Think of Cleveland, as a health reporter, and your first thought jump to the Cleveland Clinic, the group of well-known medical centers rated one of the nation’s most premier hospitals (and one of the hosts for AHCJ’s conference in the city April 7-10.)
Is housing a prescription for better health for the poor? And, if so, who pays for it?
That was the question before a several experts this month at briefing on Capitol Hill. Hosted by the Alliance for Health Reform, a nonpartisan health policy group, the panel examined the role of Medicaid and housing, and how the joint federal-state program also could be used to provide more stable housing with the goal of boosting health. Continue reading
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
Judi Kanne, a registered nurse and freelance writer for Georgia Health News took a look at dental care for seniors and found that her state, and many others, have been coming up short.
She interviewed elderly patients who sought care at Mercy Care, a downtown Atlanta charity clinic.
One of them was 71-year-old Johnnie Collier who told her he went there to get a tooth extracted that had been hurting him for years.
Despite the work of such charity clinics, Kanne wrote, millions of older adults are unable to get the dental services they need.
Then she offered a good summary of the predicament. Continue reading
The physical manifestations of stress are something Kenneth Pitts, M.S., research scientist at the U.S. Army Research Institute of Environmental Medicine in Natick, Mass., knows a heck of a lot about. A U.S. Army veteran who deployed to Afghanistan, Kosovo and Panama during his 23 years of military service, Pitts opened his talk with a YouTube video portraying how to drive a Hummer in Iraq: Basically, never stop, even if that means bumping other vehicles out of the way and driving the wrong way to avoid encountering an improvised explosive device.
“They think their life depends on it,” Pitts said.
Maintaining that level of alertness has lasting physiological effects, disrupting the body’s levels of the stress hormones adrenaline, prompting the first wave of the fight-or-flight response, and cortisol, which supports the body as it takes action. Cortisol is known to increase the storage of emotional memories.
“You can maintain that 60 miles per hour but you’re going to wear out your car,” Pitts said, noting that chronic stress produces increased inflammation that is linked to heart disease, strokes and autoimmune disorders. Continue reading
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.
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.”