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VA New England Healthcare System

Bedford/Boston Administrative Integration Proposal FAQ's

Potential Administrative Integration of
VA Boston Healthcare System and Bedford VA Medical Center

Frequently Asked Questions

What was the experience with the past integrations in VISN 1?

VA New England Healthcare System’s previous integrations have led to improved coordination, better availability of services and more efficient health care.

The integration of the VA medical centers in Connecticut resulted in the current VA Connecticut Healthcare System, comprised of two campuses (West Haven and Newington) and five CBOCs. The earlier integration of the three Boston campuses resulted in many efficiencies, without the loss of services in the Boston area. Indeed, with the opening of additional community-based outpatient clinics, there are now more services in Boston than before the integration. In both cases, the integrations were major successes.

While mission changes occurred during the earlier integration of the three Boston campuses, all of the campuses continue to operate as vibrant health care facilities with broad clinical programs, high levels of staff, fully occupied buildings, and clear missions. Should this integration move forward, all four of the campuses in the greater Boston area (Jamaica Plain, West Roxbury, Brockton and Bedford) would continue to operate. Bedford VAMC, with nationally renowned programs in geriatrics and mental health, would be a large and important component in the integrated healthcare system for greater Boston, should the proposal move forward.

A number of integrations have happened within VA nationally over the past two decades. Almost all cities across the country to have a single VA health care system, often consisting of multiple campuses providing care to a given metropolitan area.

When are the town halls scheduled for?

A schedule of all the upcoming town halls can be found here. We welcome all stakeholders to attend one of the town halls to learn more about the proposal and ask questions.

How do patients find out about the town halls?

Flyers are being mailed to all patients, as well as placed in prescription bags and appointment reminders. Flyers will also be left in the waiting areas.

When would this happen? 

Following the stakeholder feedback period, if we recommend the proposal to the Secretary, and he decides to integrate the facilities, we anticipate the integration would take effect on October 1, 2012 at the earliest. If the proposal moves forward and the Secretary approves the integration, we would form a steering committee and several work groups to facilitate the integration.

Would integration affect any of the construction projects underway?

No, these important improvements would continue.

Would staffing be reduced? 

No, staffing would not be reduced should the proposal move forward. There are many opportunities for further growth of Veterans Health Administration services in the greater Boston area and integration could support that growth.

If I am a patient, would I have to change where I go for services? 

No, VA New England Healthcare System does not anticipate moving any patients should the proposal move forward. We respect patient preferences on where they choose to receive their care.

How would community-based outpatient clinics be impacted by integration?

Changes to existing CBOCs are not part of this proposal. Community-based outpatient clinics are very important to the mission of our organization and would continue to operate.

Would there be transfers (of patients)?

No current inpatients would be moved as part of this potential integration.

Who would lead the healthcare system, should integration move forward?

This is a detail that would need to be worked out should the integration move forward, however Bedford VAMC would still maintain local leadership through an Assistant Director.

If I am an employee would I be reassigned to another campus? 

There are no plans to move any employees from their duty station should the proposal move forward. However, currently all VA facilities in VISN 1, including VA Boston HCS and Bedford VAMC, provide care at multiple sites. It is current practice at all VA facilities, following appropriate policies, practices and procedures, to have staff work at sites other than their usual duty station if this is required for safe patient care. This would be no different with an integrated system in greater Boston.

If I am an employee, would I have to attend meetings at another campus? 

Possibly, but we would also rely on technology (videoconferencing and teleconferencing), as is done currently throughout VA New England Healthcare System as much as possible, should the proposal move forward.

If I am an employee, would my pay change? 

Most pay, including nurse pay, is based on the physical location of the employee. Pay schedules would continue to be developed for nurses and nurse practitioners, based on their locality and appropriate survey data, should the proposal move forward. We have carefully reviewed this with human resources, and we cannot identify any circumstances in which pay for any employee would decrease as a result of this integration.

Would the shuttles between campuses continue? Would shuttle services change?

Yes, the shuttles would continue if the proposal moves forward. VISN 1 would also explore expanding shuttle services.

How would this impact administrative services?

Savings and efficiencies would likely occur from the reduction of administrative overhead for the identified facilities, if the proposal moves forward. The earlier integration of the three Boston campuses resulted in savings and efficiencies, without loss of services in the Boston area. An integration would eliminate double reviews and accreditations (e.g., Joint Commission), and would improve regional planning.

Would this make it easier for patients?

Yes, integration would make it easier for patients because:

  • Integration of the electronic medical record systems would mean that all clinical information (doctor’s notes, labs and x-rays, etc.) would be immediately available to doctors across both sites. Currently Boston and Bedford have different medical records;
  • A single medical staff would allow specialists at Boston to add clinics at Bedford;
  • A single appointment system would make it easier to coordinate appointments at all of the facilities;
  • All services in the Boston area would be readily available to all patients, rather than having two systems. For example, patients would no longer be required to travel to Boston to have blood work done when it is ordered by Boston specialists. This could be done at Bedford or any of the CBOCs (Gloucester, Lynn and Haverhill);  
  • Transportation systems would be combined and better coordinated;
  • Administrative overhead would be reduced, freeing up funds to provide care.

What type of feedback have you received? How do I provide feedback?

We have received a number of comments, which can be found here. We encourage people to continue to provide feedback, and they can do so anonymously or by providing their contact information. A recommendation will not be sent to Secretary Shinseki until after the town hall meetings are completed in November. In addition to the web, people can also provide feedback through comment boxes located throughout the Bedford VAMC campus:

  • Building 1: Human Resources
  • Building 2: Lobby, across from elevators
  • Building 78: Crossroads, Canteen Dining Room, Starbucks
  • Building 61: Lobby, entrance
  • Building 6: Basement, elevator

Feedback can also be provided by writing to Bedford/Boston Proposal, c/o Kathleen Cosgrove Makela, VISN 1, 200 Springs Road, Building 61, Bedford, MA 01730. When people submit questions instead of comments, the answers to those questions are then posted in this frequently asked questions document.

How would we invest in the proposed integration?

VISN 1 realizes that an investment would be needed to ensure that the integration occurs smoothly, should the proposal move forward. This would include an investment in funds and staff.

What would be the square footage of the combined Greater Boston Healthcare System?

A VA Greater Boston Healthcare System would have 3,730,925 gross square feet of owned property and 132,312 net square feet of usable space leased.

Have you discussed this plan with academic affiliates?

The potential integration has been discussed with the academic affiliates.

Would allocation of HUD-VASH vouchers change?

Vouchers are distributed to communities.  The communities would maintain their vouchers if the proposal moves forward.  HUD-VASH vouchers would be combined (and therefore preserved).  

Would this require Congressional approval?

The Secretary of Veterans Affairs would approve this integration. It does not require Congressional approval.

Would Bedford have an Acting Nurse Executive and an Acting Director until a decision is made?

Yes. An integrated system would have only one Director and one Nurse Executive. These are positions which are filled at a national level and represent major career moves for those in the role. A decision on the integration proposal should be made prior to deciding to fill these positions permanently.  

What CBOCs would the Greater Boston Healthcare System cover?

If the integration moves forward, the System would cover eight CBOCs, including Lynn, Gloucester, Haverhill, Lowell, Causeway, Quincy, Dorchester and Framingham. That number would grow to nine, following the opening of the Plymouth CBOC.

Do you plan to use Bedford VAMC only as an outpatient facility in five years or ten years?

There are no plans to use Bedford VAMC as only an outpatient facility in five years or ten years. Specific changes in services are not part of this potential integration. 

How would you address the similarities between the Bedford and Brockton campuses?

While this is a detail that would need to be worked out, no facilities would close as a result of this integration, and no current inpatients would be moved.  

Would this fix the problem of volunteers having to register and sign in separately at VA Boston HCS and Bedford VAMC?

Yes, the proposed integration would alleviate volunteers having to register and sign in separately at the different facilities.

What would the plan be for integrating research, R&D, and the IRBs at both sites?

IRBs would likely be combined, the overall research program would be strengthened, and it would likely provide opportunities for further expansion, if the proposal moves forward. Many opportunities for further growth of VHA services exist in the greater Boston area, including continued expansion of its research and teaching activities. The integration would contribute to ensuring such growth occurs in a value added, coordinated way.

How would this impact clinical services?

Changes in current clinical services are not part of this proposed integration; however, VISN 1 would explore the expansion of some specialty services at Bedford VAMC.

Would this result in increased funding?

Not necessarily.  Funding for Network programs is a function of patient workload, which would likely not increase significantly as an immediate consequence of the proposed integration.  However, through outreach and other efforts combined with continuous improvement efforts, we hope that, over time, workload would increase, resulting in longer term increases in funding levels.   

Is it financially feasible to add Bedford VAMC to VA Boston HCS?

It is expected that the proposed integration of Bedford VAMC and VA Boston HCS would lead to multiple efficiencies, including financial efficiencies resulting from combining complementary clinical service lines and reducing the number of medical centers in the Network.

How would the integration impact those Veterans from Manchester, Maine, etc.?

The proposed integration is expected to have little or no impact on Veterans from other states.

How would you determine chiefs/service line structures?

This is a detail that would need to be worked out should the proposal move forward.  Those involved in strategic planning at both facilities, as well as Service Chiefs/Service Line Managers, would have input in developing a plan.  Any plan developed would be sensitive to those currently encumbering management positions.   

How would you determine grades?

Procedures exist under the Title 5 classification system and through the Title 38/Hybrid Title 38 boarding process that address situations in which an integration would result in an individual’s position changing in scope, complexity or responsibility.  At the present time, it is not anticipated that the proposed integration would have a substantive impact on positions. 

Why not just have VA Boston HCS doctors/specialists work from Bedford VAMC a couple of days a week?

Unfortunately, having to work across two medical record systems has been an impediment for specialists.  Labs, clinic notes, and imaging studies from VA Boston HCS are more difficult to find in Bedford VAMC’s system than when the patients are seen at VA Boston HCS.  As an example, a gynecologist who sees a patient in Bedford VAMC has to access his/her notes from VA Boston HCS when needed to do surgery. Likewise, (s)he would not be able to enter their pre-operative orders in Bedford VAMC, because these need to be taken off in VA Boston HCS. There are too many barriers for the care of the thousands of Bedford VAMC patients who already access services in VA Boston HCS.  Furthermore, it would allow optimal deployment all of the resources of both facilities to meet the needs of VA Boston HCS and Bedford VAMC patients.

What if my position is moved and I don't want to make the new commute?

There are no plans as part of this proposal that would require anyone to move to a new duty location.

How would you address services taking on huge increases in numbers of staff members?

We would look for input on how best to structure the new organization, should the proposal move forward.  Human resources is examining other large organizations to gain insight into the advantages and disadvantages of different administrative models.

How do we prevent staff from "cutting and running" during the transition?

If this proposal moves forward, we need to continually remind staff of both organizations that they have an important role in sustaining the excellent programs that have been developed.   We need all the employees at both organizations to be forward thinking on how we can continue to improve and expand the services we provide. If the proposal moves forward, as decisions are made regarding the integration, they would be communicated to all stakeholders so that they understand how their role fits into the larger picture.

Would the current unions remain?

This would need to be worked out with the Federal Labor Relations Authority should the integration take place.

How did employee satisfaction change after the earlier Boston integration?

The current format of the All Employee Survey started in 2005.  Since that time, there has been a progression upwards in all the elements.  The most significant gains under Job Satisfaction have been in the Senior Management, Promotion Opportunity, Work Condition, and Praise job factors. Under Organizational Assessment, the job factors Innovation, Rewards, and Employee Development have seen the most improvement. Under Culture, the job factors Group and Entrepreneurial improved the most. In 2010, VA Boston HCS had the eighth highest overall score among hospitals/health care systems in the country. It was also named by the Boston Globe as one of the “Top Places to Work.”

What is magnet status (nursing)?

Magnet status is an award given by the American Nurses’ Credentialing Center, an affiliate of the American Nurses Association, to hospitals that satisfy a set of criteria designed to measure the strength and quality of their nursing. A Magnet hospital is stated to be one where nursing delivers excellent patient outcomes, where nurses have a high level of job satisfaction, and where there is a low staff nurse turnover rate and appropriate grievance resolution. Magnet status is also said to indicate nursing involvement in data collection and decision making in patient care delivery.

Due to the space and parking issues at Bedford VAMC, do you feel the telework would be utilized more frequently for administrative positions?

Telework eligibility is based on the position.  The proposed integration does not include plans to change work assignments for staff, so it is not anticipated that there would be any new telework opportunities. Current Bedford VAMC guidance on telework can be found in Hospital Memorandum 5.44.

Would there still be a human resources office located at Bedford?

Yes. It would be important to continue to have human resources support at Bedford VAMC to service the managers and employees, if the proposal moves forward.

Would the Geriatric Research, Education and Clinical Center inpatient program remain and would it continue as a research facility? Would there be changes to staff and programs for the unit?

Under the proposal, no current inpatients would be moved to a different facility, and no staff would lose employment. The work that is done there is excellent and we hope that this program would grow in the future. This proposal does not involve specific plans for individual clinical programs.

Is integration of the VistA system part of the plan?

Should the proposal move forward, we will request an Office of Information and Technology national support team to provide us with database migration/integration services. However, it is likely that we can expect to receive the same support services that we are currently receiving for the Fitchburg and Worcester realignment to Northampton. Those support services provide for a limited integration of the 2 VistA databases, specifically:

  • Clinical Data
    • Patient Demographics
    • Future Appointments
    • Future Orders
    • Active Prescriptions
    • Allergies
  • Administrative Data
    • Space and Equipment Files
    • Employee (PAID) data

All other components of the medical record are not being integrated for Fitchburg and Worcester, including:

  • Test results
  • Progress Notes
  • Clinical Reminders
  • Past Appointments
  • Past Prescriptions

The other items not being migrated for Worcester and Fitchburg can still be viewed from the old medical records via the web. Staff are being provided with dual access to view additional historical medical records. All new patient activity will be entered on the VA Central Western Massachusetts Healthcare System records.

Aren't medical records already integrated?

Medical records are integrated within each medical center. Although portions of the medical records at one facility can be viewed electronically at all other VAMCs, the medical records are not integrated across medical centers.

What about integrated medical record for entire VISN?

VA no longer supports full VistA database integrations.