|
The greatest risk is among males with bipolar
disorder and females with substance abuse disorders, according to the
researchers at the U.S. Department of Veterans Affairs and Healthcare
System and the University of Michigan. Overall, bipolar disorder (the least common
diagnosis at 9 percent) was more strongly associated with suicide than
any other psychiatric condition. The researchers examined the psychiatric records of
more than three million veterans who received any type of care at a VA
facility in 1999 and were still alive at the beginning of 2000. The
patients were tracked for the next seven years. During that time, 7,684 of the veterans committed
suicide. Slightly half of them had at least one psychiatric diagnosis.
All of the psychiatric conditions included in the study -- depression,
schizophrenia, bipolar disorder, substance abuse disorders,
post-traumatic stress syndrome (PTSD) and other anxiety disorders --
were associated with increased risk of suicide. "In men, the risk of suicide was greatest for those
with bipolar disorder, followed by depression, substance abuse
disorders, schizophrenia, other anxiety disorders and PTSD," the
researchers wrote. "In women, the greatest risk of suicide was found
in those with substance abuse disorders, followed by bipolar disorder,
schizophrenia, depression, PTSD and other anxiety disorders." Since bipolar illness was most likely to be
associated with suicide, "this makes bipolar disorder particularly
appropriate for targeted intervention efforts or attempts to improve
medication adherence," the researchers wrote. The study found that many veterans with psychiatric
conditions weren't identified by the VA health system. "This could be owing to stigma, which may have made
individuals less likely to report their mental health symptoms to
physicians, an effect that could be more pronounced among men with
military experience," the researchers wrote. "These findings highlight
the importance of improved identification, diagnosis and treatment of
psychiatric diagnoses (particularly bipolar disorder, depression,
substance use disorders and schizophrenia) of all health care system
users." The study appears in the November issue of the
journal Archives of General Psychiatry. The U.S. Department of Veterans Affairs has more
about veterans' mental health. -- Robert Preidt SOURCE: JAMA/Archives journals,
news release, Nov. 1, 2010 Hope for the Journey - Diabetes Research at VA VA
researchers are seeking better ways to prevent and treat diabetes,
especially in special populations including the elderly, minorities,
those with amputations or spinal cord injuries, and those with
kidney or heart disease. Diabetes is a
serious chronic disease in which the body cannot produce or properly
use insulin. The disease affects about 16 million Americans,
including more than 800,000 Veterans receiving care from VA. Much of VA’s
research focuses on controlling the risk of cardiovascular disease
in patients with type 2 diabetes, which is by far the most common
type. For example, researchers at the Atlanta VA Medical Center are
working to stave off progression of the condition before it reaches
a full-blown stage. “I think (this project has) extended my life,”
says Veteran Roger Parton, a participant in this research study.
In another
important area of diabetes-related study—vision health—VA and its
research partners have demonstrated that Veterans could be
accurately tested for an eye disease called diabetic retinopathy
using a method not requiring eye dilation. This new efficient and
accurate eye test is helping reduce the risk of blindness in
Veterans with diabetes throughout VA’s health care system, and the
program is now being expanded to evaluate some other important
causes of vision loss. In yet
another study that changed the face of diabetes care, researchers at
the Miami VA Medical Center looked at whether glucose control
affected the rate of cardiovascular disease in those with the
disease. This seven-year trial found little reduction in the risk of
stroke, heart attack, and other cardiovascular complications,
compared with standard treatment. In light of the results of this
study and others, major health organizations such as the American
Diabetes Association issued new treatment guidance for doctors and
patients. Additional
recent advances in VA diabetes research include:
·
Promising studies
on the connection between insulin resistance—the hallmark of type 2
diabetes—and Alzheimer's disease.
·
A determination
that, in some people, chromosome 12p is a likely site of genes
associated with high triglycerides (a condition closely linked to
diabetes, as well as obesity and heart disease).
·
Studies finding
that walking on a treadmill can prevent and even reverse diabetes in
chronic stroke patients. “This kind of
diabetes research is advancing the type of care we’re able to give
Veterans,” notes Jennifer Marks, MD, chief of endocrinology at the
Miami VA Medical Center and the VA Diabetes Trial’s principal
investigator. “The care we provide gets better because of research.”
For additional information on diabetes for Veterans, their families,
and providers, go to
www1.va.gov/diabetes. For more information on how VA research is
improving Veterans’ lives, go to
www.research.va.gov.
Media
Contact:
Katie Roberts
Press Secretary
VA Office if Public and
Intergovernmental Affairs
(202) 461-4982 WOODLAND HILLS, Calif.,
Nov. 2, 2010 /PRNewswire/ -- The
nation pauses to honor its veterans on
November 11 for their patriotism, love of country, and
willingness to serve and sacrifice for the common good. Naturally,
we want our veterans to be taken care of, especially when it comes
to their health. Those who have served their country through
the United States military have
several options when it comes to their health care coverage. Qualifying veterans receive care at VA facilities.
Additionally, those 65 years old and older – and those with
certain disabilities – may qualify for Medicare. "Many veterans
don't know about their Medicare rights," said
Krista Bowers, president of senior
business at Anthem Blue Cross. "Most have earned access to the
Medicare system, just as they've earned their VA benefits. They
shouldn't lose the opportunity, especially since some of these
benefits may be offered at low or no cost. VA and Medicare offer
different, yet valuable, benefits to veterans." Through the VA, eligible veterans have access to a full range
of preventive outpatient and inpatient services as long as they
stay within the VA health care system, which includes hospitals,
clinics, nursing homes, pharmacies and doctors nationwide. VA
co-payments and deductibles, including the costs of prescription
drugs, are generally less than Medicare. Eligibility for benefits
is based on a priority system. According to the United States
Department of Veterans Affairs website, there are more than 8
million people covered by the VA Health Care System. Medicare has four parts – A, B, C and D. Part A covers
inpatient services, including hospital, skilled nursing facility,
home health and hospice care. Part B covers outpatient medical
services, such as doctor visits, preventive care and durable
medical equipment. Part C, also known as Medicare Advantage (MA),
combines Parts A and B into one plan that is run by private
insurance company, like Anthem Blue Cross, rather than the
government. These plans may also include Part D, which is drug
coverage. Most people, including veterans, don't pay a premium for Part
A. In most cases, these costs have been covered by payroll taxes.
In contrast, Part B generally requires a monthly payment. Some
companies offer Medicare Advantage plans (Part C) that cover
everything included in Parts A and B, and more, including
preventative services, at no additional cost. These are known as
"zero premium plans." Some of these plans could also include
dental, vision and hearing coverage. Other plans provide the same
services, but require a monthly premium. Enrollment processes and eligibility differ for VA and
Medicare. Veterans can choose to participate in one program or the
other or both. Enrollment in a Medicare plan does not affect an
individual's VA eligibility. On its website the VA recommends veterans not decline Medicare
based solely on their VA coverage. The VA says there is no
guarantee funds will continue to be appropriated for medical care
for all enrollment priority groups. This could leave some
veterans, especially those enrolled in one of the lower priority
groups, with no access to care. For this reason, having a
secondary source of coverage, like Medicare, may be in a veteran's
best interest, the VA says. Additionally, people who decline Medicare Part B when they are
first eligible to receive it face substantial financial penalties
if they decide to enroll later. The initial enrollment period
typically occurs in the three months before the person's 65th
birthday, their birthday month and the three subsequent months.
There is no similar penalty for veterans who delay Part D
enrollment because the VA's drug coverage is deemed equal to or
better than Medicare. Other benefits of Medicare for veterans include having access
to doctors, hospitals and pharmacies outside the VA network and
potentially having a larger list of covered drugs. Wider access
could be important in case of an emergency or if a veteran needs a
second opinion or specialized care. There are additional benefits to having a Medicare Advantage
plan. They vary by insurer, but may include some or all of the
following: It's important to remember that Medicare cannot generally pay
for the same service paid for by the Department of Veterans
Affairs (VA). Nor can the VA generally pay for the same service
paid for by Medicare "Obviously, this can get very complicated," said Bowers. "There
are many things for veterans to consider when selecting health
care, including premiums, copayments and access. At Anthem Blue
Cross we provide health benefits to many veterans and are happy to
answer their questions to help them understand their options.
After all, they deserve the absolute best health care coverage
they can get." For more information about veterans and Medicare, visit the
Department of Veterans Affairs Web site at
http://www4.va.gov/healtheligibility/ and click on "Medicare
Information for Veterans." About Anthem Blue Cross Anthem Blue Cross is the trade name of Blue Cross of
California. Anthem Blue Cross
and Anthem Blue Cross Life and Health Insurance Company are
independent licensees of the Blue Cross Association. ® ANTHEM is a
registered trademark of Anthem Insurance Companies, Inc. The Blue
Cross names and symbols are registered marks of the Blue Cross
Association. SOURCE Anthem Blue Cross
Dabigatran More Cost Effective Than Warfarin In Stroke Prevention -
New Study A recent study conducted by researchers at the Stanford
University School of Medicine and the Veterans Affairs Palo Alto
Health Care System indicates that Dabigatran, an anti-coagulant drug
which recently received approval from the U.S. Food and Drug
Administration (FDA) to be used as an alternative drug to warfarin
in the treatment of atrial fibrillation, may also provide patients
with a more cost-effective way of preventing strokes, as well as
offering better health outcomes, when compared to warfarin. Mintu Turakhia, MD, MAS, who is a Cardiac Electrophysiologist, an
Instructor of Medicine at the Stanford University School of
Medicine, a Veterans Affairs Investigator, as well as the senior
author of this research, issued the following comment about the
study: “Dabigatran is the first new drug in 20 years to be approved
for stroke prevention in atrial fibrillation, and we wanted to see
if it could be cost-effective even before it made its debut in the
United States. We now have sufficient efficacy and
cost-effectiveness data to help inform policy on this drug in the
United States.” Turakhia, who specializes in the treatment and research of atrial
fibrillation, also commented on the need for a more effective drug
for the treatment of atrial fibrillation: “Among my patients, I get
asked about alternatives to warfarin a dozen times a week. Many of
them are just unhappy with the need for regular, often lifelong
blood testing.” VA: Long Term Care Benefits Through Department of
Veterans Affairs A quick little history lesson for you: The veterans assistance program goes back to 1636 when Pilgrims of
Plymouth Colony fought with the Pequot Indians. The Pilgrims enacted a
law from English law that reads, “If any man shall be sent forth
as a soldier and shall return maimed, he shall be maintained
competently by the colony during his life.” In 1789 U. S.
congress passed as law that pensions were to be provided to disabled
veterans and their dependents and in 1811 the first domiciliary and
medical facility for veterans was completed. Since that time the Department of Veterans Affairs has opened a
multitude of care facilities nationwide. An article from the US
Department of Veterans Affairs website states: “VA’s health care system has grown from 54 hospitals in 1930 to 157
medical centers in 2005, with at least one in each state, Puerto Rico
and the District of Columbia . More than 5.3 million people received
care in VA health care facilities in 2005, a 29 percent increase over
the 4.1 million treated just four years earlier. The
National Care Planning Council has a piece on nursing homes
available to veterans: Veterans Nursing Homes are generally available to active duty
veterans but some states have beds for people who served with the
reserves or National Guard and the spouses of veterans. The majority
of these homes offer nursing care but some may offer assisted living
or domiciliary care. Generally there is no income or asset test. Most
veterans in most states would qualify. Many states have waiting lists
of weeks to months for available beds. Each facility has different
eligibility rules and there is an application process. You cannot
simply walk in the door and arrange for nursing care on the spot. You
must contact the veterans home you are interested in to find out the
availability of beds and the application process. There are other
veteran benefits which make money available that may be a better
solution to your care needs. In my experience in the in home care industry, I’ve noticed that
many seniors who are eligible for veteran’s benefits do not completely
understand exactly what they qualify for. As the benefits relate to
in home care, often times you must have served during a time of war to
qualify for an in home care benefit. The good news is if you find yourself needing to access an in home
care benefit, many professionals will know how to help you out. For
instance, a social worker, in home care provider, discharge planner,
or other senior provider can either educate you or find the right
resource for VA benefits. You can also find many answers to your
questions in the healthcare section of the VA website.
Senior Life Care Planning, LLC
A fact sheet issued by VA Health Care states that all veterans
stationed at Camp Lejeune from 1957-1987 should have been
contacted through a mail campaign initiated by the Department of
the Navy.
A fact sheet issued by VA Health Care states that all veterans
stationed at Camp Lejeune from 1957-1987 should have been
contacted through a mail campaign initiated by the Department of
the Navy.
Camp LeJeune’s water contamination stems from PCE exposure.
by
Frank Morris
November 7, 2010
Audio for this story from
Weekend Edition Sunday will be available at approx. 12:00
p.m. ET
The number of women serving in the military has mushroomed in
recent decades to more than 200,000 active duty, not counting
National Guard and reservists. This growing population faces
many of the same problems as men — but also health and mental
issues that are unique to female veterans.
In
a wide hallway at a junior college in Kansas City, Mo.,
veterans — many of them homeless — drift from table to table.
They're collecting everything from clothes and soap to legal
advice.
The recent event, hosted by the Women's Bureau of the Labor
Department, was designed specifically for female veterans.
Air National Guard Lt. Col. Connie Johnson-Cage smiles at the
sight of so many of them.
"What do we typically see on TV? We see men fighting in the
war. We see men veterans," Johnson-Cage says. "We never hear
about the women in the back supporting the men. Now that we
have women on the battlefield as well, we need to understand
that we are all inclusive, and we are all veterans."
When Johnson-Cage's mother served in Vietnam, women made up
about 3 percent of the military. Now women hold 15 percent of
active-duty roles, according to the Department of Veterans
Affairs.
But, the military, and the veterans system, was originally
built by and for men. That legacy frustrates Kim Rushing, a
20-year veteran of the Navy. From her wheelchair, she scoffs
at tables piled with olive drab long johns.
"All this stuff, is all men's stuff," she says. "I'm a woman
and I served my country, and that's what I get, is men's
stuff."
Gender-Specific Treatment
Veterans Affairs lags behind the surge of women joining the
military. Though, Patricia Hayes, the VA's national director
of women's health services, says it's come a long way in the
past couple of decades.
Eli Reichman
Even though she has served for a decade, Army Reserve Sgt.
Miesha Wooten-Carr says she didn't know the VA provides
comprehensive health care for women until last year.
"First of all, the woman might say that when she walked in she
felt like she was walking a gauntlet," Hayes says. "There'd be
a lot of men sitting in the waiting room. No images of women
veterans. And the clerk may have said, 'Gee, are you here for
your husband?'"
As
recently as three years ago, only about a third of VA
hospitals and clinics offered women's care. Hayes says that
soon all of them, more than 1,000 facilities, will provide
gender-specific treatment.
"So we're having this cultural change throughout the VA, which
is also based on meeting their medical and health needs," she
says.
Hayes says the VA is committed to getting the word out to
women like Army Reserve Sgt. Miesha Wooten-Carr.
In
her living room in Kansas City, Mo., Wooten-Carr is going over
spelling words with her lively 6-year-old daughter. Although,
Wooten-Carr has served for a decade, it was only on her way
home from Iraq last year, when she learned that the VA
provides comprehensive health care for women.
"Wow. Head to toe, really? As a woman, you're going to take
care of everything in this one clinic? Uh, yeah, I was so
amazed! And so far, the services have been really good," she
says.
1
In 5 Faces Sexual Assault
The VA is also addressing women's psychological trauma.
According to the agency, more than 1 in 5 military women
reports being raped or severely harassed in the service.
Eli Reichman
Army veteran Hannah Jones says she spiraled into drugs,
alcoholism and prostitution after being raped by a superior
officer. She was homeless for years before getting help
through the VA.
Army veteran Hannah Jones, 49, lives in a subsidized apartment
in Kansas City. There she recounts being raped by a superior
officer as a young recruit.
"If I tell anyone, he said, he'll know, and he will kill me,"
she says. "Every day, I saw him. Several times a day. I was so
scared. I was 19."
Jones she says never reported the incident. She spiraled into
drugs, alcoholism and prostitution. She was homeless for years
before getting counseling, full medical benefits, and even
housing, through the VA.
"I
just, I love the VA — all this help they've given me, I can't
help but love them," she says.
Jones says the range of mental and physical care the VA
provides keeps her off the streets.
And that could be true of many more women after her: The VA
expects the number of women seeking its services to double in
the next decade. VA Health System Shines in
Quality-of-Care Study
A
report in the November issue of the national publication Medical Care
finds that the Department of Veterans Affairs (VA) health system
generally outperforms the private sector in following recommended
processes for patient care.
K.
Shinseki. "The systems and quality-improvement measures VA actively
uses are second to none, and the results speak for themselves."
By Donna
Carbone, West Palm Beach Women's Issues Examiner
·
·
Earlier this year, I wrote a post entitled “The Military, Mental
Health and Suicide Statistics,” which detailed the horrifying fact
that 18 veterans kill themselves each day. Each day! If that is
true, the total per year is 6,570 men and women dying because
mental health care is failing them.
A 2008 study by the Rand Corporation estimated that more than
620,000 veterans who had served in the Middle East would need long
term care for traumatic brain injuries. According to that study,
one in five soldiers returning from the Middle East display
symptoms of PTSD, putting them at a higher risk for suicide. Now
consider that in 2008 over 22,000 veterans called a suicide hot
line begging for help.
A few months ago, I wrote a follow up post entitled,
“Incompatible: Military Macho and the Mind.” This was my attempt
to understand why death was more appealing than life to so many of
our brethren in uniform. Suicide is often described as a permanent
solution to a temporary problem, but that philosophy fails to take
into consideration that “temporary” can be an endless time frame.
Soldiers are expected to be brave in the face of all danger,
unwavering in their allegiance to their country; following orders
blindly even knowing that death will be their reward. Should they
not be able to perform to these standards, shame is their only
companion. Is it possible that the “shame” of not being able to
re-enter society and behave “normally” weighs so heavily on their
minds that eternal darkness is the only solution. Are we shaming
our soldiers to death?
It is now 2010 – nearly 2011 – and the Veterans’ Administration is
still at a loss for answers.
As if the deficiencies in health care aren’t enough, statics for
veterans living on the streets are mind-boggling. The Department
of Veterans Affairs estimates that approximately 107,000 soldiers
are homeless. Last year, 92,000 veterans applied for help through
the VA’s specialized programs. Another 100,000 reached out to
churches and charities for food, shelter and clothing.
According to the National Coalition for Homeless Veterans, the
majority of “old soldiers” without a roof over their heads are men
(5% female). They are single and suffer from mental illness and
substance abuse. A staggering 50% served during the Vietnam War,
which ended in 1975. Am I to assume these wounded warriors have
been tucking themselves into cardboard boxes for 35 years?
By now you have realized that the recurring theme in all these
scenarios is mental illness. Obviously, post-traumatic stress
disorder and traumatic brain injuries are not a recent side effect
of battle. Veterans of yesteryear are homeless as a result of
these conditions. Today’s veterans choose suicide.
Why is it taking so long to find solutions to problems that that
began with the cavalry somewhere on the open plains of the wild,
wild west? Three years are all that was needed to develop the
hydrogen bomb. Can nuclear fission really been easier to
understand than the human mind?
Napoleon Bonaparte said, “Death is nothing, but to live defeated
and inglorious is to die daily.”
Let’s not let that sentiment be the thanks we give to our veterans
for their service to our country.
By D Ken Kizer is the miracle man of U.S.
health care. Mr. Kizer brought in bold reform that transformed
the vast and woeful Veterans Health Administration into an
efficient, effective model institution with sky-high patient
satisfaction. Starting in 1994, it took him five years to reduce
costs and increase quality of care, while nearly doubling the
number of patients. The measurable results included a
reduction in medication errors and patient deaths. “What's wrong with expecting the
government to do a good job?” he would ask those professing
amazement at the change. Key to the VHA's stunning improvement was
the implementation of easily accessible electronic health
records (EHRs). What's so great about electronic
health records? It allows you to have all the information
you need when you're actually face to face with the patient. It
allows you to track and monitor performance and what should be
done. Instead of sitting there and reciting a bunch of numbers
to a patient, you can show them a single coloured graph that
shows – for a diabetic, say – all their hemoglobin A1c readings
for the last three years. And so much more. It changes the
dialogue. It changes the way health care is provided.
What happened when you instituted
them at VHA? ... It would be less than honest to say
that it wasn't stressful and there wasn't some fallout. We lost
between five to 10 per cent of our physicians. Are there any downsides?
There are obviously risks of information
leakage, although there are technical ways to prevent that
happening. And you have to remember that EHR is just a tool. The
real way it improves care is by making you focus on improving
the process of care. If you automate a bunch of lousy processes,
then you just get automated lousy processes. How difficult was it to do this in
a country where many people believe health care should be left
to the private sector? People said there was no way it could
work, because it was government. But the number one lesson of
the VHA is that governments can provide efficient,
patient-centred, high-quality health care. Where is the United States at now
in terms of EHRs? There's a lot of activity and a lot of
money pouring in, but I'm not sure we're any better than you are
in Canada. You have headed a company that
promoted “open-source” software for EHR, instead of a pricier
proprietary system. Why do you think open source is better?
I believe the solution to health-care
information technology lies in the open-source world that
basically gives away the code. That is then adapted to local
circumstances. With the proprietary model, you are always going
back to the vendor for changes, and they decide whether to do
them and how much they will cost. In Europe, open source EHR
software is zooming. It's the most widely deployed EHR system in
the world, but not here. Why not? ... We have this very established and
influential, private software industry that has done a good job
of dissing the open-source system we put in at VHA. And people
don't understand the conceptual difference between the two
systems.
VA Study Finds Similar Results WASHINGTON (Nov. 4, 2010)-- Patients
taking warfarin, a widely used blood-thinning pill that requires
careful dose monitoring, have similar outcomes whether they come
to a clinic or use a self-testing device at home, according to a
recent Department of Veterans Affairs (VA) study. The findings, published in the Oct. 21
issue of the New England Journal of Medicine, are good news for
heart patients who live far from clinics or are homebound. "This study helps answer an important
question for cardiologists, primary care physicians and other
health providers, and will lead to improved care for their
patients," says VA Chief Research and Development Officer Joel
Kupersmith, MD, himself a cardiologist. "The results are
significant for a great number of Veterans currently receiving
care through VA." Traditionally, doctors, pharmacists and
nurses monitor patients who are taking warfarin, sold as
Coumadin, over several clinic visits. They test how fast the
blood clots and adjust the dose accordingly: Too low a dose will
not prevent dangerous blood clots and blood flow to the heart,
brain or other areas of the body could be inadvertently blocked.
Too high a dose could lead to dangerous internal bleeding. Patients have the option of tracking
their own blood response at home, using blood analyzers known as
international normalized ratio (INR) monitors. Patients do a
finger stick, apply a small amount of blood to a test strip and
feed the strip into the device. The procedure resembles the one
used by people with diabetes to check their blood sugar. Patients can then call in the results to
their provider and get advice on dose adjustments without coming
to the clinic. In some cases, they can even set the proper dose
of warfarin on their own. The authors of the VA study expected
home monitoring to work better than clinic monitoring, partly
because self-testing can be done at home more frequently-weekly,
compared with the typical monthly schedule of the best
clinic-based monitoring. As a result, off-target INR values can
be adjusted more regularly and more quickly. However, the VA study found little
difference between weekly self-testing and monthly testing by
clinic-based care teams in the measured outcomes, which are
strokes, major bleeding incidents and death. The study did find, though, that
self-testing at home may offer advantages in other areas: It
moderately boosted patients' satisfaction with the medication
and slightly increased the length of time they were in the
appropriate dose range. Study co-leaders were Dr. David Matchar,
M.D., an internist with the Durham, N.C., VA Medical Center,
Duke University School of Medicine and Duke-NUS Graduate Medical
School, and Dr. Alan Jacobson, M.D., a cardiologist and
researcher with VA and Loma Linda, Calif., University School of
Medicine. They said the main message of the study is that
patients who are systematically monitored-no matter by what
means-are likely to have good outcomes. The study was sponsored by VA's
Cooperative Studies Program, part of the VA Office of Research
and Development. TRICARE to Beneficiaries: Use Mail
Order
-------------------------------------------- TRICARE, the managed health-care
plan for members of the armed forces, says it could greatly
curtail expenses if more beneficiaries used the mail-order
option when filling or refilling prescription medication.
Roughly 9.7 million beneficiaries have used mail order to
fill 10.5 million prescriptions last year – encouraging
numbers, particularly when compared to the 9 million
prescriptions filled similarly in 2008, according to TRICARE.
But the 9.7-million figure still represents only about eight
percent of all prescriptions filled in 2009. While most
beneficiaries fill their prescriptions at retail pharmacies,
that option remains the most expensive – for the agency as
well as patients themselves, according to TRICARE.
Prescription costs are lowest when beneficiaries pick their
prescriptions up at pharmacies located on military treatment
facilities. But often, distance and logistics can make that
impossible. In those cases, the agency says, mail order is
the best option, with patients paying a third of the price
for their medications as they would at civilian pharmacies.
Veterans Warned of False Email ---------------------------------- Veterans who receive an e-mail
touting a piece of legislation that would double their
disability pay should not pay any attention to it,
advocates advise. The e-mail is wrong. The bill mentioned
in the e-mail – the Veterans' Compensation Cost-of-Living
Act of 2010, is real, the Fleet Reserve Association (FRA) notes. But the e-mail's
claim about the increase in the payable amount of
disability compensation from the Department of Veterans
Affairs (VA) is not. Rather, as always, any cost-of-living
adjustments (COLAs) for disabled veterans,
retired military members, or Social Security recipients
will be pegged to the Consumer Price Index (CPI), a
calculation of out-of-pocket expenses produced by the U.S.
Labor Department's Bureau of Labor Statistics. The
Veterans' Benefits Act of 2010 (H.R. 3219), which has
cleared Congress and awaits President Obama's signature,
does include some increased allowances and improved
benefits, FRA says.
Veterans Day, held every November 11 in the United States, honors
veterans past and present through events and remembrance across the
nation. Raising
mesothelioma
awareness is important on Veterans Day since so many veterans were
exposed to asbestos during service and subsequently developed
mesothelioma cancer. The association between
veterans and mesothelioma traces back to exposure that occurred
during service. According to the United States Department of Veterans
Affairs, thousands of military veterans have suffered from the
asbestos-related illness mesothelioma. Many veterans from each
division were exposed to the fibrous mineral asbestos during service,
and on naval vessels where it was used as the main form of
insulation. All divisions of U.S. Armed Forces used asbestos, but the Navy
found more uses than other sectors. More than 300 asbestos-containing
products
were used through the 1970s, where it appeared on most ships used by
the Navy and in the shipyards where vessels were built. The Navy issued a ban on asbestos-contaminated materials on new
ships in 1973, but then violated its own ban for the next five years.
In 1983, the Navy Asbestos Control Program was created to help
facilitate compliance with asbestos-related regulations set by the
U.S. Department of Labor’s Occupational Safety and Health
Administration. Despite these actions, many veterans continued to be
exposed to high levels of asbestos even after the Navy began to
replace contaminated ships. Asbestos, a toxic mineral, was commonly used as insulation in
piping, boilers, sleeping quarters and navigation halls aboard
vessels. The mineral’s innate resistance to fire and highly durable
qualities made it an ideal choice for use in all sectors of the
military, where it was also used for aircraft, vehicles and buildings. Mesothelioma typically develops decades after moderate to heavy
exposure to asbestos. When toxic asbestos fibers are inhaled, they may
become lodged in organs or body cavities, causing inflammation or
infection. Approximately 2,000 to 3,000 new mesothelioma cases are
reported every year in the United States. Military veterans who suffer
from mesothelioma may apply for Veteran Affairs (VA) benefits. Today’s annual National Veterans Day Ceremony will be held at
Arlington National Cemetery in Arlington, Va., commencing with a
wreath laying at the Tomb of Unknowns, the day’s events include a
concert,
parade and remarks from dignitaries. Additional information on
mesothelioma and
asbestos exposure among veterans may be found through the Mesothelioma
Center.
Marcia G. Yerman at the
Huffington Post It is a given that before a person is equipped to be part of a
military fighting machine, he or she must be trained — physically
and mentally. What is not explicit is that upon a return to civilian
life, there is no preparation for reentry into the previous rhythm
of life. Hopefully, with voices demanding to be heard, the public,
lawmakers, and other agencies will listen to the urgent calls to
action that must be heeded. The current situation for veterans is not new, just different.
This Veterans Day, HBO is debuting a documentary entitled
Wartorn:
1861-2010. Through interviews, personal letters and
journals of soldiers, photos and archival footage, the 68-minute
film traces post-traumatic stress disorder (PTSD) back to the Civil
War. At that time, survivors were labeled as hysterical,
melancholic, or insane. In fact, it is noted that “after the Civil
War, over half of the patients in mental institutions were
veterans.” In World War I, the condition was referenced as
“shell-shock.” During World War II, the term “combat fatigue” was
euphemistically employed. (Included in Wartorn is a scene
with a group of World War II vets sharing their stories for the
first time. One man explains, “I had no one to turn to. No one
understood.” Another reveals, “You’re just not coming home the same
guy you left.”) We now have the terminology and psychological insights to
recognize the problem. But are we doing any better? When
interviewed, General Peter Chiarelli, the Vice Chief of Staff of the
U.S. Army who is working to stem the rising tide of suicides states,
“You’re fighting a culture that doesn’t believe that injuries you
can’t see can be as serious as injuries you can see.” In reality,
Chiarellli points out, “these are hidden wounds as serious as losing
an arm or a leg.” He adds, “We’ve got to get them off the
battlefield.” Suicides among veterans expanded by 26 percent from 2005 to 2007.
That doesn’t include the veteran deaths that were the result of
high-risk behavior. More than 1,000 vets in California under the age
of 35 died after returning home from Iraq and Afghanistan between
2005-2008. Author and journalist,
Aaron Glantz, succinctly
outlined this problem in his article, “After
Service, Veterans Deaths Surge.” He wrote that the “figure is
three times higher than the number of California service members who
were killed in the Iraq and Afghanistan conflicts over the same
period.” He drilled down on the lack of response from the government
when he appeared on the “War
and Peace Report” hosted by Amy Goodman of Democracy Now. What’s actually being done in a nuts and bolts way to support
veterans? I checked in with
America Works of New York,
which serves veterans by offering psychological and substance abuse
counseling, health insurance guidance, interview and resume
preparation, and ultimately job placement. America Works is a
for-profit company that is 100 percent performance based. The staff
saw an upsurge of veterans into their program approximately three
years ago. In 2008, they applied to the federally funded entity “Homeless
Veterans Reintegration Program,” and were contracted to place
160 homeless vets in jobs within a year. They reached their goal and
got a follow up three-year contract. The founders of America Works,
Dr. Lee Bowes and
Peter Cove, have taken their “work first” model, which
originated in 1984, and tailored it to the needs of soldiers
returning from Iraq and Afghanistan — at least one in 10 of whom are
unemployed. In the 18-24 demographic the stats drop to one in five
unemployed, as many enlistees join the service directly from high
school — and are looking for a civilian job for the first time. The facts put out by America Works explain that nationwide
approximately 154,000 veterans are homeless each night. Foreclosure
rates in military towns have been on the upswing of four times the
national average. In 2008, more than 1.3 million vets were living in
poverty. Almost one million were unemployed. More than a third of
incarcerated veterans have screened for PTSD. In the New York City
homeless vet population, approximately 85 percent is comprised of
those who served in Vietnam and Korea. Many vets move to New York,
looking for services and employment they couldn’t find at home. While I was at the offices of America Works, I had the
opportunity to dialogue with Retired Navy SEAL Captain
Pete Wikul, vice president of
America Works of Washington, D.C. Wikul served more than 39 years in
the U.S. Navy and was the “Bullfrog” — a title given to the longest
serving Navy SEAL on active duty. He shares the 1988 Nobel Peace
Prize with all the Peacekeeping Forces who served in Lebanon from
1948-1988. Outspoken, with lots of personality, Wikul was emphatic about the
need to heal suicidal vets. “That’s what I want,” he told me. His
figures related that 17 to 34 vets commit suicide daily. “It is
estimated by veteran suicide counselors that perhaps as many as
three times as many veterans have taken their own lives than the
number who died in the Vietnam War.” He said, “The first greatest
sin of this country was slavery. The second is how it treats its
military vets.” For Wikul, the problem lies with the individual’s separation from
the service. He penned an
op-ed with
Bob Kerrey outlining the need to prepare vets for rejoining
civilian life. Wikul had definitive opinions on the crisis. “The
nation is responsible,” he said. “I fault our political leaders.”
Referencing the lip service paid to the needs of veterans he
emphasized, “I want to see the line item in the budget. It’s the
lawmakers that hold the purse strings.” As a man used to
accomplishing his mission, his frustration was palpable. “We need
analysis, and then a cure for this social ill.” Wikul recommends the
America Works mantra of “work first and a rapid attachment to work”
as a great leveler, and the way for an individual to maintain
his/her self-esteem. Looking at the issues from another perspective is Ryan Berg, a
28-year-old, California-based vet, who spent seven years in the
Marine Corps. He joined up because he chose not to be in an academic
situation immediately after high school. He wanted to be a leader.
He currently attends UC Berkeley on the GI Bill, where he is
completing a four-year degree focusing on communications. He is the
founding editor at WhatFits.org, whose mission is
to “help build lasting veterans’ communities across the United
States.” In addition, they house a news and opinion blog dedicated
to the movement of building “real community” among the returning
veterans of Iraq and Afghanistan. Berg has become proactive in seeking to build a “community” of
veterans that is modeled on the support structure that was forged
during time of service. He described how during deployment, there
was a “life saving mechanism borne out of the group experience.” He
believes that this core essence needs to be translated into a new
language — to help vets adapt back into civilian life. “The
important thing to remember,” he said, “is that there is a specific
sensibility that needs to be connected between vets. We need support
from those who are like us, people who have come out of the same
experience. We’re learning what this new mission we are on is. We
need to feel as influential in civilian society as we did in the
military. We need the care of each other in order to start the new
mission. The mission of coming home is a task we aren’t used to.” For Berg, the most powerful prescription a veteran could receive
is that of “community.” He qualified it as follows: “It’s when we
have a group of people that hang out and speak to each other in a
different way, because of our lives. Whatever stage we are at in our
coming home process, life begins to matter more as we speak the same
language to others who are like us.” He continued, “It’s kind of
like a family. Thinking about what’s next. It’s about guys and girls
talking to each other. It’s the platoon mentality. It’s everyone
having each other’s back. Getting a veteran into a mental health
appointment is nearly impossible without the encouragement of
another vet.” The need to connect to others who understand a shared history was
repeatedly articulated in Wartorn. The common denominator
pointed to was the refrain “No one except a soldier can understand
what a soldier has to endure.” In 1946, William Wyler directed
The Best Years of Our
Lives, which won the Academy Award for that year’s top
picture. It told the story of three servicemen from the same small
town trying to pick up the threads of their previous lives. Samuel
Goldwyn decided to produce the film after he read an article about
the difficulties experienced by men returning from World War II. The
topics of familial disconnect, estrangement, and unemployment are
captured in the scene below when former Army Air Force Captain
Derry, who is afflicted with nightmares, wanders through an aircraft
boneyard. At the beginning of Wartorn, there is a visual quote by
Homer from The Odyssey. It reads, “Must you carry the
bloody horror of combat in your heart forever?” 1861, 1946, 2010. The time to do something is now.
By D
The Department of
Veterans Affairs has for years touted the achievements of its
health care system, but a new study shows that its health
outcomes are ... about like everybody else's.
The VA highlighted
the study, published in the journal Medical Care, saying in a
press release this week that "VA Health System Shines in
Quality-of-Care Study."
"This report is
strong evidence of the advancements VA continues to make in
improving health care over the past 15 years," VA Secretary Eric
Shinseki said in the release. "The systems and
quality-improvement measures VA actively uses are second to
none, and the results speak for themselves."
However, the study -
which synthesized the results of three dozen other studies that
compared VA health care to care provided by non-VA providers -
concluded that the VA performed well on many measures of medical
care, but also found that the VA had little impact on the key
question of whether the patient lived or died.
Moreover, most of the
research the study depended on to reach its conclusions dates to
when Bill Clinton was president. One source for the study is
dated 1991, when George H.W. Bush was in the White House.
The issue of how good
is VA care is a hot topic among veterans' advocates and
Congress. Some recent studies have been used to make the case
that VA care is not only pretty good, it's also among the best
in the country. That's a big turnaround from two decades ago,
when the VA was widely derided for poor quality. Since then, the
agency has transformed from a hospital-based system to an
integrated network of hospitals and clinics that is commended
for its emphasis on preventive care.
But the best care
anywhere?
What the latest study
shows is that the VA performs well on what are known as
"process" measures - whether a certain test was ordered, for
example. But studies that compare health outcomes - do patients
in the VA system do better or live longer? - are equivocal.
Of 12 studies that
compared mortality, for example, three showed a better outcome
for VA patients, two showed a better outcome for non-VA
patients, and seven showed no difference.
That's very different
from the process measures, which showed an overwhelming VA
advantage.
Researchers aren't
sure what causes that disconnect. If veterans are taking their
drugs and getting their tests done, the thinking goes, they
should be living longer. But for the most part, the data don't
show that.
"When it comes to
mortality, we found that the VA does no better and does no
worse," said study author Amal Trivedi, an investigator at a VA
medical center in Providence, R.I.
It would be helpful
to study other health outcomes - so-called "intermediate
outcomes" that detail health status short of death - but those
aren't often measured, Trivedi said.
There were some other
caveats to the study. One is what's known as a "publication
bias," since most of the studies researchers found were funded
by the VA. But researchers weren't sure why that would show a VA
advantage on process measure but not one on outcomes.
The lack of fresh
data was a central problem with the study, Trivedi said.
"We need more recent
data," Trivedi said. "There have been a number of efforts in the
private sector to improve care." But those efforts wouldn't have
shown up in this analysis.
Researchers initially
combed through 175 VA quality studies, excluding most for a
variety of design or other problems. They were left with 36.
Of those, about 60
percent included data gathered only during the Clinton
administration. One included data from 1991.
The freshest data
were five years old, collected from 2005.
Joseph Francis, the
VA health system's chief quality and performance officer, said
the relative age of the research "was kind of surprising to me."
Part of that has to
do with the length of time it takes to complete and publish
rigorous research. He also said the VA is working to complete
more studies on health outcomes, which will show how VA patients
fare compared with non-VA patients.
Other researchers
have found it difficult to compare VA care to non-VA care, in
part because so many veterans get care from different places.
The Congressional
Budget Office, for example, recently reported that 79 percent of
veterans in the VA system also had health coverage elsewhere,
typically Medicare but also private health plans.
"I think we do have a
challenge understanding the totality of care veterans receive -
and that includes care rendered outside the walls of our
system," Francis said.
In 2008, the VA
treated 5.5 million people in its system of about 150 hospitals,
900 outpatient clinics and other facilities. VA Launching New Personalized Veterans Health Benefits Handbook
Yale-Led Study to Examine Post-Combat Trauma Among Women Veterans
Related articles:
United States >
National News
NEW HAVEN, Conn.—A new nationwide study on the gender difference of
how female and male military combat
veterans
readjust to civilian life is underway. The study was made possible
by a $2.2 million grant from the U.S.
Department of Veterans Affairs
(VA) and represents one of the first empirical studies of its kind. National clinic to assist vets coping with
tinnitus BY PHILIP
HALDIMAN Nov 19, 2010
07:24AM PHOENIX, Ariz.
-- Tinnitus, commonly known as noise or ringing in the ears, is
a major health issue for soldiers returning from combat in
Afghanistan and Iraq, Veterans Administration hospital official
say. The condition
was the most-claimed service-connected disability for veterans
receiving compensation in fiscal year 2009-10, according to the
Veterans Affairs Health Care System. The disorder can
be the result of extreme noise exposure, such as that
experienced by combat veterans, and is associated with hearing
loss, also is a common complaint from veterans. Because of
increased patient demand, the audiology clinic at the Phoenix
veterans hospital extended its daily hours from five to six days
open each week. It also added staff. In January, the
hospital will launch a national tinnitus program called
Progressive Tinnitus Management to help veterans with the
disorder. Audiologists and
mental-health professionals will work together to help veterans
manage their reaction to tinnitus. The VA has been
developing the program for five years using research literature,
textbooks and clinical experience. Tinnitus happens
when hairs in the inner ear move in relation to entering sound
waves. Then an electrical signal is sent from the ear to the
brain. Dr. Cathy Kurth,
an audiology specialist at the Audiology and Hearing Aid Center
in Scottsdale, said the brain interprets these signals as sound.
If the hairs inside the inner ear are bent or broken, this could
cause tinnitus. It involves the sensation of hearing sound when
no external sound is present. Kurth said there
isn't an effective surgery for tinnitus, so management is the
best way to treat the condition. This can be done through aural
rehabilitation and hearing aids. Busting Myths About VA Health Care The following post was originally featured on
the VA’s
VAntage Point blog. Rumor mills are permanent fixtures in schools, offices
and wherever people congregate, and most of the time
they’re pretty innocuous. But myths and rumors that deal
with health–in this case Veterans health–are a serious
matter that can prevent qualified Vets from seeking the
care they both need and deserve. Many have come up in the
comments section, and others I hear from the guys in my
old unit. The myths won’t die unless they are addressed
publicly and clearly, so we present you with the most
common we hear, and the straightforward answers they
need. Myth Number One - I wasn’t injured
in the service, so I’m not eligible for VA health care. Status: False - Also, if new regulations are established regarding
health benefits, VA will automatically reassess your
case if it’s on file. Myth Number Two — I can only
receive care for service connected injuries. Status: False - A small number of Veterans, such as Filipino Vets and
bad conduct discharges, can only be treated for their
service connected disabilities and nothing else. If
one of those Vets is service connected for their left
foot, they can only use VA health care for their left foot
and nothing else. Myth Number Three — I make too much
money to qualify for VA health care. Status: It depends - Myth Number Four — I can’t use VA
health care if I have private health insurance. Status: False - “We strongly encourage Veterans to receive all your
health care through VA. However, if you choose to receive
treatment from private doctors, VA will work with them to
meet your health care needs and coordinate effective
treatment. We call this Co-managed Care or
Dual Care — which means that your VA and private
doctors will work together to provide safe, appropriate,
and ethical medical care.” Myth Number Five — If I’m 100
percent disabled, that means I’m permanently disabled Status: False - My hope is that this information sheds a little light
on the sometimes confusing realm of VA medical care.
These myths and answers are very general, but we hope to
receive more specific questions in the comment section.
We look forward to dispelling myths about other parts of
VA as well. Veterans: Traumas resurface at end-of-life
U.S. researchers have tailored a program to help
veterans whose traumas resurface at end-of-life.
Researchers led by Dr. Joshua Hauser of Northwestern
University Feinberg School of Medicine in Chicago and
Dr. Amos Bailey of the University of Alabama at
Birmingham have developed a program they say is tailored
to meet veterans' end-of-life needs.
"Many veterans, at the end of their lives, struggle with
issues related to a traumatic event they had during
their time in service," Bailey says in a statement.
"They may have had a physical or emotional disability
related to their time in service."
In addition to dealing with battle experiences, the new
program -- Education on Palliative and End-of-Life Care
for Veterans Project -- addresses sexual trauma and
substance abuse during service, as well as how the
particular war in which a veteran served affects both
emotional and physical care, and other issues.
"Because these war memories come up more frequently near
the end of life, palliative care providers need to be
alert for these issues," Hauser says. "We want to show
healthcare professionals how someone's individual war
memories come up and how those can be talked about."
The program, which began in October, is scheduled to be
introduced in 170 Veterans Administration Medical
Centers around the country during the next 12 months.
Physician assistants working in the Department of Veterans Affairs
Denni J. Woodmansee, PA-C; Roderick S. Hooker, PhD, PA-C
November 25 2010
ABSTRACT
There is broad consensus among medical workforce analysts that the
demand for physician assistants (PAs), physicians, nurses, allied
health, and other medical providers has substantially increased
since the late 1990s. While researchers tend to examine the
deployment of various providers in private medical offices, they
often overlook federally-employed PAs. Since the late 1980s, the
Department of Veterans Affairs (VA) has been a major employer of PAs.
The demand for services is projected to increase by 30% over the
next decade as the VA undergoes expansion.
We examined the characteristics of PAs in the Veterans Health
Administration (VHA), the medical arm of the VA. In 2010, 1,878 PAs
were employed in 153 VA medical centers and many of the more than
900 community-based outpatient clinics. The majority work full time,
and 49% are female. VHA PAs are distributed broadly across medical
services (38%), surgery (47%), mental health (11%), and other
services (4%). Thirty-one percent of PAs have prior military
experience. The average years of VHA PA employment is 10.5, and the
average age of a VHA PA is 49 years (range 23-74 years); one-third
(34%) are within 5 years of retirement eligibility. Annual attrition
for PAs is 9%, consistent with doctors, nurses, and pharmacists in
the VHA. Projected demand for PA services in the VHA is expected to
grow to 2,550 by 2018. Strategies are under way to improve the PA
workforce in the VA.
Near the end of the last century, the Veterans Health Administration
(VHA) in the Department of Veterans Affairs (VA) initiated a medical
workforce re-engineering effort to improve its quality of care.1,2
The VHA is vertically integrated and comprehensive.3
Admired for its ability to deliver services in both urban and rural
areas, it has also been a leader in advance medical record
integration technology and safety.4 Additionally, the VHA
is a major employer of physician assistants (PAs).
The VHA is notable for its commitment to primary care, and this
specialty serves as the entry point for beneficiaries to access the
health system. It is also a model of a managed health system that
relies heavily on electronic record access to all aspects of care.
Because of a commitment to improve all aspects of care to veterans,
the VHA boosts its efforts to improve quality through performance
measurement.5 However, an increasing transition of active
duty military members to VA status and new policies on beneficiary
enrollment over the past decade have created backlogs in access to
medical care and processing claims.6 Furthermore, the VA
takes care of a different population than the civilian sector;
predominantly male, elderly, vulnerable, and burdened with
significant chronic diseases. The profile of this beneficiary
structure produces large differences in patterns of practice within
the VA, and as a result, more care is inpatient-based and
specialist-oriented with higher per capita expenditures than in
private practices. These veterans, many with service-connected
disabilities and without any other means of medical care, consume
resources at different rates than a non-VA population. Nonetheless,
the VA is challenged to make systematic improvements while at the
same time implementing economy of scale measures of
cost-effectiveness. Because the VA is vertically organized with most
of the care produced under one roof, it serves as a model
institution to study optimal delivery of health care services.
Since the late 1990s, the VHA has increasingly turned to PAs to
improve access and maintain continuity of care. Employment criteria
include graduation from an accredited PA program and a passing score
on the PA National Certification Examination (VA policy). Each of
the 153 VA medical centers or the more than 900 community-based
outpatient centers employs providers according to its need. As a
result, the utilization of PAs is irregular across the nation. Some
locations have no PAs, and other regions make very high use of PAs.
Administration is hierarchical; each medical officer (MO) and PA
reports to the service chief. The service chief reports to the
medical director of the facility. A director of PA services reports
to the chief patient care services officer. In turn, a VHA physician
assistant field advisory committee advises the PA director on policy
matters.
PAs employed in federal institutions often bypass state control of
provider services. For example, state PA practice laws tend to have
little bearing on whether a VA facility permits PAs to perform
medical or surgical procedures. PAs practice under federal
authority, and states do not have jurisdiction over federal health
care facilities. If the facility approves a scope of practice that
includes performing colonoscopy (or any other procedure), it can be
granted by that facility under federal law.
The VA also supports PA education. For example, a VA Medical Center
in Durham, North Carolina, has provided clinical education sites
dating back to the first PA students at Duke University in the
1960s. The St. Louis University PA program was partially funded by
the VA in 1971. In 1972, the VA standardized the role of PAs,
defined the areas of the hospital in which PAs could be utilized,
and specified the type and level of tasks assigned to them.
Implementing and using team delivered care has been a major goal of
the VHA, and PAs are part of this effort. In one study of 32 VHA
medical centers, 84% of operating room (OR) and 75% of intensive
care units had implemented team concepts to improve care. As a
result, efficiency improvements were reported by 94% of OR
implementation teams. Almost all facilities (97%) reported a success
story or avoiding an undesirable event.7
A major goal of the VA is to enlarge the medical workforce to meet
the needs of an increasing enrollment of veteran beneficiaries. One
of the VHA's stated goals is to grow PA services to 2,550 by 2018.
Increased recruitment is part of a larger goal to expand the size
and capacity of the VA. This expansion will necessitate an increase
in the number of doctors, nurses, and other personnel during the
same time period. This investment in human resources requires more
information to be made available both internally and in the public
domain.
We undertook an organizational examination of PAs in the VA because
their role in the federal workforce has been described only broadly.8
There is growing interest in understanding the PA workforce and the
extent it is used in this institution. Our aim was to establish
historical data for medical workforce planning purposes and to
contribute to the growing body of literature on the US medical
system of care.
METHODS
A descriptive study of PAs in the VHA was undertaken using existing
administrative files from the VA Central Office. One author (DW) is
the manager of PA medical workforce data and advisor to the under
secretary for health. Administrative files were probed for pertinent
information on employment trends, gender, age, role,
and
pay. The data were aggregated, descriptive statistics were used, and
no individual employee was identifiable
in
the analysis. The study was approved by the VA Central Office.
RESULTS
As of 2010, the VHA was composed of 1,878 PAs; 49% were female. The
mean age was 49 years (median 54 years; range 24-74 years) (Figure
1). During the period 1992 to 2009, the cadre of PAs in the VA
grew by 55% (on average, an additional 45 PAs were added each year)
(Figure 2). The percentage of PAs in the VHA workforce who
will be of retirement age or older (65 years or older) within the
next 5 years is 16.24%; 35% of PAs in the VHA are older than 55
years. The turnover rate from 2000 to 2009 is shown in Figure 3.
The national VA system is composed of 21 integrated service networks
(VISNs), and the deployment of PAs
is
spread over these VISNs. The ratio of medical officers
to
PAs and nurse practitioners (NPs) differs widely depending on the
VISN. In 2010, the ratio of PA/NP to MO was 3:7, with approximately
1.5 times as many NPs as PAs (Figure 4). Overall PAs were
grouped broadly under medical services (38%), surgery (47%), mental
health (11%), and other services (4%, including anesthesia/pain
clinic, radiology, rehabilitation, and administration).
The wage for VHA-employed PAs is structured through the General
Schedule (GS) system of the US Office of Personnel Management and is
the pay structure for most federal workers. PA salary ranges from
GS-9 to GS-13 (92% of PAs are GS-12 or GS-13). Most pay is assigned
a locality adjustment for cost of living differences across the
country (www.opm.gov/oca/10tables). In 2010, a GS-13 who had topped
out in pay scale steps earned an annual salary of around $110,000.
The benefit structure in the federal compensation system is about
25% on top of the wage and includes 4 weeks vacation, holidays,
health insurance, and education. Once a PA is a government employee,
transfers are possible both within a VA health facility and across
the nation (including other federal services) depending on need and
supply.
Approximately 50 PA programs used the VA System for clinical
rotation. More than 250 PA students rotated through VHA facilities
in 2010, and 58 qualified for a stipend. Institutional agreements
are usually on the local level, and arrangements of PA students who
are provided clinical sites for training may exceed this estimate.
All new employees are surveyed for their reasons for joining the VA.
In 2009 and 2010, 48 respondents cited the benefit structure and
loan repayment as the two leading reasons for accepting employment
within the VA as a PA.
DISCUSSION
Since 1967, the VHA has been an employer of PAs (personal
communication Vic Germino, PA, July 2010); a trend to employ more
has been under way since 1992. As of 2010, 1,872 PAs were working in
most of the 153 VA medical centers and 976 community-based
outpatient clinics. The majority work full time, and half are
female. These VHA PAs are distributed broadly across medicine and
surgery, and their diverse roles are known only broadly. Less than
1% of PAs are in senior administrative roles. This distribution
among the rank and file of clinical PAs is analogous to the military
in the late 1900s, when there was a dearth of senior officers in PA
ranks. Only when PAs began moving into senior command levels did
policy improvements in the utilization and career focus of PAs in
uniform change.9 We suggest that similar senior
administrative VA positions need to be filled by PAs who can provide
a representative voice in organizational change and policy
decisions.
An important observation about the PA in the VA is the age
distribution. The average age of a VHA PA is 49 years, but the age
curve shows that more than half are older than 50 years.
Furthermore, about one-third of PAs (34%) are within 5 years of
retirement eligibility. The average years of VHA PA employment is
10.5, and the annual attrition rate of PAs is 9% (consistent with
doctors, nurses, and pharmacists in the VHA). These observations
suggest that the pool of older, more experienced PAs are eligible to
depart in large numbers over the next few years, producing
recruitment and retention challenges ahead. Not only does the VA
want to expand its corps of PAs (along with all other clinicians),
but it will need to replace at least 100 PAs a year to stay even and
more than 200 PAs per annum to reach full complement by decade's
end. Retention and recruitment are significant issues for the VHA,
as competition from the private sector vies for scarce human
resources in health. Pay disparity leads this list of challenges
because compensation tends to be high on the priorities list of
graduates wishing to pay off loans acquired in training. In
addition, older males with decades of procedural experience are
being replaced with younger females with newer knowledge of medicine
and technology. Such generational changes also present challenges
for
managers.
Strategies to help cope with challenges for recruitment and
retention are being developed. Policy makers are proposing new
initiatives that will permit those in government service to have
their accrued education costs repaid if they extend their federal
career for a period of time. Contracting with retirees to return as
part-time clinicians is an option in some locations. Increasing the
PA student's experience in VA settings may provide the needed
contact for recruitment. Developing postgraduate traineeships for
physician assistants may be another option.
LIMITATIONS
Medical workforce research relies on surveys such as censuses or
secondary data such as administrative files. Both have their
advantages and limitations. Administrative data capture all workers
employed but sacrifice candid responses that help shape attitudes,
roles, and relationships. Research on public organizations reveals a
substantial and growing body of empirical evidence relevant to many
international issues in political economy and organization theory,
such as the privatization of public services. However, certain
assumptions are made that may mislead goals. While the institutional
data we obtained have a great deal of integrity due to accurate
compensation and benefit structure, the data do not capture the role
delineation of PAs employed in federal service. As a result of
policy, specifics had to be set aside to avoid identifying
characteristics such as age and gender co-variables or PA density in
certain VISNs. Also missing are qualitative studies needed to probe
the organizational issues concerned with job satisfaction in the VA
and how federally employed PAs compare to those in the private
sector.
CONCLUSION
The re-engineering of the VHA that began in the 1990s has resulted
in an unprecedented enrollment of American veterans. Along with this
came a broad mix of providers: one that mirrors the diversity of
medical care clinicians in American society. Included in this mix
are PAs, many of whom are veterans themselves. Several principles
adopted by the VA in its quality-improvement projects include an
emphasis on the use of PAs to expand services to veterans. This
integration of provider services, designed to achieve high-quality,
effective, and timely care, has been embodied by the architects of
VA service change and delivery.2
Our findings suggest that initiatives based on principles that
improve the quality of care in the VA are being carried out with PA
involvement on many levels. This trend in task transfer and
integrated skill mix using PAs in the VA is consistent with the
changing pace of health care in America. However, the VHA may be
challenged by social changes where demand for PAs is high and
compensation is increasing in the private sector. On top of this is
an impending loss of human intellectual capital over the next few
years. Improving the representation of PAs with managerial skills in
the hierarchy of the VHA is a critical piece needed to achieve a
dynamic, integrated health care system that is highly prized by
social system advocates. JAAPA
Denni Woodmansee
is the acting director of physician assistant services in the US
Department of Veterans Affairs. Roderick Hooker is a physician
assistant in the Department of Veterans Affairs, Dallas, Texas. The
authors have indicated no relationships to disclose relating to the
content of this article.
REFERENCES
1. Iglehart JK. Reform of the Veterans Affairs health care system.
N Engl J Med. 1996;335:1407-1412.
2. Jha AK, Perlin JB, Kizer KW, Dudley RA. Effect of the
transformation of the Veterans Affairs health care system on the
quality of care. N Engl J Med. 2003;348(22):2218-2227.
3. Oliver A. The Veterans Health Administration: an American success
story? Milbank Q. 2007;85(1):
5-35.
4. Oliver A. Public-sector health-care reforms that work? A case
study of the US Veterans Health Administration. Lancet.
2008;371(9619):1211-1213.
5. Fisher ES. Medical care—is more always better? N Engl J Med.
2003;349(17):1665-1667.
6. Asch SM, McGlynn EA, Hogan MM, et al. Comparison of quality of
care for patients in the Veterans Health Administration and patients
in a national sample. Ann Intern Med. 2004;141(12): 938-945.
7. Neily J, Mills PD, Lee P, et al. Medical team training and
coaching in the Veterans Health Administration; assessment and
impact on the first 32 facilities in the programme. Qual Saf
Health Care. 2010;19(4):360-364.
8. Hooker RS. Federal employed physician assistants. Mil Med.
2008;173(9):895-899.
9. Hooker RS, Cawley JF, Asprey DP. Physician Assistants: Policy
and Practice. 3rd ed. Philadelphia, PA: FA Davis Co; 2010.
TOM PHILPOTT: A Positive Historical Perspective on Caring for Our
Nation's Veterans
Posted November 26, 2010 at 8:07 p.m.
Some of us, when we see a proposal to raise VA health care
fees for a category of veteran in a report on ways to curb
federal budget deficits, jump to the conclusion that veteran
benefits are under fresh attack.
Bernard Rostker, former undersecretary of defense for
personnel and now a senior fellow at the RAND Corp., has a
more optimistic perspective on how, over time, America cares
for and compensates its wartime veterans.
For more than a year Rostker has been researching what will
be a two-volume study on the treatment of veterans and their
survivors, going back to before the Revolutionary War, with
a special focus on wounded warrior care.
His original working premise, as he explained it in a phone
interview, was that veterans’ care and benefits today
reflect a deeper attachment to the force, the result of
moving away from a military of conscripts, after the Vietnam
War, to a more professional force comprised entirely of
volunteers.
But as he completed volume one of his study, covering the
Colonial era through World War II, Rostker said he found the
working premise to be wrong. Much of what’s being done today
for veterans of the all-volunteer force is “rediscovering”
what’s been done before.
One glaring exception, he said, is the focus today on
treating mental wounds of war, post-traumatic stress
disorder. Resources aimed at the invisible wounds are
unprecedented, reflecting more medical knowledge, the nature
of current wars and an attitude shift, even since the
Persian Gulf War.
“Today it’s remarkably different. Much more willing to deal
with issues of stress than what came out of the Gulf War,”
said Rostker. In the late 1990s he was the defense
secretary’s special assistant on Gulf War Illness.
Otherwise the infusion of money and staff for veterans’ care
and benefits today fits an historical pattern, Rostker said,
the nation’s deep appreciation for those who fight for
country and suffer wounds or illness.
Other patterns emerge, Rostker said. Government support
tends to deepen with budget surpluses. Benefits tend to
improve as veterans age, their ranks thin out, and
enhancements become more affordable.
Wars bring change too. The Department of Veterans Affairs
budget has more than doubled since U.S. troops invaded
Afghanistan in October 2001 -- from $51 billion then to $114
billion in the fiscal years that ended Sept. 30. VA spending
is set to climb another 10 percent this year, to $125
billion.
Vet groups laud a 25 percent rise in VA spending since
President Obama took office. Some contrast that largess to
the Bush administration difficulty in June 2005 when it had
to request $2 billion supplemental for VA to meet pressing
health care obligations. Some veterans groups had called the
original budget that year “tightfisted, miserly” and
“woefully inadequate.”
Rostker avoids such comparisons. But his research might
inform cost-conscious politicians about the perils of
scrimping on veterans.
President Franklin Roosevelt made such a misstep, he said,
while trying to pull the nation out of the Great Depression.
At his urging, Congress in 1933 passed the Economy Act,
which cut deeply into veterans’ benefits. Roosevelt told the
American Legion convention “the mere wearing of a uniform”
in war should not entitle a veteran, and later his
survivors, to a pension for disabilities incurred after he
left service.
The backlash was strong enough that the following March,
Congress had enough votes to override Roosevelt’s veto and
it restored almost all of the benefits it had cut a year
earlier.
The Continental Congress in 1776 first recognized
responsibility for wounded veterans, voting to authorize
half pay for life to anyone who lost a limb or their ability
to earn a living due to the revolution. By 1805 Congress
approved pay for disabilities developed years after a
veteran left service.
Support for lifetime “half pay,” particularly for officers,
drew criticism. Funds to pay it sometimes could not be
found. Yet Congress extended the same pension rights to
disabled veterans from the War of 1812 and other wars.
By
1818, with federal coffers flush with tariff money, the
Department of War gave pensions to anyone who served in
wartime, not just disabled.
Ten years later Congress settled complaints of Revolutionary
War veterans by granting 850 surviving officers and soldiers
full pay for life.
Rostker noted too that in 1833 Congress first approved
“concurrent receipt” — payment of both an “invalid pension”
and service pension. In 1836, Congress extended pension
eligibility to widows and children of Revolutionary War
veterans, adding enormously to the cost. The last spouse
eligible for that Revolutionary War pension died in 1906,
Rostker said.
The Civil War Pension Law of 1862 was viewed as the most
generous any government had ever adopted, Rostker said,
allowing disability payments for injuries or ailments
incurred as a direct result of service. It even set up a
medical screening system, though reliance on hometown
doctors led to rampant fraud and soon a purging of the
rolls, Rostker said.
Payments to surviving spouse and children could exceed what
veterans got. The last Civil War pensioners lived well into
the 20th Century, all the while drawing payments.
Our conversation provided just a glimpse of how America has
cared for veterans long ago. The study will span newer, more
controversial periods including Gen. Omar Bradley’s reform
of the VA after World War II, Korea and Vietnam and Gulf War
Syndrome.
Given the history, I asked, what might be ahead for the
newest generation of war veterans. More effective help,
Rostker suggested. The nation knows now that not all wounded
have missing limbs or physical scars.
Through history, he said, “you see the generosity in many
ways. You see it in the amount of money given, in the change
of eligibility standards. And recently in the understanding
of the mental aspects of conflict.”
Weiner, vets decry proposed health care cuts By Joe Anuta
Rep. Anthony Weiner (c.) speaks out
with war veterans against a proposed cut to veterans'
health care outside the American Legion post in Forest
Hills. Photo by Joe Anuta A Forest Hills congressman said proposed cuts
to the federal budget went too far last week when they targeted
health care for veterans, especially since Queens is home to so
many. ADVERTISEMENT
Instead of cutting health care, Weiner
suggested curbing several other areas of government with bloated
budgets such as farm subsidies or the Defense Department.
Gates Seeking to Contain Military Health Costs
WASHINGTON — Francis Brady enjoys a six-figure salary and generous
benefits at the consulting firm Booz Allen Hamilton, but as a
retired Marine lieutenant colonel he and his family remain on the
military’s bountiful lifetime
health insurance, Tricare, with fees of only $460 a year.
He calls the benefit “phenomenal.”
“It is so cheap compared to what Booz Allen has,” Colonel Brady said
in a recent interview, acknowledging that premiums called for by
private employers can run many times greater.
Of nearly 4.5 million military retirees and their families, about
three-quarters are estimated to have access to health insurance
through a civilian employer or group. But more than two million of
them stay on Tricare. As the costs of private health care continue
to climb, their numbers are only expected to grow.
Now, as part of a broad offensive to cut Pentagon spending, that
group is once again in the sights of Defense Secretary
Robert M. Gates, who is seriously considering whether to
ask for Tricare fee increases in next year’s budget — and perhaps
start one of the last fights of his public career.
Already, he has met with the chairmen of
President Obama’s bipartisan fiscal commission, which
faces a deadline this week for getting an agreement on a plan to
address the
federal budget deficit.
The battle over Tricare pits the efforts of the Pentagon to contain
the exploding cost of health care for nearly 10 million eligible
beneficiaries against the pain and emotions of those who say they
have already “paid up front” with service in uniform, particularly
those who deployed to America’s two current wars. The 10 million
figure includes active-duty personnel, retirees, members of the
National Guard and Reserves and their families.
The arguments reflect the broader debate over the huge Pentagon
budget that will intensify next year when Mr. Gates, who says he
will step down in 2011, continues his campaign to cut off what he
calls the “gusher” of defense spending. Total health care costs for
the Pentagon, which is the nation’s single largest employer, top $50
billion a year, a tenth of its budget and about the same amount that
it is spending this year on the war in Iraq. Ten years ago, health
care cost the Pentagon $19 billion; five years from now it is
projected to cost $65 billion.
But Tricare fees have not increased since 1995.
“Health care costs are eating the Defense Department alive,” Mr.
Gates said in a
much-noticed speech in May. Defense budget analysts say
that rising health care costs will make less money available for new
weapons, repairs to a worn-out arsenal and quality-of-life programs
like schools on military bases.
“In the long run, it could actually limit our ability to field a
military of sufficient size,” said Todd Harrison, a senior fellow
for defense budget studies at the
Center for Strategic and Budgetary Assessments in
Washington.
Veterans groups and military officers’ lobbies have responded by
going on high alert. One of the most powerful of them, the
Military
Officers Association of America, is preparing a public
relations campaign that will focus on what it calls the broken
promise between the nation and the people who defend it.
“Don’t ask the folks who have done so much more for this country,
who have been called to act since 9/11, to be the first in line to
give some more,” said Norbert R. Ryan Jr., a retired vice admiral
and president of the military officers’ group. As for Tricare’s
generous benefits, Admiral Ryan said that anyone “can get this good
deal — go over to a recruiting office and sign up for Iraq and
Afghanistan.”
Defense officials point out that Mr. Gates is weighing only whether
to increase the cost of health insurance for retirees and their
families, not those on active duty, who receive Tricare at no cost.
Any fee increases would also not affect military retirees 65 and
older, who use a free program called Tricare for Life that
supplements
Medicare. It is not possible to estimate the exact
savings without knowing what rate increase might be proposed, but
analysts say even a modest rise could recoup billions of dollars
annually for the Pentagon.
If the past is any guide, veterans groups are expected to point out
that any fee increases could affect those disabled by the wars in
Iraq or Afghanistan who do not use the free services available to
them at veterans’
hospitals, either because they choose not to or because
they live too far away.
Mr. Gates has included proposals to increase Tricare fees for
retirees in three of his past four Pentagon budgets. In 2008, when
he held the same job under the Bush administration, Mr. Gates
proposed a five-year phased increase of the annual $460 family fee
for Tricare Prime, the popular H.M.O.-like option offered to
military retirees, to a maximum of $1,260 to $2,460, depending on a
retiree’s income, according to an analysis by the
Congressional Budget Office.
Tricare refers to the $460 payment as an “enrollment fee,” not a
premium. With $12 co-pays per doctor visit, some drug prescription
payments and other costs, the current annual out-of-pocket expense
for a family on Tricare Prime is estimated at $1,200 per year, still
substantially less than what is available from private employers.
Congress, unwilling to be seen as inflicting any kind of pain on the
military or veterans, rejected the increases. Mr. Gates said he got
the message — “The proposals routinely die an ignominious death on
Capitol Hill,” he said in May — and he did not try again in 2010.
But in shaping that budget proposal, Obama administration officials
also told the Pentagon not to raise it, lest it distract from Mr.
Obama’s overhaul of the nation’s health care system earlier this
year.
Some Pentagon officials and military advocacy groups have suggested
alternatives to raising fees that could cut costs. One idea is to
renegotiate the lucrative Tricare packages with the insurance
companies, hospitals and drug companies that actually operate the
programs. Another is to promote a cost-saving mail-order pharmacy.
Defense officials say that Mr. Gates has to make up his mind about
any health care fee increases in the next weeks, in time for the
Pentagon to submit its 2012 spending plans to the White House budget
director in December. Defense analysts who spoke to Mr. Gates over
the summer said he told them that he did not know if it was
realistic to try to increase military health care costs while troops
were at war.
But Defense Department officials have since said they see a window
of opportunity in the growing alarm over the federal debt, the focus
of two bipartisan panels that are proposing deep cuts in government
spending.
Mr. Gates met in recent weeks with the leaders of one of the panels,
former Senator
Alan K. Simpson, a Republican, and
Erskine B. Bowles, a Democrat and the former chief of
staff to President
Bill Clinton. They are the co-chairmen of
Mr. Obama’s fiscal commission, which has proposed raising
Tricare fees. The panel is trying to deliver a final report to the
White House on Wednesday, if the members can reach a consensus that
fast.
The panel is considering proposals to increase fees for military
retirees working for civilian companies, but it would also require
employers to reimburse the government for a share of the health
insurance costs of those on their payroll who opt for Tricare. That
measure alone, described as an effort to make civilian employers pay
“a normal business expense,” could recoup $3 billion annually for
the Pentagon.
In the meantime, Colonel Brady, 51, said he did not want to be
overly dramatic about what was at stake. Although he spent 22 years
in the
Marines, six of them deployed, including to the 1991
Persian Gulf war, he said he could not buy the argument about a
broken promise.
“Tricare is a very good deal for me, and if it costs some more,
well, O.K.,” he said. Raising Tricare fees would be a financial
burden for many retirees, he acknowledged, but he could not honestly
say it would be for him.
“Not that I want to pay a ton of money,” he said. VA Testing Quicker Access to Medical Records |
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