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Wednesday, March 25, 2015

The Veterans Affairs Department Asks for Better Legislation For Specialty Care


Veteran's Voice of America

The Veterans Affairs Department has asked for new legislation that would let it pay for private health care for veterans who live near a VA clinic but can't get the treatment they need because it's not offered at that location.
VA Deputy Secretary Sloan Gibson told the Senate Veterans' Affairs Committee Tuesday that vets are "frustrated" with the VA Choice program, particularly the requirement that measures eligibility by a veteran's proximity to any VA health facility — even those that are not full-service medical centers.
Gibson said many veterans are excluded from the program because of this provision in the law and few have applied for waivers to the rules.
"Many veterans are frustrated with the Choice program," Gibson said. "Such confusion leads to lower use of Choice."
The VA announced earlier Tuesday that it will change another aspect of the program, the definition of the 40-mile distance rule for veterans to access the Veterans Choice program.
Instead of using an "as the crow flies" measure of 40 miles, VA will rely on actual driving distance from a VA medical facility as the qualifier to use the program.
Some lawmakers expressed skepticism that VA needs formal legislation to make the change to accommodate veterans who live within the 40-mile distance but can't get the care they need.
But lawmakers pledged to make the fix. Sen. Johnny Isakson, R-Ga., chairman of the Senate committee, said his staff would work with the staff of the committee's ranking Democrat, Sen. Richard Blumenthal, D-Conn., to draft legislation in the next two weeks.
"The faster we act on that, the better off we are. I don't think there's any disagreement on the committee," Isakson said.
VA officials say the department distributed nearly 8 million VA Choice Cards when the program was initiated in November 2014. To date, it has approved about 46,000 requests for care and managed 44,461 appointments.
VA has a process to get patients to private care if they face undue burdens accessing VA care, but only 125 have asked for a waiver so far, Gibson said.
"It's our program, and we're working hard to improve it, to quickly overcome issues as we discover them and to ask for your assistance in areas where we need help," Gibson told the senators.
He said next month VA will send teams to facilities in some areas served by private contracts to analyze why they have long wait lists for care but few Veterans Choice referrals.
He also asked Congress to update the laws that allow VA to enter into agreements for providing care through civilian doctors.
"This change would let us streamline and speed up how we purchase care for an individual veteran," Gibson said.
Representatives of veterans' advocacy groups who testified at the hearing said they're delighted that VA decided to change the criteria for enforcing the 40-mile rule — a change that VA says will take effect in the coming weeks — but still harbor some concerns about VA's support of the Choice program.
"Seems to be a problem of following the letter of the law instead of the spirit of the law," grumbled Roscoe Butler, the American Legion's deputy director for health care.
Blumenthal also expressed concern that regardless of future legislative changes, VA might find loopholes to deny veterans care. He urged the department to act quickly in helping veterans use the program.
"This is not a threat to VA," Blumenthal said. "It's a different mode of helping serving the health care needs of veterans."

Tuesday, March 24, 2015

12 Million Salmon Take Road Trip




Image: Salmon

Image: Salmon
For the second year in a row, the California drought will cause millions of salmon to take a road trip. Around 12 million juvenile Chinook salmon could be trucked starting this week from the Coleman National Fish Hatchery in Anderson, California, down at least 180 miles to other sites on the Sacramento River. "Doing this two years in a row, it's unprecedented," Steve Martarano, a public affairs specialist with the U.S. Fish and Wildlife Service, told NBC News. Typically, the salmon are released into the nearby Battle Creek tributary, but California's long-lasting drought has made the area inhospitable to juveniles. Starting this week, many of the young fish, called smolts, will be transported in specially retrofitted trucks capable of carrying 2,800 gallons of water to Rio Vista, Mare Island and San Pablo Bay.

Image: Salmon stream
The Coleman National Fish Hatchery is sited two miles upstream from this view of Battle Creek, a tributary of the Sacramento River. When the salmon aren't being trucked, they're released directly from the hatchery into these waters. Fish hatcheries in Northern California exist generally to mitigate habitat loss from the construction of dams, which flood prime breeding ground for salmon.

Officials stressed that this was a last resort. Transporting the smolts in trucks increases the chances that they will stray and never find their way back to the hatchery. "If we released them on-site, we would probably lose them all," Martarano said. "This is not something we like to do." Similar operations have taken place in the past on a smaller scale. In 2011, 1.3 million salmon were moved from the Coleman National Fish Hatchery. Last year that number jumped to 7.5 million. That was just a fraction of the 25 million salmon that were transported by truck in 2014 from five fisheries statewide.

Saturday, March 14, 2015

Sturgeon Revived By Wildlife Officers, Returned To Sacramento River

66-Inch Sturgeon Revived By Wildlife Officers, Returned To Sacramento River; Man Cited On Poaching Charges

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A video posted on YouTube shows a group of fishermen catching a green sturgeon, a protected species, in the Delta. (CBS)
A video posted on YouTube shows a group of fishermen catching a green sturgeon, a protected species, in the Delta. (CBS)

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YOLO COUNTY : California wildlife officers successfully resuscitated a 66-inch sturgeon and cited a man on poaching charges last week, before returning the fish to the Sacramento River.
The suspected sturgeon poacher was being watched by officers from the California Department of Fish and Wildlife (CDFW) on the river near Clarksburg, when they saw him hook what appeared to be a very large fish. According to CDFW, as the officers watched, the suspect immediately moved the fish to the bed of his pickup and left the scene.
An additional wildlife officer was called in and conducted a traffic stop. The fish was found to be a white sturgeon, oversized (at 66 inches) and untagged. The 34-year-old suspect Eric Solden, of Hood, was cited.
CDFW resuscitate over-sized sturgeon in Sacramento River:

The fish was measured and photographed for evidence and taken to the river’s edge to be revived. A group of nearby sturgeon fishermen shot a video of the rescue effort of the nearly-dead fish. The fish was able to swim on its own after about 20 minutes.
The CDFW says anglers are required to release white sturgeon if they are caught shorter than 40 inches or greater than 60 in what’s called a “slot limit”. The larger fish are most important to the species with regards to breeding purposes.
Sturgeon anglers are limited to three retained sturgeon per year and are issued three tags for each.
Green sturgeon are a federally threatened species and may not be retained.

Monday, March 9, 2015

VA Hospital manager's e-mail mocks veteran suicides

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INDIANAPOLIS — A VA medical center manager appears to mock the mental-health problems of returning combat veterans in an e-mail to her employees.
The e-mail contains photographs of a toy Christmas elf posing as a patient in what appears to be the hospital's transitional clinic for returning veterans. In one photograph, the elf pleads for Xanax. In another photo, he hangs himself with an electrical cord.
The woman who sent the e-mail is Robin Paul, a licensed social worker who manages the Seamless Transition Integrated Care Clinic at Roudebush Veteran Affairs Medical Center here. The clinic provides returning veterans with transition assistance, including mental- health and readjustment services.
When initially asked about the e-mail, Paul responded, "Oh my goodness." She then referred a reporter to the hospital's public affairs department, which e-mailed The Indianapolis Star a statement on her behalf.
"I would like to sincerely apologize for the e-mail message and I take full responsibility for this poor judgment," Paul said. "I have put my heart and soul into my work with veterans for many years. I hold all veterans and military personnel in the highest regard and am deeply remorseful for any hurt this may have caused."
Julie Webb, a Roudebush spokeswoman, said administrators were made aware of the e-mail a couple of months ago.
"The e-mail is totally inappropriate and does not convey our commitment to veterans," she said. "We apologize to our veterans and take suicide and mental-health treatment seriously, striving to provide the highest quality."
Webb said the issue was "administratively addressed." She declined to provide specifics, citing employee confidentiality.
Paul remains employed at the hospital and continues to manage the clinic, earning an annual salary of $79,916. She received a $2,000 performance bonus in 2013, records show. More recent bonus information was not immediately available.
The Dec. 18 e-mail was sent to the "IND STICC Team" with the subject, "Naughty Elf in the STICC clinic."
So, photos have appeared that indicate that the STICC clinic may have been invaded. Looks like this magical character made his way through a few areas.
One photo depicts the elf peering between the legs of a female doll. "Trying his skills as a primary-care provider (doing a PAP smear)," the e-mail says.
Another shows the elf next to a sticky note with the words, "Out of XANAX — please help!" A caption says, "Self-medicating for mental-health issues when a CNS would not give him his requested script."
A third photograph shows the elf hanging from a strand of Christmas lights. "Caught in the act of suicidal behavior (trying to hang himself from an electrical cord)," the e-mail says.
It is unclear from the e-mail whether other VA employees were involved in the joke, but a note visible in one photo appears to include directions about passing the elf to others.
Webb said she didn't know how many employees were involved.
The e-mail surfaces as the nation grapples with an epidemic of veteran suicides. An estimated 22 veterans commit suicide across the USA every day, according to the VA.
The e-mail immediately drew outrage from veterans groups.
"It is a slap in the face to our recent and past veterans suffering from mental health issues every single day," said Ken Hylton, commander of the Indiana Department of the American Legion. "These men and women went to war and do not deserve this type of ridicule. This is a disgusting display of mockery. This is supposedly someone who is caring for our veterans, and we in the Indiana American Legion are disgusted."
He called for an investigation and the "immediate dismissal of this government employee and all of those who received this correspondence and said nothing."
Paul Rieckhoff, founder and chief executive of Iraq and Afghanistan Veterans of America, has lobbied for federal legislation intended to help stem veteran suicides.
"We hope it's an isolated incident," he said. "We hope this person has been dealt with aggressively because we're in the middle of a suicide problem."
The suicide crisis has prompted action from Congress and President Barack Obama.
Just last month, the Clay Hunt Suicide Prevention for American Veterans Act was signed into law. The measure will help the VA study new strategies for suicide prevention and give student loan incentives to recruit psychiatrists to work with veterans.
In December, the Sexton Act was signed into law as part of a national defense bill. It requires annual mental-health assessments for all service members, maintains privacy protections and requires the Pentagon to evaluate existing military mental-health practices. Authored by Sen Joe Donnelly, D-Ind., it is named after Jacob Sexton, a 21-year-old Indiana National Guardsmen from Farmland who shot himself in the head at a Muncie movie theater while home on a 15-day leave from Afghanistan.
The issue of veteran suicide is a personal one for Gregg Keesling of Indianapolis. His 25-year-old son, Chancellor, shot himself in Baghdad in 2009, two weeks into his second tour.
He called the e-mail "wrong" but stopped short of calling for terminations.
"It's very inappropriate, but I can understand it — making light of something awful because it's so awful," he said. "I think it's a way of coping with things."
Still, he said, "They are trying to be funny. It's not ... Somebody should get in trouble. Maybe not fired but taken out to the woodshed, as they say."


Thursday, March 5, 2015

Choice Card confusion frustrates veterans, Congress

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Air Force veteran Mark Gendron lives just a few miles from a psychiatrist who can help treat his post-traumatic stress disorder.
But Veterans Affairs Department officials won't pay for the treatment.
"So I'm paying for it myself," the 55-year-old Minnesota resident said. "I don't understand why I have to. They sent me a card that was supposed to let me go see any doctor. But VA won't let me use it."
Gendron is one of tens of thousands of veterans left scratching their heads about the VA's new Choice Card program, designed to give veterans in remote areas or facing long wait times a chance to easily turn to private care providers.
The closest available VA psychiatrist Gendron can visit is 70 miles away in St. Cloud, an unbearable burden for the retired vet who is also his disabled son's primary caregiver. Private care options are supposed to be open to any veterans who live more than 40 miles from a VA facility.
But VA officials say Gendron doesn't qualify for the private care options, because there is a VA clinic just 12 miles from his home. It doesn't have the personnel or services he needs, but it's enough to disqualify him from the program.
"I just want to get the care I need," he said. "I shouldn't have to deal with this."
Lawmakers and veterans groups have been dismayed with the implementation of the new Choice Card system so far, complaining that program officials seem more focused on keeping individuals out of the program than getting it running. VA officials note that Congress — not the department — set the eligibility rules and needs to make fixes if gaps are emerging.
A survey this week by the Veterans of Foreign Wars found 80 percent of individuals who thought they qualified for the outside care options were rejected by VA, a figure the group calls call unsettlingly high.
"This program is intended to be the solution to last year's nationwide crisis in care and confidence," VFW National Commander John Stroud said in a statement. "[We] will not let it fail."
VA officials have received more than 500,000 inquiries into the program since cards went out last fall, but only about 30,000 have been able to receive private care appointments through the program, and only a small fraction of those veterans live far enough from VA facilities to qualify.
Last week, 41 senators petitioned the department to relax its interpretation of the 40-mile rule, taking service availability into account instead of just geography. Sen. Johnny Isakson, R-Ga., chairman of the Senate Veterans' Affairs Committee, said he and his colleagues will take up legislative fixes to the problem in coming weeks.
VA Secretary Bob McDonald said his department is looking into fixes too, and said he'll come back to Congress with a "reinterpretation" of the 40-mile rule in the near future.
But he also lamented that, despite his promises to reform VA into a more customer-focused organization, "I'm kind of a prisoner of the system."
McDonald has asked for flexibility to shift Choice Card funds to other accounts if needed, noting that planners still have questionable estimates about veterans' interest in and use of the program.
Critics have called that an attempt to undermine the still-new offering, rather than investing time into making sure it works. VA officials have said they have numerous tools to send veterans to outside care if needed, but integrating all of them together will take time.
Veterans denied the Choice Card program can request a "geographic burden" exception if they think the 40-mile rule is being applied unfairly. But fewer than 50 veterans have done so, prompting department officials to ask if patients and administrators are aware of the option.
And while the fight over the program rages in Washington, D.C., veterans like Gendron are left waiting for a fix.
The Minnesota veteran said he already has an overdue bill of about $1,500 for outside VA medical services, a debt that will only grow with his new out-of-pocket psychiatry expenses.
"There's a problem with what they're doing," he said. "I don't understand why I'm left suffering here, and that's what really bothers me."

Thursday, February 26, 2015

The Veterans Independence Act: Vets Way Out Of Socialized Medicine






Few Americans who read a newspaper didn’t hear about last year’s Veterans Health Administration scandal, in which VA officials manipulated patient waiting lists in order to deny care to ailing veterans. I observed at the time that the VA’s brand of government-run medicine was far worse than Obamacare. And I questioned why lawmakers hadn’t done more to reform veterans’ health care. Today, Concerned Veterans for America ispublishing the most comprehensive effort in decades to reform the VA, and to ensure that veterans gain access to the same high-quality health care available to most Americans.
‘The most politically hidebound and sclerotic’ government agency
Government programs are notoriously hard to reform. But the VA is in a class all its own. In 1994, President Clinton tapped Kenneth Kizer of the University of Southern California to lead the VHA. “There was universal consensus,” Kizer later told Phillip Longman, “that if there was one agency that was the most politically hidebound and sclerotic, it’s the VA.” Last year, I noted how an innocent suggestion by Mitt Romney on VA reform turned into partisan attack ad:
On Veteran’s Day in 2011, Mitt Romney met with a group of veterans in South Carolina. The vets shared with him their difficulty in getting treatment from VA hospitals. Observed Romney, “If you’re the government, they know there’s nowhere else you guys can go. You’re stuck. Sometimes you wonder if there would be some way to introduce some private-sector competition, somebody else that could come in and say, you know, that each soldier gets X thousand dollars attributed to them, and then they can choose whether they want to go in the government system or in a private system with the money that follows them.”
For this innocuous and appropriate suggestion, Romney was pilloried by the usual suspects on the left—but also, inexcusably, by the Veterans of Foreign Wars, whose spokesperson said, “The VFW doesn’t support privatization of veterans’ health care.” Romney, stung by the VFW’s rebuke, walked back his suggestion, and Republicans have stayed silent on it ever since.
After that article came out, I got a call from Pete Hegseth, CEO of Concerned Veterans for America. Pete asked me to put my money where my mouth was, and co-chair a task force on veterans’ health reform. Other participants included former Sen. Bill Frist (R., Tenn.), former Rep. Jim Marshall (D., Ga.), and former VHA chief Mike Kussman.
Our basic idea was the same as the one that millions of veterans—and civilians like Mitt Romney—have proposed: why not put vets in charge of the dollars the VA spends on them? It’s a simple idea in theory, but it’s harder than it looks.
Lawmakers have tried several times in the past to reform the VA along these lines. They’ve run into three basic problems: (1) the veterans’ service organizations, like the VFW, have opposed reform; (2) the Congressional Budget Office has scored previous reform efforts as increasing the deficit; (3) the VHA’s officials have feared that if veterans obtain private health care, the VHA’s facilities will wither. We went about addressing each of these issues.
An overwhelming majority of vets want reform
The leaders of traditional veterans’ service organizations, like the Veterans of Foreign Wars and the American Legion, have long opposed reform, illustrated by the Mitt Romney vignette above. But officials from these older organizations are increasingly out of step with what rank-and-file veterans actually want.
Last fall, Concerned Veterans for America and the Tarrance Group conducted a nationwide survey of over 1,000 veterans. 88 percent of respondents agreed that eligible veterans should be given the choice to receive medical care from any source that they themselves choose. 95 percent said it was “extremely” or “very important” to have the option to seek the best possible care, even if that means getting that care outside a VA facility.
Most impressively, 77 percent of veterans thought it was “extremely” or “very important” to give veterans more choices in their insurance products, even if those alternatives involved higher out-of-pocket costs like co-pays and deductibles.
So, the next time you hear a VA or VSO official claim that vets don’t want private options, you know they’re not telling the truth.
But that doesn’t mean that all vets dislike VA-based care. And so it is important for any reform to ensure that those who prefer traditional VA care can continue to obtain it.
Private care may be costlier than VA-based care
It’s widely believed that VA-based care is less costly than private care. In a December 2014 report, the Congressional Budget Office found that “limited evidence and substantial uncertainty make it difficult to reach firm conclusions about those relative costs or about whether it would be cheaper to expand veterans’ access to health care in the future through VHA facilities or the private sector.”
Nonetheless, for those who use it, the CBO assumes that private care is more expensive. That doesn’t mean that VA care is better, but it does mean that previous efforts to offer vets private options have run aground on fiscal considerations.
Our proposal—the Veterans Independence Act—strives to achieve deficit neutrality through two mechanisms. First, the plan’s private coverage options include some co-pays and deductibles, unlike traditional VA care, which requires no patient cost-sharing. Second, the plan makes an effort to restructure the VHA’s hospital and clinical facilities. More on that in the next section.
Accountable care for veterans
If we were starting from scratch, and trying to offer health coverage to veterans, it would be ludicrous for the VA to build its own network of proprietary hospitals and clinics. But the VA system evolved before the broader U.S. hospital system did, and so the VA has its own federally-run hospitals.
The interesting thing about the VA hospital and physician network is that it resembles a model that interests a lot of health reformers: that of accountable care organizations, or ACOs. ACOs don’t by themselves save any money, but they do hold out the promise of higher-quality health care, because they make a strong effort to coordinate the care that patients get if and when they have multiple doctors looking out for them.
The Veterans Independence Act proposes to turn the VA’s health care facilities into a new Veterans Accountable Care Organization, or VACO. VACO could be required to report how it’s performing on health quality benchmarks, and compare its performance to leading private-sector ACOs like the Cleveland Clinic and the Mayo Clinic.
In addition, the Act proposes to give VACO institutional independence from the Department of Veterans Affairs. As a government-chartered non-profit corporation, VACO could have more latitude to close unused hospitals and improve well-used ones. An independent panel, modeled after the Defense Base Realignment and Closure Act of 1990 (BRAC), could formalize that independence.
The VIA phases in its private coverage options for veterans, so that VA hospitals can adjust to a reformed system. For the first five years under the law, only veterans with injuries connected to their military service would be eligible for private coverage. After that, all remaining eligible vets would gain the same options.
Finally, vets using VA-sponsored private insurance will get a discount if they obtain care from VA facilities: neither co-pays nor deductibles. As a result, there won’t be a rush to the exits among veterans who use the VA system today.
A careful, crafted proposal
The full proposal is highly detailed, and I don’t want to put you to sleep; if you’re interested in learning more, you can download the report yourself. But we feel that we’ve anticipated the major political and policy problems that have stymied previous reform efforts. We’ll find out in the next few days if we were right.