Transcription
Task Force Subgroup Report:Sensory and PhysicalRehabilitation Services (SPRS)VA New Hampshire VISION 2025 Task ForceErik Sargent and Lauren RussellNovember 1, 20170
Membership Eileen Bayer, Speech(Maine) Ann Hogan, Audiology(Boston) Stephen Imbruno,Prosthetics (VISN 1) Kristine Incandella-Lucas,Audiology (Maine) Kelly Jarosz, Blind Rehab(CWM) Catherine Kelly, PhysicalTherapy (PT) (Boston) KatherineLangille,VETERANSHEALTH ADMINISTRATION Occupational Therapy (OT)(Boston)Lauren Russell, PresidentialManagement Fellow (PMF)(VISN 1)Erik Sargent, Lead/VISN 1SPRS Service Line Director(Maine)Nadene Stillings, Recreation(Bedford)Deidre Tukey, Pain (Maine)Randi Woodrow, AmputationCare (Boston)1
ProcessData reviewed: Monthly Management Report (MMR)Provider Profile – Summary of MeasuresService Line Subject Matter ExpertsVSSC Encounter CubeSite visits completed: September 12, 2017On-Site Staff Listening Sessions: September 22, 2017October 5, 2017October 10, 2017VETERANS HEALTH ADMINISTRATION2
ProcessManchester VAMC staff one-on-one listening sessions completed: Dr. Grigory Chernyak, AnesthesiologistMr. Paul Galante, Registered NurseDr. Ed Kois, PhysiatristMs. Patricia Kulhoff, Chief of ProstheticsMs. Abby LaRock, Occupational TherapistDr. Dan Plante, AudiologistDr. Tom Provost, AnesthesiologistDr. Claire Tenny, Chief of Mental HealthMs. Julie Vose, Occupational TherapistVETERANS HEALTH ADMINISTRATION3
ProcessOther resources considered: Blind Rehabilitation Center Program Procedures (Veterans Health Administration Handbook 1174.04; December 2,2009)Blind Rehabilitation Outpatient Specialist Program Procedures (Veterans Health Administration Handbook1174.01; February 19, 2016)Commission on Accreditation of Rehabilitation Facilities (CARF): Medical Rehabilitation Standards Manual (CARFInternational; July 1, 2017 – June 30, 2018)Denver VA Prosthetics/Orthotics Lab BlueprintErnest Bland and AssociatesNational Program Consultant / Melissa MorleyOutpatient Blind and Vision Rehabilitation Clinic Procedures (Veterans Health Administration Handbook 1174.05;July 1, 2011)Polytrauma System of Care (Veterans Health Administration Handbook 1172.01; March 20, 2013)Prosthetics and Sensory Aids Service (VA Space Planning Criteria (308); March 2008)SCIPSpinal Cord Injury and Disorders System of Care (Veterans Health Administration Directive 1176; October 1, 2010)Tampa Organizational ChartTampa Pain Clinic / Jen MurphyVeterans Health Administration Eye Care (Veterans Health Administration Handbook 1121.01; March 10, 2011)VISN I PH II Integrated Planning (Manchester Master Plan by Ernest Bland and Associates)VETERANS HEALTH ADMINISTRATION4
Sensory and PhysicalRehabilitation Services (SPRS)Background Informationto support Options and DiscussionVETERANS HEALTH ADMINISTRATION5
Functions/ServicesAudiologyBlind RehabilitationOutpatient, Comp and Pen, Hearing Tests, Hearing AidFitting/Checks, Advanced Diagnostics (OAE, ABR, ECoG, CAPD),Vestibular Diagnostics (VHIT, VNG, Rotary Chair), CochlearImplants, TRT, CLCEastern Blind Rehabilitation Center (Inpatient Rehab CARF), VisualImpairment Service Team (VIST), Blind Rehabilitation OutpatientSpecialistsSpeech-Language PathologyInpatient, Outpatient, CLC, Modified Barium Swallow Studies, VoiceTherapy including Transgender Voice Treatment, ALS Clinic,Polytrauma Clinic, Assistive Technology, Head and Neck CancerPhysical TherapyAcute Care, Outpatient, CLC, Home Care, PACT/COE, Bone andJoint Clinic, Wheelchair Clinic, ALS Clinic, Cancer Center, ParkinsonConsortium, Falls Prevention Committee, Pain Rehab School,Clinical Education, Pulmonary Rehab, Lymph Edema; assessmentsfor CHOICE program.Occupational TherapyAcute Care, Outpatient, CLC, Mental Health, SCI Clinic, StrokeClinic, Certified Hand Therapy, Clinical Education, HBPCPhysiatryIntegrative Pain Clinic, Ultrasound Guided Injections, FluoroscopicGuided Procedures, Spinal Cord Stim trails and implants, Pain MiniResidency, Residency Teaching (Rheum, Chiro, Anesthesia,Geriatrics), Acupuncture, ResearchPolytrauma/Traumatic Brain Injury (TBI)Chiropractic CareResidency Program, Acupuncture, ResearchAmputation System of CareTele Health, Peer Support, Brace ClinicWheel Chair ClinicHome Modifications, Stair Glides/Lifts, Adaptive Driving, Van Modifications,Advanced Seating, Environmental ControlsRecreational TherapyComplimentary Integrative MedicineCancer Center, MOVE, CLC-Adaptive Sports, Blind Center,Substance Abuse Day Program (SADP), Mental Health; Giant Steps,PTSD FIRM, CRP Community Reintegration Program, 8E InpatientPsych, Golden Age Games, Creative Arts, Northeast Passage GrantPilates, Yoga, BowenworkSpinal Cord InjuryVETERANS HEALTH ADMINISTRATIONInpatient Rehab (CARF)Chronic Pain Rehabilitation (CARF)6
VISN 1 Rehab Choice NumbersVISN 1 Facility NameCONNECTICUTCENTRAL WESTERN MASSBOSTON HCSBEDFORDPROVIDENCETOGUSWHITE RIVER JCTMANCHESTERVETERANS HEALTH ADMINISTRATIONRehab Choice Numbers by Facility52661182793647432,55210,1107
Manchester VAMCProjection DataAcute Inpatient MedicineAcute Inpatient Mental HealthAcute Inpatient SurgeryInpatient Blind RehabInpatient LTSSInpatient Residential RehabInpatient Spinal Cord InjuryIP Professional ServicesAmb Dental ClinicAmb LTSS Home and Community BasedAmb Medical SpecialtiesAmb Mental Health ProgramsAmb PathologyAmb Primary CareAmb RadiologyAmb Rehab TherapiesAmb Surgical SpecialtiesVETERANS HEALTH ADMINISTRATIONFY2021 ModeledFY2026 Modeled FY2036 869117,58824,39237,34037,7808
Manchester VAMCSPRS Projection DataAmb Rehab: Audiology (Service)Amb Rehab: Blind Rehabilitation (Service)Amb Medical: Chiropracty (Service)Amb Rehab: Occupational Therapy (Service)Amb Medical: Pain Medicine (Service)Amb Medical: Physical Medicine & Rehabilitation (Service)Amb Rehab: Physical Therapy (Service)Amb Rehab: Recreational Therapy (Service)Amb Rehab: Speech Language Pathology (Service)VETERANS HEALTH ADMINISTRATIONFY2021 Modeled FY2026 Modeled FY2036 84765395429
New Hampshire MapKeyManchester VAMCCommunity BasedOutreach Clinic(CBOC)VETERANS HEALTH ADMINISTRATION10
Initial Options ConsideredOption 1: Expand outpatient services to meet currentdemand at Manchester VAMC: close existing space, staff, andequipment gapsOption 2: Expand outpatient services to meet currentdemand at Manchester VAMC and enhance CommunityBased Outpatient Clinic (CBOC) capacity: meet the needs ofenrolled veterans at Manchester VAMC and New HampshireCBOCsOption 3: Develop a comprehensive experience to addresscurrent needs with emphasis on special populations: reducethe need to use community resources, and provide services toeligible veterans throughout New HampshireVETERANS HEALTH ADMINISTRATION11
Option 1On Manchester Campus Continue with current Audiology construction planRemodel current space for Blind Rehab; create additional storage space for essential equipment; should beconveniently located for visually impaired veteransAdd 1 – 2 exam rooms for ChiroAdd 2 treatment rooms and 1 group room for Complementary Integrated Health (CIH)Renovate current space and create space for wheelchair clinic for Occupational Therapy (OT)Add 4 exam rooms and add 2 interventional rooms for Pain ClinicContinue with current plan for Pain RehabRenovate current space and create 2 additional exam rooms for Physical Medicine and Rehabilitation (PM&R)Renovate current space; create dedicated space for group clinic and amputation clinic care for Physical Therapy(PT)Renovate current space to create 2 – 3 additional exam rooms for Polytrauma / Traumatic Brain Injury (TBI)Renovate entire space for proper short- and long- term storage of inventory and separation of clean andused/return items for ProstheticsDedicated space for inpatient recreation clinic for Recreation TherapyIncrease and renovate current space for Speech Language PathologyRenovate current space to create 2 – 3 additional exam rooms for Spinal Cord Injury (SCI)VETERANS HEALTH ADMINISTRATION12
Option 2On Manchester CampusAt Community Based Outpatient Clinic Create three exam rooms for ChiroAdd telehealth room and capabilities for Pain ClinicDevelop an enhanced wellness center with spacefor residential Commission on Accreditation ofRehabilitation Facilities (CARF) rehab program forPain RehabDesign patient-centered space where allPolytrauma/Traumatic Brain Injury (TBI) and SpinalCord Injury (SCI) staff are located in the same areaDedicated space for adaptive sports clinic forRecreationVETERANS HEALTH ADMINISTRATION Add 1 – 2 sound booths for AudiologyCreate space for Blind RehabEstablish space for Complementary IntegratedHealth (CIH)Create space for Occupational Therapy (OT)Add 1 exam room for Physical Medicine andRehabilitation (PM&R)Allocate exam and treatment space for PhysicalTherapy (PT)Create inventory space for ProstheticsAdministrative and clinical space for SpeechLanguage Pathology13
Option 3On Manchester CampusAt Community Based Outpatient Clinic Add room(s) for otolaryngology (ENT) under AudiologyCreate space for intermediate low vision clinic underBlind RehabDevelop enhanced wellness center for ComplementaryIntegrated HealthAllocate space to provide platelet-rich plasma (PRP)treatment and ketamine infusions for Pain ClinicCreate enhanced wellness center with space forinpatient Commission on Accreditation of RehabilitationFacilities (CARF) rehab program; develop space foraddiction and detox for Pain RehabEstablish inpatient capability for Physical Medicine andRehabilitation (PM&R)Dedicated telehealth and peer support capabilities forPolytrauma/Traumatic Brain Injury (TBI)Add space for certified Prosthetics labDevelop space in an enhanced wellness center forRecreationCreate additional clinical space for Speech LanguagePathologyDedicated telehealth and peer support capabilities forSpinal Cord Injury (SCI)VETERANS HEALTH ADMINISTRATIONAdd 2 exam rooms for ChiroAllocate space for administrative purposes forOccupational Therapy (OT)14
Questions and DiscussionVETERANS HEALTH ADMINISTRATION15
Blind Rehabilitation Center Program Procedures (Veterans Health Administration Handbook 1174.04; December 2, . Polytrauma System of Care (Veterans Health Administration Handbook 1172.01; March 20, 2013) Prosthetics and Sensory Aids Service (VA Space Planning Criteria (308); March 2008)
