JOHNSON CITY, Tenn. (WJHL) — If recommendations in a federal Department of Veterans Affairs report become reality, some significant growth and realignment is in the James H. Quillen Mountain Home VA Medical Center’s not-too-distant future.

News Channel 11 sat down with Quillen’s director, Dean Borsos, about recommendations from the so-called “AIR Commission” — an effort that grew out of the MISSION Act Congress passed in 2018. The AIR Commission looked at every VA market nationwide, more than 60 in all, aiming to position the VA for a care network “with the right facilities, in the right places, to provide the right care for all Veterans,” according to a VA news release.

With a late March report now public on each market area, the president and Congress will review the recommendations and decide whether to accept them and okay implementation, which could take several years.

Notable recommendations in the report, which looks out over the next decade, include considering construction of a new nursing home in Knoxville, opening a multi-specialty outpatient clinic in Kingsport, opening an outpatient clinic in Greeneville and converting the nursing home and domiciliary rooms at the Johnson City campus to single occupancy.

A map showing proposed changes within the Quillen VA market based on an AIR Commission report.

“That would be a really good thing in terms of the treatment and quality of life for our veterans that are using the (nursing home) and the domiciliary,” Borsos said.

For Mountain Home and its service area that stretches from Knoxville to Mountain City and covers much of Southwest Virginia, any changes will be a continuation of what began several years ago when the MISSION Act looked to broaden veterans’ access to care by allowing more involvement by private providers.

“Trying to get to the right facilities in the right location providing the right care … is what Mountain Home and James H. Quillen has been trying to do all along and has been working very well,” Borsos said. He cited expansion of radiation oncology services, addition of a second MRI machine and addition of intensive care beds at the hospital among examples of what he said were market-driven upgrades “to continue the growth of our ability to provide that care.”

The AIR recommendations are comprehensive and include projections about changes in demand for various types of services and the numbers of veterans in the market. Borsos said the bottom line, though, is that the VA wants veterans to look to the system first — and that the system is becoming more and more integrated with partners in academia and the private sector.

“The crux of this is that the VA remains at the center of care,” Borsos said. “And so James H Quillen and our supporting VA clinics will continue to be the main focus on how we provide care to veterans.”

But Borsos said the report calls for, and he supports, expanding work with East Tennessee State University and even more particularly the University of Tennessee Medical Center in Knoxville, where the highest growth in demand is projected.

“We can use our academic affiliates and then we can use community partners, community providers, to make sure our networks are more robust so that the veterans that, whatever care we may not be able to provide here, can access in their local community get more ready access to that,” Borsos said. “That can be a big benefit, especially as we get further out to the rural areas.”

The AIR report notes that 43.6% of the 67,000-plus enrollees in Quillen’s market live in rural areas, which is 34% higher than the national average of 32.5%.

The main campus and hospital, and those clinics, are likely to undergo some significant changes if the study’s recommendations. The study compared its own recommendations to maintaining the status quo and to a plan that would modernize existing health care infrastructure but doesn’t have a market study backing it up.

The total costs over 30 years aren’t terribly different, with the status quo at $15.1 billion, modernization at $15.9 billion and the VA recommendation from the study at $16.1 billion. But a related cost-benefit analysis gave the new plan a much higher “benefit score” (15) than the modernization (11) or status quo (10) options.

Borsos said he wants Quillen and all its care providers — staffing has grown by several hundred in the last few years — to continue improving and adapting to the best care models. He believes the system has done a good job of that and said he was particularly proud to learn the hospital got a five-star rating for patient satisfaction earlier this year from Becker’s Hospital Review.

But he said the landscape is always shifting and there’s always room for improvement.

“If we were to focus on one area where I think we may be able to do a little bit more would be to perhaps look at our operating room space, and maybe the ability to add another operating room or two or three … so that we can keep up with the medical surgical workload that’s going on in the community.”

Borsos said he’d be particularly pleased to see changes at the domiciliary and nursing home in terms of a shift to single-occupancy rooms. The domiciliary serves veterans who are trying to overcome substance abuse or mental health issues that have hampered their ability to function well in society. Many come having been homeless.

“Many talks about how it’s incrementally, or in other instances just overwhelmingly changed their lives and given them a new sense of direction,” Borsos said. (The program has) enabled them to advance and move out of the domiciliary, have their own places, get jobs and then continue to be very productive in life. They have come back afterwards thanking the staff which is so appreciative of their ability to engage in change their lives.”

The AIR Commission report on the Quillen market begins on page 18 of this link.