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- Categorized in: 2013 Compendium of Federal Medicine
Unique regional boundary lines for the ECoE program pose some challenges with assessments and specific activities, as the boundaries are state and not VISN driven, a previously noted contrast to other programs. The challenges encompass uneven ECoE distributions across the nation. For example, in the Southeast Region, all ECoEs are in two East Coast states; however, the region covers states from the coast over to Louisiana and up to Missouri. The current program design is dependent on resources, affiliation and seizure-specialized services. Efficient communication, physical movement of patients and management of activities can become problematic and complex with large distances between ECoEs and other medical facilities. The Southeast Region adopted a nucleus leadership (clinical and administrative staff responsible for the coordination of standardized processes and referral communication) to complement national administrative core for orchestrating maximum efficiency. Other regions are following suit due to confirmed quality and sustained cost with this model.
Prior to the establishment of ECoE, specialized epilepsy healthcare was diverted to external (non-VA) providers when resources were unavailable. PL made provisions for funding to enhance resources within the VA. Justification of ECoE cost for Veterans care can be addressed with Cost-Based Analysis (CBA).
“CBA rests on the premise that a project or policy will improve social welfare if the benefits associated with it exceed the cost.”19 For epileptic specialized care, significant decrease in fees basis that surpasses the cost of VA care is a good predictor of sustainability.
Therefore, though monetizing the indirect cost for net benefit is challenging, a comprehensive evaluation is required to determine market-value differences. Congressional lobbying/trust lost, untreated patients (decreased life expectancy and quality of life changes), and appropriate resource utilization are examples of intangibles (net benefit= (indirect & direct value benefits) – (indirect and direct cost)).20 This process theory is appropriate for ensuring that all factors involved in the program’s cost are considered in the future decision-making.
Without the existence of COE, the specialized care needed will be fractured. The initiatives emphasize the need to work as a unit and as part of an organization to maximize limited specialized resources. Leveraging technology; strong referral and well-organized communication plans; and valid efficiency evaluation models to analyze the impact of these critical pieces are imperative for the success of the COE concept.
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