April 2011 Archives

Filner Bill Allows Elderly Veterans to Use Their Earned Medicare Dollars

April 7, 2011

Written by Imperial Valley News   

Wednesday, 06 April 2011

Washington, DC - Ranking Democratic Member Bob Filner (D-CA) reintroduced H.R. 814, legislation to allow veterans to use their earned Medicare benefits to receive health care and services from the Veterans Health Administration at the Department of Veterans Affairs (VA).

“There are veterans who have earned VA health care benefits with their service to our country,” stated Bob Filner.  “They have also earned Medicare benefits by contributing to the Medicare program during their working years.  Because VA cannot bill Medicare, elderly veterans are unable to use their Medicare benefits, even if they may prefer to receive care at a VA facility among their fellow veterans.  So for those veterans, they basically forgo the hard-earned dollars that they contributed towards Medicare benefits during their working years.  This bill is important legislation that would allow elderly veterans to access both VA health care and their Medicare benefits.”

Under current law, VA has the authority to bill enrolled veterans and their private health care insurers for the treatment of veterans’ non-service-connected conditions.  Current law, however, prohibits the billing of Medicare, barring elderly veterans from using their earned Medicare benefits at VA health care facilities.  H.R. 814, the Medicare Reimbursement Act of 2011, would require VA to develop a program that would allow VA to bill Medicare for services rendered to veterans enrolled in Medicare Part A or B.

Emergency Care
Eligibility Checklist
April 10, 2011

If you meet all of the following criteria, you are eligible for reimbursement for nonservice-connected emergency services rendered by non-VA medical facilities:

You are enrolled in the VA Health Care System.
You have been provided care by a VA health care clinician or provider within the last 24 months.
You were provided care in a hospital emergency department or similar facility providing emergency care.
You have no other form of health insurance.
You do not have coverage under Medicare, Medicaid, or a state program.
You do not have coverage under any other VA programs.
Department of Veterans Affairs or other federal facilities are not feasibly available at time of emergency event.
A reasonable layperson would judge that any delay in medical attention would endanger your health or life.
You are financially liable to the provider of the emergency treatment for that treatment.
You have no other contractual or legal recourse against a third party that will pay all or part of the bill.
For more information on your eligibility for this benefit, call toll-free 1-877-222-VETS (1-877-222-8381) or obtain information on the Internet at www.va.gov/health/elig

'Low priority' vets could lose VA health care

The House Budget Committee, chaired by Rep. Paul Ryan, R-Wis., has told a veterans’ group it is studying a plan to save $6 billion annually in VA health care costs by cancelling enrollment of any veteran who doesn’t have a service-related medical condition and is not poor.

Committee Republicans, searching for ways to curb federal deficits and rein in galloping VA costs, are targeting 1.3 million veterans who claim priority group 7 or 8 status and have access to VA care.

Priority group 8 veterans have no service-connected disabilities and annual incomes, or net worth, that exceed VA means-test thresholds and VA “geographic income” thresholds, which are set by family size.

Priority Group 7 veterans also have no service-connected disabilities and their incomes are above the means-test thresholds. But their incomes or net worth fall below the geographic index.  In other words, because of where they live, in high cost areas, they likely struggle financially.

Joseph Violante, national legislative director for Disabled American Veterans, said he learned of the committee’s interest in narrowing access to VA clinics and hospitals from a DAV member from Wisconsin, chairman Ryan’s home state.

A budget committee staffer reminded Violante that proponents for opening VA health care to all veterans had argued it would be cost neutral because VA would charge  modest co-payments for care.  Also VA would bill  veterans’ private health insurance plans.

That 1996 argument was wrong. Co-payments and private insurance plan billings cover only 18 percent of the cost of care for group 7 and 8 veterans. By 2009, the annual net cost to  treat these veterans was $4.4 billion or 11 percent of VA’s annual medical appropriation.

The figures come from the Congressional Budget Office’s annual report to Congress, “Reducing the Deficit: Spending and Revenue Options.”  Among options it presented this year to  Congress for reducing VA spending is one to close enrollment in VA care for veterans in groups 7 and 8 and to cancel existing enrollments.

CBO said this would save VA $62 billion in the first 10 years, from 2012 to 2021. But the net savings to the government over the same period, CBO said, would be about half that amount. That’s because many of the veterans are old enough or poor enough to use Medicare or Medicaid, which would drive up the cost of those programs.

During the Clinton administration, Congress enacted the Veterans’ Health Care Eligibility Act of 1996. The law directed VA to build clinics across the country. To ensure enough patients, the VA secretary was given authority to expand care eligibility.

The ban on group 7 and 8 veterans was ended by 1999.  Over the next three years their enrollment climbed to 30 percent of total enrollees. By 2003, then-VA Secretary Anthony Principi stopped group 8 enrollments, saying their numbers strained the system for higher priority veterans, including wounded returning from Afghanistan and Iraq.

Violante said DAV members worry that tossing 1.3 million veterans from VA care would leave the system without the “critical mass” of patients needed to provide “a full continuum of care.”

CBO presented pros and cons for cancelling 7 and 8 enrollments.  An advantage is VA could refocus services on “its traditional group of patients — those with the greatest needs or fewest financial resources.”

It noted 90 percent of group 7 and 8 enrollees had other health care coverage.  Those who don’t could be eligible for health insurance exchanges in the future.

One disadvantage is that many veterans who rely on VA for at least part of their medical care would see that care interrupted.

The Obama administration and Congress had been moving  to expand VA enrollment, until Republicans won the House. As Obama took office in 2009, VA announced that up to 266,000 veterans with no service-connected health conditions would be allowed to enroll in VA health care. Rep. Chet Edwards, D-Texas, had fought successfully to add $350 million to the 2009 VA budget so income thresholds controlling priority 8 enrollments could be raised 10 percent.

Edwards lost his reelection bid last year.  And new priority 8 enrollees haven’t rushed to join the system.

Group 8 and 7 veterans using VA care pay $15 per outpatient visit and a little more for specialty care.  Inpatient fees also are modest.  The most popular benefit for many of enrollees is discounted prescription drugs. The co-pay usually is $8 for a 30 day supply.

Tim Tetz with American Legion said his organization and many veterans groups would strongly oppose tossing out group 7 and 8 veterans.  He credits their enrollment since 1999 as helping to improve VA care.

“If as great of a health care system as we have, shouldn’t we let all of our veterans have access to it, in some manner,” Tetz asked.

While deficit hawks weigh this issue, VA still is enrolling new group 8 veterans who fall below its income thresholds. Those without dependents and living outside high-cost areas, for example, must have income below a means test threshold of $32,342.  More information on group 8 enrollment is online at www.va.gov/healtheligibility or call (877) 222-VETS (8387).


To comment, send e-mail to milupdate@aol.com or write to Military Update, P.O. Box 231111, Centreville, VA, 20120-1111

VA Infection Control Practices Featured in New England Journal of Medicine
Recent VA News Releases
April 13, 2011

WASHINGTON (April 13, 2011)- A Department of Veterans Affairs (VA) initiative that reduced the global health care issue of methicillin resistant Staphylococcus aureus (MRSA) infections by more than 60 percent in intensive care units (ICU) across the Nation is featured in
the latest issue of the New England Journal of Medicine. It reports
data from the first three years of the initiative that is now in its fourth year of implementation, and which continues to be associated with decreased rates of MRSA infections.

"This is a landmark initiative for VA and health care in general," said VA's Under Secretary for Health, Dr. Robert Petzel. "No one should have to worry about acquiring an illness or infection from the place they trust to deliver their care. I am proud that VA is leading the way."

The article reviews a bundle of four infection control practices that marked a dramatic improvement in preventing hospital-acquired MRSA infections. MRSA infections are a serious global health care issue and are difficult to treat because the bacterium is often resistant to many antibiotics.

The prevention practices consist of patient screening programs for MRSA, contact precautions for hospitalized patients found to have MRSA, and hand hygiene reminders with readily available hand sanitizer stations placed strategically in common areas, patient wards, and specialty clinics throughout medical centers. The strategy also involved creating a culture that promotes infection prevention and control as everyone's responsibility.

"MRSA is a serious threat to patient health that can be minimized with a few achievable strategies," said Dr. Rajiv Jain, VA's chief consultant for specialty care services and lead author of the study. "I am extremely grateful I work for an agency with 152 integrated medical centers across the Nation so these strategies could be implemented, assessed, and ultimately, shown to work on a vast scale of many different environments. These results mean better health care for Veterans and a way for the people they defended to also benefit from this effort in the future."

"These are the types of results hospitals should be striving for," said Dr. John Jernigan, chief of the interventions and evaluation section in the division of healthcare quality promotion at the Centers for Disease Control. "The bottom line is that MRSA prevention and control is possible."

More than 1.7 million screening tests for MRSA were done on Veteran patients during the period reported in the analysis. VA operates the largest integrated health care system in the United States with more than 1,000 medical facilities throughout the United States serving more than six million Veterans a year. To review the article in the New England Journal of Medicine, go to http://www.nejm.org/doi/full/10.1056/NEJMoa1007474.

Wilford Hall and Central Texas Veterans Health Care System join forces

Posted 4/12/2011   Updated 4/12/2011 Email story   Print story

by Staff Sgt. Robert Barnett
59th Medical Wing Public Affairs

4/12/2011 - LACKLAND AIR FORCE BASE, Texas  -- The Central Texas Veterans Health Care System partners with Wilford Hall Medical Center's Hearing Center of Excellence in a mutually beneficial agreement that improves their patients' care.

According to their website, CTVHCS is a patient-centered integrated health care organization for veterans providing excellent health care, research and education. In fiscal year 2009, CTVHCS treated more than 80,000 unique patients and provided more than 9,000 inpatient days of care in the hospital. CTVHCS collaborates with Fort Hood, the largest military base in the world with the biggest troop commitment to Operation Enduring Freedom and Operation Iraqi Freedom.

"I was the first combat otolaryngologist and I saw that the most common thing that Veteran's Affairs makes these days is hearing aids," said Col. (Dr.) Joseph Brennan, 59th Medical Wing Otolaryngology Program director. "I was deployed to Afghanistan in 2004. I saw 600-700 patients, and the number of hearing loss injuries was the most by far."

Dr. Brennan noticed that many of the combat service members chose not to wear their issued hearing protection because it interfered with their combat operations. This resulted in unprotected ears around the most common danger in Afghanistan -- improvised explosive devices.

Many of these patients go to CTVHCS, Dr. Brennan said, but some of their facilities aren't prepared for complex cases, so they are sent to Wilford Hall Medical Center here for additional treatment.

"Clinics at CTVHCS operate one to two weeks a month," said Dr. Brennan. "They don't treat some things, so the more complicated cases come here."

This cooperative relationship enables the patients to get the high quality care they need, and also helps the Wilford Hall Hearing Center of Excellence increase their knowledge database, called a registry, for research and development.

"The ultimate goal is to restore hearing and scientists are working hard to develop a way to restore the hairs that are destroyed in a blast," said Lt. Col. (Dr.) Mark Packer, Hearing Center for Excellence director. "That's what we intend to do, continue to improve the system of care for our troops and continue monitoring and caring of the research process that is the answer to the way ahead."

UT study helps identify soldiers more at risk for PTSD

Researchers measured how long soldiers looked at images of fearful faces.

By Jeremy Schwartz


University of Texas researchers have discovered that soldiers who quickly look away from fearful images are more vulnerable to developing post-traumatic stress disorder, a finding that could lead to better training and preparation for service members before they go off to war.

The study, which evaluated Fort Hood soldiers before, during and after a deployment to Iraq, also found that soldiers who fixated on sad images were more susceptible to depression.

An estimated 20 percent of service members in Iraq and Afghanistan return with PTSD or major depression, and researchers say their findings could help the U.S. military develop prevention programs to help soldiers cope with the stresses of war.

The costs of combat-related PTSD are high. Service members can suffer from flashbacks, emotional detachment, nightmares and difficulties maintaining relationships, sometimes for years. A 2008 Rand Corp. study estimated that in the two years after deployment, the cost of treating PTSD or major depression in service members, coupled with the value of their lost productivity, was more than $6 billion.

The study, which will be published in the July edition of the American Journal of Psychiatry, is part of the Texas Combat PTSD Risk Project , a Department of Defense-funded initiative that included brain imaging, genetic screening and other tests aimed at discovering factors that could make a person more prone to developing PTSD. Future studies are set to be released as results are finalized, university officials say.

More than 180 Fort Hood soldiers were given a variety of psychological and emotional tests before and after deploying to southern Iraq in late 2007.

As part of the study, 139 pre-deployment soldiers underwent eye-tracking tests, in which they viewed sad, happy, neutral and fearful facial expressions on a screen.

Soldiers who looked away more quickly from the fearful faces were more likely to develop PTSD symptoms while deployed than their counterparts who lingered longer on the fearful images. Researchers discovered that the less time soldiers spent looking at the images, the more vulnerable they were to PTSD.

While in Iraq, soldiers filled out periodic, Web-based questionnaires in which they rated the severity of traumatic experiences, such as roadside bombs or firefights.

Chris Beevers , an associate professor of psychology at UT and lead researcher on the eye-tracking study, said the results confirmed researchers' initial hypothesis.

"It may reflect a tendency to avoid thinking about threatening experiences," he said. "Other studies have shown that the avoidance of processing traumatic events can maintain the disorder."

On the other hand, soldiers who fixate on the images for a longer period of time might prove to be more psychologically resilient when faced with battlefield stressors.

Edna Foa, director of the Center for the Treatment and Study of Anxiety at the University of Pennsylvania, said the results tap into previous research on PTSD.

"What's interesting here is this tendency to avoid \u2026 is also a risk factor," Foa said. "Certain people have this tendency, almost like a personality characteristic. They avoid fearful situations in general, so that goes well with (existing) theories."

Beevers said the eye-tracking test potentially could be used by the military to identify vulnerable service members who would benefit from additional, pre-deployment training or to identify people who might need additional support in war zone environments.

The eye-tracking test also found that soldiers who gazed longer on sad faces were more likely to experience depression after going to war, a finding that experts said also confirmed existing theories.

"This will certainly add to the body of knowledge and in several instances will be stepping stones to further research," said Brian Baldwin , a retired Army colonel and project manager at UT's Institute for Advanced Technology . "What I think this study has done is identify a mechanism that can be used to pursue answers to questions like, 'Why does one soldier develop PTSD and another doesn't?'\u2009"

jschwartz@statesman.com; 912-2942




March 30, 2011                                      

VA Extends Post-Incarceration Health Care

Measure Would Help Reduce Repeat Offenses

WASHINGTON – The Department of Veterans Affairs (VA) will extend health care to eligible Veterans in halfway houses and other temporary, post-incarceration housing under a new program aimed at cutting back on repeat offenses.

“There’s hard evidence that lack of access to health care, including mental health care, for newly released inmates is a factor in people becoming homeless or returning to prison and jail,” said Jim McGuire, director of VA’s Veterans Justice Outreach Programs. “These are Veterans who otherwise qualify for VA health care.”

A long-standing rule has barred VA from providing health care to Veterans for whom another federal, state or local government has an obligation to provide health care.  Frequently, that means inmates of prisons and jails.

Under the changed rule, that prohibition would be amended and VA would be allowed to provide health care to Veterans in halfway houses and other temporary, post-incarceration housing.

An Urban Institute study in 2008 found that good health care in the first months of community reentry played a key role in easing readjustment and reducing recidivism.

About 29,000-56,000 Veterans are released annually from state and federal prisons, and at least 90,000 Veterans are released each year from city and county jails, according to Department of Justice’s Bureau of Justice Statistics.

Atomic Veterans Have New Voice on Advisory Board

Roadman is New Chair for Dose Reconstruction

WASHINGTON--(BUSINESS WIRE)--Dr. Charles H. Roadman II, a retired Air Force lieutenant general and professor of military and emergency medicine at the Uniformed Services University of the Health Sciences, assumed duties as the chairman of the Veterans’ Advisory Board on Dose Reconstruction last month.

“General Roadman brings years of medical expertise and leadership experience, a passion for helping his fellow Veterans and a profound sense of urgency to reach all those who may have been exposed to ionizing radiation during their military service”

“General Roadman brings years of medical expertise and leadership experience, a passion for helping his fellow Veterans and a profound sense of urgency to reach all those who may have been exposed to ionizing radiation during their military service,” said Secretary of Veterans Affairs Eric K. Shinseki. “We are committed to supporting his efforts.”

Roadman, who previously served as the surgeon general of the Air Force, succeeded retired Vice Adm. James A. Zimble, physician who served as chairman of the advisory board. Roadman sits on the board of directors of Assisted Living Concepts, Inc., and Air Force Village. He is a member of various non-profit and for-profit scientific advisory boards.

As its second chairman, Roadman provides leadership to the board, a federal advisory committee that works with VA and the Department of Defense through the Defense Threat Reduction Agency on issues of importance to the nation’s atomic Veterans.

Atomic Veterans include service members who participated in the 1945-1946 occupation of Hiroshima or Nagasaki in Japan, and in atmospheric nuclear testing sponsored by the United States between 1945 and 1962. As part of its charter, the board conducts periodic, random audits of dose reconstructions and decisions on claims for radiogenic diseases and assists VA and DoD in communicating information on the mission, procedures, and evidentiary requirements of the dose reconstruction program to Veterans.

VA examines and treats atomic Veterans, or other Veterans exposed to ionizing radiation in service. It also evaluates disability claims and pays compensation to Veterans whose health has been adversely affected by exposure.

Roadman retired in 1999 as the Air Force Surgeon General. Since his retirement, he served as president and CEO of the American Health Care Association in Washington, D.C., from 1999-2004.

Please visit www.VBDR.org for more information on advisory board activities and www.publichealth.va.gov/exposures/radiation for information on VA services for exposed Veterans.


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