By Stephen Spotswood
CHICAGO — If VA and DoD expect to use the Lovell Federal Healthcare Center (FHCC) in Chicago as a blueprint for future joint facility integration projects, the departments will need to develop some kind of way to evaluate the success or failure at Lovell — something they have yet to do, according to an Institute of Medicine report.
According to the IoM report, the departments lack a comprehensive evaluation plan that includes measurable criteria for determining how well the integration process at Lovell has progressed. This creates a roadblock for VA and DoD, which are seeking to use lessons learned at Lovell to inform other healthcare facility mergers.
From 1926 until 2010, VA and DoD had operated separate healthcare facilities less than 2 miles apart in North Chicago. By the 1990s, both facilities were chronically underused. In 1999, an internal VA study proposed closing all inpatient care at the VAMC, while the Navy facility needed to be replaced.
The proposed solution was not only partnering on a new facility but also creating a fully joint entity — one that would be run equally by VA and the Navy and serve both their patient populations. The result was the Capt. James A. Lovell FHCC, which opened its doors in October 2010.
—U.S. Navy photo by Paul Engstrom
That same year, DoD asked IoM to evaluate whether the Lovell FHCC had improved healthcare access, quality and cost for DoD and VA, compared with operating separate facilities. At the same time, IoM was asked to determine whether patients and providers were satisfied with this new model of joint delivery of care to active duty servicemembers and veterans.
According to IoM, data on changes in efficiency and cost savings is not readily available, so it’s too early to determine whether the facility has been successful in delivering at least the same quality of healthcare as was received before.
The IoM committee warned, however, that numerous differences in VA and DoD policies and procedures need to be addressed before any future integrated facilities are undertaken.
One that has received a large amount of attention in recent months is the integration of the two departments’ electronic health record (EHR) systems. Currently, VA and the Navy have to maintain separate EHR systems, so that Navy personnel and veterans can continue to receive care at other facilities without worrying whether providers will be able to access their records.
The work-arounds developed by facility administrators — including relying on five full-time pharmacists to manually check for potential drug interactions and allergies — have added considerable time and expense.
The IoM committee went so far as to recommend to VA and DoD that no new federal healthcare centers be implemented until an interoperable or joint EHR system is available. The earliest such a system will exist is currently projected for 2017.
When first agreeing on the policies by which Lovell would operate, VA and the Navy underwent a long series of negotiations. Conflicting policies required VA and the Navy to decide either to use one or the other of the departments’ policies, or to craft a new one. Many of these negotiations took months or even years to resolve. In some cases, Congress had to enact legislation to allow the departments to work together.
Because of the many instances where no agreement could be reached, instead of creating a joint practice, the facility has had to implement both methods of operation simultaneously, as with the EHR systems.
“The bottom-up consensus process used in implementing the Lovell FHCC accounted in part for the outcome of incomplete integration,” the IoM report stated. “That approach was very useful for bringing to the surface differences in departmental procedures and statutory authorizations that had to be addressed [during implementation].
The report also added, “Planners of future federal healthcare centers should not repeat the negotiations that took months and sometimes years to resolve such issues and, instead, should adopt solutions already developed and approved by VA and DoD where they exist.”
To best achieve that, Lovell staff needs to develop joint VA/DoD guidance materials and a set of best practices documents explaining exactly how they went about solving the problems that emerged during implementation, according to the IoM report, which pointed out that such materials do not currently exist and that VA and DoD need to systematically compile them.
The Lovell FHCC could provide a roadmap for issues that will inevitably arise in any facility merger, but that map is useful only if VA and DoD systematically analyze the data and create official documentation of the challenges that arose and how they were, or were not, overcome, the report added.