Surgery
VHA Invasive Procedure Complexity for Surgical Programs
The Department of Veterans Affairs (VA), the nation’s largest health care system, has processes in place to ensure that invasive procedures are performed under the safest possible conditions at facilities with the resources to support them.
The Veterans Health Administration (VHA) assigned each of its Surgical Programs an “invasive procedure complexity” level of Inpatient Complex, Inpatient Intermediate, Ambulatory Procedure Center (APC) Advanced, Inpatient Standard, or APC Basic. The policy that governs invasive procedure complexity is Directive 1220(1) Facility Procedure Complexity Designation Requirements to Perform Invasive Procedures In Any Clinical Setting. Learn more about what invasive procedure complexity means.
A listing of all approved VHA Surgery Programs and their invasive procedure complexity designations is below. The listing below does not include the additional invasive procedure designations for non-surgical facilities. The list is sorted by state.
| VHA Surgical Program Location | Veterans Integrated Service Network (VISN) | Operative Complexity Designation |
|---|---|---|
| Birmingham, AL | 7 | Inpatient Complex |
| Montgomery, AL | 7 | Inpatient Standard |
| Fayetteville, AR | 16 | Inpatient Intermediate |
| Little Rock, AR | 16 | Inpatient Complex |
| Phoenix, AZ | 22 | Inpatient Complex |
| Tucson, AZ | 22 | Inpatient Complex |
| Fresno, CA | 21 | Inpatient Intermediate |
| Martinez, CA | 21 | APC Advanced |
| Sacramento, CA | 21 | Inpatient Complex |
| Palo Alto, CA | 21 | Inpatient Complex |
| San Francisco, CA | 21 | Inpatient Complex |
| Loma Linda, CA | 22 | Inpatient Complex |
| Long Beach, CA | 22 | Inpatient Complex |
| San Diego, CA | 22 | Inpatient Complex |
| West Los Angeles, CA | 22 | Inpatient Complex |
| Denver, CO | 19 | Inpatient Complex |
| Grand Junction, CO | 19 | Inpatient Standard |
| West Haven, CT | 1 | Inpatient Complex |
| Washington, DC | 5 | Inpatient Complex |
| Wilmington, DE | 4 | Inpatient Intermediate |
| Bay Pines, FL | 8 | Inpatient Complex |
| Cape Coral, FL | 8 | APC Advanced |
| Gainesville, FL | 8 | Inpatient Complex |
| Jacksonville, FL | 8 | APC Basic |
| Lake Baldwin, FL | 8 | APC Basic |
| Lake City, FL | 8 | APC Advanced |
| Miami, FL | 8 | Inpatient Complex |
| Orlando, FL | 8 | Inpatient Intermediate |
| Pensacola Naval, FL | 16 | APC Basic |
| Tampa, FL | 8 | Inpatient Complex |
| West Palm Beach, FL | 8 | Inpatient Intermediate |
| Augusta, GA | 7 | Inpatient Complex |
| Atlanta, GA | 7 | Inpatient Complex |
| Dublin, GA | 7 | APC Basic |
| Des Moines, IA | 23 | Inpatient Intermediate |
| Iowa City, IA | 23 | Inpatient Complex |
| Boise, ID | 20 | Inpatient Intermediate |
| Danville, IL | 12 | APC Basic |
| Chicago-Jesse Brown, IL | 12 | Inpatient Complex |
| Hines, IL | 12 | Inpatient Complex |
| North Chicago, IL | 12 | Inpatient Intermediate |
| Marion, IL | 15 | Inpatient Standard |
| Evansville, IN | 15 | APC Basic |
| Fort Wayne, IN | 10 | APC Advanced |
| Indianapolis, IN | 10 | Inpatient Complex |
| Leavenworth, KS | 15 | Inpatient Standard |
| Topeka, KS | 15 | APC Basic |
| Wichita, KS | 15 | Inpatient Intermediate |
| Lexington, KY | 9 | Inpatient Complex |
| Louisville, KY | 9 | Inpatient Complex |
| New Orleans, LA | 16 | Inpatient Complex |
| Pineville, LA | 16 | APC Advanced |
| Shreveport, LA | 16 | Inpatient Complex |
| Boston-Jamaica Plain, MA | 1 | APC Advanced |
| West Roxbury, MA | 1 | Inpatient Complex |
| Baltimore, MD | 5 | Inpatient Complex |
| Togus, ME | 1 | Inpatient Intermediate |
| Ann Arbor, MI | 10 | Inpatient Complex |
| Detroit, MI | 10 | Inpatient Complex |
| Saginaw, MI | 10 | APC Basic |
| Iron Mountain, MI | 12 | APC Basic |
| Minneapolis, MN | 23 | Inpatient Complex |
| St. Cloud, MN | 23 | APC Basic |
| Columbia, MO | 15 | Inpatient Complex |
| Kansas City, MO | 15 | Inpatient Complex |
| St. Louis, MO | 15 | Inpatient Complex |
| Biloxi, MS | 16 | Inpatient Intermediate |
| Jackson, MS | 16 | Inpatient Complex |
| Billings, MT | 19 | APC Basic |
| Fort Harrison, MT | 19 | Inpatient Standard |
| Asheville, NC | 6 | Inpatient Complex |
| Charlotte, NC | 6 | APC Basic |
| Durham, NC | 6 | Inpatient Complex |
| Fayetteville, NC | 6 | Inpatient Standard |
| Fayetteville-ASC, NC | 6 | APC Basic |
| Kernersville, NC | 6 | APC Advanced |
| Salisbury, NC | 6 | Inpatient Intermediate |
| Fargo, ND | 23 | Inpatient Intermediate |
| Omaha, NE | 23 | Inpatient Complex |
| Manchester, NH | 1 | APC Basic |
| East Orange, NJ | 2 | Inpatient Complex |
| Albuquerque, NM | 22 | Inpatient Complex |
| Reno, NV | 21 | Inpatient Intermediate |
| Las Vegas, NV | 21 | Inpatient Intermediate |
| Albany, NY | 2 | Inpatient Complex |
| Buffalo, NY | 2 | Inpatient Complex |
| Syracuse, NY | 2 | Inpatient Complex |
| Bronx, NY | 2 | Inpatient Complex |
| Brooklyn, NY | 2 | Inpatient Complex |
| Northport, NY | 2 | Inpatient Complex |
| New York, NY | 2 | Inpatient Complex |
| Cincinnati, OH | 10 | Inpatient Complex |
| Cleveland-ASC, OH | 10 | APC Basic |
| Cleveland, OH | 10 | Inpatient Complex |
| Columbus, OH | 10 | APC Advanced |
| Dayton, OH | 10 | Inpatient Intermediate |
| Muskogee, OK | 19 | Inpatient Intermediate |
| Oklahoma City, OK | 19 | Inpatient Complex |
| Eugene, OR | 20 | APC Advanced |
| Portland, OR | 20 | Inpatient Complex |
| Roseburg, OR | 20 | APC Basic |
| Altoona, PA | 4 | APC Advanced |
| Erie, PA | 4 | APC Advanced |
| Lebanon, PA | 4 | Inpatient Intermediate |
| Philadelphia, PA | 4 | Inpatient Complex |
| Pittsburgh, PA | 4 | Inpatient Complex |
| Wilkes-Barre, PA | 4 | Inpatient Intermediate |
| San Juan, PR | 8 | Inpatient Complex |
| Providence, RI | 1 | Inpatient Intermediate |
| Charleston, SC | 7 | Inpatient Complex |
| Columbia, SC | 7 | Inpatient Complex |
| Fort Meade, SD | 23 | Inpatient Standard |
| Hot Springs, SD | 23 | APC Basic |
| Sioux Falls, SD | 23 | Inpatient Intermediate |
| Memphis, TN | 9 | Inpatient Complex |
| Mountain Home, TN | 9 | Inpatient Intermediate |
| Murfreesboro, TN | 9 | APC Basic |
| Nashville, TN | 9 | Inpatient Complex |
| Houston, TX | 16 | Inpatient Complex |
| Dallas, TX | 17 | Inpatient Complex |
| Harlingen, TX | 17 | APC Basic |
| Lubbock, TX | 17 | APC Basic |
| Northwest San Antonio, TX | 17 | APC Basic |
| San Antonio, TX | 17 | Inpatient Complex |
| Temple, TX | 17 | Inpatient Complex |
| Amarillo, TX | 17 | Inpatient Intermediate |
| El Paso, TX | 17 | APC Basic |
| Salt Lake City, UT | 19 | Inpatient Complex |
| Clarksburg, WV | 5 | Inpatient Intermediate |
| Hampton, VA | 6 | Inpatient Intermediate |
| Richmond, VA | 6 | Inpatient Complex |
| Salem, VA | 6 | Inpatient Intermediate |
| White River Junction, VT | 1 | Inpatient Intermediate |
| Seattle, WA | 20 | Inpatient Complex |
| Spokane, WA | 20 | Inpatient Standard |
| Tacoma, WA | 20 | APC Basic |
| Green Bay, WI | 12 | APC Basic |
| Madison, WI | 12 | Inpatient Complex |
| Milwaukee, WI | 12 | Inpatient Complex |
| Martinsburg, WV | 5 | Inpatient Intermediate |
| Beckley, WV | 5 | Inpatient Standard |
| Huntington, WV | 5 | Inpatient Complex |
| Cheyenne, WY | 19 | Inpatient Standard |
More information about VHA Invasive Procedure Complexity
VHA “invasive procedure complexity” establishes the infrastructure that is required at a VHA facility in relationship to the complexity of the procedures being performed. This requirement ensures that the scope of the invasive procedure is within the capability of the facility. This requirement makes sure that invasive procedures are performed under the safest possible conditions. A facility infrastructure refers to: physicians, nursing, other medical personnel, space, equipment, supplies, sterile processing, and other support services related to an invasive procedure.
Examples of procedures performed in a VHA Surgery Program at the different types of Invasive Procedure Complexity designations are:
- Example of an APC Basic procedure is cataract surgery (replacement of the eye lens).
- Example of an Inpatient Standard procedure is an appendectomy (removal of the appendix).
- Example of an APC Advanced procedure is a total knee replacement (arthroplasty).
- Example of an Inpatient Intermediate procedure is a shoulder joint reconstruction.
- Example of an Inpatient Complex procedure is a coronary artery bypass graft (CABG), a type of open-heart surgery.