NAME AND LOCATION OF VA FACILITY

VA Medical Center
Allen Park, Michigan 48101

1. Cescribe in d tail, including numbers of staff and total funds, the reduction in resources allocated for your facility in fiscal year 1979 to date (Octor 1, 1978 through February 12, 1979). Please indicate what effect the reductions will have on the delivery of health services, both quality and quantity, to veterans in your catchment area.

In conjunction with the MB mandated bed reductions, 19 FTP/FTEC & $403,595 were withdrawn. This reduction was effective October 1, 1978. An

additional 33 FTP, FTEE were wi hdrawn on 1/15/79. Although plans are to

1imit services to the non-service connected veteran in an attempt to maintain quality, a decline in both is likely (See Attachment 1.) Nonprescription medications, drugs and supplies will not be furnished to non-service onnected veterans (See Attachment 2). Additional reductions in service to on-service connected veterans will probably be neces: ary.

2. Has the Presidential freeze on employment had an impact on the ability of your staff to deliver health care to veterans? If yes, please explain. The impact of the Presidential freeze was somewhat reduced by the above t finding reduct' ns. However, the combination has had a negative pact on our delivery capabilities. Service connected veterans are provided priocity treatment in accordance with the law nd current directives from Central Of Tee. However, non-service connected veterans are treated as resources permit. For example, the increasing demand we are experiencing for inpatient psychiatric services from non-service connected vetera is, especially those in state hospitals cannot be met, in total, at VAMC Allen Park with presently available recours. In fact, we have had to establish a witing list for non-service connected veterans presently in state facilities that want to receive their medical che at this Medical Center. This does not prelude our extension of compassion, concern and courtesy to all veterans and their families.

3. What is your fiscal year 1980 target allowance for FIFE and total funding for medical care?

Although the FY '80 T.A. did not assign FTEE, the current assignment of

1467.7 includes trainees, is assumed to continue through FY '80. The total funding for this Medical Center for F.Y. 'SO is $47,969, 103

NIME A LOCATION OF VA FACILITY

VA Medical Center
Allen Tark, MI

43101

4. What further impact will the fiscal year 19.0 target allowance have on the delivery of health care to veterans for the reminder of fiscal year 1979? Fr fiscal year 1980?

It will b necessary to reduce employment and services during this F.Y. in order to meet F.Y. 80 T.A. levels. This reduction will be gradual during F.Y. 79 and remain at the reduced level through F.Y, 30cm

In addition, required ceiling and funding for the approved-expansion--of our Hemodialysis Unit was not included in the F.Y. 80 T.A

5. Have there been any changes in policy, either nationally or locally,
that will result in a reduction in the inpatient workload, outpatient
visits (staff or fee), VA nursing home care workload, or contract
comamaity nursing care outplacements? The Committee wants to know,
specifically, if there has been or will be a reduction in nonsurvice-
connected cases applying for and being provided medical services and
hospital care. (VA centers with domiciliaries should include data
for this activity separately).

A Lajor impact is expected because of the National emphasis on service
connected priorities and the resulting local actions in the same direction.
This will be magnified by the reduced funding and staffing levels. Although
Initially no reduction in d. and from non-service connected veterans is
expected, the workload will not be met in a timely manner. This will
cause these veterans to seek other sources of care or neglect their health
until more serious and expensive inpatient care is required. An eventual
decline in demand from non-service connected veterans is expected b cause
of our inability to provide satisfactory services.

6. Any other comment you care to make to the Committee on Veterans' Affairs that you believe would serve to strengthen the VA medical program or assist the House Committee in its continuing efforts to support the delivery of health care to veterans.

To date, VA Medical Centers have not been requested to address the further employment reductions which are anticipated in FY '80. The FY '80 target

allowance does not reflect these reductions However, additional ____. reductions will pose even greater problems in providing our veterans with continuous quality care.

1. The Medical District 14 Councilf Chiefs of Staff, at their
quarterly meeting, Janua y 22, 1979, discussed in great detail the
impact that the FY 1979 TP reduction will have on our medical
centers. Given the guidelines from VA Central Office that the
quality of care would not be jec, ardized, the Council discussed
the possibility of reducing certain outpatient workload. However,
the disease categories that historically generate a large volume of
outpatient visits are those that cannot be reduced whether they be
e service-connected or not.

2. A brief discussion was held concerning reductions in administra-
tive areas. The Council felt that without this support the quality
of medical care would be jeopardized. Also discussed was the impact
that these reductions would have on the quality of our specialized
medical programs.
Albeit the reductions would not be taken in those
programs, all such programs are partially supported by the core, which
is now being further eroded.

3.

The Council is fully aware of the total impact that these reductions will have. The total FTP reduction of 181 in conjunction with the FTEE ceiling control can have a definite adverse effect. Since these are accumulative ceilings and our medical centers were up to or over the FY 1978 ceiling, the effect of "front loading" will require drastic cuts to get down by September 30, 1979.

4. The Chiefs of Staff, speaking for their respective staffs, for the selves, and as a Medical District Council wish to advise the Medical District 14 Executive Council of their grave concern out these reductions. Every effort will be made to maintain quality,

"To care for him who shall have borne the battle, and for his widow, and his orphan, "-- ABRAHAM LINCOLN

Director

Medical District #14

but let there be no mistake, whatever is done, this reduction will se ously impact patient care. The Council strongly urges the District Executive Council to bring these concerns to the attention of the appropriate VA Central Office officials.

VETERANS ADMINISTRATION

MEDICAL DISTRICT 14

ANN ARBOR, MichigAN 48105

AUTACICIENT 2.

IN REPLY
REFER TO:

TO ALL NON-SERVICE CONNECTED VETERANS:

Congress, the Office of Management and Budget and the Veterans
Administration recognize that it is spending an increasing share
of the available resources for the care of Non-Service Connected
Verans. Public Law 95-581 established priorities for the care
of Veterans and gives top priority to Service Connected Veterans.
I vie of limita ons in the Federal Budget, immediate steps ust
be taka in order to assure that we can continue to give priority to
Service Connected Veterans.

Effective July 1, 1979 we will no longer provide Non-Service
Connected Veterans with medications, drugs, and supplies which
are available commercially without prescription. These on-
prescription medications, drugs and supplies include such items
as aspirin and aspirin-related products, antacids, laxatives,
dietary supplements, swabs, vitamins, cold and cough preparations.
This means that the Non-Service Connected Veterans must purchase
these iters, since they will no longer be supplied by the Medical
District 14 Medical Centers. (Please see attached list.)

Our Medical Staffs will continue to inform the Non-Service Connected
patient of the need for such medications, drugs, and supplies, but
these will not be provided by our Pharmacies. We regret we are no
longer able to provide this service, but we recognize our responsi-
bility to give priority to the care of Veterans with Service-Con-
nected disabilities. Should you have any questions, please feel
free, to contact us.

“To care for him who shall I ave borne the ! xitle, and for his widow, and his orphan." - suKAHAM LINCOLN