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
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.
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
Overview Document Purpose
4
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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
Source: 1. BY17 EHCPM 2. FY20Q1 VAST 8.V08.PuertoRicoVirginIslands
Note: Mobile sites are not listed.
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
*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.
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
County-Based Enrollee Projec�ons
11
Market Projected Enrollee 10-Year Change (FY17-27)Demographics
Source: BY17 EHCPM VetPop & Enrollment 11.V08.PuertoRicoVirginIslands
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
Sectors Coun�es
12
Market Enrollee and Eligible DemographicsDemographics
Source: BY17 EHCPM VetPop & Enrollment 12.V08.PuertoRicoVirginIslands
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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
Source: BY17 EHCPM VetPop & Enrollment 13.V08.PuertoRicoVirginIslands
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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
Source: BY17 EHCPM VetPop & Enrollment 14.V08.PuertoRicoVirginIslands
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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
Source: BY17 EHCPM VetPop & Enrollment 15.V08.PuertoRicoVirginIslands
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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
Source: BY17 EHCPM VetPop & Enrollment 188.V08.PuertoRicoVirginIslands
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.
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
DemographicsUrban Enrollees Rural Enrollees* % Rural Total Enrollees
* Includes Rural and Highly Rural Loca�ons.
20
County Urban Enrollees Rural Enrollees* % Rural Total Enrollees R
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
Market Current Enrollment Rurality — FY18, cont.County
Source: Geocoded Enrollee File FY18Q4 18.V08.PuertoRicoVirginIslands#2
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
DemographicsUrban Enrollees Rural Enrollees* % Rural Total Enrollees
* Includes Rural and Highly Rural Loca�ons.
21
County Urban Enrollees Rural Enrollees* % Rural Total Enrollees R
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
Market Current Enrollment Rurality — FY18, cont.County
Source: Geocoded Enrollee File FY18Q4 18.V08.PuertoRicoVirginIslands#3
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
DemographicsUrban Enrollees Rural Enrollees* % Rural Total Enrollees
* Includes Rural and Highly Rural Loca�ons.
22
County Urban Enrollees Rural Enrollees* % Rural Total Enrollees R
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
Market Current Enrollment Rurality — FY18, cont.County
Source: Geocoded Enrollee File FY18Q4 18.V08.PuertoRicoVirginIslands#4
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
DemographicsUrban Enrollees Rural Enrollees* % Rural Total Enrollees
* Includes Rural and Highly Rural Loca�ons.
23
County Urban Enrollees Rural Enrollees* % Rural Total Enrollees R
Saint John, VI
Total
0
59,107
101
5,382
100.0%
8.3%
101
64,489
81
82
Market Current Enrollment Rurality — FY18, cont.County
Source: Geocoded Enrollee File FY18Q4 18.V08.PuertoRicoVirginIslands#5
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
DemographicsUrban Enrollees Rural Enrollees* % Rural Total Enrollees
* Includes Rural and Highly Rural Loca�ons.
24
Market RuralityDemographics
Source: 1. Geocoded Enrollee File FY18Q4 2. HRSA Data Warehouse 19.V08.PuertoRicoVirginIslands
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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.
VA Market Area Health Systems Op�miza�on
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
Valida�on of the data for this slide is not required
San Juan Area
193.V08.PuertoRicoVirginIslands.672
27
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
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
Primary Care Specialty CareFacility
30
Primary Care Encounters – FY15-18Demand
Source: 1. VSSC Encounters Cube 2. Geocoded Enrollee File FY18Q4 26.V08.PuertoRicoVirginIslands#IMG
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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
County FY15-18 AvgEncounters
FY18 Encounters Most Commonly Used Facility % ofEncounters
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
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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.
33
County FY15-18 AvgEncounters
FY18 Encounters Most Commonly Used Facility % ofEncounters
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
Source: 1. VSSC Encounters Cube 2. Geocoded Enrollee File FY18Q4 27.V08.PuertoRicoVirginIslands#3
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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.
34
County FY15-18 AvgEncounters
FY18 Encounters Most Commonly Used Facility % ofEncounters
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
Source: 1. VSSC Encounters Cube 2. Geocoded Enrollee File FY18Q4 27.V08.PuertoRicoVirginIslands#4
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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.
35
County FY15-18 AvgEncounters
FY18 Encounters Most Commonly Used Facility % ofEncounters
Saint John,VITotal
127222,111
118195,213
(672GB) Saint Thomas 81.9%
County
Demand
Source: 1. VSSC Encounters Cube 2. Geocoded Enrollee File FY18Q4 27.V08.PuertoRicoVirginIslands#5
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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.
36
Primary Care Drive Times for FY18 EnrolleesDemand
Source: Geocoded Enrollee File FY18Q4 28.V08.PuertoRicoVirginIslands
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market — San Juan
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) (672) San Juan
(V08) (672) San Juan
(V08) (672B0) Ponce
(V08) (672B0) Ponce
(V08) (672BZ) Mayaguez
(V08) (672BZ) Mayaguez
(V08) (672BZ) Mayaguez
(V08) (672GA) Saint Croix
(V08) (672GB) Saint Thomas
(V08) (672GC) Arecibo
(V08) (672GC) Arecibo
(V08) (672GD) Ceiba
(V08) (672GD) Ceiba
(V08) (672GE) Guayama
(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
(323) PRIMARY CARE/MEDICINE
(322) Comprehensive Women’s Primary Care Clinic
(323) PRIMARY CARE/MEDICINE
(350) GeriPACT
(322) Comprehensive Women’s Primary Care Clinic
(323) PRIMARY CARE/MEDICINE
(323) PRIMARY CARE/MEDICINE
(323) PRIMARY CARE/MEDICINE
(322) Comprehensive Women’s Primary Care Clinic
(323) PRIMARY CARE/MEDICINE
(322) Comprehensive Women’s Primary Care Clinic
(323) PRIMARY CARE/MEDICINE
(322) Comprehensive Women’s Primary Care Clinic
(323) PRIMARY CARE/MEDICINE
(323) PRIMARY CARE/MEDICINE
(323) PRIMARY CARE/MEDICINE
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
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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
VA Market Area Health Systems Op�miza�on
Home-Based Primary Care, cont.
FacilityFY15 FY16 FY17 FY18 AVG FY15 FY16 FY17 FY18 AVG
VISN 08: Puerto Rico Virgin Islands Market
Uniques Encounters
40
Demand
Source: VSSC Encounters Cube 165.V08.PuertoRicoVirginIslands
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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
Source: 1. VSSC Encounters Cube 2. Geocoded Enrollee File FY18Q4 32.V08.PuertoRicoVirginIslands#IMG
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
FY15-18 Average Mental Health Encounters by County
42
Mental Health Encounters — FY15-18, cont.Demand
Source: 1. VSSC Encounters Cube 2. Geocoded Enrollee File FY18Q4 33.V08.PuertoRicoVirginIslands
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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%
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.
43
Mental Health Encounters — FY15-18, cont.Demand
Source: 1. VSSC Encounters Cube 2. Geocoded Enrollee File FY18Q4 33.V08.PuertoRicoVirginIslands#2
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
County FY15-18 Avg Encounters FY18 Encounters Most Commonly Used Facility % of Encounters
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%
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.
44
Mental Health Encounters — FY15-18, cont.Demand
Source: 1. VSSC Encounters Cube 2. Geocoded Enrollee File FY18Q4 33.V08.PuertoRicoVirginIslands#3
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
County FY15-18 Avg Encounters FY18 Encounters Most Commonly Used Facility % of Encounters
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%
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.
45
Mental Health Encounters — FY15-18, cont.Demand
Source: 1. VSSC Encounters Cube 2. Geocoded Enrollee File FY18Q4 33.V08.PuertoRicoVirginIslands#4
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
County FY15-18 Avg Encounters FY18 Encounters Most Commonly Used Facility % of Encounters
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%
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.
46
Mental Health Encounters — FY15-18, cont.Demand
Source: 1. VSSC Encounters Cube 2. Geocoded Enrollee File FY18Q4 33.V08.PuertoRicoVirginIslands#5
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
County FY15-18 Avg Encounters FY18 Encounters Most Commonly Used Facility % of Encounters
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%
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.
47
Top Mental Health Stop Code* Trends FY15-18 — San JuanDemand
Source: VSSC Encounters Cube – Public Grouping (Mental Health) 34.V08.PuertoRicoVirginIslands.672
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market — San Juan
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) (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) (672GB) Saint Thomas
(V08) (672GB) Saint Thomas
(V08) (672GB) Saint Thomas
(V08) (672GC) Arecibo
(V08) (672GC) Arecibo
(502) MH CLINIC IND
(513) SUB USE DISORDER INDIV
(550) MH CLINIC GROUP
All Others
(502) MH CLINIC IND
(550) MH CLINIC GROUP
(534) MH INTGRTD CARE IND
All Others
(502) MH CLINIC IND
(550) MH CLINIC GROUP
(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
(550) MH CLINIC GROUP
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) (672GC) Arecibo
(V08) (672GC) Arecibo
(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
Encounters Unique Pa�ents CPT Work RVU
*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.
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
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market — San Juan
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
(V08) (672GE) Guayama
(V08) (672GE) Guayama
(V08) (672GE) Guayama
(V08) (672GE) Guayama
(V08) (672QA) Comerio
(V08) (672QB) Utuado
(V08) (672QC) Vieques
(509) PSYCHIATRY
(502) MH CLINIC IND
(550) MH CLINIC GROUP
(562) PTSD-INDIV
All Others
(502) MH CLINIC IND
(550) MH CLINIC GROUP
(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
Encounters Unique Pa�ents CPT Work RVU
*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.
49
Specialty Encounters – FY15-18Demand
Source: 1. VSSC Encounters Cube 2. Geocoded Enrollee File FY18Q4 35.V08.PuertoRicoVirginIslands#IMG
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
FY15-18 Average Specialty Encounters by County
50
Specialty Encounters — FY15-18, cont.Demand
Source: 1. VSSC Encounters Cube 2. Geocoded Enrollee File FY18Q4 36.V08.PuertoRicoVirginIslands
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.
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
Id
County FY15-18 Avg Encounters FY18 Encounters Most Commonly Used Facility % of Encounters
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) (672) San Juan
(V08) (672) San Juan
(V08) (672) San Juan
(V08) (672B0) Ponce
(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) (672BZ) Mayaguez
(V08) (672BZ) Mayaguez
(V08) (672) San Juan
(V08) (672B0) Ponce
(V08) (672) San Juan
(V08) (672) San Juan
(V08) (672BZ) Mayaguez
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
Specialty Encounters — FY15-18, cont.Demand
Source: 1. VSSC Encounters Cube 2. Geocoded Enrollee File FY18Q4 36.V08.PuertoRicoVirginIslands#2
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.
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
Id
County FY15-18 Avg Encounters FY18 Encounters Most Commonly Used Facility % of Encounters
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) (672) San Juan
(V08) (672) San Juan
(V08) (672B0) Ponce
(V08) (672) San Juan
(V08) (672) San Juan
(V08) (672BZ) Mayaguez
(V08) (672) San Juan
(V08) (672) San Juan
(V08) (672) San Juan
(V08) (672) San Juan
(V08) (672B0) Ponce
(V08) (672) San Juan
(V08) (672) San Juan
(V08) (672) San Juan
(V08) (672BZ) Mayaguez
(V08) (672) San Juan
(V08) (672) San Juan
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
Specialty Encounters — FY15-18, cont.Demand
Source: 1. VSSC Encounters Cube 2. Geocoded Enrollee File FY18Q4 36.V08.PuertoRicoVirginIslands#3
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.
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
Id
County FY15-18 Avg Encounters FY18 Encounters Most Commonly Used Facility % of Encounters
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) (672BZ) Mayaguez
(V08) (672) San Juan
(V08) (672BZ) Mayaguez
(V08) (672B0) Ponce
(V08) (672) San Juan
(V08) (672) San Juan
(V08) (672B0) Ponce
(V08) (672BZ) Mayaguez
(V08) (672) San Juan
(V08) (672) San Juan
(V08) (672) San Juan
(V08) (672BZ) Mayaguez
(V08) (672B0) Ponce
(V08) (672BZ) Mayaguez
(V08) (672) San Juan
(V08) (672) San Juan
(V08) (672) San Juan
(V08) (672) San Juan
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
Specialty Encounters — FY15-18, cont.Demand
Source: 1. VSSC Encounters Cube 2. Geocoded Enrollee File FY18Q4 36.V08.PuertoRicoVirginIslands#4
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.
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
Id
County FY15-18 Avg Encounters FY18 Encounters Most Commonly Used Facility % of Encounters
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) (672) San Juan
(V08) (672) San Juan
(V08) (672B0) Ponce
(V08) (672BZ) Mayaguez
(V08) (672) San Juan
(V08) (672) San Juan
(V08) (672) San Juan
(V08) (672) San Juan
(V08) (672BZ) Mayaguez
(V08) (672B0) Ponce
(V08) (672) San Juan
(V08) (672B0) Ponce
(V08) (672) San Juan
(V08) (672) San Juan
(V08) (672) San Juan
(V08) (672) San Juan
(V08) (672BZ) Mayaguez
(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
Specialty Encounters — FY15-18, cont.Demand
Source: 1. VSSC Encounters Cube 2. Geocoded Enrollee File FY18Q4 36.V08.PuertoRicoVirginIslands#5
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.
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
Id
County FY15-18 Avg Encounters FY18 Encounters Most Commonly Used Facility % of Encounters
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
(V08) (672) San Juan
(V08) (672) San Juan
(V08) (672) San Juan
(V08) (672BZ) Mayaguez
(V08) (672BZ) Mayaguez
(V08) (672) San Juan
(V08) (672) San Juan
(V08) (672) San Juan
(V08) (672) San Juan
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
Source: VSSC Encounters Cube 37.V08.PuertoRicoVirginIslands
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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
Specialty Title FY15 FY16 FY17 FY18 4 Yr. Ch. FY15 FY16 FY17 FY18 4 Yr Ch.
……………………………………………………
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
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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, cont.
57
Id
Specialty Title FY15 FY16 FY17 FY18 4 Yr. Ch. FY15 FY16 FY17 FY18 4 Yr Ch.
……………………………………………………
DermatologyEmergency Medicine
EndocrinologyGeriatric Medicine
NephrologyNeurology
Occupa�onal HealthOphthalmology
OptometryOtolaryngology
PathologyPharmacy
Physical Medicine & Rehabilita�onPodiatry
Prosthe�cs/Ortho�csRadiology
Speech PathologySurgeryUrology
(V08) (672BZ) Mayaguez
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
Source: VSSC Encounters Cube 37.V08.PuertoRicoVirginIslands#3
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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, cont.
58
Id
Specialty Title FY15 FY16 FY17 FY18 4 Yr. Ch. FY15 FY16 FY17 FY18 4 Yr Ch.
……………………………………………………
Blind Rehabilita�onCardiology
Cri�cal Care / Pulmonary DiseaseDermatology
EndocrinologyGeriatric Medicine
NephrologyNeurology
Occupa�onal HealthOphthalmology
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
Source: VSSC Encounters Cube 37.V08.PuertoRicoVirginIslands#4
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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, cont.
59
Id
Specialty Title FY15 FY16 FY17 FY18 4 Yr. Ch. FY15 FY16 FY17 FY18 4 Yr Ch.
……………………………………………………
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
OptometryPathologyPharmacy
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
Source: VSSC Encounters Cube 37.V08.PuertoRicoVirginIslands#5
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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, cont.
60
Id
Specialty Title FY15 FY16 FY17 FY18 4 Yr. Ch. FY15 FY16 FY17 FY18 4 Yr Ch.
………………………………………
OptometryPathologyPharmacy
Physical Medicine & Rehabilita�on(V08) (672GE) Guayama
Cri�cal Care / Pulmonary DiseaseDermatology
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
19N/AN/AN/AN/AN/AN/A
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
Source: VSSC Encounters Cube 37.V08.PuertoRicoVirginIslands#6
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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, cont.
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
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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.
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market — San Juan
Telehealth — FY18 Telehealth U�liza�on
Telehealth U�liza�on Na�onal
63
San Juan VAMC & Trea�ng Facility Encounters by Provider Site
Demand
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market — San Juan
161.V08.PuertoRicoVirginIslands.672
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).
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market — San Juan
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.
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market — San Juan
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
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
Primary Care Mental Health Medicine Surgery Rehab Medicine
Non-VA Community Care (NVCC) FY16-18 – Outpa�ent CPT Authoriza�ons
69
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
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
1N/AN/AN/AN/AN/AN/AN/AN/AN/A
21
N/AN/AN/AN/AN/AN/AN/AN/A
1N/AN/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
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
Primary Care Mental Health Medicine Surgery Rehab Medicine
Non-VA Community Care (NVCC) FY16-18 – Outpa�ent CPT Authoriza�ons, cont.
70
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
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
Source: VHA Office of Community Care 44.V08.PuertoRicoVirginIslands#3
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
Primary Care Mental Health Medicine Surgery Rehab Medicine
Non-VA Community Care (NVCC) FY16-18 – Outpa�ent CPT Authoriza�ons, cont.
71
Sector County Name 2017Enrollees
FY16 FY17 FY18 FY16 FY17 FY18 FY16 FY17 FY18 FY16 FY17 FY18 FY16 FY17 FY18 ,
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
Source: VHA Office of Community Care 44.V08.PuertoRicoVirginIslands#4
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
Primary Care Mental Health Medicine Surgery Rehab Medicine
Non-VA Community Care (NVCC) FY16-18 – Outpa�ent CPT Authoriza�ons, cont.
72
NVCC Outpa�ent CPT Authoriza�ons (Primary Care and Mental Health)Demand
Source: VHA Office of Community Care 46.V08.PuertoRicoVirginIslands
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
Primary Care NVCC CPT Authoriza�ons per County Mental Health NVCC CPT Authoriza�ons per County
73
Demand
Source: VHA Office of Community Care 47.V08.PuertoRicoVirginIslands
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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
Source: VHA Office of Community Care 48.V08.PuertoRicoVirginIslands
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market — San Juan
FY18FY17FY16
Commercial*
49.V08.PuertoRicoVirginIslands.672Source: VHA Office of Community Care*Commercial includes authoriza�ons from federally qualified health centers and provider agreements.
76
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
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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
Source: BY17 EHCPM U�liza�on Projec�ons 53.V08.PuertoRicoVirginIslands
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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
Source: BY17 EHCPM U�liza�on Projec�ons 54.V08.PuertoRicoVirginIslands
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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
Source: BY17 EHCPM U�liza�on Projec�ons 189.V08.PuertoRicoVirginIslands
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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%
2017 2027Health Systems Planning Category (HSPCs)
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).
FY17 FY22 FY27 10 YearChange
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
Source: BY17 EHCPM U�liza�on Projec�ons 55.V08.PuertoRicoVirginIslands
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
Primary Care Workload – Historic & ProjectedFY18 Primary Care Encounters by County FY17-FY27 Primary Care RVU Growth Rate by Sector
84
Demand
Source: 1. VSSC Encounters Cube 2. BY17 EHCPM U�liza�on Projec�ons 57.V08.PuertoRicoVirginIslands#IMG
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
Mental Health Workload – Historic & ProjectedFY18 Mental Health Encounters by County FY17-FY27 Mental Health RVU Growth Rate by Sector
85
Demand
Source: 1. VSSC Encounters Cube 2. BY17 EHCPM U�liza�on Projec�ons 58.V08.PuertoRicoVirginIslands#IMG
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market — San Juan
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
Source: BY17 EHCPM U�liza�on Projec�ons 60.V08.PuertoRicoVirginIslands.672
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market — San Juan
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
Source: BY17 EHCPM U�liza�on Projec�ons 61.V08.PuertoRicoVirginIslands.672
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market — San Juan
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%
Obstetrics & Gynecology
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
Source: BY17 EHCPM U�liza�on Projec�ons 62.V08.PuertoRicoVirginIslands.672
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market — San Juan
Outpa�ent Parent Facility U�liza�on Projec�ons by Health Systems Planning Category (HSPC) Medical Special�es RVUs — San Juan VAMC
90
Demand
Source: BY17 EHCPM U�liza�on Projec�ons 190.V08.PuertoRicoVirginIslands.672
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market — San Juan
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%
2017 2027Health Systems Planning Category (HSPCs)
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
FY17 FY22 FY27 10 YearChange
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
FY17 FY22 FY27 10 YearChange
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%
Source: BY17 EHCPM U�liza�on Projec�ons 63.V08.PuertoRicoVirginIslands.672
VA Market Area Health Systems Op�miza�on
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
VISN 08: Puerto Rico Virgin Islands Market — San Juan
* Provided at procedure level given the limited RVU repor�ng for these services.
92
Demand
Source: N/A 64.V08.PuertoRicoVirginIslands
VA Market Area Health Systems Op�miza�on
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
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
66.V08.PuertoRicoVirginIslands.672
*RRTP includes Domiciliary and CWT/TR Bed Services **Market: Within a 60 minute drive �me of the VAMC
VA Market Area Health Systems Op�miza�on
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
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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
(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
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
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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
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
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
(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
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
Medical/Surgical BDOC — FY15-18, cont.Demand
Source: 1. VSSC Trea�ng Specialty Cube 2. Geocoded Enrollee File FY18Q4 68.V08.PuertoRicoVirginIslands#2
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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.
98
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
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
(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
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
Medical/Surgical BDOC — FY15-18, cont.Demand
Source: 1. VSSC Trea�ng Specialty Cube 2. Geocoded Enrollee File FY18Q4 68.V08.PuertoRicoVirginIslands#3
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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.
99
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 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
(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
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
Medical/Surgical BDOC — FY15-18, cont.Demand
Source: 1. VSSC Trea�ng Specialty Cube 2. Geocoded Enrollee File FY18Q4 68.V08.PuertoRicoVirginIslands#4
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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.
100
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
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) (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) (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
Medical/Surgical BDOC — FY15-18, cont.Demand
Source: 1. VSSC Trea�ng Specialty Cube 2. Geocoded Enrollee File FY18Q4 68.V08.PuertoRicoVirginIslands#5
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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.
101
Demand
Source: VSSC Trea�ng Specialty Cube 69.V08.PuertoRicoVirginIslands
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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) (672) San Juan
(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
In and Out of Market% of Total BDOC
(V08) (672) San Juan
(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
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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*
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%
*Enrollees enrolled in a market and received care at a facility outside of their market.
103
Top DRGs for Surgery in FY18Demand
Source: VSSC Trea�ng Specialty Cube 70.V08.PuertoRicoVirginIslands
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
Id
4_5 Facility DRG In MarketBDOC
In Market BDOC % ofTotal
In and Out ofMarket BDOC
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
4_5 Facility DRG In MarketBDOC
In Market BDOC % ofTotal
In and Out ofMarket BDOC
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
Source: 1. VSSC Trea�ng Specialty Cube 2. VHA Office of Community Care 158.V08.PuertoRicoVirginIslands
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
Top Surgery DRGs in the Community and Outside of the Market. DRG FY18 BDOC % of Total BDOC
Care in the Community
(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%
. DRG FY18 BDOC % of Total BDOC
Care in the Community
(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%
*Enrollees enrolled in a market and received care at a facility outside of their market.
VA Care Outside of the Market*
105
Mental Health BDOC – FY15-18Demand
Source: 1. VSSC Trea�ng Specialty Cube 2. Geocoded Enrollee File FY18Q4 71.V08.PuertoRicoVirginIslands#IMG
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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.
107
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.
.
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
Source: 1. VSSC Trea�ng Specialty Cube 2. Geocoded Enrollee File FY18Q4 72.V08.PuertoRicoVirginIslands#2
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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.
108
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.
.
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
Source: 1. VSSC Trea�ng Specialty Cube 2. Geocoded Enrollee File FY18Q4 72.V08.PuertoRicoVirginIslands#3
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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.
109
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.
.
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
Source: 1. VSSC Trea�ng Specialty Cube 2. Geocoded Enrollee File FY18Q4 72.V08.PuertoRicoVirginIslands#4
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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.
110
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.
.
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
Source: 1. VSSC Trea�ng Specialty Cube 2. Geocoded Enrollee File FY18Q4 72.V08.PuertoRicoVirginIslands#5
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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.
111
4_8 DRG In MarketBDOC
In Market BDOC% of Total
In and Out ofMarket BDOC
In and Out of Market% of Total 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
4,0962,0241,3451989274656693
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
Source: VSSC Trea�ng Specialty Cube 73.V08.PuertoRicoVirginIslands
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
Top DRGs for Mental Health in FY184_8 DRG In Market
BDOCIn Market BDOC
% of TotalIn and Out ofMarket BDOC
In and Out of Market% of Total 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
Source: 1. VSSC Trea�ng Specialty Cube 2. VHA Office of Community Care 159.V08.PuertoRicoVirginIslands
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
Top Mental Health DRGs in the Community and Outside of the Market. DRG FY18 BDOC % of Total BDOC
Care in the Community
(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%
. DRG FY18 BDOC % of Total BDOC
Care in the Community
(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%
*Enrollees enrolled in a market and received care at a facility outside of their market.
VA Care Outside of the Market*
113
Demand
Source: 1. Office of Community Care 74.V08.PuertoRicoVirginIslands.672
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market – San Juan
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
Source: VHA Office of Community Care 75.V08.PuertoRicoVirginIslands
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
Medicine Mental HealthSurgerySector/ County Name
Sector County Name 2017 Enrollees 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/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
Source: VHA Office of Community Care 75.V08.PuertoRicoVirginIslands#2
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
Medicine Mental HealthSurgerySector/ County Name
Sector County Name 2017 Enrollees 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
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
NVCC FY16-18 – Inpa�ent BDOC, cont.Demand
Source: VHA Office of Community Care 75.V08.PuertoRicoVirginIslands#3
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
Medicine Mental HealthSurgerySector/ County Name
Sector County Name 2017 Enrollees 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
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
NVCC FY16-18 – Inpa�ent BDOC, cont.Demand
Source: VHA Office of Community Care 75.V08.PuertoRicoVirginIslands#4
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
Medicine Mental HealthSurgerySector/ County Name
Sector County Name 2017 Enrollees FY16 FY17 FY18 FY16 FY17 FY18 FY16 FY17 FY18
Market Total Market Total 459 626 1,596 593 591 891 5,744 4,353 7,992
118
Demand
Source: VHA Office of Community Care 77.V08.PuertoRicoVirginIslands
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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.
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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
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/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.
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
Nursing Home BDOC Distribu�on, cont.
121
County FY18 Non-VA Community Care* FY18 VA FY18 Total BDOC Id
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
84N/AN/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
*Data is only for fee basis and does not encompass all Community Care.
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
Nursing Home BDOC Distribu�on, cont.
122
County FY18 Non-VA Community Care* FY18 VA FY18 Total BDOC Id
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
Source: 1. VSSC Trea�ng Specialty Cube 2. VSSC NVCC Cube 3. Defini�ve HC 79.V08.PuertoRicoVirginIslands#3
*Data is only for fee basis and does not encompass all Community Care.
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
Nursing Home BDOC Distribu�on, cont.
123
County FY18 Non-VA Community Care* FY18 VA FY18 Total BDOC Id
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
Source: 1. VSSC Trea�ng Specialty Cube 2. VSSC NVCC Cube 3. Defini�ve HC 79.V08.PuertoRicoVirginIslands#4
*Data is only for fee basis and does not encompass all Community Care.
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
Nursing Home BDOC Distribu�on, cont.
124
County FY18 Non-VA Community Care* FY18 VA FY18 Total BDOC Id
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
Source: 1. VSSC Trea�ng Specialty Cube 2. VSSC NVCC Cube 3. Defini�ve HC 79.V08.PuertoRicoVirginIslands#5
*Data is only for fee basis and does not encompass all Community Care.
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
Nursing Home BDOC Distribu�on, cont.
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
Source: VSSC Trea�ng Specialty Cube 80.V08.PuertoRicoVirginIslands
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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.
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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
82.V08.PuertoRicoVirginIslands#IMG
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
Residen�al Rehab BDOC, cont.
129
Demand
Source: VSSC OR Produc�vity Cube
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market – San Juan
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.
84.V08.PuertoRicoVirginIslands.672
130
Demand
Source: VSSC OR Produc�vity Cube
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market – San Juan
Surgical Cases FY15-18 – San Juan, cont.Facility Se�ng Specialty FY15 FY16 FY17 FY18 FY15-18 % Chg
(V08) (672) San Juan
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
(V08) (672) San Juan
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
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
Source: BY17 EHCPM U�liza�on Projec�ons 86.V08.PuertoRicoVirginIslands
Note: Percent changes are for 5 and 10 years.
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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
Source: BY17 EHCPM U�liza�on Projec�ons 87.V08.PuertoRicoVirginIslands
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
FY17 FY22 FY27
Citc Total Bed FY17 Total Bed FY22 Total Bed FY27
Total Bed Need* 135 92 69
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
In-House BDOCCommunity BDOC
Total BDOCADC By HSPG
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
Note: Percent changes are for 5 and 10 years.
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
Total Bed Need* 266 188 141
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
In-House BDOCCommunity BDOC
Total BDOCADC By HSPG
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
Source: BY17 EHCPM U�liza�on Projec�ons 88.V08.PuertoRicoVirginIslands.672
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market — San Juan
*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
Note: Percent changes are for 5 and 10 years.
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
Source: BY17 EHCPM U�liza�on Projec�ons 89.V08.PuertoRicoVirginIslands.672
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market — San Juan
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
Total Bed Need* 123 122 97
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 .
In-House BDOCCommunity BDOC
Total BDOCADC By HSPG
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
Note: Percent changes are for 5 and 10 years.
136
Overall Inpatient Commercial Demand – Puerto RicoDemand
Source: N/A 90.V08.PuertoRicoVirginIslands
VA Market Area Health Systems Op�miza�on
• 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
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.
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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
93.V08.PuertoRicoVirginIslands
*Reflects service is not provided in-house or there is no VA set produc�vity target.
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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
94.V08.PuertoRicoVirginIslands
* Reflects service is not provided in-house or there is no VA set produc�vity target.
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market — San Juan
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 ResourcedN/A
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
2 - Under ResourcedN/A
2 - Under ResourcedN/A
3 - InefficientN/A
4 - Over Resourced2 - Under Resourced
N/A2 - Under Resourced
4 - Over Resourced2 - Under Resourced
N/A3 - Inefficient
2 - Under ResourcedN/A
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
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market — San Juan
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
4 - Over Resourced2 - Under Resourced
1 - Op�mized Prac�ce1 - Op�mized Prac�ce
2 - Under Resourced2 - Under Resourced
N/A1 - Op�mized Prac�ce
4 - Over ResourcedN/AN/AN/AN/A
3 - InefficientN/A
3 - InefficientN/A
1 - Op�mized Prac�ce1 - Op�mized Prac�ce
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
N/A2 - Under 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
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market — San Juan
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
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market — San Juan
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.
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market — San Juan
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.
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market — San Juan
San Juan VAMC Open FTE Posi�ons
147
Occupa�on FY18 FY19* .
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
*FY19 vacant posi�ons as of December 2019.
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market — San Juan
San Juan VAMC Open FTE Posi�ons
148
Occupa�on FY18 FY19* .
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
*FY19 vacant posi�ons as of December 2019.
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market — San Juan
San Juan VAMC Open FTE Posi�ons
149
Supply
101.V08.PuertoRicoVirginIslands#IMG
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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
102.V08.PuertoRicoVirginIslands
*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.
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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.
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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%
17N/AN/AN/AN/AN/AN/A
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.
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market — San Juan
Community Hospital Current and Future Inpa�ent Demand & Supply
Med/Surg/Acute Mental Health Rehab CMI
Valida�on of the data for this slide is not required 155
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
80%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
75%OccupancyBed Need
80%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
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.
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market — San Juan
Community Hospital Current and Future Inpa�ent Demand & Supply, cont.
Es�mated 2029Surplus of beds
Shortage of beds
Future Supply and Demand
Valida�on of the data for this slide is not required 156
Community Hospital Current and Future Inpatient Demand & Supply, cont.Supply
167.V08.PuertoRicoVirginIslands
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
106.V08.PuertoRicoVirginIslands
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
107.V08.PuertoRicoVirginIslands.672
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market — San Juan
Known Major Changes in Community Hospitals — San Juan Area
Source: Defini�ve Healthcare
159
Facility FY15 FY16 FY17 FY18 FY15 FY16 FY17 FY18 FY15 FY16 FY17 FY18
(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.
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
Same Day Appointments FY15-18
Mental Health Primary Care Specialty Care
161
Facility FY15 FY16 FY17 FY18 FY15 FY16 FY17 FY18 FY15 FY16 FY17 FY18
(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
Source: VSSC Completed Appointments Cube 110.V08.PuertoRicoVirginIslands
N/A: Not Available
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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
Source: VSSC Completed Appointments Cube 111.V08.PuertoRicoVirginIslands
N/A: Not Available
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
Mental Health Primary Care Specialty Care
163
Average New Pa�ent Wait (Days) from Create Date (CD)
New Pa�ent Appointments FY15-18
Facility FY15 FY16 FY17 FY18 FY15 FY16 FY17 FY18 FY15 FY16 FY17 FY18 Id
(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
Source: VSSC Completed Appointments Cube 112.V08.PuertoRicoVirginIslands
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
Specialty CarePrimary Care
N/A: Not Available
Mental Health
164
New 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
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
Source: VSSC Completed Appointments Cube 113.V08.PuertoRicoVirginIslands
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
Mental Health Primary Care Specialty Care
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.
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market — San Juan
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.
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market — San Juan
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 Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market — San Juan
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.
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market — San Juan
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
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
Es�mated 30 Minute Drive Time Zones
170
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) 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
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
Mental Health Primary Care Specialty Care
171
Cancelled by Clinic Report
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) 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.
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
Mental Health Primary Care Specialty Care
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 Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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
121.V08.PuertoRicoVirginIslands
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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
VA Market Area Health Systems Op�miza�on
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
170.V08.PuertoRicoVirginIslands
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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
171.V08.PuertoRicoVirginIslands
* 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.
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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
172.V08.PuertoRicoVirginIslands
* 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.
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
Access
Facility FacilityClassifica�on
O Enroll30
O Users30
O Enroll60
O Users60
NOEnroll 30
NOUsers 30
NOEnroll 60
NO Users60
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) Vieques
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
Source: Geocoded Enrollee File FY18Q4 173.V08.PuertoRicoVirginIslands
* 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.
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
Access
County Name TotalEnrollees
Enrollees Outside of30-Minute Drive Time
Enrollees Outside of60-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
Source: Geocoded Enrollee File FY18Q4 173.V08.PuertoRicoVirginIslands#2
* 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.
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
Access
County Name TotalEnrollees
Enrollees Outside of30-Minute Drive Time
Enrollees Outside of60-Minute Drive Time
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
Source: Geocoded Enrollee File FY18Q4 173.V08.PuertoRicoVirginIslands#3
* 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.
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
Access
County Name TotalEnrollees
Enrollees Outside of30-Minute Drive Time
Enrollees Outside of60-Minute Drive Time
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
Enrollment Proximity to VA Site* by County, cont.
181
Source: Geocoded Enrollee File FY18Q4 173.V08.PuertoRicoVirginIslands#4
* 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.
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
Access
County Name TotalEnrollees
Enrollees Outside of30-Minute Drive Time
Enrollees Outside of60-Minute Drive Time
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
Enrollment Proximity to VA Site* by County, cont.
182
Source: Geocoded Enrollee File FY18Q4 173.V08.PuertoRicoVirginIslands#5
* 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.
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
Access
County Name TotalEnrollees
Enrollees Outside of30-Minute Drive Time
Enrollees Outside of60-Minute Drive Time
SAINT JOHN, VI 102 102 102
Enrollment Proximity to VA Site* by County, cont.
183
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)
Quality & Sa�sfac�on
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 Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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
Quality & Sa�sfac�on
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.
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
% 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
Quality & Sa�sfac�on
Source: SAIL Scorecards 126.V08.PuertoRicoVirginIslands.672
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market — San Juan
VA Market Facility Trends – Access/Quality/Pa�ent Sa�sfac�on.
Measure Measure Unit Pref.Dir.
16Q3 17Q3 18Q3 18Q3Median
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%
.
Measure Measure Unit Pref.Dir.
16Q3 17Q3 18Q3 18Q3Median
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
Quality & Sa�sfac�on
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 Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market — San Juan
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
Quality & Sa�sfac�on
Source: VSSC Pa�ent Experiences Survey Reports 128.V08.PuertoRicoVirginIslands
Note: Green cells indicate a score at or above na�onal average. Red cells indicate a score below na�onal average.
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
% 9 or 10
189
VA Pa�ent Sa�sfac�on – Outpa�ent (PCMH), cont.
Facility Survey Date Access Care Coordina�on Communica�on Office Staff Overall Ra�ng ofProvider
OverallSa�sfac�on
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
Quality & Sa�sfac�on
Source: VSSC Pa�ent Experiences Survey Reports 128.V08.PuertoRicoVirginIslands#2
Note: Green cells indicate a score at or above na�onal average. Red cells indicate a score below na�onal average.
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
% 9 or 10
190
VA Pa�ent Sa�sfac�on – Outpa�ent (Specialty Care)
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) (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
Quality & Sa�sfac�on
Source: VSSC Pa�ent Experiences Survey Reports 129.V08.PuertoRicoVirginIslands
Note: Green cells indicate a score at or above na�onal average. Red cells indicate a score below na�onal average.
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
% 9 or 10
191
VA Pa�ent Sa�sfac�on – Outpa�ent (Specialty Care), cont.
Facility Survey Date Access Care Coordina�on Communica�on Office Staff Overall Ra�ng ofProvider
OverallSa�sfac�on
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
Quality & Sa�sfac�on
Source: VSSC Pa�ent Experiences Survey Reports 129.V08.PuertoRicoVirginIslands#2
Note: Green cells indicate a score at or above na�onal average. Red cells indicate a score below na�onal average.
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
% 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
OverallSa�sfac�on
(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
Quality & Sa�sfac�on
Source: VSSC Pa�ent Experiences Survey Reports 160.V08.PuertoRicoVirginIslands
Note: Green cells indicate a score at or above na�onal average. Red cells indicate a score below na�onal average.
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
% 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.
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market — San Juan
Valida�on of the data for this slide is not required194
Quality & Sa�sfac�on
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market — San Juan
Valida�on of the data for this slide is not required
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
Quality & Sa�sfac�on
Source: CMS.gov 132.V08.PuertoRicoVirginIslands
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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
Quality & Sa�sfac�on
Source: CMS.gov 133.V08.PuertoRicoVirginIslands
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
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
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 %
VA Market Area Health Systems Op�miza�on
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
Valida�on of the data for this slide is not required 198
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
Auxilio Mutuo Hospital
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
Auxilio Mutuo Hospital
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
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market — San Juan
Valida�on of the data for this slide is not required
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
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
137.V08.PuertoRicoVirginIslands.672
* 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.
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market — San Juan
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.
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market — San Juan
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
139.V08.PuertoRicoVirginIslands.672
*Total 10-Year Capital Investment and Current FCA Backlog Divided by Owned SF; **Sum of Major and Minor Construc�on and NRM spending.
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market — San Juan
Facili�esMinor Construc�on Funding
$0
$5,000,000
FY09 FY10 FY11 FY12 FY13 FY14 FY15 FY16 FY17 FY18
VHA Average Minor VISN Average Minor Facility Minor
NRM Funding
$0
$20,000,000
$40,000,000
FY09 FY10 FY11 FY12 FY13 FY14 FY15 FY16 FY17 FY18
VHA Average NRM VISN Average NRM Facility NRM
Total Construc�on Funding
$0
$100,000,000
FY09 FY10 FY11 FY12 FY13 FY14 FY15 FY16 FY17 FY18
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
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market — San Juan
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
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market — San Juan
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.
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
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
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market — San Juan
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
Func�on Title Current Use YearBuilt
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
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market — San Juan
Facili�esSan Juan
Building Inventory (Leased)
207
Summary of Architectural and Engineering Challenges – San Juan
Source: Locally Provided GFI 143.V08.PuertoRicoVirginIslands.672
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market — San Juan
Facili�es
208
Note: All ac�ve projects have received all levels of approvals and are assumed to be proceeding.
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market — San Juan
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 8/7/18Construc�on awarded 12/10/18
Construc�on awarded 3/18/19Construc�on awarded 4/30/18
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
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 8/7/18Construc�on awarded 12/10/18
Construc�on awarded 3/18/19Construc�on awarded 4/30/18
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
Note: All ac�ve projects have received all levels of approvals and are assumed to be proceeding.
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market — San Juan
Facili�es Ac�ve and Planned Projects — San Juan, cont.
10_8 Program Project SF/Count Status Es�matedCost
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 3/27/14Design awarded 9/27/17
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
10_8 Program Project SF/Count Status Es�matedCost
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 3/27/14Design awarded 9/27/17
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
Note: All ac�ve projects have received all levels of approvals and are assumed to be proceeding.
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market — San Juan
Facili�es Ac�ve and Planned Projects — San Juan, cont.
10_8 Program Project SF/Count Status Es�matedCost
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
Construc�on awarded 3/25/19Design awarded 8/6/19
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
10_8 Program Project SF/Count Status Es�matedCost
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
Construc�on awarded 3/25/19Design awarded 8/6/19
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
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).
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market — San Juan
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).
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market — San Juan
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
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market — San Juan
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
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market — San Juan
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.
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market — San Juan
MissionTop 5 Projects by Funding $
217
152.V08.PuertoRicoVirginIslands
VA Market Area Health Systems Op�miza�on
VISN 08: Puerto Rico Virgin Islands Market
Cost Conceptual Cost Analysis for Inpa�ent Services – Methodology Overview
Valida�on of the data for this slide is not required
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
153.V08.PuertoRicoVirginIslands.672
VISN 08: Puerto Rico Virgin Islands Market — San Juan
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
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)
VA Market Area Health Systems Optimization
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)
VA Market Area Health Systems Optimization
Market Total Enrollee Rank FY19
Total Enrollee Rank FY29
% Change Rank
(V08) Puerto Rico Virgin Islands 58 71 95
County-Based Enrollee Projections
VA Market Area Health Systems Optimization
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)
VA Market Area Health Systems Optimization
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)
VA Market Area Health Systems Optimization
Market Rural Enrollees Total Enrollees % Rurality
(V08) Puerto Rico Virgin Islands 5,253 62,921 8.3%
County Enrollment Rurality
VA Market Area Health Systems Optimization
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%
County Enrollment Rurality
VA Market Area Health Systems Optimization
Market County Rural Enrollee Total Enrollees % Rurality
(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%
County Enrollment Rurality
VA Market Area Health Systems Optimization
Market County Rural Enrollee Total Enrollees % Rurality
(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
VA Market Area Health Systems Optimization
Market Name Core Uniques
(V08) Puerto Rico Virgin Islands 52,732
Core Uniques
VA Market Area Health Systems Optimization
Market Facility FY15 FY16 FY17 FY18 FY19 5 Year % Change
(V08) Puerto Rico Virgin Islands
(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
VA Market Area Health Systems Optimization
Market Facility Measure FY17 FY18 FY19 3 Year % Change
(V08) Puerto Rico Virgin Islands
(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
VA Market Area Health Systems Optimization
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)
VA Market Area Health Systems Optimization
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%
Specialty Care 216 153 10 -95.4%
(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%
Specialty Care 406 328 30 -92.6%
(V08) (672QC) Vieques Mental Health 18 0 10 -44.4%
Primary Care 719 492 738 2.6%
Outpatient Encounters (FY17-19)
VA Market Area Health Systems Optimization
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)
VA Market Area Health Systems Optimization
Market Facility Specialty FY17 FY18 FY19 3 Year % Change
(V08) Puerto Rico Virgin Islands
(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%
Obstetrics & Gynecology
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%
Specialty Care Encounters (FY17-19)
VA Market Area Health Systems Optimization
Market Facility Specialty FY17 FY18 FY19 3 Year % Change
(V08) Puerto Rico Virgin Islands
(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%
(V08) (672B0) Eurípides Rubio Department of Veterans Affairs Outpatient Clinic
Audiology / Speech Pathology
1,470 1,121 1,484 1.0%
Blind Rehabilitation 65 2 5 -92.3%
Cardiology 2,270 1,747 1,728 -23.9%
Critical Care / Pulmonary Disease
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%
Physical Medicine & Rehabilitation
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%
Specialty Care Encounters (FY17-19)
VA Market Area Health Systems Optimization
Market Facility Specialty FY17 FY18 FY19 3 Year % Change
(V08) Puerto Rico Virgin Islands
(V08) (672B0) Eurípides Rubio Department of Veterans Affairs Outpatient Clinic
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
Audiology / Speech Pathology
1,845 1,804 1,450 -21.4%
Blind Rehabilitation 80 7 5 -93.8%
Cardiology 164 139 131 -20.1%
Critical Care / Pulmonary Disease
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%
Physical Medicine & Rehabilitation
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%
Obstetrics & Gynecology
25 0 0 -100.0%
Physical Medicine & Rehabilitation
13 16 0 -100.0%
Specialty Care Encounters (FY17-19)
VA Market Area Health Systems Optimization
Market Facility Specialty FY17 FY18 FY19 3 Year % Change
(V08) Puerto Rico Virgin Islands
(V08) (672GB) Saint Thomas VA Clinic Cardiology 16 13 0 -100.0%
Nutrition 119 89 9 -92.4%
Obstetrics & Gynecology
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%
Critical Care / Pulmonary Disease
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%
Physical Medicine & Rehabilitation
271 231 299 10.3%
(V08) (672GD) Ceiba VA Clinic Dermatology 15 15 46 206.7%
Nutrition 216 144 18 -91.7%
Obstetrics & Gynecology
0 0 0
Optometry 380 247 160 -57.9%
Pathology 90 102 80 -11.1%
Pharmacy 215 216 379 76.3%
Physical Medicine & Rehabilitation
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%
Physical Medicine & Rehabilitation
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%
Specialty Care Encounters (FY17-19)
VA Market Area Health Systems Optimization
Market Facility Specialty FY17 FY18 FY19 3 Year % Change
(V08) Puerto Rico Virgin Islands
(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)
VA Market Area Health Systems Optimization
Market Facility Setting FY15 FY16 FY17 FY18 FY19 5 Year % Change
(V08) Puerto Rico Virgin Islands
(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
VA Market Area Health Systems Optimization
Market Facility Bed Service FY15 FY16 FY17 FY18 FY19 5 Year % Change
(V08) Puerto Rico Virgin Islands
(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
VA Market Area Health Systems Optimization
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)
VA Market Area Health Systems Optimization
Market Parent Facility Bed Service Funding Source FY19 Actual
FY29 Projected
10 Year % Change
(V08) Puerto Rico Virgin Islands
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)
VA Market Area Health Systems Optimization
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)
VA Market Area Health Systems Optimization
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)
VA Market Area Health Systems Optimization
Market Planning Category Group Funding Source FY19 RVUs Actual
FY29 RVUs Projected
10 Year % Change
(V08) Puerto Rico Virgin Islands
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)
VA Market Area Health Systems Optimization
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
VA Market Area Health Systems Optimization
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
VA Market Area Health Systems Optimization
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
(V08) Puerto Rico Virgin Islands
San Juan 0.0 26 1969 0 $26,826,788 $212,494,054 High
Building FCA
VA Market Area Health Systems Optimization
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
VA Market Area Health Systems Optimization
Market Facility Training Category Program Name Paid WOC Total HPTs
(V08) Puerto Rico Virgin Islands
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
VA Market Area Health Systems Optimization
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)
VA Market Area Health Systems Optimization
Market Facility Total HPTs National Ranking (out of
154 sites)(V08) Puerto Rico Virgin Islands San Juan 1,179 42
FY21 Research Funding
VA Market Area Health Systems Optimization
Market Medical Center Total Funding (VA and Non-VA)
Rank
(V08) Puerto Rico Virgin Islands San Juan $364,212 85
Footnotes
VA Market Area Health Systems Optimization
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
VA Market Area Health Systems Optimization
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
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