The 254 bed West Palm Beach Medical Center has 63,000 enrolled veterans and provided over 525,000 outpatient visits in 2007 at the hospital and through six community based outpatient clinics in Palm Beach and surrounding counties. Patient demand has mitigated since the peak enrollment of 70,000 in 2005 but factors such as the skyrocketing home market, hurricanes, taxes and insurance costs that impacted patient growth are now less influential and slow enrollment growth is expected given the rising number of Iraq and Afghanistan war veterans at the facility. The hospital is recognized within the VA nationally as a top performer finishing the 2007 year number one in our complexity group of 33 hospitals for aggregate performance in clinical quality, access and patient satisfaction. Given this performance, the immediate challenge is to maintain timely access for current veterans who are now presenting with greater specialty care needs as they age. Fifty five percent of the enrollees are between the ages of 65-84 which places high demand on medical and surgical specialty care. Twenty five percent are 45-64 and together with the newest veterans they present high demand for mental health and substance abuse services. Given this picture our hospital challenges for 2008 are:

  • Timely access of services which requires effective recruitment and retention and space expansion/modification. Most pressing needs for staff are in skilled technician areas such as Radiology and Nuclear Medicine technicians, Radiologists, nurses and specialty care physicians. Currently a ward modification construction project is underway to expand Primary Care exam rooms and an office expansion project in anticipation of rising demand for mental health services.
  • Emergency Room Capacity and the medical center will be awarding a 12 bed expansion construction project in 2008 as well as work on patient flow process improvement.
  • Competition for limited capital dollars for construction and high cost technology. Though federal government capital dollars are not obtained like counterparts in the private sector, the available dollars are limited and can impact services. Ensuring internal capacity helps minimize out of system care needs and enhances continuity of care.
  • Implementation of the new medical residency program between the University of Miami, Florida Atlantic University, the West Palm Beach VA Hospital and JFK Medical Center. The residency requirements will be completed between the VA and JFK Medical Center growing from 22 residents in 2008 to full capacity of 66 by 2010. The VA will support 30 residents at full capacity. It is hoped this program will help alleviate physician shortages in Palm Beach County.
  • Continued emphasis on patient safety to consistently strive for a safe, effective patient care environment and high quality care.
  • Balancing the cost of Technology enhancements in support of telemedicine, the electronic medical record, diagnostic imaging and home telehealth with available funds.

These operational challenges don’t vary much from the private sector hospitals who can probably expect similar challenges in workload impacting net profit margins, recruitment/retention issues, capital funding issues, emergency room services and quality care concerns amidst a slowing economic picture in south Florida.