Net Changes 1. Explanation of Request for Increase of $23,811,000 for Payroll Increases. An increase of $23,811,000 for legislated salary changes and other payroll costs will be experienced in fiscal year 1974 for the reasons explained in Part I, Department of Medicine and Surgery Summary. 2. Explanation of Request for an Increase of $41,719,000 in FY 1974 for Activation of New Facilities and Other workload Changes. The increased staffing and monetary amounts requested under this section of the estimate cover (a) net increases of 1,395 average employment and $20,699,000 for the activation and operation of new VA hospitals, (b) net decrease of 3,625 average employment and $51,969,000 for existing hospitals and net increases of $68,946,000 and 1,619 average employment for other increased workloads and increased rates in VA existing facilities and non-VA facilities; (c) increases of 47 average employment and $4,043,000 for activation of new facilities other than hospitals. a. New Hospitals In fiscal year 1974 new hospital activations will require net increases of 1,395 average employment and $20,699,000. The following table identifies by location the planned fiscal year 1974 workload, employment and dollar increases for the new hospitals. These increases will provide for (1) the continued activation of the VA hospitals at Columbia, Missouri (406 beds), San Antonio, Texas (760 beds), San Diego, California (781 beds), and Tampa, Florida (720 beds) and (2) the continued activation of the additional general hospital building (370 beds) to the existing hospital facilities at Lexington, Kentucky and the initial funding of the additional facility at White River Junction, Vermont (174 beds). The parenthetical entries are tradeoff decreases at the respective hospitals with existing facilities. b. Other Workload Changes Net increases or decreases related to workloads are as follows: A decrease of 2,769 ADPC, 3,625 FTEE and $51,958,000 is estimated in FY 1974 for veteran beneficiaries receiving treatment in a hospital facility. The decreases related to VA hospitals will be offset with the activation of new facilities noted above. While a reduction in census is estimated, workloads will increase. Applications will rise by 150,000 to a level of 1,800,000. The admissions are expected to rise by 3.0% resulting in an increase of 28,000 patients treated. Currently, the turnover rate is expected to increase by 5.8%. This continues the trend of treating more patients in the same or fewer number of beds. The small drop in Contract load is due to the availability of VA beds in areas previously wholly dependent upon private facilities for veterans' care such as VA Hospital, San Diego, California. The increase in dollars is due to higher per diem costs in the private hospital sector. The drop in State Home hospitalization reflects the States' inability to provide the resources for hospital construction or modernization which would provide suitable beds for veteran patients. Domiciliaries Decreases of 849 ADMC, 203 FTEE and $2,749,000 are projected in FY 1974 covering both VA and State domiciliary programs. This is the result of the increased availability or nursing beds in both the VA and the State programs. With the advancing age of domiciliary members the need for nursing care becomes more prevalent to meet the medical needs of this group of beneficiaries. Nursing Care Increases of 1,432 ADNC, 331 FTEE and $9,267,000 in FY 1974 will provide for program advances in VA and State nursing facilities and maintain Community Nursing loads at the FY 1973 level of 4,700 ADNC. An increase of $2,589,000 is required in Community nursing for an average per diem increase of $1.50 from $19.50 to $21.00. As the veteran population increases in age a continuing demand for expansion of nursing care facilities will be maintained. World War I veterans in particular have reached the age where the need for nursing care becomes a dominant modality in meeting their needs. C. Outpatient Care In conformance with trends in health care delivery, increases in outpatient care of 1,916,079 medical visits, 1,491 FTEE and $55,965,000 are estimated. The cause of this significant rise in outpatient activity relates to additional workloads for new clinics in new hospitals as well as new independent clinics; effects of new specialized medical programs, particularly the drug treatment program; and a continued expansion throughout the system in the use of outpatient care as a treatment modality for service-connected veterans and for pre-bed and post-hospital care. The latter is a direct result of a shortening of length-of-stay in hospital bed care and the increased turnover rates in the hospital system. Outpatient dental workloads are expected to remain stable in both staff and fee due to a leveling out of the input from Vietnam veterans and our ability to reduce excess workloads to normal levels in FY 1973. Miscellaneous Benefits The $6,452,000 increase in Miscellaneous Benefits is attributed to an increase of approximately 2.5 million inpatients and outpatients who will be eligible to receive beneficiary travel payments in conjunction with their medical treatment. Other New Facilities The new facilities listed need funding support in 1974, as no funds are provided elsewhere. Increases of 47 FTEE and $2,326,000 are needed to cover Building Management and Engineering support for various facilities and $1,717,000 is requested for other programs. A chart in detail follows: |