Tagged: military health care

MHS Changes Care Model To Avoid Systemic Issues Similar To the VA

Posted by Debi Teter
Care-changes-in-Military-Health-SystemThe New York Times has reported months’ worth of investigation showing “a pattern of avoidable errors that has led to injuries and contributed to some deaths” in Military Health System (MHS) facilities.  The reports document widespread problems in infection control and patient safety. Some startling findings included that mothers giving birth at MHS facilities were significantly more likely to hemorrhage after childbirth than mothers at civilian hospitals and found that babies born in military hospitals were twice as likely to suffer injuries as newborns nationally. The DoD has acknowledged systemic problems across the Military Health System (MHS) for active-duty and retired troops similar to the pattern of poor care and management that has plagued the VA.  The MHS has 56 hospitals and 361 clinics worldwide serving 9.6 million beneficiaries in a system that is separate from the VA. The beneficiaries include 1.45 million active-duty service members, 1.7 million active-duty family members and 610,000 retired service members who are served by more than 133,000 military and civilian doctors, nurses, medical educators, researchers and other health professionals. The problems in care and management at the MHS come at a time when Defense Secretary Hagel and the service chiefs have been seeking to cut or at least slow the growth of health care costs in the military. In testimony to Congress, Hagel has repeatedly pointed out that military health care costs have more than doubled since 2001 to the current annual cost of about $52 billion. Meanwhile, the MHS has also been undertaking a major shift in the way it delivers services. In March, MHS leadership communicated to its employees that “after more than a decade of war and in a period of national evolution in concepts of health care, the Military Health System must re-engineer processes by which we bring health to the 9.6 million beneficiaries we serve.” The new MHS plan is to shift the focus to a “patient-centered medical home model,” described as being central to the strategy to form a partnership with each patient for whom the MHS provides primary care.

The home model “holds promise as a way to improve health care in America by transforming how primary care is organized and delivered,” MHS said.


Bill to Expand Abortion Access for Military Women Introduced in Senate

Posted by Jason Van Steenwyk

abortion services for military womenSenator Kirsten Gillebrand (D-New York) has introduced a bill in the Senate that would allow military servicewomen to obtain abortions in military medical facilities, provided they pay for them out of pocket. Current law forbids federal dollars from directly funding abortions except to protect the life of the mother, or in cases of rape or incest. The law also currently prohibits military members and their families from using their own money to pay for abortions in military hospitals.

Representative Louise Slaughter (D-New York) introduced similar legislation last month in the House of Representatives.

The proposed bill, called the Military Access to Reproductive Care and Health Act (or the MARCH Act, as suckers for acronyms like to call it), is intended to allow military women to get abortions in American military facilities overseas rather than have to take leave and go back to the United States to get it or risk having an unsafe abortionist in an overseas country do it. Gillebrand and the law’s supporters are also concerned about overseas language barriers, the health and safety records of overseas abortion providers, questionable regulation, and a lack of privacy.

The Department of Defense estimates that as many as 19,000 servicemembers are sexually assaulted each year,” said Senator Gillebrand in a statement.  “While victims of rape or incest now can receive abortion services at military medical facilities, for some disclosing their assault would be especially problematic; for example, because their commanding officer is the perpetrator of the assault.  Other women may decide that they simply do not want to disclose that they were raped.  Either way, the MARCH Act of 2013 would provide a path for women in this difficult position to receive services without compromising their privacy.”

Senator Gillebrand is the chairperson of the Senate Armed Services Subcommittee on Personnel.

The Senate version of the bill has also picked up co-sponsorship from Senators Dick Durbin (Ill.), Al Franken (Minn.), Tom Harkin (Ia.), Frank Lautenberg (N.J.), Jeff Merkley (Ore.), Patty Murray (Wash.), Bernie Sanders (Vt.), Jean Shaheen (N.H.), Sheldon Whitehouse (R.I.) and Ron Wyden (Ore.). All the Senate cosponsors are Democrats, except for Sanders, who an independent but who describes himself as a “democratic socialist.”

The House version of the bill has 45 co-sponsors, all of them Democrats. Passage in the house is impossible without some Republican support, since Republicans still hold the majority in the House of Representatives. 

“Our women in uniform continue to play increasingly critical roles in our military and there is no reason for them to be excluded from the same types of health care services available to those in the private sector,” said Senator Patty Murray.

“Women serving in foreign countries deserve access to safe and legal health care, which in many cases is not available off the military base.  Women in the U.S. military shouldn’t have to forfeit their rights when they serve abroad, and this legislation would bring unjust treatment to an end,” said Senator Frank R. Lautenberg. 

Supporters of the House version of the bill state that there is a ‘conscience clause’ that allows military health care providers who object to performing abortions to refuse to provide it.

In 1993, the Clinton Administration issued an executive order that lifted the ban on using private funds to pay for abortions in military hospitals. However, Congress reinstated the ban in 1995, prohibiting private funding for abortions at military facilities except in cases involving a threat to the life of the mother, rape or incest. Congress also restricted public funding for abortions to cases involving a threat to the mother’s life. A more extensive legislative and political history is available from the Guttmacher Institute here. The Guttmacher Institute consistently supports abortion rights.

Both Senator Slaughter and Gillebrand have attempted to push similar legislation in 2011 and 2012, but without success. 

Beware of Local “Emergency Centers” Not Authorized by TRICARE

Posted by Jason Van Steenwyk

tricareTRICARE beneficiaries may have noticed new kinds of “Emergency Centers” popping up in their area. It may seem like a tempting health care option but, free-standing emergency rooms (ER) that are not affiliated with a hospital may not be TRICARE-authorized. If a provider, such as a free-standing ER, is not authorized then TRICARE is prohibited from paying it “facility fees.” That can leave a beneficiary stuck with a big bill.

Beneficiaries need to “know before you go.” Check a free-standing ER’s TRICARE status – before emergency care is needed. Beneficiaries can check if a provider is TRICARE-authorized by calling their regional contractor. Contact information for regional contractors is available at www.tricare.mil/contactus.  All TRICARE network providers are also searchable at www.tricare.mil/findaprovider

TRICARE defines an emergency department as an organized, hospital-based facility available 24 hours a day providing emergency services to patients who need immediate medical attention. Emergency departments affiliated with a hospital are most likely TRICARE-authorized providers. Beneficiaries who seek care at a free-standing ER need to ask if the facility is affiliated with a hospital-based emergency department. If it isn’t, the beneficiary will need to make a decision about getting care elsewhere or being responsible for the facility charges.

Learn more about emergency care under TRICARE at www.tricare.mil/emergency.

Source material here.

President Signs Burn-Pit Registry Law

Posted by Jason Van Steenwyk

US Army burn pitPresident Barack Obama signed a law last week directing the Department of Veterans Affairs to set up and maintain a ‘burn-pit’ registry. This is a list of veterans who have been exposed to potentially toxic fumes emanating from diesel fuel, human excrement, and other waste and debris in Iraq, Afghanistan and other austere areas of operation.

Although burn-pits are nothing new – they date back to ancient times – NBC News has referred to burn-pit exposure as “this generation’s Agent Orange.”

This isn’t necessarily about the small latrine pits made out of 55-gallon drums. Some contractors in Iraq actually maintained massive burn pits that were hundreds of yards wide, and did so very close to troops working and living areas, in some cases. These pits used diesel fuel to burn plastics, tires, chemicals, excrement, batteries – including rare earth and heavy metal batteries.

One study measured the cancer rate among troops stationed at Balad – a major Forward Operating Base in Iraq and home to perhaps the largest burn pit in the country – and found the cancer risk was eight times higher among those troops stationed at Balad for more than a year than among the general population, controlling for age and sex. Dioxin and particulate exposure were also each 50 times higher than acceptable levels, according to a 2007 study.

The new law follows a series of lawsuits against prominent military contractors, Kellogg, Brown and Root and Halliburton, alleging that these burn pit operators failed to properly maintain these pits, mitigate hazards or warn servicemembers of the potential harmful effects of the fumes.

One suit alleges that KBR built a large burn pit upwind of troops’ living quarters – in violation of their contract and DoD directives.

The burn-pit directory will give the Department of Veterans Affairs a database of individuals with exposure to the pits, help them track long-term medical issues among this population and compare them with other groups, and facilitate communication if effective treatments are discovered.

A series of academic studies has been undertaken, and some of them have been published within the last year. At least one study found an increase in incidents of asthma and other pulmonary disorders after deployments to Iraq and Afghanistan.

The VA has not yet issued instructions on how to sign up for the burn-pit registry. It will publish instructions when the registry is up and running.

Three New Year’s Resolutions Worth Starting Now

Posted by Kelli McKinney

military new year's resolutionsWe’re two weeks into the New Year and already some of my fellow resolution-makers have effectively called their new year’s plans DOA. That’s a tough place to find yourself this early in the year. Most people start their new year’s resolutions with a blaze of energy and good intention, but no real planning or consideration. That leaves them just like my friends: only a few days into a new year and already frustrated and burned out.

This is exactly why I prefer to give myself some time during the month of January to scrutinize my current situation and formulate some appropriate, tactically-achievable plans. If you’re like many who gave some serious thought to making a couple of changes this year, then put the thought aside to tend to your daily family or military service obligations, rest assured it’s not too late to make and start positive changes. After some careful consideration, the list below offers a few that are worth starting today. Make them, start them, keep them, and next year at this time you’ll be glad you did.

1: Get serious about your financial future. Good financial planning starts with a hard look at your financial situation. If you haven’t already, take stock of your finances. Know what your military financial benefits are and for crying out loud, use them.

2: Get serious about giving up bad habits. You know the ones I’m talking about. Everybody has something they just can’t seem to quit. It’s time to do it. Break those chains of bondage, whether it’s to cigarettes and alcohol or sodas and sugar. You’ll feel a sense of pride and accomplishment, not to mention in some cases you’ll improve your health. If you need some help, the military has services that can provide you with the tools and support to get you through.

3. Get serious about learning something new. Studies show that people who commit themselves to lifelong education make more money, have a more positive outlook, and experience less stress than those who do not. Who doesn’t want that? Although the financial impact of education can be discouraging, the military offers education benefits that are second to none. If you haven’t already, put those benefits to good use – you’ve earned them – and consider pursuing or completing a degree or certification. It’s an investment in your future health, wealth and happiness.

If the thought of all three of these makes your head spin, consider tackling them one at a time. Or pick the goal that would result in the most important, meaningful change for you and create a plan around that one. Remember what Bill Murray’s character says in the movie “What About Bob:” Baby steps. Take each goal, create simple, achievable, measureable steps to accomplish it, and tackle those steps one at a time. Before you know it, you’ll be one of the happy few who can truly claim they kept their New Year’s Resolution – and all the benefits that come with reaching your goals.

170,000 Getting Booted from TRICARE Prime

Posted by Jason Van Steenwyk

Tricare booting members despite Obama's promise“If you like your health care plan, you can keep it.” That was the promise Barack Obama made in 2009, selling his health reform plan that became the Affordable Care Act.

It turns out that’s not even true for federal TRICARE beneficiaries.

If you live more than 40 miles from a military installation, chances are you are no longer welcome with TRICARE Prime. Pentagon officials have announced that most of these retired and surviving widow(ers) will be booted from TRICARE Prime as of October 1.

Most of those affected will have to enroll in TRICARE Standard.

The change will not affect those enrolled in Medicare and using TRICARE for Life, nor will those on active duty. However, the change will affect any adults under age 26 enrolled in the TRICARE Young Adult program, if they are over 40 miles from a military installation.

This is actually a six-month reprieve – officials were originally considering forcing enrollees off of TRICARE Prime as of April 1.

TRICARE officials are looking at making an exception for those within 100 miles of primary care managers if they sign a drive-time access waiver.

What does this mean? According to the Reserve Officers Association of America, you may have to find a new doctor.

Also, your costs will change: You will no longer pay flat co-payments per visit and an annual enrollment fee. Instead, you will have to pay a deductible of $150 per year (for singles) or $300 per year (for families), as well as a 25 percent co-insurance – up to $3,000 per fiscal year.

There is the potential for an exception for retired servicemembers, military families, and young adults to remain in Prime if they reside within 100 miles of an available primary care manager and sign a drive-time access waiver.

The Pentagon estimates that limiting TRICARE Prime coverage to those outside of 40 miles of military installations will save taxpayers some $56 million per year.

TRICARE Standard, incidentally, has higher customer satisfaction ratings than TRICARE Prime, according to the Military Officers Association of America.

Ironically, even as the U.S. government kicks 170,000 of its own retirees, survivors and adult children of servicemembers off of their preferred health insurance plan, the White House still maintains on its website that rumors of people being forced to change doctors or forced off their health care plans is a “myth.”

Navy Family in Battle with TRICARE to Treat Special Needs Child

Posted by Jason Van Steenwyk

TRICARE won't pay for child's therapy with a horseKaitlyn N. Samuels, the 16-year-old daughter of a Navy officer, was born with a variety of congenital disabilities, including cerebral palsy, severe life-threatening progressive scoliosis, and developmental retardation – her brain functions at the toddler level.

Kaitlyn needs ongoing physical therapy to help her exercise the muscles that allow her to sit upright and stabilize herself. Otherwise the curvature of her spine will eventually cause bones to leave their sockets and crush her lungs. She doesn’t respond to physical therapy in a hospital or clinic setting, though. So her therapists hit on the idea – get her on the back of a horse.

The response was positive. While Kaitlyn would shut down and not cooperate with her therapy sessions in a clinical setting, she loves riding the horse. And it accomplishes many of the physical therapy treatment objectives – she has to concentrate on sitting upright and using her thigh, back and abdominal muscles to stabilize herself and compensate for the movement of the horse.

And what American girl doesn’t love horses?

Naturally, TRICARE, being a government bureaucracy, can’t figure that out. They issued a final decision denying coverage for her physical therapy.

While TRICARE does normally provide coverage for physical therapy in general, it won’t cover Kaitlyn’s, because Kaitlyn doesn’t do her therapy in a clinical setting with a ball and bench and other traditional clinical tools.

Hippotherapy – that is, doing physical therapy on horseback, rather than with the usual set of balls, benches and weights in a clinical setting – does not qualify for TRICARE funding, the government asserted – and so when they realized that the therapist was using a horse to get positive results rather than a ball to get no results, they stopped funding the treatment.

They even sent Kaitlyn’s father a bill – $1,324 – to reimburse them for treatment they had already funded.

The Samuels family went to appeal TRICARE’s decision. And won, initially. The hearing officer sided with Kaitlyn’s family. He held that physical therapy was physical therapy, regardless of whether it took place on horseback or in a clinic with benches, weights and braces. If physical therapy was a covered benefit, and hippotherapy was an effective form of it, it didn’t matter whether the tool was a horse or a large plastic ball.

 “It cannot be forgotten that even though [Kaitlyn] is 15 years old, she has the mental capacity of a toddler-preschool child,” he wrote in his recommendation. “It would be a waste of the Government’s money to pay for therapy in a traditional setting for it would provide no benefit.”

TRICARE’s Deputy Chief of Policy and Operations, Michael O’Bar, even went against the recommendations of his own hearing officer in the case, stating that he believed the hearing officer misapplied the statutes that govern the nature of medical documentation and peer-reviewed studies required to prove the efficacy of hippotherapy for the medical condition. As of this writing, Kaitlyn’s hippotherapy is not covered under TRICARE, period. They would fund it if she were not cooperating with her therapy in a hospital and getting no results. But TRICARE refuses to fund a treatment that has actually proven to be effective, in Kaitlyn’s case.

TRICARE officials, for their part, argue that they cannot responsibly fund experimental therapies, nor can they fund therapies that do not have a body of peer-reviewed work demonstrating effectiveness.

Kaitlyn’s family, her therapist and their lawyers, meanwhile, argue that the treatment is the same – the fact that hippotherapy takes place on a horse instead of on a ball is incidental. And given that the treatment modality, other than the context and the specific tool used, is identical, it doesn’t make sense for the government to fund one but not the other.

The government lawyer assigned to argue the case, however, argued that if one treatment that they didn’t fund worked, and the treatment that they were willing to cover was useless, then they couldn’t be the same treatment.

The government still maintains that they will fund the useless therapy in the hospital or clinic setting – but they will not fund the therapy that actually works.

O’Bar’s finding is the final authority within the TRICARE appeals process. The next step, should the Samuels family decide to pursue it, is a lawsuit in federal court – an expensive and time-consuming process.

Medicaid Doesn’t Work for Military Families

Most families with severely disabled children can apply for Medicaid benefits in the states in which they live. But for military families, Medicaid isn’t so simple: While Medicaid dollars are largely federal, each state runs its own Medicaid program – and waiting lists for Medicaid benefits are routine. In some cases, families can be on the waiting list for years before becoming eligible for benefits. But military families move every three years – usually out of state – and have to start at the bottom of the waiting list each time. That’s what’s happening here, according to Kaitlyn’s mother. Her daughter does qualify for Medicaid, but the family doesn’t stay in one state long enough for that to matter, because of the waiting list requirements. If Kaitlyn’s daughter were a deadbeat dad, she says, “We wouldn’t be here right now.”

Hippotherapy and the Romney Family

Hippotherapy came to public attention earlier this year, when it became public that Ann Romney, wife of former Republican presidential candidate Mitt Romney, credited horseback therapy with saving her life. Ann Romney was diagnosed with multiple sclerosis in 1998. The Romneys – being a family of substantial means – own a partnership in a competitive horse breeding operation, and have ready access to horses.

Ann Romney’s use of horse therapy actually became a campaign issue, briefly, and MSNBC television personality Lawrence O’Donnell actually mocked for her use of hippotherapy to treat her MS symptoms.

A number of studies have, indeed, supported the clinical benefits of hippotherapy for a variety of conditions. TRICARE, however, continues to deny treatment for the Kaitlyn Samuels.

The Fifth Dentist Hands Out Slushees

Posted by Kelli McKinney

dental examThe first time I took our son to the dentist, he was three years old. We’d showed him how to use a toothbrush as soon as that first little chicklet of a tooth appeared, and we’d talked up his first dentist trip. You’d have thought the boy was going to meet Santa himself, the way we hyped it up.

We have been very fortunate to have good dental care – there are about 17 million kids in our country who don’t, which means that more than 50 million school hours are missed because of dental problems and accompanying infections. We wanted our son to grow up being familiar with his dentist and medical care providers, to be confident enough to ask questions of them, and – most importantly – to learn good self-care habits.

Dentists are, in my opinion, some pretty brave people. These are people who put their (gloved) hands into what is essentially a giant pool of bacteria and utensils (teeth). Not my cup of tea. They aren’t our nation’s first line of defense, or anything like that, but I do still have an enormous amount of respect for them.

Back to the bacteria, or as we call it, “cavity bugs” or my other favorite “tooth dirt.”  The big bad bacteria of the mouth – the one that causes cavities – is streptococcus mutans. That’s right, it’s in the same family of bugaboos that causes strep throat. When this strep is introduced to sugar, it produces an acid that is mostly neutralized by saliva. But if a person, say, drinks a couple of sugary juice boxes or eats a handful of candy corn, the saliva is overwhelmed by acid. Ultimately, exposure to that acid damages your teeth’s protective enamel and causes cavities. If you have cavities, you get fillings, which means drills, which nobody wants, and that brings us back to my son’s first visit to the dentist at age three.

So at his monumental first dental visit, my preschooler got to look around the dentists’ office, look at the big chair and the lights and the tray of shiny instruments. He giggled when the hygienist counted his teeth and talked to him about “tooth dirt” and showed him how to brush and floss waaaay back in the back of his little mouth. He was happy. I felt like an awesome, proactive mom.

When it was time to go, I was riding a happy wave of attentive motherhood, until the dentist said, “Okay buddy, you’ve done such a great job today that you get to pick two treats.”  Two treats?  This is amazing. Little guy is going to look forward to coming to the dentist, and we’re going to avoid hours of nasty arguments and complaining and tears. Huzzah.

“First, you have to tell me what flavor you like, raspberry or green apple?”  He walked us over to a countertop where there was a giant slushy machine, churning up great troughs of blue and green frothy syrup. My son’s eyes widened and he looked at me for permission. I laughed and said “Setting yourself up for repeat business, eh?  Quite a deal.”   Then a rather obnoxiously  large serving of frozen blue goodness was passed down to my son’s eager hands, who received the treasure as though it were, well, actual treasure.

The dentist was a good sport and he laughed, then he reached behind a counter and pulled out a giant white plastic tub with a smiling tooth outlined on the front. He plunked the plasticware down on the countertop with a huge thunk. The tub was filled with packets of Trident gum in all flavors imaginable.

* Insert record scratch sound effect here.*

“Um, gum?  Am I in the right place?  Isn’t this a dentist’s office?”  I asked. I felt like looking around for the camera crew, because surely this was some kind of reality tv show or prank on unsuspecting overcautious mothers.

Thankfully, the dentist was a good-humored man and laughed with me. He explained that yes, he is actually handing out gum. He said that, especially for younger children, gum that contains xylitol is beneficial. It has been proven to prevent cavities in children by inhibiting the growth of bacteria – strep bacteria, in particular, are unable to metabolize xylitol.

In fact, the United States Army’s Public Health Command recommends that soldiers and their families chew xylitol-sweetened chewing gum.

So, it would appear that much in the world of tooth health has changed since I was a kid. I’m working hard to embrace the change, and as a result, I am now fully immersed in a bubble-blowing contest with my son. I can’t help but wonder, though, why – if sugar-free gum is good for us – gum is still banned in schools across the country. Even a few minutes chew-time after lunch would probably help kids who don’t get regular dental care. As long as the kids and teachers follow the “he who sticks it, picks it” rule, the desk and carpet scraping could be minimal.

Were you aware of the Army’s gum-chewing recommendation? Are there other health-related tips you’ve received in the military that you’d like to share? Comment below!

DoD Putting Off Announcement of TRICARE Cuts until After the Election

Posted by Jason Van Steenwyk

TRICARE Prime cutsMilitary Times is reporting that an unnamed source has said that the Department of Defense is deliberately delaying announcing broad cuts in TRICARE Prime benefits for some military members, retirees and their families until after “a certain date in November.”

The Presidential elections, with a lot of down-ticket races at stake as well, are scheduled for Tuesday, November 6th.

The planned changes would eliminate access to TRICARE Prime in five areas in the West and Midwest, including Iowa; Minnesota; Oregon; Reno, Nevada and Springfield, Missouri, effective April 1 of next year. As we reported last week, these changes have been contemplated by members of both parties since at least 2007, as a way to contain military health care costs. TRICARE Prime enrollees will have to enroll in TRICARE Standard, which provides less in the way of benefits.

The changes will affect perhaps as many as 170,000 participants, who would have to switch to Prime or drive farther to see a doctor.

The Administration is locked in a fierce battle to win the 2012 presidential contest – and health care and the economy are major issues.

At least one Congressman, Representative Greg Walden (R-OR) wants to know why the Pentagon is delaying the formal announcement.

The delay comes on the heels of another parallel controversy: The Obama Administration pressured the defense industry to delay issuing layoff notices legally required under the Worker Adjustment and Retraining Notice Act (the “WARN Act”),  until after the election – a move that Senator Lindsey Graham argues is “patently illegal.”

Senator Dean Heller (R-NV) has also written to TRICARE’s chief doctor, asking for clarification – and pushing for a formal announcement of any cuts prior to the election.

At issue: A contract change between two providers. While the Pentagon is not confirming anything at this time, the incoming contractor for the TRICARE West region, United Healthcare, does not plan on providing TRICARE Prime services beyond 40 miles from major treatment facilities. This could cause around 30,000 plan participants to lose their access to the Prime plan, requiring them to pay more out of pocket.

TRICARE Prime Enrollment Fees Going Up In October

Posted by Jason Van Steenwyk

increasing costsBrace yourselves: If you’re a military retiree or retiree dependent/family member, your TRICARE enrollment fee will be going up, effective tomorrow, October 1. The amount of the hike depends on when you enrolled. The new fee will be $269.28 per year for individual enrollees, and $538.56 per year for families. For those of you who were enrolled prior to October 1st of 2011, your 2011 fees were $230 and $460, respectively.

If you enrolled after that date, your current fee is slightly larger than those who enrolled prior to October 1, 2011.

Even so, TRICARE rates are bargain-basement, compared to private sector plans offering benefits anywhere near comparable – even where civilian employers are paying half your premium. On a monthly basis, TRICARE Prime costs $22.44 per month for individuals, and precisely twice that for families.

Exception: If you are a survivor of a deceased servicemember, or if you have been medically retired, your fees will not be going up. You are exempted from fee hikes, as long as you are continuously enrolled in TRICARE Prime.