VISN 12 Northern Market Data Discovery & Findings

VISN 12 Northern Market DataDiscovery & FindingsSubmission to VISN LeadershipOctober 4, 2019

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

372979102133142162175197221243248

123456789

10111213

VA Market Area Health Systems Op�miza�on

VISN 12: Northern Market

Table of Contents

2

Overview

3

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

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

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



Overview Document Purpose

4


VISN 12: Northern MarketOverview 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 July 18, 2019 will not be reflected.

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

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

5



• Commercial Market Data & AnalysisüThe commercial market capacity assessment considers only reported physical capacity and does not incorporate: 1) ability to staff pa�ent care services or accept VA pa�ents; 2) length of �me to change facili�es to accommodate Veteran demand; and 3) any nego�a�ons for specific rates for care provided in the community.

üPediatric healthcare was not considered.

üIBM Market Expert FTE es�mated demand is based on a median provider produc�vity level by service line.

üThe 10 year commercial workload es�mates are based on the 10 year IBM/Watson Health Market Expert projec�ons straight-lined through 2028.

üCommunity hospitals within a 60 minute drive �me of the VAMC’s zip code were the primary focus for assessment and used as a comparison to each VAMC.

üDue to differences in hospitals’ cost repor�ng periods, FY18 CMS Cost Report data was used when available and FY17 CMS Cost Report data was used when FY18 data was not available.

• QualityüDifferences in quality metrics between VA and widely accepted commercial benchmarks introduce significant subjec�vity.

• Cost Analysis and Recommenda�onsüThis is a high-level cost analysis. It compares three data points: internal VA cost to provide care to Veterans, poten�al cost to acquire the same care in the market at Medicare rates, and exis�ng experience with purchase of Non-VA care as applicable.

üAdjusted total cost by DRG as well as non-VA purchased care paid by DRG was provided by VA.

Assump�ons, cont.Overview

6

Demographics Market Geography and Demographics

7

Exis�ng VA Market and Facility HierarchyDemographics

Source: 1. BY17 EHCPM 2. FY18Q4 VASTNote: Mobile sites are not listed 1.1.V12.Northern



8

Key Market Sta�s�cs

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

and lab.

Total 2017 Enrollee Popula�on: 53,022

Market OverviewDemographics

Source: 1. BY17 EHCPM 2. VSSC Unique Pa�ents Cube 1.2.V12.Northern



• Top Coun�es by Enrollee Popula�on: Id

◦ La Crosse, WI: 4,168◦ Marathon, WI: 3,732◦ Monroe, WI: 3,446

139140141

• Total Enrollees: 66th of 96 markets

• Es�mated 10-Year Enrollee Change: -9.0%◦ 77th of 96 markets

Total 2017 Eligible Veteran Popula�on: 80,399• -20.7% es�mated 10-Year Eligible Veteran Popula�on Change

Id

◦ (V12) (585) Iron Mountain◦ (V12) (676) Tomah-Wisconsin

11

2018 Core Uniques:* 42,107

.VAMC:

Exis�ng VHA System

9

Market Enrollee Demographics

County Sector FY17 FY27 10 Yr. Change FY37 20 Yr. Change DO

Marque�e, MIDelta, MIDickinson, MIChippewa, MIHoughton, MIMenominee, MIGogebic, MIIron, MIOntonagon, MISchoolcra�, MIMackinac, MIAlger, MIBaraga, MILuce, MIKeweenaw, MISector SubtotalMarine�e, WIOneida, WIOconto, WIVilas, WI

12-h-9-B12-h-9-B12-h-9-B12-h-9-B12-h-9-B12-h-9-B12-h-9-B12-h-9-B12-h-9-B12-h-9-B12-h-9-B12-h-9-B12-h-9-B12-h-9-B12-h-9-B12-h-9-B12-h-9-D12-h-9-D12-h-9-D12-h-9-D

2,8862,0611,6261,4661,3401,169

902765497455423468367223121

14,7672,3981,7301,5471,089

2,8471,9481,5161,4551,1871,097

810696437425424423352201107

13,9232,0861,5071,272

978

-1.35%-5.50%-6.74%-0.73%

-11.48%-6.14%

-10.13%-8.98%

-11.96%-6.48%0.22%

-9.68%-4.25%-9.93%

-12.17%-5.71%

-13.03%-12.89%-17.78%-10.17%

2,4091,6251,3101,189

983902656578354369369353294175

8511,653

1,6601,197

980768

-16.52%-21.15%-19.40%-18.85%-26.65%-22.85%-27.23%-24.35%-28.79%-18.78%-12.62%-24.50%-19.82%-21.79%-29.86%-21.09%-30.77%-30.81%-36.64%-29.52%

123456789

1011121314151617181920

Demographics

Source: BY17 EHCPM VetPop & Enrollment 1.3.V12.Northern

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



County-Based Enrollee Projec�ons

10

Market Enrollee Demographics, cont.


Langlade, WIForest, WIIron, WIFlorence, WIMenominee, WISector SubtotalLa Crosse, WIMonroe, WIJuneau, WIWinona, MNVernon, WITrempealeau, WIJackson, WIHouston, MNAdams, WIBuffalo, WISector SubtotalMarathon, WIWood, WIPortage, WI

12-h-9-D12-h-9-D12-h-9-D12-h-9-D12-h-9-D12-h-9-D12-h-9-E12-h-9-E12-h-9-E12-h-9-E12-h-9-E12-h-9-E12-h-9-E12-h-9-E12-h-9-E12-h-9-E12-h-9-E12-h-9-F12-h-9-F12-h-9-F

941505365306122

9,0054,1683,4461,3801,2731,0881,071

899799719544

15,3873,7323,3812,068

853497306253109

7,8633,7113,3421,2611,105

944944868723630479

14,0073,2792,9791,852

-9.39%-1.61%

-16.10%-17.30%-10.45%-12.68%-10.97%

-3.02%-8.60%

-13.21%-13.19%-11.86%

-3.44%-9.46%

-12.49%-12.00%

-8.97%-12.16%-11.91%-10.46%

684396233197

856,2003,1643,0491,022

937791805706618516399

12,0082,7242,4251,500

-27.35%-21.65%-36.13%-35.66%-30.61%-31.15%-24.09%-11.52%-25.96%-26.37%-27.25%-24.81%-21.47%-22.63%-28.24%-26.70%-21.96%-27.01%-28.28%-27.47%

2122232425262728293031323334353637383940

Demographics

Source: BY17 EHCPM VetPop & Enrollment 1.3.V12.Northern#2





11

Market Enrollee Demographics, cont.


Lincoln, WIClark, WIWaushara, WIPrice, WITaylor, WISector SubtotalMarket Total

12-h-9-F12-h-9-F12-h-9-F12-h-9-F12-h-9-F12-h-9-F12-h

1,4071,090

973663548

13,86353,022

1,3161,059

903576505

12,46848,261

-6.51%-2.90%-7.11%

-13.13%-7.80%

-10.06%-8.98%

1,097896772479408

10,30140,163

-22.04%-17.81%-20.63%-27.69%-25.62%-25.69%-24.25%

41424344454647

Demographics

Source: BY17 EHCPM VetPop & Enrollment 1.3.V12.Northern#3





12

Sectors Coun�es

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




13

Market Enrollee and Eligible Demographics

Geography Measure FY17 FY27 10 Yr. Change FY37 20 Yr. Change DisplayO…

VISNMarketNa�onalVISNMarketNa�onal

EOY EnrolleesEOY EnrolleesEOY Enrollees

Eligible VeteransEligible VeteransEligible Veterans

374,57053,022

8,753,704628,212

80,39914,271,277

344,45148,261

8,896,391461,313

63,78312,265,488

-8.0%-9.0%1.6%

-26.6%-20.7%-14.1%

292,34240,163

8,262,997349,304

48,67310,448,365

-22.0%-24.3%

-5.6%-44.4%-39.5%-26.8%

123456

Market-Based Enrollee and Eligible Projec�ons

Demographics




Es�mated Eligible Veterans by Year

0

50,000

100,000

FY 2017 FY 2022 FY 2027

80,39972,041

63,783

FY 2017 FY 2022 FY 2027

-10.4%5 Year Chg in Eligibles

-20.7%10 Year Chg in Eligibles

Es�mated Eligible Veterans by Year

14

Market Enrollee and Eligible Demographics, cont.Demographics




Sector Measure FY17 FY27 10 Yr. Change FY37 20 Yr. Change Id

12-h-9-B12-h-9-D12-h-9-E12-h-9-F12-h-9-B12-h-9-D12-h-9-E12-h-9-F

EOY EnrolleesEOY EnrolleesEOY EnrolleesEOY EnrolleesEOY EligiblesEOY EligiblesEOY EligiblesEOY Eligibles

14,7679,005

15,38713,86322,45613,72621,83222,385

13,9237,863

14,00712,46817,93010,42318,27017,159

-5.7%-12.7%

-9.0%-10.1%-20.2%-24.1%-16.3%-23.3%

11,6536,200

12,00810,30113,402

7,28214,95413,034

-21.1%-31.1%-22.0%-25.7%-40.3%-46.9%-31.5%-41.8%

604605606607631632633634

Sector-Based Enrollee and Eligible Projec�ons

15

Demographics




2017-2027 Market Enrollee Breakdown by PriorityPriority Enrollees 2017 % Enrollees 2017 Enrollees 2027 % Enrollees 2027 10 Year % Change

12345678

Grand Total

12,2224,4128,098

8769,7393,6351,723

12,31753,022

23.1%8.3%

15.3%1.7%

18.4%6.9%3.2%

23.2%100.0%

17,3444,0937,088

9007,1612,158

6048,913

48,261

35.9%8.5%

14.7%1.9%

14.8%4.5%1.3%

18.5%100.0%

41.9%-7.2%

-12.5%2.8%

-26.5%-40.6%-64.9%-27.6%

-9.0%

Market Enrollee Priority Groups

27%

8%

14%2%

20%

6%

4%

19%1

2

3

4

5

6

7

8

19%

7%

12%

3%21%

7%

7%

24%1

2

3

4

5

6

7

8

VISN 12Na�onal

16

2017

15.4%

26.6%49.7%

8.4%<45

45-64

65-84

85+

19.8%

26.5%44.4%

9.3%

<45

45-64

65-84

85+

2017 2027 10 Year % Change

3,179 4,321 35.9%

0

10,000

20,000

30,000

MAL

E

<45 45-64 65-84 85+

-3.7% 1.0%-14.8%-14.7%

Female Enrollee Popula�on

2017 Northern Market Age Breakdown

Market Enrollees and Growth Rates by Age Group




Market Enrollee Popula�on — Age and Gender

2017 VISN 12 Age Breakdown

• • 2027

0

500

1,000

1,500

2,000

FEM

ALE

<45 45-64 65-84 85+

6.3% 1.0%173.2%21.2%

Demographics

17

Category VA FacilityCare

Na�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

24.3%

47.7%

0.2%

21.3%

61.3%

18.6%

12.9%

52.3%

88.2%

61.1%

24.2%

27.5%

46.3%

7.4%

23.3%

56.7%

18.5%

13.6%

42.7%

81.1%

47.6%

25.1%

-3.2%

1.4%

-7.3%

-2.0%

4.5%

0.1%

-0.7%

9.7%

7.1%

13.5%

-1.0%

11.2%

4.0%

32.8%

10.5%

2.5%

8.7%

12.9%

8.0%

2.2%

0.0%

10.6%

6.1%

2.6%

33.4%

5.1%

2.8%

5.5%

7.8%

9.5%

3.0%

0.0%

6.7%

5.0%

1.3%

-0.6%

5.3%

-0.3%

3.2%

5.1%

-1.5%

-0.9%

0.0%

4.0%

35.5%

51.7%

32.9%

31.8%

63.7%

27.3%

25.7%

60.3%

90.4%

61.1%

34.8%

33.7%

48.9%

40.8%

28.4%

59.5%

24.0%

21.4%

52.2%

84.2%

47.6%

31.8%

1.8%

2.8%

-7.8%

3.4%

4.2%

3.3%

4.3%

8.1%

6.2%

13.5%

3.0%

1

2

3

4

5

6

7

8

9

10

11Projec�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 1.12.V12.Northern



Market RelianceDemographics

18

Market Current Enrollment Rurality – FY18Demographics

Source: Geocoded Enrollee File FY18Q4 1.14.V12.Northern#IMG

* Includes Rural and Highly Rural Loca�ons



FY18 Rurality by County

19

County Urban Enrollees Rural Enrollees* % Rural Total Enrollees R

Adams, WI

Alger, MI

Baraga, MI

Buffalo, WI

Chippewa, MI

Clark, WI

Delta, MI

Dickinson, MI

Florence, WI

Forest, WI

Gogebic, MI

Houghton, MI

Houston, MN

Iron, MI

Iron, WI

Jackson, WI

Juneau, WI

Keweenaw, MI

La Crosse, WI

Langlade, WI

0

0

0

0

0

0

0

0

0

0

0

0

223

0

0

0

0

0

3,817

0

1,193

446

403

484

1,462

974

1,960

1,623

311

543

890

1,336

510

750

385

972

1,359

127

438

914

100.0%

100.0%

100.0%

100.0%

100.0%

100.0%

100.0%

100.0%

100.0%

100.0%

100.0%

100.0%

69.6%

100.0%

100.0%

100.0%

100.0%

100.0%

10.3%

100.0%

1,193

446

403

484

1,462

974

1,960

1,623

311

543

890

1,336

733

750

385

972

1,359

127

4,255

914

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 1.13.V12.Northern

* Includes Rural and Highly Rural Loca�ons.



DemographicsUrban Enrollees Rural Enrollees* % Rural Total Enrollees

20


Lincoln, WI

Luce, MI

Mackinac, MI

Marathon, WI

Marine�e, WI

Marque�e, MI

Menominee, MI

Menominee, WI

Monroe, WI

Oconto, WI

Oneida, WI

Ontonagon, MI

Portage, WI

Price, WI

Schoolcra�, MI

Taylor, WI

Trempealeau, WI

Vernon, WI

Vilas, WI

Waushara, WI

0

0

0

2,587

0

0

0

0

0

5

0

0

0

0

0

0

0

0

0

0

1,253

225

437

1,197

2,217

2,926

1,197

173

3,460

1,699

1,797

451

2,273

666

436

605

945

1,007

1,125

1,115

100.0%

100.0%

100.0%

31.6%

100.0%

100.0%

100.0%

100.0%

100.0%

99.7%

100.0%

100.0%

100.0%

100.0%

100.0%

100.0%

100.0%

100.0%

100.0%

100.0%

1,253

225

437

3,784

2,217

2,926

1,197

173

3,460

1,704

1,797

451

2,273

666

436

605

945

1,007

1,125

1,115

21

22

23

24

25

26

27

28

29

30

31

32

33

34

35

36

37

38

39

40


Source: Geocoded Enrollee File FY18Q4 1.13.V12.Northern#2





21


Winona, MN

Wood, WI

Total

0

0

6,632

1,349

2,901

46,534

100.0%

100.0%

87.5%

1,349

2,901

53,166

41

42

43


Source: Geocoded Enrollee File FY18Q4 1.13.V12.Northern#3





22

Market RuralityDemographics

Source: 1. Geocoded Enrollee File FY18Q4 2. HRSA Data Warehouse 1.15.V12.Northern



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

23

Parent Facility Trea�ng Facility Number Trea�ng Facility Name Ini�a�ve Title Approved Funding

(V12) (585) Iron Mountain 585 (V12) (585) Iron Mountain Simula�on Learning, Educa�on, and Research Network (SimLEAR… $0

Rank: 113 out of 117 Parent Facili�es (ranked by total $ funding)

$0

$1,000,000

$0

$1,479,993

Facility Na�onal Average

Medical Center % Na�onal 2019 Total Funding Id

Iron MountainNa�onal

0.00%100.00%

$0$173,159,235

107108

Demographics

Source: VHA Office of Rural Health 1.16.V12.Northern.585

Note: The FY19 Funded Project List includes the top ten projects by approved funding.


VISN 12: Northern Market — Iron Mountain

Office of Rural Health FY19 Funded Project List

Office of Rural Health Project Funding Alloca�on

FY19 Office of Rural Health Funded Project Alloca�on vs. Average Na�onal Alloca�on*

*111 Parent Facili�es received ORH Funding Alloca�on for FY19

24

Parent Facility Trea�ng Facility Number Trea�ng Facility Name Ini�a�ve Title Approved Funding

(V12) (676) Tomah-Wisconsin(V12) (676) Tomah-Wisconsin(V12) (676) Tomah-Wisconsin(V12) (676) Tomah-Wisconsin(V12) (676) Tomah-Wisconsin

676676676676676

(V12) (676) Tomah-Wisconsin(V12) (676) Tomah-Wisconsin(V12) (676) Tomah-Wisconsin(V12) (676) Tomah-Wisconsin(V12) (676) Tomah-Wisconsin

Clinical Pharmacy Specialist (CPS) ProvidersSocial Work in Pa�ent Aligned Care Teams (PACT)Simula�on Learning, Educa�on, and Research Network (SimLEAR…Telerehabilita�on SpokeMilitary Sexual Trauma Web Based Therapy

$596,312$454,209$166,011$162,475$123,005

Rank: 38 out of 117 Parent Facili�es (ranked by total $ funding)

$0

$1,000,000

$2,000,000$1,502,012

$1,479,993

Facility Na�onal Average

Medical Center % Na�onal 2019 Total Funding Id

Tomah-WisconsinNa�onal

0.87%100.00%

$1,502,012$173,159,235

219220

Demographics

Source: VHA Office of Rural Health 1.16.V12.Northern.676

Note: The FY19 Funded Project List includes the top ten projects by approved funding.


VISN 12: Northern Market — Tomah-Wisconsin

Office of Rural Health FY19 Funded Project List

Office of Rural Health Project Funding Alloca�on

FY19 Office of Rural Health Funded Project Alloca�on vs. Average Na�onal Alloca�on*

*111 Parent Facili�es received ORH Funding Alloca�on for FY19

25

* Popula�on projec�ons available through 2023; straight line growth rates applied through 2028.

17%

4%

10%

11%23%

15%

20%

0-14

15-17

18-24

25-34

33-54

55-64

65+

Label 2018 2028* % Change Dis…

Popula�onMaleFemale

1,241,939629,922612,017

1,240,028628,871611,157

-0.2%-0.2%-0.1%

123

Demographic Summary – Northern

Demographics

Source: IBM Market Expert 1.17.V12.Northern



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

Popula�on Distribu�on by Age Group

90%

3%4%

White Non-Hispanic

Hispanic

Black Non-Hispanic

Asian & Pacific Is. Non-Hispanic

All Others

11%

11%

26%19%

13%

19% <$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 26

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

* Popula�on projec�ons available through 2023; straight line growth rates applied through 2028. Popula�on based on area

within 60 minute drive from applicable VAMC/HCC.

14%

3%8%

9%

22%

18%

25%

0-14

15-17

18-24

25-34

35-54

55-64

65+

Label 2018 2028* % Change Di…

Popula�onFemaleMale

63,98331,63432,349

61,87130,62031,256

-3.3%-3.2%-3.4%

123

Demographic Summary – Iron Mountain Area

Demographics

Source: IBM Market Expert 1.18.V12.Northern.585




94%

2% 3%White Non-Hispanic

Hispanic

Black Non-Hispanic


All Others

13%

13%

29%20%

11%

14% <$15K

$15-25K

$25-50K

$50-75K

$75-100K

Over $100K



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

Iron Mountain Area

27

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

* Popula�on projec�ons available through 2023; straight line growth rates applied through 2028. Popula�on based on area

within 60 minute drive from applicable VAMC/HCC.

18%

4%

10%

12%23%

14%

19%

0-14

15-17

18-24

25-34

35-54

55-64

65+

Label 2018 2028* % Change Di…

Popula�onFemaleMale

347,542172,899174,643

356,593177,531179,057

2.6%2.7%2.5%

123

Demographic Summary – Tomah-Wisconsin Area

Demographics





90%

3% 2%White Non-Hispanic

Hispanic

Black Non-Hispanic


All Others

10%

11%

27%

20%

13%

20% <$15K

$15-25K

$25-50K

$50-75K

$75-100K

Over $100K




Tomah-Wisconsin Area

28

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

29

Facility FY13 FY14 FY15 FY16 FY17 FY18 6 Year Change

(V12) (585) Iron Mountain(V12) (585GA) Hancock(V12) (585GB) Rhinelander(V12) (585GC) Menominee(V12) (585GD) Ironwood(V12) (585GF) Manis�que(V12) (585HA) Marque�e(V12) (585HB) Sault Saint Marie(V12) (676) Tomah-Wisconsin(V12) (676BU) Tomah VADOM(V12) (676GA) Wausau(V12) (676GC) River Valley(V12) (676GD) Wisconsin Rapids(V12) (676GE) Clark County(V12) (676PA) Tomah PRRTP Wi

15,4261,7883,4662,1471,409

N/A2,5521,106

18,444312

5,3666,0885,6381,097

26

15,8791,8193,4132,2751,672

N/A2,7271,227

18,662341

5,0716,2425,6801,267

30

16,2651,9563,5262,1481,557

N/A3,3011,294

19,305474

3,8106,4025,6001,414

24

16,7422,0273,5092,0131,515

N/A3,2651,324

19,759226

4,5326,7495,8561,420

27

16,9801,9073,4771,8901,879

5863,0811,238

19,664231

4,5326,7365,9951,495

26

17,1321,8523,4581,8921,774

7843,1201,309

19,834254

4,7516,5025,8221,429

22

11.1%3.6%

-0.2%-11.9%25.9%

N/A22.3%18.4%

7.5%-18.6%-11.5%

6.8%3.3%

30.3%-15.4%

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

Demand

Source: VSSC Uniques Cube 2.13.V12.Northern



Core Uniques Trends by FacilityCore Uniques*

30

Outpa�ent Encounters FY15-18

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

(V12) (585) Iron Mountain(V12) (585GA) Hancock(V12) (585GB) Rhinelander(V12) (585GC) Menominee(V12) (585GD) Ironwood(V12) (585GF) Manis�que(V12) (585HA) Marque�e(V12) (585HB) Sault Saint Marie(V12) (585) Iron Mountain Total(V12) (676) Tomah-Wisconsin(V12) (676BU) Tomah VADOM(V12) (676GA) Wausau(V12) (676GC) River Valley(V12) (676GD) Wisconsin Rapids(V12) (676GE) Clark County(V12) (676) Tomah-Wisconsin Total(V12) Northern Total

10,2272,6451,8791,8301,231

N/A3,8801,233

22,92533,954

N/A5,8149,4952,782

46452,50975,434

15,0132,6722,0972,2911,278

N/A3,6561,879

28,88629,971

N/A5,7489,5972,742

52948,58777,473

15,1022,7722,5931,8301,175

6843,7772,012

29,94532,296

N/A5,9399,0262,763

91650,94080,885

16,1852,6662,2552,3951,3091,3353,8481,895

31,88836,118

N/A6,1768,4453,169

92654,83486,722

16,0113,0966,1883,9542,870

N/A5,4183,161

40,69821,637

N/A6,043

10,2747,8281,986

47,76888,466

14,2973,4346,7233,7862,733

N/A6,3293,557

40,85918,536

N/A9,1479,8328,3762,016

47,90788,766

14,2193,6096,4053,7483,353

9185,9013,388

41,54118,197

N/A9,2069,9289,2261,849

48,40689,947

14,2974,1536,7074,1773,5501,9515,7783,466

44,07917,744

N/A8,958

10,6568,4811,991

47,83091,909

43,157326891559190N/A657194

45,97443,899

236439

1,4317,155

22853,38899,362

44,528417

3,393540279N/A838285

50,28045,624

45767

1,3677,027

32055,150

105,430

42,661453

2,943475278

98836383

48,12742,544

2804

1,5008,549

30753,706

101,833

41,296537

3,038522311204788492

47,18843,589

2744

1,6218,614

31854,888

102,076

Mental Health

Demand

Source: VSSC Outpa�ent Encounters Cube 2.20.V12.Northern



Primary Care Specialty CareFacility

31

Primary Care Encounters – FY15-18Demand

Source: 1. VSSC Encounters Cube 2. Geocoded Enrollee File FY18Q4 2.1.V12.Northern#IMG



FY15-18 PC Average Encounters by County

32

County FY15-18 AvgEncounters

FY18 Encounters Most Commonly Used Facility % ofEncounters

Adams,WIAlger,MIBaraga,MIBuffalo,WIChippewa,MIClark,WIDelta,MIDickinson,MIFlorence,WIForest,WIGogebic,MIHoughton,MIHouston,MNIron,MIIron,WIJackson,WIJuneau,WIKeweenaw,MILa Crosse,WILanglade,WI

1,432833644789

2,8511,7563,2943,761

665974

1,5942,6541,1991,486

6081,4652,468

2266,6001,393

1,406767662816

2,9021,8153,5214,001

664978

1,6722,9341,1951,650

6781,5092,493

3086,7231,443

(676) Tomah-Wisconsin(585HA) Marque�e(585GA) Hancock(618GE) Chippewa Valley(585HB) Sault Saint Marie(676GE) Clark County(585) Iron Mountain(585) Iron Mountain(585) Iron Mountain(585GB) Rhinelander(585GD) Ironwood(585GA) Hancock(676GC) River Valley(585) Iron Mountain(585GD) Ironwood(676) Tomah-Wisconsin(676) Tomah-Wisconsin(585GA) Hancock(676GC) River Valley(585GB) Rhinelander

54.6%73.8%79.5%34.8%93.3%59.4%76.4%92.9%91.3%45.7%88.6%93.9%83.2%93.9%86.1%92.0%84.3%97.4%82.8%57.5%

County

Demand

Source: 1. VSSC Encounters Cube 2. Geocoded Enrollee File FY18Q4 2.1.V12.Northern

Note: Yellow cells indicate coun�es going out of Market/VISN for the majority of encounters.



Primary Care Encounters – FY15-18, cont.FY18

EncountersFY15-18 Avg Encounters

Most Commonly Used Facility % of Encounters

33



Lincoln,WILuce,MIMackinac,MIMarathon,WIMarine�e,WIMarque�e,MIMenominee,MIMenominee,WIMonroe,WIOconto,WIOneida,WIOntonagon,MIPortage,WIPrice,WISchoolcra�,MITaylor,WITrempealeau,WIVernon,WIVilas,WIWaushara,WI

2,245329812

5,6504,5915,3042,170

1846,7313,0942,961

8453,114

8161,031

7431,6381,7361,7111,635

2,408362849

5,8204,9955,3502,360

1496,5223,0883,070

9593,098

8701,173

7981,6571,8191,7591,701

(676GA) Wausau(585HB) Sault Saint Marie(585HB) Sault Saint Marie(676GA) Wausau(585GC) Menominee(585HA) Marque�e(585GC) Menominee(695GD) Green Bay(676) Tomah-Wisconsin(695GD) Green Bay(585GB) Rhinelander(585GA) Hancock(676GD) Wisconsin Rapids(585GB) Rhinelander(585GF) Manis�que(676GE) Clark County(676) Tomah-Wisconsin(676GC) River Valley(585GB) Rhinelander(676GD) Wisconsin Rapids

60.2%54.7%44.2%88.3%43.7%89.1%61.7%67.1%93.2%65.8%86.7%44.4%66.7%38.5%91.1%46.9%43.1%49.5%73.3%37.2%

County

Demand

Source: 1. VSSC Encounters Cube 2. Geocoded Enrollee File FY18Q4 2.1.V12.Northern#2

Note: Yellow cells indicate coun�es going out of Market/VISN for the majority of encounters.






34



Winona,MNWood,WITotal

1,7516,066

91,849

1,7945,786

94,524

(676GC) River Valley(676GD) Wisconsin Rapids

45.8%80.5%

County

Demand







35

Primary Care Drive Times for FY18 EnrolleesDemand

Source: Geocoded Enrollee File FY18Q4 2.3.V12.Northern



36

Demand

Source: VSSC Encounters Cube – Public Grouping (Primary Care) 2.4.V12.Northern.585

Note: Data limited to workload from pa�ents origina�ng from within the coun�es of Phase Two VISNs in the Market Assessments. * Includes top 3 stop codes, where applicable (some sites reported less than 3).



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

(V12) (585) Iron Mountain

(V12) (585GA) Hancock

(V12) (585GB) Rhinelander

(V12) (585GC) Menominee

(V12) (585GD) Ironwood

(V12) (585GF) Manis�que

(V12) (585HA) Marque�e

(323) PRIMARYCARE/MEDICINE







16,011

3,096

6,188

3,954

2,870

N/A

5,418

14,297

3,434

6,723

3,786

2,733

N/A

6,329

14,219

3,609

6,405

3,748

3,353

918

5,901

14,297

4,153

6,707

4,177

3,550

1,951

5,778

-10.7%

34.1%

8.4%

5.6%

23.7%

6.6%

7,316

1,329

3,330

2,044

1,469

N/A

2,168

6,562

1,451

3,357

1,914

1,450

N/A

2,394

6,365

1,539

3,325

1,785

1,819

493

2,254

5,934

1,608

3,362

1,777

1,722

696

2,356

-18.9%

21.0%

1.0%

-13.1%

17.2%

8.7%

16,034

2,666

7,928

4,204

2,791

N/A

5,281

14,248

3,713

8,888

4,109

2,813

N/A

6,363

13,846

3,895

8,398

3,585

3,359

759

6,062

14,251

4,159

8,495

3,861

3,302

1,569

5,916

-11.1%

56.0%

7.1%

-8.1%

18.3%

12.0%

CPT Work RVUUnique Pa�entsEncounters

Top Primary Care Stop Code* Trends FY15-FY18 — Iron Mountain

37

Demand

Source: VSSC Encounters Cube – Public Grouping (Primary Care) 2.4.V12.Northern.585#2





(V12) (585HB) Sault SaintMarie


3,161 3,557 3,388 3,466 9.6% 1,169 1,268 1,178 1,238 5.9% 2,988 3,214 2,986 2,891 -3.2%


Top Primary Care Stop Code* Trends FY15-FY18 — Iron Mountain, cont.

38

Demand

Source: VSSC Encounters Cube – Public Grouping (Primary Care) 2.4.V12.Northern.676





(V12) (676) Tomah-Wisconsin


(V12) (676GA) Wausau

(V12) (676GC) River Valley


(V12) (676GD) WisconsinRapids

(V12) (676GE) Clark County


(322) ComprehensiveWomen's Primary CareClinic(323) PRIMARYCARE/MEDICINE


(322) ComprehensiveWomen's Primary CareClinic(323) PRIMARYCARE/MEDICINE


21,273

364

6,043

10,149

125

7,828

1,982

18,185

351

9,147

9,725

107

8,376

1,982

17,866

331

9,206

9,816

112

9,226

1,849

17,499

245

8,958

10,622

34

8,481

1,991

-17.7%

-32.7%

48.2%

4.7%

-72.8%

8.3%

0.5%

8,755

266

3,053

5,133

88

3,629

1,177

7,912

269

4,115

5,003

85

3,847

1,114

7,262

260

4,146

4,987

87

4,072

1,027

7,544

210

4,040

5,097

32

3,880

1,056

-13.8%

-21.1%

32.3%

-0.7%

-63.6%

6.9%

-10.3%

22,326

553

6,667

10,380

186

7,140

2,546

20,825

615

10,598

10,783

159

7,651

2,374

20,160

548

9,782

11,845

168

8,692

2,265

18,900

373

9,487

12,278

54

8,081

2,322

-15.3%

-32.6%

42.3%

18.3%

-71.2%

13.2%

-8.8%


Top Primary Care Stop Code* Trends FY15-FY18 — Tomah-Wisconsin

39

Demand

Source: VSSC Encounters Cube – Public Grouping (Primary Care) 2.4.V12.Northern.676#2





(V12) (676GE) Clark County (322) ComprehensiveWomen's Primary CareClinic

4 34 N/A N/A -100.0% 4 23 N/A N/A -100.0% 7 40 N/A N/A -99.6%


Top Primary Care Stop Code* Trends FY15-FY18 — Tomah-Wisconsin, cont.

40

Home-Based Primary CareDemand

Source: VSSC Encounters Cube 2.14.V12.Northern#IMG



FY18 HBPC Encounters by County

41

2_14 Selected Facility FY15 FY16 FY17 FY18 AVGer FY15 FY16 FY17 FY18 AVG

(585) Iron Mountain(676) Tomah-Wisconsin (676GD) Wisconsin Rapids

113115

56

105118

79

109124102

84152

98

102127

83

3,0091,336

713

2,8341,444

770

2,4661,6731,035

1,9941,5091,366

2,5751,490

971

FY15-18 HBPC Uniques & Encounter Distribu�on

Demand

Source: VSSC Encounters Cube 2.14.V12.Northern


Home-Based Primary Care, cont.

Facility UniquesFY15 FY16 FY17 FY18 AVG FY15 FY16 FY17 FY18 AVG

Encounters


42

Demand

Source: VSSC Encounters Cube 2.36.V12.Northern



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

Provider Type MD RN SW MH RD Other I

EncountersPercentage

20.0%

2,91859.9%

3797.8%

1733.6%

3276.7%

1,07022.0%

99

43

Mental Health Encounters – FY15-18Demand




FY15-18 Average Mental Health Encounters by County

44

Mental Health Encounters — FY15-18, cont.Demand




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

Alger,MI

Baraga,MI

Chippewa,MI

Delta,MI

Dickinson,MI

Gogebic,MI

Houghton,MI

Iron,MI

Keweenaw,MI

Luce,MI

Mackinac,MI

Marque�e,MI

Menominee,MI

Ontonagon,MI

Schoolcra�,MI

Houston,MN

Winona,MN

Adams,WI

444

585

2,020

2,541

4,450

1,035

2,142

1,429

192

245

672

4,125

1,860

535

1,040

790

1,383

902

488

441

2,406

2,538

5,307

1,115

2,267

1,423

304

300

739

4,625

2,255

426

1,317

885

1,160

979



(V12) (585HB) Sault Saint Marie







(V10) (539A4) Cincinna�-Fort Thomas









40.0%

53.1%

64.7%

62.3%

76.1%

64.0%

68.6%

92.8%

52.0%

31.0%

28.1%

56.1%

41.7%

46.0%

53.3%

58.2%

29.2%

49.3%

45






Buffalo,WI

Clark,WI

Florence,WI

Forest,WI

Iron,WI

Jackson,WI

Juneau,WI

La Crosse,WI

Langlade,WI

Lincoln,WI

Marathon,WI

Marine�e,WI

Menominee,WI

Monroe,WI

Oconto,WI

Oneida,WI

Portage,WI

Price,WI

611

876

819

570

351

1,040

1,879

7,093

806

1,541

5,193

3,975

317

11,876

1,168

2,214

2,327

794

441

682

677

558

329

1,005

2,192

7,241

895

1,455

4,497

4,740

403

11,920

1,263

2,506

2,688

1,033

(V23) (618GE) Chippewa Valley














(V12) (695GD) Green Bay


(V12) (676GD) Wisconsin Rapids

(V12) (695BU) VADOM Milwaukee

30.2%

50.0%

93.5%

53.8%

63.8%

64.5%

72.7%

59.3%

26.4%

52.0%

71.3%

47.9%

82.1%

82.7%

45.0%

41.3%

29.5%

20.3%

46






Taylor,WI

Trempealeau,WI

Vernon,WI

Vilas,WI

Waushara,WI

Wood,WI

Total

507

1,284

1,339

1,063

1,178

3,699

78,904

501

1,272

1,031

1,039

1,272

4,601

83,216







34.9%

39.6%

44.5%

39.8%

35.8%

36.2%

47

Top Mental Health Stop Code* Trends FY15-FY18 — Iron MountainDemand

Source: VSSC Encounters Cube – Public Grouping (Mental Health) 2.7.V12.Northern.585

Note: Data limited to workload from pa�ents origina�ng from within the coun�es of Phase Two VISNs in the Market Assessments *Includes top 3 stop codes, where applicable (some sites reported less than 3)



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





















(502) MH CLINIC IND

(562) PTSD-INDIV

(550) MH CLINIC GROUP

(502) MH CLINIC IND

(562) PTSD-INDIV


(502) MH CLINIC IND

(562) PTSD-INDIV


(502) MH CLINIC IND

(562) PTSD-INDIV


(502) MH CLINIC IND

(562) PTSD-INDIV


(502) MH CLINIC IND

(562) PTSD-INDIV

(513) SUB USE DISORDER INDIV

(502) MH CLINIC IND


7,764

395

1,336

2,477

1

N/A

1,584

278

10

1,493

N/A

285

1,022

N/A

90

N/A

N/A

N/A

3,808

61

10,344

1,435

1,297

2,214

340

N/A

1,526

501

33

1,346

433

267

1,078

36

80

N/A

N/A

N/A

3,205

70

10,517

1,813

1,238

2,226

446

N/A

1,992

495

74

1,267

303

150

983

90

89

491

154

39

3,456

89

11,497

1,665

1,192

1,825

816

16

1,891

239

98

2,005

204

95

1,031

178

96

888

358

86

3,431

194

48.1%

321.5%

-10.8%

-26.3%

81500.0%

0.0%

19.4%

-14.0%

880.0%

34.3%

0.0%

-66.7%

0.9%

0.0%

6.7%

0.0%

0.0%

0.0%

-9.9%

218.0%

1,734

61

126

733

1

N/A

317

58

6

253

N/A

20

181

N/A

15

N/A

N/A

N/A

1,184

17

2,041

234

121

730

57

N/A

291

63

7

253

47

16

164

18

8

N/A

N/A

N/A

951

15

2,001

274

111

541

66

N/A

311

63

11

224

40

12

162

28

10

108

29

6

814

20

2,121

272

111

441

105

4

343

51

9

282

26

10

170

36

13

172

36

13

774

43

22.3%

345.9%

-11.9%

-39.8%

10400.0%

0.0%

8.2%

-12.1%

50.0%

11.5%

0.0%

-50.0%

-6.1%

0.0%

-13.3%

0.0%

0.0%

0.0%

-34.6%

152.9%

12,639

960

200

4,532

0

N/A

3,468

896

0

2,896

N/A

99

1,673

N/A

103

N/A

N/A

N/A

8,859

36

17,757

2,996

231

3,336

930

N/A

1,366

1,062

0

2,513

1,278

96

1,646

43

54

N/A

N/A

N/A

5,842

0

18,870

3,724

279

3,606

1,112

N/A

2,669

1,045

0

2,010

788

29

1,511

196

55

665

294

68

5,936

0

20,909

3,406

248

2,840

1,934

9

1,120

19

0

3,747

565

0

1,471

379

57

1,187

707

152

5,813

0

65.4%

255.0%

23.8%

-37.3%

0.0%

0.0%

-67.7%

-97.9%

0.0%

29.4%

0.0%

-100.0%

-12.1%

0.0%

-45.2%

0.0%

0.0%

0.0%

-34.4%

-100.0%

585-1

585-2

585-3

585GA-1

585GA-2

585GA-3

585GB-1

585GB-2

585GB-3

585GC-1

585GC-2

585GC-3

585GD-1

585GD-2

585GD-3

585GF-1

585GF-2

585GF-3

585HA-1

585HA-2

Encounters Unique Pa�ents CPT Work RVU

48

Top Mental Health Stop Code* Trends FY15-FY18 — Iron Mountain, cont.Demand

Source: VSSC Encounters Cube – Public Grouping (Mental Health) 2.7.V12.Northern.585#2









(562) PTSD-INDIV

(502) MH CLINIC IND

(562) PTSD-INDIV

(513) SUB USE DISORDER INDIV

N/A

1,217

N/A

4

271

1,355

446

19

200

1,555

440

16

187

1,451

434

9

0.0%

19.2%

0.0%

125.0%

N/A

179

N/A

2

57

192

50

5

21

194

49

3

26

207

59

4

0.0%

15.6%

0.0%

100.0%

N/A

2,394

N/A

0

617

1,961

902

22

330

2,147

979

5

194

1,712

900

0

0.0%

-28.5%

0.0%

0.0%

585HA-3

585HB-1

585HB-2

585HB-3


49

Top Mental Health Stop Code* Trends FY15-FY18 — Tomah-WisconsinDemand

Source: VSSC Encounters Cube – Public Grouping (Mental Health) 2.7.V12.Northern.676




















(587) Residen�al Rehabilita�on TreatmentProgram (RRTP)- Group

(502) MH CLINIC IND

(562) PTSD-INDIV

(502) MH CLINIC IND

(562) PTSD-INDIV

(560) SUB USE DISORDER GROUP

(502) MH CLINIC IND

(562) PTSD-INDIV

(534) MH INTGRTD CARE IND

(502) MH CLINIC IND



(502) MH CLINIC IND

(562) PTSD-INDIV


18,100

9,080

2,743

1,668

2,948

305

6,299

2,063

487

2,372

329

45

282

76

106

16,247

7,736

2,599

1,420

2,786

247

6,068

2,513

546

2,039

592

54

305

72

152

19,176

6,761

2,542

2,195

2,781

201

5,380

2,772

518

2,038

629

85

806

50

60

21,344

8,179

2,448

3,164

2,600

267

4,527

2,604

774

2,405

714

50

859

37

30

17.9%

-9.9%

-10.8%

89.7%

-11.8%

-12.5%

-28.1%

26.2%

58.9%

1.4%

117.0%

11.1%

204.6%

-51.3%

-71.7%

279

2,190

839

505

389

35

1,312

321

301

475

239

15

162

11

76

227

2,050

597

482

380

27

1,346

567

297

476

227

9

170

13

103

278

1,798

574

691

363

30

1,339

584

241

516

284

13

363

7

42

286

2,127

554

810

409

27

954

555

513

581

450

16

316

5

20

2.5%

-2.9%

-34.0%

60.4%

5.1%

-22.9%

-27.3%

72.9%

70.4%

22.3%

88.3%

6.7%

95.1%

-54.5%

-73.7%

7,242

13,809

4,973

1,632

6,651

208

7,239

5,869

772

5,202

679

40

140

0

70

5,711

9,794

4,960

1,864

6,290

157

7,366

6,481

754

3,599

2,464

16

167

2

108

5,797

9,387

4,200

3,693

6,309

124

7,721

6,744

718

3,046

1,460

23

734

0

58

6,374

11,035

4,031

5,037

5,961

162

6,082

6,292

731

3,347

1,092

17

696

0

30

-12.0%

-20.1%

-19.0%

208.6%

-10.4%

-22.3%

-16.0%

7.2%

-5.4%

-35.7%

60.8%

-57.9%

395.9%

0.0%

-57.5%

676-1

676-2

676-3

676GA-1

676GA-2

676GA-3

676GC-1

676GC-2

676GC-3

676GD-1

676GD-2

676GD-3

676GE-1

676GE-2

676GE-3


50

Specialty Encounters – FY15-18Demand




FY15-18 Average Specialty Encounters by County

51

Specialty Encounters — FY15-18, cont.Demand




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

Wood,WI

Waushara,WI

Florence,WI

Taylor,WI

Trempealeau,WI

Vernon,WI

Vilas,WI

Portage,WI

Price,WI

Monroe,WI

Oconto,WI

Oneida,WI

Menominee,WI

Marathon,WI

Marine�e,WI

Langlade,WI

Lincoln,WI

La Crosse,WI

7,743

2,980

1,410

813

2,397

2,560

2,576

4,262

1,052

13,603

4,624

4,148

333

5,707

7,947

1,974

2,769

7,704

7,856

3,124

1,297

756

2,307

2,423

2,672

4,317

1,021

13,406

4,871

4,609

248

5,208

7,996

2,034

2,653

8,006



















44.7%

33.7%

83.7%

39.7%

60.0%

65.8%

50.1%

39.7%

27.5%

81.4%

59.3%

39.7%

47.6%

36.0%

63.9%

42.6%

21.5%

66.3%

…

…

…

…

…

…

…

…

…

…

…

…

…

…

…

…

…

…

52






Juneau,WI

Forest,WI

Iron,WI

Jackson,WI

Clark,WI

Buffalo,WI

Schoolcra�,MI

Ontonagon,MI

Menominee,MI

Gogebic,MI

Houghton,MI

Iron,MI

Keweenaw,MI

Luce,MI

Mackinac,MI

Marque�e,MI

Baraga,MI

Delta,MI

5,065

2,039

719

2,553

2,372

986

1,295

1,291

3,681

1,717

2,754

3,178

189

382

758

5,584

898

6,231

5,665

1,802

695

2,765

2,166

987

1,166

1,270

3,760

1,763

3,023

3,373

252

338

768

5,439

902

5,958






(V23) (618) Minneapolis-Minnesota













66.2%

62.4%

36.5%

74.5%

52.2%

41.9%

61.1%

66.5%

65.2%

60.9%

61.1%

76.2%

50.4%

57.1%

36.5%

69.6%

67.6%

77.8%

…

…

…

…

…

…

…

…

…

…

…

…

…

…

…

…

…

…

53






Dickinson,MI

Chippewa,MI

Alger,MI

Adams,WI

Houston,MN

Winona,MN

Total

7,570

1,712

869

2,751

1,545

2,413

133,149

7,513

1,692

831

2,877

1,457

2,372

133,638







81.4%

47.1%

71.2%

51.9%

68.3%

48.4%

…

…

…

…

…

…

…

54

Specialty Care Stop Code Trends FY15-18

Id

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

60176018601960206021602260236024602560266027602860296030603160326033603460356036

(V12) (585) Iron MountainAudiology & Speech Pathology

CardiologyCri�cal Care / Pulmonary Disease

DermatologyEndocrinology

GastroenterologyHematology-Oncology

Infec�ous DiseaseInternal Medicine

NephrologyNeurology

Nutri�onOphthalmology

OptometryOrthopaedic Surgery

OtolaryngologyPain Medicine

Physical Medicine & Rehabilita�onPodiatry

38,8237,666

895162137

2,638311

2,68712

2,429136

1,1671,513

1144,1122,072

693136

5,7192,964

40,7567,956

730149104

2,494218

2,34624

2,040122914

1,934101

7,4722,336

627285

4,3282,791

39,2847,526

654153

502,040

912,269

361,754

97840

1,712N/A

8,6092,130

599181

4,2112,979

38,3567,139

537187

642,155

432,134

441,541

101848

1,323N/A

9,1702,204

633232

4,3113,067

-1.2%-6.9%

-40.0%15.4%

-53.3%-18.3%-86.2%-20.6%266.7%-36.6%-25.7%-27.3%-12.6%

-100.0%123.0%

6.4%-8.7%70.6%

-24.6%3.5%

37,0103,976

39322

3,874208

2,9820

152128

2,605962180

4,6973,055

968279

5,6762,632

42,8403,535

27510

3,80297

2,7931

39274

1,7851,360

11311,296

3,209900675

4,2043,434

41,3713,131

8110

3,22143

2,8902

4750

1,657888N/A

12,2883,017

899424

4,4053,707

41,4043,004

220

3,39425

2,7680

5932

1,6411,302

N/A12,934

2,917972545

4,5553,599

11.9%-24.4%-99.5%

0.6%-100.0%

-12.4%-87.8%

-7.2%N/A

290.2%-98.5%-37.0%35.3%

-100.0%175.4%

-4.5%0.4%

95.0%-19.8%36.7%

6037 Polytrauma 17 18 20 14 -17.6% 53 51 51 40 -24.7%

Demand

Source: VSSC Encounters Cube – Public Grouping (Specialty Care) 2.10.V12.Northern



CPT Work RVU4 Yr. Ch. 4 Yr. Ch.Encounters*

*Special�es were only included if there were greater than 15 encounters in any of the past four years.Note: Data limited to workload from pa�ents origina�ng from within the coun�es of Phase Two VISNs in the Market Assessments

55

Specialty Care Stop Code Trends FY15-18, cont.

Id


60386039604060416042604360446045604660476048604960506051605260536054605560566057

RheumatologySurgeryUrology

Vascular Surgery(V12) (585GA) Hancock



NephrologyNeurology

Nutri�onRheumatology

(V12) (585GB) RhinelanderCardiology

Cri�cal Care / Pulmonary DiseaseDermatology

EndocrinologyNephrology

Neurology

671,6631,496

17319113

1814

12216

31716

885187

17397331

9

702,2511,404

42403

822539

14222166116

3,379158

1792984345

651,9281,340

N/A440101

3215

16026425113

2,928184

1066

1455451

641,858

687N/A526181

3616

165353846

93,028

2202470

1674245

-4.5%11.7%

-54.1%-100.0%

64.9%60.2%

100.0%14.3%35.2%

118.8%1166.7%

170.6%-43.8%242.1%

17.6%41.2%79.5%

128.8%35.5%

400.0%

02,3811,805

0740020000

530900210

03,2411,601

0621020000

2,739300112

02,6551,535

N/A411020000

2,287200201

02,377

733N/A

620021100

2,102410410

-100.0%-0.2%

-59.4%N/A

-17.8%-57.3%-50.0%

N/A8.1%

200.0%300.0%

N/A0.0%

296.3%-57.8%100.0%

N/A62.9%

-33.3%-50.0%

6058 Nutri�on 11 66 65 86 681.8% 0 0 0 0 N/A

Demand

Source: VSSC Encounters Cube – Public Grouping (Specialty Care) 2.10.V12.Northern#2




*Special�es were only included if there were greater than 15 encounters in any of the past four years. Note: Data limited to workload from pa�ents origina�ng from within the coun�es of Phase Two VISNs in the Market Assessments

56


Id


60596060606160626063606460656066606760686069607060716072607360746075607660776078

Pain MedicinePhysical Medicine & Rehabilita�on

Rheumatology(V12) (585GC) Menominee



NephrologyNeurology

Nutri�onPhysical Medicine & Rehabilita�on

Rheumatology(V12) (585GD) Ironwood



NeurologyNutri�on

N/A490

28552104

3317

30238

832

N/A18

18187

561

9N/A

8

N/A2,831

29530

802520

2162733

113N/A

16264

769

80231936

N/A2,321

32464

832713

197284054

418

271811070183334

342,312

28516140

44N/A207

2124392516

296951769183237

N/A371.8%

0.0%-6.5%34.6%33.3%

-100.0%-31.5%-44.7%200.0%

21.9%N/A

-11.1%63.5%

9.2%240.0%

13.1%100.0%

N/A362.5%

N/A518

013

200

10100

N/A100000

N/A0

N/A2,732

010

1107010

N/A01000000

N/A2,282

071104000001000000

112,082

1210

N/A1000001001000

N/A302.3%

50.0%-83.8%-55.5%-50.0%

N/A-88.4%

-100.0%N/AN/AN/A

-100.0%600.0%

N/A-100.0%

N/AN/AN/AN/A

6079 Rheumatology 11 21 25 28 154.5% 0 0 0 0 N/A

Demand






57


Id


60806081608260836084608560866087608860896090609160926093609460956096609760986099

(V12) (585GF) Manis�queCardiology

EndocrinologyNutri�on

(V12) (585HA) Marque�eCardiology

Cri�cal Care / Pulmonary DiseaseDermatology


NeurologyNutri�on

PolytraumaRheumatology

(V12) (585HB) Sault Saint MarieAudiology & Speech Pathology



N/AN/AN/AN/A648

601517

3047

19530

515

187N/A

389

4289

N/AN/AN/AN/A827

482421

22821

347962022

2591225178874

863647

3823

5015

8210

14444

491914

358135

141347

101

154706024

771541510

20419

43989

13468205

249

5999

N/AN/AN/AN/A

19.0%-10.0%

0.0%-41.2%-32.9%171.4%125.1%-73.3%80.0%

-13.3%150.3%

N/A-36.8%

0.0%40.5%11.2%

N/AN/AN/AN/A510

10090

4813

1512

N/A0001

N/AN/AN/AN/A784

010

100

7133

560000000

1010

91700060

8590

520200001

1110

93100090

8930

280210001

N/AN/AN/AN/A

82.4%-85.1%

N/A-100.0%

4.1%N/A

85.7%-100.0%

85.0%-100.0%

-7.5%N/A

-100.0%-100.0%

N/A-48.9%

6100 Neurology 1 9 14 22 2100.0% 0 0 0 0 N/A

Demand






58


Id


61016102610361046105610661076108610961106111611261136114611561166117611861196120

Nutri�on(V12) (676) Tomah-Wisconsin

Audiology & Speech PathologyCardiology

Clinical PharmacologyDermatology

Geriatric MedicineHematology-Oncology

Infec�ous DiseaseInternal Medicine

NephrologyNeurology

Nutri�onOptometry


PodiatryPolytrauma

RheumatologySCI

837,873

5,936528111

1,86836

129

1,8832

9381,9957,070

13713,471

3,093762

94

3439,541

6,583665251

1,920461941

2,67018

9501,9007,128

28113,428

3,148450

2023

3437,841

5,813184238

1,8821629

1002,059

19760

1,9237,164

22713,063

4,078243

2221

5039,168

6,093150361

2,1073030

1241,793

26415

2,1017,448

12312,547

5,574198

2721

525.0%3.4%2.6%

-71.6%225.2%

12.8%-16.7%

2900.0%327.6%

-4.8%1200.0%

-55.8%5.3%5.3%

-10.2%-6.9%80.2%

-74.0%200.0%425.0%

042,527

3,672416

112,308

70

14199

02,620

27014,253

21013,595

3,6901,254

90

042,804

3,435774

432,083

271

361,405

12,607

21313,910

36313,701

3,649527

227

035,739

2,2307

291,884

169

1651,238

61,736

33112,497

7911,217

4,043217

269

035,219

2,2586

2102,300

392

1911,516

2811611

12,21924

11,2093,595

2105

11

N/A-17.2%-38.5%-98.6%

1735.3%-0.3%

430.6%N/A

1305.1%660.1%

N/A-69.0%126.1%-14.3%-88.5%-17.5%

-2.6%-83.3%-49.7%

N/A6121 (V12) (676BU) Tomah VADOM 236 45 2 2 -99.2% 3 0 0 0 -100.0%

Demand






59


Id


61226123612461256126612761286129613061316132613361346135613661376138613961406141

Dermatology(V12) (676GA) Wausau

Audiology & Speech PathologyCardiology


EndocrinologyHematology-Oncology

Infec�ous DiseaseNephrology


Rheumatology(V12) (676GC) River Valley


Hematology-OncologyNephrology


236433217

141764

N/AN/A

221

2469

51,379

N/A82

N/A2

121,281

45748445

93697

N/A6

15152991

51,334

N/A8112

53

1,225

2794533

151764

N/A13

613229417

1,46029653116

N/A1,300

2724361

173

1103416

72033

10023

1,58323

137372269

1,275

-99.2%67.2%66.4%21.4%

-82.4%71.9%

N/AN/A

-68.2%1900.0%

37.5%44.9%

360.0%14.8%

N/A67.1%

N/A1000.0%

475.0%-0.5%

322

0700

N/AN/A

80006

1,618N/A

1N/A

00

1,614

017

0400

N/A040305

1,608N/A

0000

1,598

08159

200

N/A00060

151,474

0000

N/A1,454

03513

40

100000305

1,6040900

111,582

-100.0%60.5%

N/A-42.5%

-100.0%N/AN/AN/A

-100.0%N/A

1044.0%N/A

-23.2%-0.8%

N/A1212.1%

N/AN/AN/A

-2.0%6142 Rheumatology 2 8 19 20 900.0% 3 10 20 3 -5.4%

Demand






60


Id


61436144614561466147614861496150615161526153615461556156615761586159616061616162

(V12) (676GD) Wisconsin RapidsAudiology & Speech Pathology

CardiologyClinical Pharmacology


Geriatric MedicineHematology-Oncology

Infec�ous DiseaseNutri�on

OptometryPain Medicine

Physical Medicine & Rehabilita�onRheumatology

(V12) (676GE) Clark CountyAudiology & Speech Pathology



7,1432,861

2921

150N/A

3N/A

19117

2,4405

1,4953

207143

3112327

7,0172,596

2140

250N/A

1614

8106

2,76813

1,17411

289188

10371638

8,5292,552

2432

239N/A

4225

8102

4,356109

1,02218

277183

1636

933

8,6012,459

1225

247454228

8587

4,10944

97619

285203

5331034

20.4%-14.1%-58.6%19.0%64.7%

N/A1300.0%

N/A-57.9%401.7%

68.4%780.0%-34.7%533.3%

37.7%42.0%66.7%

200.0%-56.5%25.9%

8,4631,682

1200

N/A1

N/A53

4,4139

2,3353000000

8,1201,411

1100

N/A100

605,125

271,469

16300030

8,6341,012

300

N/A200

1076,254

1481,087

21400040

8,295955

207

26000

3505,762

11,180

1210

20270

-2.0%-43.2%-87.8%

N/A1463.6%

N/A-100.0%

N/A-100.0%

13918.0%30.6%

-89.7%-49.5%314.7%

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

Demand






61

Facility FY15 FY16 FY17 FY18 4 Yr ch. FY15 FY16 FY17 FY18 4 Yr ch. Id

(V12) (585) Iron Mountain(V12) (676) Tomah

4,9496,037

4,8565,844

4,5935,061

4,3917,048

-11.3%16.7%

474,531519,568

464,227492,593

417,840425,120

412,779757,498

-13.0%45.8%

264266

Demand

Source: Office of Den�stry 2.35.V12.Northern

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



Specialty Care Stop Code Trends FY15-18 – Dental

Visits 4 Yr. Ch. RVU Equivalent 4 Yr. Ch.Dental*

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)

22.8%1.8%

21.0%1.7%4.1%0.4%

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

Iron Mountain

Demand

Source: VSSC Telehealth Dashboard - Connected Care 2.15.V12.Northern.585

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



Telehealth — FY18 Telehealth Utilization — Iron Mountain

Telehealth U�liza�on Na�onal

63

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

Iron Mountain VAMC & Trea�ng Facility Encounters by Provider Site

Demand



2.16.V12.Northern.585

Pa�ent Site FY15 FY16 FY17 FY18 4 Yr Avg

(V12) (585) Iron Mountain(V12) (585GA) Hancock(V12) (585GB) Rhinelander(V12) (585GC) Menominee(V12) (585GD) Ironwood(V12) (585GF) Manis�que(V12) (585HA) Marque�e(V12) (585HB) Sault Saint MarieTotal

3,367797

1,1631,270

671

947962

9,177

2,9061,1341,9841,243

739

1,1341,223

10,363

3,1871,3402,0831,261

727341

1,1781,201

11,318

3,3981,3962,6521,352

778599

1,1661,398

12,739

3,2141,1661,9701,281

728470

1,1061,196

10,899

Provider Site FY15-18 TotalEncounters

% of TotalEncounters

(V12) (585) Iron Mountain(V12) (695) Milwaukee-Wisconsin(V12) (585HA) Marque�e(V12) (585GD) Ironwood(V12) (607) Madison(V12) (585GA) Hancock(V12) (537) Chicago-Illinois(V12) (585HB) Sault Saint Marie(V12) (578) Hines(V12) (585GF) Manis�que(V12) (585GC) Menominee(V04) (642) Philadelphia-Pennsylvania(V12) (585GB) Rhinelander(V01) (689) West Haven(V12) (676) Tomah-Wisconsin(V12) (556) North Chicago(V12) (695GD) Green Bay

19,8209,8104,9872,2112,0581,4501,063

806421396220177125

2717

54

45.5%22.5%11.4%

5.1%4.7%3.3%2.4%1.8%1.0%0.9%0.5%0.4%0.3%0.1%0.0%0.0%0.0%

Telehealth Encounters by Pa�ent and Provider Site* — Iron Mountain

*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 Type Report

64


Demand




Telehealth Encounters by Specialty* — Iron Mountain



65

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)

14.9%1.8%

11.2%3.2%1.5%0.6%

Tomah-Wisconsin

Demand

Source: VSSC Telehealth Dashboard - Connected Care 2.15.V12.Northern.676

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



Telehealth — FY18 Telehealth Utilization — Tomah-Wisconsin

Telehealth U�liza�on Na�onal

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

66


Tomah-Wisconsin VAMC & Trea�ng Facility Encounters by Provider Site

Demand




Pa�ent Site FY15 FY16 FY17 FY18 4 Yr Avg

(V12) (676) Tomah-Wisconsin(V12) (676BU) Tomah VADOM(V12) (676GA) Wausau(V12) (676GC) River Valley(V12) (676GD) Wisconsin Rapids(V12) (676GE) Clark CountyTotal

2,180257

1,997627

1,083521

6,665

3,28047

1,876639

1,477707

8,026

2,7293

1,601678

1,676781

7,468

2,25114

1,498720

2,075949

7,507

2,61080

1,743666

1,577739

7,416

Provider Site FY15-18 TotalEncounters

% of TotalEncounters

(V12) (676) Tomah-Wisconsin(V12) (676GC) River Valley(V12) (537) Chicago-Illinois(V12) (676GE) Clark County(V12) (607) Madison(V12) (676GD) Wisconsin Rapids(V12) (676GA) Wausau(V12) (695) Milwaukee-Wisconsin(V19) (660) Salt Lake City(V12) (676BU) Tomah VADOM(V12) (550) Danville-Illinois(V12) (695GD) Green Bay(V23) (618) Minneapolis-Minnesota

12,3338,5812,7602,1852,1431,071

352167

27181611

2

41.6%28.9%

9.3%7.4%7.2%3.6%1.2%0.6%0.1%0.1%0.1%0.0%0.0%

Telehealth Encounters by Pa�ent and Provider Site* — Tomah-Wisconsin



67


Demand




Telehealth Encounters by Specialty* — Tomah-Wisconsin



68

Urgent Care Uniques (FY15-18)Demand

Source: HRSA Data Warehouse 2.27.V12.Northern#IMG



Unique Patients by County FY15-18

69

Urgent Care Encounters (FY15-18) – Iron Mountain VAMC

EncountersCPT Code FY15 FY16 FY17 FY18

99201992029920399204992059921199212992139921499215

17

2216

61079

476468155

652

10999

16152

5871,9862,221

410

241727

64

104247

1,4773,146

762

22253824

883

2331,8422,869

693Total 1,240 5,683 5,814 5,837

CPT codes filtered by Stop Code 131 Urgent Care Clinic

91.2% of encounters seen between FY15-18 occurred between 8 A.M. and 10 P.M

Encounters FY15-18

0

500

1,000

1,500

2,000

2,500

3,000

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

101

82 85 82 132 24

562

71,

370

1,95

7 2,16

22,

129

1,73

71,

625

1,42

01,

111

895

695

547

498

430

277

182

148

139

Demand

Source: 1. VSSC Encounters Cube 2.27.V12.Northern.585



82.4% of encounters seen between FY15-FY18 occurred on weekdays vs. weekends

70

Urgent Care Encounters (FY15-18) – Tomah-Wisconsin VAMC

EncountersCPT Code FY15 FY16 FY17 FY18

99201992029920399204992059921199212992139921499215

53022

6

341494

3,2641,698

42

19393813

5421,1662,7921,711

85

23576722

385724

2,3812,214

70

30120

6835

3219976

2,9602,427

69Total 5,902 6,405 5,943 6,907

CPT codes filtered by Stop Code 131 Urgent Care Clinic

92.5% of encounters seen between FY15-18 occurred between 8 A.M. and 10 P.M

Encounters FY15-18

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

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

17 19 14 21 27 791,

648

2,25

42,

919 3,20

92,

943

2,48

52,

391

2,10

91,

873

1,40

683

055

415

511

559 55 38 33

Demand

Source: 1. VSSC Encounters Cube 2.27.V12.Northern.676



N/A N/A N/AN/A

86.3% of encounters seen between FY15-FY18 occurred on weekdays vs. weekends

71

Sector County Name 2017Enrollees

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


Alger, MIBaraga, MIChippewa, MIDelta, MIDickinson, MIGogebic, MIHoughton, MIIron, MIKeweenaw, MILuce, MIMackinac, MIMarque�e, MIMenominee, MIOntonagon, MISchoolcra�, MISector SubtotalFlorence, WIForest, WIIron, WILanglade, WI

467367

1,4652,0601,625

9011,340

764121223422

2,8851,168

496454

14,758305505365941

211

171321

N/A23

N/A15

N/A39

11

N/A30

115

51N/AN/A

21

N/A2124

142

86N/A

4N/A

9

91

20132N/A

194

N/A8939

185

228N/A

51

13

2N/A

37

1314

N/AN/A

11

10426

54N/A

312

1221

12N/A

1N/AN/AN/AN/A

332

N/A27

N/A318

3257

16N/A

23

N/A114122

49N/A

1N/A

8

2149

276215117

75130

627

3280

243785459

1,49829593294

5774

336330231

86260137

265289

375102

7694

2,325387936

133

114168978791462225571213

39139274729283171188

5,345108154

86261

2931

182173

88835853

32933

110442434

97418472251

4642

208204128

73143

74122748

212744951

1,39128622163

9482

621500288144350174

3382

170405221127116

3,40767

11670

168

161887

10521458215

67

2382382110

5762

272826

59

47902746

1012811

31099573122

58638

2724

2455

156188

2478

21356282453

242127

5843

1,3691

134149

00000000000000010000

12-h-9-D12-h-9-D12-h-9-D12-h-9-D12-h-9-D12-h-9-D

Marine�e, WIMenominee, WIOconto, WIOneida, WIVilas, WISector Subtotal

2,398122

1,5471,7301,0899,002

32

1878

70

35

1013

35

194

3048

84

82

1691

42

8N/A

143

28

21796

34

1736

133163110799

22016

113198147980

53528

279418322

2,191

1004

598166

448

1415

61132104617

42217

170286231

1,547

80N/A

434929

284

871

332437

244

2163

584353

477

000001

Sector/County Name

Demand

Source: VHA Office of Community Care 2.30.V12.Northern



Primary Care Mental Health Medicine Surgery Rehab Medicine

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

72

Sector County Name 2017Enrollees

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

12-h-9-E12-h-9-E12-h-9-E12-h-9-E12-h-9-E12-h-9-E12-h-9-E12-h-9-E12-h-9-E12-h-9-E12-h-9-E12-h-9-F12-h-9-F12-h-9-F12-h-9-F12-h-9-F12-h-9-F12-h-9-F12-h-9-F12-h-9-F

Adams, WIBuffalo, WIHouston, MNJackson, WIJuneau, WILa Crosse, WIMonroe, WITrempealeau, WIVernon, WIWinona, MNSector SubtotalClark, WILincoln, WIMarathon, WIPortage, WIPrice, WITaylor, WIWaushara, WIWood, WISector Subtotal

719544798899

1,3804,1683,4451,0701,0871,272

15,3821,0901,4073,7322,068

662548972

3,38113,860

21

N/A1221

N/A32

146

136427

574114

422

707

N/A1

N/AN/AN/A

1N/A

2N/A

1517

152

28N/A

81

62

26

N/A212

N/A213

194315

461

203

83

2N/A

21

N/A45

N/A28

246

N/A13

5218

N/A35

3N/AN/A

2N/A

39129

2912863

N/A10

131

2N/A

18178

N/A24

3345

1913

5N/A

131372

78203460

118239229

425865

94367

100292163

823871

2321,045

109354475

110279293

747857

1,15494

160342166

965683

2681,265

25757

110187236624623148177106

2,525210332828413201114216626

2,940

3418244533

150169

475243

6154182

1156046153875

472

3518294455

156200

314637

6515383

17874632429

107611

98298784

140326380101

9682

1,423142175430255

9667

119354

1,638

2212

236

2424

81224

1372726

1073716

71859

297

2118

267

1515

85

23120

3531

1073417201879

341

5823

814193219161649

2544862

199102

404447

134676

00000000001000000001

Market To… Market Total 53,002 830 188 414 155 115 188 4,285 5,724 13,001 2,509 3,270 8,015 1,294 1,291 2,776 2

Sector/County Name

Demand

Source: VHA Office of Community Care 2.30.V12.Northern#2



Primary Care Mental Health Medicine Surgery Rehab Medicine

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

73

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

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




74

Demand




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

75

Demand




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

76

Top Services Provided by NVCC for Iron Mountain

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

ER VISIT/URGENT CAREPHYSICAL THERAPYACUPUNCTUREOPHTHALMOLOGY TESTS, PROCEDURES, STUDIESNIC HOMEMAKER/HOME HEALTH AIDCARDIOLOGY TESTS, PROCEDURES, STUDIESInpa�entORTHOPEDIC TESTS, PROCEDURES, STUDIESCHIROPRACTICNIC SKILLED NURSINGRADIOLOGY NOSUROLOGY TESTS, PROCEDURES, STUDIESDERMATOLOGY TESTS, PROCEDURES, STUDIESHEMATOLOGY/ONCOLOGYRADIOLOGY MAMMOGRAMSLEEP STUDY/POLYSOMNOGRAPHYPAIN MANAGEMENTSURGERY GENERALCOLONOSCOPYRADIOLOGY ULTRASOUND

1,256395305269

1,52062

58379

124478227

4282

134122

26159158

15117

1,564499331409

1,502326794242124803278

76127170116184203165138139

1,7871,5371,2661,1321,074

957957846842824688632551546488484478436399355

20802081208220832084208520862087208820892090209120922093209420952096209720982099

NEUROLOGY TESTS, PROCEDURES, STUDIESRADIOLOGY CT SCANRADIOLOGY MRI/MRAOPTOMETRYNIC RESPITE CAREOtherTotal

265635

401203

1,0677,941

89135127

90214

1,78510,630

334332303282227

4,22521,982

2100210121022103210421052106

Demand



FY18FY17FY16

Commercial*

2.26.V12.Northern.585Source: VHA Office of Community Care*Commercial includes authoriza�ons from federally qualified health centers and provider agreements

77

Top Services Provided by NVCC for Tomah-Wisconsin

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

ER VISIT/URGENT CARERADIOLOGY MRI/MRANIC HOMEMAKER/HOME HEALTH AIDCOLONOSCOPYInpa�entPHYSICAL THERAPYORTHOPEDIC TESTS, PROCEDURES, STUDIESORTHOPEDICPAIN MANAGEMENTRADIOLOGY MAMMOGRAMCARDIOLOGY TESTS, PROCEDURES, STUDIESHEMATOLOGY/ONCOLOGYGASTROENTEROLOGY TESTS, PROCEDURES, STUDIESSURGERY GENERALACUPUNCTUREGASTROENTEROLOGYOPHTHALMOLOGY TESTS, PROCEDURES, STUDIESOPTOMETRYOPHTHALMOLOGYNIC SKILLED HOME CARE

1,169311695246502187

42260107

986

277692689723

126

115

1,123263886217393

8965

184784448

1067979318215

225

155

940830744736508505444404353347331324303272250245212198192169

21072108210921102111211221132114211521162117211821192120212121222123212421252126

SLEEP STUDY/POLYSOMNOGRAPHYCHIROPRACTICUROLOGYNEUROSURGERYDERMATOLOGY TESTS, PROCEDURES, STUDIESOtherTotal

23029

235

1,4635,709

55

192116

7744,804

165152132129121

1,94310,949

2127212821292130213121322133

Demand



FY18FY17FY16

Commercial*

2.26.V12.Northern.676Source: VHA Office of Community Care*Commercial includes authoriza�ons from federally qualified health centers and provider agreements

78

Demand Es�mated Future Market Demand — Outpa�ent

79

HSPC Group Trimmed RvuInHouse2017 RvuCc2017 Total2017 FY22 FY27

10 YearChange in Total

10 Year %Change in Total

Rehab TherapiesDental ClinicPrimary CareMedical Special�esMental Health ProgramsSurgical Special�es

1,823,636813,059155,384

92,661148,116

46,893

570,487147,438

18,80953,646

1,85338,172

2,394,123960,497174,193146,308149,970

85,064

3,292,9811,311,261

218,962203,749189,141125,804

3,973,8401,389,202

245,476229,827221,755146,234

1,579,717428,705

71,28383,52071,78661,170

+66%+44.6%+40.9%+57.1%+47.9%+71.9%

l 2017 l 2027

0

1,000,000

2,000,000

3,000,000

4,000,000

0.0T%

0.0T%

0.0T%

0.0T%

RVU

s

Rehab Therapies Dental Clinic Primary Care Medical Special�es Mental Health Programs Surgical Special�es

66.0% 71.9%40.9% 47.9%57.1%44.6%

Total2017 Rvu2027 Percent Change 3_1

Demand

Source: BY17 EHCPM U�liza�on Projec�ons 3.1.V12.Northern



BY17 Market Utilization Projections (Outpatient) — Northern Market

Health Systems Planning Group (HSPGs)

BY17 VISN 12: Northern Market U�liza�on Projec�ons (RVUs)

TotalTotalTotalCommunity

FY17

In-House

80

Ambulatory Mental Health, Health Systems Planning Categories (HSPCs)

20,000

40,000

60,000

80,000

0M%

5000M%

10000M%

15000M%

20000M%

Health Systems Planning Categories (HSPCs)

RVU

s

Homeless IntensiveCommunityMental Hlth

Recovery(ICMHR)

Psychiatry Psychology PsychosocialRehabilita�onand Recovery

Centers

MH RRTPOutpa�entEncounters

MH RRTPResiden�alEncounters

Work Therapy Community CareSocial Work

Non Psychiatristand Psychologist

-14.9% 64.7%107.1%-20.6%67.7%-16.2% -12.7%4.5% -18.4%66.5%

2017 2027 Percent Change

Outpatient Utilization Projections by Health Systems Planning Category (HSPC) Mental Health RVUs — Northern Market

Demand




l 2017 l 2027

81

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

5,000

10,000

15,000

20,000

25,000

30,000

Health Systems Planning Categories (HSPCs)

RVU

s

NeurologicalSurgery

Obstetrics &Gynecology

OrthopaedicSurgery

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

99.7% 97.0% 79.3% 71.8% 70.2% 58.0% 59.2% 75.9% 58.6% 44.8% 89.5%

Rvu2017 Rvu2027 Rvu2027 % difference from Rvu2017

Outpatient Utilization Projections by Health Systems Planning Category (HSPC) Surgical Specialties RVUs — Northern Market

Demand




l 2017 l 2027

82

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

0

20,000

40,000

60,000

5T%

10T%

15T%

Health Systems Planning Category (HSPCs)

RVU

s

Cardiology

Cri�cal Care/Pulmonary Dise

ase

Emergency Medicine

Gastroenterology

Neurology

Optometry

Physical Medicine & Rehabilita

�on

Allergy and Immunology

Chiropracty

Dermatology

Endocrinology

Hematology-Oncology

Infec�ous Dise

ase

Nephrology

Pain Medicine

Rheumatology

50.7% 53.0%106.0%25.6% 83.8%30.8%48.0%51.3% 58.6%54.8% 81.6%49.5% 52.1% 82.6% 45.4%90.4%


Demand




Outpatient Utilization Projections by Health Systems Planning Category (HSPC) Medical Specialties RVUs —Northern Market

l 2017 l 2027

83

BY17 Northern Market In-House LTSS U�liza�on Projec�ons (RVUs).

FY17 FY22 FY27 10 Year Change 10 Year % Change

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

62,863

047

12,044

13,544

082

12,385

13,941

072

11,951

-51,078

025

-93

-83.3%37.7%

53.2%-0.8%

0

50,000

100,000

150,000

200,000

250,000

50,000%

100,000%

150,000%

200,000%

Community AdultDay Health Care

Home Respite Care Purchased SkilledHome Care

Home HospiceCare

Homemaker/HomeHealth AidePrograms

36.9% 57.2%63.6% 14.3%26.0%

Total2017 U�l2027 U�l2027 % difference from Total2017l 2017 l 2027

Outpatient Utilization Projections by Health Systems Planning Category (HSPC) Ambulatory Long Term Support Services — Northern Market

0

5,000

10,000

0%

50,000%

100,000%

150,000%

200,000%

VA Adult DayHealth Care

Home-BasedPrimary Care

SCI&D HomeCare

CommunityResiden�al Care

HomeTelehealth

-83.3% -0.8%53.2%37.7%

Total2017 Rvu2027 Rvu2027 % difference from Total2017l 2017 l 2027

BY17 Northern Market Community LTSS U�liza�on Projec�ons (Procedures).

FY17 FY22 FY27 10 Year Change 10 Year % Change

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

2,5034,148

17,3232,544

134,974

3,1815,822

21,4102,939

191,036

3,4276,787

21,8342,907

212,239

9242,6394,511

36377,265

36.9%63.6%26.0%14.3%57.2%

Demand




0

84

FY18 Primary Care Encounters by County

Demand

Source: 1. VSSC Encounters Cube 2. BY17 EHCPM U�liza�on Projec�ons 3.6.V12.Northern#IMG



FY17-FY27 Primary Care RVU Growth Rate by Sector

Primary Care Workload – Historic & Projected

85

FY18 Mental Health Encounters by County

Demand




FY17-FY27 Mental Health RVU Growth Rate by Sector

Mental Health Workload – Historic & Projected

86

FY18 Specialty Care Encounters by County

Demand




FY17-FY27 Specialty Care RVU Growth Rate by Sector

Specialty Care Workload (Med/Surg Special�es Combined) – Historic & Projected

87

0.0M

0.5M

1.0M

1.5M

2.0M

Rehab Therapies Dental Clinic

2017 2022 2027 Order

0K

50K

100K

Primary Care MedicalSpecial�es

SurgicalSpecial�es

Mental HealthPrograms

2017 2022 2027 Order

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

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

69,30225,59418,89157,285

575,808270,716

11,77029,22719,612

799312,507126,715

81,07254,82138,50358,084

888,315397,431

103,85681,69458,13678,058

1,268,601544,075

116,61992,65467,37095,390

1,534,616578,349

35,54737,83328,86737,306

646,301180,918

43.8%69.0%75.0%64.2%72.8%45.5%

123456

Demand

Source: BY17 EHCPM U�liza�on Projec�ons 3.9.V12.Northern.585



FY17 FY22 FY27

10 Year

Change in

Total

10 Year %

Change in

Total

28.1%43.8% 69.0% 75.0% 64.2%

49.0% 51.0% 34.4%

BY17 Parent Facility Utilization Projections (Outpatient) – Iron Mountain VAMCBY17 Iron Mountain VAMC U�liza�on Projec�ons (RVUs)

42.8% 36.9%72.8% 45.5%

88

0.0M

0.5M

1.0M

1.5M

2.0M

2.5M

Rehab Therapies Dental Clinic

2017 2022 2027 Order

0K

50K

100K

Primary Care MedicalSpecial�es

SurgicalSpecial�es

Mental HealthPrograms

2017 2022 2027 Order

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

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

78,21135,668

4,77583,571

1,153,987353,125

6,39921,24414,895

959195,302

14,057

84,61056,91219,67084,530

1,349,289367,182

105,32378,99532,514

102,6421,799,615

502,274

118,49789,10838,038

116,8122,171,495

536,728

33,88732,19618,36832,282

822,206169,546

40.1%56.6%93.4%38.2%60.9%46.2%

123456

Demand




FY17 FY22 FY27

10 Year

Change in

Total

10 Year %

Change in

Total

24.5%40.1% 56.6% 93.4% 38.2%

38.8% 65.3% 21.4%

BY17 Parent Facility Utilization Projections (Outpatient) – Tomah-Wisconsin VAMCBY17 Tomah-Wisconsin VAMC U�liza�on Projec�ons (RVUs)

33.4% 36.8%60.9% 46.2%

89


5,000

10,000

15,000

20,000

25,000

30,000

35,000

0.0%

5000000000.0%

10000000000.0%

15000000000.0%

20000000000.0%

Health Systems Planning Category (HSPC)

RVU

s

Homeless Intensive Community MHRecovery (ICMHR)

Psychiatry Psychology Psychosocial Rehabilita�onand Recovery Centers

Work Therapy

-14.9% -20.7%68.5%-16.1% 0.0%67.1%

ActualRvu2017 ProjectedRvu2027 Percent Change

Demand




l 2017 l 2027

Outpatient Parent Facility Utilization Projections by Health Systems Planning Category (HSPC) Mental Health RVUs — Iron Mountain VAMC

90


5,000

10,000

15,000

20,000

0.0%

5000000000.0%

10000000000.0%

15000000000.0%

20000000000.0%


RVU

s

Homeless IntensiveCommunity MH

Recovery (ICMHR)

Psychiatry Psychology PsychosocialRehabilita�on andRecovery Centers

MH RRTP Outpa�entEncounters

MH RRTP Residen�alEncounters

Work Therapy

-14.6% -20.6%69.2%-16.2% -10.2%4.6% -15.1%68.9%

ActualRvu2017 ProjectedRvu2027 Percent Change

Demand




l 2017 l 2027

Outpatient Parent Facility Utilization Projections by Health Systems Planning Category (HSPC) Mental Health RVUs — Tomah-Wisconsin VAMC

91


2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

2000000000.0%

4000000000.0%

6000000000.0%

8000000000.0%

10000000000.0%

12000000000.0%

14000000000.0%

16000000000.0%

18000000000.0%

20000000000.0%


RVU

s

Neurological Obstetrics &Gynecology

Orthopaedic Otolaryngology Plas�c Podiatry Surgery Thoracic Urology Vascular Ophthalmology

122.0% 106.2%52.9%77.7% 94.4% 66.8%88.8%97.2% 84.4% 60.8% 86.0%

ActualRvu2017 ProjectedRvu2027 Percent Change 3_11

Demand




l 2017 l 2027

Outpatient Parent Facility Utilization Projections by Health Systems Planning Category (HSPC) Surgical Specialties RVUs — Iron Mountain VAMC

92


2,000

4,000

6,000

8,000

10,000

12,000

2000000000.0%

4000000000.0%

6000000000.0%

8000000000.0%

10000000000.0%

12000000000.0%

14000000000.0%

16000000000.0%

18000000000.0%

20000000000.0%


RVU

s

Neurological Obstetrics &Gynecology

Orthopaedic Otolaryngology Plas�c Podiatry Surgery Thoracic Urology Vascular Ophthalmology

123.1% 109.8%134.6% 60.7%96.1% 107.5% 86.8% 117.4% 97.6%96.4% 97.5%

ActualRvu2017 ProjectedRvu2027 Percent Change 3_11

Demand




l 2017 l 2027

Outpatient Parent Facility Utilization Projections by Health Systems Planning Category (HSPC) Surgical Specialties RVUs — Tomah-Wisconsin VAMC

93


0

5,000

10,000

15,000

20,000

25,000

2T%

4T%

6T%

8T%

10T%

12T%

14T%

16T%

18T%

Health Systems Planning Category

RVU

s

Cardiology Cri�cal Care/PulmonaryDisease

Emergency Medicine Gastroenterology Neurology Optometry Physical Medicine &Rehabilita�on

92.1% 107.2%26.7% 52.2%66.2%60.8% 60.1%


Demand




Outpatient Parent Facility Utilization Projections by Health Systems Planning Category (HSPC) Medical Specialties RVUs — Iron Mountain VAMC

l 2017 l 2027

94


0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

2T%

4T%

6T%

8T%

10T%

12T%

14T%

16T%

18T%

Health Systems Planning Category

RVU

s

Cardiology Cri�cal Care/PulmonaryDisease

Emergency Medicine Gastroenterology Neurology Optometry Physical Medicine &Rehabilita�on

68.9% 65.6%25.9% 67.1% 45.2%51.7% 56.1%


Demand




Outpatient Parent Facility Utilization Projections by Health Systems Planning Category (HSPC) Medical Specialties RVUs — Tomah-Wisconsin VAMC

l 2017 l 2027

95

0

1,000

2,000

3,000

4,000

5,000

0%

200000%

400000%

600000%

800000%

1000000%

TenY

rPer

cDel

taTo

tal

Home-Based Primary Care Home Telehealth

38.1% -0.5%

Actual Projected2027Rvu TenYrPercDeltaTotal

0

100,000100000%

200000%

TenY

rPer

cDel

taTo

tal



Home HospiceCare

Homemaker/HomeHealth Aide Progr…

41.1% 57.5%63.6% 14.5%26.2%

Actual Projected2027U�liza�on TenYrPercDeltaTotal

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

HSPC

FY17 FY22 FY27 10 YearChange

10 Year %Change

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

455

3,34513,070

193102,883

583

4,69416,149

223145,710

642

5,47316,489

221162,036

187

2,1283,419

2859,153

41.1%

63.6%26.2%14.5%57.5%

HSPC


10 Year %Change

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

N/AN/AN/A

1,006

5,274

N/AN/AN/A

1,247

5,432

N/AN/AN/A

1,390

5,248

N/AN/AN/A

384

-26

N/AN/AN/A

38.1%

-0.5%



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

BY17 Iron Mountain VAMC In-HouseLTSS U�liza�on Projec�ons (RVUs)

BY17 Iron Mountain VAMC CommunityLTSS U�liza�on Projec�ons (Procedures)*

Demand

FY17 FY22 FY27 FY17 FY22 FY27

l 2017 l 2027 l 2017 l 2027


Homemaker/Home

Health Aide Programs

96

0

5,000

500000%

1000000%

TenY

rPer

cDel

taTo

tal

Community Residen�alCare

Home-Based Primary Care Home Telehealth

173.3% 0.1%38.4%

Actual Projected2027Rvu TenYrPercDeltaTotal

0

20,000

40,000

100000%

200000%

TenY

rPer

cDel

taTo

tal



Home Hospice Care Homemaker/HomeHealth Aide Progr…

38.6% 58.4%63.2% 14.8%26.8%

Actual Projected2027U�liza�on TenYrPercDeltaTotal

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

HSPC


10 Year %Change

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

1,786

5362,1602,362

34,629

2,277

7492,6712,739

49,189

2,475

8752,7382,712

54,858

689

339578350

20,229

38.6%

63.2%26.8%14.8%58.4%

HSPC


10 Year %Change

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

N/AN/A

60

1,963

6,752

N/AN/A186

2,435

6,980

N/AN/A163

2,716

6,761

N/AN/A104

753

9

N/AN/A

173.3%

38.4%

0.1%



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

BY17 Tomah-Wisconsin VAMC In-HouseLTSS U�liza�on Projec�ons (RVUs)

BY17 Tomah-Wisconsin VAMC CommunityLTSS U�liza�on Projec�ons (Procedures)*

Demand

FY17 FY22 FY27 FY17 FY22 FY27

l 2017 l 2027 l 2017 l 2027


Homemaker/Home

Health Aide Programs

97

Demand




• Overview:

ü Outpa�ent demand es�mates (pa�ent visits)

were also developed to understand current

and future expected commercial outpa�ent

demand

ü Demand es�mates are based on non-Veteran

pa�ent origin within a 60 minute drive �me

from parent VA Medical Center/ Health Care

Center noted

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

General/Family Prac�ceInternal MedicinePrimary Care TotalAllergy/ImmunologyCardiologyDermatologyEndocrinologyGastroenterologyHematology/OncologyInfec�ous DiseaseNephrologyNeurologyPain ManagementPulmonologyRheumatologyVascularSpecialty Care (Medicine) Sub-TotalCardio/Thoracic SurgeryColorectal SurgeryGeneral Surgery

73,55947,071

120,6302,406

14,92413,643

3,5635,585

12,989767

2,3514,3682,6323,4533,087

97570,743

454383

4,734

74,35848,783

123,1412,469

16,26314,196

3,6535,827

14,080798

2,5684,5022,7933,6723,1971,078

75,096479394

4,921

75,94750,757

126,7032,562

17,60614,861

3,7706,096

15,134833

2,7864,6642,9663,8963,3261,182

79,682503409

5,118

7991,7132,511

631,339

55490

2421,091

31216134160219110104

4,3532611

186

1.1%3.6%2.1%2.6%9.0%4.1%2.5%4.3%8.4%4.1%9.2%3.1%6.1%6.3%3.6%

10.6%6.2%5.7%3.0%3.9%

2,3873,6866,073

1562,6821,218

206511

2,14565

435297334443239208

8,9394926

384

3.2%7.8%5.0%6.5%

18.0%8.9%5.8%9.2%

16.5%8.5%

18.5%6.8%

12.7%12.8%

7.7%21.3%12.6%10.9%

6.8%8.1%

10411042104310441045104610471048104910501051105210531054105510561057105810591060

NeurosurgeryOphthalmologyOrthopedic SurgeryOtolaryngologyPlas�c SurgeryUrologySpecialty Care (Surgery) Sub-TotalMedicine/Surgery TotalObstetrics/GynecologyWomen's Health TotalPsychiatryMental Health TotalPhysical Medicine/RehabRehab TotalEmergency/Cri�cal Care

1,02413,96113,607

5,7431,0127,126

48,043118,786

12,11312,113

7,9847,9843,2083,208

39,843

1,04314,97913,965

5,8941,0507,558

50,284125,380

12,11712,117

7,9517,9513,3153,315

41,610

1,06816,02914,421

6,0951,0928,021

52,757132,439

12,32212,322

8,0478,0473,4493,449

43,081

191,018

358151

38433

2,2416,593

44

-34-34108108

1,767

1.9%7.3%2.6%2.6%3.7%6.1%4.7%5.6%0.0%0.0%

-0.4%-0.4%3.4%3.4%4.4%

442,068

814352

80896

4,71313,652

210210

6363

242242

3,237

4.3%14.8%

6.0%6.1%7.9%

12.6%9.8%

11.5%1.7%1.7%0.8%0.8%7.5%7.5%8.1%

106110621063106410651066106710681069107010711072107310741075

Growth Projec�onsPa�ent Visits

Overall Outpa�ent Commercial Demand – Iron Mountain Area


Demand

Source: IBM Market Expert 3.14.V12.Northern.585#2



• Overview:




demand




Center noted


Emergency Services TotalNurse Prac��onerPhysician AssistantOther Services TotalGrand Total

39,84310,453

7,41017,863

320,427

41,61010,999

7,88718,887

332,401

43,08111,625

8,40620,030

346,072

1,767546477

1,02411,974

4.4%5.2%6.4%5.7%3.7%

3,2371,172

9962,168

25,645

8.1%11.2%13.4%12.1%

8.0%

10761077107810791080


Overall Outpa�ent Commercial Demand – Iron Mountain Area, cont.


Demand




• Overview:




demand




Center noted


General/Family Prac�ceInternal MedicinePrimary Care TotalAllergy/ImmunologyCardiologyDermatologyEndocrinologyGastroenterologyHematology/OncologyInfec�ous DiseaseNephrologyNeurologyPain ManagementPulmonologyRheumatologyVascularSpecialty Care (Medicine) Sub-TotalCardio/Thoracic SurgeryColorectal SurgeryGeneral Surgery

307,103190,982498,085

9,30780,09249,51613,71129,16259,562

3,23113,20219,43813,37415,69111,034

5,907323,227

2,2361,823

24,691

321,026205,987527,012

9,81393,26153,18214,54732,68968,372

3,52415,44720,99715,20917,69711,801

7,002363,542

2,5172,002

27,470

339,692222,635562,327

10,459106,280

57,35215,54036,33177,077

3,83717,66622,72717,07919,72612,674

8,078404,827

2,7942,195

30,340

13,92215,00528,927

50613,169

3,666836

3,5278,811

2932,2451,5591,8352,006

7671,094

40,315280179

2,779

4.5%7.9%5.8%5.4%

16.4%7.4%6.1%

12.1%14.8%

9.1%17.0%

8.0%13.7%12.8%

7.0%18.5%12.5%12.5%

9.8%11.3%

32,58931,65364,242

1,15226,188

7,8361,8287,170

17,516606

4,4643,2893,7054,0351,6402,170

81,600558372

5,650

10.6%16.6%12.9%12.4%32.7%15.8%13.3%24.6%29.4%18.8%33.8%16.9%27.7%25.7%14.9%36.7%25.2%25.0%20.4%22.9%

21212122212321242125212621272128212921302131213221332134213521362137213821392140

NeurosurgeryOphthalmologyOrthopedic SurgeryOtolaryngologyPlas�c SurgeryUrologySpecialty Care (Surgery) Sub-TotalMedicine/Surgery TotalObstetrics/GynecologyWomen's Health TotalPsychiatryMental Health TotalPhysical Medicine/RehabRehab TotalEmergency/Cri�cal Care

4,54054,42353,29723,081

5,16026,481

195,732518,959

55,68655,68637,89837,89813,94313,943

224,885

4,89561,08257,02024,694

5,71229,357

214,748578,290

57,75157,75139,21339,21315,20315,203

247,404

5,28267,89561,23026,542

6,29032,345

234,913639,740

61,10961,10941,30541,30516,58116,581

270,130

3556,6593,7241,613

5522,876

19,01759,331

2,0652,0651,3151,3151,2601,260

22,519

7.8%12.2%

7.0%7.0%

10.7%10.9%

9.7%11.4%

3.7%3.7%3.5%3.5%9.0%9.0%

10.0%

74213,472

7,9333,4611,1315,863

39,182120,781

5,4235,4233,4073,4072,6382,638

45,244

16.3%24.8%14.9%15.0%21.9%22.1%20.0%23.3%

9.7%9.7%9.0%9.0%

18.9%18.9%20.1%

214121422143214421452146214721482149215021512152215321542155


Overall Outpa�ent Commercial Demand – Tomah-Wisconsin Area


Demand

Source: IBM Market Expert 3.14.V12.Northern.676#2



• Overview:




demand




Center noted


Emergency Services TotalNurse Prac��onerPhysician AssistantOther Services TotalGrand Total

224,88550,07336,77886,851

1,436,306

247,40455,50441,35296,856

1,561,730

270,13061,33646,121

107,4561,698,648

22,5195,4314,574

10,005125,424

10.0%10.8%12.4%11.5%

8.7%

45,24411,263

9,34320,605

262,342

20.1%22.5%25.4%23.7%18.3%

21562157215821592160


Overall Outpa�ent Commercial Demand – Tomah-Wisconsin Area, cont.


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

102

Commercial Provider Case Mix Index⁴

Inpa�ent Demand and CMI – Iron Mountain

VAMC Case Mix Index³

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

MedicalSurgeryTotal Med/SurgCLCVAMC Total

152

174057

152

174057

152

174057

152

174057

152

174057

7.9N/A7.9

35.143.0

7.70.07.7

35.843.5

6.5N/A6.5

34.140.6

4.90.04.9

37.942.8

-38.0%N/A

-38.0%8.0%

-0.5%

12345

Facility 2015Unique

2016Unique

2017Unique

2018Unique

2015CMI

2016CMI

2017CMI

2018CMI

MedianCMI*

HighCMI**

Id

(585) Iron Mountain 516 486 429 383 0.97 0.96 0.96 0.98 1.60 1.60 …

Demand


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


VISN 12: Northern Market – Iron Mountain

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

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 onMedicare only popula�on from 2018 CMS Cost Reports

103

Commercial Provider Case Mix Index⁴

Inpa�ent Demand and CMI – Tomah-Wisconsin

VAMC Case Mix Index³

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

MedicalTotal Med/SurgMental HealthRRTP*CLCVAMC Total

1010

N/A30

180220

10101145

180246

10101170

180271

10101180

180281

10101180

145246

5.35.35.6

32.1146.0189.0

4.74.72.6

26.8128.5162.6

5.35.34.5

34.2132.0176.0

5.35.35.2

39.2132.3182.0

0.0%0.0%

-7.1%22.1%-9.4%-3.7%

123456

Facility 2015Unique

2016Unique

2017Unique

2018Unique

2015CMI

2016CMI

2017CMI

2018CMI

MedianCMI*

HighCMI**

Id

(676) Tomah-Wisconsin 342 319 377 375 0.88 0.84 0.84 0.87 1.58 1.95 …

Demand


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


VISN 12: Northern Market – Tomah-Wisconsin

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

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 onMedicare only popula�on from 2018 CMS Cost Reports

104

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

Source: 1. VSSC Trea�ng Specialty Cube 2. Geocoded Enrollee File FY18Q4 4.1.V12.Northern#IMG



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

105

Medical/Surgical BDOC — FY15-18, cont.County FY18 BDOC FY18 ADC % ADC FY15-18 AVG BDOC Majority Receiving Facility % BDOC …

Alger, MI

Baraga, MI

Chippewa, MI

Delta, MI

Dickinson, MI

Gogebic, MI

Houghton, MI

Iron, MI

Keweenaw, MI

Keweenaw, MI

Luce, MI

Mackinac, MI

Mackinac, MI

Marque�e, MI

Menominee, MI

Ontonagon, MI

Schoolcra�, MI

Houston, MN

34

51

93

451

631

100

126

316

0

0

6

25

25

410

261

94

57

26

0.1

0.1

0.3

1.2

1.7

0.3

0.3

0.9

0.0

0.0

0.0

0.1

0.1

1.1

0.7

0.3

0.2

0.1

23.0%

13.5%

22.0%

23.5%

20.6%

15.5%

14.1%

22.1%

0.0%

0.0%

12.5%

17.6%

17.6%

23.6%

22.5%

22.7%

23.8%

10.5%

37

95

106

480

768

161

223

357

9

9

12

36

36

434

290

104

60

62



(V10) (506) Ann Arbor-Michigan




(V12) (695) Milwaukee-Wisconsin



(V22) (678) Tucson


(V10) (506) Ann Arbor-Michigan

(V08) (673) Tampa-Florida






70.6%

66.7%

71.0%

58.1%

63.7%

39.0%

63.5%

58.5%

0.0%

0.0%

100.0%

32.0%

32.0%

41.2%

48.7%

70.2%

57.9%

57.7%

…

…

…

…

…

…

…

…

…

…

…

…

…

…

…

…

…

…

Demand

Source: 1. VSSC Trea�ng Specialty Cube 2. Geocoded Enrollee File FY18Q4 4.1.V12.Northern



106


Winona, MN

Adams, WI

Buffalo, WI

Clark, WI

Florence, WI

Forest, WI

Iron, WI

Jackson, WI

Juneau, WI

La Crosse, WI

Langlade, WI

Lincoln, WI

Marathon, WI

Marine�e, WI

Marine�e, WI

Menominee, WI

Monroe, WI

Oconto, WI

209

366

86

170

99

186

23

174

491

348

185

76

405

487

487

14

1,552

129

0.6

1.0

0.2

0.5

0.3

0.5

0.1

0.5

1.3

1.0

0.5

0.2

1.1

1.3

1.3

0.0

4.3

0.4

30.7%

28.6%

21.8%

33.1%

15.3%

32.6%

9.1%

20.9%

22.0%

23.5%

27.0%

10.0%

29.7%

16.3%

16.3%

12.8%

25.6%

13.5%

170

320

99

129

162

143

63

208

557

371

171

190

341

746

746

27

1,517

239


(V12) (607) Madison


(V12) (607) Madison




(V12) (607) Madison

(V12) (607) Madison



(V12) (607) Madison

(V12) (607) Madison






67.8%

73.8%

58.1%

60.6%

69.7%

49.5%

60.9%

54.0%

73.9%

43.7%

63.2%

47.4%

50.4%

48.7%

48.7%

64.3%

56.9%

82.7%

…

…

…

…

…

…

…

…

…

…

…

…

…

…

…

…

…

…

Demand

Source: 1. VSSC Trea�ng Specialty Cube 2. Geocoded Enrollee File FY18Q4 4.1.V12.Northern#2



107


Oneida, WI

Portage, WI

Price, WI

Price, WI

Taylor, WI

Trempealeau, WI

Vernon, WI

Vilas, WI

Waushara, WI

Wood, WI

Total

207

165

14

14

47

208

126

101

240

417

9,731

0.6

0.5

0.0

0.0

0.1

0.6

0.3

0.3

0.7

1.1

26.7

22.3%

18.0%

6.2%

6.2%

20.9%

32.7%

14.7%

10.4%

28.5%

19.8%

N/A

232

230

56

56

56

159

215

244

211

527

11,459


(V12) (607) Madison

(V12) (607) Madison


(V12) (607) Madison


(V12) (607) Madison


(V12) (607) Madison

(V12) (607) Madison

31.4%

76.4%

50.0%

50.0%

76.6%

42.3%

65.9%

48.5%

62.5%

73.6%

N/A

…

…

…

…

…

…

…

…

…

…

…

Demand




108

Demand

Source: VSSC Trea�ng Specialty Cube 4.2.V12.Northern



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



O (292) Heart Failure & Shock W CcO (194) Simple Pneumonia & Pleurisy W CcO (603) Celluli�s W/o MccO (872) Sep�cemia W/o Mv 96+ Hours W/o MccO (871) Sep�cemia W/o Mv 96+ Hours W MccO (293) Heart Failure & Shock W/o Cc/mccO (191) Chronic Obstruc�ve Pulmonary Disease W CcO (690) Kidney & Urinary Tract Infec�ons W/o MccO (57) Degenera�ve Nervous System Disorders W/o MccO (291) Heart Failure & Shock W MccOtherTotalO (194) Simple Pneumonia & Pleurisy W CcO (603) Celluli�s W/o MccO (690) Kidney & Urinary Tract Infec�ons W/o MccO (292) Heart Failure & Shock W CcO (195) Simple Pneumonia & Pleurisy W/o Cc/mccO (57) Degenera�ve Nervous System Disorders W/o MccO (190) Chronic Obstruc�ve Pulmonary Disease W MccO (293) Heart Failure & Shock W/o Cc/mcc

104916563614940394342

8821479

9885687257275443

7.0%6.2%4.4%4.3%4.1%3.3%2.7%2.6%2.9%2.8%

59.6%100.0%

7.9%6.8%5.5%5.8%4.6%2.2%4.3%3.5%

107918363614944444342

9031530

10589757257565446

7.0%5.9%5.4%4.1%4.0%3.2%2.9%2.9%2.8%2.7%

59.0%100.0%

7.8%6.6%5.5%5.3%4.2%4.1%4.0%3.4%

O (177) Respiratory Infec�ons & Inflamma�ons W MccO (641) Nutri�onal & Misc Metabolic Disorders W/o MccOtherTotal

3532

6711242

2.8%2.6%

54.0%100.0%

3534

7291352

2.6%2.5%

53.9%100.0%

4_4 Facility DRG In MarketBDOC

In Market BDOC% of Total

In and Out ofMarket BDOC




O (292) Heart Failure & Shock W CcO (194) Simple Pneumonia & Pleurisy W CcO (603) Celluli�s W/o MccO (872) Sep�cemia W/o Mv 96+ Hours W/o MccO (871) Sep�cemia W/o Mv 96+ Hours W MccO (293) Heart Failure & Shock W/o Cc/mccO (191) Chronic Obstruc�ve Pulmonary Disease W CcO (690) Kidney & Urinary Tract Infec�ons W/o MccO (57) Degenera�ve Nervous System Disorders W/o MccO (291) Heart Failure & Shock W MccOtherTotalO (194) Simple Pneumonia & Pleurisy W CcO (603) Celluli�s W/o MccO (690) Kidney & Urinary Tract Infec�ons W/o MccO (292) Heart Failure & Shock W CcO (195) Simple Pneumonia & Pleurisy W/o Cc/mccO (57) Degenera�ve Nervous System Disorders W/o MccO (190) Chronic Obstruc�ve Pulmonary Disease W MccO (293) Heart Failure & Shock W/o Cc/mcc

104916563614940394342

8821479

9885687257275443

7.0%6.2%4.4%4.3%4.1%3.3%2.7%2.6%2.9%2.8%

59.6%100.0%

7.9%6.8%5.5%5.8%4.6%2.2%4.3%3.5%

107918363614944444342

9031530

10589757257565446

7.0%5.9%5.4%4.1%4.0%3.2%2.9%2.9%2.8%2.7%

59.0%100.0%

7.8%6.6%5.5%5.3%4.2%4.1%4.0%3.4%

O (177) Respiratory Infec�ons & Inflamma�ons W MccO (641) Nutri�onal & Misc Metabolic Disorders W/o MccOtherTotal

3532

6711242

2.8%2.6%

54.0%100.0%

3534

7291352

2.6%2.5%

53.9%100.0%

109

Demand

Sources: 1. VSSC Trea�ng Specialty Cube 2. VHA Office of Community Care 4.13.V12.Northern



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

(292) HEART FAILURE & SHOCK W CC(57) DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC(291) HEART FAILURE & SHOCK W MCC(189) PULMONARY EDEMA & RESPIRATORY FAILURE(305) HYPERTENSION W/O MCC(287) CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH W/O MCC(603) CELLULITIS W/O MCC(560) AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W CC(392) ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC(561) AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W/O CC/MCCOtherTotal(871) SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC(291) HEART FAILURE & SHOCK W MCC(189) PULMONARY EDEMA & RESPIRATORY FAILURE(393) OTHER DIGESTIVE SYSTEM DIAGNOSES W MCC(682) RENAL FAILURE W MCC(208) RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT <=96 HOURS(378) G.I. HEMORRHAGE W CC(698) OTHER KIDNEY & URINARY TRACT DIAGNOSES W MCC

256122117104

767574676460

2,3873,402

241233

896968616056

7.5%3.6%3.4%3.1%2.2%2.2%2.2%2.0%1.9%1.8%

70.2%100.0%

9.4%9.1%3.5%2.7%2.7%2.4%2.3%2.2%

(834) ACUTE LEUKEMIA W/O MAJOR O.R. PROCEDURE W MCC(389) G.I. OBSTRUCTION W CCOtherTotal

5452

1,5712,554

2.1%2.0%

61.5%100.0%

. DRG FY18 BDOC % of Total BDOC



(292) HEART FAILURE & SHOCK W CC(57) DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC(291) HEART FAILURE & SHOCK W MCC(189) PULMONARY EDEMA & RESPIRATORY FAILURE(305) HYPERTENSION W/O MCC(287) CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH W/O MCC(603) CELLULITIS W/O MCC(560) AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W CC(392) ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC(561) AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W/O CC/MCCOtherTotal(871) SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC(291) HEART FAILURE & SHOCK W MCC(189) PULMONARY EDEMA & RESPIRATORY FAILURE(393) OTHER DIGESTIVE SYSTEM DIAGNOSES W MCC(682) RENAL FAILURE W MCC(208) RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT <=96 HOURS(378) G.I. HEMORRHAGE W CC(698) OTHER KIDNEY & URINARY TRACT DIAGNOSES W MCC

256122117104

767574676460

2,3873,402

241233

896968616056

7.5%3.6%3.4%3.1%2.2%2.2%2.2%2.0%1.9%1.8%

70.2%100.0%

9.4%9.1%3.5%2.7%2.7%2.4%2.3%2.2%

(834) ACUTE LEUKEMIA W/O MAJOR O.R. PROCEDURE W MCC(389) G.I. OBSTRUCTION W CCOtherTotal

5452

1,5712,554

2.1%2.0%

61.5%100.0%

Note: Enrollees enrolled in a market and received care at a facility outside of their market

110

Top DRGs for Surgery in FY18Demand




Id





……………

(V12) (585) Iron Mountain O (983) Extensive O.r. Procedure Unrelated To Principal Diagnosis W/o Cc/mccO (623) Skin Gra�s & Wound Debrid For Endoc, Nutrit & Metab Dis W CcO (821) Lymphoma & Leukemia W Major O.r. Procedure W CcO (981) Extensive O.r. Procedure Unrelated To Principal Diagnosis W MccTotal

14

44

22

63.6%

18.2%18.2%

100.0%

14544

27

51.9%18.5%14.8%14.8%

100.0%

Id





……………

(V12) (585) Iron Mountain O (983) Extensive O.r. Procedure Unrelated To Principal Diagnosis W/o Cc/mccO (623) Skin Gra�s & Wound Debrid For Endoc, Nutrit & Metab Dis W CcO (821) Lymphoma & Leukemia W Major O.r. Procedure W CcO (981) Extensive O.r. Procedure Unrelated To Principal Diagnosis W MccTotal

14

44

22

63.6%

18.2%18.2%

100.0%

14544

27

51.9%18.5%14.8%14.8%

100.0%

111

Demand




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



(470) MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCC(253) OTHER VASCULAR PROCEDURES W CC(271) OTHER MAJOR CARDIOVASCULAR PROCEDURES W CC(254) OTHER VASCULAR PROCEDURES W/O CC/MCC(330) MAJOR SMALL & LARGE BOWEL PROCEDURES W CC(988) NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS W CC(236) CORONARY BYPASS W/O CARDIAC CATH W/O MCC(853) INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W MCC(269) AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON W/O MCC(247) PERC CARDIOVASC PROC W DRUG-ELUTING STENT W/O MCCOtherTotal(329) MAJOR SMALL & LARGE BOWEL PROCEDURES W MCC(3) ECMO OR TRACH W MV >96 HRS OR PDX EXC FACE, MOUTH & NECK W MAJ O.R.(470) MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCC(330) MAJOR SMALL & LARGE BOWEL PROCEDURES W CC(25) CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES W MCC(233) CORONARY BYPASS W CARDIAC CATH W MCC(235) CORONARY BYPASS W/O CARDIAC CATH W MCC(853) INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W MCC

145133

8073725752504640

1,3352,083

202187161130

72717164

7.0%6.4%3.8%3.5%3.5%2.7%2.5%2.4%2.2%1.9%

64.1%100.0%

7.1%6.6%5.7%4.6%2.5%2.5%2.5%2.3%

(326) STOMACH, ESOPHAGEAL & DUODENAL PROC W MCC(4) TRACH W MV >96 HRS OR PDX EXC FACE, MOUTH & NECK W/O MAJ O.R.OtherTotal

6259

1,7582,837

2.2%2.1%

62.0%100.0%




(470) MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCC(253) OTHER VASCULAR PROCEDURES W CC(271) OTHER MAJOR CARDIOVASCULAR PROCEDURES W CC(254) OTHER VASCULAR PROCEDURES W/O CC/MCC(330) MAJOR SMALL & LARGE BOWEL PROCEDURES W CC(988) NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS W CC(236) CORONARY BYPASS W/O CARDIAC CATH W/O MCC(853) INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W MCC(269) AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON W/O MCC(247) PERC CARDIOVASC PROC W DRUG-ELUTING STENT W/O MCCOtherTotal(329) MAJOR SMALL & LARGE BOWEL PROCEDURES W MCC(3) ECMO OR TRACH W MV >96 HRS OR PDX EXC FACE, MOUTH & NECK W MAJ O.R.(470) MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCC(330) MAJOR SMALL & LARGE BOWEL PROCEDURES W CC(25) CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES W MCC(233) CORONARY BYPASS W CARDIAC CATH W MCC(235) CORONARY BYPASS W/O CARDIAC CATH W MCC(853) INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W MCC

145133

8073725752504640

1,3352,083

202187161130

72717164

7.0%6.4%3.8%3.5%3.5%2.7%2.5%2.4%2.2%1.9%

64.1%100.0%

7.1%6.6%5.7%4.6%2.5%2.5%2.5%2.3%

(326) STOMACH, ESOPHAGEAL & DUODENAL PROC W MCC(4) TRACH W MV >96 HRS OR PDX EXC FACE, MOUTH & NECK W/O MAJ O.R.OtherTotal

6259

1,7582,837

2.2%2.1%

62.0%100.0%

Note: Enrollees enrolled in a market and received care at a facility outside of their market

112

Mental Health BDOC – FY15-18Demand

Source: 1. VSSC Trea�ng Specialty Cube 2. Geocoded Enrollee File FY18Q4 4.4.V12.Northern#IMG



FY15-18 Average Mental Health Days of Care by County

113

Mental Health BDOC – FY15-18, cont.County FY18 BDOC FY15-18 AVG BDOC Majority Receiving Facility % BDOC Id

Alger, MIBaraga, MIChippewa, MIDelta, MIDickinson, MIGogebic, MIHoughton, MIIron, MILuce, MIMackinac, MIMarque�e, MIMenominee, MIOntonagon, MISchoolcra�, MIHouston, MNWinona, MNAdams, WIBuffalo, WIClark, WIFlorence, WI

37N/A

315050146218

5N/A

4633

225

N/A348

184

233

176

275685224228

87

8619

21421

172361313

2

(V09) (603) Louisville(V10) (515) Ba�le Creek(V10) (553) Detroit-Michigan(V12) (695) Milwaukee-Wisconsin(V12) (676) Tomah-Wisconsin(V12) (695) Milwaukee-Wisconsin(V12) (695) Milwaukee-Wisconsin(V12) (676) Tomah-Wisconsin(V01) (631) Central Western Massa…(V04) (542) Coatesville(V12) (695) Milwaukee-Wisconsin(V12) (676) Tomah-Wisconsin(V12) (607) Madison(V12) (676) Tomah-Wisconsin(V12) (607) Madison(V23) (618) Minneapolis-Minnesota(V12) (676) Tomah-Wisconsin(V12) (676) Tomah-Wisconsin(V12) (676) Tomah-Wisconsin(V08) (548) West Palm Beach

27.0%N/A

90.3%48.0%36.0%28.6%74.2%

100.0%60.0%

N/A34.8%

100.0%100.0%

44.0%N/A

86.8%72.2%

100.0%56.5%

100.0%

……………………………………………………

Demand

Source: 1. VSSC Trea�ng Specialty Cube 2. Geocoded Enrollee File FY18Q4 4.4.V12.Northern



114


Forest, WIIron, WIJackson, WIJuneau, WILa Crosse, WILanglade, WILincoln, WIMarathon, WIMarine�e, WIMenominee, WIMonroe, WIOconto, WIOneida, WIPortage, WIPrice, WITaylor, WITrempealeau, WIVernon, WIVilas, WIWaushara, WI

12

35116245N/A

3080

142N/A719

44142115

261

1411010

223

32104198

11227177

6818

193947

93

43681124

(V12) (607) Madison(V12) (695) Milwaukee-Wisconsin(V12) (676) Tomah-Wisconsin(V12) (676) Tomah-Wisconsin(V12) (676) Tomah-Wisconsin(V12) (607) Madison(V12) (607) Madison(V12) (676) Tomah-Wisconsin(V12) (695) Milwaukee-Wisconsin(V12) (607) Madison(V12) (676) Tomah-Wisconsin(V12) (607) Madison(V12) (695) Milwaukee-Wisconsin(V12) (676) Tomah-Wisconsin(V12) (607) Madison(V01) (405) White River Junc�on(V12) (676) Tomah-Wisconsin(V12) (676) Tomah-Wisconsin(V12) (695) Milwaukee-Wisconsin(V12) (676) Tomah-Wisconsin

100.0%100.0%100.0%

50.9%91.0%

N/A43.3%81.3%45.1%

N/A65.6%63.6%

100.0%71.4%86.7%

100.0%80.3%89.4%

100.0%100.0%

……………………………………………………

Demand




115


Wood, WITotal

282,485

382,336

(V12) (676) Tomah-Wisconsin 100.0%N/A

……

Demand




116

Demand




Top DRGs for Mental Health in FY184_8 DRG In Market

BDOCIn Market BDOC

% of TotalIn and Out ofMarket BDOC




O (884) Organic Disturbances & Mental Retarda�onN (885) PsychosesO (883) Disorders Of Personality & Impulse ControlTotalN (885) PsychosesN (882) Neuroses except depressiveO (880) Acute Adjustment Reac�on & Psychosocial Dysfunc�onN (881) Depressive neurosesO (884) Organic Disturbances & Mental Retarda�onO (883) Disorders Of Personality & Impulse ControlN (887) Other mental disorder diagnosesTotal

4417

768

711197

45291517

1014

64.7%25.0%10.3%

100.0%70.1%19.4%

4.4%2.9%1.5%1.7%

100.0%

5617

780

1052234

98371917

41461

70.0%21.3%

8.8%100.0%

72.0%16.0%

6.7%2.5%1.3%1.2%0.3%

100.0%

4_8 DRG In MarketBDOC






O (884) Organic Disturbances & Mental Retarda�onN (885) PsychosesO (883) Disorders Of Personality & Impulse ControlTotalN (885) PsychosesN (882) Neuroses except depressiveO (880) Acute Adjustment Reac�on & Psychosocial Dysfunc�onN (881) Depressive neurosesO (884) Organic Disturbances & Mental Retarda�onO (883) Disorders Of Personality & Impulse ControlN (887) Other mental disorder diagnosesTotal

4417

768

711197

45291517

1014

64.7%25.0%10.3%

100.0%70.1%19.4%

4.4%2.9%1.5%1.7%

100.0%

5617

780

1052234

98371917

41461

70.0%21.3%

8.8%100.0%

72.0%16.0%

6.7%2.5%1.3%1.2%0.3%

100.0%

117

Demand




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



(885) PSYCHOSES(884) ORGANIC DISTURBANCES & INTELLECTUAL DISABILITY(881) DEPRESSIVE NEUROSES(880) ACUTE ADJUSTMENT REACTION & PSYCHOSOCIAL DYSFUNCTION(882) NEUROSES EXCEPT DEPRESSIVE(883) DISORDERS OF PERSONALITY & IMPULSE CONTROLTotal(885) PSYCHOSES(882) NEUROSES EXCEPT DEPRESSIVE(881) DEPRESSIVE NEUROSESTotal

690120102

7058

71,047

30510

3318

65.9%11.5%

9.7%6.7%5.5%0.7%

100.0%95.9%

3.1%0.9%

100.0%




(885) PSYCHOSES(884) ORGANIC DISTURBANCES & INTELLECTUAL DISABILITY(881) DEPRESSIVE NEUROSES(880) ACUTE ADJUSTMENT REACTION & PSYCHOSOCIAL DYSFUNCTION(882) NEUROSES EXCEPT DEPRESSIVE(883) DISORDERS OF PERSONALITY & IMPULSE CONTROLTotal(885) PSYCHOSES(882) NEUROSES EXCEPT DEPRESSIVE(881) DEPRESSIVE NEUROSESTotal

690120102

7058

71,047

30510

3318

65.9%11.5%

9.7%6.7%5.5%0.7%

100.0%95.9%

3.1%0.9%

100.0%

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

118

Demand

Source: 1. Office of Community Care 4.17.V12.Northern.585



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

Vendor FY16 FY17 FY18

DLP MARQUETTE GENERAL HOSPITAL …BELLIN MEMORIAL HOSPITALASPIRUS WAUSAU HOSP INCST VINCENT HOSPITALST CLARES HOSP WESTON INCSACRED HEARTFROEDTERT MEMORIAL LUTHERANAll Other VendorsCommunity Total (ADC)

0.60.80.00.00.10.00.10.62.2

1.00.50.20.10.00.0

N/A0.62.5

2.00.80.30.30.20.20.21.05.0


DLP MARQUETTE GENERAL HOSPITAL L…BELLIN MEMORIAL HOSPITALASPIRUS WAUSAU HOSP INCSACRED HEARTDICKINSON COUNTY HEALTHCAREFROEDTERT MEMORIAL LUTHERANAll Other VendorsCommunity Total (ADC)

1.20.50.00.20.40.10.73.1

1.30.40.10.30.40.11.33.9

1.40.60.30.30.20.21.14.2

Vendor FY16 FY17 FY18 .

BEHAVIORAL HEALTH CENTERCHIPPEWA COUNTY WAR MEM HOSP I…DLP MARQUETTE GENERAL HOSPITAL …SACRED HEARTMARQUETTE GENERAL HOSPITALAll Other VendorsCommunity Total (ADC)

0.00.10.20.1

N/A0.00.4

0.10.00.30.10.00.00.7

0.30.10.10.1

N/AN/A0.7

1234567

119

Demand

Source: 1. Office of Community Care 4.17.V12.Northern.676


VISN 12: Northern Market – Tomah-Wisconsin

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


MCHS HOSPITALS INCWAUSAU HOSPITALGUNDERSEN LUTHERAN MED CTR INCAll Other VendorsCommunity Total (ADC)

N/A0.10.50.61.2

0.00.20.70.61.5

0.20.41.40.62.6


MCHS HOSPITALS INCMCHS FRANCISCAN MED CTR INCWAUSAU HOSPITALGUNDERSEN LUTHERAN MED CTR INCAll Other VendorsCommunity Total (ADC)

N/A0.20.31.40.72.6

N/A0.30.21.50.72.7

0.20.30.41.10.52.5

Vendor FY16 FY17 FY18 .

MCHS FRANCISCAN MED CTR INCST JOSEPHS HOSPST MICHAELS HOSPGUNDERSEN LUTHERAN MED CTR INCLUTHER HOSPITALAll Other VendorsCommunity Total (ADC)

N/AN/A0.00.0

N/AN/A0.1

0.00.10.00.1

N/A0.00.2

N/AN/A0.00.0

N/AN/A0.0

1234567

120

NVCC FY16-18 – Inpatient BDOCDemand




Medicine Mental HealthSurgerySector/ County Name

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


Alger, MIBaraga, MIChippewa, MIDelta, MIDickinson, MIGogebic, MIHoughton, MIIron, MIKeweenaw, MILuce, MIMackinac, MIMarque�e, MIMenominee, MIOntonagon, MISchoolcra�, MISector SubtotalFlorence, WIForest, WIIron, WILanglade, WI

467367

1,4652,0601,625

9011,340

764121223422

2,8851,168

496454

14,758305505365941

105

35122176

206154

55

20173

361413

74939581421

72286

151162

19717212

N/A7

17480

722

8921532

747

168

7964

186N/A104

5119

419

259762311

91929701531

92

1156

1471627

562

12159

381321

524337024

6

75320

127121

246443

62740

1223956

N/A749

813

530

458164

228138

43182

55121225

290571556

1,30345691038

N/A2

18N/A

4N/A

317

N/AN/AN/A

73N/AN/AN/A117N/AN/AN/AN/A

N/AN/A

3045

N/AN/A

2014

N/AN/AN/A

63N/AN/A

2174N/A

7N/AN/A

1312

1549610

414

N/AN/AN/AN/A

7N/AN/AN/A310N/AN/AN/AN/A

12-h-9-D12-h-9-D12-h-9-D12-h-9-D12-h-9-D12-h-9-E

Marine�e, WIOconto, WIOneida, WIVilas, WISector SubtotalAdams, WI

2,3981,5471,7301,0898,880

719

123545219

38025

189746898

53025

19147

139113635

58

110804829

4007

181654035

37727

12748

14260

5396

8N/A

18N/A

26N/A

1N/A

271449

N/A

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

121

NVCC FY16-18 – Inpatient BDOC, cont.Demand

Source: VHA Office of Community Care 4.12.V12.Northern#2



Medicine Mental HealthSurgerySector/ County Name

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

12-h-9-E12-h-9-E12-h-9-E12-h-9-E12-h-9-E12-h-9-E12-h-9-E12-h-9-E12-h-9-E12-h-9-E12-h-9-F12-h-9-F12-h-9-F12-h-9-F12-h-9-F12-h-9-F12-h-9-F12-h-9-F12-h-9-FMarket Total

Buffalo, WIHouston, MNJackson, WIJuneau, WILa Crosse, WIMonroe, WITrempealeau, WIVernon, WIWinona, MNSector SubtotalClark, WILincoln, WIMarathon, WIPortage, WIPrice, WITaylor, WIWaushara, WIWood, WISector SubtotalMarket Total

544798899

1,3804,1683,4451,0701,0871,272

15,3821,0901,4073,7322,068

662548972

3,38113,86052,880

6164347

113370

108

62700

1358

10828

22

2089

3202,149

18395520

153335

183033

7265

879332

77

17102350

2,498

N/A9

6153

147187

462235

6181764

13537

N/A5

14110382

2,554

25N/A

142999

112261227

351641515

513

31554

1841,459

297

196855

1692

2427

4273229

1051013101767

2831,836

N/A108

5234

226115

1934

8602

4733

15011

2226959

3932,837

33

N/AN/AN/A

32

N/AN/A

11N/AN/AN/A

22

N/AN/A

711

165

N/AN/AN/AN/A

757

1N/A

1176

N/A729

N/AN/AN/A

220

319

N/AN/A

2N/AN/A

4N/AN/A

28

N/AN/AN/AN/AN/AN/AN/AN/AN/A318

122

Demand




NVCC FY16-18 – Inpatient Utilization PatternsFY16-18 Med/Surg Bed Days of Care FY16-18 Mental Health Bed Days of Care

123

Nursing Home BDOC DistributionDemand

4.7.V12.Northern#IMG

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



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

FY15-18 Average BDOC by County

124

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

Alger, MIBaraga, MIChippewa, MIDelta, MIDickinson, MIGogebic, MIHoughton, MIIron, MIKeweenaw, MILuce, MIMackinac, MIMarque�e, MIMenominee, MIOntonagon, MISchoolcra�, MIHouston, MNWinona, MNAdams, WIBuffalo, WIClark, WI

28

498442

90373520

1,664208

44928

497374412

18539

3731,737

783166

1,3934,113

67270

1,097

59846603

30

297238760133391

10631

5641,8354,203

440790

2,761208

0508874

1,100404412315777760506

2,128

15401541154215431544154515461547154815491550155115521553155415551556155715581559

Demand

Source: 1. VSSC Trea�ng Specialty Cube 2. VSSC NVCC Cube 3. Defini�ve HC 4.7.V12.Northern

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



Nursing Home BDOC Distribu�on, cont.

N/A

N/A N/AN/A

N/A

N/A

125


Florence, WIForest, WIIron, WIJackson, WIJuneau, WILa Crosse, WILanglade, WILincoln, WIMarathon, WIMarine�e, WIMenominee, WIMonroe, WIOconto, WIOneida, WIPortage, WIPrice, WITaylor, WITrempealeau, WIVernon, WIVilas, WI

93236

230

1,533262

834,0181,864

2130

248154157

42552

369302

642426

527825

1,913200224259

2,471

38,5761,165

4169811

128213170244

6421,358

36529855

3,446462307

4,2774,335

2138,606

1,413570255

11553265539546

15601561156215631564156515661567156815691570157115721573157415751576157715781579

Demand

Source: 1. VSSC Trea�ng Specialty Cube 2. VSSC NVCC Cube 3. Defini�ve HC 4.7.V12.Northern#2





N/A

N/A

N/A

N/A

126


Waushara, WIWood, WITotal

236327

19,331

98742

59,818

3341,069

79,149

158015811582

Demand

Source: 1. VSSC Trea�ng Specialty Cube 2. VSSC NVCC Cube 3. Defini�ve HC 4.7.V12.Northern#3





127

FY10-18 Long Stay BDOC vs. Short Stay BDOC

0

10,000

20,000

30,000

40,000

Bed

Days

of C

are

FY10 FY11 FY12 FY13 FY14 FY15 FY16 FY17 FY18

47,077 36,14947,350

32,122

42,52642,38735,958

42,427

39,621

25,722 23,67028,125

14,775

24,234

22,41627,738

18,344

25,403

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 31 27 0 0 0 0 0 18 0.0%40-54 3,187 2,301 2,751 3,144 3,208 1,765 814 456 746 -76.6%55-64 11,791 12,251 7,734 7,620 8,702 6,702 5,163 3,859 4,491 -61.9%65-79 18,024 17,304 17,609 17,872 17,676 20,858 20,684 20,889 24,194 34.2%80+ 14,061 15,338 14,291 13,643 12,940 10,296 9,296 6,918 6,700 -52.4%

Total Long 47,077 47,350 42,427 42,387 42,526 39,621 35,958 32,122 36,149 -23.2%Short < 40 27 12 308 131 311 44 15 22 160 492.6%

40-54 1,564 1,824 1,716 1,838 1,431 1,914 403 403 721 -53.9%55-64 5,917 5,423 7,344 7,586 6,809 3,845 1,933 2,801 3,278 -44.6%65-79 9,086 8,742 9,217 8,788 8,815 9,220 7,392 9,791 11,273 24.1%80+ 9,009 7,727 8,701 8,639 7,435 7,280 4,984 5,212 8,025 -10.9%

Total Short 25,722 24,234 27,738 28,125 25,403 22,416 14,775 18,344 23,670 -8.0%

111112333334

Demand




In-House LTSS Short Stays vs. Long Stays BDOC

128

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

(V12) (585) Iron Mountain(V12) (676) Tomah-WisconsinTotal

40180220

40145185

37.9132.3170.2

25.821.947.7

Demand

Source: 1. VSSC Beds Using PTF Cube 2. VSSC NVCC Cube 3. Defini�ve Healthcare 4.9.V12.Northern



Community Nursing Home vs. In-House BDOC

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

(V12) (585) Iron Mountain(V12) (676) Tomah-Wisconsin

300328

256.0268.0

85.6%82.8%

2944

……

*Poten�al Available Beds is defined as Opera�ng Beds less ADC based on a 95% occupancy

**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

VA (In-House)

Community Sta�s�cs***

129

Residential Rehab BDOCDemand




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

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

130

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

Monroe, WILa Crosse, WIWood, WIDickinson, MIMenominee, MIPortage, WIMarque�e, MIJuneau, WIMarine�e, WIMarathon, WI

4,4881,560

743187212362610158344437

4,0821,106

433263

4335414

32360441

5,7921,348

408244

44439764191

1,007801

5,977805651536475449436325312307

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) 4.10.V12.Northern



Residen�al Rehab BDOC, cont.

131

Demand

Source: VSSC OR Produc�vity Cube 4.11.V12.Northern.585



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

(V12) (585) Iron Mountain Inpa�ent

Outpa�ent

Total

GENERAL SURGERYORTHOPEDICSPODIATRYUROLOGYInpa�ent TotalGENERAL SURGERYOPHTHALMOLOGYORTHOPEDICSPODIATRYUROLOGYOutpa�ent Total

1N/A

214

114

214

549498

1N/A

57

137237

15330

339631644

N/A156

1271

N/A6524

299459471

N/AN/A

64

1040

N/A7812

150280290

-100.0%N/A

200.0%300.0%150.0%263.6%

-100.0%271.4%200.0%177.8%197.9%195.9%

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

(V12) (585) Iron Mountain Inpa�ent

Outpa�ent

Total

GENERAL SURGERYORTHOPEDICSPODIATRYUROLOGYInpa�ent TotalGENERAL SURGERYOPHTHALMOLOGYORTHOPEDICSPODIATRYUROLOGYOutpa�ent Total

1N/A

214

114

214

549498

1N/A

57

137237

15330

339631644

N/A156

1271

N/A6524

299459471

N/AN/A

64

1040

N/A7812

150280290

-100.0%N/A

200.0%300.0%150.0%263.6%

-100.0%271.4%200.0%177.8%197.9%195.9%

Surgical Cases FY15-18 – Iron Mountain

Facility Total

132

Demand Es�mated Future Market Demand — Inpa�ent

133

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* 74 78 71

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 62.7 66.3 60.7

0

5,000

10,000

Tota

l BDO

C (In

-Hou

se +

Com

mun

ity)

Med Surg Psych

2017 2022 2027

BY17 Market U�liza�on Projec�ons (Acute Inpa�ent) — Northern Market

Citc

Med Surg Psych Med Surg Psych Med Surg Psych

In-House BDOCCommunity BDOC

Total BDOCADC By HSPG

8,0523,532

11,58432.0

3,4213,4326,853

18.8

3,876577

4,45312.0

8,6053,793

12,39834.0

3,7763,8247,600

20.8

3,675544

4,21912.0

7,9733,521

11,49431.0

3,4783,5186,996

19.2

3,190471

3,66110.0

Demand




10.9%

Note: Percent changes are for 5 and 10 years

2.1% -17.8%-5.3%7.0% -0.8%

BY17 VISN 12 Northern Market U�liza�on Projec�ons BDOC

FY17

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

134

0

20,000

40,000

60,000

80,000

100,000

Tota

l BDO

C (In

-Hou

se +

Com

mun

ity)

Blind Rehab LTSS Res. Rehab SCI

2017 2022 2027

*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) — Northern MarketDemand




FY17 FY22 FY27


34.7% 47.4%

Citc Total Bed FY17 Total Bed FY22 Total Bed FY27


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

Total ADC 255.9 264.7 267.3

Citc

BlindRehab

LTSS ResRehab

SCI BlindRehab

LTSS ResRehab

SCI BlindRehab

LTSS ResRehab

SCI

ADC By HSPGTotal BDOC

Community BDOCIn-House BDOC

0.7268

0268

215.778,71616,77861,938

36.313,235

013,235

3.21,181

01,181

1.0361

0361

227.983,17621,54361,633

32.711,941

011,941

3.11,131

01,131

1.1395

0395

235.285,84325,01660,827

28.210,295

010,295

2.81,036

01,036

5.7% -9.8% -4.2% -12.3%-22.2%9.1%

BY17 VISN 12 Northern Market U�liza�on Projec�ons BDOC

135

BY17 Parent Facility Utilization Projections (Acute Inpatient) — Iron Mountain VAMCDemand




136

BY17 Parent Facility Utilization Projections (Acute Inpatient) — Tomah-Wisconsin VAMCDemand




137

0

5,000

10,000

15,000

20,000

25,000

Tota

l BDO

C (In

-Hou

se +

Com

mun

ity)


2017 2022 2027

*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) — Iron Mountain VAMCDemand





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


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

Total ADC 54.9 61.0 64.8

Measure BlindRehab

LTSS ResRehab

SCI BlindRehab

LTSS ResRehab

SCI BlindRehab

LTSS ResRehab

SCI .



N/AN/AN/AN/A

12,9247,132

20,05654.9

N/AN/AN/AN/A

N/AN/AN/AN/A

N/AN/AN/AN/A

12,9509,329

22,28061.0

N/AN/AN/AN/A

N/AN/AN/AN/A

N/AN/AN/AN/A

12,79210,85923,651

64.8

N/AN/AN/AN/A

N/AN/AN/AN/A

1234

11.1% 17.9%

BY17 Iron Mountain VAMC U�liza�on Projec�ons BDOC

FY17 FY22 FY27

138

0

20,000

40,000

60,000

Tota

l BDO

C (In

-Hou

se +

Com

mun

ity)


2017 2022 2027

*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) — Tomah-Wisconsin VAMCDemand





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


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

Total ADC 191.2 192.1 191.2

Measure BlindRehab

LTSS ResRehab

SCI BlindRehab

LTSS ResRehab

SCI BlindRehab

LTSS ResRehab

SCI .



N/AN/AN/AN/A

49,2848,057

57,341157.1

12,462N/A

12,46234.1

N/AN/AN/AN/A

N/AN/AN/AN/A

49,04710,12959,176

162.1

10,928N/A

10,92829.9

N/AN/AN/AN/A

N/AN/AN/AN/A

48,50011,83060,329

165.3

9,466N/A

9,46625.9

N/AN/AN/AN/A

1234

3.2% -12.3% -24.0%5.2%

BY17 Tomah-Wisconsin VAMC U�liza�on Projec�ons BDOC

FY17 FY22 FY27

139

Growth Projec�ons (#,%)Total Inpa�ent Bed Days of Care (BDOC)

• Overview:

ü Commercial market inpa�ent demand

es�mates were developed to understand

current and future expected inpa�ent

demand trends for non-Veteran

popula�ons

ü Demand es�mates are based on non-

Veteran pa�ent origin within a 60

minute drive �me from parent VA

Medical Center/ Health Care Center

noted

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

General MedicineNephrologyNeurologyRheumatologyHematologyGastroenterologyDermatologyOncology MedicalPulmonaryCardiologyHIVEndocrineMedicine Sub-TotalNeurosurgeryOrthopedicsOpen HeartGeneral SurgeryOphthalmologyTraumaVascular Surgery

4,1471,7342,652

111369

2,711662949

3,6584,658

13685

22,349451

3,884914

3,85125

229490

4,5911,8242,720

104363

2,597620905

3,3914,190

11510

21,826437

3,468870

3,72424

214454

4,9371,8972,765

95355

2,561613873

3,0983,726

10445

21,375422

3,014841

3,64923

198427

4449068-7-6

-114-42-44

-267-468

-2-175-523

-14-416

-44-127

-1-15-36

10.7%5.2%2.6%

-6.3%-1.6%-4.2%-6.3%-4.6%-7.3%

-10.0%-15.4%-25.5%

-2.3%-3.1%

-10.7%-4.8%-3.3%-4.0%-6.6%-7.3%

790163113-16-14

-150-49-76

-560-932

-3-240-974

-29-870

-73-202

-2-31-63

19.0%9.4%4.3%

-14.4%-3.8%-5.5%-7.4%-8.0%

-15.3%-20.0%-23.1%-35.0%

-4.4%-6.4%

-22.4%-8.0%-5.2%-8.0%

-13.5%-12.9%

123456789

1011121314151617181920

Thoracic SurgeryDen�stryUrologyOtolaryngologySurgery Sub-TotalMedicine/Surgery TotalOB/DeliveryOther OBGynecologyWomen's Health TotalPsych/Drug AbuseMental Health TotalAcute RehabRehab TotalOther TotalGrand Total

1,10625

432136

11,54333,892

1,503104124

1,7313,2193,219

5959

338,904

1,04222

38798

10,74032,566

1,4449782

1,6233,4033,403

4141

337,636

98019

37580

10,02831,403

1,4039267

1,5623,5473,547

2828

336,543

-64-3

-45-38

-803-1,326

-59-7

-42-108184184-18-18

0-1,268

-5.8%-12.0%-10.4%-27.9%

-7.0%-3.9%-3.9%-6.7%

-33.9%-6.2%5.7%5.7%

-30.5%-30.5%

0.0%-3.3%

-126-6

-57-56

-1,515-2,489

-100-12-57

-169328328-31-31

0-2,361

-11.4%-24.0%-13.2%-41.2%-13.1%

-7.3%-6.7%

-11.5%-46.0%

-9.8%10.2%10.2%

-52.5%-52.5%

0.0%-6.1%

21222324252627282930313233343536

Demand



5.5.V12.Northern.585Source: IBM Market Expert

Overall Inpa�ent Commercial Demand – Iron Mountain Area


Growth Projec�ons (#,%)Total Inpa�ent Bed Days of Care (BDOC)

• Overview:

ü Commercial market inpa�ent demand

es�mates were developed to understand

current and future expected inpa�ent

demand trends for non-Veteran

popula�ons

ü Demand es�mates are based on non-

Veteran pa�ent origin within a 60

minute drive �me from parent VA

Medical Center/ Health Care Center

noted

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

General MedicineNephrologyRheumatologyNeurologyDermatologyHematologyGastroenterologyOncology MedicalPulmonaryCardiologyHIVEndocrineMedicine Sub-TotalOrthopedicsNeurosurgeryOpen HeartVascular SurgeryGeneral SurgeryOphthalmologyTrauma

10,3223,498

3096,9361,786

9837,8642,895

10,76911,298

492,023

58,73211,979

1,4282,5701,319

12,46273

1,089

11,6233,770

3007,3341,785

9507,6692,853

10,24310,498

441,625

58,69410,924

1,4042,4791,257

12,19569

1,040

12,7284,005

2847,6751,837

9167,6832,8419,5869,566

411,489

58,6519,6991,3792,4271,208

12,19466

988

1,301272

-9398

-1-33

-195-42

-526-800

-5-398

-38-1,055

-24-91-62

-267-4

-49

12.6%7.8%

-2.9%5.7%

-0.1%-3.4%-2.5%-1.5%-4.9%-7.1%

-10.2%-19.7%

-0.1%-8.8%-1.7%-3.5%-4.7%-2.1%-5.5%-4.5%

2,406507-25739

51-67

-181-54

-1,183-1,732

-8-534

-81-2,280

-49-143-111-268

-7-101

23.3%14.5%-8.1%10.7%

2.9%-6.8%-2.3%-1.9%

-11.0%-15.3%-16.3%-26.4%

-0.1%-19.0%

-3.4%-5.6%-8.4%-2.2%-9.6%-9.3%

123456789

1011121314151617181920

Thoracic SurgeryDen�stryUrologyOtolaryngologySurgery Sub-TotalMedicine/Surgery TotalOB/DeliveryOther OBGynecologyWomen's Health TotalPsych/Drug AbuseMental Health TotalAcute RehabRehab TotalOther TotalGrand Total

2,69077

1,216418

35,32194,053

7,364470357

8,19112,51912,519

4646

0114,809

2,54170

1,093324

33,39692,090

7,109440247

7,79613,61213,612

3131

0113,529

2,40462

1,069273

31,76990,420

7,024428210

7,66214,78414,784

2121

0112,887

-149-7

-123-94

-1,925-1,963

-255-30

-110-395

1,0931,093

-15-15

0-1,280

-5.5%-9.1%

-10.1%-22.5%

-5.5%-2.1%-3.5%-6.4%

-30.8%-4.8%8.7%8.7%

-32.6%-32.6%

0.0%-1.1%

-286-15

-147-145

-3,552-3,633

-340-42

-147-529

2,2652,265

-25-25

0-1,922

-10.6%-19.5%-12.1%-34.7%-10.1%

-3.9%-4.6%-8.9%

-41.2%-6.5%18.1%18.1%

-54.3%-54.3%

0.0%-1.7%

21222324252627282930313233343536

Demand



5.5.V12.Northern.676Source: IBM Market Expert

Overall Inpa�ent Commercial Demand – Tomah-Wisconsin Area


Supply Es�mated Current Total VA Market Supply

142

0

50

100

150

200

250

300

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

51

12

216

3651

10

235

2827

80

220

11

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 6.1.V12.Northern



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

2027 — FY18 VAMC Beds•

143

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

6.2.V12.Northern

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



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

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

144

Ambulatory Surgical (HSPCs)

0K

5K

10K

15K

20K

25K

30K

35K

RVU

s

NeurologicalSurgery

Obstetrics &Gynecology

Ophthalmology OrthopaedicSurgery

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


Supply

6.3.V12.Northern




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

145

Ambulatory Rehab (HSPCs)

0.0M

0.5M

1.0M

1.5M

2.0M

2.5M

RVU

s

Audiology Kinesiotherapy Occupa�onal Therapy Physical Therapy Recrea�on Therapy Speech Language Pathology


Supply

6.4.V12.Northern




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

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

146

Physician Efficiency — Iron Mountain VAMCSupply

Source: 1. VSSC SPARQ Report 2. VSSC Physician Produc�vity Cube 3. VSSC MPCR3 Cube 6.5.V12.Northern.585



Id

Specialty SPARQ Quadrant2016

SPARQ Quadrant2017

SPARQ Quadrant2018

2016 MDFTEs

2017 MDFTEs

2018 MDFTEs

2016 APPFTEs

2017 APPFTEs

2018 APPFTEs

20252026202720282029203020312032203320342035203620372038203920402041204220432044

AnesthesiaAnesthesiologyCardiologyChiropractyCri�cal Care / Pulmonary DiseaseDermatologyEmergency MedicineEndocrinologyGastroenterologyGeriatric MedicineHematology-OncologyInfec�ous DiseaseInternal MedicineNephrologyNeurologyOptometryOrthopaedic SurgeryOtolaryngologyPain MedicinePathology

N/AN/A

3 - Inefficient2 - Under Resourced

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

1 - Op�mized Prac�ceN/A

1 - Op�mized Prac�ce2 - Under Resourced2 - Under Resourced


4 - Over ResourcedN/AN/A

N/AN/AN/A

3 - InefficientN/AN/AN/AN/AN/AN/A


4 - Over ResourcedN/A

2 - Under ResourcedN/AN/A


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




N/A0.9

N/A0.8

N/AN/A0.1

N/AN/AN/A0.7

N/A9.10.10.81.8

N/A0.2

N/AN/A

N/A0.9

N/A0.8

N/AN/A1.3

N/AN/AN/A0.9

N/A10.9N/A0.82.0

N/A0.2

N/AN/A

N/A0.9

N/A1.7

N/AN/A1.6

N/AN/AN/A0.8

N/A8.8

N/A0.82.0

N/A0.2

N/AN/A

N/A0.41.60.00.10.26.40.70.03.40.00.0

42.60.11.20.31.40.50.40.1

0.10.72.0

N/A0.10.13.50.50.03.20.00.0

43.10.10.80.61.40.70.4

N/A

0.00.92.2

N/A0.10.13.00.60.03.00.00.0

49.90.10.80.31.30.50.60.0

147

Physician Efficiency — Iron Mountain VAMC, cont.Supply

Source: 1. VSSC SPARQ Report 2. VSSC Physician Produc�vity Cube 3. VSSC MPCR3 Cube 6.5.V12.Northern.585#2



Id


SPARQ Quadrant2017

SPARQ Quadrant2018

2016 MDFTEs

2017 MDFTEs

2018 MDFTEs

2016 APPFTEs

2017 APPFTEs

2018 APPFTEs

204520462047204820492050205120522053205420552056

Physical Medicine & Rehabilita�onPodiatryPrimary CarePsychiatryPsychiatry/PsychologyPsychologyRadiologyRheumatologySurgeryUrologyVascular SurgeryTotal

N/A1 - Op�mized Prac�ce1 - Op�mized Prac�ce

2 - Under ResourcedN/A


2 - Under Resourced1 - Op�mized Prac�ce

N/AN/A

N/A1 - Op�mized Prac�ce1 - Op�mized Prac�ce

2 - Under ResourcedN/A

3 - InefficientN/AN/A

1 - Op�mized Prac�ceN/AN/AN/A

N/AN/A

1 - Op�mized Prac�ce2 - Under Resourced

N/A2 - Under Resourced

N/AN/A

2 - Under ResourcedN/AN/AN/A

N/A0.8

N/A1.6

N/A9.7

N/AN/A1.60.6

N/A28.8

N/A0.9

N/A2.1

N/A9.7

N/AN/A1.50.6

N/A32.8

N/A0.9

N/A1.9

N/A6.8

N/AN/A1.3

N/AN/A27.6

1.00.0

N/AN/A6.60.30.10.11.40.00.0

68.9

0.7N/AN/AN/A6.90.3

N/A0.01.5

N/AN/A66.6

1.20.0

N/AN/A4.40.20.00.01.5

N/AN/A70.9

148

Physician Efficiency — Tomah-Wisconsin VAMCSupply

Source: 1. VSSC SPARQ Report 2. VSSC Physician Produc�vity Cube 3. VSSC MPCR3 Cube 6.5.V12.Northern.676



Id


SPARQ Quadrant2017

SPARQ Quadrant2018

2016 MDFTEs

2017 MDFTEs

2018 MDFTEs

2016 APPFTEs

2017 APPFTEs

2018 APPFTEs

41774178417941804181418241834184418541864187418841894190419141924193419441954196

AnesthesiologyCardiologyChiropractyCri�cal Care / Pulmonary DiseaseDermatologyEmergency MedicineEndocrinologyGeriatric MedicineHematology-OncologyInfec�ous DiseaseInternal MedicineNephrologyNeurologyOptometryOrthopaedic SurgeryPain MedicinePathologyPhysical Medicine & Rehabilita�onPodiatryPrimary Care

N/A1 - Op�mized Prac�ce

3 - InefficientN/AN/AN/AN/AN/AN/AN/A


4 - Over Resourced2 - Under Resourced

N/AN/AN/A

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

N/A4 - Over Resourced

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

4 - Over Resourced3 - Inefficient


N/AN/AN/AN/AN/A

1 - Op�mized Prac�ce

N/AN/AN/AN/A

2 - Under ResourcedN/AN/AN/AN/AN/A



N/AN/AN/A


1 - Op�mized Prac�ce

N/A0.00.9

N/AN/AN/AN/A0.4

N/AN/A12.5N/A0.92.7

N/AN/AN/A0.00.8

N/A

N/AN/A0.8

N/AN/AN/AN/A0.8

N/AN/A13.1

0.70.83.2

N/AN/AN/AN/A0.7

N/A

N/AN/A0.9

N/A0.5

N/AN/AN/AN/AN/A12.9N/A0.53.2

N/AN/AN/A0.10.7

N/A

N/A0.10.10.11.15.7

N/A6.10.00.0

45.80.00.00.1

N/AN/A0.00.6

N/AN/A

N/A0.10.20.10.96.80.03.70.00.1

51.40.00.00.10.0

N/A0.00.40.0

N/A

0.00.00.30.00.86.10.04.40.10.1

48.20.00.00.00.00.00.00.1

N/AN/A

149

Physician Efficiency — Tomah-Wisconsin VAMC, cont.Supply

Source: 1. VSSC SPARQ Report 2. VSSC Physician Produc�vity Cube 3. VSSC MPCR3 Cube 6.5.V12.Northern.676#2



Id


SPARQ Quadrant2017

SPARQ Quadrant2018

2016 MDFTEs

2017 MDFTEs

2018 MDFTEs

2016 APPFTEs

2017 APPFTEs

2018 APPFTEs

4197419841994200420142024203

PsychiatryPsychiatry/PsychologyPsychologyRadiologyRheumatologySurgeryTotal


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





5.5N/A8.2

N/AN/AN/A32.0

4.3N/A9.7

N/AN/AN/A34.1

7.5N/A10.0N/AN/AN/A36.5

N/A17.1

0.9N/A0.00.5

78.1

N/A14.4

0.70.00.00.0

78.8

N/A11.3

0.90.00.00.0

72.7

150

Poten�al Physician Addi�onal Capacity — Iron Mountain VAMCSupply

Source: OPES Physician Capacity Reports 6.6.V12.Northern.585

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



Physician Specialty Poten�al Addi�onal RVU Capacity Id

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

--

729-------

3,139---------

20172018201920202021202220232024202520262027202820292030203120322033203420352036

151

Poten�al Physician Addi�onal Capacity — Iron Mountain VAMC, cont.Supply

Source: OPES Physician Capacity Reports 6.6.V12.Northern.585#2





PathologyPhysical Medicine & Rehabilita�onPlas�c SurgeryPodiatryPsychiatryPsychologyRadiologyRheumatologySurgeryThoracic SurgeryUrologyVascular Surgery

----------

110-

203720382039204020412042204320442045204620472048

152

Poten�al Physician Addi�onal Capacity — Tomah-Wisconsin VAMCSupply

Source: OPES Physician Capacity Reports 6.6.V12.Northern.676





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

--

93-

235--------

993------

40654066406740684069407040714072407340744075407640774078407940804081408240834084

153

Poten�al Physician Addi�onal Capacity — Tomah-Wisconsin VAMC, cont.Supply

Source: OPES Physician Capacity Reports 6.6.V12.Northern.676#2





PathologyPhysical Medicine & Rehabilita�onPlas�c SurgeryPodiatryPsychiatryPsychologyRadiologyRheumatologySurgeryThoracic SurgeryUrologyVascular Surgery

-426

--

9,8032,481

------

408540864087408840894090409140924093409440954096

154

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

(V12) (585) Iron Mountain(V12) (585GA) Hancock(V12) (585GB) Rhinelander(V12) (585GC) Menominee(V12) (585GD) Ironwood(V12) (585HA) Marque�e(V12) (585HB) Sault Saint Marie

4.91.50.30.01.30.80.0

8.00.00.00.00.00.40.0

1.60.00.00.00.00.00.0

4.40.90.70.80.01.40.5

19.02.41.10.81.32.60.5

FY18 Iron Mountain VAMC & CBOC Physicians by Outpa�ent Clinical Category

Physicians by Outpa�ent Clinical CategorySupply

Source: VSSC Physician Produc�vity Cube 6.7.V12.Northern.585

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



155

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

(V12) (676) Tomah-Wisconsin(V12) (676GA) Wausau(V12) (676GC) River Valley(V12) (676GD) Wisconsin Rapids

9.10.61.51.7

4.10.00.31.6

0.00.00.00.0

12.70.83.10.9

25.91.44.94.2

FY18 Tomah-Wisconsin VAMC & CBOC Physicians by Outpa�ent Clinical Category

Physicians by Outpa�ent Clinical CategorySupply

Source: VSSC Physician Produc�vity Cube 6.7.V12.Northern.676

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



156

Occupa�on FY18 FY19* DisplayOrd…

0083 Police0102 Social Science Aid and Technician0180 Psychology0185 Social Work0203 Human Resources Assistance0301 Miscellaneous Administra�on and Program0303 Miscellaneous Clerk and Assistant0318 Secretary0340 Program Management & 0344 Management and …0341 Administra�ve Officer0343 Management and Program Analysis0544 Civilian Pay0601 General Health Science0602 Medical Officer0603 Physician's Assistant0610 Nurse0620 Prac�cal Nurse0621 Nursing Assistant0630 Die��an and Nutri�onist0633 Physical Therapist

2.02.02.04.01.01.01.01.0

N/AN/A1.0

N/A1.06.70.65.11.00.51.0

N/A

2.0N/A3.65.0

N/AN/AN/A1.01.01.0

N/A1.0

N/A6.7

N/A9.11.02.0

N/A1.0

123456789

1011121314151617181920

0644 Medical Technologist0649 Medical Instrument Technician0660 Pharmacist0671 Health System Specialist0675 Medical Records Technician

4.01.01.01.0

N/A

N/AN/AN/AN/A1.0

2122232425

Vacant Posi�onsSupply

Source: VHA Office of Workforce Management 6.8.V12.Northern.585

*FY19 vacant posi�ons as of March 2019



Iron Mountain VAMC Open FTE Posi�ons

157


0679 Medical Support Assistance0680 Dental Officer1601 General Facili�es and Equipment3566 Custodial Worker4204Pipefi�ng4749 Maintenance Mechanic5703 Motor Vehicle OperatorGrand Total

3.01.0

N/A1.0

N/AN/A1.0

43.9

2.01.01.0

N/A1.01.0

N/A41.4

2627282930313233

Vacant Posi�ons, cont.Supply

Source: VHA Office of Workforce Management 6.8.V12.Northern.585#2




Iron Mountain VAMC Open FTE Posi�ons

158


0060 Chaplain0081Fire Protec�on And Preven�on0083 Police0101 Social Science0102 Social Science Aid and Technician0180 Psychology0181 Psychology Aid and Technician0185 Social Work0186Social Services Aid And Assistant0187Social Services0189Recrea�on Aid And Assistant0203 Human Resources Assistance0301 Miscellaneous Administra�on and Program0303 Miscellaneous Clerk and Assistant0305 Mail and File0318 Secretary0341 Administra�ve Officer0343 Management and Program Analysis0544 Civilian Pay0601 General Health Science

1.0N/A1.06.02.58.50.79.5

N/AN/AN/A2.03.07.01.01.01.01.01.02.0

N/A3.61.03.01.09.5

N/A9.51.01.01.02.0

N/A6.0

N/AN/AN/A2.0

N/A1.0

123456789

1011121314151617181920

0602 Medical Officer0603 Physician's Assistant0610 Nurse0620 Prac�cal Nurse0621 Nursing Assistant

12.93.0

54.86.6

37.8

11.0N/A51.0

5.538.4

2122232425

Vacant Posi�onsSupply

Source: VHA Office of Workforce Management 6.8.V12.Northern.676




Tomah-Wisconsin VAMC Open FTE Posi�ons

159


0622 Medical Supply Aide and Technician0635Kinesiotherapy0636 Rehabilita�on Therapy Assistant0638 Recrea�on/Crea�ve Arts Therapist0640 Health Aid and Technician0644 Medical Technologist0660 Pharmacist0661 Pharmacy Technician0662 Optometrist0665 Speech Pathology and Audiology0671 Health System Specialist0679 Medical Support Assistance0680 Dental Officer0681 Dental Assistant0682Dental Hygiene0801 General Engineering0858 Biomedical Engineering1101General Business And Industry1715 Voca�onal Rehabilita�on2005 Supply Clerical and Technician

1.0N/A1.0

N/A3.53.0

N/AN/AN/A1.0

N/A10.5

1.0N/AN/A3.01.0

N/AN/A1.0

1.01.01.01.0

N/A1.03.00.01.01.01.07.4

N/A1.01.01.01.01.01.0

N/A

2627282930313233343536373839404142434445

2010 Inventory Management2805 Electrician3566 Custodial Worker4607Carpentry4749 Maintenance Mechanic

N/A2.0

10.0N/AN/A

1.0N/A6.01.01.0

4647484950







160


5703 Motor Vehicle Operator6907 Materials Handler7408 Food Service WorkerGrand Total

2.02.03.5

208.7

1.0N/A5.0

187.0

51525354







161

Supply Es�mated Current Total Community Market Supply

162

Supply




Exis�ng Federal Facili�es

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

Federal Facili�es

163

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

12-h-9-B

12-h-9-B

12-h-9-D

12-h-9-D

12-h-9-E

12-h-9-E

12-h-9-F

12-h-9-F

FQHC (12)

IHS (15)

FQHC (4)

IHS (4)

FQHC (4)

IHS (5)

FQHC (18)

IHS (2)

●Ewen Medical-Dental Center●Ewen Dental Center●Northern Menominee Health Center●Newberry Community Health Center●Escanaba Tribal Health●Watersmeet Health Center●Dba Northern Health Centers, Inc.●Bridge Clinic An�go●Marshfield Clinic - Minocqua Behavioral Health Center●Menominee Health Center●Peter Christensen Health Center●Sokaogon Chippewa Health Clinic●Mauston Dental Center●Scenic Bluffs Chc - Admin●Scenic Bluffs Chc - Cashton●Ho-Chunk Chemical Dependency Outpa�ent Program●Black River Falls Health Center●Tomah Health Office●Marshfield Clinic Park Falls Ctr●Marshfield Clinic - Park Falls Dental Center●Marshfiled Clinic-Phillips Center●Nekoosa Field Health Loca�on●Nekoosa Field Health Office

●47, (V12) (585GD) Ironwood, MI●47, (V12) (585GD) Ironwood, MI●31, (V12) (585) Iron Mountain, MI●56, (V12) (585GF) Manis�que, MI●55, (V12) (585GF) Manis�que, MI●54, (V12) (585GD) Ironwood, MI●54, (V12) (585GC) Menominee, MI●43, (V12) (676GA) Wausau, WI●25, (V12) (585GB) Rhinelander, WI●54, (V12) (695GD) Green Bay, WI●36, (V12) (585GB) Rhinelander, WI●31, (V12) (585GB) Rhinelander, WI●30, (V12) (676) Tomah-Wisconsin, WI●27, (V12) (676GC) River Valley, WI●26, (V12) (676GC) River Valley, WI●30, (V12) (676) Tomah-Wisconsin, WI●30, (V12) (676) Tomah-Wisconsin, WI●4, (V12) (676) Tomah-Wisconsin, WI●61, (V12) (585GD) Ironwood, MI●61, (V12) (585GD) Ironwood, MI●59, (V12) (585GB) Rhinelander, WI●13, (V12) (676GD) Wisconsin Rapids, WI●13, (V12) (676GD) Wisconsin Rapids, WI

Supply

7.1.V12.Northern



*FQHC quan�ty in parentheses reflects total number of FQHCs within a sector.

**The three FQHCs listed reflect the three most distant FQHCs from a VA POC.

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

164

Supply

Source: 1. Defini�ve Healthcare 2. Geocoded Enrollee File FY18Q4 7.2.V12.Northern#IMG



Market Community Hospital Overview

Note: Map provides context of community hospital density as 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

165

VAMC Area Hospitals* Total Staffed Beds Total Occupancy**

(585) Iron Mountain(676) TomahTotal Hospitals in the Market

21448

121740

2,518

26.1%43.4%42.9%

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.

Supply

Source: 1. Defini�ve Healthcare 2. Geocoded Enrollee File FY18Q4 7.2.V12.Northern



Market Community Hospital Overview, cont.Community Hospital Overview


TopHospitals Beds³ Occupancy⁴ Beds³ Occupancy⁴ Beds³ Occupancy⁴ CMI .

Dickinson County Memorial HospitalAspirus Iron River Hospital*Other Hospitals in Area (0)Total

9625

121

25.8%27.1%

N/A26.1%

N/AN/A

N/AN/AN/AN/A

N/AN/A

N/AN/AN/AN/A

1.60N/AN/A1.60

12

1617

Top Hospitals¹᾽²

Supply

Source: 1. CMS Cost Reports 2. IBM Market Expert 7.3.V12.Northern.585



Community Hospital Current and Future Inpa�ent Demand & Supply

Med/Surg/Acute

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 = total Bed Days of Care (BDOC)

divided by staffed opera�ng beds. 5. Applied growth rate and assumes actual beds remains the same. 6. BDOC and Projec�on Rate from IBM Market Expert

* Includes acute rehabilita�on

Mental Health Rehab CMI


OccupancyType ADC BDOC Actual Beds 2018 ActualOccupancy

75%OccupancyBed Need


Projec�onRate

ADC BDOC Actual Beds 2028Projected

Occupancy



.

Medicine/Surgical*Medicine/Surgical* Conceptual Excess

Mental HealthMental Health Conceptual Excess

32

0

11,506

0

121

0

26.1%

0.0%

427900

398200

-7.3%

10.2%

29

0

10,661

0

121

0

24.1%

0.0%

398200

378400

1234




2018

Supply




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

Es�mated 2028Surplus of beds

Shortage of beds

Future Supply and Demand


TopHospitals Beds³ Occupancy⁴ Beds³ Occupancy⁴ Beds³ Occupancy⁴ CMI .

Gundersen Lutheran Medical CenterMayo Clinic Hospital - Franciscan HealthcareAspirus Riverview HospitalSSM Health St Clare Hospital - BarabooMile Bluff Medical CenterReedsburg Area Medical Center*Gundersen St Josephs Hospital *Mayo Clinic Hospital - Franciscan Healthcare in Sparta*Gundersen Moundview Hospital *Tomah Memorial Hospital*Marshfield Medical Center - Neillsville*Black River Memorial Hospital*Vernon Memorial Hospital*Mayo Clinic Hospital - Oakridge*Other Hospitals in Area (0)Total

252142

454340252525252525252518

672

68.1%46.2%52.4%39.0%17.2%31.2%

9.7%3.5%4.6%

29.5%9.2%

20.7%34.5%

7.1%N/A

44.2%

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

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

16N/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/A

16

79.4%N/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/A

79.4%

1.951.661.581.201.19N/AN/AN/AN/AN/AN/AN/AN/AN/AN/A1.60

123456789

10111213141617

Top Hospitals¹᾽²

Supply




Community Hospital Current and Future Inpa�ent Demand & Supply

Med/Surg/Acute




Mental Health Rehab CMI


N/A N/A N/A

169

OccupancyType ADC BDOC Actual Beds 2018 ActualOccupancy



Projec�onRate

ADC BDOC Actual Beds 2028Projected

Occupancy



.

Medicine/Surgical*Medicine/Surgical* Conceptual Excess

Mental HealthMental Health Conceptual Excess

334

0

121,938

0

756

0

44.2%

0.0%

445311

00

418338

00

-3.9%

18.1%

315

0

114,888

0

756

0

41.6%

0.0%

420336

00

393363

00

1234




2018

Supply




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

Es�mated 2028Surplus of beds

Shortage of beds

Future Supply and Demand


Specialty 2018 FTE Supply 2018 FTE Demand Shortage/Surplus

1. Primary CareGeneral/Family Prac�ceInternal Medicine

2. Specialty Care (Medical)Allergy/ImmunologyCardiologyDermatologyEndocrinologyGastroenterologyHematology/OncologyInfec�ous DiseaseNephrologyNeurologyPulmonologyRheumatology

3. Specialty Care (Surgical)Cardio/Thoracic SurgeryColorectal SurgeryGeneral SurgeryNeurosurgeryOphthalmologyOrthopedic SurgeryOtolaryngologyPlas�c SurgeryUrologyVascular

4. Women's HealthObstetrics/Gynecology

5. Mental HealthPsychiatry

6. RehabPhysical Medicine/Rehab

7. Emergency ServicesEmergency/Cri�cal Care

8. Other ServicesPain Management

338

02200102320

0080

2320

18414612221

2051

10-12

-1-6-2-1-4-5-1000

-1

-203

-1152010

4

2

0

10

3

462221

8

8

2

23

1

-3-10

-2-1-1

-3

-6

-2

-12

2

2018 FTE Supply and 2018 FTE Demand by Specialty

0

20

40

FTE

General/Family …

Emergency/Cri�cal Care

General Surgery

Internal Medicine

Orthopedic Surgery

Obstetric

s/Gynecology

Neurology

Pain Management

Otolaryngology

Cardiology

Dermatology

Nephrology

Psychiatry

Pulmonology

Hematology/Oncology

OphthalmologyUrology

Neurosurgery

Allergy/Immunology

Cardio/Thoracic Surgery

Colorectal Surgery

Endocrinology

Gastroenterology

Infec�ous Dise

ase

Physical Medicine/Rehab

Plas�c Surgery

Rheumatology

Vascular

2018 FTE Supply 2018 FTE Demand

Supply

Source: IBM Watson Market ExpertNote: FTE demand based on median produc�vity by specialty



Community Physician Current Supply & Demand

Provider Surplus/Shortage vs. 2018 FTE Demand*

0%

200%

Surp

lus/

Shor

tage

Pain Management

General Surgery

General/Family Prac�ce

Orthopedic Surgery

Pulmonology

Dermatology

Obstetric

s/Gynecology


Urology

Internal Medicine

Neurosurgery

Cardiology

Ophthalmology

Psychiatry

Hematology/Oncology

Allergy/Immunology


Colorectal Surgery

Endocrinology

Gastroenterology

Infec�ous Dise

ase


Plas�c Surgery

Rheumatology

Vascular

204%

46%

42%

-16%

-17%

-44%

-45%

-55%

-58%

-60%

-61%

-74%

-75%

-76%

-84%

-100

%

-100

%

-100

%

-100

%

-100

%

-100

%

-100

%

-100

%

-100

%

-100

%


*FTE net percentage of supply for special�es between -15% and 15% are not included given the FTE supply for those special�es are comparable to FTE demand


Specialty 2018 FTE Supply 2018 FTE Demand Shortage/Surplus

1. Primary CareGeneral/Family Prac�ceInternal Medicine

2. Specialty Care (Medical)Allergy/ImmunologyCardiologyDermatologyEndocrinologyGastroenterologyHematology/OncologyInfec�ous DiseaseNephrologyNeurologyPulmonologyRheumatology

3. Specialty Care (Surgical)Cardio/Thoracic SurgeryColorectal SurgeryGeneral SurgeryNeurosurgeryOphthalmologyOrthopedic SurgeryOtolaryngologyPlas�c SurgeryUrologyVascular

4. Women's HealthObstetrics/Gynecology

5. Mental HealthPsychiatry

6. RehabPhysical Medicine/Rehab

7. Emergency ServicesEmergency/Cri�cal Care

8. Other ServicesPain Management

254118

112113

91218

71015

94

70

499

9880

54113

52030

4131011

4

71

294

15638

6-20

-14

-8-11

2-35

-20

-1-120

5183110

693

25

40

13

54

1

1625

9995

35

39

9

129

4

261

-40

-2

-10

1

3

-75

-3

2018 FTE Supply and 2018 FTE Demand by Specialty

0

200

FTE

General/Family …

Internal Medicine


General Surgery

Psychiatry

Orthopedic Surgery

Obstetric

s/Gynecology

Cardiology

Hematology/Oncology

Ophthalmology

Neurology

Dermatology


Gastroenterology

Allergy/Immunology

Nephrology

OtolaryngologyUrology

Neurosurgery

Pulmonology

Endocrinology

Infec�ous Dise

ase


Plas�c Surgery

Rheumatology

Vascular

Pain Management

Colorectal Surgery

2018 FTE Supply 2018 FTE Demand

Supply

Source: IBM Watson Market ExpertNote: FTE demand based on median produc�vity by specialty



Community Physician Current Supply & Demand

Provider Surplus/Shortage vs. 2018 FTE Demand*

0%

200%

Surp

lus/

Shor

tage

General/Family Pr…

Allergy/Immunology

Neurosurgery

Endocrinology

General Surgery

Infec�ous Dise

ase

Internal Medicine

Neurology


Orthopedic Surgery

Pulmonology

Nephrology

Obstetric

s/Gynecology

Hematology/Oncology

Gastroenterology

Plas�c Surgery

Vascular

Cardiology


Pain Management

Colorectal Surgery

159%

144%

137%

90%

70%

57%

48%

46%

35%

25%

-18%

-21%

-29%

-37%

-39%

-39%

-39%

-49%

-58%

-76%

-100

%


*FTE net percentage of supply for special�es between -15% and 15% are not included given the FTE supply for those special�es are comparable to FTE demand


Supply




Known Major Changes in Community Hospitals – Iron Mountain Area

Source: Definitive Healthcare, Iron Mountain Daily News, WULC Upper Michigan

173

Supply




Known Major Changes in Community Hospitals – Tomah-Wisconsin Area

Source: Definitive Healthcare

174

Access Current Access

175


(V12) (585) Iron Mountain(V12) (585GA) Hancock(V12) (585GB) Rhinelander(V12) (585GC) Menominee(V12) (585GD) Ironwood(V12) (585GF) Manis�que(V12) (585HA) Marque�e(V12) (585HB) Sault Saint MarieFacility Total(V12) (676) Tomah-Wisconsin(V12) (676BU) Tomah VADOM(V12) (676GA) Wausau(V12) (676GC) River Valley(V12) (676GD) Wisconsin Rapids

35366

3022920

N/A8842

900661N/A345429139

70949

366613

46N/A360344

2,487680N/A328327175

39971

402216

42114196384

1,824591N/A312457148

38638798437

111151119

1,005466N/A175613356

1,306150382383316N/A681653

3,8714,376

N/A1,1561,6082,189

1,183269535364353N/A690621

4,0151,394

N/A1,2831,5312,123

1,676292538385347

98623706

4,6651,897

N/A1,4691,3211,941

1,382310423399398157670553

4,2922,806

N/A1,6221,4861,563

5,6385

2590

N/A3319

5,7292,833

395886

828

5,2688

14172

N/A9

635,4982,967

657

154682

4,6818

124621

2133

4,8762,879

041

1661,489

4,7825

114283

1142

4,9672,460

064

1971,477

Same Day Appointment Totals

Access

Source: VSSC Completed Appointments Cube 8.1.V12.Northern

N/A: Not Available



Same Day Appointments (FY15-18)

Mental Health Primary Care Specialty Care

176


(V12) (676GE) Clark CountyFacility TotalMarket Total

581,6322,532

461,5564,043

211,5293,353

91,6192,624

2509,579

13,450

3576,688

10,703

2946,922

11,587

2837,760

12,052

523,8969,625

943,9609,458

594,6349,510

584,2569,223

Same Day Appointment Totals

Access

Source: VSSC Completed Appointments Cube 8.1.V12.Northern#2

N/A: Not Available



Same Day Appointments (FY15-18), cont.


177


(3V12) (585) Iron Mountain, MI (Oscar G. Johnson)(3V12) (585GA) Hancock, MI(3V12) (585GB) Rhinelander, WI(3V12) (585GC) Menominee, MI(3V12) (585GD) Ironwood, MI(3V12) (585GF) Manis�que, MI(3V12) (585HA) Marque�e, MI(3V12) (585HB) Sault Saint Marie, MI(3V12) (676) Tomah, WI(3V12) (676BU) Tomah, WI - VADOM(3V12) (676GA) Wausau, WI(3V12) (676GC) River Valley, WI(3V12) (676GD) Wisconsin Rapids, WI(3V12) (676GE) Clark County, WINa�onal Average

2.31.32.03.12.5

N/A4.72.10.7

N/A1.41.23.01.22.9

1.41.11.01.11.9

N/A1.61.01.3

N/A2.61.53.10.62.7

2.01.51.91.41.31.42.31.71.0

N/A2.81.75.11.02.6

1.71.12.51.11.53.33.42.71.1

N/A3.12.62.31.53.3

4.01.92.90.31.0

N/A2.70.31.6

N/A1.41.61.52.14.0

3.41.31.90.41.1

N/A1.80.62.7

N/A1.72.71.92.34.4

4.42.02.80.71.31.92.31.02.3

N/A2.42.02.51.34.1

3.91.63.82.41.22.94.11.54.5

N/A5.33.75.13.44.3

4.14.33.02.71.2

N/A4.02.64.10.00.21.94.40.14.5

2.95.82.12.64.2

N/A3.14.35.20.00.32.38.30.05.3

4.75.91.94.03.12.95.63.55.20.00.23.46.50.05.4

6.08.73.36.07.25.39.75.0

10.70.02.55.38.60.06.3

Established Pa�ent Appointments (FY15-18)Access


N/A: Not Available



Specialty CarePrimary CareMental Health

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

178

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

(V12) (585) Iron Mountain(V12) (585GA) Hancock(V12) (585GB) Rhinelander(V12) (585GC) Menominee(V12) (585GD) Ironwood(V12) (585GF) Manis�que(V12) (585HA) Marque�e(V12) (585HB) Sault Saint Marie(V12) (676) Tomah-Wisconsin(V12) (676BU) Tomah VADOM(V12) (676GA) Wausau(V12) (676GC) River Valley(V12) (676GD) Wisconsin Rapids(V12) (676GE) Clark CountyNa�onal Average

98.4%99.2%98.2%96.2%98.1%

N/A95.4%98.3%99.5%

N/A98.5%99.8%97.2%98.5%97.7%

99.5%99.2%99.2%99.0%98.6%

N/A99.1%98.9%99.7%

N/A98.0%99.8%97.2%

100.0%98.2%

98.8%98.9%99.1%98.7%99.5%99.6%98.8%99.1%99.6%

N/A97.9%99.2%95.6%99.3%98.5%

99.3%99.3%99.2%99.3%99.3%98.6%97.5%98.8%99.3%

N/A98.4%98.4%98.9%99.8%97.6%

98.6%99.8%99.7%99.8%

100.0%N/A

98.5%100.0%

99.6%N/A

99.7%99.7%99.2%99.4%96.8%

100.0%100.0%100.0%100.0%100.0%

N/A100.0%100.0%

99.3%N/A

99.7%99.1%99.6%98.8%96.8%

98.9%100.0%

99.5%100.0%100.0%

99.3%99.7%

100.0%99.4%

N/A99.7%99.6%99.4%99.5%97.4%

98.4%99.8%98.8%98.7%99.9%98.8%97.5%99.8%97.7%

N/A96.8%97.7%95.6%98.9%97.2%

97.5%96.0%98.9%99.1%

100.0%N/A

96.1%98.5%96.4%

100.0%100.0%100.0%

94.4%100.0%

96.1%

99.2%92.4%99.5%97.9%95.1%

N/A96.8%94.2%96.2%

100.0%99.6%

100.0%90.2%

100.0%95.3%

97.4%93.8%99.4%96.4%97.4%97.6%95.2%96.9%95.1%

100.0%100.0%

99.4%94.1%

100.0%95.5%

94.6%92.2%98.7%93.8%92.3%95.9%89.9%95.6%90.1%

100.0%98.3%98.2%90.1%

100.0%94.5%

716717718719720721722723724725726727728729730

Access





N/A: Not Available

179

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

New Pa�ent Appointments (FY15-18)


(3V12) (585) Iron Mountain, MI (Oscar G. Johnson)(3V12) (585GA) Hancock, MI(3V12) (585GB) Rhinelander, WI(3V12) (585GC) Menominee, MI(3V12) (585GD) Ironwood, MI(3V12) (585GF) Manis�que, MI(3V12) (585HA) Marque�e, MI(3V12) (585HB) Sault Saint Marie, MI(3V12) (676) Tomah, WI(3V12) (676BU) Tomah, WI - VADOM(3V12) (676GA) Wausau, WI(3V12) (676GC) River Valley, WI(3V12) (676GD) Wisconsin Rapids, WI(3V12) (676GE) Clark County, WINa�onal Average

21.121.337.144.445.3N/A17.019.511.8N/A7.87.89.41.1

12.4

16.313.018.1

9.612.3N/A13.416.5

9.9N/A8.76.46.83.8

12.0

15.06.6

11.112.5

7.610.718.116.4

8.8N/A4.54.26.18.1

11.3

11.98.8

10.510.7

8.214.815.714.112.9N/A11.0

1.52.66.5

11.3

20.614.016.015.418.0N/A10.112.911.2N/A10.4

9.212.215.621.2

21.315.811.714.013.7N/A10.813.312.8N/A14.415.620.216.222.7

16.211.911.314.1

9.68.6

14.012.4

7.9N/A14.411.321.5

9.222.6

14.710.218.413.3

8.316.019.414.714.0N/A20.522.933.020.221.2

19.322.728.138.429.7N/A24.413.518.3

5.08.4

13.124.812.021.5

18.919.019.229.743.3N/A32.4

8.916.7

2.211.013.332.6

9.021.2

21.029.630.547.444.914.034.8

8.920.1N/A17.615.330.211.721.0

21.928.813.132.125.227.741.2

7.826.1N/A16.514.837.3

9.622.5

707708709710711712713714715716717718719720721

Access




Specialty CarePrimary Care

N/A: Not Available

Mental Health

180

New Pa�ent Appointments (FY15-18), cont.


(V12) (585) Iron Mountain(V12) (585GA) Hancock(V12) (585GB) Rhinelander(V12) (585GC) Menominee(V12) (585GD) Ironwood(V12) (585GF) Manis�que(V12) (585HA) Marque�e(V12) (585HB) Sault Saint Marie(V12) (676) Tomah-Wisconsin(V12) (676BU) Tomah VADOM(V12) (676GA) Wausau(V12) (676GC) River Valley(V12) (676GD) Wisconsin Rapids(V12) (676GE) Clark CountyNa�onal Average

75.6%78.9%62.3%50.8%56.3%

N/A87.5%92.0%89.7%

N/A96.1%95.2%94.0%

100.0%90.1%

87.7%98.1%81.8%97.6%94.7%

N/A85.7%96.4%93.3%

N/A96.7%97.3%99.0%96.7%90.8%

93.5%100.0%

95.3%88.1%

100.0%100.0%

79.7%96.7%93.9%

N/A97.3%98.7%98.2%

100.0%91.2%

94.5%100.0%100.0%

96.9%96.3%

100.0%88.2%80.0%92.9%

N/A95.6%99.4%99.6%

100.0%N/A

80.6%98.0%94.9%96.8%84.2%

N/A97.7%93.0%95.7%

N/A98.3%99.2%84.4%93.5%76.4%

78.7%95.9%96.2%

100.0%93.2%

N/A96.1%95.7%97.0%

N/A89.8%88.2%79.2%89.7%73.2%

84.7%94.7%95.5%86.5%98.4%96.5%97.4%96.3%97.6%

N/A93.9%96.2%87.7%97.9%73.8%

91.3%100.0%

86.8%92.1%95.2%90.4%88.9%96.7%93.6%

N/A82.2%71.6%50.0%89.5%

N/A

80.5%68.9%66.3%51.5%54.8%

N/A67.5%83.7%80.9%97.2%97.3%94.4%62.5%91.5%75.2%

83.1%69.8%78.9%61.9%38.0%

N/A49.5%87.9%87.2%

100.0%92.7%96.9%47.8%91.1%76.2%

79.4%57.5%67.8%41.3%38.0%75.0%45.6%87.8%79.9%

N/A81.5%92.2%54.5%91.9%76.3%

73.9%67.4%92.2%68.5%63.4%61.9%46.9%87.9%67.2%

N/A81.9%91.1%43.2%91.8%

N/A

7…7…7…7…7…7…7…7…7…7…7…7…7…7…7…

Access


N/A: Not Available




Percent of New Pa�ent Appointments Completed within 30 Days

181

Rece ReceivingFacility FY18 Consults Avg

S

(321) GI ENDOSCOPY(409) ORTHOPEDICS/JOINT SURGERY(401) GENERAL SURGERY(116) RESPIRATORY THERAPY(323) PRIMARY CARE/MEDICINE(205) PHYSICAL THERAPY(123) NUTRITION/DIETETICS-INDIVIDUAL(180) DENTAL(160) CLINICAL PHARMACY(125) SOCIAL WORK SERVICE

(V12) (585) Iron Mountain(V12) (585) Iron Mountain(V12) (585) Iron Mountain(V12) (585) Iron Mountain(V12) (585) Iron Mountain(V12) (585) Iron Mountain(V12) (585) Iron Mountain(V12) (585) Iron Mountain(V12) (585) Iron Mountain(V12) (585) Iron Mountain

1,2141,4331,2081,0581,8853,5711,0592,0344,6891,407

62.734.428.821.013.6

9.97.04.03.61.5

…………………4……

Average Wait Time for Top 10 Consults – Iron MountainReceiving Service Stop Code

(Top 10 by FY18 Consults)

Access

Source: VSSC Consults Cube V2 8.6.V12.Northern.585



Receiving Facility FY18 ConsultsAverage Days to

Completed Consult

182

Rece ReceivingFacility FY18 Consults Avg

S

(401) GENERAL SURGERY(411) PODIATRY(502) MH CLINIC IND(304) DERMATOLOGY(205) PHYSICAL THERAPY(116) RESPIRATORY THERAPY(350) GeriPACT(180) DENTAL(160) CLINICAL PHARMACY(408) OPTOMETRY

(V12) (676) Tomah-Wisconsin(V12) (676) Tomah-Wisconsin(V12) (676) Tomah-Wisconsin(V12) (676) Tomah-Wisconsin(V12) (676) Tomah-Wisconsin(V12) (676) Tomah-Wisconsin(V12) (676) Tomah-Wisconsin(V12) (676) Tomah-Wisconsin(V12) (676) Tomah-Wisconsin(V12) (676) Tomah-Wisconsin

9541,1761,7241,7227,5664,2821,1101,9723,678

10,829

36.632.925.023.212.3

7.05.44.54.02.0

…………………………

Average Wait Time for Top 10 Consults – Tomah-WisconsinReceiving Service Stop Code

(Top 10 by FY18 Consults)

Access




Receiving Facility FY18 ConsultsAverage Days to

Completed Consult

183

ReceivingServiceStopCode Facility FY18 Consults AvergeDaysToCompletedConsult 8_8 Sort

(159) COMPLEMENTARY AND INTEGRATIVE HEALTH TREATMENT(321) GI ENDOSCOPY(550) MH CLINIC GROUP(435) SURGICAL PROCEDURE UNIT(538) PSYCH TESTING(318) GERIATRIC PROBLEM-FOCUSED CONSULTATION CLINIC(106) EEG(104) PULMONARY FUNCTION(409) ORTHOPEDICS/JOINT SURGERY(203) AUDIOLOGY

(V12) (585) Iron Mountain(V12) (585) Iron Mountain(V12) (585) Iron Mountain(V12) (585) Iron Mountain(V12) (585) Iron Mountain(V12) (585) Iron Mountain(V12) (585) Iron Mountain(V12) (585) Iron Mountain(V12) (585) Iron Mountain(V12) (585) Iron Mountain

1331,214

35108266

22127687

1,43379

68.962.747.144.141.940.939.838.234.433.6

68.858862.748547.052644.066741.946540.933339.775738.180834.432633.5636

Access




Longest Wait Time – Top 10 ConsultsAverage Days to

Completed Consult (Top 10 Stop Codes)

FY18 ConsultsReceiving FacilityReceiving Service Stop Code

184

ReceivingServiceStopCode Facility FY18 Consults AvergeDaysToCompletedConsult 8_8 Sort

(151) MAGNETIC RESONANCE IMAGING/MRI(322) Comprehensive Women’s Primary Care Clinic(513) SUB USE DISORDER INDIV(420) PAIN CLINIC(401) GENERAL SURGERY(203) AUDIOLOGY(306) DIABETES(310) INFECTIOUS DISEASE(411) PODIATRY(301) GENERAL INTERNAL MEDICINE

(V12) (676) Tomah-Wisconsin(V12) (676) Tomah-Wisconsin(V12) (676) Tomah-Wisconsin(V12) (676) Tomah-Wisconsin(V12) (676) Tomah-Wisconsin(V12) (676) Tomah-Wisconsin(V12) (676) Tomah-Wisconsin(V12) (676) Tomah-Wisconsin(V12) (676) Tomah-Wisconsin(V12) (676) Tomah-Wisconsin

1349

968

954306268

301,176

34

48.046.846.837.636.636.235.434.332.930.6

4846.7646.75

37.555636.583

36.223835.421734.347832.9067

30.64

Access




Longest Wait Time – Top 10 ConsultsAverage Days to

Completed Consult (Top 10 Stop Codes)

FY18 ConsultsReceiving FacilityReceiving Service Stop Code

185

VA Facility

Total Uniq Total Enc Prim Enc Prim Unq Cnt Of Prm Tms Ovr Tms Un Pcp Cap Cap Le� PanelFul

Third

(V12) (585) Iron Mountain(V12) (585GA) Hancock(V12) (585GB) Rhinelander(V12) (585GC) Menominee(V12) (585GD) Ironwood(V12) (585GF) Manis�que(V12) (585HA) Marque�e(V12) (585HB) Sault Saint Marie

18,7811,8513,4581,8921,774

7843,1191,309

207,35213,15515,321

9,6706,2255,109

14,8547,505

14,2974,1536,7074,1773,5501,9515,7783,466

5,9341,6083,3621,7771,722

6962,3561,238

4N/A

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

3N/A

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

0N/A

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

2,470N/A

1,500N/AN/AN/AN/AN/A

491N/A659N/AN/AN/AN/AN/A

80.0%N/A

56.0%N/AN/AN/AN/AN/A

9.24.7

12.54.7

10.613.210.310.2

Primary Care PACT Teams

Es�mated Capacity for Outpa�ent WorkloadAccess

Source: 1.VSSC Encounters Cube 2. VSSC PACT Compass Cube 8.8.V12.Northern.585



VA Facility

FY18 Actual Primary Care (PC) EncountersFY18

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

186

*Other includes Post Deployment and Homeless Teams

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

Source: VSSC PACT Compass Cube 8.15.V12.Northern



187

VA Facility

Total Uniq Total Enc Prim Enc Prim Unq Cnt Of Prm Tms Ovr Tms Un Pcp Cap Cap Le� PanelFul

Third

(V12) (676) Tomah-Wisconsin(V12) (676BU) Tomah VADOM(V12) (676GA) Wausau(V12) (676GC) River Valley(V12) (676GD) Wisconsin Rapids(V12) (676GE) Clark County

22,5265

4,7516,4935,8211,427

270,55114

23,39128,62630,226

4,906

17,744N/A

8,95810,656

8,4811,991

7,630N/A

4,0405,1023,8801,056

3N/A

513

N/A

1N/A

210

N/A

2N/A

202

N/A

2,292N/A

3,096943

2,198N/A

415N/A

-175-54119N/A

82.0%N/A

106.0%106.0%

95.0%N/A

10.2N/A8.97.89.67.9

Primary Care PACT Teams

Es�mated Capacity for Outpa�ent WorkloadAccess

Source: 1.VSSC Encounters Cube 2. VSSC PACT Compass Cube 8.8.V12.Northern.676



VA Facility

FY18 Actual Primary Care (PC) EncountersFY18

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

188

*Other includes Post Deployment and Homeless Teams

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

Source: VSSC PACT Compass Cube 8.15.V12.Northern



189

Es�mated 30 Minute Drive Time ZonesAccess

Source: Geocoded Enrollee File FY18Q4 8.9.V12.Northern#IMG



190


(V12) (585) Iron Mountain(V12) (585GA) Hancock(V12) (585GB) Rhinelander(V12) (585GC) Menominee(V12) (585GD) Ironwood(V12) (585GF) Manis�que(V12) (585HA) Marque�e(V12) (585HB) Sault Saint Marie(V12) (676) Tomah-Wisconsin(V12) (676BU) Tomah VADOM(V12) (676GA) Wausau(V12) (676GC) River Valley(V12) (676GD) Wisconsin Rapids(V12) (676GE) Clark County

52.0%74.0%56.0%71.0%60.0%

-81.0%74.0%46.0%

-67.0%55.0%52.0%16.0%

57.0%73.0%62.0%58.0%72.0%

-74.0%70.0%43.0%

-62.0%55.0%47.0%24.0%

65.0%77.0%63.0%66.0%75.0%69.0%77.0%70.0%42.0%

-61.0%57.0%52.0%43.0%

64.0%80.0%64.0%73.0%77.0%78.0%77.0%78.0%58.0%

-72.0%58.0%56.0%48.0%

79.0%72.0%86.0%70.0%84.0%

-83.0%70.0%71.0%

-48.0%54.0%57.0%52.0%

78.0%68.0%80.0%70.0%77.0%

-84.0%77.0%66.0%

-62.0%61.0%64.0%45.0%

70.0%73.0%80.0%69.0%68.0%61.0%84.0%74.0%61.0%

-70.0%67.0%73.0%51.0%

70.0%70.0%76.0%63.0%65.0%74.0%79.0%70.0%74.0%

-79.0%77.0%79.0%70.0%

68.0%13.0%23.0%22.0%8.0%

-31.0%18.0%65.0%83.0%35.0%74.0%61.0%24.0%

62.0%11.0%48.0%21.0%10.0%

-30.0%20.0%65.0%50.0%32.0%68.0%66.0%34.0%

61.0%8.0%

40.0%12.0%

3.0%3.0%

19.0%14.0%63.0%25.0%29.0%65.0%56.0%21.0%

62.0%5.0%

38.0%8.0%3.0%3.0%

16.0%9.0%

64.0%67.0%41.0%64.0%71.0%21.0%

656657658659660661662663664665666667668669

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

Source: VSSC Clinic U�liza�on Cube 8.10.V12.Northern




191

Cancelled by Clinic Report


(V12) (585) Iron Mountain(V12) (585GA) Hancock(V12) (585GB) Rhinelander(V12) (585GC) Menominee(V12) (585GD) Ironwood(V12) (585GF) Manis�que(V12) (585HA) Marque�e(V12) (585HB) Sault Saint Marie(V12) (676) Tomah-Wisconsin(V12) (676BU) Tomah VADOM(V12) (676GA) Wausau(V12) (676GC) River Valley(V12) (676GD) Wisconsin Rapids(V12) (676GE) Clark CountyTotal

1,115382309303153N/A433289

2,286N/A782658479

347,223

930222214230

68N/A241186

1,338N/A694752329

325,236

866274239205135

89372251

1,427N/A805786507

526,008

875261224139

97117357184

1,764N/A589626285

575,575

1,737785559339132N/A681287

2,085N/A560740879151

8,935

1,212459459303129N/A542303

1,615N/A846810820

827,580

1,336539590264209

83612239

2,077N/A

1,1551,1161,114

739,407

1,031436541211125103429184

2,220N/A

1,2831,3071,341

989,309

5,82557

1587124

N/A8432

6,1717

33134

1,07918

13,693

3,28347

2494826

N/A8022

7,0974

45117789

1211,819

2,76775

2425123257024

7,9831

51128958

1112,409

2,13538

2463525164948

5,1741

83108822

218,801

712713714715716717718719720721722723724725726

Access

Source: VSSC No Show and Cancella�on Cube 8.11.V12.Northern

Note: Appointments cancelled within 45 days




192

Market/Parent Facility Exis�ng VA Drive Times AssessmentAccess

Source: 1. Dartmouth Atlas 2. Geocoded Enrollee File FY18Q4 8.12.V12.Northern#IMG



VA & Commercial Drive Time Measures

Note: 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. HSA total enrollees are displayed on map. A Dartmouth Atlas Hospital Referral Region (HRR) is a

ZIP code-defined geography encompassing the community where the ZIP code's Medicare residents predominantly receive their cardiovascular and neurosurgery hospital care.

193

FY 2018 # of TotalEnrollees

# of enrolleeswithin 30

minutes drive�me

% of enrolleeswithin 30minutes

# of enrolleesoutside 30

minutes drive�me

% of enrolleesoutside 30

minutes

# of enrolleeswithin 60

minutes drive�me

% of enrolleeswithin 60minutes

# of enrolleesoutside 60

minutes drive�me

% of enrolleesoutside 60

minutes

Id

(V12) Northern 55,815 33,103 59.3% 22,712 40.7% 21,469 38.5% 34,346 61.5% 1

Access

8.13.V12.Northern



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

194

Poten�al Service GapsAccess

Source: 1. Dartmouth Atlas 2. Geocoded Enrollee File FY18Q4 8.14.V12.Northern#IMG


VISN 12: Northern Market Potential service gaps are areas identified by the Dartmouth Atlas in a Hospital Service Area (HSA). The medical community in these areas provides

opportunities to consider different tactics 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 particular

HSA. Planning best practice suggests that 4,800 enrollees are required to justify establishing a new site of care.

Poten�al Service Gaps

195

Poten�al Service Gaps, cont.Access

Source: 1. Dartmouth Atlas 2. Geocoded Enrollee File FY18Q4 8.14.V12.Northern


VISN 12: Northern Market Potential service gaps are areas identified by the Dartmouth Atlas in a Hospital Service Area (HSA). The medical community in these areas provides

opportunities to consider different tactics 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 table below shows the number of Enrollees that reside within a particular

HSA. Planning best practice suggests that 4,800 enrollees are required to justify establishing a new site of care.

196

mnirenberg001

Stamp

Quality & Sa�sfac�on

197

Category Sub-Category Na�onal . ..

Insurance (Reliance) Have Private Insurance PlanPlanned Use of VA as Primary Source of CareUninsured

Sa�sfac�on (Best CareAnywhere)

Appointments 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 Referrals

Access (Choose VA) Believes Care in the Community is Easier to Get to than VA(Answered Yes)Believes Care in the Community Quality is Be�er than VA (AnsweredYes)

Internet Use(Telehealth Poten�al)

Internet Use to Look at Health Informa�on (Answered Yes)Used Internet to Make Medical Appointments (Answered Yes)

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

43.0 %

76.1 %36.5 %

33.1 %40.5 %

9.3 %56.0 %84.1 %53.8 %67.0 %

34.9 %

69.1 %29.7 %

1112223

3

44

1. Sa�sfac�on denominator = enrolled Veterans who said they had used VA since January 1, 20162. Access denominator = enrolled Veterans who said they had used a provider other than VA for some or all of their care since January 1, 20163. The denominator for Internet Use = enrolled Veterans who said they used the internet at least occasionally


Source: 2018 Survey of Enrollees Market Profiles 9.1.V12.Northern



VA Pa�ent Feedback: Survey of Enrollees – Northern MarketNorthern Market

198

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

(V12) (585) Iron Mountain(V12) (585) Iron Mountain(V12) (585) Iron Mountain(V12) (585) Iron Mountain(V12) (676) Tomah-Wisconsin(V12) (676) Tomah-Wisconsin(V12) (676) Tomah-Wisconsin(V12) (676) Tomah-WisconsinVISN 12 AverageVISN 12 AverageVISN 12 AverageVISN 12 AverageNa�onal AverageNa�onal AverageNa�onal AverageNa�onal Average

2015201620172018201520162017201820152016201720182015201620172018

65.063.358.067.055.351.652.143.353.552.251.655.052.053.253.254.2

85.886.591.692.585.388.278.574.974.573.671.972.469.970.069.670.4

73.066.264.074.665.178.667.349.065.260.162.666.261.261.962.663.4

73.981.080.482.567.868.068.367.175.074.775.176.573.874.775.175.7

82.582.682.986.673.374.773.769.175.374.573.576.872.173.173.574.6

65.368.865.0N/A51.344.653.9N/A62.661.762.2N/A60.160.159.5N/A

N/AN/AN/A72.4N/AN/AN/A51.6N/AN/AN/A59.6N/AN/AN/A57.9

58.358.762.560.155.556.458.760.854.651.152.856.049.349.850.151.4

73.767.964.372.261.758.866.065.061.159.959.862.458.859.759.761.0

75.576.480.584.462.572.962.260.969.068.966.567.265.565.866.766.9

56.057.257.760.746.752.948.645.452.652.652.953.549.750.852.051.9

77.974.883.184.961.473.662.166.669.367.466.068.264.365.265.466.2

89.989.988.588.689.892.184.491.786.485.785.286.984.785.385.686.2

76.683.676.685.276.878.078.175.576.976.176.377.474.075.375.475.5

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


Source: VSSC Pa�ent Experiences Survey Reports 9.2.V12.Northern

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



% Strongly Agree % 9 or 10 % Yes

199


Source: SAIL Scorecards 9.3.V12.Northern.585



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

200




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

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

9.13.V12.Northern.585Source: SAIL Scorecards

201


Source: SAIL Scorecards 9.3.V12.Northern.676



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

202




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

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

9.13.V12.Northern.676Source: SAIL Scorecards

203

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

(V12) (585) Iron Mountain(V12) (585) Iron Mountain(V12) (585) Iron Mountain(V12) (585) Iron Mountain(V12) (585GA) Hancock(V12) (585GA) Hancock(V12) (585GA) Hancock(V12) (585GA) Hancock(V12) (585GB) Rhinelander(V12) (585GB) Rhinelander(V12) (585GB) Rhinelander(V12) (585GB) Rhinelander(V12) (585GC) Menominee(V12) (585GC) Menominee(V12) (585GC) Menominee(V12) (585GC) Menominee(V12) (585GD) Ironwood(V12) (585GD) Ironwood(V12) (585GD) Ironwood(V12) (585GD) Ironwood

20152016201720182015201620172018201520162017201820152016201720182015201620172018

42.654.355.462.436.267.769.774.135.760.159.155.148.255.360.460.040.271.163.859.1

N/A64.965.469.3N/A67.972.176.0N/A67.264.863.3N/A60.664.468.2N/A72.665.763.0

72.376.379.980.877.387.389.292.473.780.880.679.767.375.281.685.275.189.381.079.9

74.074.876.881.287.487.595.592.667.279.072.172.167.069.778.381.483.088.183.977.6

61.665.968.775.369.376.884.884.564.667.176.667.062.163.578.478.971.579.271.365.7

N/AN/AN/A85.9N/AN/AN/A93.9N/AN/AN/A79.8N/AN/AN/A89.4N/AN/AN/A85.3

……………………………………………………

% Always






% 9 or 10

204

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



CK

(V12) (585GF) Manis�que(V12) (585GF) Manis�que(V12) (585HA) Marque�e(V12) (585HA) Marque�e(V12) (585HA) Marque�e(V12) (585HA) Marque�e(V12) (585HB) Sault Saint Marie(V12) (585HB) Sault Saint Marie(V12) (585HB) Sault Saint Marie(V12) (585HB) Sault Saint Marie(V12) (676) Tomah-Wisconsin(V12) (676) Tomah-Wisconsin(V12) (676) Tomah-Wisconsin(V12) (676) Tomah-Wisconsin(V12) (676GA) Wausau(V12) (676GA) Wausau(V12) (676GA) Wausau(V12) (676GA) Wausau(V12) (676GC) River Valley(V12) (676GC) River Valley

20172018201520162017201820152016201720182015201620172018201520162017201820152016

63.157.840.745.558.169.032.960.864.661.541.954.961.359.834.955.452.549.050.870.2

61.268.3N/A52.861.770.0N/A62.868.271.6N/A66.563.160.6N/A58.959.870.8N/A76.3

76.782.571.471.876.783.877.186.489.691.172.080.075.679.276.778.675.086.083.790.3

82.788.383.373.581.585.476.083.883.187.370.279.477.078.979.275.873.277.776.682.2

66.567.566.960.972.273.872.174.583.583.365.970.168.664.471.767.763.579.674.983.7

N/A88.8N/AN/AN/A87.7N/AN/AN/A87.3N/AN/AN/A83.1N/AN/AN/A87.4N/AN/A

……………………………………………………

% Always


Source: VSSC Pa�ent Experiences Survey Reports 9.4.V12.Northern#2




% 9 or 10

205

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



CK

(V12) (676GC) River Valley(V12) (676GC) River Valley(V12) (676GD) Wisconsin Rapids(V12) (676GD) Wisconsin Rapids(V12) (676GD) Wisconsin Rapids(V12) (676GD) Wisconsin Rapids(V12) (676GE) Clark County(V12) (676GE) Clark County(V12) (676GE) Clark County(V12) (676GE) Clark CountyVISN 12 AverageVISN 12 AverageVISN 12 AverageVISN 12 AverageNa�onal AverageNa�onal AverageNa�onal AverageNa�onal Average

201720182015201620172018201520162017201820152016201720182015201620172018

68.366.144.050.163.654.553.773.364.167.644.155.855.658.537.449.249.851.3

73.371.4N/A61.364.760.4N/A63.966.655.1N/A63.363.365.5N/A58.458.760.1

87.787.973.775.081.776.582.590.286.087.474.579.079.281.870.975.675.877.1

81.885.279.380.981.175.183.191.088.487.870.373.474.374.566.269.170.071.0

82.079.470.364.974.264.678.875.074.575.868.170.973.174.565.268.168.969.7

N/A90.7N/AN/AN/A84.2N/AN/AN/A90.7N/AN/AN/A85.7N/AN/AN/A80.3

………………………………………………

% Always






% 9 or 10

206

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



CK

(V12) (585) Iron Mountain(V12) (585) Iron Mountain(V12) (585) Iron Mountain(V12) (585GA) Hancock(V12) (585GA) Hancock(V12) (585GA) Hancock(V12) (585GB) Rhinelander(V12) (585GB) Rhinelander(V12) (585GB) Rhinelander(V12) (585GC) Menominee(V12) (585GC) Menominee(V12) (585GC) Menominee(V12) (585GD) Ironwood(V12) (585GD) Ironwood(V12) (585GD) Ironwood(V12) (585GF) Manis�que(V12) (585GF) Manis�que(V12) (585HA) Marque�e(V12) (585HA) Marque�e(V12) (585HA) Marque�e

20162017201820162017201820162017201820162017201820162017201820172018201620172018

61.4%66.3%65.4%23.1%38.3%78.2%17.1%41.6%29.1%39.2%64.2%65.3%53.4%

9.8%73.1%

100.0%41.4%36.2%47.2%74.8%

63.3%65.8%69.5%45.5%73.4%54.1%46.9%63.6%64.8%72.3%50.8%61.4%79.6%12.1%88.9%69.8%53.6%54.6%53.7%40.2%

78.9%81.4%81.0%65.5%94.0%71.6%66.9%85.6%72.9%94.7%84.4%81.4%78.0%22.4%92.1%69.8%79.3%59.4%59.0%76.1%

81.4%82.3%87.5%60.7%88.2%81.1%38.2%62.1%69.1%93.5%98.9%84.4%82.6%26.3%99.6%69.8%60.6%77.4%82.5%78.7%

74.5%75.0%77.1%30.0%85.7%78.9%67.2%88.6%68.3%93.6%83.7%58.2%74.7%14.8%

100.0%69.8%80.2%53.9%33.4%65.1%

N/AN/A

89.6%N/AN/A

84.4%N/AN/A

85.0%N/AN/A

86.4%N/AN/A

100.0%N/A

79.9%N/AN/A

81.5%

12…12…12…12…12…12…12…12…12…12…12…12…12…12…12…12…12…12…12…12…

% Always






% 9 or 10

207

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



CK

(V12) (585HB) Sault Saint Marie(V12) (585HB) Sault Saint Marie(V12) (585HB) Sault Saint Marie(V12) (676) Tomah(V12) (676) Tomah(V12) (676) Tomah(V12) (676GA) Wausau(V12) (676GA) Wausau(V12) (676GA) Wausau(V12) (676GC) River Valley-La Cro…(V12) (676GC) River Valley-La Cro…(V12) (676GC) River Valley-La Cro…(V12) (676GD) Wisconsin Rapids(V12) (676GD) Wisconsin Rapids(V12) (676GD) Wisconsin Rapids(V12) (676GE) Clark County-Owen(V12) (676GE) Clark County-Owen(V12) (676GE) Clark County-OwenVISN 12 AverageVISN 12 Average

20162017201820162017201820162017201820162017201820162017201820162017201820162017

25.5%71.9%34.0%56.4%57.1%53.3%30.6%35.2%30.7%52.0%59.8%77.9%67.7%53.6%51.6%

3.4%81.5%46.4%51.7%51.5%

51.5%53.1%47.7%58.9%60.1%58.7%44.4%58.1%60.5%73.3%62.0%74.2%65.1%65.8%61.9%46.1%61.5%42.8%57.0%59.0%

52.6%87.9%74.0%74.8%79.0%74.9%68.1%82.1%81.0%85.5%84.1%72.8%84.8%86.2%78.3%

100.0%73.9%82.9%74.4%76.0%

99.4%68.9%74.0%79.9%76.5%81.5%87.3%60.0%61.0%80.3%78.9%91.8%83.3%85.8%77.2%98.8%

100.0%98.1%71.9%71.9%

67.9%49.5%62.9%61.8%69.0%71.3%63.5%62.8%74.9%71.2%79.8%69.1%78.7%72.1%77.7%

100.0%65.2%97.0%67.2%68.6%

N/AN/A

85.2%N/AN/A

85.1%N/AN/A

61.6%N/AN/A

81.3%N/AN/A

85.9%N/AN/A

100.0%N/AN/A

12…12…12…12…12…12…12…12…12…12…12…12…12…12…12…12…12…12…12…12…

% Always






% 9 or 10

208

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



CK

VISN 12 AverageNa�onal AverageNa�onal AverageNa�onal Average

2018201620172018

55.0%47.3%48.7%49.7%

60.1%55.1%56.2%57.1%

76.4%73.2%74.2%75.3%

74.7%69.1%70.4%71.7%

71.4%65.4%66.8%68.4%

84.6%N/AN/A

81.0%

12…12…12…12…

% Always






% 9 or 10

209

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


(V12) (585) Iron Mountain(V12) (585) Iron Mountain(V12) (585) Iron Mountain(V12) (676) Tomah-Wisconsin(V12) (676) Tomah-Wisconsin(V12) (676) Tomah-WisconsinVISN 12 AverageVISN 12 AverageVISN 12 AverageNational AverageNational AverageNational Average

201620172018201620172018201620172018201620172018

68.870.474.978.355.278.363.466.471.858.862.164.5

62.058.864.887.049.862.251.159.263.950.454.255.3

65.266.975.087.259.173.964.567.375.863.766.468.0

53.753.253.274.846.052.447.751.555.647.049.251.0

21.951.044.065.839.242.637.943.745.442.244.545.7

12.046.354.157.743.441.835.742.346.441.043.744.8

50.150.947.663.539.451.138.346.846.742.745.247.0

89.461.263.577.349.969.661.755.166.551.653.454.9

91.259.966.187.256.365.362.656.668.959.660.662.5

54.961.071.171.156.375.162.163.472.859.962.166.0

34.860.074.774.148.072.459.460.772.159.862.266.1

72.072.488.273.162.683.366.472.383.671.774.076.9

VA Pa�ent Sa�sfac�on – Community Care

% Always






% 9 or 10 % Strongly Agree

% Very Sa�sfied

or Sa�sfied

210

Quality of Community Hospitals – Iron Mountain AreaQuality & Sa�sfac�on

Source: 1. Best Care Report 2. Defini ve Healthcare 9.6.V12.Northern.585

Note: Data is reported by provider number and may includes mul�-campus hospitals repor�ng under a single provider number, N/A = Not Applicable


VISN 12: Northern Market — Iron MountainValida�on of the data for this slide is not required 211

Quality of Community Hospitals – Tomah-Wisconsin AreaQuality & Sa�sfac�on

Source: 1. Best Care Report 2. Defini ve Healthcare 9.6.V12.Northern.676

Note: Data is reported by provider number and may includes mul�-campus hospitals repor�ng under a single provider number, N/A = Not Applicable


VISN 12: Northern Market — Tomah-WisconsinValida�on of the data for this slide is not required 212


Sources: 1. US News and World Report Flagship Hospital Rankings 2. Hospital website 9.7.V12.Northern.585



Awards and Recogni�on of Top Five Largest Community Hospitals* – Iron Mountain 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 in for Notable Awards indicate the hospital did not list any care or service delivery awards website. Reflects informa�on that was available as of July 29th, 2019.



Sources: 1. US News and World Report Flagship Hospital Rankings 2. Hospital website 9.7.V12.Northern.676



Awards and Recogni�on of Top Five Largest Community Hospitals* – Tomah-Wisconsin 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 in for Notable Awards indicate the hospital did not list any care or service delivery awards website. Reflects informa�on that was available as of July 29th, 2019.



Source: CMS.gov 9.8.V12.Northern



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 the Centers for Medicare & Medicaid Services

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 Measuresü 9 Submi�ed Via a Web-Based Tool Measuresü 1 Outcome Claims-Based Measuresü Commercial Market Data & Analysis

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

215

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 made available by CMS and are not included in this analysis.

Acute Myocardial Infarc�on /

Chest Pain Measure Score


Source: CMS.gov 9.9.V12.Northern



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


Id

Outpa�entQuality Category

Measure Name Preferred Direc�on Hospital1 Hospital2 Hospital3 Hospital4 Hospital5 Na�onalRate

547

548549550551

552553

554

555

556557

558559560

561

562563564565

566

Outpa�entQuality CategoryAMI / Chest Pain

Structural(Submi�ed Via aWeb-Based Tool)

Outcome Claims-BasedED – Throughput

ED – Volume

ImagingEfficiency

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 ?Avoidance of 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 Colonoscopy

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-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 RiskSurgery (%)OP-14: Simultaneous Use of Brain Computed Tomography (CT) and Sinus ComputedTomography (CT) (%)

Preferred Direc�on

HighLowLowYes

YesHigh

High

High

HighLow

LowLowN/A

Low

LowLowLowLow

Low

Dickinson CountyMemorial HospitalN/AN/A6Yes

Yes99.0%

94.0%

N/A

86.0%14.1%

1421.0%Low (0-19,999pa�ents annually)38.3%

4.1%18.5%5.8%5.4%

0.0%

Aspirus Iron RiverHospitalN/AN/A6N/A

N/AN/A

N/A

N/A

N/AN/A

1191.0%Low (0-19,999pa�ents annually)N/A

7.9%4.5%0.0%N/A

N/A

N/A

N/AN/AN/AN/A

N/AN/A

N/A

N/A

N/AN/A

N/AN/AN/A

N/A

N/AN/AN/AN/A

N/A

N/A

N/AN/AN/AN/A

N/AN/A

N/A

N/A

N/AN/A

N/AN/AN/A

N/A

N/AN/AN/AN/A

N/A

N/A

N/AN/AN/AN/A

N/AN/A

N/A

N/A

N/AN/A

N/AN/AN/A

N/A

N/AN/AN/AN/A

N/A

Na�onal Rate

59.0%628N/A

N/A88.0%

90.0%

95

86.0%14.8%

1372.0%N/A

39.3%

8.9%7.8%1.5%4.6%

1.1%

567 OP-23: Head CT or MRI Scan Results Within 45 minutes of ED Arrival (%) High 50.0% N/A N/A N/A N/A 73.0%

Id



547

548549550551

552553

554

555

556557

558559560

561

562563564565

566




ED – Volume

ImagingEfficiency

Measure Name







HighLowLowYes

YesHigh

High

High

HighLow

LowLowN/A

Low

LowLowLowLow

Low

Dickinson CountyMemorial HospitalN/AN/A6Yes

Yes99.0%

94.0%

N/A

86.0%14.1%

1421.0%Low (0-19,999pa�ents annually)38.3%

4.1%18.5%5.8%5.4%

0.0%

Aspirus Iron RiverHospitalN/AN/A6N/A

N/AN/A

N/A

N/A

N/AN/A

1191.0%Low (0-19,999pa�ents annually)N/A

7.9%4.5%0.0%N/A

N/A

N/A

N/AN/AN/AN/A

N/AN/A

N/A

N/A

N/AN/A

N/AN/AN/A

N/A

N/AN/AN/AN/A

N/A

N/A

N/AN/AN/AN/A

N/AN/A

N/A

N/A

N/AN/A

N/AN/AN/A

N/A

N/AN/AN/AN/A

N/A

N/A

N/AN/AN/AN/A

N/AN/A

N/A

N/A

N/AN/A

N/AN/AN/A

N/A

N/AN/AN/AN/A

N/A

Na�onal Rate

59.0%628N/A

N/A88.0%

90.0%

95

86.0%14.8%

1372.0%N/A

39.3%

8.9%7.8%1.5%4.6%

1.1%

567 OP-23: Head CT or MRI Scan Results Within 45 minutes of ED Arrival (%) High 50.0% N/A N/A N/A N/A 73.0%




*As measured by total staffed beds **A rate of 8% - 14% is typically ideal for mammography follow-up rates N/A = Not available/reported Green: at/above Na�onal Rate

Source: 2017 CMS.gov

Quality & Sa�sfac�on Key Quality Metrics of Top Five Largest Community Hospitals* – Iron Mountain Area

217

Id



1114

1115111611171118

11191120

1121

1122

11231124

112511261127

1128

1129113011311132

1133




ED – Volume

ImagingEfficiency

Measure Name







HighLowLowYes

YesHigh

High

High

HighLow

LowLowN/A

Low

LowLowLowLow

Low

Gundersen LutheranMedical CenterN/AN/AN/AYes

Yes93.0%

93.0%

N/A

98.0%15.8%

1662.0%High (40,000-59,999pa�ents annually)

26.7%

6.1%3.2%0.1%4.9%

0.8%

Mayo Clinic Hospital -Franciscan HealthcareN/AN/AN/AYes

Yes96.0%

97.0%

N/A

N/A14.2%

1031.0%Medium (20,000-39,999 pa�entsannually)42.6%

5.4%7.8%0.1%5.9%

1.1%

Aspirus RiverviewHospitalN/AN/A9Yes

Yes85.0%

93.0%

N/A

100.0%14.8%

1453.0%Medium (20,000-39,999 pa�entsannually)N/A

5.0%2.8%0.0%4.2%

1.0%

Mile Bluff MedicalCenterN/AN/A8Yes

Yes0.0%

85.0%

N/A

N/A15.0%

1221.0%Low (0-19,999pa�ents annually)

39.1%

9.6%5.6%0.4%4.7%

N/A

Gundersen StJosephs HospitalN/AN/A8N/A

N/AN/A

N/A

N/A

N/AN/A


N/A

7.1%N/AN/AN/A

0.0%

Na�onal Rate

59.0%628N/A

N/A88.0%

90.0%

95

86.0%14.8%

1372.0%N/A

39.3%

8.9%7.8%1.5%4.6%

1.1%

1134 OP-23: Head CT or MRI Scan Results Within 45 minutes of ED Arrival (%) High N/A N/A 89.0% N/A N/A 73.0%

Id



1114

1115111611171118

11191120

1121

1122

11231124

112511261127

1128

1129113011311132

1133




ED – Volume

ImagingEfficiency

Measure Name







HighLowLowYes

YesHigh

High

High

HighLow

LowLowN/A

Low

LowLowLowLow

Low

Gundersen LutheranMedical CenterN/AN/AN/AYes

Yes93.0%

93.0%

N/A

98.0%15.8%

1662.0%High (40,000-59,999pa�ents annually)

26.7%

6.1%3.2%0.1%4.9%

0.8%

Mayo Clinic Hospital -Franciscan HealthcareN/AN/AN/AYes

Yes96.0%

97.0%

N/A

N/A14.2%

1031.0%Medium (20,000-39,999 pa�entsannually)42.6%

5.4%7.8%0.1%5.9%

1.1%

Aspirus RiverviewHospitalN/AN/A9Yes

Yes85.0%

93.0%

N/A

100.0%14.8%

1453.0%Medium (20,000-39,999 pa�entsannually)N/A

5.0%2.8%0.0%4.2%

1.0%

Mile Bluff MedicalCenterN/AN/A8Yes

Yes0.0%

85.0%

N/A

N/A15.0%


39.1%

9.6%5.6%0.4%4.7%

N/A

Gundersen StJosephs HospitalN/AN/A8N/A

N/AN/A

N/A

N/A

N/AN/A


N/A

7.1%N/AN/AN/A

0.0%

Na�onal Rate

59.0%628N/A

N/A88.0%

90.0%

95

86.0%14.8%

1372.0%N/A

39.3%

8.9%7.8%1.5%4.6%

1.1%

1134 OP-23: Head CT or MRI Scan Results Within 45 minutes of ED Arrival (%) High N/A N/A 89.0% N/A N/A 73.0%




*As measured by total staffed beds **A rate of 8% - 14% is typically ideal for mammography follow-up rates N/A = Not available/reported Green: at/above Na�onal Rate

Source: 2017 CMS.gov

Quality & Sa�sfac�on Key Quality Metrics of Top Five Largest Community Hospitals* – Tomah-Wisconsin Area

218

Id

9… 9_12_1A Output ProcedureType Hospital1 Hospital2 Hospital3 Hospital4 Hospital5

309

310311312313

314315316317318319

1

2345

6789

1011

Outpatient Quality Category

OP Surgical ProcedureVolume

Procedure Type

GastrointestinalEye

Nervous SystemMusculoskeletal

SkinGenitourinaryCardiovascular

RespiratoryOtherTotal

Dickinson County MemorialHospital

2,5902947

281

4,28978273

20466

8,361

Aspirus Iron River Hospital

N/AN/AN/AN/A

N/AN/AN/AN/AN/A

0

N/A

N/AN/AN/AN/A

N/AN/AN/AN/AN/A

0

N/A

N/AN/AN/AN/A

N/AN/AN/AN/AN/A

0

N/A

N/AN/AN/AN/A

N/AN/AN/AN/AN/A

0

Id


309

310311312313

314315316317318319

1

2345

6789

1011



Procedure Type

GastrointestinalEye




Dickinson County MemorialHospital

2,5902947

281

4,28978273

20466

8,361

Aspirus Iron River Hospital

N/AN/AN/AN/A

N/AN/AN/AN/AN/A

0

N/A

N/AN/AN/AN/A

N/AN/AN/AN/AN/A

0

N/A

N/AN/AN/AN/A

N/AN/AN/AN/AN/A

0

N/A

N/AN/AN/AN/A

N/AN/AN/AN/AN/A

0

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

Source: 2017 CMS.gov 9.11.V12.Northern.585



N/A = Not available/reported

*As measured by total staffed beds

• 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).


Id


320

321322323324

325326327328329330

1

2345

6789

1011



Procedure Type

GastrointestinalEye




Gundersen Lutheran MedicalCenter8,6514,339

4171,007

11,4141,880

592679369

29,348

Mayo Clinic Hospital -Franciscan Healthcare

3,613790168821

20650322590

1036,519

Aspirus Riverview Hospital

2,81313214

113

57113702431

3,367

Mile Bluff Medical Center

229370

121

29172

619

604

Gundersen St JosephsHospital

N/AN/AN/AN/A

N/AN/AN/AN/AN/A

0

Id


320

321322323324

325326327328329330

1

2345

6789

1011



Procedure Type

GastrointestinalEye




Gundersen Lutheran MedicalCenter8,6514,339

4171,007

11,4141,880

592679369

29,348

Mayo Clinic Hospital -Franciscan Healthcare

3,613790168821

20650322590

1036,519

Aspirus Riverview Hospital

2,81313214

113

57113702431

3,367

Mile Bluff Medical Center

229370

121

29172

619

604

Gundersen St JosephsHospital

N/AN/AN/AN/A

N/AN/AN/AN/AN/A

0

Hospitals* – Tomah-Wisconsin AreaOutpa�ent Procedure Volumes of Top Five Largest CommunityQuality & Sa�sfac�on

Source: 2017 CMS.gov 9.11.V12.Northern.676



N/A = Not available/reported

*As measured by total staffed beds

• 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).


Facili�es

221

1 2

Acres availableMain 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 CostTotal 10-Year Capital Investment*Facili�es Condi�ons Assessment DeficienciesSeismic RiskOpera�onal Leases

019482019317,636 sq. �105,965 sq. � 33.0% of BGSF26 acres 0 acres available**$4,875,713$77,607,247$6,844,620 $383/UniqueLow Risk8 Leases $887,305 total annual cost 33,621 total NUSF

1 2 3

Facility Complexity Level (2017): Low-3 1

1 2 3

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

Low-317,873

12

REAL PROPERTY OVERVIEW




Facili�es

Facility Name: Iron Mountain

Inpa�ent Campus Snapshot

Source: CAI Buildings and FCA Condi�on Gaps Reports 9-7-2019, and CAPRES CEOSH Report 1-29-2019

* Sum of Major and Minor Con. and 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.

222

1. Includes Acute Psych, Medicine, and Surgical Beds




Facili�es

Source: CAI Buildings, Floor, Leases, and FCA Red Green Reports 9-7-2019; VSSC Core Uniques Cube; CAPRES CEOSH Report 1-29-2019; Locally Provided GFI

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

2. Includes Spinal Cord, Blind Rehab, CLC, DRRTP, and Intermediate Beds3. Only reflects SF related to VA owned and leased fixed facili�es

223

Major Construc�on Funding

$0

$10,000,000

FY09 FY10 FY11 FY12 FY13 FY14 FY15 FY16 FY17 FY18

VHA Average Major VISN Average Major Facility Major

Measure Facility VISN Average VHA Average Id

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

$22$6,844,620

$244$77,607,247

317,636

$130$175,569,558

$128$146,789,803

1,145,274

$139$123,886,618

$155$137,521,745

886,486

1313131313

Investment – Iron Mountain


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



Facili�esMinor Construc�on Funding

$0

$5,000,000


VHA Average Minor VISN Average Minor Facility Minor

NRM Funding

$0

$10,000,000

$20,000,000


VHA Average NRM VISN Average NRM Facility NRM

Total Construc�on Funding

$0

$10,000,000

$20,000,000


VHA Average Total VISN Average Total Facility Total

Source: CAI Buildings and FCA Red Green Reports 9-7-2019; FMS 830 837, Accounts 110, 111, and 162 (Cost Center 8542, BOC 32XX, (less BOC 3222 and BOC 3224))

224

Site Plan

Source: Locally Provided GFI 10.4.V12.Northern.585



Facili�esIron Mountain

225

Building Inventory (Owned)

Func�on Title Current Use YearBuilt

BuildingGross Sq.

Ft.

Outpa�entSq. Ft.

Inpa�ent Non-Clinical

Other Vacant Cost of FCADeficiencies*

FullReplacement

Cost

Historical Status SeismicRisk

TotalMain Hospital (1)Boiler Plant/Garage/Generators (2)Apartment Quarters (5)Adminstra�ve (6)Administra�ve (4)Adminstra�ve (3)Secondary Generator (11)Salt Shed (19)Storage Bldg. (10)Quarters Garage (8)Storage (12)Storage (16)East Smoking Shelter (20)Hazardous Waste (14)West Smoking Shelter (18)South Smoking Shelter (17)Storage (13)

HospitalIndustrialHousingOfficeOfficeOffice

IndustrialWarehousesWarehousesWarehouses

IndustrialWarehouses

All OtherWarehouses

All OtherAll OtherIndustrial

19481948195019501950195019832011197919501983200020122000200920002000

317,636270,867

15,0367,9966,9484,8714,0062,2941,6801,344

843640336265263105

7864

75,62270,677

000

1,4923,453

00000000000

30,34330,343

0000000000000000

73,22264,079

5,9850

3,1499000000000000

133,023104,324

9,0517,9963,187

0553

2,2941,6801,344

843640336265263105

7864

5,4261,444

00

6123,370

000000000000

$6,618,391$3,368,819

$378,269$623,247

$1,666,735$276,096$274,576

$6,958$0

$8,373$791

$12,157$791

$0$791

$0$0

$791

$213,045,178$183,373,057

$9,587,668$4,889,994$4,444,479$3,150,499$2,554,416$1,462,763$1,071,248

$856,998$537,537$408,094$214,250$168,977$167,701

$66,953$49,737$40,809

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

ExemptExemptExemptExemptExemptExemptExempt

Not ListedExemptExemptExempt

Not ListedNot ListedNot ListedNot ListedNot ListedNot Listed

Iron Mountain

Source: CAI Buildings & FCA Condi�on Gaps Report 9-7-2019 10.5.V12.Northern.585

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



Facili�es

226


BuildingGrossSq. Ft.

Outpa�entSq. Ft.


Other Vacant Lease Termina�on (Hard) Year ofAc�va�on

Annual Rent

TotalRhinelander CBOC IIMarque�e CBOCMenominee CBOC IIHancock CBOCManis�que CBOCManis�que ORH Outreach ClinicSault Ste. Marie CBOCIronwood CBOC

CBOCCBOCCBOCCBOCCBOCOutreach ClinicCBOCCBOC

19742009197819701988198820102006

33,6216,3095,6804,6164,5003,1963,1963,1243,000

31,4886,0195,2924,4113,7313,1963,1962,9192,724

000000000

22548472625

00

4138

1,908242341179744

00

164238

000000000

Sunday, February 28, 2027Sunday, December 31, 2028Friday, December 31, 2027Saturday, July 31, 2027Tuesday, July 31, 2029Wednesday, August 7, 2019Friday, April 30, 2021Thursday, April 30, 2026

20172019201820172019200920112016

$887,305$156,148$178,459

$89,676$91,245$75,713$75,713

$156,927$63,424

Source: CAI Leases Report 9-7-2019 10.6.V12.Northern.585



Facili�esIron Mountain

Building Inventory (Leased)

227

Summary of Architectural and Engineering Challenges – Iron Mountain




Facili�es

228

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




Facili�es Ac�ve and Planned Projects — Iron Mountain

10_8 Program Project SF/ Count Status Es�matedCost

.

Ac�ve Minor Construc�on¹

Ac�ve NRMs¹

Expand CLC (585-335)Expand Primary Care (585-336)Add Catwalks in Boiler Plant (585-18-104)Install Perimeter Heat in Imaging and 4 East (585-17-105)Prepare Site for Nuc Med/CT (585-18-110)Renovate Basement West (585-17-115)Renovate Building No. 4 (585-14-105)Repair MRI Pad (585-18-107)Repair Pharmacy Clean Room (585-18-109)Replace Fire Doors & Frames (585-16-116)Upgrade 3 West and Center (585-18-123)Upgrade 4 Center (585-18-113)Upgrade 4 East Inpa�ent Rooms (585-17-107)Upgrade 5 Center (585-18-106)Upgrade AHU09 and Locker Room (585-17-111)Upgrade AHU's 10 and 11 (585-18-111)Upgrade Building 1 Entrances and Main Corridor (585-18-114)Upgrade Elevator Control Panels. (585-18-112)Upgrade Exterior Signage and Wayfinding (585-18-129)Upgrade Heat Exchangers and Replacement Perimeter Hea�ng (585-17-120)

16,20012,268

2,500435

5,0004,871

2001,000

11,00010,000

9,0004,0004,000

10,000

250

Construc�on Awarded 02/27/19Design Awarded 02/06/19

Construc�on Awarded 05/22/19Construc�on Awarded 12/03/18Construc�on Awarded 07/31/19

Design Awarded 12/26/17Construc�on Awarded 03/29/19Construc�on Awarded 05/05/19

Design Awarded 09/25/18Construc�on Awarded 01/17/19

Design Awarded 04/11/19Design Awarded 02/27/19


Construc�on Awarded 03/14/19Construc�on Awarded 04/30/19



$9,030,000$9,000,000

$86,000$645,000$225,000

$1,150,000$280,000

$80,000$85,000

$245,000$800,000$522,500$900,000$910,000$885,000$880,000$660,000$100,000$110,000

$2,613,242

11111111111111111111

Upgrade Mechanical Rooms (585-18-116) Design Awarded 04/01/19 $275,000 1


.


Ac�ve NRMs¹

Expand CLC (585-335)Expand Primary Care (585-336)Add Catwalks in Boiler Plant (585-18-104)Install Perimeter Heat in Imaging and 4 East (585-17-105)Prepare Site for Nuc Med/CT (585-18-110)Renovate Basement West (585-17-115)Renovate Building No. 4 (585-14-105)Repair MRI Pad (585-18-107)Repair Pharmacy Clean Room (585-18-109)Replace Fire Doors & Frames (585-16-116)Upgrade 3 West and Center (585-18-123)Upgrade 4 Center (585-18-113)Upgrade 4 East Inpa�ent Rooms (585-17-107)Upgrade 5 Center (585-18-106)Upgrade AHU09 and Locker Room (585-17-111)Upgrade AHU's 10 and 11 (585-18-111)Upgrade Building 1 Entrances and Main Corridor (585-18-114)Upgrade Elevator Control Panels. (585-18-112)Upgrade Exterior Signage and Wayfinding (585-18-129)Upgrade Heat Exchangers and Replacement Perimeter Hea�ng (585-17-120)

16,20012,268

2,500435

5,0004,871

2001,000

11,00010,000

9,0004,0004,000

10,000

250



Design Awarded 12/26/17Construc�on Awarded 03/29/19Construc�on Awarded 05/05/19




Construc�on Awarded 03/14/19Construc�on Awarded 04/30/19



$9,030,000$9,000,000

$86,000$645,000$225,000

$1,150,000$280,000

$80,000$85,000

$245,000$800,000$522,500$900,000$910,000$885,000$880,000$660,000$100,000$110,000

$2,613,242

11111111111111111111

Upgrade Mechanical Rooms (585-18-116) Design Awarded 04/01/19 $275,000 1

Source: 1. Capital Assets database (PTR as of 9-4-19) 2. Strategic Capital Investment Plan (FY2020 submission) 3. CFM Major Construc�on Monthly Report, ORP Project Repor�ng, CAI Proposed (New) Leases (9-7-19)

229




10.8.V12.Northern.585#2

Facili�es Ac�ve and Planned Projects — Iron Mountain, cont.


.

Ac�ve NRMs¹

Ac�ve Projects Total Es�mated Cost (Major, Minor, NRM)¹SCIP FY2020 Submi�ed Projects (10-Year-Plan)

Upgrade Outbuilding Hea�ng Systems (585-18-117)Upgrade Staff Parking Areas and U�li�es (585-17-110)Upgrade Subbasement Sanitary Sewer System (585-18-115)Ac�ve Projects Total Es�mated Cost (Major, Minor, NRM)Minor Construc�onNRM-Infrastructure Moderniza�onNRM-SustainmentTotal Es�mated Cost SCIP Projects

1225


Design Awarded 12/11/18

$160,000$1,700,000

$110,000$31,451,742

$6,500,000$4,950,000$5,390,000

$16,840,000

11111111


.

Ac�ve NRMs¹

Ac�ve Projects Total Es�mated Cost (Major, Minor, NRM)¹SCIP FY2020 Submi�ed Projects (10-Year-Plan)

Upgrade Outbuilding Hea�ng Systems (585-18-117)Upgrade Staff Parking Areas and U�li�es (585-17-110)Upgrade Subbasement Sanitary Sewer System (585-18-115)Ac�ve Projects Total Es�mated Cost (Major, Minor, NRM)Minor Construc�onNRM-Infrastructure Moderniza�onNRM-SustainmentTotal Es�mated Cost SCIP Projects

1225


Design Awarded 12/11/18

$160,000$1,700,000

$110,000$31,451,742

$6,500,000$4,950,000$5,390,000

$16,840,000

11111111


230

1 2

Acres availableMain 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 CostTotal 10-Year Capital Investment*Facili�es Condi�ons Assessment DeficienciesSeismic RiskOpera�onal Leases

419462014722,338 sq. �259,965 sq. � 36.0% of BGSF174 acres 4 acres available**$7,591,772$111,281,378$108,992,732 $5,221/UniqueLow Risk7 Leases $791,586 total annual cost 36,548 total NUSF

1 2 3

Facility Complexity Level (2017): Low-3 1

1 2 3

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

Low-320,876

12

REAL PROPERTY OVERVIEW




Facili�es

Facility Name: Tomah-Wisconsin

Inpa�ent Campus Snapshot

Source: CAI Buildings and FCA Condi�on Gaps Reports 9-7-2019, and CAPRES CEOSH Report 1-29-2019

* Sum of Major and Minor Con. and 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.

231

1. Includes Acute Psych, Medicine, and Surgical Beds




Facili�es

Source: CAI Buildings, Floor, Leases, and FCA Red Green Reports 9-7-2019; VSSC Core Uniques Cube; CAPRES CEOSH Report 1-29-2019; Locally Provided GFI

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

2. Includes Spinal Cord, Blind Rehab, CLC, DRRTP, and Intermediate Beds3. Only reflects SF related to VA owned and leased fixed facili�es

232

Major Construc�on Funding

$0

$10,000,000


VHA Average Major VISN Average Major Facility Major

Measure Facility VISN Average VHA Average Id

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

$151$108,992,732

$154$111,281,378

722,338

$130$175,569,558

$128$146,789,803

1,145,274

$139$123,886,618

$155$137,521,745

886,486

2726262626

Investment – Tomah-Wisconsin


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



Facili�esMinor Construc�on Funding

$0

$10,000,000


VHA Average Minor VISN Average Minor Facility Minor

NRM Funding

$0

$10,000,000

$20,000,000


VHA Average NRM VISN Average NRM Facility NRM

Total Construc�on Funding

$0

$10,000,000

$20,000,000


VHA Average Total VISN Average Total Facility Total

Source: CAI Buildings and FCA Red Green Reports 9-7-2019; FMS 830 837, Accounts 110, 111, and 162 (Cost Center 8542, BOC 32XX, (less BOC 3222 and BOC 3224))

233

Site Plan

Source: Site Plan dated January 2017 as provided by facility 10.4.V12.Northern.676



Facili�esTomah-Wisconsin

234

Building Inventory (Owned)


BuildingGross Sq.

Ft.

Outpa�entSq. Ft.



FullReplacement

Cost


TotalAdministra�on & Medical (400)Community Living Center (402)Administra�on (408)Community Living Center (401)Community Living Center (403)Community Living Center (406)Administra�on (407)RRTP & MH Clinic (404)Kitchen & Dining Hall (424)RRTP (405)Vacant Nursing Quarters (2)Connec�ng Corridors (CC)Recrea�onal Therapy (455)Administra�on (23)Shops (40)Laundry & MH (416)Warehouse (414)Fire Sta�on & Grounds (36)CLC Home (409)

HospitalHospital

OfficeHospitalHospitalHospital

OfficeHospitalServiceHospital

Dorms/Barr…Ins�tu�onal

All OtherOffice

IndustrialIns�tu�onalWarehouses

ServiceHospital

1946194619471946194619471947194719592016193219472016191519431947201919302014

722,33885,43856,02654,25953,10450,77649,51242,35038,36530,96028,72026,75617,69514,59514,00513,998

9,7649,0728,7178,558

100,68239,50914,330

5,1320

4,2343,5388,6837,873

00000

3,9710

4,778000

159,2838,578

17,1340

33,91831,83616,459

022,788

012,212

00000000

8,179

169,8358,493

86330,98913,571

6,7982,512

15,5231,599

24,2650000

4,94112,316

4,9869,0724,346

221

206,52226,432

6,73117,308

5,6157,908

10,54418,144

6,1056,6952,000

017,69514,595

5,0931,682

00

4,371158

86,0162,426

16,968830

00

16,459000

14,50826,756

00000000

$100,200,555$4,207,571$4,619,404

$16,097,731$1,404,498$3,215,548

$13,130,626$12,996,936$12,373,076

$594,856$0

$10,999,285$1,572,859

$11,437$7,731,789$1,243,440

$908,141$0

$710,445$77,237

$477,305,796$64,472,420$37,144,504$36,637,675$33,923,863$33,025,283$32,450,525$30,884,883$25,267,346$23,231,535$18,856,747

$4,013,400$11,823,843

$9,752,415$12,187,350

$9,353,499$6,729,771$6,061,933$5,983,571$5,255,157

EligibleEligibleEligibleEligibleEligibleEligibleEligibleEligibleEligible

Not HistoricEligibleEligible

Not HistoricEligible

Non-Cont. ele. of Landmar…Non-Cont. ele. of Landmar…

Not HistoricEligible

Not Historic

ExemptExemptExemptExemptExemptExemptExemptExemptExempt

Not ListedExemptExempt

Not ListedExemptExemptExempt


Tomah-Wisconsin

Source: CAI Buildings & FCA Condi�on Gaps Report 9-7-2019 10.5.V12.Northern.676




Facili�es

235

Building Inventory (Owned), cont.


BuildingGross Sq.

Ft.

Outpa�entSq. Ft.



FullReplacement

Cost


CLC Home (410)Housing (3)IT (32)Storage (260)Boiler Plant (415)Administra�on & Warehouse (25)Gymnasium (15)Warehouse (402A)Greenhouse (423)Chapel (425)SPS (452)Housing (12)Daycare (10)Storage (270)Vacant Housing (4)Housing (18)Housing (5)Garages (223)Garages (212)Vacant Housing (1)

HospitalHousingOffice

ServiceService

WarehousesIns�tu�onalWarehouses

ServiceIns�tu�onal

HospitalHousingSchool

Ins�tu�onalHousingHousingHousing

Ins�tu�onalIns�tu�onal

Housing

20141915192520111946190519101982195519641992192019251892198619101920194319431925

8,5588,3668,2457,5007,4297,1716,6026,4506,4296,3705,2613,8403,1003,0302,9162,3672,3602,1401,9281,707

00000000

6,4291,090

0000000000

8,1790000000000000000000

2210

7,24500

7,171272

6,4500

4,1073,874

000000000

1588,3661,0007,5007,429

06,330

00

1,1731,3873,8403,1003,030

02,367

02,1401,928

0

00000000000000

2,9160

2,36000

1,707

$10,142$1,042,072$1,081,104

$4,126$1,824,167

$45,391$610,955$229,761$384,522$431,051$242,944$148,125$493,017

$86,187$63,789

$743,497$109,868

$33,287$69,499

$202,860

$5,255,157$6,031,025$5,509,330$5,011,519$4,964,076$4,791,680$4,430,223$4,309,906$4,496,925$4,290,537$3,565,494$2,513,381$2,071,428$2,024,654

$437,400$2,633,283

$354,000$1,371,419$1,235,559

$256,050



EligibleEligible


Non-Cont. ele. of Landmar…Eligible




Eligible


Not ListedExemptExemptExemptExemptExemptExemptExemptExemptExemptExemptExemptExempt

Tomah-Wisconsin

Source: CAI Buildings & FCA Condi�on Gaps Report 9-7-2019 10.5.V12.Northern.676#2




Facili�es

236

Building Inventory (Owned), cont.


BuildingGross Sq.

Ft.

Outpa�entSq. Ft.



FullReplacement

Cost


Garages (240)Storage (290)Housing (6)Vacant Golf Shack (295)Primary Power Sta�on (428)Storage & Switch Vault (33)Vacant Well #1 (280)Generator B402 (451)Generator B403 (445)Generator B401 & 406 (446)Generator B400 (447)Generator B407 & 408 (448)Generator B36 & B40 (449)Well #4 (427)Well #3 (210)Well #2 (421)Water Filtra�on (215)Switchgear Vault (240A) (V1)Waste Storage (28)

Ins�tu�onalWarehouses

HousingServiceService

WarehousesIndustrial

ServiceServiceServiceServiceServiceServiceService

IndustrialIndustrialAll OtherService

All Other

1943194319201943197819101960201119781978197819781978194319431952201019861930

1,4191,1151,004

812462452274260235235235235235184184184144130100

01,115

00000000000000000

0000000000000000000

0000000000000000000

1,4190

1,0040

462452

0260235235235235235184184184144130100

000

81200

274000000000000

$27,504$40,559$32,541$15,610$34,232$14,466$23,947

$0$12,772$19,948$21,452$13,182$39,945$48,813$57,103$46,770

$470$0$0

$909,366$792,988$643,413$121,800$308,710$302,028

$41,100$173,733$157,028$157,028$157,028$157,028$157,028$122,949$122,949$122,949

$96,221$86,866$66,820


EligibleEligible


Non-Cont. ele. of Landmar…Not Historic

EligibleEligibleEligibleEligible



Not HistoricNon-Cont. ele. of Landmar…Non-Cont. ele. of Landmar…


Not ListedExemptExemptExemptExemptExemptExemptExemptExempt


Tomah-Wisconsin

Source: CAI Buildings & FCA Condi�on Gaps Report 9-7-2019 10.5.V12.Northern.676#3




Facili�es

237


BuildingGrossSq. Ft.

Outpa�entSq. Ft.


Other Vacant Lease Termina�on (Hard) Year ofAc�va�on

Annual Rent

TotalWI Rapids CBOC 1Wausau CBOCLa Crosse CBOCTomah WarehouseClark County CBOCLaCrosse Mental Health FacilityPrice County Telehealth Clinic

CBOCCBOCCBOCWarehouseCBOCMental HealthSatellite OPC

1975197920001962201119681990

36,5489,7169,4285,0375,0004,0003,315

52

26,0596,2829,4285,037

01,9453,315

52

00000000

6,279624

00

5,000655

00

4,2102,810

000

1,40000

00000000

Friday, December 31, 2038Wednesday, March 31, 2021Thursday, December 31, 2015Monday, June 8, 2020Tuesday, August 31, 2021Monday, August 31, 2015Monday, September 5, 2022

2019200920062010201120082012

$791,586$124,913$247,862$205,318

$21,600$105,432

$86,449$12

Source: CAI Leases Report 9-7-2019 10.6.V12.Northern.676



Facili�esTomah-Wisconsin

Building Inventory (Leased)

238

Summary of Architectural and Engineering Challenges – Tomah-Wisconsin




Facili�es

239





Facili�es Ac�ve and Planned Projects — Tomah-Wisconsin


.


Ac�ve NRMs¹

Construct Two Community Living Center Homes (676-324)Expand and Renovate B404 for Outpa�ent Mental Health (676-325)Expand/Relocate Urgent Care and Renovate First Floor for Pa�ent Flow - Building 400 (676-327)Abate and Renovate B36 (676-19-006)Construct 1st and 2nd floors B405 (676-18-107)Construct Warehouse (676-CSI-001)Correct Legionella Deficiencies B403 (676-14-121C)Correct SPS Deficiencies (676-18-102)Correct SPS Deficiencies B452 (D) (676-18-203)Design Exterior Signage (676-18-103)Electronic Message Board B400 (676-19-011)Enlarge opening to Dental (676-19-115)Install CAT 6 Cable VA Wireless (676-19-111)Install Door Access Control B406 (676-19-112)Install Modular IV Prep Room (676-19-119)Perform arc Flash Study (676-19-103)PREPARE B400 ROOMS 2042 & 2044 FOR NEW CT SCANNER AND FLUOROSCOPE (676-CSI-002)Prepare Space Medical Supply Disribu�on (676-14-019)Remove Asbestos in Crawl Space (676-16-103)Renovate B-18 for Residency Use (676-19-104)

17,13242,925

6,1911,0001,000

15,000

5,670

1,5001,700

1,680

Construc�on Awarded 01/09/18PlannedPlanned


PlannedConstruc�on Awarded 09/20/18


PlannedPlannedPlanned

Construc�on Awarded 03/21/19Planned


PlannedDesign Awarded 08/02/19

Construc�on Awarded 07/22/19

$7,338,100$15,849

$11,000,000$250,000

$3,000,000$4,600,000

$250,000$500,000

$3,850,000$1,540,000

$20,000$15,000

$110,000$65,000$60,000

$125,000$255,054$183,000

$1,575,000$380,000

11111111111111111111

Renovate B407 Whole Health Swing Space (676-19-014) 1,027 Planned $100,000 1


.


Ac�ve NRMs¹

Construct Two Community Living Center Homes (676-324)Expand and Renovate B404 for Outpa�ent Mental Health (676-325)Expand/Relocate Urgent Care and Renovate First Floor for Pa�ent Flow - Building 400 (676-327)Abate and Renovate B36 (676-19-006)Construct 1st and 2nd floors B405 (676-18-107)Construct Warehouse (676-CSI-001)Correct Legionella Deficiencies B403 (676-14-121C)Correct SPS Deficiencies (676-18-102)Correct SPS Deficiencies B452 (D) (676-18-203)Design Exterior Signage (676-18-103)Electronic Message Board B400 (676-19-011)Enlarge opening to Dental (676-19-115)Install CAT 6 Cable VA Wireless (676-19-111)Install Door Access Control B406 (676-19-112)Install Modular IV Prep Room (676-19-119)Perform arc Flash Study (676-19-103)PREPARE B400 ROOMS 2042 & 2044 FOR NEW CT SCANNER AND FLUOROSCOPE (676-CSI-002)Prepare Space Medical Supply Disribu�on (676-14-019)Remove Asbestos in Crawl Space (676-16-103)Renovate B-18 for Residency Use (676-19-104)

17,13242,925

6,1911,0001,000

15,000

5,670

1,5001,700

1,680

Construc�on Awarded 01/09/18PlannedPlanned


PlannedConstruc�on Awarded 09/20/18






Construc�on Awarded 07/22/19

$7,338,100$15,849

$11,000,000$250,000

$3,000,000$4,600,000

$250,000$500,000

$3,850,000$1,540,000

$20,000$15,000

$110,000$65,000$60,000

$125,000$255,054$183,000

$1,575,000$380,000

11111111111111111111

Renovate B407 Whole Health Swing Space (676-19-014) 1,027 Planned $100,000 1


240




10.8.V12.Northern.676#2

Facili�es Ac�ve and Planned Projects — Tomah-Wisconsin, cont.


.

Ac�ve NRMs¹ Renovate Midway for MDS (676-19-021)Renovate Room 2739 for R-Place East (676-19-013)Renovate Sports Complex (676-19-118)Repair B400 Canopy (676-19-109)Repair Chapel Waterline (676-19-010)Repair Entrances and Exists (676-18-110)Repair Entrances and Exits (676-16-110)Replace Boilers (676-14-105)Replace Burner (676-11-117)Replace dry sprinkler system B400 (676-19-004)Replace expansion joints in tramway (676-18-009)REPLACE FIRE DOORS (676-18-001)Replace Gym Roof on B15 (676-19-005)Replace HVAC Equipment in B-404 (676-16-102)Replace HVAC Equipment in Building 406 (D) (676-16-111)Replace Med Vacuum pumps B400 (676-19-107)Replace medical air intake & exhaust piping (676-05-107)Replace Parking Lots, Curb and Gu�er, and Sidewalks (676-19-101)Replace Steam Lines (676-19-105)Replace Windows Building 400 (676-13-107)

19,000260

1,200




PlannedConstruc�on Awarded 03/29/19Construc�on Awarded 05/24/19Construc�on Awarded 03/29/19Construc�on Awarded 03/29/19



Construc�on Awarded 07/03/19Design Awarded 04/10/19Design Awarded 02/27/13

$19,000$20,000$90,000

$500,000$20,000

$395,000$550,000

$8,470,000$176,000$200,000$350,000$350,000$150,000

$1,485,000$5,115,000

$50,000$26,250

$975,000$3,850,000

$775,000

11111111111111111111

Replace Windows Building 424 (676-15-107) Construc�on Awarded 12/28/18 $215,000 1


.

Ac�ve NRMs¹ Renovate Midway for MDS (676-19-021)Renovate Room 2739 for R-Place East (676-19-013)Renovate Sports Complex (676-19-118)Repair B400 Canopy (676-19-109)Repair Chapel Waterline (676-19-010)Repair Entrances and Exists (676-18-110)Repair Entrances and Exits (676-16-110)Replace Boilers (676-14-105)Replace Burner (676-11-117)Replace dry sprinkler system B400 (676-19-004)Replace expansion joints in tramway (676-18-009)REPLACE FIRE DOORS (676-18-001)Replace Gym Roof on B15 (676-19-005)Replace HVAC Equipment in B-404 (676-16-102)Replace HVAC Equipment in Building 406 (D) (676-16-111)Replace Med Vacuum pumps B400 (676-19-107)Replace medical air intake & exhaust piping (676-05-107)Replace Parking Lots, Curb and Gu�er, and Sidewalks (676-19-101)Replace Steam Lines (676-19-105)Replace Windows Building 400 (676-13-107)

19,000260

1,200




PlannedConstruc�on Awarded 03/29/19Construc�on Awarded 05/24/19Construc�on Awarded 03/29/19Construc�on Awarded 03/29/19



Construc�on Awarded 07/03/19Design Awarded 04/10/19Design Awarded 02/27/13

$19,000$20,000$90,000

$500,000$20,000

$395,000$550,000

$8,470,000$176,000$200,000$350,000$350,000$150,000

$1,485,000$5,115,000

$50,000$26,250

$975,000$3,850,000

$775,000

11111111111111111111

Replace Windows Building 424 (676-15-107) Construc�on Awarded 12/28/18 $215,000 1


241




10.8.V12.Northern.676#3

Facili�es Ac�ve and Planned Projects — Tomah-Wisconsin, cont.


.

Ac�ve NRMs¹

Ac�ve Projects Total Es�mated Cost (Major, Minor, NRM)¹Minor Leases in Procurement

SCIP FY2020 Submi�ed Projects (10-Year-Plan)

Study of Roadways and Appurtenances (676-19-102)Upgrade B23 2nd Floor (676-19-108)Ac�ve Projects Total Es�mated Cost (Major, Minor, NRM)LaCrosse Home (Proposed New)Minor Construc�onNRM-Infrastructure Moderniza�onNRM-SustainmentTotal Es�mated Cost SCIP Projects

1,500

7,000676

19

Design Awarded 03/29/19Planned

Proposed New (CAI)

$250,000$350,000

$59,613,253$15,000

$51,422,000$37,335,000$24,756,000

$113,513,000

11111111


.

Ac�ve NRMs¹

Ac�ve Projects Total Es�mated Cost (Major, Minor, NRM)¹Minor Leases in Procurement

SCIP FY2020 Submi�ed Projects (10-Year-Plan)

Study of Roadways and Appurtenances (676-19-102)Upgrade B23 2nd Floor (676-19-108)Ac�ve Projects Total Es�mated Cost (Major, Minor, NRM)LaCrosse Home (Proposed New)Minor Construc�onNRM-Infrastructure Moderniza�onNRM-SustainmentTotal Es�mated Cost SCIP Projects

1,500

7,000676

19

Design Awarded 03/29/19Planned

Proposed New (CAI)

$250,000$350,000

$59,613,253$15,000

$51,422,000$37,335,000$24,756,000

$113,513,000

11111111


242

Mission

243

Mission

Source: Facility Summary Report provided by Office of Academic Affiliation 11.1.V12.Northern.585

*Base Posi�ons = Training Posi�ons, GME = Graduate Medical Educa�on, VACAA = Addi�onal GME Slots aligned to The Veterans Access, Choice, and Accountability Act of 2014 (VACAA).



Medical Educa�on/Training – Iron Mountain11_1 Sponsoring Facility Program Type Specialty D

O

Other Training Programs Associated HealthAssociated HealthAssociated Health

Audiology Doctoral Extern (4th Year)PsychologySocial Work

1.00.02.0

123

Sponsoring Facility Program Type Specialty DO

Other Training Programs Associated HealthAssociated HealthAssociated Health

Audiology Doctoral Extern (4th Year)PsychologySocial Work

1.00.02.0

123

AY 2019 Training Positions (FTEs)*

244

Mission





Medical Education/Training – Iron Mountain, cont.

245

Mission





Medical Educa�on/Training – Tomah-Wisconsin11_1 Sponsoring Facility Program Type Specialty D

O

Medical College of Wisconsin Affiliated Hospitals, IncOther Training Programs

VACAAAssociated HealthAssociated Health

PsychiatryPsychologySocial Work

1.60.02.0

123

Sponsoring Facility Program Type Specialty AY 2019 Training Positions (FTEs)*

DO

Medical College of Wisconsin Affiliated Hospitals, IncOther Training Programs

VACAAAssociated HealthAssociated Health

PsychiatryPsychologySocial Work

1.60.02.0

123

246

Mission





Medical Education/Training – Tomah-Wisconsin, cont.

247

Cost

248

12.1.V12.Northern



Cost Conceptual Cost Analysis for Inpa�ent Services – Methodology Overview

Source: 1. MCAO Discharge National Data Extract, adjusted by netting out Fixed Indirect overhead as calculated by MCAO 2. 2018 CMS Medicare Standard AnalyticalFiles (SAF) from Defini�ve Healthcare limited by a 50 mile radius from the parent facility 3. Based on JAMA study ‘Administra�ve Costs Associated With Physician Billingand Insurance-Related Ac�vi�es at an Academic Health Care System,’ February 20, 2018 4. Office of Community Care


Conceptual Cost Analysis for Inpa�ent Services – Iron Mountain




Cost


Conceptual Cost Analysis for Inpa�ent Services – Tomah-Wisconsin




Cost


VISN 12 Northern Market Data Discovery & Findings Informational Addendum – Enrollment Proximity Analysis

252

VA Market Area Health Systems Optimization


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

2

253



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

3

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

254



Access Enrollment Proximity to VA Site* by Facility

4

Facility NameFacility

Classification

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

Enrollees Users Enrollees Users Enrollees Users Enrollees Users(V12) (585) Iron Mountain VAMC 2,170 1,855 4,182 3,547 2,170 1,855 3,752 3,184(V12) (585GA) Hancock CBOC 1,264 1,032 1,812 1,487 1,264 1,032 1,812 1,487(V12) (585GB) Rhinelander CBOC 1,669 1,328 5,895 4,641 1,669 1,328 4,526 3,624(V12) (585GC) Menominee CBOC 2,177 1,746 5,316 4,220 2,177 1,746 3,432 2,763(V12) (585GD) Ironwood CBOC 1,113 904 2,403 1,861 1,113 904 2,488 1,932(V12) (585GF) Manistique CBOC 413 337 1,831 1,445 413 337 1,589 1,268(V12) (585HA) Marquette CBOC 2,672 2,018 3,373 2,566 2,672 2,018 3,335 2,532(V12) (585HB) Sault Saint Marie CBOC 1,122 800 1,599 1,159 1,122 800 1,375 998(V12) (676) Tomah-Wisconsin VAMC 4,401 3,379 15,332 11,819 4,401 3,379 5,662 4,331(V12) (676GA) Wausau CBOC 4,126 3,043 13,072 9,751 4,126 3,043 5,476 4,057(V12) (676GC) River Valley CBOC 4,824 3,603 12,029 9,110 4,824 3,603 8,118 6,146(V12) (676GD) Wisconsin Rapids MS-CBOC 3,869 3,039 12,790 9,689 3,869 3,039 6,528 5,132(V12) (676GE) Clark County CBOC 986 747 11,763 8,605 928 703 2,009 1,514

FY18Q4 Enrollment by ZIP Code. Enrollee population within each Point of Care’s (POC) drive time (30 and 60 minutes) was calculated by intersecting the drive-time area and the ZIP Code Centroid, then aggregating the ZIP code population to the POC.

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

255



Access Enrollment Proximity to VA Site* by County

5

CountyName

TotalEnrollees

Enrollees Outside of 30-Minute Drive Time


Adams, WI 693 693 0

Alger, MI 461 454 33Baraga, MI 355 355 64Buffalo, WI 529 529 0Chippewa, MI 1,466 344 118Clark, WI 1,059 364 0Delta, MI 2,012 2,012 864Dickinson, MI 1,647 102 0Florence, WI 276 50 0Forest, WI 487 487 0Gogebic, MI 886 112 57Houghton, MI 1,345 119 12Houston, MN 780 391 0Iron, MI 749 749 0Iron, WI 357 18 0Jackson, WI 897 897 0Juneau, WI 1,375 197 0Keweenaw, MI 120 82 9La Crosse, WI 4,195 59 0Langlade, WI 928 928 1Lincoln, WI 1,390 112 0Luce, MI 224 224 165Mackinac, MI 414 293 18Marathon, WI 3,651 263 0Marinette, WI 2,373 955 0

FY18Q4 Enrollment by ZIP Code. Enrollee population within each Point of Care’s (POC) drive time (30 and 60 minutes) was calculated by intersecting the drive-time area and the ZIP Code Centroid, then aggregating the ZIP code population to the POC.

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

CountyName

TotalEnrollees



Marquette, MI 2,918 253 0

Menominee, MI 1,132 321 0Menominee, WI 123 123 0Monroe, WI 3,420 88 0Oconto, WI 1,531 887 0Oneida, WI 1,741 586 0Ontonagon, MI 472 472 260Portage, WI 2,110 704 0Price, WI 659 659 0Schoolcraft, MI 455 42 0Taylor, WI 536 480 0Trempealeau, WI 1,062 967 0Vernon, WI 1,058 794 0Vilas, WI 1,094 1,094 0Waushara, WI 968 968 0Winona, MN 1,295 1,132 0Wood, WI 3,315 852 0

256

Click to edit Master title style

Post-DD&F Data Addendum

Data Compendium - General Information


PurposeThe Data Discovery and Findings (DD&F) data books prepared for each market presented a standardized collection of data used across markets to understand important aspects of each market. Because of the passage of time since the original market assessment phases were conducted, VA has developed an appendix to the DD&F to capture more recent data for key data points. Because the COVID-19 pandemic impacted 2020 and 2021 data, 2019 was the latest fiscal year incorporated for most data elements.

ContentsProjected PopulationRuralityOutpatient DemandOutpatient EncountersSpecialty Care EncountersSurgical CasesInpatient Demand (Facility Level)Market DemandEnrollment ProximityFacilityBuilding FCAAcademic MissionResearch MissionFootnotesSources

Additional InformationThe Footnotes page provides additional details about tables and individual data elements when required. The Sources page provides the relevant data cube or program office sourcing information for each of the data elements.

Projected Veteran Enrollee and Eligible Population (Market)


Market Group FY19 FY29 10 Year % Growth

(V12) Northern Eligible Veterans 75,442 58,878 -22.0%

Enrollees 52,925 46,841 -11.5%

Market Population Rank (out of 95 markets)


Market Total Enrollee Rank FY19

Total Enrollee Rank FY29

% Change Rank

(V12) Northern 65 66 74

County-Based Enrollee Projections


Market Sector County FY19 Enrollees FY29 Enrollees 10 Year % Change

(V12) Northern 12-h-9-B (26003) Alger, MI 485 415 -14.4%

(26013) Baraga, MI 366 356 -2.7%

(26033) Chippewa, MI 1,499 1,379 -8.0%

(26041) Delta, MI 2,040 1,838 -9.9%

(26043) Dickinson, MI 1,642 1,482 -9.8%

(26053) Gogebic, MI 843 715 -15.2%

(26061) Houghton, MI 1,391 1,200 -13.7%

(26071) Iron, MI 746 630 -15.6%

(26083) Keweenaw, MI 127 105 -17.3%

(26095) Luce, MI 235 198 -15.8%

(26097) Mackinac, MI 443 424 -4.2%

(26103) Marquette, MI 2,888 2,694 -6.7%

(26109) Menominee, MI 1,165 1,014 -12.9%

(26131) Ontonagon, MI 492 430 -12.7%

(26153) Schoolcraft, MI 484 450 -7.0%

12-h-9-D (55037) Florence, WI 288 227 -20.9%

(55041) Forest, WI 485 446 -8.0%

(55051) Iron, WI 372 299 -19.7%

(55067) Langlade, WI 899 772 -14.1%

(55075) Marinette, WI 2,349 1,976 -15.9%

(55078) Menominee, WI 116 101 -13.4%

(55083) Oconto, WI 1,546 1,235 -20.1%

(55085) Oneida, WI 1,780 1,505 -15.5%

(55125) Vilas, WI 1,112 986 -11.4%

12-h-9-E (27055) Houston, MN 762 692 -9.3%

(27169) Winona, MN 1,310 1,119 -14.6%

(55001) Adams, WI 692 580 -16.2%

(55011) Buffalo, WI 545 477 -12.4%

(55053) Jackson, WI 902 840 -6.9%

(55057) Juneau, WI 1,380 1,201 -12.9%

(55063) La Crosse, WI 4,116 3,618 -12.1%

(55081) Monroe, WI 3,482 3,377 -3.0%

County-Based Enrollee Projections


Market Sector County FY19 Enrollees FY29 Enrollees 10 Year % Change

(V12) Northern 12-h-9-E (55121) Trempealeau, WI 1,070 936 -12.5%

(55123) Vernon, WI 1,030 907 -12.0%

12-h-9-F (55019) Clark, WI 1,047 973 -7.1%

(55069) Lincoln, WI 1,445 1,308 -9.5%

(55073) Marathon, WI 3,631 3,164 -12.9%

(55097) Portage, WI 2,059 1,813 -12.0%

(55099) Price, WI 676 608 -10.0%

(55119) Taylor, WI 624 538 -13.8%

(55137) Waushara, WI 1,012 933 -7.7%

(55141) Wood, WI 3,346 2,881 -13.9%

Projected Veteran Enrollee and Eligible Population (Demographics)


Market Group Measure Description

Measure Categories

FY19 FY29 10 Year % Change

(V12) Northern Eligible Veterans Age <45 12,719 9,970 -21.6%

45-64 19,389 14,392 -25.8%

65+ (Combination)

43,333 34,516 -20.3%

65-84 35,504 27,428 -22.7%

85-89 5,078 4,433 -12.7%

90+ 2,751 2,655 -3.5%

Gender Female 5,805 6,297 8.5%

Male 69,637 52,581 -24.5%

Priority Priority 1-6 60,210 48,771 -19.0%

Priority 7-8 15,232 10,107 -33.6%

Enrollees Age <45 8,430 7,682 -8.9%

45-64 13,872 12,716 -8.3%

65+ (Combination)

30,623 26,442 -13.7%

65-84 26,041 21,918 -15.8%

85-89 3,020 2,845 -5.8%

90+ 1,562 1,679 7.5%

Gender Female 3,547 4,686 32.1%

Male 49,378 42,156 -14.6%

Priority Priority 1-6 39,958 38,639 -3.3%

Priority 7-8 12,967 8,202 -36.7%

Market Enrollment Rurality (FY19)


Market Rural Enrollees Total Enrollees % Rurality

(V12) Northern 45,016 51,667 87.1%

County Enrollment Rurality


Market County Rural Enrollee Total Enrollees % Rurality

(V12) Northern Adams, WI 1,110 1,110 100.0%

Alger, MI 445 445 100.0%

Baraga, MI 391 391 100.0%

Buffalo, WI 480 480 100.0%

Chippewa, MI 1,451 1,451 100.0%

Clark, WI 998 998 100.0%

Delta, MI 1,891 1,891 100.0%

Dickinson, MI 1,612 1,612 100.0%

Florence, WI 295 295 100.0%

Forest, WI 526 526 100.0%

Gogebic, MI 822 822 100.0%

Houghton, MI 1,311 1,311 100.0%

Houston, MN 473 713 66.3%

Iron, MI 720 720 100.0%

Iron, WI 366 366 100.0%

Jackson, WI 965 965 100.0%

Juneau, WI 1,310 1,310 100.0%

Keweenaw, MI 132 132 100.0%

La Crosse, WI 394 4,092 9.6%

Langlade, WI 871 871 100.0%

Lincoln, WI 1,245 1,245 100.0%

Luce, MI 226 226 100.0%

Mackinac, MI 431 431 100.0%

Marathon, WI 910 3,618 25.2%

Marinette, WI 2,123 2,123 100.0%

Marquette, MI 2,887 2,887 100.0%

Menominee, MI 1,185 1,185 100.0%

Menominee, WI 127 127 100.0%

Monroe, WI 3,377 3,377 100.0%

Oconto, WI 1,683 1,688 99.7%

Oneida, WI 1,674 1,674 100.0%

Ontonagon, MI 452 452 100.0%

County Enrollment Rurality


Market County Rural Enrollee Total Enrollees % Rurality

(V12) Northern Portage, WI 2,119 2,119 100.0%

Price, WI 659 659 100.0%

Schoolcraft, MI 460 460 100.0%

Taylor, WI 551 551 100.0%

Trempealeau, WI 947 947 100.0%

Vernon, WI 893 893 100.0%

Vilas, WI 1,183 1,183 100.0%

Waushara, WI 1,115 1,115 100.0%

Winona, MN 1,301 1,301 100.0%

Wood, WI 2,905 2,905 100.0%

FY19 Market Core Uniques


Market Name Core Uniques

(V12) Northern 42,806

Core Uniques


Market Facility FY15 FY16 FY17 FY18 FY19 5 Year % Change

(V12) Northern (V12) (585) Oscar G. Johnson Department of Veterans Affairs Medical Facility

16,265 16,742 16,980 17,132 17,579 8.1%

(V12) (585GA) Hancock VA Clinic 1,956 2,027 1,907 1,852 1,784 -8.8%

(V12) (585GB) Rhinelander VA Clinic 3,526 3,509 3,477 3,458 3,302 -6.4%

(V12) (585GC) Menominee VA Clinic 2,148 2,013 1,890 1,892 1,890 -12.0%

(V12) (585GD) Ironwood VA Clinic 1,557 1,515 1,879 1,774 1,356 -12.9%

(V12) (585GF) Manistique VA Clinic 586 784 802

(V12) (585HA) Marquette VA Clinic 3,301 3,265 3,081 3,120 3,082 -6.6%

(V12) (585HB) Sault Saint Marie VA Clinic 1,294 1,324 1,238 1,309 1,328 2.6%

(V12) (676) Tomah VA Medical Center 19,305 19,759 19,664 19,834 20,518 6.3%

(V12) (676BU) Tomah VADOM 474 226 231 254 358 -24.5%

(V12) (676GA) Wausau VA Clinic 3,810 4,532 4,532 4,751 4,816 26.4%

(V12) (676GC) La Crosse VA Clinic 6,402 6,749 6,736 6,502 6,849 7.0%

(V12) (676GD) Wisconsin Rapids VA Clinic 5,600 5,856 5,995 5,822 6,107 9.1%

(V12) (676GE) Clark County VA Clinic 1,414 1,420 1,495 1,429 1,334 -5.7%

(V12) (676PA) Tomah PRRTP Wi 24 27 26 22 14 -41.7%

(V12) (676QA) Tomah VA Mobile Clinic 15

Urgent Care Encounters


Market Facility FY17 FY18 FY19 3 Year % Change

(V12) Northern (V12) (585) Iron Mountain 5,814 5,837 5,193 -10.7%

(V12) (676) Tomah-Wisconsin 5,943 6,907 6,500 9.4%

Outpatient Encounters (FY17-19)


Market Facility Clinic Grouping FY17 FY18 FY19 3 Year % Change

(V12) Northern (V12) (585) Iron Mountain Mental Health 21,607 21,226 20,721 -4.1%

Primary Care 25,217 25,549 29,597 17.4%

Specialty Care 133,369 131,018 126,049 -5.5%

(V12) (585GA) Hancock Mental Health 4,575 4,407 4,028 -12.0%

Primary Care 6,599 7,800 9,100 37.9%

Specialty Care 768 774 786 2.3%

(V12) (585GB) Rhinelander Mental Health 4,279 3,874 4,004 -6.4%

Primary Care 8,536 7,826 8,191 -4.0%

Specialty Care 3,452 3,530 3,316 -3.9%

(V12) (585GC) Menominee Mental Health 1,911 2,440 2,523 32.0%

Primary Care 5,359 6,295 4,963 -7.4%


(V12) (585GD) Ironwood Mental Health 1,297 1,484 1,706 31.5%

Primary Care 4,138 4,229 3,501 -15.4%


(V12) (585GF) Manistique Mental Health 1,437 2,731 2,946 105.0%

Primary Care 945 2,055 2,253 138.4%


(V12) (585HA) Marquette Mental Health 5,303 5,202 5,382 1.5%

Primary Care 8,676 8,300 8,863 2.2%

Specialty Care 1,300 1,238 1,275 -1.9%

(V12) (585HB) Sault Saint Marie Mental Health 2,371 2,335 2,104 -11.3%

Primary Care 4,124 4,342 5,910 43.3%


(V12) (676) Tomah-Wisconsin Mental Health 63,895 60,387 78,259 22.5%

Primary Care 48,878 45,691 45,413 -7.1%

Specialty Care 125,952 129,949 131,851 4.7%

(V12) (676GA) Wausau Mental Health 8,782 7,745 7,545 -14.1%

Primary Care 11,783 12,764 13,875 17.8%

Specialty Care 1,776 2,318 2,482 39.8%

(V12) (676GC) River Valley Mental Health 10,054 9,240 9,295 -7.5%

Primary Care 12,698 13,721 16,739 31.8%

Outpatient Encounters (FY17-19)


Market Facility Clinic Grouping FY17 FY18 FY19 3 Year % Change

(V12) Northern (V12) (676GC) River Valley Specialty Care 3,802 4,526 5,199 36.7%

(V12) (676GD) Wisconsin Rapids Mental Health 3,944 4,224 5,220 32.4%

Primary Care 14,586 13,525 14,609 0.2%

Specialty Care 11,458 12,044 14,039 22.5%

(V12) (676GE) Clark County Mental Health 1,058 931 1,064 0.6%

Primary Care 2,651 3,033 2,995 13.0%

Specialty Care 603 539 550 -8.8%

Specialty Care Encounters (FY17-19)


Market Facility Specialty FY17 FY18 FY19 3 Year % Change


Anesthesiology 776 1,075 1,001 29.0%

Audiology / Speech Pathology

7,438 7,090 7,358 -1.1%

Cardiology 2,450 2,463 2,192 -10.5%

Chiropracty 2,205 2,735 971 -56.0%

Critical Care / Pulmonary Disease

1,599 2,280 2,569 60.7%

Dermatology 50 63 29 -42.0%

Emergency Medicine 5,749 5,855 5,228 -9.1%

Endocrinology 2,011 2,137 2,450 21.8%

Gastroenterology 91 43 816 796.7%

Geriatric Medicine 3,910 3,669 3,825 -2.2%

Hematology-Oncology 2,631 2,450 2,391 -9.1%

Infectious Disease 36 44 42 16.7%

Nephrology 123 112 132 7.3%

Neurology 1,047 1,070 838 -20.0%

Nutrition 1,688 1,310 1,143 -32.3%

Occupational Health 125 158 129 3.2%

Optometry 8,543 9,155 9,707 13.6%

Orthopaedic Surgery 2,109 2,197 2,234 5.9%

Otolaryngology 588 630 507 -13.8%

Pain Medicine 178 232 1,000 461.8%

Pathology 52,044 52,833 50,264 -3.4%

Pharmacy 5,290 2,537 2,349 -55.6%

Physical Medicine & Rehabilitation

5,670 5,431 6,349 12.0%

Podiatry 2,957 3,044 3,315 12.1%

Prosthetics/Orthotics 1,200 1,425 1,302 8.5%

Radiology 14,877 14,523 14,317 -3.8%

Rheumatology 65 64 65 0.0%

Surgery 6,591 5,706 3,525 -46.5%

Urology 1,328 687 1 -99.9%




(V12) Northern (V12) (585GA) Hancock VA Clinic Cardiology 198 322 282 42.4%


32 36 33 3.1%

Dermatology 15 16 16 6.7%

Endocrinology 159 159 231 45.3%


Nephrology 26 35 41 57.7%

Neurology 42 38 28 -33.3%

Nutrition 49 46 64 30.6%

Optometry 29 18 28 -3.4%

Pharmacy 36 25 19 -47.2%


171 69 24 -86.0%

Prosthetics/Orthotics 0 0 2

(V12) (585GB) Rhinelander VA Clinic Cardiology 450 523 561 24.7%


12 24 41 241.7%



Nephrology 54 42 48 -11.1%

Neurology 52 45 59 13.5%

Nutrition 63 86 138 119.0%

Optometry 24 23 35 45.8%

Pain Medicine 0 34 16

Pharmacy 76 86 102 34.2%


2,485 2,407 2,082 -16.2%



(V12) (585GC) Menominee VA Clinic Cardiology 207 355 297 43.5%


27 69 89 229.6%





(V12) Northern (V12) (585GC) Menominee VA Clinic Nephrology 28 21 35 25.0%

Neurology 39 24 22 -43.6%

Nutrition 54 36 62 14.8%

Optometry 19 7 12 -36.8%

Pharmacy 13 20 29 123.1%


118 97 65 -44.9%



(V12) (585GD) Ironwood VA Clinic Cardiology 150 157 161 7.3%


10 17 20 100.0%



Neurology 30 32 45 50.0%

Nutrition 34 37 59 73.5%

Optometry 7 13 19 171.4%


71 35 26 -63.4%


(V12) (585GF) Manistique VA Clinic Cardiology 55 133 123 123.6%


Nutrition 3 24 21 600.0%

Optometry 10 3 17 70.0%


42 49 59 40.5%

(V12) (585HA) Marquette VA Clinic Cardiology 163 173 158 -3.1%


14 23 64 357.1%

Dermatology 8 10 13 62.5%



Neurology 658 668 675 2.6%




(V12) Northern (V12) (585HA) Marquette VA Clinic Nutrition 49 8 54 10.2%

Optometry 21 11 18 -14.3%


166 123 44 -73.5%


(V12) (585HB) Sault Saint Marie VA Clinic Audiology / Speech Pathology

135 205 249 84.4%

Cardiology 166 147 164 -1.2%


13 27 61 369.2%


Endocrinology 100 98 96 -4.0%

Neurology 14 22 14 0.0%

Nutrition 34 50 49 44.1%

Optometry 19 17 2 -89.5%


72 54 74 2.8%

(V12) (676) Tomah VA Medical Center Audiology / Speech Pathology

5,765 6,054 6,509 12.9%

Cardiology 1,245 949 909 -27.0%

Chiropracty 1,281 1,161 1,084 -15.4%


1,464 1,799 2,959 102.1%

Dermatology 1,869 2,094 3,558 90.4%

Emergency Medicine 5,916 6,885 6,497 9.8%

Geriatric Medicine 3,798 5,147 5,601 47.5%

Hematology-Oncology 29 30 34 17.2%



Neurology 766 420 523 -31.7%

Nutrition 2,029 2,252 2,199 8.4%

Occupational Health 646 705 522 -19.2%

Optometry 7,231 7,514 7,428 2.7%

Pain Medicine 227 121 393 73.1%




(V12) Northern (V12) (676) Tomah VA Medical Center Pathology 57,434 55,599 55,532 -3.3%

Pharmacy 2,321 4,356 3,597 55.0%


16,857 16,376 16,758 -0.6%

Podiatry 4,048 5,562 5,752 42.1%

Prosthetics/Orthotics 1,518 1,811 1,457 -4.0%

Radiology 10,278 9,834 9,289 -9.6%


Surgery 1,089 1,103 1,049 -3.7%

(V12) (676GA) Wausau VA Clinic Audiology / Speech Pathology

532 356 306 -42.5%

Cardiology 15 17 10 -33.3%


83 121 107 28.9%

Dermatology 64 110 179 179.7%


Geriatric Medicine 34 12 19 -44.1%



Nutrition 22 33 32 45.5%

Optometry 42 45 2 -95.2%

Pharmacy 278 966 1,087 291.0%


562 451 492 -12.5%

Prosthetics/Orthotics 99 113 85 -14.1%


Surgery 1 1 7 600.0%

(V12) (676GC) La Crosse VA Clinic Chiropracty 434 912 793 82.7%


62 90 22 -64.5%

Dermatology 65 136 194 198.5%

Hematology-Oncology 31 37 28 -9.7%





(V12) Northern (V12) (676GC) La Crosse VA Clinic Nutrition 0 51 113

Optometry 2 5 25 1150.0%

Pain Medicine 0 69 51

Pharmacy 1,333 1,145 1,598 19.9%


1,701 1,827 2,167 27.4%

Prosthetics/Orthotics 51 116 72 41.2%


Surgery 88 96 98 11.4%

(V12) (676GD) Wisconsin Rapids VA Clinic Audiology / Speech Pathology

2,540 2,451 3,022 19.0%

Cardiology 26 16 8 -69.2%


73 77 4 -94.5%

Dermatology 237 247 364 53.6%


Geriatric Medicine 1,392 2,490 2,883 107.1%


Nutrition 104 579 917 781.7%

Optometry 4,392 4,147 4,868 10.8%

Pain Medicine 107 44 2 -98.1%

Pharmacy 156 130 106 -32.1%


2,302 1,698 1,664 -27.7%

Prosthetics/Orthotics 81 72 61 -24.7%


(V12) (676GE) Clark County VA Clinic Audiology / Speech Pathology

183 203 257 40.4%


Nutrition 9 10 24 166.7%

Pharmacy 56 42 19 -66.1%


295 222 190 -35.6%

Prosthetics/Orthotics 24 29 29 20.8%




(V12) Northern (V12) (676QA) Tomah VA Mobile Clinic Occupational Health 0 0 0

Surgical Cases (FY15-19)


Market Facility Setting FY15 FY16 FY17 FY18 FY19 5 Year % Change


IP Cases 4 14 11 10 1 -75.3%

OP Cases 96 633 460 286 122 27.1%

Historical VAMC ADC


Market Facility Bed Service FY15 FY16 FY17 FY18 FY19 5 Year % Change


CLC 35.1 35.8 34.1 37.9 36.4 3.7%

Medical 7.9 7.7 6.5 4.9 3.9 -50.6%

Surgery

Total Med/Surg

7.9 7.7 6.5 4.9 3.9 -50.6%

VAMC Total 43 43.5 40.6 42.8 40.3 -6.3%

(V12) (676) Tomah VA Medical Center CLC 146 128.5 132 132.3 130.4 -10.7%

Medical 5.3 4.7 5.3 5.3 3.4 -35.8%

Mental Health 5.6 2.6 4.5 5.2 4.4 -21.4%

RRTP* 32.1 26.8 34.2 39.2 56.5 76.0%

Surgery

Total Med/Surg

5.3 4.7 5.3 5.3 3.4 -35.8%

VAMC Total 189 162.6 176 182 194.7 3.0%

FY19 RRTP Beds and ADC


Market Facility RRTP Service FY19 ADC Operational Beds

(V12) Northern Tomah CWT/TR 7.0 10

DOM SA 31.3 22

General DOM 22.8 35

PTSD 7.4 13

FY19 Community Capacity


Market Facility Bed Section Beds Beds Available % Occupancy

(V12) Northern Iron Mountain Acute 58 21 44.0%

Nursing Home 291 22 82.7%

Psych 0 0

Rehab 0 0

Tomah Acute 709 254 44.2%

Nursing Home 239 23 80.4%

Psych 0 0

Rehab 17 0 82.0%

BY19 Projected Parent Facility ADC (EHCPM)


Market Parent Facility Bed Service Funding Source FY19 Actual

FY29 Projected

10 Year % Change

(V12) Northern Iron Mountain, MI HCS Acute Inpatient Med/Surg Community 10.1 12.8 26.0%

In-House 3.7 3.4 -7.6%

Acute Inpatient Medicine Community 5.1 6.9 36.2%

In-House 3.6 3.3 -7.5%

Acute Inpatient Mental Health Community 0.5 0.7 48.1%

In-House 0.5 0.4 -18.3%

Acute Inpatient Surgery Community 5.1 5.9 15.7%

In-House 0.1 0.1 -10.4%

Inpatient LTSS Community 26.3 40.1 52.7%

In-House 35.3 37.1 4.9%

Tomah, WI HCS Acute Inpatient Med/Surg Community 7.8 9.8 26.4%

In-House 2.2 2.0 -8.3%


In-House 2.2 2.0 -8.3%

Acute Inpatient Mental Health Community 0.4 0.5 46.4%

In-House 5.9 5.7 -2.9%



In-House 129.4 131.1 1.3%

Inpatient Residential Rehab In-House 54.7 49.4 -9.6%

BY19 Projected Market ADC (EHCPM)


Market Planning Category Group Funding Source FY19 ADC Actual

FY29 ADC Projected

10 Year % Change

(V12) Northern Acute Inpatient Med/Surg Community 20.5 25.2 22.5%

In-House 22.0 19.2 -13.0%


In-House 14.9 13.2 -11.6%

Acute Inpatient Mental Health

Community 1.1 1.7 54.6%

In-House 8.8 8.3 -6.4%


In-House 7.1 6.0 -16.1%

Inpatient Blind Rehab Community 0.0 0.0

In-House 0.4 0.5 49.9%


In-House 160.3 163.0 1.7%

Inpatient Residential Rehab Community 0.0 0.0

In-House 42.3 35.7 -15.5%

Inpatient Spinal Cord Injury Community 0.0 0.0

In-House 2.9 2.5 -15.0%

BY18 RRTP Projected Market ADC (3D Model)


Market Market (BY18) RRTP Bed Section FY28 ADC FY28 Bed Need

(V12) Northern 12-h All Bed Sections 21.0 25

Dom Homeless 5.2 6

Gen Dom 7.2 8

PTSD 2.5 3

Substance Abuse 6.2 7

BY19 Projected Market RVUs (EHCPM)


Market Planning Category Group Funding Source FY19 RVUs Actual

FY29 RVUs Projected

10 Year % Change

(V12) Northern Amb LTSS Home and Community Based In-House 32,070 38,483 20.0%

Amb Medical Specialties Community 98,419 176,232 79.1%

In-House 92,710 132,741 43.2%

Amb Mental Health Programs Community 5,066 13,088 158.3%

In-House 177,874 248,286 39.6%

Amb Pathology Community 6,822 15,260 123.7%

In-House 4,037 5,257 30.2%

Amb Primary Care Community 25,630 68,178 166.0%

In-House 160,552 217,749 35.6%

Amb Radiology Community 31,734 51,146 61.2%

In-House 24,885 34,108 37.1%

Amb Rehab Therapies Community 20,182 35,408 75.4%

In-House 37,431 52,795 41.0%

Amb Surgical Specialties Community 77,417 148,226 91.5%

In-House 34,572 51,227 48.2%

Specialty Care (Amb Med/Surg/Rehab) Community 196,018 359,866 83.6%

In-House 164,713 236,763 43.7%

BY19 Projected Market Dental Procedures (EHCPM)


Market Funding Source FY19 Procedures

Actual

FY29 Procedures Projected

Projected % Change

(V12) Northern Community 7,551 9,754 29.2%

In-House 26,506 33,972 28.2%

Enrollment Proximity to Current VA Sites by Market


Market Market (FY18) Total Enrollees

Primary Care # of Enrollees

within 30 Min Drive Time

Primary Care % of Enrollees

within 30 Min Drive Time

Secondary Care # of Enrollees within 60 Min

Drive Time

Secondary Care % of Enrollees within 60 Min

Drive Time(V12) Northern 12-h 55,563 32,337 58.2% 20,651 37.2%

Real Property Overview


Market Facility Acres Available

Property Size

Main Patient Care Facility Construction

Date

Most Recent Renovation Date (Main

Hospital Building)

Estimated Annual

Operations and Maintenance

Cost

FCA Cost Seismic Risk

(V12) Northern Iron Mountain 0.0 26 1948 2019 $4,875,713 $4,321,288 Low Risk

Tomah 4.0 174 1946 2014 $7,591,772 $110,804,537 Low Risk

Building FCA


Market Station Building No Function Title FCA Correction Cost

(V12) Northern Iron Mountain 1 Main Hospital $1,231,852

10 Storage Bldg. $7,991

11 Secondary Generator $6,640

12 Electrical Switchgear $11,602

13 Hazardous Waste $754

14 Storage $754

16 Storage $754

2 Boiler Plant/Garage $351,049

3 Administrative Offices $262,032

4 Director's Quarters $161,426

5 Apartment Quarters $594,775

6 Administrative $1,590,592

8 Quarters Garage $754

Site Iron Mountain Site $100,313

Tomah 1 Housekeeping Quarter $211,732

10 Daycare $514,578

12 Housekeeping Quarter $154,603

15 Gymnasium $611,324


2 Storage $11,461,931

210 Pump House - Well #3 $59,600

212 Garages $72,539

215 Filtration Building $491

223 Garages $34,743

23 Swing Storage/Vacant $7,207,875

240 Garages $28,707

25 Recycling & AFGE $37,276

260 Vehicle Maintenance Building $4,306

270 Storage $89,956


290 Pallet Storage $42,333

295 Shelter $16,293

Building FCA



(V12) Northern Tomah 296 Picnic Shelter $2,289

3 Housekeeping Quarter $1,087,645

32 IRM Building $1,128,385

33 Storage & Switch Vault $15,099

36 Fire Station and R/G/T $741,515


40 M & R Shops $1,297,820

400 Ward and Administration $4,082,955

401 Admin $1,447,281

402 Ward Building $3,876,606

402A Warehouse $239,810




407 Support/Outleased $13,492,193


409 Green House $80,614

410 Green House $10,586

415 Boiler Plant $1,903,945

416 Storage $947,858


423 Greenhouse $401,339

424 Kitchen/Dining $420,148

425 Chapel $449,903


428 Primary Power Station $35,729

445 Emergency Gen. Building $13,331

446 Emergency Gen. $20,820




452 SPD $253,569

Building FCA



(V12) Northern Tomah 455 Recreation Therapy $11,937



CC Connecting Corridors $1,641,647

Site Tomah Site Utilities $8,831,015

V1 Switchgear Vault $0

FY20 Allocated Training Positions


Market Facility Training Category Program Name Paid WOC Total HPTs

(V12) Northern Iron Mountain Admin Healthcare Administration 0 1 1

Associated Health Chiropractor Resident 0 1 1

Occupational Therapist Assistant 0 1 1

Pathology, Medical Technologist 0 2 2

Pharmacist Resident/Fellow 0 1 1

Phlebotomist 0 1 1

Physical Therapist Assistant 0 1 1

Psychologist Intern 2 0 2

Social Worker Fellow 2 0 2

Tomah Admin Health Information Technician 0 1 1

Associated Health Nutritionist/dietitian Intern/Fellow 0 3 3

Occupational Therapist Assistant 0 1 1

Optometrist Resident/Fellow 0 2 2

Pharmacist Resident/Fellow 0 5 5

Physician Assistant Resident 0 1 1

Radiologic Technologist 0 2 2

Recreation Therapist 0 1 1

Social Worker Fellow 2 1 3

Nurse APN-Midwife 0 4 4

APN-NP Student 0 3 3

Registered Nurse Student 0 73 73

RN Doctoral (PhD-ND-DNP-DNS) 0 1 1

Psychiatry/Neurology Psychiatry 0 6 6

Academic Ranking (by Total HPTs)


Market Facility Total HPTs National Ranking (out of

154 sites)(V12) Northern Iron Mountain 12 151

Tomah 106 128

Footnotes


Market Population Rank (out of 95 markets)Note: The VISN 02 Finger Lakes and Southern Tier markets merged in 2019 during the market assessments, changing the count of markets assessed from 96 to 95.

County-Based Enrollee ProjectionsNote: Market totals do not exactly match the values in the Rurality tables due to a difference in data sources. Note: Counties with fewer than 10 enrollees were reduced to 0 based on privacy guidelines.

RuralityNote: FY19 enrollees in this data differ from the values shown in the EHCPM (Projected Population). This data is sourced from the Geocoded Enrollee file.Note: Rural enrollees include enrollees residing in rural and highly rural locations.Note: Counties with fewer than 10 enrollees were reduced to 0 based on privacy guidelines.

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

Historical VAMC ADCNote: *RRTP includes Domiciliary and Compensated Work Therapy/Transitional Residence (CWT/TR) bed services.

FY19 Community CapacityNote: Although similar data was incorporated in the DD&F, community capacity in this compendium displays the supply of total community beds, occupancy, and beds available among community providers within 60 minutes of each VAMC or HCC. Each community hospital or nursing home which is not currently included in the Veterans Community Care Program or does not meet the minimum quality criteria established in the Section 203 Criteria analysis is excluded. Additionally, providers at or above target occupancy (80% for short-term acute care hospitals, 90% for nursing homes) are assumed to have no bed availability.

BY19 Projected Market RVUs (EHCPM)Note: Specialty Care includes Medical Specialties, Surgical Specialties, and Rehab Therapies.

OP Encounters & SC EncountersNote: The stop code mapping used in the data compendium is based on a custom stop code mapping created by VA for the market assessments. The Data Discovery and Findings (DD&F) documents used the Public Data Clinic Group stop code mapping.

Enrollment Proximity to Current VA Sites by MarketNote: Primary care sites include VAMCs, HCCs, MS CBOCs, and CBOCs. Secondary care sites include VA facilities providing ambulatory surgery or acute inpatient services.

Real Property OverviewNote: Acres available provides an indication of any excess or surplus land, not currently in use and has no plans for future expansion needs that could be used for future development.

Building FCANote: Project Costs to remediate FCAs vary significantly, from below assessed value to more than 3 times the value.

FY20 Allocated Training PositionsNote: This data displays the number of paid, unpaid (WOC), and total Health Profession Trainees (HPTs) at each facility by training program. This data was acquired from the Office of Academic Affiliations.

Sources


Facility HierarchyFY21 Q4 VA Site Tracking (VAST)

Enrollee ProjectionsBY19 EHCPM

RuralityGeocoded Enrollee FY19 Q4

Core UniquesVSSC Uniques Cube

ED/UCC EncountersVSSC Encounters Cube

ED Transfers & AdmissionsEmergency Medicine Management Tool

Surgical CasesNational Surgery Office

Outpatient EncountersVSSC Encounters Cube

Historical VAMC ADCMCAO Discharge Cube

Projected DemandBY19 EHCPM

Projected RRTP DemandRRTP 3D Model

FY19 RRTP Beds and ADCRRTP Program Office

FY19 Quality Community Capacity2019 CMS Cost Reports

Enrollment Proximity to Current VA Sites by MarketFY19 Q4 Enrollment; FY19 Q4 VAST data; VHA OPP Planning Systems Support Group

Real Property OverviewCAI Buildings and FCA Condition Gaps Report (November 2021)

Building FCACAI Buildings and FCA Condition Gaps Report (November 2021)

Emergency Preparedness Primary Receiving CentersOffice of Emergency Management

Academic Mission - Allocated Training PositionsOffice of Academic Affiliations

Research Mission - Research FundingOffice of Research and Development

VISN 12 Northern Market Data Discovery & Findings

Documents