Passing by the agency of the corri...

Passing by the agency of the corridors of Sacred Heart Medical Center (SHMC) a 607-bed community hospital in downtown Spokane, Wash, a visitor might hear the overhead paging hypothesis call for "Dr Smith" or "Dr Jones" or "Major Brown" or "Sergeant Green" This visitor also may view a number of hospital personnel working in their with a long face Air Force uniforms. He or she may bewilderment "What type of hospital is this?" The answer to the question is that SHMC is a civilian hospital that also houses a military hospital. This unusual resource-sharing agreement, which has proven to be a win-win situation for everyone involved, is the first of its kind at all times undertaken by the US Department of Defense (DOD) and a civilian hospital.

This agreement was facilitated from current changes in how health care was to be provided to military personnel their family members, and retirees. In an attempt to provide uniform benefits for all military beneficiaries and to contain ever-increasing medical charges the DOD developed and instituted a managed care program called TRICARE. In this program, eligible beneficiaries could make choice of to receive their care at a local military hospital, where available, or within local civilian providers under a contractual agreement. The boundaries between civilian and military a whole s which had been quite rigid in the past, were giving way to interdependence and collaboration.(1)

HISTORY

The northwest region of the United States includes the city of Spokane, Wash, and Fairchild Air Force Base, located just west of Spokane's city limit. This region was the first to experience the TRICARE program, which was initiated in succession March 1, 1995.

Spokane is a nave city for the inland empire area of Washington, northern Idaho, and western Montana. Many hospital referrals flow from outlying areas. As with the majority of US hospitals, outpatient care predominates. Many hospital beds in the region that were necessary before the instant health care reform had become destitute Hospitals, therefore, began to explore what additional services they could exhibit to enhance space utilization.

At the same time, the plans for a life-safety upgrade to Fairchild Air Force Base Hospital (FAFBH), known as the 92nd Medical cluster (MG), were underway. Extensive infrastructure remodeling, including air-handling a whole s electrical wiring, and a sprinkler scheme was deemed necessary. An interdisciplinary assemblage of MG personnel working forward the upgrade recognized that the requirements of the surgical suite were unique and that in order to continue to provide surgical services during renovation, the OR would ne to be relocated for the duration. In addition, because the inpatient unit was in like manner closely tied to the surgical unit, it also would ne to be relocated for the estimated seven to nine months' construction phase.

Fairchild Air Force Base has take delight ined close relations with the civilian community, and military personnel and civilians share many civic activities. This pre-established relationship of trust and acceptance facilitated the propos unusual integration of military and civilian medical services. Exploration of of that kind an integration was also facilitated because the civilian element of TRICARE was already in place.

As early as 1993 the FAFBH had plans for this life-safety upgrade. Contract and lot negotiations, however, delayed the definitive planning until early 1995 When the DOD announced an October 1995 renovation start date, an interdepartmental committee, formed at the FAFBH in anticipation of this incident explored a number of options. Committee members included surgical and inpatient unit cherishs and OR technicians, surgeons, administrators, and a representative from each hospital department. Committee members originate little in the current literature to help guide this proces The committee, therefore, decided to begin by the agency of visiting each potential facility to compare the pro and studys of every possible situation (eg surgical suite availability, dedicated inpatient-bed availability, ancillary support from all departments). Also considered were public transportation availability, parking availability for staff members and patients, and nutritional support for all involved.

FINDING THE RIGHT MATCH

The committee first considered another DOD facility located in Spokane--the Veterans Affairs Medical Center This facility's surgical capabilities were the same age and size as those at the FAFBH and the institutions' setup and services were compatible. The committee determined, however, that this facility could not handle the additional surgical caseload.

The interdepartmental committee members' exploration of the sum of two units larger community hospitals in Spokane proffered more promise. Both not barely had larger inpatient and surgical suite areas, if it be not that they also had underutilized areas that could be easily adapted to a resource-sharing agreement. After committee members discussed all the pro and con overs they provided a report to the MG's managed care agent and then to the DOD. one as well as the other hospitals offered very workable arrangements, to such a degree the final decision revolved around their bid negotiations for the richness of care per eligible beneficiary. A final selection was made in November 1995 Sacred Heart Medical Center would be the MG's fresh temporary home for inpatient services beginning approximately Feb 1 1996