Benefits of Chiropractic Treatment: February 2014

Great news for our veterans who suffer from musculoskeletal problems more than almost anything else. July 23, 2013 1 DEPARTMENT OF VETERANS AFFAIRS Veterans Health Administration Office of Academic Affiliations Washington, DC PROGRAM ANNOUNCEMENT Chiropractic Care Residency Pilot Initiative New Chiropractic Care Residency Programs for Academic Year 2014-2015 1. This announcement solicits applications to establish Department of Veterans Affairs (VA) Chiropractic Care Residency training programs and provides information and procedures for those applications. This is a pilot program with funding planned for up to 6 resident positions in the first year, to be located in 3-5 sites. Initial funding is planned for 3 years depending on accreditation, availability of funding, and demonstrated success of the program. REQUEST FOR PROPOSALS. Applications for new chiropractic physician residency training programs in Integrated Clinical Practice will be considered. These programs will emphasize the provision of chiropractic care within an integrated health care system, in collaboration with primary care Patient Aligned Care Teams (PACTs), specialty care, and other medical and associated health providers and trainees. Funding decisions will be based primarily on the quality of the proposals submitted and on their congruence with VA strategic initiatives. Selected sites will be provided with funding and positions effective Academic Year 2014-2015. Since there are few positions to be allocated, only those programs that are demonstrably able to offer high quality or innovative clinical education are encouraged to apply. 2. The Office of Academic Affiliations (OAA) leads the Veterans Health Administration (VHA) health professions statutory education mission that enables VA to enhance the learning environment, to provide excellent care to Veterans, and to develop, recruit, and retain high quality professional staff. The VHA Office of Patient Care Services Strategic Plan has identified expanded access to chiropractic care as a key component of the goal to provide Veterans personalized, proactive, patient-driven health care. Chiropractic residency training programs are hoped to be effective mechanisms for the development and recruitment of a pool of highly-competent chiropractors able to provide diagnostic and therapeutic clinical services for Veterans. These Chiropractic Care Residency pilots will be the first in this discipline to receive OAA funding. BACKGROUND. Chiropractic Residency RFP 2013 July 23, 2013 2 3. a. OAA’s Associated Health Education Office (OAA/10A2D) maintains overall responsibility for administration of VA’s Chiropractic Care Residency Programs. POLICY b. All positions requested must be for one year, full-time appointments. Residents are expected to complete training within the one year training program. Exceptions may be approved by OAA on a case by case basis. c. Facilities must demonstrate the ability to provide quality training consistent with VHA Directive 2009-035, Chiropractic Care. d. It is the intent of this announcement to encourage proposals that emphasize the Secretary’s Strategic Plan, including the Guiding Principles of being People Centric, Results Driven, and Forward Thinking. Also, proposals should also take into consideration other VA goals for improving quality and access to care, increasing Veteran satisfaction, improving readiness to provide care in a time of crisis and making the VA an employer of choice. e. VA Chiropractic Residency programs must become accredited by the Council on Chiropractic Education (CCE) and approved by OAA. The application for approval as a VA training site must include a realistic timetable and plan to obtain accreditation. Sites that fail to obtain accreditation within 3 years of the start of the training program will not be funded for subsequent years. f. Chiropractic Residents recruited by VA facilities must (1) Hold a Doctor of Chiropractic degree from a Council on Chiropractic Education (CCE) accredited program. (2) Have a current, full, active, and unrestricted chiropractic license in a State, Territory or Commonwealth of the United States, or in the District of Columbia, or be eligible for such licensure. (3) Be citizens of the United States. g. OAA will provide approved VA facilities with stipends, VA’s share of the Federal Insurance Contribution Act (FICA) contributions, and VA’s share of health and life insurance premiums. Continuation of funding will depend on availability of funds as well as successful implementation and accreditation of the proposed programs. h. Facilities collaborating with an academic institution must follow the guidelines in VA Manual M-8 Part 1 Chapter 2, Affiliations with Academic Institutions or successor regulations. 4. CRITERIA FOR VA FACILITY ELIGIBILITY a. The nature of the chiropractic residency program, populations served, training experiences provided, and qualifications and skills of faculty and staff must be appropriate to the VA mission and to CCE standards. Clinical settings should provide a range of experiences in patient diagnosis and management, provide exposure to patients of varying backgrounds and cultures, and foster substantial responsibility in carrying out professional functions. Chiropractic Residency RFP 2013 July 23, 2013 3 b. Site Characteristics. The facility must provide evidence of committed leadership, appropriate clinical and educational programming, and sufficient workload to support a culture of excellence in chiropractic training. The site must demonstrate: (1) VISN, facility, and clinical leadership commitment to build and sustain an outstanding learning environment. (2) Strong leadership by the facility’s Designated Education Officer (DEO). (3) Evidence-based clinical activities and workload to support proposed training programs. (4) Experience providing overall excellence in health professions education. (5) Experience with or commitment to interprofessional training and care models. (6) Administrative infrastructure to support the proposed chiropractic residency program. (7) Evidence of sound strategies for programmatic and learner evaluation. (8) A minimum of 2 full-time credentialed and privileged chiropractic staff, at least one of whom must be a VA employee, for provision of supervisory support, professional role modeling, and administrative functions. (9) An identified chiropractic residency director with appropriate administrative time to manage program-related activities. It is estimated that 0.25 FTE would be required, depending on the size and complexity of the training program. (10) Facility willingness to obtain and fund CCE accreditation. (11) Funded facilities will need to submit an annual report of activities and outcomes for the resident program to OAA. This should include at a minimum, number of individuals that applied, lessons learned, changes proposed for the next year, analysis of feedback from residents, analysis of feedback from academic or other partners (if any), results of accreditation efforts, overall satisfaction with the program by resident and faculty, and job placement for graduating residents. 5. APPLICATION INSTRUCTIONS a. . A nonbinding Letter of Intent (LOI) to submit a proposal must be submitted by the facility DEO to the Office of Academic Affiliations by 5:00 p.m. Eastern Daylight Time on August 13, 2013. This LOI must be one page maximum, and specify the name and contact information for the proposed chiropractic residency director. It need not provide details of the submission under development. The letter should be e-mailed in Word or PDF format to Debbie.Hettler@va.gov and to Stacy.Pommer@va.gov. The Letter of Intent will be used for planning reviews and for tracking additional proposal information. b. The full proposal should be submitted electronically in one PDF file containing all of the documents. The proposal must be received in OAA by 5:00 p.m. Eastern Daylight Time on September 10, 2013. Send the file to Debbie.Hetter@va.gov and to Stacy.Pommer@va.gov. The core document of the application may not exceed 10 Chiropractic Residency RFP 2013 July 23, 2013 4 single-spaced pages, excluding the transmittal letter and appendices c. The . Longer applications will not be reviewed. Pages must have at least one-inch margins all around, and the font size must be 12 point Arial or Calibri. core document (1) Introductory Information of the application (10 pages or less) must include these elements. Please follow this outline explicitly. (a) Location and Name of Facility (b) Number of positions requested (1 or 2) (c) Names and email addresses of individuals to be notified of proposal review outcome, including facility director and Designated Education Officer (e) Academic collaborator (if any) (2) (a) Describe your existing chiropractic clinical program. Specify the number of DCs privileged and providing care at your facility, and identify the appointment type and FTE for each. Specify the number of unique patients and encounters seen in the chiropractic clinic for the current and past 2 fiscal years. Identify the most common services delivered in the clinic. Background Statement (b) Describe your current and previous chiropractic student training programs. Describe your relationship and collaborations with any academic affiliates. Specify the number of trainees who rotate through your facility each year without compensation (WOC). (c) Describe the role of the chiropractic program or staff DCs in any of the following at your facility: current interprofessional educational activities; ongoing research activities; administrative initiatives; or other relevant projects. (3) (a) Residency Program Description Mission Statement (b) . Briefly state the program purpose and emphasis areas. Personnel and Resources (c) . Identify and describe the roles of the program director, program faculty, and other program personnel. Describe the physical location and other resources available to the program including office space, computer availability, electronic resources and library support, and access to other unique training opportunities. Resident Appointments (d) . Describe the processes for resident recruitment and selection. Educational Program i. Curriculum. Describe the curricular competencies to be developed by residents, along with representative learning objectives for each competency. Ensure that these competencies are consistent with the CCE Chiropractic Residency Standards. . Chiropractic Residency RFP 2013 July 23, 2013 5 ii. Interprofessional education. Identify the services in which residents will engage in clinical educational rotations. At minimum this must include: a) primary care; b) at least 2 medical or surgical specialties; c) at least 1 mental health specialty; and d) at least 2 rehabilitation disciplines. (e) Evaluation (f) . Describe the processes for resident, faculty, and overall program evaluation. At minimum these must include resident performance, graduate employment placement, and formal written evaluation of the program by residents. Duty hours and locations (g) . Specify the number of hours residents will spend weekly in all clinical and academic activities related to the program. Identify how this will be distributed across VA and non-VA locations. Describe the mechanism to ensure that hours, supervision, and administrative oversight will be controlled by VA. Partnerships . If you are partnering with an academic chiropractic institution, describe the partnership and the delineation of responsibilities for each. Describe the support from the partner including provision of clinical staffing, administrative support, faculty development and resident training opportunities outside of VA. Include letters of support and commitment from planned affiliates. d. Appendices (1) may be up to 20 pages in addition to the 10 core document page limit and should include: Transmittal letter (a) names of the chiropractic clinic lead/chief, chiropractic residency program director, and clinical staff from the facility Director expressing support for the program, to include: (b) support for dedicated time for the program director and clinical staff who supervise trainees (c) facility's agreement to cover any costs associated with accreditation (2) Letters of support (3) from chiefs of other services in which residents will engage in clinical educational rotations. Biosketches (4) of the chiropractic clinic lead/chief and the chiropractic residency program director. Letters of support (5) from the Veterans Integrated Service Network (VISN) Director, Designated Education Officer (DEO), director of the service line responsible for this program, and academic institution partners if any. Timeline for applying for and receiving accreditation, demonstrating that initial work towards this goal begins during this pilot funding period. Chiropractic Residency RFP 2013 July 23, 2013 6 6. The merit of applications will be assessed by an Ad Hoc Review Committee appointed by the Chief Academic Affiliations Officer. Applications will be reviewed within the context of CCE accreditation criteria, VA standards, and support of VA’s Strategic Plans. The committee will evaluate specific items in the application that reflect: REVIEW PROCESS Evidence of an existing robust, well-integrated chiropractic clinical program; availability of appropriate clinical space and support resources such as support staff, library, and computer access; facility commitment to establish a residency training program, including release time for the program director. 20 points Evidence of a strong track record of accomplishments among staff DCs in areas including clinical care, education, and research; evidence of staff DCs’ participation in broader facility initiatives, committees, and other integrated efforts. 20 points Experience with previous chiropractic resident training; experience with previous chiropractic student training; evidence of successful prior collaboration with the partnering academic affiliate. 20 points Evidence of strong, clear educational objectives consistent with CCE competencies. The description should include the breadth of content, and mechanisms for delivery of content. 20 points Evidence of sufficient interprofessional training opportunities available to residents, including the number and scope of observational rotations, rounds, educational presentations and other interprofessional learning activities. 20 points TOTAL 100 points 7. a. The per annum stipend for Chiropractic Residency positions may be found on the OAA Support website ( APPOINTMENT AND PAY http://vaww.oaa.med.va.gov/). OAA will provide approved facilities with stipends, VA’s share (7.65%) of Federal Insurance Contribution Act (FICA) contributions, and VA’s share of health and life insurance premiums. Other expenses connected with trainee recruitment, educational activities, or travel must be funded from other sources. b. Appointments will be made under 38 U.S.C. 7405(a)(1) for a period not to exceed three years. The resident appointment, however, will be terminated after one year and one day. For PAID coding purposes, Chiropractic Residents c. Chiropractic Residents may be detailed to other educational institutions without loss of pay for not more than one-sixth of the time of their training period. (Reference: VA Handbook 5007, Part II, Chapter 2, paragraph 2.m.(1)(b)) will be identified by the use of Pay Plan AD; Series Code 0601 Title Code 80, Assignment Code 00; Title Chiropractic Resident; Subaccount, 1051; FTE, 1.0. Chiropractic Residency RFP 2013 July 23, 2013 7 d. General Schedule annual and sick leave policy applies to trainees under this program. (Reference: VHA Manual M-8, Part II, Chapter 2, Paragraph 2.14). Chiropractic Residents are eligible for life and health insurance benefits. e. Chiropractic Residents will be protected from personal liability while providing professional services at a VA health care facility under the Federal Employees Liability Reform and Tort Compensation Act, 28 U.S.C. 2679 (b)-(d). 8. CONTACT PERSON: For information concerning this program announcement, contact Debbie Hettler, OD, MPH, FAAO, Clinical Director, Associated Health Education Office (10A2D), at Debbie.Hetter@va.gov or at 202-461-9499, Stacy Pommer, LMSW, Health Systems Specialist, Associated Health Education Office (10A2D), at Stacy.Pommer@va.gov or 202-461-9877, or Anthony Lisi, DC, National Program Director, Chiropractic Service (10P4R) at Anthony.Lisi@va.gov or 203-932-5711 Ext 5341. 9. NATIONAL PROGRAM REVIEW AT CONCLUSION OF PILOT 10. . Since this is a national pilot program, its continuation beyond three years is not guaranteed, but rather is dependent on availability of funding and measurable outcomes, including program accreditation, resident completion, hiring of residents into VA, hiring of residents into other health care systems and/or academic institutions, and resident and program satisfaction. OAA and Rehabilitation Services will jointly conduct the formal review to determine continuation. SCHEDULE July 23, 2013 Program Announcement August 13, 2013, 5:00 pm Eastern Letter of Intent (Nonbinding) due to OAA September 10, 2013, 5:00 pm Eastern Application due to OAA. To be sent as a single PDF file to Debbie.Hettler@va.gov and Stacy.Pommer@va.gov. October 4, 2013 Notification of selected sites Between July 1 and October 1, 2014 Initiation of Program 3 Years after Initiation of Program Program must be CCE accredited to receive continued funding. Reposted by: Dr. Vohn Watts

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