VA Testimony of Charleen Szabo before Congress on March 26, 2004

United States Department of Veterans Affairs

STATEMENT OF
CHARLEEN R. SZABO, FACHE
ACTING NETWORK DIRECTOR
VA STARS & STRIPES HEALTHCARE NETWORK
VETERANS HEALTH ADMINISTRATION
DEPARTMENT OF VETERANS AFFAIRS
BEFORE THE
COMMITTEE ON VETERANS' AFFAIRS
UNITED STATES SENATE

March 26, 2004

Mr. Chairman and Members of the Committee:

I am pleased to appear before the Committee to discuss VISN 4’s ongoing efforts with regard to CARES. With me today is Mr. James Palmer, Director of the Erie VA Medical Center, and Dr. Michael Adelman, Chief of Staff.

The Erie VA Medical Center serves a nine-county primary service area in northwestern Pennsylvania, eastern Ohio and southwestern New York that is home to approximately 79,000 veterans. The terrain is mainly rural, with many two-lane roads and a lack of major public transportation systems. Currently, about 18,500 of these veterans take advantage of the services provided by the medical center, which include primary care, inpatient acute medical and surgical care, ambulatory surgery, and long-term care. Behavioral health, rehabilitation medicine, emergency medicine, and dental services are also part of the comprehensive primary care services provided.

Over the past several years, the medical center has been very successful in increasing access for local veterans to quality health care services. Three Community Based Outpatient Clinics (CBOCs) have been established to bring VA care closer to where the veteran lives. These include two VA-staffed clinics in Ashtabula, Ohio, and Meadville, Pennsylvania, and one contracted clinic in Smethport, Pennsylvania. The medical center is planning to open two new CBOCs in Venango and Warren Counties before the end of Fiscal Year 2004. The CBOCs and enhanced access techniques account for much of the growth in unique veterans treated at the Erie VAMC: from approximately 8400 veterans in 1993 to the current 18,500 veterans.

In addition, a number of specialty clinics are conducted by medical center staff or consultants from the local community. The medical center maintains a Level IV emergency room, which provides acute care for most emergencies 24 hours per day. The emergency room experienced over 8000 veterans seeking emergent care in Fiscal Year 2003. Trauma patients are provided appropriate care at emergency departments of nearby community hospitals.

The medical center inpatient capacity consists of 87 operating beds: 35 acute care beds and 52 extended care beds. Services that are not available at the medical center are provided by referral to the VA Pittsburgh Healthcare System, contracted for locally, or provided via the fee-basis program. In Fiscal Year 2003, 1370 veterans required hospitalization. Of these, approximately 93 - or 7% - were referred to the VA Pittsburgh Healthcare System, 71 - or 5% - were referred to the community, and the remainder - 88% - were admitted to the Erie VAMC. The Erie VAMC also provided observation care on the acute care unit for over 300 veterans requiring less than a 23 hour admission.

The medical center provides both outpatient and inpatient services to veterans residing at the Pennsylvania Soldiers’ and Sailors’ State Veterans Home in Erie.

The medical center has increased access to specialty care services on-site through contractual arrangements with local health care providers in many sub-specialties such as urology, oncology, cardiology, and optometry. Service enhancements made in recent months include home-based primary care, on-site lithotripsy, and shared medical appointments.

Several improvements have also been made at the medical center to enhance services to veterans. All inpatient care space, including the Nursing Home Care Unit, has been completely renovated. Primary care and specialty clinic space at the medical center was recently expanded. A recently completed minor construction project significantly enhances outpatient services with a new Rehabilitation Suite, Emergency Room and primary care clinic. Another minor project, currently under design, will increase the medical center’s specialty care and ancillary support capacity and allow for other patient flow renovations.

The care and services provided by the Erie VAMC are of high quality and appreciated by those who receive them. The medical center consistently scores very high on specific measures related to overall patient satisfaction - 83% - which is higher than the national average of 73%; and, on access to care - 86% - which is higher than the national average of 79%.

Erie VAMC received the Robert W. Carey Quality Trophy Award in 2000, which is the highest quality award given within the Department of Veterans Affairs for organizational effectiveness, performance and excellence.

The draft national CARES plan has taken note of the critical services provided by the Erie VAMC, and has proposed that the inpatient medicine, outpatient and long-term care programs continue. In the case of inpatient surgical care services, the plan proposes that inpatient surgical beds be converted to surgical observation beds, but that ambulatory surgery continue. The plan also called for an evaluation of the continuation of Intensive Care Unit (ICU) services.

In summary, whatever ultimate decisions are made regarding patient beds at VAMC Erie, the VA, VHA, VISN 4, and local officials are committed to ensuring that changes will not affect the care provided to area veterans, now and in the future.