VISN 08 Puerto Rico Virgin Islands Market Data Discovery ...

VISN 08 Puerto Rico Virgin Islands MarketData Discovery & FindingsNovember 6, 2020

Sec�on Slide Numbers Order

OverviewMarket Geography and DemographicsEs�mated Current and Historic Market Demand – Outpa�entEs�mated Future Market Demand – Outpa�entEs�mated Current and Historic Market Demand – Inpa�entEs�mated Future Market Demand – Inpa�entEs�mated Current Total VA Market SupplyEs�mated Current Total Community Market SupplyCurrent AccessQuality & Sa�sfac�onFacili�esMissionCost

38287794132138150160184200212218

123456789

10111213

VA Market Area Health Systems Op�miza�on

VISN 08: Puerto Rico Virgin Islands Market

Table of Contents

2

Overview

3

The Data Discovery & Findings (DD&F) deck is a standardized collec�on of data that will be used across market assessments to understand important aspects of each market. It is similar to the deck that was presented during previous VHA Office of Policy and Planning (OPP) market assessment trainings and will be used to develop key findings and inform the development of opportuni�es to create high-performing networks of care.

Data is pulled from a wide range of VA and commercial sources, and each slide cites the relevant data source.

The DD&F is one piece of the overall market assessment process. The assessments will also be informed by review of local data and site visits to ensure that both qualita�ve and quan�ta�ve data are considered. No single data point will be used as the deciding factor in determining opportuni�es for the market.



Overview Document Purpose

4



Overview Assump�ons• VA Data & AnalysisüAll VA data was extracted and provided by VA for use in the DD&F.

üWhen there were discrepancies between data obtained from local sources and data obtained from na�onal sources, na�onal sources were used.

üIn various places throughout the deck, there are mappings to translate data between different data types (e.g., HSPC, bed sec�ons, stop codes, specialty, services lines, CPTs, DRGs, etc.). These mappings were provided by the Office of Policy & Planning (OPP) and implemented to aggregate or categorize data for display in the slides. It also allows for a be�er programma�c view of care.

üTrea�ng facili�es that have a parent in a different market are displayed in both the trea�ng facility market and the parent market.

üEnrollee Health Care Projec�on Model (EHCPM) cita�ons include a combina�on of market-based and facility-based projec�ons. These two projec�on model views are different, and the numbers are not intended to match.

üEHCPM data for the year 2017 is pulled from the “Actuals” databases instead of the projected year 2017.

üThe facili�es contained within the DD&F are based on the Facility Hierarchy file provided by OPP. Any data for facili�es not in this file are not included in the DD&F. Addi�onally, the facility market, county, parent, and name are found within this file.

üThe market hierarchy geography used to create the DD&F is from the BY17 EHCPM. All VISN/Market/County mappings are based off of this geography.

üNumeric values of data throughout the DD&F are rounded.

üOffice of Community Care data was obtained using the Program Integrity Tool. This data may have anomalies, gaps, and missing values due to various methods of processing Choice data within the last several years. Any iden�fied gaps were addressed with reasonable logic wherever possible; however, errors may remain.

üFor maps, any site of care deac�vated in VAST a�er April 1, 2019 will not be reflected.

üFor workload trending purposes, slides may contain facili�es that are deac�vated, if they had workload in FY15, FY16, FY17, FY18, or FY19.

üPlanned sites of care are not included on maps unless specifically requested and jus�fied.

5



Assump�ons, cont.Overview

• Commercial Market Data & Analysis The commercial market capacity assessment considers only reported physical capacity and does not incorporate: 1) ability to

staff patient care services or accept VA patients; 2) length of time to change facilities to accommodate Veteran demand; and 3)any negotiations for specific rates for care provided in the community.

Pediatric healthcare was not considered. IBM Market Expert FTE estimated demand is based on a median provider productivity level by service line. Future-state commercial market demand estimates for Puerto Rico are not available from IBM/Watson Health Market Expert.

Estimates of bed surplus/need and physician future demand were based on current bed and physician totals availableextrapolated based on estimated population for 2028. Sources reviewed for potential input are included on the following slide.

Community hospitals within a 60 minute drive time of the VAMC’s zip code were the primary focus for assessment and used asa comparison to each VAMC.

• Quality Differences in quality metrics between VA and widely accepted commercial benchmarks introduce significant subjectivity.

• Cost Analysis and Recommendations The cost analysis used in the assessment is high-level and considers market average Medicare reimbursement payment as a

proxy for potential cost for purchased care in the commercial market. Direct cost by DRG and CPT were provided by VA.

6



Assump�ons, cont.Overview

Source Comments

IBM Watson Market Expert IBM Watson Market Expert is a web-based tool that includes public and IBM proprietary Watson Health research data. Neither projected hospital bed demand nor physician demand was found for Puerto Rico and the Virgin Islands.

Advisory Board Advisory Board provides health industry research, education, and tools. Neither projected hospital bed demand nor physician demand was found for Puerto Rico and the Virgin Islands.

Departamento de Salud de Puerto Rico The Department of Health of Puerto Rico, or Departamento de Salud de Puerto Rico, publishes public health statistics and reports as well as Puerto Rico hospitals’ service information. Neither projected hospital bed demand nor physician demand was found for Puerto Rico and the Virgin Islands.

Kaiser Family Foundation (KFF) KFF is a non-profit organization reporting national health news and research. Reports and articles regarding Puerto Rico were found, however, neither projected hospital bed demand nor physician demand was found.

Estudios Tecnicos Inc. Estudios Tecnicos Inc. provides disaster recovery research, marketing, urban planning, and economic consulting services. Published reports werereviewed, however, neither projected hospital bed demand nor physician demand was found.

Puerto Rico Open Data Interconnection Portal (data.pr.gov)

Data.pr.gov is the Puerto Rico government’s open data portal. Data health is available, however, neither projected hospital bed demand nor physician demand was found.

U.S Department of Health and Human Services (HHS) HHS publishes research, news, resources, and training tools regarding medicine, public health, and social services. Published reports were reviewed, however, neither projected hospital bed demand nor physician demand was found.

Registro Central de Cancer de Puerto Rico The Puerto Rico Cancer Registration, or Registro Central de Cancer de Puerto Rico, provides multiple data sets, statistics, an interactive map, and reports, however, neither projected hospital bed demand nor physician demand was found.

U.S. Bureau of Labor Statistics The U.S. Bureau of Labor Statistics measures labor market activity, productivity, and other significant measures related to the labor force in the U.S. economy. Data is available for Puerto Rico, however, physician demand projections were not found.

IndexMundi IndexMundi is a collation of facts and statistics from other open sources. There is health data available for Puerto Rico, however, neither projected hospital bed demand nor physician demand was found.

Medicaid and CHIP Payment and Access Commission (MACPAC)

MACPAC is a non-partisan US agency that provides policy and data analysis to Congress, HHS, and state governments. Reports on Puerto Rico’s health industry were found, however, neither projected hospital bed demand nor physician demand was found.

• No future state commercial demand projections were available for Puerto Rico and the Virgin Islands through standard MAHSO data sources. Thefollowing sources were reviewed as alternative sources, however, no projected hospital bed demand nor physician demand was found.

7

Demographics Market Geography and Demographics

8

Source: 1. BY17 EHCPM 2. FY20Q1 VAST 8.V08.PuertoRicoVirginIslands

Note: Mobile sites are not listed.



Demographics Exis�ng VA Market and Facility Hierarchy

9

Total 2017 Enrollee Popula�on: 69,262• Top Coun�es by Enrollee Popula�on: Id

◦ No Applicable County Name, PR: 66,586◦ Virgin Islands Non-Specified County, VI: 2,676

9394

Market OverviewDemographics

Source: 1. BY17 EHCPM 2. VSSC Unique Pa�ents Cube 9.V08.PuertoRicoVirginIslands



*Core uniques excludes uniques who have only used

telephone triage, pharmacy, and lab.

◦ 96th of 96 markets based on percent change

Total 2017 Eligible Veteran Popula�on: 73,630

• Es�mated 10-Year Enrollee Change: -33.7%

2018 Core Uniques:* 50,035

. Id

• (V08) (672) San Juan 1

VAMC:

• Total Enrollees: 53rd of 96 markets

• -29.4% es�mated 10-Year Eligible Veteran Popula�on Change

Exis�ng VHA System

◦ 95th of 96 markets based on net enrollees

Key Market Sta�s�cs

10

Market Enrollee Demographics

County Sector FY17 FY27 10 Year Change FY37 20 Year Change DO

No Applicable County Name, PRSector SubtotalVirgin Islands Non-Specified County, VISector SubtotalMarket Total

08-k-9-A08-k-9-A08-k-9-B08-k-9-B08-k

66,58666,586

2,6762,676

69,262

43,56543,565

2,3562,356

45,921

-34.6%-34.6%-12.0%-12.0%-33.7%

31,46831,468

2,0222,022

33,490

-52.7%-52.7%-24.4%-24.4%-51.6%

12345

Demographics

Source: BY17 EHCPM VetPop & Enrollment 10.V08.PuertoRicoVirginIslands

Note: Market totals do not exactly match following slides due to rounding by county within EHCPM.



County-Based Enrollee Projec�ons

11

Market Projected Enrollee 10-Year Change (FY17-27)Demographics




Sectors Coun�es

12

Market Enrollee and Eligible DemographicsDemographics




Geography Measure FY17 FY27 10 Year Change FY37 20 Year Change DisplayO…

VISNMarketNa�onalVISNMarketNa�onal

EOY EnrolleesEOY EnrolleesEOY Enrollees

Eligible VeteransEligible VeteransEligible Veterans

736,66169,262

8,763,3951,108,277

73,63014,285,357

714,12445,921

8,906,620920,851

51,96512,279,863

-3.1%-33.7%

1.6%-16.9%-29.4%-14.0%

641,38233,490

8,273,504749,461

36,33410,462,623

-12.9%-51.6%

-5.6%-32.4%-50.7%-26.8%

123456

Market-Based Enrollee and Eligible Projec�ons

Es�Esm�maatetd Eliged Eligible Vible Veettereraans bns by Yy Yearear

0

50,000

FY 20222 FY 2027 2027

73,63061,342

51,965

-16.7%5 Year Chg in Eligibles

-29.4%10 Year Chg in Eligibles

FY 2017

13

Market Enrollee and Eligible Demographics, cont.Demographics




Sector Measure FY17 FY27 10 Year Change FY37 20 Year Change Id

08-k-9-A08-k-9-B08-k-9-A08-k-9-B

EOY EnrolleesEOY EnrolleesEOY EligiblesEOY Eligibles

66,5862,676

69,5534,078

43,5652,356

48,7423,224

-34.6%-12.0%-29.9%-20.9%

31,4682,022

33,6772,657

-52.7%-24.4%-51.6%-34.8%

371372403404

Sector-Based Enrollee and Eligible Projec�ons

14

Demographics




2017-2027 Market Enrollee Breakdown by PriorityPriority

Enrollees 2017 % Enrollees 2017 Enrollees 2027 % Enrollees 2027 10 Year % Change

12345678

Grand Total

18,1583,9516,6204,689

25,0562,754

2837,751

69,262

26.2%5.7%9.6%6.8%

36.2%4.0%0.4%

11.2%100.0%

18,7953,0824,7771,4579,1711,108

447,487

45,921

40.9%6.7%

10.4%3.2%

20.0%2.4%0.1%

16.3%100.0%

3.5%-22.0%-27.8%-68.9%-63.4%-59.8%-84.5%

-3.4%-33.7%

Market Enrollee Priority Groups

27%

8%

14%2%

20%

6%

4%

19%1

2

3

4

5

6

7

8

24%

8%

14%3%

22%

6%

3%

21%1

2

3

4

5

6

7

8

VISN 08Na�onal

15

*Market Rank is the rank of the average age from youngest to oldest for 96 markets. In cases where mul�ple market had the same average age, the same ranking was applied to all of those markets.2017

13.3%

27.2%

47.4%

12.1%<45

45-64

65-84

85+

17.6%

30.6%42.9%

9.0%<45

45-64

65-84

85+

2017

2027 10 Year % Change

2,929 3,425 17.0%

Female Enrollee Popula�on

2017 Puerto Rico Virgin Islands Market Age Breakdown

Market Enrollees and Growth Rates by Age Group




Market Enrollee Popula�on — Age and Gender

2017 VISN 08 Age Breakdown

• • 2027

Demographics

MAL

E

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

<45

-29.3%

45-64

-43.8%

65-84

-33.3%

85+

-36.0%

FEM

ALE

0

200

400

600

800

1,000

1,200

1,400

<45

-20.9%

45-64

4.9%

65-84

180.6%

85+

263.5%

Average Age Market Rank

66 13

Average Age of Enrollees and Market Rank*

16


Note: Eligibles is an es�mate. Market Share was calculated as Enrollees/Eligibles. Eligible Veterans may be greater than total Veterans in the cube data.



Demographics Current Market Share

Current Market Share

17

Projec�ons from the VA Enrollee Health Care Projec�on Model (EHCPM) account for new enrollment based on demographic changes• Projec�ons therefore account for a different pool of enrollees in the future as the enrollment popula�on changes• Some Veterans who are currently ineligible and unenrolled may become enrollees in the future

Poten�al use of health care in VA is projected for those Veterans who are assumed to be eligible and enrolled at a given point• The EHCPM projects u�liza�on of health care services rather than projec�ng pa�ent/user counts

○ Some pa�ents may use few services and some pa�ents may use many, so projec�ng by u�liza�on of health services providesa be�er picture of the amount of health care VA will need to provide

• Modeled projec�ons accounts for the amount of care enrollees are expected to receive through VA rather than from their othersources of health care

Source: E&F C22-7217ACBY17 2017 Reliance by Service Category 20181025 16.V08.PuertoRicoVirginIslands



Market RelianceDemographicsCategory VA Facility

CareNa�onal VAFacility Care

VA FacilityVariance fromNa�onal

CommunityCare

Na�onalCommunityCare

CommunityCare Variancefrom Na�onal

TotalReliance

Na�onal TotalReliance

Total RelianceVariance fromNa�onal

DO

OP MED

PATHOLOGY

DIALYSIS

OP SURG

AUDIOLOGY

IP MED

IP SURG

IP MH

OP MH

PROSTHETICS

TOTAL

57.8%

69.3%

11.4%

54.1%

61.7%

55.7%

37.3%

64.5%

86.1%

73.7%

53.6%

27.5%

46.3%

7.4%

23.3%

56.7%

18.5%

13.6%

42.7%

81.1%

47.6%

25.1%

30.3%

23.0%

4.0%

30.8%

5.0%

37.2%

23.7%

21.8%

5.0%

26.1%

28.4%

4.0%

1.4%

38.2%

2.6%

2.6%

1.0%

1.5%

30.3%

2.5%

0.0%

4.2%

6.1%

2.6%

33.4%

5.1%

2.8%

5.5%

7.8%

9.5%

3.0%

0.0%

6.7%

-2.2%

-1.2%

4.9%

-2.6%

-0.2%

-4.4%

-6.2%

20.7%

-0.5%

0.0%

-2.5%

61.8%

70.7%

49.6%

56.7%

64.3%

56.7%

38.9%

94.8%

88.6%

73.7%

57.8%

33.7%

48.9%

40.8%

28.4%

59.5%

24.0%

21.4%

52.2%

84.2%

47.6%

31.8%

28.1%

21.8%

8.8%

28.2%

4.8%

32.7%

17.5%

42.5%

4.5%

26.1%

26.0%

1

2

3

4

5

6

7

8

9

10

11

18

Market Current Enrollment Rurality – FY18Demographics

Source: Geocoded Enrollee File FY18Q4 17.V08.PuertoRicoVirginIslands#IMG



FY18 Rurality by County

19

County Urban Enrollees Rural Enrollees* % Rural Total Enrollees R

San Juan, PR

Bayamon, PR

Ponce, PR

Carolina, PR

Caguas, PR

Toa Baja, PR

Arecibo, PR

Mayaguez, PR

Guaynabo, PR

Aguadilla, PR

Cayey, PR

Juana Diaz, PR

Toa Alta, PR

Cabo Rojo, PR

Trujillo Alto, PR

Humacao, PR

Coamo, PR

Vega Baja, PR

Fajardo, PR

Isabela, PR

5,812

4,335

3,670

3,378

2,644

1,681

1,522

1,496

1,484

1,326

1,166

1,082

1,074

1,026

1,015

929

0

901

876

876

0

0

6

0

0

0

0

0

0

0

0

0

0

0

0

0

922

0

0

0

0.0%

0.0%

0.2%

0.0%

0.0%

0.0%

0.0%

0.0%

0.0%

0.0%

0.0%

0.0%

0.0%

0.0%

0.0%

0.0%

100.0%

0.0%

0.0%

0.0%

5,812

4,335

3,676

3,378

2,644

1,681

1,522

1,496

1,484

1,326

1,166

1,082

1,074

1,026

1,015

929

922

901

876

876

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

Market Current Enrollment Rurality — FY18, cont.County

Source: Geocoded Enrollee File FY18Q4 18.V08.PuertoRicoVirginIslands



DemographicsUrban Enrollees Rural Enrollees* % Rural Total Enrollees

* Includes Rural and Highly Rural Loca�ons.

20


Yauco, PR

Rio Grande, PR

Guayama, PR

San German, PR

Gurabo, PR

Canovanas, PR

Cidra, PR

Salinas, PR

Dorado, PR

San Sebas�an, PR

Mana�, PR

Juncos, PR

Sabana Grande, PR

Vega Alta, PR

Ha�llo, PR

Aibonito, PR

Moca, PR

Aguada, PR

San Lorenzo, PR

Lajas, PR

817

812

781

710

694

667

653

130

609

584

583

575

574

558

558

552

532

531

520

515

0

0

0

0

0

0

0

508

0

0

0

0

0

0

0

0

0

0

0

0

0.0%

0.0%

0.0%

0.0%

0.0%

0.0%

0.0%

79.6%

0.0%

0.0%

0.0%

0.0%

0.0%

0.0%

0.0%

0.0%

0.0%

0.0%

0.0%

0.0%

817

812

781

710

694

667

653

638

609

584

583

575

574

558

558

552

532

531

520

515

21

22

23

24

25

26

27

28

29

30

31

32

33

34

35

36

37

38

39

40


Source: Geocoded Enrollee File FY18Q4 18.V08.PuertoRicoVirginIslands#2





21


Santa Isabel, PR

Las Piedras, PR

Penuelas, PR

Guayanilla, PR

Camuy, PR

Corozal, PR

Quebradillas, PR

Utuado, PR

Yabucoa, PR

Naguabo, PR

Barranquitas, PR

Hormigueros, PR

Luquillo, PR

Morovis, PR

Anasco, PR

Aguas Buenas, PR

Lares, PR

Naranjito, PR

Guanica, PR

Villalba, PR

0

486

468

461

445

452

448

440

438

424

411

389

380

378

362

370

367

365

362

347

502

0

0

0

10

0

0

1

1

0

0

0

0

0

11

0

2

0

0

0

100.0%

0.0%

0.0%

0.0%

2.2%

0.0%

0.0%

0.2%

0.2%

0.0%

0.0%

0.0%

0.0%

0.0%

2.9%

0.0%

0.5%

0.0%

0.0%

0.0%

502

486

468

461

455

452

448

441

439

424

411

389

380

378

373

370

369

365

362

347

41

42

43

44

45

46

47

48

49

50

51

52

53

54

55

56

57

58

59

60







22


Barceloneta, PR

Ceiba, PR

Arroyo, PR

Catano, PR

Orocovis, PR

Adjuntas, PR

Pa�llas, PR

Rincon, PR

Loiza, PR

Ciales, PR

Vieques, PR

Comerio, PR

Jayuya, PR

Florida, PR

Maunabo, PR

Las Marias, PR

Maricao, PR

Culebra, PR

Saint Croix, VI

Saint Thomas, VI

336

335

333

297

282

0

274

262

252

226

0

215

0

158

0

96

0

0

0

0

0

0

0

0

0

275

0

0

0

0

222

0

199

0

158

1

66

36

1,183

1,178

0.0%

0.0%

0.0%

0.0%

0.0%

100.0%

0.0%

0.0%

0.0%

0.0%

100.0%

0.0%

100.0%

0.0%

100.0%

1.0%

100.0%

100.0%

100.0%

100.0%

336

335

333

297

282

275

274

262

252

226

222

215

199

158

158

97

66

36

1,183

1,178

61

62

63

64

65

66

67

68

69

70

71

72

73

74

75

76

77

78

79

80







23


Saint John, VI

Total

0

59,107

101

5,382

100.0%

8.3%

101

64,489

81

82







24

Market RuralityDemographics

Source: 1. Geocoded Enrollee File FY18Q4 2. HRSA Data Warehouse 19.V08.PuertoRicoVirginIslands



FQHCs Within Rural Coun�es (>50% Rurality)

25

Overall Market Popula�on (Veterans and Non-Veterans) —

15%

4%

10%

12%

26%

13%

21%

0-14

15-17

18-24

25-34

35-54

55-64

65+

Gender

2018 2028 % Change

Popula�onMaleFemale

3,302,1301,571,2961,730,834

3,237,0001,537,0001,700,000

-2.0%-2.2%-1.8%

Demographic Summary — Puerto Rico Virgin Islands Area

Demographics

192.V08.PuertoRicoVirginIslands



Popula�on Distribu�on by Age Group

0%

96%

1%All Others

Asian & Pacific Is. Non-Hispanic

Black Non-Hispanic

Hispanic

White Non-Hispanic

38%

19%

24%

10%4% 5%

<$15K

$15-25K

$25-50K

$50-75K

$75-100K

Over $100K

Popula�on Distribu�on by Race/Ethnicity

Households by Income Group

Valida�on of the data for this slide is not required

Puerto Rico Virgin Islands

Popula�on Sta�s�cs: Popula�on Es�mates and Projec�ons, 2019 3. U.S. Census Bureau 2010 U.S. Virgin Islands Demographic Profile Data - Survey P5Source: 1. U.S. Census Bureau American Community Survey (ACS) 2018 1-Year Es�mate - Puerto Rico and United States 2. World Bank Group Health Nutri�on and

26

Overall Facility Area Popula�on (Veterans and Non-Veterans) —

14%4%

9%

13%

25%

13%

21%

0-14

15-17

18-24

25-34

35-54

55-64

65+

Gender

2018 2028 % Change

Popula�onMaleFemale

1,056,792491,924564,868

1,035,992481,187554,805

-2.0%-2.2%-1.8%

Demographic Summary – San Juan Area

Demographics

Source: 1. U.S. Census Bureau American Community Survey (ACS) 2018 1-Year Es�mate - Puerto Rico and United States 2. World Bank Group Health Nutri�on and Popula�on Sta�s�cs: Popula�on Es�mates and Projec�ons, 2019 3. Data USA

Note: Data for popula�on, gender, age group and household income includes data for the following coun�es within a 60 minute drive �me of theSan Juan VAMC: Bayamon, Caguas, Carolina, Guaynabo, San Juan, Toa Alta, Toa Baja, and Trujillo Alto. Race/Ethnicity data only reflects San JuanCounty. 2028 popula�on projec�ons for the San Juan VAMC area are calculated by applying the projected growth rates by age for Puerto Rico.


VISN 08: Puerto Rico Virgin Islands Market — San Juan

Popula�on Distribu�on by Age Group

1%

98%

0%White Non-Hispanic

Hispanic

Black Non-Hispanic

Asian & Pacific Is. Non-Hispanic

All Others

33%

16%26%

12%

5%7% <$15K

$15-25K

$25-50K

$50-75K

$75-100K

Over $100K

Popula�on Distribu�on by Race/Ethnicity

Households by Income Group


San Juan Area

193.V08.PuertoRicoVirginIslands.672

27

Demand Es�mated Current and Historic Market Demand — Outpa�ent

28

Facility FY13 FY14 FY15 FY16 FY17 FY18 6 Yr. Ch

(V08) (672) San Juan(V08) (6729AA) San Juan(V08) (672B0) Ponce(V08) (672BZ) Mayaguez(V08) (672GA) Saint Croix(V08) (672GB) Saint Thomas(V08) (672GC) Arecibo(V08) (672GD) Ceiba(V08) (672GE) Guayama(V08) (672QA) Comerio(V08) (672QB) Utuado(V08) (672QC) Vieques

51,025586

11,67210,002

901838

4,5303,8291,769

N/AN/AN/A

50,608583

11,7849,940

813806

4,5433,8271,708

N/AN/AN/A

50,382559

11,7999,691

834803

4,4543,8121,594

N/AN/AN/A

50,012662

11,5869,688

866882

4,3633,7711,658

N/AN/AN/A

49,281724

11,2769,751

840831

4,2093,6161,629

473474202

48,325535

10,8389,467

730775

3,3913,3381,521

480477188

-5.3%-8.7%-7.1%-5.3%

-19.0%-7.5%

-25.1%-12.8%-14.0%

N/AN/AN/A

*Core uniques excludes uniques who have only used telephone triage, pharmacy, and lab.

Demand

Source: VSSC Uniques Cube 24.V08.PuertoRicoVirginIslands



Core Uniques*

Core Uniques Trends by Facility

29

Outpa�ent Encounters FY15-18

Facility FY15 FY16 FY17 FY18 FY15 FY16 FY17 FY18 FY15 FY16 FY17 FY18

(V08) (672) San Juan(V08) (6729AA) San Juan(V08) (672B0) Ponce(V08) (672BZ) Mayaguez(V08) (672GA) Saint Croix(V08) (672GB) Saint Thomas(V08) (672GC) Arecibo(V08) (672GD) Ceiba(V08) (672GE) Guayama(V08) (672QA) Comerio(V08) (672QB) Utuado(V08) (672QC) Vieques(V08) (672) San Juan Total(V08) Puerto Rico Virgin Islands Total

71,525N/A

19,06018,596

23664

4,6231,4273,669

N/AN/AN/A

119,200119,200

73,415N/A

17,70719,657

27037

4,3921,8203,848

N/AN/AN/A

121,146121,146

75,536N/A

17,48319,761

27636

4,5432,0322,942

1N/A

16122,626122,626

69,605N/A

15,61717,425

17367

3,0871,7922,660

N/A1

N/A110,427110,427

124,291N/A

33,78139,586

1,9371,994

17,40813,908

5,720N/AN/AN/A

238,625238,625

125,773N/A

34,87340,760

2,1722,351

17,34514,147

5,848N/AN/AN/A

243,269243,269

117,420N/A

35,39039,394

2,1952,205

16,50912,505

5,5151,102

744458

233,437233,437

112,588N/A

33,46936,486

1,7031,961

11,56412,411

4,5121,283

898422

217,297217,297

262,250N/A

33,81325,297

266271365328178N/AN/AN/A

322,768322,768

279,8931

33,78726,441

279336338497189N/AN/AN/A

341,761341,761

269,463N/A

31,40426,494

147189402443151

332427

328,777328,777

250,742N/A

29,71826,034

109104254463248

815

1307,696307,696

Mental Health

Demand

Source: VSSC Outpa�ent Encounters Cube 25.V08.PuertoRicoVirginIslands



Primary Care Specialty CareFacility

30

Primary Care Encounters – FY15-18Demand

Source: 1. VSSC Encounters Cube 2. Geocoded Enrollee File FY18Q4 26.V08.PuertoRicoVirginIslands#IMG



FY15-18 PC Average Encounters by County

31

County FY15-18 AvgEncounters

FY18 Encounters Most Commonly Used Facility % ofEncounters

San Juan,PRPonce,PRBayamon,PRCarolina,PRCaguas,PRMayaguez,PRToa Baja,PRArecibo,PRAguadilla,PRGuaynabo,PRCabo Rojo,PRJuana Diaz,PRFajardo,PRTrujillo Alto,PRToa Alta,PRIsabela,PRHumacao,PRCayey,PRCoamo,PRYauco,PR

20,65613,72014,90911,409

9,0936,8465,9415,9105,0915,1244,3263,5743,4183,5893,5523,1782,9943,3962,8672,804

16,98913,38012,186

9,2847,5456,3024,9514,8634,7564,2743,9673,4553,3023,0543,0152,9772,8592,8002,7322,708

(672) San Juan(672B0) Ponce(672) San Juan(672) San Juan(672) San Juan(672BZ) Mayaguez(672) San Juan(672GC) Arecibo(672BZ) Mayaguez(672) San Juan(672BZ) Mayaguez(672B0) Ponce(672GD) Ceiba(672) San Juan(672) San Juan(672BZ) Mayaguez(672GD) Ceiba(672) San Juan(672B0) Ponce(672B0) Ponce

98.0%97.0%98.5%98.4%97.6%97.3%98.7%89.5%94.9%97.7%96.5%94.9%82.5%98.6%97.5%85.2%67.8%90.1%93.7%85.2%

County

Demand

Source: 1. VSSC Encounters Cube 2. Geocoded Enrollee File FY18Q4 27.V08.PuertoRicoVirginIslands



Primary Care Encounters – FY15-18, cont.FY18

EncountersFY15-18 Avg Encounters

Most Commonly Used Facility % of Encounters

Most Commonly Used Facility is the facility in the specified county with the most encounters summed across all fiscal years. The % of Encounters is the Most Commonly Used Facility's total summed encounters divided by the county's total encounters summed across all fiscal years.

32



Rio Grande,PRVega Baja,PRSan German,PRGuayama,PRAguada,PRCanovanas,PRSan Sebas�an,PRSalinas,PRGurabo,PRSabana Grande,PRLajas,PRCidra,PRDorado,PRHa�llo,PRMoca,PRJuncos,PRNaguabo,PRGuayanilla,PRSanta Isabel,PRPenuelas,PR

2,9842,8812,5702,3472,2902,2262,1111,9942,2232,1032,0112,0052,0662,0651,7841,8021,6831,6051,5681,713

2,5692,4122,3862,1172,0732,0361,9821,8801,8801,7951,7801,7731,7611,7571,7111,6971,6171,5871,5701,561

(672) San Juan(672) San Juan(672BZ) Mayaguez(672GE) Guayama(672BZ) Mayaguez(672) San Juan(672BZ) Mayaguez(672GE) Guayama(672) San Juan(672BZ) Mayaguez(672BZ) Mayaguez(672) San Juan(672) San Juan(672GC) Arecibo(672BZ) Mayaguez(672) San Juan(672GD) Ceiba(672B0) Ponce(672B0) Ponce(672B0) Ponce

54.5%84.3%95.6%83.0%97.3%79.2%88.7%45.3%96.3%82.8%92.1%93.5%98.0%89.6%95.1%92.0%80.0%96.3%92.9%97.4%

County

Demand

Source: 1. VSSC Encounters Cube 2. Geocoded Enrollee File FY18Q4 27.V08.PuertoRicoVirginIslands#2







33



Hormigueros,PRMana�,PRLas Piedras,PRAnasco,PRSan Lorenzo,PRAibonito,PRVega Alta,PRCeiba,PRYabucoa,PRQuebradillas,PRUtuado,PRLuquillo,PRCorozal,PRCamuy,PRGuanica,PRLares,PRBarranquitas,PRAguas Buenas,PRNaranjito,PRVillalba,PR

1,7041,7531,7121,6311,7021,5991,7811,5301,4741,5021,6131,4791,5631,5141,2811,2641,3361,2051,3221,107

1,5581,5421,5311,5131,4471,4471,4341,4321,3981,3641,3341,3281,2651,2401,1741,1461,1411,1401,1041,042

(672BZ) Mayaguez(672GC) Arecibo(672GD) Ceiba(672BZ) Mayaguez(672) San Juan(672) San Juan(672) San Juan(672GD) Ceiba(672GD) Ceiba(672GC) Arecibo(672GC) Arecibo(672GD) Ceiba(672) San Juan(672GC) Arecibo(672B0) Ponce(672GC) Arecibo(672) San Juan(672) San Juan(672) San Juan(672B0) Ponce

97.7%58.7%52.3%97.8%96.0%63.2%95.5%87.0%70.6%56.3%58.5%71.8%96.5%81.7%60.6%67.8%74.7%97.7%93.0%95.7%

County

Demand








34



Morovis,PRRincon,PRAdjuntas,PRBarceloneta,PRArroyo,PRCatano,PROrocovis,PRComerio,PRLoiza,PRPa�llas,PRCiales,PRJayuya,PRVieques,PRMaunabo,PRFlorida,PRLas Marias,PRMaricao,PRCulebra,PRSaint Thomas,VISaint Croix,VI

1,1691,106

9501,0921,0381,011

808810867830782644794540505305251

881,9221,988

998998948902830822739712693687632620581456436269251

881,8201,690

(672) San Juan(672BZ) Mayaguez(672B0) Ponce(672GC) Arecibo(672GE) Guayama(672) San Juan(672) San Juan(672) San Juan(672) San Juan(672GE) Guayama(672GC) Arecibo(672B0) Ponce(672) San Juan(672GE) Guayama(672GC) Arecibo(672BZ) Mayaguez(672BZ) Mayaguez(672GD) Ceiba(672GB) Saint Thomas(672GA) Saint Croix

76.8%97.7%96.5%78.4%82.4%98.1%62.4%74.4%94.8%77.2%49.4%90.2%62.2%53.8%76.0%97.0%98.1%52.6%92.0%92.1%

County

Demand








35



Saint John,VITotal

127222,111

118195,213

(672GB) Saint Thomas 81.9%

County

Demand








36

Primary Care Drive Times for FY18 EnrolleesDemand




FY18 Primary Care Drive Times

37

*Includes top 3 stop codes, where applicable (some sites reported fewer than 3). All stop codes that resulted in a �e for the 3rd highest number of FY18 encounters are shown.

Demand

Source: VSSC Encounters Cube – Public Grouping (Primary Care) 29.V08.PuertoRicoVirginIslands.672



Facility Stop Code FY15 FY16 FY17 FY18 4 Yr. Ch. FY15 FY16 FY17 FY18 4 Yr. Ch. FY15 FY16 FY17 FY18 4 Yr. Ch.

(V08) (672) San Juan



(V08) (672B0) Ponce

(V08) (672B0) Ponce

(V08) (672BZ) Mayaguez



(V08) (672GA) Saint Croix

(V08) (672GB) Saint Thomas

(V08) (672GC) Arecibo


(V08) (672GD) Ceiba

(V08) (672GD) Ceiba

(V08) (672GE) Guayama


(V08) (672QA) Comerio

(V08) (672QB) Utuado

(V08) (672QC) Vieques

(323) PRIMARY CARE/MEDICINE

(350) GeriPACT

(322) Comprehensive Women’s Primary Care Clinic




(350) GeriPACT













110,407

10,727

3,157

33,781

N/A

37,774

1,521

291

1,937

1,994

17,312

96

13,872

36

5,720

N/A

N/A

N/A

N/A

109,355

12,889

3,529

34,834

39

38,834

1,593

333

2,172

2,351

17,258

87

14,121

26

5,848

N/A

N/A

N/A

N/A

98,647

15,118

3,655

35,308

82

37,437

1,634

323

2,195

2,205

16,432

77

12,487

18

5,515

N/A

1,102

744

458

94,030

15,201

3,357

33,387

82

34,453

1,708

325

1,703

1,961

11,525

39

12,407

4

4,510

2

1,283

898

422

-14.8%

41.7%

6.3%

-1.2%

N/A

-8.8%

12.3%

11.7%

-12.1%

-1.7%

-33.4%

-59.4%

-10.6%

-88.9%

-21.2%

N/A

N/A

N/A

N/A

27,171

2,487

745

9,090

N/A

8,350

745

157

805

765

4,200

64

3,488

32

1,496

N/A

N/A

N/A

N/A

27,033

2,962

762

9,037

37

8,211

759

168

825

827

4,146

60

3,475

25

1,464

N/A

N/A

N/A

N/A

25,620

3,164

824

8,883

78

8,155

853

166

787

800

3,985

50

3,341

17

1,424

N/A

460

280

170

24,880

3,081

844

8,581

76

7,846

817

171

693

760

3,273

28

3,101

4

1,351

1

474

283

148

-8.4%

23.9%

13.3%

-5.6%

N/A

-6.0%

9.7%

8.9%

-13.9%

-0.7%

-22.1%

-56.3%

-11.1%

-87.5%

-9.7%

N/A

N/A

N/A

N/A

99,665

15,663

3,039

34,957

N/A

39,054

2,501

285

2,547

2,127

15,770

125

12,766

48

6,271

N/A

N/A

N/A

N/A

100,483

16,338

4,040

36,118

30

39,468

2,697

332

2,814

2,776

15,082

108

13,309

36

4,976

N/A

N/A

N/A

N/A

86,655

16,109

4,225

33,160

88

32,500

2,533

258

2,771

2,566

13,713

95

12,160

32

4,816

N/A

1,091

807

386

81,253

15,665

3,795

30,053

78

27,579

2,288

186

2,132

2,160

10,910

50

11,432

4

3,694

2

1,347

876

347

-18.5%

0.0%

24.9%

-14.0%

N/A

-29.4%

-8.5%

-34.5%

-16.3%

1.5%

-30.8%

-60.1%

-10.4%

-91.3%

-41.1%

N/A

N/A

N/A

N/A

Encounters Unique Pa�ents CPT Work RVU

Top Primary Care Stop Code* Trends FY15-18 — San Juan

38

Home-Based Primary CareDemand

Source: VSSC Encounters Cube 30.V08.PuertoRicoVirginIslands#IMG



FY18 HBPC Encounters by County

39

Facility

FY15 FY16 FY17 FY18 AVGer FY15 FY16 FY17 FY18 AVG

(V08) (672) San Juan(V08) (672B0) Ponce(V08) (672BZ) Mayaguez(V08) (672QB) Utuado

374209194N/A

360218194N/A

366209235

1

407271235

1

377227215

1

7,2304,4533,931

N/A

8,2454,8013,962

N/A

8,2304,5754,449

1

8,3155,4804,811

1

8,0054,8274,288

1

FY15-18 HBPC Uniques & Encounter Distribu�on

Demand

Source: VSSC Encounters Cube 31.V08.PuertoRicoVirginIslands


Home-Based Primary Care, cont.

FacilityFY15 FY16 FY17 FY18 AVG FY15 FY16 FY17 FY18 AVG


Uniques Encounters

40

Demand




Home-Based Primary Care by Provider TypeFY18 HBPC Encounters by Provider Type

Provider Type Medical Doctor Registered Nurse Social Worker Mental Health Registered Die��an Other I

EncountersPercentage

3,27617.6%

9,43450.7%

1,4057.6%

4382.4%

1,2216.6%

2,83315.2%

66

41

Mental Health Encounters – FY15-18Demand




FY15-18 Average Mental Health Encounters by County

42

Mental Health Encounters — FY15-18, cont.Demand




County FY15-18 Avg Encounters FY18 Encounters Most Commonly Used Facility % of Encounters

San Juan, PR

Bayamon, PR

Ponce, PR

Carolina, PR

Caguas, PR

Toa Baja, PR

Aguadilla, PR

Cayey, PR

Mayaguez, PR

Toa Alta, PR

Guaynabo, PR

Arecibo, PR

Coamo, PR

Isabela, PR

Cabo Rojo, PR

Juana Diaz, PR

Vega Baja, PR

Fajardo, PR

10,130

7,196

6,300

5,069

4,761

3,252

3,140

2,528

2,490

2,410

2,347

2,241

2,166

2,125

2,083

2,054

1,774

1,691

9,953

6,609

5,712

4,776

3,945

2,481

2,667

2,292

2,194

2,075

2,154

2,007

2,317

2,093

1,917

1,894

1,721

1,565

(672) San Juan

(672) San Juan

(672B0) Ponce

(672) San Juan

(672) San Juan

(672) San Juan

(672BZ) Mayaguez

(672) San Juan

(672BZ) Mayaguez

(672) San Juan

(672) San Juan

(672GC) Arecibo

(672B0) Ponce

(672BZ) Mayaguez

(672BZ) Mayaguez

(672B0) Ponce

(672) San Juan

(672) San Juan

94.7%

96.7%

87.0%

96.7%

95.0%

96.9%

87.7%

88.4%

89.6%

94.8%

95.6%

54.3%

80.9%

78.5%

87.8%

87.6%

90.8%

76.1%


43






Trujillo Alto, PR

Yauco, PR

Guayama, PR

Rio Grande, PR

Humacao, PR

Aguada, PR

Salinas, PR

San German, PR

Gurabo, PR

Cidra, PR

Sabana Grande, PR

Moca, PR

Dorado, PR

Canovanas, PR

Aibonito, PR

Santa Isabel, PR

San Lorenzo, PR

Barranquitas, PR

1,683

1,677

1,675

1,669

1,664

1,535

1,519

1,380

1,373

1,357

1,351

1,346

1,279

1,278

1,276

1,165

1,121

1,080

1,611

1,334

1,238

1,319

1,659

1,303

1,413

1,340

1,315

1,218

1,194

1,431

1,046

1,308

1,107

1,147

967

1,072

(672) San Juan

(672B0) Ponce

(672GE) Guayama

(672) San Juan

(672) San Juan

(672BZ) Mayaguez

(672B0) Ponce

(672BZ) Mayaguez

(672) San Juan

(672) San Juan

(672BZ) Mayaguez

(672BZ) Mayaguez

(672) San Juan

(672) San Juan

(672) San Juan

(672B0) Ponce

(672) San Juan

(672) San Juan

97.0%

73.6%

68.3%

87.4%

81.4%

88.6%

42.3%

90.4%

95.4%

95.2%

80.8%

89.3%

97.5%

90.9%

66.7%

76.5%

96.9%

83.1%


44






Vega Alta, PR

Mana�, PR

San Sebas�an, PR

Corozal, PR

Las Piedras, PR

Yabucoa, PR

Lajas, PR

Penuelas, PR

Ha�llo, PR

Juncos, PR

Naguabo, PR

Hormigueros, PR

Camuy, PR

Naranjito, PR

Luquillo, PR

Guayanilla, PR

Ceiba, PR

Morovis, PR

1,060

1,034

1,019

987

946

913

885

883

864

863

813

798

759

746

732

729

706

705

913

766

935

881

910

804

731

790

647

925

786

682

501

649

543

589

563

613

(672) San Juan

(672) San Juan

(672BZ) Mayaguez

(672) San Juan

(672) San Juan

(672) San Juan

(672BZ) Mayaguez

(672B0) Ponce

(672GC) Arecibo

(672) San Juan

(672) San Juan

(672BZ) Mayaguez

(672GC) Arecibo

(672) San Juan

(672) San Juan

(672B0) Ponce

(672) San Juan

(672) San Juan

96.7%

66.4%

78.8%

94.3%

87.8%

80.9%

82.6%

92.4%

61.6%

95.6%

74.7%

88.1%

46.2%

96.5%

76.3%

89.6%

70.8%

87.2%


45






Anasco, PR

Utuado, PR

Quebradillas, PR

Villalba, PR

Guanica, PR

Adjuntas, PR

Arroyo, PR

Barceloneta, PR

Pa�llas, PR

Rincon, PR

Comerio, PR

Aguas Buenas, PR

Ciales, PR

Jayuya, PR

Lares, PR

Orocovis, PR

Catano, PR

Loiza, PR

697

678

664

617

606

604

594

587

568

536

515

502

494

484

480

456

454

349

632

561

579

507

451

504

463

465

480

427

412

449

337

445

417

510

394

198

(672BZ) Mayaguez

(672GC) Arecibo

(672BZ) Mayaguez

(672B0) Ponce

(672B0) Ponce

(672B0) Ponce

(672GE) Guayama

(672) San Juan

(672GE) Guayama

(672BZ) Mayaguez

(672) San Juan

(672) San Juan

(672) San Juan

(672B0) Ponce

(672GC) Arecibo

(672) San Juan

(672) San Juan

(672) San Juan

92.7%

45.4%

36.5%

85.3%

56.9%

91.9%

64.3%

52.2%

70.2%

92.0%

97.3%

98.7%

77.4%

84.6%

55.7%

74.0%

95.9%

96.4%


46






Maunabo, PR

Florida, PR

Las Marias, PR

Vieques, PR

Maricao, PR

Culebra, PR

Saint Croix, VI

Saint Thomas, VI

Saint John, VI

Total

311

213

204

162

81

20

752

244

28

116,518

240

124

280

129

82

26

815

265

15

104,829

(672GE) Guayama

(672) San Juan

(672BZ) Mayaguez

(672) San Juan

(672BZ) Mayaguez

(672) San Juan

(672) San Juan

(672) San Juan

(672) San Juan

57.4%

51.4%

69.5%

87.9%

93.8%

79.0%

59.0%

58.8%

50.5%


47

Top Mental Health Stop Code* Trends FY15-18 — San JuanDemand

Source: VSSC Encounters Cube – Public Grouping (Mental Health) 34.V08.PuertoRicoVirginIslands.672



Facility Stop Code FY15 FY16 FY17 FY18 4 Yr. Ch. FY15 FY16 FY17 FY18 4 Yr. Ch. FY15 FY16 FY17 FY18 4 Yr. Ch. .





(V08) (672B0) Ponce

(V08) (672B0) Ponce

(V08) (672B0) Ponce

(V08) (672B0) Ponce













(502) MH CLINIC IND

(513) SUB USE DISORDER INDIV

(550) MH CLINIC GROUP

All Others

(502) MH CLINIC IND


(534) MH INTGRTD CARE IND

All Others

(502) MH CLINIC IND


(513) SUB USE DISORDER INDIV

All Others

(502) MH CLINIC IND

(509) PSYCHIATRY

(562) PTSD-INDIV

(502) MH CLINIC IND

(562) PTSD-INDIV

(509) PSYCHIATRY

(502) MH CLINIC IND


29,303

11,424

4,800

25,998

14,019

2,225

967

1,849

12,232

2,203

1,836

2,325

N/A

236

N/A

N/A

N/A

64

3,789

590

34,334

11,482

5,352

22,247

12,295

3,187

1,070

1,155

11,322

3,653

1,805

2,877

140

130

N/A

16

3

18

3,625

574

38,784

11,809

9,083

15,860

11,924

3,750

1,356

453

11,484

4,109

1,718

2,450

276

N/A

N/A

26

10

N/A

3,736

707

35,592

11,907

6,248

15,858

11,072

3,172

1,111

262

10,979

2,863

1,425

2,158

173

N/A

N/A

49

18

N/A

2,913

148

21.5%

4.2%

30.2%

-39.0%

-21.0%

42.6%

14.9%

-85.8%

-10.2%

30.0%

-22.4%

-7.2%

N/A

-100.0%

N/A

N/A

N/A

-100.0%

-23.1%

-74.9%

6,479

1,179

644

9,084

2,750

287

498

466

2,580

242

370

814

N/A

71

N/A

N/A

N/A

27

1,035

95

8,768

1,220

702

7,965

2,709

396

524

279

2,567

378

342

1,075

61

54

N/A

10

3

9

1,063

113

10,284

1,318

824

3,848

2,716

417

632

164

2,654

425

384

940

91

N/A

N/A

16

3

N/A

1,122

140

9,852

1,228

694

3,746

2,691

347

606

81

2,541

332

323

872

56

N/A

N/A

22

6

N/A

968

34

52.1%

4.2%

7.8%

-58.8%

-2.1%

20.9%

21.7%

-82.6%

-1.5%

37.2%

-12.7%

7.1%

N/A

-100.0%

N/A

N/A

N/A

-100.0%

-6.5%

-64.2%

53,404

14,756

5,800

58,314

44,325

2,542

2,069

1,336

21,173

3,469

1,995

3,146

N/A

93

N/A

N/A

N/A

12

10,066

369

64,925

16,338

6,114

50,709

31,149

3,258

2,087

426

23,573

2,907

2,077

4,009

31

22

N/A

3

0

6

8,487

367

90,846

18,384

23,880

32,269

27,139

3,017

3,495

417

26,581

3,327

2,436

3,651

72

N/A

N/A

5

1

N/A

9,271

457

90,252

23,357

9,260

30,954

23,403

1,836

2,281

201

21,800

2,486

1,969

3,104

23

N/A

N/A

5

1

N/A

7,199

101

69.0%

58.3%

59.7%

-46.9%

-47.2%

-27.8%

10.3%

-85.0%

3.0%

-28.3%

-1.3%

-1.3%

N/A

-100.0%

N/A

N/A

N/A

-100.0%

-28.5%

-72.5%

144

144

144

144

144

144

144

144

144

144

145

145

145

145

145

145

145

145

145

145



(V08) (672GD) Ceiba

(V08) (672GD) Ceiba

(562) PTSD-INDIV

All Others

(534) MH INTGRTD CARE IND

(562) PTSD-INDIV

85

159

1,328

N/A

132

61

1,794

26

100

N/A

2,029

3

26

N/A

1,781

11

-69.4%

-100.0%

34.1%

N/A

19

65

480

N/A

34

37

669

4

21

N/A

751

2

7

N/A

712

2

-63.2%

-100.0%

48.3%

N/A

302

42

2,646

N/A

217

5

2,664

3

247

N/A

3,208

0

104

N/A

2,770

0

-65.6%

-100.0%

4.7%

N/A

146

146

146

146



48

Top Mental Health Stop Code* Trends FY15-18 — San Juan, cont.Demand

Source: VSSC Encounters Cube – Public Grouping (Mental Health) 34.V08.PuertoRicoVirginIslands.672#2



Facility Stop Code FY15 FY16 FY17 FY18 4 Yr. Ch. FY15 FY16 FY17 FY18 4 Yr. Ch. FY15 FY16 FY17 FY18 4 Yr. Ch. .

(V08) (672GD) Ceiba








(509) PSYCHIATRY

(502) MH CLINIC IND


(562) PTSD-INDIV

All Others

(502) MH CLINIC IND


(502) MH CLINIC IND

99

2,772

629

N/A

268

N/A

N/A

N/A

N/A

2,977

561

196

114

N/A

N/A

N/A

N/A

2,384

282

231

45

1

N/A

16

N/A

2,232

248

143

37

N/A

1

N/A

-100.0%

-19.5%

-60.6%

N/A

-86.2%

N/A

N/A

N/A

48

520

33

N/A

136

N/A

N/A

N/A

N/A

571

82

92

85

N/A

N/A

N/A

N/A

577

39

107

34

1

N/A

10

N/A

561

14

89

22

N/A

1

N/A

-100.0%

7.9%

-57.6%

N/A

-83.8%

N/A

N/A

N/A

38

6,156

737

N/A

896

N/A

N/A

N/A

N/A

6,587

581

489

440

N/A

N/A

N/A

N/A

4,813

296

639

136

0

N/A

2

N/A

4,992

155

523

151

N/A

0

N/A

-100.0%

-18.9%

-79.0%

N/A

-83.2%

N/A

N/A

N/A

146

146

146

146

146

146

147

147



49

Specialty Encounters – FY15-18Demand




FY15-18 Average Specialty Encounters by County

50

Specialty Encounters — FY15-18, cont.Demand


Most Commonly Used Facility is the facility in the specified county with the most encounters summed across all fiscal years. The % of Encounters is the Most Commonly Used Facility's total summedencounters divided by the county's total encounters summed across all fiscal years.



Id


88

88

88

88

88

88

88

88

88

89

89

89

89

89

89

89

89

89

San Juan, PR

Bayamon, PR

Carolina, PR

Ponce, PR

Caguas, PR

Toa Baja, PR

Guaynabo, PR

Toa Alta, PR

Trujillo Alto, PR

Cayey, PR

Arecibo, PR

Mayaguez, PR

Aguadilla, PR

Vega Baja, PR

Juana Diaz, PR

Rio Grande, PR

Humacao, PR

Cabo Rojo, PR

31,909

24,683

19,468

16,019

15,479

10,599

8,664

6,414

6,154

5,897

5,892

5,829

5,520

5,178

4,966

4,877

4,541

4,399

28,099

21,223

16,852

15,372

13,091

8,821

7,626

5,419

5,394

4,947

5,970

5,897

5,452

4,572

4,576

4,225

4,022

4,273




(V08) (672B0) Ponce











(V08) (672B0) Ponce




98.2%

98.7%

98.5%

63.3%

98.0%

98.3%

98.2%

97.7%

98.8%

96.2%

93.5%

65.8%

56.6%

98.6%

58.4%

97.8%

97.1%

61.0%

51






Id


89

90

90

90

90

90

90

90

90

90

90

91

91

91

91

91

91

91

Coamo, PR

Fajardo, PR

Gurabo, PR

Yauco, PR

Dorado, PR

Canovanas, PR

Isabela, PR

Cidra, PR

Juncos, PR

Vega Alta, PR

San Lorenzo, PR

Salinas, PR

Las Piedras, PR

Guayama, PR

Mana�, PR

San German, PR

Aibonito, PR

Corozal, PR

4,241

4,192

4,134

3,889

3,816

3,776

3,699

3,507

3,084

3,077

3,063

2,831

2,753

2,747

2,688

2,677

2,640

2,584

4,035

3,801

3,536

3,404

3,163

3,406

3,576

3,327

2,956

2,566

2,619

2,774

2,534

2,635

2,545

2,553

2,344

2,171

(V08) (672B0) Ponce



(V08) (672B0) Ponce








(V08) (672B0) Ponce







57.2%

96.2%

97.5%

56.6%

98.0%

97.4%

49.3%

98.7%

99.1%

98.8%

98.6%

51.5%

97.0%

54.5%

96.7%

59.3%

81.6%

97.7%

52






Id


91

91

91

92

92

92

92

92

92

92

92

92

92

93

93

93

93

93

Aguada, PR

Naranjito, PR

Sabana Grande, PR

Penuelas, PR

Ha�llo, PR

Barranquitas, PR

Santa Isabel, PR

San Sebas�an, PR

Yabucoa, PR

Naguabo, PR

Luquillo, PR

Lajas, PR

Guayanilla, PR

Moca, PR

Quebradillas, PR

Aguas Buenas, PR

Utuado, PR

Catano, PR

2,480

2,347

2,340

2,297

2,269

2,266

2,262

2,179

2,128

2,085

2,026

2,005

1,991

1,972

1,951

1,910

1,855

1,854

2,485

2,057

2,147

2,117

2,132

2,196

2,358

1,947

1,925

1,683

1,955

1,965

1,895

1,903

2,050

1,761

1,387

1,550




(V08) (672B0) Ponce



(V08) (672B0) Ponce






(V08) (672B0) Ponce






61.8%

98.7%

50.9%

61.5%

92.0%

89.0%

57.2%

54.2%

96.6%

96.6%

95.7%

60.2%

59.4%

58.9%

68.2%

99.0%

77.0%

97.5%

53






Id


93

93

93

93

93

94

94

94

94

94

94

94

94

94

94

95

95

95

Morovis, PR

Camuy, PR

Guanica, PR

Anasco, PR

Loiza, PR

Lares, PR

Ceiba, PR

Barceloneta, PR

Hormigueros, PR

Villalba, PR

Orocovis, PR

Adjuntas, PR

Ciales, PR

Arroyo, PR

Pa�llas, PR

Comerio, PR

Rincon, PR

Jayuya, PR

1,834

1,712

1,602

1,526

1,494

1,489

1,488

1,469

1,449

1,447

1,374

1,350

1,230

1,180

1,177

1,160

1,112

859

1,652

1,638

1,464

1,579

1,098

1,454

1,383

1,297

1,328

1,151

1,204

1,189

1,167

1,054

908

984

996

852



(V08) (672B0) Ponce







(V08) (672B0) Ponce


(V08) (672B0) Ponce






(V08) (672B0) Ponce

98.7%

82.5%

47.6%

64.7%

98.5%

70.6%

95.3%

96.1%

65.7%

59.1%

83.6%

59.8%

95.3%

54.6%

59.0%

97.9%

63.6%

57.6%

54






Id


95

95

95

95

95

95

95

96

96

96

Vieques, PR

Maunabo, PR

Florida, PR

Las Marias, PR

Maricao, PR

Culebra, PR

Saint Croix, VI

Saint Thomas, VI

Saint John, VI

Total

720

703

570

296

225

133

1,641

1,307

92

314,735

552

575

464

308

269

140

1,173

1,045

107

282,320










92.5%

80.0%

97.6%

64.9%

72.3%

96.8%

70.4%

61.3%

50.7%

55

Id

Specialty Title FY15 FY16 FY17 FY18 4 Yr. Ch. FY15 FY16 FY17 FY18 4 Yr Ch.

……………………………………………………

(V08) (672) San JuanAllergy and Immunology

AnesthesiologyAudiology

Blind Rehabilita�onCardiology

Cri�cal Care / Pulmonary DiseaseDermatology

Emergency MedicineEndocrinology

GastroenterologyGeriatric Medicine

Hematology-OncologyInfec�ous Disease

NephrologyNeurological Surgery

NeurologyObstetrics & Gynecology

Occupa�onal HealthOphthalmology

750,2091,497

10,08913,744

1,00524,50119,86911,53938,001

5,05012,68214,49410,555

1,5828,3141,1266,6171,6212,577

38,338

783,4181,3868,445

14,3211,111

25,49819,50112,15438,980

6,16414,57117,95711,741

1,8138,6371,1646,5371,4112,610

36,644

750,1461,5168,817

14,208737

24,69323,619

9,78837,284

6,06612,72218,74611,108

1,7648,0711,0825,8031,1402,991

37,153

674,4831,8347,949

13,474821

22,70028,059

8,67336,622

5,95311,29816,21210,457

1,4847,0501,2415,211

9522,487

34,966

-10.1%22.5%

-21.2%-2.0%

-18.3%-7.4%41.2%

-24.8%-3.6%17.9%

-10.9%11.9%

-.9%-6.2%

-15.2%10.2%

-21.2%-41.3%

-3.5%-8.8%

564,910915

20,6929,3441,363

25,09725,94613,10850,760

3,25831,41315,810

7,8691,8177,6961,517

10,7922,056

77837,662

571,852848

13,6919,9061,623

28,13219,20213,73657,961

5,91837,47117,809

8,6882,5276,7261,378

11,7841,615

73936,299

550,170922

13,1888,6911,177

25,80119,79112,55960,051

7,38637,29417,802

8,1452,6675,8201,352

10,0791,440

81441,162

525,6621,306

16,8567,1551,258

25,14323,78911,70759,764

7,24734,04315,661

8,6501,9444,5011,6149,2741,946

71438,848

-6.9%42.7%

-18.5%-23.4%

-7.7%.2%

-8.3%-10.7%17.7%

122.5%8.4%-.9%9.9%7.0%

-41.5%6.4%

-14.1%-5.4%-8.2%3.2%

… Optometry 14,796 15,395 15,387 14,896 .7% 19,942 21,250 21,245 21,428 7.4%

Demand




CPT Work RVUEncounters*

*Special�es were only included if there were greater than 15 encounters in any of the past four years.

Specialty Care Encounter Trends FY15-18

56

Id


……………………………………………………

Orthopaedic SurgeryOtolaryngology

Pain MedicinePathologyPharmacy

Physical Medicine & Rehabilita�onPlas�c Surgery

PodiatryProsthe�cs/Ortho�cs

RadiologyRheumatology

Speech PathologySurgery

Thoracic SurgeryUrology

Vascular Surgery(V08) (672B0) Ponce

AudiologyBlind Rehabilita�on

Cardiology

9,0215,7851,610

289,1668,569

69,508536

3,5681,241

84,4871,0563,023

21,984368

12,290N/A

77,0751,418

1392,169

9,2076,4452,975

296,9809,284

70,124740

4,0223,309

91,7081,1612,692

25,724350

12,6561

76,1191,445

1092,128

7,8015,8635,230

282,55211,63062,334

1,1864,1362,332

84,1121,0522,985

24,129382

11,621106

71,9761,417

712,305

5,6956,1515,472

238,46410,94556,724

1,0623,267

47278,234

9352,791

18,341311

12,1621,118

62,6331,072

21,770

-36.9%6.3%

239.9%-17.5%27.7%

-18.4%98.1%-8.4%

-62.0%-7.4%

-11.5%-7.7%

-16.6%-15.5%

-1.0%N/A

-18.7%-24.4%-98.6%-18.4%

8,76411,694

1,84116,755

2,27990,879

63412,920

43167,438

1,7364,435

39,259197

17,811N/A

49,278332229

2,617

8,21812,276

4,16517,699

66682,791

52013,783

95370,425

2,0353,740

38,927457

17,8932

48,472389264

2,650

6,70410,344

7,88116,688

10368,832

66011,914

74065,941

1,8844,222

39,355180

17,26082

43,323398180

2,188

4,69212,973

8,63116,824

8364,977

5215,849

23462,235

1,5973,889

31,104138

17,9351,132

40,489272

41,770

-46.5%10.9%

368.8%.4%

-96.4%-28.5%-17.8%-54.7%-45.7%

-7.7%-8.0%

-12.3%-20.8%-30.1%

.7%N/A

-17.8%-18.0%-98.4%-32.4%

… Cri�cal Care / Pulmonary Disease 99 115 121 94 -5.1% 33 27 16 6 -81.5%

Demand

Source: VSSC Encounters Cube 37.V08.PuertoRicoVirginIslands#2





Specialty Care Encounter Trends FY15-18, cont.

57

Id


……………………………………………………

DermatologyEmergency Medicine

EndocrinologyGeriatric Medicine

NephrologyNeurology


OptometryOtolaryngology

PathologyPharmacy

Physical Medicine & Rehabilita�onPodiatry

Prosthe�cs/Ortho�csRadiology

Speech PathologySurgeryUrology


38536

3636,080

7462

993,9963,743

62928,310

1,02816,928

1,87367

5,57289

1,1632,420

56,853

394N/A101

6,27426

43698

3,8294,466

65427,755

89316,009

1,881553

5,23276

1,1662,479

58,628

192N/A350

5,41538

34173

3,5576,002

59026,295

35713,894

1,670341

5,14375

1,0142,715

56,615

143N/A284

6,24425

31096

3,1377,736

53219,759

18212,361

1,529N/A

3,92267

8792,489

52,165

-62.9%-100.0%

-21.8%2.7%

257.1%-32.9%

-3.0%-21.5%106.7%-15.4%-30.2%-82.3%-27.0%-18.4%

-100.0%-29.6%-24.7%-24.4%

2.9%-8.2%

3433

1627,347

81,360

23,4424,6641,020

0618

19,3891,984

172,314

311,8611,780

29,348

25N/A

848,776

101,295

13,1395,1061,218

073

17,1331,961

1422,169

122,2431,759

28,264

8N/A634

7,4958

1,0036

3,3795,673

95010

13,8811,747

882,118

91,8211,720

26,580

1N/A501

7,15514

8602

2,7815,975

85111

14,0871,504

N/A1,704

31,4201,577

26,032

-97.9%-100.0%209.8%

-2.6%77.3%

-36.8%11.7%

-19.2%28.1%

-16.6%400.0%-99.9%-27.3%-24.2%

-100.0%-26.4%-88.8%-23.7%-11.4%-11.3%

… Audiology 1,310 1,598 1,806 1,759 34.3% 586 951 1,208 1,113 90.0%

Demand







58

Id


……………………………………………………

Blind Rehabilita�onCardiology


EndocrinologyGeriatric Medicine

NephrologyNeurology


OptometryPathologyPharmacy

Physical Medicine & Rehabilita�onPodiatry

Prosthe�cs/Ortho�csRadiology

Speech PathologySurgeryUrology

113133133419709

5,1033

6874

2,9934,324

26,5491,3319,949

33131

1,00774

3681,831

122192120438

785,083

395460

3,9794,156

26,1471,3159,422

323852

2,67679

2741,621

81164121165464

5,708485573

3,3655,514

25,0751,1899,645

242259

2,2807570

216

9139109210404

5,582216669

2,6936,802

21,3281,1088,943

2741

1,46159

1041,024

-92.0%4.5%

-18.0%-49.9%-43.0%

9.4%600.0%

-2.9%-6.8%

-10.0%57.3%

-19.7%-16.8%-10.1%-17.2%-96.8%45.1%

-20.3%-71.7%-44.1%

177624433

6355,704

3207

342,5983,853

0672

11,536162

8262

25171

2,577

300543123

1205,601

19154

233,8613,031

0146

10,64768

248676

17214

2,080

1702518

7864

6,88513

21212

2,9173,474

01

9,9563465

5761018

114

1136

24

7106,344

4253

262,2474,123

01

9,28730

1367

032

1,441

-93.6%-42.3%-96.2%-87.9%11.7%11.2%57.2%22.2%

-21.3%-13.5%

7.0%N/A

-99.9%-19.5%-81.7%-84.9%40.3%

-100.0%-81.3%-44.1%

… (V08) (672GA) Saint Croix 202 202 85 31 -84.7% 155 129 32 7 -95.2%

Demand







59

Id


……………………………………………………

CardiologyDermatology

Obstetrics & GynecologyPhysical Medicine & Rehabilita�on

(V08) (672GB) Saint ThomasCardiology

Obstetrics & GynecologyPathologyPharmacy

Physical Medicine & Rehabilita�on(V08) (672GC) Arecibo

CardiologyCri�cal Care / Pulmonary Disease

DermatologyNeurology


Physical Medicine & Rehabilita�on(V08) (672GD) Ceiba

378

8671

1691381

6N/A

691,380

4576

16225

483154435N/A711

48176770

23833

1109

N/A86

1,1515662

170N/A293119451N/A

1,231

47N/A

2513

1031746

333

41,265

555562

N/A319146437191940

15N/AN/A

166413

N/A2328

N/A422

115

1N/AN/A

48120237902

-59.5%-100.0%-100.0%

-77.5%-62.1%

.0%-100.0%283.3%

N/A-100.0%

-69.4%-97.8%-80.3%-99.4%

-100.0%-100.0%

-68.8%-72.4%

N/A26.9%

106

9346

2123

1070

N/A103611

2020

810

2830

270N/A357

81

6852

2756

1400

N/A130262

796

N/A146

093

N/A469

8N/A

222

703

53058

186372

N/A133

07

34334

3N/AN/A

431

N/A02

N/A44

000

N/AN/A

00

44257

-65.5%-100.0%-100.0%

-91.2%-98.5%-57.1%

-100.0%N/AN/A

-100.0%-92.7%

-100.0%-98.2%-94.1%

-100.0%-100.0%

N/A-100.0%

N/A-28.1%

… Dermatology 48 134 15 15 -68.8% 3 2 0 0 -100.0%

Demand







60

Id


………………………………………


Physical Medicine & Rehabilita�on(V08) (672GE) Guayama


EndocrinologyPharmacy

Physical Medicine & Rehabilita�on(V08) (672QB) Utuado

PathologyRadiology

(V08) (672QC) ViequesPathology

167122246128260

37101

3785

N/AN/AN/AN/AN/AN/A

53890

297172381

50109

30192N/AN/AN/AN/AN/AN/A

38390

216236343

495028

18630

397301

962121

249102219317318

371721

131112346262

842424

49.1%-16.4%-11.0%147.7%

22.3%.0%

-83.2%-43.2%54.1%

N/AN/AN/AN/AN/AN/A

980

142115104

11201359

N/AN/AN/AN/AN/AN/A

3110

47109

459

116


21208

11426

68606

953659

00

15105

10125

1040

20761463

00

54.9%N/A

-96.7%-12.2%-75.4%-87.2%

-100.0%-67.4%

-100.0%N/AN/AN/AN/AN/AN/A

Demand







61

Facility FY15 FY16 FY17 FY18 4 Yr. Ch. FY15 FY16 FY17 FY18 4 Yr. Ch.

(V08) (672) San Juan(V08) (672BZ) Mayaguez

16,4013,736

17,9324,101

18,1914,014

17,1063,257

4.3%-12.8%

1,257,444298,490

1,449,777380,070

1,397,283392,026

1,370,625310,185

9.0%3.9%

Demand

Source: Co Dental Comanaged 39.V08.PuertoRicoVirginIslands



Specialty Care Trends FY15-18 – Dental

Visits RVU EquivalentDental*

*Dental Data is derived from the Office of Den�stry’s dataset and represents Visits, RVU Equivalents, and Unique Pa�ents.

62

TelehealthU�liza�on Forma�ed FacilityPerc Na�onalPerc

Telehealth Use (Tele1) Home Telehealth (Tele2) Clinical Video Telehealth (Tele3) Store and Forward Telehealth (Tele4)eConsult (SC10)Video Telehealth to Off Site Pa�ents (Tele9)

10.0%2.1%2.9%5.6%

10.5%0.1%

13.1%2.3%6.6%5.3%8.3%0.5%

San Juan

Demand

Source: VSSC Telehealth Dashboard - Connected Care 40.V08.PuertoRicoVirginIslands.672

Note: Telehealth u�liza�on is based on percentage of unique pa�ents leveraging telehealth-related tools/technology.



Telehealth — FY18 Telehealth U�liza�on

Telehealth U�liza�on Na�onal

63

San Juan VAMC & Trea�ng Facility Encounters by Provider Site

Demand




Pa�ent Site FY15 FY16 FY17 FY18 4 Yr Avg

(V08) (672) San Juan(V08) (672B0) Ponce(V08) (672BZ) Mayaguez(V08) (672GA) Saint Croix(V08) (672GB) Saint Thomas(V08) (672GC) Arecibo(V08) (672GD) Ceiba(V08) (672GE) Guayama(V08) (672QA) Comerio(V08) (672QB) Utuado(V08) (672QC) ViequesTotal

3,4842,0982,065

365199

1,055563277

10,106

3,1772,1022,037

413184865989266

10,033

2,0762,0581,591

385212715662125

582972

7,983

1,2231,9441,573

275199

31460129

234

5,861

2,4902,0511,817

360199667669199

411772

8,496

Provider Site FY15-18 TotalEncounters

% of TotalEncounters

(V08) (672) San Juan(V08) (672B0) Ponce(V08) (672GD) Ceiba(V08) (672BZ) Mayaguez(V04) (529) Butler-Pennsylvania(V08) (672GC) Arecibo(V08) (546) Miami(V08) (672GA) Saint Croix(V08) (672GB) Saint Thomas(V08) (573) Gainesville(V08) (672GE) Guayama(V19) (660) Salt Lake City(V08) (672QA) Comerio(V08) (672QC) Vieques(V06) (652) Richmond-Virginia(V08) (673) Tampa(V08) (672QB) Utuado(V23) (636A8) Iowa City-Iowa(V12) (607) Madison

28,3552,489

992913556370147

4329251918

8544321

83.4%7.3%2.9%2.7%1.6%1.1%0.4%0.1%0.1%0.1%0.1%0.1%0.0%0.0%0.0%0.0%0.0%0.0%0.0%

Telehealth Encounters by Pa�ent and Provider Site* — San Juan

*Includes 4 Types: CVT General (690/692,693,699), CVT Na�onalCenter (644/645), CVT ProviderToHomePa�ent(179), and SF General (694/695,696).

Source: FY15-18 Detailed Telehealth Workload by Pa�ent Site, Provider Site, Stop Codes, and Telehealth .

Note: Pa�ent site indicates the clinic loca�on by primary stop code where the pa�ent receives the service.

64

Telehealth Encounters* by SpecialtyDemand

Source: FY15-18 Detailed Telehealth Workload by Pa�ent Site, Provider Site, Stop Codes and Telehealth Type Report 41.V08.PuertoRicoVirginIslands.672

*Includes 4 Types: CVT General (690/692,693,699), CVT Na�onalCenter (644/645), CVT ProviderToHomePa�ent (179), and SF General (694/695,696).



Facility Special�es FY15 FY16 FY17 FY18 4 Yr Avg Id

.

San Juan Physical Medicine & Rehabilita�onPain MedicineOphthalmologyNutri�onMental HealthDermatologyCri�cal Care / Pulmonary DiseaseClinical Pharmacology All Other Special�esTotal

20N/A

3,652328

1,0252,936

39736

2,17310,567

193

3,244396

1,0923,206

36726

2,07610,429

3513

3,369505915

1,387367

601,7698,420

2010

2,849484630616266

341,3736,282

249

3,279428916

2,036349

391,8488,925

…………………………

0000000001

Facility Special�es FY15 FY16 FY17 FY18 4 Yr Avg Id

.

San Juan Physical Medicine & Rehabilita�onPain MedicineOphthalmologyNutri�onMental HealthDermatologyCri�cal Care / Pulmonary DiseaseClinical Pharmacology All Other Special�esTotal

20N/A

3,652328

1,0252,936

39736

2,17310,567

193

3,244396

1,0923,206

36726

2,07610,429

3513

3,369505915

1,387367

601,7698,420

2010

2,849484630616266

341,3736,282

249

3,279428916

2,036349

391,8488,925

…………………………

0000000001

65

Emergency Department Uniques FY15-18Demand

Source: HRSA Data Warehouse 42.V08.PuertoRicoVirginIslands#IMG

Note: Map shows acute and cri�cal access hospitals with Emergency Departments and does not include freestanding Emergency Departments.



Unique Pa�ents by County FY15-18

66

2_28 Data Level Title CPT Code FY15 FY16 FY17 FY18

Encounters

Total EncountersVA Admissions %

% Transfers

9928199282992839928499285TotalTotalTotal

4,0425,635

19,1145,528

50434,82317.1%

0.3%

3,8135,420

16,7909,168

82336,01418.6%

0.3%

3,8184,953

14,8408,3412,311

34,26319.7%

0.3%

4,5505,442

14,0137,1882,878

34,07119.4%

0.3%

2_28 Data Level Title CPT Code FY15 FY16 FY17 FY18 DataLevel

Encounters

Total EncountersVA Admissions %

% Transfers

9928199282992839928499285TotalTotalTotal

4,0425,635

19,1145,528

50434,82317.1%

0.3%

3,8135,420

16,7909,168

82336,01418.6%

0.3%

3,8184,953

14,8408,3412,311

34,26319.7%

0.3%

4,5505,442

14,0137,1882,878

34,07119.4%

0.3%

Encount…Encount…Encount…Encount…Encount…Total En…VA Adm…% Trans…

78.0% of encounters seen between FY15-18 occurred between 8 A.M. and 8 P.M.

Emergency Department Encounters FY15-18 — San Juan VAMC

Encounters FY15-18

0

5,000

10,000

15,000

20,000

Enco

unte

rs

1:00 AM2:00 AM

3:00 AM4:00 AM

5:00 AM6:00 AM

7:00 AM8:00 AM

9:00 AM

10:00 AM

11:00 AMNoon

1:00 PM2:00 PM

3:00 PM4:00 PM

5:00 PM6:00 PM

7:00 PM8:00 PM

9:00 PM

10:00 PM

11:00 PM

Midnight

Average

1,40

5

1,24

6

1,24

4

1,65

9

3,91

8

6,88

2

7,71

7

11,3

05

14,3

82 15,7

51

13,8

00

10,7

48

9,88

7

9,34

1

7,95

2

6,34

2

5,15

3

4,94

2

4,45

7

3,67

6

2,96

3

2,48

0

1,85

9

1,77

8

Demand

Source: 1. VSSC Encounters Cube 2. Emergency Medicine Management Tool 168.V08.PuertoRicoVirginIslands.672



79.6% of encounters seen between FY15-18 occurred on weekdays vs. weekends.

67

Emergency Department Opera�onsDemand

Source: Integrated Flow Management Tool (IFMT) 156.V08.PuertoRicoVirginIslands



12_5 Measure FY17 FY18 FY17 Na�onal FY18 Na�onal

(V08) (672) San Juan Observa�on to AdmissionsED Door to Inpa�ent Floor (Min)ED Admit Delay (Min)ED % Boarded > 4 HrsDiversion Total Hours

21.0%835346

39.9%83

17.6%531152

15.7%2,665

27.1%313127

15.5%126,215

26.9%316129

16.0%192,413

12_5 Measure FY17 FY18 FY17 Na�onal FY18 Na�onal

(V08) (672) San Juan Observa�on to AdmissionsED Door to Inpa�ent Floor (Min)ED Admit Delay (Min)ED % Boarded > 4 HrsDiversion Total Hours

21.0%835346

39.9%83

17.6%531152

15.7%2,665

27.1%313127

15.5%126,215

26.9%316129

16.0%192,413

68

Sector County Name 2017Enrollees

FY16 FY17 FY18 FY16 FY17 FY18 FY16 FY17 FY18 FY16 FY17 FY18 FY16 FY17 FY18 ,

08-k-9-A08-k-9-A08-k-9-A08-k-9-A08-k-9-A08-k-9-A08-k-9-A08-k-9-A08-k-9-A08-k-9-A08-k-9-A08-k-9-A08-k-9-A08-k-9-A08-k-9-A08-k-9-A08-k-9-A08-k-9-A08-k-9-A08-k-9-A

Adjuntas, PRAguada, PRAguadilla, PRAguas Buenas, PRAibonito, PRAnasco, PRArecibo, PRArroyo, PRBarceloneta, PRBarranquitas, PRBayamon, PRCabo Rojo, PRCaguas, PRCamuy, PRCanovanas, PRCarolina, PRCatano, PRCayey, PRCeiba, PRCiales, PR

N/AN/AN/AN/AN/AN/AN/AN/AN/AN/A

12

N/AN/AN/AN/AN/AN/AN/AN/A

N/AN/AN/AN/A

1N/AN/AN/AN/AN/AN/A

1N/AN/AN/AN/AN/AN/AN/AN/A

1N/A

1N/AN/AN/AN/AN/AN/AN/A

1N/A

1N/AN/AN/AN/AN/A

2N/A

4N/A

1N/A

1239327

211914

12N/A

1722

1N/AN/AN/A

2N/A

12

N/A4

12N/A

7N/A

415

N/A711

6242

26N/A

1063

2451

324

24

364

3647

3949

134425521

147303151

525101383

4969

32453

1382832

263495213616

138252848

32759

2413732

26928772015

18519614283469

61420

18381

1232518

139176116

8

84

284

106

1618

11831244

49

461223

52

91012

89

N/A15

765

621550

21142

823

41

91112

611

33511

87

1232363

324

1064

1781

N/AN/A

20131

17N/A

2347352

N/AN/A

423

229331

26143

141017

44

112

1454

17

277

195

6568

14921962

91664103616

6

00000000000000000000

08-k-9-A08-k-9-A08-k-9-A08-k-9-A08-k-9-A08-k-9-A

Cidra, PRCoamo, PRComerio, PRCorozal, PRCulebra, PRDorado, PR

N/AN/AN/AN/AN/AN/A

N/AN/AN/AN/AN/AN/A

1N/AN/AN/AN/AN/A

210

46

N/A4

1223

N/A2

620

711

N/A7

78104

4159

5110

55781743

286

2254

919

225

1313

6219

1529

12

N/A4

2034

7414

N/A3

N/A1

N/A3

3512

N/A3

1216

210

N/A23

000000

Sector/County Name

Demand

Source: VHA Office of Community Care 44.V08.PuertoRicoVirginIslands



Primary Care Mental Health Medicine Surgery Rehab Medicine

Non-VA Community Care (NVCC) FY16-18 – Outpa�ent CPT Authoriza�ons

69




Fajardo, PRFlorida, PRGuanica, PRGuayama, PRGuayanilla, PRGuaynabo, PRGurabo, PRHa�llo, PRHormigueros, PRHumacao, PRIsabela, PRJayuya, PRJuana Diaz, PRJuncos, PRLajas, PRLares, PRLas Marias, PRLas Piedras, PRLoiza, PRLuquillo, PR

N/AN/AN/AN/AN/AN/AN/AN/AN/AN/A

3N/AN/AN/AN/AN/AN/AN/AN/AN/A

N/AN/AN/AN/AN/AN/A

1N/AN/AN/A


21

N/AN/AN/AN/AN/AN/AN/AN/A


63

N/A23421

N/A33

N/A61

N/AN/AN/A

2N/A

5

2N/AN/A

31211

N/A3

N/A142

N/A1

N/A7

N/A5

43

N/A45

12312

1462

1341

N/AN/A

81

11

8018435346

159925136948631

144795738

9681645

659

2144339366442068562085412927

336

334

268

3134355228252342441193242425

620

430

133

11131415

745

104197

15N/AN/A

6N/A

2

183

15271715

642552

2810

21

N/A4

N/A3

2455

20192427

5N/A

1987

1311

915

N/A15

N/A2

5N/A

1N/AN/AN/A

15193

N/A3

N/A2

N/AN/A

5N/A

2

9244573845814156

N/A626

345384

262422

61720

71111

616

111

112

00000000000000000000

08-k-9-A08-k-9-A08-k-9-A08-k-9-A08-k-9-A08-k-9-A

Mana�, PRMaricao, PRMaunabo, PRMayaguez, PRMoca, PRMorovis, PR

N/AN/AN/A

1N/AN/A

N/AN/AN/AN/AN/AN/A

N/AN/AN/A

1N/AN/A

N/AN/AN/A

1N/A

4

3N/AN/A

2N/A

1

6N/AN/A

434

462

18121

5247

455

13724029

2373

973816

534

1113

413

17N/A

8

151

N/A26

23

7N/A

19

N/A2

111

N/A10

33

16N/AN/A

1510

6

000000

Sector/County Name

Demand

Source: VHA Office of Community Care 44.V08.PuertoRicoVirginIslands#2




Non-VA Community Care (NVCC) FY16-18 – Outpa�ent CPT Authoriza�ons, cont.

70




Naguabo, PRNaranjito, PROrocovis, PRPa�llas, PRPenuelas, PRPonce, PRQuebradillas, PRRincon, PRRio Grande, PRSabana Grande, PRSalinas, PRSan German, PRSan Juan, PRSan Lorenzo, PRSan Sebas�an, PRSanta Isabel, PRToa Alta, PRToa Baja, PRTrujillo Alto, PRUtuado, PR

N/AN/AN/AN/AN/A

1N/A

1N/AN/AN/AN/A

1N/AN/AN/A

111

N/A

N/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/A

11

N/A

N/AN/AN/AN/AN/AN/A

1N/AN/AN/AN/AN/A

2N/A

1N/AN/A

2N/AN/A

19412

31N/A

261239

N/AN/A

37

1724

N/A6211

11N/AN/A

2N/AN/AN/A

10N/AN/A

51

11N/AN/A

61711

36

35313

N/A52

4812

101033

87

5741382371

3503923

116635776

556605641

143251104

54

2944122150

268331966382541

37048254286

1877444

1617

91045

257262037343346

21124354847633820

8116

1343

24

231019

275

210

6155225

9

2235

1298

11

251320

486

94

12184123

7

49547

7913

1241116

3143

123

13284135

8

25

N/A134112113631

N/A2413

51

N/AN/A

529

435327

2072

N/A5857

14685

125521

224

787

81121516273611

9

00000000000000000000

08-k-9-A08-k-9-A08-k-9-A08-k-9-A08-k-9-A08-k-9-A

Vega Alta, PRVega Baja, PRVieques, PRVillalba, PRYabucoa, PRYauco, PR

N/AN/AN/AN/AN/AN/A

N/AN/AN/AN/AN/AN/A

21

N/AN/AN/A

1

58

N/A2

N/A2

11

N/A13

N/A

1824

N/A625

73131

16413799

4898

9332950

2448

4291764

119416

15

97

N/A68

21

148253

20

1N/AN/AN/A

2N/A

211

N/A239

927

N/A48

10

000000

Sector/County Name

Demand






71



08-k-9-AMarket To…

Sector SubtotalMarket Total

00

1313

66

2222

303303

162162

682682

6,8456,845

4,6434,643

3,1433,143

918918

987987

1,3411,341

187187

416416

1,2781,278

12

Sector/County Name

Demand






72

NVCC Outpa�ent CPT Authoriza�ons (Primary Care and Mental Health)Demand




Primary Care NVCC CPT Authoriza�ons per County Mental Health NVCC CPT Authoriza�ons per County

73

Demand




NVCC Outpa�ent CPT Authoriza�ons (Medicine and Surgery)Medicine NVCC CPT Authoriza�ons per County Surgery NVCC CPT Authoriza�ons per County

74

Demand




NVCC Outpa�ent CPT Authoriza�ons (Physical Medicine)Physical Medicine NVCC CPT Authoriza�ons per County

75

Top Services Provided by NVCC for San Juan

Category of Care Total Authoriza�ons Total Authoriza�ons Total Authoriza�ons Id

NIC HOMEMAKER/HOME HEALTH AIDLAB AND PATHOLOGYPHYSICAL THERAPYNIC SKILLED NURSINGCOLONOSCOPYRADIOLOGY ULTRASOUNDRADIOLOGY MRI/MRARADIATION THERAPYRADIOLOGY CT SCANSURGERY GENERALNIC SKILLED HOME CARESLEEP STUDY/POLYSOMNOGRAPHYNIC HOSPICE/PALLIATIVE CARECARDIOLOGY TESTS, PROCEDURES, STUDIESNEUROSURGERYDIALYSISInpa�entER VISIT/URGENT CAREDERMATOLOGYNIC IV THERAPY/INFUSION

8,17185

147469283

99175266

28559239369107425

33190260147

51214

7,4233638

3838722

201391

33320194178158355233233322144122234

6,6541,643

567547505494483396384339303288278246234225214211210208

14051406140714081409141014111412141314141415141614171418141914201421142214231424

MENTAL HEALTHCHIROPRACTICOPHTHALMOLOGY TESTS, PROCEDURES, STUDIESOPHTHALMOLOGYGASTROENTEROLOGYOtherTotal

283121

646239

6,09418,980

36563328

53,580

14,845

190174169147119

1,11516,343

1425142614271428142914301431

Demand



FY18FY17FY16

Commercial*

49.V08.PuertoRicoVirginIslands.672Source: VHA Office of Community Care*Commercial includes authoriza�ons from federally qualified health centers and provider agreements.

76

Demand Es�mated Future Market Demand — Outpa�ent

77

HSPC Group Trimmed

RvuInHouse2017 RvuCc2017 Total2017 FY22 FY27 10 YearChange in Total

10 Year %Change in Total

Primary CareMedical Special�esSurgical Special�esMental Health ProgramsRehab TherapiesDental Clinic

341,597240,886137,231287,168

6,179,4731,622,880

3,91616,58811,780

4,825215,573101,507

345,514257,474149,011291,993

6,395,0461,724,387

325,718250,565152,202306,380

6,691,3421,732,750

309,007244,050155,535317,614

6,983,4891,570,393

-36,507-13,424

6,52425,621

588,443-153,994

-10.6%-5.2%+4.4%+8.8%+9.2%-8.9%

Demand

Source: BY17 EHCPM U�liza�on Projec�ons 51.V08.PuertoRicoVirginIslands



BY17 Market U�liza�on Projec�ons (Outpa�ent) — Puerto Rico Virgin Islands MarketBY17 VISN 08: Puerto Rico Virgin Islands Market U�liza�on Projec�ons (RVUs)

TotalTotalTotalCommunity

FY17

In-House

RVU

s

0

50,000

100,000

150,000

200,000

250,000

300,000

350,000

Primary Care

-10.6%

Medical Special�es

-5.2%

Surgical Special�es

4.4%

Mental Health Programs

8.8%

2017 2027

RVU

s

0

2,000,000

4,000,000

6,000,000

8,000,000

Rehab Therapies

9.2%

Dental Clinic

-8.9%

2017 2027

78

Outpa�ent U�liza�on Projec�ons by Health Systems Planning Category (HSPC) Mental Health RVUs — Puerto Rico Virgin Islands Market

Demand

Source: BY17 EHCPM U�liza�on Projec�ons52.V08.PuertoRicoVirginIslands



Ambulatory Mental Health, Health Systems Planning Categories (HSPCs)

RVU

s

0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

180,000

Homeless

-51.5%

Intensive Community Mental Hlth

Recovery (ICMHR)

-51.5%

Psychiatry

10.6%

Psychology

18.7%

Psychosocial Rehabilita�o

n and Recovery Centers

-37.8%

MH RRTP Outpa�ent Encounters

-39.3%

MH RRTP Residen�al Encounters

-31.7%

Work Therapy

-49.7%

Community Care Social

Work

72.6%

Non Psychiatrist

and Psychologist

12.6%

2017 2027

Health Systems Planning Categories (HSPCs)

79

Outpa�ent U�liza�on Projec�ons by Health Systems Planning Category (HSPC)Surgical Special�es RVUs — Puerto Rico Virgin Islands Market

Demand




l 2017 l 2027

Ambulatory Surgical Special�es, Health Systems Planning Categories (HSPCs)

RVU

s

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

45,000

50,000

55,000

60,000

Neurological Surgery

11.0%

Obstetrics & Gynecology

45.9%

Ophthalmology

-0.3%

Orthopaedic Surgery

17.8%

Otolaryngology

6.2%

Plas�c Surgery

11.2%

Podiatry

3.4%

Surgery

0.0%

Thoracic Surgery

2.7%

Urology

3.4%

Vascular Surgery

11.8%

Health Systems Planning Categories (HSPCs)

80

Demand




Outpa�ent U�liza�on Projec�ons by Health Systems Planning Category (HSPC) Medical Special�es RVUs — Puerto Rico Virgin Islands Market

Ambulatory Medical Special�es, Health Systems Planning Categories (HSPCs)

RVU

s

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

45,000

Cardiology

-1.4%

Cri�cal Care/Pulmonary Disease

-1.7%

Emergency Medicine

-30.6%

Gastroenterology

0.0%

Neurology

4.8%

Optometry

-3.5%

Physical Medicine & Rehabilita�

on

2.6%

Allergy and Immunology

15.7%

Chiropracty

23.9%

Dermatology

5.3%

Endocrinology

7.4%

Hematology-Oncology

-2.8%

Infec�ous Disease

-18.0%

Nephrology

-26.2%

Pain Medicine

9.3%

Rheumatology

4.5%

2017 2027Health Systems Planning Category (HSPCs)

81

Demand




Outpatient Utilization Projections by Health Systems Planning Category (HSPC) Rehab Specialties RVUs – Puerto Rico Virgin Islands Market

Rehab Special�es, Health Systems Planning Categories (HSPCs)

RVU

s

0

300,000

600,000

900,000

1,200,000

1,500,000

1,800,000

2,100,000

2,400,000

2,700,000

Audiology

3.4%

Blind Rehabilita�on

-22.0%

Kinesiotherapy

12.4%

Occupa�onal Therapy

9.7%

Physical Therapy

15.9%

Recrea�on Therapy

7.1%

Speech Language Pathology

7.3%


82

BY17 Puerto Rico Virgin Islands Market In-House LTSS U�liza�on Projec�ons (RVUs).

FY17 FY22 FY27 10 YearChange

10 Year %Change

VA Adult Day Health CareHome-Based Primary CareSCI&D Home CareCommunity Residen�al CareHome Telehealth

7616,973

3,305143

8,791

2412,462

2,195124

6,826

209,7141,662

815,557

-56-7,259-1,643

-62-3,234

-73.7%-42.8%-49.7%-43.4%-36.8%

Outpa�ent U�liza�on Projec�ons by Health Systems Planning Category (HSPC) Ambulatory Long Term Support Services — Puerto Rico Virgin Islands Market

BY17 Puerto Rico Virgin Islands Market Community LTSS U�liza�on Projec�ons (Procedures).


10 Year %Change

Community Adult Day Health CareHome Respite CarePurchased Skilled Home CareHome Hospice CareHomemaker/Home Health Aide Programs

01,9778,1857,604

413,024

141,6526,2125,696

366,905

111,4374,8064,245

295,442

11-540

-3,379-3,359

-117,582

N/A-27.3%-41.3%-44.2%-28.5%

Demand




RVU

s

0

4,000

8,000

12,000

16,000

20,000

VA Adult Day Health

Care

-73.7%

Home-Based Primary

Care

-42.8%

SCI&D Home Care

-49.7%

Community Residen�al

Care

-43.4%

Home Telehealth

-36.8%

2017 2027Pr

oced

ures

0

60,000

120,000

180,000

240,000

300,000

360,000

420,000

Community Adult Day

Health Care

N/A

Home Respite

Care

-27.3%

Purchased Skilled

Home Care

-41.3%

Home Hospice

Care

-44.2%

Homemaker/Home

Health Aide

Programs

-28.5%

2017 2027

83

Demand

Source: 1. VSSC Encounters Cube 2. BY17 EHCPM U�liza�on Projec�ons 56.V08.PuertoRicoVirginIslands#IMG



Primary Care Workload – Historic & ProjectedFY18 Primary Care Encounters by County FY17-FY27 Primary Care RVU Growth Rate by Sector

84

Demand




Mental Health Workload – Historic & ProjectedFY18 Mental Health Encounters by County FY17-FY27 Mental Health RVU Growth Rate by Sector

85

Demand




Specialty Care Workload (Med/Surg Special�es Combined) – Historic & ProjectedFY18 Specialty Care Encounters by County FY17-FY27 Specialty Care RVU Growth Rate by Sector

86

. In-House Community Total Total Total .. ... o

Primary CareMedical Special�esSurgical Special�esMental Health ProgramsRehab TherapiesDental Clinic

347,752241,586136,291290,526

6,227,6151,644,367

3,94816,44811,795

4,785209,428102,968

351,700258,034148,086295,311

6,437,0431,747,335

334,385253,097152,279312,850

6,764,4451,767,872

319,845248,038156,548327,085

7,086,1211,614,035

-31,855-9,9968,462

31,774649,078

-133,300

-9.1%-3.9%5.7%

10.8%10.1%-7.6%

123456

Demand

Source: BY17 EHCPM U�liza�on Projec�ons 59.V08.PuertoRicoVirginIslands.672



FY17 FY22 FY27

10 Year

Change in

Total

10 Year %

Change in

Total

BY17 Parent Facility U�liza�on Projec�ons (Outpa�ent) – San Juan VAMCBY17 San Juan VAMC U�liza�on Projec�ons (RVUs)

RVU

s

0

60,000

120,000

180,000

240,000

300,000

360,000

Primary Care

-4.9% -9.1%

Medical Special�es

-1.9% -3.9%

Surgical Special�es

2.8% 5.7%

Mental Health Programs

5.9% 10.8%

2017 2022 2027

RVU

s

0

2,000,000

4,000,000

6,000,000

8,000,000

Rehab Therapies

5.1% 10.1%

Dental Clinic

1.2% -7.6%

2017 2022 2027

87

Ambulatory Mental Health, Health Systems Planning Categories (HSPCs)

RVU

s

0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

180,000

Homeless

-46.0%

Intensive Community MH

Recovery (ICMHR)

-50.4%

Psychiatry

12.7%

Psychology

20.1%

Psychosocial Rehabilita�on and Recovery

Centers

-36.8%

Work Therapy

-48.9%

Health Systems Planning Category (HSPC)

Demand




Outpa�ent Parent Facility U�liza�on Projec�ons by Health Systems Planning Category (HSPC)

l 2017 l 2027

Mental Health RVUs — San Juan VAMC

88

Demand




Outpa�ent Parent Facility U�liza�on Projec�ons by Health Systems Planning Category (HSPC) Surgical Special�es RVUs — San Juan VAMC

Ambulatory Surgical Special�es, Health Systems Planning Categories (HSPCs)

RVU

s

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

45,000

50,000

55,000

60,000

Neurological

11.4%


47.5%

Orthopaedic

19.2%

Otolaryngology

7.3%

Plas�c

13.3%

Podiatry

4.6%

Surgery

1.1%

Thoracic

5.1%

Urology

4.9%

Vascular

14.1%

Ophthalmology

1.1%

2017 2027Health Systems Planning Category (HSPC)

89

Ambulatory Medical Special�es, Health Systems Planning Categories (HSPCs)

RVU

s

0

3,000

6,000

9,000

12,000

15,000

18,000

21,000

24,000

27,000

30,000

33,000

36,000

39,000

42,000

45,000

Cardiology

-0.4%

Cri�cal Care/Pulmonary

Disease

-0.5%

Emergency Medicine

-28.7%

Gastroenterology

0.9%

Neurology

6.2%

Optometry

-2.3%

Physical Medicine &

Rehabilita�on

4.1%

2017 2027Health Systems Planning Category

Demand




Outpa�ent Parent Facility U�liza�on Projec�ons by Health Systems Planning Category (HSPC) Medical Special�es RVUs — San Juan VAMC

90

Demand




Outpa�ent Parent Facility U�liza�on Projec�ons by Health Systems Planning Category (HSPC) Rehab Special�es RVUs — San Juan VAMC

Rehab Special�es, Health Systems Planning Categories (HSPCs)

RVU

s

0

300,000

600,000

900,000

1,200,000

1,500,000

1,800,000

2,100,000

2,400,000

2,700,000

Audiology

4.4%

Blind Rehabilita�on

-20.4%

Occupa�onal Therapy

10.9%

Physical Therapy

16.8%

Recrea�on Therapy

7.1%

Speech Language Pathology

8.5%


91

0

4,000

8,000

12,000

16,000

20,000

SCI&D Home Care

-49.0%

Community Residen�al Care

-40.1%

Home-Based Primary Care

-42.1%

Home Telehealth

-35.9%

2017 2027

0

200,000

400,000

Home Respite Care

-27.3%

Purchased Skilled Home

Care

-39.6%

Home Hospice Care

-43.7%

Homemaker/Home Health Aide Programs

-27.9%

2017 2027

HSPC


10 Year %Change

Community Adult Day HealthCareHome Respite CarePurchased Skilled Home CareHome Hospice CareHomemaker/Home Health AidePrograms

N/A

1,9588,2997,684

414,950

N/A

1,6366,3875,781

369,981

N/A

1,4235,0104,325

299,152

N/A

-535-3,289-3,359

-115,798

N/A

-27.3%-39.6%-43.7%-27.9%

HSPC


10 Year %Change

SCI&D Home CareVA Adult Day Health CareCommunity Residen�alCareHome-Based PrimaryCareHome Telehealth

3,333N/A147

16,944

8,856

2,230N/A132

12,510

6,924

1,699N/A

88

9,816

5,673

-1,634N/A-59

-7,128

-3,183

-49.0%N/A

-40.1%

-42.1%

-35.9%



Outpa�ent Parent Facility U�liza�on Projec�ons by Health Systems Planning Category (HSPC)Ambulatory Long Term Support Services — San Juan VAMC

BY17 San Juan VAMC In-HouseLTSS U�liza�on Projec�ons (RVUs)

BY17 San Juan VAMC CommunityLTSS U�liza�on Projec�ons (Procedures)*

Demand

FY17 FY22 FY27 FY17 FY22 FY27


* Provided at procedure level given the limited RVU repor�ng for these services.

92

Demand

Source: N/A 64.V08.PuertoRicoVirginIslands


Overall Outpatient Commercial Demand – Puerto RicoPatient Visits Growth Projections

Clinical Service Line 2018 2023 2028 5 Year Chg % Chg 10 Year Chg % Chg453,242 472,483 496,057 19,241 4.2% 42,815 9.4%General/Family Practice

Internal Medicine 294,739 319,190 345,125 24,451 8.3% 50,386 17.1%Primary Care Total 747,982 791,674 841,183 43,692 5.8% 93,201 12.5%Allergy/Immunology 13,680 14,328 15,140 648 4.7% 1,460 10.7%Cardiology 132,190 153,572 175,479 21,382 16.2% 43,289 32.7%Dermatology 72,655 78,016 83,900 5,361 7.4% 11,246 15.5%Endocrinology 21,179 22,508 23,977 1,329 6.3% 2,798 13.2%Gastroenterology 46,612 52,180 57,990 5,568 11.9% 11,378 24.4%Hematology/Oncology 95,508 110,059 124,799 14,551 15.2% 29,291 30.7%Infectious Disease 4,971 5,449 5,944 477 9.6% 973 19.6%Nephrology 21,553 25,112 28,774 3,559 16.5% 7,221 33.5%Neurology 30,381 32,867 35,486 2,486 8.2% 5,105 16.8%Pain Management 21,654 24,578 27,628 2,924 13.5% 5,974 27.6%Pulmonology 25,140 28,404 31,759 3,264 13.0% 6,619 26.3%Rheumatology 17,587 18,917 20,349 1,329 7.6% 2,762 15.7%Vascular 9,733 11,462 13,242 1,728 17.8% 3,509 36.0%Specialty Care (Medicine) Sub-Total 512,843 577,451 644,469 64,608 12.6% 131,626 25.7%

3,545 4,007 4,469 463 13.1% 924 26.1%2,867 3,149 3,448 282 9.8% 581 20.3%

38,533 42,996 47,583 4,462 11.6% 9,049 23.5%7,058 7,633 8,233 575 8.1% 1,176 16.7%

88,137 99,212 110,746 11,076 12.6% 22,609 25.7%80,362 86,205 92,475 5,843 7.3% 12,112 15.1%34,248 36,613 39,231 2,365 6.9% 4,983 14.6%

7,996 8,859 9,762 863 10.8% 1,766 22.1%

Cardio/Thoracic SurgeryColorectal SurgeryGeneral SurgeryNeurosurgeryOphthalmologyOrthopedic SurgeryOtolaryngologyPlastic SurgeryUrology 40,654 45,204 49,944 4,550 11.2% 9,290 22.9%Specialty Care (Surgery) Sub-Total 303,400 333,878 365,890 30,479 10.0% 62,490 20.6%Medicine/Surgery Total 816,243 911,329 1,010,359 95,086 11.6% 194,116 23.8%Obstetrics/Gynecology 77,970 79,678 82,817 1,708 2.2% 4,847 6.2%Women's Health Total 77,970 79,678 82,817 1,708 2.2% 4,847 6.2%Psychiatry 56,968 58,335 60,513 1,367 2.4% 3,545 6.2%Mental Health Total 56,968 58,335 60,513 1,367 2.4% 3,545 6.2%Physical Medicine/Rehab 21,831 23,818 25,956 1,987 9.1% 4,125 18.9%Rehab Total 21,831 23,818 25,956 1,987 9.1% 4,125 18.9%Emergency/Critical Care 319,892 356,676 392,836 36,784 11.5% 72,944 22.8%Emergency Services Total 319,892 356,676 392,836 36,784 11.5% 72,944 22.8%Nurse Practitioner 76,720 84,938 93,846 8,219 10.7% 17,126 22.3%Physician Assistant 56,924 64,026 71,566 7,102 12.5% 14,643 25.7%Other Services Total 133,643 148,964 165,412 15,320 11.5% 31,769 23.8%Grand Total 2,174,528 2,370,473 2,579,075 195,944 9.0% 404,547 18.6%

Projection data was not available for Puerto Rico from common data

sources including IBM Watson and Advisory Board. Numerous

additional sources from the Puerto Rico Department of Health to other

special studies were found to be lacking projection data as well. This lack of data was confirmed by local

VAMC leadership.

Valida�on of the data for this slide is not requiredVISN 08: Puerto Rico Virgin Islands Market — San Juan

•

Overview:Outpatient demand estimates (patient visits)

were also developed to understand current

and future expected commercial outpatient

demand

Demand estimates are based on non-Veteran

patient origin within a 60 minute drive time

from parent VA Medical Center/ Health Care

Center noted

93

Demand Es�mated Current and Historic Market Demand — Inpa�ent

94

Inpa�ent Demand and CMI – San Juan

Bed Service FY15 FY16 FY17 FY18 Current FY15 FY16 FY17 FY18 FY15-18 Change % DO

MedicalSurgeryTotal Med/SurgMental HealthRRTP*CLCRehab MedBlindSpinal CordVAMC Total

17840

21830

N/A122

201220

422

17840

21830

N/A122

201220

422

17840

21830

N/A122

201220

422

15840

19830

N/A122

201220

402

15439

19332

0119

201220

396

134.718.2

152.927.9N/A

102.714.8

9.215.7

323.2

139.815.5

155.326.5

0.196.813.3

9.614.0

315.6

142.617.5

160.128.4

0.2102.2

13.28.1

15.7327.9

134.415.9

150.326.9

0.295.213.2

6.215.4

307.4

-0.2%-12.6%

-1.7%-3.6%

N/A-7.3%

-10.8%-32.6%

-1.9%-4.9%

123456789

10

0 Opera�ng Beds from PTF Cube Average Daily Census (ADC)Opera�ng Beds Reported by Field

Facility 2015 2016 2017 2018 2015CMI

2016CMI

2017CMI

2018CMI

MedianCMI**

HighCMI**

Id

(672) San Juan 4,922 5,077 5,140 4,944 1.41 1.40 1.37 1.40 1.47 2.33 161

Demand


*RRTP includes Domiciliary and CWT/TR Bed Services **Market: Within a 60 minute drive �me of the VAMC


VISN 08: Puerto Rico Virgin Islands Market – San Juan

Uniques VAMC Case Mix Index Commercial Provider Case Mix IndexUniques

Source: 1. Beds reported by the field in GFI submission 2. VSSC Beds Using PTF Cube 3. MCAO Discharge Cube 4. CMI (acute inpa�ent care) based on Medicare only popula�on from 2018 CMS Cost Reports

95

Medical/Surgical Bed Days of Care (BDOC) – FY15-18Demand

Source: 1. VSSC Trea�ng Specialty Cube 2. Geocoded Enrollee File FY18Q4 67.V08.PuertoRicoVirginIslands#IMG



FY15-18 Average Medical/Surgical Bed Days of Care by County

96

County Total FY18 BDOC Total FY18 ADC % FY18 ADC of Market Total FY15-18 AVG BDOC Majority Receiving Facility % FY15-18 BDOC toMajority Receiving Facility

Id

San Juan, PR

Bayamon, PR

Carolina, PR

Caguas, PR

Toa Baja, PR

Guaynabo, PR

Trujillo Alto, PR

Ponce, PR

Rio Grande, PR

Toa Alta, PR

Arecibo, PR

Juana Diaz, PR

Cayey, PR

Humacao, PR

Dorado, PR

Gurabo, PR

Canovanas, PR

Vega Baja, PR

9,428

6,069

5,061

3,016

2,840

2,282

2,125

1,525

903

1,348

1,107

869

1,006

1,240

907

902

804

846

25.8

16.6

13.9

8.3

7.8

6.3

5.8

4.2

2.5

3.7

3.0

2.4

2.8

3.4

2.5

2.5

2.2

2.3

16.4%

9.6%

8.2%

5.7%

4.4%

3.8%

3.0%

2.4%

2.2%

2.1%

1.8%

1.7%

1.7%

1.6%

1.6%

1.5%

1.4%

1.4%

8,389

4,918

4,193

2,925

2,246

1,934

1,529

1,238

1,127

1,066

911

871

855

820

803

769

721

695



















98.1%

98.5%

98.2%

98.1%

98.8%

98.4%

98.0%

96.1%

99.4%

96.6%

96.0%

98.3%

97.7%

98.7%

98.1%

97.9%

97.8%

97.3%

881

882

883

884

885

886

887

888

889

890

891

892

893

894

895

896

897

898

Medical/Surgical BDOC — FY15-18, cont.Demand

Source: 1. VSSC Trea�ng Specialty Cube 2. Geocoded Enrollee File FY18Q4 68.V08.PuertoRicoVirginIslands



Majority Receiving Facility is the facility in the specified county with the most BDOC summed across all fiscal years. The % FY15-18 BDOC to Majority Receiving Facility is the Majority Receiving Facility's total summed BDOC divided by the county's total BDOC summed across all fiscal years.

97


Id

Fajardo, PR

Aguadilla, PR

Naranjito, PR

Juncos, PR

Catano, PR

San Lorenzo, PR

Cidra, PR

Vega Alta, PR

Isabela, PR

Mana�, PR

Corozal, PR

Aguas Buenas, PR

Las Piedras, PR

Mayaguez, PR

Naguabo, PR

Luquillo, PR

Aibonito, PR

Ha�llo, PR

762

777

977

611

572

713

573

417

500

340

557

325

499

204

302

344

258

454

2.1

2.1

2.7

1.7

1.6

2.0

1.6

1.1

1.4

0.9

1.5

0.9

1.4

0.6

0.8

0.9

0.7

1.2

1.2%

1.2%

1.2%

1.0%

1.0%

0.9%

0.9%

0.9%

0.8%

0.8%

0.8%

0.8%

0.7%

0.7%

0.7%

0.6%

0.6%

0.6%

637

626

615

515

511

487

475

440

425

416

414

408

374

360

339

329

317

316



















97.3%

96.4%

97.7%

99.2%

96.5%

95.8%

94.9%

99.0%

94.3%

97.8%

96.3%

99.4%

93.0%

92.3%

98.4%

97.0%

98.2%

97.0%

899

900

901

902

903

904

905

906

907

908

909

910

911

912

913

914

915

916


Source: 1. VSSC Trea�ng Specialty Cube 2. Geocoded Enrollee File FY18Q4 68.V08.PuertoRicoVirginIslands#2




98


Id

Utuado, PR

Barranquitas, PR

Yauco, PR

Yabucoa, PR

Ceiba, PR

Salinas, PR

Guayama, PR

Morovis, PR

Quebradillas, PR

Cabo Rojo, PR

Guayanilla, PR

Coamo, PR

Barceloneta, PR

Loiza, PR

Penuelas, PR

Camuy, PR

Orocovis, PR

Comerio, PR

397

369

239

261

363

205

346

277

288

300

360

298

320

164

270

148

210

243

1.1

1.0

0.7

0.7

1.0

0.6

0.9

0.8

0.8

0.8

1.0

0.8

0.9

0.4

0.7

0.4

0.6

0.7

0.6%

0.6%

0.6%

0.6%

0.6%

0.5%

0.5%

0.5%

0.5%

0.5%

0.5%

0.5%

0.4%

0.4%

0.4%

0.4%

0.4%

0.4%

311

295

293

292

284

279

278

263

252

252

235

232

219

216

202

193

192

186



















90.0%

99.6%

94.8%

96.9%

94.6%

99.4%

95.1%

97.7%

91.3%

92.9%

91.1%

92.6%

97.3%

99.2%

95.7%

95.6%

99.1%

98.5%

917

918

919

920

921

922

923

924

925

926

927

928

929

930

931

932

933

934






99


Id

San Sebas�an, PR

Aguada, PR

Arroyo, PR

Lares, PR

Vieques, PR

Ciales, PR

Florida, PR

Pa�llas, PR

Moca, PR

Guanica, PR

Villalba, PR

San German, PR

Santa Isabel, PR

Sabana Grande, PR

Lajas, PR

Maunabo, PR

Adjuntas, PR

Anasco, PR

142

133

250

214

148

184

188

110

188

84

188

107

96

74

86

154

130

162

0.4

0.4

0.7

0.6

0.4

0.5

0.5

0.3

0.5

0.2

0.5

0.3

0.3

0.2

0.2

0.4

0.4

0.4

0.4%

0.4%

0.3%

0.3%

0.3%

0.3%

0.3%

0.3%

0.2%

0.2%

0.2%

0.2%

0.2%

0.2%

0.2%

0.2%

0.2%

0.1%

185

181

179

170

144

138

137

128

127

126

114

113

111

105

94

94

79

72



















98.9%

98.9%

95.8%

99.6%

98.3%

99.1%

100.0%

95.1%

88.9%

92.3%

97.1%

94.2%

96.6%

96.4%

95.5%

92.8%

96.8%

97.2%

935

936

937

938

939

940

941

942

943

944

945

946

947

948

949

950

951

952






100


Id

Jayuya, PR

Hormigueros, PR

Rincon, PR

Culebra, PR

Las Marias, PR

Maricao, PR

Saint Croix, VI

Saint Thomas, VI

Saint John, VI

Total

106

33

17

12

4

7

0

0

0

59,338

0.3

0.1

0.0

0.0

0.0

0.0

0.0

0.0

0.0

162.6

0.1%

0.1%

0.1%

0.0%

0.0%

0.0%

0.3%

0.2%

0.1%

100.0%

71

61

39

18

13

11

213

121

81

51,295









(V08) (673) Tampa

98.6%

98.4%

86.6%

98.6%

92.0%

81.0%

85.0%

58.8%

29.9%

N/A

953

954

955

956

957

958

959

960

961

962






101

Demand

Source: VSSC Trea�ng Specialty Cube 69.V08.PuertoRicoVirginIslands



Top DRGs for Medicine in FY184_4 Facility DRG In Market

BDOCIn Market BDOC

% of TotalIn and Out ofMarket BDOC

In and Out of Market% of Total BDOC


(V08) (6729AA) San Juan

O (871) Sep�cemia W/o Mv 96+ Hours W MccO (291) Heart Failure & Shock W MccO (57) Degenera�ve Nervous System Disorders W/o MccO (872) Sep�cemia W/o Mv 96+ Hours W/o MccO (698) Other Kidney & Urinary Tract Diagnoses W MccO (194) Simple Pneumonia & Pleurisy W CcO (870) Sep�cemia W Mv 96+ HoursO (178) Respiratory Infec�ons & Inflamma�ons W CcO (690) Kidney & Urinary Tract Infec�ons W/o MccO (207) Respiratory System Diagnosis W Ven�lator Support 96+ HoursOtherTotalO (872) Sep�cemia W/o Mv 96+ Hours W/o MccTotal

3,7441,9701,9341,3051,3521,1321,1361,068

976929

31,23246,778

33

8.0%4.2%4.1%2.8%2.9%2.4%2.4%2.3%2.1%2.0%

66.8%100.0%100.0%100.0%

3,8762,0601,9781,3681,3581,1531,1361,099

989953

32,75648,726

33

8.0%4.2%4.1%2.8%2.8%2.4%2.3%2.3%2.0%2.0%

67.2%100.0%100.0%100.0%

4_4 Facility DRG In MarketBDOC

In Market BDOC% of Total

In and Out ofMarket BDOC



(V08) (6729AA) San Juan

O (871) Sep�cemia W/o Mv 96+ Hours W MccO (291) Heart Failure & Shock W MccO (57) Degenera�ve Nervous System Disorders W/o MccO (872) Sep�cemia W/o Mv 96+ Hours W/o MccO (698) Other Kidney & Urinary Tract Diagnoses W MccO (194) Simple Pneumonia & Pleurisy W CcO (870) Sep�cemia W Mv 96+ HoursO (178) Respiratory Infec�ons & Inflamma�ons W CcO (690) Kidney & Urinary Tract Infec�ons W/o MccO (207) Respiratory System Diagnosis W Ven�lator Support 96+ HoursOtherTotalO (872) Sep�cemia W/o Mv 96+ Hours W/o MccTotal

3,7441,9701,9341,3051,3521,1321,1361,068

976929

31,23246,778

33

8.0%4.2%4.1%2.8%2.9%2.4%2.4%2.3%2.1%2.0%

66.8%100.0%100.0%100.0%

3,8762,0601,9781,3681,3581,1531,1361,099

989953

32,75648,726

33

8.0%4.2%4.1%2.8%2.8%2.4%2.3%2.3%2.0%2.0%

67.2%100.0%100.0%100.0%

102

Demand

Source: 1. VSSC Trea�ng Specialty Cube 2. VHA Office of Community Care 157.V08.PuertoRicoVirginIslands



Top Medicine DRGs in the Community and Outside of the Market. DRG FY18 BDOC % of Total BDOC

VA Care Outside of the Market

Care in the Community

(871) SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC(291) HEART FAILURE & SHOCK W MCC(57) DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC(194) SIMPLE PNEUMONIA & PLEURISY W CC(690) KIDNEY & URINARY TRACT INFECTIONS W/O MCC(65) INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W CC OR TPA IN 24 HRS(287) CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH W/O MCC(809) MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL W CC(306) CARDIAC CONGENITAL & VALVULAR DISORDERS W MCC(92) OTHER DISORDERS OF NERVOUS SYSTEM W CCOtherTotal(561) AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W/O CC/MCC(639) DIABETES W/O CC/MCC(301) PERIPHERAL VASCULAR DISORDERS W/O CC/MCC(192) CHRONIC OBSTRUCTIVE PULMONARY DISEASE W/O CC/MCC(871) SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC(57) DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC(66) INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W/O CC/MCC(682) RENAL FAILURE W MCC

116797662514742424040

1,2291,824

260171153117

50494943

6.4%4.3%4.2%3.4%2.8%2.6%2.3%2.3%2.2%2.2%

67.4%100.0%

16.3%10.7%

9.6%7.3%3.1%3.1%3.1%2.7%

(552) MEDICAL BACK PROBLEMS W/O MCC(812) RED BLOOD CELL DISORDERS W/O MCCOtherTotal

4133

6301,596

2.6%2.1%

39.5%100.0%

. DRG FY18 BDOC % of Total BDOC

VA Care Outside of the Market*


(871) SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC(291) HEART FAILURE & SHOCK W MCC(57) DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC(194) SIMPLE PNEUMONIA & PLEURISY W CC(690) KIDNEY & URINARY TRACT INFECTIONS W/O MCC(65) INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W CC OR TPA IN 24 HRS(287) CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH W/O MCC(809) MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL W CC(306) CARDIAC CONGENITAL & VALVULAR DISORDERS W MCC(92) OTHER DISORDERS OF NERVOUS SYSTEM W CCOtherTotal(561) AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W/O CC/MCC(639) DIABETES W/O CC/MCC(301) PERIPHERAL VASCULAR DISORDERS W/O CC/MCC(192) CHRONIC OBSTRUCTIVE PULMONARY DISEASE W/O CC/MCC(871) SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC(57) DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC(66) INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W/O CC/MCC(682) RENAL FAILURE W MCC

116797662514742424040

1,2291,824

260171153117

50494943

6.4%4.3%4.2%3.4%2.8%2.6%2.3%2.3%2.2%2.2%

67.4%100.0%

16.3%10.7%

9.6%7.3%3.1%3.1%3.1%2.7%

(552) MEDICAL BACK PROBLEMS W/O MCC(812) RED BLOOD CELL DISORDERS W/O MCCOtherTotal

4133

6301,596

2.6%2.1%

39.5%100.0%

*Enrollees enrolled in a market and received care at a facility outside of their market.

103

Top DRGs for Surgery in FY18Demand




Id


In Market BDOC % ofTotal


In and Out of Market %of Total BDOC

………………………………

(V08) (672) San Juan O (4) Trach W Mv 96+ Hrs Or Pdx Exc Face, Mouth & Neck W/o Maj O.r.O (247) Perc Cardiovasc Proc W Drug-elu�ng Stent W/o MccO (3) Ecmo Or Trach W Mv 96+ Hrs Or Pdx Exc Face, Mouth & Neck W Maj O.r.O (853) Infec�ous & Parasi�c Diseases W O.r. Procedure W MccO (470) Major Joint Replacement Or Rea�achment Of Lower Extremity W/o …O (329) Major Small & Large Bowel Procedures W MccO (330) Major Small & Large Bowel Procedures W CcO (987) Non-extensive O.r. Proc Unrelated To Principal Diagnosis W MccO (246) Perc Cardiovasc Proc W Drug-elu�ng Stent W Mcc Or 4+ Vessels/ste…O (240) Amputa�on For Circ Sys Disorders Exc Upper Limb & Toe W CcOtherTotal

1,972493314300283284258244186174

4,8269,334

21.1%5.3%3.4%3.2%3.0%3.0%2.8%2.6%2.0%1.9%

51.7%100.0%

2,036500383300286284258244229184

5,0729,776

20.8%5.1%3.9%3.1%2.9%2.9%2.6%2.5%2.3%1.9%

51.9%100.0%

Id


In Market BDOC % ofTotal


In and Out of Market %of Total BDOC

………………………………

(V08) (672) San Juan O (4) Trach W Mv 96+ Hrs Or Pdx Exc Face, Mouth & Neck W/o Maj O.r.O (247) Perc Cardiovasc Proc W Drug-elu�ng Stent W/o MccO (3) Ecmo Or Trach W Mv 96+ Hrs Or Pdx Exc Face, Mouth & Neck W Maj O.r.O (853) Infec�ous & Parasi�c Diseases W O.r. Procedure W MccO (470) Major Joint Replacement Or Rea�achment Of Lower Extremity W/o …O (329) Major Small & Large Bowel Procedures W MccO (330) Major Small & Large Bowel Procedures W CcO (987) Non-extensive O.r. Proc Unrelated To Principal Diagnosis W MccO (246) Perc Cardiovasc Proc W Drug-elu�ng Stent W Mcc Or 4+ Vessels/ste…O (240) Amputa�on For Circ Sys Disorders Exc Upper Limb & Toe W CcOtherTotal

1,972493314300283284258244186174

4,8269,334

21.1%5.3%3.4%3.2%3.0%3.0%2.8%2.6%2.0%1.9%

51.7%100.0%

2,036500383300286284258244229184

5,0729,776

20.8%5.1%3.9%3.1%2.9%2.9%2.6%2.5%2.3%1.9%

51.9%100.0%

104

Demand




Top Surgery DRGs in the Community and Outside of the Market. DRG FY18 BDOC % of Total BDOC


(708) MAJOR MALE PELVIC PROCEDURES W/O CC/MCC(116) INTRAOCULAR PROCEDURES W CC/MCC(220) CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC W/O CARD CATH W CC(14) ALLOGENEIC BONE MARROW TRANSPLANT(707) MAJOR MALE PELVIC PROCEDURES W CC/MCC(981) EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W MCC(470) MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCC(982) EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W CC(617) AMPUTAT OF LOWER LIMB FOR ENDOCRINE,NUTRIT,& METABOL DIS W CC(329) MAJOR SMALL & LARGE BOWEL PROCEDURES W MCCOtherTotal(330) MAJOR SMALL & LARGE BOWEL PROCEDURES W CC(3) ECMO OR TRACH W MV >96 HRS OR PDX EXC FACE, MOUTH & NECK W MAJ O.R.(460) SPINAL FUSION EXCEPT CERVICAL W/O MCC(405) PANCREAS, LIVER & SHUNT PROCEDURES W MCC(219) CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC W/O CARD CATH W MCC(656) KIDNEY & URETER PROCEDURES FOR NEOPLASM W MCC(406) PANCREAS, LIVER & SHUNT PROCEDURES W CC(407) PANCREAS, LIVER & SHUNT PROCEDURES W/O CC/MCC

67664741383626232117

191573

6765524343423432

11.7%11.5%

8.2%7.2%6.6%6.3%4.5%4.0%3.7%3.0%

33.3%100.0%

7.5%7.3%5.8%4.8%4.8%4.7%3.8%3.6%

(356) OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W MCC(1) HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM W MCCOtherTotal

2929

455891

3.3%3.3%

51.1%100.0%



(708) MAJOR MALE PELVIC PROCEDURES W/O CC/MCC(116) INTRAOCULAR PROCEDURES W CC/MCC(220) CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC W/O CARD CATH W CC(14) ALLOGENEIC BONE MARROW TRANSPLANT(707) MAJOR MALE PELVIC PROCEDURES W CC/MCC(981) EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W MCC(470) MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCC(982) EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W CC(617) AMPUTAT OF LOWER LIMB FOR ENDOCRINE,NUTRIT,& METABOL DIS W CC(329) MAJOR SMALL & LARGE BOWEL PROCEDURES W MCCOtherTotal(330) MAJOR SMALL & LARGE BOWEL PROCEDURES W CC(3) ECMO OR TRACH W MV >96 HRS OR PDX EXC FACE, MOUTH & NECK W MAJ O.R.(460) SPINAL FUSION EXCEPT CERVICAL W/O MCC(405) PANCREAS, LIVER & SHUNT PROCEDURES W MCC(219) CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC W/O CARD CATH W MCC(656) KIDNEY & URETER PROCEDURES FOR NEOPLASM W MCC(406) PANCREAS, LIVER & SHUNT PROCEDURES W CC(407) PANCREAS, LIVER & SHUNT PROCEDURES W/O CC/MCC

67664741383626232117

191573

6765524343423432

11.7%11.5%

8.2%7.2%6.6%6.3%4.5%4.0%3.7%3.0%

33.3%100.0%

7.5%7.3%5.8%4.8%4.8%4.7%3.8%3.6%

(356) OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W MCC(1) HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM W MCCOtherTotal

2929

455891

3.3%3.3%

51.1%100.0%



105

Mental Health BDOC – FY15-18Demand

Source: 1. VSSC Trea�ng Specialty Cube 2. Geocoded Enrollee File FY18Q4 71.V08.PuertoRicoVirginIslands#IMG



FY15-18 Average Mental Health Days of Care by County

106

Mental Health BDOC – FY15-18, cont.County Total FY18

BDOCTotal FY18

ADC% FY18 ADC of

MarketFY15-18 AVG

BDOCMajority Receiving Facility FY15-18 % BDOC to Majority

Receiving Facility.

.

San Juan, PRBayamon, PRCaguas, PRCarolina, PRToa Baja, PRGuaynabo, PRVega Baja, PRTrujillo Alto, PRToa Alta, PRAguadilla, PRGurabo, PRPonce, PRCayey, PRRio Grande, PRArecibo, PRMayaguez, PRVega Alta, PRSan Lorenzo, PRMorovis, PRMoca, PR

2,0871,299

774735309532181412171242336151262163128118

82106197151

5.73.62.12.00.81.50.51.10.50.70.90.40.70.40.40.30.20.30.50.4

18.1%11.3%

6.7%6.4%2.7%4.6%1.6%3.6%1.5%2.1%2.9%1.3%2.3%1.4%1.1%1.0%0.7%0.9%1.7%1.3%

1,9651,104

708698428354288275247226207201195191191160160138128125

(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan

96.4%96.9%95.2%97.7%98.2%99.4%92.0%98.2%98.2%91.8%98.2%71.1%97.8%99.9%89.1%73.9%98.4%

100.0%95.5%99.4%

123456789

1011121314151617181920

00000000000000000000

Demand

Source: 1. VSSC Trea�ng Specialty Cube 2. Geocoded Enrollee File FY18Q4 72.V08.PuertoRicoVirginIslands




107


BDOCTotal FY18

ADC% FY18 ADC of

MarketFY15-18 AVG


Receiving Facility.

.

Cidra, PRDorado, PRJuana Diaz, PRCorozal, PRFajardo, PRHumacao, PRAguas Buenas, PRBarranquitas, PRLas Piedras, PRIsabela, PRSan Sebas�an, PRAibonito, PRYabucoa, PRJuncos, PRCanovanas, PRQuebradillas, PRMana�, PRLares, PRNaranjito, PRNaguabo, PR

189114145154105

8156

142969964

123126120

8864

10963

10066

0.50.30.40.40.30.20.20.40.30.30.20.30.30.30.20.20.30.20.30.2

1.6%1.0%1.3%1.3%0.9%0.7%0.5%1.2%0.8%0.9%0.6%1.1%1.1%1.0%0.8%0.6%0.9%0.5%0.9%0.6%

122117117115114106104102102101

95949392878483777171

(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V10) (539) Cincinna�-Ohio(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan

98.6%92.5%81.9%

100.0%98.0%85.8%99.5%94.6%88.9%19.9%99.2%

100.0%96.2%

100.0%96.0%84.5%81.9%

100.0%100.0%100.0%

2122232425262728293031323334353637383940

00000000000000000000

Demand





108


BDOCTotal FY18

ADC% FY18 ADC of

MarketFY15-18 AVG


Receiving Facility.

.

Hormigueros, PRSalinas, PRHa�llo, PRCoamo, PRCamuy, PRCabo Rojo, PRCiales, PRAguada, PRUtuado, PRGuayama, PRComerio, PROrocovis, PRMaricao, PRLuquillo, PRSanta Isabel, PRMaunabo, PRSan German, PRYauco, PRSabana Grande, PRBarceloneta, PR

N/A115

8144354118

698383754234259

418

N/A1634

N/A0.30.20.10.10.10.00.00.30.10.10.10.10.10.20.00.0

N/A0.00.1

N/A1.0%0.7%0.4%0.3%0.4%0.2%0.1%0.8%0.3%0.3%0.5%0.2%0.4%0.5%0.0%0.2%N/A

0.1%0.3%

7060565554535150505049484636353333323130

(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan

99.0%98.8%99.6%93.7%96.3%78.1%

100.0%97.4%82.6%84.8%

100.0%100.0%100.0%

97.9%85.0%96.9%96.9%

100.0%86.9%

100.0%

4142434445464748495051525354555657585960

00000000000000000000

Demand





109


BDOCTotal FY18

ADC% FY18 ADC of

MarketFY15-18 AVG


Receiving Facility.

.

Pa�llas, PRCatano, PRLajas, PRAdjuntas, PRCeiba, PRVieques, PRArroyo, PRRincon, PRGuanica, PRLas Marias, PRAnasco, PRLoiza, PRVillalba, PRJayuya, PRPenuelas, PRFlorida, PRGuayanilla, PRCulebra, PRSaint Croix, VISaint Thomas, VI

392153

N/A19

N/A2624

4N/AN/A

1313

N/A3

122

N/AN/AN/A

0.10.10.1

N/A0.1

N/A0.10.10.0

N/AN/A0.00.0

N/A0.00.00.0

N/AN/AN/A

0.3%0.2%0.5%N/A

0.2%N/A

0.2%0.2%0.0%N/AN/A

0.1%0.1%N/A

0.0%0.1%0.0%N/AN/AN/A

30262422222218181515151312121010

72

13049

(V08) (672) San Juan(V08) (672) San Juan(V21) (593) North Las Vegas(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V02) (630) Manha�an(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V02) (526) Bronx-New York(V08) (672) San Juan(V08) (672) San Juan(V02) (526) Bronx-New York(V08) (672) San Juan(V08) (672) San Juan(V07) (508) Atlanta

100.0%100.0%

29.6%88.1%96.6%

100.0%83.3%30.2%

100.0%100.0%

91.1%100.0%100.0%

47.8%90.3%

100.0%64.3%

100.0%57.8%56.2%

6162636465666768697071727374757677787980

00000000000000000000

Demand





110


BDOCTotal FY18

ADC% FY18 ADC of

MarketFY15-18 AVG


Receiving Facility.

.

Saint John, VITotal

N/A11,532

N/A31.6

N/A100.0%

2011,175

(V08) (672) San Juan 100.0%N/A

8182

01

Demand





111

4_8 DRG In MarketBDOC

In Market BDOC% of Total



(V08) (672) San Juan N (885) PsychosesO (897) Alcohol/drug Abuse Or Dependence W/o Rehabilita�on Therapy W/o MccO (884) Organic Disturbances & Mental Retarda�onN (881) Depressive neurosesN (882) Neuroses except depressiveO (895) Alcohol/drug Abuse Or Dependence W Rehabilita�on TherapyO (896) Alcohol/drug Abuse Or Dependence W/o Rehabilita�on Therapy W MccO (880) Acute Adjustment Reac�on & Psychosocial Dysfunc�onO (886) Behavioral & Developmental DisordersO (894) Alcohol/drug Abuse Or Dependence, Le� AmaTotal

4,0962,0241,3451989274656693

7,972

51.4%25.4%16.9%2.5%1.2%0.9%0.8%0.8%0.1%0.0%

100.0%

4,6962,5771,40820097866866123

9,213

51.0%28.0%15.3%2.2%1.1%0.9%0.7%0.7%0.1%0.0%

100.0%

Demand




Top DRGs for Mental Health in FY184_8 DRG In Market

BDOCIn Market BDOC

% of TotalIn and Out ofMarket BDOC


(V08) (672) San Juan N (885) PsychosesO (897) Alcohol/drug Abuse Or Dependence W/o Rehabilita�on Therapy W/o MccO (884) Organic Disturbances & Mental Retarda�onN (881) Depressive neurosesN (882) Neuroses except depressiveO (895) Alcohol/drug Abuse Or Dependence W Rehabilita�on TherapyO (896) Alcohol/drug Abuse Or Dependence W/o Rehabilita�on Therapy W MccO (880) Acute Adjustment Reac�on & Psychosocial Dysfunc�onO (886) Behavioral & Developmental DisordersO (894) Alcohol/drug Abuse Or Dependence, Le� AmaTotal

4,0962,0241,345

19892746566

93

7,972

51.4%25.4%16.9%

2.5%1.2%0.9%0.8%0.8%0.1%0.0%

100.0%

4,6962,5771,408

2009786686612

39,213

51.0%28.0%15.3%

2.2%1.1%0.9%0.7%0.7%0.1%0.0%

100.0%

112

Demand




Top Mental Health DRGs in the Community and Outside of the Market. DRG FY18 BDOC % of Total BDOC


(885) PSYCHOSES(897) ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY W/O MCC(882) NEUROSES EXCEPT DEPRESSIVE(884) ORGANIC DISTURBANCES & INTELLECTUAL DISABILITY(881) DEPRESSIVE NEUROSES(895) ALCOHOL/DRUG ABUSE OR DEPENDENCE W REHABILITATION THERAPY(883) DISORDERS OF PERSONALITY & IMPULSE CONTROL(880) ACUTE ADJUSTMENT REACTION & PSYCHOSOCIAL DYSFUNCTION(896) ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY W MCCTotal(885) PSYCHOSES(897) ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY W/O MCC(884) ORGANIC DISTURBANCES & INTELLECTUAL DISABILITY(882) NEUROSES EXCEPT DEPRESSIVE(881) DEPRESSIVE NEUROSES(880) ACUTE ADJUSTMENT REACTION & PSYCHOSOCIAL DYSFUNCTION(896) ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY W MCC(886) BEHAVIORAL & DEVELOPMENTAL DISORDERS(894) ALCOHOL/DRUG ABUSE OR DEPENDENCE, LEFT AMATotal

341113103

534115

976

6887,4382,146

206184129

251810

410,160

49.6%16.4%15.0%

7.7%6.0%2.2%1.3%1.0%0.9%

100.0%73.2%21.1%

2.0%1.8%1.3%0.2%0.2%0.1%0.0%

100.0%



(885) PSYCHOSES(897) ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY W/O MCC(882) NEUROSES EXCEPT DEPRESSIVE(884) ORGANIC DISTURBANCES & INTELLECTUAL DISABILITY(881) DEPRESSIVE NEUROSES(895) ALCOHOL/DRUG ABUSE OR DEPENDENCE W REHABILITATION THERAPY(883) DISORDERS OF PERSONALITY & IMPULSE CONTROL(880) ACUTE ADJUSTMENT REACTION & PSYCHOSOCIAL DYSFUNCTION(896) ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY W MCCTotal(885) PSYCHOSES(897) ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY W/O MCC(884) ORGANIC DISTURBANCES & INTELLECTUAL DISABILITY(882) NEUROSES EXCEPT DEPRESSIVE(881) DEPRESSIVE NEUROSES(880) ACUTE ADJUSTMENT REACTION & PSYCHOSOCIAL DYSFUNCTION(896) ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY W MCC(886) BEHAVIORAL & DEVELOPMENTAL DISORDERS(894) ALCOHOL/DRUG ABUSE OR DEPENDENCE, LEFT AMATotal

341113103

534115

976

6887,4382,146

206184129

251810

410,160

49.6%16.4%15.0%

7.7%6.0%2.2%1.3%1.0%0.9%

100.0%73.2%21.1%

2.0%1.8%1.3%0.2%0.2%0.1%0.0%

100.0%



113

Demand

Source: 1. Office of Community Care 74.V08.PuertoRicoVirginIslands.672



Community Care (Inpa�ent)FY16-18 Medicine NVCC (ADC) FY16-18 Surgery NVCC (ADC) FY16-18 Mental Health NVCC (ADC)

Vendor FY16 FY17 FY18

AUXILIO MUTUO HOSPITALASHFORD PRESBYTERIAN COMM HOSPHOSAPITAL UNIVERSITARIO DE ADULTOSPROFESSIONAL HOSPITAL GUAYNABO I…HOSPITAL DAMASCLINICA PEREAADMIN DE SVCS MEDICOSHOSP HIMA SAN PABLO BAYAMONHOSP EPISCOPAL SAN LUCAS IIHOSPITAL ONCOLOGICOAll Other VendorsCommunity Total (ADC)

0.30.20.10.40.0

N/AN/A0.00.1

N/A0.41.4

0.50.00.00.30.0

N/A0.00.10.20.10.31.5

0.50.30.20.20.10.10.10.00.00.00.11.8

Vendor FY16 FY17 FY18

MILLENIUM INST. FOR AVANCED NURSI…MULTY MED FACILITIES CORPHOSPITAL DE LA CONCEPCIONHOSP EPISCOPAL SAN LUCAS IIMENONITA GENERAL HOSPITAL AIBONI…HOSPITAL DAMASSISTEMAS INTEGRADOS DE SALUD DEL …CLINICA PEREACENTRO CARDIOVASCULAR DE PR Y DE…MANATI MEDICAL CENTER DR OTERO L…All Other VendorsCommunity Total (ADC)

N/AN/A0.10.1

N/A0.30.10.00.00.00.31.0

N/A0.50.20.10.00.20.10.0

N/A0.00.61.8

1.91.10.20.20.20.20.10.10.10.10.64.8

Vendor FY16 FY17 FY18 .

SAN JUAN CAPESTRANO HOSP INCFIRST HOSPITAL PANAMERICANOHOSPITAL METROPOLITANO CABO ROJOINSPIRA BEHAVIORAL CARE CORPHOSPITAL PAVIA YAUCOHOSP METROPOLITANO DE LA MONTA…HOSPITAL MENONITA CIMAMILLENIUM INST. FOR AVANCED NURS…SAN JUAN BAUTISTA MED CTRHOSPITAL PAVIA HATO REYAll Other VendorsCommunity Total (ADC)

5.311.8

0.80.7

N/A0.0

N/AN/AN/A0.0

N/A18.5

5.96.40.80.50.10.00.0

N/A0.0

N/AN/A13.6

15.96.71.10.40.00.00.00.0

N/AN/AN/A24.1

123456789101112

114

NVCC FY16-18 – Inpa�ent BDOCDemand




Medicine Mental HealthSurgerySector/ County Name

Sector County Name 2017 Enrollees FY16 FY17 FY18 FY16 FY17 FY18 FY16 FY17 FY18



N/A49

N/AN/AN/A

8N/AN/AN/A

31316

3N/A

30N/A

33

N/A

N/AN/AN/AN/A

4N/A

5N/AN/A

327

214

3N/A

42N/AN/AN/AN/A

11827

N/A29

532

N/A4525

2092249

N/A1

13015

02010

8N/A

9214

26N/A

188

471215

N/A2

3554

N/A4

4N/A

8N/AN/AN/A

2N/AN/AN/A

572921

41

493

32N/A

6

641311

9N/A

2920

N/A39

991629

N/A4

51N/AN/A

8N/A

4734

157513269

125N/A

3629

30461

23132

106297

17152N/A

31

2653

1036241

350

82438

31077

1282412

1092154

N/AN/A

N/A58

144182

8220

124N/A

2959

63764

4664829

37220

1441036

08-k-9-A08-k-9-A08-k-9-A08-k-9-A08-k-9-A08-k-9-A

Cidra, PRCoamo, PRComerio, PRCorozal, PRDorado, PRFajardo, PR

N/A8

N/AN/A

8N/A

N/A9

N/A15

57

1718

N/A1757

N/A

715

N/AN/A

317

N/A43

N/A128

N/A9

N/AN/AN/A

15

51127

21316241

75113N/A

259420

55113

3414

119106

115

NVCC FY16-18 – Inpa�ent BDOC, cont.Demand







Florida, PRGuanica, PRGuayama, PRGuayanilla, PRGuaynabo, PRGurabo, PRHa�llo, PRHormigueros, PRHumacao, PRIsabela, PRJayuya, PRJuana Diaz, PRJuncos, PRLajas, PRLares, PRLas Marias, PRLas Piedras, PRLoiza, PRLuquillo, PRMana�, PR

N/A4

N/A19

7N/A

5722

N/A6

N/AN/A

2N/AN/AN/AN/AN/A

915

N/A2

1297

N/AN/A

15N/A

12N/AN/AN/AN/AN/AN/AN/AN/A

5153

179

15N/A

212

N/A18

N/A16

N/A7

N/AN/AN/AN/AN/A

7

N/A935

20N/AN/A

23N/A

1N/AN/A

142

N/AN/A

10N/AN/AN/A

N/A1352

12

N/AN/AN/AN/A

13N/AN/A

08

N/AN/AN/AN/A

3N/A

N/A10261213

59

N/AN/A

2N/A

171

204

N/AN/AN/A

32

1730643879

104515524

11711

1674114111114

84534

7461359

1201653

5655832

13912

922

N/A7

N/A1340

26N/A

4876

192974644

105121

40232

40100

47N/A

72112947

08-k-9-A08-k-9-A08-k-9-A08-k-9-A08-k-9-A08-k-9-A

Maricao, PRMaunabo, PRMayaguez, PRMoca, PRMorovis, PRNaguabo, PR

N/AN/A

372

N/AN/A

N/AN/A

46N/AN/A

77

N/A12451617

N/A

N/A2

332110

N/A

N/AN/A

2N/AN/AN/A

N/AN/A

38N/AN/A

11

17

2267344

9

N/AN/A153112

1816

N/A6

13559

10540

116








Naranjito, PROrocovis, PRPa�llas, PRPenuelas, PRPonce, PRQuebradillas, PRRincon, PRRio Grande, PRSabana Grande, PRSalinas, PRSan German, PRSan Juan, PRSan Lorenzo, PRSan Sebas�an, PRSanta Isabel, PRToa Alta, PRToa Baja, PRTrujillo Alto, PRUtuado, PRVega Alta, PR

N/AN/AN/A

114710

42

28221911

N/A28

N/A10

6N/A

132

N/A2

N/AN/A

6710

N/A2

N/A10

471

612

N/A2825

N/A2

N/A

103

N/AN/A

80163947

N/A44

160N/A

61

262718

91

N/AN/AN/AN/A

51N/AN/A

36N/A

10N/A

10N/A

5N/A

334

592

N/AN/AN/AN/A

57N/AN/A

351510

N/A54

N/A1

N/A6

17742

N/A4

N/A0

576

N/A1

N/A3

N/A84

1N/AN/A

3382

64

N/A

2036

552

441661477414960

57730726078

187797118

2815

358

437453432611635

52521239787

14862

N/A45

53494540

359106

7158

648522

1,422203595

142100

7744

12308-k-9-A08-k-9-A08-k-9-A08-k-9-A08-k-9-A08-k-9-A

Vega Baja, PRVieques, PRVillalba, PRYabucoa, PRYauco, PRSector Subtotal

N/AN/AN/AN/A

45459

N/AN/AN/AN/A

47626

12N/AN/A

1016

1,596

12

N/AN/A

3593

8N/AN/AN/A

11591

N/AN/AN/A

444

891

1117

2116

1175,744

50N/A

71722

4,353

80N/A

69681

7,992

117







Market Total Market Total 459 626 1,596 593 591 891 5,744 4,353 7,992

118

Demand




NVCC FY16-18 – Inpa�ent U�liza�on Pa�ernsFY16-18 Med/Surg Bed Days of Care FY16-18 Mental Health Bed Days of Care

119

Nursing Home BDOC Distribu�onDemand

78.V08.PuertoRicoVirginIslands#IMG

Note: Data is only for fee basis and does not encompass all Community Care.



Source: 1. VSSC Trea�ng Specialty Cube 2. VSSC NVCC Cube 3. Defini�ve HC

FY15-18 Average BDOC by County

120

County FY18 Non-VA Community Care* FY18 VA FY18 Total BDOC Id


N/AN/A471N/AN/AN/A

1N/AN/AN/A

4436

N/AN/AN/A

354379

N/AN/A

134362124145

72431230212294N/A

2,506109

2,24210

9462,610

303301

767

134362595145

72431231212294N/A

2,550145

2,24210

9462,645

346380

767

881882883884885886887888889890891892893894895896897898899900

Demand

Source: 1. VSSC Trea�ng Specialty Cube 2. VSSC NVCC Cube 3. Defini�ve HC 79.V08.PuertoRicoVirginIslands

*Data is only for fee basis and does not encompass all Community Care.



Nursing Home BDOC Distribu�on, cont.

121


Cidra, PRCoamo, PRComerio, PRCorozal, PRCulebra, PRDorado, PRFajardo, PRFlorida, PRGuanica, PRGuayama, PRGuayanilla, PRGuaynabo, PRGurabo, PRHa�llo, PRHormigueros, PRHumacao, PRIsabela, PRJayuya, PRJuana Diaz, PRJuncos, PR

N/AN/AN/AN/AN/A


39N/AN/AN/AN/AN/AN/AN/A

202194430

132

708963

257

301726

1,814290570N/A890559N/A511878

202194430

132

792963

257

301726

1,814329570N/A890559N/A511878

901902903904905906907908909910911912913914915916917918919920

Demand

Source: 1. VSSC Trea�ng Specialty Cube 2. VSSC NVCC Cube 3. Defini�ve HC 79.V08.PuertoRicoVirginIslands#2





122


Lajas, PRLares, PRLas Marias, PRLas Piedras, PRLoiza, PRLuquillo, PRMana�, PRMaricao, PRMaunabo, PRMayaguez, PRMoca, PRMorovis, PRNaguabo, PRNaranjito, PROrocovis, PRPa�llas, PRPenuelas, PRPonce, PRQuebradillas, PRRincon, PR

N/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/A

N/A97

N/A113

48319341N/A200

19180

68177412206N/A261970110N/A

N/A97

N/A113

48319341N/A200

19180

68177412206N/A261970110N/A

921922923924925926927928929930931932933934935936937938939940

Demand






123


Rio Grande, PRSabana Grande, PRSalinas, PRSan German, PRSan Juan, PRSan Lorenzo, PRSan Sebas�an, PRSanta Isabel, PRToa Alta, PRToa Baja, PRTrujillo Alto, PRUtuado, PRVega Alta, PRVega Baja, PRVieques, PRVillalba, PRYabucoa, PRYauco, PRNo Applicable County Name, PRVirgin Islands Non-Specified County, VI

N/AN/AN/AN/A

31N/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/A

32N/AN/A

583158

8182

6,420310

12N/A502635581338220

1,151489

504

56N/AN/A

583158

8182

6,451310

12N/A502635581338220

1,151489

504

88N/AN/A

941942943944945946947948949950951952953954955956957958959960

Demand






124


Saint Croix, VISaint John, VISaint Thomas, VITotal

248N/AN/A

1,143

N/AN/AN/A

35,417

248N/AN/A

36,560

961962963964

Demand






125

FY10-18 Long Stay BDOC vs. Short Stay BDOC

0

10,000

20,000

Bed

Days

of C

are

FY10 FY11 FY12 FY13 FY14 FY15 FY16 FY17 FY18

25,186

13,526

27,965

10,027

20,288

19,28811,156

27,594

16,40916,009

21,891

13,058 13,795

20,56620,080

18,74914,205 14,205

Long Short

FY10-18 Long Stay BDOC vs. Short Stay BDOC

Stay Age FY10 FY11 FY12 FY13 FY14 FY15 FY16 FY17 FY18 % Change s

Long < 40 0 0 0 0 0 7 366 365 364 0.0%40-54 970 978 1,454 400 667 138 0 19 19 -98.0%55-64 3,378 3,094 3,493 2,904 3,540 2,858 1,065 1,427 1,678 -50.3%65-79 10,979 12,009 11,255 6,836 8,325 5,602 4,539 4,274 7,023 -36.0%80+ 9,494 11,148 11,397 8,616 7,383 7,439 5,185 3,942 4,441 -53.2%

Total Long 25,186 27,594 27,965 19,288 20,288 16,409 11,156 10,027 13,526 -46.3%Short < 40 0 0 7 0 0 177 12 8 13 0.0%

40-54 753 272 176 390 608 374 161 108 203 -73.0%55-64 2,347 1,963 1,685 2,428 1,619 1,231 781 2,037 1,831 -22.0%65-79 6,567 4,319 3,482 7,470 7,687 6,063 5,592 4,815 6,882 4.8%80+ 6,252 7,651 7,707 9,743 8,835 12,721 7,249 7,237 12,961 107.3%

Total Short 16,009 14,205 13,058 20,080 18,749 20,566 13,795 14,205 21,891 36.7%

111112333334

Demand




In-House LTSS Short Stays vs. Long Stays BDOC

126

Facility Opera�ng Beds Reported in the PTF Cube Opera�ng Beds Reported by the Field FY18 ADC NVCC, FY18 ADC*

(V08) (672) San JuanTotal

122122

119119

95.295.2

N/AN/A

Demand

Source: 1. VSSC Beds Using PTF Cube 2. VSSC NVCC Cube 3. Defini�ve Healthcare 81.V08.PuertoRicoVirginIslands

*Data is only for fee basis and does not encompass all Community Care.**SNFs within a 30 minute drive �me of facility. Does not include SNFs in which the ADC overly exceeded opera�ng beds (>30%) as it indicates a coding issue. ***Poten�al Available Beds is defined as Opera�ng Beds less ADC based on a 95% occupancy.



Community Nursing Home vs. In-House BDOC

Facility Opera�ng Beds FY18 ADC Occupancy Poten�al Available Beds*** Id

(V08) (672) San Juan 100 14.0 14.0% 81 …

VA (In-House)

Community Sta�s�cs**

127

Residen�al Rehab BDOCDemand




Source: VSSC Trea�ng Specialty Cube; Substance Abuse and Mental Health Services Administra�on (SAMHSA) (2018)

FY15-18 Average Residen�al Rehabilita�on Days by County

128

Top 10 Market Coun�es FY15 BDOC FY16 BDOC FY17 BDOC FY18 BDOC

Bayamon, PRSan Juan, PRVega Baja, PRCoamo, PRAguadilla, PRCaguas, PRMoca, PRCorozal, PRToa Baja, PRBarranquitas, PR

0211

010

0246

000

16

0465

400

11400

2520

0320

0183

0111

0463171

596408276245212146131112103

62

Care Received in a VAMC/VA Facility(not limited to VA Facili�es in the market)

Demand

Source: VSSC Trea�ng Specialty Cube; Substance Abuse and Mental Health Services Administra�on (SAMHSA) (2018) 83.V08.PuertoRicoVirginIslands



Residen�al Rehab BDOC, cont.

129

Demand

Source: VSSC OR Produc�vity Cube



Surgical Cases FY15-18 – San JuanFacility Se�ng Specialty FY15 FY16 FY17 FY18 FY15-18 % Chg

(V08) (672) San Juan Inpa�ent

Outpa�ent

ANESTHESIOLOGYCARDIAC SURGERYEAR, NOSE, THROAT (ENT)GENERAL SURGERYNEUROSURGERYOB/GYNOPHTHALMOLOGYORAL SURGERYORTHOPEDICSPERIPHERAL VASCULARPLASTIC SURGERYTHORACIC SURGERYUROLOGYInpa�ent TotalANESTHESIOLOGYCARDIAC SURGERYEAR, NOSE, THROAT (ENT)GENERAL SURGERYNEUROSURGERYOB/GYN

1468854

4686312

41

190142425

2371,326

3554

129666

243

1176756

45235

912

4160

513121

2551,270

29510

124672

328

37035

3753710

64

143312128

157920103

1104775

233

26318

33252

573

9822

918

101730

645

91751

222

-98.6%-28.4%-66.7%-29.1%-17.5%-58.3%75.0%

200.0%-48.4%57.1%

-62.5%-28.0%-57.4%-44.9%-82.0%25.0%

-29.5%12.8%

0.0%-48.8%

OPHTHALMOLOGYORAL SURGERY

1,37527

1,72727

1,05716

80926

-41.2%-3.7%

Facility Se�ng Specialty FY15 FY16 FY17 FY18 FY15-18 % Chg

(V08) (672) San Juan Inpa�ent

Outpa�ent

ANESTHESIOLOGYCARDIAC SURGERYEAR, NOSE, THROAT (ENT)GENERAL SURGERYNEUROSURGERYOB/GYNOPHTHALMOLOGYORAL SURGERYORTHOPEDICSPERIPHERAL VASCULARPLASTIC SURGERYTHORACIC SURGERYUROLOGYInpa�ent TotalANESTHESIOLOGYCARDIAC SURGERYEAR, NOSE, THROAT (ENT)GENERAL SURGERYNEUROSURGERYOB/GYN

1468854

4686312

41

190142425

2371,326

3554

129666

243

1176756

45235

912

4160

513121

2551,270

29510

124672

328

37035

3753710

64

143312128

157920103

1104775

233

26318

33252

573

9822

918

101730

645

91751

222

-98.6%-28.4%-66.7%-29.1%-17.5%-58.3%75.0%

200.0%-48.4%57.1%

-62.5%-28.0%-57.4%-44.9%-82.0%25.0%

-29.5%12.8%

0.0%-48.8%

OPHTHALMOLOGYORAL SURGERY

1,37527

1,72727

1,05716

80926

-41.2%-3.7%

Note: In May 2020, the OR Produc�vity Cube switched from MCAO Surgical Na�onal Data Extract (MCAO Sur NDE) to the Corporate Data Warehouse (CDW) as the data source. This decision was madeto provide more �mely updates. During the switch, data prior to FY17 were dropped from the OR Produc�vity Cube. FY15 and FY16 data represents data from the MCAO Sur NDE and FY17 and FY18represents data from CDW.


130

Demand

Source: VSSC OR Produc�vity Cube



Surgical Cases FY15-18 – San Juan, cont.Facility Se�ng Specialty FY15 FY16 FY17 FY18 FY15-18 % Chg


Facility Total

Outpa�ent

UnknownTotal

ORTHOPEDICSPERIPHERAL VASCULARPLASTIC SURGERYTHORACIC SURGERYUROLOGYOutpa�ent TotalUnknown TotalFacility Total

5781292

21,6574,942

N/A6,268

37159

2245

9034,448

N/A5,718

37968

2973

5223,360

44,284

24050

2849

5262,879

73,616

-58.5%316.7%208.7%350.0%-68.3%-41.7%

N/A-42.3%

Facility Se�ng Specialty FY15 FY16 FY17 FY18 FY15-18 % Chg


Facility Total

Outpa�ent

UnknownTotal

ORTHOPEDICSPERIPHERAL VASCULARPLASTIC SURGERYTHORACIC SURGERYUROLOGYOutpa�ent TotalUnknown TotalFacility Total

5781292

21,6574,942

N/A6,268

37159

2245

9034,448

N/A5,718

37968

2973

5223,360

44,284

24050

2849

5262,879

73,616

-58.5%316.7%208.7%350.0%-68.3%-41.7%

N/A-42.3%

Note: In May 2020, the OR Produc�vity Cube switched from MCAO Surgical Na�onal Data Extract (MCAO Sur NDE) to the Corporate Data Warehouse (CDW) as the data source. This decision was madeto provide more �mely updates. During the switch, data prior to FY17 were dropped from the OR Produc�vity Cube. FY15 and FY16 data represents data from the MCAO Sur NDE and FY17 and FY18represents data from CDW.

84.V08.PuertoRicoVirginIslands.672#2

131

Demand Es�mated Future Market Demand — Inpa�ent

132

FY22 FY27

Citc Vw_ph2_5_1_1 Total Bed FY17 Vw_ph2_5_1_1 Total Bed FY22 Vw_ph2_5_1_1 Total Bed FY27

Total Bed Need* 261 180 133

Citc Vw_ph2_5_1_1 Total ADC FY17 Vw_ph2_5_1_1 Total ADC FY22 Vw_ph2_5_1_1 Total ADC FY27

Total ADC 221.5 153.3 113.1

BY17 Market U�liza�on Projec�ons (Acute Inpa�ent) — Puerto Rico Virgin Islands Market

Citc

Med Surg Psych Med Surg Psych Med Surg Psych

In-House BDOCCommunity BDOC

Total BDOCADC By HSPG

49,947913

50,860139.3

13,239591

13,83037.9

10,1616,005

16,16644.3

33,575613

34,18893.7

10,339474

10,81329.6

6,8794,072

10,95130.0

24,661450

25,11168.8

7,886363

8,24922.6

4,9422,9617,903

21.7

Demand


Note: Percent changes are for 5 and 10 years.



BY17 VISN 08 Puerto Rico Virgin Islands Market U�liza�on Projec�ons BDOC

FY17

*Total Bed Need is based on an 85% occupancy rate

Tota

l BDO

C(In

-Hou

se +

Com

mun

ity)

0

9,000

18,000

27,000

36,000

45,000

54,000

Med

-32.8%

-50.6%

Surg

-21.8%-40.4%

Psych

-32.3%-51.1%

2017 2022 2027

133

*Total Bed Need is based on a 95% occupancy for LTSS and 85% occupancy for Blind Rehab, Residen�al Rehab, and SCI

BY17 Market U�liza�on Projec�ons (Other Inpa�ent) — Puerto Rico Virgin Islands MarketDemand




FY17 FY22 FY27

Citc Total Bed FY17 Total Bed FY22 Total Bed FY27


Citc Vw_ph2_5_2_1 Total ADC FY17 Vw_ph2_5_2_1 Total ADC FY22 Vw_ph2_5_2_1 Total ADC FY27

Total ADC 127.2 86.9 65.1

Citc

BlindRehab

LTSS ResRehab

SCI BlindRehab

LTSS ResRehab

SCI BlindRehab

LTSS ResRehab

SCI



2,7920

2,7927.6

34,761805

35,56697.4

2,4530

2,4536.7

5,6210

5,62115.4

1,9250

1,9255.3

23,181765

23,94665.6

2,0500

2,0505.6

3,8130

3,81310.4

1,5400

1,5404.2

17,320717

18,03749.4

1,5250

1,5254.2

2,6730

2,6737.3

BY17 VISN 08 Puerto Rico Virgin Islands Market U�liza�on Projec�ons BDOCTo

tal B

DOC

(In-H

ouse

+ C

omm

unity

)

0

9,000

18,000

27,000

36,000

Blind Rehab

-31.1% -44.8%

LTSS

-32.7%

-49.3%

Res. Rehab

-16.4% -37.8%

SCI

-32.2% -52.4%

2017 2022 2027


134

LABEL Vw_ph2_5_3_1 Total Bed FY17 Vw_ph2_5_3_1 Total FY22

Vw_ph2_5_3_1 Total Beds FY27


LABEL Vw_ph2_5_3_1 Total ADC FY17 Vw_ph2_5_3_1 Total ADC FY22

Vw_ph2_5_3_1 Total ADC FY27

Total ADC 226.3 159.6 119.6

BY17 Parent Facility U�liza�on Projec�ons (Acute Inpa�ent) — San Juan VAMC

LABEL

Med Surg Psych Med Surg Psych Med Surg Psych



51,237827

52,064142.6

13,312492

13,80437.8

10,2716,443

16,71445.8

35,031577

35,60897.6

10,582397

10,97930.1

7,1194,560

11,67932.0

26,065435

26,49972.6

8,199310

8,51023.3

5,2193,4388,657

23.7

Demand




*Total bed need is based on an 85% occupancy rate

BY17 San Juan VAMC U�liza�on Projec�ons BDOC

FY17 FY22 FY27

Tota

l BDO

C(In

-Hou

se +

Com

mun

ity)

0

9,000

18,000

27,000

36,000

45,000

54,000

Med

-31.6%

-49.1%

Surg

-20.5% -38.4%

Psych

-30.1%-48.2%

2017 2022 2027


135

*Total bed need is based on a 95% occupancy for LTSS and 85% occupancy for Blind Rehab, Residen�al Rehab, and SCI

BY17 Parent Facility U�liza�on Projec�ons (Other Inpa�ent) — San Juan VAMCDemand




Measure Vw_ph2_5_4_1 Total Beds Needed FY17 Vw_ph2_5_4_1 Total Bed Needed FY22 Vw_ph2_5_4_1 Total Beds Needed FY27


Measure Vw_ph2_5_4_1 Total ADC FY17 Vw_ph2_5_4_1 Total ADC FY22 Vw_ph2_5_4_1 Total ADC FY27

Total ADC 116.8 112.3 88.8

Measure BlindRehab

LTSS ResRehab

SCI BlindRehab

LTSS ResRehab

SCI BlindRehab

LTSS ResRehab

SCI .



2,868N/A

2,8687.9

33,99310

34,00393.2

12N/A

120.0

5,756N/A

5,75615.8

2,026N/A

2,0265.5

22,82510

22,83562.6

12,125N/A

12,12533.2

4,011N/A

4,01111.0

1,658N/A

1,6584.5

17,1618

17,16947.0

10,697N/A

10,69729.3

2,890N/A

2,8907.9

1234

BY17 San Juan VAMC U�liza�on Projec�ons BDOC

FY17 FY22 FY27

Tota

l BDO

C(In

-Hou

se +

Com

mun

ity)

0

4,000

8,000

12,000

16,000

20,000

24,000

28,000

32,000

36,000

Blind Rehab

-29.4% -42.2%

LTSS

-32.8%

-49.5%

Res. Rehab

100,940.2% 89,038.1%

SCI

-30.3% -49.8%

2017 2022 2027


136

Overall Inpatient Commercial Demand – Puerto RicoDemand

Source: N/A 90.V08.PuertoRicoVirginIslands


• Overview: Commercial market inpatient demand

estimates were developed to understand

current and future expected inpatient

demand trends for non-Veteran

populations

Demand estimates are based on non-

Veteran patient origin within a 60

minute drive time from parent VA

Medical Center/ Health Care Center

noted

Total Inpatient Bed Days of Care (BDOC) Growth Projections (#,%)

Clinical Service Line 2018 2023 2028 5 Year Chg 5 Year % Chg 10 Year Chg 10 Year % Chg

General Medicine 22,581 25,887 28,616 3,306 14.6% 6,035 26.7%Nephrology 8,469 9,100 9,620 631 7.5% 1,151 13.6%Neurology 15,370 16,273 17,021 903 5.9% 1,651 10.7%Rheumatology 590 562 524 -28 -4.7% -66 -11.2%Hematology 2,117 2,080 2,031 -37 -1.7% -86 -4.1%Dermatology 3,917 3,822 3,855 -95 -2.4% -62 -1.6%Gastroenterology 17,232 16,843 16,812 -389 -2.3% -420 -2.4%Oncology Medical 5,910 5,795 5,747 -115 -1.9% -163 -2.8%Pulmonary 22,388 21,264 19,782 -1,124 -5.0% -2,606 -11.6%Cardiology 27,716 25,741 23,519 -1,975 -7.1% -4,197 -15.1%HIV 140 128 120 -12 -8.6% -20Endocrine 4,118 3,325 3,003 -19.3% -Medicine Sub-Total 130,548 130,820 130,650

-793272 0.2%

-1,115102

-14.3%27.1%

0.1%Neurosurgery 2,923 2,893 2,842 -30 -1.0% -81 -2.8%Orthopedics 23,358 21,487 19,237 -1,871 -8.0% -4,121 -17.6%Open Heart 6,281 6,182 6,143 -99 -1.6% -138 -2.2%General Surgery 26,134 25,687 25,508 -447 -1.7% -626 -2.4%Trauma 1,622 1,546 1,457 -76 -4.7% -165 -10.2%Vascular Surgery 2,961 2,799 2,652 -162 -5.5% -309 -10.4%Ophthalmology 187 176 169 -11 -5.9% -18 -9.6%Thoracic Surgery 7,128 6,818 6,465 -310 -4.3% -663 -9.3%Dentistry 189 171 151 -18 -9.5% -38 -20.1%Urology 2,883 2,633 2,539 -250 -8.7% -344 -11.9%Otolaryngology 860 640 523 -220 -25.6% -337 -39.2%Surgery Sub-Total 74,526 71,032 67,686 -3,494 -4.7% -6,840 -9.2%Medicine/Surgery Total 205,074 201,852 198,336 -3,222 -1.6% -6,738 -3.3%OB/Delivery 8,702 8,032 7,626 -670 -7.7% -1,076 -12.4%Other OB 622 562 534 -60 -9.6% -88 -14.1%Gynecology 904 610 484 -294 -420Women's Health Total 10,228 9,204 8,644 - -Psych/Drug Abuse 25,936 28,062 29,764Mental Health Total 25,936 28,062 29,764

-1,0242,1262,126

-32.5%10.0%

8.2%8.2%

-1,5843,8283,828

-46.5%15.5%14.8%14.8%

Acute Rehab 494 301 182Rehab Total 494 301 182 - - - -Other Total 2 2 2

-193193

0

-39.1%39.1%

0.0%

-312312

0

-63.2%63.2%

0.0%Grand Total 241,734 239,421 236,928 -2,313 -1.0% -4,806 -2.0%

DisplayOrder

123456789

101112131415161718192021222324252627282930313233343536

Projection data was not available for Puerto Rico from common data

sources including IBM Watson and Advisory Board. Numerous

additional sources from the Puerto Rico Department of Health to other

special studies were found to be lacking projection type data as well. This lack of data was confirmed by

local VAMC leadership.

Valida�on of the data for this slide is not requiredVISN 08: Puerto Rico Virgin Islands Market — San Juan

137

Supply Es�mated Current Total VA Market Supply

138

0

50

100

150

200

Tota

l Pro

ject

ed In

-hou

se a

nd C

ITC

Bed

Nee

d

Med/Surg Sub-Total Mental Health Nursing Home Residen�al Rehab

209

52

103

8

108

25

52

5

218

0

30

122

Veteran Inpa�ent Projected Demand and VA Supply

Supply

• 2017

Source: 1. BY17 EHCPM U�liza�on Projec�ons 2. VSSC Beds Using PTF Cube 92.V08.PuertoRicoVirginIslands

Note: Med/Surg, Mental Health, and Residen�al Rehab is based on an 85% occupancy rate. Nursing Home is based on a 95% occupancy rate.



Comparing Total Market Veteran Demand vs. VA Medical Center Supply — Inpa�ent Services

2027 — FY18 VAMC Beds•

139

Ambulatory Medical (HSPCs)

0K

20K

40K

60K

RVU

s

Allergy & Immunology

Cardiology

Chiropracty*

Cri�cal Care/Pulmonary Dise

ase

Dermatology

Emergency Medicine*

Endocrinology

Gastroenterology

Hematology-Oncology

Infec�ous Dise

ase

Nephrology

Neurology

Optometry

Pain Medicine

Physical Medicine & Rehabilita

�on

Rheumatology

2017 2027 2017 RVU Capacity (FTE x Produc�vity Target)

Supply


*Reflects service is not provided in-house or there is no VA set produc�vity target.



Comparing Total Market Veteran Demand vs. VA Medical Center Supply — Outpa�ent Services — Ambulatory Medical Special�es (HSPCs)

Source: 1. BY17 EHCPM U�liza�on Projec�ons 2. OPES Physician Capacity Reports 3. VSSC Physician Produc�vity Cube 4. VSSC MPCR3 Cube

140

Ambulatory Surgical (HSPCs)

0K

10K

20K

30K

40K

50K

60K

70K

RVU

s

NeurologicalSurgery

Obstetrics &Gynecology

Ophthalmology OrthopaedicSurgery

Otolaryngology Plas�c Surgery Podiatry Surgery Thoracic Surgery Urology Vascular Surgery

2017 2027 2017 RVU Capacity (FTE x Produc�vity Target)

Supply


* Reflects service is not provided in-house or there is no VA set produc�vity target.



Comparing Total Market Veteran Demand vs. VA Medical Center Supply — Outpa�ent Services — Ambulatory Surgical Special�es (HSPCs)

Source: 1. BY17 EHCPM U�liza�on Projec�ons 2. OPES Physician Capacity Reports 3. VSSC Physician Produc�vity Cube 4. VSSC MPCR3 Cube

141

Physician Efficiency — San Juan VAMCSupply

Source: 1. VSSC SPARQ Report 2. VSSC Physician Produc�vity Cube 3. VSSC MPCR3 Cube 96.V08.PuertoRicoVirginIslands.672



Id

Specialty SPARQ Quadrant2016

SPARQ Quadrant2017

SPARQ Quadrant2018

2016 MDFTEs

2017 MDFTEs

2018 MDFTEs

2016 APPFTEs

2017 APPFTEs

2018 APPFTEs

37013702370337043705370637073708370937103711371237133714371537163717371837193720

Allergy and ImmunologyAnesthesiologyCardiologyCri�cal Care / Pulmonary DiseaseDermatologyEmergency MedicineEndocrinologyGastroenterologyGeriatric MedicineHematology-OncologyInfec�ous DiseaseInternal MedicineNephrologyNeurological SurgeryNeurologyObstetrics & GynecologyOphthalmologyOptometryOrthopaedic SurgeryOtolaryngology

2 - Under ResourcedN/A

2 - Under Resourced1 - Op�mized Prac�ce

4 - Over ResourcedN/A

1 - Op�mized Prac�ce2 - Under Resourced

N/A2 - Under Resourced

1 - Op�mized Prac�ce1 - Op�mized Prac�ce1 - Op�mized Prac�ce

4 - Over Resourced1 - Op�mized Prac�ce

4 - Over Resourced4 - Over Resourced

3 - InefficientN/A

4 - Over Resourced


2 - Under Resourced4 - Over Resourced

N/AN/A

1 - Op�mized Prac�ce2 - Under Resourced

N/A2 - Under Resourced2 - Under Resourced

1 - Op�mized Prac�ce1 - Op�mized Prac�ce

3 - Inefficient2 - Under Resourced

4 - Over Resourced3 - Inefficient

N/A3 - Inefficient3 - Inefficient



3 - InefficientN/A

4 - Over Resourced2 - Under Resourced



N/A3 - Inefficient


3 - Inefficient4 - Over Resourced

3 - InefficientN/A

0.26.74.27.41.69.81.14.19.82.71.5

91.71.71.02.81.37.96.12.53.6

0.26.34.07.91.5

10.91.24.7

10.03.02.1

92.91.41.13.11.07.86.03.33.4

0.37.54.17.81.5

10.61.24.68.83.12.2

90.21.61.52.00.87.46.02.83.5

N/AN/A4.90.05.0

N/A0.00.16.40.00.0

27.5N/AN/AN/A0.8

N/A0.0

N/AN/A

N/AN/A5.00.05.2

N/AN/A0.1

10.90.00.0

23.9N/AN/AN/A0.0

N/A0.6

N/AN/A

N/AN/A2.50.05.7

N/AN/A0.0

13.30.0

N/A21.6N/A0.0

N/A0.00.00.60.00.0

142

Physician Efficiency — San Juan VAMC, cont.Supply

Source: 1. VSSC SPARQ Report 2. VSSC Physician Produc�vity Cube 3. VSSC MPCR3 Cube 96.V08.PuertoRicoVirginIslands.672#2



Id

Specialty SPARQ Quadrant2016

SPARQ Quadrant2017

SPARQ Quadrant2018

2016 MDFTEs

2017 MDFTEs

2018 MDFTEs

2016 APPFTEs

2017 APPFTEs

2018 APPFTEs

372137223723372437253726372737283729373037313732373337343735

Pain MedicinePathologyPhysical Medicine & Rehabilita�onPlas�c SurgeryPodiatryPrimary CarePsychiatryPsychologyRadiologyRheumatologySurgeryThoracic SurgeryUrologyVascular SurgeryTotal

N/AN/A



2 - Under Resourced2 - Under Resourced

N/A1 - Op�mized Prac�ce

4 - Over ResourcedN/AN/AN/AN/A

3 - InefficientN/A

3 - InefficientN/A


2 - Under Resourced2 - Under Resourced

N/A1 - Op�mized Prac�ce

N/AN/A

3 - Inefficient4 - Over Resourced

N/A

3 - InefficientN/A

2 - Under Resourced4 - Over Resourced

N/AN/A

1 - Op�mized Prac�ce4 - Over Resourced


3 - InefficientN/AN/A

3 - InefficientN/A

0.93.3

15.10.32.4

N/A45.032.314.0

0.76.6

N/A5.40.4

294.1

1.23.3

14.50.82.4

N/A43.032.213.2

0.75.8

N/A4.51.3

294.5

0.72.9

14.51.11.6

N/A42.231.911.1

0.75.3

N/A4.41.5

285.1

0.6N/A8.3

N/AN/AN/A1.00.60.0

N/A0.11.5

N/AN/A56.6

1.6N/A7.7

N/AN/AN/A0.70.4

N/AN/A0.02.7

N/A0.0

58.8

1.6N/A7.5

N/A0.0

N/AN/A0.1

N/AN/A0.10.40.22.5

56.1

143

Poten�al Physician Addi�onal Capacity — San Juan VAMCSupply

Source: OPES Physician Capacity Reports 97.V08.PuertoRicoVirginIslands.672

Poten�al Addi�onal RVU Capacity = (Produc�vity Standard – Produc�vity), N/A = Data Not Available



Physician Specialty Poten�al Addi�onal RVU Capacity Id

Allergy and ImmunologyCardiologyChiropractyCri�cal Care / Pulmonary DiseaseDermatologyEndocrinologyGastroenterologyGeriatric MedicineHematology-OncologyInfec�ous DiseaseInternal MedicineNephrologyNeurological SurgeryNeurologyObstetrics & GynecologyOphthalmologyOptometryOrthopaedic SurgeryOtolaryngologyPain Medicine

00

N/A0

2,48835

000

310

1,4944,581

00

13,8684,7405,2252,008

0

39373938393939403941394239433944394539463947394839493950395139523953395439553956

PathologyPhysical Medicine & Rehabilita�onPlas�c Surgery

00

1,070

395739583959

144

Poten�al Physician Addi�onal Capacity — San Juan VAMC, cont.Supply

Source: OPES Physician Capacity Reports 97.V08.PuertoRicoVirginIslands.672#2

Poten�al Addi�onal RVU Capacity = (Produc�vity Standard – Produc�vity), N/A = Data Not Available



Physician Specialty Poten�al Addi�onal RVU Capacity Id

PodiatryPsychiatryPsychologyRadiologyRheumatologySurgeryThoracic SurgeryUrologyVascular Surgery

7990

6,1746,738

05,277

N/A0

5,065

396039613962396339643965396639673968

145

VA Facility Primary Care* Specialty Care Emergency Care Mental Health Total

(V08) (672) San Juan(V08) (6729AA) San Juan(V08) (672B0) Ponce(V08) (672BZ) Mayaguez(V08) (672GA) Saint Croix(V08) (672GB) Saint Thomas(V08) (672GC) Arecibo(V08) (672GD) Ceiba(V08) (672GE) Guayama(V08) (672QA) Comerio(V08) (672QB) Utuado

95.42.2

12.611.8

0.73.03.53.11.40.30.0

101.10.25.22.00.00.0

N/A0.00.0

N/AN/A

10.6N/AN/AN/AN/AN/AN/AN/AN/AN/AN/A

56.3N/A7.07.1

N/AN/A1.40.71.7

N/AN/A

263.42.4

24.820.9

0.73.04.83.83.10.30.0

FY18 San Juan VAMC & CBOC Physicians by Outpa�ent Clinical Category

Physicians by Outpa�ent Clinical CategorySupply

Source: 1. VSSC Physician Produc�vity Cube 2. VSSC MPCR3 Cube 98.V08.PuertoRicoVirginIslands.672

*Primary Care includes Internal Medicine and Geriatric Medicine; Note: Contract clinics do not have FTEs represented.



146

Occupa�on FY18 FY19* .

0083 Police0086 Security Clerical and Assistance0101 Social Science0102 Social Science Aid and Technician0180 Psychology0181 Psychology Aid and Technician0185 Social Work0201 Human Resources Management0203 Human Resources Assistance0301 Miscellaneous Administra�on and Program0303 Miscellaneous Clerk and Assistant0305 Mail and File0318 Secretary0340 Program Management & 0344 Management and Program Clerical and Assistance0341 Administra�ve Officer0343 Management and Program Analysis0503 Financial Clerical and Assistance0525 Accoun�ng Technician0540 Voucher Examining0544 Civilian Pay

N/AN/A1.01.05.5

N/A13.6

6.02.02.0

20.5N/A5.0

N/A2.02.0

N/A1.0

N/A2.0

6.01.01.0

N/A4.51.08.36.0

N/A5.06.03.07.02.01.04.01.0

N/A1.01.0

123456789

1011121314151617181920

0560 Budget Analysis0601 General Health Science0602 Medical Officer0603 Physician's Assistant0610 Nurse

2.02.5

23.4N/A86.0

2.07.0

20.01.0

35.0

21222324

Vacant Posi�onsSupply

Source: VHA Office of Workforce Management 99.V08.PuertoRicoVirginIslands.672

*FY19 vacant posi�ons as of December 2019.



San Juan VAMC Open FTE Posi�ons

147


0620 Prac�cal Nurse0621 Nursing Assistant0622 Medical Supply Aide and Technician0630 Die��an and Nutri�onist0631 Occupa�onal Therapist0633 Physical Therapist0636 Rehabilita�on Therapy Assistant0638 Recrea�on/Crea�ve Arts Therapist0640 Health Aid and Technician0644 Medical Technologist0645 Medical Technician0647 Diagnos�c Radiologic Technologist0649 Medical Instrument Technician0660 Pharmacist0661 Pharmacy Technician0662 Optometrist0665 Speech Pathology and Audiology0667 Ortho�st and Prosthe�st0668 Podiatrist0671 Health System Specialist

50.0N/A1.00.50.22.01.5

N/A15.0

3.42.02.03.0

13.58.5

N/A1.52.01.05.0

17.01.05.02.70.23.01.01.0

16.55.41.55.04.07.05.00.51.01.0

N/A3.0

2627282930313233343536373839404142434445

0675 Medical Records Technician0679 Medical Support Assistance0680 Dental Officer0681 Dental Assistant0801 General Engineering

8.029.8

2.02.02.0

4.025.5N/A1.0

N/A

4647484950

Vacant Posi�ons, cont.Supply

Source: VHA Office of Workforce Management 99.V08.PuertoRicoVirginIslands.672#2





148


1105 Purchasing1106 Procurement Clerical and Technician1601 General Facili�es and Equipment2003 Supply Program Management2005 Supply Clerical and Technician2010 Inventory Management2805 Electrician3566 Custodial Worker4749 Maintenance Mechanic5703 Motor Vehicle Operator6907 Materials Handler7304 Laundry Working7404 Cook7408 Food Service WorkerGrand Total

7.0N/AN/AN/A5.03.08.01.03.08.0

N/AN/A1.02.0

371.4

N/A1.01.01.01.02.08.07.06.03.01.05.0

N/A6.0

277.1

515253545556575859606162636465

Vacant Posi�ons, cont.Supply

Source: VHA Office of Workforce Management 99.V08.PuertoRicoVirginIslands.672#3





149

Supply Es�mated Current Total Community Market Supply

150

Supply




Source: 1. FQHC – HRSA Data Warehouse 2. IHS – ESRI Meta Data 3. DoD – Federal Prac��oner, 2019 Directory

Federal Facili�es

Exis�ng Federal Facili�es

151

Exis�ng Federal Facili�es, cont.Sector Type* Partner Facility Name** Distance From VA POC (x miles, POC Name) Id

08-k-9-A FQHC (59) •Ciales Primary Health Care Services, Inc. •Morovis Community Health Center, Inc. •Culebra Health Center

•35, (672GC) Arecibo, PR •31, (672GC) Arecibo, PR •30, (672GD) Ceiba, PR

1

Supply


*FQHC quan�ty in parentheses reflects total number of FQHCs within a sector.**The three FQHCs listed reflect the three most distant FQHCs from a VA POC.



Source: 1. FQHC – HRSA Data Warehouse 2. IHS – ESRI Meta Data 3. DoD – Federal Prac��oner - 2019 Directory

152

Supply

Source: 1. Defini�ve Healthcare 2. Geocoded Enrollee File FY18Q4 103.V08.PuertoRicoVirginIslands#IMG



Note: Map provides context of community hospital density although map scale prevents illustra�on of all hospitals. A Dartmouth Atlas Hospital Service Area (HSA) is a ZIP code-defined geography encompassing the community where the ZIP code’s Medicare residents predominantly receive their hospital care.

Community Hospitals and FY18 Enrollees

Market Community Hospital Overview

153

VAMC Area Hospitals* Total Staffed Beds Total Occupancy**

(V08) (672) San JuanTotal Hospitals in the Market

2961

4,4377,873

60.6%59.1%

Supply

Source: Defini�ve Healthcare 104.V08.PuertoRicoVirginIslands

Note: The VAMC area is defined as the area within a 60 minute drive �me of VAMC. *Includes short term acute, cri�cal access, psychiatric, and rehabilita�on hospitals with a CMS Cost Report in FY17 or FY18 (does not include pediatric or DoD hospitals) and can include mul�-campus hospitals repor�ng under a single provider number.**Occupancy is based on total staffed beds.



Market Community Hospital Overview, cont.Community Hospital Overview

Valida�on of the data for this slide is not required 154

TopHospitals Beds³ Occupancy⁴ Beds³ Occupancy⁴ Beds³ Occupancy⁴ CMI

Auxilio Mutuo HospitalHIMA San Pablo Caguas HospitalHIMA San Pablo Bayamon HospitalDoctors Center Hospital Mana�Mana� Medical CenterUniversity of Puerto Rico HospitalUniversity District HospitalFirst Hospital PanamericanoHospital Menonita of CaguasHospital Pavia SanturceHIMA San Pablo FajardoAshford Presbyterian Community HospitalSan Juan City HospitalSan Juan CP HospitalRyder Memorial HospitalOther Hospitals in Area (14)Total

430440336262251234232

200199180175174

1651,1594,437

68.1%59.4%75.0%85.5%72.0%52.0%82.4%

N/A57.1%70.9%23.6%60.6%46.8%

N/A14.8%56.5%60.6%

N/AN/AN/AN/AN/AN/AN/A216N/AN/AN/AN/AN/A172N/A

93481

N/AN/AN/AN/AN/AN/AN/A

81.8%N/AN/AN/AN/AN/A

80.0%N/A

83.7%81.5%


N/AN/AN/AN/AN/A

N/A3148

63.9%N/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/A

70.2%68.0%

1.891.531.531.361.521.292.07N/A1.511.711.232.001.27N/A1.261.451.51

Top Hospitals¹᾽²

Supply

Source: 1. CMS Cost Reports 2. IBM Market Expert 105.V08.PuertoRicoVirginIslands.672

1. Top hospitals based on number of staffed beds. 2. All beds within acute psychiatric and rehab commercial hospitals were assumed to be psychiatric or rehab beds. 3. Indicates staffed beds. 4. Occupancy rate = Average Daily Census (ADC) divided by staffed opera�ng beds.



Community Hospital Current and Future Inpa�ent Demand & Supply

Med/Surg/Acute Mental Health Rehab CMI


OccupancyType ADC BDOC ActualBeds

2019 ActualOccupancy

A 75%OccupancyBed Need

A 80%OccupancyBed Need

Projec�onRate

ADC BDOC Actual Beds 2029Projected

Occupancy¹

75%OccupancyBed Need


.

Medicine/Surgical*Medicine/Surgical* Conceptual Excess

Mental HealthMental Health Conceptual Excess

2,721N/A392N/A

993,183N/A

143,123N/A

4,485N/A481N/A

60.7%N/A

81.5%N/A

3,628857523-42

3,4011,084

490-9

N/AN/AN/AN/A

N/AN/AN/AN/A

N/AN/AN/AN/A

4,485N/A481N/A

N/AN/AN/AN/A

N/AN/AN/AN/A

N/AN/AN/AN/A

1234

OccupancyType ADC BDOC Actual Beds 2019 ActualOccupancy



Medicine/Surgical*Medicine/Surgical* Conceptual Excess

Mental HealthMental Health Conceptual Excess

2,721N/A392N/A

993,183N/A

143,123N/A

4,485N/A481N/A

60.7%N/A

81.5%N/A

3,628857523-42

3,4011,084

490-9

2019

Supply

Source: 1. CMS Cost Reports 2. IBM Market Expert 167.V08.PuertoRicoVirginIslands.672

1. Applied growth rate and assumes actual beds remains the same. BDOC and Projec�on Rate from IBM Market Expert* Includes acute rehabilita�on.



Community Hospital Current and Future Inpa�ent Demand & Supply, cont.

Es�mated 2029Surplus of beds

Shortage of beds

Future Supply and Demand


Community Hospital Current and Future Inpatient Demand & Supply, cont.Supply


VA Market Area Health Systems Op�miza�on Valida�on of the data for this slide is not requiredVISN 08: Puerto Rico Virgin Islands Market — San Juan

1. Assumes 2019 actual beds remains the same.

Source: 1. IMB Watson Health Cost Report 2. U.S. Census Bureau American Community Survey (ACS) 2018 1-Year Estimate - Puerto Rico and United States 2. World BankGroup 3. CMS Medicare Hospital Compare 4. Kaiser Family Foundation

The below table does not follow the US markets’ DD&F methodology of projecting bed demand, as future demand projection data was not available for Puerto Rico. However, the below table uses actual population and an actual ADC per 1,000 people rate and extrapolates assumed demand based on projected 2028 population. This projection is illustrative in nature and meant to provide directional perspective. The methodology used is as follows: Projected 2028 population is used to calculate 2028 bed demand using three different ADC per 1,000 people rates (a low rate, a flat rate, and a high rate). The low ADC rate is the actual 2019 ADC rate minus .33 (the difference between the U.S. and Puerto Rico’s hospital bed rates per 1,000 people), the flat rate uses the actual 2019 ADC per 1,000 people rate, and the high rate is the actual 2019 ADC rate plus .33.

Surplus of beds

Shortage of beds Population** ADCActual Beds

ADC per 1,000 people

Actual Beds per 1,000

people

Actual Occupancy

Population** Beds

Low ADC Rate

Flat ADC Rate

High ADC Rate

3,108 3,941 4,773Conceptual Surplus 1,810 977 145

ADC per 1,000 people (low assumption) 2.4

ADC per 1,000 people (high assumption) 3.7

2.4

2.7

0.64

64

* Includes acute rehabilitation

** 2019 and 2028 population within 60 minutes of San Juan

Additional Context

United States beds per 1,000 people (Actual 2018)

World hospital beds per 1,000 people (Actual, 2011)

Difference between US and Puerto Rico's rates above

Number of hospitals in Puerto Rico (2015)

Number of hospitals in Puerto Rico (2019) 58

Future Supply and Demand

80% Occupancy Bed Need

1,035,992Medicine, Surgical,* and Mental Health 1,012,329

2019 Estimated 2028

4,91862.6% 4.9 3.0 4,918 3,081

157

Community Physician Current Supply & DemandSupply


VA Market Area Health Systems Op�miza�on Valida�on of the data for this slide is not requiredVISN 08: Puerto Rico Virgin Islands Market — San Juan

2028

FY14-FY18 % change applied to FY18- FY28 (Slower rate of change)

Total Population 3,548,397 3,411,307 3,302,130 -7% 3,237,000

Total Active Patient Care Physicians per 100,000 Population 230.9 236.3 251.3 9% 273.5Percent of Active Physicians Who Are Age 60 or Older 33.9% 38.7% 43.4% 28% 55.6%Total Residents/Fellows in ACGME Programs per 100,000 Population as of December 31, (YYYY) 22.6 22.9 26.9 19%

32

Percentage of Physicains Retained in State from Graduate Medical Education (GME) 75.60% 74.60% 73.4% -3%

71%

Total Residents 802 782 860 7% 922

Physician Quantities, All Specialties 9,839 9,874 9,787 -1% 9,735Allergy & Immunology 12 12 14 17% 16Anatomic / Clinical Pathology 92 93 92 0% 92Anesthesiology 172 174 171 -1% 170Cardiovascular Disease 223 221 220 -1% 217Child & Adolescent Phsychiatry ** 78 77 80 3% 82Critical Care Medicine 23 23 21 -9% 19Dermatology 76 73 74 -3% 72Emergency Medicine 185 193 210 14% 238Endocrinology, Diabetes & Metabolism 59 67 75 27% 95Family Medicine / General Practice 1,925 1,872 1,791 -7% 1,666Gastroenterology 135 143 155 15% 178General Surgery 261 264 253 -3% 245Geriatric Medicine *** 44 49 49 11% 55Hematology & Oncology 105 111 116 10% 128Infectious Disease 81 81 85 5% 89Internal Medicine 1,144 1,183 1,149 0% 1,154Interventional Cardiology * 12 15 15Neonatal-Perinatal Medicine 44 47 47 7% 50Nephrology 85 87 87 2% 89Neurological Surgery 19 23 26 37% 36Neurology 111 109 111 0% 111Neuroradiology 15 15 14 -7% 13Obstetrics & Gynecology 448 449 437 -2% 426Ophthalmology 167 170 179 7% 192Orthopedic Surgery 91 88 89 -2% 87Otolaryngology 56 58 57 2% 58Pain Medicine & Pain Management 21 21 22 5% 23Pediatrics ** 900 880 866 -4% 833Physical Medicine & Rehabilitation 211 210 210 0% 209Plastic Surgery 35 34 36 3% 37Preventive Medicine 63 60 57 -10% 52Psychiatry 386 383 380 -2% 374Pulmonary Disease 82 83 83 1% 84Radiation Oncology 20 20 21 5% 22Radiology & Diagnostic Radiology 198 198 202 2% 206Rheumatology 64 63 67 5% 70Thoracic Surgery 18 18 15 -17% 13Urology 100 98 94 -6% 88Vascular & Interventional Radiology 15 14 14 -7% 13

Community Physician Workforce Profile, Historic and Projected Supply

4-Yr % change

201820162014

* Counts for specialties with fewer than 10 physicians are not shown** Only those 21 years or younger are included in People Per Physician

The adjacent table does not follow the US markets’ DD&F methodology of projecting physician demand, as this information was not available for Puerto Rico. However, the table shows actual historic Puerto Rico physician information, calculates the four-year percent change between 2014 and 2018, and extrapolates a 2028 demand estimate assuming each categories’ respective change rate over a 10-year period (decreasing the rate of change).

This projection is illustrative in nature and meant to provide directional perspective.

Source: 1. U.S. Census Bureau 2. AMA Physician Masterfile (December 31, 2018)3. AMA Physician Masterfile (December 31, 2016) 4. AMA Physician Masterfile (December 31, 2014)

158

Supply




Known Major Changes in Community Hospitals — San Juan Area

Source: Defini�ve Healthcare

159

Access Current Access

160


(V08) (672) San Juan(V08) (672B0) Ponce(V08) (672BZ) Mayaguez(V08) (672GA) Saint Croix(V08) (672GB) Saint Thomas(V08) (672GC) Arecibo(V08) (672GD) Ceiba(V08) (672GE) Guayama(V08) (672QA) Comerio(V08) (672QB) Utuado(V08) (672QC) ViequesFacility TotalMarket Total

10,1241,6032,032

91

545297259N/AN/AN/A

14,87014,870

10,4612,2412,356

91

518615385N/AN/AN/A

16,58616,586

11,3712,0212,107

40

453818293N/AN/A

017,06717,067

11,6632,0752,222

30

324610153N/AN/AN/A

17,05017,050

43,1788,675

16,058313517

7,0433,3681,301

N/AN/AN/A

80,45380,453

46,8559,559

18,743395607

6,3593,7681,241

N/AN/AN/A

87,52787,527

48,70111,64618,444

525557

6,0403,8981,429

134146

9491,61491,614

48,00610,43317,170

360487

3,3683,390

980175232165

84,76684,766

38,8012,5423,088

912

1013426

N/AN/AN/A

44,61344,613

37,7492,3623,279

102164

11136

N/AN/AN/A

43,63243,632

36,1253,6624,739

210292626

100

44,62044,620

40,2045,2505,194

21

233934

00

N/A50,74750,747

Same Day Appointment Totals

Access

Source: VSSC Completed Appointments Cube 109.V08.PuertoRicoVirginIslands

N/A: Not Available Note: Appointment create date equals the appointment date. This includes CVT visits where the pa�ent is scheduled for the day of for administra�ve purposes.



Same Day Appointments FY15-18

Mental Health Primary Care Specialty Care

161


(2V08) (672) San Juan, PR(2V08) (672B0) Ponce, PR (Eurípides Rubio)(2V08) (672BZ) Mayaguez, PR(2V08) (672GA) Saint Croix, VI(2V08) (672GB) Saint Thomas, VI(2V08) (672GC) Arecibo, PR(2V08) (672GD) Ceiba, PR(2V08) (672GE) Guayama, PR(2V08) (672QA) Comerio, PR(2V08) (672QB) Utuado, PR(2V08) (672QC) Vieques, PRNa�onal Average

2.00.82.08.11.81.40.51.0

N/AN/AN/A2.9

2.80.61.41.32.50.10.90.6

N/AN/AN/A2.7

4.30.71.1

12.69.20.71.01.5

N/AN/A0.02.6

4.72.14.09.87.95.90.83.9

N/AN/AN/A3.3

1.91.00.70.71.80.21.41.1

N/AN/AN/A4.0

2.60.60.40.12.10.32.20.5

N/AN/AN/A4.4

3.20.70.60.52.40.93.50.82.91.83.94.1

3.61.62.50.31.26.33.62.95.51.88.24.3

1.60.41.38.35.20.42.90.1

N/AN/AN/A4.5

3.50.20.94.76.40.53.80.0

N/AN/AN/A5.3

5.52.00.8

15.68.82.6

14.30.65.45.7

27.75.4

7.24.63.1

11.510.914.320.1

6.40.0

N/AN/A6.3

Established Pa�ent Appointments FY15-18Access


N/A: Not Available



Specialty CarePrimary CareMental Health

Average Established Pa�ent Wait (Days) from Preferred Date (PD)

162

Established Pa�ent Percent of Appointments Completed within 30 Days of Clinically Indicated/Pa�ent Preference

Established Pa�ent Appointments FY15-18, cont.

Facility FY15 FY16 FY17 FY18 FY15 FY16 FY17 FY18 FY15 FY16 FY17 FY18 Id

(V08) (672) San Juan(V08) (672B0) Ponce(V08) (672BZ) Mayaguez(V08) (672GA) Saint Croix(V08) (672GB) Saint Thomas(V08) (672GC) Arecibo(V08) (672GD) Ceiba(V08) (672GE) Guayama(V08) (672QA) Comerio(V08) (672QB) Utuado(V08) (672QC) ViequesNa�onal Average

99.2%99.5%99.4%94.8%98.2%99.0%99.6%99.5%

N/AN/AN/A

97.7%

99.7%99.7%99.9%99.2%96.8%

100.0%99.9%99.9%

N/AN/AN/A

98.2%

98.2%99.9%99.8%95.5%86.7%99.7%99.9%99.5%

N/AN/A

100.0%98.5%

97.0%99.6%96.2%96.9%88.0%96.0%99.8%99.0%

N/AN/AN/A

97.6%

99.7%99.6%99.6%99.6%99.7%99.8%99.1%99.6%

N/AN/AN/A

96.8%

99.8%99.9%

100.0%100.0%

99.6%99.9%99.5%99.9%

N/AN/AN/A

96.8%

99.4%99.9%99.8%99.9%99.5%99.8%99.1%99.9%99.9%99.9%97.1%97.4%

98.8%99.3%98.7%

100.0%99.8%95.4%98.5%99.0%99.3%99.6%94.0%97.2%

99.6%99.7%99.3%91.5%95.7%

100.0%98.8%

100.0%N/AN/AN/A

96.1%

97.5%99.9%99.7%94.9%93.5%

100.0%95.0%

100.0%N/AN/AN/A

95.3%

95.3%98.2%99.7%77.8%92.9%97.7%87.3%

100.0%94.1%

100.0%72.7%95.5%

93.4%95.7%97.3%90.8%88.1%88.5%84.4%94.8%

100.0%N/AN/A

94.5%

468469470471472473474475476477478479

Access


N/A: Not Available




163

Average New Pa�ent Wait (Days) from Create Date (CD)

New Pa�ent Appointments FY15-18


(2V08) (672) San Juan, PR(2V08) (672B0) Ponce, PR (Eurípides Rubio)(2V08) (672BZ) Mayaguez, PR(2V08) (672GA) Saint Croix, VI(2V08) (672GB) Saint Thomas, VI(2V08) (672GC) Arecibo, PR(2V08) (672GD) Ceiba, PR(2V08) (672GE) Guayama, PR(2V08) (672QA) Comerio, PR(2V08) (672QB) Utuado, PR(2V08) (672QC) Vieques, PRNa�onal Average

8.311.8

6.625.714.811.2

9.018.2N/AN/AN/A12.4

10.814.710.416.716.416.6

7.216.2N/AN/AN/A12.0

11.015.810.921.2

100.519.6

4.516.6N/AN/A51.311.3

10.610.110.217.627.520.0

5.113.7N/AN/AN/A11.3

15.715.510.615.132.417.115.922.3N/AN/AN/A21.2

19.513.010.618.926.017.516.630.0N/AN/AN/A22.7

17.212.610.313.516.615.917.919.6

9.817.315.022.6

20.820.855.015.116.619.413.918.516.215.213.021.2

19.323.230.141.435.1

7.810.211.9N/AN/AN/A21.5

22.433.027.632.959.112.6

4.965.8N/AN/AN/A21.2

24.937.227.939.560.627.434.2

7.038.226.6

101.221.0

24.226.726.424.740.146.749.221.624.779.5N/A22.5

456457458459460461462463464465466467

Access




Specialty CarePrimary Care

N/A: Not Available

Mental Health

164

New Pa�ent Appointments FY15-18, cont.


(V08) (672) San Juan(V08) (672B0) Ponce(V08) (672BZ) Mayaguez(V08) (672GA) Saint Croix(V08) (672GB) Saint Thomas(V08) (672GC) Arecibo(V08) (672GD) Ceiba(V08) (672GE) Guayama(V08) (672QA) Comerio(V08) (672QB) Utuado(V08) (672QC) ViequesNa�onal Average

98.2%94.1%95.2%57.7%

100.0%99.0%96.8%84.7%

N/AN/AN/A

90.1%

92.3%84.5%92.5%84.0%80.0%84.0%97.2%83.7%

N/AN/AN/A

90.8%

90.6%79.3%87.2%71.0%33.3%79.4%97.5%79.7%

N/AN/A

33.3%91.2%

94.0%86.7%89.7%75.0%69.2%91.2%95.2%92.3%

N/AN/AN/A

90.5%

89.3%93.2%93.8%95.5%56.4%82.4%85.4%76.6%

N/AN/AN/A

76.4%

73.2%92.2%93.9%86.7%70.3%84.2%79.8%43.3%

N/AN/AN/A

73.2%

76.3%88.6%90.0%97.3%73.5%86.1%78.7%76.5%

100.0%100.0%

83.3%73.8%

62.9%63.0%52.1%84.6%72.8%79.7%89.3%75.6%80.0%80.0%

100.0%76.3%

79.2%71.4%49.8%49.4%70.2%95.9%82.8%90.0%

N/AN/AN/A

75.2%

73.7%52.7%60.5%52.5%48.5%91.7%96.6%72.6%

N/AN/AN/A

76.2%

70.8%50.4%68.7%41.7%39.5%65.3%52.5%96.7%50.0%80.0%14.3%76.3%

76.0%62.7%65.8%69.7%33.3%30.8%43.2%74.4%66.7%50.0%

N/A73.9%

4…4…4…4…4…4…4…4…4…4…4…4…

Access





Percent of New Pa�ent Appointments Completed within 30 Days

N/A: Not Available

165

Rece ReceivingFacility FY18 Consults Avg

S

(201) PM&RS PHYSICIAN(407) OPHTHALMOLOGY(337) HEPATOLOGY CLINIC(205) PHYSICAL THERAPY(206) OCCUPATIONAL THERAPY(303) CARDIOLOGY(718) EYE TELEHEALTH SCREENING(323) PRIMARY CARE/MEDICINE(697) CHART CONSULT(180) DENTAL

(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan

12,4036,1498,4398,4216,6069,3916,2667,975

14,5547,027

54.850.136.031.825.115.8

4.32.41.41.2

……

36…………………

Average Wait Time for Top 10 Consults – San Juan

Stop Code

Access

Source: VSSC Consults Cube V2 114.V08.PuertoRicoVirginIslands.672

Note: Physical therapy consults include inpa�ent and outpa�ent consults. Radiology consults include administra�ve related consults.



Receiving Facility FY18 ConsultsAverage Days to

Completed Consult

166

ReceivingServiceStopCode Facility FY18 Consults AvergeDaysToCompletedConsult 8_8 Sort

(426) WOMENS SURGERY(405) HAND SURGERY(565) MH INTERVENTION BIOMED CARE GROUP(212) EMG - ELECTROMYOGRAM(420) PAIN CLINIC(115) ULTRASOUND(430) CYSTO ROOM UNIT FOR OUTPATIENT(690) CVT PATIENT SITE(550) MH CLINIC GROUP(201) PM&RS PHYSICIAN

(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan

6942

2975

1,1833,050

526144100

12,403

198.0105.8

91.083.076.070.468.463.858.854.8

198105.8

918376

70.468.463.858.854.8

Access

Source: VSSC Consults Cube V2 115.V08.PuertoRicoVirginIslands.672

Note: Physical therapy consults include inpa�ent and outpa�ent consults. Radiology consults include administra�ve related consults.



Longest Wait Time – Top 10 ConsultsAverage Days to

Completed Consult FY18 ConsultsReceiving Facility Stop Code

167

VA Facility Total Uniq Total Enc Prim Enc PrimUnq

Cnt Of Prm Cnt OfWmn

Cnt OfGer

Tms Ovr Tms Un Pcp Cap Cap Le� PanelFul

Third

(V08) (672) San Juan(V08) (672B0) Ponce(V08) (672BZ) Mayaguez(V08) (672GA) Saint Croix(V08) (672GB) Saint Thomas(V08) (672GC) Arecibo(V08) (672GD) Ceiba(V08) (672GE) Guayama(V08) (672QA) Comerio(V08) (672QB) Utuado(V08) (672QC) Vieques

53,56210,959

9,652730782

3,3943,3351,521

480664195

1,000,461121,988120,071

2,8802,907

16,61819,276

8,8171,4551,397

572

112,58833,46936,486

1,7031,961

11,56412,411

4,5121,283

898422

26,9918,5838,097

693760

3,2773,1011,351

474283148

227711342

N/AN/AN/A

222

N/AN/A

3N/AN/AN/AN/AN/A

5N/AN/AN/AN/AN/AN/AN/AN/AN/AN/A

185100220

N/AN/AN/A

42611122

N/AN/AN/A

17,5846,1446,921

919926

1,9543,0811,853

N/AN/AN/A

-3,480-230755229197124

60555N/AN/AN/A

119.8%103.7%

89.1%75.1%78.7%93.7%98.1%70.1%

N/AN/AN/A

21.810.7

5.21.33.34.47.13.63.43.47.3

Primary Care PACT Teams

Es�mated Capacity for Outpa�ent WorkloadAccess

Source: 1.VSSC Encounters Cube 2. VSSC PACT Compass Cube 116.V08.PuertoRicoVirginIslands.672



VA Facility

FY18 Primary CareFY18

Total Uniques UniquesPrimary Care

Encounters

Countof Primary

CarePACT Teams

Number of

Teams at or

Over

Capacity

Number of

Teams at or

Under

Capacity

Team PCP

Capacity

Total

CapacityLe�

PanelFullness

3rd Next Available

Appt.

FY18 Total

Encounters

Count of Women's

PACT Teams

Count of Geriatric

PACT Teams

168

VA Facility Tele Primary Care HBPC Specialty

Academic Other* Total

(V08) (672) San Juan(V08) (672B0) Ponce(V08) (672BZ) Mayaguez

N/AN/AN/A

321

5N/AN/A

N/AN/AN/A

N/AN/AN/A

821

Es�mated Capacity for Outpa�ent Workload, cont.Access

Source: VSSC PACT Compass Cube 166.V08.PuertoRicoVirginIslands.672

*Other includes Post Deployment and Homeless Teams.



Other Teams

VA Facility Tele Primary Care HBPC Specialty Academic Other* Total

169

Es�mated 30 Minute Drive Time ZonesAccess

Source: Geocoded Enrollee File FY18Q4 117.V08.PuertoRicoVirginIslands#IMG



Es�mated 30 Minute Drive Time Zones

170


(V08) (672) San Juan(V08) (672B0) Ponce(V08) (672BZ) Mayaguez(V08) (672GA) Saint Croix(V08) (672GB) Saint Thomas(V08) (672GC) Arecibo(V08) (672GD) Ceiba(V08) (672GE) Guayama(V08) (672QA) Comerio(V08) (672QB) Utuado(V08) (672QC) Vieques

53.3%66.0%41.5%62.5%70.0%72.5%18.3%74.4%

N/AN/AN/A

56.3%68.8%63.0%63.1%63.8%75.1%38.6%79.0%

N/AN/AN/A

45.4%63.1%60.3%77.5%47.2%75.0%53.4%68.4%

N/AN/A

73.1%

48.5%64.6%62.2%59.7%42.2%64.7%40.4%64.1%

N/AN/A

16.7%

39.9%42.4%54.1%22.4%19.9%28.0%51.1%36.5%

N/AN/A

49.5%

54.2%52.7%65.8%28.2%23.2%40.8%54.1%54.8%

N/AN/A

64.2%

44.0%45.4%59.6%26.0%20.7%38.6%48.4%37.3%55.2%27.5%67.1%

50.3%61.9%62.7%20.3%16.9%48.3%59.2%61.3%64.3%36.3%46.2%

71.9%81.0%78.4%60.7%38.7%33.0%48.3%2.4%N/AN/AN/A

77.8%85.1%84.1%62.4%68.2%43.3%67.3%24.3%

N/AN/AN/A

77.9%79.2%82.7%66.8%75.3%61.8%73.7%28.0%17.4%53.1%80.5%

79.2%75.9%75.0%64.1%58.2%51.0%76.2%41.7%

6.8%20.6%33.3%

449450451452453454455456457458459

Clinic U�liza�on — Percent Slots Used of Total SlotsAccess

Source: VSSC Clinic U�liza�on Cube 118.V08.PuertoRicoVirginIslands




171

Cancelled by Clinic Report


(V08) (672) San Juan(V08) (672B0) Ponce(V08) (672BZ) Mayaguez(V08) (672GA) Saint Croix(V08) (672GB) Saint Thomas(V08) (672GC) Arecibo(V08) (672GD) Ceiba(V08) (672GE) Guayama(V08) (672QA) Comerio(V08) (672QB) Utuado(V08) (672QC) ViequesTotal

7,0922,7992,367

9812

349170425N/AN/AN/A

13,312

7,7521,9442,388

74N/A345134316N/AN/AN/A

12,953

8,5162,8142,722

3212

632236550N/AN/A

2415,538

6,7252,3282,070

437

714148495N/AN/A

612,536

15,2172,5363,480

433356

3,0721,618

595N/AN/AN/A

27,307

10,5151,9262,294

321230

2,5681,225

258N/AN/AN/A

19,337

14,2323,4673,078

411276

2,6981,415

60381

127118

26,506

12,0082,8872,957

415145

1,2831,186

48586

152119

21,723

23,3494,8653,012

13483423135

N/AN/AN/A

31,551

21,2353,8122,427

8835712831

N/AN/AN/A

27,727

30,3385,1543,328

6056

1205643

376

39,171

21,5514,4123,108

3316

159799921

411

29,493

139140141142143144145146147148149150

Access

Source: VSSC No Show and Cancella�on Cube 119.V08.PuertoRicoVirginIslands

Note: Appointments cancelled within 45 days prior to the appointment date or appointments cancelled any�me a�er the appointment date.




172

Market/Parent Facility Exis�ng VA Drive Times AssessmentAccess

Source: 1. Dartmouth Atlas 2. Geocoded Enrollee File FY18Q4 120.V08.PuertoRicoVirginIslands#IMG

Note: A Dartmouth Atlas Hospital Service Area (HSA) is a ZIP code-defined geography encompassing the community where the Medicare residents predominantly receive their hospital care. HSA totalenrollees are displayed on map. A Dartmouth Atlas Hospital Referral Region (HRR) is a ZIP code-defined geography encompassing the community where the Medicare residents predominantly receivetheir cardiovascular and neurosurgery hospital care.



VA & Commercial Drive Time Measures

173

FY 2018 # of TotalEnrollees

# of Enrolleeswithin 30

Minutes DriveTime

% of Enrolleeswithin 30

Minutes DriveTime

# of Enrolleesoutside 30

Minutes DriveTime

% of Enrolleesoutside 30

Minutes DriveTime

# of Enrolleeswithin 60

Minutes DriveTime

% of Enrolleeswithin 60

Minutes DriveTime

# of Enrolleesoutside 60

Minutes DriveTime

% of Enrolleesoutside 60

Minutes DriveTime

Id

(V08) Puerto Rico Virgin Islands 68,063 51,719 76.0% 13,813 24.0% 41,957 61.6% 23,575 38.4% 1

Access




Drive Time Summary

Secondary CarePrimary Care

Source: 1. FY2018 Q4 Enrollment 2. FY2018 Q4 VA Site Tracking (VAST) data; VHA OPP Planning Systems Support Group

174

Poten�al Service GapsAccess

Source: 1. Dartmouth Atlas 2. Geocoded Enrollee File FY18Q4 122.V08.PuertoRicoVirginIslands#IMG


VISN 08: Puerto Rico Virgin Islands MarketPoten�al service gaps are areas iden�fied by the Dartmouth Atlas in a Hospital Service Area (HSA). The medical communi�es in these areas provide

opportuni�es to consider different tac�cs to extend the VA network of care. Strategies for expansion might include telehealth, FQHC partnership, unique

rural outreach, contracted provider(s), or a new VA asset. The following page shows the number of Enrollees that reside within a par�cular HSA. Planning

best prac�ce suggests that 4,800 enrollees are required to jus�fy establishing a new site of care.

Poten�al Service Gaps

Note: Dartmouth Atlas does not include U.S. territories in Hospital Service Area or Hospital Referral Region definitions.

175




Access Enrollment Proximity to VA Site (HSA and HRR Alignment)Enrollment Proximity to VA Site (HSA and HRR Alignment)

Note: Dartmouth Atlas does not include U.S. territories in Hospital Service Area or Hospital Referral Region definitions.

Source: 1. Dartmouth Atlas 2. Geocoded Enrollee File FY18Q4

176


* VA sites include VAMCs, HCCs, MS CBOCs, CBOCs, and OOS; drive �mes are not comparable to Primary and Secondary Care Enrollment Access measures as defined by PSSG.



Access Enrollment Proximity to VA Site (30- and 60-minute Drive Times)*Enrollment Proximity to VA Site (30- and 60-minute Drive Times)*

Source: Geocoded Enrollee File FY18Q4

177


* VA sites include VAMCs, HCCs, MS CBOCs, CBOCs, and OOS; drive �mes are not comparable to Primary and Secondary Care Enrollment Access measures as defined by PSSG.** Drive �me polygons overlap and may include ZIP code popula�on assigned to two or more POC.*** Drive �me polygons are adjusted to closest facility to eliminate overlap and duplica�on of ZIP code popula�on assignment to a POC.



Access

Facility FacilityClassifica�on

O Enroll30

O Users30

O Enroll60

O Users60

NOEnroll 30

NOUsers 30

NOEnroll 60

NO Users60

Id


(V08) (672B0) Ponce





(V08) (672GD) Ceiba





VAMC

MS-CBOC

MS-CBOC

OOS

OOS

CBOC

CBOC

CBOC

OOS

OOS

OOS

21,383

7,363

4,531

842

1,187

3,454

2,194

2,023

2,038

698

222

16,490

6,109

3,693

470

667

2,665

1,763

1,565

1,629

580

167

36,278

14,371

12,232

1,185

1,187

14,675

15,491

15,179

26,573

11,473

222

28,266

11,669

9,955

679

667

11,530

12,157

12,099

20,789

9,238

167

21,459

7,363

4,531

842

1,187

3,454

2,942

2,023

2,038

698

222

16,546

6,109

3,693

470

667

2,665

2,328

1,565

1,629

580

167

25,638

8,647

8,414

1,185

1,187

6,776

4,716

2,181

4,407

940

222

19,919

7,165

6,814

679

667

5,274

3,750

1,690

3,465

782

167

1

1

1

1

1

1

1

1

1

1

1

30 minFacility Name FacilityClassifica�on Enrollees Users Enrollees Users Enrollees

60 min

Users Enrollees Users

30 min 60 minTotal (Overlapping)** Total (Non-Overlapping)***

Source: 1. FY20Q1 VAST 2. Geocoded Enrollee File FY18Q4

Enrollment Proximity to VA Site* by Facility

178





Access

County Name TotalEnrollees

Enrollees Outside of30-Minute Drive Time


SAN JUAN, PRBAYAMON, PRPONCE, PRCAROLINA, PRCAGUAS, PRTOA BAJA, PRARECIBO, PRGUAYNABO, PRMAYAGUEZ, PRAGUADILLA, PRCAYEY, PRJUANA DIAZ, PRTOA ALTA, PRTRUJILLO ALTO, PRCABO ROJO, PRHUMACAO, PRCOAMO, PRVEGA BAJA, PRISABELA, PRFAJARDO, PR

5,9234,2913,6863,3652,6421,6741,5221,4951,4811,3271,0891,0841,0791,012

994928922894876872

100000000

1,3271,089

01,079

00

748922894876

0

10000000000000000000

Enrollment Proximity to VA Site* by County

179





Access




RIO GRANDE, PRYAUCO, PRGUAYAMA, PRSAN GERMAN, PRGURABO, PRCANOVANAS, PRCIDRA, PRSALINAS, PRDORADO, PRSAN SEBASTIAN, PRMANATI, PRSABANA GRANDE, PRJUNCOS, PRAIBONITO, PRHATILLO, PRVEGA ALTA, PRAGUADA, PRSAN LORENZO, PRLAJAS, PRMOCA, PR

849816781714693679652637610584583580574571558556530520516509

8490000

67900

610584

00

574548

0556530520516509

00000000000000000000

Enrollment Proximity to VA Site* by County, cont.

180





Access




SANTA ISABEL, PRLAS PIEDRAS, PRPENUELAS, PRGUAYANILLA, PRCAMUY, PRCOROZAL, PRQUEBRADILLAS, PRUTUADO, PRYABUCOA, PRNAGUABO, PRBARRANQUITAS, PRHORMIGUEROS, PRLUQUILLO, PRMOROVIS, PRANASCO, PRAGUAS BUENAS, PRLARES, PRNARANJITO, PRGUANICA, PRVILLALBA, PR

502486467461455450447441439424411389380378373371371365362347

0486

000

450447

16439

0000

37800

3710

3620

00000000000000000000


181





Access




CEIBA, PRBARCELONETA, PRARROYO, PRCATANO, PROROCOVIS, PRPATILLAS, PRADJUNTAS, PRRINCON, PRLOIZA, PRCIALES, PRVIEQUES, PRCOMERIO, PRJAYUYA, PRMAUNABO, PRFLORIDA, PRLAS MARIAS, PRMARICAO, PRCULEBRA, PRSAINT THOMAS, VISAINT CROIX, VI

338336332289282273273254237226222216199158157

976636

1,1871,185

0000

28200

254237226

00

199158157

976636

0343

00000000000000000

3600


182





Access




SAINT JOHN, VI 102 102 102


183

Quality & Sa�sfac�on

184

Category Sub-Category Na�onal Market

Insurance (Reliance)

Sa�sfac�on (Best Care Anywhere)

Access (Choose VA)

Internet Use (Telehealth Poten�al)

Have Private Insurance PlanPlanned Use of VA as Primary Source of CareUninsuredAppointments are Always/Nearly Always Easy to Get with VAVery Sa�sfied with Respect Given by Health Care ProfessionalsVery Sa�sfied with the Ability to Get ReferralsBelieves Care in the Community is Easier to Get to than VA (Answered Yes)Believes Care in the Community Quality is Be�er than VA (Answered Yes)Internet Use to Look at Health Informa�on (Answered Yes)Used Internet to Make Medical Appointments (Answered Yes)


Source: 2018 Survey of Enrollees Market Profiles 124.V08.PuertoRicoVirginIslands

Note: A significant number of invita�ons to enrollees in V08 Puerto Rico Virgin Islands Market were returned as undeliverable in 2018. Given the likelihood that this was due to reloca�on caused byHurricane Maria, data collec�on was suspended in 2018.



VA Pa�ent Feedback: Survey of Enrollees – Puerto Rico Virgin Islands MarketPuerto Rico Virgin Islands Market

27.6%40.5%19.2%45.3%72.3%32.4%66.0%43.0%76.1%

36.5%

N/AN/AN/AN/AN/AN/AN/AN/AN/A

N/A

185

Facility SurveyDate

CareCoord.

Cleanlinessof Hospital

Envt.

CommaboutMeds

Commw/

Doctors

Commw/

Nurses

PainMgmt.

CommaboutPain

QuietnessOf

HospitalEnvt.

Hosp.Staff

Respon-siveness

Recom-mend

Hospital

CareTransi�on

Hosp.Ra�ng

DischargeInfo

SharedDecisionMaking

(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San JuanVISN 08 AverageVISN 08 AverageVISN 08 AverageVISN 08 AverageNa�onal AverageNa�onal AverageNa�onal AverageNa�onal Average

201520162017201820152016201720182015201620172018

56.956.159.558.652.653.253.955.152.053.253.254.2

83.381.386.285.268.266.367.067.869.970.069.670.4

52.856.859.156.858.158.159.861.461.261.962.663.4

81.881.881.383.373.875.575.576.273.874.775.175.7

76.374.977.078.870.572.173.775.572.173.173.574.6

58.762.057.9N/A57.658.758.0N/A60.160.159.5N/A

N/AN/AN/A50.7N/AN/AN/A56.6N/AN/AN/A57.9

60.862.661.265.248.149.350.153.949.349.850.151.4

60.859.061.062.955.155.558.159.758.859.759.761.0

84.783.084.083.970.470.272.071.865.565.866.766.9

59.357.259.563.151.552.353.854.749.750.852.051.9

80.982.083.682.766.269.268.469.164.365.265.466.2

80.583.384.582.983.885.085.185.684.785.385.686.2

73.172.674.575.872.873.874.775.274.075.375.475.5

VA Pa�ent Sa�sfac�on – Inpa�ent% Reported as Always % Definitely Yes


Source: VSSC Pa�ent Experiences Survey Reports 125.V08.PuertoRicoVirginIslands

Note: Green cells indicate a score at or above na�onal average. Red cells indicate a score below na�onal average.



% Strongly Agree % 9 or 10 % Yes

186

Measure Measure Unit Pref.Dir.

16Q3 17Q3 18Q3 18Q3Median

.

Care Transi�on1. Ambulatory Care Sensi�ve Condi�on hospitaliza�ons2. Hospital-wide 30-day readmission ratea. Cardiorespiratory cohortb. Cardiovascular cohortc. Medicine cohortd. Neurology cohorte. Surgical cohort

3. Disease specific 30-day readmission ratea. AMI RSRRb. CHF RSRRc. Pneumonia RSRRd. COPD RSRRe. Stroke RSRR

Pa�ent Experience1. Overall ra�ng of hospital (inpa�ent)2. Overall ra�ng of primary care providers3. Overall ra�ng of specialty care providers4. Care Transi�on (inpa�ent)5. PCMH Stress Discussed (Q40)

hosp/1000 pts%%%%%%

%%%%%

wct %wct %wct %wct %wct %

↓↓↓↓↓↓↓

↓↓↓↓↓

↑↑↑↑↑

25.49912.35515.79514.27412.406

8.89410.028

15.94424.426

16.73N/AN/A

81.26977.74666.398

N/AN/A

25.74511.94413.71411.45113.092

7.7928.717

15.94424.426

16.73N/AN/A

81.59276.98267.067

N/AN/A

34.40812.38213.64412.58714.012

10.267.827

19.12225.33818.51716.16910.886

85.08274.40667.17963.09351.566

25.05511.45812.92210.09512.8258.9878.482

16.75318.79414.52715.36510.046

67.13970.75069.16651.81459.113

2425262728293031323334353637383940414243

Employee Sa�sfac�on1. Best places to worka. Overall job sa�sfac�onb. Sa�sfac�on with organiza�onc. Recommend my organiza�on as a good place to work

2. Registered nurse turnover rate

score (1-100)score (1-5)score (1-5)score (1-5)%

↑↑↑↑↓

65.083.803

3.633.9592.209

68.7673.9173.7473.9551.745

64.9263.8323.679

3.923.024

65.1523.8203.6163.8335.163

444546474849


Source: SAIL Scorecards 126.V08.PuertoRicoVirginIslands.672



VA Market Facility Trends – Access/Quality/Pa�ent Sa�sfac�on.



12345678911111111112

Acute care mortality1. Acute care Standardized Mortality Ra�o (SMR)2. Acute care 30-day Standardized Mortality Ra�o (SMR30)a. AMI RSMRb. CHF RSMRc. Pneumonia RSMRd. COPD RSMRe. Stroke RSMR

Avoidable adverse events1. In-hospital complica�ons2. Healthcare associated infec�ons (HAI)a. Catheter associated urinary tract infec�onb. Central line associated bloodstream infec�onc. Ven�lator associated events (IVAC Plus)d. Methicillin-resistant Staphylococcus aureus (MRSA) infec�one. C. difficile infec�on

3. Pa�ent safety indicator (PSI)4. Post acute care events

Length of Stay and U�liza�on Management1. Adjusted length of stay

O/EO/E%%%%%

O/E

inf/1k device daysinf/1k device days

events/1k device daysinf/1k bed days

inf/10k bed daysO/EO/E

days

↓↓↓↓↓↓↓

↓

↓↓↓↓↓↑↓

↓

1.1271.0369.123

11.1419.922

N/AN/A

1.144

0.950.57511.490.122

N/A-0.163

N/A

5.98

1.3521.0979.123

11.1419.922

N/AN/A

0.99

0.8870.6511.6430.031

N/A-0.392

N/A

5.847

1.3341.11

8.86510.01811.285

4.0026.655

0.989

1.1371.9611.6760.1044.956

-0.9261.066

5.417

0.8220.9237.7416.8439.3515.8056.148

0.838

0.4670.3640.0000.0565.5970.3600.924

4.324222

2. U�liza�on managementa. Admission reviews met, adjustedb. Con�nued stay reviews met, adjusted

%%

↑↑

88.19671.079

86.67464.817

87.12364.817

76.04267.607

187

Category

Shorthand . .

Above Highest Benchmark of 10th or 90th Percen�le

Between Median and Favorable Percen�le

Between Median and Unfavorable Percen�le

Below Lowest Benchmark of 10th or 90th Percen�le

Superior

Good

Acceptable

Needs Improvement

20

44

61

26

13%

29%

40%

17%

Total 151 100%

.



55555555556666666666

Performance measures1. Inpa�ent performance measures (ORYX)2. Outpa�ent performance measures (HED90_1)3. Outpa�ent performance measures (HED90_ec)

Access1. PCMH / Specialty Care Access ques�onsa. PCMH �mely appointment, care and informa�onb. Specialty Care �mely appointment, care and informa�onc. Days Waited for Urgent Appointment (PCMH)c. Get an urgent care appointment as soon as needed (SC)d. Get a rou�ne care appointment as soon as needed (SC)

2. Wait �mesa. Primary care new pa�ent wait �me <=30 days from create …b. Specialty care new pa�ent wait �me <=30 days from create…c. Mental health care new pa�ent wait �me <=30 days from c…

3. Call center responsivenessa. Call center speed in responding to calls in secondsb. Call center abandonment rate

Mental Health1. Popula�on coverage

%wct %

%

wct %wct %wct %

%%

%%%

seconds%

Standardized scoreStandardized score

↑↑↑

↑↑↑↑↑

↑↑↑

↓↓↑↑

71.229N/AN/A

54.819N/A

52.22745.54648.887

99.15288.85999.872

14.7257.3030.1161.486

85.335N/AN/A

55.70649.65556.751

N/AN/A

98.35982.35999.127

24.0497.052

-0.5041.436

89.25185.98880.807

55.17447.48853.839

N/AN/A

72.55576.00492.508

27.0037.923

-0.3080.896

83.07088.76778.367

53.03250.83040.916

80.44475.41992.311

50.6986.7040.326-0.248

77777

2. Con�nuity of care3. Experience of care

Efficiency and Capacity1. Efficiency (1/SFA)2. Physician Capacity

Standardized scoreStandardized score

Score (0-100)%

↑↑

↑↓

-0.411-0.82

94.186N/A

-0.061-2.476

95.5572.152

-0.584-0.991

93.1815.864

0.8550.066

94.0967.505


Source: SAIL Scorecards 127.V08.PuertoRicoVirginIslands.672

Note: Performance Measures cited above represent composite measures. Some measures have changed, but appear to be rela�vely close to current measures and therefore are reported for periodsshown (PCMH Timely Appointments, Days Waited for Urgent Appointment).



VA Market Facility Trends – Access/Quality/Pa�ent Sa�sfac�on, cont.

San Juan VAMC Summary for all 3 Quarters

VAMC FY18 Star Ra�ng: 2

188

VA Pa�ent Sa�sfac�on – Outpa�ent (PCMH)

Facility Survey Date Access Care Coordina�on Communica�on Office Staff Overall Ra�ng ofProvider

OverallSa�sfac�on

CK

(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672B0) Ponce(V08) (672B0) Ponce(V08) (672B0) Ponce(V08) (672B0) Ponce(V08) (672BZ) Mayaguez(V08) (672BZ) Mayaguez(V08) (672BZ) Mayaguez(V08) (672BZ) Mayaguez(V08) (672GA) Saint Croix(V08) (672GA) Saint Croix(V08) (672GA) Saint Croix(V08) (672GA) Saint Croix(V08) (672GB) Saint Thomas(V08) (672GB) Saint Thomas(V08) (672GB) Saint Thomas(V08) (672GB) Saint Thomas

20152016201720182015201620172018201520162017201820152016201720182015201620172018

41.153.553.656.041.761.257.863.629.349.862.052.630.436.842.821.510.149.428.738.8

N/A50.555.152.4N/A51.748.952.5N/A53.957.755.1N/A53.864.144.8N/A38.543.941.8

78.578.778.276.981.683.380.677.876.579.985.485.677.774.573.867.057.870.177.466.4

69.669.665.673.775.982.077.573.965.865.573.964.771.164.065.459.042.970.560.466.3

78.577.474.468.980.481.276.568.475.779.880.682.068.459.860.748.542.476.446.348.6

N/AN/AN/A76.4N/AN/AN/A77.3N/AN/AN/A78.1N/AN/AN/A62.0N/AN/AN/A63.1

……………………………………………………

% Always






% 9 or 10

189

VA Pa�ent Sa�sfac�on – Outpa�ent (PCMH), cont.



CK

(V08) (672GC) Arecibo(V08) (672GC) Arecibo(V08) (672GC) Arecibo(V08) (672GC) Arecibo(V08) (672GD) Ceiba(V08) (672GD) Ceiba(V08) (672GD) Ceiba(V08) (672GD) Ceiba(V08) (672GE) Guayama(V08) (672GE) Guayama(V08) (672GE) Guayama(V08) (672GE) GuayamaVISN 08 AverageVISN 08 AverageVISN 08 AverageVISN 08 AverageNa�onal AverageNa�onal AverageNa�onal AverageNa�onal Average

20152016201720182015201620172018201520162017201820152016201720182015201620172018

40.557.051.260.132.856.757.158.729.653.454.050.337.851.252.353.537.449.249.851.3

N/A56.357.259.9N/A56.551.656.9N/A48.847.347.9N/A58.759.759.9N/A58.458.760.1

82.384.080.589.476.685.784.581.064.775.775.769.072.377.077.177.670.975.675.877.1

75.770.369.972.179.981.979.682.573.673.585.668.964.066.468.469.666.269.170.071.0

79.180.382.586.471.379.986.177.861.567.360.958.568.271.271.070.865.268.168.969.7

N/AN/AN/A81.5N/AN/AN/A80.9N/AN/AN/A76.2N/AN/AN/A80.2N/AN/AN/A80.3

……………………………………………………

% Always


Source: VSSC Pa�ent Experiences Survey Reports 128.V08.PuertoRicoVirginIslands#2




% 9 or 10

190

VA Pa�ent Sa�sfac�on – Outpa�ent (Specialty Care)



CK

(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San Juan(V08) (672B0) Ponce(V08) (672B0) Ponce(V08) (672B0) Ponce(V08) (672BZ) Mayaguez(V08) (672BZ) Mayaguez(V08) (672BZ) Mayaguez(V08) (672GC) Arecibo(V08) (672GC) Arecibo(V08) (672GC) Arecibo(V08) (672GD) Ceiba(V08) (672GD) Ceiba(V08) (672GE) Guayama(V08) (672GE) Guayama(V08) (672GE) GuayamaVISN 08 AverageVISN 08 AverageVISN 08 Average

20162017201820162017201820162017201820162017201820162018201620172018201620172018

50.5%49.8%45.4%47.4%47.6%60.4%36.8%43.3%41.9%42.9%

N/A40.9%

N/A80.5%28.2%79.7%63.4%48.4%49.8%48.9%

49.8%48.3%49.3%51.0%48.9%48.9%48.2%55.3%50.5%65.6%79.6%60.8%80.3%43.9%14.5%29.2%47.4%55.5%56.1%57.2%

71.6%71.9%72.9%73.4%73.2%80.8%65.2%73.0%75.7%77.6%79.9%80.2%

100.0%93.0%31.7%62.5%54.9%73.7%74.1%75.7%

70.5%66.2%69.8%68.2%73.6%81.5%54.8%78.9%72.9%

100.0%100.0%

81.3%100.0%

72.0%74.5%83.8%51.0%67.9%69.5%71.3%

69.4%67.4%65.6%65.7%64.4%77.6%62.6%66.8%69.8%55.2%76.6%67.0%

100.0%72.0%34.8%67.6%21.5%67.3%68.3%70.1%

N/AN/A

79.4%N/AN/A

83.1%N/AN/A

68.4%N/AN/A

81.3%N/A

81.2%N/AN/A

100.0%N/AN/A

81.2%

08…08…08…08…08…08…08…08…08…08…08…08…08…08…08…08…08…08…08…08…

% Always






% 9 or 10

191

VA Pa�ent Sa�sfac�on – Outpa�ent (Specialty Care), cont.



CK

Na�onal AverageNa�onal AverageNa�onal Average

201620172018

47.3%48.7%49.7%

55.1%56.2%57.1%

73.2%74.2%75.3%

69.1%70.4%71.7%

65.4%66.8%68.4%

N/AN/A

81.0%

08…08…08…

% Always


Source: VSSC Pa�ent Experiences Survey Reports 129.V08.PuertoRicoVirginIslands#2




% 9 or 10

192

Facility SurveyDate

ProviderRa�ng

CommunityCare

Received

Commu-nica�on

ProviderAwareHistory

ProviderInformed

VAProviderInformed

Next StepClear

TestFollow-

up

TestResult to

VA

First Appt.Soon asNeeded

First Appt.Easy to Get


(V08) (672) San Juan(V08) (672) San Juan(V08) (672) San JuanVISN 08 AverageVISN 08 AverageVISN 08 AverageNational AverageNational AverageNational Average

201620172018201620172018201620172018

62.267.065.063.960.566.558.862.164.5

56.554.370.257.253.656.650.454.255.3

59.765.470.064.665.469.263.766.468.0

44.846.640.149.749.149.647.049.251.0

45.943.036.145.440.245.542.244.545.7

49.752.146.644.341.343.641.043.744.8

46.540.237.949.944.446.142.745.247.0

43.046.141.151.355.856.551.653.454.9

72.349.252.961.660.663.859.660.662.5

65.377.466.365.555.961.459.962.166.0

62.263.071.964.355.162.359.862.266.1

77.377.766.877.072.674.971.774.076.9

VA Pa�ent Sa�sfac�on – Community Care

% Always






% 9 or 10 % Strongly Agree

% Very Sa�sfied

or Sa�sfied

193

Quality of Community Hospitals – San Juan AreaQuality & Sa�sfac�on

Source: 1. Best Care Report 2. Defini�ve Healthcare 130.V08.PuertoRicoVirginIslands.672

Note: Data is reported by provider number and may includes mul�-campus hospitals repor�ng under a single provider number; N/A = Not Applicable; Quality Rank for Overall Quality was based on the Best Care Report. In cases where there are fewer than 10 hospitals, the closest hospitals were included.



Valida�on of the data for this slide is not required194





Awards and Recogni�on of Top Five Largest Community Hospitals* – San Juan Area

*As measured by total staffed beds. Excludes rehabilita�on, psychiatric, and long term care facili�es. Note: N/A for High Performing Ranked Special�es/Programs and High Performing Procedures/Condi�ons indicates the hospital did not meet criteria or volume thresholds set by US News and World Report to be eligible for a ra�ng/ranking. N/A for Notable Awards indicates the hospital did not list any care or service delivery awards on its website. Reflects informa�on that was available as of January 15th, 2020.

131.V08.PuertoRicoVirginIslands.672Source: 1. US News and World Report Flagship Hospital Ra�ngs 2. Healthgrades 3. The Leapfrog Group 4. American Nurses Creden�aling Center

195


Source: CMS.gov 132.V08.PuertoRicoVirginIslands



Quality of Top Community Hospital Outpa�ent ServicesHospital Outpa�ent Quality Repor�ng Program Overview

• The Hospital Outpa�ent Quality Repor�ng Program (Hospital OQR) is a pay for quality data repor�ng program implemented by the Centers for Medicare & Medicaid Services (CMS) for outpa�ent hospital servicesü Mandated by the Tax Relief and Health Care Act of 2006 by CMS to promote higher quality and more

efficient health care for Medicare beneficiaries through measurement

• Subsec�on (d) hospitals that meet Hospital OQR Program requirements during a given calendar year receive a full OPPS payment update, also called the Outpa�ent Department (OPD) fee schedule increase factor, for the upcoming calendar year

• Eligible hospitals that do not par�cipate or par�cipate but fail to meet program requirements receive a two percentage point reduc�on of their annual payment update (APU) for the applicable payment year

• Hospitals must submit data for 26 quality measures:ü 5 Cardiac Care Measuresü 3 ED-Throughput Measuresü 1 Pain Management Measuresü 6 Imaging Efficiency Measuresü 1 Stroke Measureü 9 Submi�ed Via a Web-Based Tool Measuresü 1 Outcome Claims-Based Measures

For more informa�on, including measure specifica�ons and minimum case count requirements, see CMS.gov

196

This analysis is subjec�ve in nature and is only meant to provide a direc�onal opinion as to the current state of VA and non-VA providers in the market.

*ED volume (EDV) is not a Hospital OQR measure, but OP-18 and OP-22 na�onal data are based on ED volumes.

**The first repor�ng period for OP-35 and -36 began January 1, 2018 and goes through December 31, 2018, for the CY 2020 payment determina�on. Data for these 2 measures have not been made available by CMS and are not included in this analysis.

Acute Myocardial Infarc�on /

Chest Pain Measure Score


Source: CMS.gov 133.V08.PuertoRicoVirginIslands



Quality of Top Community Hospital Outpa�ent Services, cont.•In order to be�er compare outpa�ent quality between hospitals, the 21 outpa�ent quality measure were grouped into broader categories

•Na�onal outpa�ent data was also grouped following the same methodology and used as a benchmark comparison

• OP-2: Fibrinoly�c Therapy Received Within 30 Minutes of ED arrival (%)

• OP-3: Median Time to Transfer to Another Facility for Acute Coronary Interven�on (mins)

• OP-5: Median Time to ECG (mins)

Structural

(Submi�ed Via a

Web-based Tool)

• OP-12: The Ability for Providers with HIT to Receive Laboratory Data Electronically

Directly into their ONC-Cer�fied EHR System as Discrete Searchable Data (Y/N)

• OP-17: Tracking Clinical Results between Visits (Y/N)

• OP-29: Appropriate Follow-up Interval for Normal Colonoscopy in Average Risk Pa�ents

(%)

• OP-30: Colonoscopy Interval for Pa�ents with a History of Adenomatous Polyps –

Avoidance of Inappropriate Use (%)

• OP-31: Cataracts – Improvement in Pa�ent’s Visual Func�on within 90 days Following

Cataract Surgery (survey)

•OP-33 Facility 7-Day Risk-Standardized Hospital Visit Rate a�er Outpa�ent Colonoscopy

• OP-8: MRI Lumbar Spine for Low Back Pain (%)

• OP-9: Mammography Follow-up Rates (%)

• OP-10: Abdomen CT-Use of Contrast Material (%)

• OP-11: Thorax CT-Use of Contrast Material (%)

• OP-13: Cardiac Imaging for Preopera�ve Risk Assessment for Non-Cardiac Low Risk Surgery (%)

• OP-14: Simultaneous Use of Brain Computed Tomography (CT) and Sinus Computed

Tomography (CT) (%)

• OP-32 Facility 7-Day Risk-Standardized Hospital Visit Rate a�er Outpa�ent Colonoscopy

• OP-35: Admissions and Emergency Department (ED) Visits for Pa�ents Receiving Outpa�ent

Chemotherapy**

• OP-36: Hospital Visits a�er Hospital Outpa�ent Surgery**

ED - Throughput • OP-18: Median Time from ED Arrival to ED Departure for Discharged ED Pa�ents (mins)

• OP-22: Le� Without Being Seen (%)

• EDV - Emergency Department Volume

• OP-23: Head CT or MRI Scan Results for Acute Ischemic Stroke or Hemorrhagic Stroke Pa�ents

who Received Head CT or MRI Scan Interpreta�on Within 45 minutes of ED Arrival (%)

Hospital Outpa�ent Quality Repor�ng Groupings

ED - Volume*

Imaging Efficiency

StrokeOutcome Claims-Based

Valida�on of the data for this slide is not required197

Id

. Measure Name Preferr… Hospital1 Hospital2 Hospital3 Hospital4 Hospital5 Na�onal…

379

380381382383

384385386

387

388389390391392

393394395396397

398

Outpa�ent QualityCategoryAMI / Chest Pain

Structural (Submi�edvia a Web-Based Tool)

Outcome Claims-BasedED – Throughput

ED – Volume

Imaging Efficiency

Measure Name

OP-2: Fibrinoly�c Therapy Received Within 30 Minutes of ED arrival (%)OP-3: Median Time to Transfer to Another Facility for Acute Coronary Interven�on (mins)OP-5: Median Time to ECG (mins)OP-12: Receive Laboratory Data Electronically Directly as Discrete Searchable Data (Y/N)

OP-17: Tracking Clinical Results between Visits (Y/N)OP-29: Appropriate Follow-up Interval for Normal Colonoscopy in Average Risk Pa�ents (%)OP-30: Colonoscopy Interval for Pa�ents with a History of Adenomatous Polyps - Avoidanceof Inappropriate Use (%)OP-31: Cataracts - Improvement in Pa�ent's Visual Func�on within 90 days FollowingCataract Surgery (survey)OP-33: External Beam Radiotherapy for Bone Metastases (%)OP-32: Facility 7-Day Risk-Standardized Hospital Visit Rate a�er Outpa�ent ColonoscopyOP-18: Median Time from ED Arrival to ED Departure for Discharged ED Pa�ents (mins)OP-22: Le� Without Being Seen (%)EDV: Emergency Department Volume

OP-8: MRI Lumbar Spine for Low Back Pain (%)OP-9: Mammography Follow-up Rates (%)**OP-10: Abdomen CT-Use of Contrast Material (%)OP-11: Thorax CT-Use of Contrast Material (%)OP-13: Cardiac Imaging for Preopera�ve Risk Assessment for Non Cardiac Low Risk Surgery(%)OP-14: Simultaneous Use of Brain Computed Tomography (CT) and Sinus ComputedTomography (CT) (%)

PreferredDirec�onHighLowLowYes

YesHighHigh

High

HighLowLowLowN/A

LowLowLowLowLow

Low

Auxilio Mutuo Hospital

N/AN/AN/AN/A

N/AN/AN/A

N/A

N/AN/AN/AN/AN/A

N/AN/AN/AN/AN/A

N/A

HIMA San Pablo CaguasHospitalN/AN/AN/AN/A

N/AN/AN/A

N/A

N/AN/AN/AN/AN/A

N/AN/AN/AN/AN/A

N/A

HIMA San PabloBayamon HospitalN/AN/AN/AN/A

N/AN/AN/A

N/A

N/AN/AN/AN/AN/A

N/AN/AN/AN/AN/A

N/A

Doctors CenterHospital Mana�N/AN/A13Yes

YesN/AN/A

N/A

N/AN/A3351.0 %High (40,000-59,999pa�ents annually)N/AN/A17.4 %N/AN/A

N/A

Mana� MedicalCenterN/AN/A28N/A

N/AN/AN/A

N/A

N/AN/A471N/AN/A

N/AN/A7.1 %N/AN/A

0.0 %

Na�onalRate58.0 %648N/A

N/A88.0 %90.0 %

95

86.0 %14.8 %1352.0 %N/A

38.7 %8.9 %6.9 %1.4 %4.7 %

1.2 %

399 OP-23: Head CT or MRI Scan Results Within 45 minutes of ED Arrival (%) High N/A N/A N/A 66.0 % 0.0 % 72.0 %

Id

. Measure Name Preferr… Hospital1 Hospital2 Hospital3 Hospital4 Hospital5 Na�onal…

379

380381382383

384385386

387

388389390391392

393394395396397

398

Outpa�ent QualityCategoryAMI / Chest Pain

Structural (Submi�edvia a Web-Based Tool)

Outcome Claims-BasedED – Throughput

ED – Volume

Imaging Efficiency

Measure Name

OP-2: Fibrinoly�c Therapy Received Within 30 Minutes of ED arrival (%)OP-3: Median Time to Transfer to Another Facility for Acute Coronary Interven�on (mins)OP-5: Median Time to ECG (mins)OP-12: Receive Laboratory Data Electronically Directly as Discrete Searchable Data (Y/N)

OP-17: Tracking Clinical Results between Visits (Y/N)OP-29: Appropriate Follow-up Interval for Normal Colonoscopy in Average Risk Pa�ents (%)OP-30: Colonoscopy Interval for Pa�ents with a History of Adenomatous Polyps - Avoidanceof Inappropriate Use (%)OP-31: Cataracts - Improvement in Pa�ent's Visual Func�on within 90 days FollowingCataract Surgery (survey)OP-33: External Beam Radiotherapy for Bone Metastases (%)OP-32: Facility 7-Day Risk-Standardized Hospital Visit Rate a�er Outpa�ent ColonoscopyOP-18: Median Time from ED Arrival to ED Departure for Discharged ED Pa�ents (mins)OP-22: Le� Without Being Seen (%)EDV: Emergency Department Volume

OP-8: MRI Lumbar Spine for Low Back Pain (%)OP-9: Mammography Follow-up Rates (%)**OP-10: Abdomen CT-Use of Contrast Material (%)OP-11: Thorax CT-Use of Contrast Material (%)OP-13: Cardiac Imaging for Preopera�ve Risk Assessment for Non Cardiac Low Risk Surgery(%)OP-14: Simultaneous Use of Brain Computed Tomography (CT) and Sinus ComputedTomography (CT) (%)

PreferredDirec�onHighLowLowYes

YesHighHigh

High

HighLowLowLowN/A

LowLowLowLowLow

Low


N/AN/AN/AN/A

N/AN/AN/A

N/A

N/AN/AN/AN/AN/A

N/AN/AN/AN/AN/A

N/A

HIMA San Pablo CaguasHospitalN/AN/AN/AN/A

N/AN/AN/A

N/A

N/AN/AN/AN/AN/A

N/AN/AN/AN/AN/A

N/A

HIMA San PabloBayamon HospitalN/AN/AN/AN/A

N/AN/AN/A

N/A

N/AN/AN/AN/AN/A

N/AN/AN/AN/AN/A

N/A

Doctors CenterHospital Mana�N/AN/A13Yes

YesN/AN/A

N/A

N/AN/A3351.0 %High (40,000-59,999pa�ents annually)N/AN/A17.4 %N/AN/A

N/A

Mana� MedicalCenterN/AN/A28N/A

N/AN/AN/A

N/A

N/AN/A471N/AN/A

N/AN/A7.1 %N/AN/A

0.0 %

Na�onalRate58.0 %648N/A

N/A88.0 %90.0 %

95

86.0 %14.8 %1352.0 %N/A

38.7 %8.9 %6.9 %1.4 %4.7 %

1.2 %

399 OP-23: Head CT or MRI Scan Results Within 45 minutes of ED Arrival (%) High N/A N/A N/A 66.0 % 0.0 % 72.0 %


134.V08.PuertoRicoVirginIslands.672Source: 2017 CMS.gov

Quality & Sa�sfac�onVISN 08: Puerto Rico Virgin Islands Market — San Juan

*As measured by total staffed beds. **A mammography follow-up rate of 8%–14% is typically ideal. N/A = Not available/reported. Green = Equal to or be�er than the na�onal rate.

Key Quality Metrics of Top Five Largest Community Hospitals* – San Juan Area


Outpa�ent Quality Category ProcedureType Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5

Outpa�ent Quality Category

OP Surgical Procedure Volume

Procedure Type

Gastrointes�nal

Eye

Nervous System

Musculoskeletal

Skin

Genitourinary

Cardiovascular

Respiratory

Other

Total


N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

0

HIMA San Pablo Caguas Hospital

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

0

HIMA San Pablo Bayamon Hospital

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

0

Doctors Center Hospital Mana�

33

35

0

93

17

87

5

17

4,554

4,841

Mana� Medical Center

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

0

Outpa�ent Quality Category ProcedureType Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5

Outpa�ent Quality Category

OP Surgical Procedure Volume

Procedure Type

Gastrointes�nal

Eye

Nervous System

Musculoskeletal

Skin

Genitourinary

Cardiovascular

Respiratory

Other

Total


N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

0

HIMA San Pablo Caguas Hospital

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

0

HIMA San Pablo Bayamon Hospital

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

0

Doctors Center Hospital Mana�

33

35

0

93

17

87

5

17

4,554

4,841

Mana� Medical Center

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

0

Hospitals* – San Juan AreaOutpa�ent Procedure Volumes of Top Five Largest CommunityQuality & Sa�sfac�on




N/A = Not available/reported. *As measured by total staffed beds.Source: 2017 CMS.gov 135.V08.PuertoRicoVirginIslands.672

• Most hospital outpa�ent procedures (99%) fall into one of eight categories: Cardiovascular, Eye, Gastrointes�nal, Genitourinary, Musculoskeletal, Nervous System, Skin, and Other (CMS.gov; green: at/above Na�onal Rate)

• Research has suggested higher procedure volumes are associated with lower costs and be�er quality (Advisory Board).

199

Facili�es

200

1 2

Main Pa�ent Care Facility Construc�on DateMost Recent Renova�on Date (Main Hospital Building)BGSF (campus total)DGSF (direct pa�ent care)Property SizeAnnual Opera�ons and Maintenance CostFacili�es Condi�ons Assessment DeficienciesTotal 10-Year Capital Investment*Seismic RiskOpera�onal Leases

1969N/A1,452,452 SF559,107 SF 38.0% of BGSF26 acres 0 acres available**$26,826,788$253,169,112 $5,239/Unique$350,084,899High10 Leases $7,001,082 total annual cost 185,867 total NUSF

1 2 3

1 2 3

Parent Facility Complexity Level (2017):FY18 Core Facility Uniques (VAMC only):

High-1A48,325

12

REAL PROPERTY OVERVIEW


* Sum of Major and Minor Construc�on and Non-Recurring Maintenance (NRM) spending. ** Provides an indica�on of any excess or surplus land, not currently in use and with no plans for future expansion needs that could be used for future development.



Facili�es

Facility Name: San Juan

Inpa�ent Campus Snapshot

Source: CAI Buildings and FCA Condi�on Gaps Reports 9-14-2020, and CAPRES CEOSH Report 1-29-2019

Campus Historic Considera�ons: The San Juan campus does not have any historic designa�on.

201

Source: CAI Buildings, Floor, Leases, and FCA Red Green Reports 9-14-2020; VSSC Core Uniques Cube; CAPRES CEOSH Report 1-29-2019; Locally Provided GFI 138.V08.PuertoRicoVirginIslands.672

1. Includes Acute Psych, Medicine, and Surgical Beds.2. Includes Spinal Cord, Blind Rehab, CLC, DRRTP, and Intermediate Beds.3. Only reflects SF related to VA owned and leased fixed facili�es.



Facili�es Inpa�ent Campus and Outpa�ent Care Loca�ons

202

Major Construc�on Funding

$0

$50,000,000

FY09 FY10 FY11 FY12 FY13 FY14 FY15 FY16 FY17 FY18

VHA Average Major VISN Average Major Facility Major

Measure Facility VISN Average VHA Average DisplayOrder

FCA Backlog/SF*Current FCA BacklogInvestment/SF*Total 10-Year Capital Investment**Owned SF

$174$253,169,112

$241$350,084,899

1,452,452

$94$115,638,453

$211$259,614,969

1,227,788

$138$123,999,084

$153$137,521,745

898,038

54321

Investment – San Juan


*Total 10-Year Capital Investment and Current FCA Backlog Divided by Owned SF; **Sum of Major and Minor Construc�on and NRM spending.



Facili�esMinor Construc�on Funding

$0

$5,000,000


VHA Average Minor VISN Average Minor Facility Minor

NRM Funding

$0

$20,000,000

$40,000,000


VHA Average NRM VISN Average NRM Facility NRM

Total Construc�on Funding

$0

$100,000,000


VHA Average Total VISN Average Total Facility Total

Source: CAI Buildings and FCA Red Green Reports 9-14-2020; FMS 830 837, Accounts 110, 111, and 162 (Cost Center 8542, BOC 32XX, (less BOC 3222 and BOC 3224))

203

Site Plan

Source: Locally Provided GFI 140.V08.PuertoRicoVirginIslands.672



Facili�esSan Juan

204

Building Inventory (Owned)

Func�on Title Current Use YearBuilt

BuildingGross SF

Outpa�entSF

Inpa�entSF

Non-Clinical SF

Other SF VacantSF

Cost of FCADeficiencies*

FullReplacement

Cost

Historical Status SeismicRisk

TotalMain Hospital (1)Laundry (2)Nursing Home/Blind Rehab (10)Hazardous Waste Storage (11)Pump House 1 (12)Fire Cistern Pump House (13)Boiler Plant (16)District Counsel (18)Outpa�ent Addi�on (19)Medical Waste/Paint Shop (22)Chiller Plant (24)SICU- Surgical Intensive Care UNit (26)Electrical Synchroniza�on Building (27)Radia�on Therapy Trailers (28)Electrical Distribu�on Building (29)South Bed Tower (30)Administra�on Building (40)Modular Building Village 1 (50)Modular Building Village 2 (51)

HospitalService

Ins�tu�onalWarehouses

ServiceIndustrialIndustrial

OfficeOutpa�ent F…

ServiceIndustrialHospital

IndustrialHospital

IndustrialHospital

OfficeOutpa�ent F…

Service

1969196919881990201020151997199219991990200020092010201220152010201220152015

1,452,452569,601

10,03063,900

550310393

2,0632,160

350,0375,1792,103

11,4773,5981,2709,480

229,877169,538

12,2781,954

337,904153,524

01,150

00000

167,68700

7230

8700

4,7850

7,5330

221,20318,259

048,957

00000000

10,403000

143,584000

255,462104,547

7,7222,968

000

2100

25,0963,300

00000

13,69389,556

3,3481,674

416,41285,744

2,30810,825

550310393

1,8532,160

155,8591,8792,103

3513,598

4009,480

67,81569,944

560280

221,471207,527

0000000

1,3950000000

10,038837

0

$222,202,690$172,910,288

$3,135,340$23,533,362

$23,710$44,585$27,864

$1,338,938$291,870

$7,276,103$874,594

$1,495,989$1,404,935

$335,589$15,912

$161,596$3,791,805$2,012,644$2,054,138

$355,701

$866,075,003$335,715,053

$6,373,676$35,078,366

$302,908$170,730$216,442

$1,136,182$1,189,604

$210,352,004$2,852,295$1,158,211$8,650,128$1,981,572

$839,559$5,221,039

$149,319,278$93,558,128

$6,956,198$1,076,151

Not HistoricNot HistoricNot HistoricNot HistoricNot HistoricNot HistoricNot HistoricNot HistoricNot HistoricNot HistoricNot HistoricNot HistoricNot HistoricNot HistoricNot HistoricNot HistoricNot HistoricNot HistoricNot Historic

Extremel…Not Listed

ExemptNot ListedNot ListedNot Listed

ExemptNon-Exe…

ExemptExempt

Non-Exe…Not ListedNot ListedHigh Risk

Not ListedNot ListedNot ListedNot ListedNot Listed

San Juan

Source: CAI Buildings & FCA Condi�on Gaps Report 9-14-2020 141.V08.PuertoRicoVirginIslands.672



Facili�es

*Project Costs to remediate FCAs vary significantly, from below assessed value to more than 3 �mes the value.Note: “Non-Contribu�ng” is a non-contribu�ng element of a landmark or listed district.

205

Building Inventory (Owned), cont.


BuildingGross SF

Outpa�entSF

Inpa�entSF

Non-Clinical SF

Other SF VacantSF

Cost of FCADeficiencies*

FullReplacement

Cost

Historical Status SeismicRisk

Modular Building Village 3 (52)CT Scan Trailer (53)MRI Trailer (54)

ServiceOutpa�ent F…Outpa�ent F…

201520182018

5,022768864

0768864

000

3,34800

000

1,67400

$636,940$16,068

$464,719

$2,765,829$546,659$614,991

Not HistoricNot HistoricNot Historic

Not ListedNot ListedNot Listed

San Juan

Source: CAI Buildings & FCA Condi�on Gaps Report 9-14-2020 141.V08.PuertoRicoVirginIslands.672#2



Facili�es

*Project Costs to remediate FCAs vary significantly, from below assessed value to more than 3 �mes the value.Note: “Non-Contribu�ng” is a non-contribu�ng element of a landmark or listed district.

206


BuildingGross SF

Outpa�entSF

Inpa�entSF

Non-Clinical

SF

OtherSF

VacantSF

LeaseTermina�on

(Hard)

Stands�ll/Holdover/Extension

in Place

Stands�ll/Holdover/Extension

Termina�on Date

Year ofAc�va�on

Annual Rent

TotalMayaguez VA Clinic (672BZ)Eurípides Rubio Outpa�ent Clinic (672B0)Carolina Warehouse La CeramicaCarolina 3 Warehouse ( La Ceramica)Carolina 2 Warehouse (La Ceramica)Ceiba VA Clinic (672GD)Guayama VA Clinic (672GE)Comerio VA Clinic (672QA)Utuado VA Clinic (672QB)Vieques VA Clinic (672QC)Replacement Ponce CBOC (Proposed-New)Mental Health Residen�al (Proposed-New)Warehouse Replacement (Proposed-New)Arecibo CBOC 2 (Proposed-New)Comerio Rural Clinic Succeeding lease (Propose…

CBOCSatellite OPCWarehouseWarehouseWarehouseCBOCCBOC OtherOutreach ClinicSatellite OPCCBOCMental HealthWarehouseCBOC Other

20001971197119711999

19702007

401,67682,45256,55010,000

9,5009,5008,8466,0751,3611,000

583114,378

53,41726,26320,390

1,361

285,93151,75533,993

000

3,9784,3091,161

806583

114,37853,417

020,390

1,161

0000000000000000

87,18119,13411,33610,000

9,5009,500

616367200

65000

26,2630

200

28,56411,56311,221

000

4,2521,399

0129

000000

0000000000000000

10/29/332/27/205/31/185/31/185/31/189/4/2210/31/259/19/201/24/206/15/20

FalseTrueTrueTrueTrueFalseFalseTrueTrueTrueFalseFalseFalseFalseFalse

2/27/205/31/185/31/185/31/18

9/19/201/24/206/15/20

2014200020042004200420122015201020102018

$7,001,082$5,089,217$1,325,597

$123,300$117,135$117,135

$29,264$185,288

$1$14,144

$1

Source: CAI Leases Report 9-14-2020 142.V08.PuertoRicoVirginIslands.672



Facili�esSan Juan

Building Inventory (Leased)

207

Summary of Architectural and Engineering Challenges – San Juan

Source: Locally Provided GFI 143.V08.PuertoRicoVirginIslands.672



Facili�es

208

Note: All ac�ve projects have received all levels of approvals and are assumed to be proceeding.



Facili�es Ac�ve and Planned Projects — San Juan

10_8 Program Project SF/Count Status Es�matedCost

Ac�ve Minor Construc�onAc�ve Major Construc�on

Ac�ve NRMs¹

Acquire Land for the San Juan Fisher House (672-304)Seismic Correc�ons Bldg. 1Construct Monumental Stairwell Suicide Deterrent Glass Enclosure (672-19-118)Construct New Canopy for Drop-Off Area and Pedestrian Walkway (672-12-125)Expand Emergency Department & Observa�on Unit (SCIP 2012) (672-12-101)FCA Fire Alarm Replacement Phase 2 (672-11-600)Improve Building 19 (OPA) for the Whole Health Program (672-19-125)Install Heat Transfer Machine (672-14-203)Install Legionella Preven�on and Scald Control System (672-15-400)Install Medical Air Back-Up Pipe at OPA (672-18-108)Install New 38 KV Power line (672-15-111)Install New Reverse Osmosis System in SPS (672-16-919)Install Pneuma�c Tube Transporta�on System (672-14-901)Install Reverse Osmosis at RME SPS MOPC (672-18-110)Perform Retrofit at Surgical Suites (672-18-603)Provide an Equivalent Level of Life Safety Code Compliance at Main Building Hospital Corridors (672-18-103)Provide New Canopy From Administra�on Building To Main Hospital Entrance (672-18-109)Provide Public Address System on all Buildings (672-19-715)Relocate PAICU to SBT (672-17-105)Renovate Chiller Plant (672-14-200)

Design awarded 7/25/18Construc�on awarded 9/23/09Construc�on awarded 7/24/19Construc�on awarded 3/30/15Construc�on awarded 8/23/17

Construc�on awarded 12/29/11Construc�on awarded 10/10/19

Construc�on awarded 8/17/16Construc�on awarded 9/14/16Construc�on awarded 6/25/18Construc�on awarded 9/22/16Construc�on awarded 6/14/16Construc�on awarded 6/26/18

Construc�on awarded 10/10/17Design awarded 9/5/18



Construc�on awarded 6/1/18

$6,356,000$307,000,000

$400,000$995,568

$9,420,000$3,462,489$1,864,554$3,639,960$3,400,000

$220,000$10,560,000

$421,920$932,310$107,516$960,690$717,020$500,000

$1,500,000$741,841

$3,872,286Renovate Community Living Center (672-14-106) Construc�on awarded 9/29/16 $3,068,658


Ac�ve Minor Construc�onAc�ve Major Construc�on

Ac�ve NRMs¹

Acquire Land for the San Juan Fisher House (672-304)Seismic Correc�ons Bldg. 1Construct Monumental Stairwell Suicide Deterrent Glass Enclosure (672-19-118)Construct New Canopy for Drop-Off Area and Pedestrian Walkway (672-12-125)Expand Emergency Department & Observa�on Unit (SCIP 2012) (672-12-101)FCA Fire Alarm Replacement Phase 2 (672-11-600)Improve Building 19 (OPA) for the Whole Health Program (672-19-125)Install Heat Transfer Machine (672-14-203)Install Legionella Preven�on and Scald Control System (672-15-400)Install Medical Air Back-Up Pipe at OPA (672-18-108)Install New 38 KV Power line (672-15-111)Install New Reverse Osmosis System in SPS (672-16-919)Install Pneuma�c Tube Transporta�on System (672-14-901)Install Reverse Osmosis at RME SPS MOPC (672-18-110)Perform Retrofit at Surgical Suites (672-18-603)Provide an Equivalent Level of Life Safety Code Compliance at Main Building Hospital Corridors (672-18-103)Provide New Canopy From Administra�on Building To Main Hospital Entrance (672-18-109)Provide Public Address System on all Buildings (672-19-715)Relocate PAICU to SBT (672-17-105)Renovate Chiller Plant (672-14-200)

Design awarded 7/25/18Construc�on awarded 9/23/09Construc�on awarded 7/24/19Construc�on awarded 3/30/15Construc�on awarded 8/23/17


Construc�on awarded 8/17/16Construc�on awarded 9/14/16Construc�on awarded 6/25/18Construc�on awarded 9/22/16Construc�on awarded 6/14/16Construc�on awarded 6/26/18




Construc�on awarded 6/1/18

$6,356,000$307,000,000

$400,000$995,568

$9,420,000$3,462,489$1,864,554$3,639,960$3,400,000

$220,000$10,560,000

$421,920$932,310$107,516$960,690$717,020$500,000

$1,500,000$741,841

$3,872,286Renovate Community Living Center (672-14-106) Construc�on awarded 9/29/16 $3,068,658

Source: 1. Capital Assets database (PTR as of 1-8-2020) 2. CFM Major Construc�on Monthly Report, ORP Project Repor�ng, CAI Proposed (New) Leases (12-30-19) 3. Strategic Capital Investment Plan (FY2020 submission) total es�mated cost ($ in thousands) 144.V08.PuertoRicoVirginIslands.672

209




Facili�es Ac�ve and Planned Projects — San Juan, cont.


Ac�ve NRMs¹ RENOVATE COMMUNITY LIVING CENTER RESTROOMS/SHOWERS (672-12-128)Renovate Hema Onco (672-16-902)Renovate Parking Garage (672-15-101)Repair Main Building Basement Metal Deck (672-14-607)Replace Air Handling Units at Various Sites (672-14-600)Replace Community Living Center Terrace Roof (672-16-920)Replace Dampers at VACHS (672-19-113)Replace Exhaust Fans (672-14-604)Replace Generator Number 2 (672-15-102)Replace Generator Number 5 (672-17-601)Replace Medical Gases Components (672-19-104)Replace Pa�ent Li�s at CLC (672-19-127)Replace Reheat System (672-14-208)Upgrade Air Emission Control System and Data Collec�on for Standby Power Generators (672-17-101)Upgrade Current Sterile Prepara�on To Meet USP 797/800 (672-19-130)Upgrade Domes�c Water System for Hurricane Hardening (672-19-716)Upgrade Exterior Doors for Hurricane Resistance and Install Hurricane Shu�ers (672-19-710)Upgrade Lightning Protec�on System at VACHS (672-18-601)Upgrade Nurse Call System (672-19-115)Upgrade Perimeter Fence Upgrade FCA D (672-12-606)


Construc�on awarded 6/22/16Construc�on awarded 6/19/18Construc�on awarded 4/10/18Construc�on awarded 4/25/18Construc�on awarded 6/19/19Construc�on awarded 4/10/18Construc�on awarded 8/31/16Construc�on awarded 9/14/18

Design awarded 9/19/19Construc�on awarded 5/7/19Construc�on awarded 4/6/18Construc�on awarded 8/8/18

PlannedDesign awarded 3/29/19

Construc�on awarded 8/16/19Construc�on awarded 9/17/18Construc�on awarded 6/26/19Construc�on awarded 4/27/18

$558,071$974,460$773,926$679,900$945,600$287,525$750,000$739,033

$3,934,370$3,679,894$2,300,000$1,165,000

$890,000$661,755

$1,436,530$2,750,000$3,500,000

$261,059$1,600,000$5,416,138

Upgrade SPS Workflow and HVAC System to comply with New Direc�ve at San Juan Medical Center (672-17-6… Design awarded 9/28/18 $881,500


Ac�ve NRMs¹ RENOVATE COMMUNITY LIVING CENTER RESTROOMS/SHOWERS (672-12-128)Renovate Hema Onco (672-16-902)Renovate Parking Garage (672-15-101)Repair Main Building Basement Metal Deck (672-14-607)Replace Air Handling Units at Various Sites (672-14-600)Replace Community Living Center Terrace Roof (672-16-920)Replace Dampers at VACHS (672-19-113)Replace Exhaust Fans (672-14-604)Replace Generator Number 2 (672-15-102)Replace Generator Number 5 (672-17-601)Replace Medical Gases Components (672-19-104)Replace Pa�ent Li�s at CLC (672-19-127)Replace Reheat System (672-14-208)Upgrade Air Emission Control System and Data Collec�on for Standby Power Generators (672-17-101)Upgrade Current Sterile Prepara�on To Meet USP 797/800 (672-19-130)Upgrade Domes�c Water System for Hurricane Hardening (672-19-716)Upgrade Exterior Doors for Hurricane Resistance and Install Hurricane Shu�ers (672-19-710)Upgrade Lightning Protec�on System at VACHS (672-18-601)Upgrade Nurse Call System (672-19-115)Upgrade Perimeter Fence Upgrade FCA D (672-12-606)


Construc�on awarded 6/22/16Construc�on awarded 6/19/18Construc�on awarded 4/10/18Construc�on awarded 4/25/18Construc�on awarded 6/19/19Construc�on awarded 4/10/18Construc�on awarded 8/31/16Construc�on awarded 9/14/18

Design awarded 9/19/19Construc�on awarded 5/7/19Construc�on awarded 4/6/18Construc�on awarded 8/8/18

PlannedDesign awarded 3/29/19

Construc�on awarded 8/16/19Construc�on awarded 9/17/18Construc�on awarded 6/26/19Construc�on awarded 4/27/18

$558,071$974,460$773,926$679,900$945,600$287,525$750,000$739,033

$3,934,370$3,679,894$2,300,000$1,165,000

$890,000$661,755

$1,436,530$2,750,000$3,500,000

$261,059$1,600,000$5,416,138

Upgrade SPS Workflow and HVAC System to comply with New Direc�ve at San Juan Medical Center (672-17-6… Design awarded 9/28/18 $881,500

Source: 1. Capital Assets database (PTR as of 1-8-2020) 2. CFM Major Construc�on Monthly Report, ORP Project Repor�ng, CAI Proposed (New) Leases (12-30-19) 3. Strategic Capital Investment Plan (FY2020 submission) total es�mated cost ($ in thousands) 144.V08.PuertoRicoVirginIslands.672#2

210




Facili�es Ac�ve and Planned Projects — San Juan, cont.


Ac�ve NRMs¹

Ac�ve Projects Total Es�mated Cost (Major, Minor, NRM)Major Leases in Procurement²

Minor Leases in Procurement²

SCIP FY2020 Submi�ed Projects (10-Year Plan)³

Upgrade Synchroniza�on Standby Power System (672-19-101)Upgrade Video Assessment Surveillance System (VASS) at San Juan Campus (672-19-709)Ac�ve Projects Total Es�mated Cost (Major, Minor, NRM)Choice Act 1.0 CBOC - Ponce, PRMental Health - San Juan, PRArecibo CBOC 2Compensa�on & Pension UnitMental Health Residen�alReplacement Ponce CBOCWarehouse ReplacementGMP-GreenMajor Construc�onMajor LeasesNRM-IMNRM-SusTotal Es�mated Cost SCIP Projects

114,30052,00020,39012,33553,417

114,37826,263

342

312363


Lease awarded 9/28/18Lease awarded 9/30/19

Proposed New (CAI)Proposed New (CAI)Proposed New (CAI)Proposed New (CAI)Proposed New (CAI)

$4,879,767$14,084,000

$413,289,340$5,315,077$3,622,589

N/AN/AN/AN/AN/A

$10,110$276,853

$41,729$159,766$121,763$610,221


Ac�ve NRMs¹

Ac�ve Projects Total Es�mated Cost (Major, Minor, NRM)Major Leases in Procurement²

Minor Leases in Procurement²

SCIP FY2020 Submi�ed Projects (10-Year Plan)³

Upgrade Synchroniza�on Standby Power System (672-19-101)Upgrade Video Assessment Surveillance System (VASS) at San Juan Campus (672-19-709)Ac�ve Projects Total Es�mated Cost (Major, Minor, NRM)Choice Act 1.0 CBOC - Ponce, PRMental Health - San Juan, PRArecibo CBOC 2Compensa�on & Pension UnitMental Health Residen�alReplacement Ponce CBOCWarehouse ReplacementGMP-GreenMajor Construc�onMajor LeasesNRM-IMNRM-SusTotal Es�mated Cost SCIP Projects

114,30052,00020,39012,33553,417

114,37826,263

342

312363


Lease awarded 9/28/18Lease awarded 9/30/19

Proposed New (CAI)Proposed New (CAI)Proposed New (CAI)Proposed New (CAI)Proposed New (CAI)

$4,879,767$14,084,000

$413,289,340$5,315,077$3,622,589

N/AN/AN/AN/AN/A

$10,110$276,853

$41,729$159,766$121,763$610,221

Source: 1. Capital Assets database (PTR as of 1-8-2020) 2. CFM Major Construc�on Monthly Report, ORP Project Repor�ng, CAI Proposed (New) Leases (12-30-19) 3. Strategic Capital Investment Plan (FY2020 submission) total es�mated cost ($ in thousands) 144.V08.PuertoRicoVirginIslands.672#3

211

Mission

212

Mission

Source: Facility Summary Report provided by Office of Academic Affilia�on. 147.V08.PuertoRicoVirginIslands.672

*Base Posi�ons = Training Posi�ons, GME = Graduate Medical Educa�on, VACAA = Addi�onal GME Slots aligned to The Veterans Access, Choice, and Accountability Act of 2014 (VACAA).



Medical Educa�on/Training – San Juan11_1 Sponsoring Facility Program Type Specialty FY 2019 Training

Posi�ons (FTEs)*DO

Ponce Health Sciences University

San Juan City HospitalSan Juan VAMC

GMEVACAAVACAAGMEVACAAGMEGMEVACAAGMEGMEGMEDentalGMEGMEGMEGMEGMEGMEVACAA

Addic�on PsychiatryGeriatric PsychiatryPsychiatryPsychiatryPsychosoma�c MedicineHematology and OncologyCardiovascular DiseaseCardiovascular DiseaseChief Resident (IM - Quality and Pa�ent Safety)Chief Resident (IM)Cri�cal Care MedicineDen�stry - General Prac�ce Residency 12 MonthsGastroenterologyInfec�ous DiseaseInternal MedicineNephrologyPhysical Medicine and Rehabilita�onPulmonary Disease and Cri�cal Care MedicinePulmonary Disease and Cri�cal Care Medicine

1.01.02.0

10.01.03.06.03.01.02.02.02.09.04.0

61.03.0

12.06.03.0

123456789

10111213141516171819

Sponsoring Facility Program Type Specialty AY 2019 TrainingPosi�ons (FTEs)*

DO

Ponce Health Sciences University

San Juan City HospitalSan Juan VAMC

GMEVACAAVACAAGMEVACAAGMEGMEVACAAGMEGMEGMEDentalGMEGMEGMEGMEGMEGMEVACAA

Addic�on PsychiatryGeriatric PsychiatryPsychiatryPsychiatryPsychosoma�c MedicineHematology and OncologyCardiovascular DiseaseCardiovascular DiseaseChief Resident (IM - Quality and Pa�ent Safety)Chief Resident (IM)Cri�cal Care MedicineDen�stry - General Prac�ce Residency 12 MonthsGastroenterologyInfec�ous DiseaseInternal MedicineNephrologyPhysical Medicine and Rehabilita�onPulmonary Disease and Cri�cal Care MedicinePulmonary Disease and Cri�cal Care Medicine

1.01.02.0

10.01.03.06.03.01.02.02.02.09.04.0

61.03.0

12.06.03.0

123456789

10111213141516171819

213

Mission

Source: Facility Summary Report provided by Office of Academic Affilia�on. 147.V08.PuertoRicoVirginIslands.672#2

*Base Posi�ons = Training Posi�ons, GME = Graduate Medical Educa�on, VACAA = Addi�onal GME Slots aligned to The Veterans Access, Choice, and Accountability Act of 2014 (VACAA).



Medical Educa�on/Training – San Juan, cont.11_1 Sponsoring Facility Program Type Specialty FY 2019 Training

Posi�ons (FTEs)*DO

University of Puerto Rico School of Medicine

Other Training Programs

GMEGMEGMEGMEGMEGMEGMEGMEAssociated HealthAssociated HealthNursingAssociated HealthAssociated HealthAssociated HealthAssociated HealthAssociated HealthAssociated Health

AnesthesiologyGeriatric MedicineNeurologyNuclear MedicineOphthalmologyOrthopaedic SurgerySurgery-generalUrologyAudiology Doctoral Extern (4th Year)Blind Rehab Mstrs InternNursing - Administra�onNutri�on/Diete�cs InternPharmacy ResidentPsychologySocial WorkSpeech Path Masters InternSpeech Pathology Fellow

4.04.04.02.03.02.08.02.01.02.02.0

10.04.08.04.02.00.0

2021222324252627282930313233343536

Sponsoring Facility Program Type Specialty AY 2019 TrainingPosi�ons (FTEs)*

DO

University of Puerto Rico School of Medicine

Other Training Programs

GMEGMEGMEGMEGMEGMEGMEGMEAssociated HealthAssociated HealthNursingAssociated HealthAssociated HealthAssociated HealthAssociated HealthAssociated HealthAssociated Health

AnesthesiologyGeriatric MedicineNeurologyNuclear MedicineOphthalmologyOrthopaedic SurgerySurgery-generalUrologyAudiology Doctoral Extern (4th Year)Blind Rehab Mstrs InternNursing - Administra�onNutri�on/Diete�cs InternPharmacy ResidentPsychologySocial WorkSpeech Path Masters InternSpeech Pathology Fellow

4.04.04.02.03.02.08.02.01.02.02.0

10.04.08.04.02.00.0

2021222324252627282930313233343536

214

Number of Training Posi�ons: VAMC vs Na�onal Average

0

100

200 194

113

VAMC Na�onal Average

Medical Educa�on/Training – San Juan, cont.

Program Type Budget AY 2019 TrainingPosi�ons (FTEs)*

DisplayOrder

Associated HealthDentalGMENursingVACAA

$806,934$124,141

$8,814,025$3,420

$558,636

31.02.0

149.02.0

10.0

12345

Total $10,307,156 194.0 15

Total VAMC Budget and FTE by Program Type

• GME = Graduate Medical Educa�on• VACAA = Addi�onal GME Slots aligned to The Veterans Access, Choice, and

Accountability Act of 2014 (VACAA).

Rank: 37 out of 157 training sites (ranked by number of posi�ons)

Source: Facility Summary Report provided by Office of Academic Affilia�on. 148.V08.PuertoRicoVirginIslands.672



Mission

* Base Posi�ons = Training Posi�ons

Number of Training Posi�ons: VAMC vs Na�onal Average

215

Funding Group Number ofProjects

Reported FundingFY17

.

Private Proprietary CompanyDepartment of Veterans Affairs (VACO)Na�onal Ins�tutes of Health (NIH)Academic Ins�tu�on, Donor, or Government

18311

$212,560$99,771$42,831

$1,250

2125609977142831

1250TOTAL 23 $356,412 356412

Research dollars for the Quality Enhancement Research Ini�a�ve (QUERI) are included in the formula for alloca�ng research support dollars.

Medical Center % Na�onal 2019VERA Alloca�on

Total Research VERAAlloca�on

DisplayOrder

(V08) (672) San JuanNa�onal Total

0.0%100.0%

$193,928$618,264,000

12

Source: FY2019 VERA Research Back Up Data and Alloca�on file 149.V08.PuertoRicoVirginIslands.672



Mission

VERA Alloca�on

Total VAMC Supported Research Projects

2019 VERA Alloca�on vs Average Na�onal Alloca�on*

$0

$2,000,000

$4,000,000

$6,000,000

$193,928

$6,440,250

VAMC Na�onal Average

*96 VAMCs received VERA Alloca�on for FY19

Rank: 84 out of 96 research sites (ranked by total funding)

2019 VERA Alloca�on vs Average Na�onal Alloca�on*

Research – San Juan

216

Project Name FY17 Actual Funding¹ .

CSP#577 Colonoscopy vs. Fecal Immunochemical Test in Reducing Mortality fromColorectal Cancer (CONFIRM)ONC-LN-04 A Study to Evaluate a Panel of blood Biomarkers for Use in Pa�entsUndergoing Evalua�on for Lung CancerDynamic Mul�-cohort Predic�on Modeling of ProstateBiopsy Outcome.GS-US-384-1943 A Phase 3, Randomized, Double-Blind, Placebo-Controlled StudyEvalua�ng the Safety and Efficacy of Selonser�b in Subjects with NonalcoholicSteatohepa��s (NASH) and Bridging (F3) FibrosisAPI-01 A Phase I/II Study of Lintuzumab-Ac225 in Older Pa�ents with UntreatedAcute Myeloid Leukemia

$86,307

$46,231

$42,831$30,166

$17,729

86307

46231

4283130166

17729

Project Title FY17 Actual Funding¹ .

CSP#577 Colonoscopy vs. Fecal Immunochemical Test in Reducing Mortality fromColorectal Cancer (CONFIRM)CSP #574 - Extend Steroid in CAP (ESCAPe): Phase III Clinical Trial of Evaluate theSafety & Efficacy of Low-Dose Methylprednisolone InfusionEnhancing Language Access: A Pilot Study to develop linguis�cally and culturallyappropriate Spanish adapta�ons of Trauma�c Brain Injury (TBI) assessmentinstruments for Face-to-Face & Telehealth interven�ons

$86,307

$13,121

$343

86307

13121

343

Research – San Juan, cont.

Top 5 VACO-Funded Projects by $

Source: FY17 Research Submissions by VISN and Facility 150.V08.PuertoRicoVirginIslands.6721. The project’s actual (non-discounted) grant dollars.



MissionTop 5 Projects by Funding $

217

Cost

218




Cost Conceptual Cost Analysis for Inpa�ent Services – Methodology Overview


Source: 1. MCAO Discharge Na�onal Data Extract, adjusted by ne�ng out Fixed Indirect overhead as calculated by MCAO 2. 2018 CMS Medicare Standard Analy�cal Files (SAF) from Defini�ve Healthcare limited by a 50 mileradius from the parent facility 3. Based on JAMA study ‘Administra�ve Costs Associated With Physician Billing and Insurance-Related Ac�vi�es at an Academic Health Care System,’ February 20, 2018 4. Office of CommunityCare

219

Conceptual Cost Analysis for Inpa�ent Services – San JuanCost

Id

Top Community Care DRGs by Total Discharges FY2018³ Total Community Care Discharges³ Avg Payment Per Case³

4…4…4…4…4…4…4…4…4…4…4…

(885) PSYCHOSES(897) ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY W/O MCC(561) AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W/O CC/MCC(460) SPINAL FUSION EXCEPT CERVICAL W/O MCC(882) NEUROSES EXCEPT DEPRESSIVE(881) DEPRESSIVE NEUROSES(884) ORGANIC DISTURBANCES & INTELLECTUAL DISABILITY(407) PANCREAS, LIVER & SHUNT PROCEDURES W/O CC/MCC(027) CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES W/O CC/MCC(192) CHRONIC OBSTRUCTIVE PULMONARY DISEASE W/O CC/MCCRemaining DRGs

827243

2521181515

977

210

$5,668$6,368

$13,611$15,818

$5,485$5,233$9,293

$14,307$20,187

$6,348$11,988



Top VA DRGs by Total Discharges FY2018¹ Total VA Discharges¹ Average VA Total CostPer Case¹

Es�mated Cost to Purchase Total Community Care Charges Average Payment Per Case .

(871) SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC(885) PSYCHOSES(291) HEART FAILURE & SHOCK W MCC OR PERIPHERAL EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)(897) ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY W/O MCC(872) SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC(392) ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC(194) SIMPLE PNEUMONIA & PLEURISY W CC(683) RENAL FAILURE W CC(690) KIDNEY & URINARY TRACT INFECTIONS W/O MCC(057) DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCCRemaining DRGs

455451289285212210183182176171

6,707

$28,898$14,994$18,398$13,694$14,131

$7,475$13,036$12,370$12,133$24,964$22,746

$17,335$5,382

$13,957$6,297

$12,032$7,995

$10,748$10,594

$8,902$17,316

N/A

N/A827N/A243N/A

4N/AN/AN/AN/AN/A

N/A$5,668

N/A$6,368

N/A$4,749

N/AN/AN/AN/AN/A

……………………………

In-House vs Community Care Total Discharges Total Cost .

In-House Inpa�ent Cost

Community Care Cost

9,321

1,397

$197,297,011

$9,863,399

69

70

*Comparing FY2018 VA Average Adjusted Total Cost per Discharge against the CMS average payment/claim per discharge for CY2018. DRGs with a high Average VA Total Cost poten�ally �ed to low volume and high LOS. Es�mated cost to purchase equals the es�mated total cost based on Medicare rates (Part A + Part B) plus a proxy of TPA costs. A proxy of 40% of Medicare Part A costs was used to es�mate poten�al Medicare Part B costs. A proxy of 15% of total es�mated Medicare costs (Part A + Part B) was used to es�mate TPA costs. Medicare claim payments not available for claims/procedures with 10 or fewer discharges due to CMS privacy requirements.

Sources: 1. MCAO Discharge Na�onal Data Extract, adjusted by ne�ng out Fixed Indirect overhead as calculated by MCAO 2. 2018 CMS Medicare Standard Analy�cal Files (SAF) from Defini�ve Healthcare limited by a 50 mile radius from the parent facility 3. Office of Community Care (Community Care DRGs with 3 or fewer discharges were not included in the VA Cost and Cost Comparison by DRG table)

Es�mated Cost to Purchase²*

Community Care Costs by DRG

Total Community Care Discharges³ Avg Payment per Case³Avg VA Cost Per Case¹Total VA Discharges¹Top VA DRGs by Total Discharges FY2018¹

VA Cost and Cost Comparisons by DRG

Valida�on of the data for this slide is not requiredVA Market Area Health Systems Op�miza�on220

Click to edit Master title style

Post-DD&F Data Addendum

Data Compendium - General Information

VA Market Area Health Systems Optimization

PurposeThe Data Discovery and Findings (DD&F) data books prepared for each market presented a standardized collection of data used across markets to understand important aspects of each market. Because of the passage of time since the original market assessment phases were conducted, VA has developed an appendix to the DD&F to capture more recent data for key data points. Because the COVID-19 pandemic impacted 2020 and 2021 data, 2019 was the latest fiscal year incorporated for most data elements.

ContentsProjected PopulationRuralityOutpatient DemandOutpatient EncountersSpecialty Care EncountersSurgical CasesInpatient Demand (Facility Level)Market DemandEnrollment ProximityFacilityBuilding FCAAcademic MissionResearch MissionFootnotesSources

Additional InformationThe Footnotes page provides additional details about tables and individual data elements when required. The Sources page provides the relevant data cube or program office sourcing information for each of the data elements.

Projected Veteran Enrollee and Eligible Population (Market)


Market Group FY19 FY29 10 Year % Growth

(V08) Puerto Rico Virgin Islands Eligible Veterans 72,556 50,194 -30.8%

Enrollees 64,749 42,781 -33.9%

Market Population Rank (out of 95 markets)


Market Total Enrollee Rank FY19

Total Enrollee Rank FY29

% Change Rank

(V08) Puerto Rico Virgin Islands 58 71 95

County-Based Enrollee Projections


Market Sector County FY19 Enrollees FY29 Enrollees 10 Year % Change

(V08) Puerto Rico Virgin Islands 08-k-9-A (72999) No Applicable County Name, PR

62,259 40,778 -34.5%

08-k-9-B (78999) No Applicable County Name, VI

2,490 2,002 -19.6%

Projected Veteran Enrollee and Eligible Population (Demographics)


Market Group Measure Description

Measure Categories

FY19 FY29 10 Year % Change

(V08) Puerto Rico Virgin Islands

Eligible Veterans Age <45 10,692 8,213 -23.2%

45-64 17,831 11,604 -34.9%

65+ (Combination)

44,032 30,378 -31.0%

65-84 34,905 22,872 -34.5%

85-89 6,068 4,123 -32.1%

90+ 3,059 3,383 10.6%

Gender Female 4,716 4,724 0.2%

Male 67,840 45,470 -33.0%

Priority Priority 1-6 65,778 45,607 -30.7%

Priority 7-8 6,778 4,588 -32.3%

Enrollees Age <45 8,876 6,189 -30.3%

45-64 17,086 11,371 -33.4%

65+ (Combination)

38,787 25,221 -35.0%

65-84 30,080 19,824 -34.1%

85-89 5,828 3,041 -47.8%

90+ 2,879 2,356 -18.2%

Gender Female 3,076 3,545 15.2%

Male 61,673 39,236 -36.4%

Priority Priority 1-6 57,786 37,352 -35.4%

Priority 7-8 6,963 5,429 -22.0%

Market Enrollment Rurality (FY19)


Market Rural Enrollees Total Enrollees % Rurality

(V08) Puerto Rico Virgin Islands 5,253 62,921 8.3%

County Enrollment Rurality


Market County Rural Enrollee Total Enrollees % Rurality

(V08) Puerto Rico Virgin Islands Adjuntas, PR 261 261 100.0%

Aguada, PR 0 535 0.0%

Aguadilla, PR 0 1,389 0.0%

Aguas Buenas, PR 0 354 0.0%

Aibonito, PR 0 534 0.0%

Anasco, PR 0 391 0.0%

Arecibo, PR 0 1,543 0.0%

Arroyo, PR 0 317 0.0%

Barceloneta, PR 0 320 0.0%

Barranquitas, PR 0 384 0.0%

Bayamon, PR 0 4,126 0.0%

Cabo Rojo, PR 0 1,033 0.0%

Caguas, PR 0 2,571 0.0%

Camuy, PR 0 436 0.0%

Canovanas, PR 0 696 0.0%

Carolina, PR 0 3,271 0.0%

Catano, PR 0 332 0.0%

Cayey, PR 0 1,236 0.0%

Ceiba, PR 0 338 0.0%

Ciales, PR 0 216 0.0%

Cidra, PR 0 626 0.0%

Coamo, PR 895 895 100.0%

Comerio, PR 0 195 0.0%

Corozal, PR 0 433 0.0%

Culebra, PR 38 38 100.0%

Dorado, PR 0 633 0.0%

Fajardo, PR 0 853 0.0%

Florida, PR 0 165 0.0%

Guanica, PR 0 259 0.0%

Guayama, PR 0 754 0.0%

Guayanilla, PR 0 428 0.0%

Guaynabo, PR 0 1,497 0.0%




(V08) Puerto Rico Virgin Islands Gurabo, PR 0 702 0.0%

Hatillo, PR 0 530 0.0%

Hormigueros, PR 0 363 0.0%

Humacao, PR 0 918 0.0%

Isabela, PR 0 829 0.0%

Jayuya, PR 185 185 100.0%

Juana Diaz, PR 0 1,044 0.0%

Juncos, PR 0 547 0.0%

Lajas, PR 0 496 0.0%

Lares, PR 0 349 0.0%

Las Marias, PR 0 86 0.0%

Las Piedras, PR 0 484 0.0%

Loiza, PR 0 207 0.0%

Luquillo, PR 0 393 0.0%

Manati, PR 0 571 0.0%

Maricao, PR 59 59 100.0%

Maunabo, PR 153 153 100.0%

Mayaguez, PR 0 1,457 0.0%

Moca, PR 0 525 0.0%

Morovis, PR 0 371 0.0%

Naguabo, PR 0 415 0.0%

Naranjito, PR 0 360 0.0%

Orocovis, PR 0 275 0.0%

Patillas, PR 0 272 0.0%

Penuelas, PR 0 445 0.0%

Ponce, PR 0 3,542 0.0%

Quebradillas, PR 0 450 0.0%

Rincon, PR 0 349 0.0%

Rio Grande, PR 0 812 0.0%

Sabana Grande, PR 0 546 0.0%

Saint Croix, VI 1,187 1,187 100.0%

Saint John, VI 100 100 100.0%




(V08) Puerto Rico Virgin Islands Saint Thomas, VI 1,157 1,157 100.0%

Salinas, PR 488 603 80.9%

San German, PR 0 662 0.0%

San Juan, PR 0 5,543 0.0%

San Lorenzo, PR 0 513 0.0%

San Sebastian, PR 0 567 0.0%

Santa Isabel, PR 502 502 100.0%

Toa Alta, PR 0 1,061 0.0%

Toa Baja, PR 0 1,663 0.0%

Trujillo Alto, PR 0 987 0.0%

Utuado, PR 0 427 0.0%

Vega Alta, PR 0 543 0.0%

Vega Baja, PR 0 850 0.0%

Vieques, PR 207 207 100.0%

Villalba, PR 0 332 0.0%

Yabucoa, PR 0 427 0.0%

Yauco, PR 0 796 0.0%

FY19 Market Core Uniques


Market Name Core Uniques

(V08) Puerto Rico Virgin Islands 52,732

Core Uniques


Market Facility FY15 FY16 FY17 FY18 FY19 5 Year % Change


(V08) (672) San Juan VA Medical Center 50,382 50,012 49,281 48,325 48,962 -2.8%

(V08) (6729AA) VANURS San Juan 559 662 724 535 497 -11.1%

(V08) (672B0) Eurípides Rubio Department of Veterans Affairs Outpatient Clinic

11,799 11,586 11,276 10,838 11,188 -5.2%

(V08) (672BZ) Mayaguez VA Clinic 9,691 9,688 9,751 9,467 9,523 -1.7%

(V08) (672GA) Saint Croix VA Clinic 834 866 840 730 743 -10.9%

(V08) (672GB) Saint Thomas VA Clinic 803 882 831 775 816 1.6%

(V08) (672GC) Arecibo VA Clinic 4,454 4,363 4,209 3,391 3,619 -18.7%

(V08) (672GD) Ceiba VA Clinic 3,812 3,771 3,616 3,338 3,490 -8.4%

(V08) (672GE) Guayama VA Clinic 1,594 1,658 1,629 1,521 1,631 2.3%

(V08) (672QA) Comerio VA Clinic 473 480 472

(V08) (672QB) Utuado VA Clinic 474 477 291

(V08) (672QC) Vieques VA Clinic 202 188 192

Emergency Department (ED) Encounters


Market Facility Measure FY17 FY18 FY19 3 Year % Change


(V08) (672) San Juan 99281 3,818 4,550 4,035 5.7%

99282 4,953 5,442 5,457 10.2%

99283 14,840 14,013 11,637 -21.6%

99284 8,341 7,188 8,452 1.3%

99285 2,311 2,878 3,218 39.2%

Total Encounters 34,263 34,071 32,799 -4.3%

(V08) (672QB) Utuado 99283 1

Total Encounters 0 1 0

ED % Transfers & Admissions


Market Description Facility Measure FY17 FY18 FY19

(V08) Puerto Rico Virgin Islands (V08) (672) San Juan % Transfers 0.3% 0.3% 0.3%

VA Admission % 19.7% 19.4% 19.9%

Outpatient Encounters (FY17-19)


Market Facility Clinic Grouping FY17 FY18 FY19 3 Year % Change

(V08) Puerto Rico Virgin Islands (V08) (672) San Juan Mental Health 116,836 93,918 107,432 -8.0%

Primary Care 156,629 134,472 156,776 0.1%

Specialty Care 725,032 610,846 708,469 -2.3%

(V08) (672B0) Ponce Mental Health 19,990 17,199 21,318 6.6%

Primary Care 47,769 40,668 40,626 -15.0%

Specialty Care 71,088 62,152 74,597 4.9%

(V08) (672BZ) Mayaguez Mental Health 22,170 19,365 21,324 -3.8%

Primary Care 46,209 41,164 42,432 -8.2%

Specialty Care 55,914 51,535 58,569 4.7%

(V08) (672GA) Saint Croix Mental Health 673 480 34 -94.9%

Primary Care 2,958 2,256 140 -95.3%

Specialty Care 164 113 6 -96.3%

(V08) (672GB) Saint Thomas Mental Health 105 265 66 -37.1%

Primary Care 2,736 2,423 324 -88.2%


(V08) (672GC) Arecibo Mental Health 5,591 3,493 5,298 -5.2%

Primary Care 21,930 12,397 17,895 -18.4%

Specialty Care 1,366 415 730 -46.6%

(V08) (672GD) Ceiba Mental Health 2,518 2,346 2,460 -2.3%

Primary Care 17,524 15,546 15,697 -10.4%

Specialty Care 1,271 1,152 1,143 -10.1%

(V08) (672GE) Guayama Mental Health 2,879 2,648 3,264 13.4%

Primary Care 7,061 5,295 6,770 -4.1%

Specialty Care 355 368 544 53.2%

(V08) (672QA) Comerio Mental Health 1 0 0 -100.0%

Primary Care 1,271 1,419 1,627 28.0%

Specialty Care 21 5 26 23.8%

(V08) (672QB) Utuado Mental Health 10 8 0 -100.0%

Primary Care 773 956 1,013 31.0%


(V08) (672QC) Vieques Mental Health 18 0 10 -44.4%

Primary Care 719 492 738 2.6%

Outpatient Encounters (FY17-19)


Market Facility Clinic Grouping FY17 FY18 FY19 3 Year % Change

(V08) Puerto Rico Virgin Islands (V08) (672QC) Vieques Specialty Care 45 23 9 -80.0%

Specialty Care Encounters (FY17-19)


Market Facility Specialty FY17 FY18 FY19 3 Year % Change


(V08) (672) San Juan VA Medical Center Allergy and Immunology

1,498 1,773 2,379 58.8%

Anesthesiology 8,538 7,296 7,536 -11.7%

Audiology / Speech Pathology

16,407 14,354 15,705 -4.3%

Blind Rehabilitation 692 705 1,393 101.3%

Cardiology 23,594 20,042 24,590 4.2%

Critical Care / Pulmonary Disease

22,960 26,016 29,477 28.4%

Dermatology 9,399 7,736 10,142 7.9%

Emergency Medicine 35,624 32,376 35,591 -0.1%

Endocrinology 5,912 5,477 6,968 17.9%

Gastroenterology 12,413 10,519 12,082 -2.7%

Geriatric Medicine 17,132 13,047 16,336 -4.6%

Hematology-Oncology 10,593 9,239 11,150 5.3%

Infectious Disease 1,706 1,376 1,318 -22.7%

Nephrology 7,618 6,150 6,855 -10.0%

Neurological Surgery 1,034 1,170 1,218 17.8%

Neurology 5,667 4,824 5,735 1.2%

Nutrition 434 1,105 1,792 312.9%


1,124 938 981 -12.7%

Occupational Health 2,972 2,374 2,551 -14.2%

Ophthalmology 35,769 31,359 33,259 -7.0%

Optometry 14,917 13,644 14,712 -1.4%

Orthopaedic Surgery 7,637 5,296 5,265 -31.1%

Otolaryngology 5,693 5,650 6,110 7.3%

Pain Medicine 5,125 5,133 5,975 16.6%

Pathology 272,210 215,268 253,473 -6.9%

Pharmacy 10,870 9,152 10,270 -5.5%

Physical Medicine & Rehabilitation

62,897 53,798 63,579 1.1%

Plastic Surgery 1,138 947 1,117 -1.8%





(V08) (672) San Juan VA Medical Center Podiatry 4,015 2,895 3,287 -18.1%

Prosthetics/Orthotics 2,268 436 1,583 -30.2%

Radiology 81,047 70,767 83,189 2.6%

Rheumatology 1,033 860 953 -7.7%

Sleep Medicine 0 0 5

Surgery 23,379 16,835 18,132 -22.4%

Thoracic Surgery 370 293 226 -38.9%

Urology 11,243 11,004 12,056 7.2%

Vascular Surgery 104 992 1,479 1322.1%



1,470 1,121 1,484 1.0%

Blind Rehabilitation 65 2 5 -92.3%

Cardiology 2,270 1,747 1,728 -23.9%


119 92 108 -9.2%

Dermatology 191 143 251 31.4%

Endocrinology 348 283 471 35.3%

Geriatric Medicine 5,295 6,074 6,303 19.0%

Nephrology 38 25 29 -23.7%

Neurology 334 306 359 7.5%

Nutrition 7 66 286 3985.7%

Occupational Health 73 96 113 54.8%

Ophthalmology 3,500 3,094 3,946 12.7%

Optometry 5,880 7,622 8,812 49.9%

Otolaryngology 583 526 675 15.8%

Pathology 25,936 19,546 22,939 -11.6%

Pharmacy 348 182 199 -42.8%


13,944 12,541 15,812 13.4%

Podiatry 1,642 1,503 1,960 19.4%

Prosthetics/Orthotics 337 0 0 -100.0%

Radiology 5,051 3,852 4,617 -8.6%






Surgery 991 863 984 -0.7%

Urology 2,666 2,468 3,516 31.9%

(V08) (672BZ) Mayaguez VA Clinic Allergy and Immunology

0 0 0


1,845 1,804 1,450 -21.4%

Blind Rehabilitation 80 7 5 -93.8%

Cardiology 164 139 131 -20.1%


119 108 106 -10.9%

Dermatology 161 209 341 111.8%

Endocrinology 452 396 438 -3.1%

Geriatric Medicine 5,666 5,577 6,178 9.0%

Nephrology 48 21 26 -45.8%

Neurology 55 66 100 81.8%

Nutrition 52 2 4 -92.3%

Occupational Health 73 69 76 4.1%

Ophthalmology 3,328 2,655 2,770 -16.8%

Optometry 5,424 6,698 7,246 33.6%

Pathology 24,708 21,017 23,016 -6.8%

Pharmacy 1,163 1,092 1,375 18.2%


9,554 8,858 10,038 5.1%

Podiatry 237 270 331 39.7%

Prosthetics/Orthotics 256 1 0 -100.0%

Radiology 2,248 1,443 2,643 17.6%

Surgery 70 104 55 -21.4%

Urology 211 999 2,240 961.6%

(V08) (672GA) Saint Croix VA Clinic Cardiology 47 14 2 -95.7%

Nutrition 79 83 4 -94.9%


25 0 0 -100.0%


13 16 0 -100.0%





(V08) (672GB) Saint Thomas VA Clinic Cardiology 16 13 0 -100.0%

Nutrition 119 89 9 -92.4%


46 0 0 -100.0%

Pathology 2 23 0 -100.0%

Pharmacy 33 28 1 -97.0%

(V08) (672GC) Arecibo VA Clinic Cardiology 55 1 0 -100.0%


54 15 10 -81.5%

Dermatology 62 1 41 -33.9%

Nutrition 40 0 0 -100.0%

Optometry 312 0 248 -20.5%

Pathology 145 47 54 -62.8%

Pharmacy 427 120 78 -81.7%


271 231 299 10.3%

(V08) (672GD) Ceiba VA Clinic Dermatology 15 15 46 206.7%

Nutrition 216 144 18 -91.7%


0 0 0

Optometry 380 247 160 -57.9%

Pathology 90 102 80 -11.1%

Pharmacy 215 216 379 76.3%


355 428 460 29.6%

(V08) (672GE) Guayama VA Clinic Critical Care / Pulmonary Disease

48 37 36 -25.0%

Dermatology 48 15 19 -60.4%

Endocrinology 24 20 0 -100.0%

Nutrition 22 59 231 950.0%

Pharmacy 184 127 167 -9.2%


29 110 91 213.8%

(V08) (672QA) Comerio VA Clinic Nutrition 21 5 26 23.8%

(V08) (672QB) Utuado VA Clinic Nutrition 15 2 29 93.3%





(V08) (672QB) Utuado VA Clinic Pathology 295 250 1 -99.7%

Radiology 96 76 0 -100.0%

(V08) (672QC) Vieques VA Clinic Nutrition 25 0 9 -64.0%

Pathology 20 23 0 -100.0%

Surgical Cases (FY15-19)


Market Facility Setting FY15 FY16 FY17 FY18 FY19 5 Year % Change


(V08) (672) San Juan VA Medical Center IP Cases 946 1,041 1,155 941 721 -23.8%

OP Cases 5,232 4,666 3,876 3,194 3,310 -36.7%

Historical VAMC ADC


Market Facility Bed Service FY15 FY16 FY17 FY18 FY19 5 Year % Change


(V08) (672) San Juan VA Medical Center

Blind 9.2 9.6 8.1 6.2 5.8 -37.0%

CLC 102.7 96.8 102.2 95.2 88 -14.3%

Medical 134.7 139.8 142.6 134.4 114.8 -14.8%

Mental Health 27.9 26.5 28.4 26.9 28.1 0.7%

Rehab Med 14.8 13.3 13.2 13.2 12.3 -16.9%

RRTP* 0.1 0.2 0.2

Spinal Cord 15.7 14 15.7 15.4 16.8 7.0%

Surgery 18.2 15.5 17.5 15.9 12.3 -32.4%

Total Med/Surg

152.9 155.3 160.1 150.3 127.1 -16.9%

VAMC Total 323.2 315.6 327.9 307.4 278.1 -14.0%

FY19 Community Capacity


Market Facility Bed Section Beds Beds Available % Occupancy

(V08) Puerto Rico Virgin Islands San Juan Acute 4,801 860 62.9%

Psych 49 1 78.4%

Rehab 20 4 61.5%

BY19 Projected Parent Facility ADC (EHCPM)


Market Parent Facility Bed Service Funding Source FY19 Actual

FY29 Projected

10 Year % Change


San Juan, PR HCS Acute Inpatient Med/Surg Community 5.2 5.0 -5.4%

In-House 141.1 70.3 -50.2%

Acute Inpatient Medicine Community 3.7 3.5 -3.5%

In-House 113.9 55.2 -51.5%

Acute Inpatient Mental Health Community 25.7 18.4 -28.5%

In-House 26.1 14.3 -45.4%

Acute Inpatient Surgery Community 1.6 1.4 -9.7%

In-House 27.2 15.1 -44.5%

Inpatient Blind Rehab In-House 5.9 3.4 -41.8%

Inpatient LTSS Community 0.1 0.1 -31.2%

In-House 88.6 44.7 -49.6%

Inpatient Residential Rehab In-House 0.0 20.8

Inpatient Spinal Cord Injury In-House 16.8 7.0 -58.2%

BY19 Projected Market ADC (EHCPM)


Market Planning Category Group Funding Source FY19 ADC Actual

FY29 ADC Projected

10 Year % Change

(V08) Puerto Rico Virgin Islands Acute Inpatient Med/Surg Community 5.7 5.4 -5.7%

In-House 141.0 68.9 -51.2%

Acute Inpatient Medicine Community 4.1 3.9 -3.4%

In-House 112.7 53.5 -52.6%

Acute Inpatient Mental Health

Community 22.6 14.1 -37.8%

In-House 25.3 12.9 -49.1%

Acute Inpatient Surgery Community 1.6 1.5 -11.3%

In-House 28.3 15.4 -45.6%

Inpatient Blind Rehab Community 0.0 0.0

In-House 5.6 3.1 -44.3%

Inpatient LTSS Community 3.1 2.4 -23.0%

In-House 88.9 43.5 -51.0%

Inpatient Residential Rehab Community 0.0 0.0

In-House 9.3 5.8 -38.3%

Inpatient Spinal Cord Injury Community 0.0 0.0

In-House 16.4 6.7 -59.1%

BY18 RRTP Projected Market ADC (3D Model)


Market Market (BY18) RRTP Bed Section FY28 ADC FY28 Bed Need

(V08) Puerto Rico Virgin Islands 08-k All Bed Sections 13.0 15

Dom Homeless 2.7 3

Gen Dom 4.5 5

PTSD 1.4 2

Substance Abuse 4.4 5

BY19 Projected Market RVUs (EHCPM)


Market Planning Category Group Funding Source FY19 RVUs Actual

FY29 RVUs Projected

10 Year % Change


Amb LTSS Home and Community Based In-House 88,624 44,103 -50.2%

Amb Medical Specialties Community 38,166 49,211 28.9%

In-House 254,382 241,005 -5.3%

Amb Mental Health Programs Community 14,153 19,626 38.7%

In-House 336,822 348,815 3.6%

Amb Pathology Community 1,859 4,299 131.2%

In-House 16,468 15,323 -7.0%

Amb Primary Care Community 7,302 29,721 307.0%

In-House 355,152 321,759 -9.4%

Amb Radiology Community 20,542 21,010 2.3%

In-House 69,542 68,286 -1.8%

Amb Rehab Therapies Community 11,198 13,789 23.1%

In-House 99,219 98,449 -0.8%

Amb Surgical Specialties Community 11,452 18,315 59.9%

In-House 130,599 132,049 1.1%

Specialty Care (Amb Med/Surg/Rehab) Community 60,816 81,315 33.7%

In-House 484,200 471,503 -2.6%

BY19 Projected Market Dental Procedures (EHCPM)


Market Funding Source FY19 Procedures

Actual

FY29 Procedures Projected

Projected % Change

(V08) Puerto Rico Virgin Islands Community 4,814 4,208 -12.6%

In-House 57,166 50,302 -12.0%

Enrollment Proximity to Current VA Sites by Market


Market Market (FY18) Total Enrollees

Primary Care # of Enrollees

within 30 Min Drive Time

Primary Care % of Enrollees

within 30 Min Drive Time

Secondary Care # of Enrollees within 60 Min

Drive Time

Secondary Care % of Enrollees within 60 Min

Drive Time(V08) Puerto Rico Virgin Islands 08-k 67,622 49,867 73.7% 41,665 61.6%

Real Property Overview


Market Facility Acres Available

Property Size

Main Patient Care Facility Construction

Date

Most Recent Renovation Date (Main

Hospital Building)

Estimated Annual

Operations and Maintenance

Cost

FCA Cost Seismic Risk


San Juan 0.0 26 1969 0 $26,826,788 $212,494,054 High

Building FCA


Market Station Building No Function Title FCA Correction Cost

(V08) Puerto Rico Virgin Islands San Juan 1 Main Hospital $145,076,642

10 Nurs. Home/Blind Rehab $19,768,024

11 Hazardous Waste Storage $19,916

12 Pump House 1 $37,451

13 Fire Cistern Punmp House $23,406

16 Boiler Plant $1,124,708

18 District Counsel $245,171

19 Outpatient Addition $6,111,927

2 Laundry $2,633,686

20 Parking Garage $894,064

22 Medical Waste/Paint Shop $734,659

24 Chiller Plant $1,256,630

26 SICU-Sugical Intensive Care Unit $1,180,145

27 Electrical Synchronization Building $281,895

28 Radiation Therapy Trailers $13,366

29 Electrical Distribution Building $135,741

30 South Bed Tower $3,185,116

40 Administration Building $1,690,621

50 Modular Builing Village 1 $1,725,476

51 Modular Building Village 2 $298,789

52 Modular Building Village 3 $535,030

53 CT Scan Trailer $13,497

54 MRI Trailer $390,364

60 South Parking Garage $329,171

Site Site Utilities $24,706,546

ST4 Above Ground Water Tank (1m Gal) $39,621

ST5 Above Ground Water Tank (1m Gal) $42,393

FY20 Allocated Training Positions


Market Facility Training Category Program Name Paid WOC Total HPTs


San Juan Admin Healthcare Administration 0 6 6

Anesthesiology/Surgery Anesthesiology 4 0 4

Ophthalmology 3 0 3

Orthopaedic Surgery 2 0 2

Urology 2 0 2

Associated Health Blind Rehabilitation Specialist 6 1 7

Cardiology Technician 0 5 5

Nutritionist/dietitian Intern/Fellow 8 0 8

Occupational Therapist Student/Intern 0 17 17

Pathology, Medical Technologist 0 39 39

Pharmacist Student/Extern 0 45 45

Pharmacy Technician 0 3 3

Physical Therapist Student/Intern 0 19 19

Radiologic Technologist 0 3 3

Social Worker Student/Intern 7 1 8

Speech-Language Pathologist Student/Intern

3 0 3

Combined Physicians Diagnostic Radiology/Nuclear medicine 0 24 24

Dental Dentist, General Practice 2 34 36

Medical Allergy & Immunology 0 1 1

Internal Medicine 64 41 105

Internal Medicine-Cardiovascular Disease

9 6 15

Internal Medicine-Chief Resident 2 0 2

Internal Medicine-Chief Resident in Quality and Safety

1 0 1

Internal Medicine-Gastroenterology 9 0 9

Internal Medicine-Hematology & Medical Oncology

2 0 2

Internal Medicine-Nephrology 3 0 3

Internal Medicine-Pulmonary Disease and Critical Care Medicine

9 0 9

Medical Student 0 435 435

Physical Medicine & Rehabilitation 12 0 12

Nurse Registered Nurse Student 0 240 240

Psychiatry/Neurology Neurology 4 32 36

FY20 Allocated Training Positions


Market Facility Training Category Program Name Paid WOC Total HPTs

(V08) Puerto Rico Virgin Islands San Juan Psychiatry/Neurology Psychiatry 12 52 64

Psychiatry-Chief Resident in Quality and Safety

1 0 1

Psychiatry-Consultation-Liaison 1 0 1

Radiology/Pathology Nuclear Medicine 0 9 9

Academic Ranking (by Total HPTs)


Market Facility Total HPTs National Ranking (out of

154 sites)(V08) Puerto Rico Virgin Islands San Juan 1,179 42

FY21 Research Funding


Market Medical Center Total Funding (VA and Non-VA)

Rank

(V08) Puerto Rico Virgin Islands San Juan $364,212 85

Footnotes


Market Population Rank (out of 95 markets)Note: The VISN 02 Finger Lakes and Southern Tier markets merged in 2019 during the market assessments, changing the count of markets assessed from 96 to 95.

County-Based Enrollee ProjectionsNote: Market totals do not exactly match the values in the Rurality tables due to a difference in data sources. Note: Counties with fewer than 10 enrollees were reduced to 0 based on privacy guidelines.

RuralityNote: FY19 enrollees in this data differ from the values shown in the EHCPM (Projected Population). This data is sourced from the Geocoded Enrollee file.Note: Rural enrollees include enrollees residing in rural and highly rural locations.Note: Counties with fewer than 10 enrollees were reduced to 0 based on privacy guidelines.

Core UniquesNote: Core uniques excludes uniques who have only used telephone triage, pharmacy, and lab.

Historical VAMC ADCNote: *RRTP includes Domiciliary and Compensated Work Therapy/Transitional Residence (CWT/TR) bed services.

FY19 Community CapacityNote: Although similar data was incorporated in the DD&F, community capacity in this compendium displays the supply of total community beds, occupancy, and beds available among community providers within 60 minutes of each VAMC or HCC. Each community hospital or nursing home which is not currently included in the Veterans Community Care Program or does not meet the minimum quality criteria established in the Section 203 Criteria analysis is excluded. Additionally, providers at or above target occupancy (80% for short-term acute care hospitals, 90% for nursing homes) are assumed to have no bed availability.

BY19 Projected Market RVUs (EHCPM)Note: Specialty Care includes Medical Specialties, Surgical Specialties, and Rehab Therapies.

OP Encounters & SC EncountersNote: The stop code mapping used in the data compendium is based on a custom stop code mapping created by VA for the market assessments. The Data Discovery and Findings (DD&F) documents used the Public Data Clinic Group stop code mapping.

Enrollment Proximity to Current VA Sites by MarketNote: Primary care sites include VAMCs, HCCs, MS CBOCs, and CBOCs. Secondary care sites include VA facilities providing ambulatory surgery or acute inpatient services.

Real Property OverviewNote: Acres available provides an indication of any excess or surplus land, not currently in use and has no plans for future expansion needs that could be used for future development.

Building FCANote: Project Costs to remediate FCAs vary significantly, from below assessed value to more than 3 times the value.

FY20 Allocated Training PositionsNote: This data displays the number of paid, unpaid (WOC), and total Health Profession Trainees (HPTs) at each facility by training program. This data was acquired from the Office of Academic Affiliations.

Sources


Facility HierarchyFY21 Q4 VA Site Tracking (VAST)

Enrollee ProjectionsBY19 EHCPM

RuralityGeocoded Enrollee FY19 Q4

Core UniquesVSSC Uniques Cube

ED/UCC EncountersVSSC Encounters Cube

ED Transfers & AdmissionsEmergency Medicine Management Tool

Surgical CasesNational Surgery Office

Outpatient EncountersVSSC Encounters Cube

Historical VAMC ADCMCAO Discharge Cube

Projected DemandBY19 EHCPM

Projected RRTP DemandRRTP 3D Model

FY19 RRTP Beds and ADCRRTP Program Office

FY19 Quality Community Capacity2019 CMS Cost Reports

Enrollment Proximity to Current VA Sites by MarketFY19 Q4 Enrollment; FY19 Q4 VAST data; VHA OPP Planning Systems Support Group

Real Property OverviewCAI Buildings and FCA Condition Gaps Report (November 2021)

Building FCACAI Buildings and FCA Condition Gaps Report (November 2021)

Emergency Preparedness Primary Receiving CentersOffice of Emergency Management

Academic Mission - Allocated Training PositionsOffice of Academic Affiliations

Research Mission - Research FundingOffice of Research and Development

VISN 08 Puerto Rico Virgin Islands Market Data Discovery ...

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