Tag Archives: military

VA secretary addresses some of department’s challenges #ahcj15

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org.

Photo: Pia ChristensenRobert McDonald

Pia Christensen/AHCJRobert McDonald

More than 140 journalists at Health Journalism 2015 gathered early Friday to hear Veterans Affairs Secretary Robert McDonald – and to question him about VA policies, including the agency’s notorious opaqueness with reporters.

McDonald readily acknowledged that the VA has had what he called a “Kremlin-esque” mentality, and told the roomful of journalists that he was trying to change it. The VA is publishing patient access data (waiting times for appointments) on the website every two weeks, and he said he’s trying to promote a culture of openness. Continue reading

‘Escape Fire’ movie tells powerful patient stories

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org.

I wrote earlier this fall about several new documentaries about health care. I’ve now had a chance to watch one of them, “Escape Fire” and talk to the filmmakers Matthew Heineman and Susan Froemke.

Joanne Kenen

Joanne Kenen (@JoanneKenen) is AHCJ’s health reform topic leader. If you have questions or suggestions for future resources, please send them to joanne@healthjournalism.org.

The film has a fairly simple basic message: The American health care system is a mess. But solutions, at least partial solutions, are there for the taking.

Part of the film focuses on the payment and delivery of health care – what those of us who write about this a lot may think of as the Dartmouth Atlas message. The fee-for-service system rewards quantity over quality and encourages all sorts of stuff to be done that doesn’t make a lot of sense and isn’t necessarily right for the patients. A part of the film looks at the – related – issue of designing a health care system around people who are sick, rather than emphasizing investment in keeping people well; Dean Ornish, Andrew Weil and Wayne Jonas all appear. We know a fair amount about keeping people well. But that’s not what our system primarily pays for.

The filmmakers, Heineman and Froemke, whose interest in the health care system was stirred when they made a film a few years ago on Alzheimer’s disease, spent more than three years on this project. The more they learned about the health system, the more astonished they became at the scope of its flaws.

“We have worse outcomes but we’re spending twice as much as other nations, “ Heineman said. And despite all that money, we don’t have a “patient-centered preventive and safe system.” The system, as he put it, is “high-tech over high-touch.”

The filmmakers weren’t alone. “We found out that no one in the medical profession is happy” about much of American medicine, they said. Doctors who want to do primary care, or who want to have a more “whole patient” approach even as a specialist, encounter all sorts of barriers. “It’s the spending structure,” Froemke said. “Medicine became a for-profit industry; we lost our moral compass.”

The film has its share of experts, some of whom like Donald Berwick, M.D., will be (I hope!) familiar to health journalists. But the heart of the film, as Froemke put it, is the stories it tells about ordinary – or maybe not so ordinary—patients and doctors.Three stories in particular stood out for me: Continue reading

Military’s spotty recordkeeping hurts veterans

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

At the Center for Investigative Reporting, Aaron Glantz dug deep into the widespread recordkeeping errors and lapses that are bedeviling the VA’s disability claims system and making it difficult for veterans of Vietnam, the Gulf wars, and the war in Afghanistan to prove they were in combat, exposed to harmful substances, or even injured. A few days later, ProPublica and The Seattle Times published a similar investigation, which focuses most on more recent conflicts.

According to Glantz, “A Center for Investigative Reporting review of the VA’s performance data reveals chronic errors – committed in up to 1 in 3 cases – and an emphasis on speed over accuracy that clogs the VA system with appeals, increasing delays for all veterans.”

A few more numbers from Glantz’s work:

  • “The VA acknowledges it makes mistakes on 14 percent of disability claims.”
  • “A CIR analysis of 18 audits published this year by the VA’s inspector general shows the problem could be much worse, especially in high-profile cases. The analysis found a 38 percent average error rate for claims involving disabilities like traumatic brain injury and illnesses linked to the Vietnam-era defoliant Agent Orange.”
  • One internal VA document … shows that during the first three months of 2008 … the agency failed to perform its duty to assist in nearly 11,000 cases.

Likewise, the Seattle Times/ProPublica reporters write that military historians found that “at least 15 brigades serving in Iraq at various times from 2003 to 2008 had no records on hand. The same was true for at least five brigades deployed to Afghanistan.”

Records were so scarce for 62 more units that served in Iraq and 10 in Afghanistan that they were written up as “some records, but not enough to write an adequate Army history.” This group included most of the units deployed during the first four years of the Afghanistan war.

Plenty of stories in how ACA could affect veterans’ health care

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org.

While preparing for a veterans health panel I moderated at the recent AHCJ conference in Atlanta, I remembered an article in the Journal of the American Medical Association that AHJC’s Pia Christensen had sent me on what the health reform law would do for veterans. It’s behind a pay wall, but AHCJ members get free access. It’s written by Kenneth Kizer, who is at the University of California, Davis, but used to run the Veterans Health Administration (better known as the VA) – which is the nation’s largest health care system – when he was under secretary for health in the Department of Veterans Affairs.

There are more than 22 million veterans and the number is obviously growing. About one-third (37 percent in 2011) were enrolled in the VA, which usually means they either have a service-connected disability and/or are low income. Most (80 percent) are covered by Medicare starting at age 65. Most have some kind of coverage or mix of coverage (private insurance, Medicaid, or TRICARE, which also covers military retirees and their dependents). Only about 7 percent – well under the national average and most states’ rates – are uninsured, which in most cases means they are poor but not poor enough to get into the VA.

Joanne KenenJoanne Kenen (@JoanneKenen) is AHCJ’s health reform topic leader. If you have questions or suggestions for future resources, please send them to joanne@healthjournalism.org.

The Affordable Care Act (assuming it survives the Supreme Court) doesn’t affect the VA per se – although one could argue that some of the VA’s initiatives on care coordination and its early adoption of electronic medical records did affect the shape of the ACA. But not affecting the VA doesn’t mean it won’t affect veterans. Kizer expects that to be a mixed blessing.

For that 7 percent who are uninsured (and for those who may be paying a lot for insurance that may or may not be comprehensive in the individual or small group markets) the coverage expansion could make a big difference. Some may qualify for the expanded Medicaid. Other will be able to get insurance, often with a federal subsidy, in the new state-based insurance exchanges. And that’s a gain.

Those options will be open, too, to some veterans who are VA eligible. This is where Kizer argues the benefits aren’t so clear cut. On one hand, it gives veterans more choices, and they may be able to get care that is more convenient and timely. The drawback, though, is the care may be more fragmented and disconnected once they venture outside the VA’s closed system of coordinated care.

“Fragmentation of care is of concern because it diminishes continuity and coordination of care, resulting in more emergency department use, hospitalizations, diagnostic interventions, and adverse events. The VA serves an especially large number of persons with chronic medical conditions or behavioral health diagnoses – populations especially vulnerable to untoward consequences resulting from fragmented care,” Kizer wrote.

There is even some data suggesting that vets who get some care in the VA and some outside are more likely to be rehospitalized and die within a year than VA-only users, although the data is limited. The new choices by expanded coverage options could also mean more veterans end up getting care outside the VA system – from doctors who may not be as well-versed in the medical problems prevalent among vets (including PTSD) or the resources available to help them. There could be some good local stories on this aspect – and on the broader issue of whether mental health providers in the community are plugged into the needs of veterans, whether or not they are eligible for the VA itself.

There are also a bunch of questions about financing – and these too are worth a local look. If more vets seek care outside the VA, will that mean that some low-volume rural VA services will be cut back? How will that affect the remaining vets who want to get those services from the VA? Will coverage expansion in general – not just for vets – lure more doctors and nurses and physical therapists etc out of the VA to meet the higher demand for health providers among the newly insured? And will the increased options for vets cost the government money? For instance, the government may be making redundant payments now – think about a vet over age 65 who gets some care in the VA and is also enrolled in a government-subsidized Medicare Advantage plan, or is a dual-eligible getting subsidized Medicare, Medicaid – and VA care. Will this kind of duplicative payments rise if vets get subsidized coverage through Medicaid or the exchange – and also draw on VA services? Is anyone in your state even thinking about this? Kizer suggests research needs to be done on this, and says Florida, Texas and California – together home to nearly one in four vets – would be good places to start.

He raises other questions about the health care work force, the safety net, the oft-neglected needs of women vets but concludes with a call to recognize that “providing health care for veterans is an ongoing cost of foreign policy foreign policy and national defense strategies and that the nation has a long-standing social contract with veterans to ensure that those who have experienced harm during military service have ready access to health care.”

Medical, support network lacking for returning National Guard, reservists

Pia Christensen

About Pia Christensen

Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates social media efforts of AHCJ and assists with the editing and production of association guides, programs and newsletters.

National Guardsmen and reservists returning from duty in Iraq and Afghanistan “have been hastily channeled through a post-deployment process that has been plagued with difficulties, including reliance on self-reporting to identify health problems,” according to an investigation by graduate students in Northwestern University’s Medill School.

nat-guard-iraq

Photo by The National Guard via Flickr

Hidden Surge” found members of the National Guard must navigate disparate health care and support providers, made more difficult by the fact that many of them live in rural areas. Three of the stories were published in The Washington Post.

The reporters also found that, in the immediate aftermath of 9/11, most reservists were medically unready to deploy – an assessment made by a private contractor. “More than 2,400 Army Reserve soldiers were held back, at least temporarily, because of inaccurate assessments by the contractor, according to data provided by the Army Reserve Medical Command.”

Meanwhile, some soldiers with behavioral problems that could be aggravated by the stress of deployment and combat were improperly sent overseas.

The project, done by 10 students, was directed by faculty member Josh Meyer, who covered national security for the Los Angeles Times for 20 years. Students used video and interactive graphics to help tell the stories. A “How We Did It” sidebar says the students interviewed more than 150 people, reviewed documents and reports and traveled to nine states to do the reporting.

According to a press release, the Hidden Surge project is part of Medill’s National Security Journalism Initiative, funded by the McCormick Foundation.