You asked for examples of affiliations between the U. S. Department of Veterans Affairs (VA) hospitals and academic medical centers.

SUMMARY

The VA has a 63-year history of affiliations with academic medical centers. Currently, 107 of the nation's 125 medical schools, including the UConn Health Center, have affiliation agreements with VA hospitals. These primarily involve medical students and residents training in VA facilities. The VA funds about 8,000 residencies a year, and it estimates that about 30,000 medical students and 20,000 residents rotate through the VA health care system at some point in their medical training.

But some VA hospitals and academic medical centers have already gone beyond affiliation by jointly operating clinical programs and even facilities. VA hospitals in Charleston, South Carolina and College Station, Texas jointly operate research facilities with, respectively, the Medical University of South Carolina (MUSC) and Texas A & M Health Science Center. The Charleston VA and MUSC discussed jointly constructing facilities, but that collaboration foundered on cultural differences between the two organizations and cost concerns due to federal construction requirements.

The VA hospital in New Orleans and the Louisiana State University (LSU) Medical Center of New Orleans have been engaging in a joint construction venture since Hurricane Katrina severely damaged both their hospitals in 2005. They have secured nearly $ 2 billion in funding for adjacent facilities linked by a shared facility housing shared services and have recently begun acquiring land.

In late 2006, the VA appointed a blue ribbon commission to examine ways to advance these affiliations. The commission's chairman was quoted as envisioning the panel to move the relationship beyond affiliation to “something more akin to a formal partnership. ” The commission is expected to report in fall 2009.

CHARLESTON, SOUTH CAROLINA

The Charleston's VA Medical Center (VAMC) has a long history of collaboration with the Medical University of South Carolina. Most of the VAMC's attending physicians are MUSC faculty, all of the doctors-in-training at VAMC are MUSC residents, and the two organizations share a research facility. But a partnership to jointly construct shared hospital facilities failed.

Joint Research Facility

MUSC and the VAMC have jointly operated a 150,000 square foot research facility since 1996. The facility, which is halfway between the two campuses, was built with federal, state, and private money. MUSC owns the facility and the VA has a 20-year lease for half the space at a favorable rate. The two share space and some staff, make joint space utilization decisions, and have a single institutional review board. And, they do not compete for grants. Dr. John Raymond, MUSC's provost and a VA physician, says it is a very successful endeavor.

Joint Hospital Construction

In 2002, MUSC, as part of a plan to replace its 50-year old teaching hospital, proposed that it and the VA jointly construct and operate a new medical center. In 2004, a commission assessing the VA's capital asset requirements recommended that the VA evaluate this proposal, even though it did not recommend replacing the VAMC. In 2005, MUSC and the VA created a 12-member group to evaluate collaboration options.

The group focused on collaborations that would increase the quality of services, lower facility and operational costs, and ensure optimal land use. It assumed that in any integration model (1) the VA would have its own bed tower containing general medical and surgical beds staffed by VA personnel and clearly identified as the VAMC and (2) sharing would come in support areas, particularly technology, such as operating rooms and facilities for cardiac diagnosis and catheterization, hemodialysis, endoscopy, and interventional radiation.

The group explored various models for facility sharing and finance, legal, and governance issues. It ultimately suggested two options:

1. as part of MUSC's next building phase the VA would construct a new VAMC that would include all VA clinical services and additional beds that MUSC would lease or

2. MUSC would build its own bed tower while sharing clinical services and high-cost technology with the VA.

MUSC and the VA then created a planning group to fully develop a viable venture, but the project stalled, and MUSC has proceeded on its own. Dr. John Raymond, MUSC's provost and a VA physician gave several reasons for this: (1) rules requiring new federal construction to meet anti-terrorism standards add significantly to costs, (2) the VA approval process is tedious, (3) MUSC officials had difficulty dealing with VA union concerns, (4) veterans' service organizations feared a joint facility would lose its VA identity, and (5) mid-level VA managers feared their loss of control.

TEXAS

In 2003, the Texas A & M Health Sciences Center, the Central Texas Veterans Health Care System, and the Scott & White Memorial Hospital (affiliated with Texas A & M School of Medicine) dedicated an $ 11. 5 million cardiovascular research institute. The 35,000 square foot building sits on the VA campus. All three institutions contributed to the institute's creation: the VA paid for construction, the hospital provided substantial start-up funding, and the university pays faculty salaries.

LOUISIANA

Hurricane Katrina severely damaged both Charity Hospital, a component of the LSU Medical Center of Louisiana at New Orleans, and the New Orleans VA hospital. These facilities were across the street from one another and had a long history of collaboration. Before Katrina, the

VA purchased over $ 3 million a year in clinical and other services from LSU, including cardiothoracic surgery, radiation therapy, and dermatology; many physicians worked at both facilities; and residents from both LSU and Tulane medical schools rotated to both hospitals.

Both facilities needed to be replaced. This situation led the VA and LSU in March 2006 to enter a memorandum of understanding to create a group comprised of experts from both organizations to develop options for sharing facilities and services. The group operated under the assumption that both LSU and the VA would continue to oversee the care they delivered, employ their own staff, and be governed within their respective governmental systems.

In June 2006, the group recommended the construction of two separate hospital towers, one built and operated by the VA and one by LSU, joined by a corridor containing space for shared clinical services, capital equipment, and lab services. One of the partners would own this corridor and the other would contract to use its services and facilities. The report anticipated this collaboration would save nearly $ 400 million in operating costs over 30 years.

The VA anticipated building a 200-bed facility costing about $ 675,000,000. In spring 2007, consultants hired by the state's Office of Facility Planning and Control recommended that LSU build a 484-bed hospital that would cost about $ 1. 2 billion. The recommendations for LSU were based on the goals of (1) moving from a hospital whose main function was to serve indigent patients to one that was part of an “evidence-based academic medical center,” (2) increasing the hospital's market share and diversifying its payor mix, and (3) generating enough revenue both to repay construction bonds and pay for facility maintenance and infrastructure and technology upgrades. In 2008, the Jindal administration reduced the LSU hospital plan to 424 beds, 364 acute care and 60 psychiatric beds.

In 2007, the Louisiana legislature approved the $ 1. 2 billion for the project. The funds came from several sources: $ 75 million in General Fund appropriations for land acquisition and planning, $ 225 million from general obligation bonds, and a $ 900 million mix of revenue bonds and Federal Emergency Management Administration (FEMA) payments. Congress has approved $ 75 million for planning and designing the VA hospital and another $ 550 million, subject to further authorization, for construction.

The original study group anticipated starting construction in 2008 and the facilities opening in 2012. But a dispute over the level of FEMA payment (the state claimed nearly $ 500 million, FEMA estimated $ 20 million) and local preservationists' concerns that 165 historic structures would be destroyed delayed the project. Final site selection was made only in November 2008. The state is currently acquiring land on behalf of both LSU and the VA for their adjacent sites. LSU and the VA are also in the planning and design phase of their respective hospitals.

SS: df