VA’s timeline to appointment in 7 days conflicted with Joint Policy Letter (JPL) to appointment in 4 days. 3. VA Managed Care Office review added to delay in accepting/rejecting referral. RESOLUTIONS TO ISSUES RELATED TO ACCESS TO CARE & REFERRAL MANAGEMENT: 1. VA continues to receive/process referrals based on capacity for ENT and Podiatry and will consider other referrals for specialty services based on capacity. 2. Revised JPL to ensure VA accepts/rejects referrals within 4 days and if accepted, schedules an appointment within 7 days. 3. Pilot project in ENT with MTF contacting clinic directly. Reduced referral processing time, increased the number of patients the 377 MDG can refer to the VA. The ENT pilot was so successful that it has now been expanded to Podiatry.

12. 377 MDG/NMVAHCS: Joint Venture Review 12 Future Initiatives and/or Proposals NEAR TERM (1-2 YEARS) INITIATIVES: 1. VA to perform surgical procedures in 377 MDG Ambulatory Surgery Unit space beginning January 2011. 2. 377 MDG to refer all Oral surgery patients to the VA Oral Surgeon beginning January 2011. 3. Pilot for AF Podiatry in progress. If successful referrals to be sent directly to VA Podiatry Clinic. 4. 2011 JIF proposal – Renovation of space to construct 8 bed Sleep Study Laboratory. Projected expense $4.9M LONG TERM (>2 YEARS) GOALS / INITIATIVES / STRATEGIES: 1. 377 MDG Oral Surgery space – Possibility exists for the VA to use 377 MDG Oral Surgery space. 2. Disability Evaluation System – Possibility exists for the VA to use 377 MDG space to perform examinations.

13. 377 MDG/NMVAHCS: Joint Venture Review Solar Covered Parking Project: –Project dates: Awarded in May 2010 “Notice to Proceed” given July 2010 Expected completion is March 2011 –Total cost: VA & MDG Total cost is $19,040,424. MDG parking lot portion of that is $4,987,769. –Energy supplied back to VA Projected is expected to generate over 4.9 million kilowatt hours, which is over 20% of VA’s annual electricity usage 13 Additional Information

14. 377 MDG/NMVAHCS: Joint Venture Review 14 Solar Covered Parking Project