formal sharing agreement was signed in March 1976. Under the agreement, the VA provided medical services and laboratory tests on a reimbursement basis. In the 1980s, the Air Force was faced with renovating its hospital at a cost of $26 million at the same time that the VA was planning the construction of a new Albuquerque VAMC. Rather than renovate the Air Force hospital, the VA agreed to include a 40-bed inpatient medical-surgical unit for the 377th MDG to staff and manage in the new VA facility, to be called the New Mexico Regional Federal Medical Center, which opened in 1987. The Air Force also agreed to manage the emergency room and, in 1989, constructed an ambulatory care center next to the hospital. The VA provided all ancillary services to the Air Force–staffed inpatient unit. The joint venture underwent a major change in 2002, when the Air Force, due to substantial reductions in personnel stationed at Kirtland, closed the inpatient unit and revised the interagency sharing agreement to allow the purchase of inpatient services from the VA (GAO, 1978; Simmons, 1989; VA/DoD, 2002).
In a recent development, the DoD invested $2.9 million for the renovation of its same-day-surgery unit, which was completed in 2011. As of the end of February 2012, the director of the joint venture indicated that the associated sharing agreement is pending review and approval by the Air Force Medical Support Agency, and the reopening was anticipated for March 2012.2 The sharing agreement will be between the 377th MDG and the NMVAHCS for the VA to occupy DoD ambulatory surgery space in exchange for providing 30 free surgeries a month for DoD beneficiaries (VA/DoD, 2011b).
Lessons learned at the Albuquerque joint venture include that successful agreements are worked out over time and through extensive planning efforts. Sharing agreements or joint ventures are unique to their locations and will not work unless the arrangement is cost effective for both partners. Leadership, personalities, and communications are important, and cultural issues must be overcome. Leadership needs to make strategic plans in the anticipation of accommodating the fluctuating availability of resources in an unpredictable environment. Sharing partners and their leaders must be committed, flexible, open-minded, and patient in their planning efforts, and they must look for opportunities to expand and modify arrangements as needed (Anderson, 1995; Baine, 1995; Carlton, 2000; Rogers, 2007; Spaulding and Catton, 2008; VA/DoD, 2011b).
2 Personal communication with Patricia L. Ospino, M.B.A., Joint Venture Director, February 24, 2012.