Lapas attēli
PDF
ePub

proper; it simply creates large expanses of space. By utilizing mobile or semimobile partitions, it will be possible for us to readjust the facilities in the hospital as the needs change.

Between each floor there is a space in which all of the utilities are carried.

Mr. SHIPLEY. These changes you are talking about, Doctor, are these more costly as far as construction is concerned?

Mr. JOHNSON. Yes. It runs about 10 percent over conventional construction.

Mr. WILSON. But the important thing is if you change something later on because of new modalities or new services, it is less costly to make the changes.

Dr. MUSSER. Without any question, it is one of the newest concepts in hospital design. We are looking forward to it with a great deal of enthusiasm, to the activation of this hospital.

The hospital at Tampa, Fla., will have 720 beds. It will be equally modern. It will increase our capability of providing for the veterans in Florida, tremendously. We have needed this hospital a long time.

Now there were and still are plans for a new medical school at the University of Southwestern Florida; however, this has been delayed in its development. So probably the school will not be operational by the time we open our hospital. But that hospital, plus the hospital at San Diego, will serve as the major teaching hospital for the two medical schools with which they are affiliated.

Mr. SHIPLEY. Who are the contractors on these buildings?

Mr. MILLER. J. W. Bateson & Co., Inc., is the contractor for San Diego. For the Tampa hospital, it is J. A. Jones Construction Co. For Columbia, Mo., it is Robert E. McKee, Inc. At Northport, N.Y., it is Blackhawk & Donovan.

Mr. SHIPLEY. How about Lexington?

Mr. MILLER. For Lexington, Ky., the contractor is the Foster & Creighton Co.

NEW HOSPITAL CONSTRUCTION COSTS

Mr. SHIPLEY. Could we have the cost of each of these facilities and by how much, if any, the cost exceeded the original estimate?

Mr. MILLER. I have the current cost estimates. Do you want those? Mr. JOHNSON. I think we should provide these for the record to be fully accurate.

Mr. SHIPLEY. All right.

(The information follows:)

ORIGINAL COST AND CURRENT COST OF SELECTED HOSPITALS (THOUSANDS OF DOLLARS)

[blocks in formation]

SPECIALIZED MEDICAL SERVICES

Mr. SHIPLEY. Would you further discuss for us, the establishment of specialized medical services.

Dr. MUSSER. This is what Dr. Chase was discussing a short while ago. These are the additional special medical programs which we hope to activate during fiscal 1972.

There is a chart that has been inserted in the record showing the numbers of these. I would comment further that as far as intensive coronary care units are concerned, we are attempting to have these in all of our hospitals. Thus in 1972 we will construct as many as we can in additional hospitals.

Then because of the large number of amputees coming out of the Vietnam war, it has become necessary to increase the numbers of our prosthetic treatment centers so that we can more adequately provide for these veterans. These are simply examples of the types of new special medical programs which, in various of our hospitals, we will be activating in 1972.

COST REDUCTION SAVINGS

Mr. SHIPLEY. On page 2-7, paragraph 3 states:

"In anticipation of providing better services in several operating areas at a lower cost, the department has established a $5 million cost reduction and paperwork management goal for fiscal year 1972." Will this be a reoccurring savings you are talking about?

Dr. MUSSER. In each of our annual budgets for the last 10 years that I know of, there has been this item of cost savings by virtue of more efficient administration. So this is an annual item in our budget. It has been increased from $3 million to $5 million in fiscal year 1972. Mr. JONAS. What you are saying is, that this is not an actual saving, it is what you call a cost avoidance thing; that is right, is it not?

Dr. MUSSER. Yes, sir, to a large extent.

OUTPATIENT PROGRAM LEVELS

Mr. SHIPLEY. Also on page 2-7 in item No. 4, you tell us that the outpatient medical visits are estimated to increase by about 474,000 to a total of 8,094,000.

Dr. MUSSER. Yes, sir.

Mr. SHIPLEY. This is one reason that you can open up the beds sooner and faster, because the outpatient load has increased, isn't it?

Dr. MUSSER. This helps us to increase our turnover, shortens our length of stay. Also, it enables us to provide better continuity of care for veterans because some of them particularly some of the chronically ill veterans that Mr. Jonas was talking about yesterday, need continued care after they have had treatment in the hospital for their acute problem, whatever it might be.

This in a way is preventive medicine because by virtue of following them as outpatients, we can do a pretty good job of preventing acute exacerbations in their illness.

Mr. SHIPLEY. Doctor, in the 1971 budget you told us that for 1971 the outpatient medical visits would be 8,164,000. The 1971 estimate is now 7,620,000 visits? Could you tell us what happened? Are these comparable figures?

Dr. MUSSER. Actually we anticipate an increase in outpatient visits. However, there are two sets of figures so they are not comparable. There are some figures that relate only to those outpatient visits that are handled by our own staffs. Then also, as I mentioned earlier, other sets of figures will show the addition of the dental outpatient load. Also, we have a fee basis program that enables the service-connected veteran to be treated by his own private physician.

There are sets of figures that include those visits. But our statistics here show that our outpatient medical staff visits in fiscal 1970, were 6,135,634; in 1971, estimated, 6,450,000, and in 1972, the estimate for just this type is 6,855,000.

Mr. SHIPLEY. Maybe it is the way you prepare it, but they should be comparable.

Mr. SHYTLE. We would like to put this in the record.
Mr. JOHNSON. We can straighten this out.

Let us clarify it for the record.

(The information follows:)

[merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][ocr errors][merged small][merged small][merged small][ocr errors][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small]

Mr. SHIPLEY. Dr. Haber?

Dr. HABER. Actually, our outpatient visits have been steadily increasing each year since 1962. The fee visit, portion, that is the hometown medical program, has declined somewhat. It is going to increase faster than it had for a while. The reasons for this are many, but actually, we find going back 4 years that our projections for increasing outpatient visits were too modest.

We had to revise these projections, as recently as 2 years ago, upward in order to take care of an increasing amount of outpatient activity.

HOSPITAL WORKLOAD DECREASES AND INCREASES

Mr. SHIPLEY. Workload decreases in Veterans' Administration hospitals encompassing medical, surgical, and psychiatric bed sections involve decreases of 4,780 average census, 2,331 full-time equivalent employment, and $33,999,000.

Explain these decreases, including the staffing/patient ratio.

Dr. MUSSER. This relates to the reduction in our census to 79,000 patients. Therefore, in our medical, surgical, and psychiatric bed sections, there will be a reduction in the census.

Because we will be reducing our census, there will be a reduction in certain types of personnel that will amount to the 2,331. The $33,999,000 represents the actual cost of maintaining this particular census. Of course our personnel losses will be more than offset by personnel accessions in our several new hospitals and in the special medical programs which Dr. Chase talked about.

So there will be a total gain within the system of personnel, but there will be a shifting of types of personnel.

All this figure indicates is the number of a certain type of personnel that will not be necessary any longer as we reduce our census.

Mr. SHIPLEY. On page 2-8, there is an increase of $17,313,000, which is for 1,663 full-time equivalent employment. Tell us why you need this extra amount.

Dr. MUSSER. Of the $17,313,000 and 1,663 average employment increase requested, $4,834,000 and 526 employment will provide improved staffing in existing spinal cord injury units and prosthetic units. The remaining $12,479,000 and 1,137 employment increases are requested for staffing improvement at VA hospitals as an increment toward achieving a 2:1 employee to patient ratio for medical and surgical bed sections.

Mr. JOHNSON. In addition, I might say, Mr. Chairman, that in previous testimony before I believe this committee as well as the Veterans' Affairs Committee in prior years, we discussed the wisdom, viability, and desirability of a staffing ratio of 2 to 1 in spinal cord injury centers. We are moving rapidly toward that. This will insure it. Mr. JONAS. May I ask a question?

Mr. SHIPLEY. Yes.

HOSPITAL ADMISSION POLICY

Mr. JONAS. Unless there is an emergency which is obvious, for example a bad automobile wreck causing serious injury, do your admissions officers admit anybody to your hospitals as patients without an examination, first by your own doctors, as to whether hospitalization is necessary?

« iepriekšējāTurpināt »