Strong Leadership

The departments chose local leaders for the Lovell FHCC merger process who were committed to its success. The Navy has consistently selected commanders of the naval hospital who strongly support the FHCC concept and even assigned a commanding officer to an unusually long tour of duty—4 instead of 2 years—for the period leading up to the launch of the FHCC in 2010. In addition, it was decided at the beginning to appoint the director of the North Chicago VAMC as director of the FHCC, who does not rotate as do military officers, which has provided important continuity in the key leadership position. Meanwhile, there have been four Navy medical leaders since 2003. There is also regular turnover in the active duty servicemembers leading the main subdivisions of the FHCC.

Differing Financial Systems

Differing financial systems have made it difficult for joint ventures to function optimally in several ways. First, they make it difficult for the partners to determine the costs of the services they provide to the other partner and to bill fairly. Second, they impose constraints on what each partner can pay for, even though it would be better overall for one partner to fund the equipment or the personnel of the other partner. The Lovell FHCC was designed to pool and spend funding in a way that does differentiate the sources. Instead, the departments are developing an innovative process for assigning responsibility for funding the FHCC in proportion to each department’s patient workload, which takes place after the fact. That process for reconciliation is scheduled to be completed and automated by FY 2014 and to form the basis for each department’s funding of the FHCC. The Hawaii joint venture is developing an alternative joint system, called the bi-directional enhanced document referral, or eDR, system, which has four modules: billing, third-party collections, analytics, and patient referral management.

Differing Personnel Systems

The DoD and the VA personnel systems for civilians have different statutory bases—Title 5 and Title 38 of the U.S. Code, respectively—and different job descriptions, which result in differences in pay, benefits, career ladders, and bonus systems for people who do the same work. This situation affects employee morale. The FHCC expects to solve this problem by transferring everyone into the same personnel system, the VA’s in this case.

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