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NCR Healthcare Redesign. Tri-Service Symposium 13 July 06. Objectives Driving MJCSG Planning. Reduce excess capacity Relocate medical care into facilities and installations of higher military value and capacity Provide greater opportunity for medics to maintain medical currency

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Ncr healthcare redesign

NCR Healthcare Redesign

Tri-Service Symposium

13 July 06


Objectives driving mjcsg planning
Objectives Driving MJCSG Planning

  • Reduce excess capacity

  • Relocate medical care into facilities and installations of higher military value and capacity

  • Provide greater opportunity for medics to maintain medical currency

  • Enhance Jointness


Brac scenarios for ncr mtfs
BRAC Scenarios for NCR MTFs

  • Closure of WRAMC and placement of consolidated medical facilities and functions at Bethesda (North) and Fort Belvoir (South).

  • No loss of capability and continue to serve as a world class center for casualty care

  • Based on actual workload, no purchased care recapture

  • 1.3M new SF in the NCR

    • 300 bed tertiary care MEDCEN in the north – 300K SF

    • 165 bed community hospital in south - 1M SF

  • $781M capital investment

  • 1376 manpower eliminations from closure of WRAMC installation

  • Downsize Malcolm Grow Medical Center to an outpatient facility with ambulatory surgery capability.


Ncr mhs brac intent
NCR MHS BRAC Intent

“Let me describe what this new Walter Reed National Military Medical Center would look like.  It will be the centerpiece of military health care, clinical practice, education, and research.  It will rival Mayo Clinic, Johns Hopkins, and the other great medical institutions of the world, and it will be jointly staffed. ”

LtGen Peach Taylor, Medical Joint Cross Service Group, 13 May 05

“Whatever it costs, we need to incur that cost to provide that world-class care to an extraordinary group of men and women in harm’s way.”

Anthony Principi, Chairman, 2005 BRAC Commission

“In Washington, the new Walter Reed National Military Medical Center will be a joint medical facility, and the – not a – but the world leader in military medicine – in quality, in research, in technology, and in training…”

Dr. William Winkenwerder, Jr.,

Assistant Secretary of Defense for Health Affairs, 30 Jan 06


WRAMC Migration Diagram

Chemical Biological Defense RDA COE

Aberdeen Proving Ground, MD

Not moving

Old location

New location

PDA

PEB

Medical Biological Defense Research COE

Ft Detrick

RIID

WRAIR

Bio

NMRC

Bio

5 Dec 05

ICD

WRAIR

Chem.

Ft. Belvoir

Non-Tertiary

Care

Forest Glen Annex, MD

Bldg 509/510

Bldg 503

Bethesda, MD

MEDCEN

NMRC

Inf Dis

Walter Reed

National

Military

Medical

Center

Non-Tertiary Care

WRAIR

Chem.

Tertiary Care

(AFIP)

ACTUR

Tissue

Repository

Borden

Institute

WRAIR

Bio

WRAIR

Inf Dis

NARDC

PDA/PEB

MSMO

CID

NARCO

NARMC

NARVC

2290TH

AMSA

WRAMC

MAIN POST

NMRC

Bio

WRAIR

CCC

Dept of

Retrovirology

NMRC

CCC

AFIP

Dover AFB, DE

Infectious Disease Research COE

Medical Museum

Legal Med

Ctr for Clin Lab

DoD Pt Safety

Program Mgmt Off

Enlisted Histology

DoD Vet

Path

Medical

Examiner

Ft. Sam Houston, TX

Medical Examiner

DNA Repository

Accident Invest

(AMEDDC&S)

Borden Inst

Enlisted

Histology

DNA

Repository

Forest Glen, MD

NMRC

CCC

Dept of

Retrovirology

Accident

Investigation

WRAIR

CCC

Rockville, MD


Ncr mhs missions
NCR MHS Missions

  • Force Health Protection

    • Deploying a medically ready force

    • Deploying a ready medical force

      • Maintaining clinical competence

      • Support to other MTFs

    • GME and Non-GME training

    • Mobilization/De-mobilization mission

  • Active Duty and Beneficiary Care

    • Tertiary Care

    • Casualty Care

    • World-wide referral

    • Executive Medicine

  • Research

    • Force Health Protection Related

    • Health Professions Education Related

    • Collaborative Research with other Federal Agencies


Ncr brac planning principles
NCR BRAC Planning Principles

NCR BRAC Planning:

  • Is Workload based

  • Does not go beyond intended throughput

  • Approaches planning from a Market perspective

  • Considers BRAC actions at individual facilities to be indivisibly linked

  • Seeks to maximize seamless beneficiary care between the North and South, and throughout the NCR


Methodology used for joint service ncr brac planning

North and South Markets

Methodology Used for Joint Service NCR BRAC Planning

  • Divided NCR into North and South based on distance/drive time to Bethesda and Fort Belvoir

  • Pulled data (visits, admits, RVUs/RWPs) for NNMC, WRAMC, and Fort Belvoir based on geographic distribution (patients home zip code)

  • Redistributed South “tertiary care” workload to the North based on a combination of qualitative and quantitative clinical service data and input

  • Approximately 20% of South-generated inpatient activity (and 13% Ambulatory care) is expected to migrate to the North


Workload distribution based on market based analysis
Workload Distribution Based on Market-Based Analysis

  • The FY04 Inpatient (ADPL & RWPs) and Outpatient (RVU) projections used in planning facilities for the NCR (in response to BRAC) are below MJCSG COBRA estimates.




Ncr mtf realignment recap
NCR MTF Realignment Recap

Pre-BRAC

COBRA

DD1391

After 14 Nov 05

Renovations =

167K SF

Renovations =

260K SF

Bethesda

196 Beds

113 ADPL

839K RVUs

10.5K RWPs

1.4M GSF

WRNMMC

300 Beds

240 ADPL (80%)

1,184K RVUs

18K RWPs

1.9M GSF

WRNMMC

346 Beds

276 ADPL

1,143K RVUs

19K RWPs

2.1M GSF

WRNMMC

345 Beds

262 ADPL

1,143K RVUs

17.2K RWPS

1.76M GSF

Reduce

77.5K SF

clinical

337K SF

total

Shift subspecialty inpatient North

WRAMC

294 Beds

189 ADPL

1,148K RVUs

16.5K RWPs

2.8M GSF

Shutdown

2.8M SF clinical

7.8M SF total

Ft Belvoir

120 Beds

92 ADPL

706K RVUS

10.8K RWPS

872K GSF

Ft Belvoir

147 Beds

109 ADPL

706K RVUs

12K RWPs

977K GSF

Ft Belvoir

165 Beds

116 ADPL (70%)

1,372K RVUs

13K RWPs

1.05M GSF

Reduce

105K SF

clinical

Ft Belvoir

45 Beds

20 ADPL

568K RVUs

1.9K RWPs

377K SF

Shutdown

377K SF clinical

Net Shutdown

1.8M SF clinical

6.8M SF total

Net Shutdown

1.6M SF clinical

6.6M SF total

Net Shutdown

1.8M SF clinical

6.7M SF total

MGMC

60 Beds

33 ADPL

314K RVUs

2.7K RWPs

MGMC

0 Beds

0 ADPL

300k+/- RVUs

0 RWPs

MGMC

0 Beds

0 ADPL

300k+/- RVUs

0 RWPs

Inpatient workload to the Network.

No change in SF

595 Beds 322 ADPL 60% Occupancy

465 Beds

356 APPL

76% Occupancy

465 Beds

354 ADPL

76% Occupancy


Ncr market solution
NCR Market Solution

  • Use existing market assets to decrease capital construction investment and still be fully mission capable.

  • Optimizes direct care system

  • Does this comply with BRAC Law? Yes

  • Does this exceed COBRA Model? Yes

    • Includes omissions, inadequate scope due to test-fit, and community support services, but further decreases 14 Nov 05 construction requirements by using existing market spaces and other alternatives minimize MILCON requirements.

*PA and PD cost only. Does not include Initial Outfitting & Transition, or CAT E & F Equipment


Risks included in the NCR MHS BRAC Business Plan

  • Reducing the Supporting Facility cost factor from 20% to 13%

  • Reducing the Army’s Corps of Engineers and the Navy’s Facilities Engineering Command Supervision, Inspection & Overhead (SIOH) rate from 5.7% to 3%.

  • $80M reduction in Initial Outfitting and Transition in FY11

  • Unit cost escalation fixed at 2.45%

  • Business Plan is tightly constrained and assumes vigorous control of costs and full realization of savings.


Initial outfitting and transition reductions
Initial Outfitting and TransitionReductions

  • Reduced planning factors:

    • Initial Outfitting from 30/25% to 18%

    • Transition from 5% (10% for renovations) to 4% (8%)

  • Risk = $80M

  • Risk mitigation:

    • Maximize reuse and relocation of existing equipment

    • Standard planning factors not scaled for extremely large projects.


Brac facility planning process
BRAC Facility Planning Process

  • COBRA Analysis – Spring 2005

  • NCR BRAC Planning – Summer 2005

  • Solicit NCR User Group input in developing Program for Design (PFD) requirements – Fall 2005

  • NCR MHS BRAC Business Planning – Winter 2006

  • Complete the Program for Design – Summer 2006

  • NNMC Master Plan – Summer/Fall 2006

  • Design Authority – Summer 2006

  • Engage architects to design facilities – Fall 2006


Ncr mhs brac and integration
NCR MHS BRAC and Integration

  • Inherent in MHS BRAC 2005 actions is the integration of MTFs such that they begin to function as an Integrated Delivery System.

  • MEDCENS, Inpatient facilities, and Ambulatory commands in the NCR are proceeding with Integration as we plan and execute BRAC.


NCR Portfolio Integration Planning

BRAC

Health Care Planning/PFD

Integration Planning

Mission

Population Forecasting

Workload Forecasting

Staffing/Manpower Rqmts

Direct vs. Purchased Care

Demand Analysis

2 MEDCENs to 1

Market Inpatient Integration

Market Direct Care Integration

Network Integration

Functional Integration

Capital Asset Inventory

Market Assessment

Defining Characteristics

Supply Management

Maximize use of Capital Assets

Increase Beneficiary Access

Recapture Purchased Care

Lower Operating Costs

Provider Requirements

Volume Thresholds/

Optimization

Functional Alignment

Consolidation

Planning Scenarios

Space Requirements

Forecast

Space Program

Functional Options

Optimize Capital Assets

Facility Planning Scenarios

Functional & Facilities Analysis

Alternative Architectural Solutions

Project Identification

Facility Planning & Development

Establish Program Management Office tied to NCR

Market Governance, Office of Integration and MSMO

Documentation


Revolutionary Change

Evolutionary Change

“Business as usual”

MEDCEN #1

MEDCEN #1

“VISION”

“VISION”

ONE MEDCEN

MEDCEN #2

ONE MEDCEN

MEDCEN #2

TIME

TIME

Disadvantages: too many last minute details – won’t get it right; appears

disorganized; will disenfranchise patients and staff; probably take longer to get where you want to be.

Advantages: less traumatic; people know where they are going; less degradation of MEDCEN assets; earlier you start the easier it will be.

BRAC, Integration, and Change


Msmo focus

Priority of efforts:

Build an Integrated Delivery System (IDS) in the NCR

Include MGMC BRAC actions in the NCR integration plans

Develop a seamless continuum of care between the North/South

Functionally integrate WRAMC and NNMC

NNMC

#4

WRAMC

#1

#3

Other NCR

MG

#2

Ft. Belvoir

National Capital Area (NCR) Military Health System (MHS)

MSMO Focus

The circle diagram describes a single NCR-wide integrated entity with WRAMC and NNMC integration of specialized, tertiary-level care and support functions at the center. Through this Northern merger of people, processes, and structure, North/South functional integration, and along with other NCR component facilities, health services are aligned.


Integration office

Priority of efforts:

Functionally integrate WRAMC and NNMC

Develop a seamless continuum of care between the North/South

Include MGMC BRAC actions in the NCR integration plans

Build an IDS in the NCR

NNMC

#1

WRAMC

#4

#2

Other NCR

MG

#3

Ft. Belvoir

National Capital Area (NCR) Military Health System (MHS)

Integration Office

  • Focus - Clinical Care, Healthcare Care Ops, & GME/Research


Ncr integration
NCR Integration

  • The NCR is approaching Integration from both a MEDCEN perspective and a Market perspective

  • The Office of Integration focuses on functionally merging the MEDCENS and functionally integrating the MEDCENS with the community hospital at Fort Belvoir

  • The MSMO focuses on developing the NCR Market as an integrated health care delivery system.

  • Building Blocks

    • MEDCEN = WRAMC + NNMC + USUHS

    • Inpatient/Specialty care = MEDCEN + DeWitt + MGMC

    • Direct Care = Inpatient & Specialty Care + Primary Care ambulatory commands


NCR Integration Org Chart

IMPLEMENTATION

IMPLEMENTATION


Areas of intense focus
Areas of Intense Focus

  • Office of Integration

    • Health Care Operations

    • Administrative Services

    • Information Systems

    • Communications and Marketing

    • Nursing

    • Clinical Services

    • Health Professions Education

    • Research

  • MSMO

    • Manpower

    • Healthcare Operations

    • Logistics

    • Resource Management



Shared vision for integration 18 aug 05
Shared Vision for Integration18 Aug 05

In concert with the medical provisions of BRAC 2005, we envision one unified NCR military health care system. Jointly staffed inpatient campuses at the Walter Reed National Military Medical Center at Bethesda (North) and Fort Belvoir (South), and other NCR MTFs - also jointly staffed - will provide high quality, efficient and convenient care for our beneficiaries. The WRNMMC will serve as a world class academic medical center focused on highest quality tertiary care, graduate medical education, and clinical research while serving as a worldwide military referral center. The Ft. Belvoir community hospital will be the major satellite teaching hospital. Both campuses will be sized to provide health care at the closest facility to the beneficiary whenever clinically appropriate.


Ncr brac planning assumptions
NCR BRAC Planning Assumptions

  • BRAC plans based on NCR MSMO analysis

  • NCR MSMO BRAC plans workload based, used FY04, vice COBRA (more accurate plan based current workload)

    3. Eligible Population will remain stable at 450,000

    4. Enrolled population will remain stable:

    5. Worldwide referral capability is an enduring mission and the volume of patients will remain stable in the near and mid-term

  • MHS Workload in the NCR will remain relatively stable

  • GME programs will remain relatively stable

  • Current MTF-based research missions in the NCR will remain stable


Ncr brac planning assumptions1
NCR BRAC Planning Assumptions

  • In regards to Manpower, planning will achieve at least 1,376 fewer people in Federal employment as a result of BRAC Scenario 169 A & B.

  • The 543 AF staff moving into the NCR will allow additional Manpower savings above the 1,376 positions identified through the COBRA model.

  • There will be ongoing Forest Glen/Glen Haven BASEOPS requirement after Walter Reed compound closure

  • BRAC transition plans will include moving some service to WRAMC during Bethesda renovations.

  • Walter Reed compound will not close until construction at Bethesda and Belvoir completed.


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