• artificial limbs and prosthetic devices such as the Seattle Foot; 



• cardiac pacemakers and CAT scanners; and 



• Nobel prizewinning efforts in the areas of radioisotopes and endocrine disorders. 



Department of Veterans Affairs' Expectations/Requirements for its 

 Relationship with Universities: 



The VHA enters into affiliation agreements with over 1400 health professions schools across the Nation. Under 

 these agreements, VA provides the venue for a portion of health professions training in its hospitals and clinics. 

 Universities provide the students and faculty and supervise education programs. VA chnical and research staff be- 

 come faculty members at the appropriate health professions schools. Conversely, VA-based research faculty are fully 

 enfranchised members of the university faculty with access to its research support services and educational resources. 



The quality and rigor of educational opportunities is maintained at the same level throughout each public- 

 private sector training program. Both VA and their academic partners adhere to a rigorous scientific peer review 

 process. 



VA enters into sharing agreements with universities for joint purchase, use and maintenance of high technology 

 medical and research equipment. Sharing of high technology resources such as computational and diagnostic tools 

 and specialized scientific expertise allows both VA and its academic partners to maximize results of expenditures for 

 research activities. 



Issues with Current Relationship/Barriers to an Effective Relationship: 



Changing requirements for federal indirect costs reimbursement, as well as new Medicare reimbursement 

 policies, pose a serious financial threat to major university teaching hospitals, and may limit the teaching and re- 

 search programs in which VA hospitals participate. At the same time, direct federal funding for research and patient 

 care is growing at a slower than historic rate, conuibuting to financial instability and retrenchment at research univer- 

 sities. 



The steadily increasing burden of federal regulation of biomedical research and health care shifts valuable 

 resources away from the conduct of research and the delivery of care. Recent requirements to provide the exact daily 

 work schedules of all residents to HCFA, and the extension of the honoraria ban for federal employees to university 

 faculty with even a part-time affiliation with a VA hospital, are examples. 



Elements/Characteristics of a Productive Future Relationship: 



A coordinated effort to prepare the future health care and scientific workforce for America 2000 is much 

 needed. Any such effort should emphasize the continued need for collegial collaboration on education of health 

 professionals and for coordinated and non-duplicative biomedical research support. Increased emphasis should be 

 placed on collaborative efforts to sU-engthen clinical/human subjects research programs. Objectivity in the scientific 

 review process must be preserved if we are to maintain a position of worldwide leadership in biomedical research. 



Legislative/Executive Authorities for Department of Veterans Affairs' Relationships with 

 Research Intensive Universities: 



The authority for VA's relationship with research intensive universities is established in 38 United States 

 Code — Veterans Benefits, as amended. Section 7302 authorizes Veterans Health Administration (VHA) health care 

 personnel education and U-aining programs. Section 7303 authorizes the functions of VHA research programs. 



45 



