VA Declares Brownsboro Site The Final Choice For New Hospital.

Is this the last word?

The Record of Decision dated May 30, 2017 and signed by the Secretary of the U.S. Department of Veterans Affairs on October 12 makes it sound like an easy decision. The 23-page document contains only three words or phrases in the text highlighted by the VA to draw attention to the central logic of the decision.

Page 1. “The purpose of the proposed project is to provide Louisville area Veterans with facilities of sufficient capability (functional) and capacity to meet their current and projected future health care needs.”

“The proposed project is needed because the current hospital and CBOCs [outpatient clinics] are operating at maximum capacity and are unable to accommodate the projected increase in the regional Veteran population. The configuration and condition of the existing 63•year-old Louisville VAMC facility offers limited options to expand to meet these needs, and parking at the Zorn Avenue VAMC is insufficient.”

Page 7. “For these reasons, VA does not view the general locations or sites suggested in public comments as reasonable alternatives warranting additional investigation and detailed evaluation in the EIS [Environmental Impact Statement]. Chapter 2 of the Final EIS includes a detailed description of the site selection process, as well as the reasons for eliminating the Fegenbush and Downtown sites, and for not reconfiguring the existing VAMC on Zorn Avenue.”

It has not been a straight path! Continue reading “VA Declares Brownsboro Site The Final Choice For New Hospital.”

KentuckyOne Health To Sell Its Major Assets In Louisville.

Beginning last Thursday, word began trickling out to journalists and the public that KentuckyOne Health, a major regional unit of Catholic Health Initiatives (CHI), was preparing to announce plans to sell almost all its hospitals and medical centers in Louisville and a handful elsewhere in the state. I had been told earlier in the week that the announcement would be made today, Monday, but there were so many leaks that KentuckyOne sent an email to its employees outlining its plans.  I presume KentuckyOne wanted take control of the message before the reportage dam broke. The email can be read here.

For those of us in Louisville, the only major facility not being sold is Our Lady of Peace, a psychiatric hospital.  Both of KentuckyOne’s acute care hospitals, (Jewish Hospital and Sts. Mary and Elizabeth Hospital), the Frazier Rehabilitation Institute, and all four outpatient Medical Centers (Jewish East, South, Southwest, and Northeast) are on the chopping block. Nearby Jewish Hospital Shelbyville, which recently underwent a critical review by the Inspector General for an EMTALA violation, is also for sale.  KentuckyOne employs many physicians. The fate of individual owned- or contracted medical practices in Louisville and elsewhere is not clear to me from the email. Continue reading “KentuckyOne Health To Sell Its Major Assets In Louisville.”

What Is Happening at Louisville’s Veterans Hospital?

hearing-crowd-11-15-16-750pxA public hearing to present the results and hear comments about the draft Environmental Impact Statement for the proposed Replacement VA Medical Center in Louisville was held on November 15 at Christ Church United Methodist on Brownsboro Road. This is just down the road from the favored site on a vacant former farm on the southeast corner of the intersections of the I-264/Waterson Expressway and Route 42/22/Brownsboro Road. Two separate sessions were held: at noon and 6 pm. I attended the earlier session which lasted just shy of three hours. I did not count heads, but I estimate that something fewer than 100 people were in attendance including VA staff, consultants, and reporters. I learned about the hearing earlier from the newspaper. When I got home that afternoon, I found my personal notice in the mail delivered after the fact by the VA to all those who signed up as interested persons.  I do not know if more people would have attended had more timely notice been given in this manner.  The people who did show up were clearly already engaged, seemed to be largely neighbors of the project, and almost uniformly against locating the project at Brownsboro for multiple reasons. I do not know how the evening session went and will limit my comments to the midday session. Continue reading “What Is Happening at Louisville’s Veterans Hospital?”

Temporary Annoyance Or Tactical Setback For Louisville VA Hospital Replacement Process?

Several news outlets recently noted a decision by the Department of Veterans Affairs in Washington DC to conduct full environmental impact studies (EIS) on the previously proposed sites for a replacement VA hospital at the first-choice Brownsboro Road and Waterson Expressway site, and the runner-up on Factory Lane near the Jefferson Expressway and  Old Henry Rd.  This latter location is adjacent to Jewish Hospital Northeast Medical Center.  This latter was also been called the “St. Joseph Site” because the original large acreage was owned my the St. Joseph Catholic Orphans Society. Earlier less rigorous (and correspondingly less expensive and time consuming) EIS assessments did not uncover unmanageable obstacles to proceeding.  Accordingly, planning for the favored Brownsboro Rd. site is well along with ground-breaking anticipated in 2017.  I commented on the playing of the EIS card by opponents in my report on the public hearing held last September.  Just this week I received the attached notice from the VA giving a few more details.


Continue reading “Temporary Annoyance Or Tactical Setback For Louisville VA Hospital Replacement Process?”

Replacement Robley Rex Veterans Hospital– On Track Or Not?

It ain’t over ’til it’s over. (R.I.P. Yogi Berra, 1925-2015)

Earlier this month on September 10. the Robley Rex Veterans Hospital held a “Town Hall” to provide a forum for VA beneficiaries.  I went to see what was being said about the replacement hospital being constructed at the intersection of Route 42/Brownsboro Rd and the Waterson Expressway.  A tag-team of residents in the area have joined forces with University and business advocates who are still lobbying to have the hospital built downtown. These groups have been trying to scuttle the process including using the same strategies employed successfully by River Fields and others to delay and modify the construction of the new East-End bridge across the Ohio River.  For example, the big push now is for a second even more extensive environmental impact study or to try to find a possible burial site somewhere on the property!

The current partnership combines tenacious forces of anywhere-else-but-here with no-where-else-but-here and which have had some limited success.  It doesn’t hurt their efforts that the local Courier-Journal newspaper and city government aligned themselves with the downtown-only forces over 12 years ago when the replacement hospital initiative began.  Lots of free editorial ink has been assured.  As for the Veterans themselves, they have been largely unanimous in expressing their wishes to stay-where-we-are-now, or to go anywhere-except-downtown!  The local and Washington VA authorities are being pushed and pulled in every which way. One can easily feel sorry for them!  I have chronicled the process extensively elsewhere in these pages. Continue reading “Replacement Robley Rex Veterans Hospital– On Track Or Not?”

Building A New VA Hospital— What Would Robley Rex Think?

robley-rexThe lengthy and tortuous planning process to build a replacement Robley Rex Veterans Administration hospital came into public view again these last three weeks. On January 15, dual afternoon and evening public hearings were held at the Clifton Center to allow public comment on the site-specific draft environmental assessment of the former farmland. It is my understanding that these were expected to be the last public hearings to held for the relocation project.

I estimate that some 60 people attended each session, but I could not completely differentiate program development and VA staff members from the public. There were probably some, like me, that attended both hearings. An initial (and certainly futile) request was made to keep the session on topic— to focus comments on the draft environmental assessment. Although some general questions might be answered, it was made clear that the intent was not to fully answer questions so much as to collect them for incorporation into the final environmental assessment.

Each session was begun with a welcome and introduction of the new VA director, Martin J. Traxler, and a presentation from planning staff member Mary Peters summarizing the environmental assessment. That presentation, the full environmental assessment report, and its summary are available from the Louisville VA website. The large bulk of environmental questions and comments related to concerns about traffic and disruptions during the multiyear construction process itself. Continue reading “Building A New VA Hospital— What Would Robley Rex Think?”

Stopgap Bill to Provide Healthcare to Veterans Passed by Congress.

Last week, Congress finally sent to the President the “Veterans Access, Choice, and Accountability Act of 2014.” While the “accountability” in this title refers to making heads roll among the administration of the Veterans Administration, there was clearly some embarrassment and a deficit of legislative accountability that forced a dragging-and-kicking pair of adversarial political parties to agree to bail out a Veterans Administration that had been negligently and predictably starved into delinquency.

Vets couldn’t get timely appointments.
The substance of the bill deals almost entirely with the problem that veterans were facing unacceptably long delays in obtaining appointments for medical services. Not unexpectedly, a few items from the larger mouldering VA appropriation bills were tacked on. Since these were presumably items that were easy to agree on, I predict that passing the rest of the necessary VA legislation will become even more difficult, if it passes at all. Continue reading “Stopgap Bill to Provide Healthcare to Veterans Passed by Congress.”

Patient Access Data at Veterans Hospital Medical Centers.

Mixed results at Robley Rex Hospital in Louisville but mostly better than average.

I recently commented about the reaction in Washington to revelations that veterans trying to get appointments at VA medical centers were facing long waits and that utilization data for at least a handful of centers had been altered to make them look better than they were. I was subsequently asked how our local Robley Rex VA Hospital in Louisville stacked up against others. While I have heard good things in support of the Louisville VA from veterans at public hearings, and while the hospital has done well in national accreditation and quality surveys, I had no specific information about waiting times. The release of national patient access data from the Veterans Administration in Washington gives us something to go on and will be presented below. In brief, our hospital has little to be ashamed of, but the data as presented are not easy for me to interpret.

One of the pitfalls in analysis of data-dumps like this one is that without knowledge of exactly what is being counted or measured, how items are defined, or the operational measures used to assemble the data; the robustness of any conclusions may be compromised. My lack of day-to-day working knowledge of how appointments are actually made at VA hospitals or how the various lists of waiting times were compiled for this report limits my confidence. Nonetheless, assuming the data from the various medical centers has been collected in the same way, an overview and some rough comparisons seem reasonable. Continue reading “Patient Access Data at Veterans Hospital Medical Centers.”

Congress To Allow Veterans Access to Private Healthcare Providers?

The revelation that a Veterans Administration Hospital in Phoenix falsified its reporting of waiting times for veterans seeking medical care pushed a festering problem past its breaking point forcing Washington to wake up and take action. General Eric Shinseki, Secretary of Veterans Affairs and probably one of the most honest men in the city, ended up falling on his sword for his commander over the matter. On the theory that it is bad politics to appear soft on supporting our veterans, funding committees for the Veterans Administration that had been languishing in the hyper-polarized and consequently paralyzed Congress, sprang into life. Both the House and Senate have just passed versions of their own bills to address the wait-time issue and some attendant reforms. It is virtually certain some compromise will emerge soon.

The term scandal has been used with regard to the long wait-times. Certainly to the extent that quality and utilization data were falsified in order to look good on paper, scandal is too kind a word. Another kind of scandal is demanding that the VA system perform to a specified standard but withholding the resources required to do so. We see a lot of that in Washington.

Is it better in the private sector?
When it appeared that the VA system itself did not have sufficient capability to provide services to existing veterans, and that the location of clinics and hospitals does not always match up with the locations of the veterans themselves, a groundswell of suggestions arose proposing that if the VA cannot do it alone, let the private sector help! This is not intrinsically an unreasonable suggestion. The private sector is already helping with military retirees and families. There are certainly capabilities that the VA must have that the private sector is ill-suited to deal with, but most care provided in the VA system is nuts-and-bolts medicine that can be provided by the same providers used by nonveterans. Indeed, I have argued in these pages that better coordination or contracting with non-VA facilities can avoid community duplication and help assure that Veterans get at least as good care as the rest of us. It is only a short step to a system in which the government pays non-VA providers directly, at least for specific services or in places where the VA does not have resources available in a timely manner. (Of course, wait-times in the private sector are often very long too, especially for those without commercial insurance!) Continue reading “Congress To Allow Veterans Access to Private Healthcare Providers?”

Opponents of Brownsboro Location for New VA Hospital Going All-In.

p.s. It’s not about the neighbors or the disputed $3.1 million!

The Courier-Journal has long advocated for a downtown location for the replacement Mobley Rex VA Medical Center. The newspaper’s leadership and a variety of downtown-boosters are obviously disappointed with the result of a long-studied and reasonable determination not to place the hospital downtown, but rather on a site near the intersection of the Watterson Expressway and Brownsboro Road. A series of articles and an editorial earlier this month focused on the appraisal process used for the Brownsboro parcel purchased by the VA in July, 2012 for $12.9 million. The newspaper seems to insinuate that hanky-panky has occurred and that a cover-up is underway. Rep. Yarmouth has joined the fray asking for a governmental examination of the appraisal and purchase process. That is a fair request, especially since the reputation of some individuals has been questioned in unavoidable service to the interests of others, some of whom also wish to profit from a downtown location. Be well advised, that this controversy is no longer about the interests of the neighbors of the Brownsboro site who would have seen a major new commercial project there in any event.

Possible overpayment does not invalidate site-selection process.
I have been involved with or reporting on the site-selection process for the new VA since its inception. I believe my reports have been the most comprehensive available on the matter. Many of the public documents are available in these pages. I believe I have attended every public hearing and some non-public ones as well. The Courier-Journal and allied downtown-boosters are conflating the site-appraisal process with the site-selection process in a last ditch effort to pressure the federal government to relocate the hospital in downtown Louisville. The two processes are separate and very different things. Any inadvertent overpayment by the Federal Government for the land invalidates in no way the tediously careful process of site selection that went on. Continue reading “Opponents of Brownsboro Location for New VA Hospital Going All-In.”