Tagged: VA healthcare

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.

       

Shinseki: “I have work to do”

Posted by Debi Teter
Shinseki-asked-to-resign_militaryauthority.comIn an interview with The Wall Street Journal Tuesday, Eric Shinseki, the head of the Department of Veterans Affairs, said “I serve at the pleasure of the president. I signed on to make some changes, I have work to do.” Several veterans groups and some members of Congress have called for Shinseki’s resignation after allegations of misconduct at several VA hospitals have surfaced, including the use of a secret wait list used at the Phoenix VA created to cover up delays in appointment times for veterans seeking medical care. Shinseki admitted he has work to do to rebuild the confidence of veterans, but also tried to highlight what he said were positive changes he has made while heading the department. The VA, the VA’s inspector general and the House Committee on Veterans Affairs are conducting reviews of the Phoenix VA. “As a result of what’s under way in Phoenix, I’m very sensitive to the allegations,” Shinseki told the Journal. “I need to let the independent IG complete his investigation.” There are allegations of mismanagement at other VA facilities including Pittsburg; Memphis; Atlanta; Columbia, SC; Augusta, GA; and Fort Collins, CO. Meanwhile, the House Veterans’ Affairs Committee today issued a subpoena over the scandal in Phoenix. #VAscandal #Shinseki  

What is Co-Managed Care for Veterans?

Posted by Debi Teter
militaryauthority.com co managed care for veteransIf you are a veteran who is receiving care from both a VA provider and a private community provider it is important for your health and safety that your care from both your providers be coordinated, resulting in one treatment plan. This means your VA and private community providers communicate about your health status, medications, treatments, and diagnostic tests. In order for your VA provider and your private community provider to communicate about your care, your VA provider will need copies of the following information from your private community provider’s office.The name, address and phone number of your community provider


  • Prescription(s)
  • Office visit notes supporting the prescription(s)
  • Blood work results
  • Other test results supporting the prescription(s)
You will also need to provide information on any insurance coverage you may have. You may either bring these copies with you to your next scheduled VA medical appointment or have your private community provider fax this information to your VA provider. In the course of your care, you may have recommendations for medications, treatments, and diagnostic tests from your private community provider that you wish to have accomplished through VA. It is the responsibility of your VA provider to use their own clinical judgment to decide what medical treatment and tests are appropriate, effective, and necessary. Only then are medications, tests and treatments ordered by your VA provider. VA medications are listed on the VA Drug List (Formulary), which covers a broad range of generic and brand name medications. VA providers will choose the appropriate medication for you; however, it may not necessarily be a brand name drug. If VA medications require periodic blood work (monitoring), this will need to be done at a VA facility.   #VAhealthcare #VeteransHealth

Pentagon budgets for 2015; Congress debates changes to 2014 COLA

Posted by Debi Teter

militaryauthority.com federal budget breakdown“The President’s 2015 Budget will be released on March 4. Now that Congress has finished its work on this year’s appropriations, the Administration is able to finalize next year’s Budget. We are moving to complete the Budget as quickly as possible to help Congress return to regular order in the annual budget process,” Steve Posner, a spokesman for the White House’s Office of Management and Budget said in an email last week.

The Defense Department, which receives the most funding of any federal agency, plans to spend about $606 billion in fiscal 2014 and is also expected to release its budget request for fiscal 2015 on March 4.

We would be very surprised, though, if the 2015 budget becomes a settled matter so many months before it goes into effect. After all, the 2014 budget is still being “tweaked” by Congress to fix issues pertaining to COLA and veterans’ health benefits even though it was passed without the usual drama we’re accustomed to seeing in Washington.

The cap on COLA for working-age military retirees was just enacted by Congress last month in an effort to save $6 billion over the next 10 years as part of the bipartisan budget deal. But after military organizations decried the move as yet another broken promise to service members, Congress seems desperate to undo the cap before it becomes a larger political issue.

Senator Bernie Sanders (I-Vt), chairman of the Senate Veterans Affairs Committee, has introduced a mammoth 400+ page bill called the “Comprehensive Veterans Health and Benefits and Military Retirement Pay Restoration Act of 2014? which ties the COLA cap to an overhaul of other veterans benefits. Majority Leader Harry Reid (D-Nev) backs the bill, which seeks to strengthen more than 130 veterans programs of every kind.

The bill won’t sail through Congress as easily as the budget did, however. Senator Tom Coburn (R-Okla) blocked a similar, but smaller, bill last month because the spending wasn’t paid for by other offsets. Coburn argued that the VA has increased spending 58% in the last five years while showing that it can’t effectively administer the benefits it already provides, so adding new health and education benefits cannot be justified.

 

#VeteransBenefits #2014COLA #2015Budget

Image source: omnilligence.net


VA Proposes Change in Appeals Process

Posted by Jason Van Steenwyk

militaryauthority.com US Dept of Veterans AffairsThe Department of Veterans Affairs is proposing a change in the way it handles appeals, according to a recent entry in the Federal Register. According to the VA’s proposal, “there are two major components of these proposed changes. The first is to require all claims to be filed on standard forms prescribed by the Secretary, regardless of the type of claim or posture in which the claim arises. The second is to provide that VA would accept an expression of dissatisfaction or disagreement with an adjudicative determination by the agency of original jurisdiction (AOJ) as a Notice of Disagreement (NOD) only if it is submitted on a standardized form provided by VA for the purpose of appealing the decision, in cases where such a form is provided. The purpose of these amendments is to improve the quality and timeliness of the processing of veterans’ claims for benefits.”

The public has 60 days to comment on the change before it becomes official. VA executives can then enact the new policies as written, make changes based on the public’s input as well as their own judgment, or scrap the plan altogether. You can read the full proposal and comment on it by clicking on the link above.

 

Will you comment on the proposed changes? Let us know what you say to the VA in the comments below.

Fun Friday: Party Rock! The Government is Open.

Posted by Debi Teter

Commisaries are open again. The VA is offering services to veterans. Tuition Assistance payments are going out. It’s time to have a dancy party.

 

Hopefully that made you smile. Enjoy your weekend and relax knowing we have three months before we go through this stress again.

VA Secretary: Benefits to Cease November 1 If Shutdown Not Resolved

Posted by Jason Van Steenwyk

militaryauthority.com shinseki VA shutdown November  1 testimonyVA benefits will cease as of November 1st, unless the President and Congress agree to fund the agency, or the government shutdown is resolved. That was the testimony on Wednesday, October 9th, from Secretary of Veterans Affairs Eric K. Shinseki to the House Committee on Veterans Affairs. 

According to Secretary Shinseki, the Department of Veterans Affairs is due to pay out $6.25 billion in claims on November 1. But the Department has only $2 billion on hand to pay them with. The money would be used to pay tuition for GI Bill beneficiaries and for retroactive claims. Stipends of up to $1,700 per month for veterans attending school would cease. Claims processing for compensation, pension, education, vocational rehabilitation, and employment benefits will be suspended due to lack of funding. Once mandatory funds are depleted at the end of this month, nearly 5,600 Veterans a day will not receive a decision on their disability claims.

This is despite furloughing some 7,800 claims processors – an act that is already beginning to result in an increase in the stubborn backlog of past-due (more than 125 days old) claims. Half of those furloughed are veterans themselves, said Shinseki. 

Additionally, if the shutdown continues through late October, compensation payments to more than 3.8 million Veterans will halt. These include thousands of Veterans who have the most severe disabilities. Payments will also stop for over 364,000 survivors and over 1,200 children receiving special benefits, such as children with spina bifida born to Vietnam Veterans and certain Korean War Veterans as well as children of women Veterans with birth defects, the Secretary said. Furthermore, pension payments will stop for almost 315,000 Veterans and over 202,000 surviving spouses and dependents.

The Secretary also said that while they still had 13,000 claims processors on the job, paid with left-over funds from FY 2013, that money would be exhausted by the end of the month. At that point, the Department of Veterans Affairs would have to lay off all but 1,500 employees. The remaining workers would be assigned to staff call centers and receive and time-stamp new benefits applications. But no more applications will be processed until the Department is funded again. 

The House of Representatives has already passed a bill that would provide for partial funding of the Department of Veterans Affairs. However, Senate Majority Leader Harry Reid (D – Nevada) has indicated that his coalition will not allow the bill to come up for a vote. The President has also said that he would veto the bill if it came to his desk. 

According to Shinseki’s testimony, however, full services to veterans would not restore completely even if the Department itself is fully funded. This is because the Department’s functions integrate with other federal departments that are themselves affected by the shutdown. 

Shinseki’s full testimony is available here.


Report: VA Patients 33 Percent More Likely to Die of Overmedication

Posted by Jason Van Steenwyk

militaryauthority.com VA patients more like to overdosePatients at Veterans Affairs hospitals and clinics are 33 percent more likely to die from accidental overdoses of medications than the general population, CBS News has found.

The report focused on the case of a 35-year old Army veteran, Scott MacDonald, who was proscribed a cocktail of seven different medications for pain and psychiatric conditions, including narcotics like Percocet and Vicodin – both opiate derivatives.

According to CBS’s reporting, sources within the VA are saying that VA officials have been encouraging doctors to sign off on painkiller and other medications – including narcotics – on patients they don’t see. In the short run, the practice actually saves money, because patients with enough painkillers tend to make fewer appointments and consume fewer health care services.

In the long run, however, doctors signing off on these assembly line prescriptions are putting patients at risk of opiate or prescription medicine addiction and a host of negative side effects, including accidental fatal overdose. 

The CBS report builds on earlier reporting from a local NBC affiliate in Ohio, which found that the number of unintentional drug overdose deaths in Ohio tripled between 2001 and 2011. Furthermore, an earlier study published in the Journal of Psychiatry found that veterans had a significantly elevated risk of death due to accidental overdose compared to the general population nationwide.

In 2010, Dr. Pamela Gray, then a VA physician, became concerned because, as she states, VA officials were asking her and other doctors to sign off on continuing narcotics prescriptions on patients they had not even seen, much less evaluated. She took her concerns to Senator Jim Webb (D-VA), who in turn had the VA launch an investigation. Gray subsequently lost her job – she says because she blew the whistle, though the VA cites poor communications skills as the reason she no longer practices at the VA. However, according to reporting by the Virginian Pilot, the VA’s own internal investigation mostly cleared themselves of wrongdoing, though four of the fifteen physicians interviewed said they, too, had been asked to write prescriptions for patients they had not seen. The VA Inspector General’s office wrote that there was, indeed, a perception of pressure to write narcotics prescriptions and an expectation of retaliation against any doctor who failed to do so.

At the same time media reports are highlighting the possible overreliance on psychoactive medications such as anti-psychotics in more general settings. 

VA Backlog is 443 Days in Florida

Posted by Jason Van Steenwyk

VA backlogThe current average wait time for new Veterans Administration claims in Florida is 433 days.

That’s the latest, according to a report today from WFTV News, serving Central Florida from Orlando to Daytona Beach and Melbourne. The wait time for Florida veterans is therefore nearly twice the national average, which is 273 days.

That’s the result of a mounting backlog at the VA regional office for Florida. There is only one regional office in the entire state. VA officials state the backlog is due to the large concentration of veterans within the state of Florida. However, that’s hardly news – the VA has not mentioned why it wouldn’t staff the Florida office appropriately.

Since President Obama was inaugurated in 2009, the number of veterans waiting a year or more for their benefits has exploded from 11,000 to 245,000. That amounts to a more than 2,000 percent increase, according to reporting earlier this year from the Center for Investigative Reporting. The same organization also reports this week that with the 2012 election safely over, the VA has “backed off” its promise to reduce the claims backlog.

According to WFTV’s reporting, a VA official states that the Administration has decided to devote resources to creating a paperless system, rather than create more regional offices in Florida. 

Legionnaire’s Outbreak at Pittsburgh VA Hospital Kills 5; Director Awarded $63k Bonus

Posted by Jason Van Steenwyk

legionnaire’s diseaseWhat happens to Veterans Administration employees when they decide close the VA Special Pathogens Laboratory and sack two of the leading experts on legionnaire’s disease mitigation and eradication in 2006 when six years later there’s a legionnaire’s disease outbreak at the hospital they oversee that kills five people?

Well, apparently, in Shinseki’s world, they get a bonus. $62,895 bonus, to be exact. Michael Moreland received the bonus, along with a Distinguished Rank Award, given to just one percent of senior federal employees, in a black-tie banquet last week. 

On April 23rd, three days before Moreland received the bonus, the VA’s Inspector General published this report, which found that while there were some solid efforts underway to mitigate the spread of legionnaire’s bacteria in the hospital water supply (an ongoing challenge for any health care facility), the Pittsburgh VA had not followed through adequately on them.

The findings in the VA report are rather tame. But the VA IG doesn’t go into the backstory with the Special Pathogens lab, documented here.

In 2006, the efforts of Lab director Dr. Victor Yu, chief of Infectious Disease Prevention at the VA, and and Dr. Janet Stout, the director of at the Special Pathogens lab in pioneering legionnaire’s disease prevention techniques were lauded in the Pittsburgh press. Yu, Stout and the other clinical staff were getting noticed in the medical community nationwide for their work.

Nevertheless, just three days after the Pittsburgh Tribune Review published this laudatory article about the lifesaving contributions of the Special Pathogens Laboratory, VA officials in the Bush Administration abruptly shut down the Special Pathogen Laboratory for reasons that are still unclear. Five clinical staff were terminated immediately, while another, Dr. Janet Stout, was demoted to bench technician. The Lab’s director, Dr. Victor Yu, appealed to Michael Moreland’s office, but Moreland affirmed the decision to shutter the lab. 

“This absolutely will jeopardize lives,” Dr. Yu told press at the time. “Outbreaks will be missed; we can’t do testing for any more hospitals. We have been given 48 hours.”

According to correspondence from the last days of the Lab’s operation, Moreland was an obstacle to the orderly closing of the lab and the processing of remaining samples for legionnaire’s bacteria testing. Dr. Yu wrote at the time:

You promised the Special Pathogens Lab personnel 14 days to process clinical and lab specimens. While you have kept your promise, Moreland and the administration have initiated a series of actions that have proven extraordinarily disruptive.  They are now locked out of the lab. The security guard is stationed there today ostensibly to prevent the lab personnel from entering.

Yesterday, a security guard sabotaged Sue Meitzner’s cultures on patient respiratory samples by refusing her to complete her work. The fact that Mr Moreland and his staff walked through the lab before the guard appeared suggests that they ordered the security guard to force her out of the lab.

We insist that two patient specimens be re-processed since they have been ordered by VA physicians for their patients. Unfortunately we need the original sputum specimen and those two specimens were taken by Cheryl Wanzie. We also need the microscopes which were removed from the

lab without our permssion. In addition, there are at least 200 environmental samples that require processing. The samples are from Johns Hopkins University, NY Alice Hyde Hospital, Erie St Vincent Hospital, Bayview Medical Center, SUNY-Buffalo, Phoenix VAMC. These specimens must be performed for humanitarian reasons.

I will not accept the suggestion that these specimens be processed in the clinical microbiology lab. No more disruptions. Let them finish their job in the lab that they have worked in for 10 years.

Finally, let us both agree to assist the laboratory personnel so they can conclude their work. Bureaucratic politics is taking too much of their time and yours. 

Dr. Stout likewise documented several instances of Moreland’s employees interfering with her work, “bordering on harassment.”

On Wednesday and Thursday, at least 14 different individuals paraded unannounced through the lab performing walk-throughs. This included a 5 member labor crew who removed clinical specimens,microscopes, all of the diagnostic test kits, and supplies during while the lab personnel were trying to conclude their work. When Dr Melhelm came, she was accompanied by 2 security guards.

On July 12, 2006, Dr. Yu, still smarting from the closure (he uses the term “destruction”) of the Special Pathogens Laboratory, Dr. Yu requested to be allowed to interview applicants for the Clinical Microbiology Lab directorship position. Moreland and his staff refused the request. When they hired someone who had not been active in the field for many years, Dr. Yu emailed Both Michael Moreland and Dr. Rajiv Jain:

Dear Dr Jain and Mr Moreland

Given our record of clinical excellence, it seemed reasonable for me to interview the new supervisor of the Clinical Microbiology Lab.  However, this reasonable request was denied, and an unqualified individual was hired.?? 

It took over 20 years to raise the VA Special Pathogens Lab to a lab of excellence that was self-sufficient and internationally-recognized.  Similarly, we elevated the VA Clinical Microbiology Lab to be the most responsive lab to clinicians at this hospital. However, the lab also became a lab of excellence as documented below.??

In a period of 2 weeks, both of you took part in the destruction of 2 great labs in the US because of a presumed bureaucratic issue.?? 

In sadness,

Victor L Yu MD 

In early 2007, Yu continued to press the VA over the destruction of numerous samples and cultures that were vital to continued research.

The closure led to Congressional hearings in 2008, however.

Melhem insisted repeatedly that she did not know the thousands of vials — each marked with letters and numbers and placed in racks — were being used for research when she ordered staff to toss them…

Michael Moreland, who headed the VA Pittsburgh Healthcare System at the time, said he was unaware of the collection’s significance. 

Although the VA Inspector General’s report does not directly reference the closure of the Special Pathogen Laboratory in 2006, and only mentions Moreland once, they do cite Yu and Stout’s research in legionnaire’s disease pathogen control within the report’s footnotes.

Meanwhile, in addition to the finding published last week, the Veterans Affairs Inspector General’s office is conducting a criminal probe into the way senior VA managers in Pittsburgh handled the legionnaire’s outbreak. The U.S. Attorney’s office is also conducting its own criminal investigation, according to reporting from the Pittsburgh Tribune. According to reporting from the Pittsburgh Post-Gazette, “The Pittsburgh VA first publicly revealed it had an outbreak on Nov. 16, 2012, even though officials, including Mr. Moreland, knew they had a serious problem as early as July 2011.”

Nevertheless, none of the information from the VA Inspector General’ report, nor the background story involving the dismantling of the VA Special Pathogens Laboratory, nor the congressional hearings establishing the reckless disregard for clinical procedure under Moreland’s direction, nor even the fact that Moreland’s operation is under two separate ongoing criminal probes from the VA’s own IG and by the local U.S. Attorney, was enough to slow-track Moreland’s bonus, equal to 35 percent of his $179,000+ annual salary 

Note: the occasional typographical error in quoted correspondence was intentionally retained for accuracy’s sake.