1. Installation Name: Joint Venture Review 2011 VA/DoD Joint Venture Conference Mike O’Callaghan Federal Hospital Briefing

2. VA Southern NV Healthcare System & 99 MDG (Nellis AFB) Agreement: Agreement allows the VA an inpatient presence in the Las Vegas Valley and provides VA/AF integrated services in Emergency Dept, ICU, SDU, OR, PACU, Dietary, and ancillaries. AF bills VA for services provided to VA patients; in turn, VA bills AF for services rendered by VA to DoD patients. Baseline and Current Status: Baseline is VA admits 300-350 patients per month to the MOFH. VA patients overflow to the AF unit to avoid admissions in the network and a new initiative is AF admits VA patients to the AF unit; whereas before, VA would admit to the AF unit. Quantitative Results from the Agreement: Cost avoidance over time will be achieved when, on days the VA ward is full, AF admits of VA patients will equate to savings. With a “preferred provider” rate, the VA will realize tremendous savings. VA data show, on average, there are 31 admits/day in the network; so, results of this initiative are expected to be favorable. Tracking will begin in Oct 11. Qualitative Value of the Agreement: Non-quantitative values include meeting more of the healthcare needs of VA and DoD populations and reducing private sector care costs. Wartime readiness clinical currency requirements of AF specialists will continue to provide excess capacity to the VA. AF leadership is focused on making specialty capacity stable and predictable to VA while meeting ongoing deployment requirements. Services Provided: Integrated services at Mike O’Callaghan Federal Hospital (MOFH)

3. Installation Name: Joint Venture Review Joint Venture Performance Measures PMs USED TO TRACK JV SUCCESS: 1. Average Daily Census (ADC) of VA patients admitted to AF unit 2. Customer Satisfaction 3. ORYX/HEDIS 4. IDES metrics 5. Patient Safety DATA SOURCES USED FOR THE PMs: 1. Utilization (ADC >34 patients at the MOFH) 2. SDA & Customer Service Cards 3. CHCS/ESSENTRIS/CPRS External Audits 4. VA/DOD Veterans Tracking Application ( VTA ) 5. Audits OUTCOMES FOR EACH PM LISTED: 1. Due to start monitoring Nov 2011 when AF begins admitting VA patients to the AF ward in Oct 11 2. Exceed standard (>95%) 3. Exceed on many; progress being made on exceptions 4. Standard is 295 days (standard not met, yet improvements underway) 5. DoD Award for Pt Safety, 2009, 2010 VA National Center for Pt Safety Cornerstone Recognition Award, Silver Level 3

4. Installation Name: Joint Venture Review Future Initiatives and/or Proposals NEAR TERM (1-2 YEARS) INITIATIVES: 1. VAMC’s move to new facility—allows partnership to grow—100K enrollees (VA/DoD)/more capabilities to reduce private sector costs 2. Implementation of the NEW Master Sharing Agreement for 2012 and beyond 3. Cath Lab JIF (FY09) Stand-Up—first patient 13 Oct 2011 4. VA will open four, new Primary Care Clinics 5. Committed to VA/AF Collocating in Primary Care Clinics, at two sites 6. Implementation of the outpatient Sharing Agreement based on space availability 7. Implement Transfer Center to direct downtown ED cases to either MOFH or new VAMC LONG TERM (>2 YEARS) GOALS / INITIATIVES / STRATEGIES: 1. Capitalize on Cardiac Cath/Vascular Lab Capabilities and establish Cardiothoracic Surgery at MOFH 2. Submit JIF (2012 submission) for Linear Accelerator at new VAMC 3. Advance Population Health/Wellness/Healing Arts initiatives for joint populations 4. Seek ER Residency, Internal Medicine Residency, Surgical Residency GME 5. Renovate MOFH to support future capabilities as a medical center to further support VA/DoD partnership 4

5. Installation Name: Joint Venture Review Best Practices – Lessons Learned Best Practices: Multidisciplinary Team Rounds for Patient Safety TeamSTEPPS/Med Teams Streamlined security access for VA patients to AF facility MRSA Program Lessons Learned: 1. Early detection of MRSA reduces length of stay and minimizes internal nosocomial infection 2. Active monitoring of fall patients, reduces potential sentinel events and misadventures for patients with histories of falls 3. Use of patient lift system, minimizes patient and staff injuries associated with patients being transferred 5

6. Installation Name: Joint Venture Review 1. Cross train medical staffs and getting AF providers credentialed using VetPro. 2. 99 MDG focus is on making specialty capacity stable and predictable to VA while meeting ongoing deployment requirements. Current Challenges (other than IM/IT) 6